Assisted Living: The Perfect Place for Nursing
Article Outline
Dr. Barbara Resnick
Assisted living is seen as a philosophy of service that focuses on maximizing each resident’s independence and dignity. Generally, assisted living housing is described as any group homelike residential program with the capacity to care for people with disabilities on an as-needed basis.1, 2 Residents pay rents that range from $1,500 upward for shared or private rooms with any variety of services (help with personal care activities, housekeeping, medication reminders, laundry etc.). The goal of assisted living is to help older adults receive the care they need in a homelike setting and in a way that promotes dignity and independence.
Assisted living facilities (ALFs) provide care to a vulnerable and medically, functionally, and cognitively impaired population3, 4, 5, 6 the majority of whom require some assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs).4, 5, 7 These individuals tend to demonstrate functional declines over time that are similar to what is found in nursing home residents.8, 9 Needless to say, the role and opportunity for nursing in these settings is critical. Successful living in ALFs is, after all, based on health promotion, disease prevention, and optimization of function, all of which are under the purview of nursing. Prevention of acute medical problems or exacerbation of underlying problems is critical to maintaining optimal physical and psychosocial health and function and in increasing the likelihood of remaining in the ALF without increasing the cost of care (i.e., paying for additional supportive help).
A New Philosophy of Care
Optimal care in ALFs requires that nursing change the philosophy of care in geriatrics from one that is focused on service provision and meeting care needs to one that optimizes health and function for each resident. We may believe we do this already in geriatric nursing, but let’s step back and consider. Think about your own care practices. Where do your hands go when you see an older adult struggling with getting shoes, a jacket, or a nightgown on or off? When you see someone attempting to come to stand, or when someone asks to be pushed to get to the dining room? Do you stand back and ask, what is best for this individual? If I put on his or her clothes, what has occurred? The task gets done, and the resident may thank you and be quite content. That resident, however, has lost the opportunity to range a joint or practice coming to stand and strengthening quadriceps muscles. Moreover, the nursing care may have resulted in lowering the resident’s confidence in his or her own ability to come to stand. How many residents have entered long-term care settings only to receive wonderful and loving nursing care that results in a marked decline in function? Over time, independent of disease, the individual that is cared for may lose the ability to range his or her shoulders or ambulate.
As nurses move into ALFs, can we change this pattern of care and resident decline in function and embrace a philosophy of care that will optimize function and help residents to “age in place”? There are already groups and resources to help. Groups such as the American Assisted Living Nurses Association and the National Assisted Living Nurses Association are wonderful resources for nurses working in assisted living as are interdisciplinary organizations such as the Centers for Excellence in Assisted Living. To share the work coming out of these groups specifically dedicated to assisted living, Geriatric Nursing has established a new column that will address the challenges noted in assisted living and innovative solutions to those challenges. Ethel Mitty, Ed.D., RN, from New York University, John A. Hartford Institute for Geriatric Nursing, and Sandi Flores, RN, C, from Community Education, LLC Senior Resource Group, LLC, will serve as the coauthors for that column. I encourage you to read and respond to the topics addressed and join in with other geriatric nurses to make assisted living what it is meant to be—a home that optimizes the health and function of the older individuals that reside in it.
References
- . Trajectories of functional impairment in later life. J Health Soc Behav. 1992;33:114–125
- . The effect of long-term care environments on health outcomes. Gerontologist. 2000;40:422–428
- . Do impaired older persons with health care needs occupy U.S. assisted living facilities: an analysis of six national studies. J Gerontol Series B Psychol Sci. 2004;59B:S68–S79
- Predictors of functional impairment in residents of assisted living facilities: The Maryland Assisted Living Study. J Gerontol A Biol Sci Med Sci. 2005;60:258–264
- How good is assisted living? (Findings and implications from an outcomes study). J Gerontol B Psychol Sci Social Sci. 2005;60:S195–S204
- Health and functional outcomes and health care utilization of persons with dementia in residential care and assisted living facilities: comparison with nursing homes. Gerontologist. 2005;1:124–132
- . Utility of the Maryland Assisted Living Functional Assessment Tool. Poster presentation Gerontological Society of America. Orlando, FL: Gerontological Society of America; 2005;
- . Patterns in functioning among residents of an affordable assisted living housing facility. Geronotologist. 2002;42:178–187
- Outcome trajectories for assisted living and nursing facility residents in Oregon. Health Serv Res. 2001;36:91–111
PII: S0197-4572(06)00350-8
doi:10.1016/j.gerinurse.2006.11.003
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