There are several kinds and sizes of assisted living housing: full-size
one-bedroom apartments; studio apartments with small kitchenettes; studios
without a kitchen or with a partial kitchen that has no cooking facilities;
single rooms; and shared rooms. An assisted living apartment or room may be
furnished or unfurnished. Even if a space is furnished, some places permit
residents to bring in some furnishings of their own, which can make a new
place feel more like home.
Assisted living apartments and rooms tend to be smaller than living
spaces intended for the general public. They are often fitted with safety
devices such as handrails and special bathroom fixtures, and may include a
hospital bed if needed. In addition to the small rooms and space-eating
fixtures, people tend to bring more of their own furnishings than would
otherwise fit easily into the space. As a result, many assisted living
apartments feel crowded and even smaller than they are. It is often
difficult for a new resident to adjust to the smaller, more cramped
quarters.
Special Care for Alzheimer's or
Disorientation
Many people suffer mild symptoms from the early stages of Alzheimer's or
other age-related disorientation. Their need for monitoring and assistance
makes independent living too difficult or dangerous, but they do not need
the high level of care provided by a nursing facility. For them, assisted
living is often an excellent solution.
However, the kind of assistance these people need is different from that
required by those who have only physical limitations. The same assisted
living residence that provides good care for someone with only physical
frailties does not necessarily work well for a person with mild dementia.
Most assisted living facility administrators will tell you that they are
experienced with Alzheimer's residents, but it is the quality of that
experience that counts. Most important is whether the staff is trained to
handle the difficulties of dementia sufferers. You want staff trained to
provide special attention to residents who are mildly disoriented -- not
merely to shuttle them from one place or activity to another, but if
necessary to explain what is going on, without treating the residents as
children.
If you are considering an assisted living facility for someone with mild
disorientation problems, watch how the staff interacts with current
residents who have similar difficulties. Also pay close attention to how the
staff -- not just the administrator who gives you a tour -- interacts with
you or your loved one during a meal, an activity or an explanation of
facility rules.
Services Provided
The main difference between assisted living and independent living
residences -- usually housing complexes built or renovated for older
residents who are basically able to care for themselves -- is that
assisted living gives residents more help in meeting their daily needs.
While assisted living does not offer either the medical care or the level
of attention of a nursing facility, it does provide personal care in a
resident's living space and common areas, meals, household tasks and
extensive monitoring of each resident's physical condition.
Personal Assistance.
Most
people move to assisted living because they need help with one or more of
what are known as the activities of daily living (ADLs). ADLs include
eating, bathing, dressing, continence and using the toilet, walking and
getting in and out of a bed or chair.
An assisted living facility will help a resident with any ADL -- but
not all the time, and not whenever a resident wants help. Instead, a
schedule will be developed that takes into account the resident's needs
and the staff's availability. For example, an aide might help a resident
get in and out of bed in the morning, once or twice during the day, at
bedtime and once again during the night. Or a resident will be given a
full bath three or four times a week, but not every day.
When you consider a particular assisted living residence, ask precisely
what it offers for the specific ADLs with which you need assistance. If
the facility offers you the kind and frequency of assistance you need,
make certain that care is spelled out in the written residence agreement
you and the management sign.
Health monitoring.
In
addition to help with daily activities, assisted living facilities monitor
a resident's health. That does not mean nursing or other active treatment
of a medical condition. Rather, it means keeping track of and helping the
resident take the correct dose of medications, helping the resident with
self-administered health aids such as prostheses and oxygen, providing
emergency call systems and checking on a resident's well-being during the
night.
Most assisted living residences have a nurse on duty to check on any
resident who has health difficulty or whose physical condition seems to be
changing, and to refer the resident for medical care if it seems
necessary. Health monitoring may also include coordinating care with the
resident's primary care physician and keeping track of a resident's
medical appointments. Also, most facilities provide or arrange
transportation to and from those appointments.
