The freedom to "age in place" conveys hope for seniors-a chance to
enjoy the final season of life without being institutionalized and
without burdening family members. As evidenced by exponential growth in
assisted living, independent living and community-based programs,
consumers are driving the long-term care market and they demand
options, autonomy and the freedom to make choices-including choices
that entail risk.
Balancing autonomy with safety, however, presents a
serious challenge to assisted-living facilities striving to deliver on
the hope of aging in place for their frail and elderly residents.
Risk aboundsIn a community of residents with an average age of 84 who depend on
assistance for many daily tasks, risk abounds. Just consider the
obvious risks in a population where 86% require assistance with
medications, 68% with bathing, 47% with dressing and 25% with eating.
And do not minimize the fact that, on average, half the residents also
suffer from some form of dementia. Falls, elopements, abuse,
medication issues and contagious infections are just a few of the more
common problems that keep both administrators and family members up at
night.
But there is another layer of less obvious risks. Some seniors, who
thought they bought the complete lifetime package, will face the risk
of eviction. Glossy marketing brochures that assured prospective
residents of services to meet all needs of all residents all the time
have faded away leaving only a trail of broken promises.
Jim Moore, a respected assisted living consultant, refers to it as the
"million dollar wake-up call" for assisted-living facilities. He notes
that by adding just 60 minutes of assistance per day for just 40% of
residents, a facility's costs can increase by $123,000 per month.
Unless the facility can cover those expenses with higher prices,
promises are broken. Even in the wake of broken promises, many
residents will resist the need to move along the continuum of care.
Likewise, many administrators who find themselves under constant
pressure to keep the facility full may not pursue a transfer.
The confluence of these factors leads into another equally undesirable
set of risks. Although the phrase "aging in place" conjures up
favorable images for the majority of seniors, the reality may be a
disappointment for them and their family members. Because
assisted-living facilities are not regulated by the federal government,
and only loosely regulated by state government, the level of services
provided from facility to facility varies significantly. In an effort
to minimize operating expenses, many facilities depend heavily on
unlicensed personnel (universal workers) for a majority of resident
care, including the administration of medication. For seniors with
deteriorating health conditions and multiple chronic diseases, lack of
adequate nursing care and nursing supervision can spell disaster. In
fact, most mistakes that result in injuries to residents are typically
rooted in staffing issues.
