1 Chapter 4. Assisted Living Long-Term Care: Managing Across the Continuum (Second Edition)
Dec 17, 2015
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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 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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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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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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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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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 & 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 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 Trends
Movement toward agreementIncreased regulationGrowth in managed care coverage –
private and governmentIntegration with other providers