An assisted living residence or assisted living facility (ALF) is a housing facility for people with
disabilities
Disability is the experience of any condition that makes it more difficult for a person to do certain activities or have equitable access within a given society. Disabilities may be cognitive, developmental, intellectual, mental, physical, se ...
or for adults who cannot or who choose not to live
independently. The term is popular in the
United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...
, but the setting is similar to a
retirement home
A retirement home – sometimes called an old people's home or old age home, although ''old people's home'' can also refer to a nursing home – is a multi-residence housing facility intended for the elderly. Typically, each person or couple i ...
, in the sense that facilities provide a group living environment and typically cater to an older adult population. There is also
Caribbean
The Caribbean (, ) ( es, El Caribe; french: la Caraïbe; ht, Karayib; nl, De Caraïben) is a region of the Americas that consists of the Caribbean Sea, its islands (some surrounded by the Caribbean Sea and some bordering both the Caribbean Se ...
assisted living, which offers a similar service in a resort-like environment (somewhat like assisted vacationing).
The expansion of assisted living has been the shift from "care as service" to "care as business" in the broader
health care
Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profe ...
system predicted in 1982. A consumer-driven industry, assisted living offers a wide range of options, levels of care, and diversity of services (Lockhart, 2009) and is subject to state rather than federal regulatory oversight. What "Assisted living" means depends on both the state and provider in question: variations in state regulatory definitions are significant and provider variables include everything from
philosophy
Philosophy (from , ) is the systematized study of general and fundamental questions, such as those about existence, reason, knowledge, values, mind, and language. Such questions are often posed as problems to be studied or resolved. Some ...
, geographic location and
auspice
Augury is the practice from ancient Roman religion of interpreting omens from the observed behavior of birds. When the individual, known as the augur, interpreted these signs, it is referred to as "taking the auspices". "Auspices" (Latin ''ausp ...
, to organizational size and structure. Assisted living evolved from small "board and care" or "personal care" homes and offers a "social model" of care (compared to the medical model of a skilled nursing facility). The assisted living industry is a segment of the senior housing industry and assisted living services can be delivered in stand-alone facilities or as part of multi-level senior living community. The industry is fragmented and dominated by for-profit providers. In 2010, six of the seventy largest providers were non-profit and none of the top twenty was non-profit (Martin, 2010). Information in this edit is from an article published in 2012 that reviewed the industry and reports results of a research study of assisted living facilities.
In 2012 the
U.S. Government
The federal government of the United States (U.S. federal government or U.S. government) is the national government of the United States, a federal republic located primarily in North America, composed of 50 states, a city within a fede ...
estimated that there were 22,200 assisted living facilities in the U.S. (compared to 15,700
nursing home
A nursing home is a facility for the residential care of elderly or disabled people. Nursing homes may also be referred to as skilled nursing facility (SNF) or long-term care facilities. Often, these terms have slightly different meanings to in ...
s) and that 713,300 people were residents of these facilities. The number of assisted living facilities in the U.S. has increased dramatically since the early 2000s.
In the U.S., ALFs can be owned by for-profit companies (publicly traded companies or limited liability companies
LCs
LCS may refer to:
Schools and organizations
* Laboratory for Computer Science, research institute at the Massachusetts Institute of Technology
* Lake County Schools school district of Lake County, Florida
* Lakefield College School an independe ...
, non-profit organizations, or governments.
These facilities typically provide supervision or assistance with
activities of daily living
Activity may refer to:
* Action (philosophy), in general
* Human activity: human behavior, in sociology behavior may refer to all basic human actions, economics may study human economic activities and along with cybernetics and psychology may st ...
(ADLs); coordination of services by outside health care providers; and monitoring of resident activities to help to ensure their health, safety, and well-being. Assistance often includes the administration or supervision of
medication
A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and re ...
, or personal care services.
There has been controversy generated by reports of
neglect
In the context of caregiving, neglect is a form of abuse where the perpetrator, who is responsible for caring for someone who is unable to care for themselves, fails to do so. It can be a result of carelessness, indifference, or unwillingness and ...
,
abuse
Abuse is the improper usage or treatment of a thing, often to unfairly or improperly gain benefit. Abuse can come in many forms, such as: physical or verbal maltreatment, injury, assault, violation, rape, unjust practices, crimes, or other t ...
and mistreatment of residents at assisted living facilities in the U.S.
