What is Assisted Living Care?
Assisted living offers a different kind of care than nursing homes, but many families aren’t sure what to expect. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guest Sarah O’Connor to break down what assisted living care really is, who it’s best for, and how to choose the right facility for your loved one.
O’Connor:
And really when somebody’s getting ready to be a two person, a sister, they already are. They really need to have a sit to stand or a full mechanical lift for safety. If the behaviors get very severe, uncontrolled, they are unpredictable. Just can be aggressive and maybe a threat to themselves or to other residents or to staff, that also would not be appropriate.
Intro
Schenk:
Hey out there. Welcome back to the Nursing Home Abuse podcast. My name is Rob. I’ll be your host for this episode. Today we’re talking about assisted living care. Who qualifies what? What is assisted living care and when does someone no longer qualify to to be an assisted living facility, and they should go somewhere where there’s skilled nursing.
We’re not having that conversation alone. We have the fantastic Sarah O’Connor with us today to walk us through that process.
We have the fantastic Sarah O’Connor to talk with us today. With nearly 16 years of experience, Sarah O’Connor is a dedicated registered nurse specializing in long-term care assisted living, wound care and dementia. She is certified in wound care, dementia, and gerontological nursing. As the owner of a legal nurse consulting business, Sarah partners with attorneys to provide expert insights on nursing standards and patient care.
And I myself have used Sarah on a couple of cases involving assisted living. Trust me, she knows what she’s talking about. Outside of work, she enjoys time with her family and outdoor activities like sporting clays and snowmobiling. And I had to look up what sporting clays is. It’s clay shooting.
It’s where you yell out, pull and they shoot out the clay and you, I guess you shoot it with the shotgun, which growing up in mountain, Juliet, Tennessee, we had to, that was a part of our health class. Like you, you actually had to shoot a shotgun at a clay. For a grade and I think it was either eighth or ninth grade.
I’m not sure if that’s standard everywhere, like I’m saying that that’s crazy talk. Maybe that’s, maybe that actually is more common than. Anyway. Sorry, I digress. Sorry about that, Sarah. Anyway Sarah, welcome to the show.
O’Connor:
Thank you. It’s great to be here.
What are the basic requirements for assisted living care?
Schenk:
I’ve mentioned before in previous episodes about how I feel like there’s a there’s a misconception about the care that is provided at nursing homes versus assisted living facilities.
And so that’s why I wanted to have you on today is to elaborate more on what an assisted living facility is and who goes there and what kind of treatment, if any, they get. So the kind of the first question that I would have are who fits the profile of assisted living? Who, who is the person that would be right to go into an assisted living facility in general?
O’Connor:
That’s a great question. Assisted living is for folks who are medically stable and they need some assistance with their daily life. They don’t require that medical care that oh, supervision, I should say. It does not require that medical supervision continuously around the clock. So it’s like a bridge between the independent living and the nursing home.
Schenk:
What are those, when you say those activities of daily living that somebody might need help with, what are those in general?
O’Connor:
That’s a good question. Basically I wanna start off by saying it’s, what I forgot to say is that also assisted living is ideal for residents who might not be able to maneuver safely in their home, and not necessarily cognitive, but just the logistics of the house is just not safe to, to move around, or they’re just getting the household chores are just becoming too cumber cumbersome.
So that’s, assisted living really takes the stressor. Of their plate and what the type of assistance that they would receive? The stressor that would be taken off their plate would be, they don’t have to make their bed anymore. They get their beds made, they get their laundry done, housekeeping comes in and the trash is removed.
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They don’t have to cook their meals, they, the meals are prepared by a chef. And those stressors get removed and they really get to just enjoy the activities. So these residents are still fairly independent and can engage in the social activities. So when we’re looking for somebody who is moving into an assisted living facility, we are looking at their functional abilities, the medical status and their, or medical needs and their cognitive status.
