Affordable Assisted Living Publications

We have provided the links below to help you access reports and other publications related to affordable assisted living.  If you have resource suggestions, please contact Candace Baldwin at (703) 647-2352.

Reports

Building Adult Foster Care Report(PDF 1,401KB)*    Adult Foster Care IN BRIEF (PDF 70KB)*
NEW! States are currently facing major budget shortfalls and are looking for viable options to provide services and supports to older adults and people with disabilities. As states attempt to “balance” LTSS to offer consumers a broader array of services, they need to consider how to develop, regulate and fund an array of home and community-based services (HCBS) including adult foster care. This PPI report examines the role of adult foster care (AFC) within the array of long-term services and supports and offers guidance to policy-makers interested in developing or expanding AFC.

Assisted Living in Rural Markets (PDF, 1,714 KB)*
NEW! This publication was written as part of the Coming Home Program. The purpose of this study was 1) to evaluate the efficacy of applying standard market study methodologies and benchmarks for assisted living to rural communities and 2) to identify factors that may contribute to the success of AL residences in rural communities in order to inform the development of additional successful rural AL projects.

Study of Negotiated Risk Agreements in Assisted Living: Final Report  (PDF, 104 pages, 1,267 KB)*
The use of negotiated risk agreements (NRAs) is a new topic in a relatively new long-term care setting. This study, prepared in partnership with NCBDC (now NCB Capital Impact), U.S. Department of Health and Human Services (HHS), RTI International and others, is designed to inform state policy makers, assisted living providers, and key stakeholders about NRAs and issues related to their use.

Making Quality Assisted Living an Affordable Community-Based Care Option (PDF, 464 KB)*  This white paper identifies roles, risks and recommendations for Medicaid and other public subsidies.  Co-authored by our staff, it was produced in relation to the Center for Excellence in Assisted Living (CEAL) expert summit in Washington, DC in August 2005.

In Brief:  An Overview of Assisted Living: 2004
A short summary of the similarly titled AARP Public Policy Institute Issue Brief in which Bernadette Wright discusses the characteristics of assisted living residents; assisted living’s philosophy and the degree to which it is carried out; the services, cost and affordability of assisted living; assuring quality and consumer protection; efforts to promote affordability and quality, and policy implications.

A Profile of Older Americans, 2004 (PDF, 18 pages)*

Concise, compact and comprehensive collections of facts and figures about the age 65 and older population in the United States. Topics include health, life expectancy, marital status, living arrangements, geographic distribution, racial/ethnic composition, economic status, employment, education. Compiled annually since 1982 by the Administration on Aging (AoA) of the U.S. Department of Health and Human Services (HHS).

Iowa Coming Home Program's "Monitoring for Quality Care in Assisted Living" (June 2003)(MS Word, 11 pages)
This report summarizes the findings of an evaluation of the Iowa Coming Home Program's "Monitoring for Quality Care in Assisted Living" (MQCAL) pilot project. The purpose of the evaluation was to determine: 1) the effectiveness of consumer-driven quality measures developed and implemented under the MQCAL project; 2) the reliability and validity of consumers, families and employees as reporters and evaluators; and 3) the effectiveness of using a cooperative quality monitoring model for driving improvements in Iowa's assisted living programs (ALPs). The pilot program was implemented by the Iowa Department of Elder Affairs under a grant and with technical assistance from our Coming Home Program during fiscal years 2000-2001.

Assisted Living Workgroup Final Report (April 2003)

The Assisted Living Workgroup (ALW), a broad-based coalition of consumer advocates, assisted living providers, health care professionals, aging organizations, and regulatory agencies, spent 18 months drafting recommendations for improving quality of care in assisted living in response to a request from the Senate Special Committee on Aging. NCBDC (now NCB Capital Impact) was a participant in all aspects of the ALW, serving as a participant, a Steering Committee member, and a co-chair of the Affordability Topic Group. The ALW presented its final report to the Committee on April 29, 2003. The report is available as sectional PDF files in the left menu bar of the ALW website.

"State Assisted Living Policy 2002"
This comprehensive November 2002 report, by Robert Mollica, examines current regulations and Medicaid reimbursement policies for assisted living facilities in each of the 50 states. The report includes detailed comparisons of state policy and a summary of each state's assisted living regulations.

"Affordable Assisted Living: Surveying the Possibilities" (PDF, 112 pages)*
The Joint Center of Housing Studies of Harvard University released a January 2003 report outlining the issues surrounding the development of affordable assisted living for low-income seniors. Jenny Schuetz investigates the demand for affordable assisted living and the challenges of subsidizing the development and maintenance of housing programs for seniors. Schuetz argues that affordable assisted living for lower income seniors provides not only a more comfortable environment than institutional care, but also a more cost-effective one. States should coordinate funding and initiatives, develop flexible facility regulation, and facilitate the appropriate application of Medicaid funds for assisted living.

"High Service or High Privacy Assisted Living Facilities, Their Residents and Staff: Results from a National Survey"
This report was prepared under contracts between the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Disability, Aging, and Long-Term Care Policy (ASPE) and Research Triangle Institute. In addition to ASPE, other support for the study, A National Study of Assisted Living for the Frail Elderly, has been provided by the American Association of Retired Persons, the Alzheimer's Association and the National Institute on Aging. For additional information, you may visit the DALTCP website at http://aspe.os.dhhs.gov or contact the ASPE Project Officer, Pamela Doty, at HHS/ASPE/DALTCP, H.H. Humphrey Building, Room 424E, 200 Independence Avenue, SW, Washington, DC 20201.

