By Robyn Stone
Assisted living will change the future of aging if providers can tap into the evolutionary spirit that spurred its early success, writes Robyn Stone.
For the past 80 years, the residential care model we call “assisted living ” has had an uncanny ability to evolve so it could better meet the needs of older consumers. Now is the time for our assisted living communities to tap into that evolutionary spirit once again.
The assisted living model first appeared in board-and-care homes during the 1940s. But assisted living experienced its most dramatic evolution in the 1980s and 1990s. That’s when a growing number of providers began delivering personalized supportive services in homelike settings that emphasized resident choice, independence, dignity, and privacy, according to a recent commentary in Health Affairs that I co-authored with Sheryl Zimmerman of the University of North Carolina at Chapel Hill, Paula Carder of Portland State University, and Kali Thomas of Johns Hopkins University.
Older adults liked the assisted living model, so we built more communities, and consumers came in droves to experience this new approach to residential care. Despite its appeal, however, assisted living could not avoid the disruptive demographic, workforce, and market changes that have rocked our field in recent years.
It’s easy to be discouraged by these disruptions. However, I prefer to see them as opportunities that can inspire us to examine the current state of assisted living with clear eyes and take action to ensure that this model will evolve to meet the needs of a changing older population and the demands of a changing marketplace.
If we do this work now, assisted living will surely change the future of aging services. But if we postpone this work, I fear our once-revolutionary assisted living model may fail to keep the promise we made to older adults decades ago: that our high-quality, person-centered assistance would always be available to those who needed it.
What should our work entail? I have a few suggestions.
Improve quality of care. Improving quality of care is an ongoing mission that we must all undertake, no matter how well we think we are meeting resident needs. We must adopt up-to-date, research-based approaches to providing services and supports and we must track our progress through robust quality improvement efforts. Only then will the people we serve, and the people we want to serve, be assured that the care we provide is the best available.
Strengthen the workforce. Today’s assisted living residents have more extensive care needs than their predecessors. A growing percentage of these residents are living with some level of cognitive impairment. Many have multiple chronic conditions. We need an exceptionally competent, stable workforce to provide quality care and promote quality of life for these high-acuity consumers. Higher wages, better training, and career development initiatives can help us recruit and retain these caregivers.
Balance autonomy, choice, and safety. Given the increasing cognitive and physical needs of the assisted living population, we must think more seriously about developing an approach to residential care that acknowledges and accepts certain safety risks posed by a resident’s preferred activities. Developing this approach in collaboration with residents and their families will be challenging, but it will also offer us an opportunity to provide high-quality care and support that is truly person-centered.
Promote affordability. Assisted living will eventually lose consumer appeal if most prospective residents can’t afford its rising cost. Lowering the price consumers pay for care won’t be easy, given the limited availability of private insurance coverage and the variability of financial assistance through the Medicaid program. However, we must persist in seeking ways to make assisted living more affordable for the growing number of people who need it.
This is not all we can do, but it’s a good start. I urge you to read our Health Affairs commentary for more ideas.
Robyn I. Stone, DrPH, is senior vice president of research at LeadingAge, and co-director of the LeadingAge LTSS Center @UMass Boston. Her widely published work addresses long-term care policy and quality, chronic care for people with disabilities, the aging services workforce, affordable senior housing, and family caregiving.