This is the second in a series of articles aimed at providing what I hope to be very useful information when it comes to caring for seniors.

In the first article, which appeared in the paper last month, I introduced the most popular senior care services today, which are Senior Independent Living, Assisted Living, Memory Care, Home Care and Skilled Nursing.  I then focused on the pro and cons of Independent Living.

Today we will focus more on Assisted Living, also known as Residential Care Facility for the Elderly (RCFE).

By definition, Assisted Living is a non-medical facility designed to help seniors to continue living semi-independently in a non-institutional setting. A wide range of options are available for housing, help with daily and personal activities and some health-related care. The quality and range of services, as well as rates, can vary greatly between different Assisted Living facilities. Assisted Living is a residential setting with ability to provide a great deal of care and ideal for residents needing assistance with ADL, medication, nutrition etc. Undoubtedly, it improves the quality of life of seniors, no matter what they think...

It is an excellent choice for long-term care; in our building, we have residents who have been there for more than six years and, because of our focus and ability to provide a high level of care, the ultimate goal is for the resident to spend the rest of their life in our community. To help with this goal, most AL offer hospice in place and can provide assistance until end of life.

Like for any product, the quality of facility, service, care, socialization, food, nursing and cost vary greatly; you need to research and set priorities. It must be said that Assisted Living provides a safe and secure setting but does not guarantee that accidents will not occur. It is a residential facility that focus on managing the resident care so that they can maintain as much independence as possible, thus in such a setting accidents occur.

In Assisted Living, there is a nursing presence. How strong of a presence vary also, but a chart for each resident is kept in the nurse's office ,and their condition is monitored on an ongoing basis. While a great deal of care can be provided, Assisted living is not a good idea for seniors with unstable serious medical conditions needing 24-hour nursing care. In these cases, Skilled Nursing would be a more appropriate placement.

Contrary to many beliefs, Memory Care (for residents with Alzheimner's or other type of dementia) is also offered in many Assisted Living communities. It must be said, however, that these Assisted Living Communities must adhere to specific standards to offer memory care. This includes an additional plan of operation, training of staff, personal and structural safety measures, compatibility assessment, specific activities and more.

RCFE provides delay egress and secure settings, but they are not lockdown facilities. It means that additional safety precautions and features are in place to limit the possibility of a resident wandering outside of the building, at the same time allowing the resident to live in a residential environment. It is also important to distinguish that residents with memory impairment in an RCFE do not forfeit their rights, including their right to refuse medication.

Clearly the Assisted Living environment is a wonderful option for resident with memory impairment to maintain a high level of independence and dignity while cared for by specialized staff and being immersed in a social settings where specially designed activities regularly take place. Residents that unfortunately have a violent disposition or could pose a danger to their selves or others are not suitable or permitted to live in an Assisted Living community.

Should a resident experience a violent episode, he/she would be removed from the building and placed in a Psyche Unit which is a lockdown unit with 24 hours medical supervision. This could be a temporary placement to find a medication regiment that would eliminate violent behavior, or a permanent placement if the behavior cannot be modified.

One of the questions I am frequently asked is which referral source should be trusted when making a decision. This is a difficult question because there is a tremendous amount of misinformation about Assisted living, including amongst medical professionals. Referral agencies advertise a free service, however you should know that their service are not free, as they get paid a hefty commission by the facility that eventually gets the placement, thus their judgment is impaired by a conflict of interest.

You should also know that, if a community does not have a contract with a referral agency, it will never be referred to you. If you have the chance, always do your own research. The Internet is a great place to start.

Select a few places and then you must absolutely visit in person. No referral source can ever be more accurate than your gut instinct. You will know right away if the place you are visiting is a good match for you and your loved ones.

For any questions or comments, please feel free to e-mail me at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or call 760-542-6071.