The Assisted Living Dilemma

Yesterday, I watched a PBS program called Frontline. This particular episode was an investigative journey into the world of assisted living facilities. In particular, it was an excoriating look at communities run by the Emeritus corporation, the nation's largest provider of assisted living care.  The stories that were told were horrifying and embody everything that people fear about institutionalized senior care.

There is no question that the senior demographic is a fast growing market. The plain reality is that while there are numerous new and exciting options for aging boomers, there is still a desperate need for a solution to the "Age Wave." Assisted living facilities have largely stepped into that gap. Unfortunately, assisted living facilities find themselves in a perfect storm of controversy which is a combination of a number of complex factors.

Among those who work with seniors and their families it is common knowledge that "assisted living facilities" have become the new "skilled nursing facilities." A skilled nursing facility is what has traditionally been known as a nursing home. SNiF's, as they are commonly called, are places where seniors go when they are no longer able to live their lives without significant supervision and assistance. Regrettably, most seniors would rather die than go into a nursing home. That is a sadly ironic choice for many. Enter the Assisted Living Facilities or ALF's. These communities are designed to accomodate seniors who wish to live on their own but require basic assistance.  Meals are prepared. Activities and field trips are planned. Staff members are available to provide assistance with eating, bathing and walking 24/hrs a day...according to the brochure. The reality is that assisted living communities are set up to work like insurance policies. There should be some residents who are almost completely independent. There should be some residents who require more assistance. In a perfect world, the balance between the two provides an affordable option with adequate care.

But this is the real world.

There are several equally causal factors which create the assisted living dilemma as I see it.

1. Families don't want to put Mom into a nursing home.

The decision to put an aging parent into a facility is one of the most difficult any adult child is likely to face. In most cases, families neglect to sit down and rationally discuss the aging process until they are too far into the journey to be able to look at things without the understandable emotional entanglements. The choices become nothing more than well-intentioned guesses and many times carry with them regrets which will last a lifetime. A family may cognitively realize that their parent requires more care than can be reasonably expected of an ALF but emotionally not be able to handle placement into a nursing home. The assisted living facility becomes an enabler of sorts which acts as  a functional bridge of care until the reality is completely undeniable. In order to postpone the inevitable, families will sometimes shine the warmest possible light on the situation. Neglecting to paint a picture which resembles reality, they not only place their parents into dangerous situations, they deny the communities the information needed to hire adequate staff in order to provide the needed care.

2. Facilities do not like empty rooms.

While many business professionals may tell you that it isn't about the numbers, at some level it must be about the numbers. The directors and marketing professionals in senior living communities of every care level are held accountable to their census. If there is no room at the proverbial inn and a waiting list of seniors then all is well. This would seem to be a reasonable expectation given the rapidly aging populace and the limited number of alternative housing options available. However, human nature does not typically gravitate towards making difficult decisions. Without an understandable amount of coaxing on the part of the marketing personnel, most families would rather postpone a tough choice than pull the inevitable trigger. In a 'may the best salesperson win' environment the senior almost always loses.

3. Great Expectations.

Blindfolds and rose colored glasses do not typically produce great clarity. Facilities at some points over-promise. Families at some points under-disclose. Those two competing visions of reality can spell disaster for the senior stuck in the middle. Furthermore, fully two thirds of all seniors in assisted living communities have been diagnosed with Alzheimer's or some other form of dementia according to recent studies. This removes the possibility of receiving credible feedback from the one person best able to assess the situation. "Sure, Mom says that they are not attentive but she has dementia and doesn't always remember." "Mrs.Johnson in room 318 says she pressed the call button an hour ago but she has dementia and hasn't really been waiting that long." Combine ingredients and simmer until things begin to breakdown.

There is plenty of blame to be laid at the feet of assisted living facilities. While some issues are individual failures, still others are indicative of more systemic problems. My intent is not to take sides. I know how difficult it is for families to deal with decisions of this magnitude. I also know many of the people who take great pride in the work of making their facilities feel like home to the seniors in their care. There is not some vast conspiracy among senior living facilities to victimize seniors by providing them with substandard care. There is, however, a great chasm which exists between the needs of seniors and the way we meet them. Hopefully, the day will soon come when we can all stop pointing fingers and start joining hands to find a solution.