Skip to main content

Rights and Dignity of Seniors in Assisted Living: A Victory

An unfortunate practice has been tolerated for too long at some continuing care retirement communities (CCRs). CCRs provide housing and services for seniors, often with a wide range of needs. Residents who are fully independent may be in one part of the CCR, while residents who are disabled and need assistance may live in the assisted living wing. Often over time, a resident will transfer from the independent to the assisted living wing.

But many CCRs needlessly go way beyond separating the housing units for independent and disabled seniors. They completely separate independent seniors from those who need assistance, sometimes actively preventing contact between these groups. In these facilities, the independent and assisted living seniors eat in different facilities and participate in completely different social activities. They may never see each other.

Many of the facilities claim that health needs dictate this segregation. But the need for this level of segregation is seldom justified on health or clinical grounds. Some have alleged that one reason for this segregation is marketing. The housing communities want to portray the seniors in their independent living facility as active and vigorous. And seeing disabled elders in the dining room may force the non disabled to confront their fear of aging and disability.

It is bad enough that many facilities minimize interaction and socialization between independent and assisted living seniors. But particularly egregious is what happens to seniors who start on the independent side of the community, but then become frailer and move to the assisted living side. They are no longer permitted to dine in the "independent living" dining room and they are no longer permitted to participate in the independent living social activities. I have heard of situations in which the grounds of the independent living wing are practically off limits to those in the assisted living wing.

So at the same time an older person is trying to cope and adapt to new needs for assistance, they are ripped away from their social networks and friends--and sometimes even their spouses.

In the community my Grandmother lived during the last 5 years of her life, the independent residents would talk about neighbors who had gone over to the "other side". I was always really proud that my Grandmother visited her friends on the assisted living side. She even organized a weekly bridge game in the assisted living wing. Her loyalty to her friends was one of many things that made her special.

But it should have been much easier. There should have never been an "other side." There was no medical reason why the move to assisted living should necessitate this degree of social separation. Her friends should have still had a seat at their old dining table and at their favorite bridge game.

But recently, some courageous seniors have begun to fight back. As reported by Paula Span in a series of posts on the New York Times New Old Age Blog (here and here) an upscale retirement community told residents in the assisted living wing that they no longer had a seat at the table in the independent living dining room. Many had eaten in this dining room for years. But the facility then banned assisted living residents from the independent living dining room. In some cases, assisted living residents could no longer share dinner with their independent living spouses. Assisted living residents were also banned from social activities in the independent living facility.

But these seniors reminded us that just because you need some help does not mean you are a pushover. They and their families fought back. They protested to board members and hired an elder care attorney. And by calling Paula Span, they shined a national spotlight on their plight. In the end, the retirement community did the right thing. Residents can once again eat in any dining room. 86 year old Dorothy Evans summed it up best: "Don't mess with us." Bravo!

So we should all give a big thank you to these seniors who have won an important victory for the rights of persons in assisted living. And thanks to Paula Span for telling this story.

For now, this is just a local victory, but it will hopefully spur a national movement.

by: Ken Covinsky (@geri_doc)

Comments

Sara said…
This practice is demeaning and unnecessary. It also violates peoples rights under the Americans with Disabilities Act. The place my Mom lived in allowed people to stay in their same apartments as the went from independent living to assisted living and yes, sometimes, back to independent living. That's the way it should be.
Dan Matlock said…
More advocacy for frail elders...I love this important stance that is a recurrent theme on geripal.
Few of the reasons why elders do not want to move to nursing homes and assisted living facilities are that they want to keep their dignities and that they are afraid that their rights may be violated in these care setting. It's such a relief to know that there are people exerting effort so that seniors can keep these and they are senior residents themselves. Kudos to senior power!

Popular posts from this blog

The Future of Palliative Care: A Podcast with Diane Meier

There are few names more closely associated with palliative care than Diane Meier.  She is an international leader of palliative care, a MacArthur "genius" awardee, and amongst many other leadership roles, the CEO of the Center to Advance Palliative Care (CAPC).  We were lucky enough to snag Diane for our podcast to talk about everything we always wanted to ask her, including:
What keeps her up at night?Does palliative care need a national strategy and if so why and what would it look like?The history of CAPC and the leadership centersAdvice that she has for graduating fellows who want to continue to move palliative care forward as they start their new careersWhat she imagines palliative care will look like in 10 or 15 years?What is the biggest threat facing palliative care? So take a listen and if you want to dive a little deeper, here are two articles that we discussed during the podcast:
A National Strategy For Palliative Care. Health Affairs 2017Palliative Care Leadership…

Advance Care Planning before Major Surgery: A Podcast with Vicky Tang

This week's podcast is all about the intersection of geriatrics, palliative care, advanced care planning and surgery with our guest Dr. Vicky Tang.  Vicky is an assistant professor and researcher here at UCSF.  We talk about her local and national efforts focused on this intersection, including:
Her JAMA Surgery article that showed 3 out of 4 older adults undergoing high risk surgery had no advance care planning (ACP) documentation. Prehab clinics and how ACP fits into these clinicsThe Geriatric Surgery Verification Quality Improvement Program whose goal is to set the standards for geriatric surgical care including ACP discussions prior to surgeryHow frailty fits in and how to assess it (including this paper from JAGS on the value of the chair raise test) So take a listen and check out some of those links.  For those who want to take a deeper dive into how GeriPal and surgery fit together, check out these other podcasts: Zara Cooper on Trauma Surgery, Geriatrics, and Palliative Car…

Psychedelics: Podcast with Ira Byock

In this week's podcast, we talk with Dr. Ira Byock, a leading palliative care physician, author, and public advocate for improving care through the end of life.

Ira Byock wrote a provocative and compelling paper in the Journal of Pain and Symptom Management titled, "Taking Psychedelics Seriously."

In this podcast we challenge Ira Byock about the use of psychedelics for patients with serious and life-limiting illness.   Guest host Josh Biddle (UCSF Palliative care fellow) asks, "Should clinicians who prescribe psychedelics try them first to understand what their patient's are going through?" The answer is "yes" -- read or listen on for more!

While you're reading, I'll just go over and lick this toad.

-@AlexSmithMD





You can also find us on Youtube!



Listen to GeriPal Podcasts on:
iTunes Google Play MusicSoundcloudStitcher
Transcript
Eric: Welcome to the GeriPal Podcast. This is Eric Widera.

Alex: This is Alex Smith.

Eric: Alex, I spy someone in our …