Researching Arizona senior living options? Here's how to find quality care
Choosing an assisted living facility for a loved one is one of the most difficult decisions families have to make — yet state regulators responsible for holding the industry accountable do not make it easy for families to decipher quality care from bad care.
The Arizona Department of Health Services posts every assisted living facility inspection over the past three years to AZcarecheck.com. But consumers have to know exactly what they're looking for and wade through dense reports to get a sense for a facility's record.
The website also does not include details about thousands of complaints state investigators don't substantiate.
Their investigations have not always been thorough and the Department of Health Services depends on Adult Protective Services to determine whether abuse, neglect or exploitation happened. A recent audit exposed that program for substantiating less than 1% of cases it reviews.
The bottom line: Bad things happen at facilities that never make it online where the public can find it.
After investigating the state's senior living system for more than a year, The Arizona Republic is publishing some new tools to help families research their options.
Check out our resources at seniorcare.azcentral.com.
Facility citations made more accessible
Over the past three years, the state issued more than 3,500 citations to assisted living centers that serve the most vulnerable residents. Facilities most commonly get in trouble for relying on unqualified employees and for inadequate plans that should outline each resident's unique needs.
But Azcarecheck.com doesn't spell that out for consumers.
With The Republic's tool, you can plainly read what each citation means and see how common it is.
Republic reporters wrote a program that downloaded every citation from AzCarecheck and formatted the information into a database. Reporters then looked up each administrative code associated with citations (there were about 300 unique ones) and wrote brief descriptions.
To get a sense for how common each type of citation is, reporters categorized citations into groups based on carefully designed definitions.
They also uploaded each citation report to the cloud, generated PDF links and added those to the citation data so consumers can read the full report if they wish. The process was complicated, but the resulting tool for Arizonans is easy to use. Find the citations database at seniorcare.azcentral.com.
Complaints made more transparent
Arizona found no broken rules in its investigations of more than 8,700 reports alleging problems at nursing homes and assisted living homes and centers from January 2017 to the end of October 2023. None of the narratives explaining the allegations live online and you need to know what you're looking for to submit a proper request for them.
So, The Republic is publishing the state's log of all closed investigations against facilities. The searchable database allows you to find out when reports were filed about the facility you're researching so you can submit a request for more information.
We've written out some boilerplate language to help you craft your request just like we would. You can find that on the same page with the citations.
Once you get the narrative, we recommend using it to ask facility management how they handled the situation in question. Also, you might find reference to a police report that could shed even more light on what happened. Find the complaints database at seniorcare.azcentral.com.
Nobody tracked resident-on-resident harm, so we did
In 2022, The Republic requested police reports about resident injuries at hundreds of facilities from about 40 different police jurisdictions. We compiled each incident we found of residents hurting each other or staff. The state doesn’t track this information, so our site is the only place you’ll find it.
You can find that at https://shorturl.at/fqsFR or at seniorcare.azcentral.com.
A couple of caveats: We didn’t get everything we asked for. So don’t assume that a facility’s absence from the database means they’ve got a clean record.
Also, some facilities may call the police for incidents that others wouldn’t, so don’t assume that a facility is more troubled than others based on the incident count.
If you find an incident that happened at a facility you’re considering, we recommend asking the management about how they handled it and what they do to prevent similar issues from happening again.
If you’re interested in seeing the entire police report, ask us! Our emails are at the bottom of this article.
Ask tough questions on tour
Well-manicured grounds, sparkling lobbies and friendly tour guides can easily woo prospective residents and their families. But you should come prepared with questions when shopping for facilities. Find a printable checklist from AARP at https://shorturl.at/nsAPV to take with you on tours.
We’ve also interviewed families of residents, assisted living employees, attorneys and industry experts and created this list of questions that are most helpful:
What is the facility’s certified-caregiver-to-resident ratio during peak hours, overnight and on weekends? Compare these ratios when evaluating options. There isn’t a nationwide standard, though some states require minimums. For example, Nevada requires one employee for every six residents during waking hours for facilities licensed to serve people with dementia. Generally, the more certified caregivers per resident means more attentive care. But the key word is “certified,” as only those caregivers can work solo with residents and — in a pinch — facilities sometimes put assistant caregivers on tasks they’re not trained to do.
Does the facility have an on-site nurse or a medical team? Keep in mind that the state doesn’t require assisted living to have medical professionals on staff.
What does the facility do to ensure that employees know the residents? A key factor in quality care is tailoring activities and engagement to each resident’s specific personality, preferences and needs.
Does the facility use any technology to alert staff when a resident has fallen?
What sort of technology do residents in this facility receive to alert a caregiver when they need help? Are there call buttons, or a lanyard that residents can wear that will ping staff?
How does the facility document incidents like falls, or if a resident claims that someone hurt them? Do employees investigate those incidents and keep the documentation on file? The facility won’t have to give these documents to you, but managers should be able to explain their process.
Who owns this facility? Who operates it — does it belong to a chain?
Ask for a copy of the facility’s most recent state inspector survey. Facilities are required to help you find their most recent inspection. If they don’t, it’s not only a violation of the rules, but also a red flag for transparency issues.
What training – in addition to state requirements – do managers and caregivers receive to work with people with dementia? The state requires assisted living managers to take fewer than 8 hours of training on developing systems for managing residents with dementia, Alzheimer’s disease or difficult behaviors. Caregivers have to take 4 hours of instruction on the care of cognitively impaired residents, such as those with dementia.
Just because a facility bills itself as specializing in “behavioral” or “memory” care, don’t assume that it’s licensed any differently than other assisted living facilities, or is staffed with workers trained any differently than certified caregivers. If a facility claims to have a behavioral unit, ask to see their behavioral license.
