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Assisted Living Communities are often viewed as the best of both worlds. Residents enjoy as much independence as desired with the knowledge that personal care and support services are available if needed.

An assisted living home is a facility where the elderly and those with disabilities reside on a full-time basis. The staff at the facility help the residents with activities of daily living such as bathing, dressing and eating. Some states allow assisted living staff to offer medication assistance.

Licensure. Individual states determine the licensing procedure for an assisted living facility. Licensing requirements often include proof of managerial qualifications and educational requirements for the management and staff. An applicant for a license will likely require proof that the building or structure where the residents are to be housed meets all health, fire and safety code requirements.

Regulations. Once they are licensed, assisted living facilities are subject to state regulations generally requiring regular inspections and yearly re-certification. The regulations also provide information for complaint procedures for suspected abuse or neglect.

Assisted living care is predominately paid with private funds or is covered by many long-term care insurance policies.

Independent Living and Retirement Communities come in many different forms ranging from 55+ apartment communities to villa homes on the campus of a retirement village or continuing care community. Continuing care communities offer several levels of care, including assisted living homes at the same site. Independent living is paid from private funds and unless they are subsidized at the state or federal level for low income seniors, they do not require licensing and have no formal regulation requirements.

Skilled Nursing Facilities or Nursing Homes. In 1987 Congress enacted the Nursing Home Reform Act specifying that skilled nursing facilities (or nursing homes) that participate in Medicare and Medicaid programs, “Must provide services and activities to attain or maintain the highest practical physical, mental and psychosocial well-being of each resident in accordance with a written plan of care.”

Nearly all of these types of care facilities participate in the government programs and numerous federal and state laws were developed to provide patients protection from abuse and neglect. Additionally, patients have privacy, security and other rights.

To participate in the programs, nursing homes must comply with the federal requirements for long-term care facilities. Under these regulations, the nursing home must:

• Provide sufficient nursing staff licensed to administer medications.
• Conduct a comprehensive and accurate assessment of each resident’s functional capacity.
• Develop a comprehensive care plan for each resident.
• Prevent the deterioration of a resident's ability to bathe, dress, groom, transfer and ambulate, toilet, eat, and to communicate.
• Provide, if a resident is unable to carry out activities of daily living, the necessary services to maintain good nutrition, grooming, and personal oral hygiene.
• Ensure that residents receive proper treatment and assistive devices to maintain vision and hearing abilities.
• Ensure that residents do not develop pressure sores and, if a resident has pressure sores, provide the necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing.
• Provide appropriate treatment and services to incontinent residents to restore as much normal bladder functioning as possible.
• Ensure that the resident receives adequate supervision and assistive devices to prevent accidents.
• Maintain acceptable parameters of nutritional status.
• Provide each resident with sufficient fluid intake to maintain proper hydration and health.
• Ensure that residents are free of any significant medication errors.
• Promote each resident's quality of life.
• Maintain dignity and respect of each resident.
• Ensure that the resident has the right to choose activities, schedules, and health care.
• Provide pharmaceutical services to meet the needs of each resident. The medications be must administered in a manner that enables the nursing home to use its resources effectively and efficiently.
• Maintain accurate, complete and easily accessible clinical records on each resident.


Residents’ Bill of Rights. Under the Nursing Home Reform Act, nursing home residents’ rights are also protected as follows:

• The right to freedom from abuse, mistreatment and neglect
• The right to freedom from physical restraints
• The right to privacy
• The right to accommodation of medical, physical, psychological, and social needs
• The right to participate in resident and family groups
• The right to be treated with dignity
• The right to exercise self-determination
• The right to communicate freely
• The right to participate in the review of one's care plan and to be fully informed in advance about any changes in care, treatment, or change of status in the facility.
• The right to voice grievances without discrimination or reprisal

Where to turn if there is a problem. Most states have their own long-term care Ombudsman Program authorized by the Federal Older American Act. The primary responsibility of the program is to investigate and resolve complaints made by, or on behalf of, individual residents in long-term care facilities. These facilities include nursing homes, residential care facilities for the elderly and assisted living facilities.

The Ombudsman's advocacy role takes two forms:

• To receive and resolve individual complaints and issues by, or on behalf of, these residents; and

• To pursue resident advocacy in the long-term care system, its laws, policies, regulations, and administration through public education and consensus building. Residents or their family members can file a complaint directly with the local Long-Term Care Ombudsman.

This article is a contribution from Gloria Schneider, senior staff writer for 800seniors.com.

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