Running head: ASSISTED LIVING OR NURSING HOME page # 1

Which is Best, Assisted Living Facility OR Nursing Home for Your Loved Ones?

FreidaWeatherspoon Moody
November 27, 2012
Columbia Southern University
Professor Monica Saniz
MBA 5652 Research Methods
Introduction
The improved life expectancy has given rise to a sizeable elderly population in all the developed societies of the world (Joseph, 2001).Today’s fast moving technological age has made time a scarce commodity, resulting in less care and time being devoted to the elderly members of the family. This has in turn created a host of problems for these senior members who includes but are not limited to loneliness, anxiety, depression and the resultant loss of self-confidence. Many families with aged parents or other relatives may at some point of time find themselves considering long term care solutions for their aging relatives such as nursing homes and assisted living facilities.
The Assisted Living Federation of America defines Assisted Living as “ a combination of housing, personalized supportive services, and healthcare designed to meet the individual needs of persons who require help with the activities of daily living but who do not require the skilled medical care provided by a nursing home” (James, 2004). The daily activities for which people need help include eating, bathing, dressing, getting to and using bathroom, getting out of bed or chair and the activities which require general mobility.
US Department of Health and Human Services defines Assisted living as “a residential setting that provides either routine general protective oversight or assistance with activities necessary for independent living for mentally or physically limited persons” (James, 2004).
A Nursing home on the other hand provides more personalized and extensive range of services and care to elderly and those who cannot independently take care of themselves and continuously need the assistance of a caregiver (Peter, 2009).Registered Nursing Home Association defines Nursing Home as a “facility distinct from a residential care home that provides a kind of care which requires the specific skills of a qualified nurse or the supervision of a qualified nurse”. This may be due to a variety of reasons. For example if the general health of a person deteriorates to such an extent that he or she is unable to take care of him/herself at his/her own and needs the constant help of a qualified nurse. Nursing home differs from an Assisted Living Facility in that it also provides a high level of medical care. Physicians and Therapist are available to look after the needs of the residents. Nursing homes are generally setup in a medically- oriented design.
Problem Statement
Based upon current research it is not known how or to what extent decisions for long term care based solely upon affordability and quality of care impact the lives of aging individuals. Families seeking long term care solutions for aging parents may not be left with many choices based upon their financial status. At the same time determination of what kind of assistance the senior needs to live a quality life disturbs their near ones.
Rationale for Research
The purpose of the research is to find out how best a family having seniors at home which need custodial and medical care should decide which place they should move them so that they are looked after well. The families need to consider number of issues before they make a decision. These factors that includes but are not limited to the general physical and mental state of the senior, daily medication requirements, personal hygiene, doctor’s appointment, whether the need is temporary or permanent, distance between home and the place, and the costs involved. All these and other factors will affect the family decision on how and where the aging parents are to be re-located and how well the decision will improve their quality of living. They have to weigh all such options and then make their decisions.
Statement of the Research Objective
What factors affect the decision and choices to be made to select an Assisted Living Facility or a Nursing Home for the seniors of the family who are no more able to look after their physical and medical needs independently and need continuous assistance for all or most activities of their day-to-day routine.
Hypothesis
It is generally believed that a Nursing Home is a better choice as compared to an Assisted Living Facility due to the range of custodial and medical care services it offers. However, cost and the general condition of the seniors are the factors which compel a final decision on the subject. An assisted living facility could instead be a better choice if the senior does not have any health complications.
Definition of Terms
EHR- Electronic Health Record
Nursing Home- A private establishment providing care for persons (as the aged or chronically ill) who are unable to care for themselves.
Assisted Living Facility- Assisted living communities are designed to provide residents with assistance with basic ADLs (activities of daily living) such as bathing, grooming, dressing, and more. Some states also allow assisted living to offer medication assistance and/or reminders. Assisted living communities differ from nursing homes in that they don’t offer complex medical services.
Dementia- Deterioration of cognitive functioning (as in Alzheimer’s disease).
Alzheimer’s disease-a degenerative brain disease characterized esp. by progressive mental deterioration and memory loss.
Summary
The improved life expectancy has increased population of elderly people and given rise to a host of new issues. The main point being the attention and care elderly people require in their daily routine. This care cannot be provided at home due to various reasons. Moreover, people suffering from chronic aging problems like Dementia, Alzheimer disease and certain other physical and mental problems require close attention and care on 24 hours basis by qualified health workers. Nursing homes and Assisted Living Facilities have made the task of caring about the elderly people easy. However, it is a difficult decision to select one of the two facilities as the selection has to be based on a number of factors and a customer has to decide which facility satisfies his needs with minimum cost. Nursing homes are costly as compared to the assisted living facility but have qualified nursing staff, required medical equipment and doctors on call to look after seriously ill and impaired people. Whereas, an assisted living facility suits people with sound mental health who want to live an independent life but need assistance in carrying out their daily routine with comfort and ease. With these factors in mind one can make a judgment which facility to choose.
Literature Review
Assisted living facilities have become one of the vastly expanding industries in the United States. An estimated one million elderly people are availing the services of this vastly growing industry. Assisted living is a long term care alternative that involves the services of professionally managed personal and healthcare services in a communal and group setting that is residential in character and meets the scheduled and unscheduled needs of its residents while ensuring physical and mental independence to these people. The primary aim of assisted living facility is to provide services tailored to the individual’s needs in a residential setting (Binyamin, 2001).
The philosophy of assisted living emphasizes provisioning of personal and healthcare services to physically and cognitively impaired people with dignity, independence, privacy and autonomy (Wilson, 1996).
