A senior care or simply eldercare, is the fulfilment of the special needs and requirements that are unique and necessary to senior citizens. This broad term encompasses such services as assisted living, adult day care, long term care, nursing homes or residential care, hospice care, and home care. Because of the wide variety of elderly care found nationally, as well as differentiating cultural perspectives on senior citizens, cannot be limited to any one practice. Elderly care emphasizes the social and personal requirements of senior citizens who need some assistance with daily activities and health care, but who desire to age with dignity. It is an important distinction, in that the design of housing, services, activities, employee training and such should be truly customer-centered.
In the last 150 years, senior care has undergone a remarkable transformation. Old ideas of clinical, minimal senior care have been left behind in favour of full-service catered care. The way that we think about ageing is changing and the future is full of promise.
Historically, senior living facilities were focused primarily on providing health services for those at an advanced age. However, the idea of senior living – as well as the facilities designed and built to accommodate this population – has changed significantly in recent years. This evolution has been especially evident as the Baby Boomer generation has aged into the primary users of senior care facilities.
The Beginning of Assisted Living Facilities
Before the 1970s there weren’t many options for senior citizens. You could have someone come to your home to provide in-home care or go to nursing home, which at that time we’re not a very pleasant place to be. During this period, nursing homes were institutions where lower-income seniors were sent to die out of sight. These facilities were cold and sterile, and the entire institution was known for neglecting and abusing elders.
Assisted living facilities are now one of the most popular choices available to seniors, but they are a relatively new concept.
Birth of a Paradigm Shift: 1979 to 1985
Residential Care Before Assisted Living
Residential settings for older people with health problems, ranging from ordinary boarding homes to philanthropically funded organizations often called homes for the aged, typically predated the 1965 enactment of Medicare and Medicaid, which shaped the modern nursing facility. After 1965, many homes for the aged converted to nursing facilities with encouragement from state governments, which welcomed matching federal money to help state and local governments finance long-term care for low-income people. The nursing facility sector expanded rapidly after Medicare’s and Medicaid’s enactment. Over time, nursing facilities became more hospital-like in their design and physical operation. But some residential care facilities did not convert to certified nursing facilities, either because they could not meet the regulatory standards even for the lesser level.
The residential care industry continued to expand even as the demand for nursing facility beds grew. Retirement housing aimed at well-to-do seniors was sold as a lifestyle choice for seniors seeking company, meals, and housekeeping.
Early Hybrid Model
Assisted living developed independently at about the same time in Oregon and Virginia as a uniquely defined long-term-care option designed to appeal to older people seeking a more residential setting, a more familiar and comfortable lifestyle, and assistance for a wide range of needs. We call these hybrid models because they represented a composite of the hospitality, health care, and housing fields. The models were considered novelties during this early period and were quite controversial. Licensing agencies, nursing facility providers, many professionals, and some advocate groups openly talked about their potential to be unlicensed nursing facilities. Financing was largely through private equity capital. Traditional institutional lenders such as real estate investment trusts, the U.S. Department of Housing and Urban Development, commercial banks, and mortgage lenders had virtually no interest in funding their development, and therefore growth was extremely limited.
Aging in Place and the Divergence of East and West
Although both the eastern and western models shared a philosophy emphasizing resident autonomy in homelike settings, they diverged with respect to server capacity, at least in part because of differing state policy environments. Virginia and other states mandated fairly restrictive residency criteria for those permitted to live in assisted living, resulting in less incentive for providers to develop internal service capacity. The ability to remain in assisted living despite escalating care needs was often contingent on arrangements for ancillary or third-party providers to deliver services beyond those provided by the setting. Conversely, the State of Oregon was committed to a high level of service in care settings other than nursing facilities and almost from the beginning was willing to use Medicaid as an individual funding stream for services. It also envisaged and implemented policies and programs to encourage heavy care and ageing in place to happen, including modification of nurse practice acts and permissive regulations.
From 1986 to 1993
New converts in Oregon: State, Consumers, and providers
From 1986 to 1993, the providers, consumers, and government became interested and created four distinguishable kinds of assisted living communities. They included hybrid (reworking the old style), hospitality (resort-like setting), housing (55+), and health care (continuum care model) appeared.
The state of Oregon conducted one of the earliest such studies of assisted living in 1986 when a second pilot, Regency Park, a 142-unit setting also licensed as a residential care facility under regulatory waivers, opened in Portland.
Thus reassured, in 1988 the State of Oregon launched a major new statewide initiative to support the development of assisted living. Because assisted living expansion required more capital investment than did foster home development (which largely relied on existing housing stock), the decision to cover assisted living as a waiver service ushered in an 18-month-long process of rule writing, public hearings, and state-sponsored training on the nature of assisted living in Oregon, which also resulted in substantial awareness and buy-in from all relevant state agencies.
Evolution of Models: Diversity Reigns
From its earliest days, assisted living was a lightning rod, attracting arguments about what it was, who it was for, how it should be regulated, and whether it could deliver on its promise. In 1992, AARP commissioned a national study of assisted living, which was the first to propose a working definition of the term: a group residential setting not licensed as a nursing facility that provides or arranges personal care to meet functional requirements and routine nursing services.
During this period of evolution, it became possible to identify four different broad types of assisted living that took their predominant character depending on whether they represented the hybrid model, a hospitality model, a housing model, or a health care model. Each contributed something to the entity that assisted living ultimately became.
From Model to an Industry: 1994 to 2000
Assisted Living Goes Public
In November 1994 the Assisted Living Concepts went public, going Wall Street for money to build more of its Oregon model of assisted living across the United States.
In 1995 and 1996, other assisted living companies also went public, including Sunrise, Atria, Sterling, and Karrington, all of which were small early adopters of the hybrid model of assisted living. But now, with Wall Street firmly in the picture, assisted living providers had access to capital and a mandate to grow.
Today, due to older adults living longer, the eruption of chronic illnesses, and the exploding boomer market assisted living is reorganizing and examining its standards and how it provides care.
Question About Quality
Regional daily newspapers ran stories of services not being provided and of residents being asked to get extra private help, and advocates for frail elders expressed concerns that individuals were being kept too long in assisted living. These advocates asked pointed questions about what assisted living was and for whom it was appropriate. Assisted living needed clarity, and consumers and payers needed to know what they were buying. The industry answered this concern by vowing support for disclosure, encouraging providers to define their services and providing that information to prospects before they moved in.
2000 to Present
Today the majority of assisted living facilities want to provide seniors with a secure, but independent experience, which emphasizes the quality of life above everything else. Assisted living communities, like Stellar, provide high-quality health care 24 hours a day, fine dining options, and a huge variety of activities for seniors to socialize and pursue their favourite hobbies.
Many assisted care homes to accept Medicaid, making them a feasible option for people like Brown Wilson’s mother with little to spend. A simple suggestion from one senior to her daughter helped shape how millions of ageing Americans live today.
After a long and productive life, seniors have earned the ability to choose a lifestyle they find dignified and personally satisfying. The advent and spread of assisted care homes spoke to that need and put the option for a better life in the hands of many seniors.