By Alec Pruchnicki, MD
Most people who have been to assisted living facilities (ALFs) are greeted with the sight of an overwhelmingly white, somewhat wealthy population of elderly people, mostly women. Since ALF rents are usually more expensive than living in the community, due to the level of additional services they provide, a higher than average income is usually needed.
Assisted living, in general, is considered a form of housing, not a form of medical care. Originally, ALFs followed the “social model” where socialization to prevent isolation was offered along with a low level of medical and nursing services, if any. But, as people started to view assisted living as a way to avoid nursing home placement, sicker and more debilitated people came to ALFs and the “new” or “nursing” model developed. Services weren’t as extensive as nursing home care, but they included more than community or social model ALF care.
Since ALFs are considered a form of housing and not medical care, rent was usually not covered by Medicare, Medicaid, or private insurance any more than the rent in any apartment would be. Eventually, the states, whose nursing home Medicaid budgets are massive, began to consider using Medicaid funds to pay for ALF rents. This would save the state money, and keep some people out of nursing homes and still living in community based ALFs, which often had a nicer ambience. But, with Medicaid money comes Medicaid regulations and many ALFs refuse to accept residents on Medicaid, especially since Medicaid reimbursement rates are low. Sometimes an ALF will even evict an elderly resident when funds run out, the same way you might evict anyone who can’t pay the rent on any apartment.
But, not always. When New York State started to use Medicaid funds to pay for ALF services, a non-profit community organization in East Harlem was given permission to build a facility which would receive those funds. The Robert Lott (named after Father Robert Lott a Catholic priest at a local church) was opened in 2000. It is a community run, non-profit, Medicaid supported facility with 127 single person studio apartments on Fifth Avenue and 108th street overlooking Central Park. In 2019 it was re-named Vista on 5th, which is its official title now.
All of the residents are enrolled in Medicare and about 90% are also in Medicaid, the so-called “dual eligible”. Unlike many profit making ALFs, it is multi-racial with about one third each white, African American, and Hispanic residents. Residents include those who were formerly homeless along with retired doctors, lawyers, artists, musicians, domestic workers and others.
Services are extensive, and often significantly more than fancier for-profit ALFs. On site, there is a geriatrics fellowship trained full-time primary care physician (the author ), a variety of part-time medical services (Ophthalmology, Psychiatry, Vascular Surgery, Podiatry, and sometimes Dentistry), two part-time psychologists for memory training and talk therapy, along with a certified home healthcare nursing service, and a long-term rehabilitation group for physical and occupational therapy. An outside laboratory comes in for blood and urine tests, along with another for portable x-rays and ultrasounds. These are in addition to the facility’s social workers, recreation therapists, and others.
The purpose of such an extensive level of services is not just to directly address resident needs. It is hoped, and some of our data shows, that we can sometimes keep people away from emergency rooms and out of the hospital and nursing home. Geriatricians have done this for years, but now the rest of organized medicine has realized that community care is often better and safer than a hospitalization. And now, with Medicaid funding, more people can actually achieve it.
Vista on Fifth
212-534-6464, ext 5153
Speak to Dorothy the intake manager
