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
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.
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.
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.
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.
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