The reasons for placing a loved one in an assisted living facility often boil down to one word: safety.
When a sick or frail family member can no longer care for him or herself, the safest place may be such a community, where both medical care and safety are provided. Assisted living facilities must adhere to strict requirements mandated by federal, state and local regulations.
“Each state establishes its own licensing, safety and care standards to ensure residents’ safety and well-being,” says Dr. Chuck Webb, a board member of the National Continuing Care Residents Association.
Keeping residents safe while allowing them some freedom isn’t easy, and safety programs do not follow a one-size-fits-all approach, says John Mastronardi, executive director of the Nathaniel Witherell, a short-term rehab and skilled nursing care center in Greenwich, Connecticut.
“Each resident has a personalized care plan because they still have a personality and preferences you want to pay attention to that can inform and drive the care plan. The crux of this is getting to the core of that person’s preferences if you possibly can, then tailoring a plan of care so that they can thrive as best they can, safely.”
When choosing an assisted living facility, it’s important to make sure that you look for one that is fully staffed and equipped with various tools to safeguard residents, such as preventing falls, wandering, infections and medication errors.
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Fall Prevention
Falling is one of the leading causes of fatal and nonfatal injuries among people ages 65 and older, according to the Centers for Disease Control and Prevention. In the past, those at high risk for falls were often restrained from moving, but the Centers for Medicare and Medicaid Services now precludes using restraints except where medically necessary.
Fall prevention begins at admittance, when the resident is screened for his or her risk of falling. The Agency for Healthcare Research and Quality also recommends rescreening quarterly, annually and when health conditions change.
To minimize risk, assisted living facilities:
1. Manage chronic and acute medical conditions carefully
Conditions like low blood pressure, Parkinson’s disease, arthritis, diabetes and many others increase fall risk.
“Most falls occur near the bed and in the bedroom. They might have low blood sugar, don’t realize it, get up too fast and end up falling,” Mastronardi says.
2. Schedule bathroom breaks and other potentially unsafe activities
Assisted living facility staff members consider their residents’ habits and activities of daily living — such as when they wake up, eat and use the bathroom — to identify any potential accidents.
“If they are an early riser, we would anticipate them being active early and make sure their needs are met for eating and toileting, and engage them in activities to keep them busy and not want to move around,” says Dr. Elaine Healy, medical director and vice president of medical affairs at United Hebrew in New Rochelle, a senior living campus in Westchester County, New York.
3. Provide physical and occupational therapy exercises
Engaging in exercises for preventing falls can help residents work on balance, walking gait and strength.
4. Clear pathways and remove potential hazards
Staff can fix, adjust or remove environmental hazards — such as beds, walkers, flooring, furniture and clutter — that may pose potential falling hazards.
In addition, they may use raised-perimeter mattresses for a safe sleeping environment to keep residents from rolling off the bed or trying to get off the bed.
5. Make sure personal items are safely within reach
This ensures residents don’t have to reach too far to retrieve these items.
“We want to hit the sweet spot that maintains the resident’s function while protecting them. It’s a continual process of assessment and planning,” Healy says.
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Wandering and Elopement Prevention
Also known as elopement, wandering into unsafe areas or out of the facility is a major concern for memory care residents with Alzheimer’s disease or other forms of dementia.
“It’s crucial to implement secure doors and identification systems to ensure the safety and proper monitoring of residents,” Webb says.
As with falling, each resident is assessed for risk of wandering and planned for accordingly.
Ways to prevent wandering and elopement include:
— Security equipment. Cameras and security systems at all entrances and exits.
— Monitoring. Checking on communal areas and residents’ apartments or rooms.
— Secure entrances and exits. Locked memory care units with doors that require special codes to open.
— Wander guards. Residents wear wrist bracelets that activate an alarm if they go past a detector at an elevator or staircase.
— Security awareness. The security stations have pictures of everyone at risk.
— Personal adjustments. Mastronardi remembers a resident who liked to walk so fast the staff had a hard time keeping tabs on him. “I said, why don’t we start a walking program with him. One of the nursing staff can walk with him at a specified time,” he said. “Yes it is more time-consuming, but it helped him tremendously. He didn’t get anxious and stressed.”
