For families with a loved one who has Alzheimer's disease or other dementia, assisted living facilities hold out significant promise. First, they are thought to provide oversight, supervision, and assistance with personal care for persons with cognitive impairment but to do so in a less regimented and more "normal" or homelike setting than that found in many nursing homes. Thus, residents may live in apartments or rooms in which they have their own personal furniture and other possessions and which look less like a traditional health care facility. Second, assisted living facilities may provide a more appropriate level of care for persons with cognitive impairment who are still without significant limitations in the activities of daily living (ADLs). Thus, for example, elders who need help with medications, supervision for safety, and help with only bathing and dressing, may be more appropriately cared for in assisted living facilities than in nursing homes which typically house residents who have greater levels of ADL limitations and who need daily nursing care or oversight. Third, assisted living facilities provide an environment in which family members could live with the loved one who requires more care and supervision that the family member could reasonably provide in their own homes. Finally, many assisted living facilities offer families the possibility that the loved one can "age in place." Thus, families often expect that the facilities will adjust their care patterns and service provision to meet the changing needs of the loved one with Alzheimer's or another dementia.
Available evidence suggests that many assisted living facilities are, in fact, providing care to substantial numbers of persons with cognitive impairment. Operators of assisted living facilities, even those that do not advertise themselves as having a specialized Alzheimer's care unit, estimate that between 30 and 40 percent of all residents have some level of cognitive impairment. A recently completed study of board and care homes, which included many assisted living facilities, provides evidence that supports this perception. The study of more than 3200 residents in 500 facilities in 10 States found that an estimated 40 percent of residents had moderate to severe cognitive impairment (Hawes et al., 1995).
Given the increasing importance of assisted living as a source of long-term care for persons with Alzheimer's and other dementias, it is important to learn how well these facilities perform and what role they play in the repertoire of long-term care services and settings. One of the first step in such an endeavor is determining what families and elders expect from assisted living and how the define "quality" in this setting. The Alzheimer's Association, therefore, provided support for study that examined the views of family members of loved ones with dementia who are current residing in assisted living facilities.