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 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 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: 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 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. image3.jpeg image1.jpeg image2.jpeg Chapter 6 Assisted Living ...

1. 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
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

2. 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
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

3. 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:
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

4. 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
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.
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5. 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

6. 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

7. 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

8. 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

9. 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
Basic requirements

10. 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.
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Long-Term Care: Managing Across the Continuum, Fourth
Edition
John R. Pratt
CHAPTER SIX: ASSISTED LIVING
CHAPTER HIGHLIGHTS
What is assisted living?

11. -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.
- 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:

12. choice
preferences
© 2015 Jones and Bartlett Publishers, LLC 1
Long-Term Care: Managing Across the Continuum, Fourth
Edition
John R. Pratt
increase
Ownership of Assisted Living Facilities
Approximately 82 percent were for-profit and the remainder
were not-for-profit or were
owned by government entities
-for-profit is increasing
Services Provided
-hour supervision;
Services

13. ing and Maintenance
Consumers Served
© 2015 Jones and Bartlett Publishers, LLC 2
Long-Term Care: Managing Across the Continuum, Fourth
Edition
John R. Pratt
By age and gender:
Where they come from:

14. retirement community,
children)
Where they go:
he most common (59%) destination is to a nursing facility,
generally because of loss of
functional capacity.
death of the resident
Market Forces
– potential residents looking for
alternatives to nursing
facilities
– loss of nuclear family impacting care of
elderly family members
-Cutting Efforts – payers are looking for less costly
alternatives.
Regulations
dents – there is concern about
following the nursing facility

15. model too closely.
© 2015 Jones and Bartlett Publishers, LLC 3
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%
ered pricing for bundled services: 51%
Reimbursement:
- use of an individual's own funds - remains the
largest source of

16. reimbursement for assisted living.
some coverage under
Social Security Supplemental Income (SSI).
Staffing/Human Resource Issues
Nature of the Workforce:
© 2015 Jones and Bartlett Publishers, LLC 4
Long-Term Care: Managing Across the Continuum, Fourth
Edition
John R. Pratt
Staffing Regulations:
long-term care, although
that is changing in many instances.
Training:

17. of assisted living
Legal/Ethical Issues
-Making - need to balance the
residents’ desire to be independent
with the facility's responsibility to protect them from harm.
– problem with providing all of the services
needed or desired.
Management of Assisted Living
Where ALF administrators come from:
moved
from that other kind of
long-term care provider
-term care
department heads who
are familiar with the setting and the residents, and desire to
become top-level
administrators
Management Qualifications:
© 2015 Jones and Bartlett Publishers, LLC 5

18. Long-Term Care: Managing Across the Continuum, Fourth
Edition
John R. Pratt
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:
– 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
- , the field of assisted living
has begun to take on more
coherence and stability.

19. – regulation is growing, but still
inconsistent and not uniform.
–
public payers are seeing
assisted living as a lower cost alternative to nursing facility
care.
– 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.
© 2015 Jones and Bartlett Publishers, LLC 6
CHAPTER SIX: ASSISTED LIVINGCHAPTER
HIGHLIGHTSWhat is assisted living?How Assisted Living
DevelopedPhilosophy of CareMaximizing dignity, autonomy,
independence, privacy, and choiceProviding a homelike
environmentAccommodating residents' changing care needs and
preferencesMinimizing the need to move when a resident's care
needs increaseInvolving families and the communityOwnership
of Assisted Living FacilitiesServices Provided24-hour
supervision;Three meals a day plus snacksPersonal Care
ServicesHealth Care ServicesSocial ServicesSupervision of
Persons with Cognitive DisabilitiesSocial and Religious
ActivitiesExercise and Educational ActivitiesArrangements for
TransportationLaundry and Linen ServiceHousekeeping and
MaintenanceConsumers ServedWhere they come from:Where
they go:Market ForcesSeeking Care Alternatives – potential
residents looking for alternatives to nursing facilitiesImpact on
Children – loss of nuclear family impacting care of elderly
family membersCost-Cutting Efforts – payers are looking for

20. less costly alternatives.RegulationsRegulations affecting
residents – there is concern about following the nursing facility
model too closely.Other regulations – similar to nursing facility
regulations.AccreditationFinancing Assisted
LivingCosts/Charges – vary widely depending on services
provided:Reimbursement: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).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.
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