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Assisted living facilities are slow to gain acceptance
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When 91-year-old Marie Holtzapfel arrived at RoseCrest Assisted Living Residence in July from another long-term care facility, she could hardly have been aware she was part of some rare vanguard in Pennsylvania.
For one thing, like all 15 initial residents in the homelike setting in Mars, Mrs. Holtzapfel has had dementia for years. For another, RoseCrest wasn't supposed to be the only licensed assisted-living center in southwestern Pennsylvania as of the end of October, and one of just 10 in the state.
State officials began using the new category of long-term care called assisted living in January as a middle ground between Pennsylvania's long-existing personal care home and nursing home industries. The Rendell administration, which oversaw development of the assisted-living regulations, had predicted there would be at least 150 centers licensed by now, aiming for a less institutional atmosphere than nursing homes but higher standards than what is mandated in personal care homes.
The new category is part of a trend in which state governments have tried to de-emphasize nursing home use because it is the most costly form of long-term care to help fund, in addition to being the least desired by the public.
But assisted living's growth depends on an upgrade to it among the more than 1,300 personal care homes in Pennsylvania. Thus far, they are reacting to it with all the eagerness of frail Aunt Hazel hearing it's time to move out of her longtime home into a group facility for her own good.
Ten months after implementing the new system, the state's Office of Long-Term Living had seven new staff devoted to overseeing the 10 licensed facilities -- nearly one regulator for each operator. Another 26 assisted-living wannabes were in the pipeline, awaiting approval to be licensed.
Representatives of long-term care providers said they anticipated such reluctance, especially after state officials backed off of a plan to infuse the field with funding that would cover care of low-to-moderate income residents. In addition to higher licensing fees for assisted living than personal care, facilities have to do more staff training and in many cases would need to renovate rooms to allow more living space and include in each a private shower and kitchen appliances.
Actually, Pennsylvania has had many places branding themselves "assisted living" for years. The new regulations, adopted in 2010 after years of difficult debate in Harrisburg over both those and the legislation preceding them, prohibit any facility from using the term any longer unless it upgrades to the new licensing category.
Thus, there have been name changes in the past year, such as Vincentian Assisted Living in McCandless becoming Vincentian Personal Care. But officials in the industry say that one marketing limitation and other incentives are insufficient to make many invest in the upgrade.
"Right now, we just haven't seen enough of a competitive advantage" in moving toward that, said Jim Pieffer, senior vice president of Oakmont-based Presbyterian SeniorCare, which operates five personal care homes.
Stuart Shapiro, president of the Pennsylvania Health Care Association, said that because of the costs, "People are sitting back and letting the new industry sort itself out and evolve rather than jumping right in."
Kevin Longenecker, director of the division of licensing for the state Office of Long-Term Living, said there has been a natural period for providers to assess how the regulations will be worked out and enforced. He remains confident, however, that within several years there will be 200 or more assisted-living centers.
"It's smaller than we thought, but it's new to everybody -- the public as well as the providers," Mr. Longenecker said. "The ones who have applied, who wanted to be first, have been more informed and proactive about the regulations. ... More and more providers will convert over."
Industry officials say that will depend, as so many business decisions do, on money. In this case, the Rendell administration had said all along that it would seek federal government agreement to begin providing Medicaid funding to assisted-living residents for the first time. Federal and state dollars under Medicaid already support people living in nursing homes.
But as Pennsylvania's budget picture seriously soured near the end of Gov. Ed Rendell's tenure last year, his administration never sought the necessary federal consent, which has been given in other states. The Corbett administration had no interest in a program that would add new state spending either, as it instead sought to cut the budget this year.
"It would be unfair to look at expanding services for an assisted living waiver for such a small number of recipients when we have had to scale back benefits ... for other recipients," said Department of Public Welfare spokeswoman Anne Bale.
That leaves any assisted-living facilities in the same situation as personal care homes have always been, depending on residents' own ability to pay. Low-income residents can qualify for a government personal care home supplement amounting to about $1,000 a month that goes to the facility, but that is unacceptable to many modern, large facilities because it does not come close to covering costs.
Ron Barth, president of LeadingAge PA, which represents many nonprofit providers, said they are likely to try to enter the assisted-living category if they undertake new construction, but the lack of government support makes it unlikely existing facilities would renovate to come up to the new standards.
"If [the state is] serious about wanting to keep people out of nursing homes, which we agree with as a goal ... they're going to have to get serious about how they're going to fund these services," Mr. Barth said.
"They come at you with high-end regulations, but no way to pay for it."
Debbie Hollenbach, administrator at RoseCrest, which is part of Lutheran SeniorLife, said its 30-bed facility was built to meet the new standards, which she finds are fair in terms of the benefit to residents. Built on a hilltop adjacent to the St. John Specialty Care Center, it has filled half of its beds since opening in June with a rate of $4,790 a month.
Ms. Hollenbach said there was no doubt about wanting the dementia-specific facility to be classified as assisted living. It enables residents to remain in place as their physical health declines, including to die there, whereas personal care homes are supposed to transfer individuals to nursing homes when their medical needs intensify.
"No one wants to live in their home and then have to go somewhere for a couple of days or weeks for the end of their lives," she said.
In order to market itself for dementia care, RoseCrest has to meet even higher standards than other assisted-living centers, including specialized training of its staff. Its soft colors, comfortable furnishings, outdoor courtyard and abundant use of wood and glass in its design all present a soothing atmosphere to assist the aides. Residents get a relatively spacious private living quarters -- 250 square feet, plus kitchenette and bathroom -- within a cozy shared space overall in two 15-bed cottages.
"This is smaller, more intimate, better staffed -- a homey feeling," said Barb Holtzapfel of Ross, showing up at RoseCrest to visit her mother at lunchtime recently, four months after transferring her from another facility.
Of the other applicants for assisted living, the only one in Allegheny County is UPMC Seneca Manor in Penn Hills. Others in the region awaiting approval include Weatherwood Manor in Greensburg, Retirement Village of North Strabane, Hawthorne Woods Assisted Living in Washington, Pa., and Strabane Woods of Washington.
First Published November 28, 2011 12:02 am
