In this regard, Sheve adds that, "For these people, assisted living may be the answer. Assisted living facilities fill a gap between complete independence and around-the-clock care. It's an option for those who are 'mostly abled' and who still want (and can safely live with) a high degree of freedom and independence" (para. 4). Not surprisingly, the continuum of care required for the elderly is closely associated with the age, with older individuals requiring higher levels of care as shown in Figure 2 below.
Figure 2. Percentage of elderly in the U.S. requiring assistance with everyday activities by age group
Source: Based on data from U.S. Census Bureau, Population Division at http://www.med carelifts.com/65plus.htm
In response to the growing elderly population, there are currently more than 23,000 long-term care facilities of some type in the United States that deliver care for more than a million-and-a-half elderly residents, and the number of long-term care facility residents is projected to increase by more than 50% during the period 1989 to 2020 (Osgood, Brant & Lipman, 1999). The implications of these alternative living arrangements for the elderly, though, are profound. Besides the fundamental adjustment problems that many elderly experience when moving into an institution of some type, Nishtala, McLachlan, Bell and Chen (2008) also emphasize that, "Mental and behavioral disorders are highly prevalent among long-term care facility residents and pose a major challenge to behavioral management in this setting. The estimates of the prevalence of dementia and other psychiatric disorders among long-term care facility residents range from 30% to 62%" (p. 621).
It is reasonable to suggest that many elderly residents of long-term care facilities would have opted for a less institutionalized setting, including most preferably their own homes, but the key issue involved is the amount of resources that are available for housing and requisite care. In this regard, Kamo and Zhou (1999) advise that, "In order to sustain independent living, an elderly person has to secure sufficient resources. Resources of an elderly person may be measured by labor force status and income. Previous studies have shown that elderly living arrangements are affected by income and other economic resources, such as home ownership" (p. 545). This point is also made by Szinovacz (1999) who notes that, "Limited economic resources constrain both adult children's and parents' choices of alternative living arrangements, such as formal help or placement in retirement homes. Consequently, coresidence appears to be more prevalent among lower socioeconomic status groups" (p. 700). Most authorities appear to agree that the significant increase in the numbers of elderly living alone is primarily attributable to concomitant increases in their economic independence (Phua, Kaufman & Park, 2001). As a result, "Today's elderly and their children prefer a modified extended family, whereby even though parental elderly and their children live apart, they keep close contact. However, independent living is more common among elderly whites than among elderly minorities. Elderly minorities' extended living arrangements are often argued as culturally desirable" (Phua et al., 2001, p. 263).
When an elderly individual becomes too disabled or incapacitated to remain in the home, the next level on the continuum is care is most likely an assisted living facility where they may or may not require the full range of services the facility offers. Assisted living facilities provide living arrangements for the elderly who may require assistance with daily living needs such as dressing, bathing, eating, and toileting; however, the continuum of care is still less than that provided by the more intensive medical and nursing care that is delivered in nursing homes (Assisted living, 2010). According to Chesser, Harrison and Barry (2002), "Assisted-living facilities include small homes to large apartment-style complexes that offer a way for older adults to maintain an independent lifestyle in a residential atmosphere that provides them with some assistance and support" (p. 53). Depending on the cost, these facilities can also range from the bare minimums to the luxurious and plush, but they are characterized by certain commonalities in the types of services they provide. In this regard, Chesser et al. note that, "While the types and sizes of the facilities can vary, all provide meals and social activities and are staffed with people who can help residents with activities of daily living, such as bathing and dressing" (2002, p. 54).
Assisted living facilities can be stand-alone operations, or they form part of a larger complex such as a nursing home, retirement community, or senior housing complex (What is assisted living?, 2010). The terms used to describe these facilities and the licensure requirement for them differ from state to state, but some of the more common terms that are used to describe assisted...
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