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.