Assisted living facilities stress community, independence

Assisted living facilities, also known as residential care centers, offer a happy medium between independent living communities and nursing homes.

While independent living stresses the social aspect of a community and nursing homes focus primarily on medical care and monitoring, assisted living is appropriate for older people who desire privacy and independence, but also need some medical monitoring or help with physical chores, caregivers said.

Residential care apartments may be studio style with one large room and kitchenette or more a conventional one-bedroom apartment with separate living room, bedroom and, because meals are served in a communal dining room, a minimal kitchenette.

Nursing staff dispense medications and check on residents several times daily, as well as provide help with bathing or other physical tasks when needed.

Residents may also take advantage of frequently offered planned activities ranging from bingo and light exercise classes to trips to Branson or local restaurants, caregivers said.

Springfield now has 16 assisted living facilities, and several more are available in outlying towns. Most share a campus with a skilled nursing facility.

Prices vary, but the average cost is $2,000 per month per individual.

According to Diana Richards, information and assistance director of the Southwest Missouri Office on Aging, her "biggest concern is that families speak to their physician or a caseworker from an area aging agency to determine if assisted living is the right level of care for their elderly relative.

"If someone is fairly independent, it may be too much care. Or it may not be enough if the person actually needs to be medically monitored and helped with most basic tasks."

Richards pointed out that some places offer "a continuum of care, which allows the residents to move from assisted living to skilled nursing care, even Alzheimer's care in some situations."

This, she said, makes the transition to assisted living easier for older people and their families.

Although choosing the right facility may seem to be a daunting task, staff at the Office on Aging are available to discuss the process and provide a list of facilities.

The in-person visit

Once a client chooses a list of possible facilities, the next step is an in-person visit.

According to Robert Snook, program manager for the Missouri Division of Aging Institutional Services Office, nursing homes certified for Medicare and Medicaid are inspected several times a year for violations.

The inspectors, by checking sample resident charts, look to see that the various types of resident needs are being met.

"Violation notices must be posted in a conspicuous place where they can be found without a visitor having to ask," Snook said. An extensive list, or one that shows potentially dangerous violations, should serve as a caution regarding that facility.

Larry McGee, a nurse with the Division of Aging, suggests that "a common-sense tour of a place can tell you a lot. Clean bathrooms and shower rooms show care; mildewed corners and grime don't. A visit during a meal can tell a lot about the nutrition program. Take a careful look at the residents, because poorly groomed or dirty residents are not having all their needs met."

The average age when people enter any sort of elder care nursing homes, assisted living or independent living is 83 years.

Depending on longevity, finances may be a problem. Assisted living is strictly a private-pay service, although some small Medicaid grants are available to supplement low incomes.

If there is a chance that money will run out and the self-pay resident eventually needs to be moved to a skilled-care room, it is wise to choose a facility that has Medicaid certification and a program in place.

Solving disputes

Assisted care facilities try to accommodate the needs of their residents, but should a dispute arise that the resident or his family cannot resolve, the Long-Term Care Ombudsman Program, a federally mandated and funded organization, headed regionally by Connie Payne, is available to help negotiate the problem.

"Residents have a lot of rights to choose their own physicians, to refuse or accept treatment, to participate in their own care," Payne said.

"If these rights are being violated, people can call us. The number is at the bottom of the resident rights poster, which must be posted where residents can see it. Even if the issue is bad food or lost clothing, and it can't be resolved, residents are always welcome to call us."

Payne said in some cases, the nursing homes provide their own volunteers to resolve situations. "Some nursing homes have a volunteer ombudsman on hand to help," she said.