Introduction to Assisted Living and Senior Housing

Practice flashcards created from the lecture transcript covering assisted living facilities, operations, regulations, financing, staffing, and various senior housing arrangements.

Is assisted living classified as an institutional or non-institutional setting on the continuum of care?

It is technically classified on the institutional side of the continuum of care, although it prides itself on being a home-like setting.

What specific type of care is provided in assisted living to assist residents with Activities of Daily Living?

Personal care.

What level of staff oversight is maintained around the clock in assisted living facilities?

Twenty four hour supervision.

Does twenty four hour supervision in an assisted living facility imply twenty four hour nursing care?

No, staff is present around the clock, but it is not necessarily nursing staff.

How are assisted living facilities regulated compared to federal nursing home regulations?

Assisted living has no federal regulations or uniform standards across the country; regulation is left entirely up to individual states.

What does the abbreviation RCAL stand for in senior care resources and research?

Residential care / assisted living.

What does the abbreviation ALF stand for?

Assisted living facility.

How many residents typically live in a small community group home?

Usually less than $10$ residents, and often just $3$ to $5$ residents.

Who typically owns and provides daily care in small mom-and-pop group homes?

The owners who live in the home take care of the residents.

What specific population under age $65$ frequently resides in community group homes?

Younger adults with disabilities who cannot live independently.

What primary public program pays for individuals with disabilities to reside in group homes?

Medicaid.

What was the main reason for creating the assisted living industry?

It was created as an alternative to traditional nursing homes, blending a home-like environment with care for a person's sick needs.

What five key principles define the philosophy of care in assisted living?

Maximizing dignity, autonomy, independence, privacy, and choice.

What layout is standard for room accommodations in most assisted living facilities?

Mostly private rooms, which are often one- or two-bedroom apartment-style units featuring a kitchenette.

What term describes the goal of assisted living to accommodate a resident's changing needs so they can stay in the facility until end of life?

Aging in place.

How do assisted living facilities handle residents who develop increased functional limitations?

They offer tiered service plans and add-on services (such as laundry, showering, or ADL assistance) for an extra fee.

What local retirement community was cited as an example that includes nursing care, assisted living, and independent living?

VMRC.

What is the predominant ownership model of assisted living facilities?

Mostly for-profit, with slightly over half belonging to a chain.

Which large assisted living chain did the instructor mention collaborating with in past course semesters?

Brookdale.

Why is assisted living the fastest growing senior care provider for private equity and corporate investors?

Because there are no federal regulations, state regulations are loose, and facilities primarily rely on private pay rather than government reimbursement.

Does Medicare cover any assisted living care or room and board expenses?

No, Medicare does not cover assisted living under any circumstance.

What is the typical bed size for the majority of assisted living and residential care facilities nationwide?

Most are small facilities, reflecting group homes and small residential care operations.

What level of nurse is typically staffed during daytime hours in assisted living facilities that employ nursing oversight?

Licensed Practical Nurse (LPN) level rather than Registered Nurse (RN) level.

Who is permitted to administer medications to residents in most states instead of a licensed nurse?

A personal care attendant with a little extra training in medication administration.

What specialized unit in assisted living provides higher staffing and a locked environment for residents with dementia?

A memory care unit.

How do the ADL assistance needs of assisted living residents compare to nursing home residents?

Assisted living residents are less frail; while about half of nursing home residents require help with $4$ or more ADLs, assisted living residents need less ADL help.

What functional needs primarily lead older adults to move into assisted living?

Limitations in Instrumental Activities of Daily Living (IADLs), such as transportation, meal prep, cooking, and medication management.

What are the primary demographic characteristics of assisted living residents?

Advanced age and a high percentage of females.

Where do most residents live immediately prior to moving into an assisted living facility?

At home, either living independently or with a caregiver.

Where is an assisted living resident most likely to move if the facility can no longer meet their clinical needs?

To a nursing facility.

