Academic journal article Care Management Journals

Dignity for All: Affordable Assisted Living

Academic journal article Care Management Journals

Dignity for All: Affordable Assisted Living

Article excerpt

In 2026, the first of the baby boomers, including Presidents Clinton and Bush, will reach the age of 80, the average age of residents currently in assisted living facilities. In her book The Denial of Aging: Perpetual Youth, Eternal Life, and Other Dangerous Fantasies, Muriel Gillick proposes that the baby boomers will seek assisted living as an alternative to nursing home care.1 But what about that portion of the population not able to afford the high cost of private assisted living? What option will be available to the low-asset/low-income population in lieu of nursing home care?

Keywords: assisted living; ALP; affordable assisted living; Medicaid assisted living; senior housing; performance improvement

Nearly two decades after its emergence as a form of longterm care for the elderly in the United States, "assisted living" remains poorly defined and sometimes misunderstood. The Assisted Living Federation of America defines assisted living as "a special combination of housing, supportive services, personalized assistance and healthcare designed to respond to the individual needs of those who require help with the activities of daily living."2 However, the concept has been confused by the variety of boardinghouses, adult homes, and retirement apartment complexes that have also adopted the name "assisted living" but differ significantly in services, staffing, and charges.3 In New York State, such residential programs range from senior housing that may organize services for its residents but not serve as a direct provider to enriched housing and adult homes that offer some services, such as bathing, dressing, grooming, and medical reminders, but usually contract for nursing services and refer to health care providers. The State of New York recently passed legislation4 to license and regulate entities that will be permitted to utilize the term "assisted living"; however, the regulations for these entities to be licensed as assisted living residences (ALRs) have yet to be completed. This legislation will regulate adult homes and high-end national assisted living chains doing business in New York State but will not carry with it any form of reimbursement. Assisted living programs (ALPs), described next in this article, are exempt from the ALR legislation.

Currently, there are approximately 800,000 people living in assisted living settings in the United States. The typical assisted living resident is an 80-year-old woman who is mobile but needs assistance with approximately two activities of daily living per day.5 Nationally, the average length of stay in assisted living facilities is approximately 2.5 years.6 Many assisted living facilities claim to promote ambiance, dignity, independence, and quality of life for its residents.7 Facilities that adopt this concept, known as the "residential/social model," usually refer residents to outside medical providers or have limited in-house medical service, primarily because it is not reimbursable, because it is not within the competency of the operators, or because the operators are reluctant to have their facilities resemble nursing homes. There is, however, indication that there may now be movement toward the provision of more medical services, as the ALR legislation includes "enhanced assisted living" and "specialized needs" certification within the context of ALR licensing to care, respectively, for residents requiring 24-hour nursing care and specialized needs, including dementia.


In the early 1990s, at the height of nursing home development, a new model of long-term care emerged in New York State. Sue Kelly, the deputy commissioner of social services, described the rationale as follows: "New York State population trends indicate that the over 65 population may reach three million by the year 2000. The increase in the elderly population has resulted in a shortage of affordable low income housing in some areas of New York State causing many frail elderly individuals to seek premature placement in residential health care facilities (RHCFs). …

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