assisted living; includes: rest home; domiciliary; retirement home; residential care facility; aged care facility

Introduction

Not covered by Medicare or Medicaid.

Not regulated by Centers for Medicare & Medicaid (CMS)

Also see nursing home.

Long-term care insurance may cover assisted living.

Comprises:

• housing
• personalized supportive services
• health care for residents needing assistance with activities of daily living (ADL)

Generally includes:*

• 24 hour supervision
• personal care
• social services
• medication management
• meals
• health promotion activities

* does not include nursing services (GRS9)

May include locked-door facilities for residents with dementia

• 1/3 of assisted-living residents have dementia

On admission:

• assessment of physical & psychosocial needs
• a service agreement is developed to coordinate delivery of services to each resident

Regulation differs from state to state.

Only some states require training & certification of staff.

Demographics:

• 80% of residents are women
• median age of women is 80 years of age
• median age of men is 82 years of age
• median annual income is $25,000
• median financial assets is $100,000
• 26% of residents are completely independent in ADL
• average need for 2 ADL
• 80% need of accept assistance with medications
• 45% are discharged to a nursing home*
• average length of stay is 3 years
• 25% of facilities have monthly rent of $1500-$2000
• 90% of assisted living is paid with private funds

* skilled nursing care & nursing care in general is not provided

• a nurse may be on staff & may oversee medications & monitor residents but does not provide nursing services
• nursing care in assisted living facilities may be provided by home health agency

Notes

• 43 items constituting expert consensus recommendations for medical & mental health care in assisted living, organized based on importance & grouped into 5 categories:
  • staff & staff training
  • nursing & related services
  • resident assessment & care planning
  • policies & practices
  • medical & mental health clinicians & care
• the item most recommended was in the domain of staff training: training on person-centered care
• the highest recommendations in the other domains were
  • provision of routine toenail care
  • resident present during assessment/care planning
  • has a policy/procedure regarding aggressive or other behaviors
  • all off-site medical or mental health visits include post-visit notes with findings
• alternative models of care vs usual care
  • may not affect emergency department visits
  • may reduce unplanned hospital admissions
  • may not improve health-related quality of life
  • probably no effect on mortality

Additional terms

• health care setting