Nursing homes are residential care facilities that care for the medical needs of their residents. They mostly act as midway point for those who have such physical and mental conditions that need nursing expertise extensively in their day-to-day routine but their condition is such that they do not need hospitalization. These nursing homes are staffed by medical teams that include nurses, nurse's aides, housekeepers, physical and occupational therapists, and social workers. These teams work to provide medical care and supervision, hygienic assistance, rehabilitation of physical and occupational tasks and assistance with personal issues. These homes are almost equipped with the same kind of equipment that is found in the hospitals. Nursing homes can look after and treat patients of heart disease, dialysis, respiratory infections and cancer. An ideal nursing home provides house like environments and are comfortable, pleasant and informal for their occupants (Wise Geek, 2012). These homes provide both indoor and outdoor treatment. However, they are costly to be utilized. At an average a resident needs to pay 70,000 dollars annually to utilize the services of these homes (Medline Plus, 2012).Some nursing homes have “Special Care Units” for people with serious memory problems like ‘Dementia’. These units closely look after residents with such diseases (US Department of Health and Human Services).
Assisted living facility on the other hand provide a residence facility to senior members of the families who are seeking a place to reside that offers them medical monitoring and minor medical care while still ensuring personal freedom and privacy to their residents. It falls between an independent living and the nursing home. An assisted living facility provides 24 hours monitoring of its residents while ensuring provisioning of support services such as medication, bathing, while providing more freedom and privacy generally available in a nursing home. An Assisted living facility is therefore, more useful to those senior members of the families who because of the aging feel a decline in their health and are unable to look after themselves and need the services of a care taker(Assisted Living Facilities.org).
The difference between the two facilities is the level of care and freedom given to the senior residents. While a nursing home provides a more comprehensive care that includes the medical care to its residents, an assisted living facility provides more freedom and access to its residents while still providing care and that includes the medical care to a lesser extent. Nursing home residents are unable to leave the facility at their own because of the their physical or mental disability, whereas, assisted living residents can at their own move in and out of the facility because of their comparatively better mental and physical health (Assisted Living Facility.Org). More than 50% of the nursing home residents are the hospital discharge cases who are in need of post discharge nursing care because of the aging and care issues at home (Richard, 2007).
Before making a choice whether to select a nursing home or an assisted living facility, following factors need to be considered: 1. Cost 2. Personal and Medical needs of the senior 3. What services are you looking to be provided to the senior? A Nursing home is much more expensive than the assisted living facility. A nursing home may cost a senior around 70-80,000/- dollars annually, whereas, an assisted living facility may cost around 24- 74,000 dollars annually. Therefore, a decision is to be made whether the cost is affordable or not.
Personal and Medical care needs are the other important aspects which need consideration before a decision is made. A nursing home provides more comprehensive medical and health care services as compared to an assisted living facility. Therefore, seniors with more serious disabilities may need to be kept in a nursing home whereas; seniors with minor aging issues may opt for assisted living facilities.
Services generally required by the seniors determine the selection of a facility. After the budget and medical needs and services required by the seniors have been decided, the next step is to decide the services that the seniors need in their day-to-day routine and how can they be provided by the two facilities and at what cost. Distance involved from family home to the facility is another important factor to be given due consideration.
Lawrence (2004) says that Assisted Living Facility is meant for people who cannot live independently and who require some kind of help and assistance in their daily life. In addition they may need reminders to take their prescribed medicines. These seniors may not yet have reached to a stage whereby, the need the services of a nursing home. As regards to the nursing home, he contends that when an individual is unable to carry out his daily activities at his/her own without the help of a care taker, a nursing home then becomes a necessity. According to a study carried out by Brown University in 1999, one in two women and one in three men who reach advanced age would require the services of a nursing home at some point of time. Nursing homes are not meant for elderly people only; they can be utilized by people of any age group having severe disabilities. Some of these patients may recover quickly while others may take a longer time. An assisted living facility almost costs half of what a nursing home costs. However, medicines and doctors fee are not included in this. This would wary from case to case.
According to Lee Simon (2011) there are four rules of thumb on the basis of which one can decide where to go, whether to a nursing home or an assisted living facility. These four rules are:- * Can one select his/her clothes and dress up without any help from others? * Can one prepare his/her food and eat it without anybody’s help? * Can one go to the bathroom at his/her own? * Can one keep his/her self-clean, bathed or showered without any body’s help?
Simon says that one has to make a decision when he or she needs to move to a nursing home or an assisted living facility based upon a combination of above stated rules.
Recent researches indicate that elderly people suffering with Dementia have been found to be equally comfortable in nursing homes and assisted living facility. Dementia did not made any difference with the in the kind of services provided by the two facilities (Stephen and Joan Hyde, 2008).
Nursing homes are a facility where your loved ones can be happy and in turn you could also feel happy and satisfied. The time to move your seniors to a nursing home is when they cannot get up from the bed without help or go to the toilet without some body’s assistance or have a heart problem or respiratory problems. It is time to make a decision and move them to a nursing home where 24 hours nursing staff can effectively look after all these problems and you can also enjoy a quality life (Lynn Dickenson et al, 2006).
Alan M. (1997) says it is important that after a stroke or an open heart surgery, the patient is kept at a place where maximum attention is available to him on 24 hours basis till he completely recovers from his illness. It could be his home provided a qualified attendant is available to him. However, it would be better if he is admitted in a nursing home where qualified nursing staff can monitor his progress and attend to any emergency in which the patient may get into any time.

