Given that maintaining a sense of place, a home, is very important to older adults, it should not come as a surprise that they would prefer living options that help foster that desire. That is how the option of assisted living came into being (Scheidt & Schwarz, in press). Assisted living facilities are housing options for older adults that provide a supportive liv­ing arrangement for people who need assistance with personal care (such as bathing or taking medications) but who are not so impaired physically or cognitively that they need 24-hour care.

An ideal assisted living situation has three essen­tial attributes (Scheidt & Schwarz, in press). First, the physical environment where a person lives is designed to be as much like a single-family house as possible. That way, the setting has a residential appearance, a small scale, and personal privacy that includes at a minimum a private room and a full bath that is not shared with other residents unless the resident explicitly wishes. The public spaces in the facility are designed to provide indoor and out­door access, which enhances a resident’s autonomy and independence.

Second, the philosophy of care at an ideal assisted living facility emphasizes personal control, choice, dignity, and autonomy, and promotes a preferred lifestyle that residents and their families consider to be a “normal,” good quality of life. This philosophy is implemented by understanding residents’ personal preferences and priorities, and allowing residents to exert control over their lives, their schedules, and their private dwellings.

Third, ideal assisted living facilities should be able to meet residents’ routine services and special needs. “Essential elements in service capacity include offering or arranging: competent initial assessments of needs and preferences; individualized service planning; kind, capable, and responsive personal care 24 hours a day, 7 days a week; 3 meals a day; housekeeping; identification of changes in residents’ physical functioning and condition; arrangements for specialized assessments and interventions; and responses to emergency situations. The provider must also offer or arrange routine nursing service, including mediations management, but ‘nursing services’ should not be construed as services that can only be performed by a registered or licensed nurse” (Kane & Brown-Wilson, 2001, p. 3).

Despite the fact that assisted living facilities have existed for more than 20 years, there are serious gaps (Scheidt & Schwarz, in press). For example, no national consensus or federal guidelines exist to govern the characteristics of the people who can and should be served in these facilities, the services that can be provided, or the minimum staffing stan­dards. The different combinations of housing and service arrangements that today are called assisted living “make simple generalizations about either their physical settings or their care environments particularly challenging—and inevitably contribute to consumer confusion” (Golant, 2008, p. 7).

Despite the problems with precisely defining assisted living facilities, the number of them con­tinues to grow. Between 1998 and 2000, the number of licensed assisted living residence units grew 33%, slowed to 13% between 2000 and 2002, slowed even more to 3% between 2002 and 2004, but increased to 6% between 2004 and 2007. By 2007 there were 947,585 units in 38,373 licensed facilities (Mollica, 2008). One important reason for this growth is the fact that assisted living offers a more cost-effective approach than nursing homes for those older adults who cannot live independently but who do not need the level of nursing care provided in a nursing home.

Residents in assisted living facilities are in inde­pendent apartments or similar units. The services that are provided vary, but usually include moni­
toring and management of health care, assistance with activities of daily living, housekeeping and laundry, reminders or assistance with medication, recreation and entertainment activities, transporta­tion, and security (U. S. Department of Health and Human Services, 2005). Before choosing an assisted living facility, you should check several things:

• Think ahead. What will the resident’s future needs be and how will the facility meet those needs?

• Is the facility close to family and friends? Are there any shopping centers or other businesses nearby (within walking distance)?

• Do admission and retention policies exclude people with severe cognitive impairments or severe physical disabilities?

• Does the facility provide a written statement of the philosophy of care?

• Visit each facility more than once, sometimes unannounced.

• Visit at meal times, sample the food, and observe the quality of mealtime and the service.

• Observe interactions among residents and staff.

• Check to see if the facility offers social, recreational, and spiritual activities.

• Talk to residents.

• Learn what types of training staff receive and how frequently they receive training.

• Review state licensing reports.

Residents generally pay the costs of assisted living facilities, which averaged about $35,000 per year in 2008. Medicare does not pay for either living costs or any of the services that are provided. In some cases, Medicaid may pay for services depending on the situation. Given that assisted living is usu­ally less expensive than nursing homes, the lack of broad financial support for these programs means that the cost of care is not as low as it could be.

Research on assisted living has increased as more assisted living options have appeared. Despite knowledge gaps, the findings support the impor­tance of the central attributes of assisted living for frail elderly (Polivka & Salmon, 2008; Zimmerman et al., 2005). Future assisted living facilities will have to be able to serve residents who, because they will

be more frail, will have more service needs. Assisted living facilities will have to be based on more adap­tive and flexible designs in order to serve older adults with a broad range of care demands.

One of the main future challenges will be the blurring of congregate (independent) living, assisted living, and nursing homes into hybrids of these arrangements (Scheidt & Schwarz, in press). The hope is that more stringent regulations will follow the blending of these forms of housing, and that services will not destroy the special characteristics of assisted living. Another future challenge will be the cost of assisted living, which could put it out of the reach of many American elderly. Finally, the future role of the government in providing funds for afford­able shelter and care will continue to be limited. Therefore experts predict that families will assume the largest financial burden of providing long-term care funds for their loved ones (Golant, 2008).

Concept Checks

1. How does one age in place?

2. What process do people go through to make the best living arrangement decision?

3. What modifications are typically done in a person’s current home to provide a more supportive environment?

4. What services are provided in adult day care?

5. What is congregate housing?

6. What are the characteristics of assisted living facilities?