Nursing Homes and Assisted Livings for Elderly - Research Paper Example

?Running Head: NURSING HOMES & ASSISTED LIVINGS FOR ELDERLY Nursing Homes & Assisted Livings for Elderly Nursing Homes & AssistedLivings for Elderly Introduction The population of adults over age 65 is expected to more than double by the year 2050, and the population over age 85 is growing the fastest. Reliance on long-term care (LTC) is increasing, and concern over the quality of life of those living in LTC is mounting (Hebert et al., 2001). Long-term care is generally described as a diverse array of services provided over a sustained period of time to people of all ages with chronic conditions and functional limitations. Long-term care includes in-home services, such as housekeeping and personal assistance, adult daycare, meal delivery programs, as well as living facilities (Carlson, 2003). Age is generally associated with progressive, irreversible losses in function, health and resources. Long-term care use is tied to loss of functional ability; thus, an increasing number of older adults who can no longer function independently consider either in-home services or care facilities (Katz; 1970; Carder & Hernandez, 2004). Although older adults may prefer to remain in their own homes, many with functional impairments rely on informal and formal assistance services, including family, friends, and community programs in order to live at home. However, a number of older adults relocate to LTC facilities. Today, the variety of LTC facilities available provides a continuum of living arrangements, including continuing care retirement centers, assisted living, residential care, adult foster care, and nursing homes. Long-Term Care Facilities Long-term care facilities are group-housing environments that provide services for those who lack some capacity for self-care. There are many different LTC facility types (e.g., assisted living, residential care, adult foster care, nursing homes), established and operated according to federal, state, and local regulations and licensing requirements (Dobbs, 2004). The dominant feature of all LTC facility types is arguably the level of care provided. The facility license stipulates the level of care allowed and the training and experience requirements for staff. Unfortunately, care levels are not classified according to the same system for each type of facility making it difficult to directly compare facility types. For example, nursing homes are licensed to provide skilled and/or intermediate care, terms established in federal regulations (Dobbs, 2004). Skilled care is a level of care that requires services that can only be performed safely by a licensed nurse whereas intermediate care is health-related care and services that do not necessarily require licensed practitioners. In contrast, assisted living, residential care, and adult foster care are licensed under state regulations based on the activities of daily living requirements (ADLs) of individuals. The ADLs measure individuals' physical, cognitive, and behavioral functioning. A common ADL measure is whether the individual is "independent," "dependent," or "needs assistance" with bathing, dressing, toileting, transferring, continence, and eating. Arguably, the most important factor to influence both the older individuals' relocation to a LTC facility and the type of LTC facility chosen is the level of care needed, that is, the individuals' physical and functional limitations and degree of cognitive impairment. Other factors include financial status, availability of supportive family and friends, and regional case management practices. The four facility types are described below. Assisted Living Facilities Assisted living facilities (ALFs) are one of the newest living arrangements for elders, designed around a social rather than a medical model of care. In many ways, the function of assisted living is fairly clear: it is a congregate housing alternative for seniors who are unable to live independently, but who do not require the intensive skilled nursing services available in nursing homes. As the population in America ages, the need for housing alternatives for seniors will grow. In 2002, there were 35 million Americans aged 65 or older. It is estimated that by 2030, their number will exceed 70 million (Administration on Aging, 2002). In Connecticut, the population of residents older than 85 years increased by nearly 37% between 1990 and 2000. By age 80, 74% of people need assistance with at least one activity of daily living (ADL). Nearly 35% of 80 year olds require assistance with ADLs (Administration on Aging, 2002). Not all of these older adults will require skilled nursing care. Assisted living is viewed as an attractive alternative to nursing home placement, since it provides residents with assistance with basic ADLs (such as bathing and dressing) and instrumental ADLS (such as cooking and cleaning), which meet many older adults' needs. The typical resident of assisted living is an 84-year-old woman who needs assistance with activities of daily living (Hawes, Rose & Phillips, 2000). Some degree of cognitive impairment is seen in 44% of the residents of assisted living (Hyde, 2001). Minimal cognitive impairments are present in about one quarter of residents, while moderate (15%) and severe (4%) impairments are less common (Hyde, 2001). Residents of assisted living facilities are getting older and needing more services than originally anticipated by developers (Maynard & Cameron, 1997; Gold, 1997). Over half of the residents in a national study of assisted living residents study required assistance with bathing and nearly 80% received assistance with medication management (Hawes, Rose, & Philips, 2000). The average length of stay of residents in their study was 2 % years. Adult Foster Care Homes Adult foster care homes (AFCs) are licensed to provide care for up to five residents with impairments requiring personal care and/or supervision 24 hours a day. The adult foster care home is meant to provide a family living environment as an alternative for those at risk of institutionalization. A live-in "resident manager," who may or may not be the owner, must reside in each adult foster care home. A common setting is a single ­family private home in which the caregiver is also the homeowner, although it is not uncommon for owners to operate multiple homes with a staff of live-in caregivers. In general, the regulations for AFCs are less stringent than those of NHs, as care is provided in a private family home rather than a medical setting (Hawes, Rose, & Philips, 2000). Residential Care Facilities Residential care facilities (RCFs) are licensed to provide on-site meals and assistance with ADLs for six or more residents. Residential care serves a wide range of individuals, including able-bodied elders, physically and developmentally disabled adults of all ages, as well as the terminally ill. There are two license classifications for RCFs. Class I facilities provide basic residential care to people who require some assistance with ADLs. Class II facilities provide basic residential care services to people who may require full assistance in activities of daily living; in addition, they serve people with cognitive impairments (Hawes, Rose, & Philips, 2000). Providers are required to provide 24-hour supervision and services ranging from room and board, assistance with physical care needs, medication monitoring, planned activities, and transportation. Some offer private rooms and some registered nurse consultation services. Residential care facilities can be large or small with either congregate or family-style meals, depending on their size. They can be single-story structures resembling many NHs or apartment-like buildings. They are not required to have private rooms, but they are allowed to have locking doors if they do. Nursing Homes Nursing homes and assisted living residences differ in many features. The federal oversight of nursing homes (contrasted with the state oversight of assisted living residences) has resulted in a tremendous amount of regulation of the industry. In order to be assured funding through state and federal sources, nursing homes must document compliance with a vast array of policies and procedures. The justification for the extensive set of regulations in nursing homes is that they will maximize quality of care for the residents (Eaton, 2000; Vladeck, 1980). Advocates of assisted living, however, claim that the lack of tight controls enhances residents' quality of life (Regnier, Hamilton, & Yantabe, 1995). People with medical conditions that are complex and/or unstable are able to receive care and monitoring in nursing homes. While physicians are not typically on site for more than visits or clinics in nursing homes, the nursing staff is capable of monitoring complex medical conditions and managing tasks such as bladder catheterization, wound care, intravenous administration of medication, and feeding via a nasogastric tube. Nursing home personnel are capable of caring for frail elders in most instances with the exception of a serious, acute illness, in which case discharge to an acute care hospital is required. Residents who enter nursing homes do so with the awareness that they may remain at the facility until they die. Assisted living facilities, however, have varying capabilities to maintain residents with declining health conditions, largely dependent on state regulations. From a design standpoint, there are stark differences (Brandi, Kelley­ Gillespie, Liese, & Farley, 2004). Nursing homes generally have a central nurse's station on each floor, where patients' medical charts are visible. Long narrow corridors are lined with patient rooms. Linoleum floors, starkly painted walls, and medicine carts lend little warmth to the environment. Assisted living facilities tend to have a more homelike feel. Again, depending on the state, the building may be an actual home that has been licensed as an assisted living residence, or it may be a large, purpose-built facility with a grand entrance, spacious multi-purpose rooms, lounges for meetings with friends and family, carpeted hallways, fresh flowers, and pets roaming the halls. Resident choice and control are limited in nursing homes (Kane & Caplan, 1990). The abundance of regulations and the nature of the staffing patterns make it difficult for residents to assume any personal responsibility for the management of major or routine issues (Cohen-Mansfield et al., 1995). Regulations specify when residents will eat and how much food will be served. The amount and types of personal possessions that residents may have are limited to minimize fire risk. Residents have little choice in the matters of roommate selection, timing of care routines, or leaving the facility for short trips. In a text on assisted living, Calkins and Weisman (1999) claim that a benefit of assisted living over nursing homes is that "the physical, social and organizational environments of assisted-living are more supportive of personal control and autonomy, continuity with past routines and patterns of behavior, and independence." (p. 131 ) Summary Assisted living represents the fastest growing sector of housing with supportive services for senior citizens. It emerged as a housing option in the 1980s, as older adults and their families became frustrated by the limitations of nursing homes, and called for alternatives. Assisted living is characterized as a group residential setting with the ability to meet residents' personal care needs, and a philosophy based in the social, rather than medical, model of care (Carder, 2002). 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