Assisted living facilities are a residential option for older adults no longer able to live independently, but who do not require nursing home care (Allen, 1999). Although these individuals may be frail, assisted living promotes continued independence by combining housing and personalized supportive services. While other residential housing choices for older adults offer hoteltype services such as shelter, meals, housekeeping and laundry, assisted living facilities provide individualized personal care assistance plus the ability to respond to unscheduled and unanticipated needs.
The decade of the 1990s saw rapid development of assisted living facilities in the United States. Today there are approximately 30,000 to 40,000 facilities serving an estimated 1 million individuals (PricewaterhouseCoopers, 1998). Whether called assisted living facilities, residential care facilities, or board and care facilities, these centers offer older adults a long-term care option that follows a social, rather than a medical model, and stresses independence, individuality, choice, privacy, and dignity (Joel, 1998).
The popularity of assisted living facilities is based in part on their differences from traditional nursing homes and on the public's negative images of nursing homes. In contrast to stereotypical nursing homes, assisted living facilities offer a more home-like, less institutional, environment that accommodates the resident's personal style and encourages personal belongings and furnishings. Furnishings resemble those used in private residences or hotels, rather than those used in hospitals or nursing homes. Private rooms with doors that lock are common. A wide variety of activities are provided. The cost of care is often lower than the cost of nursing home care.
Little research related to assisted living facilities has been published. Furthermore, few nursing studies in assisted living have been conducted; thus, little evidence is available for practice. Assisted living offers exciting opportunities for gerontological nursing practice and research.
Current issues in assisted living facilities suggest several areas for gerontological nursing research. Many assisted living residents are frail at admission. The average age is 83 (National Center for Assisted Living [NCAL], 1998). Residents have multiple chronic medical conditions and are at risk for episodic illness and exacerbation of chronic conditions. Another issue is the phenomenon of aging-in-place. Older adults prefer to remain in these facilities (Frank, 2001).
Little is known about the reasons elderly individuals relocate to nursing homes from assisted living facilities. Research examining strategies to assist frail older adults to remain in assisted living is urgently needed. Studies testing both health promotion and illness management interventions would be helpful. A further area for nursing research centers on the staff - their experiences, their knowledge or need for knowledge, and appropriate staff numbers and skill mix. The role for professional nurses in this setting also needs further exploration and evaluation.
The state of nursing research in assisted living facilities currently resembles the state of nursing home research in the 1980s. There is work to be done. It is time for us to roll up our sleeves, ask our questions, and discover the answers that will enhance the quality of care in assisted living facilities.
- Allen, J.E. (1999). Assisted living administration: The knowledge base. New York: Springer.
- Frank, J. (2001). How long can I stay? The dilemma of aging in place in assisted living. Journal of Housing for the Elderly, 15(1/2), 5-30.
- Joel, L. (1998). Assisted living: Another frontier. American Journal of Nursing, 98, 7.
- National Center for Assisted Living (NCAL). (1998). Facts and trends: The assisted living sourcebook. Washington, DC: Author.
- PricewaterhouseCoopers. (1998). An Overview of the Assisted Living Industry, 1998. Fairfax, VA: Assisted Living Federation of America.