Canada
In Canada, there are also some differences in how assisted living is understood from one province to the next. In most provinces, the phrase is understood as less independent than it is in the United States. People often require help with more than one of the
activities of daily living
Activity may refer to:
* Action (philosophy), in general
* Human activity: human behavior, in sociology behavior may refer to all basic human actions, economics may study human economic activities and along with cybernetics and psychology may st ...
or the more intensive ADLs like feeding or bathing. In the province of
Alberta
Alberta ( ) is one of the thirteen provinces and territories of Canada. It is part of Western Canada and is one of the three prairie provinces. Alberta is bordered by British Columbia to the west, Saskatchewan to the east, the Northwest Ter ...
, "supportive living" is the distinct phrasing used for a type of care that is otherwise synonymous. The province's ''Supportive Living Accommodation Licensing Act'' is a comprehensive act with specific prescriptions governing care homes licensing, inspections and more.
United States
Within the United States assisted living spectrum, there is no nationally recognized definition of assisted living. Assisted living facilities are regulated and licensed at the US state level. These regulations include staffing, training, and quality and safety standards. This is differentiated from nursing homes, which are regulated on a federal level and are generally held to more stringent standards. More than two-thirds of the states use the
licensure
Licensure means a restricted practice or a restriction on the use of an occupational title, requiring a license. A license created under a "practice act" requires a license before performing a certain activity, such as driving a car on public roa ...
term "assisted living." Other licensure terms used for this philosophy of care include residential care home, assisted care living facilities, and personal care homes. Each state licensing agency has its own definition of the term it uses to describe assisted living. Because the term assisted living has not been defined in some states it is often a marketing term used by a variety of senior living communities, licensed or unlicensed. Assisted living facilities in the United States had a national median monthly rate of $3,500.00 in 2014, a 1.45% increase over 2013 and a 4.29% increase over a five-year period from 2009 to 2014.
Types
As widely varied as the state licensing and definitions are, so are the types of physical layouts of buildings in which assisted living services are provided. The average assisted living facility is in a commercial building, yet some assisted living services use large residential buildings, known as Residential Assisted Living homes, or "RAL". Residential Assisted Living homes can vary in price and amenities, and can even be grouped into a separate term known as a Luxury Residential Assisted Living Home, or "LRAL". Assisted living facilities can range in size from a small residential house for one resident up to very large facilities providing services to hundreds of residents. Assisted living falls somewhere between an independent living community and a skilled nursing facility in terms of the level of care provided.
Continuing care
A continuing care retirement community (CCRC), sometimes known as a life plan community, is a type of retirement community in the U.S. where a continuum of aging care needs—from independent living, assisted living, and skilled nursing care— ...
retirement facilities combine independent living, assisted living, and nursing care in one facility.
People who live in newer assisted living facilities usually have their own private apartment. There is usually no special medical monitoring equipment that one would find in a nursing home, and their nursing staff may not be available at all hours. However, trained staff are usually on-site around the clock to provide other needed services. Household chores are performed: sheets are changed, laundry is done, and food is cooked and served as part of the base rent and included services. Depending on their disclosure of services, assisted living services may include medication management, bathing assistance, dressing, escorts to meals and activities, toileting, transferring, and insulin injections by an RN. Some assisted living providers also offer amenities like exercise rooms or a beauty parlor on site. Grocery service is often available too. Where provided, private apartments generally are self-contained; i.e., they have their own bedroom and bathroom, and may have a separate living area or small kitchen. Registered nurses and licensed practical nurses are available by phone or e-mail 24 hours a day, to ensure proper teaching and/or education of staff is available.
Alternatively, individual living spaces may resemble a
dormitory
A dormitory (originated from the Latin word ''dormitorium'', often abbreviated to dorm) is a building primarily providing sleeping and residential quarters for large numbers of people such as boarding school, high school, college or university s ...
or hotel room consisting of a private or semi-private sleeping area and a shared bathroom. There are usually common areas for socializing, as well as a central kitchen and dining room for preparing and eating meals.
Typical resident
An assisted living resident is defined as a resident who needs assistance with at least one of the
activities of daily living
Activity may refer to:
* Action (philosophy), in general
* Human activity: human behavior, in sociology behavior may refer to all basic human actions, economics may study human economic activities and along with cybernetics and psychology may st ...
.
A typical assisted living facility resident would usually be an
older adult
Old age refers to ages nearing or surpassing the life expectancy of human beings, and is thus the end of the human life cycle. Terms and euphemisms for people at this age include old people, the elderly (worldwide usage), OAPs (British usage ...
who does not need the level of care offered by a nursing home but prefers more companionship and needs some assistance in day-to-day living. Age groups will vary with every facility. There is currently a transformation occurring in long-term care. Assisted living communities are accepting higher and higher levels of care and nursing homes are becoming a place for those who are undergoing rehabilitation after a hospital stay or who need extensive assistance. Many assisted living communities now accept individuals who need assistance with all activities of daily living.
