A National Study of Assisted Living for the Frail Elderly: Final Summary Report. C. Conclusions


These results indicate that significant differences in policies and performance exist between groups of facilities categorized on the basis of different combinations of service and privacy levels. They respond differently to residents’ needs and preferences and embody, to varying degrees, key elements of the philosophy of assisted living. Some features seem to have a fairly direct effect. For example, ALFs with higher levels of privacy tend to offer residents both greater privacy and greater levels of autonomy. However, the effect of facility characteristics is more complex when multiple characteristics (i.e., service and privacy) are considered. Moreover, some features will increase one desirable performance indicator (e.g., environmental autonomy) and decrease another (e.g., affordability). Perhaps the most significant finding, however, is that no one model or type of ALF appeared to maximize ALF performance across all or even most of the indicators. Thus, at present, the results provide only limited guidance for policy.

It is important to note the limitations of this analysis. First, this array of performance indicators is limited in scope. Moreover, the basic classification system for ALFs is restricted in scope, and there may be a variety of other facility classification schemes that could work equally well with these and other indicators. The task for future analyses is to develop a wider range of indicators of residents’ needs and preferences and more sensitive facility classification schemes that might provide more comprehensive and consistent differentiation among these indicators.

These findings -- and their necessarily limited nature -- present policy-makers and consumers with significant challenges. For consumers, the multiplicity of models of assisted living and the differential effects of key features on facility performance mean that consumers must seek and consider substantial, diverse information when selecting from among a group of facilities. For policy-makers it seems clear that they must not consider the effect of individual features but instead take into account their combined effects when setting standards for licensure or certification (e.g., for participation in Medicaid waiver programs).

Differences Among Services and Policies in High Privacy or High Service Assisted Living Facilities
AUTHORS: Charles D. Phillips, Catherine Hawes and Miriam Rose
DATE: November 2000
     Full Report (http://aspe.hhs.gov/daltcp/reports/alfdiff.htm)

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