Models of Care in Assisted Living Communities

There has been an evolution in the way assisted living for older Americans is being approached. Through this article, we discuss the three primary types of assisted living models that are being utilized in this day and age. These are:

  • Medical model
  • Green house model
  • Eden alternative

In this article, we also provide some basic information about services of an assisted living facility. In this instance, we primarily focus on services typically required by state law or regulation. These requirements do vary from one jurisdiction to another. They are also subject to change from time to time.

Before discussing the trio of assisted living models mentioned a moment ago, we also provide an overview of what are called the principles of assisted living in this day and age. Armed with this information, you will be in a better position to make a decision about assisted living. This is the case if you are seeking this type of community for yourself or if you are an adult child with a parent that can benefit from assisted living at this point in time or in the not too distant future.

Services of Assisted Living

Depending on where an assisted living community is located, there is a set slate of services typically required by state law or regulation. These services include but are not limited to:

  • 24-hour staff to provide scheduled and unscheduled elder needs
  • Limited health related services (like medication management)
  • Social services
  • Assistance with activities of daily living and instrumental activities of daily living
  • Meals
  • Housekeeping
  • Transportation

Residents in assisted living have the right to receive these services with:

  • Dignity
  • Autonomy
  • Independence
  • Quality of life

Core Principles of Assisted Living

The Assisted Living Workgroup Report to the United States Senate outlined what it called the core principles of an assisted living community or facility. These core principles are:

  • Creation of a residential environment that is supportive of each resident’s right to:
  • Privacy (as defined by each resident)
  • Choice
  • Dignity
  • Independence
  • Quality of life
  • Offer of quality supportive services that are collaboratively developed and individualized for each resident
  • Provision of resident-focused services emphasizing individual needs and incorporating:
    • Creativity
    • Innovation
    • Variety
  • Support of an individual’s decision-making control whenever possible
  • Fostering social climate that allows individuals to develop and maintain social relationships
  • Provide consumers with full disclosure of service provision and cost prior to and during the elder’s stay in the facility
  • Minimize the need to move
  • Creation of a culture that provides a quality environment for:
    • Elders
    • Staff
    • Administrators
    • Families
    • Volunteers
    • Larger community

Medical Model

The medical model is the moniker traditionally applied to care delivery in a variety of facilities in the United States. This includes long-term care facilities of different types.

Under the medical model, aging is viewed in terms of a series of changes in both physiological and psychological processes. The focus of care in the traditional medical model is to:

  • Promote health
  • Maintain functioning
  • Improve outcomes
  • Enhance quality of life

Green House Model

The green house model was developed at the very end of the 20th century. While it focuses primarily on nursing homes, there are elements of the green house model that have application in an assisted living setting.

“Green” in green house model does not reference the protection of the environment, as that term is more commonly utilized in this day and age. Rather, green is intended to signify life and continued growth, even during the latter years of life.

The green house model envisions smaller individual nursing care or assisted living residents with a dozen or fewer residents. The idea is for these residences to be part of a broader residential neighborhood. While clinical services are provided as appropriate in a particular facility, the green house model has a primary focus on quality of living.

Eden Alternative

The Eden alternative has an underlying objective of reimagining long-term care of all types, including assisted living. As is the case with the green house model, the focus of the Eden alternative is on quality of life. 

The objectives of the Eden alternative are to make life in assisted living and other long-term facilities as normal as possible. These include cultural changes that include the introduction of such things as gardens, children, families, pets, and other things associated with typical living into an assisted living community on an ongoing basis. 

If you are a senior considering moving into an assisted living community, or if you are the adult child of an older parent thinking about assisted living, it can be helpful for you to have this basic understanding of services, core principles, and the different models of care that are associated with assisted living and other long-term facilities.