Employment as a caregiver in an assisted living community can provide many rewards, but like employment in any industry, true job satisfaction in assisted living comes from working with people who have shared values, goals, objectives, and philosophies about serving the elderly, and in being compensated in a way that is commensurate with your contributions and commitments to these shared values.

In recent years the term Assisted Living has been frequently used to describe so many different housing and care options that it has come to mean many things to many people. As government, seniors, their families, and society in general begins to transition or accept the shift from the "medical model" of a traditional long term care setting to the "social model" of assisted living it is important to understand and some of the commonly held principles and philosophies of assisted living so that you can make an informed decision on whether assisted living is right for you.

The Social Model Defined

The contemporary definition of the "social model" is one which acknowledges that the underlying the approach to delivering services in the assisted living environment focuses upon upholding prevailing cultural norms, lifestyles and values of older persons. It preserves and respects the following commonly accepted principals (sic) of assisted living:

1. Individuality is defined as recognizing variability and individual nature of each resident’s needs and preferences and demonstrating a flexibility to organize a wide range of service possibilities in response. It is holistic by nature.

2. Independence is defined as identifying each individual resident’s unique attributes, and abilities and facilitating use of those abilities to the broadest extent possible in developing and delivering services.

3. Dignity is defined as providing support in such a way as to validate the self-worth of each individual. It is supported programmatically by services and amenities that are responsive to attitudes, beliefs and values of each resident.

4. Choice is defined as creating viable options for residents that enable them to exercise greater control over their lives. It s supported by programs and approaches which encourage maximum resident involvement and direction in selection, scheduling, and methods of service delivery.

5. Privacy is defined as specifying living areas that are not shared, other than by personal choice, and over which the resident maintains a maximum degree of control.

6. Home is defined as a living environment which creates to the greatest extent possible an atmosphere which most closely resembles the residents personal definition of a comfortable safe, aesthetically pleasing, non institutional, and socially cohesive place.

The Benefits of the Social Model

Anticipated benefits to staff include increased morale, reduction in staff turnover and absenteeism, improved understanding of staff expectations with respect to resident capabilities and potential, improvement in staff accountability, and increased personal satisfaction of staff and the residents because of the increased interaction and the more personalized relationship between staff and residents.

The anticipated benefits to the residents include reduction of confusion, memory loss and withdrawal, increased ADL functioning, a reduction in medication usage, limitation of the fragmentation of care and services to the resident and a renewed emphasis on the resident as a whole person adapting to, and aging in place in a new environment.

The social model reinforces the idea that the Residents' skills, interests and needs dominate and direct the decision making about and implementation of staff roles, goals and responsibilities in their interaction with each Resident. If successfully implemented a partnership will develop between the staff members and each Resident in which they share accountability for the Resident's evolving role as an aging resident of the assisted living community.

The social model stresses that The "Care" component is helpful in nature and does not foster dependency. It is care that is whole-person oriented and, intentionally does not fragment services to a Resident into convenient categories of tasks that ignore the individuality of the Resident, as is frequently the case in the traditional long-term care setting.

It emphasizes a balanced relationship being established between each Resident and the caregiver that is based upon respect for each residents’ abilities, attributes, and rights, needs and preferences. This means that the caregiver interacts on an equal basis with the Residents as contrasted with the traditional staff-resident interaction where the staff member, (usually a nurse) initiates, controls and terminates the interaction with a Resident.

The prospective caregiver recognizes that, in the absence of a balanced relationship, a resident predictably will become dependent and passive and will exhibit such behavior as increasing dependencies, loss of decision-making skills, cognitive diminishment, loss of verbal and other social skills, isolationism, regression and withdrawal.

A successful caregiver will acknowledge and embrace in an affirmative manner, the importance of "resident-centered care", and the emerging role of the residents, as individuals aging in place.

The entire assisted living community staff benefits from social model of care delivery by their increased personal satisfaction resulting from the heightened interaction and more personalized relationship that develops between staff members and residents.

If successfully implemented and continually reinforced by management the social model of care delivery provides the optimal opportunity for an older person to actuate his/her potential for independence, to enhance his/her individual capabilities and interest and to preserve his/her individuality, and to age in place graciously.

Examining the Myths

Understanding what Assisted Living is not, may be as important as understanding what it is. This understanding starts with an examination of several prevailing myths surrounding assisted living employment in an assisted living environment

Myth #1: Working in an Assisted Living Environment is easier duty than working in a nursing home.