Analyses of Residential Transition of Older Americans:
Estimates of the Risk of Long-Term Care: Assisted Living and Nursing Home Facilities|

Trends in Residential Long-Term Care: Use of Nursing Homes and Assisted Living and Characteristics of Facilities and Residents

There are four main questions addressed in this project: (1) How do characteristics (both individual and environmental) of elderly persons residing in institutional settings differ from those residing in community-based settings? (2) How do these characteristics vary over time? (3) Are there differences in these characteristics between subgroups of institutionalized and non-institutionalized elderly? (4) What is the relationship between selected individual and environmental factors and the transition of the elderly between community and institutional residential settings? Data from six years of the Medicare Current Beneficiary Survey is used to answer these questions.

"Analyses of Changes in Elderly Disability Rates: Implications for Healthcare Utilization and Costs"
In this study, the 1984 to 1999 National Long-Term Care Survey (NLTCS) and the Medicare Current Beneficiary Survey (MCBS) were used to understand the nature of recent declines in elderly disability rates and their implications for health care utilization and costs. Understanding the structure of the decline will give insight into the reasons for the overall decline, the likelihood that disability rates will continue to fall in the future, and its potential impact on health care spending. This project is a first step in understanding the policy implications of the changes that we are observing in elderly disability rates.

"National Study of Assisted Living for the Frail Elderly"
The purpose of this project is to analyze the role of assisted living within the current long-term care system from the perspective of consumers, owners/operators, workers, regulators, investors and other stakeholders, and to issue a report on its current status and future directions. The study addresses several broad policy-relevant issues, including supply and demand trends; barriers; how closely practice parallels philosophy; the impact of key features on outcomes; and quality and accountability.

"Understanding Medicaid Home and Community Services: A Primer"
This Primer is designed to encourage use of the Medicaid program in a manner that minimizes reliance on institutions and maximizes community integration in a cost-effective manner. Its intended audience is policymakers and others who wish to understand how Medicaid can be used--and is being used--to expand access to a broad range of home and community-based services and supports, and to promote consumer choice and control. In addition to comprehensive explanations of program features states can implement to achieve these goals, the Primer presents examples of state programs that have taken advantage of Medicaid's flexibility to expand home and community-based services for people of all ages with disabilities.

"Long-Term Care: Consumer Protection and Quality-of-Care Issues in Assisted Living"(PDF, 41 pages)*
There is rising concern that the rapid growth in the assisted living industry may be outpacing many states' ability to monitor and regulate care. To determine whether an assisted living facility is appropriate for them, prospective residents rely on information provided by the facility, including contracts that set forth residents' rights and provider responsibilities. These contracts are often vague and confusing. This U.S. General Accounting Office report discusses state management of quality-of-care issues, and the need to provide prospective residents with accurate and adequate information for the decision-making process.

"Creating Affordable and Supportive Renter Accommodations (The CASERA Project)"(abbreviated)
This project, funded by the Retirement Research Foundation, addresses the issue of "aging in place". Dr. Stephen Golant presents five service delivery models to link older tenants more effectively with the supportive services they need to remain independent, in their current accommodations.

"AAAs and NORCs"
Dr. Susan Lanspery describes the NORC phenomenon (Naturally Occurring Retirement Communities), and how it can help AAAs to better serve the older people in their area.

"Consumer Perspectives on Private Versus Shared Accommodations in Assisted Living Settings"
Despite the predominance of private apartments in assisted living, policy discussions on whether to require private rooms for licensure have generated substantial debate. Adequate research on consumer preferences regarding private or shared accommodations has been lacking in this debate. To begin to address the issue, in 1996, the American Association of Retired Persons (AARP) surveyed older persons aged 50 and over about their preferences. This 1998 study strongly reaffirms the preference of consumers and their families for private apartments in assisted living.

"Long-Term Care for the Elderly: Profile of Thirteen States" (PDF, 87 pages)*
Assessing the New Federalism is a multi-year Urban Institute project designed to analyze the devolution of responsibility for social programs from the federal government to the states, focusing primarily on health care, income security, job training, and social services. Researchers monitor program changes and fiscal developments. In collaboration with Child Trends, Inc., the project studies changes in family well-being. The project aims to provide timely, nonpartisan information to inform public debate and to help state and local decision makers carry out their new responsibilities more effectively.

"A National Study of Assisted Living for the Frail Elderly: Results of a National Study of Facilities"
This report was prepared in a collaborative effort by the U.S. Department of Health and Human Services (HHS) and the Research Triangle Institute. For additional information about the study, visit the DALTCP home page.

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Guides, Brochures, and Books

Affordable Assisted Living Operations Manual

Technical Assistance Development Manual
These materials for developers include an overview of facility development and operational issues, a tool for preliminary feasibility analysis, and helpful case studies.

Underwriting Training Binder and Video Guide
NCB Capital Impact offers this training binder and video guide to those seeking to develop and to underwrite affordable assisted living projects.

"Choosing an Assisted Living Facility"
This publication is put out by the Consumer Consortium on Assisted Living (CCAL) to help seniors and their family members find an Assisted Living facility that meets their needs and preferences.

Long Term Care Community Coalition guidebooks
The Long Term Care Community Coalition offers free guidebooks on its website for both consumers and providers of assisted living. The consumer guides offer suggestions for those thinking about or currently living in an assisted living community. The provider guides provide information on how to support the values of assisted living, especially resident choice and independence. Visit www.assisted-living411.org to download these free publications.

State Assisted Living Practices and Options: A Guide for State Policy Makers (PDF, 889 KB)* This is a joint publication of NCB Capital Impact's Coming Home Program and the National Academy for State Health Policy, designed to be a resource for policy makers when considering new assisted living regulations or regulatory revisions. Print copies are no longer available.

 

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