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Posted: October 13, 2004

Professional Caregiving

A Rose by Any Other Name . . .
Is Still Assisted Living

But What Is It Really?

I have been spending hours on a new caregiving project that raises the timeworn question, ?Which came first, the chicken or the egg?? You tell me after reading this.

In my home state of Missouri , like in many states throughout the country, assisted living facilities have been popping up all over, yet many states have yet to define, regulate or license them. This has created great confusion in the senior residential marketplace.

Recently, I was invited to sit on Missouri 's Assisted Living Coalition Task Force of Stakeholders to develop recommendations to submit to a newly appointed Assisted Living Task Force of state legislators. The National Assisted Living Workgroup (NALW) addressed the first meeting of our state workgroup and reported that many states are struggling with the same issue and before legislators develop legislation on regulations and oversight mandates for this growing component of the continuum of care. No surprise.

The stakeholders have an imperative to pound out the language and deliver it to the legislators, or who knows what will come out of their deliberations! The NALW, representing more than 40 national aging advocacy groups, spent uncounted hours over a period of 18 months, working toward consensus on definitional recommendations and regulatory language for this new industry to be used by U.S. legislators hammering out regulatory legislation for this industry.

Our group is using its document to guide our discussions. Sitting around our table are Missouri 's aging stakeholders representing aging advocacy groups-professionals, service providers, consumers, caregivers, disease related associations, industry related associations along the continuum of care, AARP, Area Agencies on Aging, governor's advisory council (my assignment) and many others.

While the assisted living industry was in its early years, the nursing home industry was simultaneously beginning to feel the negative effects of repeated reports of nursing home abuses and neglect cases that showed up in the papers from the New York Times to local community papers. These shocked the public and jump-started an energized effort to rethink ways of caring for our older loved ones, preferably in less costly non-institutional settings.

The concept of assisted living seemed to be an answer. It is philosophically different -- it is about choice, about resident control, about negotiated risk contracts. But to compete for this market, many residential and nursing care facilities took on the name as well, despite still having protective oversight mandates due to their license as residential care facilities. Here you see how the chicken (assisted living facilities) came before the egg (a clearly understood definition). That's today's dilemma in this field.

Assisted living as a concept showed up decades ago as an attractive alternative to the residential needs of seniors who at any point may need care but wanted to have a clear voice in the care they received.

That is what the customer is looking for these days: control over their lives. That's because many viewed as overkill, even in the case of their own parents or loved ones, the ?protective oversight? mandated (and rightly so) for care facilities attending to people who cannot oversee their own care. The same oversight that protected some, limited choice for those with less care needs.

So, long story short, there are many facilities out there that are licensed as RCF's but call themselves assisted living. There are others that are not licensed and do their variation of assisted living. There are (and will continue to be) many feckless/brilliant (you pick the adjective) entrepreneurs using the term assisted living as a marketing tool, not a reference to being a provider of a philosophically different residential service. The rub is in the mandate of protective oversight that is philosophically at odds with the concept of assisted living.

So call them whatever you like, they are operated not unlike the nursing home down the street -- because they ARE the nursing home down the street. They simply call themselves something that sounds sexier.

Additionally, there are unlicensed entities that call themselves assisted living, and they are operating under a philosophical position more or less coming out of the assisted living movement. No surprise, customers got easily confused. Legislation designed to clearly define and regulate this product is needed.

This dilemma is why we here in Missouri, and in many other states, are struggling to craft a working definition for a service that justifies and explains the differences between what we already have and what assisted living was intended to be.

In this case, I think, it's apparent: the chicken came before the egg!


Sylvia Nissenboim is a licensed clinical social worker and who has been working in the field of adult day services in the St. Louis area. She is the director of four adult care and enrichment centers for the American Red Cross and also operates a personal and professional coaching firm, LifeWork Transitions, specializing in caregiving concerns, adult day care management and other aging services, such as virtual coaching and family care giving support groups. She co-authored The Positive Interactions Program, is a national speaker, and has served as president of the Missouri Adult Day Care Association and as a member of the Missouri Governor's Advisory Council on Aging..

© 2004 Pederson Publishing, Inc. All Rights Reserved.
Commercial use, redistribution or other forms of reuse of this information is strictly prohibited without the prior written permission of Pederson Publishing.

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