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Assisted Living Provides New Options for Seniors

Healthier old age calls for lower-tech nursing help

(HealthDay is the new name for HealthScoutNews.)

WEDNESDAY, Aug. 6, 2003 (HealthDayNews) -- A fall that twists an ankle or breaks a hip, too many lonely days in front of the television, or forgetting medicines might mean your elderly mother shouldn't be living alone anymore. But you know she's far too healthy for a nursing home.

Enter assisted living, the fastest growing residential option for elderly adults, according to Ethel L. Mitty, a nursing professor at New York University and author of an article on assisted living in the August issue of the American Journal of Nursing.

Assisted living, a residential facility that is staffed 24 hours a day to provide a safe environment for elders, is aimed at those who need help with daily tasks but who do not need regular medical care, says Mitty. Happily, this is a growing population.

"People in their 80s are not as disabled as the same age group a generation before," she says. "Chronic disease catches up with them in the last three years of their lives instead of the last eight."

The result, she says, "is that people don't need the high-tech interventions of nursing home care. They want assistance with the traditional tasks of living -- going shopping, meal preparation, driving -- but like a residential environment that is more in keeping with their lifestyle."

While estimates vary quite a bit as to how many facilities there are in the country -- the range is from 10,000 to as many as 40,000 -- Mitty says all agree that the number has grown considerably in the last several years, with the AARP reporting a jump of between 15 percent and 20 percent.

At Summit Place of Beaufort, a small assisted living facility in South Carolina, executive director Eric Fennell reports a 30 percent increase in inquiries for places in the last year.

"Our county is one of the fastest growing counties in South Carolina, and we are more tailored as a retirement area," he says, so that often people in their early 60s will move down with an elderly parent who will come to Summit Place.

What brings people to the facility, Fennell says, is a safe environment in a residential setting that gives basic care for those with mild dementia, or some physical deterioration, perhaps from a fall in their home, or who have been living alone and are no longer functioning well on their own.

"An adult child might notice her mother isn't eating properly -- she may be having soup three times a day -- or watching television all day long, or doesn't go out of her apartment for several days at a time."

Once in the facility, Fennell says, care is tailored to the person, and may range from helping them choose their clothes, to reminding them to brush their teeth or take medicine, to arranging outings to keep them active.

Fennell says a nurse on the staff monitors medications and clinical issues such as blood pressure or skin problems. Nurses also oversee all the systems of the center, but they cannot take care of seriously ill people, those who are bedridden or have broken bones, or those who use a feeding tube.

"The main difference between assisted living and nursing homes is that in nursing homes people are not able to take of themselves," he says.

Therein lies the value of assisted living facilities, Mitty says. "Assisted living helps those people who aren't quite safe living independently," she says. "We need this intermediate step. It definitely fills a need, and there is a niche for it."

Such care comes at a price, an average of $2,000 monthly, Mitty says, and there is little uniformity as to what, if any, health insurance is available to help cover costs.

She reports that 41 states now pay for some 50,000 Medicaid-eligible people in assisted living, and that some long-term health insurers will pick up a portion of the costs. Mitty adds that more attention has to be focused on cost effectiveness and how well assisted care facilities work before Medicaid would become more involved in assisted living care.

Other facts from her report include: The average length of stay at assisted living facilities is from 26 months to three years; that 33 percent of patients leave to go nursing homes and 28 percent die in the facilities; about 25 percent of the facilities have Alzheimer units; 90 percent offer nursing services and 50 percent of nurses who work in assisted living have experience in long-term care or in nursing homes; and regulations regarding admission and staffing vary widely from state to state.

"Those looking at assisted care facilities have to check them out one by one," Mitty says, "even the facilities owned by chains, because different states have different regulations."

More information

For information about assisted living, you can visit the AARP. Another fact sheet on trends in assisted living can be found at the Family Caregiver Alliance.

SOURCES: Ethel L. Mitty, Ed.D., R.N., adjunct clinical professor, nursing, research associate, Division of Nursing, New York University, New York City; Eric Fennell, M.S.A., executive director, Summit Place, Beaufort, S.C.; August 2003 American Journal of Nursing
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