Posted: March 23rd, 2017

Identify and discuss ethical issues affecting assisted living facilities. Identify trends affecting assisted living facilities into the coming millennium and describe the impact of those trends.



After completing this chapter, readers will be able to:

  1. Define and describe assisted living facilities, where they fit in the continuum of care, the consumers who use them, and the services they offer.
  2. Identify sources of financing for assisted living facilities.
  3. Identify and describe regulations affecting assisted living facilities.
  4. Identify and discuss ethical issues affecting assisted living facilities.
  5. Identify trends affecting assisted living facilities into the coming millennium and describe the impact of those trends.


What is assisted living?

How Assisted Living Developed

Developed along two tracks:

  1. As residential care facilities, known more commonly as boarding homes or boarding care facilities, their services were traditionally provided in small homes caring for one or several seniors.
  2. For people who, with a bit of assistance, could live more independently.

Philosophy of Care

Based on:

  • Maximizing dignity, autonomy, independence, privacy, and choice
  • Providing a homelike environment
  • Accommodating residents’ changing care needs and preferences
  • Minimizing the need to move when a resident’s care needs increase
  • Involving families and the community

Ownership of Assisted Living Facilities

  • Approximately 82 percent were for-profit and the remainder were not-for-profit or were owned by government entities
  • Percent of not-for-profit is increasing

Services Provided

  • 24-hour supervision;
  • Three meals a day plus snacks
  • Personal Care Services
  • Health Care Services
  • Social Services
  • Supervision of Persons with Cognitive Disabilities
  • Social and Religious Activities
  • Exercise and Educational Activities
  • Arrangements for Transportation
  • Laundry and Linen Service
  • Housekeeping and Maintenance

Consumers Served

By age and gender:

  • Mostly elderly (average age 87)
  • Mostly female (74%)

Where they come from:

  • Most (about 70 percent) come from home,
  • 14 percent from another assisted living residence or retirement community,
  • 7% moved from a family residence (such as living with adult children)
  • 9 percent from a nursing home

Where they go:

  • The most common (59%) destination is to a nursing facility, generally because of loss of functional capacity.
  • The second most common (33%) reason for leaving is the death of the resident

Market Forces

  • Seeking Care Alternatives – potential residents looking for alternatives to nursing facilities
  • Impact on Children – loss of nuclear family impacting care of elderly family members
  • Cost-Cutting Efforts – payers are looking for less costly alternatives.


  • Regulations affecting residents – there is concern about following the nursing facility model too closely.
  • Other regulations – similar to nursing facility regulations.


  • Joint Commission
  • CARF

Financing Assisted Living

Costs/Charges – vary widely depending on services provided:

  • One all-inclusive rate: 24%
  • Ala Carte/fee-for-service: 17%
  • Hourly charge or other time fee: 4%
  • Tiered pricing for bundled services: 51%


  • Private pay – use of an individual’s own funds – remains the largest source of reimbursement for assisted living.
  • Medicare does not cover it, although in some cases, there is some coverage under Social Security Supplemental Income (SSI).
  • Medicaid is a small, but growing source of reimbursement

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