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February 13, 2012

The History of Assisted Living (AL)
The Who, What, Where, When & Why of Assisted Living
Assisted Living History -- The Evolution of Assisted Living Facilities

Monica Trivedi

Below is a detailed overview of how assisted living facilities have evolved over the years, as well as some thoughts about the future of assisted living. This site is designed to be a helpful resource for any looking to learn more about what assisted living is, exactly, and the origins of this particular segment of elderly care.

What is Assisted Living?
Assisted Living is a type of elderly care that offers a level of attention and independence between those offered by nursing homes (which land on the higher end of the spectrum) and independent living (which would fall on the lower end).

Inception of the Modern Assisted Living Facility
By the late 1970s it was becoming apparent that the institutionalized setting of nursing homes was no longer acceptable for most aging seniors and their families. As advances in medicine allowed seniors to age in place, many were balking at the idea of nursing home placement. With rumors of mistreatment and neglect surrounding long-term care gaining more and more publicity, the need for change was evident.

Health, Housing and Hospitality
In the mid-70s, Dr. Keren Brown Wilson's mother motivated her to take a stance for the frail and aging. It is reported that as a 60-year-old resident of a nursing home, Jessie F. Richardson, asked her daughter to do something to help people like herself. It was those words that helped motivate Brown Wilson to focus her life's work on assisting frail and low-income elders.

With custodial care being a predominant function of nursing homes, Brown Wilson examined the aspects which were most "institutional such as shared bathrooms, communal showers and doors that don't lock; all of which take away a very basic right to privacy. She wanted to devise a way to keep providing medical and daily care for older adults while also providing them with the dignity and respect they so deserved. She told the Oregonian in 2010, "We basically combined what I call the three Hs: health, housing and hospitality."

Known by many as the architect of the assisted living model, Brown Wilson jumped through financial hoops in order to secure funding for what would become the nation's first recognized assisted living facility in Portland Oregon. In 1981 Park Place opened its doors and was a hit from the beginning. "It did things that weren't prohibited, but that weren't popular (at the time), like let people have a lock on their door," Brown Wilson said.

By 1986, the model of ALs included 24-hour staffing to provide residents with personal and health-related services, but also offered expansive community area and activities designed to facilitate social-interaction. The services provided by the facilities were individualized and could provide care ranging from medication administration and dementia care to incontinence maintenance.

Between the mid-90s and 2000, the number of assisted livings grew exponentially. From mom and pop private establishments to large corporate (for-profit and not-for-profit) establishments, assisted living quickly became a mainstream option for aging adults. Companies like Presbyterian Homes, Genesis HealthCare and Heartland have paved the way for advances in assisted living.

Best of Both Worlds
So, what exactly is an assisted living facility? Perhaps the best definition for assisted living can be found within Oregon's care philosophy. It states: Assisted living is a program that promotes resident self-direction and participation in decisions that emphasize choice, dignity, privacy, individuality, independence and homelike surroundings. Often seen as the best of both worlds, assisted livings provide their residents with the privacy and comforts of home, but also provides the necessary means to assist in activities of daily living (ADL). Most residents of ALs need more supervision and assistance than can be received at home without outside support, but do not require the intensive medical or custodial care that is provided in a skilled nursing facility.

Today, many ALs are not only able to provide assistance with basic ADLs but also provide medical care for those who are not sick enough to be hospitalized and don't require the care of a skilled nursing facility. There is also a trend for ALs to offer physical, occupational and speech therapy to residents in order to allow them to maintain their highest level of function. This is particularly important for seniors whose goal is to age in place.

In addition to the traditional assisted living facility, personal care and board homes, group homes and residential care homes fall under the AL umbrella. These small-scale facilities are usually located in residential settings and are privately owned. In many states, these smaller facilities do not require the same staffing levels as required by the ALFs.

The regulations for any assisted living facility are state regulated. Each state has set forth standards which the facilities must adhere to. The Assisted Living Federation of America lists the specific regulations for each state.

Evolution of Financial Responsibility
In the beginning, assisted livings were geared towards those who could afford to pay for their care. It quickly became evident that the masses were not in a position to be able to pay privately for the long durations. Brown Wilson was not only instrumental in developing the first ALF, but also for developing the first assisted living program reimbursed by Medicaid.

In most states, low-income seniors can apply for Medicaid waiver programs which will help pay for home and health services in assisted living facilities. Unfortunately, medical assistance doe not usually cover room and board for assisted living. Often, residents are forced to give portions of their social security to the facilities as compensation.

Even though many senior citizens are living on a fixed income a vast majority still pay out of pocket for assisted living costs. Most funds are drawn from savings, trust funds or investment accounts. Others find their relatives willing to help pay for their long-term care. In addition to private pay options, long-term care insurance, veteran's benefits and in some cases medical assistance can help cover the costs of assisted living.

Growth of AL
Since 1981, it is estimated that over 40,000 more assisted living facilities have been developed nationwide. The 1990s were a period of mass expansion as In a Harvard faculty study published in the journal Health Affairs it was found that there is, on average, 23 assisted-living beds per every 1,000 people aged 65 and older across the United States. This varies state to state and does not include facilities with less than 25 beds. The top three states for assisted living are Minnesota, Virginia and Orgeon with a combined total of 193 beds per 1,000 persons 65 and over, where as West Virginia, Connecticut and Hawaii round out the bottom three with only 13 beds per 1,000. The study also showed that the vast majority of assisted livings are located in wealthier and better educated areas and are less likely to be located in rural areas or those with minority populations. The author of the study, David Stevenson, believes this is simply due to the fact that most ALs are paid by private resources.

Reprinted by permission
Assisted Living History -- The Evolution of Assisted Living Facilities

Of Interest:
Long Term Care
Skilled Nursing, Assisted Living, Independent Living, Continuing Care Retirement Communities
Medical Social Workers

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