The proliferation of differing and sometimes contradictory definitions of “assisted living” is confusing to consumers and leads to unnecessary variability when policy is being made and research is being conducted. Thus, as part of its ongoing national collaborative to further the well-being of those who live and work in assisted living, the Center for Excellence in Assisted Living (CEAL@UNC) has released the following definition of assisted living communities:
Assisted living communities are licensed residential settings that provide housing; personal care; wellness, social, recreational, and health-related services such as nursing and dementia care; and 24-hour access to staff. These communities’ core principles include person-centered services and policies, as well as an adequate number of well-trained, supported staff. Person-centered services and policies promote quality of life, privacy, choice, dignity, inclusion and independence as defined by each individual and those who know them best.
With all 50 states providing a unique regulatory definition of assisted living and a plethora of licensure categories, alongside organization-based definitions such as those provided by the National Center for Assisted Living and the Centers for Disease Control and Prevention’s National Center for Health Statistics, it is natural to ask: Do we need yet another definition of assisted living? In short, yes.
Defining what is and is not assisted living is consequential for regulation and policy, financing, staffing, accreditation, care provision, quality improvement, recommendations, research and consumer education. With that broad lens, CEAL@UNC’s intent is to bring unity to the varying definitions and make clear the key constructs that are not fully recognized in existing definitions.
A recent review of state licensure definitions conducted by CEAL@UNC found that few states currently define assisted living as providing person-centered care. From its inception, the philosophy of assisted living has been one of personalized services. Expressly noting the intent of person-centered services — such as to promote quality of life — provides a measurable metric to determine whether assisted living is meeting its mission, which may be determined by residents or by those who know them best. Explicitly including the phrase “those who know them best” acknowledges that the majority of assisted living residents have some degree of cognitive impairment, underscoring why “dementia care” is referenced as a health-related service.
Only half of current state licensure definitions reference assisted living as providing dementia or nursing-type healthcare, which fails to reflect the status of today’s assisted living: the 2020 National Post-acute and Long-term Care Study reports that 86% of communities offer pharmaceutical management; 75% physical, occupational or speech therapy; and 65% skilled nursing. Those numbers reflect what has been said for years: that assisted living residents look like nursing home residents from more than a decade ago.
For that reason, well-trained and supported staff members, in adequate numbers, are critical to meet residents’ cognitive and healthcare needs, yet as in nursing homes, severe staffing shortages and turnover plague the industry. It seems an obvious oversight, then, that virtually all definitions of assisted living — other than CEAL@UNC’s — are silent on the matter of having an adequate number of well-trained and supported staff members. Adequacy should be determined by resident acuity, and similar to person-centered and quality outcomes, the sufficiency of staffing levels, and the training and support staff receive, are measurable.
The comprehensive definition of assisted living provided by CEAL@UNC addresses the foundational intent of assisted living as well as the evolving reality and complexities of the setting. By emphasizing the centrality of person-centered care, health and dementia-related services, and the support and training of staff, this definition not only aligns with the realities faced by residents and caregivers but also sets a standard for quality and accountability.
As the landscape of assisted living continues to change, CEAL@UNC’s definition serves as a unifying framework that can guide practice, policy and research, as well as inform consumers. Ultimately, a common definition can promote efforts to ensure that assisted living communities are well-equipped to provide holistic, dignified and individualized care, honoring the lives of residents and the dedication of those who care for them.
Sheryl Zimmerman, PhD, is the executive director of the Center for Assisted Living, CEAL@UNC.
The opinions expressed in each McKnight’s Senior Living guest column are those of the author and are not necessarily those of McKnight’s Senior Living.
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