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The gap between real assisted living residents and what they need
Thu, 03/07/2013 - 16:39 - Laurie Orlov
We don’t see ourselves as aging with dementia – and neither did senior housing providers. Chew on this thought from a senior housing strategist, who encourages providers to "look at entryways differently," Traci Bild says. "You often see a lot of furniture where people sleep in the lobby. Instead, make it a place where people can congregate to talk, rather than to sleep, by placing high top tables." Meanwhile, back at the reality ranch, where sitting at high-top tables, uh, may not work so well -- the average age of resident move-in to assisted living is now 87 -- says Allison Guthertz, Vice President, Quality Resident Services at Benchmark Senior Living: "These days when residents move in, they already need help with three to five activities of daily living (ADLs)."
Okay – now is the right time, but wrong building, wrong staff, wrong vision. So buildings that were designed quite recently feature long hallways (ending 5 or 6 units away from a nurse’s station), as well as soft-cushioned furnishings that incontinent and frail residents can become trapped in while watching a movie. We see dementia units (notable by the presence of locked doors) in which those residents who are up and about gravitate towards alarm-blaring doors; where activity programs are designed for bingo and dancing – neither of which match the needs of wheelchair-bound residents with dementia. Says Victor Regnier, a professor of architecture and gerontology -- in an understatement -- times have changed. A decade ago, says Regnier, he was consulting with a large assisted living provider who was "shocked" when he recommended including a dementia unit adjacent to or within the community that was being designed. Shocked, eh? But an NIH study that ended in 2003 (oops, that WAS a decade ago), indicated that 1 in 7 Americans age 71+ had dementia. So coincidentally that’s when many independent and assisted living buildings were on the drawing board. And still the industry seems startled that so much of their future requires an expertise and an environment that they did not foresee. One that requires redesign, retrofit, and retraining.
What you see may not be what you need – or what you get. Today Professor Regnier acknowledges that memory care units may turn out to be 80% of the business of assisted living providers. Surely this is also because they are so profitable -- an average of 42% price increase, but without a comparable increase in service. So providers are marketing to family members who are depressed at seeing so many sleeping 89-year-olds in the lobby, but maybe they would worry more if they’re falling off the chairs tucked under the high-top tables? And are PERS devices or fall detectors provided on move-in day? Not exactly. Nor are cameras, sensors, or much of any other technology. In fact, what exactly, should family expectations be for dementia units or even for assisted living in general? Well, it depends on what state you’re in – services are not standardized -- nor is training, so expectations for an average 2-year stay cannot be properly managed.
Will the real consumer profile please stand up? The assisted living industry has been vocal over the years that they are NOT nursing homes – and therefore they should not be regulated as such. But with the availability of locked 'memory' units, hospice care, the rise of move-in ages, the presence of numerous wheel-chair bound individuals, and with an average age 89, who is kidding whom? Transparency matters in all things, and those who design and configure assisted living today must acknowledge the characteristics of the consumer and manage the expectations of families. That is the only way we will shrink the disconnect between expectations, decor and real need.
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Assisted living facilities
I have been a medical social worker since the 1980s. I remember working with elderly patients needing nursing home placements. They would implore "don't send me to the poor house" a depression era reference that faded over time. I suspect that same fear is making a strong return.
The horror stories are only beginning to emerge from assisted living facilities. Here's an example http://www.miamiherald.com/neglected_to_death/.
This is a very important topic Laurie please keep ringing the bell on this one. State Medicaid programs are now outsourcing their placement responsibilities to managed care organization. What's the motivation of managed care, to make a profit. So the State can wipe away their social commitment to protect seniors by contracting with companies that don't have the same values (ok I am attributing a social protection mission to State governments).
No doubt we need to find mechanisms to control the rising cost of long term care on State budgets but to offload that responsibility to companies who then contract with unlicensed or under regulated assisted living facilities and nursing homes puts our frail silent seniors at great peril.
Assisted Living
Your observations are spot on. Coupled with the facility issues, the caregiver to client ratio in many assisted living facilities is appalling, especially given the higher average number of ADLs for which residents now require help. One caregiver and one med aide cannot adequately cover 60-75 residents in an overnight shift. These minimum wage individuals, with no oversight during the nighttime hours, are required to make triage decisions when call buttons go off simultaneously. Should they respond to the person who has fallen, the one who has had explosive diarrhea or the one who is moderately demented and wandering the halls? The resident who is too incapacitated to ring his/her call button can lie in urine while the caregivers sort out these more obvious problems. I have seen a resident who was incapable of feeding himself become malnourished and dehydrated in an assisted living setting. Many are receiving inadequate socialization because there isn't enough staff to encourage participation in group activities and certainly not enough time for staff to chat with them in their rooms. As one gentleman, now trapped in this impossible environment, exclaimed, "This is NOT what I expected!"
Frightening observations
Very interesting to see the gap between the research and reality.
Hopefully blogs like yours can keep pressure on governments and institutes to maintain standards and improve the living conditions of the people we love.
Thanks for the post.
An Honest Look Inside Assisted Living Communities
The non-standardization of services between states in assisted living is a regulatory issue. More concerning to the actual residents and their families, is the non-standardization of services and care levels between different assisted living facilities in the same geographic area.
For example, who knows what the care levels really mean for Sunrise, Emeritus, Atria, and dozens of other providers? Sunrise uses the care level terms of Plus, Plus Plus, and Enhanced Care, while Emeritus and Atria opt a numerical system up to 6 for Emeritus and up to 4 for Atria. Good luck deciphering the differences, even with the glossy sales brochures. It's as useful as comparing nutritional information if the FDA didn't define precisely what the units must be.
We work to standardize this information for everyone. Our service completes high-touch research on each community to provide families with exactly the comparative information they need to make a wise choice. We only publish what we've written and photographed ourselves, so we're not acting as a marketing service for the communities by re-printing their sales brochures. Our team visits each community multiple times during our research and we keep on top of the communities through ongoing Freedom of Information Requests to the state's inspection departments.
Tal Ziv
www.silverliving.com
An Honest Look Inside Assisted Living Communities
Assisted living, nursing care, nursing home
Such type of communities play an important role and offer seniors the chance to build up new friendships, social and cultural activities and it’s good to hear that 94% of assisted living residents are happy with the assisted living facilities.
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