Between Home and Nursing Home

By Mary Beth Franklin

The promises and realities of assisted living.

Over the past two decades, assisted living has emerged as an attractive alternative to nursing-home care. Ideally, assisted living provides a place where the frail elderly can live in a homelike setting while receiving help with daily needs, such as meals, medication and personal care. But opinions vary greatly over how well this goal is being accomplished. Like the blind men who offer wildly conflicting descriptions of an elephant depending on which part of the beast they touch, whether assisted living is successful depends on whom you ask.

Providers and supporters tout assisted-living facilities as the model for "aging in place"--offering older adults only as much help as they need and maximizing their independence for as long as possible. Critics call them nursing homes without nurses, promising care they can't deliver in understaffed facilities. With typical fees running from $1,000 to more than $3,000 a month (and usually little or no insurance to help foot the bills), choosing such a facility is a high-priced gamble.

Fortunately, there are some excellent facilities out there. The trick is to find the right one in the right location to suit your loved one's needs. With nearly 30,000 places to choose from, ranging from small, independently owned homes that care for a few residents to large, corporate-owned campuses that serve hundreds, you have to do your homework -- online, on the phone and in person.

So take off the blindfold and see the whole assisted-living beast for what it is: a place where your aging parents can live for a while -- perhaps for the rest of their lives, but not necessarily. As their needs outstrip the assistance available, they may be forced to leave and search for another home.

Home Hunting

In many ways, Anne Engerrand's story is typical. The fortysomething mother of two in Houston was spending more and more time worrying about her widowed mother, Gloria Walts, who lived alone two and a half hours away.

Walts, 77, was showing signs of dementia: forgetting names, getting lost, skipping her medications. Once a week, Engerrand would drive to her mother's home in San Marcos, Tex., to chauffeur her to doctors' appointments and on errands. The grueling routine convinced Engerrand that she had to find an alternative. She turned to the Internet, logging on to Senior Housing Net (www.seniorhousing.net) to begin her research and compile lists of facilities near her mother's home and her own. She downloaded helpful consumer checklists, such as the excellent guide offered by the Consumer Consortium on Assisted Living (www.ccal.org, or write to P.O. Box 3375, Arlington, VA 22203), to learn what to look for -- and what to look out for.

Then Engerrand started visiting facilities, first listening to the formal sales pitch and then popping back in unannounced. She liked to visit at lunchtime to chat with residents and watch them interact with the staff and one another. If a facility complained about the surprise visit, she immediately crossed it off her list.

"I used the consumer checklists and my gut instincts," Engerrand recalls. "If it didn't smell right, if the residents weren't happy, I kept looking." She wanted a place where her mother would be encouraged to remain active and not be treated as an invalid.

Ultimately, she chose Epoch Assisted Living, in Houston, which is a few miles from her home. It allows her daughters to stay overnight with their grandmother and permits residents to keep small pets. Her mother pays $3,800 a month for a one-bedroom apartment with a kitchenette and private bath. The monthly fee includes three meals a day, housekeeping, assistance with her medication, and use of an exercise room, whirlpool and round-the-clock wellness center.