The True Toll Of COVID-19 In Assisted Living Homes

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When Tony Chicotel walks his dog around downtown Berkeley, he passes a nursing home and an assisted living facility. The nursing home, in the middle of a pandemic that has claimed the lives of more than 163,000 long-term care residents and staff, is like a miracle: It suffered only a few, isolated cases of COVID-19, and no one has died.

The assisted living facility is another story. Inside, an outbreak that began around Thanksgiving has spread to nearly 60 residents and killed 14, making it one of the deadliest long-term care facilities in the Bay Area.

Chicotel, who works for the California Advocates for Nursing Home Reform, can’t see inside to know why the outbreak is so bad. Neither, really, can anyone else.

Assisted living facilities and nursing homes share unique vulnerabilities to COVID-19, like elderly residents living close together, and underpaid, overworked staff who care for many residents at once while shuttling between multiple jobs. But there’s a key difference in how assisted living facilities are regulated: While nursing homes answer to federal regulators, assisted living facilities are regulated by the states. The rules are uneven, and many states have loopholes that allow dangerous health situations in assisted living to fall through the cracks.

“‘Black hole’ is not too dramatic of a way to put it,” said Mike Dark, a colleague of Chicotel’s. “The regulatory oversight is much more laissez-faire than hospitals and even nursing homes.”

At the start of the pandemic, when Dark and Chicotel were fielding panicked phone calls from residents and their families about staff not wearing masks, they learned there was little they could do. California’s health department doesn’t oversee assisted living — its social services department does — and so state rules on mask usage in health care facilities didn’t apply. Several states, including populous ones like Ohio, don’t have the ability to fine assisted living facilities that flout state rules. Nearly a dozen states aren’t publicizing death and infection counts for assisted living at all, while others — Indiana is one — went months without making the death and infection rates public for specific facilities.



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