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Testimony submitted by Assisted Living Federation of America

Mr. Chairman,
My name is Richard Grimes, the President and CEO of the Assisted Living Federation of America ( Thank you for giving me the opportunity to submit testimony on the need and value of person-centered long term care for American seniors. 

Assisted living is, by definition, a person-centered (resident-centered) alternative to institutional care. Assisted living is home for almost one million seniors in 38,000 assisted living communities.  These residents are frail seniors who need some assistance with activities of daily living and can no longer (or choose not to) live in their family home—but do not need 24/7 nursing care. Assisted living is a philosophy of care that embraces choice, independence and the opportunity for seniors to live enriching lives with dignity, respect and privacy.    It is for these reasons that assisted living is the fastest growing long term care option in the United States.

Because assisted living is resident-centered, it supports the resident’s decision on how and where a person should live. The communities are as varied as the lifestyle choices of our residents.  They range from high rise urban communities to bucolic country settings with lush gardens and pleasant fishing ponds. Consumer surveys, including those conducted by state regulatory agencies, repeatedly show an astonishing satisfaction rate of more than 90 percent. We are convinced that our success is linked to our resident-or person-centered focus on consumer need and preferences.

Aging in America has changed. Thanks to advances in pharmacology and health care and the benefits of our affluent society, people are living longer than they ever imagined. The US Census bureau reports that the fastest growing demographic in our nation are the very old. Seniors are not only living decades longer than their parents and grandparents but they are healthier and more active. Study after study show that older Americans want to remain in their communities as they age and stay near friends, family and the familiar. Virtually no one wants to go into an institutionalized setting.
The typical assisted living resident is an 85-year old widow who needs some help with the activities of daily life, such as bathing or dressing. She likely takes almost as many medications as a nursing home resident but her medications enable her to manage chronic health conditions and live in her own room or apartment in an assisted living community.  The community provides her meals and a variety of social and recreational activities from card games to book clubs. A van takes her to her doctor’s office, to local entertainment events, and to the local mall for shopping trips. She lives surrounded by caring staff and friends and maintains control over her own life, deciding when to go to bed, when to get up, when to bathe and when to eat.

Frail seniors living alone at home often do not eat well or otherwise take care of themselves. Home care is a viable option for those who can afford it.  But many seniors in need of care become depressed and isolated because of restricted mobility.  Although many assisted living residents are reluctant to leave the family home for an assisted living community, our experience shows that the quality of life for frail residents dramatically improves after they move into an assisted living community.    Sadly, the fear of institutional forms of care and ignorance about assisted living as a life-enriching alternative often intersect to immobilize frail seniors with sometimes tragic consequences.  

While the long term care industry is no longer monolithic and nursing homes are not the only option, there is an understandable institutional bias against home and community based settings such as assisted living in government funded programs.  That is because Medicaid and Medicare, the twin safety net programs for the poor and aging, were created by Congress long before the private assisted living industry existed in the United States.  Assisted living is not looking for government funding but we are concerned about the ability of all Americans to afford the care they need and to have the means to choose the type of care they want.  With the population aging, this poses significant public policy questions for your committee.

Assisted living has proven to be cost effective.  Assisted living costs half as much as nursing home care and is often a more appropriate choice for a senior who might need some help with the activities of daily life but not round the clock nursing care. States, always the incubators of innovation, are showing the way in this respect. AARP recently conducted a study that reported a disproportionate amount of Medicaid long term care dollars go to nursing homes, some 75 percent. However, it also showed that spending on home and community-based services, which includes assisted living, is increasing at a faster rate than Medicaid spending for nursing homes. In other words powered by consumer preference, the trend is away from institutionalized care and towards the more resident-focused options.
Nursing homes will always play an important role in meeting long term care needs for many. The Green House model is an excellent example of a type of person-centered care that has proven to be a successful alternative to the traditional nursing home model.  However, nursing homes are not the right answer for all Americans. We look forward to working with the Committee on continuing to expand long term care options and help ensure all Americans receive the services they need in the places they choose to call home.

 The Assisted Living Federation of American is the largest national association serving companies operating professionally managed assisted living communities for seniors. ALFA is the voice for senior living and advocates for informed choice, quality care and accessibility for all Americans needing assistance with long term care. For more information visit


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