An assisted living residence or assisted living facility (ALF) is a housing facility for people with Disability or for adults who cannot or choose not to live independent living. The term is
popular in the United States but is similar to a retirement home in the sense that facilities provide a group living environment and typically cater to an older adult population. There is also Caribbean assisted living, which offers a similar service, in a resort-like environment (like assisted vacationing).
Assisted living exemplifies the shift from "care as service" to "care as business" in the broader health care arena predicted more than three decades ago.Starr, P. 1982. The Social Transformation of American Medicine. New York: Basic Books. A consumer-driven industry, assisted living offers a wide range of options, levels of care, and diversity of services (Lockhart, 2009) and is subject to state rather than federal regulatory oversight. Exactly what "assisted living" means depends on both the state and provider in question: variations in state regulatory definitions are significant and provider variables include everything from philosophy, geographic location and auspice, to organizational size and structure. Assisted living evolved from small "board and care" or "personal care" homes and offers a "social model" of care (compared to the medical model of a skilled nursing facility). The assisted living industry is a segment of the senior housing industry and assisted living services can be delivered in stand-alone facilities or as part of multi-level senior living community. The industry is fragmented and dominated by for-profit providers. In 2010, only six of the seventy largest providers were non-profit and none of the top twenty was non-profit (Martin, 2010). Information in this edit is from an article published in 2012 that reviewed the industry and reports results of a research study of assisted living facilities.Cirka, C.C., & Messikomer, C.M. 2012. Behind the facade: Aligning artifacts, values and assumptions in assisted living. Business & Professional Ethics Journal, 31 (1), 79 - 107.
In 2012 the U.S. Government estimated that there were 22,200 assisted living facilities in the U.S. (compared to 15,700 nursing homes) and that 713,300 people were residents of these facilities.CDC, Long Term Care Services, 2013, https://www.cdc.gov/nchs/data/nsltcp/long_term_care_services_2013.pdf The number of assisted living facilities in the U.S. has increased dramatically since the early 2000s.
In the U.S., ALFs can be owned by for-profit companies (publicly traded companies or limited liability companies [LLCs]), non-profit organizations, or governments. These facilities typically provide supervision or assistance with activities of daily living (ADLs); coordination of services by outside health care providers; and monitoring of resident activities to help to ensure their health, safety, and well-being. Assistance often includes the administration or supervision of medication, or personal care services.
There has been controversy generated by reports of neglect, abuse and mistreatment of residents at assisted living facilities in the U.S.
More recently built facilities are designed with an emphasis on ease of use for disabled people. Bathrooms and kitchens are designed with wheelchairs and walker (tool)s in mind. Hallways and doors are extra-wide to accommodate wheelchairs. These facilities are by necessity fully compliant with the Americans with Disabilities Act of 1990 (ADA) or similar legislation elsewhere.
The socialization aspects of ALFs are very beneficial to the occupants. Normally the facility has many activities scheduled for the occupants, keeping in mind different disabilities and needs.
The investigation found dozens of incidents of gross mismanagement and criminal behavior at assisted living facilities across Florida, a state of 20 million people which is popular with American retirees. The newspaper requested the release of state documents related to the deaths of over 300 people in assisted living facilities between 2003 and 2011 but were denied these documents. Still, the newspaper's investigation found no less than 70 people who had died due to the "actions of their caregivers."Miami Herald, April 30, 2011 5:00 AM, NEGLECTED TO DEATH | Part 2: Assisted-living facility caretakers unpunished: ‘There’s a lack of justice’, http://www.miamiherald.com/news/special-reports/neglected-to-death/article1938087.html The deaths were found to have resulted from the mismanagement of assisted living facilities and by the practices of their staff and managers who drugged residents, deprived them of basic necessities such as food and water, abused residents verbally, psychologically and physically, and neglecting their needs.
At the time the documentary was broadcast and published, ''Frontline'' stated that, "Today, nearly 750,000 people live in assisted living facilities across the country. National for-profit chains, concerned both about caring for their residents and pleasing their shareholders, have come to dominate the industry. Standards for care and training—and even definitions for the term 'assisted living'—vary from state to state. Assisted living facilities, unlike nursing homes, are not regulated by the federal government." An accompanying written brief cites deaths of residents, facilities that are understaffed, employees that are inadequately trained, and that an overall "push to fill facilities and maximize revenues has left staff overwhelmed and the care of residents endangered."
A related article by ''ProPublica'' (Thomson and Jones, July 29, 2013) states that a facility operated by Emeritus Senior Living "...had been found wanting in almost every important regard. And, in truth, those 'specially trained' staffers hadn’t actually been trained to care for people with Alzheimer’s and other forms of dementia, a violation of California law." It goes on to say, "The facility relied on a single nurse to track the health of its scores of residents, and the few licensed medical professionals who worked there tended not to last long," but also that "During some stretches, the facility went months without a full-time nurse on the payroll." ''ProPublica's'' article claimed the problem was not specific to one facility and that "State inspectors for years had cited Emeritus facilities across California." Emeritus replied to that claim, describing "any shortcomings as isolated," as well as that "any problems that arise are promptly addressed." The company cited their "growing popularity as evidence of consumer satisfaction."
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