Assisted Living and Care Retirement Communities

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Assisted Living and Care Retirement Communities

• Carmen Ng
• September 13, 2001

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Sources of information

• Presentations of
• Thomas J. Fairchild, Ph.D., University of North
  
• Taxas Health Science Center at Fort Worth
• Basis Beiza, BN, Ph.D., Associate Professor,
• Biobehavioral, Nursing and Health Systems,
• University of Washington
• Connie Evashwick, Sc.D., Professor and
• Endowed Chair, Center for Health Care
  Innovation,
• California State University Long Beach

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Adult Day Care
Hospital Acute
In Home Care
Regulations
Community Based Care
Hospice
Older Persons
Supportive Housing
Home Health Care
Special Care Facilities
Nursing Facilities
Regulations
Mental Health Service
Ambulatory Care
Current LTC System of Client Services
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Factors affecting LTC in U.S.

• Aging Population
• Chronic disease
• Reducing number of carers
• Revenue and costs problems
• Technology

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Factors affecting LTC in U.S.

• Aging Population
• - 50 growth in the elderly population
• over next 30 years
• - Dependency ratio
• 1990 71 youth and elderly per 100
  persons of
• working age
• 2050 87 youth and elderly per 100
  persons of
• working age

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Factors affecting LTC in U.S.

• Chronic diseases
• major cause of illness, disability, and
• death
• Significant impact on functionality - ADLs
• and IADLS
• Increases the cost of care

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Factors affecting LTC in U.S.

• Increasing rates of dementia
• 4 million Americans suffer from A.D.
• Estimated 14.3 million will have AD by
• 2050
• Cost of caring for persons with AD
• exceeds 50 billion annually

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Factors affecting LTC in U.S.

• Reducing number of potential carers
• Paid
• increasing shortages of administrators, nurses,
  
• and Certified Nurse Aides
• Unpaid
• dramatic decline in potential number of carers
  
• (50-64) available for older adults (85)
• 1970 21/1 2030 6/1
• Family mobility

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Factors affecting LTC in U.S.

• Revenue Problems
• Medicare
• changing reimbursement system
• Medicaid
• shorter and getting shorter
• Private pay
• declining

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Factors affecting LTC in U.S.

• Cost problems
• Increasing labor costs
• Escalating cost of liability insurance
• Increase and shift in residents levels of
• acuity
• Sicker residents - higher acuity level
• Change in dependency and behavioral need
• Increase in staffing needs and training
• Managed health
• reduced payment for services

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Factors affecting LTC in U.S.

• Technology
• Helping to maximize independence
• Sunrise at Home
• Thinking appliances
• Wireless internet communications

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Tale 8.2 Typical Characteristics of Multiunit
Supportive Housing
Table 8.2 Typical Characteristics of Multiunit
Supportive Housing
Typical Characteristics of Multiunit Supportive
Housing
 
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Continuing Care Retirement Communities (CCRCs)
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• Retirement housing facilities
• Provide various programs to allow residents to
  continue living in their own apartments and
  participate in community life
• Independent Living (IL) program
• Assisted Living (AL) program
• Skilled Nursing program
• Not all CCRCs provide Skilled Nursing

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Independent Living

• Mainly for those who can perform
• basic ADLs without assistance
• Health promotion
• Managing acute and chronic illness,
• interface with health care system

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Assisted Living

• Mainly for residents who need some
• assistance with ADLs
• Greater involvement in managing
• acute and chronic illnesses
• Functional and cognitive changes
• Increased involvement by family

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AL program (example)

• 24 hours personal care assistant
• Regular scheduled on-call access to RN
• Medication Monitoring
• Bathing
• Dressing/Grooming
• Laundry Service
• Continence care

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Skilled Nursing

• Need for rehabilitation, residential
• care, end of life care, support for
• cognitive impairment
• Increased involvement of skilled
• therapies
• Complex health and functional needs
• High acuity and high risk for
• complications

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Average length of stay

• Independent Living 4 years
• Assisted Living 2 years
• Nursing Care Center 2-3 years for
• C1 and Residential, 3-6 weeks for
• Rehab

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Movement around in one of the CCRCs - May 1999 to
May 2000
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IL
AL
7
5
10
5
10
NCC
Total population 386
10 couples in 2 levels of care
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ALU and NCC use by IL residents

• 60 of current Assisted Living
• residents moved from IL
• 28 of current Nursing Care Center
• residents moved from IL
• 18 IL residents received rehabilitation
• in NC and moved back to IL, last year

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Residents room
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Residents room (cont.)
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Residents room (cont.)
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Residents room (cont.)
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Common Room
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Restaurant
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Restaurant (cont.)
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Garden
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Library
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Post box
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Assisted Living Facility
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Assisted Living Facility

• Explosive growth in the last decade
• Growing interest in the publics desire for
• a non-institutional environment
• Publics dissatisfaction with quality of
• care in Nursing Facilities
• Rapid growth in government
• expenditures for nursing facility services
• Lack of government regulations

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• Profile
• Approx. 11,500 ALFs
• Approx. 600,000beds
• Approx. 500,000 residents
• Growth
• 1986 approx. 13 of current facilities
• 1996 - 1999 approx. 61 of current facilities
• Mostly private pay
• Cost for basic service 21,000/yr. Plus
  ancillary
• charges

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• Agreed philosophy of AL
• - Consumer driven
• - Preserve independence and dignity
• - Aging-in-place
• - Homelike environment

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• Little agreement about
• definition of services that are
• provided in assisted living - no
• consensus about which facilities are
• and which are not assisted living
• appropriate regulatory model for
• ALFs

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Assisted Living Services

• Meals
• Housekeeping
• Transportation
• Assistance for people with functional
  disabilities
• 24-hour security
• Emergency call systems in living unit
• Health maintenance, wellness, exercise
• programs

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Assisted Living Services (Cont.)

• Medication management
• Personal laundry services
• social and recreational activities
• Short-term respite care
• Therapy and pharmacy services
• Special programs for people with Alzheimers
  disease or other forms of dementia

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• Diverse models of care
• Significant differences between
• facilities in admission and retention
• policies
• Physical impairment - wheelchair use,
• help with locomotion, and assistance
• with transfer
• Cognitive impairment - e.g., Alzheimers
• disease
• Care or monitoring of residents by a
• licensed nurse

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Nursing Facility
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Nursing Facility

• Profile
• - 17,000 facilities
• - 1.8 million beds
• - 1.6 million residents
• - Avg. costs 47,000/year
• Decline in number of NF beds
• In 1999, 48 beds/1000 persons 65, a
• drop of 4.2 from 1998

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Nursing Facility

• Decline in number of residents
• 415,000 residents from 1994 to 1999
• Occupancy rate nation wide of 88
• Older, frailer, and demented
• residents

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Nursing Facility

• Negative public view of quality care
• Staffing adequacy
• Avg. total staffing hrs. 3.5 vs. 4.17
• Increase cost of 3.3. Billion
• Staffing shortage
• Nurses and Certified Nurse Aids

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Residents

• NFs
• Av age 83
• ADL limitation1999 4.41985 3.8
• More complex medical problems
• Av. Length of stay 30 months

• ALs
• Av age 83
• ADL limitation
• low to moderate ADL levels
• Av. Length of stay 20.5 months

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What ALs and NFs are facing ?

• Increased level of resident frailty
• and dementia
• Declining occupancy
• Increased government oversight

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• Declining revenues
• Increased focus on consumer
• Increase focus on quality as a
• competitive edge
• Increased focus on dementia care
• Increased role of medical director

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Thank You