Presidential Pondering

By Jeff Shireman, President/CEO

There are certain questions that I seem to field on a regular basis.  Questions like “How big is the Good Samaritan Fund?”, or, “What exactly does Medicare cover?”   However, in recent years, by far the most frequently asked question that residents have posed to me is:  “What is the difference between “personal care” and “assisted living” ?  At one point, I did say that I would commit my answer to writing so that everyone would have the same information.    So here we go…

Personal Care (PC) is a level of licensed care that has been around (in PA) for many decades.  It is (and was) established for folks who are not truly independent any longer, and who do require a modicum of assistance, but who are also not frail enough or sick enough to require skilled nursing care.   PC residents commonly need assistance with medications, dressing, bathing, etc.; Personal Care facilities are staffed by Personal Care Aides, and sometimes (though not required) by Licensed Practical Nurses.  In regulatory terms, Personal Care is often defined by what it is not: Personal Care residents are not in need of the 24-hour oversight of Registered Nurses.  That is technically the definition of Nursing Care.  When a Personal Care resident experiences significant physical or mental decline, they are typically transferred to nursing care.

Assisted Living (A/L) is a fairly new (2011) level of licensed care in PA.  It uses the Personal Care Home regulations as its base; the majority of the PC regulations are used intact by A/L facilities.  While there are mostly minor differences in the regulations, A/L differs from PC in two major ways: (1) the minimum resident room sizes are about 50% bigger than our current standard PC room, and, more importantly, (2) when a resident’s condition deteriorates, the A/L facility may bring in additional resources (e.g., staffing) to continue caring for the resident in A/L, and is not required to transfer the resident to a nursing facility. Having the ability to stay in the A/L facility is the provision that consumers seem to like the best.

Both PC and A/L are 100% private-pay services, meaning that Medicare and Medicaid do not fund those levels of care.  So far, most senior living providers in PA have chosen to keep their PC licenses instead of licensing their facilities as Assisted Living. Why?  The state government has not followed through on promises to provide Medicaid funding for A/L residents who run out of money.  Financially, it makes more sense for providers to transfer frail PC residents to nursing care where they can get Medicaid reimbursement for their care.  This is a situation that will very likely change (for the good or for worse?) in the next few years.  In my view, A/L has the more promising “future” and it will very likely replace many PC facilities in the years ahead.