A Place For Mom: The Best-Kept Secret in Long-Term Care

First in a series of articles about assisted living, which in many cases is an attractive option for many frail elderly whose physical and cognitive issues aren't severe enough to require nursing-home care, but for whom it is no longer advisable to live alone. In this installment, we will explore the philosophy of AL and the types of services these communities can offer. Specialties Geriatric Article


A Place For Mom: The Best-Kept Secret in Long-Term Care

A middle-aged woman tiptoes out of your elderly patient's room as you stand at the computer making your latest entry, then sneaks a look back to make sure her mother is still sleeping. Shyly, she approaches you and whispers, "Do you have a minute?"

You don't, but you close out your charting and tell her that of course you do. "I don't know what I'm going to do with Mom," she sighs, running her fingers through greying hair."This is the fifth time she's fallen in the past two months, and now Dr.Stevens says she can't live alone anymore. She says she won't go to a nursing home, but my husband was diagnosed with lymphoma last spring and I have to take care of him, make sure he gets to his appointments and so on, and I just don't think I can take care of them both."

She seems on the verge of tears as you put a comforting arm around her and push your other projects aside for the moment. Fortunately for her and her mother, you have a working knowledge of the resources in your area for seniors who are no longer safe to live independently, yet not ready or willing to enter a nursing facility. You excuse yourself for a moment and step over to the information center at the discharge planner's desk, where you pick up several pamphlets and hand them to her. "I understand completely," you reassure her. "Here is some information for you about assisted living facilities in our area."

But what is assisted living? you may be asking yourself, particularly if you're not familiar with this type of extended care setting. What sort of care do they provide? How much does it cost? What kind of staffing do they have? And how is AL different from the more traditional nursing home?

First of all, assisted living is arguably the best-kept secret in long-term care, even after some three decades in the LTC industry. More home-like and less restrictive than most nursing homes, assisted living offers the independence seniors want with the services they need in order to stay as healthy as possible given the limitations imposed by disability, cognitive decline and/or chronic illness.

While laws governing such facilities (or "communities", as they are often called) vary from state to state, you'll usually find them warm and welcoming. The buildings themselves are generally well-appointed and decorated handsomely, and staff members are usually available at the front desk to greet you. The focal point of many facilities is a large and well-lit dining room, where most of the residents take their meals in a restaurant-like setting. If you tour the building, you'll find residents living in their own furnished apartments instead of rooming with one or two other people with only thin curtains between them.

The apartments feature private bathrooms with a spacious walk-in shower and grab bars installed in strategic places, as well as kitchenettes with a microwave oven and a small refrigerator. There is wall-to-wall carpeting and a nice, large window to look out of and perhaps even raise a plant or two. All apartments have a separate heating/cooling system and call system, which can be used by the resident to summon help when he or she needs it.

There are also plenty of activities to choose from. The most popular at almost any community is Bingo, followed closely in some locales by MexicanTrain Dominoes and casino trips on the facility bus. Some residents have a community garden where they raise vegetables for dinners and flowers for the tables; others who are less active often like to sit in the library and read, do jigsaw puzzles, or work on the computer.

ALF residents come in all ages, colors, shapes, sizes, and diagnoses. They can range from the fifty-something gentleman with severe mental illness to the 99-year-old grande dame who always smells faintly of lavender and Dove soap. ALF staff take care of sliding-scale diabetics, people with dementia, amputees, ostomees, COPD'ers, stroke patients, even hospice. They give B-12 injections, take care of catheters, change wound dressings, and use compression therapy for lymphedema. And in some parts of the country, they do it all with only one licensed nurse!

In the next article, readers will be introduced to the different staffing models used in ALFs and how nurses and unlicensed staff work together to provide high-quality care at far less cost than the average nursing facility.

Long Term Care Columnist / Guide

I'm a Registered Nurse and writer who, in better times, has enjoyed a busy and varied career which includes stints as a Med/Surg floor nurse, a director of nursing, a nurse consultant, and an assistant administrator. And when I'm not working as a nurse, I'm writing about nursing right here at allnurses.com and putting together the chapters for a future book about---what else?---nursing.

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Home Health Columnist / Guide


11 Articles; 18,068 Posts

Specializes in Vents, Telemetry, Home Care, Home infusion.

Assisted living becomes the patients "HOME". Under Medicare, when acute episodes of illness occurs, especially post hospitalization, ALF residents are eligible for skilled care via a home health agency.

Payment for Assisted Living Facility care is usually private pay. Some states are looking into medicaid payment in lieu of nursing home payment as a cost effective alternative.

I had my granmother in local facility just 6 blocks from my home. I repeatedly joke with my sons that I'm getting a red scooter if my arthritis worsens; if I'm unable to remain at home, make sure it turns left at the bottom of our street so I can zip into the ALF lobby to live.

subee, MSN, CRNA

5,092 Posts

Specializes in CRNA, Finally retired.

At the point that 24/7 home care became cheaper than ALF, we admitted my mother to terrific facility. Her apt. had a lovely porch in the shade of palm trees. We were able to pay the first few months with the remains of her savings and were lucky enough so sell her apartment to pay for the rest. Medicare does NOT cover any cost of ALF.