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Infection Prevention and Control
One of the main questions you should ask when looking for an assisted living facility is what their infection rates are. If they’re high, that’s a major red flag.
That’s because seniors are at high risk of serious complications from infection, and this was true even before COVID-19. Infections — such as the flu, colds, pneumonia and Clostridium difficile — can spread quickly in a skilled nursing facility.
“During the pandemic, we learned valuable lessons about minimizing and isolating virus outbreaks, both among our workforce and residents,” says Kathleen Dess, executive director of Essex Meadows in Essex, Connecticut. “We follow consistent protocols, ensuring that if anyone has symptoms or is unwell, they are asked to stay isolated in their apartment and we will bring them their meals and take care of their needs.”
Some facilities have dedicated personnel overseeing infection control. At Vi, a senior community with 10 facilities across six states, a designated infection preventionist is available at each site.
“We operate and hold ourselves higher than the strictest state and federal levels to ensure we are accountable to infection prevention,” says Melissa Evraets, vice president of resident care and chief nursing officer at Vi in Chicago.
Several measures, in addition to infection control, should be in place at facilities, including:
— COVID-19 and flu vaccination. COVID-19 and flu vaccinations are not mandated by the state, but most facilities strongly encourage residents and their staff to get them and take booster shots when needed.
— Hygiene. These facilities have been following the drill for years: regular hand-washing, sneeze/cough control and strict cleaning policies. Masks and other personal protective equipment are now regularly used as well.
— Surveillance. Healy says they monitor CDC and state Department of Health advisories about flu in the community to stay aware of outbreaks, as well as monitor residents and staff for symptoms of flu.
— Wellness and health centers. Some facilities offer on-site wellness and health centers, staffed by health care professionals, that offer prevention check-ups, including free vaccinations for flu, COVID-19, shingles and pneumonia.
Avoiding Medication Errors
The professional staff at assisted living facilities are overburdened due to staff shortages and may rush through tasks, increasing the likelihood of making medication mistakes,
such as administering the wrong medication, incorrect dosages or failing to give medications at the proper times.
“Without adequate training, staff may also struggle with handling complex medications or recognizing side effects,” explains Webb.
Medications should also be adjusted to minimize side effects like dizziness and drowsiness that can lead to unnecessary falls.
Because medication needs typically change as the resident’s age, the team will usually step in to work closely to manage and organize medications to avoid adverse interactions with other drugs or foods that shouldn’t be mixed with prescriptions. Most facilities work with consulting pharmacists in more complex situations.
“We offer medication reminders, ensuring residents stay on track with their prescriptions, especially when cognitive decline may make it harder for them to remember,” Dess says.
Preparing for General Emergencies
In cases of heart attacks, strokes, major falls or other sudden health crises, prompt and competent responses are critical. Understaffing means fewer aides are available to recognize and act on emergencies quickly. This delay can result in worsened health outcomes.
Similarly, in the case of a fire, natural disaster or evacuation situation, insufficiently trained or inadequately staffed teams may struggle to act efficiently. Delays or errors in evacuating residents, administering first aid or even notifying the appropriate emergency services can put residents at grave risk.
“By prioritizing emergency preparedness and proper staffing, assisted living facilities can provide residents with the highest level of protection in times of crisis,” Webb says.
Bottom Line
The decision to place a loved one in an assisted living facility is often motivated by safety concerns. When individuals can no longer care for themselves due to illness or frailty, assisted living provides a safer environment with medical support and safety protocols. These facilities are required to meet strict safety standards, with each individual’s needs taken into consideration when developing a safety protocol.
To ensure resident safety, assisted living communities focus on preventing falls, wandering, infections, medication errors and emergency preparedness. Each of these areas is continuously assessed and adjusted to keep residents safe while maintaining their independence.
To find the best assisted living facility for your loved one, check out U.S. News’s Best Assisted Living rating to explore community options in your area. The ratings analyzed data from approximately 400,000 residents and families from more than 3,500 senior living communities across the country and evaluated satisfaction rates on safety, caregiving, management, staff, food and dining and activities.
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Safety Measures at Assisted Living Communities originally appeared on usnews.com
