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Aging-in-place April, 2006 (MLC)
Aging-in-place refers to the ability of a senior to remain in the place where he or she is residing even when the health of that person declines significantly. Most recently, the term is used in connection with senior housing options when a facility can extend programs and services to residents who suffer physical or mental impairments or who may need hospice care and thereby allow them to remain living there.
The Department of Health and Human Service regulations governing residential care and assisted living facilities here in Maine have long encouraged aging-in-place programs and services that further “the independence of the resident and respect[s] the privacy and personal choices of the resident, including the choice to continue to reside at home for so long as the assisted housing program‹is able to meet the needs of the resident.” Aging-in-place services in assisted living facilities offer an alternative to nursing homes for those residents whose conditions decline or are nearing end-of-life and who do not wish to be transferred to another facility.
Aging-in-place requires the assisted living facility to manage the care of any resident for as long as he or she desires to continue to reside there despite any changes in the resident’s physical, cognitive, or emotional condition. Because many residents who do move to another facility often suffer setbacks as a result of the stress of a move and changes in environment, care, and services, aging-in-place programs can offer an important advantage to residents and families. They can afford a resident critically important continuity of care and continued support of friends and caregivers at a time when a resident’s physical or emotional condition may be quite frail. “The very act of moving an individual can be traumatic [and] a move resulting in the loss of functional independence is particularly difficult to recover from and can result in confusion and diminished self-help capacity.” The State of Maine recognized these benefits and, accordingly, the regulations governing assisted housing in Maine reflect the view that residents should have the option of remaining in their homes at the assisted living facility even when their deteriorating condition might warrant transfer to a nursing home.
Assisted living facilities in Maine are prevented by the regulations from providing skilled nursing services such as wound care, intravenous medications, or hospice care unless they also hold a license as a nursing home. This means that in an aging-in-place program if such services are required by any resident, the facility must arrange for and coordinate those services with an outside agency. Those assisted living facilities that provide aging-in-place services must develop solid relationships with these outside agencies so that when a resident’s physician orders skilled nursing services or therapies such as physical therapy, occupational therapy, speech and swallowing therapy, the facility can quickly arrange for the provision of necessary treatments for the resident at the facility itself. The nurse or therapist providing the services will come directly to the resident at his or her home in the assisted living facility. This holds true for hospice care as well. With the assistance and involvement of the nursing staff of the facility, the therapist, skilled nursing staff and hospice nurses will follow and monitor the resident’s condition for as long as necessary.
It is critical that facilities offering aging-in-place have procedures in place to allow for direct, frequent and clear communication with the outside agencies providing these additional services for the resident. Coordination of the many aspects of geriatric or end-of-life care is necessary to insure that there are no gaps in care when health conditions decline.
It is important that any facility offering aging-in-place has adequate accommodations and assistive devices for residents whose physical setbacks result in substantial impairments to mobility. When a resident’s physical condition makes him or her unable to ambulate, mechanical lifts should be readily available to allow the resident to use bathroom facilities or to be bathed adequately. This is necessary for the safety of the resident and any staff member assisting with lifting the resident for toileting or bathing. These devices are also important in preserving the dignity of a resident who can no longer perform these personal tasks by him/herself. In addition, there must be adequate protections and accommodations for those residents who have cognitive impairments. This would include protection against wandering, staffing to provide necessary reminders and cueing as well as sensory and other programs to provide the requisite physical and mental stimulation. Successful aging-in-place requires that the facility have the flexibility to provide services that are appropriate and necessary for every resident’s specific condition or desire. In even a moderately-sized facility, this spectrum of resident needs and desires may be very broad. The need for this type of flexibility in tailoring care and services will pose continuing challenges for the assisted living industry in the years to come.
Many assisted housing programs are currently limited in their ability to provide practical aging-in-place services as a result of minimal nursing services, low staff to resident ratios or limited access to the equipment and assistive devices necessary to care for residents who have become extremely frail or bedridden. However, because the consuming public is recognizing the benefits of being able to remain Áat home’ in the facility when conditions decline, many facilities are working to accommodate the current demand for such services. Consumers interested in aging-in-place services should look closely at residents when touring facilities and ask direct questions about the levels of care available in the facility. Are there varying degrees of mobility or cognition among the residents? Is there available licensed nursing staff for most of the day and night? Are there available assistive devices? Are there provisions for hospice and end-of-life care? Under what circumstances must the facility discharge a resident? What are the associated costs of additional care and services? Successful aging-in-place can provide true peace of mind for residents and families and ultimately this contributes to improved well-being, a feeling of security, and better quality of life.
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