Discussion Topic- The Continuum of Care

Discussion Topic-

In this forum, after reading our text, what are some issues with senior housing (in your state “NYC” or in your country)? Are there policies that you agree with, also are there some you would like to see changed? Why is there a change needed?    

 At least 250 words 

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: 978-1-284-05459-0.

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 $

1

00,000 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

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.

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

Philosophy of Care
Giving seniors the services and assistance they need
Optimizing their independence
Letting seniors live as independently as possible
Letting them live to the maximum extent of their abilities

Services Provided:
Age-Restricted Communities
Provide the least amount of services
May provide meals, transportation, social activities, etc.
Accessible
May act as a broker to provide services through contractors

Services Provided:
Independent Living
For relatively healthy, active seniors
Variety of apartments, homes
Balances desire for independence and need for support

Services Provided:
Congregate Housing
Services similar to retirement apartment complexes
Shared meals
Housekeeping
Full-time staff on duty 24 hours
Additional service options

Services Provided:
CCRCs
Broad range of service and housing packages available
Access to other types of services as needed (e.g., skilled care)
Option to move between available housing as one’s needs change

Ownership of Senior Housing
Age-restricted communities:
For profit and publicly owned
Independent living:
Mostly for profit
CCRCs:
Mix of for-profit and nonprofit

Consumers Served
Age-restricted retirement communities:
Younger (55+), early retirees
Senior apartments:
May be looking for subsidized housing
Independent living:
Largely women with high net worth
CCRCs:
Often enter while healthy and active

Accreditation
Generally not accredited
Except CCRCs – accredited by CCAC

Financing
Mix of private, government-subsidized, and nonprofit
Wide range of fees
CCRCs are most expensive, usually private pay
Variety of contract options

Staffing
Mostly hotel-type staffing
Few health services – except SNF and assisted living components of CCRCs

Management Qualifications
Few licensing requirements
Except SNF and assisted living components of CCRCs

Significant Trends
Desire for more options
Quality of life
High occupancy rates

Summary
Senior housing services provide a variety of options for elderly consumers and have become an integral component of the continuum of long-term care.

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.