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Chapter 4. Assisted Living

Long-Term Care: Managing Across the Continuum

(Second Edition)

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Learning Objectives

1. Define and describe assisted living2. Identify sources of financing for assisted

living3. Identify and describe regulations affecting

assisted living 4. Identify and discuss ethical issues affecting

assisted living 5. Identify trends affecting assisted living into

the future and the impact of those trends

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What is Assisted Living?

Many different definitionsAssisted Living WorkgroupA long-term care residential alternative:

More assistance than a retirement community

Less medical and nursing care than a nursing facility

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Other Residential Living

Similar types of residential living:Residential CareIndependent LivingCongregate HousingContinuing Care Retirement

Community (CCRC)

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How Assisted Living Developed

Two separate tracks:Boarding homesIndependent living

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Philosophy of Care

Maximizing personal dignity, autonomy, independence, privacy, choice

Providing a homelike environmentAccommodating changing care needsMinimizing the need to change facilitiesInvolving families and the community

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Ownership of Nursing Facilities

88% For-Profit 12% Non-Profit

Reasons:High proportion of self-payFew government regulationsGood investment for owners

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Services ProvidedPersonal careHealth careSocial servicesSupervisionSocial and religious activitiesExercise and educational activitiesTransportationLaundry and linenHousekeeping and maintenance

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Consumers Served

Elderly – average age: 80Female – two-thirdsChoose facility close to family

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Prior Placement:Where They Come From

Home – 46 %Other assisted living– 20%Hospital – 14%Nursing Home – 10%Other – 10%

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Placement After ALF:Where They Go

Nursing facility- Because of higher nursing and

medical needs, or loss of functional capacity

Death

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Market Forces

Seeking care alternativesImpact on childrenCost-cutting efforts

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Regulations

• Few regulations until recently• Increasing number of states now

regulating assisted living• Very little commonality or uniformity• Assisted Living Workgroup

recommendations

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Types of Regulations

Affecting residentsOthers:

- Affecting employees- Affecting building

construction & safety

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Accreditation

JCAHOCARF/CCAC

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Financing Assisted Living

Reimbursement Sources:• Mostly self-pay• Medicaid – small, but

growing

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ChargesBasic 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.

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Staffing/Work Force

Largely non-clinicalCustomer service focusFew staffing regulations – mostly

based on nursing facility modelTraining staff to recognize residents’

privacy & independence

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Legal & Ethical Issues

Decision-making: - how to balance autonomy

& resident care & safetyAging-in-Place

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Management

Administrators come from:• Nursing facilities• Outside of long-term care• Within assisted living

- AssistantsEach must learn new culture

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Management QualificationsLicensed by a few statesDifferent state regulations re:

Minimum education Hands-on experience Continuing education

Usually less stringent than for nursing facility administrators

NAB

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Management Challenges& Opportunities

Developing an organizational identity

Interacting with residents

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Significant TrendsMovement toward agreementIncreased regulationGrowth in managed care coverage –

private and governmentIntegration with other providers

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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.