Transcript SJSUHSCI118Chapter04.ppt [PPT]

Chapter 4. Assisted Living
Long-Term Care: Managing
Across the Continuum
(Second Edition)
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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
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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
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Other Residential Living
Similar types of residential living:
Residential Care
Independent Living
Congregate Housing
Continuing Care Retirement
Community (CCRC)
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How Assisted Living Developed
Two separate tracks:
Boarding homes
Independent living
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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
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Ownership of Nursing
Facilities
 88% For-Profit
 12% Non-Profit
Reasons:
 High proportion of self-pay
 Few government regulations
 Good investment for owners
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Services Provided
Personal care
Health care
Social services
Supervision
Social and religious activities
Exercise and educational activities
Transportation
Laundry and linen
Housekeeping and maintenance
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Consumers Served
Elderly – average age: 80
Female – two-thirds
Choose 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 alternatives
Impact on children
Cost-cutting efforts
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Regulations
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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 residents
Others:
- Affecting employees
- Affecting building
construction & safety
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Accreditation
JCAHO
CARF/CCAC
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Financing Assisted Living
Reimbursement Sources:
• Mostly self-pay
• Medicaid – small, but
growing
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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.
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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
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Legal & Ethical Issues
Decision-making:
- how to balance autonomy &
resident care & safety
Aging-in-Place
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Management
Administrators come from:
• Nursing facilities
• Outside of long-term care
• Within assisted living
- Assistants
Each must learn new culture
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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
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Management Challenges
& Opportunities
Developing an organizational
identity
Interacting with residents
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Significant Trends
Movement toward agreement
Increased regulation
Growth in managed care coverage –
private and government
Integration 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.
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