Care Arrangement: Assisted Living Facilities
Whenever someone is diagnosed with dementia, they will, sooner or later, require special care arrangements. They could be cared either at home or at an external facility. They could be cared for by family members, friends, loved ones, or care professionals. While there are numerous options available, the care arrangement best suited for a dementia patient is dependant on the progress of the disease, the choices of patient and their primary caregiver, the affodordability, and the amount of care and time needed to be given to the patient. One such care arrangement is known as Assisted Living. It involves the dementia patient having to live at an external care facility on a full-time basis, where they receive care from professionals.
QUICK LINKS - TOPICS COVERED:
- ASSISTED LIVING FACILITIES EXPLAINED
- THE STATISTICS OF PEOPLE IN ASSISTED LIVING
- WHEN IS IT A GOOD FIT?
- WHAT ARE THE SERVICES PROVIDED?
- HOW TO FIND AN ASSISTED LIVING FACILITY
- WHAT TO LOOK FOR WHEN CHOOSING AN ASSISTED LIVING FACILITY WITH MEMORY CARE?
- COSTS OF ASSISTED LIVING WITH MEMORY CARE
- POTENTIAL ISSUES IN ASSISTED LIVING
- TRANSITIONING INTO AN ASSISTED LIVING FACILITY
- TIME TO FIND A NEW CARE ARRANGEMENT
- ADDITIONAL RESOURCES
ASSISTED LIVING FACILITIES EXPLAINED
Assisted living facility, also known as residential care or adult care home, is a residential-type facility for people with disabilities or for adults who need help with a number of everyday tasks. They may need help with managing their medications, dressing, bathing, cooking meals, eating, or using the bathroom, but often they don't need full-time nursing care. In other words, assisted living is best for people who need daily assistance but are not ready for a nursing home.
The facilities provide a group living environment, supervision, and assistance with activities for daily living. Thus, they ensure resident's health, safety, and well-being by offering 24-hour support and access to care, while giving them the freedom to do what they want for theirselves. Some facilities provide apartment-style living with scaled down kitchens, while others provide rooms. These facilities range from converted homes or apartment complexes to renovated schools. Most facilities have a group dining area and common areas for social and recreational activities.
Assisted living facilities can be very different from one another as it can offer different levels of service. Among them, there are specialized assisted living facilities, where the services provided is tailored for a specific type of disability or patient need. One such facility type is assisted living with memory care. Also known as specialized assisted-living facilitis (SCUs), in this type of facilities, the staff are usually trained to work with individuals with dementia. The living environment in these facilities is designed to be very safe and comfortable. In addition, it has activities and social programs that are designed for residents with dementia.
However, they don’t normally have full-time medical personnel. This makes the care arrangement unsuitable for those whose dementia has progressed to the later stages, but can be quite helpful for dementia patients still in the early stages. Regular assisted living facilities on the other hand may not always have the required levels of care arrangement available for dementia patients.
THE STATISTICS OF PEOPLE IN ASSISTED LIVING
According to the National Study of Long-Term Care Providers, in 2014 there were an estimated 835,200 current residents enrolled in 30,200 assisted living and similar residential care communities. 39.6% of the assisted living residents were people with a diagnosis of Alzheimer’s disease or other dementias. The Number of licensed beds was 1,000,000 in 2014.
Source: Harris-Kojetin L, Sengupta M, Park-Lee E, et al. Long-term care providers and services users in the United States: Data from the National Study of Long-Term Care Providers, 2013–2014. National Center for Health Statistics. Vital Health Stat 3(38). 2016.
WHEN IS IT A GOOD FIT?
In terms of level of progression, assisted living can be a good choice for dementia patients who need a higher level of personal care than what they can receive at home or at an adult day care center. They should be able to function with some external assistance. But at the same time, the patient’s progression of dementia shouldn’t be at a stage where they need the round-the-clock medical care and supervision, which can be better found in a nursing home.
Assisted living is also suitable for patients who's families may be overwhelmed by the responsibilities of caregiving and who's schedules with work may not allow them to give their loved one the quality of care they would like to or the patient needs. As the disease progresses, their loved ones needs may become more then they can manage on their own, leaving assisted living a great option to ensure their loved on it taken care of.
