By law, assisted living facilities aren't considered to be medical or mental health facilities. Their legal status is residential. In addition to a private or semi-private room, they typically offer meals, housekeeping services, assistance with medications and some social activities.
About one-half are staffed by a registered nurse either full- or part-time. But there are a number of differences between assisted living facilities and nursing homes, according to a recent study in the Elder Law Journal, published by the Illinois College of Law.
"In contrast to assisted living facilities, nursing homes are subject to federal guidelines because they rely on Medicaid and Medicare funds. A second major difference between assisted living facilities and nursing homes is their respective costs. Assisted living facilities typically cost less than nursing homes. However, this cost is misleading because assisted living residents use private funds to pay for their expenses while eligible persons can use Medicaid to cover nursing home costs."
The study surveyed the leval of regulation of assisted living facilities by state agencies, and found lax rules and inconsistent inspections. Lack of staff training, in particular, was found to be a major shortcoming in many states. Maryland, for example, requires only three hours of training to work in one of these facilities, and inspections have found residents with untreated bedsores, hypothermia and other signs of neglect.
As a result of a budget crisis, California assisted living facilties, previously inspected annually, are inspected only once every five years. In Alabama, regulators spent $5.5 million to inspect 244 nursing homes in 2002, but only $500,000 to inspect 330 assisted living facilities.
The federal 1987 Nursing Home Reform Act requires operators to provide a minimal level of service and established a resident's bill of rights.
Despite enforcement loopholes and shortcomings in inspections, the study concluded that the federal law has noticeably improved the quality of life for many nursing home residents. According to the study, "Inappropriate use of physical and chemical restraints, rates of urinary incontinence and catheterization and, most importantly, hospitalization rates have all declined."
Similarly, the study recomended imposition of federal standards that would regulate staff training, scope of care, and disclosure of coverage at these facilities, which would "provide a predictable setting for consumers, providers and payers."
It is estimated that about one million people are housed in more than 36,000 assisted living faciliteis nationwide, compared with about 600,000 seniors housed in 11,500 facilities a decade ago.
By 2020, the number of elderly Americans needing long-term residential care is expected to double--from seven million to 14 million.
Elder Law Journal published by the Illinois College of Law.