Chapter 6
Assisted Living
Learning Objectives
Define and describe assisted living facilities
Identify sources of financing for assisted living facilities
Identify and describe regulations affecting assisted living facilities
Learning Objectives (continued)
Identify and discuss ethical issues affecting assisted living facilities
Identify trends affecting assisted living facilities in the future, and describe 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
How Assisted Living Developed
Two separate tracks:
Boarding homes
Independent living
Philosophy of Care
Maximizing personal dignity, autonomy, independence, privacy, and choice
Providing a homelike environment
Providing 24-hour care, activities
Accommodating changing care needs
Minimizing the need to change facilities
Involving family and the community
Ownership of
Assisted Living Facilities
82% For profit
18% Nonprofit
Reasons:
High proportion of self-pay
Fewer government regulations
Good investment for owners
Services Provided
24-hour supervision
Three meals a day plus snacks
Personal care services
Health care
Social services
Social and religious activities
Services Provided (continued)
Exercise and educational activities
Transportation
Laundry and linen services
Housekeeping and maintenance
Consumers Served
Elderly – average age: 87
Female – three-quarters
Those with family living nearby
Prior Placement:
Where They Come From
Private home – 70 %
Nursing facility – 9%
Living communities – 9%
Family residence – 7%
Other assisted living – 5%
Placement After ALF:
Where They Go
Nursing facility – 59%
Because of loss of functional capacity and increased care and medical needs
Death – 33%
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
Center for Excellence in Assisted Living (CEAL)
Types of Regulations
Affecting residents
Other:
Affecting employees
Affecting building construction and safety
Accreditation
Joint Commission
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)
“À la carte” charges:
Residents pay for what they need
Some meals, housekeeping, laundry, etc.
Hourly charge or other fee
Tiered pricing for bundled services
Staffing/Human Resource
Largely nonclinical
Customer service focus
Few staffing regulations – mostly b ...
Must have a minimum of 120 words with referencesDq1 Descr.docx
Chapter 6Assisted Living Learning ObjectivesDefine a
1. Chapter 6
Assisted Living
Learning Objectives
Define and describe assisted living facilities
Identify sources of financing for assisted living facilities
Identify and describe regulations affecting assisted living
facilities
Learning Objectives (continued)
Identify and discuss ethical issues affecting assisted living
facilities
Identify trends affecting assisted living facilities in the future,
and describe 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
2. How Assisted Living Developed
Two separate tracks:
Boarding homes
Independent living
Philosophy of Care
Maximizing personal dignity, autonomy, independence, privacy,
and choice
Providing a homelike environment
Providing 24-hour care, activities
Accommodating changing care needs
Minimizing the need to change facilities
Involving family and the community
Ownership of
Assisted Living Facilities
82% For profit
18% Nonprofit
Reasons:
High proportion of self-pay
Fewer government regulations
Good investment for owners
Services Provided
24-hour supervision
Three meals a day plus snacks
Personal care services
Health care
Social services
Social and religious activities
3. Services Provided (continued)
Exercise and educational activities
Transportation
Laundry and linen services
Housekeeping and maintenance
Consumers Served
Elderly – average age: 87
Female – three-quarters
Those with family living nearby
Prior Placement:
Where They Come From
Private home – 70 %
Nursing facility – 9%
Living communities – 9%
Family residence – 7%
Other assisted living – 5%
Placement After ALF:
Where They Go
Nursing facility – 59%
Because of loss of functional capacity and increased care and
medical needs
Death – 33%
Market Forces
Seeking care alternatives
Impact on children
Cost-cutting efforts
4. Regulations
Few regulations until recently
Increasing number of states now regulating assisted living
Very little commonality or uniformity
Assisted Living Workgroup recommendations
Center for Excellence in Assisted Living (CEAL)
Types of Regulations
Affecting residents
Other:
Affecting employees
Affecting building construction and safety
Accreditation
Joint Commission
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)
“À la carte” charges:
Residents pay for what they need
Some meals, housekeeping, laundry, etc.
Hourly charge or other fee
Tiered pricing for bundled services
5. Staffing/Human Resource
Largely nonclinical
Customer service focus
Few staffing regulations – mostly based on nursing facility
model
Training staff to recognize residents’ privacy and independence
Legal and Ethical Issues
Decision making:
How to balance autonomy, resident care, and safety
Aging in place
Management
Administrators come from:
Nursing facilities
Outside of long-term care
Within assisted living
Assistants
Each must learn new culture
22
Management Qualifications
Licensed by increasing number of states
Different state regulations
Education level
Hands-on experience
Continuing education
Usually less stringent than for nursing facility administrators
NAB
6. Basic requirements
Management Challenges
and Opportunities
Developing an organizational identity
Interacting with residents
Significant Trends and Their Impact
Movement toward agreement
Increased regulation
Growth in managed care coverage
private and government
Integration with other providers
Summary
Assisted living has developed somewhat haphazardly, but it is
approaching maturity, which should lead to more consensus on
what it is and what it does.
