Committee Meeting Memos

99121

Prepared by the North Dakota Legislative Council staff for the Budget Committee on Long-Term Care
September 1997

COMPARISON OF ASSISTED LIVING, CONGREGATE HOUSING, BASIC CARE, AND NURSING HOMES

	Assisted Living	Congregate Housing	Basic Care	Nursing Homes
Definition	An environment where a person lives in an apartment- like setting and arranges for services necessary to accommodate that person's needs and abilities in order to maintain as much independence as possible.	An environment where a person lives in an independent apartment setting which may include a central lobby, dining room, and activity areas.	An institutionalized setting that provides room and board to individuals who, because of impaired capacity for independent living, require health, social, or personal care services but do not require regular 24-hour medical or nursing services.	An institutionalized setting that provides room and board and 24-hour care under the supervision of a licensed health care practitioner.
Comparison	Assisted living environments emphasize the freedom of choice. Residents live in apartment-like units. The services provided vary according to individual needs and may include meals, housekeeping, laundry, activities, 24-hour supervision, personal care, medication reminders, and varying levels of health care. Residents may choose their own additional home health service providers, if needed.	In congregate housing environments, residents usually live in independent apartments. The emphasis is on community/common spaces which may include a central lobby, dining room, and activity areas. Usually one meal a day is available in a common dining area. The provision of other services such as transportation and minimal housekeeping may or may not be provided.	Basic care facilities are an institutionalized setting used to provide room and board, as well as health, social, and assistance with daily living activities 24 hours a day. Other services offered include recreational and therapeutic activities, dietary consultation, and the administration of medications.	Nursing home facilities are an institutionalized setting used to provide nursing, medical, and rehabilitative care, room and board, recreational activities, and assistance with daily living and protective supervision 24 hours a day.
Funding Sources	Assisted living environments provide and charge residents separately for housing costs and for the cost of any daily living activities assistance.Individuals living in an assisted living environment may be private pay or utilize public assistance programs.If the individual qualifies, housing assistance programs may be utilized to help the individual with housing costs.If the individual qualifies, the Medicaid waiver for the aged and disabled, SPED program, and expanded SPED program may be utilized to help the individual with the cost of daily living activities assistance.	Currently the Medicaid waiver for the aged and disabled, SPED program, and expanded SPED program do not participate in congregate housing.Therefore, all individuals living in a congregate housing environment are private pay residents. Residents of congregate housing can receive public housing assistance if they qualify. This assistance only provides help with the cost of the housing. Assistance is not provided to help defray the cost of assistance with daily living activities.	Basic care facility residents are charged one rate, which provides for room and board, personal care, and daily living activities assistance.Basic care facility residents can be either private pay or state pay through the state's basic care program.	Nursing home facility residents are charged one rate, which provides for room and board, personal care, and daily living activities assistance.Nursing home facility residents can be either private pay or state pay through the Medicaid program.
License	Based on a May 3, 1994, Attorney General's opinion, the following criteria describe residential environments which provide assisted living but which are not basic care facilities: The tenant may freely choose personal service providers. The apartment-like unit in an assisted living facility must include a kitchen. The tenant determines the services that allow the tenant to maintain the degree of independence the tenant believes appropriate. Each tenant must be competent or must have an existing onsite method or substitute decisionmaking (live-in spouse, parent, or adult child). The opinion also states that the question of whether a residential environment is "institutional" in nature, and accordingly subject to licensure by the state, is a question which must be answered on a case-by-case basis.	Congregate housing is not licensed by the state.	Basic care facilities are licensed by the State Department of Health.	Nursing home facilities are licensed by the State Department of Health.