If your adult parent has become increasingly frail and needs a high level of care, there's good news. For the last 20 years, nursing homes throughout the country have been replaced by cheaper and more homelike alternatives. Those are adult family homes and assisted living communities.
Do you know the differences between the two?
1. Size--An adult family home cares for as many as 6 residents--a higher number in some states. At least one or two caregivers are responsible for residents during the day, and one at night. Assisted living communities often have between 40 and 150 residents and have a lower staffing ratio: one caregiver to 12 or 15 residents with higher staffing for heavy care assisted living communities. They also have support staff including food services, activities, environmental services, etc.
2. Cost--Adult family homes in the Seattle area range from $4000 to $6500 or slightly more per month. Assisted living communities' monthly often start lower: at about $2000 for a studio plus care, but can go as high as $12,000 for someone on hospice.
3. Residents--Adult family home residents are generally frail, in walkers and wheelchairs. The small physical area is helpful to these elders who would have difficulty navigating the long halls of an assisted living community. Many residents in an assisted living community often can do much for themselves. Perhaps they only need medication management, help with a shower, meals and housekeeping. Some communities allow residents to "age in place," staying there until their growing needs become too great for staffing levels.
3. Care--Adult family homes often have an on-call Registered Nurse who trains staff to do tasks such as insulin injections and medication administration. These homes generally offer higher levels of care than assisted living communities, and can often care for residents through end-of-life. Assisted living communities vary widely in what tasks they can perform. Some can't serve residents who can't transfer by themselves or who need insulin injections or specialized diets. Other communities offer extremely high levels of care, and some also have a section devoted to memory care for residents with dementia.
4. Social Activities--Adult family homes generally offer activities tailored to their residents' special interests: puzzles, books on tape, live music, etc. A few adult family homes have traveling activity directors who lead residents in tea parties, craft-making sessions, flower planting, etc. Assisted living communities, with their generally more active residents, offer trips, tours, shopping, church services, etc.
Sometimes a resident could fit into either an assisted living community or an adult family home. For example, a woman I'm working with lives in an assisted living, and her family wants her to move closer to them. We thought about an adult family home, since she is 93 and has some dementia. But she is social, likes to know the news about everything, and enjoys a variety of caregivers and other staffers. So her family has chosen a smaller assisted living community, one that can offer heavier care when she needs it.
Do you have questions about the difference between adult family homes and assisted living?