By Hyde, Joan; Perez, Rosa; Reed, Peter S.
Aging Today , Vol. 30, No. 2
Mr. B, an 85-year-old assisted living resident, has Alzheimer's dementia. Often, his 60-year-old son takes him out golfing and to lunch. He also enjoys visits from his great-grandchildren, but he can 't always remember them. Though popular with the staff, Mr. B can be a bit cranky; some days he resists showering and putting on clean clothes. But he still has a pretty clear sense of how he wants to live. Mr. B's son, daughtemn-law and daughter support his wishes, even his desire to take neighborhood walks, though the staff fears he might fall or become lost. So his family has made sure he is listed with the Alzheimer's Association "Safe Return" program. They've also gotten him a GPS pager that alerts the staff if he stops walking for more than /5 minutes, or if he goes too far from facility grounds. He takes cognitive-enhancing medications and participates in cognitive-stimulation activities in small groups and on the computer.
Mr. B struggles to keep up with the world; besides his cognitive problems, he has arthritis, which is managed through a combination of exercise and medications. His 85th birthday party included a fundraiser for the Alzheimer 's Association, an organization whose work Mr. B is proud to promote, though he no longer gives speeches on living with Alzheimer's.
One of the key elements enabling more cognitively or physically impaired residents to remain in assisted living is the availability of appropriate personal care and health-related services, along with social and recreational activities. Depending on state regulations, care-related services may be offered directly by the assisted living provider or they may be available by contract with outside agencies, such as visiting nurses or home health agencies. Whether assisted living is able to meet the needs of those residents with the greatest levels of physical and cognitive impairment will depend on how these services are organized and delivered.
APPROACHES TO CARE
Much is known about the needs of people with cognitive or physical disabilities. In my analysis of best practices to reinforce psychosocial care in assisted living, I outlined the commonalities between dementia care approaches of the 1993 Alzheimer's Association's Guidelines for Dignity, the American Association of Homes and Services for the Aging's Best Practices for Special Care Programs for Persons With Alzheimer's Disease or a Related Disorder, and Hearthstone Alzheimer's Care's Life Quality Model for Dementia Care in Res- idential Settings..Several key themes emerge across these models, including the articulation of a philosophy or mis- sion, the need for assessment and care planning, strategies for behavior and communication, relevance of the envi- ronment and the need for measuring indi- cators of success. These principles of in- dividualized, resident-focused care likely benefit residents regardless of type of im- pairment or setting. The contention is that no matter where people fall along the continuum of physical and cognitive im- pairment, their remaining abilities may be maximized through resident-focused approaches and environmental changes implemented in a manner commensurate with an individual's level of need.
PROCESSES ARE KEY
In this context, it is again implied that, although there has been increased emphasis on the use of outcomes to define quality in nursing homes, it may be that processes are more relevant indicators in assisted living settings. As articulated above, this is because many disabled seniors are keenly interested in the manner by which they control their Uves and get the services they need and want Recently, the Alzheimer's Association has identified a number of processes reviewed by the 2003 Assisted Living Workgroup that appear to be relevant to the most impaired assisted living residents. Some of these, such as secure exits and overnight awake staff, have not been studied but appear to be commonsense safety measures. …