Dangers of Assisted Living, Part 2

By on August 2, 2013
Elderly walking

Are You Aware of the dangers of Assisted Living? 

When I tell my clients that Assisted Living is the most dangerous part of the medical delivery system, I think that they believe I am exaggerating. How could these beautiful buildings, with a chef and wait staff in the dining room and a Steinway in the lobby, possibly be an unsafe place? When I have toured the facilities with the beautiful spiral staircase in the entrance, I wonder, what was the builder thinking?

Assisted Living has become the alternative to placing a parent into a nursing home. I get a sense that people think that because the building is beautiful, then the care is going to be extraordinary. And believe me, in the high-end Assisted Living facilities, you pay for every little thing. Want your room cleaned? There is a charge for that. Want your blood pressure taken? There is a charge for that. Anything that is over and above your set monthly fee – there is a charge. And do not judge a book by its cover. These high-dollar facilities can be as dangerous and dysfunctional as the low-end facilities.

There are buildings that will service those on Social Security. These are the low end Assisted Living Facilities. They are as scary as the high-end facilities. The clients that are referred to these buildings do not have access to the amenities that the clients of high-end facilities enjoy. In fact, those in the low end facilities often feel as if they do not have a voice. The food is often substandard and the buildings often do not have adequate heat or air conditioning. I know for a fact that one low-end facility just changed ownership and actually took out the clause in their contract that addressed heat and air-conditioning.

The one issue I find with all Assisted Living facilities is they continually remind me that they are a “social model”, NOT a medical model. Yet, if you go into any Assisted Living Facility on any given day, you see people on oxygen, using walkers, and a list of medical diagnoses, such as diabetes, kidney disease, etc. A recent study showed that as much as two thirds of residents in Assisted Living have some form of dementia.elderly crossing sign

This social model has a system that helps people with their medications. Most ALFs use a pharmacy that puts the residents’ medications into a delivery system similar to that used in a nursing home. Of course, this is a service that is an extra cost and provided to those residents that are not capable of remembering to take medications with assistance. The person passing the medications in the high-end ALFs, “may” be a nurse. In fact, most facilities train their aides to become med techs. To become a med tech takes just one day of training.

More on the Dangers of Assisted Living…

I was recently in a building where I observed the med tech giving medications to a resident. I was having a conversation with this resident. As he gave her the medications, I noticed that she was chewing all the pills. I asked the med tech why he did not put any of her pills in applesauce or yogurt to make it easier for her to swallow. He told me that none of his 156 clients needed anything to help them swallow. Then I asked what medications she was taking and whether it was acceptable to chew them? He could not answer that, but was” sure all her medications were OK to be chewed”.

This same “social model” takes people in wheel chairs into their facilities who need incontinence care, insulin injections and, at times, wound care. Of course, being a “social model”, the way the ALFs get around that is to have a home care agency come in to provide intermittent care. Of course there are the clients that need insulin and do to poor eyesight are unable to properly give themselves injections. This causes a problem; especially in the low end ALF’s because they do not have qualified staff to provide that service. Some clients require insulin injections several times a day. Insurance will not pay for this ongoing service. Yet, low-end facilities will accept a resident and attempt to figure out how to provide the service. It is about getting the census up and making money. A social model for the aging population that has multiple medical conditions is no longer a safe or acceptable alternative living arrangement.

I recently had an incident with a client. She is in an electric wheelchair and has limited ability or opportunity to get out. We decided to go to a nearby place for dinner. As we maneuvered the narrow walkway, I opened and closed the doors to the various establishments so we could get to our destination. The walkway became very narrow and my client in her heavy electric wheelchair tipped over. We had to call an ambulance to assist us in getting her up. It warranted a trip to the ER for an assessment.

When I was waiting for the ambulance, I noticed that my client’s pants were wet on the upper leg that was facing up. We had just left the building moments before, it was the change of shifts and I discovered she had not been changed. I was embarrassed for her and livid with the staff for lack of care. When I made a comment to the ambulance crew and then the hospital staff about the client’s need to be changed, the response about the reputation of the assisted living facility was strongly negative.

When I discussed my concerns with the administrator of the building, his response sickened me. It comes down to money. She is a high-dollar client they accepted into the building, and she is now on Social Security. There must be cuts in her care and his staff “is doing a great job.”

A few weeks later, I was watching the staff transfer this same client from her wheel chair to the bed. They were doing it all wrong. They put her wheelchair across the room from her bed. Then the two aides put their arms underneath her arms to drag her across the room to her bed.

The first issue is that this client’s arms have limited range of motion and grabbing her the way they did caused her pain.

The second issue is that this client does not have the use of her legs.  In addition, her feet are being treated for wounds and are heavily bandaged in gauze. When I took time to show the aides how easy it is to transfer a person by putting the chair next to the bed and making a half turn, I met with resistance. The aides told my client that they did not have to take orders from me. After all, one aide “had 14 years as an aide and knew her job.”

I made the aides well aware that not only was I an advocate for this client, I am an RN with almost 40 years’ experience, have worked in physical rehabilitation, and was trained by physical and occupational therapists as part of my training.

I have many more stories about how unsafe any assisted living facilities and board and cares can be. Before I get to the addressing solutions to help get the safest and best possible experience in an assisted living. I will share information on the response Emeritus and the ALFA (Assisted Living Federation of America). I think it is important to understand the perspective of the organizations that promote Assisted Living.

First, let me share Emeritus response to the Frontline story here