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Assisted living residences are a special combination of housing and personalized support services designed to meet the needs—both scheduled and unscheduled—of those who require help with activities of daily living. Activities of daily living include tasks related to bathing, dressing, grooming, eating, and other similar personal care needs. Assisted living is a residential option that promotes self-direction and participation in decisions regarding care and services. As a model of supportive housing, assisted living emphasizes independence, individuality, privacy, dignity, and choice. The assisted living package of services can be tailored to meet consumer needs and preferences.
Many assisted living residences offer specialized services and/or programs specifically tailored to meet the needs of people with Alzheimer’s disease or other forms of dementia. These special care units are typically located within a residence that has traditional assisted living units, although some special care residences are freestanding and only offer special care. Special care units are usually set in a secure environment with added safety and monitoring (e.g., doors equipped with alarms, special lighting, resident whereabouts checks) and have unique physical environments to foster greater independence, such as secure outdoor areas.
Special care units typically provide more supervision, structure and cues designed to maximize the abilities of people with cognitive impairments. They offer additional staff (e.g., Program Director), specialized staff training, family education programs, and social activities geared to each resident’s abilities and interests. Many also offer activities and approaches that are designed to minimize behavior symptoms such as agitation, and maximize the achievements and well-being of residents with memory loss disorders. Special care units can differ in the level of care they provide along the continuum of the disease. For instance, some residences will provide care until the person with dementia needs skilled care (nursing home care), whereas others are only staffed and equipped to provide services to people who are in the early stages of dementia.
For more information about the growth of special care in Assisted Living, read Dedicated Memory Care Communities on the Rise in Massachusetts.
Assisted living buildings can range from a high-rise apartment complex to a converted Victorian home or a renovated school. Residences may be freestanding or on a campus with other residential options, such as independent living or nursing home care. They may be operated by non-profit organizations or for-profit companies. Most residences have between 25 and 120 apartments which may vary in size from a studio to a 2 bedroom apartment. There is no single blueprint for an assisted living residence, because consumers’ preferences and needs vary.
We encourage you to look for a general philosphy of care based on 10 principles - principles that make residents in Assisted Living the top priority. The residence should:
In 1994, Mass-ALA was instrumental in passing Chapter 19D of the Massachusetts General Laws, An Act Establishing Assisted Living Residences. The Executive Office of Elder Affairs (EOEA) regulations implementing Chapter 19D are found in 651 CMR 12.00 et seq. Together, the assisted living statute and regulations provide a process for certification, along with required minimum standards and guidelines for assisted living units and services, residency agreements and service plans. The law also specifies assisted living residents’ rights, which emphasize privacy, autonomy and individual choice, and include the right to access to an assisted living Ombudsman program.
A variety of state laws and regulations regarding service delivery, consumer protection, anti-discrimination, and landlord-tenant also pertain to the operation of assisted living residences. At the local level, assisted living sponsors must adhere to the requirements of a variety of regulatory and enforcement authorities such as planning and zoning boards, building, safety and health codes, and historic district commissions. Additionally on the federal level, both the Fair Housing Amendments Act of 1988 and Title III of the Americans with Disabilities Act apply to assisted living, and are designed to protect mentally or physically impaired individuals from discrimination.
Typically, “assistance” in these residences can be defined as help with the following:
Assisted living residences in Massachusetts offer such services in private or shared apartments in an environment with twenty-four hour per day onsite staff capability. Grounds keeping and maintenance services are also provided. Personal care services are provided by staff often known as resident care assistants. Many residences have specialized units for those with memory loss that provide special care programming as well as environmental and technological features to support resident safety and improved function.
An assisted living residence and a nursing home are different options available to elders and those with chronic health conditions who can no longer live independently in the community. While both offer personal care services, assisted living residences provide a residential setting with apartment-style living for residents. This residential model provides freedom of choice, independence and a quality of life experience often similar to previous living arrangements.
Personal care services offered in assisted living cover a broad range of activities of daily life to assist the resident in maintaining the highest level of dignity and independence possible. An individualized service plan is developed for each resident and is revised as new needs arise. The service plan assures that resident needs are identified and plans are implemented to meet those needs.
Because assisted living staff are not permitted, per state regulations, to provide 24-hour skilled nursing care services, a resident may bring in any services privately, such as hospice or a visiting nurse to provide assistance with skilled care. These private services would be at an extra cost to the resident. Nursing homes provide 24-hour skilled nursing, rehabilitative services and extensive nursing assistance or intensive therapies for those who have on-going complex or unstable medical conditions.
In assisted living, residents select and make arrangements for the services they may want or need, and may include family members in the decision making, service planning and service delivery process. For residents with memory loss, family members may play a greater role. However, there may be circumstances, i.e., if a resident is determined to be incompetent to make decisions and direct care, when a legal guardian or representative must be appointed. Regardless of the resident’s level of cognitive ability, families can be an important part of the “service package” – coordinating healthcare appointments, driving residents to doctor’s offices, even providing some of the direct care, such as help with bathing.
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