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-payFewer government regulationsGood 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 reg.

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

2. 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-payFewer government
regulationsGood investment for owners

3. 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%

4. 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

5. 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 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

6. Aging in place
Management
Administrators come from:
Nursing facilities
Outside of long-term care
Within assisted livingAssistants
Each must learn new culture
*
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
Management Challenges
and Opportunities
Developing an organizational identity
Interacting with residents

7. Significant Trends and Their Impact
Movement toward agreement
Increased regulation
Growth in managed care coverageprivate 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.