After completing this chapter, readers will be able to:
1. Define and describe assisted living facilities, where they fit in the continuum of care, the consumers who use them, and the services they offer.
2. Identify sources of financing for assisted living facilities.
3. Identify and describe regulations affecting assisted living facilities.
4. Identify and discuss ethical issues affecting assisted living facilities.
5. Identify trends affecting assisted living facilities into the coming millennium and describe the impact of those trends.
What is assisted living?
· A long-term residence option that provides resident-centered care in a residential setting, designed for those who need extra help in their day-to-day lives but who do not require the 24-hour skilled nursing care.
· Assisted Living Workgroup (ALW) – a group comprised of more than 50 organizations to work together and make recommendations to ensure high-quality care and services for all assisted living residents.
How Assisted Living Developed
Developed along two tracks:
1. As residential care facilities, known more commonly as boarding homes or boarding care facilities, their services were traditionally provided in small homes caring for one or several seniors.
2. For people who, with a bit of assistance, could live more independently.
Philosophy of Care
· Maximizing dignity, autonomy, independence, privacy, and choice
· Providing a homelike environment
· Accommodating residents’ changing care needs and preferences
· Minimizing the need to move when a resident’s care needs increase
· Involving families and the community
Ownership of Assisted Living Facilities
· Approximately 82 percent were for-profit and the remainder were not-for-profit or were owned by government entities
· Percent of not-for-profit is increasing
· 24-hour supervision;
· Three meals a day plus snacks
· Personal Care Services
· Health Care Services
· Social Services
· Supervision of Persons with Cognitive Disabilities
· Social and Religious Activities
· Exercise and Educational Activities
· Arrangements for Transportation
· Laundry and Linen Service
· Housekeeping and Maintenance
By age and gender:
· Mostly elderly (average age 87)
· Mostly female (74%)
Where they come from:
· Most (about 70 percent) come from home,
· 14 percent from another assisted living residence or retirement community,
· 7% moved from a family residence (such as living with adult children)
· 9 percent from a nursing home
Where they go:
· The most common (59%) destination is to a nursing facility, generally because of loss of functional capacity.
· The second most common (33%) reason for leaving is the death of the resident
· Seeking Care Alternatives – potential residents looking for alternatives to nursing facilities
· Impact on Children – loss of nuclear family impacting care of elderly family members
· Cost-Cutting Efforts – payers are looking for less costly alternatives.
· Regulations affecting residents – there is concern about following the nursing facility model too closely.
· Other regulations – similar to nursing facility regulations.
· Joint Commission
Financing Assisted Living
Costs/Charges – vary widely depending on services provided:
· One all-inclusive rate: 24%
· Ala Carte/fee-for-service: 17%
· Hourly charge or other time fee: 4%
· Tiered pricing for bundled services: 51%
· Private pay – use of an individual’s own funds – remains the largest source of reimbursement for assisted living.
· Medicare does not cover it, although in some cases, there is some coverage under Social Security Supplemental Income (SSI).
· Medicaid is a small, but growing source of reimbursement
Staffing/Human Resource Issues
Nature of the Workforce:
· Fewer nurses and other clinical staff
· Customer Service Focus
· Much less controlled by regulation than in other levels of long-term care, although that is changing in many instances.
· Relatively little training is required
· Generally consists largely of orienting staff to the philosophy of assisted living
· Autonomy and Decision-Making – need to balance the residents’ desire to be independent with the facility’s responsibility to protect them from harm.
· Aging in Place – problem with providing all of the services needed or desired.
Management of Assisted Living
Where ALF administrators come from:
· Licensed nursing facility administrators who have moved from that other kind of long-term care provider
· From outside of the field of long-term care
· From within the field. They are assistant administrators and department heads who are familiar with the setting and the residents, and desire to become top-level administrators
· Regulation of assisted living is still very much a work in progress
· An increasing number of licensing jurisdictions are requiring their licensure
· There is little uniformity in those requirements
Management Challenges & Opportunities:
There are several challenges/opportunities that are either unique to ALFs or play a larger part in their management:
· Developing an Organizational Identity – not nursing care.
· Interacting with Residents – ALF administrators are much more personally involved with the residents than they would be in other types of long-term care.
Significant Trends and Their Impact on Assisted Living
· Movement Toward Agreement – , the field of assisted living has begun to take on more coherence and stability.
· Increased Regulation – regulation is growing, but still inconsistent and not uniform.
· Growth in Coverage by Managed Care and Government – public payers are seeing assisted living as a lower cost alternative to nursing facility care.
· Integration with Other Providers – most providers will find that they can provide better services and prosper financially by joining with other types and levels of long-term care providers in integrated systems.