70% of American adults over the age of 65 are estimated to need long-term care at some point in their life. The Institute of Medicine of the National Academies reports that 14-20% of seniors have 1 or more mental issues. Determining the right facility to address a senior’s needs isn’t always straightforward, but it’s critical to a senior’s wellbeing.
Those who are not familiar with assisted living may be asking: what is assisted living? The Assisted Living Federation of America defines assisted living as a long-term care option that provides health care services, housing, as well as supportive services as needed. Daily basic living tasks can include dressing, bathing, grooming, and assisting with taking medications. These residents need help to the extent that they can no longer live independently on their own, but not to the extent where they require continuous medical care, as in a nursing home.
Assisted living facilities are not considered medical facilities. 24-hour staff is available, but not typically continuously supervising residents. Staff at an assisted living facility provides assistive services. Assisted living facilities might have staff trained in specialized care, but this is dependent on staffing practices of individual facilities.
Assisted living facilities might provide satisfactory help in addressing mild cases or early stages of mental illness. The mental illness must be properly diagnosed with a successful treatment plan provided. Assisted living facilities commonly offer services to benefit the residents physically with daily meal service, help with medication, housekeeping and laundry services, and health and exercise programs. Organized social activities provide social interaction, preventing the common problem of senior loneliness and isolation.
Seniors with a mental issue may require additional, specialized care. Mental issues that require attention include Alzheimer’s, dementia, depression, post-traumatic stress disorder, anxiety disorder, bi-polar disorder, and schizophrenia.
The National Alliance for Mental Illness (NAMI) recommends that treatment is most successful when patients are in a stable home that is safe and affordable. This prevents hospitalization, homelessness, and possible entry into the criminal justice system.
Untreated mental health issues result in poorer physical health, higher costs, and longer hospital stays. Mentally ill seniors might not take the daily steps necessary to care for themselves or address other medical conditions, such as diabetes or hypertension.
Help or monitoring medication becomes more important in the treatment of mental illness in seniors. Staff is also able to monitor and assess any changes in behavior. Metabolism slows as we age, and seniors can be adversely affected by medication if it is not adjusted as weight and other conditions change.
The daily routine within a mental health assisted living facility is more regimented than a regular facility. Mental illness patients respond best to treatment when routines are consistent with less variation. It’s important, particularly for schizophrenia patients, to reduce confusion and stress.
Other enhancements to services provided by mental health assisted living facilities include 24-hour medical care access, emergency call systems, and 24-hour supervision and security. Many facilities have secured buildings, as well as a secured perimeter of the outdoor grounds to allow residents to benefit from outdoor exposure, but also to remain securely at the facility, for their own protection.
Mental health assisted living facilities will also be staffed by specially trained professionals. This staff will know the normal behaviors expected from conditions and are able to assess and monitor behavior changes, either due to the environmental changes or changes in mental illness condition.
Many seniors and families are resistant to the idea of requiring mental health treatment or moving to an assisted living facility. It is a difficult decision which requires an objective assessment of the situation. Such situations can include:
Moving to a mental health assisted living facility does not mean that a resident is no longer productive or is unable to properly function. It indicates that the move is beneficial to the physical and emotional wellbeing of the senior resident, as well as caregivers and family members.
Caregivers who are exposed to prolonged stress are sometimes diagnosed with PTSD. It’s important to recognize when a patient’s condition exceeds the capabilities of the caregiver. Sometimes it is beneficial for both the senior with mental illness and the caregiver for the senior to move to an assisted living facility. It is not a sign of failure.
The average cost of assisted living is $3,300 per month. Specialized care in a mental health assisted living facility can start at $5,000 per month.
The U.S. Department of Housing and Urban Development (HUD) has a guideline of 30% of income as a threshold for affordability. Many afflicted with mental illness have lower income, which complicates the aspect of finding affordable mental heath care at assisted living facilities. These patients are more likely to use government funded programs.
HUD has two popular programs. The Housing Choice Voucher Program, known as Section 8, helps low-income families and the disabled. The Supportive Housing for People with Disabilities Program, known as Section 811, is more specialized to address disabilities, including chronic mental illness. HUD can provide a list of subsidized properties and a resource guide providing information about programs.
Anyone considering the move to an assisted living facility should consider their needs. For a senior with a mental illness this becomes more important.
A good place to start when considering a move to a mental health assisted living facility is a discussion with a doctor. A doctor will be able to provide an assessment of the senior’s current abilities and needs, as well as anticipated needs. Often a senior or the family is resistant to the idea that mental health treatment is needed. One way to address this resistance is to direct conversations to address symptoms, rather than the illness by name.
