TheGolden Years: Assisted Living Community for Today’s Senior Citizen
TheGolden Years: Assisted Living Community for Today’s Senior Citizen
Themain aim of the research will be to establish a best practiceframework for elderly nursing homes in the U.S. To this end, asystematic literature review will be carried out to determine thefactors that are considered while establishing assisted livingcommunities for senior citizens. To enhance the reliability of theresearch, the literature review will be based solely on peer reviewedjournal articles.
Inmodern-day America, a third out of the entire American populationdies in a nursing home. As the baby boomer continues to age, theproportion of people dying in nursing homes is forecasted to hit the40% threshold by 2020. Furthermore, a staggering 30% of the totaldeaths occurring in hospitals are those on transit from Long-termcare (LTC) facilities and pass on within 3 days of being transferred.Though priority ought to be attached to end-of –life (EOL) careexcellence, however, there Is scarce information regarding thequality of EOL care provided in nursing homes, and the availableresearch has been largely exploratory, descriptive, and on the basisof small samples. Nursing homes have been discovered according torecent finding as being insensitive to pain, having undesirableassessment and management techniques and equipments for pain andother symptoms, over-reliance on hospitalizations, under-utilizationof hospice, neglect to proper advance care planning, as well aheightened use of feeding tubes, entirely an indication of inadequacyin EOL quality of care.
Earlierstudies related to the factors relating to EOL care quality have to alarge extent focused on measures of nursing home capability andcapacity (Pearce, 1998). Despite the fact that the vitality of careprocesses in influencing EOL care quality and outcomes has beenacknowledged by researchers, there have been only a limited number ofempirical studies aimed at analyzing the extent and impact of EOLcare processes in nursing homes.
Thoughloneliness and social isolation can affect everyone, the elderly arehighly susceptible and vulnerable especially after being abandoned byfamily and friends, lacking a source of livelihood, or reducedmobility. Reports indicate that 5-16% of the elderly (65 years andabove) are deemed to be lonely, whereas 12% feel isolated (Cacioppoet.al, 2010). However, these figures have been predicted to increasedue to certain demographic changes ranging from the ageing of thepopulation, and family dispersal. Various studies have revealed thatsocial isolation and acute loneliness can have a daunting effect onthe quality of life and well being of the affected individuals.Loneliness significantly affects any individual’s blood pressurenegatively as well as being linked to depression (either as aconsequence or cause) and subsequently increased mortality rates.Social isolation and loneliness is regarded as a public healthchallenge, with specialists in this field comparing the effect ofsocial relationships on death risk to notable lifestyle risks such asalcohol consumption and smoking.
The population in the country is aging and therefore there will be a corresponding demand for support services and housing for seniors
There will be a gradual increase in the country’s total population
The housing projects being undertaken in most parts of the country do not meet the needs of the seniors
The low income of most seniors’ limits the choices of houses they have
The need for more affordable housing options is eminent across the country
Housing and support services are needed that will maintain the seniors in their original communities.
Themain objectives of the research include:
To identify the factors considered when establishing living communities for senior citizens
To establish a best practice framework for elderly nursing homes in the U.S.
WorkBased Structure (WBS) and Budget
FactorsConsidered While Establishing Assisted Living Communities for SeniorCitizens
Ageism-there is a need to erase myths related to aging. There should becontinuous discussions that focus on the major priority areas. Thereare certain stereotypes that depict elderly people as being eitherfrail and weak or extremely vibrant. This acts as a major inhibitorin improving their care (Namazi, & Chafetz, 2001).
Communityenvironment- Researchers in this topic of study are also concerned inrelation to the connection between elderly adults’ social isolationand (more so 65 years and above) and critical changes in communityand neighborhood values over the past few decades. Numerousresearchers have reached a consensus on the need to develop acommunal arrangement that support connections and interactions amongneighbors and the community at large.
