Assisted living provides a variety of supportive services for residents who need help with their everyday routine. Residents can receive help with personal care, meals, transportation, and housekeeping in a socially-enriching environment. Assisted living housing is as diverse as our nation’s older adult population. Care can be provided in a residential home in your neighborhood or in a large apartment complex downtown. Residents may require little assistance or require help with achieving most of their daily routines. Assisted living care can be part of a continuum of services at a multilevel continuing care retirement community (CCRC) or a free-standing facility. There are many ways to provide these services. Because of the overwhelming choice available, it is crucial to understand, at a minimum, the older adults’ needs that are present and anticipated. In this way, time is spent looking at assisted living homes that can provide the appropriate type of care.
Assisted living care facilities must be licensed to provide care in certain states. In the state of Texas, state licensure is dependent on the level of care residents require. Homes with a Type A licensure provide services for residents who need basic assistance with personal care. This may include help with dressing, bathing, toileting, and housekeeping. Some homes limit the hours that these services are available. Additional charges may be incurred should residents require more than these basic personal services. Homes with a Type B licensure can care for residents with higher levels of need. In addition to the services provided by a Type A licensed home, services at these homes can include assistance with mobility and positioning for residents who cannot fully bear their own weight or use mobility aids independently. Assistance may be tiered by levels of care or by service type, allowing a resident the flexibility of assistance should needs change- and they can quite suddenly. In either type of licensure, assisted living care is exactly that. Services are designed to assist a resident in activities of daily living (ADLs), thereby promoting their independence, dignity and quality of life while allowing them to age in place. Residents who cannot participate in some way to in? their self-care will be counseled on supplemental services that are available or alternative care that may be necessary. Assisted living services are not designed to provide total care or clinical care on a 24 hour basis, although some homes will accept outside providers to supplement any needs beyond the scope of customary services such as home health, personal care assistants, or hospice.
Promoting quality of life includes enriching the social needs of each individual. A wide range of activities may include on-site and off-site events. Many homes will provide transportation and supervision for off-site excursions. Meals are also included, and many assisted livings offer therapeutic meals requiring any special textures or diet restrictions. Often an assisted living home will have a medical physician, dental provider and/or home health provide clinical supervision conveniently on-site. Residents may choose to use these services for all their clinical needs. Residents can have private or shared rooms, and meals are usually offered in a dining room with other residents. However, residents may have the option of having their meals served in their rooms. Some homes may allow residents to have a refrigerator, microwave or other simple appliances. Bathroom facilities should have safety features, such as raised toilets and grab bars. In all cases, residents should have the ability to bring in their own furnishings to make their new accommodations a true reflection of their personality. Occasionally, the homes have apartments with living areas and full or partial kitchens. Whether the residents live in apartments or small efficiencies, there are several common areas, both in and outdoors, to socialize or to enjoy a quiet change of scenery.
Staff requirements in assisted living care have changed in the past decade, with a greater focus on acquiring and developing more highly skilled and more clinically-trained staff. With this workforce, staff is better equipped to meet the needs of an older population having widespread disability and complex medical needs. In addition to the staff provide direct care for residents’ personal needs, housekeeping staff and dining services staff provide additional support for resident care. Usually, an activities director will coordinate all social events as well as one-on-one visits with residents who prefer more solitary pursuits. Administrative personnel may address concerns with residents and caregivers to assure the quality of services provided. In total, these and other staff members combine their efforts to create a respectful and homelike environment while caring for a diverse group of residents.
While there is an enormous amount of variety in how assisted living care is provided, states mandate certain criteria for the physical structure. Homes must be compliant with disability laws. It must have features, such as wide hallways and ramps, enabling residents with wheelchairs and walkers to pass each other safely. It must have grab bars and railings for safe mobility. It must have fire safety features such as, overhead sprinklers and an alarm system. Architects specializing in long term care housing design these special features to blend into the existing structures yet still serve significant purpose for resident safety.
However, assisted living companies take great pride in differentiating themselves through their environment. It is not surprising to find that the owners and staff pour many hours and dollars into finer details and furnishings throughout the building or inmajor renovations. After all, they are creating a home for their residents, and attention to details that make a home comfortable, endearing, and distinctive.
