AJN editorial board member Jeanne Anselmo believed that her 82-year-old father, John Anselmo, would be better off moving from his home to an assisted living facility that promised 24-hour emergency response. He'd had an acute cardiac episode, necessitating more home care than the family could manage. Jeanne's visit to the facility reassured her that her father would have round-the-clock assistance if he became suddenly ill, as well as opportunities to socialize.
One night, he went into acute heart failure. The only staff person on site other than a security guard in charge of the 75 residents was an untrained, inexperienced aide (her first time on night shift). The aide walked Mr. Anselmo down a long hallway to wait for an ambulance at the facility's entrance. He died a few days later.
After hearing about Jeanne's father, it was with trepidation that I agreed with my sister's suggestion that our mother, Ann Mason, 79, move to an "excellent" assisted living facility after several falls. Mom wasn't happy about giving up her place, even though she'd become somewhat isolated. But she soon became more active and now genuinely likes her new home at Newhaven Court at Clearview, in Butler, Pennsylvania. "You don't have to be lonely, unless you want to be," my mom says. "I can't wait for the concert with the 11-piece band!" Nurses regularly visit her, and when she first arrived the activities director insisted that she leave her apartment and socialize.
A 21-year prospective study published in the June 19, 2003, issue of the New England Journal of Medicine found that older adults without dementia at baseline who participated once a week in certain cognitive leisure activities-reading, playing cards, or playing a musical instrument-showed a reduction in the risk of dementia, some as high as 63%. Assisted living facilities should be offering these kinds of activities, and many do. At my mother's facility, there are more cognitive, social, and physical activities available than most residents have time for.
At a recent flea market at my mother's facility, I spoke to executive director Kathleen Brandenburg-Eury about the residents' newsletter that had reported on recent facility evaluations. The reports detailed both favorable aspects and those that needed improvement. "Well, I'm a nurse-a nurse practitioner-and we're a nurse-run facility, and our outcomes are excellent," Brandenburg-Eury told me. "We understand the importance of wellness, and that's what we're trying to promote. Whenever someone suggests that we replace the nurses [horizontal ellipsis] I argue that our RN staffing gives us a market edge."
But Jeanne pointed out that the director of her father's facility was a nurse. "Just having an RN as the director doesn't mean the facility will do the right things. The nurses who work in these facilities have to be grounded in a wellness-oriented philosophy," she said.
This month's Policy Perspectives looks at assisted living. Author Ethel Mitty, of the Hartford Institute for Geriatric Nursing at New York University, describes the differing definitions, regulatory requirements, and conditions of assisted living facilities across the nation. The article presents these facilities as prime settings for nurses' knowledge and skills and encourages us to take action in shaping the policies that will arise to regulate them. Accompanying Mitty's article is an interview with Brandenburg-Eury's nurse colleague Cynthia Schmidt, who discusses the barriers to bridging the gap between hospice care and assisted living.
My mother's facility feels like a home rather than an institution. Families and friends are encouraged to participate in activities like flea markets and concerts. When my nine-year-old niece visits, my mother and her neighbors light up. She represents extended family-which for many elderly people is a source of joy. Brandenburg-Eury understands that an intergenerational community is a vital part of promoting the health of the residents she serves.
My mother is fortunate to be in a facility that has a nursing philosophy of wellness.