A National Study of Assisted Living for the Frail Elderly: Final Summary Report. ALF Residents


The residents in the high privacy or high service ALFs were largely white, widowed females, who were quite elderly. More than one-half of the residents were 85 years of age or older. ALF residents were relatively well-educated; 45 percent had completed at least some college. They were also relatively affluent. Most entered assisted living from their own home or apartment (70 percent) and made the decision with help from someone else (90 percent), almost always their adult children. However, one-quarter of residents indicated that they had little or no control over the decision to enter a facility.

Residents in ALFs Offering High Services or High Privacy

  • One-half were aged 85 or older
  • Largely white, widowed females
  • Educated, relatively affluent
  • About 1/4 had significant cognitive impairment
  • Half received help with bathing, and one in five received assistance with some other ADL
  • Most (77%) received help with medication management
  • About 1/3 were sometimes incontinent
  • Two in five reported themselves in fair or poor health

Over one-quarter (27 percent) of the residents suffered from moderate or severe cognitive impairment, one-half of residents (51 percent) received assistance with bathing, and one-fifth of residents received assistance in some other ADL. The overwhelming majority (77 percent), however, received help with their medications, and many residents used assistive devices, especially to help with ambulation or locomotion. Almost one-third (32 percent) experienced urinary incontinence. Two-fifths of the residents considered themselves in only fair or poor health, and, in the year prior to their interview, they used inpatient hospital services at rates much higher than the general population.

Residents were relatively satisfied with the attitudes of staff and how staff treated them (e.g., with respect and affection), although some residents (i.e., between 12 percent and 26 percent) who received help with ADLs reported some problems with unmet needs. Overall, however, residents’ greatest points of concerns about staff were related to inadequate staffing levels and high staff turnover. There was also some concern about the adequacy of activities. Residents were split almost evenly in their perceptions of the availability of activities they enjoyed and on the availability of transportation to events they might enjoy. One of the more unsettling findings concerning activities was that almost three-fifths of the residents (59 percent) indicated that ALF staff never or only sometimes asked them about their activity preferences.

Assisted living residents in ALFs classified as providing high services or high privacy were almost equally likely to be found in accommodations consisting of a full apartment or only a bedroom. The majority (81 percent) had a private living space or shared it with a related individual; however, nearly one-third of the residents did not have a private full bathroom. Most residents (i.e., more than three-quarters) also had other types of autonomy over their environment, such as ability to lock their doors, furnish their apartments and arrange the furniture as they wished, and control the temperature in their room or apartment. Only about half, however, had a refrigerator and only about one-third had personal space for cooking. Most had access to key supportive devices, such as call buttons and safety railings in the bathroom.

Residents' Perceptions About ALFs Offering High Services or High Privacy

  • Generally felt they were treated with respect, affection and dignity
  • Were relatively concerned about staffing level and high staff turnover
  • Were somewhat rarely asked about their activity preferences by facility staff
  • 12% of residents who received help with locomotion and dressing and 26% who needed help with using the toilet reported having unmet needs for assistance
  • Nearly all (98%) believed they would be able to stay in the ALF for as long as they wished
  • More than 2/3 were uninformed about facility policies on retention & discharge

When they needed temporary nursing care, they were most likely to receive it from the facility staff; however, one-third of the residents who needed such care were either discharged to a hospital or nursing home or, with help from family members, arranged for home health services themselves. Finally, less than one-third of the residents reported being informed by the facility about the discharge and retention policies. Despite this, the vast majority of residents expected to be able to stay in the facility for as long as they wished.

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