Care Categories Differ in Oversight, Cost

Some longstanding professionals in the industry have questions about the sudden proliferation of assisted living facilities. "A personal care licensee is visited annually by regulators, and assisted living has no such regulatory oversight," says Burke Stephens, executive director of Jefferson Place in Louisville.

"A lot of the public… equate personal care with nursing homes, but they’ll buy assisted living because of the way it’s marketed," says Louise Epperson of the Kentucky Association of Not-for-Profit Homes and Services for the Aging, whose membership covers the whole spectrum of care.

The Association recently called for an amendment to currently pending state legislation, asking for full licensure to be required rather than just certification, and for oversight to be conducted by the Division of Licensing and Regulation rather than the Office of Aging. While the legislation now awaits the governor’s signature, the amendment was not part of the final bill.

"Our reason was resident care and safety," says Epperson. "We know that Licensing and Regulation has been doing it for years in nursing homes, and they’re set up and ready to do it."

"Another issue I have is that the assisted living movement is all targeted toward the private pay individual," claims Stephens. "When people have spent their money, there aren’t enough licensed beds for people to go to. You have to think about the people who can’t afford all these amenities – we’re creating one standard for the haves, and another for the have-nots." Stephens adds that assisted living is not necessarily a package deal, with add-on costs mounting when entities like home health care are required.

"A lot of people move into assisted living hoping to avoid going to a nursing home," says Epperson. "In some cases they can, but if they run out of money, they’re probably going to be knocking on the door of a nursing home looking for a Medicaid bed."

Some traditional nursing home practitioners also balk at the "independence" marketing thrust of assisted living, countering that they offer individualized plans for their residents too, and afford them as much independence as their often-complicated conditions will allow.

"As a nurse, I’ve met very few people in their 80s who do not have multiple diagnoses: heart problems, high blood pressure, osteoporosis, stroke, dementia," says Stephens. "When you start putting that in the mix, you want to be in an environment where there is some clinical management. That’s what licensed nursing homes do."

In response to such a kaleidoscope of needs, many operations are finding that in elderly care, like any other sector of business, networking works. The new 98-unit, $6.5 million McDowell Place facility in Danville, operated by Ephraim McDowell Health, offers both assisted living and personal care levels at the same location, as well as sections for those with memory loss and other dementia. Residents receive assistance with many daily activities, including incontinence care and medication assistance.

A significant current thrust of American Retirement Corporation’s business plan is the development of free-standing independent living communities, such as the one the company operates at Richmond Place and Homewood Residences in Lexington. The company just opened a personal care community called Homewood, and it also operates The Arbors, which offers Alzheimer’s care. ARC calls these clustered arrangements Senior Living Networks, offering residents access to the more extensive services of the larger communities, while providing economies of scale for operations. ARC currently owns or provides services for 36 such communities in 15 states.

Epperson cites Sayre Christian Village in Lexington as another example of the new hybrid community.

"Over the years, I’ve become a real believer in this campus approach, having all levels of care on one property." she says. "It’s heartbreaking when one spouse gets sick, and one of the beds is not nearby. I think it’s terrible in old age to not be close to your spouse."

"One of the biggest things that would help most people is to buy long-term care insurance," Epperson adds. "If you have an estate over $50,000, you really should have it – it will pay for a nursing home, for home health, and in some cases for assisted living as well."

—Adam Bruns

Back to Healthcare Feature

Back to April Issue

Copyright 1996-98, by Kentucky Business Online, LLC.  All rights reserved.

Editorial content is copyright 1998, Lane Communications Group
All editorial materials is fully protected and must not be reproduced in any manner without prior permission. 

Buzzword and the Buzzword balloon are registered trademarks of Buzzword, Inc.  The Lane Report is a trademark of Lane Communications Group.  All other trademarks are the property of their respective owners.