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ESAAL Executive Director Lisa Newcomb on Assisted Living Facilities in New York

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We had the pleasure of chatting with ESAAL Executive Director, Lisa Newcomb, to learn a little more about the Empire State Association of Assisted Living, and gather some insights we feel consumers may find helpful in their search for an Assisted Living Facility in New York.

Upon graduating from The University at Albany in the summer of 1986, Lisa Newcomb began her career stuffing envelopes at ESAAL. With a lot of hard work, dedication, and time spent learning the regulatory and operational issues that member providers were experiencing, the board appointed Lisa as Executive Director in 1998 — a role she holds proudly today. She leads a lean team of highly competent and committed staff covering a lot of ground to support and advance ESAAL’s mission.

Established in 1979, The Empire State Association of Assisted Living is the largest statewide trade association (representing 280+ residences) dedicated solely to NYS Department of Health-licensed Adult Care Facility and Assisted Living Residence providers.

It is our mission to strengthen, promote and advocate for New York State’s assisted living network in the best interests of residents and providers. We represent our members’ legitimate interests before the NYS Legislature and the NYS Department of Health, which is the state licensing and regulatory agency.  Also, we provide one-on-one member support to help members achieve regulatory compliance, and education to help them be the best providers and employers that they can be. ESAAL is widely considered by the Legislature and DOH to be the voice for assisted living providers.”

Having spent the last 30+ years living and breathing this mission we asked Lisa to share what drives her passion for her work and this industry. In her words...

I think there are a number of reasons:

  • First and foremost, I believe in the assisted living model with my whole heart. It is socially based, but still able to address residents’ healthcare and other needs. It strives to be responsive to not only a resident’s changing healthcare needs, but their wishes and choices as well. That’s very important.
  • The staff that serves residents are hardworking and dedicated caregivers, every day.
  • The assisted living industry has grown tremendously, both in numbers and in the services that they can provide to help residents continue to live there. With so many changes in the industry, I continue to learn and am seldom bored.
  • I am a policy wonk and after having been with ESAAL for so many years, I believe I have had, and am having, a positive influence on assisted living policy.  I have also been spending time teaching senior staff new to the industry. Assisted Living is a beautiful but regulatory complex model. I like to think I am helping the next generation to understand its nuances and its beauty.
  • I can honestly say that I truly like the people that work for our member providers. Maybe that is because assisted living attracts a certain kind of person. Direct interaction with ESAAL members is by far my favorite part of this job.
     

Lisa, what should consumers look for/ask about when seeking an ALR?

“First and foremost, consumers should always ask whether the provider and building are licensed and overseen by the NYS Department of Health. Licensing is important to ensure protection for seniors. It provides important consumer protections such as fire/building safety standards, dietary standards, and staff qualification requirements.  All state-licensed assisted living and adult care residences are required to provide consumers with a room or apartment, meals, general supervision, personal care services, medication assistance, case management, activities, laundry, and housekeeping.  Having a license guarantees that the consumer has access to these services.

Other types of senior housing, sometimes referred to as independent senior housing are not licensed, so it is important that the consumer ask whether the building is licensed and may ask for a copy of the ALR’s operating certificate.

Other types of questions to ask, and requests to make, include those that help to reflect the residence’s culture and resident quality of life and quality of care issues. They include:

  • Ask for a copy of the residence’s menu for a recent cycle
    1. How does the residence address requests for a different meal?
    2. What special diets can the residence provide and manage?
  • What is the typical staffing pattern throughout the day, evening and night hours?
  • Does the residence employ nurses?
  • Describe the residence’s training program for nurses, aides, and other employees.
  • What kinds of activities and recreation are offered, both within the residence and in the outer community? How frequently?
  • Is the community designed for a senior’s needs? For instance, if there is a long hallway, are there places to sit and rest? Are there smaller common areas where residents can get together? Are there handrails in the hallways and other areas? How is the lighting?
  • Will residence staff assist to order, store and assist with a resident’s medications if necessary?
  • Is there someone to assist with arranging for and transportation to medical and other appointments?
  • What are the “house rules” for such things as being able to keep food in the room or apartment, decorating own units, etc.
  • Are pets allowed? If so, what are the rules?
  • What are the rules for payment and for changes in the monthly rate?
  • Does the ALR have enhanced ALR (EALR) certification meaning residents can more fully age-in-place? If so, to what level or point can you meet the person’s changing needs? Does a person have to move to a nursing home at some or any point?
  • Does the ALR have special needs ALR (SNALR) certification meaning a secured memory care unit for seniors with advancing Alzheimer’s or other dementia?