Chapter 7
Senior Housing
Learning Objectives
Understand how senior housing developed and where it fits in
the continuum of care
Identify and define the components of senior housing
Identify and describe regulations affecting senior housing
providers
7. Learning Objectives (continued)
4. Understand the financial, ethical, and managerial issues
facing senior housing providers
5. Identify and discuss trends in senior housing and its
management
Why the need for Senior Housing?
Growth in number of elderly
Need for living accommodations that meet their desire for more
independent living
Demand for more choice
What is Senior Housing?
Age-restricted housing
Reverse mortgage
Age-restricted retirement communities
Senior apartments
Cohousing
Independent living
Congregate housing
Continuing care retirement communities
Life care communities
Philosophy of Care
Giving seniors the services and assistance they need
Optimizing their independence
Letting seniors live as independently as possible
Letting them live to the maximum extent of their abilities
8. Services Provided:
Age-Restricted Communities
Provide the least amount of services
May provide meals, transportation, social activities, etc.
Accessible
May act as a broker to provide services through contractors
Services Provided:
Independent Living
For relatively healthy, active seniors
Variety of apartments, homes
Balances desire for independence and need for support
Services Provided:
Congregate Housing
Services similar to retirement apartment complexes
Shared meals
Housekeeping
Full-time staff on duty 24 hours
Additional service options
Services Provided:
CCRCs
Broad range of service and housing packages available
Access to other types of services as needed (e.g., skilled care)
Option to move between available housing as one’s needs
change
Ownership of Senior Housing
Age-restricted communities:
9. For profit and publicly owned
Independent living:
Mostly for profit
CCRCs:
Mix of for-profit and nonprofit
Consumers Served
Age-restricted retirement communities:
Younger (55+), early retirees
Senior apartments:
May be looking for subsidized housing
Independent living:
Largely women with high net worth
CCRCs:
Often enter while healthy and active
Accreditation
Generally not accredited
Except CCRCs – accredited by CCAC
Financing
Mix of private, government-subsidized, and nonprofit
Wide range of fees
CCRCs are most expensive, usually private pay
Variety of contract options
Staffing
Mostly hotel-type staffing
Few health services – except SNF and assisted living
components of CCRCs
10. Management Qualifications
Few licensing requirements
Except SNF and assisted living components of CCRCs
Significant Trends
Desire for more options
Quality of life
High occupancy rates
Summary
Senior housing services provide a variety of options for elderly
consumers and have become an integral component of the
continuum of long-term care.
Long-Term Care: Managing Across the Continuum, Fourth
Edition
John R. Pratt
CHAPTER SIX: ASSISTED LIVING
CHAPTER HIGHLIGHTS
What is assisted living?
-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
11. the 24-hour skilled nursing care.
- 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
Based on:
aximizing dignity, autonomy, independence, privacy, and
choice
preferences
15. Long-Term Care: Managing Across the Continuum, Fourth
Edition
John R. Pratt
– similar to nursing facility regulations.
Accreditation
Financing Assisted Living
Costs/Charges – vary widely depending on services provided:
-inclusive rate: 24%
-for-service: 17%
Reimbursement:
- use of an individual's own funds - remains the
largest source of
reimbursement for assisted living.
some coverage under
Social Security Supplemental Income (SSI).
18. progress
their licensure
Management Challenges & Opportunities:
There are several challenges/opportunities that are either unique
to ALFs or play a larger part
in their management:
entity – not nursing care.
– 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
ward Agreement - , the field of assisted living
has begun to take on more
coherence and stability.
– regulation is growing, but still
inconsistent and not uniform.
–
public payers are seeing
20. 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).Staffing/Human Resource
IssuesNature of the Workforce:Fewer nurses and other clinical
staffCustomer Service FocusStaffing
Regulations:Training:Legal/Ethical IssuesAutonomy 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
LivingWhere ALF administrators come from:Management
Qualifications:Management Challenges &
Opportunities: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 LivingMovement 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.
Long-Term Care: Managing Across the Continuum, Fourth
Edition
John R. Pratt
CHAPTER SEVEN: SENIOR HOUSINGCHAPTER
HIGHLIGHTS
Why the growing need for senior housing?
