When Considering Assisted Living Facilities: Two Essential Items

Posted on May 10, 2015

At the point when family’s worries grow about the home safety of an elderly loved one, the search often starts for suitable assisted living facilities. There are many useful guides with  criteria and checklists available to assist with this search. Most often the search criteria focus on location, cost and reputation of the assisted living facilities. However, before deciding on an assisted living facility, consider two often overlooked elements that may directly impact the quality of elder care: advance directives and licensed nursing coverage.

First, advance directives are important since medical decisions will most likely need to be made about the treatment of acute and chronic conditions while at the assisted living facility. It’s important to thoughtfully prepare to make these medical care decisions. Understanding that there are treatment choices, which ought to be consistent with the elder’s values and preferences. For example, should dad with a diagnosis of advanced dementia have a feeding tube inserted for swallowing problems? Information to guide the aggressiveness of the medical care is necessary. The benefits and burdens of various procedures/treatments should be carefully weighed in order to honor the elder’s preferences for care as much as possible. Then the elder, family, and physician can directly address the question; when do the medical tests and interventions prolong suffering and do little to improve quality of life, and when are these interventions necessary to enhance quality of life and relieve symptoms?

Thus, the first priority for elders should be the careful completion of advance directives, POLST, and health care power of attorney documents. Next, the documents need to be shared widely with all family members, doctors, health care providers, and anyone else involved in making health care decisions. While these documents have their limitations, what is most helpful is the process of thoughtful conversations with family and care providers about the elder’s needs and treatment preferences (see  conversation guides). As a result of these conversations, the elderly loved one’s values and preferences for type and aggressiveness of care are better understood and specified. And most importantly, a health care power of attorney can be carefully chosen who will understand and honor the elder’s wishes.

Secondly, when the time comes to look for assisted living facilities, be sure to inquire about the availability of licensed nursing coverage. According to a recent NY Times article, a major obstacle to offering more treatment procedures in nursing homes is the fact that many Medicare-certified nursing homes do not have nurses on staff 24 hours a day. Since in most states, federal regulations require nursing coverage only eight hours a day. So for example, if a licensed nurse were not on the staff of the assisted living facility, the elder would require hospitalization for anemia in order to be treated with blood transfusions, or hospitalization for the administration of IV fluids to treat dehydration. Since hospitalizations can expose elders to serious risks, such as falls, hospital-acquired infections, and delirium, it’s important to reduce as much as possible, unnecessary hospitalizations for treatments that can be properly handled in the assisted nursing facilities.

When the time comes to explore assisted living facility options, carefully examine all the quality care criteria available, and be sure to prepare to make some difficult medical treatment decisions.