New Assisted Living Standards
For the most part, our monthly Newsletter focuses on topics of interest to our regional clients and colleagues. In recent months, we have received a large number of inquiries regarding the ongoing regulatory and market changes in the New York State Assisted Living Arena. In order to help answer some of these questions, we have decided to dedicate a Special Edition to New York Assisted Living.
New York is seeking to achieve Medicaid and Medicare savings through structural changes to its Long Term Care System. As this is a common theme throughout the region and the country, we feel this edition should also be of interest to our readers in other states. Let's begin with some Background.
In our last Newsletter (Late June 2013) we identified Accountable Care Organizations (ACOs) as a driving force in Managed Long Term Care (MLTC). Direct discharges from hospital emergency rooms and physicians offices to Skilled Nursing Facilities (SNFs) will make nursing homes "more subacute". SNFs will be forced to accept heavier care patients to insure their referral base. "Borderline" hospital cases will now be assigned to SNFs, where they can be cared for at lower Medicaid rates. Borderline SNF residents will also move one rung down the "Continuum of Care Ladder" into subsidized Assisted Living (AL) facilities (Adult Homes & Enriched Housing) and private pay Assisted Living Residences which have an overlay of Social and Home Health Agency Services to assist residents in activities of daily living. On the Behavioral care side, New York is focusing on reducing the census of Behavioral Adult Home residents to below 25%, mandating that the majority of these Behavioral residents be cared for in Community based supportive housing.
Public policy is focused on fostering the development of Assisted Living Residences (ALRs) where daily living costs are not subsidized by Medicaid or Medicare (although they may pay for certain medical services). ALR residents pay privately for room, board, housekeeping, meals, and an A-la-Carte array of services. Many ALRs accept Long Term Care insurance and some accept Supplemental Security Income (SSI). Each resident has an individual care plan tailored specifically to his or her specific needs. There are three types of ALRs.
A "Basic" ALR is characterized by residents who need little or no assistance to walk or climb stairs, can self-transfer from a wheelchair and can take direction and self-evacuate in an emergency.
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