The above are just a few questions for consideration. It is also advisable to speak with other residents and staff during a tour. Do residents seem happy and the staff members friendly? Are things clean and is maintenance responsive when something needs to be fixed or replaced?”

 

What is the difference between an assisted living residence (ALR), enhanced ALR (EALR), and special needs ALR (SNALR)? How would one know if a parent can age in place/the residence is able to care for them?

New York has three models of assisted living residences (ALRs). In all three settings, providers routinely assist residents in accessing nursing and other healthcare services under the direction of the resident's primary physician. All three ALR settings are required to provide consumers with a room or apartment, meals, general supervision, personal care services, medication assistance, case management, activities, laundry, and housekeeping.

The Enhanced ALR (or EALR) certification allows the ALR provider to be able to keep residents longer, because it allows them to pierce what are known as the adult care facility and/or ALR “admission and retention standards”.  For instance, unlike all other settings, residents living in an EALR may be allowed to continue to live there even if they need assistance from staff to walk, transfer, descend stairs or operate medical equipment. Some EALRs also offer nursing services.

It is important to note that NYS law does not dictate what services each EALR must offer and provides. Rather, each EALR provider develops, for Department of Health approval, a list of services based on staffing capabilities and the general needs of their resident population. For example, one EALR may provide one-person assistance to help a resident to walk but might not offer two-person assistance. One EALR might offer the aging in place services to residents already living in the ALR. Another EALR provider may accept people with already advanced needs from the outer community.

That is why when exploring EALR settings, it is critical to discuss some key issues with the EALR provider:

  • What are the specific EALR services that you are authorized to provide?
    • Typically, the EALR provider includes the list of services within the Residency Agreement and/or in another format. Request a copy of that list.
    • Ask for more detail as needed.  For instance, if they provide assistance with walking, is it only one-person assistance or two-person assistance as well? If they provide direct nursing, what are the specific nursing tasks that they do, and do not provide?
  • Does the EALR admit people with some or all these advanced needs, or only provide them to someone already living in the residence?
    • The answer may differ based on each EALR service offered and if so, specify for each.
  • Is the entire building certified as EALR, or only a certain number (if so, how many)?
  • What, specifically, would create a need for the resident to be discharged from the residence?

Is there a validated/verified source they can refer to?

 

How are these different categories of ARL’s staffed?

  • Many ALRs employ nurses. In the Enhanced ALR, there is typically one or more Registered Nurses (RNs) because of the increased frailty of residents living there. Moreover, an RN can perform a skilled assessment of a resident to determine whether they have a need for new services or evaluation from the medical community. Unlike RNs, Licensed Practical Nurses (LPNs) cannot assess; however, they can and do play an important role because they can perform many of the nursing services that residents in the Enhanced ALR require. Other services that Enhanced ALR residents need are not skilled nursing tasks. In those cases, most Enhanced ALRs use certified home health aides or certified personal care aides. Additionally, Medication Aides may provide residents with assistance with the self-administration of medications. Trained and overseen by Supervisory staff (often nurses), well-trained Medication Aides also play an important role in assisted living. It is more important for consumers to understand the residence’s training programs for these employees than to make decisions simply based on how many RNs versus how many LPNs versus how many home health aides etc. are employed.” 

 

And finally, Lisa, are all ALRs private pay?

No, there are some ALRs and Adult Care Facilities that accept public pay (Medicaid), but they are limited.  There is the Assisted Living Program, or ALP, which provides Medicaid funding to live and receive services in an Adult Care Facility or ALR and allows for aging-in-place similar to the Enhanced ALR. However, as mentioned, the number of ALPs is limited due to state control of authorization for providers to operate an ALP, as well as concern from some providers that the Medicaid reimbursement rate is not adequate.  Having said that, there are Medicaid funding assisted living options, and seniors relying on Medicaid should seek those that have Assisted Living Program, or ALP capacity.

If you’re interested in learning more about ESAAL you can find their website here and follow them on Facebook here.