Before any more time goes by I want to jot down and share some insights I have on the current state of Assisted Living and Memory Care as I recently observed it. I first gained some awareness on these types of facilities when my mother’s health started its decline. Writing about elder care is challenging because there are so many variables. I want to remain positive about this life stage but we must look at facts first. So here are my recent observations. I will follow-up with a part 2.
Observation 1 Nearly all individuals residing in an assisted living cottage or larger facility are single, widowed or divorced and they’re there because they can no longer safely care for themselves for one reason or perhaps several. Extended family either lives far away or is not willing or able to provide the level of care they need over time.
Observation 2 Assisted Living and Memory Care facilities (ALFs) are corporate franchises or otherwise privately owned and are therefore in existence primarily for profit. The state regulates these businesses and holds them to a rather extensive list of standards. Services are focused on assisting with activities of daily living (ADLs) and include: bathing, dressing, toileting, meals and dispensing medications.
Observation 3 The state’s Health and Human Services Department licenses these places according to level of care. There are two levels of care under the ALF designation. Type A is a facility or homelike setting where the residents are able to evacuate on their own in an emergency and don’t need overnight care. TypeB is for residents who can’t evacuate in an emergency on their own and/or who need to be observed and supported overnight.
Observation 4 Dispensing medications and attending to the ADLs are the central function of the facility. Almost all the staff’s time revolves around attention to these things. All medications are locked in a rolling cart. Narcotics are double-locked and must be counted and signed off on every shift. Changing colostomy bags, emptying catheters and making sure the residents (most aren’t incontinent unless they’re in Memory Care) have clean, dry undergarments and charting significant changes or reporting an urgent need are indeed valuable services.
My overall observation is that the vast majority of AL residents are in poor physical condition due to lack of regular exercise, impaired mobility and observable cognitive decline. At least 90 percent are on multiple, prescribed medications. The main co-morbidities (more than one long-term, life threatening condition) I witnessed as a training med tech were heart disease, diabetes, Parkinson’s and dementia.
The meals provided were freshly prepared but were overcooked and loaded with processed carbohydrates. Not a single serving of fresh fruit, raw vegetable or green salad was in sight. They served caffeinated coffee, occasional sodas, sweet fruit punch and tap water. The snacks provided were pre-packaged chips and candies. Nobody seemed concerned about encouraging the residents drink a healthy amount of fresh, filtered water (half a person’s body weight in ounces, daily).
Now while I have no problem with a business turning a profit, these places are notoriously understaffed. That’s been the case in my experience. This means that there is only one working staff member for 8-12 residents for 16 of every 24 hours. That leaves no time for promoting/assisting in exercise or stimulating cognitive/social activities.
There is one Registered Nurse that oversees the rest of the staff and one Licensed Vocational Nurse. One of them is always on call. They have little or no interaction with the residents. The Activities Director works part-time and provides “safe” sedentary past-times like Bingo, Baking, Crafts, Movie Nights, Card Games, Bible Readings and the occasional passive listening to live Musical Entertainment.
The majority of the residents spend most of their waking hours watching television alone in their rooms or watching it in the main lounge. Studies have shown that watching television for multiple hours a day puts the viewer in an Alpha Brain Wave pattern. Prolonged time in the alpha state is cognitively damaging to children and promotes the slowing of the ability to process information in adults.
So yes, the Assisted Living Facilities do provide a safer environment for elders in decline than if they were left to live alone but the sad fact is ALFs do little more than warehouse them. The residents absolutely do Not get the physical exercise they need to improve, let alone maintain their fragile health. Nutritional needs are not taken seriously and their cognitive decline will only worsen sitting in front of a TV all day.
This part of the healthcare system is in dire need of a fresh new perspective. The fact is, many, if not most, of the AL residents haven’t taken proper care of themselves for decades. How do we turn this around? I’ll share my thoughts on how we might improve in part two.