Developing your paper, Assisted Living as an Example

A. Importance of the concept. Describing the importance of assisted living included, for example, discussion of increasing numbers of older adults and the value of independence even with increasing frailty. Discussion also included the rapid advent of assisted living facilities, but confusion about exactly what they are.

B. Tentative definition and review of relevant literature. Incorporated definitions from both nursing literature, additional disciplines, popular press, other. The assisted living topic was new enough that there were few articles in the traditional nursing and geriatric journals. Much of the information available came from trade journals for the American Health Care Association and Association of Homes and Services for the Aging. Additionally American Association of Retired Persons carried some practical articles on choosing a place to live. Sometimes the morning or evening news shows had a series on topical issues such as aging and housing.

As last semester, try to gain as much from these nontraditional sources as possible about how the term is being defined. Remember sometimes discussing what the concept is not, is a useful approach here as well (ie how assisted living is different from a nursing home and different from independent living settings)

C. Identify your defining criteria.

My assisted living definition talks about

• a physical home-like setting, typically an apartment with safety and "function" features
• a population, typically older adults with various frailties who can still care for themselves
• a package of services (ie various combinations of help with ADLs, housekeeping, meals, and emergency call)
• staff (various combinations of professional and nonprofessional support staff, at least someone available on a 24 hour basis)

D. Briefly consider antecedents and outcomes.

• Antecedents for assisted living could include client need for the setting, availability of assisted living resources, and client financial resources for the setting.
• Outcomes would hopefully include client maximal independence and functioning in a safe environment.

E. Model, contrary, and related cases.

• A model case could further describe a specific facility that meets all the defining criteria, maybe using hypothetical Mrs. Jones as an example of a frail client, in her adapted apartment, getting selected services from staff.
• I would make a case that a nursing home is a contrary case, usually lacking the "home-like" quality and geared to meeting nursing needs of sick or dependent clients.
• A related case could include an example of a structured facility for older adults that lacks a meal service and overnight staff support.

Assisted Living, Action Approach

A. Sample Issues. After reviewing (and listing in an appendix) selected non-traditional sources, a sample of issues I come up with includes:

• Ethical issues-a whole cadre of issues exists. For example, when can frail clients no longer stay safely in assisted living? At what level of dementia are persons safe, at what level not safe? What happens to these clients if the facility asks them to leave?
• Political/Legal Issues-Sample questions include: At what level should assisted living facilities be regulated by state and federal governments? Who is qualified to administer assisted living facilities? What happens to costs of care with increased regulation? How will society be involved in supporting frail elders who can't live independently?

B. Implications

Major roles for advanced practice nursing in assisted living facilities include, but are not limited to: providing for clients' acute and chronic care needs;

• advocating for clients/families within the facility
• recommending/assisting with program development, for example: education and programming for dementia clients' needs
• support groups for new clients just giving up their homes
• support groups for clients/families re selected illnesses

Additional roles include political advocacy for safe, quality facilities that can retain a home-like setting for clients at an affordable level.

Course Home Page | Course Materials | Course Content | Module Outline | KUMC Home Page

Elaine Domain, University of Kansas Medical Center, School of Nursing, January, 2001