Frequently Asked Questions
What is Assisted Living?
How do Adult Care Facilities Differ from Nursing Homes?
Are there Requirements to be a Resident of an Adult Care Facility?
What are the Different Assisted Living Models in New York State?
What is an Assisted Living Residence (ALR)?
What is an Enhanced or Special Needs Assisted Living Residence?
Is There an Opportunity for Residents to “Age In Place” and Thus Not Be Transferred as Their Needs Change?
How Can I Find Specialized Services for My Loved One Diagnosed with Alzheimer’s Disease or Other Forms of Dementia/Cognitive Impairment?
How Do I Know If an Adult Home, Enriched Housing Program or an Assisted Living Residence Is Right for Me?
How Does an Individual Pay for the Services Provided in an Adult Home/Enriched Housing Program/Assisted Living Residence?
What is the Quality Incentive Payment Program (QUIP)?
Glossary of Terms
What is Assisted Living?
Assisted living is a general term used to describe a residence for seniors where assistance with activities of daily living is provided, as needed. These activities can include bathing, dressing, grooming, ordering and taking medications, and making doctors’ appointments. Meals, snacks, housekeeping and laundry services also are provided.
There are many different types of assisted living residences available, from simple accommodations with private or shared rooms, to apartment-style residences. Most residences provide numerous amenities. In New York, all models of assisted living must be licensed by the Department of Health as an Adult Care Facility and, depending on the type of license they have, may also be referred to as Adult Homes or Enriched Housing Programs.
The goal of assisted living is to provide each resident with considerate and respectful care, and to promote their dignity, autonomy, independence, and privacy to the extent possible, in a comfortable, residential setting.
Generally, people living in adult homes, enriched housing programs and assisted living residences do not require 24-hour skilled nursing or medical services. Rather, they need assistance with personal care tasks, such as bathing, dressing, taking medications and arranging medical appointments. Those with more acute conditions who require the ongoing presence of medical personnel, such as nurses or doctors to make medical judgments, are appropriate for a higher level of care, such as a nursing home or, in some cases, an Enhanced or Special Needs Assisted Living Residence.
Individuals may live in an Adult Home, Enriched Housing Program or Assisted Living Residence if they:
* Do not have a medical condition that requires 24-hour skilled nursing or medical care;
* Are not a danger to themselves or others; and
* Do not chronically need the assistance from another person to walk, transfer or descend stairs.
Individuals who do not meet such standards may not be admitted to an adult home, enriched housing program or assisted living residence, unless the residence is additionally certified as an Enhanced Assisted Living Residence or Assisted Living Program. Absent those two programs, those who need such services after being admitted to a residence are required by law to be discharged to a higher level of care. Should this occur, staff will help the resident find an appropriate and safe alternative living arrangement.
Adult Homes and Enriched Housing Programs are the two types of Adult Care Facilities licensed in New York. Both provide long-term residential care, including housekeeping, laundry, supervision, assistance with medications, personal care assistance, case management services, and structured activity programs.
The law requires enriched housing programs to provide less supervision and meals than it requires in Adult Homes. However, many enriched housing programs provide the same amount of supervision and meals as their adult home counterparts. Generally, enriched housing programs have apartment-style living. Adult homes provide private and/or semi-private rooms.
Assisted Living Residences are licensed by the State Department of Health (DOH) and are one of only two types of residences that that may lawfully represent themselves as providing “assisted living.” The other type is an Assisted Living Program.
Assisted Living Residences serve the same types of residents as adult homes and enriched housing programs and provide the same services. However, the law requires them to provide certain additional disclosures and resident rights.
Currently, Assisted Living Residences are pending approval with the DOH.
An Assisted Living Residence (ALR) can obtain additional certification to become an Enhanced Assisted Living Residence (EALR), which permits the ALR to offer aging in place services. It can also obtain certification to become a Special Needs Assisted Living Residence (SNALR) and offer specialized care.
ALRs with an EALR certification can admit and retain residents who exceed certain retention standards of adult homes, enriched housing programs or assisted living residences. If a residence has an EALR certification, individuals can continue to live in the ALR even if they need another person to help them walk, transfer, climb or descend stairs, or operate medical equipment. Essentially, an EALR allows residents to age in place.
