Assisted Living Staffing and Care Expectations

Lovely ladies living in assisted living.

For many elders the option of care in an assisted living is a welcome escape from the need to move to a skilled care facility. The old phrase, “I never want to go to a nursing home” is still heard often. It’s hard to make that decision to leave your home when you can no longer get dressed without some help and you need reminders to take medications and help to go to your medical appointments.  The many assisted living facilities in Northwest Arkansas are appealing when skilled nursing care is not needed daily.

But – beware!  This is a very true account of an experience in 2013 with an assisted living facility:

Mr. Jim, a WWII veteran widowed years ago, lived in a nursing home for several months, then made a decision to move to an Assisted Living Level II facility for more privacy and independence.  Partially paralyzed from stroke and complications of diabetes, Mr. J needed help getting dressed, getting to the toilet, and getting in and out of his recliner and wheelchair.  Multiple medications required reminders throughout the day.  His trust officer called me after his client had been in the assisted living for 60 days, reporting a decline in appearance, energy and also describing signs and symptoms of depression – withdrawal, loss of appetite, lack of interest in pleasurable activity.  This was not like Mr. J. 

During the first visit with Mr. Jim, he commented that he often laid in bed through the breakfast hour without help to get up. And he reported that he had been left sitting on his toilet for over two hours even while pulling the cord for assistance.  He talked with enthusiasm describing his love of models and proudly showed off his quality classic car models.  But when asked to talk about his new apartment and living in his new setting, he became quiet and withdrawn.  A review of his chart in the office showed that foot wounds required weekly wound care, yet he had not been to see the wound care clinic in three weeks.  I was told the 8 a.m. appointments were not convenient for the driver and they had meant to call and move the time to later in the day.  This was never done.  I directed the nurse to call immediately and schedule an appointment ASAP. 

On my second visit, at 10:30 a.m., I found Mr. Jim sitting in his room in a wheelchair, partially dressed.  He said his feet hurt.  I looked down at his special diabetic shoes – the right shoe was on the LEFT foot, and the left shoe was on the RIGHT foot.  No wonder his feet hurt, forced into shoes for the wrong foot!!!  These were special shoes, designed for comfort and ease, and obvious as to which was the RIGHT and LEFT shoe.  I first took a photo of this terrible mistake, then knealed down and removed the shoes from Mr. Jim’s feet.  The wound wrap was also bunched up on his heels adding pressure to his wounds. 

I asked Mr. Jim if he was happy in his new apartment.  Ne said, “NO”.  He was always alone, no one came to get him out of bed, he rarely saw a caregiver.  I told him with his permission I would call the nursing home he had lived in before and ask if he could have his room back – he said “YES”! 


Know exactly what services are provided and by whom:

Every assisted living facility is different in environment, culture, size, staffing and management.  Be sure you know exactly what services are provided after your tour, and know what education and training the staff has received.   You are trusting the daily care and health care management to this team.  It is wise to have guidance from your physician, an occupational therapist or a geriatric medical social worker to help you understand the exact care support an elder requires.  Remember, after a move from the home, if there is any memory loss or loss of executive functioning (reasoning, planning, insight, and judgment), it is most likely that a move from the familiar, comfortable environment in your home will trigger further loss of functioning, often requiring more care after the move from the home.

Staffing is so important and often overlooked.  Who do you want to provide the daily personal care assistance to help with dressing, bathing, toileting, and medication reminders? You want reliable and experienced, caring adults to help your elder family member.  When you visit an assisted living facility, stay long enough to observe the staff’s relationships and interactions with residents.  Talk to staff, ask them how long they have worked at the facility and how long they have been a professional caregiver.  Visit the facility in the morning during the hours when residents are starting their day.  Visit the facility at lunch time, ask to have lunch in the dining room to observe the environment, staff and sample the food.  Then visit again in the afternoon and evening.

Transportation be sure to ask about the availability of transportation to medical appointments.  Most facilities have vans and cars to provide this basic need, but some don’t.  All facilities provide housekeeping, laundry, three meals a day, and all the normal care assistance of either Level I or Level II care (see article defining assisted living) .

Not every assisted living facility is alike, in fact, all are very different.  Avoid making a mistake.  Take the time to tour, to read reviews, to visit often to make sure you know the environment of care, the staff, the management, and meet some of the residents.  Do your homework.  Northwest Arkansas has some of the best assisted living facilities you will find anywhere.  But we also have some that lack the quality of care that you would want for your elder.  And remember.  Owners change.  Management changes.  A facility that seems to be perfect one year may have challenges the next year due to changes. Maintain your observations and ongoing communication with the family members of residents and management.


Submitted by Sara Cain-Bartlett, MSW, LCSW, C-ASWCM   January 26, 2017                                                                                                                                                                       The CareSupport Services, PLLC   479-466-0611



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