ASSISTED LIVING: AN IDEA IN NEED OF SOME ASSISTANCE
Assisted living residences (ALR) are springing up all around us. A 1997 survey estimated that one million Americans lived in an assisted living residence. If construction of new facilities in the years since 1997 is any indication of the population of assisted living residents, which I think it is, many more people than that live in these facilities today.
ALRs are designed to provide housing options to those individuals in need of assistance with some of the activities of daily living. There are six activities of daily living: eating, clothing, bathing, toileting, continence, and transferring.
ALRs are typically new, modern, and very attractive. Some residences are managed by traditional hospitality companies, such as Marriott. On average, assisted living residences are less expensive than nursing homes.
Although assisted living is a much needed and welcomed addition in the long-term care continuum, assisted living, like any new industry, has both positive and negative aspects. In recent months, both the National Academy of Elder Law Attorneys (NAELA) and the American Bar Association’s (ABA) Commission on Legal Problems of the Elderly and Commission on Mental and Physical Disability Law have made recommendations for improving the regulation and accreditation of assisted living residences, as well as improving the general public’s access to these facilities. In many ways, the recommendations of these two nationally renown and respected legal organizations mirror one another. Spatial restrictions make it impossible for me to reiterate at length the recommendations of NAELA and the ABA, but I think the more salient points of these reports bear emphasis.
Both the ABA and NAELA recommend state oversight of assisted residences. Currently, oversight of these facilities is haphazard. A true definition of what an assisted living residence is has yet to be established.
Many of the facilities would like to see private accreditation through organizations such as the Joint Commission on Health Care Organizations (JCHCO). The problem with this form of accreditation is that organizations such as JCHCO are funded by the very facilities that they evaluate. Because of their funding source, there are conflict of interest situations inherent in the relationship. Both the ABA and NAELA recommend that the State either evaluate assisted living residences itself or oversee accreditation of these facilities by private associations such as the JCHCO.
Another issue that was common to both the NAELA and ABA reports was their discussion of the marketing materials that assisted living residences publish. Many facilities promise that they are true “aging in place” facilities, meaning that they promise prospective residences they will not have to leave the facility if their healthcare needs increase. Oftentimes, this promise is untrue. State law may prevent assisted living residences from providing higher levels of care to residences. Many residences require that the resident be ambulatory.
The reports of NAELA and the ABA point out that defined “resident’s rights” vary significantly from state to state. Those states that do provide residents with some rights – such as the right to privacy – vary considerably in the rights provided and the manner in which those rights are communicated to prospective and actual residents. Unlike assisted living residents, federal law guarantees nursing home residents certain rights. Uniformity in the nature and communication of resident’s rights is needed, so that resident’s and their families better understand the relationship that exists with the facility.
Finally, both reports discuss the need to increasing funding options for prospective residents. Long term care costs lots of money. An assisted living residence in this area of the state may cost anywhere from $2,000 to $5,000 per month. Few individuals could afford to pay this much money every month without depleting their assets.
New Jersey has a Medicaid program that will help with the cost of an assisted living residence, but the program only has 1,500 “slots,” and currently, all of those slots are filled. Assisted living, in many situations, offers an excellent alternative to nursing home placement. The State needs to increase the coverage options of its Medicaid program in order to allow more individual to qualify for much needed financial subsidization.