Drop the Cynicism, Deal with Data!


I know that sometimes my writing can come across as just a bit opinionated and blunt. 🙂 Guilty as charged. However, I try to make sure my writing is based on data, knowledge and research – doing my homework.

I have read a number of articles at myseniorportal.com that I fully support, but I just read one that has me shaking my head and feeling a bit frustrated. The article, “A Move to Assisted Living May Be Much More Than Just Deciding” has some definite truths in it, but what surprises me is that these truths turned out to be such a surprise to the author!

At Support For Home In-Home Care, we have worked closely with many assisted living facilities and even provide staffing support for some. Many of the facilities are managed by great people, and they meet the needs of an important niche group of aging adults. However, it is very important to understand just what assisted living can – and cannot – do to meet the needs of elders.

My co-owner at Support For Home actually summed it up very well, a number of years ago. What she said was, “If I want a place where housekeeping, cooking and social activity are provided, I will choose assisted living as a place to live. However, if I need assistance with transfers, personal care (e.g., incontinence), dementia, and so forth, I need to be at home, because assisted living cannot handle the 1:1 care I will need.”

She does not take this position because she is managing a home care company. She is managing a home care company because she knows the differences and understands the alternatives.

So, what has me so concerned about this “My Senior Portal” article?

The starting premise of the author seems to be that there is a one-size solution for elders, and it is assisted living. She scoffs (in another article I read by her) at the notion of “aging in place,” as if it means simply trying to be younger than we are. In fact, aging in place has a whole industry at work to adjust living spaces for safety, mobility and so forth, but that does not seem to register with the author. In a different article, she says, “Denial over  growing old  is as unrealistic as the fairy tale notion of ‘aging in place’… It all seems crazy when you know that  90% of elders interviewed in various studies insist that they want to stay in their own homes as they grow old, frail and often unable to care for themselves?”

At any rate, the author talks about a elderly couple that she had been trying to get to move into assisted living for some time. Once she finally convinced them to move,

Now we learned [emphasis hers] that making the decision is only the beginning of the process.

There is endless application paperwork to be completed, doctor forms to be submitted. One doctor refused to fill it out until he saw the husband. Maybe in a few days, he would feel better he said refusing to go. Meanwhile the doctor refused to speak to my husband about the urgency of the situation. HIPAA laws, you know.

The process of getting into a chosen community is long and frustrating, we discovered.

The one we were dealing with insisted on having the paper work completed before it would schedule interviews with a staff nurse, social worker and admitting director. We waited nervously until the interview day only to now discover there was a physical problem with one of them that prevented them from being accepted unless a doctor put in writing that the problem was under proper care. Now there was more waiting, more doctor visits and then more waiting to get the report to the facility.

In the end, the assisted living community offered a 30 day trial period. This would have required a full-time aide being present, moving furniture in, and possibly out. The prospect of physically moving in, with the prospect of moving out in 30 days, was impossible to consider. Now their only real option is to continue living on their own with full-time care.

The sad thing, in my view, is that the author, the Executive Editor of “My Senior Portal,” only learned of these issues at this date.

Below is a chart of the nature of the problem, showing how “medically complex” many seniors are –

Chronic Conditions of Elders

Chronic Conditions of Elders

We – and most of the good assisted living facilities with which we work – understand that, as the number of chronic conditions increase, the medical complexity does as well. That means the ability of an assisted living facility to provide adequate care, with a caregiver to resident ratio of 1:12 or 1:15, decreases as the number of chronic conditions rises. That is why, in many cases, assisted living is not the solution – or why, even in the facilities, Support For Home provides a good deal of 1:1 care.

To people in the elder care industry, this should not be news, nor should it be a reason to blast assisted living facilities. Most of them are doing the right things right, and that includes performing due diligence for potential and actual residents.

What are your thoughts or experiences?

Best wishes. Bert

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