The "Overview of Assisted Living Report" from 2010 stated that 54 percent of assisted living residents are 85 years or older; 27 percent are 75–84 years old; 9 percent of residents are between 65 and 74 years; and 11 percent are younger than 65 years old. 74% of assisted living residents are female; 26 percent are male.
Special needs
The residence may assist in arranging the appropriate medical, health, and
dental care services for each resident. The resident generally chooses his or her medical doctor and dental services.
Residents who have periods of temporary incapacity due to illness,
injury
An injury is any physiological damage to living tissue caused by immediate physical stress. An injury can occur intentionally or unintentionally and may be caused by blunt trauma, penetrating trauma, burning, toxic exposure, asphyxiation, o ...
, or recuperation from surgery often choose assisted living as a supportive option to help them recover quickly so they can return home. In the case of these short-term respite stays, assisted living residences act as the bridge between hospital and home.
Short-term respite stays in assisted living are also an option for families when the primary caregiver goes out of town or is otherwise unable to provide the needed care.
More recently built facilities are designed with an emphasis on ease of use for disabled people. Bathrooms and kitchens are designed with
wheelchair
A wheelchair is a chair with wheels, used when walking is difficult or impossible due to illness, injury, problems related to old age, or disability. These can include spinal cord injuries ( paraplegia, hemiplegia, and quadriplegia), cerebr ...
s and
walker
Walker or The Walker may refer to:
People
*Walker (given name)
*Walker (surname)
*Walker (Brazilian footballer) (born 1982), Brazilian footballer
Places
In the United States
*Walker, Arizona, in Yavapai County
*Walker, Mono County, California
* ...
s in mind. Hallways and doors are extra-wide to accommodate wheelchairs. These facilities are by necessity fully compliant with the
Americans with Disabilities Act of 1990
The Americans with Disabilities Act of 1990 or ADA () is a civil rights law that prohibits discrimination based on disability. It affords similar protections against discrimination to Americans with disabilities as the Civil Rights Act of 19 ...
(ADA) or similar legislation elsewhere.
The socialization aspects of ALFs are very beneficial to the occupants. Normally the facility has many activities scheduled for the occupants, keeping in mind different disabilities and needs.
Locked units
Many ALFs also serve the needs of people with some form of
dementia
Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
including
Alzheimer's disease
Alzheimer's disease (AD) is a neurodegeneration, neurodegenerative disease that usually starts slowly and progressively worsens. It is the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in short-term me ...
and others with
mental disabilities
Mental may refer to:
* of or relating to the mind
Films
* ''Mental'' (2012 film), an Australian comedy-drama
* ''Mental'' (2016 film), a Bangladeshi romantic-action movie
* ''Mental'', a 2008 documentary by Kazuhiro Soda
* ''Mental'', a 2014 Od ...
, as long as they do not present an imminent danger to themselves or others. The sections of the building where these residents live are often referred to as memory care. In the United States, legislation enacted by each state defines not only the level of care, but often what conditions are prohibited from being cared for in such a home.
* In California, these units are not "locked" they are secured by alarms, delays, keypads needing a code, etc. However, they are not locked units like a
psychiatric
Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognition, and perceptions. See glossary of psychiatry.
Initial psychi ...
ward.
Many ALFs will work to accommodate a person with severe forms of Alzheimer's by having separate private units. These specialized care areas are part of the main building but are secured so residents with Alzheimer's cannot leave and possibly do harm to themselves. These care areas usually house fewer people and more attention from the caregivers is provided.
The units, usually called locked units, focus on applying
cognitive
Cognition refers to "the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". It encompasses all aspects of intellectual functions and processes such as: perception, attention, thought, ...
and mental activities to try to help keep the mind fresh. Since there is no cure for the disease, the goal is to work at prolonging or delaying the disease. If one is not engaged in activity, his or her memory will deteriorate more rapidly.
Controversy
2011 ''Miami Herald'' investigation
A 2011 investigation by the ''
Miami Herald
The ''Miami Herald'' is an American daily newspaper owned by the McClatchy Company and headquartered in Doral, Florida, a List of communities in Miami-Dade County, Florida, city in western Miami-Dade County, Florida, Miami-Dade County and the M ...
