ElderWeb

Assisted Living, When Does It Make Sense?

Assisted living is becoming the most widely-used term for an intermediate level of housing and care services for the frail elderly which may be an attractive option for people who are no longer able to live independently, but who don't really need the level of medical care provided in a nursing home. However, many studies have shown a lack of understanding and awareness of this type of care facility by the general population.

Assisted living facilities often compare favorably against nursing homes for people with basic care needs. Assisted living has a residential focus, as compared to nursing homes which are primarily medical institutions. This residential focus generally includes provisions for individual apartments with kitchens and private baths, locking doors, private phones and mailboxes, and personal choice about meals and activities. In addition to the emphasis on privacy and autonomy, assisted living facilities are generally newer buildings with larger resident rooms than most nursing homes.

Assisted living provides many advantages over living alone for older people with care needs. Assisted living facilities provide services which may not be easily available to older people living in their own homes, such as housekeeping, transportation, laundry, meals, and some level of personal care assistance for activities of daily living (ADL) needs such as bathing, dressing, eating, and mobility.

Specifics vary from facility to facility, and state regulations and requirements vary, but generally the features of assisted living facilities include:

• Security - An assisted living facility should provide a secured building, possibly inside a gated community. Security is one of the top concerns of older people living alone in the community.
• Safety - Most facilities provide 24-hour a day supervision and/or emergency response systems, nurse call systems, or "I'm OK" systems. These can relieve the fears and anxieties of family members living too far away to closely monitor an older person's well-being.
• Accessibility - Many older homes are not designed to be easily navigated by people using walkers or wheelchairs, or whose mobility is impaired by failing eyesight. Assisted living facilities are specifically designed for people with mobility problems.
• Transportation - Most facilities provide transportation to doctors, hospitals, shopping, and other places. Transportation is a critical problem when older people can no longer drive safely.
• Housekeeping and Laundry - Some older people are not able to do housekeeping or laundry due to their own physical limitations or the layout of their homes. Assisted living facilities can provide these services.
• Meals - Many long term care providers have stories of people admitted to their facilities whose condition improved dramatically when they started getting regular, balanced meals. Nutrition problems occur in people living alone due to their inability to prepare meals because of physical problems, transportation problems which make shopping difficult or impossible, or depression caused by loneliness and isolation which leads them to skip meals or decide it's too much trouble to prepare meals for one person.
• Social Contact and Activities - Many studies have shown that social contact and meaningful activities can have a tremendous impact on the general well-being of older people. Good facilities have interesting social programs and frequent group outings. The quality and appropriateness of these programs is one distinguishing mark of a good facility.
• Alzheimers Care - in many states assisted living facilities are developing special care units for Alzheimers care, at lower rates than those charged by Alzheimers special units in nursing homes. The best facilities have designed their building to promote Alzheimers care, and provide their staff with advanced training on the disease. An assisted living facility with these features may be appropriate for early to mid-stage Alzheimers patients.
• Assistance with Medications - This is a frequent problem for people living alone because of confusion about medication schedules, difficulties in self-administering medication, or problems remembering to take medications. Assisted living facility staff can provide reminders and assistance in understanding instructions. In some states, medications would be administered by assisted living facility staff, but in others medication administration would be done by licensed home health nurses.
• Assistance with Bathing - This is the most common ADL problem in older people. Assisted living facilities have staff who can provide any level of assistance needed.
• Assistance with Dressing - another common ADL problem as people age.
• Assistance with Eating - Assisted living facilities can provide assistance to people who have trouble feeding themselves.
• Assistance with Toileting - This can range from occasional bladder problems to complete bowel and bladder incontinence. Some assisted living facilities may not be able to care for people with complete incontinence.

As mentioned above, assisted living facilities are often attractive alternatives to nursing homes, but they are not always appropriate. Someone who needs daily therapy or 24-hour nursing care probably can only be cared for appropriately in a nursing home. People with severe behavior or mental problems, or people with advanced Alzheimers may also require care which can only be provided in a nursing home.

The most problematic issue is the question of how care will be paid for. Assisted living care is generally only available to people who can pay for it privately, or who have long term care insurance policies which will pay for it. Medicare does not pay for assisted living. Medicaid varies from state to state, but in many states there are few, if any, assisted living facilities available for people on Medicaid. Long term care insurance has improved tremendously in the last few years, but not all policies allow for care in an assisted living facility.

In spite of the fact that there is little or no third party payment for assisted living, it is so popular that people are flocking to it even when they have to use most of their income to pay for the services. Recent studies have shown many people are willing to use the equity in their homes or get assistance from family members in order to stay in this desirable setting.