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

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

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

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

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

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

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

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

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

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

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

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

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

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

Accreditation JCAHO CARF/CCAC

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

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.

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

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

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

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

Management Challenges & Opportunities Developing an organizational identity Interacting with residents

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

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.