Assisted Living

One problem that is facing our community today is how to provide care to our elders so they can “age in place.” A model called assisted living is being marketed as a feasible way of helping the elders age. What is life assisted, and how does nursing practice impact that? In order to plan for future shifts in long-term care for the elderly, Home Health Nursing needs to address these questions.

According to the Assisted Living Federation of America (ALFA), assisted living is a long-term care choice that incorporates accommodation, social services and rehabilitation as required (ALFA, 2013a), which states that assisted living is intended for seniors who need assistance with daily tasks, also known as Daily Living Activities (ADL). Dressing, feeding, bathing and transition are examples of ADLs. Approximately 38 per cent of residents are funded by three or more ADLs.

Residents living in Assisted Living Facilities (ALF) are more independent compared to residents living in nursing homes. ALFs provide their residents with apartment style living which gives them a sense of self-sufficiency and privacy. Also, people moving into an ALF usually come straight from their own homes, so it’s much easier for them to move to an apartment.  Assisted living is structured to allow residents to have privacy, dignity, independence, choice and protection. Consequently, ALFs are expected to remain a significant component of the long-term care industry, and the demand for them is expected to increase due to the growth of the older population and the resulting growing demand for all kinds of healthcare. In regards to the associated costs for residents in ALFs, the evidence shows that from 2004 to 2014, the monthly costs increased incrementally each year. Each year the states with the highest and lowest monthly costs from 2004-2014 also rose.

Assisted living at its finest “combines the therapeutic elements of long-term care with a model of affordable housing and social services,’ according to the Oregon and New Jersey production models. When elderly people live in their own homes, their relatives and associations offer assisted-living services to them, who maintain treatment by delivering services such as Meals on Wheels, home health care nursing, and support and housekeeping, among others. Although this helps individuals to live at home, there also comes a time when family and community services can no longer help them. They may then live in assisted-living facilities where they can (ideally) stay as their need for assistance services increases.

A variety of problems concern nurses who provide treatment or maintain the health care provided to residents in assisted-living facilities. The lack of a clear definition of assisted living and the variations in programs offered by assisted living facilities underline the need for standardized, rigorous evaluation tools and procedures to ensure a successful match between the elderly and facilities. Additionally, the focus on mutual responsibility and risk between caregivers and elders and their effect on nursing practice needs to be discussed. Finally, the incentive to keep rates manageable for assisted living should force nurses to accept cost-cutting steps in their practice. Additionally, the focus on mutual responsibility and risk between caregivers and elders and their effect on nursing practice needs to be discussed. Finally, the incentive to keep rates manageable for assisted living should force nurses to accept cost-cutting steps in their practice. Nurses must seek the following questions:

1. How do we encourage the use of structured evaluation methods and procedures that better relate the type of services required by the elderly to the type of living facility being assisted?
2. How do we enable elderly people to move to assisted living facilities?
3. What changes do we need to make to our nursing practice to foster mutual accountability and risk?
4. How much responsibility are we willing to delegate for making assisted living more cost-effective to other personnel?

Nurses should provide comfort and encouragement to residents, especially in times of change. For those individuals who have come to the residence from afar or who have experienced a recent loss, nurses and other members of the health care system should consider and respect grief and encourage improved social connections both inside the facility and outside the community. Group support at this time is helpful. Talking and recalling with others will lower isolation and may reduce depression.

For someone with a mental impairment, the nurse must first assess if there was sufficient research performed before admission to differentiate between delirium and dementia. First, after the new resident has had time to adjust to new surroundings a repeat mental status check must be performed. Then thorough medication assessments, infection history and the status of body systems are essential. For treatment of acute conditions references are made. It is necessary for nurses to assess the applicant’s mental health and decide if the admission will endanger the protection of the resident and the community. We may need to explore more suitable positioning.

The hardest adjustment seems to be the one of the young-old group. They have the feeling of being “institutionalized.”‘ One approach to this is to encourage increased social interactions both inside and outside the residence. They should be encouraged to maintain contact with the community, possibly through involvement in voluntary activities. Those in this young-old group also have difficulty adjusting within the facility to the weakening of the frail elderly due to their fear that these individuals will portray their eventual future. 

There should be no question that there is a need to include alternative models of housing and health care, as the elderly population increases. Elderly people have become a vocal group which defines their needs and demands their rights. New care models, such as assisted living, encourage seniors to age in place, and nurses are called upon to respond to the functional challenges. We need to be sensitive to the evolving needs of the elderly population, to shift the direction of our practice guideline to a more assistive model, and we need to look at our own practice and decide what changes need to take place in order to facilitate ageing with full independence.