After reading chapter?6,?in no less than 275 words, reflect?upon?what trends you think are likely to affect assisted living in the future? You can also complete this in point form. P

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Question 1 

After reading chapter 6, in no less than 275 words, reflect upon what trends you think are likely to affect assisted living in the future?

You can also complete this in point form.

Please remember to cite your sources using the APA style.  

This week reading- Chapters 6, 7

Course Materials (Available in the Content area of the course): 

Pratt. J. Long-Term Care- Managing Across the Continuum. 4th edition. Jones and Bartlett ISBN: 978-1-284-

Long-Term Care: Managing Across the Continuum, Fourth Edition

John R. Pratt

CHAPTER SEVEN: SENIOR HOUSING

CHAPTER HIGHLIGHTS

Why the growing need for senior housing?

· Growing number of elderly

· Growing need for alternative housing options

What is “Senior Housing”?

A variety of options:

· Age-restricted housing – home ownership or rental opportunities for adults 55 years of age and older, or sometimes 62 years and older.

· Reverse mortgage – a means of borrowing money from the amount the home is worth beyond any mortgage debt.

· Age-restricted retirement communities – senior communities like any other neighborhoods or communities except restricted to people usually 55 or over or 62 and over. It often involves purchase of property or condominiums.

· Senior Apartments – is multiunit rental housing for older adults who are able to care for themselves.

· Cohousing – a type of collaborative housing in which residents participate in the design and operation of their own neighborhoods.

· Independent Living – residential living setting that may or may not provide hospitality or supportive services. In this living arrangement, the senior requires minimal or no extra assistance, and leads an independent lifestyle filled with recreational, educational and social activities amongst other seniors

· Congregate Housing – a form of independent living that usually provides convenience or supportive services like meals, housekeeping, and transportation in addition to rental housing.

· Continuing Care Retirement Community (CCRC) – a community which provides a continuum of care, offering several levels of assistance, usually including independent living, assisted living and nursing home care commonly all on one campus or site.

· Life Care Community – a form of CCRC that offers an insurance type contract and provides all levels of care. It often includes payment for acute care and physician's visits.

Philosophy of Care

The various forms of senior housing are designed to give seniors the services and assistance they need, while seeking to optimize their independence.

Services Provided

· Age-Restricted Communities:

· Provide the least amount of services of the various options.

· Some may also provide different kinds of services to the people who live there including meals, transportation, social activities and other programs.

· Independent Living – offer a variety of living arrangements, including:

· studio apartments,

· one-, two-, or three-bedroom apartments,

· cottages,

· townhouses,

· duplexes,

· cluster homes,

· single-family homes

· Congregate Housing – usually provides the same basic services as most senior retirement apartment complexes:

· Shared meals

· Fulltime staff on duty 24 hours a day to assist residents

· Housekeeping

· Areas within the building for socializing with other residents

· Secure building

· Planned recreational and social activities

Beyond these basic services, congregate housing may have the following options, often for an extra fee:

· Laundry service

· Transportation for shopping and doctors' appointments

· Health monitoring

· Help with taking medications

· Continuing Care Retirement Communities – offer a broad range of service and housing packages that allow access to independent living, assisted living, and skilled nursing facilities.

Ownership

· Age-Restricted Communities – a mix of for-profit ownership and publicly-owned.

· Independent Living – market rate, for-profit independent living communities comprise the vast majority of the independent living sector.

· CCRCs – While many CCRCs are for-profit, nonprofit organizations sponsor many of them.

Consumers Served

· Age-Restricted Retirement Communities – are apt to be younger than in some of the other options, in part because 55+ communities define “senior” a bit younger than others.

· Senior Apartments – are likely to have moved to those units to preserve their assets by selling their homes that they may no longer need and cannot care for.

· Independent Living – largely widowed, white females in their mid-80s. Most have annual household incomes ranging from $25,000 to $75,000 and a total net worth ranging from $100,000 to $500,000.

· CCRCs – seniors who enter into a CCRC contract while they are healthy and active, knowing they will be able to stay in the same community and receive nursing care should this become necessary.

Accreditation

· Most senior housing is not accredited as are some other forms of long-term care. The exception is continuing care retirement communities (CCRCs). They are accredited by the Continuing Care Accreditation Commission (CCAC).

Financing

· Age-Restricted Housing – varies from expensive high-end communities to government-subsidized senior villages.

· Independent Living – mostly private pay with rents depending on services provided.

· Congregate Housing – most facilities have a rental contract or agreement but many do not require a long-term financial commitment.

· Continuing Care Retirement Communities – the most expensive long-term-care solution available to seniors. CCRC residents sign a binding, lifelong contract at the beginning of their residency.

Staffing

· Staffed somewhat similar to non-senior housing options, they are much like the hospitality industry (hotels, apartment complexes, etc.).

Management

· Managers of senior housing range from for-profit owner/operators to hired administrators. There is no requirement that they be licensed or otherwise credentialed (again with the exception of nursing facility and assisted living components of CCRCs).