'' into assisted living facilities in
Florida
Florida is a state located in the Southeastern region of the United States. Florida is bordered to the west by the Gulf of Mexico, to the northwest by Alabama, to the north by Georgia, to the east by the Bahamas and Atlantic Ocean, and to ...
won the
Pulitzer Prize
The Pulitzer Prize () is an award for achievements in newspaper, magazine, online journalism, literature, and musical composition within the United States. It was established in 1917 by provisions in the will of Joseph Pulitzer, who had made h ...
, and found that:
# "the safeguards once hailed as the most progressive in the nation have been ignored in a string of tragedies never before revealed to the public,"
# "that the Agency for Health Care Administration, which oversees the state's 2,850 assisted-living facilities, has failed to monitor shoddy operators, investigate dangerous practices or shut down the worst offenders," and
# "as the ranks of assisted-living facilities grew to make room for Florida's booming elderly population, the state failed to protect the people it was meant to serve."
The investigation found dozens of incidents of gross mismanagement and
criminal behavior
In ordinary language, a crime is an unlawful act punishable by a State (polity), state or other authority. The term ''crime'' does not, in modern criminal law, have any simple and universally accepted definition,Farmer, Lindsay: "Crime, definit ...
at assisted living facilities across Florida, a state of 20 million people which is popular with American retirees. The newspaper requested the release of state documents related to the deaths of over 300 people in assisted living facilities between 2003 and 2011 but were denied these documents. Still, the newspaper's investigation found no less than 70 people who had died due to the "actions of their caregivers." The deaths were found to have resulted from the mismanagement of assisted living facilities and by the practices of their staff and managers who drugged residents, deprived them of basic necessities such as food and water, abused residents verbally, psychologically and physically, and neglecting their needs.
2013 ''Frontline'' investigation
On July 30, 2013 ''
Frontline
Front line refers to the forward-most forces on a battlefield.
Front line, front lines or variants may also refer to:
Books and publications
* ''Front Lines'' (novel), young adult historical novel by American author Michael Grant
* ''Frontlines ...
'' ran an hour long program with help from
ProPublica
ProPublica (), legally Pro Publica, Inc., is a nonprofit organization based in New York City. In 2010, it became the first online news source to win a Pulitzer Prize, for a piece written by one of its journalists''The Guardian'', April 13, 2010P ...
detailing some tragedies that happened in assisted living.
At the time the documentary was broadcast and published, ''Frontline'' stated that, "Today, nearly 750,000 people live in assisted living facilities across the country. National for-profit chains, concerned both about caring for their residents and pleasing their shareholders, have come to dominate the industry. Standards for care and training—and even definitions for the term 'assisted living'—vary from state to state. Assisted living facilities, unlike nursing homes, are not regulated by the federal government." An accompanying written brief cites deaths of residents, facilities that are understaffed, employees that are inadequately trained, and that an overall "push to fill facilities and maximize revenues has left staff overwhelmed and the care of residents endangered."
A related article by ''ProPublica'' (Thomson and Jones, July 29, 2013) states that a facility operated by
Emeritus Senior Living
Emeritus Corporation doing business as Emeritus Senior Living was a provider of independent living, assisted living, Alzheimer's care, and skilled nursing for seniors living in Emeritus communities throughout the United States. The company was foun ...
"...had been found wanting in almost every important regard. And, in truth, those 'specially trained' staffers hadn't actually been trained to care for people with Alzheimer's and other forms of dementia, a violation of California law." It goes on to say, "The facility relied on a single nurse to track the health of its scores of residents, and the few licensed medical professionals who worked there tended not to last long," but also that "During some stretches, the facility went months without a full-time nurse on the payroll." ''ProPublica's'' article claimed the problem was not specific to one facility and that "State inspectors for years had cited Emeritus facilities across California." Emeritus replied to that claim, describing "any shortcomings as isolated," as well as that "any problems that arise are promptly addressed." The company cited their "growing popularity as evidence of consumer satisfaction."
Comparison between assisted living and personal care
In
Pennsylvania
Pennsylvania (; ( Pennsylvania Dutch: )), officially the Commonwealth of Pennsylvania, is a state spanning the Mid-Atlantic, Northeastern, Appalachian, and Great Lakes regions of the United States. It borders Delaware to its southeast, ...
, personal care and assisted living are terms that are defined separately.
Personal care and assisted living in PA are regulated by the Pennsylvania Bureau of Human Services Licensing (a division of the
Department of Human Services
A Department of Human Services (DHS) or Ministry of Human Services (MHS) is a national or subnational umbrella agency which is responsible for providing public assistance programs to the population they serve. Various aspects or alternate names i ...
