For seniors who may benefit from round-the-clock help, but who aren't entirely dependent, assisted living facilities are a likely fit. Nearly 40,000 facilities nationwide make up this parcel of the senior housing landscape, and they are generally regarded as a step between a nursing home and, say, an adult day care service. But no two are alike, says Paul Hogan, cofounder and CEO of Home Instead Senior Care, a global provider of non-medical senior care at home. While the facilities generally provide help with bathing and dressing if needed, in addition, some offer occupational therapy services, for example, or may have an exercise room available to residents. That's why it's important to talk with your parent early on about his or her preferences and visit several facilities before deciding which one—if any—is a good place for Mom or Dad to call home, says Hogan. In their recent book, Stages of Senior Care: Your Step-by-Step Guide to Making the Best Decisions (McGraw-Hill 2009), Hogan and his wife, Lori, touch on the pros and cons of assisted living. U.S. News asked Hogan, who is well-versed in the care options available for seniors, for guidance on how to determine if assisted living is the right choice and how to pick the best facility. Edited excerpts:
How can you be sure an assisted living environment is the right fit?
Your parent has to retain a certain level of independence while living in an assisted living facility. There are rules including, for example, if there is a fire drill, how quickly she can evacuate. The facility has the responsibility to evaluate if their residents meet the requirements to live there. If Mom is not capable, she's not allowed to stay there anymore. She would have to transition to the next level of care, which is a nursing home.
What are the advantages of assisted living facilities over other senior care arrangements?
In an assisted living environment, a person who is physically challenged or perhaps is experiencing the early signs of dementia can live in a pretty independent way. There is medical care on the premises, but the care isn't ever-present or overbearing. In this environment she can cook if she likes to cook, but there's also three meals delivered daily. There is assistance with medications, and they can help her arrange for transportation.
Can you count on all facilities to offer these basic services?
You want to ask a lot of questions to find out what is included because some do and some don't. From a looks standpoint, from a service standpoint, from a cleanliness standpoint: They're not all the same. This is exactly why we wrote the book. People make assumptions about what is included, not just in this stage of care, but in all the different stages. It is so important to fully understand what this level of care is and what's included before you decide to move your loved one there. Make sure you clarify what is included in the cost. Transportation, for example, might not be.
What types of questions should you consider when visiting an assisted living facility?
During the visit, you want to walk around the premises and meet some of the residents. How well are they groomed? Do you see activities posted on the wall? How many activities are posted? How does the place smell? Does the staff interact with you? It's not enough just to go in and see the polished marble in the foyer. You need to get inside a facility. The staff should be very open to that.
In the book, you write that a downside of assisted living is that the average resident stays only two years. Why?
The needs of seniors change regularly. Someone who is 80 or older—every six-to-nine-months, her needs change. Just because you can have her in an assisted living facility today doesn't mean she will live there the rest of her life. In fact, odds are, she won't.
What if you don't want to move your mom out—is there an alternative?
A continuing-care community is a series of buildings that may include independent houses, an assisted living type of arrangement, a nursing home, and hospice care. It is like it's own city in which a senior would sort of graduate through the different levels of care, without you having to do business with another entity. In our research, we have found that the majority of people can name only two options for senior care: assisted living facilities and nursing homes. They don't mention staying home, they don't mention continuing-care communities, and they don't mention medical services at home. There is a lack of awareness about the options.