HHS Logo: bird/faces U.S. Department of Health and Human Services

State Assisted Living Policy: 1998

Robert L. Mollica, Ed.D.

National Academy for State Health Policy

June 1998

This report was prepared under contracts #HHS-100-94-0024 and #HHS-100-98-0013 between the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Disability, Aging, and Long-Term Care Policy (ASPE) and Research Triangle Institute. In addition to ASPE, other support for the study, A National Study of Assisted Living for the Frail Elderly, has been provided by the American Association of Retired Persons, the Alzheimer's Association and the National Institute on Aging. For additional information about the study, you may visit the DHHS home page at http://aspe.os.dhhs.gov or contact the ASPE Project Officer, Pamela Doty, at DHHS/ASPE/DALTCP, H.H. Humphrey Building, Room 424E, 200 Independence Avenue, SW, Washington, DC 20201. Her e-mail address is: Pamela.Doty@hhs.gov.

PREFACE

Project Overview

Assisted living facilities are a rapidly expanding source of supportive housing with services. In the view of many, such facilities represent a promising new model of long-term care, one that blurs the sharp distinction between nursing homes and community-based long-term care and reduces the chasm between long-term care in one's own home and in an institution. In this model, consumer control and choice are central to the philosophy of "assisted living." Indeed, the ability of consumers to control both key features of the environment and to direct services, under a "negotiated" or "managed risk" model, and to receive care and supervision in a "home-like" setting are considered hallmarks of the philosophy of assisted living. Further, assisted living, at least conceptually, is distinguished by a flexible service arrangement, in which there is no set "package" of services but facilities provide services to meet scheduled and unscheduled needs of residents, allowing residents to "age-in-place."

Despite the growing interest in and expansion of places calling themselves assisted living facilities, relatively little is known about their actual role and performance and the degree to which they represent a viable option for frail and disabled elders. Indeed, there is not even agreement or information on the number of such facilities currently in operation. As a result, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) of the U.S. Department of Health and Human Services is undertaking a national study of the role of assisted living. ASPE entered into a contract for a comprehensive study to be conducted by Research Triangle Institute (RTI), the Myers Research Institute, as well as its collaborators, Lewin, Inc., the University of Minnesota Long-Term Care Resources Center, and the National Academy for State Health Policy.

Purpose of the Study

The intent of the National Study of Assisted Living for the Frail Elderly is to determine where "assisted living" fits in the continuum of long term care and to examine its potential for meeting the needs of a growing population of elderly persons with disabilities. Within this broad objective, the study will address several specific goals, including:

To identify trends in demand for and supply of assisted living facilities;
To identify barriers to the development of assisted living and supply-demand factors that contribute to those barriers.

In addition, the study has further descriptive and "evaluative" goals:

To determine the extent to which the current supply matches the central philosophical and environmental tenets embodied in the concept of "assisted living" and to describe the key characteristics of the universe of assisted living facilities; and
To examine the effect of key features, particularly source, mix and privacy, on selected outcomes, including resident satisfaction, autonomy, affordability, and the potential to provide nursing-home level of care.

Overview of the Study Design

ASPE's approach to this study includes the following activities:

We will select and interview a purposive sample of lenders, developers and multi-facility owners.
We are conducting annual surveys of all state licensing agencies involved in assisted living, as well as of Medicaid agencies that provide funding for assisted living.
The study will draw a national probability sample of facilities. This will allow us to generalize our findings and make valid estimates about the status of assisted living facilities across the nation.
Using this sample, the study will describe the key characteristics of places holding themselves out to be "assisted living" facilities, based on a telephone survey of about 2,500 facilities.
We will also conduct a more in-depth telephone survey of about 200 facilities. In addition, we will select a sample of about 450 facilities that will be visited, with in-person interviews with administrators, staff and residents.
We also plan to interview families of residents with cognitive impairment and to conduct follow-up interviews at six months with residents who have been discharged or otherwise exited the facility.

Acknowledgment

The author thanks the many people in state agencies throughout the country who completed surveys and provided copies of statutes, regulations and reports needed to conduct this study. We also appreciate their willingness to review draft summaries of the material related to their state. This project is possible because of the support of dedicated professionals in state agencies who are willing to share their time and knowledge in this endeavor. We hope the information is helpful to states as policies on assisted living continue to emerge and develop over time.

SECTION I (separate file)

Executive Summary