Fiercely independent, 90 year-old Vincenzia Rinaldi wouldn"t consider a home health aide or nursing home. So Louis Critelli, her nephew had to coax the widowed homemaker into assisted living, the nation"s growing long-term care option for the elderly. For $1,100 a month, Rinaldi became the reluctant resident of an efficiency unit where she could still simmer her much-loved tomato sauce and where caregivers would make sure she took her pills. Instead, 30 months later, she died. Not because she was old. But because aides at her new home, Loretto Utica Center, one of the modern, hotel-style facilities that have sprouted across the country over the past decade, mistakenly gave her another resident"s prescription medication. That error led to her death, state inspectors concluded. Neither the state nor Loretto told her nephew about the cause of death. Critelli, thinking his aunt had been properly eared for, only learned of the finding years later from USA TODAY. "When they find something blatant like that, you"d think they"d tell the family," the shaken nephew told a reporter after a long pause. A USA TODAY investigation shows that Rinaldi"s death represents the tragic extreme in a pattern of mistakes and violations that lead to scores of injuries and occasional deaths among the estimated 1 million elderly residents of assisted living facilities. The centers are the state-regulated, largely private-pay residences that help seniors with medication and other activities of daily life. In a wide-ranging analysis, USA TODAY reviewed two years of inspection records within 2000-02 for more than 5,300 assisted living facilities in seven states: Alabama, Arizona, Colorado, Florida, Indiana, New York and Texas. The precise time period varied slightly from state to state. The analysis covered a broad range—from mom-and-pop facilities with just a few residents to corporate-run centers with scores of beds and many levels of care. It is the first time such data have been gathered and analyzed across so many states. The review included less-detailed data from five other states and focused on broad quality-of-care categories to compensate for variations in regulations from state to state. As affluent and middle-class Americans cope with the infirmities of age, many turn to assisted living as an alternative to a nursing home industry that has been periodically plagued by abuse or neglect scandals. Even though assisted living facilities generally don"t provide 24-hour skilled medical care, they increasingly serve seniors who only a decade ago might have been in nursing homes.