Sometimes, older persons need assistance with activities of daily living. Activities of daily living (often referred to as ADLs), according to the federal Administration on Aging, include eating, the ability to get around in one’s home, dressing, and bathing oneself.
The assistance you need may not require the round-the-clock, skilled health care a nursing home provides, yet your needs cannot be met living by yourself.
Assisted living residences are designed to meet special personal-service and housing needs, and often health care needs as well. Choices vary from single or double rooms to suites or apartments.
Assisted living residences, also referred to as personal care, residential care, or domiciliary care, may be part of a retirement community, nursing home, elderly housing, or they may stand alone. The goal of assisted living is to help you continue living as independently as possible.
If you decide that an assisted living facility is the best option for yourself or a family member, visit a few facilities. Talk to staff and residents, and keep in mind the following checklist of things to look for and questions to ask as you make your decision.
- Know what services the facility provides, and if these services are provided by the facility’s employees, or if arrangements are made with other agencies.
- Find out what kinds of activities and recreation are available, and how often they are offered.
- Know what the daily or monthly rate is, and what services are included in this fee. There may be other services that are available for extra charges.
- Ask about how much input you will have in your daily life and care, and how much flexibility there is in the schedule.
- Find out what choices of accommodations are offered there.
- Ask if furniture and other personal items can be brought from home.
- Consider the location of the facility, and if the location allows for frequent visits from friends and family members.
- Be sure you know what happens if you need additional assistance later on. Find out if you have to move, or if the facility will be able to provide the care you need.
- Check the facility for safety features, including well-lit stairs and halls, handrails in the bathrooms, well-marked exits and a way to call for help if needed.
- If applicable to you, find out if the facility accepts Medicare and Medicaid.
- Find out if the state you are in requires the facility to be licensed. Ask to see the most recent inspection report.
Choosing the Right Assisted Living Facility
Any group-residential program that is not licensed as a nursing home, that provides personal care to individuals who need assistance in the activities of daily living (ADL), and that can respond to unscheduled needs for assistance that might arise constitutes assisted living, according to the definition by researchers Rosalie Kane and K.B. Wilson.
However, every state in the nation has its own set of definitions regarding assisted living. And not only do the specific requirements of an assisted-living facility vary from state to state, but each facility also may vary in the range of services it offers and the type of elder it serves.
When choosing an assisted-living facility, it is essential that the combinations of services available support the maximum functioning and control of an individual rather than foster dependence. Therefore, look for a facility that provides the most support for an individual’s recovery, rehabilitation, self-esteem, and autonomy. In addition, look for a facility that will be able to continue to provide support if the elder’s health declines, while still supporting the individual’s autonomy and freedom of choice.
Assisted-living facilities have become very popular alternative-living options for older adults because they offer both independence and support when it is needed. The typical assisted-living facility offers an independent-living unit with limited cooking facilities in the unit; provides meals, general housekeeping and maintenance, transportation services, and medication monitoring; includes access to a nurse and to social and cultural activities and events; and helps with organizing and arranging therapeutic services.
Below is a checklist of situations to consider when selecting a facility.
Some facilities are designed to support persons with dementia and have provisions for wandering and specialized programs to help these elders maintain their cognitive functioning as long as possible.
When seeking a facility for someone with Alzheimer’s disease, remember that the illness is progressive and additional services will be required over time.
Explore the range of programs available and the types of situations the facility can handle, as well as the types of situations it cannot handle, and how a transition out of the facility is supported by the staff.
Check into the staffing patterns and the support available during the night, in case help is needed. Assisted-living facilities are staffed on a 24-hour basis, but there may be some limitations as to the types of services available during the night.
Bowel or Bladder Problems
Most assisted-living facilities will accept persons with some incontinence problems. It is a good idea, however, to explore the support available and the policies in place regarding incontinence.
Review the policies regarding medication management. If the elder requires help with his or her medication, make sure that the facility has a system in place to provide this help. Investigate the way staff monitors medication and the provisions in place for medication refills; make sure this system is adequate for your elder’s needs.
Find out the range of personal-care services available and the charge, if any, for routine personal care such as assistance with bathing and dressing. Even if the elder is not in need of these services when he or she moves into the facility, such care may be needed later.
The most important part of selecting an assisted-living facility is determining the “fit” between the older adult’s present and future needs and the facility’s available services. Since needs change over time, it is very important that a range of services be available. This is vital to future planning so that you are not confronted with additional expenses or, worse, an unexpected move.
Assisted-living facility costs vary from location to location and are based upon services provided. Shop around and find out what the range is in your location, as well as what services are offered as “standard” versus what services are offered for extra fees.
A useful discussion to have with an assisted-living facility staff member is a “what if” discussion. “What if Mom needs someone to get her up and dressed in the morning and ready for bed in the evening?
Do you provide support for this activity? If not, do you make arrangements for it as an extra service, or is the family expected to make these arrangements?” A list of possible “what ifs” is a useful tool to take with you during your visit to each prospective facility.
Finally, a good assisted-living facility has a philosophy of service that focuses on maximizing the independence of the residents and supports a high quality of life. Read the material carefully that is provided to you, and look for language that demonstrates the facility values the independence and autonomy of its residents.