Category Archives: Assisted Living

Wage Data by State

Source: Paraprofessional Healthcare Institute (PHI), 2015

PHI has documented the wages in each state for the three main occupations that make up the direct-care workforce.

Personal Care Aide Wages
For Personal Care Aides –who constitute the fastest-growing occupation in the nation—wages are low and trending lower across the nation.

Home Health Aide Wages
Over the next ten years, Home Health Aides will add over 400,000 jobs to the economy — a growth rate of nearly 50%.

Nursing Assistant Wages
Despite shifting preferences among service recipients and policymakers toward home and community settings, demand for institutional care continues to grow at a substantial rate.

New Evidence on the Risk of Requiring Long-Term Care

Source: Leora Friedberg, Wenliang Hou, Wei Sun, Anthony Webb and Zhenyu Li, Center for Retirement Research at Boston College, WP#2014-12, November 2014

From the abstract:
Long-term care is one of the major expenses faced by many older Americans. Yet, we have only limited information about the risk of needing long-term care and the expected duration of care. The expectations of needing to receive home health care, live in an assisted living facility or live in a nursing home are essential inputs into models of optimal post-retirement saving and long-term care insurance purchase. Previous research has used the Robinson (1996) transition matrix, based on National Long Term Care Survey (NLTCS) data for 1982-89. The Robinson model predicts that men and women aged 65 have a 27 and 44 percent chance, respectively, of ever needing nursing home care. Recent evidence suggests that those earlier estimates may be extremely misleading in important dimensions. Using Health and Retirement Study (HRS) data from 1992-2010, Hurd, Michaud, and Rohwedder (2013) estimate that men and women aged 50 have a 50 and 65 percent chance, respectively, of ever needing care. But, they also estimate shorter average durations of care, resulting, as we show, from a greater chance of returning to the community, conditional on admission. If nursing home care is a high-probability but relatively low-cost occurrence, models that treat it as a lower-probability, high-cost occurrence may overstate the value of insurance.

We update and modify the Robinson model using more recent data from both the NLTCS and the HRS. We show that the low lifetime utilization rates and high conditional mean durations of stay in the Robinson model are artifacts of specific features of the statistical model that was fitted to the data. We also show that impairment and most use of care by age has declined and that the 2004 NLTCS and the 1996-2010 HRS yield similar cross-sectional patterns of care use. We revise and update the care transition model, and we show that use of the new transition matrix substantially reduces simulated values of willingness-to-pay in an optimal long-term care insurance model.
Related Issue in Brief:
“Long-Term Care: How Big a Risk?”

Housing America’s Older Adults — Meeting the Needs of An Aging Population

Source: Harvard Joint Center for Housing Studies and AARP, 2014

From the press release:
America’s older population is in the midst of unprecedented growth, but the country is not prepared to meet the housing needs of this aging group, concludes a new report released today by the Harvard Joint Center for Housing Studies and AARP Foundation. According to Housing America’s Older Adults — Meeting the Needs of An Aging Population, the number of adults in the U.S. aged 50 and over is expected to grow to 132 million by 2030, an increase of more than 70 percent since 2000 (see interactive map). But housing that is affordable, physically accessible, well-located, and coordinated with supports and services is in too short supply…
Related:
Interactive map
Key Facts

Housing America’s  Older Adults

Just Like Home: Consumer Rights in Medicaid

Source: Eric Carlson, Hannah Weinberger-Divack and Fay Gordon, National Senior Citizens Law Center, Advocate’s Guide, May 2014

The National Senior Citizens Law Center (NSCLC) believes that home and community-based services (HCBS) should be provided as an option to every Medicaid beneficiary (consumer) who needs such services, allowing more seniors and persons with disabilities to live with dignity and independence in their homes. Under Medicaid law, HCBS funding exists to give consumers the ability to receive necessary long-term services and supports (LTSS) without moving into a nursing home or other healthcare institution. The value of the HCBS alternative would be destroyed or diluted if HCBS were provided in institution-like settings.