Other ways to research like a reporter
If you have more time, you can go deeper than citations, complaints and incidents we tracked.
Manager license actions: You can find out if your facility’s manager has a record by checking https://elicense.az.gov/ARDC_LicenseSearch.
You may have to call a facility to find out who their manager is, but once you have their name you can search their license history. The state’s license search tool links to any disciplinary actions taken against the manager.
Facility ownership and affiliation: Knowing what company, or who, owns your facility is important information to understand their motives and their track record around the state or across the country.
Sometimes it is unclear what parent company owns or operates a given assisted living facility. You might find out by asking the staff, but if that doesn’t work, check the Arizona Corporation Commission: https://ecorp.azcc.gov/EntitySearch/Index
The “principal information” you find here will tell you what other entities are associated with the facility. You may need to put those names into the state's search tool again to go a layer deeper about who the entities actually are.
Court records: Search your facility’s name, and the company or individuals associated with it, in your county’s court records. Most courthouses have online search engines that show if cases against a particular entity exist. Once you identify a case, you’ll likely need to physically go to the courthouse to understand the nature of it.
Complaint documents filed in a case will spell out what the allegations are.
Other state records: If a facility is owned, operated or affiliated with a company that operates in another state, you might find more complete data about its other properties. Colorado, for example, has a robust assisted living search tool. You can find that here: https://cdphe.colorado.gov/find-and-compare-facilities.
Police reports: Police reports may tell you about dangerous or traumatizing incidents that regulators never cited a facility for, but getting them will be the most time-intensive of all the options listed.
If you have time and energy to go this route, we recommend requesting from the relevant police jurisdiction a list of calls for service stemming from the address of the facility you are interested in. Most police departments will turn around calls for service fairly quickly.
Once you get the list, we recommend selecting incident reports having to do with fights, assaults, sex assaults, abuse or neglect of an elder and other keywords similar to these. Request the incident reports using their incident report ID numbers. Depending on the agency, this could take weeks to months. If you’re requesting from Phoenix police or the Maricopa County Sheriff’s Office, it could take more than a year.
Search our database for complaints at local assisted living facilities
Search our database for citations at local assisted living facilities
Your options may get better
After most of The Republic's series on assisted living failures published, Gov. Katie Hobbs announced legislative priorities to improve the system. If lawmakers take up her wish list, consumers may get a transparent, quality rating system for nursing homes, assisted living and long-term care facilities.
Other reforms Hobbs, a Democrat, said she will push for include:
Hiking fees and fines based on the severity of an infraction. Right now, the state Health Department can only fine facilities $500 for each violation, for each day that it occurred.
Empowering the Health Department to revoke licenses for cause and crack down on other problematic practices.
Closing inspection loopholes. Right now, assisted living facilities can skip an annual inspection if they have a clean inspection the year prior.
Implementing "robust licensure requirements for assisted living facilities."
Hiring more state Health Department employees and legal support.
Increasing regulation and certification of facilities that advertise memory care. No additional licensure is required and no set rules associated with "memory care" exist today.
Creating a transparent quality rating system for nursing homes, assisted living and long-term care facilities. The current system is hard for the average consumer to use.
Residents' families want to make a difference for future families after the suffering their loved ones endured.
Kanji Matsunaga's mother, Carol, was attacked by a fellow resident at the troubled Heritage Village facility in Mesa in 2022 and has had several falls since then. Carol doesn't remember what happened to her because of her dementia, but she would want to be part of the change to improve the system, her daughter said.
Carol taught kindergarten through third grade on the Fort Apache Indian Reservation― which she can still tell you about if you ask ― and later, college students at Arizona State University.
Heritage Village looks beautiful, with its high ceilings, big bay windows and homey environment. But, Kanji said, what she didn't see on the tour she took years ago was how inadequate her mother's care would be. She's one of several people who have told The Republic they've had to do Heritage Village caregivers' jobs for them at times.
The Republic found Heritage Village racked up nearly 150 citations in three years, many of which were related to the quality of its employees.
As frustrated as Kanji is with Heritage Village, the facility still features on its website a picture of Carol smiling by a Christmas tree.
They used her mom, she said, "as a prop."
Facility tells resident to pay for extra care — or move — after injury
Recently Kanji visited her mom at Heritage Village and found painful wounds on her legs. She alerted a caregiver and the head nurse, who said she ordered medication and would give it to Carol as soon as possible.
But when Kanji returned the next day, she said her mom's legs were worse and the medication was not ordered. She sent an email to her mom's social worker asking for help, noting the medication problem.
Carol went to the emergency room and got treated but hasn't been able to walk since. Heritage Village's director emailed Kanji to say Carol needed to move — to a skilled nursing facility, commonly known as a nursing home — or get on hospice care if she wished to remain.
But hospice isn't financially doable right now.
State rules for assisted living centers dictate that such facilities are generally not supposed to retain residents who are unable to move even with assistance.
Carol was moved to a nursing home. When Kanji went to meet her, she had new wounds on her forearm. Heritage Village did not give Kanji an explanation about the injuries, she said.
Kanji's joining the campaign to push for senior living reform in the next legislative session.
“If you had not opened Pandora’s box, this never would have been exposed,” Kanji said about The Republic. “And I didn’t have the energy to do it. I was in the middle of it. Now I’m not afraid to act. Before I was scared."
Heritage Village did not return requests for comment.
Reach Caitlin McGlade at caitlin.mcglade@arizonarepublic.com. Follow her on X, formerly Twitter, @caitmcglade. Reach Sahana Jayaraman at Sahana.Jayaraman@gannett.com. Follow her on X, formerly Twitter, @SahanaJayaraman.
Senior care in Arizona: A guide for resources, Republic investigations
This article originally appeared on Arizona Republic: Arizona senior living: Research nursing homes, assisted living options
