The Rhode Island Assisted Living Association represents the interests of assisted living communities in Rhode Island, advocating for public policy at the state and federal level, supporting advisory boards and helping assisted living providers plan for the future. That future is poised to increase demand on assisted living facilities’ services in upcoming decades. In 2016, the U.S. Department of Health & Human Services published research estimating that 52 percent of Americans turning 65 today will develop a disability requiring long-term services and support.
The population of people 65 and older is growing. According to a Population Reference Bureau report, “Aging in the United States,” the number of Americans ages 65 and older is projected to more than double from 46 million today to more than 98 million by 2060. The 65-and-older age group’s share of the total population is expected to rise from 15 percent to nearly 24 percent. Providence Business news asked Kathleen Kelly, executive director of RIALA, a few questions about the assisted living industry’s present condition and future challenges.
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PNB: What shape is the local long-term care industry in?
KELLY: The assisted living industry is growing in R.I. There have been four new communities that opened this year. There are 63 licensed assisted living communities with different amenities across the state serving more than 4,000 residents. Assisted living is regulated by the R.I. Department of Health. Each is required to provide lodging, meals, activities and personal services.
Rhode Island is one of the top three states with the most citizens over 85 years of age. And the oldest baby boomers are only 71 years of age. The boomers have quite different expectations for their older years and assisted living communities are retooling to meet their needs.
PBN: What is the most pressing challenge providers face?
KELLY: Assisted living is a great industry to work in, the challenge is to find people who are interested in working with older adults that have the compassion, maturity and the respect to do so. The vast majority of direct care workers earn much more than the minimum wage, but as the minimum wage rises, the deference narrows. If you work at Target or Walmart during a hurricane or blizzard, the store will likely close. In our industry, we are calling people into work because we operate 24/7.
Our residents are vibrant, interesting people who have lived a long time and have fabulous stories to share. Sometimes the biggest challenge is to resist sitting down to listen to their entire life story in one sitting!
With advances in medicine people are living longer with chronic diseases, and Alzheimer’s disease will be the next hurdle. This disease requires a lot of guidance and supervision; it can exhaust spouses and add a terrible strain on families. Our industry understands this disease and excels at caring for people with memory loss through engaging activities and support.
The philosophy of assisted living is to respect dignity, choice and independence while providing support where it is needed. Memory care services allow family members to care about their loved one but leave the care-giving to assisted living.
PBN: Has the Affordable Care Act’s survival improved the outlook and/or planning ability for providers?
KELLY: The majority of people pay for assisted living out of their own resources, like retirement funds or the sale of their home. Medicare does not cover assisted living services. The ACA is mainly funded by Medicaid dollars, so it has not directly impacted our industry. There is a very small Medicaid program of about 800 people that pays for assisted living for very low-income adults. The indirect issue is that as these dollars are stretched to cover health care needs for younger adults, there is no long-term plan to cover assisted living services for older adults.
PBN: What is the most important thing people considering long-term care should keep in mind?
KELLY: We plan to get married, buy a house and educate our children. And we think we will live forever, so few people plan for the last chapters of life. The most important thing is to have this tough conversation before a crisis occurs. People want to stay in their own home if possible, but being home alone isolates a person and often makes them feel very dependent on others.
Assisted living is an active, vibrant option where people dine with others and participate in activities aimed at their interests. When my favorite aunt was widowed, she spent hours watching TV and picking at the meals prepared by family members. Then she moved to assisted living; now she walks with a group of ladies every day, learned to play bocce and planted a garden. She couldn’t keep a house plant alive at home. Although she has trouble remembering names, she knows everyone in the community and is a popular first pick for anything competitive.
PBN: How are assisted living facilities regulated in R.I.?
KELLY: Other states lump group homes for people with behavioral health issues and other residential options under assisted living. In R.I., assisted living is clearly defined in law and regulation and does not include other residential options. The smallest assisted living facility serves 15 people and the largest 177.
There are two higher levels of assisted living: Specialty Care designed for people with Alzheimer’s disease who have significant memory loss, and Limited Health Services that allows for the provision of additional nursing services. The Department of Health and the State Ombudsman visit assisted living communities regularly to be sure the regulations are being followed.
Rob Borkowski is a PBN staff writer. You can email him at Borkowski@PBN.com.
