• Activities of daily living (or ADLs) such as bathing, dressing, grooming, toileting, and meal reminders;
• Self Administered Medication Management (SAMM), which provides the resident with reminders and assistance in taking medication. Some assisted living residences offer Limited Medication Administration (LMA), often for an additional fee, whereby certain medications may be administered by a nurse;
• Up to three meals a day served in a common dining room.
• Emergency call/response systems or other ways for staff to provide emergency help;
• Activities and programs tailored to seniors’ needs and interests, targeting health, exercise, socialization, recreation, and wellness;
• Housekeeping services, which usually include housecleaning, laundry, and other needs;
• Transportation services, which may include taking residents on group trips, shopping or to doctor’s appointments.

Assisted living residences in Massachusetts offer such services in private or shared apartments in an environment with twenty-four hour per day onsite staff capability. Personal care services are provided by staff, know as resident care assistants. Many residences have specialized units, for those with memory loss, that provide special care programming as well as environmental and technological features to support resident safety and improved functions.

The individual, his or her family, and the assisted living provider jointly make decisions about whether that assisted living residence is right for a particular individual. Under Massachusetts regulation, the assisted living residence is required to gather information about each potential resident to assure that it can provide the services required by the resident, and that it has the right services and staffing to meet or help arrange for the individual’s needs. You may ask to see the residence’s Disclosure Statement, which describes such criteria.

Some potential residents may not be accepted by an assisted living residence in the event that, after review, it is determined that the potential resident has skilled care needs that cannot be met by intermittent contractors, such as home health agencies, As a resident’s needs change, an assisted living residence may recommend that private services be obtained to support the care of the resident or that a more appropriate place be found for the resident The decision to move from an assisted living residence to another setting is often a hard one for everyone involved, and is governed by sections of Massachusetts’ law and the terms of the residency agreement.

Many residents with memory loss issues function well for a period of time with the support services offered in the traditional assisted living setting. The degree of memory loss is not the only important factor; other symptoms, such as lack of safety awareness, wandering and getting lost, trouble sleeping, or resisting help, may influence what kind of setting works best.

Assisted living staff are trained to offer the special attention people with memory loss may need without taking away their independence. All residents are encouraged to make decisions and choices about their lives. As resident’s needs change, and memory loss worsens, safety and wellness issues need to be continually monitored and services adjusted in a timely and appropriate manner. Residents and families need to be aware of the risks of a person with memory loss living in a traditional assisted living setting. For example, people with Alzheimer’s disease may wander. Some assisted living residences are designed with enclosed areas that allow a person to wander safely.  If a resident’s wandering is a risk to his or her safety, additional services or relocation to a more secure setting may be required.

The Executive of Elder Affairs requires that all assisted living residence staff complete orientation and ongoing training programs. Every Registered Nurse(RN) and Licensed Practical Nurse(LPN) who works in an assisted living residence must be professionally trained and certified. Personal care workers must complete either a Certified Nurse Assistant(CNA) or Home Health Aide (HHA) training program or be trained by their company following a training program with a set number of hours and topics per state regulations.

Although each resident’s personal medications are stored in his or her own apartment, many residents with dementia need help remembering how much, or when to take each drug. Assisted living offers assistance with medication management through a program called Self-Administered Medication Management, or SAMM, as well as via coordination with family members or other healthcare providers. 

At some point, many people with memory loss or dementia may require more assistance than can be offered under SAMM. It is helpful to ask the assisted living residences that you are considering how they might handle such a situation.  Some residences also offer additional administration through a program called Limited Medication Administration or LMA usually for an additional fee. Some residences may or may not provide LMA, which requires a nurse to administer medications. As dementia progresses, some people with memory loss may no longer be able to self-administer medications, even with the help of the SAMM program. Therefore it is important to ask if LMA is offered at the residence you are considering. The Disclosure Statement of each assisted living residence explains how that particular community handles its medication management services and policies.

• A structured routine for residents.
• Caring and compassionate staff who have time to interact with residents in a positive and relaxed manner.
• Well-trained staff with the ability to deal with difficult behaviors and situations.
• Clean, comfortable, safe and secure surroundings.
• Activities that reflect the preferences and routines that each individual resident has established over a lifetime.
• Policies that provide clear guidance about things such as medication management, handling safety concerns (e.g., wandering, evacuations) and behavior management.

Alzheimer’s disease and most of the related disorders are “progressive” diseases – symptoms will get worse as time goes on. Be sure to consider this as you choose an appropriate setting. As the needs of an assisted living resident change, the assisted living staff will work with the resident, legal representative, family and his or her health care providers to decide how to best assure that his or her needs are met. As additional services are required, residents and their families may elect or need to obtain services from an outside provider or agency. Payments for outside services are the financial responsibility of the resident and are paid privately to the service provider and/or through other private or public resources.

Most residences will work closely with a resident, legal representative, family and his or her healthcare providers to try to maintain a resident in his or her apartment. However this may not always be possible. An assisted living residence must consider the health and safety of all of the residents. If it is not possible to obtain the services needed to keep a resident healthy and safe in the assisted living residence, it may become necessary to find a setting more appropriate to his or her needs. The assisted living residence staff will help the resident, his or her legal representative, and/or family determine the best environment to meet the individual’s specific needs.