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What sort of expectations should I place on the Assisted Living community?
You should expect the management of the assisted living community to be diligent in training and supervision of staff. Communities operated by involved and visible managers are more likely to provide the highest level of services.
Depending upon the size of the community, the general manager (sometimes called the administrator or the executive director) may be more or less visible. In larger communities (150 or more apartments), there is likely to be assistant managers, nurses or department managers who are more involved in supervising the staff. Within smaller buildings, the general manager is more likely to be visible throughout the day, connecting with residents and staff, talking to family members, monitoring care, and ensuring quality of services.
The general manager and the nursing staff in an assisted living community set the tone. Based on their commitment to care and their interest in offering services, a community may deliver extremely high levels of care and service, or they may only offer minimal amounts of assistance. Each community has its own personality and climate. Checking and visiting each community that is of interest to you is your best way to gauge a community's climate.
The management staff (which includes nurses or care supervisors), makes decisions of what services are offered and which caregivers provide those services. They then communicate to the caregivers how and when care is to be extended to the residents. The management staff communicates their expectation levels to caregivers with regard's to how they interact with residents and how responsive they need to be to those people in their care.
We are fortunate in our area to have hundreds of options regarding senior housing and care. Each community is structured quite differently, and each extends services in a different way. Behind these service offerings are the mission of the business, the commitment of management and staff, the interpretation of the laws and regulations governing the assisted living community, and the passion and interest of each staff member involved in making the building a home for older adults.
In some Assisted Living communities, management and caregivers take steps to anticipate what each resident may need. Some people may feel that this sort of high level of care is intrusive in their lives, as caregivers may be taking action to serve people who are otherwise capable of being independent in a particular activity. To some people, this high level of service may feel like being "spoiled." This high level of service is preferred by some individuals; whereas other people prefer a higher level of independence.
On the other end of the spectrum are communities that foster independence and only respond to emergency-type situations.
The majority of assisted living providers choose to operate somewhere in-between these two extremes. The management and caregivers involve the residents and their families in making decisions about their care. The staff writes plans as to what they will do for residents, based on specific needs or preferences.
It is quite common for older adults to feel more independent and to want more independence than what their children would like to see. In other words, people living in assisted living are likely to be just fine with making all of their own decisions, doing the most they can for themselves on their own, and taking an occasional "risk," in order to be independent. For instance, a resident of an assisted living community may enjoy walking on a treadmill without having a caregiver present to monitor them.
The children of assisted living residents frequently have a higher expectation of service and monitoring than the staff is actually able to offer. The management staff of the assisted living community also has the obligation to carry out the wishes of the older adult and not the wishes of the resident's family members. In the example of the treadmill, for instance, the adult children may be very worried about dad walking alone in a room for 20 minutes without a person monitoring him or without a camera pointed at him during his exercise. Assisted Living providers ask the resident what their preference may be, and work to develop plans that balance safety with the resident needs and requests. In this example, perhaps the resident is given an alarm pendant to wear on their wrist, to alert the staff if they need help.
Balancing safety with independence is an ongoing topic for managers of assisted living communities. What may confuse adult children is that it is the older adult who is "calling the shots," and not the family. Even in specialty assisted living communities, the preferences and wishes of the older adult are given first priority over the preferences and wishes of their children.
Assisted living is NOT one-on-one care. The staffing model of assisted living is intended to give some personalized attention to each resident throughout a 24- hour period; however, no single resident should need focused, time-intensive services. Assisted Living caters to people who have needs that can be met by scheduling a caregiver to help the resident with specific tasks such as getting dressed or taking a bath or shower. Depending upon the staffing and philosophy of the community, assisted living may also be able to meet unscheduled, random needs that arise. For example, a community may give the resident a call button to notify the staff they need help getting up out of a chair.
A common misconception of the children of residents in assisted living communities is that the staff is there for their own parents' beck and call. Such is not the case. From early morning to early evening, staffing ratios are typically based on one caregiver for every six to twenty residents. From 8pm to 7am, staffing ratios are more likely to be one caregiver for every 40 to 60 residents.
Some assisted living communities are willing to staff based on a specific resident's needs. It is important to note, however, that there is an additional cost associated with staffing in a way to more readily respond to a specific resident's needs.
In general, assisted living providers budget one to two hours of personalized time per resident per day. This personalized time includes all interaction from caregivers with the resident throughout a 24- hour period.
It's important to note that not all assisted living communities follow the same staffing models. Some communities staffing is based on resident ratios. Other communities staffing is based on the projected time needed to meet anticipated needs. Yet other communities staffing is based on how much money is collected to pay for the care staff that is monitoring or providing a service to one or more residents.
Assisted Living providers should be expected to ensure the safety of residents. If a resident is at risk for injury or harm, the community is expected to take action to reduce the risk. The community is also expected by the various regulatory agencies to have a discussion with the older adult regarding their specific wishes and preferences regarding managing that particular risk. In other words, an older adult may choose to be "unsafe," if that is the older adult's wish. The management of the community then communicates back to the older adult and their family the business' willingness to support the older adult's wishes. Most certainly, assisted living providers have interest in involving the resident's family or responsible parties; however, it is the resident who is in charge of his or her care, even if a family member holds Durable Power of Attorney.
In instances where a family member or legal representative holds guardianship for a person, the assisted living community is likely to give this person a much higher level of involvement in the decisions surrounding the older adults' care; however, the resident's preferences and what the resident says and requests is likely to be given a higher priority.
Assisted Living providers should be expected to maintain a well-functioning and clean building. They should offer community spaces to engage residents in activities. They should also afford residents privacy and be respectful of a person's interest in being alone.
Assisted Living providers should be expected to have written policies and procedures they continuously use to educate their staff.
Senior communities should be expected to have written plans of care which are current and accurate, and systems should be in place to ensure that staff are meeting the specific needs of the plan set forth.
Assisted Living communities should be good at responding to the unexpected, and most certainly capable and skilled at responding to emergencies.
Assisted Living providers should not be expected to change their philosophy of care, regardless of any single resident or family member's opinion or request. Also, assisted living providers should not be expected to deliver a service they feel incapable of providing.
As the needs of residents living within an assisted living community change, regulations state that the plan of care must be revisited on an on going basis and most certainly, every time there is a change of condition. Assisted living communities are responsible for assessing what they can and can't do. They're responsible for communicating with residents and their responsible parties, and they are responsible for offering the services they state they will offer.
Last update: 2007-02-06 21:39
Author: Tech Support
Revision: 1.0
