Chapter 4. Assisted Living

1. Chapter 4. Assisted Living Long-Term Care: Managing Across the Continuum (Second Edition)

2. Learning Objectives • Define and describe assisted living • Identify sources of financing for assisted living • Identify and describe regulations affecting assisted living • Identify and discuss ethical issues affecting assisted living • Identify trends affecting assisted living into the future and the impact of those trends

3. What is Assisted Living? • Many different definitions • Assisted Living Workgroup • A long-term care residential alternative: • More assistance than a retirement community • Less medical and nursing care than a nursing facility

4. Other Residential Living • Similar types of residential living: • Residential Care • Independent Living • Congregate Housing • Continuing Care Retirement Community (CCRC)

5. How Assisted Living Developed • Two separate tracks: • Boarding homes • Independent living

6. Philosophy of Care • Maximizing personal dignity, autonomy, independence, privacy, choice • Providing a homelike environment • Accommodating changing care needs • Minimizing the need to change facilities • Involving families and the community

7. Ownership of Nursing Facilities • 88% For-Profit • 12% Non-Profit Reasons: • High proportion of self-pay • Few government regulations • Good investment for owners

8. Services Provided • Personal care • Health care • Social services • Supervision • Social and religious activities • Exercise and educational activities • Transportation • Laundry and linen • Housekeeping and maintenance

9. Consumers Served • Elderly – average age: 80 • Female – two-thirds • Choose facility close to family

10. Prior Placement:Where They Come From • Home – 46 % • Other assisted living– 20% • Hospital – 14% • Nursing Home – 10% • Other – 10%

11. Placement After ALF:Where They Go • Nursing facility - Because of higher nursing and medical needs, or loss of functional capacity • Death

12. Market Forces • Seeking care alternatives • Impact on children • Cost-cutting efforts

13. Regulations • Few regulations until recently • Increasing number of states now regulating assisted living • Very little commonality or uniformity • Assisted Living Workgroup recommendations

14. Types of Regulations • Affecting residents • Others: - Affecting employees - Affecting building construction & safety

15. Accreditation • JCAHO • CARF/CCAC

16. Financing Assisted Living • Reimbursement Sources: • Mostly self-pay • Medicaid – small, but growing

17. Charges • Basic daily charge • - Varies by type of facility and • resident’s living quarters - Single room, apartment, suite • “Ala Carte” charges: • - Residents pay for what they need • - Some meals, housekeeping, • laundry, etc.

18. Staffing/Work Force • Largely non-clinical • Customer service focus • Few staffing regulations – mostly based on nursing facility model • Training staff to recognize residents’ privacy & independence

19. Legal & Ethical Issues • Decision-making: - how to balance autonomy & resident care & safety • Aging-in-Place

20. Management • Administrators come from: • Nursing facilities • Outside of long-term care • Within assisted living - Assistants • Each must learn new culture

21. Management Qualifications • Licensed by a few states • Different state regulations re: • Minimum education • Hands-on experience • Continuing education • Usually less stringent than for nursing facility administrators • NAB

22. Management Challenges& Opportunities • Developing an organizational identity • Interacting with residents

23. Significant Trends • Movement toward agreement • Increased regulation • Growth in managed care coverage – private and government • Integration with other providers

24. In Summary: • Assisted living has developed somewhat haphazardly, but is approaching maturity, which should lead to more consensus on what it is and what it does.