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Important Considerations When Evaluating Assisted Living Communities

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The “Bridge” Option

For many, assisted living communities are a sort of “bridge” option for seniors who are experiencing difficulties maintaining a healthy, safe, and involved lifestyle when living independently. There may be some mobility issues, problems taking prescription medications correctly, lessened abilities and/or interest in cleaning and/or cooking, or maybe some assistance with personal care is now needed. If such seniors live alone, there is also the risk of depression and loneliness due to isolation. These folks do not have ongoing medical conditions requiring skilled nursing; thus, the assisted living community is a viable option.

According to MetLife Mature Market Institute, assisted living communities generally embrace the following definition and philosophy: “Assisted living communities also strive to meet the social, emotional, cultural, intellectual, and spiritual well-being of their residents. The autonomy, dignity, and independence of the older adult are the core philosophies. An important part of this philosophy is the desire to accommodate the changing needs and preferences of individuals, helping them to remain as independent as possible in an environment that gives them the security of knowing that people are available should they need assistance at any time.”

Additional Considerations

Researching assisted living communities and making those initial visits essentially is no different than when doing the same for independent living communities. Geographic location, amenities, size, costs and fees, floor plans, good food, transportation service, cleanliness and decor, courteous staff, appeal of outdoor landscaping and social areas, availability of housekeeping or laundry services…these are general factors to consider. However, when considering seniors whose needs would be better served by an assisted living community, additional factors should be evaluated before making a final decision.

Regulations:

The federal government provides no oversight for assisted living communities. This is often a surprise to some families. Each state has its own regulations, and families are advised to research. Your Area Agency on Aging or State Office on Aging are recommended starts.

Rights of Residents:

Elderlawanswers.com recommends considering the following: Are there opportunities for residents to participate in decisions to be made concerning facility management, meals, or activities? Is there a resident council? How are complaints handled? On what grounds might a resident be evicted and how are appeals handled? In the hustle of paper signing, be careful about releasing the community from liability for injury resulting from neglect.

Ongoing Care:

Who periodically assesses residents’ suitability for remaining in assisted living? Are there regularly scheduled meetings to implement or update care plans and who attends? What criteria are important for considering a transition to memory care or skilled nursing?

Staff:

Does the AL community consistently meet the State required resident to staff ratio? What are the minimal education requirements for staff who will be in contact with residents most—certified medication assistants, personal care attendants, housekeeping staff, activities coordinators/directors? What kind of ongoing training and professional development opportunities are available to staff, and what are the incentives for participating? What kind of orientation are staff given, especially those with little experience working with seniors and the issues they face as they age? How are staff recognized and rewarded for exemplary service? Are staff given training to recognize early signs of dementia?

Corporate or Organizational Health:

How financially stable is the corporation or nonprofit organization behind the AL communities you are considering? Do they have high turnover rates, a hugely common problem in the industry? How many lawsuits have they been engaged in and what were the results? How do current and former employees evaluate them on job search sites like Indeed.com? Certainly, any online reviews by former employees need to be considered with caution. Disgruntled employees who were fired sometimes seek revenge, but the positive remarks and personal testimonies deserve consideration.

A “Frontline” investigative program, “Life and Death in Assisted Living” aired on PBS in 2013. It is a comprehensive look at one nationwide corporation’s difficulties with “fatal lapses in care, understaffing, and a quest for profits.” I came upon it by accident recently online and recommend it. The future for elder care in America is precarious, and this documentary illustrates major concerns residents, families, and government officials should have.

And All Those Papers Requiring Signatures for Admission

If possible, get copies in advance, read them carefully, prepare any questions or concerns, and know what you are signing.

Two Useful Resources

Whether planning on initial visits or follow up considerations, here are two useful resources among many available online:

AARP.org – Caregiving Checklist “Assisted Living: What to Ask”

Metropolitan Life Insurance Company’s “Since You Care” publication that also includes an “Assisted Living Checklist”

Additional Resources

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Given that considerations for evaluating assisted living communities are a bit more complex than for independent living communities, what suggestions and concerns would you add?

About the Author:

Jenny Mummert, M.Ed., has a career background in higher education. She lives in mid-Missouri and has managed the care of her elderly parents, both of whom had dementia and lived 400 miles away. Her personal blog, “Drifting Toward Planet Elderly,” serves as therapy, a family history, and a case study of her family’s journey with dementia. Jenny’s mother now lives in Mid-Missouri where they enjoy daily morning coffee and chat time with friends at The Arbors at Mill Creek Village.

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