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Assisted Living and Adult Care Facilities

Assisted Living and Adult Care Facilities (ACFs) serve individuals who cannot or do not want to remain at home, and do not need continuous nursing care as would be provided in a nursing home. These facilities provide assistance, while emphasizing the resident’s autonomy and independence. It is not surprising that these options have become so popular since they offer “home-like” settings and can be less expensive than some alternatives. In addition to providing long term residential services, many assisted living facilities also allow short-term stays to give family caregivers a break, called “respite” care.

There are several categories of licensure within the umbrella terms of ACF and assisted living, and they all provide a similar package of services. Some have additional licensure or certification to provide specialized services or accept Medicaid. All are licensed and overseen by the New York State Department of Health (DOH).

Two types of ACFs that typically serve seniors are adult homes and enriched housing programs. Both provide assistance with activities of daily living, assistance with medication administration, monitoring, supervision, case management, activities, and housekeeping. The most significant difference is that enriched housing is more of an apartment model, with a kitchen. An adult home does not have a kitchen. Technically, the adult home has higher staffing requirements and must provide three meals a day, but the enriched housing model has evolved so that most operate much like adult homes, with the layout of the living space being the most significant difference. Either model may have shared or private rooms.

Services Available in All Adult Care Facilities

• Nutritious meals;

• Hospitality services including housekeeping, laundry and sometimes transportation;

• Case management;

• Monitoring and supervision;

• Activities and recreational opportunities;

• Personal care services, including help with grooming, dressing and bathing; and

• Medication assistance and supervision.

Some ACFs may have additional licensure, which is where the term “assisted living” comes in. There are two categories of licensure for assisted living in New York State – the Assisted Living Residence (ALR) and the Assisted Living Program (ALP). This additional licensure enables ACFs to build upon their existing services and provide specialized services, discussed below.

Assisted Living Residences

ALRs provide the same package of services that an ACF does, but are also held to some additional requirements. All ALRs have a specific individualized service plan for each resident and specific consumer disclosure statements about what services they offer and what these services cost. ALRs also have a specific medical evaluation form which must be completed by a physician prior to admission.

Some ALRs are also approved by DOH to provide specialized services for people with Alzheimer’s disease or other cognitive impairments, and these are called Special Needs Assisted Living Residences (SNALRs). These facilities have specialized programming, services, staffing and environment designed for people with these special needs. It should be noted that people with dementia or Alzheimer’s disease can live in “basic” Assisted Living or even an ACF. SNALRs are for those who need a specialized environment to ensure their needs are met.

With additional certification, ALRs can provide or arrange for nursing care and other additional services in the facility as a resident’s needs increase, also known as “aging in place”. These added services can include things like getting help with walking up and down stairs, assistance with transferring, help with other activities of daily living and nursing services. ALRs approved by DOH to provide these services are called Enhanced Assisted Living Residences (EALRs). Most people who need 24-hour nursing or medical care will need a higher level of care, however. It is important to note that EALRs may designate some or all of their beds as enhanced. In addition, these facilities can determine what types of “enhanced” services they will provide, or what resident needs they will be able to meet. This is spelled out in the admission agreement, and the facility should be able to describe their services to an interested consumer.

Both Special Needs and Enhanced ALRs must meet specific safety and staffing requirements to become licensed, and must also provide the basic services outlined below under “Services Available in All Assisted Living Residences.” ALRs can be certified to provide special needs and/or enhanced services, or simply provide “basic” ALR services.

Assisted Living Program

The Assisted Living Program (ALP) is the only assisted living option in the state that can accept Medicaid as payment. That being said, ALPs also accept individuals who can pay out of their own funds.

The ALP allows a person living in an ACF to remain in that setting even if the person becomes more frail and needs extra medical or personal care services. Combining the services of an ACF and a home care agency, the ALP is similar to the Enhanced Assisted Living Residence, as it too is an “aging in place” model.

Payment for ACFs and Assisted Living

Medicare does not cover assisted living or adult care facility services. Currently, there are limited options for low-income individuals. In New York, only the Assisted Living Program (ALP) is covered by Medicaid. Some facilities accept Supplemental Security Income (SSI), but these facilities are dwindling in number since the SSI payment is well below what it actually costs a facility to care for residents. Some veterans or spouses of veterans may be eligible for certain benefits which can assist in paying for ACF or assisted living services. In addition, some long term care insurance policies will cover assisted living. These options should certainly be explored, though circumstances and policies will differ. Most often, residents and their families pay for assisted living out of their own funds. Facilities have different ways of charging for services, and any ACF or assisted living facility should be able to explain the system and what exactly it covers.

At present, Medicaid managed care does not cover assisted living services, but this will change as time goes on. Managed care may cover services provided to participants residing in assisted living or ACFs, such as home care. When this arrangement occurs, the facility will coordinate services with the managed care plan.

Questions

When deciding on assisted living or ACF for services, consider asking the following questions:

• Is assisted living or an adult care facility appropriate, based on an assessment of the person’s physical, financial, mental and lifestyle needs? If needed, professional help is available to assist with this process. Ask your health care provider for information.

• What are the criteria for admission to the facility you are considering? How is the need for services determined?

• What services are included in the basic plan and what services are available for an additional fee?

• What is the dining environment like?

• What religious/spiritual programs are offered?

• Does the administrator seem to know the residents and interact with them?

• Are the staff friendly and professional?

• There are several different types of assisted living. If you have specialized needs, ask how the facility will make sure your needs are addressed.

• Can this facility meet your anticipated future needs? If you have a degenerative disease, for example, will you be able to stay or move on to another setting?

• What happens if you deplete your resources? Will you have to move to another facility?

• If you have long term care insurance, Medicaid, SSI and/or Veteran’s benefits, does the facility accept them for payment?

• What sort of relationships does the facility have with nursing homes, hospitals and home care agencies, should the resident need more or different care?

• Under what circumstances could a resident have to leave the facility?