An assisted living residence or assisted living facility (ALF) is a housing facility for people with disabilities. These facilities provide supervision or assistance with activities of daily living (ADLs); coordination of services by outside health care providers; and monitoring of resident activities to help to ensure their health, safety, and well-being.
Assistance may include the administration or supervision of medication, or personal care services provided by a trained staff person.
Assisted living as it exists today emerged in the 1990s as an eldercare alternative on the continuum of care for people, for whom independent living is not appropriate but who do not need the 24-hour medical care provided by a nursing home and are too young to live in a retirement home. Assisted living is a philosophy of care and services promoting independence and dignity.
Assisted living in the United States
Within the United States assisted living spectrum, there is no nationally recognized definition of assisted living. Assisted living facilities are regulated and licensed at the US state level. More than two-thirds of the states use the licensure term "assisted living." Other licensure terms used for this philosophy of care include residential care home, assisted care living facilities, and personal care homes. Each state licensing agency has its own definition of the term it uses to describe assisted living. Because the term assisted living has not been defined in some states it is often a marketing term used by a variety of senior living communities, licensed or unlicensed. Assisted Living facilities in the United States had a national median monthly rate of $3,500.00 in 2014, a 1.45% increase over 2013 and a 4.29% increase over a five-year period from 2009-2014.
Types
As widely varied as the state licensing and definitions are, so are the types of physical layouts of buildings in which assisted living services are provided. Assisted living facilities can range in size from a small residential house for one resident up to very large facilities providing services to hundreds of residents. Assisted living falls somewhere between an independent living community and a skilled nursing facility in terms of the level of care provided. Continuing care retirement facilities combine independent living, assisted living, and nursing care in one facility.
People who live in newer assisted living facilities usually have their own private apartment. There is usually no special medical monitoring equipment that one would find in a nursing home, and their nursing staff may not be available at all hours. However, trained staff are usually on-site around the clock to provide other needed services. Household chores are performed: sheets are changed, laundry is done, and food is cooked and served as part of the base rent and included services. Depending on their disclosure of services, assisted living services may include medication management, bathing assistance, dressing, escorts to meals and activities, toileting, transferring, and insulin injections by an RN. Some homes even have a beauty parlor on site. Grocery service is often available too. Where provided, private apartments generally are self-contained; i.e., they have their own bedroom and bathroom, and may have a separate living area or small kitchen. Registered nurses and licensed practical nurses are available by phone or e-mail 24 hours a day, to ensure proper teaching and/or education of staff is available.
Alternatively, individual living spaces may resemble a dormitory or hotel room consisting of a private or semi-private sleeping area and a shared bathroom. There are usually common areas for socializing, as well as a central kitchen and dining room for preparing and eating meals.
Typical resident
An assisted living resident is defined as a resident who needs assistance with at least one of the activities of daily living.
A typical assisted living facility resident would usually be a senior citizen who does not need the level of care offered by a nursing home but prefers more companionship and needs some assistance in day-to-day living. Age groups will vary with every facility. There is currently a transformation occurring in long-term care. Assisted living communities are accepting higher and higher levels of care and nursing homes are becoming a place for those who are undergoing rehabilitation after a hospital stay or who need extensive assistance. Many assisted living communities now accept individuals who need assistance with all activities of daily living.
The "Overview of Assisted Living Report" from 2010 stated, 54 percent of assisted living residents are 85 years or older; 27 percent are 75-84 years old; 9 percent of residents are between 65 and 74 years; and 11 percent are younger than 65 years old. 74% of assisted living residents are female; 26 percent are male.
Special needs
The residence may assist in arranging the appropriate medical, health, and dental care services for each resident. The resident generally chooses his or her medical doctor and dental services.
Residents who have periods of temporary incapacity due to illness, injury, or recuperation from surgery often are allowed to remain in the residence or to return from a rehabilitation center, skilled nursing facility or hospital if appropriate services can be provided by the assisted living residence. It is important to remember that assisted living residences are a bridge between living at home and living in a nursing home. Assisted living residences do not typically provide the level of continuous skilled nursing care found in nursing homes and hospitals.
