More seniors are moving into assisted living, not nursing homes. That could be problematic.

Last week was the final straw for Gayle and Karin Winegar, whose 100-year-old mother lives in a Highland Park assisted living memory care unit.

After more than a year of missed medications, unchanged, urine-soaked sheets and nights of unanswered calls for help, their mother Deanne got up from bed just before 10 p.m. and fell.

According to footage from a camera in her room, she cried out in pain for several hours, yet received only minimal attention from staff members, the Winegars said. X-rays taken last week revealed she’d suffered a broken femur and hip. They plan to move her to another facility.

“It’s horrifying,” Gayle Winegar said of what her mother has endured.

Such complaints are increasingly common, state officials and aging advocates said, as assisted living facilities house more medically fragile Minnesota seniors who choose them over nursing homes.

While Minnesota has nearly 24,000 nursing home beds — a number that’s shrinking — assisted living facilities now have about 64,000 beds. That includes thousands of people with dementia and other serious health challenges.

Officials say seniors and their families are choosing assisted living over nursing homes, even if their medical needs may be better met by nursing homes’ 24/7 medical care by licensed nurses and doctors.

Nursing homes were historically where seniors went after their health began to decline, treating complex health conditions such as dementia, stroke or multiple chronic diseases.

Assisted living facilities, which got their start in the late 1980s, were intended for mostly independent seniors who needed help cleaning, cooking and administering medication.

But over the last 15 to 20 years, as assistant living residents got older and their medical needs increased, experts say assisted living facilities started taking on residents with more acute health needs. In part, to keep the residents they had while also attracting new ones.

To many families, there’s no comparison.

National polls show 90% of Americans say they don’t want to live in a nursing home, said Tetyana Shippee, a professor at the University of Minnesota’s School of Public Health and an expert on aging.

“There’s such stigma and such negative reputation associated with nursing homes. Even when they’re better equipped to care for these increasingly acute care needs, for people with and without dementia,” Shippee said. “Family members often are the ones that are driving the push to assisted living, but residents [are] too, because assisted living still has a better positive association.”

That choice often comes down to how a place makes people feel, said Toby Pearson, president and CEO of Care Providers of Minnesota, which represents assisted living facilities and long-term care providers. Many are drawn to assisted living’s more home-like environment, he said.

By comparison, he said, some see nursing homes as a place from which they won’t return. And that can mean people sometimes aren’t candid about their health needs.

“When you’re doing the assessment, the individual or the family doesn’t always tell you everything,” he said. “On some level, they may not know. But on another level, especially with dementia, and the person is going to keep declining, well, if I was in their situation, would I want to admit that they need to go into a nursing facility?”

Kari Thurlow, president and CEO of LeadingAge Minnesota, which represents organizations serving older adults, said in an email that choosing senior care “is a deeply personal decision. Families weigh many factors — including the person’s care needs, financial situation, location, social connections and personal preferences — to find the setting that feels right for them."

“What we see is a system designed to give older adults and their families options — so they can find a place that aligns with their goals, values and needs," she said.

Federal officials designate assisted living as home and community-based services while nursing homes are designated as institutional living, but Shippee said such distinctions are blurring.

“Now, 50% of assisted living residents have dementia,” she said. “And, in Minnesota, the acuity of assisted living residents now mirrors the acuity of residents who were in nursing homes 10 to 15 years ago.”

There are about 2,200 assisted living facilities in Minnesota, compared to 329 Medicaid-certified nursing homes.

It didn’t take long for complaints alleging abuse, neglect and poor care at assisted living facilities to start pouring in.

Elder Voice Advocates has been collecting and analyzing those complaints, and totaling at-fault deaths as part of its Elder Care IQ online tool. In 2023 and 2024, a total of 24 deaths at assisted living facilities were caused by neglect or abuse by the facility or staff members, officials said.

So far in 2025, researcher Eilon Caspi has found 14 at-fault deaths at assisted living facilities, including a memory care resident who fell out of a scooter, a legally blind resident who started a fire while smoking in a bathroom and a resident with dementia who slipped outside of a memory care unit during the winter and perished from the cold.

Elder Voice Advocates is not yet tracking similar data for nursing homes. They want to get their analytic capabilities “up to speed” first, Sundberg said.

A common problem in those cases is either inadequate staffing or inadequate training, Sundberg said. She suspects costs are being cut to increase profits. A facility with memory care in Maple Grove has a daytime staffing ratio of 14.4 residents to one staff member, she said. At night, it’s one staff member per 28.8 residents.

“We’re doing a lot more research on this, but the indications are that [for-profit facilities] quickly come in and reduce staff, reduce the quality of the food, reduce the cost centers,” she said. “And we see the care plummeting with that.”

But Kristine Sundberg of Elder Voice Advocates isn’t hopeful.

“It’s going to be difficult, because we have a huge budget crunch federally and on the state level, and we’ve already seen huge cuts,” she said. “Our advocacy work has never been more direly needed than any time.”

Deanne Winegar of Albert Lea moved to New Perspective Senior Living in St. Paul two-and-a-half years ago. But her problems began after being moved to memory care in July 2024, following her diagnosis of frontal temporal lobe dementia, her daughters said.

Nights were hardest, when Gayle Winegar said there was often only a single staff person working with 16 residents. The family hoped installing a camera in Deanne’s room last December would help them alert staff to her needs. Instead, they said, what they saw alarmed them.

There were nights when residents were left for hours in their wheelchairs because the single staff person couldn’t attend to all of them.

The family filed four complaints with the state. Last week, they received word that their complaint that their mother’s morphine was withheld for more than a month was substantiated.

Beth Landers, the vice president of operations at New Perspective, said in a statement that the “well-being of our residents is at the heart of everything we do. We take any concerns seriously, review them thoroughly, and take action when needed. While privacy laws prevent us from discussing individual situations, families should know that we act quickly to support those in our care.”

Zosha Winegar-Schultz, Gayle’s daughter and an emergency medical technician for the past five years, said problems at her grandmother’s facility are common at others she’s visited.

“This is truly the most depressing part of my job,” she said of understaffed facilities and overwhelmed workers.

Despite the problems, the family said they were loath to move their mother. She’d made friends there. And there are staff members who clearly care. Last week changed their minds.

They visited another assisted living facility in St. Paul, but learned late last week that Deanne was not accepted. So, they sent her to the emergency room for her broken bones and hope to find a 24-hour “long-term care” facility in the weeks to come.