- 15 December, 2005 -

Although nearly 31 percent1 of aging residents do not need assistance with daily living and are quite independent, others do need the additional care that an assisted living facility (ALF) provides and sometimes more. As residents age and the longer they reside at a facility, they tend to use more of the daily living services. In some cases, residents need help with daily living beyond the maximum care an ALF can provide. In this case scenario, private care is outsourced either by the elder resident, their family members or through a referral by ALF staff. Medical and Non-medical Care Outsourced care comes in different forms for different requirements. A resident may need a home health aide to assist with a medical condition such as insulin injections for diabetes. Or the resident may need help with hygiene, shopping, excursions or housekeeping activities such as folding laundry, fixing snacks or tidying of living space. Residents, in particular those without family nearby, might desire a caregiver that serves as a familiar face for assistance and companionship -- someone to be there for fall prevention or someone to read to them, talk with them or share a laugh and a cup of tea. Whatever form of outsourced care is used, continuity of personnel is important and using caregivers that know the ALF's system is even more essential. Unfortunately, many agencies providing medical care do not require that the same caregiver report to the same residents on an ongoing basis, which is partially due to inadequate staffing. Quite often, nurses or home health aides rotate duties -- even rotate facilities -- and residents receive care from whomever is available a particular day. Secrets to Success for Working with Agencies In addition to home healthcare and nursing agencies, there are private homecare agencies that provide nonmedical care to residents. A private homecare agency assists residents with non medical daily living activities and offers companionship and familiarity. Most often, there is one caregiver focused on one resident on an ongoing basis. Private homecare provides the much needed continuity and builds a bond between resident and caregiver. Identify the Lead Agency When residents are receiving outsourced nursing or private homecare, the key to ensuring a smooth interface with ALF staff and providing the best possible service to the resident is to clearly identify the lead agency. This will prevent duplication or omission of services while ensuring the resident receives the best care. Agency confusion -- each agency believing the other agency or the ALF is accountable for a particular duty, such as medication reminders -- doesn't benefit anyone. Not knowing who is responsible reflects badly on the agency and the ALF, and ultimately the resident loses out. In the case of medication reminders, a resident's well-being could be compromised. When residents need or choose additional care, it must be clearly documented exactly who is in charge of scheduling and communication between the ALF and agencies. Share Information The ALF coordinator should discuss and share facility protocol with each outside agency involved with a resident. Agency contact information and specific caregiver information should be obtained, documented and shared. This details responsibility of each agency -- the facility, the home health agency and the private homecare agency -- and effectively establishes a plan of action while opening the lines of communication. Several important ALF systems that should be discussed include: The systems within the ALF for obtaining appropriate non-routine care for a resident. The ALF protocol for dealing with care and comfort plans (CCPs) or do-not-resuscitate (DNR) orders. The importance of communication between the ALF nurses and staff and any outside caregiving agency to ensure everyone is kept in the loop regarding health status of a resident. The ALF protocol when an elderly resident hires a caregiver. Above all, it is crucial for the ALF and caregiving agency to realize they are working toward the same goal, which is the health and well-being of residents. Assessing Resident Needs and Risks Because health, mobility and mental clarity are life components that cannot be predicted, the ALF should continually reassess care and risk management of assisted living residents. This is where medical, functional, emotional and social needs are addressed with care management. Important questions need to be answered. Does the resident need a registered nurse or home health aide to assist with a medical condition or hygiene? Does he or she have transportation needs? Can the resident still take care of housekeeping? Is the resident lonely or depressed? Is the resident interacting with others? Risk management assesses a resident's personal safety. The facility determines whether or not a resident should be allowed to do certain independent activities. Can the resident walk up or down stairs unassisted or manage the elevator? If they can't do either, should they be allowed to travel the facility unassisted or should they have a companion? An Ideal Arrangment Assisted living offers seniors an ideal living arrangement -- a degree of independent living with the benefits of shelter, security and meals. But perhaps the most significant benefit is assistance with daily living, either in-house from the ALF or from an outside agency. To maintain a quality independent living arrangement, there must be open communication and a clear chain of command between the ALF and any caregiving agency to give residents and their families peace of mind. Nate Murray, MSSW, LICSW, is the director of Visiting Angels, providers of private home care, nonmedical living assistance and companion services. For more information, e-mail: visitingangels@personalchange.net.

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