Kimberly Hadson headshot
Kimberly Hadson, BSN, RN, PMH-BC

People with serious mental illness are more likely to be admitted to nursing homes and to have their stays converted from short-term to long-term, even when they have low nursing needs.

Many older adults simply do not need this intensive level of care. Instead, they may only need a stable support base: somewhere to live, help with meals and housekeeping, and reminders to continue to take their medical and psychiatric medications. They may particularly benefit from an organized community to decrease social isolation and enhance well-being.

To address this, New York created a streamlined Assisted Living Program, or ALP, that combines established social programs to provide housing, nursing and social needs in a low-cost, less restrictive setting to those who might otherwise qualify for a nursing home stay or be placed in a nursing home unnecessarily. The ALP, built on assisted living’s philosophy of person-centered care and quality of life, offers a balance of independence and support.

Room and board is funded either privately or through Supplemental Security Income and/or New York’s State Supplement Program, and nursing needs are arranged through home health services and are funded by Medicaid at a flat rate of 50% of what would be paid to a nursing home for a medically similar resident. Housekeeping, supervision and case management services also are provided. Not all assisted living communities in the state participate in the ALP, nor must every resident in a given setting be part of the ALP.

New York’s program has successfully helped transition older adults with serious mental illness out of nursing homes and into ALPs. One social worker working at an ALP described it as the “right fit” for older adults with serious mental illness. Nearly all of the approximately 60 residents living in the ALP had a mental health diagnosis. Having both a nursing home and ALP available allowed her to take a holistic approach to ensuring a proper level of care to people living with serious mental illness, focusing on their cognitive abilities and safety.

People who can manage independent activities, such as navigating leaving and returning home, enjoy increased freedom. The ALP enabled those social workers to provide good case management and person-centered care. They know their residents deeply as people, not diagnoses.

This organization’s experiences are likely not unique. A 2019 study found the percentage of serious mental illness in New York assisted living residents to be 33.1% compared with an 11.4% average for the rest of the country.

The traditional image of assisted living as only available to those of higher socioeconomic status is rapidly changing. But there is wide variability between states in available options for financing assisted living, particularly room and board, and the process can be prohibitively complicated.

New York’s ALP is just one example of how to adapt what assisted living is and who it serves. Research and policy must continue to explore and expand opportunities for assisted living.

New York’s ALP is limited to 4,200 residents, and Medicaid-funded programs in other states often have waitlists and limited funding. Assisted living, however, is less costly than nursing home care, so enhancing such programs could lead to overall savings in health spending.

As the population of older adults with serious mental illness grows, the long-term care industry must increase options available so everyone can find a place to thrive as they age.

Kimberly Hadson, BSN, RN, PMH-BC, is a doctoral student at NYU Rory Meyers College of Nursing whose research is affiliated with the Hartford Institute for Geriatric Nursing, as well as a policy intern for the Moving Forward Coalition Workforce Committee.

The opinions expressed in each McKnight’s Senior Living guest column are those of the author and are not necessarily those of McKnight’s Senior Living.

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