What is assisted living?

Introduction

Assisted living facilities provide assistance to people who require or desire some level of assistance in activities of daily living—eating, bathing, dressing, laundry, housekeeping, and assistance with medications—but do not require constant care, and are able to live somewhat independently. Residents in these facilities range from youths with independence-limiting disorders to the elderly.

Assisted living facilities differ from nursing homes or rest homes in that their residents are more independent and do not require around-the-clock care. Therefore, assisted living facilities typically provide emergency medical assistance for their residents twenty-four hours a day, but nursing homes have a substantial medical staff on duty at all times.

Levels of Assisted Living

Upon reaching retirement age, some people are fully capable of living independently but prefer to reside in an assisted living facility because it will relieve them of the necessity of doing housekeeping, of shopping for food and preparing their own meals, and of attending to such matters as home repair and upkeep. Such people prefer assisted living facilities because they not only can reduce their responsibilities in the present but also, in most cases, can provide enhanced care as they age and require increased personal care and attention.

Assisted living facilities are not the same as board and care facilities in which residents are generally housed in multiple occupancy bedrooms with shared bathrooms. Most assisted living facilities offer self-contained apartments or cottages, usually with rudimentary kitchen facilities. They range from one-room studios, to three-bedroom suites. Most attempt to appear residential rather than institutional. Weekly housekeeping is generally included in the assessed fees, as are such services as the frequent changing of bed linens, exercise facilities, directed social events, and transportation to medical and shopping facilities. Extra charges are generally levied for such services as doing personal laundry and supervising the administration of required medications.

Meals, included in the assessed fees, are generally served in a communal dining room but can, in most cases, be served on a temporary basis in the units of people who are unable to come to the dining room. Dining rooms are important in assisted living facilities because of the social interaction that occurs among people who eat together.

Many assisted living communities can provide more intense attention if a resident’s health declines to the point that independence is compromised. Even in such situations, however, residents are encouraged to help each other with such routine matters as dressing and bathing. Assuming some responsibility for fellow residents adds to the independence of both the giver and recipient of such assistance.

People whose health makes it necessary for them to receive more intensive nursing care usually vacate the apartment in which they have been living and enter the associated facility that provides enhanced care on a long-term basis. This facility may be likened to a
hospice, which is a facility for the terminally ill, although a hospice is generally available to people who are thought to have less than six months to live, whereas an enhanced care unit attached to an assisted living facility may admit people who are frail but whose life expectancy could be several years.

Cost of Assisted Living

Assisted living facilities generally cost 20 to 30 percent less than a nursing home. Those residing in assisted living facilities often enter such facilities when they are relatively healthy and may remain in them for a decade or more. Such facilities offer graduated levels of care as those living in them begin to need more intensive care than they initially required.

Some facilities offer extensive contracts that provide unlimited long-term nursing care as needed. Such contracts, however, are initially more costly than modified contracts that guarantee only specific amounts of long-term nursing care. As residents need increasing levels of care, the monthly assessments of those holding extensive contracts will be unchanged; however, the monthly assessments of those with modified contracts will increase after a specified amount of long-term nursing care is exceeded.

In most cases, the cost of living in assisted living facilities is the responsibility of the residents, although some may have private insurance policies to cover their expenses if they require long-term nursing care. Those who exhaust their financial resources usually qualify for long-term care reimbursement under Medicaid, but to qualify, they must be approaching utter destitution.

Demand for Assisted Care

During the first half of the twentieth century, the population of the United States doubled, and by the beginning of the twenty-first century, it had doubled again. Part of this dramatic increase was the result of higher birthrates, but the greater portion resulted from a significant rise in the elderly population.

According to the US Bureau of the Census, the number of people aged eighty-five or older about doubled between 1990 and 2009, and it is anticipated to more than double between 2010 and 2040. People are not only living longer, but they also are remaining active well into their seventies or eighties, sometimes continuing to work either full time or part time during these advanced years.

As the Social Security system becomes increasingly strained for funds, the age to which people will be forced to work to qualify for full benefits will gradually increase, possibly to between seventy and seventy-four years. Diseases that earlier resulted in fatalities are increasingly instead becoming chronic conditions because of advanced medications and procedures. Such advances in medical care and increased control of chronic diseases have made working to an advanced age a realistic expectation.

Dealing with Dementia

A major problem among the aging is dementia, often the result of Alzheimer’s disease. People suffering from this disorder may become increasingly forgetful and often appear to be confused. Because people usually slip into dementia gradually, the condition may go untreated for longer than is desirable.

In assisted living apartments or cottages that have kitchen facilities, a considerable fire danger is posed by those who are forgetful. They forget that food is cooking on stovetops, causing fire alarms to sound. This sort of problem often suggests that it is time for a resident to vacate the assisted living facility and move into a facility in which closer supervision is offered.

AlthoughAlzheimer’s patients gradually lose their ability to live independently, their overall physical condition may be quite good. They require special care and monitoring on a regular basis. Many continuing care retirement communities offer such care and also involve those suffering from Alzheimer’s disease in as much social interaction as they are capable of pursuing.

Need for Service Plans

To ensure that there is no misunderstanding about the responsibilities of an assisted care facility, people entering them, in collaboration with the administrators of such facilities, usually are signatories to a written document or contract that clearly states what will and will not be provided. Such service plans are subject to modification as conditions, particularly the health of residents, warrant. Such documents should indicate the period of time covered and provide for updates at specific intervals and for changes to be made if the physical condition of a resident changes significantly.

Documents of this sort are designed to protect both the facility and the resident. The resident should be represented both by concerned parties—family members or trusted friends—and by an attorney who represents the resident’s interests. Such an attorney may be an active participant in drawing up this document that specifies the provisions of the service plan.

Bibliography

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