End of life refers to the assistance provided to patients who are in the last months or years of their lives (‘What End of Life Treatment Includes – End of Life Care Guide – NHS Options’, 2017) and the aim is to ensure that before they die, the person can have a good quality life. The word is widely used to identify people who survive for less than 12 months and suffer from an incurable illness such as dementia, or who are likely to die within one year under general circumstances. On the other hand, assisted living centers are becoming popular for the end of life care with over 1.4 million Americans living in these facilities in the year 2014. These centers provide services such as medical monitoring and daily activities such as dressing, housekeeping, laundry, bathing, and shopping. The aim is to provide the best care to the senior individuals and make sure that they enjoy their final moments of life.
A major issue related to end of life care in assisted living centers (ALC) is the provision of hospice care. Making arrangements for hospice care (medical, psychological, and spiritual end of life care and support provided by a team of medical professionals and volunteers) is difficult because States such as Idaho and Montana do not allow the provision of these services to these ALCs. Also, other states only allow the current existing seniors to access the hospice services, but any new ones are rejected. Graham (2012) posits that the level of help available in these centers is not enough for seniors who are chronically ill and requires extensive medical care. In most situations, the family members have to hire a live-in caregiver to address the needs of the old individual because the staff is overwhelmed by their chores.
The psychological turmoil the families of these senior residents go through is intensified by the fact that arranging for caregivers is expensive and the fact that Medicare does not cover for assisted living expenses. In such situations, the seniors will most likely not receive medication such as opiates to relieve their pain. Some researchers point out that many of these residents suffer from psychological issues such as increased depression and anxiety, low sense of self-worth, loneliness, and increased confusion. The above factors raise a concern to whether the ALCs provide a high quality and enjoyable lifestyle to these individuals nearing their death.
Another issue in end of life care in ALCs is the lack of state and legal oversight. ALCs are treated as non-medical, and therefore, they are not regulated by the federal of state governments. Therefore, it is up to the management of the center to develop rules, and the effect is that each and every center has its set of standards. The federal and state government have also failed to provide sufficient resources to improve the oversight on the ALSs and tackle the challenges of inadequate staff and training. The effect is that most centers have small medical staff and are ill-equipped to deal with the senior individuals who need regular assistance and medical attention. The states are slow to adapt to these challenges facing ALCs, and the seniors end up having a miserable end of life experience.
The lack of oversight and regulation has resulted in the increased cases of abuse in the ALCs. Cases of seniors suffering from fractures, sexual assault and harassment, and neglect of staff have been reported yet no legal action is taken. Of greater concern is that the family members are not informed of these cases and the neglect might in extreme cases lead to death. The staff has faced accusations of emotionally abusing the residents with the severe conditions such as dementia. The caregivers also sexually abuse these senior residents, and the real concern is that they are unable to report these cases to either their families or law enforcing agencies. A report titled Residential Care in California: Unsafe, Unregulated, and Unaccountable shows that the cases of death that result from neglect and abuse are on the rise in ALCs. The disappointing thing is that the state governments take little action because they have not devoted any resources towards the inspection of these centers.
Graham, J. (2012). Assisted Living vs. Hospice: Who’s in Charge?. The New Old Age Blog. Retrieved 14 May 2017, from https://newoldage.blogs.nytimes.com/2012/11/16/assisted-living-vs-hospice-whos-in-charge/?_r=0
What end of life care involves – End of life care guide – NHS Choices. (2017). Nhs.uk. Retrieved 14 May 2017, from http://www.nhs.uk/Planners/end-of-life-care/Pages/what-it-involves-and-when-it-starts.aspx