Strict Rules Aren't for Everyone
Assisted living offers close monitoring of residents' physical
conditions. This includes keeping track of medications, checking on
residents at night, and making sure residents eat properly. Assisted
living facilities accomplish this by setting up schedules that staff and
residents must follow. Sometimes, these schedules and rules are too
restrictive for a competent, independent-minded person.
Depending on your needs, including your need to be left alone,
independent living plus home care might fit your personality better than
assisted living -- even though you and your family will have to take
charge of organizing your care.
Meals.
For many people,
one of the most attractive things about assisted living is that meals are
provided. These facilities have a kitchen and a common dining room where
at least two and usually three meals a day are served. The cost of meals
is included in the resident's rent or fees. Residents are freed from
shopping, cooking and cleaning up; they are assured of nutritious food;
and they are brought together for the informal social exchange of a meal
with other residents.
There are several things to check about an assisted living residence's
food service. First, find out how many meals a day are included, and
whether they are all full, hot meals. Then check on the quality of the
food; it won't do you any good if you won't eat it. Try several meals in
their dining room, and see if the residents seem interested in their food
and in each other.
Housekeeping.
Assisted
living facilities provide laundry and housekeeping services. What that
housekeeping includes, however, can vary considerably. Find out how often
a resident's bedding and bath linen are laundered. Does the facility do a
resident's personal laundry as well? Is there an extra charge for personal
laundry? How often (and how well) is an individual room or apartment
cleaned?
Social activities and exercise.
It is one thing to assist residents with the basics of daily life such as
dressing and bathing; that help is guaranteed in a contract with an
assisted living residence. It is another thing entirely to help residents
lead mentally, physically and socially active lives. This is not a matter
of contract, but of the quality and style of service at a good residence.
Most facilities plan group activities such as guest lectures and exercise
classes, as well as regular gatherings for the residents to visit among
themselves. The best facilities also help individual residents participate
in these activities to the extent possible and provide alternatives -- an
assisted walk around the hallways, for example, or a one-on-one chat in a
resident's private room -- when it's not feasible to participate in a
group.
There are several ways to get a sense of the quality of group and
individual activities at a particular facility. You can always take a look
at what is scheduled for any given week, but it is also important to visit
during one of these planned activities to see if residents participate and
seem to enjoy doing so. As for more individual attention, find out whether
there are any rules against staff spending non-scheduled time with
residents, and on all your visits, watch how the staff interact with
residents: look for a friendly, relaxed manner on everyone's part.
Costs
Most assisted living spaces are rented, not purchased. The major
exception is assisted living as part of a continuing care community.
Basic Rent
Rent depends on the size of the living space. A small room with no
cooking facilities will cost much less than a spacious one-bedroom
apartment with full kitchen. The rent also varies with the amount of
services and staff provided, the location and the overall condition of the
facility. Some facilities offer more than one type of rental agreement: A
limited contract may include fewer meals and less personal assistance than
an inclusive or extensive agreement that includes all the services the
facility has to offer. Given all these variables, rent for an assisted
living unit generally runs 50% to 100% higher than for a comparable
independent living unit in the same facility, but it will still be
one-third to one-half the cost of a nursing facility of the same quality,
in the same area.
Rent Increases
As with any other rental housing, you must consider how much your rent
may go up over time. A lease can guarantee the rent for a year or two.
After that, rent increases are completely within the discretion of the
facility's ownership, unless a yearly limit is included in your rental
agreement. If there is no limit, check the facility's record of rent
increases over the previous five years. If they have raised rents in large
chunks, you have to consider whether they will price you out of your
apartment in years to come.
Some assisted living facilities charge fees in addition to rent. There
may be a one-time non-refundable entrance fee, and there may be a fee for
certain services not included in the basic assisted living contract, such
as extra or delivered meals, extra housekeeping service, local
transportation fees or personal care beyond the standard level of care
offered in the facility.
