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HEALTHCARE
- April
2000 Feature Article by Richard Adkins
Multiple
Choice Assisted living facilities, the fastest growing form of housing of any kind in this nation, are emblematic of the constantly-evolving model of long-term healthcare that various providers across the state and nation are now offering to aging consumers in response to these new trends. As defined by the National Center for Assisted Living (NCAL), the assisted living voice of the American Health Care Association, these facilities provide a combination of housing, personal services, and limited health care designed to respond to individuals who need help with normal daily activities, while placing a premium on giving residents personal space and maintaining a sense of dignity and respect for the individual. "That’s the thing that was sorely missing in earlier long-term care models," says Whitney Redding, of the Assisted Living Federation of America (ALFA). "Some residences specialize in Alzheimer’s patients, some are in suburban areas and some are converted homes run by families. But what unites them all is the fact that they are residential, not institutional. They share the philosophy of care that emphasizes independence, privacy and dignity."
Defining the terms of long-term care Assisted living has emerged on the long-term care spectrum as a rapidly growing and innovative phenomenon. Originally a Scandinavian model of service for the elderly that began to develop in the United States in the mid-1980s, the niche is still struggling to define itself here. According to NCAL, as many as 29 different terms may be used interchangeably to describe assisted living, including residential care, sheltered care, and boarding homes. NCAL’s latest survey of the industry estimates there are roughly 28,000 assisted living facilities in the United States today, housing some 1.15 million residents. These numbers are consistent with data from a 1998 Health and Human Services Department report. Costs run the gamut and largely depend on the size of units, services provided and location of the facility. The NCAL report revealed that 49 percent of all assisted living facilities charge between $1,001 and $2,000 in average monthly rent and fees. About 26 percent charge between $2,001 and $3,000; seven percent charge more than $3,000 each month; and 18 percent charge less than $1,000. In the absence of federal regulations, most assisted living providers are subject to state and local laws. The NCAL survey found that 94 percent of assisted living residences were licensed by the states in which they operate. However, regulations among states vary greatly. As a result, competition among providers has become the catalyst for establishing levels of service, controlling costs, and maintaining a high quality of care.
Residents, not patients According to officials at the Kentucky Cabinet for Health Services, Division of Licensing and Regulation, Kentucky law does not currently mandate licensure or certification of assisted living residences. However, some facilities receiving state assistance are governed by certain guidelines and all facilities operating in the state may apply for voluntary certification through the Office of the Inspector General. A bill passed by the General Assembly calls for some form of state oversight and certification of these facilities, to be administered by the Office for the Aging. The Cabinet for Health Services defines assisted living residences as apartments or home-style residences that provide "assisted living to two or more non-family member adults." Medication administration is not permitted in assisted living facilities in Kentucky, but supervision of the self-administration of prescribed and non-prescribed medicines and treatments is allowed. "That’s the main difference between ‘assisted living’ and ‘personal care,’ which is confusing to most people," says Alan Beuscher, director of marketing for Wesley Methodist Village located in Wilmore. "With the addition of our new personal care center our residents will now have 24-hour access to licensed medical personnel on staff and in-house." "Residents are free to come and go as they please. Those who live in the personal care center are treated as residents, not patients," says VivEllen Chesser, director of nursing at the new center. "While there will be nurses there 24 hours a day, they are support staff only. Staff members are merely guests in the homes of residents." "We want people to make the most out of their lives no matter what age they are," Beuscher said. Beuscher says that one of Wesley’s main goals, like other assisted living retirement communities, is to provide a trouble-free independent living experience for their residents. A monthly service fee covers all utility bills, including trash collection and cable television. The only outside bill residents pay is for personal telephone use. The service fee also covers property taxes and property and household content insurance. "The idea here is that we try to make life simple for residents, to provide the advantages of owning a home without all the burdens and chores that come with maintaining a home," Beuscher said.
