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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? What is the Quality Incentive Payment Program (QUIP)? What is Assisted Living? Nationally, assisted living is a general term used to describe a residence for seniors where assistance is provided, as needed, with activities of daily living. These activities can include, but are not limited to, bathing, dressing, grooming, ordering and taking medications, and making doctors’ appointments. Additionally, meals, snacks, housekeeping and laundry services 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 (DOH) as an Adult Care Facility (ACF) 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 person living in these residences 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. Persons with more acute conditions who require the ongoing presence of medical personnel like 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. Back to top
Are there Requirements to be a Resident of an Adult Care Facility?
In general, individuals may live in an adult home, enriched housing program or assisted living residence if they:
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 come to need such services after being admitted to a facility are required by law to be discharged to a higher level of care. Should this occur, the residence’s staff will assist a resident in finding an appropriate and safe alternative living arrangement. Back to top
What are the Different Assisted Living Models in New York State?
Adult homes and enriched housing programs are the two types of ACF’s licensed in New York. Both provide long-term residential care, housekeeping, laundry, supervision, assistance with medications, personal care assistance, case management services, and structured activity programs. Technically, 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 and adult homes provide private and/or semi-private rooms. Assisted Living Residences are licensed by the DOH and are one of only two types of residences who may lawfully represent themselves as providing “assisted living”in New York State (the other type is an Assisted Living Program). ALR’s 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, ALRs are pending approval with the NYS Department of Health (DOH). Back to top
What is an Enhanced or Special Needs Assisted Living Residence?
An Assisted Living Residence 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. Assisted Living Residences 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 Alzheimers or Dementia Many ACFs and ALRs can safely accommodate residents in the early stages of dementia or Alzheimer’s disease. These individuals are integrated into, and part of, 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 an SNALR certification have tailored programs to serve these residents and provide a secured living environment. Assisted Living Program (ALP): 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 ACFs 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 are covered by Medicaid. There are currently 4,200 approved ALP beds in New York State. Approximately sixty of the five hundred licensed adult homes and enriched housing programs in New York State currently have the additional ALP license. Recently, the State issued a request for proposal (RFP) in anticipation of authorizing 1,500 more ALP beds that will bring the total to 5,700. The ALP is an alternative to nursing home care, allowing individuals that would otherwise qualify for a nursing home to receive home health care services in the more independent setting of an ACF. This program provides care at less than half the cost of the Medicaid nursing home rate. In addition, the resident’s SSI covers room, board, and some personal care. When individuals who need them are unable to access ALP programs, they are left with no alternative but to utilize more costly institutional settings, such as nursing homes where Medicaid will pay. Currently, there are 39,362 Adult Care Facility beds in New York in 500 residences. Some of these residences are seeking additional certification or licensure as an ALP, ALR, EALR and/or SNALR.
Source: New York State Department of Health June 2007. *Pending approval Back to top
There are two programs, or certifications, that allow for an assisted living provider 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 that require skilled nursing services that cannot be provided by outside, community home health care agencies. These “aging in place” programs are available only in facilities that have received additional licensure or certification from the New York State Department of Health (DOH) to accommodate people with increased frailties.
*Pending approval from NYSDOH.
Most adult homes/enriched housing programs/assisted living residences can safely accommodate individuals in the early stages of dementia or Alzheimer’s disease. These individuals are integrated into, and part of, the general population of the residence, and receive the supervision, personal care assistance, and structured activity programs that are typically provided at this level of care.
However, as Alzheimers or dementia progresses, individuals may develop the need for more specialized services and more intense supervision because they have the tendency to wander, or 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 Department of Health approved secured Alzheimer’s/dementia units, available to serve 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 and consumers are encouraged to explore available residences. Consumers in need of long term care have different tastes, preferences, and needs, and the good news is that these residences come in all shapes and sizes in order to accommodate them. 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 to compare and decide which one fits their needs and their preferences.
Methods of payment for services in a typical adult home/enriched housing program/assisted living residence are:
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 ALP programs. However, the number of adult homes and enriched housing programs that accept SSI 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 SSI, an individual must have income and/or assets that are not in excess of amounts prescribed by the government. In New York’s adult homes and enriched housing programs, as of January 1, 2008, the monthly SSI reimbursement is $1,293 for individuals. This payment must cover the cost of living in an adult home and enriched housing program, and the comprehensive package of services offered therein, 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, $168, is provided to each SSI resident in the form of a Personal Needs Allowance (PNA) which is meant to cover the costs of personal expenses, like clothing, toiletries, transportation and entertainment. Currently this program, officially referred to as Congregate Care Level III Supplemental Security Income (SSI), pays for the care of approximately 13,500 people who live in adult homes and enriched housing programs in New York State.
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 SSI reimbursement rates for adult homes and enriched housing. This allowed many individuals who rely on SSI the option to remain in these residences rather than face unnecessary placement into expensive nursing homes, because it slowed the rash of adult home and enriched housing program closures because the SSI reimbursement simply did not cover the cost of housing, services and care. However, more needs to be done. The SSI rate has not kept pace with inflation and 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.
QUIP is a state subsidy developed to assist adult home and enriched housing providers that serve individuals receiving Supplemental Security Income (SSI) with quality of care and capital improvements in their residences. This funding is delivered in one annual lump sum payment and is essential to providers who serve the SSI population because it helps them pay for needed renovations and repairs, or service enhancements that could not otherwise be made due to modest SSI funding levels.
Almost 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 and its members. It is essential that this vital funding be preserved so that those who rely on SSI benefits to pay for their care are assured that their residences will be properly maintained and that service improvements will be available to them.
ACF – Adult Care Facility Licensed by New York State
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| The Empire State Association of Assisted Living - 646 Plank Road Suite 207 Clifton Park, NY 12065 - (518) 371-2573 - Email ESAAL |