What To Expect From Assisted Living
The management of the assisted living community is expected to be diligent in training and supervision of staff. Senior living and care communities operated by involved and visible management are more likely to provide the highest level of services.
Depending on 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, department managers, and/or nurses who are more involved in day to day operations and supervising the staff. In smaller communities, 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 nursing staff in an assisted living community set the tone of the community. Based upon their commitment to care and their interest in offering services, a senior living 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. Working with a CHOICE Advisor to define possible senior living options for you can make the task of choosing a senior community much easier.
The owners and management staff (which includes nurses or care supervisors), makes decisions of what services are offered and which caregivers provide those services. These individuals then communicate to the caregivers how and when care is to be extended to specific residents through a plan of care. The management staff communicates their expectation levels to caregivers with regards to how they interact with residents and how responsive they need to be to those people in their care.
In our area we are fortunate to have hundreds of options to choose from. Each community is structured differently from another, and each provides services in a different way. Behind the services provided are the mission of the business, the commitment of management and staff, the interpretation and compliance with 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 anticipate what each resident may need. Some people may feel that this type of high level 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, this high level of service may feel like being “spoiled.” A 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. Within this spectrum is every possibility and blending of care support and independence.
The majority of assisted living providers 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 create plans of care to define what they will do for residents, based on specific needs or preferences.
A common situation in assisted living is that an older adult will want more independence than their adult children might want to see. In other words, people living in assisted living are likely to be just fine with making 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 taking a walk without having a caregiver present to monitor them.
Balancing independence with safety is an ongoing topic for managers of assisted living communities. What may surprise and confuse adult children is that it is the older adult who is “calling the shots” and not the family. Even within memory care 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 designed 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 is intended for 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 adult children of residents in assisted living communities is that the staff is there for their own parents’ specific needs, however this 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 8am, staffing ratios are more likely to be one caregiver for every 40 to 60 residents. Memory care areas or communities offer more extensive staffing.
Some assisted living communities are willing and/or able 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 during a 24- hour period.
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. 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. In all cases, though, the senior living community is required to ensure that the defined needs of every resident are appropriately met.
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 or manage the risk. The community is also expected by 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 cases where a family member or legal representative holds guardianship or Durable Power of Attorney for a person, the assisted living community is going to give such a 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 are 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, and they should continuously communicate with and 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.
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 indicate 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 defining and communicating 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.
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