Care for Residents with Alzheimer’s or Dementia
Many Adult Care Facilities and Assisted Living Residences can safely accommodate residents in the early stages of dementia or Alzheimer’s disease. These individuals are integrated into the general population at their residence. They receive the same general supervision, personal care assistance and structured activity programs that are typically provided to all residents. However, as Alzheimer’s or dementia progresses, individuals may develop the need for more specialized services because they have the tendency to wander, are less able to receive direction, and require more frequent cueing or one-on-one assistance. Residences with a Special Needs Assisted Living Residence certification have tailored programs to serve these residents and provide a secured living environment.
Assisted Living Program: A Cost-Effective Model
The Assisted Living Program (ALP) is a very cost-effective model of care for thousands of individuals throughout New York State.
The ALP allows Medicaid-funded nursing and home care services to be delivered in Adult Care Facilities (ACF) for residents that require services above and beyond what the adult home or enriched housing program typically provides. ALPs require a special state license and are the only residential care option that is covered by Medicaid.
There are nearly 5,800 approved Assisted Living Program beds in New York State, including 1,584 that were recently approved by the State Department of Health. Approximately 60 of the 500 licensed adult homes and enriched housing programs across New York State currently have the additional ALP license, with another 30 scheduled to come on line in 2009.
An ALP is a residence that serves clients who do not require 24-hour skilled nursing care and have a stable medical condition. ALPS can allow people to age in place using on-site home care services to address their personal care needs. This program provides care at less than half the cost of the Medicaid nursing home rate. In addition, the resident’s Supplemental Security Income covers room, board and some personal care in certain situations. When individuals are unable to access ALPs, they are left with no alternative but to utilize more costly institutional settings, such as nursing homes, where Medicaid will pay.
|Statewide||# of Beds|
|Adult Care Facility (ACF)||35,215|
|AACFs with Assisted Living Program (ALP)||3,815|
|Assisted Living Residence (ALR)*||19,378|
|ALR with Enhanced Assisted Living Residence (EALR)*||5,352|
|ALR with Special Needs Assisted Living Residence (SNALR)*||2,572|
Source: New York State Department of Health, September 2008. *Pending approval
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Is There an Opportunity for Residents to “Age In Place” and Thus Not Be Transferred as Their Needs Change?
There are two programs – or certifications – that allow for an Assisted Living Provider (ALP) to accommodate a resident that can no longer walk, transfer or descend stairs without the assistance of another person.
Also, in some cases, these residences may accommodate people who require skilled nursing services that cannot be provided by outside, community home health care agencies. These aging in place programs are available only in residences that have received additional licensure or certification from the Department of Health to accommodate people with increased frailties.
Assisted Living Program: Approximately 12 percent of adult home and enriched housing programs have an additional license referred to as the Assisted Living Program license. The Assisted Living Program allows for Medicaid-funded nursing and home care services for residents who require services above and beyond what the adult home or enriched housing program typically provides. The program is an alternative to nursing home care, allowing individuals that would otherwise qualify for a nursing home to receive home health care services in a more independent setting. In New York, the Assisted Living Program is the only assisted living setting that Medicaid covers.
Enhanced Assisted Living Residence certification*: There is a new DOH certification that an Assisted Living Residence (ALR) may obtain in order to serve individuals who no longer meet the admission/discharge criteria for the Adult Home, Enriched Housing Program or ALR.
Similar to the Assisted Living Program, the “Enhanced” certification allows individuals to live in the ALR even if they need another person to assist them to walk, transfer, descend stairs or operate medical equipment. In some cases, the Enhanced certification also authorizes the assisted living provider to use its own licensed or registered nurse staff to provide nursing services.
Currently, there is no public assistance funding (i.e. Medicaid) available to help consumers pay for enhanced assisted living services. However, the state and the industry are working together to establish such funding. *Pending DOH approval
Most Adult Homes, Enriched Housing Programs and Assisted Living Residences can safely accommodate individuals in the early stages of dementia or Alzheimer’s. These individuals are integrated into the residence’s general population and receive standard supervision, personal care assistance and structured activity programs.
However, as Alzheimer’s or dementia progresses, individuals may develop the need for more specialized services and more intense supervision because they have the tendency to wander, are less able to receive direction or respond to cues from other people in order to keep them safe and healthy. At that point, they may need to live in a secured environment specifically designed to serve people with more advanced stages of the disease.
Currently, approximately 65 adult homes and enriched housing programs have State Department of Health-approved secured Alzheimer’s/dementia units, serving approximately 2,300 individuals. Under the new licensure category, these units are referred to as Special Needs Assisted Living Residences.
Unfortunately, as is the case with the Enhanced Assisted Living option, currently there is no public assistance funding (i.e. Medicaid) available to help consumers pay for a secured dementia unit/Special Needs Assisted Living Residence.
