Written by: Dr. Kathy Gennuso

What happens once you’ve chosen to live in an assisted living community? Many assisted living centers have contractual commitments to continue care after residents’ assets have been depleted and they’ve met a certain threshold for payment. This means that once committed and moved in, most will think twice about moving out . . .

Once there, residents must abide by rules whose intention and implementation may not be spelled out initially, even rules that seem to compromise their autonomy. For example, an elderly couple decided to enter an assisted living facility, which is less than 10 percent male. After being assigned a table and settling in, the wife became sick, developed trouble using her hands, and was moved to the “assist with feeding” table where no one is able to socialize. Discouraged, she’d look longingly over at her husband and the other women chatting. The aide, observing her sadness, told the resident that if she worked hard, with her help, she could be back at that table in no time. They did work hard — visitors saw the quick improvement and cheered her on. In less than 2 weeks, she returned elated.

The administrator, seeing her sitting at her old table, asked how did this happen? With pride, the aide explained what they’d accomplished. The administrator said the rule had changed; the resident must stay separated and at the other table, adding the couple needed time apart! Having no advocate, the woman remained at the “assist” table, each day quickly eating and leaving.

Where are “compassionate care” and “least restrictive environment” — buzzwords that get tossed around so casually?

Who is checking on these types of situations—not legal or safety issues – purely human dignity, quality of life issues? How do we identify and then address subtle, sensitive grievances? Governance? Oversight? Training?

Is autonomy one of the things that must be lost when you no longer can live at home?