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Chapter 4. Assisted Living

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

2 Learning Objectives Define and describe assisted living
Identify sources of financing for assisted living Identify and describe regulations affecting assisted living Identify and discuss ethical issues affecting assisted living Identify trends affecting assisted living into the future and the impact of those trends

3 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

4 Other Residential Living
Similar types of residential living: Residential Care Independent Living Congregate Housing Continuing Care Retirement Community (CCRC)

5 How Assisted Living Developed
Two separate tracks: Boarding homes Independent living

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

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

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

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

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

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

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

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

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

15 Accreditation JCAHO CARF/CCAC

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

17 Charges Basic 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.

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

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

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

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

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

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

24 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.

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