It should be noted that regular assisted living facilities may not suit a dementia patient for long. If dementia is not an immediate concern, and the patient is still relatively independent, only then regular assisted living may be a good choice. Once a person is no longer able to care for theirself due to progressive impairment, an assisted living community with memory care could be a better solution.
Before making a decision on whether an assisted living facility is needed for your loved one, there are several questions that need to be addressed:
- Does the patient need more help in the activities of daily living than what family and friends are able to provide?
- Is the primary caregiver unable to fully cater to the needs of the dementia patient due to other family commitments, a job, or living far away from the patient?
- Does the person feel lonely or isolated at home and without a social life?
- Is safety a concern? Mobility can be limited making it difficult to get out of bed and do daily activities
- Is it necessary to manage the medication?
- Is transportation an issue?
Along with the questions above, you can also look out for some of the signs below which could indicate if the dementia patient needs further assistance:
- Spoiled food in the house or the person is losing weight due to malnutrition
- Bruises could be a sign of falling, or mobility and balance problems.
- Wearing the same clothes or neglect personal hygiene. This can indicate that doing laundry and bathing is physically challenging or they simply forget to do it.
- Forgetting things, including doctor’s appointments and when to take medication. This may be due to memory loss.
- Strange or inappropriate behavior. For example, dress inappropriately for the weather. This can be a sign that he or she is experiencing confusion.
WHAT ARE THE SERVICES PROVIDED?
In general, both general assisted living and those with memory care offer basic supervised care, medical monitoring, and help with daily activities such as dressing, mobility, and hygiene. Other services that are usually offered in both types of care include:
- 24-hour staff supervision and security
- Emergency call systems
- Three daily meals
- Assistance with eating, bathing, dressing, going to the bathroom, and walking
- Housekeeping and laundry service
- Health and medical services
- Medication management
- Exercise and wellness programs
- Social programs and activities
- Access to medical care
- Staff to handle and help with both scheduled and unexpected needs
Other that these things, assisted living facilities with memory care often include:
- Code locked doors to any outside part of the facility, ensuring patients who wander cannot accidentally leave the premises.
- Structured activities or programs designed to nurture residents suffering from Alzheimer’s or dementia.
- Outdoor and indoor spaces designed to be both secure and soothing, with a range of familiar activities available and trained staff on hand.
HOW TO FIND AN ASSISTED LIVING FACILITY
In order to find the right assisted living facility for your loved one, you will have to start out by learning about your options. You can get excellent information on the types of facilities available and the services they provide through your local alzheimer’s or dementia association. Usually these organizations can provide information that is tailored for people with dementia. Additionally, you can also approach any other caregivers that you know of to ask about their experiences with such facilities. Even your loved one’s doctor can be a good starting point in terms of researching the assisted living facilities in your area. The internet is also a great resource as you can procure a lot of information from the comfort of your home.
Once you have assessed your loved one’s needs and progress of dementia and feel that they would benefit from staying at an assisted living facility, you should contact a case manager, clergy member, financial planner, hospital discharge planner, physician, or social worker to inquire about facilities in the area. It is advisable to personally check out the different assisted living facilities you have optioned in order to be fully informed and satisfied.
You can also find additional information about assisted living by investigating one or more of the 16 publically traded assisted living companies, including Alternative Living Services, American Retirement Corporation, Assisted Living Concepts, Atria Communities, Balanced Care Corporation, Brookdale Communities, Capital Senior Living, CareMatrix Corporation, and Sunrise Assisted Living.
WHAT TO LOOK FOR WHEN CHOSING AN ASSISTED LIVING FACILITY WITH MEMORY CARE?
There can be huge variations among assisted living facilities. Despite being a long and time-consuming process, rest assured that the right fit is out there. You will very likely find a facility that is well suited to your loved one and their needs.
One of the first and most important things to look out for when chosing an assisted living facility is the staff and its residents. The facility needs to have an active social atmosphere, where the residents are friendly and the staff is well-trained, caring, and warm. Thus, it is important to visit facilities during different times of the day (i.e. during activities and mealtimes) to get a look for yourself. It is also important to seek feedback from residents and their families or via online reviews. The most important factor when choosing an assisted living facility is that it feels friendly, safe, and comfortable for your loved one.
