“In the model of extended care—assisted living—someone’s medical condition is basically stable, but they have trouble with activities of daily living (ADLs). These include meal preparation, dressing, and taking their medications on time. They need help nearby,” Thomas adds. It’s estimated that 68% of adults age 65 and older will become disabled in terms of performing at least two ADLs.
“Many assisted living facilities create a home-like atmosphere, allowing residents to bring pictures, memorabilia, even furniture. It’s important for the resident to have a say in how their environment is going to look,” says Dottie Arnold, assistant director of home support for Erickson Health.
Don’t wait to start planning. “Too often, it takes a crisis to spur people looking,” says Roberta Feldhausen, A.P.R.N.-P.M.H, Erickson Health director of mental health services. That means you end up in whatever’s immediately available—not what’s really conducive to your health or peace of mind.
Changing environments
“After age 85, Alzheimer’s increases dramatically,” Weber says. That can lead to wandering and other dangers, so some assisted living facilities have certain special protections (like secured doors) that help Alzheimer’s patients avoid accidents.
Other extended care models are emphasizing ever more homelike environments. Thomas’s Eden Alternative is “an environment that’s less like a hospital, less medicine centered. We also look at someone’s mind and spirit,” Thomas says. “We recognize our residents’ desire to grow, even flourish, so we don’t design a place that almost expects them to decline.”
Erickson’s “household models” have a similar concept. “The physical design and features are based on the idea that if you have it in your house, it’s here. ou can go into the regular kitchen and take juice out of the refrigerator, just as you would at home, instead of waiting for a nurse to bring it,” says Mark McElwee, vice president of Renaissance Gardens, the extended care neighborhoods located in communities built and managed by Erickson. It’s another example of where a better staff-to-resident ratio helps forge stronger relationships.
Costs vary nationwide, depending on the model you choose. The average nursing home costs $77,745 annually, compared to $35,628 for assisted living. The latter does not include providing additional care for people with Alzheimer’s; then the costs rise to over $50,000.
Making your choice
How an environment looks is important, but Thomas warns about being swayed by what he calls a “glass and grass” façade. Observe the interactions between staff members and staff and residents.
“If I had to choose between a residence where the medicines were delivered precisely on time, but people had bad relationships, versus one where the medicines were a few minutes late, but there were deep emotional ties, I’d go with the latter,” he says.
Look at what the facility does to help you or a loved one adapt. “We have a team to help the resident and/ or family make plans, so the transition from their previous home to assisted living is accepted by all,” Arnold says.
Ask about retention standards before you sign up. “In many states there are standards that say you can stay in assisted living as long as you meet certain criteria, which vary by state. In some places it may be once your memory slips you can’t live there anymore,” Thomas says, so assisted living with an Alzheimer’s add-on may be what you need.
“Whatever the rules, don’t get surprised at the last minute.” See if it’s possible to experience the environment for a few days or more. “I think once an older adult spends some time in assisted living, they come to enjoy it. I think maybe 90% of them wind up staying,” Weber says.