And so what are their functional abilities? We wanna see how much help that we can give the resident with their IADLs, and that stands for Instrumental Activities of Daily Living. And that would be laundry, shopping arranging transportation, scheduling appointments using the telephone. Those are some of the examples of the IADLs.
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And then how much assistance do they need with their ADLs? And that would be showering, personal hygiene, dressing, toileting, transferring, those type of activities. So we want to make sure that they are medically stable, that they are able, that they medical conditions are able to be managed within the facility itself and with outside providers, because usually.
Usually assisted livings do not have a medical director on hand or the attending physician, a nurse practitioner that’s there in the building. And if there’s a problem, staff or nurses can call them anytime, day or night. And they don’t, these residents have their own primary care physician.
Learn about resident outcomes when transitioning between assisted living and skilled care on the impact of preventive health measures in elderly populations.
They have their own specialist, so it really needs to be looked at, can these medical conditions be managed? Within the facility and with an outside provider. And can, are they stable enough to be managed safely in the environment as well?
Who qualifies to provide assisted living care?
Schenk:
In a nursing home we have. An attending physician. We have a director of nursing that kind of oversees the DI direct nursing staff.
You have registered nurses, you have licensed practical nurses, and then you have certified nursing assistants that do the kind of the A DL stuff that you’ve described. These are all people that have licenses, that have certain amount of education they have to acquire to get those licenses, et cetera.
Understanding that. Living facilities are regulated from state to state, so everybody, every state is different. In terms of what is required, typically, what is the certification or what is the training, or what is the experience of someone that provides that IADL or a DL care in a typical assisted living facility, if any?
O’Connor:
I will start out by saying one of the reasons why we want to make sure that the person is medically stable and that their conditions are controlled. Because there’s usually just a nurse on duty during the day. Some facilities do have a nurse around the clock, but usually they’re there during the day and then they go home.
Operators can review key requirements in A Facility’s Guide to Meeting Georgia Assisted Living Regulations.
Now they are on call 24 7, but they’re home. So who’s left in the building or non-medical staff? We have your nursing assistants that are, that go by caregivers or care managers, and they’re usually not certified. And then you have medication technicians, which are referred to as med techs, and they’re, again, non-medical staff.
They have gone through a training program and they’re able to administer medications, but they’re not medical, so they’re really not equipped to manage this higher level of care.
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Who does and does not qualify to receive assisted living care?
Schenk:
When you’re dealing with care providers, non-medical care providers that are there a majority of the time.
How do we deal with issues of nursing assessments of changes in conditions and things like that? Like where who would be responsible for that type of thing? If you have typically only non-medical people that might not know, that might not understand baseline versus not baseline.
O’Connor:
Yeah. The nurse. The nurse is the one who, they always do the assessments and they’re the ones that do the assessment the care plan. Update the plan when they see changes or eat a significant change. That would be the nurses.
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Can someone with dementia or Alzheimer’s qualify for assisted living?
Schenk:
I guess then would, because it sounds like to me what you’re describing is somebody that, eh, I only need a little bit of help.
Maybe I walk with a cane. Maybe I, like I want, I need somebody to make my sausage biscuits in the morning for me, but other than that, I’m okay. That sounds like the picture that we’re painting, but does that mean that somebody with Alzheimer’s, somebody that is not, that is cognitively impaired, are they candidates for assisted living?
O’Connor:
They are, but they have to be in the very early stages of any kind of just the early level and the facility will, or the nurse will assess their orientation. Their ability to follow directions and instructions. They’ll look at the social behavior and risk for wandering. And if they’re, they know who they are, they know where they are, but they just get really confused with the times.
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And they may have they will have some, a little bit of short term memory loss. They will, have forgetfulness, mild confusion and just what they would need is to be reminded if that’s, that can be managed in the assisted living facility. When it’s at the early stages, they just need reminding Hey, it’s bingo, let’s come down and play.
Or it’s lunchtime. Are you hungry or. Your daughter will be here in 10 minutes to take you to your eye doctor appointment. And it’s just, you’re just giving them cues and reminders about their daily life. Maybe some prompting, some supervision but they can’t have, they can’t be socially inappropriate.