Dementia-Researchers engaged in round-table talks agree that when theircliques of other researchers are made aware of a dementia diagnosis,most of them shrink. Whereas the effects of dementia are a greatconcern to various people and their spouse, as regards socialinteractions, most researchers are in agreement that there is animmense need for various stakeholders in the healthcare sector tocomprehend the causes and social consequences of the condition. Thereis an imminent risk that can be faced by dementia diagnosedindividuals’ caregivers in such aspects as social isolation, as aresult of the competing demands of work, caregiving, as well as otherduties.
Intergenerationalrelations- Various researchers compared how the elderly faced socialisolation to that of youths who may as well be harassed or bullied byothers. A useful approach towards breaking this intergenerationalisolation was through intergrational programming as proposed bystakeholders in this sector (Jackson, & Garcia, 2011).
Leadershipon Loneliness- Numerous specialists in nursing, healthcare and moreso caregivers were strongly in support of clearly differentiatingbetween loneliness and social isolation. Social isolation was termedas being low quality and quantity of contact with others whereasloneliness was termed as taking a more subjective outlook (i.e. basedon how the individual views the quality of contact).
LifeTransitions- Roundtable discussions by various stakeholders in thefield concluded that among the major drivers of social isolationshould be life transitions. Examples of such include childrenabandoning work relocation, health issues related to old age,residence change, or co-residence (for instance hospitalization orinstitutiolization) exceeding 80 years of age (social networkshrinkage) as well as reduced mental and physical health (reducedfunctionality, lessened resilience and capacity).
Promotinghealthy aging- Everyone was in agreement that health determinedsocial isolation, thereby the promotion of healthy and active agingturned out to be beneficial. Good diet, physical activity, moderatedrinking, reduced stress, healthy body weight, non-smoking, andproper sleeping habits are all vital for the elderly to maintain ahealthy lifestyle during aging.
Accessto Information, Services and Programs for seniors
Accessto services, information, and programs- There has been a confirmationthat the elderly people face a big challenge “navigating thesystem”. Access to and awareness of appropriate programmes,information, or services are among the mentioned major barriers tosocial inclusion or attaining basic social needs.
Gatekeeper,outreach, and community registries- There has been a confirmation byparticipants that the approach that is available to meet the needs ofsocially isolated elderly individuals is majorly “reactive” innature, thereby support for the elderly is based on when a crisiswill occur so that they can be identified. Numerous stakeholders areof the idea that there is need for more outreach. Frontlinecaregivers and social workers ought to knock on more doorsproactively .These programs can attain more efficiency if set uparound areas close to the elderly or easily accessible areas withgood transport networks. Gatekeeper programs among other innovativeprograms are deemed to be successful approaches.
SharingPromising Practices- In a round table discussion, the caregivers ofelderly people stressed the need to transfer knowledge touching onsuccessful initiatives and practices. There was also a requestemanating from the caregivers in boosting connections betweenagencies, for instance through symposia or conferences that wouldgive an opportunity to participants to share knowledge and learn fromothers.
Supports,Community Capacity and Inclusion
Agingin place- The longer seniors stay home, the higher the demand forhome care services such as friendly visits, meals, repairs, homeupkeep, and healthcare, among others. Home care professionals cancome in handy in identifying mental health issues, signs ofdepression, and decline in cognitive abilities.
Collaborationsand social Partnerships- Due to the scope and complexity associatedwith social isolation, various stakeholders were in support ofcollaborative approaches that merge major players, cluster programsas well as providing a multi-disciplinary approach.
CommunityProgramming and Funding- Valuable sources of seed/ start-up fundingare such programs as funding programs that are targeted towardseradicating and preventing social isolation. Various caregiverparticipants are of the idea that it is of critical importance tocreate and sustain innovative programs and services as well asinformation gathering and sharing regarding models that have alreadyattained success and hence can inspire other organizations. Theinvolvement of elderly policy development pertaining to fundingprograms as well as community programming aroused a lot of interestalso Federal Interagency (Forum on Aging-Related Statistics (U.S.). 2010).
