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Assisted Living

Needs, Practices, and Policies in Residential Care for the Elderly

edited by Sheryl Zimmerman, Ph.D., Philip D. Sloane, M.D., M.P.H., and J. Kevin Eckert, Ph.D. foreword by M. Powell Lawton, Ph. D.

Publication Year: 2001

With the number of elderly persons needing long-term care expected to double to 14 million over the next two decades, assisted living has become the popular choice for housing or care. Assisted living represents a promising model of long-term care that blurs the sharp distinction between nursing homes and community-based care and reduces the gap between receiving long-term care in one's own home and in an "institution." Assisted Living: Needs, Practices, and Policies in Residential Care for the Elderly examines the evolving field of residential care and focuses on national issues of regulation, reimbursement, and staffing. The book is based on a four-state study of assisted living facilities and describes the facilities, the persons residing in them and their needs, and how the services vary by facility. Because one-third to two-thirds of residents in assisted living facilities have cognitive impairment, special attention is devoted to dementia care. The book also focuses on how today's long-term health care environment evolved, and it examines the future direction and implications of assisted living. Assisted Living: Needs, Practices, and Policies in Residential Care for the Elderly brings together a group of nationally recognized experts to help define the types of residential care that should be encouraged and sets guidelines for selecting an appropriate type of facility.

Published by: The Johns Hopkins University Press

Title Page, Copyright

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pp. vii-ix

My age peers and I experienced the beginning of age-targeted housing for older people. It was a time for excitement over the idea that a new form of community had been created to fill a niche of need that fell between the healthy elder able to live in the community and the frail elder who required...

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pp. xi-xiii

Assisted Living is composed of three parts. Part 1 focuses on broad, substantive matters in residential care/assisted living (RC/AL) as they have evolved in today’s long-term health care environment. Nationally recognized experts from a variety of disciplines have contributed these chapters...

List of Contributors

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pp. xv-xvii

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pp. 1-6

The past decade has seen the emergence and growth of a new industry known as assisted living. Consumer demand, concerns about nursing home quality, and pressure from providers have combined with state interest in containing long-term-care costs to produce dramatic growth in...

I: Key Topics in Assisted Living

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1. State Policy and Regulations

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pp. 9-33

Assisted living is both a generic concept and a specific model. In many states, there is considerable overlap between board-and-care and assisted living rules. Facilities and state regulators often use the terms assisted living and board and care interchangeably....

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2. Residential Care/Assisted Living in the Changing Health Care Environment

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pp. 34-52

The most significant trends in the health care environment over the 1980s and 1990s were the rise of managed care and the development of integrated provider or delivery systems. Some view these two changes as having transformed the health care system itself and as linked indicators for...

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3. Creating a Therapeutic Environment: Lessons from Northern European Models

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pp. 53-77

Assisted living provides long-term-care services in a setting that is residential in both character and appearance. Design professionals have been instrumental in leading the orientation toward assisted living and away from the traditional institutional setting of skilled nursing facilities. The...

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4. Staffing Problems and Strategies in Assisted Living

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pp. 78-91

Staffing is one of the most important challenges facing the residential care/assisted living (RC/AL) industry today. Clearly, direct-care staff are responsible for delivering many of the services that define RC/AL, and they play a key role in determining the quality of care that residents receive....

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5. African American Use of Residential Care in North Carolina

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pp. 92-114

Little is known regarding the use of long-term-care facilities by African Americans other than a few simple facts. First, it is well documented that African Americans use nursing homes less than whites (Belgrave, Wykle & Choi, 1993; Greene & Ondrich, 1990; Hing, 1987; Kemper & Murtaugh,...

II: Diversity in Profile: Assisted Living in Four States

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6. An Overview of the Collaborative Studies of Long-Term Care

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pp. 117-143

Despite the prevalence and diversity of residential care/assisted living (RC/AL) (see part 1), there are virtually no comparative outcome data in this area, and even less is known regarding the relationship of the structure and process of care to resident quality of life. To begin to address...

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7. Resident Characteristics

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pp. 144-172

Residents are a focal point in the study of residential care/assisted living (RC/AL), since their needs should drive the creation of the facilities and services. As new forms of RC/AL emerge, it is critical to understand the characteristics of residents in order to plan for an aging population. Questions...

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8. The Physical Environment

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pp. 173-197

There is little doubt that the physical environment affects the comfort and well-being of residents, staff, and visitors in residential care/assisted living (RC/AL) facilities. The environment’s contribution to quality of life is pervasive and extensive. It provides the all-important first impression...

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9. The Process of Care

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pp. 198-223

A significant impetus to the growth of the field of residential care/assisted living (RC/AL) was to provide alternative residential options for persons who did not require or desire the medical care and medical model of care embodied by nursing homes. Consequently, the policies and services...

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10. Aging in Place

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pp. 224-241

A growing number of older adults who have physical or mental disabilities are turning to residential care/assisted living (RC/AL) facilities when they can no longer live independently and require a supportive environment. Many who enter RC/AL settings do so with significant deficits in...

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11. Care for Persons with Dementia

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pp. 242-270

Alzheimer disease and related dementias are among the most common diseases and conditions leading to placement in a residential care/assisted living (RC/AL) facility or nursing home. Persons with dementia now constitute the majority of nursing home residents (Teresi et al., 2000). As is...

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12. Economics and Financing

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pp. 271-291

Economic forces play a major role in the structure and viability of the residential care/assisted living (RC/AL) industry. Conceptually, the issues relevant to the economics and financing of RC/AL facilities may be divided into two levels, as indicated in table 12.1: industry domains and individual...

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13. Connectedness in Residential Care: A Qualitative Perspective

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pp. 292-313

This chapter is about the nature of the connections in residential longterm care: connections between residents and staff, residents and residents, residents and the facilities in which they live, and residents and the larger community. Its goal is to view residents as people, living life within...

III: Future Directions in Assisted Living

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14. Emerging Issues in Residential Care/Assisted Living

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pp. 317-331

Many issues related to residential care/assisted living (RC/AL) have been raised throughout this book. This chapter compiles, summarizes, and expounds on some of the cross-cutting and pressing themes. The topics are not comprehensive and may not represent the most pressing concerns of...


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pp. 333-344

E-ISBN-13: 9780801877216
E-ISBN-10: 0801877210
Print-ISBN-13: 9780801867057
Print-ISBN-10: 0801867053

Page Count: 368
Illustrations: 5 halftones, 11 line drawings
Publication Year: 2001

Research Areas


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Subject Headings

  • Congregate housing -- United States.
  • Older people -- Housing -- United States.
  • Older people -- Care -- United States.
  • Life care communities -- United States -- Management.
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