Specializes in LTC and School Health.

I've worked at some beautiful ALF and some awful ones. I do love the idea of ALF and the independence the residents have.

country mom

379 Posts

Dear Viva: How is ALF different from Adult Foster Care? Thanks!


2,228 Posts

As with anything else, make sure you do your research.

Owner of assisted living home charged with neglect - WCIV-TV | ABC News 4 - Charleston News, Sports, Weather

"NORTH CHARLESTON, S.C. (WCIV) -- The owner of Fair Havens Manor, an assisted living facility in North Charleston, was arrested Thursday morning and charged with neglect.

According to incident reports, the North Charleston Police Department was contacted by the South Carolina Long Term Care Ombudsman office.

The ombudsman office gave detailed reports and statements taken by their staff and told of one victim who was in such poor health that he had to be hospitalized immediately.

The report states that the victim was severely dehydrated and suffering from malnutrition along with having a 'subdural hematoma' on the back of his head that may need surgery."

"Every time I come here, the place is nasty. It's smelly and it shouldn't be that way," said Jackie Johnson who's brother lives at the facility. "It's not a good environment but this is the closest place we could find for him. Everybody there is sitting around in their little crampy room."

Thursday was not Magwood's first encounter with local law enforcement officers. In 2004, she was accused of beating and robbing a 65-year-old resident at a home she operated."


425 Posts

Assisted Living is NOT Skilled Nursing. Most assisted living facilities have extra help at a premium when needed. My parents were in assisted living for three years. The place was wonderful. The cost was huge. One needs to look at the entire picture. For instance, just having medications dispensed was $400/mo for each and my dad took about 4 pills/day. The cost for both of them with medication dispense was about $80K or more/year. One year when dad had to go to skilled nursing for a month, one month of care for both was $20K. My parents were not wealthy people. After dad died, I took mom in to live with me as all their funds were exhausted.

Long Term Care Columnist / Guide

VivaLasViejas, ASN, RN

108 Articles; 9,984 Posts

Specializes in LTC, assisted living, med-surg, psych.
Dear Viva: How is ALF different from Adult Foster Care? Thanks!

ALFs are communal by nature....there can be anywhere from a dozen to hundreds of residents in a given community. AFC is usually done in a caregiver's own home with bare-bones staffing; it's definitely more intimate as they can take only a handful of residents, most of whom who need more extensive health services than is offered in ALF. A lot of residents in these settings have moderate to severe dementia or behavioral issues that a larger community cannot address, so they can be a godsend.

The advantage, obviously, is that residents in good AFCs receive more attention; the main disadvantage is the uneven quality of care in general. Some are wonderful---the caregivers really enjoy the residents and cook homestyle meals for them, sit and talk with them, do activities with them. Others, unfortunately, are basically dungeons where residents merely sit and stare at TV all day and there is little interaction with their caregivers, let alone the outside world. As an ALF nurse, I sometimes will recommend one or two of the local AFCs which I know to be good, as not everyone will do well in a large community such as ours.

Ruby Vee, BSN

47 Articles; 14,024 Posts

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

I have nothing but wonderful things to say about the ALF where my mother lived for almost three years. The moment I walked into the bright, cheerful kitchen and dining room, I knew it was a special place. My mother's room was large, comfortable and clean. The staff were hard working and friendly, and they made Mom feel as if they loved her. They even took care of ME when I visited . . . confiding that the breakfasts at the Gretel's Griddle were the best in the county, but for dinner I should have a steak at the Farmer's Inn and even presenting me with a plate of bacon and eggs the morning I arrived well before Mother got up for the day. The time I drove across the country with my six month old pup and left him in the car (it was 20 degrees outside) so I could visit Mom before finding a place to stay, they insisted that I bring him inside and then all of the residents took turns throwing the ball for him to fetch. The place really was a home, and I cried when we had to move Mom to a higher level of care.

There are as many reasons for Mom to go to an ALF as there are Mom's and daughters, but even after decades in health care, I didn't know about them until we needed to move Mom out of her house. I am so thankful we found the place we did, and so grateful to the staff for making the place a real home.


1 Article; 143 Posts

Assisted living communities are wonderful, for sure, but they come at a high cost. They take private pay only, and can exhaust a savings account very quickly. What they are also quick to do is to give families a 30 day notice of discharge when the funds are about to run out. I have given many tours at my LTC facility to families who have been told they need to find a place for their loved one who can no longer afford to be at the assisted living facility. For that reason, I have many residents who are very high functioning but who have outlived their savings accounts and now must live at a LTC facility paid by Medicaid.

Long Term Care Columnist / Guide

VivaLasViejas, ASN, RN

108 Articles; 9,984 Posts

Specializes in LTC, assisted living, med-surg, psych.

My facility is about 40% Medicaid as of this writing. In fact, of the five companies I've worked for that manage ALFs, there have been none that took only private-pay residents.


425 Posts

I guess there are some medicaid out there.......but where my parents were it was strictly private pay. We even have skilled nursing here in CA that does not take medicaid/medicare. As for the ones who do, well one must get down to 2K left to qualify.

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