The reasons for placing a loved one in an assisted living facility often boil down to one word: safety. When a sick or frail individual no longer can care for him or herself, the safest place may be such a community, where both medical care and physical safety can be assured.
Assisted living communities have numerous tools – some mandated by state and federal guidelines, some by individual rules – to protect their residents. There are numerous safety concerns, but the top three are:
- Infections, including COVID-19.
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.”
The Centers for Disease Control and Prevention names falls as one of the leading causes of fatal and nonfatal injuries among people age 65 and older. 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:
- Adjust medication to minimize side effects like dizziness and drowsiness. “We have a consulting pharmacist look at their meds, and at least monthly we try to trim them when we can,” 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.
- 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.
- Schedule bathroom breaks and other potentially unsafe behaviors. “We look at residents’ habits. 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,” Healy says.
- Provide physical and occupational therapy. This can help residents work on balance, walking gait and strength.
- Fix, adjust or remove environmental hazards, such as beds, walkers, flooring, furniture and clutter. For example, “We may use a raised-perimeter mattress to keep them from rolling off the bed or trying