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Assisted Living Is Failing to Meet the Needs of Seniors in the US

The senior population in the United States has quadrupled since 1900 and is expected to continue growing significantly, with 46 percent of the baby boomer generation now age 65 and up. According to the Administration for Community Living’s Profile of Older Americans, by 2040, there will be 80.8 million older adults, more than twice as many as in 2000. The 85-and-older population is also projected to more than double from 2020 to 2040, going from 6.7 million in 2020 to 14.4 million in 2040!

The data from the Profile of Older Americans and another recent study titled Recommendations for Medical and Mental Health Care in Assisted Living Based on an Expert Delphi Consensus Panel both look at the aging senior population and provide insights into senior living. A major finding is that assisted living communities are failing to meet the needs of the growing population of seniors and should focus more on residents’ medical and mental health concerns.

Older Adults Are Living with Multiple Chronic Diseases

According to the studies described, residents are older, sicker, and more compromised by impairments than in the past:

  • 55 percent of older adults are 85 and older;
  • 77 percent require help with bathing, 69 percent with walking, and 49 percent with toileting, according to data from the National Center for Health Statistics;
  • The leading chronic medical conditions among older adults are arthritis (47 percent), cancer (26 percent), diabetes (21 percent), and coronary heart disease (14 percent);
  • Of adults in assisted living (meaning adults who reside in an assisted living community, aka an assisted living facility), 18 percent of those aged 65 and older reported the inability to function or difficulty in at least one of six functional domains. Specifically, 21 percent had trouble seeing (even if wearing glasses), 29 percent had difficulty hearing (even with hearing aids), 39 percent had trouble with mobility, and 28 percent reported trouble with cognition;
  • 31 percent of those currently in assisted living have been diagnosed with depression, at least 11 percent have a serious mental illness, and 42 percent have dementia or moderate-to-severe cognitive impairment.

“The nature of the clientele in assisted living has changed dramatically,” yet there are no widely accepted standards for addressing their physical and mental health needs, said Sheryl Zimmerman, co-director of the Program on Aging, Disability and Long-Term Care at the University of North Carolina at Chapel Hill.

Staffing Issues Could Be One of the Major Reasons for Problems in Assisted Living Facilities

The assisted living report addresses the lack of widely accepted standards and residents not getting the assistance they need by making 43 recommendations from panel experts that address staffing, since there have been serious issues with staffing shortages. To better serve residents of assisted living facilities, the expert panel on assisted living proposes that:

  • ratios of health aides to residents be established;
  • either a registered nurse or a licensed practical nurse be available on-site;
  • staff members should get training on managing dementia and mental illness, on medication side effects, on end-of-life care, on tailoring care to individual residents’ needs, and on infection control;
  • because dementia is such a pervasive concern in assisted living, the panel recommended that residents get formal cognitive assessments and that policies be established to address aggression or other worrisome behaviors;
  • care plans should focus on the needs of individual residents, and residents should be included in the process whenever possible.

“The better trained staff are more likely to provide high-quality care to residents and less likely to feel frustrated and burned out,” said Helen Kales, chair of the Department of Psychiatry and Behavioral Sciences at UC Davis Health in California.

Can the Recommendations Be Accomplished to Improve Assisted Living?

One thing the report stressed is that the panelists don’t want assisted living to become a “medical” model, like nursing homes. LaShuan Bethea, Executive Director of the National Center for Assisted Living, agrees with this and with some of the other recommendations but is concerned about feasibility, practicality, and cost.

Because the nearly 29,000 assisted living communities in the US are regulated by states and there are no federal standards, practices vary widely. Generally, in assisted living, there are fewer protections for residents than are found in nursing homes. So it remains to be seen if the recommendations in the report will be implemented.

Make Sure You Have a Long-term Care Plan in Place

The holiday season is the perfect time to think about a long-term care plan to make sure you and your loved ones have the level of care and support needed when it is needed.

“No matter what stage of life your parents are in, talking about long-term care and creating a plan now for the future can help them live their life on their own terms,” Senior Care Advisor Tracey Chudacoff said.

When deciding on care, it’s important to consider a loved one’s needs, living conditions, and personal preferences in order to build a care plan. It’s wise to discuss this topic in advance while your loved one can still make decisions for him or herself, or when it’s time to find a new environment and appropriate senior housing for an aging parent. For instance, don’t keep your loved one in assisted living if the facility is not providing the level of care that they need. Be sure your loved one’s needs and desires are documented and the cost of care is planned for in advance for when the time comes.

Chudacoff advises adult children to set these long-term planning goals in 2023:

  • Prepare and gather essential medical and financial documents for their aging loved one;
  • Make a plan for paying for long-term care;
  • Connect with the right kind of support and resources.

Besides these things, it’s also imperative to get your legal documents in order! From relocation to respite care to alternative solutions for paying for long-term care, it’s important to plan in advance to prepare for the future!

Not Sure if Assisted Living or a Nursing Home Is a Better Option?

Many residents in assisted living can and should be in a nursing home, but many people resist putting a loved one into a nursing home because of the perceived stigma of nursing homes, and because most people think that nursing homes are more expensive than assisted living facilities. But the ironic surprise to most people is that nursing home care is often much more affordable because it can be paid for in large part by Medicaid, where Medicaid as a general rule does not pay for assisted living.

Start Planning for Long-term Care as Soon as Possible

When it comes to planning for long-term care, Medicaid Asset Protection Planning can be started while your loved one is still able to make legal and financial decisions, or can be initiated by an adult child acting as agent under a properly-drafted Power of Attorney, even if your loved one is already in a nursing home or receiving other long-term care. In fact, the majority of our Lifecare Planning and Medicaid Asset Protection Planning clients come to us when nursing home care is already in place or is imminent. Generally, the earlier someone plans for long-term care needs, the better. But, fortunately, it is never too late to begin your planning.

To afford the extremely high costs of long-term care without depleting all of your loved one’s hard-earned assets, you should begin Long-term Care Planning as soon as possible. You should also do Incapacity Planning and Estate Planning, if you haven’t done so already. Contact us to set up an initial consultation:

Elder Care Fairfax: 703-691-1888
Elder Care Fredericksburg: 540-479-1435
Elder Care Rockville: 301-519-8041
Elder Care DC: 202-587-2797

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.

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