Assisted Living Remains Viable Long-Term Care Option

HARRISBURG — Pennsylvania’s assisted living law remains an important option in the state’s long-term care continuum, but significant barriers continue to prevent the sector from reaching its full potential to serve an aging population seeking more alternatives in care, according to Russ McDaid, President and CEO of the Pennsylvania Health Care Association (PHCA).

Pennsylvania has 1,203 licensed personal care homes but only 35 licensed assisted living residences. When the law establishing “assisted living” was enacted in 2007 and took full effect in 2011, many anticipated that more personal care homes would transition to assisted living residences, but that hasn’t happened largely because of licensing fees and renovation costs.

“We believe that Pennsylvania consumers should have the opportunity to age in the most appropriate setting at each stage of their life,” McDaid said in testimony before the House Aging and Older Adult Services Committee. “There is and always will be an equally important place for personal care homes and assisted living residences on the state’s long-term care continuum. But right now, the challenges to obtain an assisted living license are still too costly and burdensome for many operators.”

Nursing homes provide the highest level of around-the-clock skilled medical care. Personal care homes provide food, shelter and personal assistance for things such as dressing, bathing, diet or financial management, with the ability to bring in additional health care services from outside providers as a resident needs them. Assisted living residences fall in between, providing food, shelter and personal supervision, as well as supplemental health-care services.

When personal care home residents need the type of skilled care provided in a nursing facility, they often need to transition to another facility. Assisted living residences are equipped to manage higher acuity, or sickness, levels among residents. The law intended for these residences to fill the gap between when individuals need more care than a personal care home can provide, but not yet 24-hour nursing home care.

McDaid indicated that two factors contributed to the slow transition from personal care home to assisted living residence: licensure fees and physical plant, or construction, requirements.

Many personal care homes already are able and willing to meet the service requirements of the assisted living residence regulations, but due to the age of their buildings or their philosophy of care, they cannot meet the physical plant requirements, such as larger room sizes, the availability of full private bathrooms, and a mandate for full kitchenettes, McDaid said.

There also is great disparity between assisted living and personal care licensure fees. An assisted living residence can pay upwards of 260 times more for their annual license renewal than a personal care home.

PHCA has been working with its members and regulators at the Pennsylvania Department of Human Services, as well as legislators, to encourage more flexibility in the physical plant requirements, and for amendments to the licensure fees to ease and encourage the transition from personal care home licensure to assisted living residence licensure.

“We want the assisted living regulations to change, without compromising safety, quality of care and the intent of the regulations, so they are less burdensome for personal care homes that choose to make a transition to assisted living,” McDaid said. “At the end of the day, we all want residents to age in the setting that’s best for them, and that ensures their safety and comfort are accommodated.”

Testimony is available on the PHCA website at https://www.phca.org/advocacy/issue-brief-testimony/.