Why is a resident dying inside an assisted living facility viewed as a positive outcome for the facility?

It means the facility successfully fulfilled its aging in place philosophy by meeting the resident's needs until death.

In which decade did the assisted living industry originate?

The 1990s.

What factors have driven the recent push for increased state regulation of assisted living facilities?

An increasingly sicker/frailer resident population and reported horror stories involving facility negligence and adverse events.

What do critics argue would happen if assisted living facilities become overly regulated?

They argue facilities would turn into 'nursing homes 2.0' and lose the flexibility that allows for a home-like care philosophy.

What basic pricing structure is used by most assisted living facilities?

A set basic fee for core services (room, board, and dining) plus additional charges for tiered service plans.

What is the average monthly cost of assisted living according to the lecture?

A little over $6,000$ dollars per month (approximately $72,000$ dollars per year).

What is the primary payment source for assisted living services?

Private pay (out-of-pocket payment by individuals and families).

What mechanism allows state Medicaid programs to cover assisted living services?

Medicaid HCBS (Home and Community Based Services) waivers.

What senior care setting is required by the federal government to be covered by all state Medicaid programs?

Nursing homes.

How do Medicaid HCBS waivers function legally for state Medicaid programs?

They allow states to waive the federal mandate requiring Medicaid funds to go to nursing homes, enabling the money to pay for alternatives like assisted living.

Why are Medicaid waivers not a guaranteed payment source for eligible assisted living residents?

States limit waiver funding and slots, leading to long waitlists and variable availability.

What percentage of assisted living residents nationwide receive coverage through a Medicaid waiver?

Approximately $20\%$ (or one in five residents).

What types of assisted living facilities are most likely to accept Medicaid waiver payments?

Group homes and smaller, more basic residential care facilities.

How does the primary staffing focus in assisted living differ from that of nursing homes?

Assisted living staff focus on customer service, hospitality, and direct care for ADLs rather than multidisciplinary clinical care.

How does a personal care attendant (PCA) compare to a certified nursing assistant (CNA) in terms of requirements?

PCAs perform similar direct care tasks as CNAs, but their training and certification requirements are less regulated and less stringent.

How many states currently require assisted living administrators to be licensed?

16 states.

Does the state of Virginia require licensure for assisted living administrators?

Yes, Virginia requires assisted living administrators to hold a license.

How do assisted living administrator licensure requirements compare to nursing home administrator requirements?

Licensure criteria for assisted living administrators are generally less stringent than for licensed nursing home administrators.

Why is hospitality and customer satisfaction particularly critical for assisted living administrators?

Because the market is primarily private pay and highly competitive, allowing consumers to choose other facilities if unsatisfied.

Why do some healthcare corporations choose to operate both nursing homes and assisted living facilities?

To achieve integration and keep residents within their system when resident care needs increase from assisted living to nursing home care.

How is senior housing broadly defined in the lecture?

A variety of housing options for older adults who do not require institutional care but choose not to or cannot remain in traditional homes.

What design concept is incorporated into senior housing to promote independence with features like single-level layouts and bathroom handrails?

Universal design principles.

What is a common marketing term for age-restricted housing communities?

Active adult community.

What age thresholds typically restrict residency in active adult communities?

55 and over, or 62 and over.

What amount of health or personal care services do age-restricted active adult communities typically provide?

They provide the least amount of services, focusing primarily on retirement lifestyle, amenities, and activities.

What type of age-restricted senior housing program receives government funding to assist low-income seniors with rental costs?

Subsidized housing programs.

Who developed the original Sun City age-restricted community in 1960?

Del Webb.

What two famous hotel properties did Del Webb build before creating Sun City?

The Beverly Hilton Hotel in Beverly Hills and the Flamingo in Las Vegas.

On what exact date did Del Webb open the model homes for Sun City to the public?

January 1, 1960.

What was the base purchase price for the original $860$ square foot model home in Sun City?

