When is assisted living not enough?
Linda Esterson
Assisted living provides a social atmosphere for adults with some supportive and health-related services, such as light housekeeping or help with remembering to take medications. Many assisted living facilities offer a dining room with meals provided or a schedule of events and activities, all with a built-in social network for residents.
But when is this not enough?
According to Marie Ickrath, LCSW-C, director of geriatric services for Baltimore Mental Health Systems, Baltimore City's public mental health system, assisted living facilities do not employ registered nurses to provide nursing care. Medical conditions requiring nurse oversight need to be treated at a more advanced level in an extended care facility or nursing home.
This includes:
- Skilled monitoring of chronic conditions like skin ulcers and diabetes
- 24-hour care for communicable diseases like tuberculosis
- Care for chronic conditions following hospitalization
"[A person's care level is] a medical issue determined by a physician or nurse," says Ickrath. "It's based on the level of care needed."
Health regulations divide assisted living care into three levels:
- Level 1: Low level of care—staff provides occasional assistance with accessing and coordinating health services and interventions, activities of daily living and medication and treatment.
- Level 2: Moderate level of care—staff provides or ensures access to all necessary health services and interventions, substantial support with some activities of daily living, and administration and monitoring of medications.
- Level 3: High level of care—staff provides or ensures ongoing access to and coordination of comprehensive health services and interventions. This includes nursing overview, providing or ensuring comprehensive support as frequently as needed to compensate for any deficiencies in activities of daily living, and providing or ensuring assistance with taking medication.
To choose the right facility, you have to look at the services and capabilities of the assisted living facility and see if they are adequately meeting the needs of your parent. Is your mother or father need at risk? How much risk is too much is an individual determination to be made by the family.
"There isn't a checklist," says Ickrath. "The decision needs to be made individually. A lot is based on tolerance."
If family members or the parent feels unsure about the level of care needed and what can adequately be provided by a facility, an assessment by his or her primary care physician is in order. In addition, each jurisdiction's health department provides what is called Adult Evaluation & Review Service, which may also assist in the decision.
"A nursing home doesn't have to be the end," adds Ickrath. "A nursing home can be a rehabilitative environment. And it's where people go to live."
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