Since the 1980’s, assisted living centers (ALCs) have offered seniors a compromise between the independence of private residences and the security and aid of nursing homes, providing residential living with varying degrees of care. According to the Massachusetts Executive Office of Elder Affairs, assisted living centers are ideal for adults who need help with some activities such as housecleaning, meals, bathing, dressing, and medication reminders but also prefer to be in a non-institutional environment. Across the U.S., there are 30,200 assisted living communities that house 1 million residents.
Although the number of assisted living communities has surpassed that of nursing homes—of which there are 15,600 in the U.S.—there are no federal regulatory agencies that handle ALCs, leaving states to work out licensing and regulating procedures. In some states, however, the departments tasked with monitoring ALCs are overwhelmed by the sheer number of residence communities. Wisconsin, which has 3,679 licensed facilities alone, has conceived an alternative.
In 2009, the Wisconsin Department of Health Services’ Division of Quality Assurance and Division of Medicaid Services, Wisconsin’s four assisted living provider associations (representing roughly 40 percent of licensed ALCs), the state’s advocacy agency The Board on Aging and Long Term Care, and a health systems research center at the University of Wisconsin–Madison formed a unique coalition for collaborative excellence in assisted living. At the heart of the coalition are the more than 400 communities that have joined the commission and now feed into the data repository in accordance with the comprehensive quality assurance and quality improvement (QA/QI) program endorsed by the Department of Health Services. The QA/QI program is based off of two data sets, the first is a standardized satisfaction survey filled out confidentially by ALC residents and the second is a set of performance measures of quality improvement structures, processes, and outcomes provided by the communities. The communities receive reports from the University of Wisconsin–Madison based off of that data in order to improve the care and service they provide.
The key to the success of the coalition has been the presence of a wide range of stakeholders who have disregarded business motives and power structures for the good of the elders they serve. Never before has a partnership existed between state government entities, major assisted living associations, corporate stakeholders, and a university-funded health service research organization in order to provide quality assurance to people in ALCs.
The collaboration between so many entities paired with the data repository have proven a winning combination for improving ALC standards. From 2013 to 2017, the average number of falls with injury and re-hospitalizations—two common metrics of quality in senior housing—declined from 1.58 falls with injury per ALC to 1.35 falls with injury per ALC and 1.57 re-hospitalizations per ALC to 1.34 re-hospitalizations per ALC.
The coalition is poised to expand and share their promising model of quality assurance in assisted living with Massachusetts. Currently, the 237 certified assisted living centers (also referred to as assisted living residences, or ALRs) in Massachusetts are regulated by the Executive Office of Elder Affairs. Residents or individuals acting on the behalf of a resident have the opportunity to contact the Assisted Living Ombudsman if they want to launch a complaint or receive information about any complaints a facility has filed against it, but the Commonwealth lacks any standardized, annual evaluation completed by ALC residents or a database of that information. While it will certainly be a challenge to bring all the various Massachusetts government entities and assisted living stakeholders together, Wisconsin has proven that it is well worth the struggle to improve the quality of life for older people in assisted living communities.