$8,500$ dollars.

How much extra did buyers pay for refrigerated air conditioning in the original 1960 Sun City model home?

$600$ dollars.

How many people visited Sun City during its opening three-day weekend in 1960?

$100,000$ people.

How many total homes are in Sun City today?

Over $27,000$ homes.

What is the total resident population of Sun City mentioned in the lecture discussion?

Approximately $40,000$ people.

How many swimming pools and golf courses does Sun City feature?

Seven swimming pools and eight golf courses.

What major tax advantage was touted in early advertisements for Sun City?

Low taxes, because there were no public schools to fund.

What sport has become the fastest growing activity among retirees in Sun City, prompting updates to recreation facilities?

Pickleball.

How is pickleball described in the Sun City video clip?

A game played on a modified tennis court using paddles and a wiffle ball.

What famous large Florida retirement community was mentioned as a well-known example of an active adult community?

The Villages.

What unique family trend is occurring in Sun City as the community ages?

Grandchildren of original residents are retiring and moving into Sun City.

Universal design features in senior housing

Single-level layouts, absence of stairs, and bathroom handrails to support independence as residents age.

Federal mandate for state Medicaid coverage in long-term care

Nursing home care (unlike assisted living, which states may optionally cover via waivers).

Cognitive impairment profile in assisted living

A sizable percentage of residents have mild-stage dementia, requiring 24/7 supervision rather than intensive medical care.

Subsidized senior housing

Government-funded, rent-controlled age-restricted housing designed for low-income older adults.

Resident driving privileges in assisted living

Residents who are capable of driving are permitted to keep their personal vehicles and use facility parking.

Assisted living quality tracking trend

A recent industry movement toward establishing quality standards and systematically measuring health and satisfaction outcomes.

Legal function of Medicaid HCBS waivers

Waives the federal requirement to spend Medicaid long-term care dollars exclusively on nursing homes, allowing funding for alternatives like assisted living.

Managed care trends in assisted living

The growing use of Medicaid managed care programs to deliver and oversee assisted living services.

Home-like common area amenities in assisted living

Features such as fireplaces, couches, and pianos designed to avoid a sterile, clinical environment.

Primary difference in staffing focus between nursing homes and assisted living

Nursing homes focus on multidisciplinary clinical care, while assisted living focuses on hospitality, customer service, and ADL support.

Percentage of nursing home residents requiring assistance with four or more ADLs

Approximately $50\%$ of residents, compared to a much lower proportion in assisted living facilities.

Main regulatory reason why assisted living facilities vary widely in definition and operations across the United States

The total absence of federal regulations and uniform national standards, leaving oversight entirely to individual states.

Primary purpose of tiered service pricing structures in assisted living

To charge a standard base fee for core room and board while allowing residents to purchase additional help with specific ADLs as their functional needs increase.

Typical daytime nursing credential in assisted living facilities that offer medical oversight

Licensed Practical Nurse (LPN) rather than Registered Nurse (RN).

Primary market driver behind the increasing resident acuity levels in modern assisted living

Stricter nursing home admission criteria keep healthier seniors out of nursing facilities, resulting in frailer individuals entering assisted living instead.

Specific IADL limitations that most frequently prompt an older adult to move into assisted living

Inability to manage transportation, meal preparation, cooking, and complex medication regimens independently.

Key difference in training and credentials between a CNA and a PCA

CNAs must complete state-mandated training hours and pass a formal certification exam, whereas PCAs face fewer regulatory training hours and less stringent oversight.

Historical age milestone reached by the Sun City community in the featured video

$55$ years old, making the community itself old enough to legally qualify for residency under its own age restrictions.

Reason age-restricted active adult communities often feature lower municipal tax rates

They exclude public schools from within community borders, eliminating tax assessments for local public education.

Role of kitchenettes in assisted living apartment layouts

To encourage independence with simple snacks and meals without providing full stoves or ovens that could pose safety risks.