Senior-care Referral Site ‘A Place for Mom’ Stays Mum on Neglect

By Christopher Rowland, Steven Rich, Todd C. Frankel, Douglas MacMillan / The Washington Post

12:25 JST, May 18, 2024

When families search the internet for senior-care homes, they inevitably come upon A Place for Mom. The site says it helps 700,000 people every year.

It calls itself the nation’s leading “trusted advisory service,” but in reality A Place for Mom is a referral service that is paid large fees by assisted-living facilities and does not independently assess their records. More than a third of its most highly recommended facilities in 28 states were cited for neglect or substandard care in the past two years, many of them repeatedly, according to a Washington Post review of inspection reports.

A Place for Mom awarded these facilities its “Best of Senior Living” award for providing “exemplary care and support to aging loved ones” – based, it said, on user reviews, which are often anonymous. Current and former staff of some large chains told The Post that these reviews are often manipulated by the care providers; some claimed they were encouraged to obtain fake reviews from their own friends and relatives.

As America searches for secure housing for an aging population, assisted living has risen to fill the void, charging an average of $6,000 a month. But unlike with nursing homes, there are no federal regulations, no mandated inspections and no nationwide report card to help people figure out which facilities are safe, comfortable and committed to providing excellent care.

Enter A Place for Mom, the leading senior-housing referral service in the nation, according to an analysis by the Federal Trade Commission. Its website pops up immediately when people search the internet for assisted-living facilities. Visitors to the site are asked how much daily assistance they need and the size of their monthly budget and offered a list of recommendations for homes in their area.

But the contrast between A Place for Mom’s recommendations and information contained in state inspection reports can be jarring.

For example, Inspired Living at Bonita Springs in Florida won a “best of” designation from A Place for Mom based on 2023 consumer reviews. Yet in 2022, state inspectors said it failed to protect a resident who died after spending more than an hour unattended on a patio on a midsummer afternoon – when the heat index was 100.4 degrees. The facility’s operator did not respond to requests for comment.

The woman was stuck in a wheelchair in direct sunlight, an inspector wrote after reviewing video surveillance footage, and can be seen “wiggling, fidgeting, and bending over at times, but chair remains in the same spot.” Last year, a Post investigation revealed that more than 100 seniors with dementia have died over the past five years after walking away or being left unattended outside assisted-living facilities. Most died from exposure to extreme heat or cold.

Other operators stand out for having a large number of facilities on A Place for Mom’s “Best of Senior Living” honor roll despite many citations from state inspectors.

California-based Pacifica Senior Living was cited by inspectors for violations at 23 of its 41 properties on A Place for Mom’s 2023 and 2024 “Best of Senior Living” lists, according to The Post review. They included medication errors, bedsores, falls, staff misconduct and exposure to hazards such as infestations by scabies and rats. Pacifica did not respond to requests for comment.

Michigan-based StoryPoint was cited at 31 of 69 locations that made A Place for Mom’s “Best of Senior Living” lists for 2023 and 2024, according to state records. StoryPoint Saline has 378 five-star reviews and four mediocre or negative reviews on A Place for Mom. Forty reviews were posted on a single day in March 2021, all with an identical headline “my review of StoryPoint Saline”; 37 of them gave five stars.

“That’s not the care that my mom got. That’s not the experience that we had,” said Judy Bottum, whose mother died at a StoryPoint location in Saline, Mich., in January 2023. A state inspection report found no record that Kathleen Bottum had received a single shower in the last month of her life. Staff did not elevate her hospital bed to provide relief from flu symptoms, nor did they administer cold and cough medications. And because staff did not alert family members that she was nearing her final hours, Judy Bottum said, Kathleen Bottum died alone.

Seeing all the accolades on the site, which she did not use to place her mother, “brings up a lot of bad memories and frustration,” Bottum said.

Staff at another StoryPoint facility, Independence Village of Avon, in Indiana, failed to send a woman with a fractured femur to the hospital in 2023, allowing her to suffer in pain for five days, according to an inspection report. She finally was taken to the hospital at the urging of a friend, the report stated.

StoryPoint did not respond to questions about specific cases or state inspection findings. “We work with the state licensing groups to address any issue or concerns they may have,” the company said in a statement to The Post. “We strive to make our communities the best that they can be through the continuous feedback we receive and openness with those we serve.”

