Assisted Living Facilities (ALF)

 A patient might not need 24-hour nursing care, but requires assistance with his activities of daily living (ADL’s). This includes supervision and monitoring to ensure his safety, assistance with meal preparation, laundry services, medication management, and showering/personal care. It might also include attending to toileting needs. These services could be provided in an (ALF), which can be a small, family-owned group home or a large corporate-run facility. An ALF typically saves the patient thousands of dollars per year over the cost of nursing home placement.

Payment for ALF’s is generally out-of-pocket (private pay). It’s possible that a long-term care policy will help to offset the cost of an ALF, but otherwise seniors are on their own. There are agencies willing to help a senior locate an assisted living that can meet his needs – generally these agencies charge the ALF a finder’s fee for the senior. Since many ALF’s aren’t willing to pay a finder’s fee, the senior’s housing options will be limited to those that will pay. If at all possible, it’s best to find an ALF on your own by looking in the phone book or asking at your local senior center.

There are other benefits to ALF’s than just financial considerations. In most instances, patients have private rooms that they are able to decorate with their own furniture and personal items. They are allowed to come and go without restrictions (unless they are in a locked unit for dementia), and can choose to eat in the dining room or in their private room without staff interfering. Their medications can be self-administered and they are monitored by staff members who have been trained by a registered nurse. ALF’s usually provide transportation to doctor’s appointments and dialysis clinics, and also offer outings and other activities.

There are different levels of care provided in ALF’s; they all have to follow their respective state laws regarding the level of care provided. However, some provide maximum assistance including transferring patients from bed to chair, helping them toilet themselves, feeding them, providing locked units, etc. Each home will assess a patient’s needs before he’s accepted to ensure that they don’t accept a patient that they can’t care for.

Most ALF’s don’t provide nurses on-site 24 hours a day; if a patient appears to be in distress the patient is sent to the emergency room for assessment. Sometimes family members are afraid to send a senior to an ALF because the senior might fall and break a hip – but this can just as easily happen in a nursing home. In fact, since ALF’s often have carpeting, it’s more likely that a patient who falls in the hospital or nursing home will be seriously injured than if he were in an assisted living.

Seniors who are frail and require a nurse to assess them on a regular basis would probably be better served in a nursing home – but much of the time seniors can maintain more independence in an ALF and enjoy the home-like atmosphere. It is often a happy medium between remaining at home and being admitted to a nursing home, if the payment issue can be worked out.

Often a doctor will recommend that the patient receive nursing home placement, but it’s possible that an ALF might also meet the patient’s needs. The doctor might prefer the nursing home because he doesn’t understand how much assistance the ALF can provide, but the choice belongs to the patient and family – not the physician. An ALF is often a good alternative to nursing home placement when the patient’s needs are able to be met in a less restrictive, less institutional environment.

The requirements for assisted living facilities vary from state to state, and they’re monitored via annual inspections from the same agency that monitors nursing home care. Since most ALF’s don’t receive federal funding, the facility won’t lose funding if violations are found but it will lose its license to provide medical services. If that happens, it’s likely that the facility will be closed. Each state has an agency that oversees licensing of healthcare facilities; to find out which agency provides oversight in your state simply ask the manager of the assisted living facility. They’re required to provide you with the contact information – if they refuse, it’s likely that they’re not licensed to provide care.

An ALF resident can receive physical therapy or nursing services from a home health agency, and many ALF’s have contracts with physical therapy companies who provide outpatient therapy in a gym located on the premises. Patients who live in ALF’s may also receive care from hospices just as if they lived at home.

If a patient would like to go to an ALF and has the funding available, all that must be done to determine whether the ALF can meet his needs is to visit a facility and speak with the admissions clerk. The ALF will request medical information from the doctor and may schedule a nursing assessment to determine whether the facility is able to meet his needs. The ALF will ensure the patient has a smooth transition into the facility and that all medications and treatments are available to the patient from the moment they arrive. (see below)

If the ALF won’t accept the senior, it’s likely that nursing home placement is the best caregiving option available for him. They’ll usually tell you why the senior is being denied, and you always have the option of visiting another facility to see if they will accept the patient instead. Just like a nursing home, if a senior is admitted and later runs out of money, he can’t be “dumped out” into the community. The ALF is required to ensure that the patient has a safe discharge plan.