Assisted living in Canada and the U.S. has become a cornerstone of long-term care in recent decades. The model provides for different combinations of personal care, nursing, security, and recreational programs at varying levels of intensity within congregate housing arrangements. The Assisted Living Residence: A Vision for the Future, edited by two recognized international experts in the field, is the most informative book that has been published in North America on the topic to date. In addition to editors Stephen Golant and Joan Hyde, 31 authors have contributed 15 chapters, which comprise an impressive list of extremely knowledgeable individuals representing academic, NGO, and public and private sectors concerned with understanding, organizing, and providing assisted living environments for older persons. This contribution to the literature is important because it places the development of assisted living within the context of major developments in long-term care and continuing-care systems: past, present, and future. Although the book focuses on the U.S., this seminal work will be of keen interest to a wide audience of CJA readers with interests in the continuum of care, housing models, and independent living.

Although definitions, characteristics, and regulatory systems of assisted living vary by country and even by province and state, the fundamental principles informing an assisted living philosophy are shared. Assisted living has arisen out of a “social model” for providing care characterized by a consumer-directed approach, rather than by a specific set of services, building types, or licensure categories. The social model contrasts with the medical model in its assumptions. First, the social model assumes that, despite significant impairment, most older people are able to make informed decisions, alone or with family members, pertaining to independent living that includes the services they require. Second, it assumes that social interaction has therapeutic value in maintaining personhood, dignity, and quality of life. Third, it assumes that aging individuals need to be embedded in a mutually supportive network to optimize the quality of their lives. Assisted living residences, however, vary in terms of the type and intensity of services that are blended within different sizes and types of shelter; the policies and regulatory systems that must be followed; and the degree to which they meet the needs of older adults presenting different combinations of care needs.

This book is organized into three sections of five chapters each. The first section focuses on the future of assisted living (although this theme runs throughout the book), addressing the influence of demographic trends; population health changes; fiscal and income patterns, shifts in regulatory environment; caregiving availability; as well as norms and preferences on the supply and demand of assisted living accommodation. Although the reader is left with a degree of uncertainty about the future supply and demand of assisted living, this section is valuable in its articulation of the complexity of factors that affect decisions to reside in assisted living in relation to alternatives and their likely consequences. When placed within the larger context of long-term care, assisted living clearly has a significant place within the continuum of care, housing, and care models, yet it is a fluid position that will change, for instance, owing to the likely decline in small family-run “board and care” homes. It is also apparent that the aging of the baby boomers will influence future patterns, in some ways that are relatively clear but also in ways that are unforeseen. The analysis of various scenarios helps us to understand the context in which assisted living models exist today and will potentially evolve in the future.

Section two of the book deals with private-sector influences on assisted living. It begins by assessing the dynamics of residents’ perspectives and the intersection of family care and assisted living. The role of technology, new and innovative models of “enhanced assisted living”, and the changing face of financing assisted living over time are covered in these chapters. The authors are successful in forcing the reader to think analytically about these issues, while extending our understanding of the institutional structures that play a role in shaping assisted living. This section also addresses issues of quality, another complex area of research.

The final section deals with public-sector influences on assisted living. It addresses historical changes in the financing of nursing homes and congregate living in the U.S. and the likely effects of the changing financial context on seniors with and without the ability to pay out of pocket. This leads into a discussion of affordable housing combined with services. Another chapter provides critical analysis of the intended and unintended consequences of state and federal policies and regulations affecting assisted living. This is followed by discussion of the effects of a major recession on assisted living facilities, and by a final chapter in which we revisit the core principles of assisted living.

In sum, The Assisted Living Residence is a highly informative book that combines state-of-the-art knowledge of assisted living based on the American scene. As with all edited books, it is impossible to fill every gap. Apart from the chapter written by Stephen Golant, this compilation could be further strengthened by regarding this knowledge within the larger conceptual and theoretical work that has arisen in the housing and aging literature. This gap may be more a function of the more applied approach to the subject adopted by the contributors. What is also missing is a comparative analysis of assisted living developments across other countries, including Canada and selected European countries. Perhaps the authors will take on this challenge in their next edition. Overall, I would encourage those with interests or involvements in assisted living research, education, and practice to take full advantage of the wealth of information contained in this book.