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US Senate Special Committee on Aging Hearing


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 health reform in an aging America.

I would like to begin my testimony by stating one emphatic fact: Aging is not a disease. This may seem like a peculiar way to begin testimony for a hearing on how long term care fits into the broader context of health reform. But those of us in the assisted living field feel very strongly that growing old should not be synonymous with ill health, dependence, institutionalization and a compromised quality of life. In considering the long term care needs of Americans, it is important to understand that not every senior needs skilled nursing care but a significant number of very old seniors may need some help in the activities of daily life to maintain a healthy and independent lifestyle.

Assisted living is the resident-centered alternative to institutional care. More than one million seniors call assisted living communities home tens of thousands of communities in every state.  Our 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 round the clock nursing care. Our typical resident is an 85 year old widow. She takes eight to 10 different drugs each day, 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.  The community provides her meals and a variety of social and recreational activities from card games to movies 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.

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.

We are convinced that assisted living is popular because of the bedrock principle of choice. Assisted living supports the resident’s decision on how and where a person should live. Many of you are grappling with the challenge of caring for aging parents and grandparents. No one wants to tell Mom that she cannot stay in the home where she raised you and your siblings and spent many happy years. But when it simply is not safe for her to live alone or when she no longer wants the responsibility of living in her own house, assisted living is a terrific option.

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. Consumer surveys, including those conducted by state regulatory agencies, repeatedly show an astonishing satisfaction rate of more than 90 percent. Many seniors grow isolated and depressed living alone as their spouses and peers die. In assisted living, we see men and women truly gain a new lease on life.
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. 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 issue for most seniors and their families is affordability.  The assisted living alternative is available everywhere in the United States but not everyone can afford it. Assisted living is a cost effective long term care option. It costs about half as much as skilled nursing home care. Medicaid saves between 50 and 66 percent for each resident cared for in an assisted living community instead of a nursing home. But any form of long term care is going to be labor intensive and cost money. While some seniors will always need skilled nursing, we want you to remember that many do not. But a tiny fraction of Americans purchase long term care insurance now and with the recent stock market decline, many have seen their savings dwindle or disappear.

To us, the public policy challenge you face as you consider long term care needs is helping Americans save for retirement and afford the type of housing and care they need as they age. ALFA strongly supports the Community Living Assistance Services and Supports (CLASS) Act which would create a nationwide public insurance program to help pay for Americans with significant functional needs. The CLASS act keeps control in the hands of the individual and guarantees choice in long term care options.

 ALFA members are known throughout the United States for  operating high quality communities and providing superb services. We take enormous pride that our members are among the most entrepreneurial, creative and successful in the senior living field. I would caution you to resist those who say that a one size fits all federal regulatory system should be imposed on assisted living as it was on skilled nursing. The record does not warrant this approach and we are convinced that heavy handed regulation would stifle the very characteristics that allow assisted living providers to innovate, adjust to the ever changing needs of a diverse senior population and set the standard for exemplary service for long term care. Every state regulates assisted living and ALFA believes that state regulators best understand  local conditions and needs. ALFA actively promotes core principles recommending staff training, criminal background checks, full consumer disclosure, annual unannounced inspections and other steps aimed at promoting the highest standards and quality of care in all communities.

The growth of assisted living, a largely private enterprise, in the last 25 years means that the long term care industry is no longer monolithic and nursing homes are not the only option.   An institutional bias in government programs lingers against home and community based settings. 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.  Indeed, when the prescription drug benefit was added to the Medicare program, it inadvertently charged a co-payment for poor seniors who live in assisted living communities, so called dual eligible recipients of both Medicare and Medicaid. We are pleased that lawmakers are trying to correct that inequity.

We are fortunate to live in a time when the average lifespan is steadily growing longer and the quality of life for older Americans is improving. The advances made since the creation of Social Security during the Great Depression are astonishing. As you grapple with health care reform, we urge you to take the broadest possible look at long term care and make certain your plans give maximum flexibility and choice to aging Americans.

ALFA and its members welcome the opportunity to provide more information to the committee as it considers this challenging topic. We are grateful for the chance to submit this testimony and look forward to working with committee members.

 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