An assisted living facility must first meet a resident’s physical needs. This means that it is safely constructed and maintained, as well as provides the assistive services required on a daily basis. Many seniors, especially if diagnosed with mental illness, may not drive so a location in a safe neighborhood close to treatment centers or community resources is beneficial. A facility that provides transportation to services is helpful.
A mental health assisted living facility needs to be a discrimination free. The Fair Housing Act bans discrimination based on disability. Residents of a mental health assisted living facility should be free of the social stigma of mental illness.
Mental health assisted living facilities vary based on what services they offer and what psychiatric disorders they feel suitable in addressing, if any. An honest discussion about the doctor recommendations, along with the aspects of the senior’s mental health illness symptoms should result in an agreement on services that will be provided.
A good practice when searching for an assisted living facility is to make a checklist. Make a list of the services required based on the doctor’s recommendation, as well as wants and needs to make living comfortable.
Use this checklist to visit and compare facilities. This checklist allows you to objectively compare and to ensure that you remember to ask the necessary questions at each facility.
Stability. Moving to a mental health assisted living facility should not be a transitional solution. It should be seen as a permanent, long-term solution. This allows the senior to establish an emotionally supportive network and become higher functioning.
Domesticity. The routine and responsibility of household chores creates a sense of ownership and daily purpose, even if help is provided by the facility. It creates normalcy and avoids the feeling of living in a hospital setting.
Staff. A less restrictive regime allows residents to create their own normalcy and a more successful, nonthreatening environment, as well as motivates residents to take part in their community within the facility. Staff that expresses emotions affects the emotional wellbeing and general stress levels of the residents.
Memory Care specifically caters to residents with Alzheimer’s, dementia, and memory problems. These are often referred to as Special Care Units (SCU). They might be a dedicated facility or a dedicated wing of a larger facility.
Memory care units within mental health assisted living facilities do not have kitchens. This precaution helps to avoid common kitchen injuries due to age and dexterity, but also to avoid damage caused by forgetting a stove or oven is in use.
The emphasis of these units is security. Entrances and exits to the units are closely monitored. The medical community recognizes the natural benefits that humans receive from being outside. A mental or cognitive deficiency does not negate those benefits. Memory care units provide residents access to the outdoors, but with perimeter security to prevent residents from wandering and getting lost.
Dementia patients benefit greatly by being in a calming environment. There is commonly a central TV room, colorful paints used in décor and a setting where natural light is plentiful. Fish tanks are not only calming, but also stimulate appetites.
Some memory care units might implement tracking bracelets to be worn by residents. These bracelets set off an alarm if drawing too near to an exit, alerting staff that immediate attention is required.
Post-Traumatic Stress Disorder (PTSD):
This is commonly associated with originating after experiencing war conditions, but it is also very common when a person experiences an assault or disaster.
The VA has recognized PTSD as an injury due to the severe emotional problems that it can cause. This designation as an injury allows veterans to access VA benefits for treatment.
Very few veterans will receive a monetary benefit from the VA. The VA provides for a 1-time mental health assessment and testing. This can provide diagnosis, medication, and treatment plan. The VA benefits also include one on one psychotherapy, as well as group therapy. There are over 200 PTSD treatment programs through the VA.
Clinical Treatment Center:
These are very specialized facilities for advanced mental illness. These facilities provide intensive professional mental health treatment on a daily basis, as well as individual psychotherapy. Group therapy is also available, as is vocational and educational counseling and support.
Regardless of what type of assisted living facility you decide will meet your needs, there will be a resident contract. These documents detail the services, charges and conditions of residency. It is not a bad idea to have the contract reviewed by your legal counsel. Of particular concern for residents with mental illness and their families are the conditions that require a resident to move. This is commonly for the protection of the other residents, staff, and possibly for the resident themselves.
If a mental condition advances past the ability of the facility, it must have a method for removal of the resident. This is common, but the time to assess its reasonableness in your case is before you sign the contract and expose yourself to fees and extra costs. If the potential resident has a condition that reasonably can be expected to progress to include actions that will cause removal from the facility, it might not be the appropriate long-term solution for that senior. You want the home to be as permanent as possible.
Contemplating a move to a mental health assisted living facility is not a minor decision. It should be made with the understanding that placement at this facility is a permanent home. The resident should be comfortable and happy in the environment that is conducive to their treatment and wellbeing. The facility should provide the services and care necessary to sustain that resident in their current condition as well as meet future needs.
Family members should feel confident in the senior resident’s care and treatment. There should be no regrets in the decisions to avoid guilty feelings by family who is unable to provide care for a person afflicted with a mental illness.
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