Assisted Living is Sometimes Living Without Assistance

May 25th, 2010 | By Dr Jerry D Elrod | Category: Senior Moments Blog

Recent gerontology issues have introduced a popular option for senior citizens and residential living.  It is called the Assisted Living Facility (ALF).  Intended to offer the aging who can no longer live alone a more independent living style than skilled nursing care, the concept of ALF has value.  Grandma and Grandpa can no longer fix their own meals and take care of their own home, so they move to an ALF, have their meals prepared for them and their room/apartment cleaned.  In addition there is a built-in social environment that contributes to their well being.  So why are so many complaining about such facilities?

The Smart Money, Wall Street Journal, article written in 2001 is still posting comments about problems in Assisted Living Facilities. And you, SCJ readers, are commenting and sending emails about problems you are experiencing with ALFs.  It’s time to take another look at the problems.

One irony is that for everything that requires assistance, once enrolled in one of these establishments, there is an add on price or tax, if you will. Basic fees include one’s room, usually commodious enough, and meals; and then everything there after requires add on costs.  No fee, no service. A horror tale, and they are becoming more frequent, heard recently in one such institution makes the point.  A woman, alone in her room, experienced a major cataclysmic diarrhea attack.  Her room, bedding and person were covered in feces.  When the aide came by to check on her, she simply opened the door asked if the occupant was okay, did not wait for a response, closed the door and went away.

The Wall Street Journal article identifies ten things ALFs won’t tell you; they are listed here:

  1. We promise more than we can deliver
  2. We can raise our prices at any time.
  3. Our staff has limited training
  4. Medication errors are common (Note: the original article also added “and our pharmacy charges too much” which is no longer the case thanks to the Medicare Prescription Drug Program enacted in 2003)
  5. We face scant regulation
  6. You are practically on your own at night
  7. You may have to hire a private-duty nurse
  8. We stop spending once our beds are full
  9. Practically anyone can hang an assisted living shingle
  10. Leave your dignity at the door

Unfortunately, this list is not the exception.  Qualified personnel and management are getting harder to find.  Add-on costs continue to rise, but the service seems to be void and lacking.  Residents complain, but their complaints go unregistered as is evidenced by the same complaint(s) being made over and over and over again.  The cosmetics of such places are usually well appointed, but underneath, check the dirty linen.

My experience with my 90 year old mother, who lives in such an institution, vacillates.  She and her friends are active and mobile and alert.  They know what is going on.  They frequently complain that no one listens to their concerns.  They talk about staff they really like and who provide good service, and staff who don’t.  They constantly talk about the food being over-cooked, mushy and watery.  They can identify what they enjoy about the facility, and what needs to be changed–and their analysis is very reasonable.  It is too easy to “blame” the residents for bad attitudes, typical complaining and insensitivity to staff needs and problems.

Of course, no one is suggesting that the resident(s) is always right .  Neither is the facility.  These women are not the problem; they need to be heard.

Assisted Living Facilities are not non-profit organizations.  They are in the business to make money.  And they seem to do that and quite well.  But they are also in business to provide a service, a service to persons who often feel powerless and without support.  Such facilities would do well to inventory their reason to be and examine how and why they are doing what they say they are in business to do.  Quality improvement processes need to be in place and need to be continually addressed.  Residents who pay the rent need to be heard.

The Consumer Consortium on Assisted Living is a non-profit advocacy organization that speaks on behalf of the elderly population who need assisted living.  They have an educational function also.  Their ten tips for choosing an ALF provide excellent counsel for any and all who are faced with moving into assisted living care.



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  1. [...] other day we chose a topic, which aroused some considerable reaction. It dealt with “Assisted Living Sometimes Means Living Without Assistance.”  We seem to have hit a nerve.  A facility with which we are acquainted, and its [...]

  2. [...] have reported on this before and aroused the executives of at least one assisted care facility, who became quite defensive. That neither excuses nor explains behaviors on part of staffs and [...]

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