Methodology

This study aims to find out which facility is more appropriate for long term care solution of elderly people who are unable to look after themselves independently. The cost factor, mental and physical health of the senior, availability of required facilities and the distance from the family home are few of the important considerations which have to be weighed before a final decision is made where the senior is to be moved for his/her better care.
To find solution to the problem, post- positivist approach along with qualitative research instrument would be employed to study and answer the research questions. Primary research through surveys and interviews would be costly and time consuming and to some extent would be un-reliable and insufficient also, as it would be carried out on a limited scale involving a hand full of respondents. Moreover, there is already lot of research carried out on the subject previously by different researchers, research groups and organizations. Plenty of information is therefore, already available on the subject and needs to be analyzed for this specific topic.
Therefore, previous researches carried out on the subject would be studied along with various theories on the subject and the assumptions drawn by different scholars. Various books, magazines and journals contain information on the subject with authoritative and authentic contents and would thus greatly help in understanding the issue and the accompanying complications if any with the subject. The contents of these researches and their reference would add authenticity to the current research and make it acceptable to the readers and those who would be wishing to use its findings for practical applications.
Post positivist approach would also help in studying various health care and medical issues and other related factors for getting a better understanding of the problem. Both these facilities are expensive to utilize, therefore, cost factor has a heavy weight and comes into consideration too often and off course the physical and the mental health and soundness are the other factors which have to be kept under consideration before a final decision is made.
Apart from print material, internet sources would also be used extensively to consult various online magazines, periodicals and scholarly journals on the subject which contain numerous articles on the subject. The views and contents of various writers presented in these magazines are a good source of authentic and practical knowledge and as such useful and reliable. In addition, various databases of the government and voluntary agencies involved in the task would also be consulted to know about latest updates on efforts being taken in this direction. These data bases also contain authentic and latest statistical data and information which make the task of a researcher easy, interesting and authentic besides saving lot of precious time that can be used into other useful activities.
Implications / Limitations

Aging is a phenomenon which is present in all societies and countries. However, it has assumed a serious dimension in the developed countries where due to the overall improved health, the life expectancy has increased considerably. However, the better life expectancy comes with its own problems. With aging, numerous physical and mental problems come in and the seniors therefore, need to be given close care in their daily routine. The busy routine of this age has however, made it difficult for the families to take time out and give it to their seniors and take proper care of them. Resultantly these seniors get into depressive cycle and lose their self-esteem and desire to live.
The concept of nursing homes and the assisted living facility has solved the problem to quite some extent. However, both these facilities are expensive to utilize and one needs to have a continuous flow of funds to maintain his/her senior in these facilities for any length of time. Nursing homes are more expensive than the assisted living facility but are better equipped to handle complicated cases professionally. Whereas, assisted living facilities lack close care and advanced medical equipment to handle emergencies. Therefore, various factors have to be correctly analyzed before a final decision where to move the senior is taken.
This research therefore, attempts to highlight various factors that need to be considered before a final selection where to keep the elderly people is taken. Although insurance and the government helps to reduce the burden, but this help is of limited period of time and is not unlimited therefore, a rational decision is to be made at the beginning so that a senior does not have to pass through a process where he or she has to adopt to frequent changes in the atmosphere and surroundings around him.
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