The Wacky World of Assisted Living


Alice
Assisted living. It brings to mind a calm and safe environment where people who need minimal assistance with the activities of daily living can reside and flourish. It’s hardly work at all. They don’t even have lifts (in theory, anyway) and because of this, the pay is less. A calm oasis, complete with shuffle board…just like in the movie Cocoon, if you will pardon the dated reference. In my experience, the reality could not be farther than that mental image.
The state in which I live has cut so much funding for mental health that there are no longer any long term treatment options available for those living with severe mental health issues. We have a short term behavioral health center that is sort of a catch-all crisis center for a variety of disorders. Three to ten days;just enough time to get a brief taste of stability before they send them on there way until the next crisis. Those of us who bring in support groups from the outside often see the same clients come in and out again and again. Fairly often, people I would see when I was volunteering at the short-term behavioral health center ended up in the assisted living facilities where I worked.
They don’t belong here. It’s not fair to the other residents. How am I supposed to take care of her. She screamed all night long. This isn’t what assisted living is supposed to be. These are the mumbling grumblings I would hear the most. I learned early on that there is no point wasting time in the land of “supposed to be”. That is the dubious luxury of the legislators who make regulations that make no sense for a world they do not understand. Poorly enforced useless regulations at that. A facility will get dinged if a caregiver accidentally wears gloves in the hall but call bells that haven’t functioned correctly in over a year are just fine…but that’s a post for another day. My point is that as a caregiver, one of the first lessons I learned is to divorce myself from all expectations. There are no supposed to be’s.
In my experience, assisted living is sixty percent mental health, twenty percent total care and twenty percent people who need moderate assistance. Or some combination of the three. I’m not a numbers person, but I would say that’s a fairly accurate assessment. On one hall, I have had a resident who was living with the damage of long term substance abuse, another who heard voices, one in the early stages of dementia, one who spoke no English, one who was legally blind and a young man who suffered permanent damage from a catastrophic car accident. Every single case required me to use a different set of skills that I learned from the floor in order to be of maximum assistance with their activities of daily living.
Think about that. Doctors and nurses have specialities; classes and separate skill sets that enable them to work in a focused area of care. For caregivers working in assisted living, our specialty is “handling it” And I love it. It keeps my job endlessly challenging, but it is not everyone’s cup of tea. If you aren’t open minded and able to adapt to the reality of the situation rather than the expectation of what it should be it’s going to be a rough road to hoe.
My question to all who struggle with what assisted living is verses what it should be is what is the alternative? In my state, at least, there isn’t another viable option readily available. Is it ideal? No. But at least my residents living with severe mental illness have a place to live and receive their medications for both physical and mental health as prescribed. At least they have food and companionship. At least they are safe.
Some of my residents living with severe psychological challenges stay in these facilities for years and some go back and forth between the streets, the short term behavior health center, and assisted living places. I have had past residents who have left the facilities where I worked only to turn up years later at the behavioral center where I volunteer.
Last winter one of my residents living with a mental disorder died in the most tragic way imaginable. I hadn’t seen him in awhile. He was so young. Just a kid really. He slipped through every imaginable crack in the system. He left the facility where I was working at the time and later turned up in the group at the behavioral health center. That was the last time I saw him alive. I speak for every caregiver who ever worked with him when I say that there isn’t any length we wouldn’t have gone to in order to prevent his death. It’s just heartbreaking to think about. So while it may not be an ideal option and the training caregivers receive in psychological disorders is sorely lacking, those of us who adapt well to the strange and interesting world of assisted living facilities will be the first to say it certainly beats no option at all.

One thought on “The Wacky World of Assisted Living

  1. minstrel

    Alice you bring up an excellent point when you mention that, unlike as in other medical professions, caregivers don’t have a speciality. As you say, in one way this is great for us, we’re constantly learning new skills. Then here is the downside. Yesterday an aide had decided that ‘Sally’ had taken enough time eating dinner and the aide was going to either take her plate away or shovel the food into Sally. Sally has advanced dementia and Parkinson’s and is wheelchair bound. She has a healthy appetite but is v.e.r.y., v.e.r.y slow. I tried to jolly the aide into giving Sally more time. “Junie, I promise that when you’re living in a dementia home and I’m your caregiver, I’ll never rush you. 🙂 I think Betty needs more time.” Junie: “We have a schedule and I have to follow that schedule. And please don’t tell me how to do my job. I know how to do my job.” As she walked away she said, “Don’t interfere with our work.” (I’m not an aide in this home, I’m a volunteer.) Now, this aide probably has 20 years of experience, against my 3 or so, and her CNA skills may be the greatest. However her dementia-care skills are way below standard. Not because she’s a bad aide, but because the powers-that-be still don’t ‘get’ person-centered care.

    For assisted living homes to go the extra mile and train aides in how to handle residents who have dementia or psychosis, the operators of these homes must believe in person-centered care/treatment. And must put their money where their mouths are and fund this training and this culture change. And if there is a void, CMS and states must step in to change the standards of care far more than their recent changes do.

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