New federal Medicaid rules for the first time set standards to ensure that Medicaid-funded HCBS are provided in settings that are non-institutional in nature. These standards, which took effect in March 2014, apply to residential settings such as houses, apartments, and residential care facilities like assisted living facilities. The standards also apply to non-residential settings such as adult day care programs.

This guide provides consumers, advocates and other stakeholders with information regarding multiple facets of the new standards, including consumer rights in HCBS, and the guidelines for determining which settings are disqualified from HCBS reimbursement. This guide is based on the federal rules and subsequently issued guidance, and will be updated as further information becomes available….

Genworth 2014 Cost of Care Survey – Home Care Providers, Adult Day Health Care Facilities, Assisted Living Facilities and Nursing Homes

Source: Genworth, March 25, 2014

Research shows that at least 70 percent of people over 65 will need long term care services and support at some point in their lifetime1. Long term care can impact people and families in many different ways including finances, careers, lifestyles and state of mind.

The Genworth 2014 Cost of Care Survey can help families evaluate options to address the increasing long term care costs. For the eleventh consecutive year, Genworth has surveyed long term care costs across the U.S. to help Americans appropriately plan for the potential cost of this type of care in their preferred location and setting. The most comprehensive study of its kind, Genworth’s 2014 Cost of Care Survey, conducted by CareScout®, covers over 14,800 long term care providers in 440 regions nationwide. …

Key Findings:
Homemaker Services – National Median Hourly Rate: $19 Increase Over 2013: 4.11% Five-Year Annual Growth: 1.20%
Home Health Aide Services – National Median Hourly Rate: $20 Increase Over 2013: 1.59% Five-Year Annual Growth: 1.32%
Adult Day Health Care (ADC) – National Median Daily Rate: $65 Increase Over 2013: 0% Five-Year Annual Growth: 3.40%
Assisted Living Facility (ALF) – National Median Monthly Rate: $3,500 Increase Over 2013: 1.45% Five-Year Annual Growth: 4.29%
Nursing Homecare – Semi-private room – National Median Daily Rate: $212 Increase Over 2013: 2.62% Five-Year Annual Growth: 3.91%
Nursing Homecare – Private room – National Median Daily Rate: $240 Increase Over 2013: 4.35% Five-Year Annual Growth: 4.19%

Related:
Download cost of care for your state.
Cost of Care app from iTunes
Methodology
Beyond Dollars

Long-Term Care Services in the United States: 2013 Overview

Source: Lauren Harris-Kojetin, Manisha Sengupta, Eunice Park-Lee, Roberto Valverde, National Center for Health Statistics, December 2013

Long-term care services include a broad range of services that meet the needs of frail older people and other adults with functional limitations. Long-Term care services provided by paid, regulated providers are a significant component of personal health care spending in the United States. This report presents descriptive results from the first wave of the National Study of Long-Term Care Providers (NSLTCP), which was conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS). Data presented in this report are drawn from five sources: NCHS surveys of adult day services centers and residential care communities, and administrative records obtained from the Centers for Medicare & Medicaid Services on home health agencies, hospices, and nursing homes. This report provides information on the supply, organizational characteristics, staffing, and services offered by providers of long-term care services; and the demographic, health, and functional composition of users of these services. Service users include residents of nursing homes and residential care communities, patients of home health agencies and hospices, and participants of adult day services center.

2011-2012 National Surveys of Customer and Employee Satisfaction National Research Reports for skilled nursing homes and assisted living communities

Source: National Research Corporation, 2012

Nursing Home Report
Assisted Living Report

2011-2012 National Surveys of Customer and Employee Satisfaction National Research Reports for skilled nursing homes and assisted living communities.

These studies are based upon the largest dataset of senior care satisfaction metrics in the U.S. The National Research Reports examine trends in customer and employee satisfaction among skilled nursing care centers and assisted living communities. These reports:

– Define key indicators of performance excellence
– Underscore correlations between customer and employee satisfaction
– Establish national benchmarks for customer and employee satisfaction that can be used to set performance targets for these professions
– Present satisfaction metrics that can be used to create greater accountability and transparency in value-based reimbursement systems to support consumer-driven healthcare choices

2013 Assisted Living State Regulatory Review​

Source: National Center for Assisted Living (NCAL), March 2013

From the summary:
Published in March 2013, this report offers a state-by-state summary of assisted living regulations covering 21 categories; provides contact information for state agencies that oversee assisted living activities; and includes each agency’s Web site address.