OlderWorkers Participating in labor force- The elderly themselves as wellas the general society are beneficiaries of active aging, which tomany people entails the progressive participation within the laborforce. Since numerous elderly individuals still possess the urge towork, it is necessary then that they are accorded the opportunity tobe productive. However, certain barriers exist within the realm ofthe society at large that may inhibit these individuals from engagingin the labor force. Barriers such as limited number of jobs, fixedretirement age, and other cultural norms and beliefs can inhibit theelderly from participating in the labor force.
Intrinsicand Extrinsic Barriers to Participation
Environmentsthat are age-friendly- The initiative by the name of ‘age-friendlycommunities’ program’ that has been implemented in the UnitedStates, Canada, and other states globally was lauded by Caregiversand other healthcare participants. This initiative created by theWorld Health Organization (WHO) in collaboration with the Americangovernment tackles eight major aspects of community living that givesthe elderly with different needs and capacities the ability to have asecure livelihood, healthy living, and full public/ societalparticipation. The various aspects include housing, transportation,respect and social inclusion, social participation, employment andcivil participation, health services and community support,information and communication, as well as outdoor building andspaces. Age-friendly communities offer opportunities for the entirecommunity, and not just for the elderly in the society.
Builtenvironment- This can act as a detriment to social participation.Various stakeholder participants noted how most of the elderly werereserved in terms of undertaking various activities such as communityactivities, strolling, or doing some small errands outside theirhomes due to their physical environment. Restrictive access tofacilities such as public washrooms can even inhibit or restrict someelderly persons, more so those suffering from various aspects ofincontinence. Developing easily accessible washrooms could go a greatlength in enhancing social engagement and integration among theelderly.
Caregiving-Among other causes of social isolation is an elderly acting as acaregiver to another family/friend caregiving recipient who residingin the same household. Although caregivers may still have access tosupport groups, the arising question is often “while I attend thesupport group, who will attend to the care recipient?” Allparticipants were in agreement that caregiving can ultimatelyimmensely strain the elderly caregiver’s health, their work lives,and the eminent risk in case of illness on the part of the caregiver.
CulturalBarriers- The risk of social isolation among the minority groups inthe United States such as the Hispanics and Black Americans canimmensely be increased by cultural barriers, as can the burden ofresponsibilities involving the caring of family members. Forinstance, elderly members of these minority groups who may be taskedwith caring for their grandchildren may lack time to culturallyintegrate, undertake community development, or learn a language.
Language-Elderly participation and social inclusion is also largely inhibitedby language barriers. The discussion group participants recognizedthe challenge faced by the elderly in finding social programs andfacilities that used their language of choice in their mainstreamcommunication. People, who enthusiastically embraced moving intoareas where they spoke foreign languages due to education or work,preferred that in their later years they can be served using theirpreferred language. However, isolation is highly likely to result inleaving an already established community or network (FederalInteragency (Forum on Aging-Related Statistics (U.S.), & NationalCenter for Health Statistics (U.S.). 2012).
Housingand Homes- Out of elderly individuals of 55 years and above inAmerica, 80% of them prefer to continue dwelling in their presentresidence for as long as possible. Some lucky elderly individuals optto be housed in residential options with some support services onoffer. In the discussion, in regard to the impact of social isolationand housing types. It was evident that there could be cases ofisolation and loneliness even when the elderly are housed inapartment complexes, more so in apartments deprived of centralizedsocial hubs. Other housing concerns that were raised included adeficiency of publically funded beds for long-term care of theseindividuals. Due to limited choices as a result of financialconstraints, some elderly individual are forced to make do with bedssituated outside their home community, which may be having numerousrestrictions such as no pets allowed, services offered in otherlanguages that are not of preference to them, or non-sensitivity totheir cultural needs.