Another very important thing to pay attention to is the caregiver to patient ratio in these facilities. Typically, in a general assisted living facility, the ratio could be as high as 1:25. While some of those assisted living facilities may accept dementia patients, it is not an ideal environment for their proper care. The most effective ratios for dementia care are around 1:5 or 1:7. It should also be noted that usually a lower caregiver to patient ratio also means higher cost for care. therefore, this should be taken into consideration when seeking a suitable facility for your loved one.
Other than that, when visiting assisted living facilities under consideration for a dementia patient, make sure you address the following items:
- Range of services offered
- How many rooms/residents are there?
- How many Alzheimer's and dementia patients live there?
- Check safety devices and precautions – door and window locks, motion detectors, monitoring systems, adequate lighting and non-slip flooring
- How is wandering is handled?
- Are the staff specially trained in dementia care and what is their experience in dealing with difficult situations and behaviors?
- How are outbursts and other difficult behaviors are handled?
- Is there is a structured routine for residents?
- Activities that reflect the resident's personality and hobbies
- Activities that are designed for people with Alzheimer's or dementia
- Activities that help people succeed at familiar tasks, such as making their bed, dressing or cleaning up their home
- Outdoor activities and safe outdoor recreation areas for walking, gardening, etc.
- How much time does the staff take to gather information about your loved one in order to provide the best care for that individual, including safety, well-being, and comfort?
- The appearance of residents. Do they look relatively healthy and content?
- How many staff members are scheduled on each shift?
- How many staff/aides work on the weekends and holidays?
- What is the ratio of caregivers to residents?
- What levels and types of care does the facility provide for all residents?
- What level and type of care is provided especially for Alzheimer's and dementia patients?
- Is transportation provided for doctors appointments or shopping?
- What is the policy on wheelchairs, oxygen tanks, and other medical equipment?
- Are residents allowed to bring personal items from home?
- Are people with incontinence accepted?
- How are aggression and other difficult behaviors handled?
- Can a patient be asked to leave due to aggression, anger, and other bad behavior?
- What safety measures are in place for Alzheimer's and dementia patients?
- Will my loved one have to move if the Alzheimer's/dementia worsens?
- Are medications used to "subdue" patients?
- What is the process for ensuring patients get their prescribed medication on time and in the correct dosage?
- What happens if there is a medical emergency? What is the protocol for contacting the family?
- How is the payment plan set-up?
- Which services are included in the base monthly plan?
- How do they identify which care services your loved one needs, and how often will he or she be reevaluated?
- Who conducts these evaluations?
- What is their policy regarding use of outside services?
- How is a laundry handled? How often will your loved one's clothes be washed?
- How often is the room cleaned?
- If there are issues/concerns with the quality of the care, who do you contact?
- How are records of your loved ones care or incidents taken and what access to do you have to them?
- How is medical attention by their physician handled and do they need to switch to another medical group affiliated with the facility?
During the visit, try to gather if the other residents appear to be happy and if they enjoy interacting with one another. Also, try to assess the different areas of the facility. Does the environment seem clean and fresh? How often is housekeeping provided for a room? Does the facility feel safe and secure? Are the areas easily accessible and have grab bars? It is also important to verify the food by sampling a meal and asking about menu options.
Finally, you will need to check if the facility is in compliance with state and local licensing requirements to make sure that the facility is licensed and in compliance. The bottom line is that the right facility is the one where it is possible to feel most at home with the best assistance that meets the patient’s needs.
COSTS OF ASSISTED LIVING WITH MEMORY CARE
While assisted living costs less than nursing home care, it is still fairly expensive. The costs of assisted living and memory care vary, depending on the following factors:
- Type of residence
- Geographic location
- Size of room or apartment
- Shared or individual space
- Services required
Many facilities charge a basic rate that covers all services, with an additional fee for special services. Most of the assisted living communities charge a base monthly rate, which covers room and board with two to three meals per day, but there are also long-term options available. Sometimes there are entrance fees, deposits and laundry and housekeeping fees.
The average cost for a one-bedroom assisted living apartment is $3,500 per month depending on the location. Assisted living facilities are owned and operated by both for-profit and non-profit organizations and can range in cost from approximately $800 to $4,000 a month or more. When it comes to specialized care and nursing services that aren’t found in regular assisted living facilities, the cost of care can be quite steep. It can go up to $5,000 per month on average, although costs vary widely. On a yearly basis the cost varies widely, ranging from $28,800 to $66,000. Some facilities cover housekeeping, laundry, and other services in their base rate, while others charge extra. But because these all vary by community, it's important to ask each community about their individual costs and services.
