Assisted Living Facilities

August 3, 2010

Assisted living (AL) is a form of long-term care that promotes self-direction and participation in decisions. As a model of supportive housing, assisted living emphasizes independence, individuality, privacy, dignity, and choice. It was initially developed to fill the gap between community-based services that support seniors living at home and nursing homes. Assisted living generally places a greater emphasis than nursing homes on preserving “home-like” qualities such as control over one’s personal space. Assisted living is growing rapidly, both because it offers an attractive option to seniors seeking assistance while maintaining independence, and because of the costs associated with traditional long-term care institutions.

Defined broadly, assisted living is any group residential program not licensed as a nursing home that can respond to unscheduled needs for assistance. The spectrum of assisted-living services includes such diverse options as congregate housing, residential-care facilities, board-and-care homes, and adult foster care homes. The package of services can be tailored according to consumer needs and preferences.

“Assistance” in these facilities can be defined as help with any “activity of daily living,” which includes bathing, grooming, administration of medications, transferring (help with moving), toileting, laundry, cleaning and meal reminders. Keep in mind that AL facilities can be very different and offer varying degrees of services. One facility may offer only limited assistance, while another may offer more comprehensive care. AL is most appropriate for the individual who needs some assistance but is not ready for a nursing home.

Are there assisted-living facilities especially for people with Alzheimer’s?
Assisted-living facilities for people with Alzheimer’s disease are often referred to as “Special Care Units” or SCUs. SCUs are staffed with individuals who are specially trained to work with people who have Alzheimer’s. As such, the environment is designed to be very safe and comfortable, and the activities are designed to benefit the person with Alzheimer’s.

SCUs can differ in the level of care they provide along the continuum of the disease. For instance, some assisted living facilities will accept people with Alzheimer’s until they need skilled care (nursing home care) whereas others will only accept people who are in the early stages of the disease.

What do I look for in a Special Care Unit (SCU)?
Some of the specific characteristics to look for in SCUs are:

  • A structured routine for residents.
  • How much time the staff takes to gather specific lifestyle information about your loved one in order to individually cater to his/her needs.
  • Comfortable, familiar and safe surroundings; ask what is done to ensure safety
  • Compassionate staff.
  • Activities that reflect the routines that each individual resident has established over a lifetime.
  • Activities that help people succeed at familiar tasks, whether it is making their bed or baking cookies. (These activities can help give the person a feeling of satisfaction and productivity.)
  • What is offered for outdoor activities, such as secured walking paths, waist-high gardening boxes for people to do their own gardening (so the person doesn’t have to bend over).
  • Staff’s ability to deal with difficult situations and behaviors; give examples and ask how they deal with them.
  • How wandering is handled.

What questions should I ask?
1. Do you accept people with Alzheimer’s disease? If so…

  • How far into the disease will you care for them?
  • Is your staff trained to specifically care for people with the disease? What training do they receive?
  • What types of activities do you provide that are designed for people who have Alzheimer’s?
  • How many people with Alzheimer’s do you currently serve?

2. How many levels of care do you have and how are they categorized?
3. Aside from the monthly fee, are there any additional costs involved?
4. What does the monthly payment include?
5. What happens when the family runs out of money? Do you accept state funding (Medicaid)? If not, what happens?
6. How many nurse’s aides are scheduled on each shift? How are weekends handled? What is the ratio of caregivers to residents?
7. Is transportation included?
8. What are your limitations regarding the needs of the person?
9. Do you allow wheelchairs?
10. Do you allow oxygen?
11. Do you take people who have incontinence problems?
12. What is your procedure for handling death and dying?
13. Do you provide hospice care services, or does the patient need to be transferred to a nursing home?

How do I pay for assisted living?
Although some facilities accept state funding (Medicaid), assisted living is ordinarily paid for privately.

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