Eighteen states reported making regulatory, statutory, or policy changes impacting assisted living/residential care communities from January 2012 through January 2013. At least nine of these states made major changes, including Colorado, Georgia, Michigan, Missouri, New Jersey, New York, Ohio, Oregon, and Washington. In 2012, states continued developing new models for surveys, expanding disclosure and reporting requirements, addressing life safety and infection control issues, and allowing increased delegation of medication administration to non-nurse staff.

– New Jersey and Colorado joined the small but growing number of states with innovative survey approaches, developed in part to help better target resources. New Jersey’s Department of Health (DOH) collaborated with The Health Care Association of New Jersey Foundation to create a voluntary program called Advanced Standing. To receive this distinction, a facility must comply with all applicable regulations as well as submit quality data reaching benchmarks established by a peer review panel. Participating facilities do not receive a routine survey, but any time a facility falls below DOH standards, it can be removed for cause from the program. The state also performs follow-up surveys based on a random sample. In January 2013, Colorado began conducting risk-based re-licensure inspections for assisted living residences (ALRs), initially on a pilot basis. Under the new system, ALRs meeting criteria specified in the law will be eligible for an extended survey cycle. In 2012, Michigan also began using a new renewal inspection system.
– After creating an additional level of licensure for assisted living communities a year earlier, Georgia updated rules for personal care homes in January 2013, including new requirements for additional staff training, staffing above minimal standards, and a resident needs assessment upon move-in. Also effective in January 2013, New York adopted rules stating that no adult home with a capacity of 80 residents or greater may admit or retain more than 25 percent census of residents with serious mental illness.
– Several states made changes to policies and rules for care provided to residents receiving Medicaid services, some to accommodate managed care contracting. In 2012, the state of Washington changed its licensure term to “assisted living facility” from the outdated “boarding home.” Oregon began requiring facilities to adopt policies for the treatment or referral of acute sexual assault victims.

The 2012 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and Home Care Costs

Source: MetLife Mature Market Institute, November 2012

From the summary:
– The national average daily rate for a private room in a nursing home is $248, while a semi-private room is $222 up from $239 and $214 respectively in 2011.
– The national average monthly base rate in an assisted living community rose from $3,477 in 2011 to $3,550 in 2012.
– The national average daily rate for adult day services remained unchanged from 2011 at $70 in 2012.
– The national average: hourly rates for home health aides ($21) remained unchanged, while the homemaker hourly rate increased by 5.3% from $19 in 2011 to $20 in 2012.

Findings Of The NCAL 2011 Assisted Living Staff Vacancy, Retention And Turnover Survey

Source: National Center for Assisted Living, October 2012

The 2011 Assisted Living Staff Vacancy, Retention and Turnover Survey is a nationwide study to collect retention, vacancy and turnover information among assisted living employees in five major job categories and sixteen job positions, including: administrative and management staff (Administrator/Executive Director, Director of Marketing, and other office staff), nursing staff (Director of Nursing/ Wellness and Director of Resident Services, Staff Registered Nurse, Licensed Practical Nurse, Certified Nurse Assistant, Non-Certified Resident Caregiver, Medication Aide, and other nursing staff), food services staff (Dietician Director/Head Chef and Dietician Aide/Dining Staff), housekeeping and maintenance staff (Housekeeper and Maintenance Worker), and social activities staff (Director of Activities and Activity Staff) (see Table 1). The survey questionnaire (see Appendix) was available on the NCAL web site for all eligible assisted living communities in the United States to complete using data from 2011. Approximately 370 assisted living communities nationwide participated in this survey.

In this report, results are presented on two aggregated levels: job category level and job position level. Retention rate, vacancy rate, and turnover rate for all five job categories (see Table 1) were reported. Results are also presented for nursing job positions.