Unlike nursing homes, the assisted living (AL) industry has largely escaped stigma and negative public perception. People are cautioned to "never promise your loved one you won't put them in a nursing home," but experts never urge against saying "I promise I'll never put you in a nice assisted living facility with a bar and a fitness center."
Background and Regulatory Status
By definition, assisted living can refer to services that are licensed as residential care facilities, homes for the aged, and personal care homes, with the basic element being some combination of housing and personal care. At minimum, services must include 24-hour awake staff, meals, housekeeping and laundry services, transportation and social services, and health-related services, such as medication management.
There are more than 36,000 licensed assisted living facilities (ALFs) in the United States, with more than one million units/beds. Based on 2008 data and ranked by total assisted living occupant capacity, the top three companies were Sunrise Senior Living, Emeritus Senior Living, and Brookdale Senior Living. Despite the credit crisis and financial meltdown that have taken a heavy toll on the real estate industry, assisted living services continue to expand. While the majority of assisted living residents today — 86.2% — pay from their personal financial resources, 41 states offer "home and community-based waivers" that allow low-income residents to live in assisted living.
The main philosophy of assisted living is providing residents with varying levels of choice and independence, ideally in a homelike environment that minimizes the need to move when needs for services increase. Unlike nursing homes, ALFs are regulated by the states, not the federal government. Although the assisted living industry is much less heavily regulated than the nursing home industry, at least half of all 50 states updated their assisted living regulations since 2008.
Medication Management and Staffing in Assisted Living
The need for assistance with medications is often one of the factors leading to admission to an ALF. But in some states, the laws are vague regarding which staff members may assist with medications, and nearly half the states permit registered nurses to delegate the administration of oral medications to aides.
Staff turnover rates may be high, with average staff turnover in assisted living estimated at 42% every year. This high turnover may be very difficult for residents who have become attached to certain staff members who may then leave for a job elsewhere. Staffing requirements vary widely: New Jersey, for example, requires that a nurse be available at all times (on call and reachable by phone), while Tennessee requires only that a nurse be available as needed.
Dementia Care in Assisted Living
The Alzheimer's Association points out that at least half of AL residents age 65 and older have Alzheimer's disease or another type of dementia, and the Maryland Assisted Living Study found that 68% of elderly assisted living residents had dementia. Other studies have found higher than expected rates of mood and anxiety disorders.Many states now have enhanced standards for the care of residents with dementia, with Massachusetts creating a new "Special Care Residence" certification category, and Florida now requiring facilities to monitor and manage ALF residents who wander.
The phrase "aging in place" has traditionally meant that when a person's circumstances change they should be able to stay put in their current living situation, because they may receive more services but not have to move. While aging in place is a central tenet of the assisted living philosophy, there are often no clear-cut criteria regarding the level of disability or illness that residents may have while in a facility.
Source:
The Senior Care Source, Novartis: Facts, Figures & Forecasts; 2008; vol. 5, pp. 34-44