They can’t be, can’t exhibit or judgment or just confusion that can make them. Unsafe. You start seeing somebody who is maybe even forgetting their walker. Now they’re getting a loss. Even though they’re in a familiar setting, they are starting to show poor judgment. That’s when that person needs to go into a memory care unit or a secure dementia unit that’s locked that can keep them safe.
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Schenk:
So that, that’s an interesting, that, that’s an interesting segue here. What is it about? The assisted living facilities memory care unit that is different from a nursing home or a nursing home’s memory care unit. Where at some point the individual with dementia becomes unsafe in an assisted living facility and needs to go to the nursing home.
Like what is the difference between the care in those two places that you would want to do a transfer?
O’Connor:
The best way I can answer that question is let’s say you have a resident, she’s reminded. It’s breakfast time and she comes to breakfast, but she’s wearing two sweaters and a coat and the staff can say, Hey Mrs.
Smith, let’s remove your coat while you eat breakfast. And then after breakfast agreeable to come back up to the room. And what else would you like to wear? Maybe she wants to stay wearing two sweaters. That’s okay. No harm, no foul. She’s safe in the building. She’s not trying to get out. She’s now just wearing two sweaters.
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That’s okay. But where you get into problems, where you get to really see the poor judgment, where this person needs to go into a memory care facility is okay. Ms. Mrs. Smith came downstairs. She’s wearing two coats or two sweaters a coat, and now she’s exit seeking and she got out of the building and and it’s 90 degrees outside.
That’s where we’re seeing the poor judgment, the exit seeking, not even realizing it’s super hot and I’m overdressed, and that would be a very clear indicator to go to a memory care.
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Schenk:
Where do you find there to be the conflict or the issue of this person is no longer right for assisted living, like they need to go to somewhere else?
Is that. Is that purely from a dementia standpoint or is it mobility? Is it the ability to be able to move outta the assisted living fac? Ambulate out of the assisted living facility? Kinda where, other than the dementia, where do you draw the line of this person might not be good for assisted living anymore.
O’Connor:
Are you saying with dementia or with anybody or with,
Schenk:
Yeah. With that, with not just dementia being the issue with somebody exit seeking, but who, who, like, when does someone no longer qualify for assisted living?
O’Connor:
That would be when they start having conditions that are medically unstable. The type of care that’s going to be given in an assisted living facility really has to be structured.
There’s supportive, there’s structure, there’s routine. There’s not this emergent situation or something that needs some intensive clinical care. It needs to really be stable and predictable. And so when that person starts needing that 24 7 oversight they’re conditions, they’re chronic conditions are now more severe.
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They, they need medical treatments, they need that continuous medical, and that’s the key medical oversight. So this would be people who are starting to need, and I guess this kind of is going to overlap with who qualifies, but IV therapy tracheostomies tube feeding. Ventilator support that would not be appropriate in assisted living.
Complex wound care pressure injuries greater than a stage two bedbound would not be appropriate. And then transfers that they need two people or more to assist with a transfer. That’s really a slippery slope. I, they, they really need to be able to bear weight and ideally not more than a one person assist.
Really when somebody’s getting ready to be a two person assist, they already are. They really need to have a sit to stand or a full mechanical lift for safety for the staff and for the resident. Oh, and then if the behaviors, let’s say they do not have a memory care unit. There’s, if the behaviors get very, I can’t think of my word, but severe uncontrolled.
They are unpredictable and just. Aggressive and maybe a threat to themselves or to other residents or to staff that also would not be appropriate.
For litigation differences, listen to What Makes Assisted Living Facility Cases Different.
Schenk:
I guess from a general standpoint then from what you’re saying is like you have with a nursing home it’s almost extremely clinical.