Many assisted living facilities use aggressive sales tactics to lure potential residents - this includes heavy calling and offering "discounted" pricing for the rooms and services. While these tactics can be bothersome, it gives the family the ability to negotiate for a better all-inclusive rate for their loved ones stay in the facility. Not all patients pay the same price. There are facilities that provide 'a la carte' services, meaning any additional service such as laundry, personal hygiene attention (shaving, showering..) may be an additional cost to the patient.
When it comes to who pays the bills, it is normally the dementia patient themselves (through their financial executor) or their family members. Health and long-term care insurance policies may cover some of the costs. However, Medicare does not cover the costs of assisted living. In terms of financial assistance, There are some options available to help pay for this care and reduce the out-of-pocket price tag, such as Medicaid and veterans’ benefits, long-term care insurance, Supplementary Security Income, or Social Services Block Grant programs.
To be sure, you should check your private long-term-care insurance plan to find out how much is covered where assisted living is concerned. In the United States, Medicare, government health insurance for older adults, does not cover the costs of assisted living. In some cases Medicaid—government health insurance based on financial need—may provide a limited benefit. Additionally, there are some board and care homes that will accept Supplemental Security income as payment. However, a limited amount of assisted living facilities accept these programs because of the lower rates they receive. Special populations like veterans may have access to VA-approved board and care homes, or veterans’ homes which provide a continuum of care. However, 86.2% of assisted living residents today pay for long-term care from their personal financial resources.
POTENTIAL ISSUES IN ASSISTED LIVING
Errors in Medication Management
- Wrong time administration (71.3%)
- Omitted dose (12.2%)
- Wrong dose (11.3%)
- Extra dose (3.7%)
- Unauthorized drug (1.4%)
- Wrong drug (0.2%)
- Wrong ordering
- Faulty admin Process
- Other staff factors
- providing meals for residents
- offering residents help with the activities of daily living
- helping residents to take care of their living spaces
- monitoring residents’ health and medical appointments
- supervising residents’ medication needs, and
- planning social events, amongst other things.
- Physical abuse – includes unwarranted physical harm such as slapping, hitting, pushing, or kicking. Improper use of restraints and excessive restraints are also included. Physical abuse occurs when the resident is denied food or drinks, or forced to consume certain foods or drinks.
- Sexual abuse – occurs when an individual engages in non-consensual sexual acts with an assisted living resident.
- Psychological abuse – may occur as verbal assault, harassment, bullying, and degradation. Psychological abuse may also occur as “babying” a resident or giving the “silent treatment” as a result of undesired actions.
- Financial exploitation – occurs when an assisted living resident is taken advantage of financially. This may include the unpermitted use of the resident’s money or property for the benefit of another.
- Time, date, place and individuals present;
- Description of the event as reported;
- Response of staff at the time of the event;
- Follow-up action;
- Administrator’s review.
Immunity and prohibition of retaliation
Filing a complaint with the management
- What happened?
- To whom did it happen?
- When did it happen?
- Where did it happen?
- Who did the abuse?
- Who was responsible for the neglect?
- The assisted living registry by contacting registry staff. No one should try to prevent you from reporting concerns to registry staff. The operator must continue to provide agreed upon services as outlined in the residence occupancy agreement and personal services plan after a complaint is made.
- The Patient Care Quality Office for your regional health authority – If you live in a publicly subsidized assisted living residence and feel that your concern about the quality of service delivered by the residence operator has not been addressed, you are encouraged to contact the Patient Care Quality Office for your region if you want to make a formal complaint.
Filing a complaint against an assisted living facility
TRANSITIONING INTO AN ASSISTED LIVING FACILITY
How to get loved one to go if they are resistant
- There's no one to get help for them
- Less socialization
- Memory loss leading to accidents
- Less responsibility when it comes to their living space.
- People around should they need medical help or other assistance
- Better nutrition
- New friends and activities
- Visit Personally: Help them feel the environment of the facility and talk to as many professionals and people as possible.
