One of the most pressing issues within the Assisted Living Federation of America (ALFA) is that of affordability for assisted living residents. To date, the perception in most camps has been that the majority of new-build assisted living communities are targeting more affluent seniors with annual incomes substantially over the $25,000 threshold.

But a recent survey cosponsored by ALFA, the National Investment Cen-ter (NIC) and Price-waterhouseCoopers - The Assisted Living Industry - An Overview 1999 - refutes that perception. According to the survey, almost two-thirds of people residing in assisted living facilities have incomes of less than $25,000 a year.

In total, ALFA has a three-pronged approach to the problem: * ALFA is working with the health insurance industry to find ways to promote the idea of private insurance for long-term care. "Together we will work with the federal government to enhance tax deductibility for these policies," says Wayne. To that end, last fall, ALFA held a summit exchange with the Health Insurance Association of America. ALFA also expects to hold another summit this fall.

* Secondly, ALFA has also conducted two summits with the managed care industry to help factor assisted living into the managed care equation. "Managed care, despite problems, is here to stay and will certainly have an impact on assisted living," says Wayne. ALFA is sponsoring research to quantify the role of assisted living in a managed care environment, with a third summit scheduled for this fall.

* Thirdly, leading assisted living providers such as Alternative Living Services have agreed to partner with states to come up with innovative approaches to affordability, through the "ALFA Cares" initiative to promote affordable and accessible assisted living. And ALFA affiliates in California, Rhode Island and Arizona have expressed interest in serving as demonstration projects for ALFA's proposed portable Medicaid voucher program.

"States are increasingly allowing Medicaid coverage of assisted living, but Medicaid waiver money is not enough; it typically does not cover assisted living housing but only care, which results in the elderly being forced into nursing homes, where both are covered," says Wayne. As of last June, 28 states covered assisted living services and nine more planned to do so.

Assisted living providers already are teaming up with state and local governments to create affordable innovations, such as tax credits or bond issues, and at the federal level using Housing and Urban Development (HUD) programs.

Major seniors housing industry players, including Marriott Senior Living Services, which have traditionally seemed to target upscale residents, have become involved with affordability projects. Others include Chicago's Senior Lifestyle Corp. with its Senior Suites project and Portland, Ore.'s Assisted Living Concepts.

ALFA is expected to focus on the affordability issue during this fall's conference, The Assisted Living '99 Conference and Expo, which will be October 3-6 at the Hyatt Regency in Crystal City, Va.