More recently built facilities are designed with an emphasis on ease of use for disabled people. Bathrooms and kitchens are designed with wheelchairs and walkers in mind. Hallways and doors are extra-wide to accommodate wheelchairs. These facilities are by necessity fully compliant with the Americans with Disabilities Act of 1990 (ADA) or similar legislation elsewhere.
The socialization aspects of ALFs are very beneficial to the occupants. Normally the facility has many activities scheduled for the occupants, keeping in mind different disabilities and needs.
Locked units
Many ALFs also serve the needs of people with some form of dementia including Alzheimer's disease and others with mental disabilities, as long as they do not present an imminent danger to themselves or others. These sections are often referred to as memory care. In the United States, legislation enacted by each state defines not only the level of care, but often what conditions are prohibited from being cared for in such a home.
- In California, these units are not "locked" they are secured by alarms, delays, keypads needing a code, etc. However, they are not locked units like a psychiatric ward in which US citizens have sought legal action to the Supreme Court.
Many ALFs will work to accommodate a person who suffers from severe forms of Alzheimer's by having separate private units. These units are part of the main building but are secured so residents with Alzheimer's cannot leave and possibly do harm to themselves. The units usually house fewer people and more attention from the caregivers is provided.
The units, usually called locked units, focus on applying cognitive and mental activities to try and help keep the mind fresh. Since there is no cure for the disease, the goal is to work at prolonging or delaying the disease. If one is not engaged in activity, his or her memory will deteriorate more rapidly.
Philadelphia Assisted Living Facilities Video
Controversy
On July 30, 2013 Frontline ran an hour long program with help from ProPublica detailing some tragedies that happened in assisted living.
At the time the documentary was broadcast and published, Frontline stated that "Today, nearly 750,000 people live in assisted living facilities across the country. National for-profit chains, concerned both about caring for their residents and pleasing their shareholders, have come to dominate the industry. Standards for care and training--and even definitions for the term 'assisted living'--vary from state to state. Assisted living facilities, unlike nursing homes, are not regulated by the federal government." A written brief about the television documentary goes on to point out deaths of residents (as companies are cited by various state regulators); facilities that are understaffed; employees that are inadequately trained; plus, that an overall "push to fill facilities and maximize revenues has left staff overwhelmed and the care of residents endangered."
A related article by ProPublica (Thomson and Jones, July 29, 2013) states that a facility operated by Emeritus Corp. "...had been found wanting in almost every important regard. And, in truth, those 'specially trained' staffers hadn't actually been trained to care for people with Alzheimer's and other forms of dementia, a violation of California law." It goes on to say, "The facility relied on a single nurse to track the health of its scores of residents, and the few licensed medical professionals who worked there tended not to last long," but also that "During some stretches, the facility went months without a full-time nurse on the payroll." At the time ProPublica's article was published, it was said that the problem was not specific to one facility; whereas, "State inspectors for years had cited Emeritus facilities across California." Emeritus replied to that claim, describing "any shortcomings as isolated," as well as that "any problems that arise are promptly addressed." The company cited their "growing popularity as evidence of consumer satisfaction."
Assisted living facilities need to be run effectively with consideration of elders' health, wellness and safety, while maintaining a balance between care and daily business functions. Assisted living facilities are wonderful for the fact that there is staff available to care for elders 24/7 (). On the other hand with a big transition some elders may not or refuse to adjust to the new living situation which may result in a decline in health (). Families need to do research about prospective facilities (). Facilities that are run by large companies may tend to lose sight of the care aspect and treat people as if they are a commodity. Although, it is their "Home" it is still a business and has to make enough to pay wages and bills to keep its doors open. This should not be permitted to take away from care being provided by staff to elders. As long as the facility maintains balance between optimal care and business functions, the elders will be more comfortable and actually consider the Assisted Living to be their home.
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