Appendix I. Assisted Living

What is Assisted Living?

There is no formal definition. Assisted living is a concept of providing alternatives to premature institutionalization (i.e. nursing home/institutional care). Fundamentally, assisted living exists in the continuum of long-term care to assist the frail elderly in varying degrees of acuteness with Activities of Daily Living (ADLs).

One definition: any group or residential program other than a licensed nursing home that provides personal care for persons with impairments in performance of ADLs and has the capacity to meet unscheduled needs for assistance.

Assisted living facilities have many names: residential care, adult congregate living, personal care, catered living, group home for adults, community residences, board and care homes, semi-dependent, continuing care retirement communities.

Assisted Living in Texas

Assisted living facility in Texas

Assisted living homes are licensed as ìPersonal Care Facilitiesî by the Texas Department of Human Services. A home with four or fewer residents does not require a license; a home with more than four residents requires a license. Currently, there are 830 licensed personal care facilities in Texas and 4,000 unlicensed facilities. Fifty-one percent of those have 16 beds or less; of that number sixty-one percent have 8 beds or less. So far, most small assisted living facilities in Texas are still "mom-and-pop" operations.

Assisted living facility in Texas

Key Features

• Congregrate housing (private/shared room or apartment in group setting)
• Supportive services (hotel services and personal care) responding to individual needs with respect to types and amounts of services.

Who Should Consider Assisted Living?

It depends on care needs. Assisted living can be an alternative for you if you:

• are no longer able to manage at home on your own; or
• are not able to get enough help from family members and others to remain at home safely; or
• are anticipating decline rather than improvement or stability in your physical capacity or health status; and/or
• are kept away from friends and favorite activities by poor health or disability.

For Whom Is Assisted Living Not Appropriate?

If you require skilled or 24-hour nursing care (i.e. involving invasive procedures), assisted living options are not for you. Assisted living is no longer appropriate when you are no longer able to understand emergency instructions or cannot self-evacuate.

How Is Assisted Living Different from Nursing Homes?

There are two compelling criteria in Personal Care homes that distinguish them from nursing home/institutional care: 1) the resident must have the ability to understand emergency instructions; and 2) the resident must be capable of self-evacuating. Within Personal Care homes there are two types: A and B homes.
Table I.1
Personal Care Homes

A Home

• resident must be capable of evacuating unassisted (includes people in wheelchairs who can transfer themselves and evacuate in an emergency);
• resident must be capable of following directions for self-preservation under emergency conditions;

AND

• resident does not require usual and routine attendance during nighttime sleeping hours.

B Home

• resident is incapacitated to the extent that she or he needs assistance to evacuate;
• resident is incapable of following directions for self-preservation under emergency conditions;
• resident requires routine supervision during nighttime sleeping hours (an attendant must be awake and on call for assistance);
• resident may not be bedfast but may be chairfast needing assistance with transferring upon arising and retiring; but once into chair is able to move independently;

OR

• resident has needs when self-care is provided an appropriate caregiver or when care is provided by contract with professional personnel to the individual resident.

Source: Texas Department of Human Services Licensing Standards for Personal Care Facilities

Cost

The mean monthly charge in Austin for a private room is $1,500, but in many assisted living facilities, there are fees for services, so it can cost more. Average private pay would be $2,400.

Compared to Nursing Homes: In general, assisted living rates can be 1/3 to 1/2 of the rates of nursing homes, with the cost of nursing homes ranging from $3,000 to $4,000 monthly.

ëDid You Know...?í Some Texas Facts

• Texas is one of the first two states to allow Medicaid funds to be used for assisted living through its Community-Based Alternatives (CBA) program.
• The Texas Community-Based Alternatives program is funding up to 22,000 residents in a range of assisted living facilities at a rate of $20-$40 per day.
• Nationwide, about 90% of assisted living services are paid for with private funds.
• Texas is one of the top five states with new assisted living construction.

Where do I find more information about licensed facilities?

Texas Department of Human Services

Directory of Personal Care Facilities

Texas Association of Residential Care Homes

Mat Mathews, President

512/276-7000

Where do I find more general information about long-term care options and other community-based care (if assisted living is not for me)?

