Federal rules will come to assisted living

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John O'Connor, editorial director, McKnight's Long-Term Care News
John O'Connor, editorial director, McKnight's Long-Term Care News

If you ever want to get an assisted living operator's blood boiling, ask how the plans for federal oversight are coming along. You'd be better off asking a less insulting question, like how that person became so fat and ugly.

For if there is one thing the field does not want to hear about — much less embrace — it's federal rules. Not that it's hard to see why.

Assisted living originated with a marketing strategy that could be boiled down to five words: We are not nursing homes.

For decades, this slice of the eldercare pie has emphasized individual choice. Industry officials have taken every opportunity to rail against federal involvement. And who could blame them? Many of the people in this sector started out in nursing homes. They have seen firsthand how federal rules can muck things up.

But any objective look at the assisted living market today should lead to an inevitable question: Why isn't Uncle Sam involved?

Let's face it: Assisted living communities are not hotels for seniors. In fact, the profile of an assisted living resident today is very similar to that of a nursing home resident circa 1990.

A recent National Center for Health Statistics study reveals the following:

• Half to two-thirds of communities offer case management services

• Two-thirds of the larger operators offer physical and/or occupational therapy

• More than one-third of residents make an emergency hospital visit each year

• More than a quarter are admitted as hospital patients each year

• More than 40% have some kind of dementia.

Keep in mind that this study also scooped in personal care homes, which would presumably have less-needy residents. So an examination that focused exclusively on assisted living centers would likely show even higher totals here.

These realities alone would probably be enough to get federal lawmakers interested in what goes in at the roughly 40,000 buildings that have hung up an assisted living shingle.

But it is the industry's own deal with the devil that likely will bring federal regulators on board. The same NCHS study notes that about 20% of residents are receiving Medicaid assistance.

There is nothing inherently wrong with that, except for this: The federal government is now an assisted living customer. And as the old saw goes, he who pays the piper calls the tune.

So here's some strong medicine for the assisted living sector: Quit trying to prevent federal regulations and prepare instead. One way to do this is to take a lesson from those nursing home operators you don't want to be compared to. They have done a masterful job of blunting anti-nursing home regulations at the state level, and also have become a legitimate voice in Congress.

Do they always get what they want? Of course not. But their efforts have led to oversight that is far less stringent than it might otherwise have been.

Preparing for a problem is almost always a better option than just hoping it doesn't happen. That's worth considering as assisted living centers continue to look and act more like skilled care settings.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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