From the April 2005 edition of Milestones Assisted Living is a ‘bridge’ between independence and more intense care By Ann L. Rapport Many of us don’t consider assisted living options until we have to. At that point, we may start learning – the hard way – that assumptions we’d made weren’t true, and there are questions we should have asked much sooner. Afraid to give up their independence, people often try to hide the fact that they’re struggling with activities of daily living, according to Liz Harbison, director of public relations at Deer Meadows Retirement Community in Northeast Philadelphia. They resist getting help or making changes until a crisis reveals they can no longer manage at home. By then, emotions and urgency can lead to hasty decisions. So it’s best to get acquainted with options before you need the help. Assisted Living can be a bridge between independent living and more intense care options and can improve the quality of life by relieving the stresses of living alone. In general, assisted living residences provide a modest level of support to individuals who can no longer keep house and who benefit from the help with personal chores like dressing, bathing or meal preparation. Depending on the residence, other advantages might include a compatible peer group, organized activities, laundry services, medication reminders and transportation. There’s no single, legal definition in Pennsylvania for assisted living, explains Stephen Ryan, long term care ombudsman at CARRIE (Center for Advocacy for the Rights & Interests of the Elderly). So be careful – your expectations may not reflect reality. Consumer advocates suggest you show a copy of the contract to an elder-law attorney before you sign anything. The Pennsylvania Health Law Project’s (PHLP) 2002 Report on Pennsylvania’s Personal Care Homes and Assisted Living Residences noted, “One obvious shortcoming is the very minimal training requirements and lack of prior experience required…” Staff qualification issues can have a serious impact on residents, notes Deer Meadows’ Harbison. Years ago, she says, residents would be taking, on average seven different medications. “Now it can be as much as 14.” She emphasizes the challenges staff members face in helping residents monitor their meds. State regulations currently require that residents receive a minimum one-hour per day of direct care, two hours if the person is not mobile. The local fire authority for an evacuation emergency determines the fewest staff currently required on night shifts, says Matt Jones, director of the Personal Care Homes Division of the state’s Department of Welfare. Anticipating both opposition and support for the proposed code changes, Jones says, “We believe we’ve struck a good balance between cost and safety.” Personal Care is private pay, and ‘tends to be very expensive,” says Dr. Cynthia Rudder, director of the Long Term Care Community Coalition in New York. If you run out of money, she warns, you can be asked to leave. Consumer advocates recommend multiple visits, scheduled and unscheduled, and at unusual times. Observe details, and consider whether the place is compatible with your lifestyle. Eat the food, smell the halls, and try to speak candidly with residents and staff. And study details in the agreement before a commitment. There’s wide variability, notes Karen Love, board chair of the Consumer Consortium on Assisted Living. “If you’ve seen one assisted living facility, all you have seen is one assisted living facility.” Milestones is a publication of the Philadelphia Corporation for Aging