ASSISTED LIVING PRESENTATION

Note: this presentation is from 2001. While most of the content is still accurate statistics and prices have changed. Additional updates noted. On March 3, 2001 the CRC sponsored a presentation titled, "What is Assisted Living" by Emily Meyer of MassALFA (Massachusetts Assisted Living Facilities Association).

Emily Meyer began her presentation by explaining the definition of assisted living and the core services it provides. Assisted living is a unique combination of housing and supportive care, designed to allow frail elders to age in a home-like setting with dignity. There are about 154 certified facilities in Massachusetts, a total of approximately 9200 units, up from 45 facilities in 1995. Another 18 are under development in 2001-2002. A number of services are provided to elders who reside in assisted living residences, including assistance with ADLs (Activities of Daily Living, such as eating, bathing, dressing, and medication management) by direct care workers, opportunities for socialization through formal and informal activities programs, and 24 hour emergency coverage. Each assisted living residence must be certified by the Executive Office of Elder Affairs (EOEA) and must update this certification every two years. The EOEA requires that each facility offer at least one meal a day (most offer three) which are generally provided in a communal dining setting. All units have at minimum, either a kitchenette or access to cooking capacity for all living areas. Programs must provide emergency response systems for each resident whose service plan requires or other means of signaling staff. They are also required to develop an individual resident service plan on move-in and update it every 6 months.

Assisted living residences in Massachusetts encompass a variety of models, and can be located in an apartment-like setting, a Victorian home, or on campus-like settings. All utilize their space differently. Some offer a large amount of common space while others offer more room in an individual's apartment, some offer a large community dining room while others have smaller family style dining rooms on separate floors. Most residences have other amenities on-site including beauty parlors, and banks and an increasing number may offer computer access. Assisted living residences view themselves as a community resource, and can have day care facilities on campus, host community programs and encourage involvement of family and friends. Many offer specialized services such as respite care and a growing number have designated units that focus on caring for residents with Alzheimer's and Dementia. There are currently about 69 facilities with 1650 units that offer this type of specialty care.

Most of the residents of assisted living are women, often widows, who are in their 80s. This average age is rising. There are some couples who reside together. Currently many of the assisted living residences are in eastern Massachusetts, though growth has expanded outside of the 495 belt in the central, western and southern parts of the state.

Assisted living is a residential model with personal care services. Assisted living residences do not provide the skilled medical care of a nursing home. The assisted living philosophy is based on resident choice and maximizing a resident's independence and dignity. For instance, a resident may choose not to participate in certain activities, or cook their own meals rather than dine communally. The role of the nurse is very different in assisted living. The nurse acts as wellness coordinator and resident care director. The nurse does not perform skilled medical services as nurses do in nursing homes. Assisted living facilities provide Self-Administered Medication Management (SAMM) services for residents who need assistance with medication management services. SAMM requires that the resident self-administer his/her medications while the staff assist the resident with reminding, observing and documenting the medication process. The resident and his/her doctor decide whether or not SAMM is appropriate for them as part of the decision of what services will be provided in assisted living. Since nurses cannot give injectables in assisted living residences, residents, especially diabetics, can be assisted in taking this type of medication by their family members and/or visiting nurses.

Assisted living is primarily a private pay service, the average price is $3,000/month for a studio apartment which can include the cost of meals, personal care services, electricity. Some residences require an additional "Community fee" and some require security deposits and/or the last month's rent in advance. Mass-ALFA recognizes that it is important and challenging to help elders and families understand the services that assisted living provides and has educational materials in a Resource Guide that is free to the public. Mass-ALFA also has information available on affordability in assisted living and programs that are available to assist elders in accessing services. The average length of stay is 24-28 months, so families need to plan on based on income and assets with this in mind, realizing that some could stay significantly longer. Mass-ALFA has developed a checklist that helps elders and their families understand all of the services offered and fees. This document helps elders to ask the right questions and better shop for a residence that meets their individual service needs. This checklist and a guide to all assisted living facilities in Massachusetts can be found on their website, www.massalfa.org, or from the CRC.

QUESTIONS AND ANSWERS:

What help is available for elders who have trouble paying privately?
Most elders are using their income and assets (generally proceeds from the sale of their home) or family assistance to pay. Low-income elders who are eligible for SSI and Medicaid can access the Group Adult Foster Care (GAFC) benefit and SSI-G for those facilities that participate in these programs (see www.massalfa.org, or see ALF Subsidies section of our website, or MGH Community News, June 1999). Check availability of openings as they may be scarce in some areas. There are some new models of providing this level of care in creative ways as well. EOEA has recently been providing assisted living-type services in subsidized elder housing facilities. HUD is also developing an assisted living conversion program which gives funds to convert HUD housing into assisted living services.

Addressing the affordability challenge:
The following is a list of additional ways in which residences lower the cost of assisted living:

• Some residences are utilizing tax-credits and other public and private sources to lower costs in developing residences (i.e., Elder Choice - where the residence receives financing in return for 20% of units for low-income elders)
• Some residences are experimenting with offering less communal space and/or smaller apartments to decrease overhead costs and then passing on the savings as lower rent
• Some utilize the universal worker. The universal worker is a staff member who performs multiple functions including personal care and or food service or other activities. This model also attempts to address the current tight employment market by increasing the job satisfaction, and therefore retention, of workers.
• Some communities/towns are realizing the importance to elders of remaining in their own communities and are cooperatively working with assisted living developers or companies to provide land or buildings that can be used for assisted living.
• As mentioned before, good communication up front about what the assisted living package includes can help potential residents make the best decision possible about what is affordable for them.

What is the average wait for units?
It is important for an elder and their family to take the time to find the appropriate assisted living residence for that elder. Spaces are available, but may depend on geography and the type of services the elder is seeking. It can be helpful if the prospective resident is flexible about geographical location. Expect waiting lists for GAFC/SSI-G units and affordable units. Mass-ALFA does not track waiting lists at this time.

Are there any regulations specific to Special Care Residences (memory care units)?
While many/most facilities advertise Special Care Residences, there had been little to no regulation of the use of the term and requirements of the services offered in these units. Regulations that went into effect July 1, 2015 now require Special Care Residences to provide structured activities for memory impaired residents (at least 3 times in each 24 hours, 7 days a week), address the residents' physical safety needs, and new residences (after October 1, 2015) must provide a secure outdoor space for their residents. Emily Meyer in her presentation said that on average, the staff has dementia care training above and beyond what is required for PCAs. Emily Meyer suggests that those considering such a program should look at a variety of programs to compare and select the residence that is most appropriate for the elder.

-This answer updated 8/15

3/01 (rev 8/15)