The best way to understand Residential Assisted Living is to first understand what it’s not.
When thinking of “senior care” most people think of a traditional Nursing Home. Not so long ago, this would have been the only option for a frail parent needing personal care.
Sadly not much has changed over the last two decades. You see long hallways, call bells ringing 24/7, and residents lined up in the hallways sleeping in their wheelchair. The staff are overworked from servicing too many residents. Morale is depressing.
Nursing Homes do play a critical role in our communities. They are still the place to go when a senior needs "skilled" medical assistance. This includes registered nurses, doctors, social workers, dietitians, occupational and physical therapy. The need is typically precipitated after a major surgery or a serious health event.
Nursing Homes also provide care to low-income Medicaid recipients who are financially unable to pay for long-term care.
Assisted Living Facility
Assisted Living Facilities are large hotel-like buildings in commercially zoned areas.
Typically, they house between 20 to 100+ residents. They focus on activities designed toward more active seniors who desire a social life. Caregiver-to-resident ratios range from 1 staff to 8, 10, 15 and even 25 or more Residents during night time hours.
Many of these facilities are designed for large group activities. You will find many special events from cooking classes to dancing sessions to bowling outings. This may be fine for independent seniors who need modest levels of support such as cooking and cleaning. But it becomes inadequate for seniors who are frail, disabled, or cognitively impaired.
Herein lies the limitation of an Assisted Living Facility. As a senior gets older and frail, greater individualized care is needed to thrive and function at the highest level. Residents with Dementia need a calm, predictable and low stimulation environment. They also need frequent and specialized behavioral interventions. Only an environment with low staff-to-resident ratio i.e. 1 caregiver to 3 residents can offer this.
Assisted Living Facilities can sometimes accomodate higher care needs by increasing caregiver services. But this “a-la-carte” model rapidly increases cost to exorbitant levels. If a resident wishes to remain in the facility they need to hire an agency caregiver to receive higher levels of care or monitoring. As a result, we routinely see costs skyrocket to between $11,000 and $20,000 per month.
Finally, most facilities will also discharge residents when their needs become incompatible. An Assisted Living Facility's business model is built around large resident group activities. They have very few caregivers servicing a large number of residents. Once individualized one-on-one caregiving is required, the resident is no longer compatible.
Whether a resident is given a discharge notice or is unable to pay for care, this option comes to an end. The resident and their family begin seeking other options. What they will find is that the BEST choice forward is overwhelmingly Residential Assisted Living.
What is Residential Assisted Living?
It is a residential home licensed by the state to provide long-term care to frail seniors and other disabled individuals.
The term Residential Assisted Living (RAL) represent an umbrella of names such as Residential Care Home/Facility, Adult Foster Home, Foster Care Home and so forth. They are the same and usage is governed on a state-by-state basis. The key term is “residential” or “home”.
In Washington state, we call them Adult Family Homes (AFH) and they are licensed to serve a maximum of 6 individuals per home.
Adult Family Homes
An Adult Family Home must be located in a residential neighborhood. It is usually a caregiver’s personal home. The typical caregiver-to-resident ratio is 1 staff to 3 residents. It is very high and unmatched by the other long-term care options. Adult Family Homes provide highly personalized and individualized care. It is often through the end of life, allowing seniors to truly “age-in-place.”
The Preferred Choice for Memory Care
When it comes to memory care, a smaller, calmer home atmosphere is critical. A home with reduced noise and stimuli contributes to a peaceful and predictable environment. Seeing fewer but familiar caregivers significantly improves challenging behaviors and resident's well being.
more affordable than institutions by 25% to 50%
The state-wide average cost of AFHs is about $6,500 monthly for complete, all-inclusive personal and memory care.
In an Assisted Living Facility, this cost can skyrocket to $20,000 monthly for the same level of care. However, service is inferior compared to the attentive, competent, and personalized care of an Adult Family Home.