- Look into Multi-Level Care Facilities: Be sure to consider the benefits of a multi-level facility or a CCRC (additional services provided, which can be good as only one change will be needed). Seniors progress through different levels of the facility as their dementia worsens.
- Taste Test: Test the meals
- See the Accommodations: Don’t believe everything you are told and visit the space so you will know how well your loved one will be accommodated.
- Activities: This will help your loved one try new things and get new hobbies. This is a major factor for breaking the initial resistance.
- Build Relationships: People that work in these places are used to resistance, ask for help and learn from their experience as they are confronted with these types of situations daily.
- Create Need: You can try to get a social worker to ask for your loved one’s help with some task or job. For people who respond to this, it can be a contributing factor to their happiness.
- Safety: Don’t wait for something terrible to happen before you make this decision. Analyze the situation rationally. If there are safety risks involved and your loved one can’t stay at home alone, act.
What to bring when moving into assisted living
- Bed Sheets (Atleast 2 sets)
- Towels (Atleast 2)
- Personal Hygiene Products (Razors, Deodorant, Soap)
- Formal clothing (for special occasions)
- End tables (If not provided by facility)
- Picture Frames
- Vase of flowers
- Music player
Tips for transitioning into assisted living facility
The transitioning period
TIME TO FIND A NEW CARE ARRANGEMENT
The best time to consider changing to an assisted living care arrangement is when you know that you can’t trust your loved one to be at home alone, and you also know that specialized care is required. As you may know, the transition is going to be difficult but it is important to keep in mind that it should happen before your loved one’s condition becomes critical.
Similarly, after some time, when the progression of your loved one’s dementia renders them completely dependant on others for assistance with even basic personal tasks, a slightly more specialized facility might be better. For example, nursing homes can be a good care arrangement where where they can receive the focused full-time care they need.
Fortunately, there are several options available for care including Care at Home, Personal Care Homes, Nursing Homes, and Continuing Care Retirement Communities.
However, before coming to a decision about this, it is best to speak to th current assisted living facility management and staff to evaluate whether your loved one’s needs are fully being met. The patient’s doctor should also be involved in this process. Only when it is deemed that their needs can be better met at a nursing home or other kinds of facilities should you move the dementia patient out of their current care arrangement.
Medication rebalancing – Geriatric Psychiatric Unit
Medication is a very sensitive issue, even in places that have trained staff. To avoid errors in medication it should follow five basic principles:
- Right time
- Right dose
- Right medication
- Right resident
- Right route
Although medication errors are known to occur, it is highly likely that there are fewer errors in these facilities than when a dementia patient is living at home, alone or with their family. Changes and progressions in the disease can bring new behaviors and symptoms that their current medications may not be mitigating as effectively as they could be.
In the case where your loved one has an extreme episode outside of the normal such as severe aggression towards the facility staff or residents, physical changes causing severe changes - seeking help from a geriatric psychiatric facility is a great way to rebalance your loved ones medications so their quality of life and the people around them improves.
Although there is a stigma and fear associated with these facilities, they are specialists that are there to help when you need it the most and might be at your wits end with helping your loved one through their disease. A typical patient stays in the in-patient facility 1-2 weeks (although dementia patients tend to stay longer) and has their medications adjusted until they are "stable" and showing improvements, eventually being discharged.
The hospital will also provide a social worker to assist with discharge planning to ensure the transition back to their original Assisted Living Facility or another care home goes smoothly and is in accordance with the needs of the patient and family.
One of the best things these facilities can offer is access to healthcare professionals. It will be easier to control the medication and there will be a closer, specialized follow-up, culminating in a treatment designed for the patient instead of a treatment designed for dementia in general.
As the medication and other parts of your loved one’s life will be more controlled, there is lesser risk of drug interactions or food interactions, for example. As a family member or former caretaker you can have an important role when it comes to medication control by sharing with your loved one's doctor, pharmacist or nurse details about the former drugs or foods your loved one used to take and contribute to a treatment that will be tailored to your loved one. Don’t forget to share anything that may be relevant in case your loved one goes home for the holidays or family activities. Don’t forget that you are an essential part of your loved one’s life, as they are an essential part of your life.
- Assisted Living Info Website
- A Place for Mom
- Argentum Assisted Living Trade Association
- National Center for Assisted Living