Assisted living housing easily can be seen as
an extension of home-based care for older persons who need frequent periodic help but are
not candidates for nursing home placement.
What Is Assisted Living?
The term "assisted living" refers
to both a housing type and a care philosophy. It is a long-term care model based on the
concept of providing professionally managed personal and health care services in a
residential environment in order to keep older frail individuals independent and out of a
nursing home. The popularity of this housing type has grown enormously in the past 10
years in response to:
the burgeoning growth of the over-age-85
population
the spiraling costs of long-term nursing care
the preference for home care and new portable
technologies that make it possible for frail older persons to remain longer in their own
home
older consumers' resistance to nursing home
placement
the cost of government-funded nursing care
which has placed pressure on state governments to explore less expensive forms of housing
and care for the frail.
Assisted living has no precise and specific
definition, in part because it represents a philosophy and can be interpreted in a range
of different housing forms. However, the following eight definitional qualities outline
the most desirable characteristics. Although few assisted-living facilities are able to
satisfy all of these criteria, these central concepts nonetheless provide appropriate
targets for the development of highly supportive, humane, residential housing for the
mentally and physically frail.
1. Appear Residential in Character
The form and character of assisted living
should be derived from the house and not the hospital to promote an atmosphere that is
home-like and similar to the environment that the older person has grown accustomed to
over the course of his or her life.
2. Perceived as Small in 'Scale and Size
The facility should be as small in size as it
can be without sacrificing monthly cost stability and the capability to provide 24 hour
assistance. Depending on the unit size, rent and services can range from $1,000-$1,600 a
month ($1,500 to $2,500 locally) per resident.
3. Provide Residential Privacy and
Completeness
The individual housing unit should be singly
occupied, with a full bathroom and kitchenette for individual use.
4. Foster Independence, Interdependence, and
Individuality
The focus of care should be on
self-maintenance with assistance. Residents should be encouraged by the facility staff to
initiate independent behaviors to help themselves and one another.
5. Focus on Health Maintenance, Physical
Movement and Mental Stimulation-
The setting should move to stabilize physical
decline through exercise, to maintain competency by involving residents in simple
decisions about their care, and to build reserve capacity.
6. Support Family Involvement
A care giving partnership should be forged
that uses informal help through family support, sharing responsibility for resident well
being rather than relying totally on the facility for all support.
7. Maintain Connections with the Surrounding
Community
The facility should integrate rather than
isolate residents from community resources such as stores and churches. Inviting
volunteers from the community to become involved with the facility and collaborating with
such community services as transportation maintains a connection with the community in
which the residents live.
8. Serve the Frail
Residents should be older people in danger of
nursing home placement because of their needs for assistance and support.
Who Lives in Assisted Living (or Who Are the
Residents)?
Both the physically and the mentally frail
can successfully reside in assisted living projects. The physically frail resident is
often an individual who suffers from a debilitating disease such as arthritis,
hypertension, or diabetes and has difficulties carrying out normal activities of daily
living. Although the resident may require assistance in bathing, toileting, grooming,
ambulation, medication supervision, and eating, service needs do not extend to requiring
full-time nursing care.
The mentally frail resident is frequently
experiencing the first stages of dementia. The resident has difficulty comprehending the
environment and may easily be confused or lost, even in familiar surroundings. As the
dementia advances, restlessness, irritability, and behavioral problems may develop. In
many facilities, rooms for residents with advanced dementia are clustered in one area so
that wandering can be controlled without placing the resident in jeopardy or disturbing
other residents.
Assisted-living settings generally serve both
of these types of individuals. Being disoriented and restless, just like being
incontinent, does not preclude living in a residential setting, such as an assisted-living
facility, rather than a nursing home. However, American (and Canadian!) social
and health policies have generally abandoned individuals with these problems. In other
cultures, the desire to keep individuals in dependent and out of nursing arrangements for
as long as possible forms the cornerstone of a comprehensive long-term care program. In
the United States, these individuals must either enter a nursing home or fend for
themselves in the community. Assisted-living facilities serve older persons in need of
some assistance with daily living in the least restrictive setting.
