The concept of “assisted living” as a unique program of care or service for elderly/minimally impaired persons has been slow, in the eyes of legislators and practitioners, to distinguish itself from other existing forms of services. The distinction becomes important for purposes of funding and financial assistance from state and federal entities. But more importantly, the distinction becomes important in the eyes of the residents and their families.
Assisted living is often described as a statement of philosophy which differentiates itself from other forms of “residential care” by focusing on a model of living that promotes independence, autonomy, privacy, and dignity for residents in a facility. In other words, the concept relates more to an approach toward care rather than to the actual care received. Moreover, families struggling with the less appealing option of placing their loved ones in traditional “nursing homes” are more soothed by the option of knowing that assisted living strives to maintain the current level of independence enjoyed by residents, but with supervision or support when needed.
In general, the term “assisted living” is used transitionally with that of “board and care” services. However, assisted living statutes and regulations usually contain language referring to “independence,” “autonomy,” “privacy,” etc. Assisted living is also different from other residential programs (e.g., homes for the aged, board and care facilities, residential care facilities, etc.) in that it is more likely to involve apartment-like settings and (if living space is to be shared) choice of apartment mates. Finally, assisted living facility staff will often make arrangements for external entities rather than internal staff members to provide nursing care or health related services to residents. This arrangement makes such services more likely to be reimbursable as “home health care services” under Medicaid or other funding initiatives.
But when assisted living residents need nursing care, the distinction between “assisted living” and other forms of residential care becomes more nebulous. In many states, assisted living facilities may admit or retain residents who meet “level of care” criteria used for admission to nursing facilities. At the same time, many nursing homes divide their beds into wards or designated areas, so as to accommodate varying levels of resident needs. They may have a skilled care area, an intermediate care area, and an “assisted living” area all within the same facility. Generally, such an arrangement is mutually beneficial to facility and patient. It keeps occupancy rates high at the facility and allows residents to move internally from one area of care to another without the need to move to another facility altogether.
Semantics aside, assisted living generally refers to a residential living arrangement in which residential amenities are combined with “as needed” assistance with “activities of daily living” (ADLs) (eating, dressing, bathing, ambulating, toileting, etc.) and personal care. Although only about half of all states actually use the term “assisted living” in their regulations or statutes, a vast majority of states have either reviewed existing legislation or enacted new laws to address the growing demand for assisted living facilities. This action occurred particularly during the years of 1995 through 2000.