One size does not fit all. Consumers are encouraged to explore available residences because individuals have varied tastes, preferences, and needs. These residences come in all shapes and sizes. Some are small Victorian homes; others are larger and specifically built for assisted living. It is important that seniors and their loved ones visit each residence, and then decide which one best fits their needs and their preferences.
Methods of payment for services in a typical adult home/enriched housing program/assisted living residence are:
* An Individual’s Private Funds. Private funds are the most common payment method. Charges vary across residences and range from $1,000 to several thousand dollars per month.
* Supplemental Security Income (SSI). For those who qualify based on income and assets, SSI will pay for base-rate Adult Home and Enriched Housing Program services. Not all adult homes and enriched housing programs will accept SSI as payment in full, as the monthly rate is insufficient to meet the costs of providing state-required housing and services.
* Long Term Care Insurance. Most long term care insurance policies include an assisted living benefit. They vary in the amount of coverage and the conditions the policy holder must meet in order to access the benefit. Individuals with long-term care insurance coverage are encouraged to review their policy for details. Long- term care insurance often will not cover services unless the facility is licensed.
* Medicaid. A limited number of residences are authorized to operate Assisted Living Programs, which provide Medicaid funding for residents that would otherwise be eligible for a nursing home. For the Enhanced and Special Needs Assisted Living Residences described above, currently the only payment options are a person’s individual funds and/or a long term care insurance policy.
Government Help For Assisted Living Expenses
Assisted living services are most often paid for from private sources. In some cases the cost is covered through publicly funded sources such as Supplemental Security Income (SSI) and Medicaid-funded Assisted Living Programs (ALP) However, the number of Adult Homes and Enriched Housing Programs that accept SSI payment as payment in full is limited because the rate is considered inadequate to cover the cost of required services and care.
How Does SSI Fund Assisted Living Today?
To be eligible for Supplemental Security Income (SSI), an individual must have income and/or assets that are not in excess of amounts prescribed by the government. As of January 1, 2009, the monthly SSI reimbursement for individuals in Adult Homes or Enriched Housing Programs is $1,368.
This payment must cover the cost of living and the comprehensive package of services offered, including room, meals, 24-hour supervision, personal care assistance, medication supervision, case management services, laundry, housekeeping and recreational activities.
A portion of the monthly payment, $178, is provided to each SSI resident in the form of a Personal Needs Allowance, which is meant to cover the costs of personal expenses, such as clothing, toiletries, transportation and entertainment. Currently this program, officially referred to as Congregate Care Level III Supplemental Security Income, pays for the care of approximately 13,800 New Yorkers who live in adult homes and enriched housing programs.
What Can Be Done To Expand SSI Funding For More Low-Income Seniors?
In 2005, the hard work of the Empire State Association of Assisted Living and other advocates resulted in an increase of the Supplemental Security Income (SSI) reimbursement rates for adult homes and enriched housing. This gave many individuals who rely on SSI the option to remain in these residences rather than face unnecessary placement into expensive nursing homes.
Because the SSI reimbursement did not cover the cost of housing, services and care, advocacy efforts also slowed the closure of many adult home and enriched housing program residences. However, more needs to be done. The SSI rate has not kept pace with inflation. As a result, there are fewer adult homes and enriched housing programs that are able to accept individuals whose sole source of payment is SSI. As our population ages, the need for access to these programs will continue to rise.
For more information on SSI eligibility standards, visit The Social Security Administration web site at www.ssa.gov.
The Quality Incentive Payment Program (QUIP) is a state subsidy developed to assist adult home and enriched housing providers that serve individuals receiving Supplemental Security Income. This funding is delivered in an annual lump-sum payment.
QUIP is essential to providers who serve the SSI population because it helps them pay for needed renovations and repairs, or create service enhancements that could otherwise not be made.
Nearly every year, the New York State Legislature appropriates funds to the QUIP program, largely as a result of the efforts of the Empire State Association of Assisted Living and its members. It is essential that this vital funding be preserved so that those who rely on SSI benefits are assured that their residences will be properly maintained and that service improvements will be available to them.
ALP – Assisted Living Program
ALR – Assisted Living Residence
DOH – New York State Department of Health
EALR – Enhanced Assisted Living Residence
Enriched Housing Program – Adult Care Facility Licensed by New York State
SNALR – Special Needs Assisted Living Residence
Transfer – those who cannot “transfer” are chronically chairfast and need assistance getting up from a sitting position
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