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When can an assisted living facility accept your loved one? When can they refuse to accept them? When can they kick them out? Unfortunately, deciding on an assisted living facility is not a simple decision. In addition to finding a facility that provides good care, you'll need to be sure you understand how long it is likely to provide a solution. For instance, in many places someone who needs a wheelchair can be involuntarily discharged, so families who know that a wheelchair may be needed in the near future should look for a facility that has more liberal policies about keeping someone if they develop that need.

"Critical Issues in Assisted Living: Who's In, Who's Out, and Who's Providing the Care", a new report from the National Senior Citizens Law Center, analyzes how consumers are protected, or harmed, by states' assisted living policies. It's a great summary of assisted living regulations across the country. Professionals will find it helpful to see how regulations vary across the country, and consumers may benefit by seeing what assisted living facilities can, and cannot, provide in their state.

I have seem some clips from what appears to be a very interesting look at life in an assisted living facility. The movie was filmed on location in an assisted living facility and actors were directed to blend in seamlessly with the normal environment. Many of the actors and all of the extras in the film are residents of the assisted living facility going about their normal lives or reacting to the action in a scene. As John Case of the Summerkamp Group put it:

"ASSISTED LIVING" was filmed on location in a working assisted living facility and paints a uniquely genuine and thought-provoking portrait of aging in America. Elliot Greenebaum'™s award-winning feature seamlessly blends the fictional story of one woman'™s poignant surrender to Alzheimer'™s with the day-to-day lives of actual patients and staff. The result is a startlingly clear-eyed allegory filled with compassion and wit.

Indiewire, the on-line authority on independent films, says 'œGreenebaum is an alchemist, combining real moments and real people with an exceptional story. What ensues is a magical film.' SYNOPSIS Assisted Living follows 21-year-old Todd through his final day of work as a janitor at a nursing home. Todd smokes pot frequently on the job, which allows him to enjoy the surreal environment of the assisted living facility. He also breaks the monotony of his days with entertaining'”and extremely unprofessional'”diversions involving the residents: he rides through the halls in borrowed wheelchairs; he plays pool and Scrabble with them; he even 'œplays God' on the telephone, giving residents the illusion of speaking to their departed loved ones in heaven. But however much these activities cheer the seniors, Todd'™s behavior angers the staff and undermines the policies of the home. It is ultimately Todd'™s interactions with Mrs. Pearlman'”a beautiful resident who longs for a visit from her son'”that jeopardize his job. Mrs. Pearlman, who is in the early stages of Alzheimer'™s, has difficulty distinguishing the real world from her memories of it. As her odd friendship with Todd develops, she begins to mistake the janitor for her son. When Todd in turn begins to assume the role, he rediscovers his own humanity and instigates a transformation for them both. FILM FESTIVALS 2003 Slamdance Film Festival GRAND JURY PRIZE 2003 GenArt Film Festival GRAND JURY PRIZE AUDIENCE AWARD 2003 Woodstock Film Festival GRAND JURY PRIZE 2003 Savannah Film Festival GRAND JURY PRIZE 2003 SXSW (South by Southwest) Festival OFFICIAL SELECTION 2003 Mill Valley Film Festival OFFICIAL SELECTION

ALFA Press Release Notes Trends and Advances in Consumer Choice

(WASHINGTON, DC, August 14, 2002) The Assisted Living Federation of America (ALFA), the leading trade association for assisted living providers, recently published its mid-year legislative wrap-up report. More than 180 bills with references to assisted living have been introduced in state legislatures around the country. The report highlights a significant push in 2002 for advances in consumer choice and rights for the states.

According to ALFA's President and CEO Paul R. Willging, Ph.D., a number of the enacted bills this year are indicative of trends shaping the regulatory environment in which assisted living providers will operate in the near future. 'When viewed in the context of legislation that has passed in other states in recent years, ALFA clearly sees a shift in trends towards consumer choice,' stated Willging. At the same time, many states have revised their assisted living regulations. The volume of state legislative and regulatory reform in assisted living is far greater than what most people think it is,' added Willging. 'What appears at first glance to a causal observer to be a patchwork of state rules is actually a growing body of consistently regulated areas of operation.' Bills enacted so far this year covered the following areas:

* consumer disclosure;
* consumer choice;
* consumer safeguards; and
* rules revision.

For a detailed description of the laws that were passed in a particular state, visit www.alfa.org and click on ALFA's Mid-Year State Legislative Wrap-Up Report under 'What's New at ALFA.' These bills demonstrate that states are continuing to take steps to protect the rights of residents. 'However, all states and providers struggle to find just the right balance of the consumer's desire for enhanced choice and control in assisted living with the responsibility of state agencies to ensure regulatory compliance and protect the welfare of residents. A new paradigm is needed that focuses on resident outcomes and customer satisfaction while preserving customer choice,' said Willging.

'There is a growing and discernible movement toward greater consistency in the way assisted living is regulated at the state level. Fortunately, state leaders and policymakers see the wisdom and benefit in allowing assisted living to be adaptive and responsive to the needs of each state's culture and its residents.'