A Place for Mom did not respond to repeated questions about why it does not list information from state inspection reports on its website or provide them to families. It said it “strongly encourages” people through its phone advisers to tour assisted-living facilities.

“We empower family caregivers with access to information, tools and resources,” A Place for Mom said in response to questions from The Post. “We also encourage families to ask questions of each community to ensure they make an informed decision based on their care needs, financial needs and overall preferences.”

But experts say that by excluding information from local regulators, the site paints an excessively rosy picture of some operators.

“You’re not helping people make good decisions,” said Richard Mollot, executive director of the Long Term Care Community Coalition, a nonprofit that advocates for stronger regulation. Of A Place for Mom’s “best of” listings, Mollot said: “It’s just utterly meaningless. It’s marketing.”

Founded by an entrepreneurial married couple in Seattle in 2000, A Place for Mom is now owned by private equity firms Silver Lake Partners and General Atlantic. As a privately held company, it is not required to disclose such key information as annual revenue and marketing budgets.

For this article, The Post gathered the company’s “Best of Senior Living” award recipients in 2023 and 2024 and looked up inspection and violation reports for 863 of them located in 28 states that make records public.

Inspectors cited 324 of these award-winners – 37.5 percent – for serious violations affecting resident care, including multiple falls, severe bed sores, medication errors, failure to respond to call buttons, failure to bathe and groom residents, failures to send injured and sick seniors to the hospital, understaffing, poor training and sometimes violence and sexual abuse.

The Post did not count citations for many less severe but common violations, including missing employee background checks, failures to update care plans, unlocked medicine carts and kitchen workers not wearing hair nets.

A Place for Mom says it bases its “best of” ratings on the hundreds of thousands of consumer reviews it hosts on its website. To get on the “best of” list, operators must have recent reviews with an average of at least 4.5 stars, according to rules posted on its website.

A Place for Mom said its goal is to “create a transparent reviews platform that surfaces a wide spectrum of positive, neutral and negative reviews so families can benefit from information posted by other families.” Its online rules prohibit reviews by current or former staff of the facilities.

A Place for Mom said its website lists only facilities that are licensed. In small print at the end of multiple pages about any given facility, it includes a link to a guide on how consumers can investigate potential problems. The link is 15 to 25 screens down, nestled between a newsletter sign-up and links for facilities in nearby cities.

The public records reviewed by The Post are available on state regulators’ websites for those 28 states (other states do not make them easily accessible). But A Place for Mom does not include these reports in its profiles of facilities – even in cases where poor care has led to death.

In the fine print of the terms and conditions people must accept to use the site, the company denies liability, saying the information on its website does not constitute “professional advice.”

“We exercise no independent judgment as to the quality of, nor do we recommend or endorse, any Participating Community,” it says.

The company pointed out that it discloses on its website that it’s a referral service paid by facility operators. A link from a drop-down menu states: “We’re paid by our participating communities if a family member moves into a senior living community.”

According to bankruptcy court documents, senior homes pay A Place for Mom a fee equal to about a month’s fees for a successful placement.

“A Place for Mom is transparent with families about how our service works,” the company said. “Our marketing materials and website clearly explain that A Place for Mom’s services come at no cost to families as we are paid by the communities and providers in our network.”

In its marketing materials, the company prominently emphasizes that its service is free to consumers – “Our service comes at no cost to your family,” states a TV ad voice-over for A Place for Mom. Experts have said for more than a decade that most consumers don’t understand how these companies make money.

“It’s a pay-to-play model,” said David Grabowski, a Harvard professor of health-care policy who specializes in the economics of long-term care.

“When I first saw A Place for Mom on the TV, I assumed it was a nonprofit,” said Paula Anderson, of Minnesota, who 12 years ago found an assisted-living facility for her mother in law with help from the company. “They were not forthcoming that they get a commission from anybody,” she said – until she asked the question directly in a follow-up phone call.

Consumer reviews are heavily featured on A Place for Mom’s website. The company encourages senior-home operators to solicit large volumes of reviews from residents, families and other sources in a bid to get new residents.

“You’ll want to ensure you’re putting your best foot forward by promoting a high volume of positive and current reviews,” it advises operators in the voice-over to a slide show on its “reputation portal.” The company says in its media releases that its research shows consumers are six times more likely to sign a contract and move in when operators have multiple, recent reviews on the A Place for Mom site.