21. · Growing number of elderly
· Growing need for alternative housing options
What is “Senior Housing”?
A variety of options:
· Age-restricted housing - home ownership or rental
opportunities for adults 55 years of age and older, or sometimes
62 years and older.
· Reverse mortgage - a means of borrowing money from the
amount the home is worth beyond any mortgage debt.
· Age-restricted retirement communities - senior communities
like any other neighborhoods or communities except restricted
to people usually 55 or over or 62 and over. It often involves
purchase of property or condominiums.
· Senior Apartments - is multiunit rental housing for older
adults who are able to care for themselves.
· Cohousing - a type of collaborative housing in which residents
participate in the design and operation of their own
neighborhoods.
· Independent Living - residential living setting that may or may
not provide hospitality or supportive services. In this living
arrangement, the senior requires minimal or no extra assistance,
and leads an independent lifestyle filled with recreational,
educational and social activities amongst other seniors
· Congregate Housing - a form of independent living that
usually provides convenience or supportive services like meals,
housekeeping, and transportation in addition to rental housing.
· Continuing Care Retirement Community (CCRC) - a
community which provides a continuum of care, offering
several levels of assistance, usually including independent
living, assisted living and nursing home care commonly all on
one campus or site.
· Life Care Community - a form of CCRC that offers an
insurance type contract and provides all levels of care. It often
22. includes payment for acute care and physician's visits.
Philosophy of Care
The various forms of senior housing are designed to give
seniors the services and assistance they need, while seeking to
optimize their independence.
Services Provided
· Age-Restricted Communities:
· Provide the least amount of services of the various options.
· Some may also provide different kinds of services to the
people who live there including meals, transportation, social
activities and other programs.
· Independent Living - offer a variety of living arrangements,
including:
· studio apartments,
· one-, two-, or three-bedroom apartments,
· cottages,
· townhouses,
· duplexes,
· cluster homes,
· single-family homes
· Congregate Housing - usually provides the same basic services
as most senior retirement apartment complexes:
· Shared meals
· Fulltime staff on duty 24 hours a day to assist residents
· Housekeeping
· Areas within the building for socializing with other residents
23. · Secure building
· Planned recreational and social activities
Beyond these basic services, congregate housing may have the
following options, often for an extra fee:
· Laundry service
· Transportation for shopping and doctors' appointments
· Health monitoring
· Help with taking medications
· Continuing Care Retirement Communities - offer a broad
range of service and housing packages that allow access to
independent living, assisted living, and skilled nursing
facilities.
Ownership
· Age-Restricted Communities – a mix of for-profit ownership
and publicly-owned.
· Independent Living - market rate, for-profit independent living
communities comprise the vast majority of the independent
living sector.
· CCRCs - While many CCRCs are for-profit, nonprofit
organizations sponsor many of them.
Consumers Served
· Age-Restricted Retirement Communities - are apt to be
younger than in some of the other options, in part because 55+
communities define “senior” a bit younger than others.
· Senior Apartments - are likely to have moved to those units to
preserve their assets by selling their homes that they may no
longer need and cannot care for.
· Independent Living – largely widowed, white females in their
mid-80s. Most have annual household incomes ranging from
$25,000 to $75,000 and a total net worth ranging from $100,000
to $500,000.
· CCRCs - seniors who enter into a CCRC contract while they
are healthy and active, knowing they will be able to stay in the
same community and receive nursing care should this become
necessary.
Accreditation
24. · Most senior housing is not accredited as are some other forms
of long-term care. The exception is continuing care retirement
communities (CCRCs). They are accredited by the Continuing
Care Accreditation Commission (CCAC).
Financing
· Age-Restricted Housing - varies from expensive high-end
communities to government-subsidized senior villages.
· Independent Living – mostly private pay with rents depending
on services provided.
· Congregate Housing - most facilities have a rental contract or
agreement but many do not require a long-term financial
commitment.
· Continuing Care Retirement Communities - the most
expensive long-term-care solution available to seniors. CCRC
residents sign a binding, lifelong contract at the beginning of
their residency.
Staffing
· Staffed somewhat similar to non-senior housing options, they
are much like the hospitality industry (hotels, apartment
complexes, etc.).
Management
· Managers of senior housing range from for-profit
owner/operators to hired administrators. There is no
requirement that they be licensed or otherwise credentialed
(again with the exception of nursing facility and assisted living
components of CCRCs).
Significant Trends and Their Impact
· Desire for More Options - today’s seniors seek (and demand)
housing options that meet their needs and also are attractive,
desirable places to live.
· Quality of Life - seniors also want the quality of their life to
not only decline when they move into senior housing, but to
improve.