Q: My father is 88 and has a girlfriend of the same age. I am concerned that he is no longer able to shop, prepare meals, clean his house and more.
He still drives, is independent and strong willed. His girlfriend is not a big help given her own health conditions. Against his wishes we are exploring assisted living.
What should we know? K.M.
A: Dear K. M.,
Maintaining a sense of independence is important for many older adults. Assisted living describes such a philosophy by providing opportunities for residents to be as physically and emotionally independent as possible. Assisted living is generally defined as a non-medical facility that offers assistance with activities of daily living, meals, medications as well as transportation, bathing and dressing for some. They typically serve individuals 60 and older and provide room, board, housekeeping, supervision and personal care assistance with hygiene, dressing, eating and walking. They are designed for people who can no longer live completely independent but do not require 24-hour nursing care.
These facilities must meet care and safety standards set by the State. The California Department of Social Services is the licensing agency. Assisted living residences may be part of a retirement community, nursing home, senior housing complex or may stand-alone.
The state establishes the admission criteria. For example, an individual cannot require a feeding tube, intravenous therapy or have severe open wounds. After that, there is great variability in what facilities will accept depending on the care that is their specialty.
Victor A. Regnier, professor of Architecture and Gerontology at USC, discusses characteristics of assisted living facilities in his book, “Assisted Living for the Elderly: Design Innovations from the United States and Europe” (Van Nostrand Reinholt). According to him:
Assisted living facilities are residential.
They are modeled after a home, not a hospital.
The housing unit includes a full bathroom and at least a kitchenette.
Assisted living provides assessment and treatment plans, recognizing each individual’s unique abilities, limitations and interests.
The focus is on stabilizing any declines, improving competency and building reserve capacity.
A partnership is formed between the resident and the family, sharing responsibilities for the well-being of the resident.
The setting integrates the individual with the community as opposed to isolating the individual.
Each assisted living community is unique in how it looks and feels ranging from a towering building to small cottages. Older residences may have two individuals to a bedroom. More recently there is a demand for private apartment-style units emphasizing privacy and greater control over daily activities.
Tips for choosing an assisted living residence:
Here are several suggestions from the U.S. Administration on Aging’s Eldercare locator. For more information, call 1-800-677-1116.
Consider the resident’s future needs; how will the facility meet them?
Is the facility close to family and friends?
Are there places to visit within walking distance such as shopping centers or parks?
Do admission and retention policies exclude people with severe cognitive impairments or severe physical disabilities?
Does the facility provide a written statement of the philosophy of care?
Visit each facility more than once, sometimes unannounced.
Visit at meal times, sample the food, and observe the quality of service.
Does the facility offer social, recreational, and spiritual activities?
Speak with the residents and observe interactions among residents and staff.
Ask about staff training and the frequency it is offered.
Review state licensing reports.
According to California Advocates for Nursing Home Reform, the monthly median cost in California is $3750. Costs can range from a low of $1,000 a month for a resident on Supplemental Social Security (SSI) to a high of $9,000 a month. Specialized services like dementia or hospice care typically are more costly. Since extra fees are charged for additional services, it is important to inquire what is included in the basic rate and how much other services will cost.
K.M., on approaching your father, don’t be surprised if he resists. Promote the positive aspects such as the possibility of moving with his girlfriend, being as independent as possible, living in a gracious environment with interesting activities and more. Take your time, include your father in your fact-finding mission and visit several places – with no pressure.
Thank you for asking an important question. At some point, many of us may be confronted with a similar decision, if not for ourselves, then for a loved one.