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WHAT IS “ ASSISTED LIVING ” ?

“Assisted Living” is a term commonly used to describe a variety of community services provided to persons in need of assistance with activities of daily living on an intermittent or ongoing basis. Used by long term care business developers as a marketing term, “assisted living” has become popularized but otherwise has no legal definition or legal standing in federal or state regulations.

However assisted living is defined, it is offered in a variety of settings ranging from one’s own home to licensed facilities such as adult foster care or nursing homes.

Providers offer a range of services which may include the following, though many do not offer all of them:

• supervision and security medications management
• group activities meals
• some assistance in bathing some assistance in toileting
• some assistance in grooming on-call nurses
• housekeeping and laundry transportation
• some assistance in dressing initial evaluation

How Do I Find A Qualified Provider?

The development of assisted living services has been in haphazard response to demand. For that reason the consumer is left pretty much on his own. There is no federal law regarding assisted living and the State of Michigan does not require that these services be licensed. You can contact your local long term care ombudsman for advice.

Assisted Living is offered by private individuals, home health agencies, businesses and corporations, as well as licensed adult foster care homes, nursing homes, and homes for the aged. Workers may be registered nurses (seldom), licensed practical nurses, or what are called Nurses Aides, who are not licensed or certified — and not required to be trained at all in non-licensed assisted living settings.

Is Assisted Living Expensive?

Yes, according to your needs and means of course. Fees charged by providers, whether in facilities or in a person’s own home, rival and often exceed out-of-pocket expenses for nursing home care. This can average as much as $3,000 per month or more.

To make matters worse, few people realize there is little to no financial assistance available from the government or insurance to help pay for assisted living. So people face eviction from assisted living facilities when their money runs out.

However, there are other programs which offer assisted living type services at much lower rates, sometimes for no cost at all. These are available through local agencies on aging, the Family Independence Agency, and community action programs. At present, the most prominent of these is the home and community-based waiver program, sometimes called the Medicaid Waiver Program. The State of Michigan is currently expanding this program through its Department of Community Health State Office of Services to the Aging.

What Is Missing From Current Services?

Two highly important services seldom offered today in assisted living are rehabilitation programs and services coordination. The services listed on page one of this fact sheet are usually not coordinated in a plan of care which establishes goals for functional maintenance or improvement. Seldom does the initial evaluation include an in-depth appraisal of an individual’s life and medical history, or an assessment for the possibility of health and functioning improvement. Such an evaluation is referred to as a comprehensive assessment. Without a comprehensive assessment-based plan of care, persons in assisted living are at risk of preventable decline and premature need of nursing home care.

What If Problems Occur In Assisted Living?

If a person lives in an assisted living facility that is licensed as an adult foster care home, home for the aged, or nursing home, he or she may file a complaint with Michigan’s Department of Consumer and Industry Services which would then conduct an on-site investigation. These licensed homes are also inspected by the Department on a regular basis.

If, however, a person is living in their own home, apartment, or unlicensed facility, their recourses are probably limited by the admission contract provisions they signed with the assisted living provider. If such a provider proves unresponsive to the person’s needs and wishes, he or she may find that the only solution is to take their business elsewhere — or pursue legal action against the provider, or both.

For Further Information:

Contact your local long-term care ombudsman or Area Agency on Aging for help in determining whether an assisted living home is licensed or not, for suggestions on dealing with any problems there and to find out more on alternatives such as the Medicaid Waiver Program. See attached checklist for guidance on shopping for assisted living.

(March 1999)

CHECKLIST FOR ASSISTED LIVING

When Shopping among assisted living providers, be sure to ask about the following:

Services & Fees

• What are the prices for each individual service? (Get them listed.)
• When and how are rates increased? (Ask for a 5 year history of rate increases.)
• Does the provider perform an initial evaluation or a comprehensive assessment?
• At what specific level of need or scenarios will services be terminated?
• Does the provider perform ongoing care planning, service coordination and ongoing evaluation?
  

