Assisted Living

Definition

Although lacking a clear and concise definition, there is consensus that assisted living is an alternative to long-term skilled nursing care for individuals who do not need around-the-clock nursing care. It is intended for older adults who can control their care plans and maintain social relationships. Karen Brown Wilson, assisted-living advocate, administrator, developer, owner, consumer, and researcher, characterized assisted living as a subset of long-term residential care that provides well-designed housing with an individualized set of routines and specialized services. In assisted living the design, service provision, and management are guided by the philosophy that quality of life is associated with autonomy. The goal is to facilitate residents’ control over their space, their care, and their routines.

Assisted-living facilities range from small, freestanding houses to large multifamily complexes; they may be specifically designed or adaptively rehabilitated for senior living. Exteriors and interiors are reminiscent of a “home” environment and designed to disguise institutional features and medical equipment. For example, many exteriors feature low roof lines and shutters. Assisted-living facilities developed in residential neighborhoods reflect the character of the surrounding community. Alternatively, assisted-living units are sometimes included in special wings or floors within a continuing care retirement community or as designated units within an independent apartment community. This arrangement is intended to provide housing stability by helping older adults age in place. Interiors include private accommodations ranging from single-room occupancy units and studios to full apartments with kitchens. Common spaces include comfortable living rooms, elegant dining rooms, libraries, patios, and game rooms furnished in durable but residential materials. Well-appointed common spaces encourage socializing between residents, as well as opportunities for residents to entertain community-based family and friends. Overall, the design goals are to evoke welcoming and homelike feelings for residents and visitors while ensuring safety, accessibility, usability and comfort.

Professionally managed assisted-living facilities are designed with the capacity to address continuous, emergency, and temporary needs for assistance with personal and health care. A la carte services include meals, assistance with activities of daily living and personal care, nursing and incontinence care, social activities, wellness programs, transportation, security and emergency call systems, housekeeping, and medication management. Service plans are flexible and individualized to address changing needs and to manage consumer costs. Services are intended to encourage autonomy and prolong stays by avoiding moves into more restrictive, institutionalized settings.

The operating philosophy of assisted living is very different from that of nursing homes. Nursing homes operate within a medical model and are strictly regulated to ensure safety and quality of care. Administrators of assisted-living facilities strive to maintain quality of life for residents by promoting autonomy, dignity, and privacy. Residents are encouraged to control their private accommodations, agree to the types of assistance they accept and pay for, and set their daily schedules. However, assisted living is also community living; staff and residents balance the philosophical priorities of [Page 30]autonomy, independence, and community engagement with the common good.

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