Assisted living is less well defined than independent living. There is no Federal oversight. Each State regulates these entities. Service levels vary based on regulations and management philosophies at these organizations. For instance, some assisted living organizations have dementia units and others have skilled short term rehabilitation units. Depending on the needs of the senior, assisted living facilities may or may not fit what the senior requires.
Assisted living facilities often use activities of daily living (ADL) assistance needs as criteria for admission. ADLs include grooming, dressing, feeding, transfers, toileting and ambulation. Variations in levels of care and services may be regulated by the State or established by the facility policies. Assistance with toileting may be acceptable, but the senior may be required to manage their own incontinence products. These questions will come about as the family and senior interview organizations.
Most assisted living care is paid for privately by the family. Some States have subsidized assisted living type care that is paid for by State Medicaid funds. If the assisted living is partially or totally paid for by Medicaid, the senior will be required to demonstrate financial need. Rental rates for assisted living units vary widely based on the amount of services needed, urban or rural and the geographic location. Some facilities charge flat rates and others have ala carte billing for services above the basic needs.
On admission, ask about the level of care that would require the senior to be discharged from the facility. Assisted living may not be able to provide adequate care as the senior ages in place. It is important to have the potential discharge discussion at the time of admission so that the family has time to prepare prospectively rather than in crisis. Assisted living may not be the final destination for safe care of the senior depending on their status across time.
Assisted living facilities usually provide cuing and supervision of the senior’s ADLs. This means that the senior may need reminders for bathing, meal time or grooming. These reminders are provided by the staff at the facility. Housekeeping and bed linen services are usually provided on a routine basis and additional services may be purchased. Ranges for cooking may or may not be provided, but a microwave oven is pretty universal. Meal service is provided with meal plans varying widely facility to facility.
Assisted living unit have an emergency call light system in the apartment. This is most frequently in the bathroom, but there may be emergency call lights in other rooms. Many residents of assisted living also purchase their own emergency call system from a commercial vendor to augment the in house system.
Assisted living facilities usually have a licensed nurse as a team member. This may be a registered nurse or a licensed vocational or practical nurse. It is unusual for the facility to have round the clock licensed nurse coverage. The licensed nurse can practice in the assisted living facility based on the practice act of the State. However, because these are not hospitals or nursing homes the nurse may have organizational or regulatory parameters limiting the nursing practice in the assisted living building. In general terms, the licensed nurse supervises medication administration, oversees the non medical attendants and staff and communicates with the attending physician providing continuity of care for the senior.
In addition to the nursing staff the assisted living facility typically has an activity director, food service director and social services director. The kind of staff will depend on the size of the facility and the kind of services delivered.
Some assisted living facilities allow private attendants hired by the family to accompany the senior in their facility. The scope of work that the private attendant may provide is guided by regulation and/or the policies of the facility.
Some assisted living organizations also have independent living units on campus. This allows the senior to move from one level of care to another without requiring relocation to another facility. However, transfer from one level of care to the next usually requires relocating to another apartment. This change from one apartment to another may be as distressing to the senior as moving to another campus.
A plan is created by the interdisciplinary team to manage the needs of the resident. This is often called a service plan and will vary based on regulatory requirements and resident issues. The plan is created shortly after admission and reviewed and updated on a periodic basis.
The association for assisted living facilities is call the Assisted Living Federation of American. It can be accessed at the following web site: www.alfa.org. This site can assist you to find facilities and information about facilities in your area.