Ideally, an assisted living has one entryway that is staffed by a receptionist and locked after business hours. After business hours, anyone visiting the building may be required to ring a doorbell to be allowed entry. Guests may be required to sign in upon arrival and sign out upon departure, as well as wear a visitor’s identification badge. Residents may also be required to sign in and out. There is typically a monitoring camera system in common areas, although this may not include parking lots. If a community has residents with confusion and wandering behaviors, the home may have more stringent monitoring policies.
For various reasons, some residents or their responsible party may request a monitoring device in a resident’s room. A community has their own policy regarding monitoring equipment in resident rooms that comply with state mandates regarding resident privacy. Administrative staff will be able to respond to any questions regarding this matter. Human resource policies also provide a level of safety regarding hiring practices. Criminal histories and current licensure are checked on all prospective hires. Staff should have some type of identification readily visible at all times.
Alzheimer's Care provides a caring home with unique features. These features are designed to enhance resident dignity, minimize confusion and agitation associated with memory loss, and provide safety and socialization within a warm and caring environment. Alzheimer’s care is supported by an extensive research community. As more is known about the effects of Alzheimer’s disease and cognitive impairment on a person’s behaviors and memory, homes incorporate new interventions into their services, activities, or environment. Great care is taken to keep staff and care practices on the leading edge of service delivery.
Typically, assistance is provided for all areas of personal care, including dressing, bathing, and toileting. Assistance is provided throughout the day and night, with residents on a daily routine to minimize change and more care may be needed as residents change, and this change may occur suddenly.
Services should be flexible enough to accommodate immediate needs related to incontinence, eating and behavior management. Residents may require total care in the later stages of Alzheimer’s disease, including full-body positioning, transfers and lifting. Some homes may be able to provide care at these later stages, but others may not have the staff available for total care. At this point, the director or clinical manager should be able to make appropriate suggestions for transfer to another facility. Some homes may provide respite or short-term care that gives caregivers of people with Alzheimer’s some personal time and rest from the emotional and physical rigors of caregiving.
Meals are usually made in a separate kitchen and served in the common dining area. However, some homes are fashioned like a house, with a kitchen in which residents can smell the aromas of meals cooking in their kitchen. Meal preparation should be able to accommodate special diet requirements, such as low sodium or chopped meats. Activities by trained recreation specialists are integral to resident life. Activities typically are designed to stimulate memory, but should not be too long or disrupt the calm environment or resident routines. Nighttime activities incorporate residents with disorientation and disturbed sleep cycles. Usually, clinical staff is available for medication administration and/or management. Unless the home is connected to a larger long-term care community, pharmacy services are outsourced but can deliver medications for the residents.
Residents can have private or shared rooms, and meals are usually offered in a small dining room with other residents. Bathrooms may be positioned to allow a resident to recall its purpose, thereby promoting independence in toileting. Bathroom facilities should have safety features, such as raised toilets, walk-in showers and grab bars. Residents may be able to furnish their own rooms.
Staff is specially-trained to work with residents experiencing memory-loss and exhibiting common behaviors associated with Alzheimer’s disease and other dementias. Their patience and gentle encouragement reassure residents who are agitated or restless. Socialization and activities redirect anxieties and provide residents with familiar routines. Optimally, the same staff members should work with the same residents, with a lower staff to resident ratio than what you would find in an assisted living facility.
The building design comforts residents who feel disoriented and inclined to wander. Often, homes are divided into “pods”, or subsections to create a smaller, home-like environment in which residents feel safer and more at ease. These homes can be stand-alone facilities or connected to a larger long-term care community. Many memory aids are incorporated into the structural design and environment.
Secured entrances protect residents who have a high risk of wandering and to screen guests. Staff may be required to admit visitors. Otherwise, primary caregivers, such as spouses or children, may be given codes, to allow entry. If there is a kitchen, it should be secured to keep residents away from a stove or walk-in refrigerator or freezer. Windows in resident accommodations should be sealed shut or limited to inhibit a resident from climbing out of their window.