The Florida Legislature
Office of Program Policy Analysis and Government Accountability
Status Report on the Pilot Project Authorizing Direct Admission to Extended Congregate Care , Report No. 95-19, December 1995
Full report in PDF
- Assisted living facilities have been licensed by the state since 1975 and provide housing, meals, and personal services in home-like settings to adults who need supervision or assistance with the activities of daily living such as bathing, eating, or dressing. The ECC license allows ALFs to provide residents with additional supportive and nursing services that they otherwise would have needed to receive in a nursing home. On average, ECC rates are lower than the rates charged for nursing home care. However, the cost-effectiveness of ECC remains open to question. ECC rates do not cover the costs of basic necessities, such as medications, included in the rates for nursing homes, and ECC residents directly pay for these necessities. In addition, since they are not as highly regulated as nursing homes, ECC may pose higher risks to their more impaired residents.
- The cost-effectiveness of and risks posed by ECC remain unresolved due to the low number of individuals who have been placed in ECC. By 1994, three years after the establishment of the ECC license, only 76 ALF residents had been placed in ECC. The pilot project should provide better information about ECC by increasing the number of people eligible for ECC placement and by providing for an evaluation of the pilot project.
- At the time of our survey, 72 ALFs were eligible to participate in the pilot project. Most of the ALF owners or administrators responding to the survey believed that extended congregate care benefits both ALFs and their residents. ALFs benefit by being able to retain residents for longer periods of time. In addition, extended congregate care makes ALFs more attractive to elders and their families, and ALFs use ECC to attract residents. Forty-one of the facilities included in our survey used their ECC license to help market their facilities. Despite these benefits, only 14 of the facilities included in our survey were admitting individuals to ECC. Most of the owners or administrators of the remaining 53 facilities said that they had not yet experienced a demand for ECC.
- A majority (35) of the ALF administrators and owners surveyed identified barriers that they believe will limit the growth of ECC. The most frequently cited barrier was affordability. Although nearly all respondents believed that ECC is less costly than nursing home care, it costs more than standard ALF care. The additional costs stem from the extra nursing and personal care services ECC clients need as well as the increased administrative workload required to meet ECC licensure requirements. Currently, most ALF residents pay for their own care. Twenty-five of the survey respondents believed that many individuals could not afford to pay for the extra costs of ECC without some type of public assistance.
- Thirty-five of the 62 ALF owners and administrators surveyed also identified a number of areas in which the regulations governing ECC could be streamlined. Two of the most frequently mentioned areas were documentation and inspection requirements. Several respondents believed that the forms for ECC residents are duplicative and cause excessive paperwork for ALF staff. In addition, several respondents believe that the quarterly inspections required for facilities with ECC residents are excessive and that the inspections conducted by various regulatory agencies, such as the Agency for Health Care Administration and fire marshals, could be better coordinated.
What other OPPAGA-related materials are available?
- Report No. 99-51 Progress Report: Other Initiatives to Decrease Long-Term Care Costs Should Accompany Medicaid Waiver Expansion, published in May 2000.
- Report No. 97-74 Supplemental Analyses of the Pilot Project Authorizing Direct Admission to Extended Congregate Care, published in June 1998.
- Report No. 97-26 Review of the Pilot Project Authorizing Direct Admission to Extended Congregate Care, published in December 1997.
- Report No. 97-01 Follow-up Report on the Comprehensive Assessment and Review for Long Term Care Services (CARES) Program Administered by the Department of Elder Affairs, published in July 1997.
- Report No. 96-26 ,Second Status Report on the Pilot Project Authorizing Direct Admission to Extended Congregate Care, published in December 1996.
- Report No. 94-33 Performance Audit of the Comprehensive Assessment and Review for Long Term Care Services (CARES) Program, published in February 1995.
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