Unit 3: Week 3 – Chapter 6 Outline




After completing this chapter, readers will be able to:

1.   Define and describe assisted living facilities, where they fit in the continuum of care, the consumers who use them, and the services they offer.

2.   Identify sources of financing for assisted living facilities.

3.   Identify and describe regulations affecting assisted living facilities.

4.   Identify and discuss ethical issues affecting assisted living facilities.

5.   Identify trends affecting assisted living facilities into the coming millennium and describe the impact of those trends.


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

·         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

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 affecting residents – there is concern about following the nursing facility model too closely.

·         Other regulations – similar to nursing facility regulations.


·         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%


·         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

·         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.


·         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:

·         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.



A.  Identify learning objectives for the session

B.  Introduce the lecture topic

C.  Discuss what assisted living is, defining and explaining the terms involved

D.  Origins & Development. Discuss how assisted living developed

E.   Philosophy of Care. Discuss the philosophy of care of assisted living, including:

1.   Maximizing dignity, autonomy, independence, privacy and choice

2.   Providing a homelike environment

3.   Accommodating residents’ changing care needs and preferences

4.   Minimizing the need to change facilities when care needs increase

5.   Involving families and the community

F.   Ownership. Identify differences in ownership of assisted living facilities

G.  Services. Discuss the services provided by assisted living:

1.   24-hour supervision;

2.   Three meals a day plus snacks in

3.   Personal care services

4.   Health care services

5.   Social services

6.   Supervision of persons with cognitive disabilities

7.   Social and religious activities

8.   Exercise and educational activities

9.   Arrangements for transportation

10. Laundry and linen services

11. Housekeeping and maintenance

H.  Consumers. Identify consumers served

1.   Where they come from

2.   Where they go

I.    Market Forces. Identify and discuss market forces impacting assisted living

1.   Seeking care alternatives

2.   Impact on children

3.   Cost cutting efforts

J.    Regulations. Discuss the regulations affecting assisted living, including:

1.   Regulations affecting residents

2.   Other regulations

K.  Accreditation. Discuss accreditation, and how it applies to assisted living

L.   Financing. Discuss how assisted living is financed, and by whom

M.  Staffing/Human Resources. Identify and discuss staffing/human resource issues, including:

1.   Nature of the work force

2.   Customer service focus

3.   Staffing regulations

4.   Training

N.  Legal & Ethical Issues. Identify and discuss legal and ethical issues, including:

1.   Autonomy and decision-making

2.   Aging in place

O.  Management. Discuss management of assisted living, including:

1.   Where ALF administrators come from

2.   Management qualifications

3.   Discuss management challenges and opportunities

P.   Trends. Identify and discuss significant trends impacting assisted living, including:

1.   Movement toward agreement

2.   Increased regulation

3.   Growth in coverage by managed care and government

4.   Integration with other providers

Q.  Summarize the discussion, recapping the key points of the lecture.



AARP (formerly the American Association of Retired Persons) – advocacy organization representing seniors.

Activities of daily living (ADLs) – Those activities that impact a person’s functional ability or disability; including bathing, transferring, toileting, eating, and communicating.

Aging in place – The concept of allowing a person to progress through different levels of long-term care services without having to move to another facility. Services are brought to the consumer instead of taking the consumer to the services.

Assisted Living/Residential Care – a residential setting that provides personal services and care, 24-hour on-site support and assistance, activities and health-related services.

Assisted Living Federation of America (ALFA) – national organization representing assisted living providers.

Autonomy – the ability of a consumer to make meaningful decisions, and in doing so, to direct or impact his or her care.

Caregiver – anyone who provides long-term care. Formal caregivers include organizational entities, while informal caregivers include family members and friends.

Cognitive disability – diminished mental capacity, such as difficulty with short-term memory.

Center for Excellence in Assisted Living (CEAL) – formed in 2004 to foster access to high-quality assisted living.

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

Continuing Care Retirement Communities (CCRC) – housing communities that offer several levels of assistance, including independent living, assisted living, and nursing home care.

Holistic philosophy of care – type of care that emphasizes the importance of the whole person

Joint Commission – an organization providing voluntary accreditation for health care providers.

Medication management – supervising the administration or taking of medications to assure that they are taken safely and appropriately.

Residential care – a level of care somewhat less intensive than nursing facility care, providing supervised housing and some nursing assistance (often synonymous with assisted living).

Senate Special Committee on Aging – government committee with a focus on aging issues.


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