The SCAN Foundation

Assisted living communities are home to a million people who are receiving long-term services and supports, but usually at a much less intense level than the care available in nursing homes. Unlike nursing homes, which are under a relatively strict set of rules because the nursing homes receive large amounts of federal money, the assisted living industry is regulated by the states, and there is great variation in state handling of this industry. The continuum of care in assisted living facilities varies — some residents may just need to be reminded to take their medicines, others will need help with bathing — making the application of regulations uncertain, with each state having different policies and approaches. “A long term care option preferred by many individuals and their families because of its emphasis on resident choice, dignity, and privacy, assisted living continues to grow while adapting to changes in consumer wants and needs,” according to a March, 2010 report “Assisted Living State Regulatory Review 2010," by the National Center for Assisted Living.

“Patients in American hospitals receive intensive medical treatments,” that are not always the best for end-of-life situations, according to the June 28, 2010 report “The Quality of Care Provided to Hospitalized Patients at the End of Life," in the Archives of Internal Medicine. “However, when life saving treatments are unsuccessful, patients often die in the hospital with distressing symptoms while receiving burdensome care,” the report said.

“An elderly person’s fear of falling can actually exacerbate underlying physical conditions, creating a ‘vicious circle,’ which could lead to a greater risk of falling,” according to May 17, 2010 story in McKnight’s Long-Term Care News. Falling often will disable a person, making them unable to function independently. They may be forced into requiring extensive long-term services and supports, according to the article “Gait Disturbances in Old Age,” from the Neurological Hospital and Health Center of the Ludwig Maximilians University in Germany.

More than a million people receiving long-term services and supports are “dual eligibles” enrolled in Medicare because they are over 65 and in Medicaid because they are poor. The “dual eligibles” have been found to have higher than average medical expenses, according to chapter five in the June 2010 report, “Report to the Congress: Aligning Incentives in Medicare," by the Medicare Payment Advisory Commission.