Options abound for diverse lifestyles Morningside Assisted Living Communities of Frankfort offers 42 private assisted living suites for senior adults. The company is owned and managed by LifeTrust America, Inc., headquartered in Nashville. They currently operate 45 residences in six states, including facilities in Bowling Green, Elizabethtown, Hopkinsville, Mayfield and Paducah. The company is constructing brand new communities in Henderson, Richmond and Pikeville. LifeTrust offers an approach to long-term care that puts a priority on partnering with families to care for and nurture older family members. Today, with adults having fewer children and their respective parents living longer, 30 percent of all working adults are caregivers to their parents and children at the same time, according to statistics cited by the company. Recently, Morningside was featured on Pat Summerall’s "Champions of Industry," an ongoing corporate recognition series airing on MSNBC since 1996. The company cited Morningside because of its innovative wellness program, Healthy Generation. "We call it ‘wellcare’ – taking care to keep you well," said Cheryl Harrod, executive director of Morningside of Frankfort. "Through this program, we focus on the five important areas of health – physical, emotional, spiritual, intellectual, and social." Healthy Generation teaches residents about a balanced lifestyle and equips them to take responsibility in each of the five areas. According to Harrod, what results is a culture where residents are learning new habits, trying new ideas, growing at their own pace, supporting each other, and reaching their full potential. The Christian Church Homes of Kentucky, Inc. serves more than 2,300 independent senior citizens and troubled children and their families in 35 homes and programs across the state of Kentucky, as they have done consistently since their formal establishment in 1884. "Active adults who enjoy a level of independence but still require some assistance with activities of daily living need alternatives to traditional nursing home care," said Lisa Griffin, director of communications and public relations for CCHK, Inc.. "The Homes has opened retirement communities that offer varying levels of care throughout the Commonwealth, with most of them being devoted to independent living." CCHK currently operates facilities in 14 cities and towns across Kentucky that offer a mix of independent living style high-rise apartments, garden homes, personal care facilities, and around-the-clock nursing care at personal (assistance with normal activities of daily living), intermediate (when health dictates that care can no longer be given in the home), and skilled care (follows a hospital stay of at least three days) levels. CCHK is opening a new garden home facility in Corbin that will offer 24 single-level apartment homes to seniors age 62 and over. The facility, dubbed "Friendship House II," will join the 49-apartment Chapel House, an independent living apartment building, and two other nursing home and independent living facilities operated by CCHK in the southeastern Kentucky town. Ellie Durham, a 101-year-old resident of the Chapel House, is a rather typical example of the personal space-craving sort who enjoys the independent living concept of care. In the year when "Mammie" Durham was born, William McKinley was President of the United States and horses out-numbered automobiles in the U.S. by a ratio of more than 10,000 to one. The Spanish-American War had just ended and the Civil War and Reconstruction were still fresh on the minds of many Americans. With the beginning of the new millennium, she is one of only a very small number of individuals who can lay claim to having lived their life across the time span of three different centuries. Durham’s son, Johnnie Durham, 65, also of Corbin and the second youngest of her nine children, visits her daily. He and his family help with her shopping and other affairs, but by and large Durham still does just fine, thank you very much. She cooks her own meals at least four days a week and walks up and down the hallways every day with the assistance of a walker. "She’s pretty independent, I’ll tell you that much," said Johnie Durham. "We talked her into moving over here (Chapel House) when she was 87, after I went over to her home one day and caught her up on top of the house tar-patching the roof. It nearly scared me and the other kids to death, but that’s just the way she is."
Richard Adkins is a staff writer for The Lane Report.
Sidebar: Care Categories Differ in Oversight, Cost
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ACCORDING
to the most recent estimates made by the U.S. Census Bureau, by the
end of the year 2000, the total population of Americans age 85 and over
will number 4.3 million persons; in 2010 it is realistically expected
to be more than 6 million. Americans live 15 years longer today than
they did only five decades ago. As Americans live longer, the business
of long-term healthcare and the many other health-related issues brought
on by the "graying" of the baby boomer generation are daunting
– and lucrative – indeed. Successful competitors in these
industries will be forced to address altogether new market-driven realities
that will become much more complex in nature, requiring innovation,
vision, and perhaps most importantly, a clearer understanding of the
consumer’s personal needs and desires. 
The
level of care required by assisted living residents is tough to pin
down. To give a rough idea: 26 percent need no help taking care of their
daily living activities. However, the average resident requires help
with about 1.7 daily living tasks, according to the NCAL report. The
average age of residents is 83 and nearly three quarters of them are
female.
Last
November, Wesley Methodist Village became the first retirement community
in the Bluegrass region to offer both individual patio homes along the
lines of the assisted living model and a new $3 million, two-story,
20-apartment personal care center licensed by the state.