Why Assisted Living Care Is Not What It Used to Be

This article is an excerpt from the Shortform book guide to "Being Mortal" by Atul Gawande. Shortform has the world's best summaries and analyses of books you should be reading.

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What is assisted living? Why is it so hard to find institutions that provide assisted living care?

It’s easy to find organizations called “assisted living” facilities. However, these facilities fail to provide care that lives up to the original assisted living model. According to Atul Gawande, the author of Being Mortal, this is because the assisted living model of care is at odds with institutional priorities.

Here’s why the original assisted living model of care is not widely practiced, according to Gawande.

Assisted Living Model of Care

The original assisted living model of care was designed in the 1980s to promote personal freedom. Residents could live in a comfortable space and direct their own lives—they could choose when they wanted to sleep, what they wanted to eat, and so on.

Early studies of assisted living care facilities found that residents had improved cognitive and physical health, higher levels of satisfaction, and less depression than those who stayed in nursing homes. 

(Shortform note: The founder of the assisted living model of care describes three distinctive features of the model: having a home-like environment, providing daily needs and health-related services, and emphasizing the personal autonomy of the residents over their own time, space, possessions, activities, and medical care. Home-like environments have become increasingly common in nursing homes, and providing services has always been a core component of the nursing home model. Therefore, the most distinctive feature of assisted living is personal autonomy. Recent studies show that care facility residents—whether in assisted living facilities or not—are healthier and happier when they feel they have autonomy.

Despite its success, this alternative assisted living model of care is rarely practiced today, though many institutions use the name. According to Keren Brown Wilson (the founder of the model), its failure exposes the ongoing difficulties we face in supporting the deeper needs of the elderly: Institutional priorities—regulations, profits, performance goals, and so on—aren’t aligned with the priorities of the residents.  

For example, metrics like blood pressure stats and injury reports often become the gauge of an institution’s success. Since independent people (the elderly included) often minimize their health and safety in favor of doing things they like, such metrics discourage organizations from giving residents autonomy. For instance, an elderly person may not be allowed to go on a nature walk due to the risk of falling. Despite their good intentions, institutions often sacrifice personal freedom and a sense of meaning in support of health, safety, and the bottom line. 

How to Evaluate Assisted Living Facilities

How can you determine if a particular assisted living institution will meet the needs and priorities of your loved one? 

Experts suggest that you evaluate whether facilities prioritize the needs of residents by looking at a few key indicators, such as residents’ quality of life, family satisfaction, and staff attentiveness and job satisfaction. Residents should have the ability to practice their religion, enjoy the food, exercise, and feel connected to others. The families of residents should be satisfied with the care their loved ones receive. Staff should be responsive and attentive and not report major concerns with their working environment and culture. 

Researching these and other indicators can help you determine if a particular assisted living community is right for you or your loved one. 

Why Assisted Living Care Is Not What It Used to Be

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  • What it's like to age and die in the 21st century
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Darya Sinusoid

Darya’s love for reading started with fantasy novels (The LOTR trilogy is still her all-time-favorite). Growing up, however, she found herself transitioning to non-fiction, psychological, and self-help books. She has a degree in Psychology and a deep passion for the subject. She likes reading research-informed books that distill the workings of the human brain/mind/consciousness and thinking of ways to apply the insights to her own life. Some of her favorites include Thinking, Fast and Slow, How We Decide, and The Wisdom of the Enneagram.

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