What is Assisted Living?
Residential Care Apartment Complex

For the purposes of this project, "assisted living" means a Residential Care Apartment Complex or RCAC. It provides a combination of housing, meals, and support services for people with long term care needs. RCAC is defined in Ch. 50.034 of the Wisconsin Statutes. Detailed regulatory requirements for RCACs are contained in the administrative rule HFS 89.

Key features of RCAC assisted living include:

1. A philosophy and procedures designed to support resident independence and choice:
• Residents control their personal space, schedule, and activities.
• Residents participate in the needs assessment and service planning.
• Residents control decisions about the services received and have a right to make what others might consider to be mistakes.
  
  
2. A written negotiated risk agreement. Control and responsibility go hand in hand. Because this model is built on the concept of resident autonomy, it also includes a mechanism to ensure that residents accept responsibility for risks inherent in the decisions that they make. That mechanism is a written risk agreement that clearly identifies potentially risky situations, spells out how the resident wants that situation to be handled, and is signed by both the resident and a provider representative.
   
   
3. A home-like, non-institutional environment where the units are recognized as private residences and have all the features of a studio (or larger) apartment – kitchenette, private bath, living and sleeping area.
   
   
4. The service needs of the residents are determined through a comprehensive assessment and an ongoing care management process to monitor, reassess, and adjust services as necessary, with a goal of providing an opportunity for residents to age in place.
   
   
5. A broad range of services is available either directly from or arranged by the RCAC. Typically, these would include housekeeping, laundry, meals, social activities, personal care, health assessment and medication administration. Other types of nursing care may also be provided.
   
   
6. Services are provided on an as needed basis and are available to meet unscheduled care needs.
   
   
7. The standard to which RCACs are held is that it meets the needs of the individual residents. This provides a great deal of flexibility and at the same time puts a responsibility on the owner to develop policies and procedures and a staffing plan to ensure that resident needs are identified and met.

Affordable Assisted Living

The Robert Wood Johnson Foundation's "Coming Home: Affordable Assisted Living" initiative has a goal of creating assisted living that is affordable to low-income seniors by reducing housing costs and accessing the Medicaid program to pay for services. To be affordable in this context, a Residential Care Apartment Complex (RCAC) in Wisconsin would need to offer rates in the following range:

• Service charges that can be paid with the funding available from the Medicaid Waiver program. For 2004, this would mean service charges averaging up to $1,273/month. The maximum charge for any individual resident may not exceed $2,366/month. Service charges should reflect the resident's level of need.

• Housing and food charges at a level that Medicaid Waiver recipients can pay out-of-pocket. For 2004, this would be from $499 to $1,627/month. A typical MA Waiver resident would have $679 per month available for room and board. Rents for housing must comply with the income and rent requirements of any housing finance program(s) used to reduce the cost of shelter in the RCAC.

Many people who are not financially eligible for Medicaid still cannot afford to pay for care in a typical Wisconsin RCAC, which averaged $23,000 in year 2000 and is most likely higher today. Moderately priced RCACs, affordable to people with incomes under $25,000, are much needed. Much of the information on this site is also useful and applicable to RCACs serving residents at a variety of income levels.