Making the move from home to an assisted living/personal care home is typically one of the most difficult decisions a family caring for aging parents will make. Frequently, adult children see what they want to see and have a hard time looking past the glamour of the environment. Every web site, marketing person of the facility and brochure touts the benefits of assisted living. These “benefits” aren’t always what they seem.
If you are lucky enough to work with an Aging Life Care Manager, they can help direct you through this maze of decisions, provide medical support when your parent enters the facility and help you understand the limitations of an assisted living.
Consumers should fully know what you are and are not getting when in an Assisted Living environment.
Where Assisted Living Fails
1. Assisted Living Environments have a social model of care vs. a medical model of care.
They are a provider of housing, not healthcare.
During the day time hours you may be fortunate to have a Licensed Practical Nurse (LPN) on staff. Now, there’s no point in denying that there are major differences in the scope of practice between LPNs and Registered Nurses (RNs.) An LPN works under the supervision of an RN or physician. They are not allowed to assess a patient. They may collect data such as vital signs, including pain and blood glucose levels, and keep the supervising RN or physician informed. LPNs may also note how the patient looks and acts, or responds to stimuli, and report this information accordingly. However, under this license, the LPN cannot interpret data, or make decisions for the patient. They have to report these findings to the RN or MD who will then make the decisions and delegate care.
Many Assisted Living Facilities, however, don’t even have an LPN on staff the majority of the time, if ever. Instead, personal care technicians with no medical education tend to residents.
Most residents of assisted living programs take several medications and visit more than one prescribing doctor. This makes medication management a challenge as the medications are being managed and distributed by unlicensed assisting personnel, uneducated in monitoring for side effects, giving the right medicine at the right time to the right patient, and knowing how to document it thoroughly. Medication technicians have completed only four hours of training. Poly-pharmacology and improper use of medications is in epidemic proportions in assisted living.
During the evening and night shifts, when emergencies typically happen, there is no one on staff that has the medical knowledge to decipher what a true emergency is. As a result, your parent may have needless admissions to the Emergency Room. Staying out of an emergency room unless absolutely necessary is always in the older adult’s best interest not only financial but also for their health.
The facility will typically call you once the person is safely in the ambulance, on their way to the hospital. An older person, especially one with a cognitive disorder, should never be alone in an emergency room. Emergency rooms are designed to save lives, without knowing all the details of the people they are trying to care for. Someone needs to be there to medically advocate for the older adult. Aging Life Care Managers can jump in and assume this role as the older adult medical advocate.
Dr. Robert Kane, a geriatrician in health policy and someone who had a personal dreadful experience with his own mother’s trips to the emergency room described his experience as “neither fish nor fowl” and “the grayest of options.”
3. A limited capacity for assisting increasing care needs
Residents need more help as time goes on. Note the term “assisted” meaning they help with the Activities of Daily Living or ADLs. The components of each level of care vary from facility to facility. However, most use a point system to determine a resident’s required level of care. Prices increase with the amount of assistance your loved one needs. Once you reach the highest level, some facilities will allow private pay caregivers in to assist in the ADL’s to allow them to remain aging in place; some don’t.
In his book, It Shouldn’t Be This Way, Dr. Kane writes about his mother’s money “hemorrhaging” in assisted living due to the ever-increasing add-ons. An Aging Life Care Manager can help predict how much care, what kind of care, and for how long that care may be necessary so that you can budget accordingly. We also work with Elder Law attorney’s who can offer recommendations on sustaining the wealth of each individual.
Where will your parent go when they move from a walker to a wheelchair? Those with macular degeneration may need help with feeding, but otherwise be very independent in their ADLs. The majority of assisted livings require transfer to a Skilled Nursing Facility in both these instances. They simply don’t have the skilled staff to care for residents who need this type of assistance. Life Care Managers can offer alternatives directed towards each individuals physical and financial needs.
5. No Relief from day to day responsibilities and care
Do not assume moving into an assisted living will relieve your family of the daily responsibilities of managing a loved one’s life. You still need to shop, monitor food intake (or lack of it due to the poor quality of food), purchase clothing, supervise medications, schedule/coordinate/transport to doctor appointments, and show up anytime that would be considered an emergency. If you are the financial POA, you also have the additional responsibility to manage their finances and assure it lasts their lifetime. Assisted Living Facilities don’t help you manage these inevitable pieces of aging care.
6. Bullies in assisted livings:
Maybe it is due to cognitive decline or physical illnesses, but just like in high school, assisted living residents can have its share of cattiness and aggressive tendencies. Derogatory comments made loud enough for other residents to hear, saving seats in the dining room so a certain resident can’t sit at a table, or all-out shouting matches can occur. Oftentimes, it’s a personality conflict between the assisted living caregiver and the resident who believes they are being bossed around. The staff to client ratio in most facilities don’t have the tools or time to deal with this kind of conflict appropriately.
They design these facilities for people with extensive funds. The average national cost is $4000.00/month and that doesn’t include the extra services mentioned above. Medicare and Medicaid (indigent elderly) typically will not cover these cost. Looking at this kind of price tag, you realize that gorgeous looking Assisted Living facility is not worth it when it lacks the quality of care your parent needs.
In short, What are you really getting when choosing Assisted Living?
Planned Social Activities
Pooled care for many people who need little to no assistance
Need a Quality Solution?
Making the decision for a family member who needs assistance can be tough. Deciding on what kind of services you need can be overwhelming for families. But now that you know what assisted livings can and cannot provide, you have the tools to make a educated decision.
The best way to ensure quality care for your loved one is to research and find a quality Aging Life Care Manager. They can help you through every life change, emergency, and unexpected obstacle. Their education in the medical field as well as their extensive knowledge on caring for aging adults will save you time, money, and the frustration of inadequate services.
If you would like assistance from an educated, licensed, and certified professional, you can refer to the Aging Life Care Association or, if you are in the Pittsburgh, PA area, feel free to contact us directly for help @ 412-486-6677 or through our ‘Contact Us’ form.
Bobbi Kolonay RN MS is Certified Care Manager, Certified Holistic Nurse and president of Holistic Aging – Options For Elder Care, providing Aging Life Care Management services for over 15 years in Pittsburgh, PA. She also serves on the Board of Directors of the Aging Life Care Association.