Assisted Living offers options to families

Johns Hopkins University Press just announced the publication of a new book about assisted living titled “Inside Assisted Living: The Search for home.” In it, the authors explore the premise of assisted living, which is that the social model of care leads to a higher quality of life than the medical model as nursing homes are designed.

In general, the authors found that caregivers in assisted living are “professional, pleasant, courteous and caring,” and that the people who live in assisted living are generally satisfied with their care. The authors interview elders living in assisted living, and explore with them issues like aging in place, financing and relationships.

As a recent owner and operator of assisted living and a long-time advocate of the social model of care, I believe that educating families about the benefits of assisted living is vital. Unfortunately, many professionals whom we typically turn to for advice about care, physicians included, don’t clearly understand assisted living or its benefits. They rely far too often on the historical solution: nursing care.

Consumers are making their preference heard, however. Today in the U.S., nursing home bed availability is holding steady or declining while new assisted living communities are being opened in every region of the country. Both families and elders clearly prefer living in an environment that feels more like home; less like a hospital.

If you’re just beginning to seek care for a loved one, be sure to explore assisted living options in your community. Because there is no national definition of care or services, you’ll need to ask questions to learn if this is an appropriate care setting for your loved one. Among the questions to ask, be sure to include these:

1. What is the limit of care my loved one can receive in this setting? Can he or she stay through the end of life here? Is hospice care available while remaining here as a resident?


2. What is the full cost of care, including rent, care, supplies or other expenses? Do you accept any third party payment from Medicaid if my loved one runs out of money?


3. How do you staff the caregivers? Are they trained and certified? What is the ratio of residents to caregivers during the day, evening and night?

Armed with this information you can begin to make an informed choice about assisted living as an option for care. Be sure, of course, to visit and talk to people living there, as well as other family visitors, if possible.

You may wish, as well, to read the book. According to Barbara Petty of Boom!, one of the reviewers of the book, it is “an excellent introduction for anyone who needs to acquaint himself or herself with assisted living in anticipation of having to choose assisted care for a parent or other loved one.”

Hospice: an important program to help family caregivers

Yesterday we signed my mother-in-law up for hospice care. She has advanced cancer and, with a recent surgery, is now failing quickly. While she may yet perk up and start eating again, she is not ever going to get completely well. It was time, clearly, to focus most specifically on comfort care for her, rather than rehabilitative care.

It’s an emotional time for the whole family, but we have some comfort in knowing that she’ll be surrounded by professionals who are trained to make sure she is pain free and well cared for, right to the end.

Even though I’ve worked with Hospice agencies over the years in a professional capacity, it was good to hear about the benefits of hospice from the family point of view. Here’s a quick summary of hospice and how it can help families:

Why hospice? Hospice is a federally defined and regulated program that is dedicated to provide comfort care to individuals who are not prospects to “get well”, but who are in a declining phase of their disease. Staff who work in hospice are specially trained to comfort both the patient and the family, and to help them accept and find value in their last days.

What services do they provide? Hospice provides a full range of services to individuals who are eligible. A hospice team typically consists of an RN assigned to the patient, aides to assist with bathing or other care, social workers to help with arrangements, adjustments and emotional needs, pastoral care, and more.

Where does hospice provide care? Many people have mistaken notions about where hospice is provided. It can be provided at home, but it can also be provided in an assisted living or nursing facility. Hospice won’t provide staff for the daily care needs of the person, but it will support those caregivers and provide special care to make sure the person is comfortable through the end of life.

What does hospice cost? Hospice is fully covered for individuals who are on Medicare. If you have other insurance coverage it will become secondary to your hospice program and coverage.

What does it pay for? Hospice covers the cost of all the equipment (hospital bed, walker, commode, etc.), medication related to comfort and all of the professionals who provide services. You do not have a co-pay or any other financial obligation when enrolled in hospice care.

When is hospice appropriate? If your loved one has a disease that is progressive, without the possibility of recovery, hospice may be appropriate. You may remember a time when a person had to be certified as within 6 months of death for hospice to be allowed; that time constraint is no longer the measure of eligibility. If your loved one has dementia, he or she may be eligible now, and may continue to be eligible until the end of his or her life. If a person begins to get better, hospice can be cancelled.

How do I get connected with a hospice agency? Talk to your loved one’s doctor and ask for hospice to be ordered. At least request a hospice evaluation to help you determine if hospice is an option for your loved one. Ask questions and learn as much as you can about the services you are eligible to receive.

For more information about hospice programs, go to www.hospicenet.org.