Declarations of independence

Need for assisted living facilities is growing with aging population

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It's no secret we're all getting older -- and so are our parents.

In increasing numbers, baby boomers are finding themselves sandwiched between caring for their aging relatives and becoming grandparents themselves. To ease the burden of everyone involved, many elderly in Allegheny County -- and nationwide -- are making the move to an independent living facility.

Generally, an independent living facility allows its residents to live on their own in an apartment-type unit, while still having 24-hour assistance with daily living.

Services vary from place to place, but residents normally require help with at least one of such daily activities as dressing, eating, transportation, general movement and keeping track of their medications.

"In the past, these facilities were thought of as nursing homes." said Ray Landis, advocacy manager for AARP in Harrisburg. Now, elderly people are choosing long-term care as consumers who want to be independent for as long as possible.

"I think it's a national trend," he said,

Waiting lists

A 2006 census update estimates that 22 percent of the Allegheny County population is over 60, and that there are about 6,000 more seniors over age 85 than there were in 2000.

A forecast by the University of Pittsburgh Center for Social and Urban Research predicts that the number of people ages 65 to 84 will increase from 170,000 in 2012 to about 200,000 in 2020. These numbers will continually increase. The number of those 85 and above will stay at about 190,000.

In Allegheny County, assisted living facilities are having no problems filling beds. Many have waiting lists, making it difficult for those who need a place quickly.

The average age of entry for many communities is 88 to 90, much older than 10 years ago, when the average age was from the late-70s to mid-80s. Jim Pieffer, senior vice president at Presbyterian Senior Care, said this is because of improved home care and medications.

At the four Presbyterian Senior Care facilities offering assisted living arrangements, the average waiting list is 60 to 90 days, said Pat Kornick, director of communications. There are a combined 300 residents in assisted living communities in Washington, Oakmont and New Wilmington. The waiting time depends on the specialty of care and varies by community.

A national problem

There is a longer list for those with dementia, said Mr. Pieffer. He added that in the late 1980s, most independent living facilities were run by nonprofit organizations. In the 1990s, there was an explosion in for-profit facilities.

Barbara Kolonay, owner of Options for Elder Care, assists several families with relocating a senior to an assisted living facility. When there is a waiting list at a client's first choice of facility, she can recommend adequate temporary assisted living that may not be as desirable, usually because of location.

A geriatric care manager and registered nurse with geriatric nursing experience, Mrs. Kolonay closely examines all aspects of a facility. Location, she said, is a factor that most greatly affects a family's choice of facility.

She has one client with Alzheimer's who, for a year, has been ninth on a waiting list to be in the same assisted living facility as his wife. He currently is in a facility in a nearby community.

"This is a national problem," she said.

Redstone Highlands in Murrysville currently has a waiting list for those wanting to move into one of its 44 assisted living units. It's unpredictable just how long a wait may be, said Linda Dickson, corporate marketing consultant for Redstone.

"Sometimes, we can go through a wait list rather quickly ... we can't predict when units will become available," she said, adding that they give regular updates to those on the list.

In addition to assisted living, Redstone offers personal and nursing levels of care. The goal is to give residents in all levels peace of mind knowing that they could move within the community should their needs change.

At Atria South Hills in Baldwin, there are 90 seniors living in a facility with 99 apartments. While it has no waiting list, there are waiting lists at other Atria communities across the nation, according to Beth Bryant, a public relations representative for Atria.

"According to the U.S. Department of Labor, overall employment for the assisted living industry is expected to grow much faster than average through 2014 due to an aging population," she said.

State regulation coming

According to Chuck Keenan, housing coordinator for the Allegheny County Department of Human Services, it's impossible to track the specific number of independent living facilities in Allegheny County or anywhere else in Pennsylvania because they are not licensed by the state.

In July, the General Assembly passed legislation to regulate assisted living. Those regulations are expected to be written by the Department of Public Welfare in the next year. Until then, anything in Pennsylvania calling itself an independent living facility is officially regulated as a personal care home.

"Medicaid does not cover costs of assisted living once the [individual's] money runs out," said Mr. Landis, of AARP.

When the state has its laws in place, it can apply to the federal government for a waiver to get Medicaid payments for these facilities.

"This is one reason why Pennsylvania so desperately needed to pass assisted living regulations," said Mr. Landis.

According to Health Policy and Tracking Services, the average cost of assisted living is from $2,000 to $2,900 per month. Rates vary depending on services, location and types of accommodations.

At Presbyterian Senior Care, the average cost ranges from $80 to $100 a day. For residents with dementia, that cost will increase from $30 to $50 more a day said Mr. Pieffer. At Atria, the flat rate for an apartment is $2,500 per month with increased rates as services are added.

If a senior living in the Redstone Highlands community should need additional, more-expensive health services -- and the money is depleted -- he or she will not be turned away. Through a charitable care fund, Redstone Highlands is able to continue care for their residents, Ms. Dickson said.

"You have that security of knowing you will be cared for," she said.

Where to start

So what do daughters and sons do for their aging parents when faced with so many decisions in difficult situations?

Ideally, older family members should have a discussion with their children or caretakers before they are in a crisis situation and faced with quickly making a decision of where to go, said Mr. Landis. The AARP Web site recommends hiring a geriatric care manager if it is affordable. They will be able to research your best options with unbiased opinions. It's also a good idea to visit about three facilities.

Ms. Kolonay suggested that families find out who is running a particular facility. Is it run by a social worker or someone with more of a marketing background? She said that in her experience, social workers tend to be more in tune with a resident's needs.

Find out whether the staff has more of a medical background or a business background. For example, if the activities director is a degreed specialist, he will encourage a variety of activities to stimulate different parts of the brain. Someone else, while caring and kind, might not have the background to know how to vary activities effectively.

What to look for

At the top of the AARP checklist is knowing how much independence residents are permitted, said Mr. Landis. Make sure your senior will have a roommate only if he or she wants one. Are there lockable doors to the units? Look into safety issues such as handrails in bathrooms and security and fire safety alarms. Inquire whether there are trained medical personnel on site 24 hours a day.

Too often, he explained, families are looking for a facility in a crisis situation.

"When a patient is discharged from a hospital, often the hospital says you must go 'here,' " he said.

Patients have the right to look at a facility, and they don't necessarily have to take the first recommendation.

If you're in a hurry and there is a wait, try to stretch out a hospital stay for another day so you have choices, he added.

With the holidays approaching, Mr. Pieffer, of Presbyterian Senior Care, recommended initiating a conversation about future accommodations for older relatives at a family gathering.

"Most seniors are happy to talk about it. It's their kids who are afraid," he said.

Laurie Bailey is a freelance writer.


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