For additional information on ALFA's Mid-Year State Legislative Wrap-Up Report, contact Francine Moore at (703) 691-8100 ext. 208 or email fmoore@alfa.org

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The Assisted Living Federation of America (ALFA), www.alfa.org, is the largest association dedicated to the assisted living industry and the population it serves. ALFA represents over 6,000 for-profit and not-for-profit providers of assisted living as well as a diverse range of organizations involved in the assisted living industry. With more than 40 state affiliates nationwide, ALFA promotes the philosophy of consumer choice and quality of life for seniors.

Many people are interested in knowing whether assisted living facilities will reduce the utilization of nursing homes. Since assisted living is less expensive than nursing home care, many states are exploring ways to move people who qualify for Medicaid and who need nursing home care into assisted living facilities instead. In addition, people who would "rather die than move into a nursing home" are hoping to find that assisted living will reduce the chance that nursing home care is in their future.

A recent study done by researchers from Texas A&M University System Health Science Center and Myers Research Institute addressed some of these issues. These researchers studied what happened to people who were discharged from assisted living facilities, including those who died in them, to help identify ways to keep people in the facilities longer. They looked at the reason for the discharge, and and found that most (80%) occurred because the resident needed more care. Those who were transferred often had cognitive problems, and many had been in the facility only a short time, which may indicate that the original placement was inappropriate or that the facilities need to be able to provide more cognitive care services. Researchers noted that the single most important factor in preventing discharges was the presence of a full-time registered nurse (RN), since facilities with RNs on staff were able to provide a broader spectrum of care.

An interesting finding in the study was how the expectations of family members involved in placement decisions changed over time. When they first looked for a facility, most family members thought that the availability of a private bedroom and bath was the most important aspect of a facility. By the time a family member was discharged, many family members said that the most important criteria was the ability of a facility to adapt to changing care needs, possibly because that might have avoided the need for a transfer.

Many people are concerned about the cost of assisted living, which is overwhelmingly paid for out-of-pocket and is not covered by Medicare and generally not covered by Medicaid. However, only 8% of the transfers in the study were made because the resident ran out of money.

Researchers found that about 24% of assisted living facility residents were discharged each year, including about 8% who died in the facility or immediately after discharge. Of those who were discharged and did not die, about 1% were able to return home and another 7% ended up moving into the home of a relative. 28% moved into another assisted living facility and 64% moved into a place that provided more care, like a nursing home, hospital, or sub-acute unit.

The U.S. Senate Special Committee on Aging is holding a hearing today about assisted living. To be discussed are issues like whether or not the federal government should provide more oversight and regulation of assisted living, which today is regulated almost entirely by the states. One of the hearing witnesses is Hillary Rodham Clinton, a member of the Subcommittee on Aging of the Senate Health, Education, Labor and Pensions Committee.

The U.S. Department of Housing and Urban Development has posted an application online for their Section 202 Assisted Living Conversion Program. The application is due June 21, 2001. If approved, the program would provide funds to nonprofit project owners of HUD 202, 236, and Section 8 low-income housing who want to convert the housing to assisted living units for low-income frail elderly. The program is intended to provide housing for people age 62 or older who are unable to perform 3 or more activities of daily living. This program was just started last year, when $50 million was appropriated and $19 million was awarded to 13 projects providing 508 units. For 2001, $75 million is available. The applications will be ranked based on criteria like the need for low income assisted living in the geographic area and the lack of financial resources available to the project owner to pay for the conversion without assistance.

HUD has posted a WebCast online which discusses the application process and the characteristics of projects which received funding last year, and the application and other program information is also available online.

In a November 1st memorandum to Florida Lt. Governor Brogan's task force, Northeast Florida Area Agency on Aging Executive Director Annette Kjeer said that in Jacksonville, eight of the largest of 37 participating ALFs were withdrawing from the Assisted Living Waiver program, and the remaining ALFs in the program are too small to handle what is approximately one-third of the total client population.

The Assisted Living Waiver program helps lower-income elderly in need of daily assistance to live in an assisted living facility, a less expensive alternative to state-funded nursing home care, and for the elderly person, a much less restrictive residential setting. For a facility to participate in the waiver program it must hold extended congregate care (ECC) or limited nursing services (LNS) licenses. Insurers are telling ALFs they will no longer cover facilities holding these licenses because of the greater potential for lawsuits, so many are dropping their ECC and LNS licenses so they can continue to stay open. Unlike nursing homes, Florida law requires ALFs to carry liability insurance as a condition of licensure.

The Florida Health Care Association, an organization of facility operators, warned that the insurance crisis jeopardizes the assisted living program. They said that some elderly clients may have no other option than state-funded nursing home care, the very thing the Assisted Living Waiver program was intended to prevent. They also report that Florida long term care facilities are three times more likely to be sued than a non-Florida facility because of the unique Florida law that provides incentives to sue nursing homes and assisted living facilities. As a consequence, Florida has the highest liability insurance rates in the nation. A recent Department of Insurance report confirms liability insurers fleeing Florida.

Lt. Governor Frank Brogan heads up a task force created to investigate the availability and affordability of long-term care, including the liability insurance crisis faced by long term care providers in the state of Florida.