). Up until January 2011, the terms "assisted living" and "personal care" were considered interchangeable. At that time, Pennsylvania began licensing assisted living facilities separately from personal care facilities.
Chapter 2800 of the 55
Pennsylvania Code
The ''Pennsylvania Code'' is a publication of the Commonwealth of Pennsylvania, listing all rules, regulations, and other administrative documents from the Government of Pennsylvania.
Citation
Title 1 section 1.2 of the ''Pennsylvania Code'' sug ...
defines assisted living as "a significant long-term care alternative to allow individuals to age in place," where residents "will receive the assistance they need to age in place and develop and maintain maximum independence, exercise decision-making and personal choice."
Likewise, Chapter 2600 of the 55 Pa. Code defines personal care as "A premise in which food, shelter and personal assistance or supervision are provided for a period exceeding 24 hours, for four or more adults who are not relatives of the operator, who do not require the services in or of a licensed long-term care facility, but who do require assistance or supervision in activities of daily living or instrumental activities of daily living."
The differences between the two levels of care is broken down into three categories:
Concept – Assisted living residences permit residents to age in place, meaning that even as their health care needs increase, they will not have to relocate to another senior living home to receive that care, such as skilled nursing.
Construction – Assisted living residences must provide residents a private room with a lockable door, a private bathroom and small kitchen. Personal care homes are not required to offer these amenities.
Level of Care – Assisted living residences must ensure that residents receive skilled nursing care if their needs surpass standard assisted living services.
United Kingdom
Assisted living is known as extra-care housing or retirement living which allows residents over the age of 55 or 60 to live independently. They are offered a self-contained flat or
bungalow
A bungalow is a small house or cottage that is either single-story or has a second story built into a sloping roof (usually with dormer windows), and may be surrounded by wide verandas.
The first house in England that was classified as a b ...
and have staff that are available to them 24 hours a day to provide personal care. Staff help with washing, dressing residents, taking medication and they do domestic duties such as shopping and laundry for them, they also prepare and serve meals to residents if provided. Residents are often asked whether to own or rent their properties independently, the average cost ranges from £500 to £1,500 depending on where the resident lives.
Assisted living accommodations would often include a scheme manager or a team of support staff, nurses and care staff onsite, 24-hour emergency alarm systems, communal lounges to socialise with other residents. Assisted living housing is regulated by the
Care Quality Commission
The Care Quality Commission (CQC) is an executive non-departmental public body of the Department of Health and Social Care of the United Kingdom. It was established in 2009 to regulate and inspect health and social care services in England.
I ...
(CQC).
See also
*
Aging in place
The U.S. Centers for Disease Control and Prevention defines aging in place as "the ability to live in one's own home and community safely, independently, and comfortably, regardless of age, income, or ability level".
Environmental gerontology
Re ...
*
Eldercare
Elderly care, or simply eldercare (also known in parts of the English-speaking world as aged care), serves the needs and requirements of senior citizens. It encompasses assisted living, adult daycare, long-term care, nursing homes (often called re ...
*
Food preferences in older adults and seniors
Food preferences in older adults and seniors take into consideration how people's dietary experiences change with aging, and help people understand how taste, nutrition, and food choices can change throughout one's lifetime. This can occur when ...
*
Retirement home
A retirement home – sometimes called an old people's home or old age home, although ''old people's home'' can also refer to a nursing home – is a multi-residence housing facility intended for the elderly. Typically, each person or couple i ...
*
Retirement community
A retirement community is a residential community or housing complex designed for older adults who are generally able to care for themselves; however, assistance from home care agencies is allowed in some communities, and activities and socializ ...
*
Transgenerational design
Transgenerational design is the practice of making products and environments compatible with those physical and sensory impairments associated with human aging and which limit major activities of daily living. The term ''transgenerational design'' ...
*
Assistive technology
Assistive technology (AT) is a term for assistive, adaptive, and rehabilitative devices for people with disabilities and the elderly. Disabled people often have difficulty performing activities of daily living (ADLs) independently, or even with ...
References
General references
* Lockhart, C. 2009. Commentary: Is assisted living in the United States well served by regulations requiring the reporting of detailed operational data that are then posted on the Internet? Journal of Aging and Social Policy, 21, 243–245.
* Mar
tin, A. 2010 March/April. 2010 largest AL providers. Assisted Living Executive, 10 - 19.
* Starr, P. 1982. The Social Transformation of American Medicine. New York: Basic Books.
{{DEFAULTSORT:Assisted Living
Caregiving
Housing for the elderly
Geriatrics
Accessibility
Community nursing