Yes the environment may be more homelike, therapeutic, newer and more residential. However, the staffing ratios may be higher, co-workers still call in absent, and residents needs and preferences are often just as demanding. If the community that you are considering has adopted the universal employee approach to staffing, the workload may be even more taxing and you may find yourself performing many functions unrelated to direct care giving

Think about it. In the task oriented "medical model" of a traditional nursing home it is actually easier to perform the activities of daily living for the resident by identifying, focusing on, and compensating for residents limitations and disabilities; than it is to personally get to know the resident, understand their abilities and coax, coach, cajole and support them in doing as much for themselves as possible.

For example, in the nursing home setting it may take a resident caregiver 20 minutes to encounter a resident, take them to the bath in a wheel chair and give them a bath. In a true assisted living setting it could taking the better part of an hour to determine when they would like a bath, how much assistance they really need or want, assist them in getting themselves to the bathroom, and or assist or monitor their activities as they bathe themselves.

Apply that approach to virtually any resident ADL, multiply by the increased number of residents that you may be responsible for and suddenly the traditional task efficient nursing home setting may start looking more attractive; unless of course you are very committed to the social model, and the principles of assisted living.

In many respects the "old" task oriented approach is more direct, cost efficient, and easier to implement than the new approaches.

Doing it the "new" way takes incredible patience, understanding, commitment and continual reinforcement on the part of the caregiver, supervisor and manager, and of course the Owner or Sponsor of the community. To suggest that it is easier and more cost effective could be misleading. Different? …………yes. More personally gratifying and rewarding? …………… perhaps. More efficient, easier or cost efficient? ……………. Not necessarily in all cases.

Myth #2: Assisted living isn’t encumbered by restrictive regulations, complex nursing procedures, charting and other care related documentation requirements.

The fact is, assisted living facilities in virtually every state are becoming more regulated with each passing month. As communities that truly implement "aging in place" continue to accept or retain residents with increasingly complex clinical needs, many savvy operators are adopting traditional LTC approaches and methods of clinical assessment, management and documentation as best practices. Thus, effectively implementing a medical component within the social model.

If you make the move to assisted living expect that many of the same principles will apply, with respect administration of medications and management of clinical needs, and care related documentation requirements.

Myth #3: All assisted living communities represent a viable alternative to skilled nursing care; for caregivers and residents alike. Fact: Skilled and Intermediate Care nursing facilities will always occupy a rightful place in the seniors housing and care continuum. Likewise they will always provide a viable employment option for individuals who wish to deliver and receive the complex care that these facilities provide.

As you contemplate your transition, having realistic expectations about what assisted living can and cannot offer, and an honest evaluation of your personal beliefs and values with respect to serving the elderly will enable you to make your transition for the right reasons.

Indeed, the physical environment of assisted living can be more therapeutic and homelike and offer a more stimulating life-affirming workplace, but it is your attitude, approach, values, and beliefs about how and why you are caring for the elderly that will truly make your employment experience a richly rewarding one.

In that way Assisted Living is really no different from the traditional nursing home.

Lee E. Cory, President
Paradigm Senior Living Inc.

Biographical Information

Lee E. Cory is the President of Paradigm Senior Living, a Northwest firm based in Portland, Oregon that specializes in the development, marketing and management of Senior Living Communities. Presently PSL manages communities in 4 states and has consulting relationships with clients across the US.

Mr. Cory’s experience in the Senior Living Industry includes more than 17 years in senior level management and executive positions and has been instrumental in the acquisition, and development and ongoing operation of 30 Senior Living Communities throughout the United States totaling more than 3,000 living units and valued at more than $200M.

His experience has involved the development and management of CCRC’s, Congregate, and Assisted Living. Since 1991 he has focused his involvement primarily in the area of stand-alone Assisted Living and Alzheimer’s communities, and most recently in developing and managing moderate income assisted living alternatives.

Prior to his involvement in Seniors Housing spent several years in the field of Hotel and Restaurant Management. Mr. Cory earned a BS Degree from Michigan State University in 1979, and is a Licensed Nursing Home Administrator.

He is a frequent speaker and educator in the areas of Operations, Marketing, and Staff Development, for many national and regional seniors housing and health care associations including the National Association for Senior Living Industry Executives, (NASLIE), Assisted Living Federation of America (ALFA), and The American Seniors Housing Assn., (ASHA), AIC Conferences, The American Health care Association (AHCA), Washington Health Care Association, and the Oregon Health Care Association,

Mr. Cory is the Author of the Operations Chapter of the Assisted Living Manual published by ALFA, is a faculty member of the Assisted Living Institute and is a contributing author of Housing for Seniors: Developing Successful Projects, a publication of the Urban Land Institute.

His articles and viewpoints have been featured in publications of Journal of Property Management, Assisted Living Today, Contemporary Long Term Care, and Retirement Community Business magazines, and his work in Assisted Living Facilities has been acknowledged by the American Seniors Housing Association’s "Senior Housing Success Stories".