Chapter 4 Assisted Living LongTerm Care Managing Across

Chapter 4. Assisted Living Long-Term Care: Managing Across the Continuum (Second Edition) 1

Learning Objectives 1. Define and describe assisted living 2. Identify sources of financing for assisted living 3. 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 2

What is Assisted Living? ü Many different definitions ü Assisted Living Workgroup ü A long-term care residential alternative: § More assistance than a retirement community § Less medical and nursing care than a nursing facility 3

Other Residential Living Similar types of residential living: üResidential Care üIndependent Living üCongregate Housing üContinuing Care Retirement Community (CCRC) 4

How Assisted Living Developed Two separate tracks: üBoarding homes üIndependent living 5

Philosophy of Care ü Maximizing personal dignity, autonomy, independence, privacy, choice ü Providing a homelike environment ü Accommodating changing care needs ü Minimizing the need to change facilities ü Involving families and the community 6

Ownership of Nursing Facilities ü 88% For-Profit ü 12% Non-Profit Reasons: § High proportion of self-pay § Few government regulations § Good investment for owners 7

Services Provided ü Personal care ü Health care ü Social services ü Supervision ü Social and religious activities ü Exercise and educational activities ü Transportation ü Laundry and linen ü Housekeeping and maintenance 8

Consumers Served ü Elderly – average age: 80 ü Female – two-thirds ü Choose facility close to family 9

Prior Placement: Where They Come From ü Home – 46 % ü Other assisted living– 20% ü Hospital – 14% ü Nursing Home – 10% ü Other – 10% 10

Placement After ALF: Where They Go ü Nursing facility - Because of higher nursing and medical needs, or loss of functional capacity ü Death 11

Market Forces ü Seeking care alternatives ü Impact on children ü Cost-cutting efforts 12

Regulations • • Few regulations until recently Increasing number of states now regulating assisted living Very little commonality or uniformity Assisted Living Workgroup recommendations 13

Types of Regulations ü Affecting residents ü Others: - Affecting employees - Affecting building construction & safety 14

Accreditation ü JCAHO ü CARF/CCAC 15

Financing Assisted Living Reimbursement Sources: • Mostly self-pay • Medicaid – small, but growing 16

Charges ü Basic daily charge - Varies by type of facility and resident’s living quarters - Single room, apartment, suite ü “Ala Carte” charges: - Residents pay for what they need - Some meals, housekeeping, laundry, etc. 17

Staffing/Work Force ü Largely non-clinical ü Customer service focus ü Few staffing regulations – mostly based on nursing facility model ü Training staff to recognize residents’ privacy & independence 18

Legal & Ethical Issues ü Decision-making: - how to balance autonomy & resident care & safety ü Aging-in-Place 19

Management Administrators come from: • Nursing facilities • Outside of long-term care • Within assisted living - Assistants Each must learn new culture 20

Management Qualifications ü Licensed by a few states ü Different state regulations re: § Minimum education § Hands-on experience § Continuing education ü Usually less stringent than for nursing facility administrators ü NAB 21

Management Challenges & Opportunities ü Developing an organizational identity ü Interacting with residents 22

Significant Trends ü Movement toward agreement ü Increased regulation ü Growth in managed care coverage – private and government ü Integration with other providers 23

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. 24