Costs, Staffing, and Services of Assisted Living in the United States

Abstract

Assisted-living facilities (ALFs), which provide a community for residents who require assistance throughout their day, are an important part of the long-term-care system in the United States. The costs of ALFs are paid either out of pocket, by Medicaid, or by long-term-care insurance. Monthly costs of ALFs have increased over the past 5 years on an average of 4.1%. The purpose of this research was to examine the future trends in ALFs in the United States to determine the impact of health care on costs. The methodology for this study was a literature review, and a total of 32 sources were referenced. Trends in monthly costs of ALFs have increased from 2004 to 2014. Within the past 5 years, there has been an increase on average of 4.1% in assisted-living costs. Medicaid is one payer for residents of ALFs, whereas another alternative is the use of long-term-care insurance. Unfortunately, Medicare does not pay for ALFs. Staffing concerns in ALFs are limited because of each state having different rules and regulations. Turnover and retention rates of nurses in ALFs are suggested to be high, whereas vacancy rate for nurses is suggested to be lower. The baby-boomer generation can be one contribution to the increase in costs. Over the years, there has been an increase in Alzheimer disease, which has had also an effect on cost in ALFs.

Program of All-Inclusive Care for the Elderly (PACE)

“…Although AL provides residential care to 1 million people in the US, little is known about its use for short-term, non-residential purposes [8][9][10]. In years past, there was little regulatory oversight of AL care (compared to heavily regulated nursing homes) [11,12].…”

Staffing and Service Availability in Assisted Living: The Importance of Nurse Delegation Policies

“…RC/AL was originally designed simply to provide housing for older adults, but rising resident acuity (e.g., functional decline, dementia) and growing health service needs has led to expansion of services provided in RC/AL. Previous work suggests that factors such as size, profit status, chain affiliation, geographic location, and staffing influence the types of services available in RC/AL . Larger, more expensive RC/AL communities employ more nurses and provide more services than smaller communities (which do not have nurses on staff) .…”

“…Previous work suggests that factors such as size, profit status, chain affiliation, geographic location, and staffing influence the types of services available in RC/AL . Larger, more expensive RC/AL communities employ more nurses and provide more services than smaller communities (which do not have nurses on staff) . Smaller, less expensive communities might have shared rooms, and minority and low‐income people receiving public assistance are more likely to use them than individuals with more resources .…”

“…Smaller, less expensive communities might have shared rooms, and minority and low‐income people receiving public assistance are more likely to use them than individuals with more resources . Care practices also vary, ranging from basic services (e.g., vital sign monitoring, medication management) to highly skilled services more typically found in NHs (e.g., blood draws, tube feedings) . These differences result in variability in staffing.…”

“…Licensed practical nurses (LPNs) or licensed vocational nurses (LVNs) and registered nurses (RNs) are employed in 47% to 70% of RC/AL communities, and approximately 20% of states require some RN staffing . Ultimately, variation in service availability is confusing for older adults, families, and even geriatric clinicians . Thus, our study provides further information about RC/AL, including the types of services provided.…”