Environment & Building Safety (facility-based assisted living only)

• Is the building clean and free of unpleasant odors?
• Is the building fitted with an emergency fire sprinkling system?
• Is there a back-up generator in case of power outages (would interior stairwells be lit)?
• Especially for multi-level complexes, are disaster drills & evacuations performed?
• Are security alarms at all exterior doorways and interior stairwells for potential dementia wanderers?
• Do individual staff know what to do in case of fire or other emergencies? (Ask them.)
• Does the building, fixtures and furnishings appear to be in good condition?
  

Staffing & Training

• What specific staff provide and/or perform actual care services?
• Who employs them (who pays them)? A home health agency? The facility?
• What initial training have the direct care staff received? Do they also received ongoing training?
• Who supervises direct care staff? What is the current ratio of supervisors to staff?
• (Ask for the “normal” ratio.)
• Are nurses involved in any aspect of direct care or supervision? At what junctures?
• Are nurses assistants (“aides”) competency evaluated by the state?
• Are activities staff employed and what credentials might they have?
• If kitchen staff are employed, how are they selected and is a registered dietician involved?
• Does the assisted living employer or facility perform criminal background checks on all employees?
  

Quality of Life

• Does the assisted living provider have in place a plan for continuous quality improvement and/or a “vision” plan for excellence? (Ask for examples of the owner’s latest activities or upcoming activities in this area.)
• Ask to talk with current customers of the given assisted living services/facility: are they satisfied with care and services? Do their needs and concerns get promptly addressed? How are the meals? Do all staff treat them courteously? (Does the assisted living provider prevent you from contacting existing customers or withhold other information? Are you allowed to meet with customers in private? Are existing customers pre-selected for you by the provider?)
• Ask for examples of ongoing community involvement with the given assisted living staff and services. (Ask for future plans in this area.)
  

How are visitors accommodated?

• Is transportation among the available services? Are customers involved in “outside” community activities and events by the assisted living provider?
• How does the assisted living provider involve existing customers and their families in program design, evaluation, management and policy development?
  

Consumer Rights & Protection

• Does the assisted living provider/facility hold a license issued by the state? What kind of license is it? (Michigan issues licenses to such facilities only as “adult foster care”, a “home for the aged” or a “nursing home”. Home health agencies themselves are not licensed in Michigan.)
  
  
• If the assisted living provider/facility is not licensed, what policies on customer rights does it have of its own? (Ask for a list of such rights.)
  
  
• If the assisted living provider/facility is not licensed, does it have an internal complaint or grievance procedure?
  
  
• How do customers appeal terminations or reductions in services? How do customers appeal decisions on grievances?
  
  
• What policies and procedures does the provider/facility have in place to prevent abuse, neglect or exploitation of vulnerable customers?
  
  
• Does the provider/facility assume full responsibility for the conduct and actions of its employees?
  
  
• What ongoing efforts does the assisted living operator make to inform its customers of their rights and choices? (Ask for latest examples and future plans in this area.)
  
  
• Does the assisted living operator provide specific information on independent advocacy organizations and allow its customers to have access to such services? (Ask if these advocacy organizations are allowed to meet privately with existing customers.)
  
  
• Does the assisted living provider/facility carry a surety bond to cover any customer deposits and/or provider held trust accounts?
  
  
• Does the home post its state inspection reports and/or make them available to you? (Remember, a non-licensed home has no state inspections.)
  

CITIZENS FOR BETTER CARE’S mission is to provide information and advocacy to enhance the self-determination and well- being of long term care consumers. CBC receives funding through contributions and from: The Michigan Office of Services to the Aging; Kent County Social Services Board; City of Grand Rapids; United Way of Michigan and various local United Ways; the Grand Rapids Foundation; and Area Agencies on Aging (Regions — Detroit-1A, 1B, The Senior Alliance-1C, II, IV, Valley-V, Tri-County-VI, VII, Western Michigan-VIII, X, Upper Peninsula XI and XIV) with support from the Older Americans’ Act and the Older Michiganians’ Act.

(March, 1999)