Lesbian,Gay, Bisexual or Transgender (LGBT) seniors- concern was raised onhow the elderly belonging to this group are reluctant to disclosetheir sexual orientation. Participants were all in agreement that adouble discrimination is the toll order for elderly homosexuals -bothin terms of sexual orientation and age- in various spheres such ashomecare, healthcare, recreation, and legal (Jackson, & Garcia,2011).
Mobility-Mobility is not only limited to societal participation in terms of(driving ability or easily accessing public transportation) and theelderly physical activity, but also entails the ability to undertakedaily specific actions such as climbing stairs, walking, amongothers. An important and noteworthy goal touching on mobility withinthe community can be narrowed down to simply “getting the elderlythere” by affordable and readily available transportation. In theroundtable stakeholder discussion, this aspect was mentioned as beingthe major factor influencing the ability of elderly individuals toengage in community programs. To add up to extrinsic mobilitybarriers, physical environments and aids, the elderly are also facedwith intrinsic barriers such as fear of falling and inability towalk. Proper measures and policies should be put in place to ensurethat every public building, whether commercial or residential,contains a built-in ramp to cater for the mobile impaired eldersacross the entire United States.
Mentalhealth- According to one professional in this field, there exist a“vicious cycle” relationship between mental health and socialisolation. Isolated elderly develop physical or mental complications,if not being depressed. In turn, elderly individuals with mentalillnesses or other psychological complications are often unable toseek the necessary help thereby further being isolated. The combinedstigma of ageism and mental illness were identified as increasing therisk of vulnerability.
Technology-While technology is a vital and requisite tool to aid in theconnectivity of people the tool is neither adopted nor accessible byall. Some elderly individuals dread the costs associated withinternet access, purchasing a computer, and even telephone servicesmay still pass as being expensive to some elderly. However, to some,it is not even an issue of cost but rather the aspect of not beingcomfortable with adopting the modern technologies.
Careprocesses entail such activities as EOL systems assessment,appropriate treatment or medication delivery, as well as properfeedback system among providers and with families or patients. Aneffective EOL care has such components as effective communicationamong providers together with residents and their families is deemedto be of critical importance. Appropriate guidance and counsellingfor family and residents regarding the burdens and benefits of EOLtreatment options for instance the use of feeding tubes is rarelyavailable. Currently the related parties are overall dissatisfiedwith the poor communication depicted by nursing home staff. Due tothe lack of knowledge and skills required of nurses for the efficientrecognition of common EOL symptoms such as shortness of breath andpain, nursing home staff exhibit the qualities of inadequacy inmanagement and assessment of these symptoms.
Pearce,B. W. (1998). Seniorliving communities: Operations management and marketing for assistedliving, congregate, and continuing care retirement communities.Baltimore: Johns Hopkins University Press.
Namazi,K. H., & Chafetz, P. (2001). Assistedliving: Current issues in facility management and resident care.Westport, Conn: Auburn House.
Connell,L. H. (2004). Nursinghomes & assisted living facilities: Your practical guide formaking the right decision.Naperville, Ill: Sphinx Pub.
FederalInteragency Forum on Aging-Related Statistics (U.S.). (2010). OlderAmericans 2010: Key indicators of well-being.Washington, DC: Federal Interagency Forum on Aging RelatedStatistics.
FederalInteragency Forum on Aging-Related Statistics (U.S.), & NationalCenter for Health Statistics (U.S.). (2012). OlderAmericans 2012: Key indicators of well-being.Washington, DC: Federal Interagency Forum on Aging RelatedStatistics.
Jackson,G. O., & Garcia, O. F. (2011). Profilesof older Americans 2010.Hauppauge, N.Y: Nova Science Publishers.
Cacioppo,J.T.,et.al.,(2010).Perceived social isolation makes me sad:5-yearcross-laggedanalyses of loneliness and depressive symptomatology in the ChicagoHealth, aging, and social relation study Psychology and Aging, 25(2),pp.453-463