Significant Trends and Their Impact

· Desire for More Options – today’s seniors seek (and demand) housing options that meet their needs and also are attractive, desirable places to live.

· Quality of Life – seniors also want the quality of their life to not only decline when they move into senior housing, but to improve.

· High Occupancy Rates – demand for senior housing is at a record high with occupancy levels running at over 90 percent throughout most of the country.

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© 2015 Jones and Bartlett Publishers, LLC

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Long-Term Care: Managing Across the Continuum, Fourth Edition John R. Pratt

CHAPTER SIX: ASSISTED LIVING

CHAPTER HIGHLIGHTS

What is assisted living?

 A long-term residence option that provides resident-centered care in a residential setting,

designed for those who need extra help in their day-to-day lives but who do not require

the 24-hour skilled nursing care.

 Assisted Living Workgroup (ALW) – a group comprised of more than 50 organizations to

work together and make recommendations to ensure high-quality care and services for all

assisted living residents.

How Assisted Living Developed

Developed along two tracks:

1. As residential care facilities, known more commonly as boarding homes or boarding care

facilities, their services were traditionally provided in small homes caring for one or

several seniors.

2. For people who, with a bit of assistance, could live more independently.

Philosophy of Care

Based on:

 Maximizing dignity, autonomy, independence, privacy, and choice

 Providing a homelike environment

 Accommodating residents' changing care needs and preferences

© 2015 Jones and Bartlett Publishers, LLC 1

Long-Term Care: Managing Across the Continuum, Fourth Edition John R. Pratt

 Minimizing the need to move when a resident's care needs increase

 Involving families and the community

Ownership of Assisted Living Facilities

 Approximately 82 percent were for-profit and the remainder were not-for-profit or were

owned by government entities

 Percent of not-for-profit is increasing

Services Provided

 24-hour supervision;

 Three meals a day plus snacks

 Personal Care Services

 Health Care Services

 Social Services

 Supervision of Persons with Cognitive Disabilities

 Social and Religious Activities

 Exercise and Educational Activities

 Arrangements for Transportation

 Laundry and Linen Service

 Housekeeping and Maintenance

Consumers Served

© 2015 Jones and Bartlett Publishers, LLC 2

Long-Term Care: Managing Across the Continuum, Fourth Edition John R. Pratt

By age and gender:

 Mostly elderly (average age 87)

 Mostly female (74%)

Where they come from:

 Most (about 70 percent) come from home,

 14 percent from another assisted living residence or retirement community,

 7% moved from a family residence (such as living with adult children)

 9 percent from a nursing home

Where they go:

 The most common (59%) destination is to a nursing facility, generally because of loss of

functional capacity.

 The second most common (33%) reason for leaving is the death of the resident

Market Forces

 Seeking Care Alternatives – potential residents looking for alternatives to nursing

facilities

 Impact on Children – loss of nuclear family impacting care of elderly family members

 Cost-Cutting Efforts – payers are looking for less costly alternatives.

Regulations

 Regulations affecting residents – there is concern about following the nursing facility

model too closely.

© 2015 Jones and Bartlett Publishers, LLC 3

Long-Term Care: Managing Across the Continuum, Fourth Edition John R. Pratt

 Other regulations – similar to nursing facility regulations.

Accreditation

 Joint Commission

 CARF

Financing Assisted Living

Costs/Charges – vary widely depending on services provided:

 One all-inclusive rate: 24%

 Ala Carte/fee-for-service: 17%

 Hourly charge or other time fee: 4%

 Tiered pricing for bundled services: 51%

Reimbursement:

 Private pay – use of an individual's own funds – remains the largest source of

reimbursement for assisted living.

 Medicare does not cover it, although in some cases, there is some coverage under

Social Security Supplemental Income (SSI).

 Medicaid is a small, but growing source of reimbursement

Staffing/Human Resource Issues

Nature of the Workforce:

 Fewer nurses and other clinical staff

© 2015 Jones and Bartlett Publishers, LLC 4

Long-Term Care: Managing Across the Continuum, Fourth Edition John R. Pratt

 Customer Service Focus

Staffing Regulations:

 Much less controlled by regulation than in other levels of long-term care, although

that is changing in many instances.

Training:

 Relatively little training is required

 Generally consists largely of orienting staff to the philosophy of assisted living

Legal/Ethical Issues

 Autonomy and Decision-Making – need to balance the residents’ desire to be independent

with the facility's responsibility to protect them from harm.

 Aging in Place – problem with providing all of the services needed or desired.

