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

[VivaLasViejas]

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.

[Miss Cola, BSN, RN]

There are so many different types of ALF's that exist,...Here in FL they are becoming more strict on the regulation of what these facilities can and can't do. All med tech's must have a certification course before passing meds. There are also varying licenses the facility can hold to allow them to perform skilled nursing tasks as well. Many ALFs in my area do not have an RN on staff, only LPNs and CNAs. There are also special criteria the pt must meet for admission (like being able to stand/pivot or no stage 3 decubs).

Also, there's so many different scenarios-good and bad. Some places are family owned and others are large campuses with various departments inside (ALF, LTC, and independent living). For many families, there is a great deal of limbo regarding the proper placement for their parents. Its a huge and very expensive decision to choose and ALF and many cannot afford it (or run out of money trying to). I do know that certain facilities accept a Medicare Waiver, I am not sure what this entails but I have heard that this cuts some costs. Many ALFs in my area charge a monthly price that includes 3 meals, housekeeping/laundry, transportation to appts/errands, and activities. Although the amenities vary from place to place, they may include toiletries and incontinence supplies or may include medication management in their price-some charge a monthly fee. For so many families who employ around the clock private duty aides, ALFs are a heaven sent-bc at the end of the day, they still need to cook/clean/arrange appts etc.... What I notice is the huge need for the facilities that have Dementia Care. At my facility, we are at capacity in our dementia wing-it is so hard to find places for exit-seekers. It is really amazing to see the growth and popularity of ALFs come to the forefront. It should be made to be more affordable because so many people are in need of this "in-between" type of healthcare.....