Topic:
ELDERLY; HOME CARE SERVICES; ASSISTED LIVING; NURSING HOMES;
Location:
ASSISTED LIVING; HOME CARE SERVICES; NURSING HOMES;

OLR Research Report


February 22, 2001

 

2001-R-0177

ASSISTED LIVING, RESIDENTIAL CARE FACILITIES, AND CONTINUING CARE RETIREMENT COMMUNITIES

 

By: Helga Niesz, Principal Analyst

You asked for a comparison of assisted living facilities, residential care facilities, and continuing care retirement communities.

SUMMARY

Assisted living, residential care homes, and continuing care retirement communities (CCRCs) all provide housing, some common meals, housekeeping, laundry, social and recreational programs, transportation, some personal assistance, and a 24-hour emergency call system mainly for elderly people who cannot live independently in the community.

The major differences are in the extent and type of additional services and how they are structured and paid for.

Assisted living is primarily for people age 55 or older who do not need full nursing home services, but require some health care, nursing, or assistance with activities of daily living, such as dressing, eating, bathing, toileting, or transferring from a bed to a chair. Although people informally refer to an “assisted living facility,” Connecticut law does not use the term (but other states do). Instead, the state regulates “assisted living services.” In Connecticut, only a state-licensed assisted living services agency (ALSA) can provide assisted living services. And the ALSA can only provide these services at a “managed residential community” (MRC), which is not licensed as such but must meet the definition of an MRC. Assisted living services can be provided in a number of different settings, such as apartments, continuing care retirement communities, or other structured settings as long as the facility itself provides the basic services to qualify as an MRC. Generally, people must pay privately for these services except for certain new income-limited limited projects for lower-income seniors.

Residential care homes provide a single or double furnished room and shared common areas such as a lounge or recreation area. They provide residents with three meals a day in a common dining area and some limited personal services. Residential care homes have no legal age requirement. They set their own policies and can also include people with physical or mental disabilities. There are also no income limits for residents (although many receive some type of public assistance).

A CCRC is a facility that provides elderly people with a lifetime “continuum of care,” although there is a no legal age requirement. Residents must usually pay a one-time entry fee, which can easily be more than $100,000, and continuing monthly payments, often ranging between $1,000 and $3,000. Thus, people must have considerable private resources to live in a CCRC. They usually obtain the entry price by selling their houses. At first, the senior lives in an independent apartment and later, when he becomes frailer, can receive assisted living services there or move into an assisted living unit. CCRCs often have small nursing homes on their premises or have a contract with a nearby nursing home for residents who ultimately need 24-hour care. They also provide some common meals and have other common spaces for leisure and recreation programs, provide housekeeping, laundry services, and transportation.

Table 1 below compares the three types of facilities in more detail.

Table 1

Comparison of Assisted Living, Residential Care Homes and Continuing Care Retirement Communities

Facility

Assisted Living

Residential Care Homes

Continuing Care Retirement Communities

Regulation

Licensing

Department of Public Health (DPH) licenses agency that provides services (ALSA). Facility where services are provided is not licensed, but must qualify as an MRC (CGS 19a-490(l), Conn. Agencies Reg. 19-13-D105).

Licensed by DPH (Conn. Agencies Reg. 19-13-D6).

Not licensed, but must register with Department of Social Services and meet certain financial requirements before construction can start. If it includes assisted living, either the facility or the outside agency providing the services must have an ALSA license. If it includes a nursing home, the nursing home part must be licensed by DPH (CGS 17b-520 etc.)

Physical Facility Regulation

No specific regulation or inspection of physical facilities for MRC. ALSA administration is extensively regulated.

DPH extensively regulates the physical requirements for the buildings and some requirements for the services that have to be offered. It inspects the homes periodically.

No specific regulation or inspection of physical facilities for CCRC, only for nursing home or assisted living services if offered. Must meet state and town building codes.

Consumer Protection

ALSA must have a written clients' bill of rights and responsibilities and provide and explain it to each client at the start of services.

Must have a resident's bill of rights. The State Long-term Care Ombudsman handles complaints from these residents.

State law and DSS extensively regulates financial and other disclosures to consumers before they sign a contract and specifies what the contract must contain.

Services

Housing Type

MRC must provide private apartments with full bath. Regulations require access to food storage and preparation equipment, but not necessarily a full kitchen in the apartment.

Resident has a single or double furnished room. Bath and toilet can be in the room or shared.

Usually private apartments with kitchenette and full baths. No specific requirements except if offering assisted living and nursing home services.

Meals

Three meals a day in the common dining room to qualify as an MRC.

Three meals a day in the common dining room.

Some meals in a common dining room depending on contract, but must offer 3 meals if qualifying as an MRC.

Housekeeping

Regularly scheduled.

Yes.

Yes.

Assistance Level

Some health care, nursing, and assistance with activities of daily living.

Some personal services (but historically resident had to be able to self-administer medicine with supervision. The law now allows unlicensed personnel to become trained and certified to administer medication) (CGS 19a-495a).

Varies depending on contract. Can provide independent living, assisted living or nursing home care as needed.

Laundry

Yes.

Yes (the extent varies).

Can be washer/dryer or more extensive laundry services depending on stage in continuum of care.

Emergency Call System

Yes.

Yes.

Yes.

Recreation

MRC must provide social and recreational programs.

Some recreation.

Some recreational programs are usually provided. No specific requirement unless offering assisted living or nursing home services.

Staffing

MRC must have on-site service coordinator. ALSA must have on-site office at MRC with a nursing supervisor on duty for specified hours depending on the number of aides working there.

One staff member per 25 residents on premises 24-hours a day.

No staff requirements for overall CCRC, but assisted living and nursing home staffing requirements apply for those parts of the facilities.

Entry Qualifications

Age and Health

Residents must have chronic and stable conditions and need help with activities of daily living. ALSA must have written criteria for furnishing services.

Must be elderly or younger persons with disabilities (home can set its own age policy.

No specific requirements. Usually the contract sets a minimum age and requires people to be relatively healthy and able to live independently when they first move in.

Income

For private facilities, no income limits. Contracts may require people to show they have enough income to cover costs.

No income limits.

No income limits. Contracts usually require people to pay lump sum entry fee and show that they have enough money to continue paying monthly fee.

Payment Source

All those currently in operation are private pay. But 1998 legislation authorized five pilot programs for people whose incomes are low enough to qualify for the Medicaid or state-assisted portion of the Connecticut Home Care Program (CHCP). 2000 legislation also allowed assisted living in two federally assisted senior housing projects and in all 24 state-assisted income-limited senior congregate housing programs (one Norwich pilot has operated for several years).

Can be private pay, but many low-income residents receive help from the federal Supplemental Security Income Program, the State Supplement Program, or state-administered or town general assistance.

All are private pay. Neither Medicaid nor state funding pays for people in CCRCs in Connecticut.

Rate Setting Authority

Private pay rates are not regulated. DSS will set them for people qualifying for assisted living services in congregate housing or the pilots under the CHCP.

The Department of Social Services sets rates it will pay for public assistance recipients who live in residential care homes. It does not regulate private pay rates.

Rates are not regulated.

Additional details on assisted living regulation are available in OLR Reports 95-R-0260 and 96-R-1010, on residential care homes in OLR Report 98-R-0443, on continuing care facilities in OLR Report 96-R-1109.

HN:ro