A column for seniors

and those who love them

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One of the great things about growing older is that you don't need to know the words to the number-one song. - Anonymous

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Guest columnist this week is attorney Carolyn L. Rosenblatt, writing in the American Bar Association journal, Experience.

As informed consumers, what do the adult children of aging parents need to understand about assisted living facilities? Very simply, what the facility can't do. Invariably, the sales pitch tells adult children what the facility can do, which is fine and to be expected.

However, as a consumer, it's very wise to be sure to understand the difference between an ALF, assisted living facility, and a skilled nursing home facility. Understanding that difference will help adult children clarify what type of care is appropriate in each case.

First, an ALF is not a nursing home with fancy furniture. AFLs are not licensed to give nursing care. Typically, ALFs are places where elders live in a supervised community with some personal care services available. Meals, social activity and help with the activities of daily living, such as bathing and dressing, are usually all offered at such facilities. The focus is on providing a healthy social environment and preventing social isolation. It is a worthy focus, as isolation is dangerous and widespread among elders whose independence is declining. Elderly suicide is a continuing risk for despondent and isolated elders who may live alone or without social enrichment.

If your parent or someone you care about is in fragile health and seems to be steadily declining physically or mentally, be cautious about recommending or choosing an ALF over a nursing home (also known as a skilled nursing facility, or SNF). No one chooses a nursing home first. Nursing homes are more like hospitals, which they must be to deliver skilled care to frail seniors. The atmosphere can never be like home. Some try their best to create a comfortable living environment for those who do not have a choice. However, they must accept the sickest "custodial care" elders and those who need attending around the clock. If your aging parents or loved one needs nursing care and must be watched day and night or you believe that he/she is likely to need such supervision in the near future, an SNF is the only reasonable choice in types of facilities.

ALFs are not licensed by Medicare or Medicaid to give skilled care. Some have a separate skilled nursing facility on-site or nearby, but it will have its own license to deliver skilled nursing care. That license does not apply to the ALF component, even if the two facilities are located on the same campus or are operated by the same parent company.

The decision to move an elderly resident from the assisted living portion of a larger facility to its skilled nursing unit is usually made by the facility administration, leaving the elder who does not want to go there with no choice in the matter. Typically, liability concerns and the need for 24-hour care are the considerations driving the choice. The point is to consider that an ALF alone is not a wise choice for an elder whose physical health is clearly declining rapidly. For those elders, the move out of assisted living is inevitable and may come sooner than anyone wants to face.

Many ALFs do not have licensed nurses on staff and may have no nurse connected to them at all. Because they are considered nonmedical facilities, having a licensed nurse on duty is not required by law. Even if a nurse is employed by the ALF, the nurse cannot give hands-on care in the form of dressing a persistent wound, administering round-the-clock insulin, oxygen or other tasks defined by federal and state government as "skilled nursing care." A nurse in an ALF can supervise and train the direct caregivers, who sometimes are certified by the state as nursing assistants. A nurse in an ALF may supervise a "wellness program," give advice or check vital signs, but cannot administer the kinds of care nurses typically administer in a licensed hospital, SNF or similar setting. If your elder has a cardiac arrest in an ALF, the nurse on staff will have to call 911, just as you would at home.

When an aging parent has to move out of the family home or any long-term residence, the move can be difficult, even traumatic. Be sure your focus is on the long run. Carefully consider what he/she will need a year down the road. Moving an elder twice within a short period of time can be extremely hard on both the elder and the family. Make your decisions based on the overall picture.

For information, see How to Understand the Pros and Cons of Assisted Living, and How to Choose a Nursing Home, available as separate volumes of The Boomer's Guide to Aging Parents, 2009 by Rosenblatt. Visit www.AgingParents.com.

Thank you for reading. Stay well. See you next week.

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The writer, a longtime resident of Bowie, is secretary of the Maryland/D.C. chapter of the National Academy of Elder Law Attorneys and a member of the Elder Law Section of the Maryland State Bar Association. You may e-mail her at seniormoments@byrdandbyrd.com.