Enhanced Assisted Living (EALR) Around Albany: Aging in Place, With Conditions

What EALR changes

Under New York's rules, an ordinary Assisted Living Residence cannot keep a resident who chronically needs another person's physical help to walk or climb stairs, depends on medical equipment needing frequent help from medical staff, or has chronic unmanaged urinary or bowel incontinence. Those needs usually mean a nursing home. EALR certification lifts that limit for a set number of beds, as long as the residence can arrange the extra nursing and aide time and its physician and nurse agree the resident can be served safely.

For a family, EALR is the difference between a parent staying in their apartment after a hip fracture and having to move.

Where the beds are

Schenectady and Saratoga counties hold a large share of the region's enhanced beds relative to their size, and several residences are certified EALR for a large portion of their apartments. Check each building's count on our assisted living roster.

The catch: a bed count

EALR is counted in beds. A residence with 20 EALR beds can serve 20 enhanced residents at a time; when they are full, a resident whose needs cross the line may have to wait at home with extra help, move to another residence with an open EALR bed, or move to a nursing home. Families rarely ask about this at the first tour, and it is the question that matters most a year or two later.

Ask how many EALR beds are occupied, how long the internal waiting list runs, and what happened the last time a resident needed an enhanced bed and none was open.

Costs

Enhanced residents usually pay at the top of a residence's care-level schedule. Ask for the full schedule in writing, how often residents are reassessed, how much notice comes before a level change, and whether incontinence supplies, two-person assistance and escorts are included or extra.

Medicaid does not pay for EALR care in ordinary assisted living. Long-term care insurance, VA Aid and Attendance and private funds are the usual sources.

A family scenario

A mother in Rotterdam moved to an assisted living residence after her husband died. Two years later, after a stroke and rehab, she can walk only with an aide at her side and needs help with incontinence. Her residence holds EALR beds, one is open, and after its nurse and her doctor assess her, she moves into an enhanced apartment on the same floor with a higher care level. The family pays more each month, but she keeps her friends and her routine.

Had the residence had no EALR beds, or had they all been full, the family would have faced a nursing home search within days of her rehab discharge. That difference is why the EALR question belongs on the first tour.

How EALR differs from a nursing home

EALR residents live in apartments, eat in a dining room and follow their own routines, with aides and nurses coming to them. A nursing home provides round-the-clock licensed nursing and is the right setting when needs are continual or medically complex. EALR fills the space between, for people whose needs are heavy but predictable.

Because EALR is private pay in most residences, it can cost less than a nursing home or more, depending on the care level. Compare the total monthly figure, not the base rate, against New York's nursing home medians before deciding.

What the assessment looks at

Before an enhanced admission or a move to an EALR bed, the residence's nurse and the resident's physician review mobility, transfers, continence, medical equipment, cognition and how much hands-on help is needed each day. The residence must also confirm it can arrange the nursing and aide time those needs require.

The assessment is repeated as needs change. If a resident later needs continual nursing, becomes bedfast, or needs care the residence cannot arrange, New York's rules require a move to a nursing home even from an EALR bed. Ask how often reassessments happen and how families are involved.

Keep copies of every assessment and care-level notice. If a disagreement arises about whether your parent can stay, those documents, together with a note from the doctor, are what the residence, the ombudsman and, if needed, the Department of Health will look at first.

Choosing with the future in mind

If a parent already uses a walker, has had a fall or has a progressive condition such as Parkinson's disease, favor residences with EALR beds and, if dementia is possible, SNALR beds too. The goal is a building that can keep your parent through the likely next few years, not just today.

Ask your parent's doctor what needs to expect over the next two years, and bring that list to every tour.