These are people that have medical conditions that need nursing and physician care. And on the other end of the spectrum, you have essentially just almost like a home environment,
O’Connor:
Absolutely, and that’s a good point about the nursing homes because one of the things that they do not have on hand because it’s homelike is oxygen.
Another reason why we want the residents to be stable too in a nursing home, if somebody requires oxygen right away, then it’s readily available. If when a resident lives in an assisted living facility, that oxygen has to be set up and ordered, just like if they lived in their own home. And same with the durable medical equipment.
If the if somebody needs a hospital bed, that won’t be readily available either, that would have to be set up just like if somebody was living in their own home. So yes, it needs to be as homelike as possible. What happens is the resident will bring in their own bed. Their own furniture, their own personal possessions, even pets.
And the family will come in and they’ll decorate the room and they’ll paint the walls and they’ll really make it their own. And they have a they have a kitchenette with a refrigerator, some counter space with a microwave sink and cabinets, and they really get to make the place their own.
What they get to do then is they don’t have the stressors of living or of managing a household. They do not have to cook. So what they get to do is go to a fine dining room experience, a fine restaurant like style, and they get to choose food off of or choose an entree off the menu, and they have staff waiting on them, and then they get to enjoy enjoy a plethora of activities.
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They have happy hour, lifelong learning exercise. Some places have swimming pools and a movie theater. And then there’s the interactive activities, the like painting or gardening and just other interactive, the stereotypical bingo and trivia. And then they have musical entertainment and just. Points of interest. They can jump on a ban and they can go where I live. Longwood Gardens is a major attraction and they can go to areas of interest, they can go shopping and and then just, or country rides. So they, that’s what they get to enjoy and that’s why it’s, I guess I, I do wanna say also that because they are higher functioning.
The care can be more tailored to their preferences, and that is key to an assisted living. They have the right to be, they have the right to autonomy, and they have the right to for self-determination. So that means with autonomy, that person can choose, they can be independent to choose what they want, and then self-determination, it kicks it up a notch and they have the freedom to choose how they want to live their life.
No matter what their medical conditions are provided that they’re stable. That’s, that is their right. So if somebody has, let’s say diabetes and they choose not to eat the carb control diet, they have their right. That, if they want to eat 10 cookies after dinner, they have the right to, and then they have their own kitchenette, but they can stop these and candy with. And so what nursing does is they educate the resident. They talk about the disease process, and the risks of not following a carb control diet. They’ll discuss this with the families. They’ll notify the physician because at that point the physician’s going to have to completely manage it from a medication standpoint.
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So that’s an example of autonomy. They don’t want to, or she doesn’t want to eat the carb control diet. And then where it comes into play with the self-determination, it’s based on what the, what. Means most to them what they value most. And if that is eating sweets, then that’s okay. So it’s, that’s not going to be controlled by assisted living. So it’s a home-like environment. They’re, they can stay, they’re a little bit independent. They can still stay social. They don’t have the burdens of a household. It’s just really a good balance between, us or assisted living, giving them the help they need, but still make their own choices.
They have their own privacy. They get to live life the way they want to live it. And so really the assisted living is just offering that support giving them life on life’s terms, and they get to have dignity. They get to have some freedom, and they get to have fun. So it’s really important when you’re looking at an assisted living, is to make sure that it’s the right fit. For the person. We wanna be able to match the person’s needs, preferences, and safety to the individual. And when it’s the right fit it has, it really gives them a good quality of life.
Schenk:
Very well said. Sarah, thank you so much for coming on the show and sharing your knowledge with us today.
O’Connor:
Thank you so much for having me.
Schenk:
All right, folks. I hope that you found this episode educational enlightening. If you did, please let me know. If you have an idea for a topic that you would like for me to discuss, please let me know. If you have a, an idea for someone that you want me to talk to, please let me know that as well.
Maybe you wanna be on here and talk to me. Let me know that. New episodes of the Nursing Home Abuse podcast come out every single week on Monday. Please be sure to enter to win your nursing home abuse podcast mug. And with that folks. We’ll see you next time.
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