Assisted Living Evolution Marked by Great Recession’s Impact

The Great Recession can be considered assisted living’s turning point, marking a pronounced shift from being primarily a lifestyle choice to primarily a needs-driven decision for consumers. “Ten to twelve years ago, assisted living was more lifestyle-driven,” says Allison Guthertz, Vice President, Quality Resident Services at Benchmark Senior Living. “These days when residents move in, they already need help with three to five activities of daily living (ADLs).”

Compared with about 10 years ago, current trends for incoming residents reflect more than just care needs: The average age of a resident upon move-in has shifted from 82 to 87, according to Guthertz, driven by the economic downturn.

In the early 2000s as an executive director at a Sunrise Senior Living community, Guthertz says it wasn’t hard to build occupancy as people wanted to be part of an active senior environment. “Then the stock markets took a plunge, and it was hard to get residents to move in,” she says. “They were very worried about their money, and didn’t want to move in until they needed to, for health reasons.” While that has impacted assisted living community design, it began evolving far before the recession to reflect changing needs.

Assisted Living Evolves
In the early 2000s, providers started talking about assisted living as the redefinition of nursing care, says Victor Regnier, FAIA, Professor of Architecture and Gerontology at the University of Southern California.“It was a big realization: we’re replacing nursing homes [for certain populations],” he says. “Most people with the means to pay for assisted living would never want to go to a nursing home.” As states started recognizing this trend, regulations developed to allow residents to stay in their assisted living communities as long as possible, with their consent and the agreement of their doctor, family and the care provider.

Many communities’ healthcare amenities have changed to facilitate aging in place. A decade or so ago, a building may have just had a small, central nurses’ office for record-keeping. Now, communities are promoting a holistic wellness approach, Gutzhertz says, creating a medical suite with spaces for doctors with a range of specialties, therapy and rehabilitation, exercise, and massage.

“People recognized very quickly that for a building to be useful and worthwhile, it needed to be focused toward individuals who had a really hard time living independently,” Regnier says, such as those with some form of dementia. It signaled a huge mindset shift, he says. When assisted living was first gaining popularity in the early 90s, only some providers recognized that memory care would be an important component, while others “didn’t quite get it.”

Back in those days, Regnier was consulting with a large assisted living provider that was “shocked” when he recommended including a dementia unit adjacent to or within the community that was being designed.“They said, ‘No, no, we’re not going to do that—that’s not our business. We want ‘young’ older people that might have some difficulty getting around, or need help with meals—that’s it,’” Regnier recounts. That changed in about five years, he says, as providers recognized that the market was for deeper health and assistance.

The Future of Assisted Living
In the last three to five years especially, the recognition that assisted living census will be increasingly comprised of people with memory impairments is being emphasized even more. While providers may have initially expected memory care to account for 40% of assisted living business, it will actually be more like 80% in the future, according to Regnier. “People who can stay at home, will stay at home,” he says. “There’s all kinds of current and potential technology available, but you have to be able to manipulate it. If you have full-blown dementia, it won’t work for you.” At this point, with no cure for Alzheimer’s and related diseases in sight, those with memory impairments will likely have to enter an assisted care setting at some point.   

We need to change our design approach to allow for transitional living for people with cognitive impairments.  Currently the option is being put away in a locked ward to wander with caregivers not having a real clear understanding or training in how to interact with this residents.  Or cognitive impaired residents try to hide out in the assisted living side where the environment overwhelms them and they become more and more isolated.  I presented a re-design of a local facility that would provide a transitional approach and would provide more interaction between residents, family member and staff with activities based upon Laura Wayman's "Loving Approach".  The design included multiple cuing for more independence in the residents performing their everyday living skills as well as increasing or maintaining their cognition

The Greenhouse Project promotes group living

“There’s no way to avoid it—people are going to live longer, and this is a population that’s going to require group living, because you just can’t do it in an independent housing environment,” Regnier says. “That’s the future right now.”

Healthcare reform under the Affordable Care Act has also been an impetus for senior living providers to start changing gears, Guthertz says.“Assisted living needs to be the cost effective referral choice for hospitals and long-term care settings to help manage cost and the Medicare benefit,” she says. “The industry needs to continue to stay on the cutting edge as competitive and cost effective—while remaining a safe environment—so when residents do move into a long-term care setting, it’s because they truly need that level of care.”

Written by Alyssa Gerace
This article is sponsored by the Assisted Living Federation of America (ALFA) as part of its efforts to advance excellence and explore topics impacting the future of senior living. For more information about ALFA, visit www.alfa.org.
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