Inside Assisted Living: The Search for Home

1 Introduction

1` ONE Introduction You know, that was my impression—that this is the last place. And I see these people lined up in wheelchairs in these homes. And I thought, well, there they sit, just waiting to die. So that was my idea of it. And then when my son thought that I had to make a change, I thought, well, I’ll try it. He brought me over here and we looked at it and I just, you know, came along with it. I wasn’t enthusiastic, but I just came along with it. And I made up my mind that I was here for a reason. So I tried to look at all the good parts. And I just settled in until it’s become my home. And I’m very, very happy here. The best thing about living here is that I don’t have to cook. I don’t miss anything. I feel like, if I was in my apartment [before moving into assisted living], I’m alone, you know, and I have to go out looking for excitement or doing things. Here I can choose. —resident of the chesapeake assisted living Some of us are familiar with long-term care and with assisted living as a long-term care option. But for a lot of people, questions and concerns are many. For instance, what choices do older people have when they require daily assistance to cook, dress, bathe, or take medications? Who monitors their chronic medical conditions and/or protects them from risks associated with cognitive impairment? How do we as a society respond to older persons who can no longer live independently in the community, but don’t need (or want) to move into a nursing facility? Increasingly, the answer to these questions is “assisted living.” The purpose of this book is to introduce readers to life in assisted living from the perspectives of individuals who reside or work in one of six actual settings in Maryland. We believe that this type of supportive housing cannot be fully understood unless we go inside different assisted 2 INSIDE ASSISTED LIVING living residences to learn about day-to-day life directly from those who live or work there. By telling their stories and relating those stories to the larger arena of long-term care, we examine some key dilemmas facing those who live in, work in, and regulate such settings. Moreover, learning more about assisted living benefits all of us as we think about the alternatives available to our families and our future selves. Over the past decade, the question of what assisted living is, should be, or should not be has consumed the time of many gerontologists and long-term care experts. These individuals have weighed in on this question as they work to develop sensible regulations and engage in influential research. Still, at both the state and the national levels, people express uncertainty and dissatisfaction, as well as varying levels of optimism, when discussing assisted living. In this book, we let the real experts— residents, their families, and employees—tell about assisted living in their own words. How these people experience life and work inside assisted living is important, because their stories educate those of us who are or will someday be considering such a move for ourselves or a family member. But beyond that, their stories serve to inform current practice and policymaking by providing a more complete understanding of what assisted living currently is and how we would like it to be. Assisted living facilities are complex places, made so by the intersection of individual lives, political and economic factors, social and cultural beliefs, and conflicting expectations. When we set out to study the nature of daily life inside six diverse settings, we did not directly ask older persons to define “assisted living.” Instead, we let them tell us their stories: how and why they came to live in an assisted living residence; what they do on a daily basis; about their neighbors, friends, and enemies, as well as the employees they preferred and the ones to avoid; and their opinions about the many spoken and unspoken rules and restrictions. They also shared their fears and disappointments as well as surprise at how nice some settings could be compared with the negative image of a nursing home so many had held in their minds. INTRODUCTION 3 Real Places, Real Lives...