Broadening the Continuum.

Editor's note: The Assisted Living Federation of America (ALFA),founded in 1990 primarily to represent assisted living providers, recently broadened its membership to welcome providers from across the continuum in recognition of their evolving interconnection. This article by one of ALFA's new leaders explains why it is critical now for all types of providers to unite under a single, shared promise to consumers.

It has been said that we live in an exciting time in history. As we enter the new millennium, we are reminded of the rapid change of pace in many areas. Housing, healthcare and services for seniors are no exception. Where existed a linear progression from one's home to congregate living to assisted living and onward to skilled nursing care, that is no longer the case. Seniors now have the option of selecting where they live and how they receive services.

Across the long-term care spectrum providers are joining forces. Almost every type of alliance exists, and new ones are forged daily. Hospitals ally with skilled nursing facilities, skilled nursing facilities ally with assisted living providers, congregate housing partners with home healthcare... the list goes on. As our population lives longer and healthier lives, personal choice of where and how to receive services is critical and, for providers, the opportunities are vast.

The Assisted Living Federation of America (ALFA), celebrating its 10th anniversary, has always championed providing independence, choice and dignity, in homelike settings, for the aging and disabled. At a recent anniversary celebration, ALFA announced it would broaden its membership from the traditional focus on assisted living organizations to embrace the full range of housing and care providers who share ALFA's consumer-focused philosophy of care. Karen Wayne, ALFA's CEO, stated, "Now is the time for all types of providers to stand together by our shared conviction that consumers want and deserve choice, dignity and independence in a homelike setting."

As the baby boomers move toward greater consumption of care and services for their parents, and as the aging population has grown accustomed to greater choices, we can expect the demand for a variety of housing and care options to accelerate. At the core of providers' ability to grow their businesses these days is resident and customer satisfaction. Survey after survey shows our customers are most satisfied when their needs are met within their desired housing parameters. In other words, it is not the building but the delivery of services and care that make the difference.

So, where do we go from here? I believe we can continue to foster and grow alliances between housing and healthcare providers and, beyond that, form links that can support an individual with the same needs in a variety of settings. Thus, congregate housing providers working with home healthcare and hospice can offer assistance to residents in place, as they progress from a relatively healthy state until death. CCRCs and similar multifacility campuses, on the other hand, can support residents in a variety of housing choices as their needs change. Hospitals can link with any housing and/or care provider to offer seamless care as patients' needs change overtime. Skilled nursing facilities can link with hospitals to offer a less medically oriented setting, while also partnering with assisted or congregate providers to handle their residents' intermittent medical needs.

As medical records continue to evolve into databases shared by a variety of providers, this will facilitate a continuing move toward more integrated care. In time, true seamlessness of care will evolve across a broad spectrum of settings, including active adult communities, clustered housing and senior apartments. And, as telemedicine advances, the promise will grow for seamless healthcare delivery.

Affordability of housing and care remains a significant area of concern. Long-term care insurance will increasingly serve larger numbers of seniors and cover a wider spectrum of services. Managed care will continue to seek low-cost options, providing needed services in very independent locations. Assisted living services will be delivered in a wide variety of settings.

Kayda Johnson is the chief operating officer of Kisco Retirement Communities, Carlsbad, California. She serves as ALFA's secretary and is on its Executive Committee and Board of Directors. She also chairs ALFA's Seniors Housing and National Quality Assurance action teams.