Management of Assisted Living

Where ALF administrators come from:

 Licensed nursing facility administrators who have moved from that other kind of

long-term care provider

 From outside of the field of long-term care

 From within the field. They are assistant administrators and department heads who

are familiar with the setting and the residents, and desire to become top-level

administrators

Management Qualifications:

© 2015 Jones and Bartlett Publishers, LLC 5

Long-Term Care: Managing Across the Continuum, Fourth Edition John R. Pratt

 Regulation of assisted living is still very much a work in progress

 An increasing number of licensing jurisdictions are requiring their licensure

 There is little uniformity in those requirements

Management Challenges & Opportunities:

There are several challenges/opportunities that are either unique to ALFs or play a larger part

in their management:

 Developing an Organizational Identity – not nursing care.

 Interacting with Residents – ALF administrators are much more personally involved

with the residents than they would be in other types of long-term care.

Significant Trends and Their Impact on Assisted Living

 Movement Toward Agreement – , the field of assisted living has begun to take on more

coherence and stability.

 Increased Regulation – regulation is growing, but still inconsistent and not uniform.

 Growth in Coverage by Managed Care and Government – public payers are seeing

assisted living as a lower cost alternative to nursing facility care.

 Integration with Other Providers – most providers will find that they can provide better

services and prosper financially by joining with other types and levels of long-term care

providers in integrated systems.

© 2015 Jones and Bartlett Publishers, LLC 6

  • CHAPTER SIX: ASSISTED LIVING
  • CHAPTER HIGHLIGHTS
  • What is assisted living?
  • How Assisted Living Developed
  • Philosophy of Care
    • Maximizing dignity, autonomy, independence, privacy, and choice
    • Providing a homelike environment
    • Accommodating residents' changing care needs and preferences
    • Minimizing the need to move when a resident's care needs increase
    • Involving families and the community
  • Ownership of Assisted Living Facilities
  • Services Provided
    • 24-hour supervision;
    • Three meals a day plus snacks
    • Personal Care Services
    • Health Care Services
    • Social Services
    • Supervision of Persons with Cognitive Disabilities
    • Social and Religious Activities
    • Exercise and Educational Activities
    • Arrangements for Transportation
    • Laundry and Linen Service
    • Housekeeping and Maintenance
  • Consumers Served
    • Where they come from:
    • Where they go:
  • Market Forces
    • Seeking Care Alternatives – potential residents looking for alternatives to nursing facilities
    • Impact on Children – loss of nuclear family impacting care of elderly family members
    • Cost-Cutting Efforts – payers are looking for less costly alternatives.
  • Regulations
    • Regulations affecting residents – there is concern about following the nursing facility model too closely.
    • Other regulations – similar to nursing facility regulations.
  • Accreditation
  • Financing Assisted Living
    • Costs/Charges – vary widely depending on services provided:
    • Reimbursement:
      • Private pay – use of an individual's own funds – remains the largest source of reimbursement for assisted living.
      • Medicare does not cover it, although in some cases, there is some coverage under Social Security Supplemental Income (SSI).
  • Staffing/Human Resource Issues
    • Nature of the Workforce:
    • Fewer nurses and other clinical staff
    • Customer Service Focus
    • Staffing Regulations:
    • Training:
  • Legal/Ethical Issues
    • Autonomy and Decision-Making – need to balance the residents’ desire to be independent with the facility's responsibility to protect them from harm.
    • Aging in Place – problem with providing all of the services needed or desired.
  • Management of Assisted Living
    • Where ALF administrators come from:
    • Management Qualifications:
  • Management Challenges & Opportunities:
    • Developing an Organizational Identity – not nursing care.
    • Interacting with Residents – ALF administrators are much more personally involved with the residents than they would be in other types of long-term care.
  • Significant Trends and Their Impact on Assisted Living
    • Movement Toward Agreement – , the field of assisted living has begun to take on more coherence and stability.
    • Increased Regulation – regulation is growing, but still inconsistent and not uniform.
    • Growth in Coverage by Managed Care and Government – public payers are seeing assisted living as a lower cost alternative to nursing facility care.
    • Integration with Other Providers – most providers will find that they can provide better services and prosper financially by joining with other types and levels of long-term care providers in integrated systems.

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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-pay

Fewer government regulations

Good 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 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

Aging in place

Management

Administrators come from:

Nursing facilities

Outside of long-term care

Within assisted living

Assistants

Each must learn new culture

22

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

Significant Trends and Their Impact

Movement toward agreement

Increased regulation

Growth in managed care coverage

private 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.

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Chapter 7

Senior Housing

Learning Objectives

Understand how senior housing developed and where it fits in the continuum of care

Identify and define the components of senior housing

Identify and describe regulations affecting senior housing providers

Learning Objectives (continued)

4. Understand the financial, ethical, and managerial issues facing senior housing providers

5. Identify and discuss trends in senior housing and its management

Why the need for Senior Housing?

Growth in number of elderly

Need for living accommodations that meet their desire for more independent living

Demand for more choice

What is Senior Housing?

Age-restricted housing

Reverse mortgage

Age-restricted retirement communities

Senior apartments

Cohousing

Independent living

Congregate housing

Continuing care retirement communities

Life care communities

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