One Size Fits All

Assisted Living and the "One Size Fits All" Syndrome

A June 13th, 2006 interactive report found on the New York Times web site today, reawakened a reality that I have been aware of for some time. This reality is the limited scope in form, philosophy, services and care which exists in facilities offering Assisted Living services.

The prevailing paradigm used in the health care industry remains the same now as it was when the concept was first launched twenty or so years ago. Beyond design which appears to be basically lacking creativity and individuality, facilities offer the same type of assistance with day to day activities nationally.

Granted, there is a need for these services which is why the facilities are built. No need-no service. No money to be made-less likely a service will be provided - needed or not. This too, for better or worse, is reality in 2006.

Important factors not considered by facilities as part of their health care regime, (and which would help to provide a holistic/whole person approach), is seen for example in menu planning, activities, and scheduling.

Dining is one of the most important daily activities of the day for many residents. Health care facilities serve meals which have received the blessing of a registered dietician. Little thought is given to the individual's needs beyond the nutritional aspect. Things like: what region did a resident grow up in (north, south, east, or west), what is their country of origin, are they urbanites or ruralites, what are their ethnic backgrounds, dietary customs, religious beliefs, and social customs are not priorities and elicit little if any consideration.

Activities which are used to provide entertainment, stimulate thought, provide socialization, and encourage movement as exercise, are basically the same whether in a facility in Maine, Kansas, or California.

All scheduling revolves around typical business hours of 9-5. The likelihood of this changing in my lifetime I'm guessing is little to none. If you've never been a morning person, have worked nights or done shift work all of your life, you'll have a difficult transition. Staffing is heavier during the day than in the evening and nights, based on the idea that most people sleep at night and not during the day. It's true many people have worked during the day and slept at night but there's a total disregard for a sizeable percentage of the population for whom this has not been the case.

Scheduling does not consider those who have sleeping disorders which can totally disrupt any semblance of "normalcy". Lack of consideration in staffing creates difficulties in facilities who have residents who don't fit into the "awake days, sleeps nights" mold.

It seems the same "cookie cutter" approach has been used to create assisted livings nationwide. Evidently health care planners, builders, and facility owners assume all residents who live in them have grown up in the same regions of the country, have the same country of birth, have the same religious persuasions, and the same cultural identities. Obviously there has been no attempt to build facilities which focus on these important issues, and there are few facilities which provide housing for those whose needs do not match the needs of the masses.

I'm only aware of a couple of facilities in the Tampa Bay area that have taken into consideration their resident's needs related to cultural backgrounds, religious preference, and related dietary and scheduling needs.

The New York Times article has brought yet another group of people to light who are faced with the dilemma of trying to keep aging loved ones at home or admitting them into health care facilities to receive care. Every U.S. citizen who feels they should assist their aging parents and loved ones, faces these same issues when they consider health facility placement versus care in the home.

Perhaps if there were facilities available which better matched their loved ones needs, caregivers and potential residents would feel more confident in their decision to call upon assisted livings to provide needed services.

You can find the NY Times article at:
http://query.nytimes.com/search/query?d=nytdsection%2b&o=e%2b&v=Health%2b&c=a%2b&query=elderly&date_select=full

Scroll down to #5 and click on Interactive Feature: Caring for the Elders

Jane Ogilvie