ACCREDITATION COMES TO ASSISTED LIVINY.

Assisted living has always been an odd mix of real estate and healthcare. As assisted living residents have aged in place, the healthcare component has become increasingly important as a marker of provider quality. Beyond providing good care, though, the provider needs to advertise and market the fact-to show consumers, competitors and those ever-watchful regulators--that residents receive all the high-quality "assistance" they need. But how can they prove this objectively? They can't talk about being "deficienty-free," because assisted living operator don't have OBRA surveys to pass (and, no doubt, hope they never will). Healthcare organizations do, however, have an answer--their own "good housekeeping seals of approval," otherwise known as accreditation.

Two accreditation agencies are stepping forward this year with new survey and accreditation programs designed specifically for assisted living. Both the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) and CARF (The Rehabilitation Accreditation Commission) expect to have assisted living standards published this year--JCHO by September and CARF possibly by the time you read this--and surveys under way by July for CARF and the fall of this year for JCAHO. What will this mean to assisted living? Recently the leaders of the long-term care operations of the two agencies responded to questions from Nursing Homes/Long Term Care Management Editor Richard L. Peack.

Peck: Why did the Joint Commission decide to add assisted living to the array of healthcare organizations it accredits?

Marianna Kern Grachek, MSN, RN, NHA, Executive Director, Long Term Care and Assisted Living Programs: Some of our accrediation customers raised the question in 1997 as to whether we would accredit assisted living. Our subsequent research showed interesting trends: More people formerly served by nursing homes were going into assisted living and, as assisted living residents aged in place, owners wanted to maintain their occupancy and offer more and better coordinated services. There is no federal oversight--no OBRA surveys or Medicare Conditions of Participation--and assisted living operators were looking for some measure of quality so they could develop and market quality services, and show that they were not just providing "hospitality."

Peck: Your final standards are due to be published as a manual in September. How will these be specific to assisted living?

Grachek: Last summer a group of assisted living leaders, including providers, national organization representatives and advocates, worked with the Joint Commission to design a set of principles upon which Joint Commission standards would be based. These principles focus on residents' rights--the right, for example, to make their own decisions about conducting their lives even if put at risk; to form a resident or family council; to have access to a variety and coordination of services; and to receive advance notification of transfer and help in planning for future options. A draft of the standards developed from this will be available this July.

Peck: How would you address the questions some might raise as to why an accreditor of healthcare organizations is getting into such issues as resident rights?

Grachek: First, it is an archaic notion that JCAHO has concerned itself only with acute care organizations, such as hospitals. At last count we have eight accreditation "product lines," including home healthcare, home medical equipment, behavioral healthcare, foster care and skilled nursing care. Secondly, resident--or patient--rights have always been of primary concern to the Joint Commission; in fact, the first chapter of all our accreditation manuals addresses this subject. It is a core value.

Peck: What can assisted living organizations expect in terms of accreditation processes and costs?

Grachek: We are pilot-testing surveys this month (March). We anticipate a typical assisted living survey will involve two days and one surveyor, for a total cost of $5,500. This would be for a three-year accreditation. As part of the fee, the organization will also receive an updated comprehensive manual in two years.

Although we have set a start date of January 2001, there is no reason why an assisted living organization couldn't apply for and be surveyed later this year, using the July standards as a basis for preparation.

Peck: Why has CARE decided to do this? Won't there be some confusion that this would apply only to rehabilitation providers?

Chris MacDonell, National Director, Adult Day Services/Assisted Living Division, CARF: This is one reason why we prefer to use the acronym CARE rather than spell out the words. CARF has been accrediting providers outside the rehabilitation field for some years now. In the case of assisted living, we had been asked by National Adult Day Services Association to develop standards for and accredit their members three years ago. When the Assisted Living Federation of America (ALFA) and the American Association of Homes and Services for the Aging (AAHSA) approached us about developing standards and accreditation for assisted living, it seemed to be a natural fit. Our mission statement is the same for all fields: to promote quality, value and optimal outcomes though a consultative accreditation process that enhances the lives of those served.

Peck: How will this process apply specifically to assisted living?

MacDonell: First of all, our draft standards have had input from assisted living providers and residents, the American Association of Retired Persons (AARP), the Older Women's League (OWL), state regulators and others. The standards will focus on three principal areas: 1) leadership, including organizational structure, ethics, strategic planning, financial management, personnel management and physical plant safety; 2) outcomes management, including customer satisfaction and performance improvement; and 3) services, including programs, resident monitoring and screening, and resident rights.

Peck: What can assisted living organizations seeking CARF accreditation expect in terms of procedure and costs?

MacDonell: Much will depend on the size of the organization, but most of our surveys last two days and employ two surveyors. At $1,000 per surveyor per day, plus a $650 application fee, the average cost would be anticipated at $4,650. The results could be a three-year accreditation, a one-year accreditation or nonaccreditation. An organization is permitted only two one year accreditations in a row, after which it's advised to review its needs and readiness for the full accreditation.