Texas Department on Aging, Area Agency on Aging

For the phone number of your nearest Area Agency on Aging, call 1-800-252-9240.

National Association of Area Agencies on Aging Eldercare Locator

(1 800) 677-1116

Tips on Finding the Right Assisted Living Facility

Remember that assisted living facilities vary greatly in type, cost, services and assistance provided because they are not uniformly regulated (yet).

Questions to Ask and Issues to Consider:

1. Lifestyle
   • What kind of environment does a facility have?
     Is it attractive and comfortable?
   • Does it provide a balance of privacy and safety?
   • Is there flexibility for individual preferences regarding meal times and places, bedtimes, transportation, etc.?
   • Does the staff seem to respect residents?
2. Health and Personal Care
   • Is there a clear service contract about resident's eligibility if care needs increase? Make sure you are clear about what arrangements will need to be made if the resident declines in physical or cognitive abilities.
   • In the context of licensing and the provider's operational capacities, how frail may a resident become and remain in that setting?
   • What medical help is available?
   • What is the nature of staff training, and the resident/staff ratio?
   • Is there help for staying healthy? Do activities and meals support healthful living?
   • Can you keep your current health providers?
3. Affordability
   • If you do not like contract provisions, can you modify them?
   • What is the cost?
   • What services are provided?
   • Are different plans or service arrangements offered?
4. Other considerations
   • Make sure you understand the license or status of the facility.
   • If you do not like contract provisions, ask if you can modify them.
   • Gauge a setting's "personality" for a good fit. Consider what you see, hear, smell and feel.

References

"Advice for the Elderly." 1997. Austin American-Statesman (March 9).

"Can Your Loved One Avoid a Nursing Home?" 1995. Consumer Reports, Vol. 60 No. 10 (October).

"Elderly get an alternative to nursing homes; Assisted-Living facilities come to Austin offering housing services, independence." 1995. Austin American-Statesman (November 24).

Equitable Foundation and Children of Aging Parents. 1995. ìAging Parents and Common Sense: A Practical Guide for You and Your Parents.î (December.)

Gordon, Kierstan. 1996. ìAssisted living: A New Paradigm for Long-term Care or a Risky Dumping Ground.î University of Texas at Austin. (December 6.) (Final paper.)

Kane, Rosalie A., and Keren Brown Wilson. 1993. ìAssisted Living in the United States: A New Paradigm for Residential Care for Frail and Older Persons?î Washington, D.C. American Association of Retired Persons Public Policy Institute.

Mathews, Mat. 1996. President, Texas Organization of Residential Care Homes, Austin, Tx. Interview, February 21.

McCollough, Laurence P., and Nancy L. Wilson. 1995. Long-Term Care Decisions: Ethical and Conceptual Dimensions. Baltimore: The John Hopkins University Press.

(no title or byline) 1996. Florida Times-Union (December 9).

Pynoos, Jon, and Stephen Golant. 1996. ìHousing and Living Arrangements for the Elderly.î In Handbook of Aging and the Social Sciences. Edited by Robert H. Binstock and Linda K. George. San Diego: Academic Press, Inc.

Texas Comptroller of Public Accounts. 1996. Fiscal Notes. (November.)

Texas Department of Human Services. 1995. Licensing Standards for Personal Care Facilities. Austin, Tex.

"What's New with Assisted Living for the Elderly?" 1996. Parent Care Advisor, Vol. 4 No. 6 (April).

Yee, Donna L., John A. Capitman, Mark Sciegaj and Walter Leutz. 1996. ìResident Centered Care in Assisted Living Programs and Residents.î Waltham, Ma.: Institute for Health Policy, The Commonwealth Fund. (May 25.)

Yee, Donna L., John A. Capitman, Mark Sciegaj, Walter Leutz, Jeffrey Prottas. 1996. ìA Consumer's Guide: Finding the Assisted Living Program for You.î Waltham, Ma.: Institute for Health Policy, The Commonwealth Fund. (March). (Draft.)