A former sales manager at a facility operated by Brookdale, the nation’s largest chain, and a current sales leader at a unit operated by Cogir, another large chain, said when A Place for Mom staffers meet with facilities’ sales departments they point out that Google’s search algorithms favor individual A Place for Mom facility pages with lots of recent reviews.

“They said this is your bread and butter. This is how you get to the top of how people search,” said a former Brookdale sales manager who spoke on the condition of anonymity to discuss details of private meetings.

In interviews, current and former employees at four large chains said facilities throughout the industry routinely manipulate the reviews by asking residents and families with only positive experiences to write them and sometimes by soliciting fake ones.

None of the sources suggested that A Place for Mom itself is involved in generating fake or manipulated reviews. But they say the site’s prominence creates incentives for facilities to push for favorable ratings.

In a statement, A Place for Mom said it checks to ensure that every review submission has a name, phone number and email address attached and that it “may have come from anyone that engaged with the community.” It did not explain how it stamps out fake or misleading reviews, but it did say that its system flags multiple submissions from the same IP address and prohibits submissions from facilities’ email domains.

While online shopping is notoriously littered with fake reviews, experts said the stakes are much higher when it comes to selecting a home for an aging parent or a person with dementia.

“This is a setting where people have very low baseline levels of information. Review manipulation is a bigger problem than on Amazon,” said Brett Hollenbeck, an economics professor and expert in online consumer reviews at the University of California Los Angeles.

In interviews, five current and former sales managers of Pacifica, StoryPoint, Brookdale and Cogir said the companies aggressively seek positive reviews, not just on A Place for Mom, but also on Caring, its largest competitor in online referrals, as well as Google. They said they are coached by executives and managers to ask residents and families who appear to be having only a positive experience to submit a review.

The former Brookdale manager said that if staff noticed a negative review, they would quickly solicit positive reviews and submit them to “push it down” on the facility’s review list.

Brookdale said in a written statement that it welcomes consumer reviews of all kinds. “Brookdale believes feedback is a gift and encourages all residents and family members to share their experiences through surveys, online reviews, and face-to-face interactions,” the statement said.

Some companies also set monthly or quarterly review quotas, according to the managers.

“We were trying get at least 10 reviews a month,” said Evelyn Orellana, a former sales leader at two different Pacifica facilities in California, one in San Bernardino and one in Apple Valley.

She said she was asked by a supervisor to submit her own review or get her family members to submit positive reviews, but she declined, because she did not believe that would be honest. She said her supervisor also told her to avoid asking certain families for reviews.

“He said if they seem to be unsatisfied, don’t even ask them for a review, because we don’t want nothing bad online,” Orellana recalled.

Pacifica did not respond to requests for comment.

A former StoryPoint executive director, speaking on the condition of anonymity to avoid possible repercussions in the industry, said he was given quotas, which led to “headhunting” reviews from the most independent residents of a facility, with minimal care needs and therefore few complaints. It did not result in a fair portrayal, he said.

“Those reviews are not come by in a way that really give an accurate understanding of the culture of the community,” the former executive director said.

StoryPoint declined to comment on the former manager’s account.

Nancy Haugen’s experience with her mother at Gable Pines at Vadnais Heights in Minnesota, which is managed by the national chain Life Care Services, prompted her to write a scathing review in 2019. “Our mother experienced delays in administration of medication to prevent pain,” it said.

Haugen said she became frustrated when her review didn’t appear on the website. After waiting for several days, she called A Place for Mom, was put on hold and could not get an answer, she said. Three weeks later, after multiple phone calls – including attempts to speak with the company’s general counsel – her review finally appeared on the listing for Gable Pines.

A Place for Mom did not comment on Haugen’s account.

Serena Jeffries placed her stepfather, James C. Boyd, 81, at Pacifica Senior Living Santa Clarita in California in May 2022. She said he soon experienced a cascade of fatal neglect: Left in his own filth for hours, his bed sores worsened. A reluctant eater, he wasted away because workers didn’t take the time to feed him.

Desperate to find better care, Jeffries moved him to a smaller facility after nine months at Pacifica, but he died a day later. She is suing the facility, which has denied in court documents that it did anything wrong. The facility did not respond to requests for comment on the lawsuit or Jeffries’s claims.

Jeffries, who did not use A Place for Mom services, said she was surprised to learn that the site awarded Pacifica Santa Clarita a “Best of Senior Living” award.

“That is very misleading,” she said. “I don’t know how much they’re looking into these places. Or if it’s just trying to get a profit.”