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Evaluation of the Assisted Living Pilot ProgramAssisted living and related community-residential care programs such as adult family homes are of growing importance. These programs offer the promise of serving persons needing long-term care in settings that can meet their needs while maximizing autonomy and privacy in a home-like setting.1 While assisted living primarily serves those who can pay out-of-pocket, the majority of states have moved to make some Medicaid funds available to allow those with lower incomes to access these programs. VA is another possible funding source to extend assisted living services to moderate and low income individuals. Long known as a leader in providing an extensive continuum of long-term care services, VA was authorized in Public Law 106-117 to provide these services as part of a pilot demonstration and evaluation to assess the "feasibility and practicability of enabling veterans to secure needed assisted living services as an alternative to nursing home care." Findings from the Evaluation of the ALPPThe Northwest VISN, VISN 20, implemented the Assisted Living Pilot Program (ALPP) in seven Medical Centers in four states: Anchorage, Alaska; Boise, Idaho; Portland, Ore.; Roseburg, Ore.; Spokane, Wash.; Puget Sound Health Care System (Seattle and American Lake, Wash.); and White City, Ore. Investigators from the Northwest and Hines HSR&D Centers of Excellence conducted the evaluation. ALPP was designed to contract with existing community facilities to serve the needs of the VA patient population while reducing costs to the system by transitioning residents to private pay or Medicaid after an initial period of VA payment. The main findings from our evaluation of the ALPP program follow. Our overall assessment was that ALPP could fill an important niche in the continuum of long-term care services at a time when VA is facing a steep increase in the number of chronically ill elderly who will need increasing amounts of long-term care. VA presented a report describing the results of the pilot evaluation to Congress with an accompanying letter from the Secretary of Veterans Affairs.3 This letter highlighted study findings and stated that VA was "not seeking authority to provide assisted living services believing that this is primarily a housing function. VA is, however, actively coordinating outpatient and home-based medical services for veterans in assisted living facilities in a variety of locations." We hope this study can assist in moving toward the long-term goal of designing the optimal system of residential care services that provides persons with chronic illnesses or disabilities a choice of high quality programs that best meet their unique needs while making the best use of finite resources. References
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