In VITAS, as in Assisted Living Communities
the Focus is on Living

By Holli Hallmark

Assisted Living Facilities have done a wonderful job over the years in responding to that need. In fact, today they are more accurately referred to as Assisted Living Communities, offering a truly residential alternative for people who choose to combine independent living with healthcare and other services that increase as their needs increase.

VITAS Innovative Hospice Care® plays an important role in aging in place. When a cure is not possible, VITAS offers comfort care. When quantity of life is not possible, VITAS offers quality of life. And VITAS brings its care to patients’ homes, knowing that everyone feels better surrounded by familiar things and familiar people.

In today’s senior living market, some of the best Assisted Living Communities include a hospice conversation at the time of admission, assuring prospective residents and their loved ones that there is no need to leave their home, even if their health worsens.

While Assisted Living Communities today are home to much frailer residents than was the case 20 or even 10 years ago, some state regulations limit the acuity of a resident who may live there. In Georgia, issues such as stage 3 and stage 4 wounds, significant weight loss or becoming bed bound may require a resident to move to a nursing home or hospital. However, a resident who qualifies for hospice and all the care and documentation it provides can remain in the Assisted Living Community—to the benefit of the resident, the family and the community itself. 

The age-in-place option is key in Assisted Living Communities, says Patrician Godfrey, assisted living rep for VITAS Innovative Hospice Care® of Atlanta. “Given the demographics of the Baby Boomers, we expect the growth of these communities will be huge,” she says. “New communities will open and beds will be harder to find. The partnership with VITAS will take aging in place to its logical conclusion: dying in place.”

Yet it can be challenging to get a timely referral to hospice for a resident, because the community’s staff or physician doesn’t realize how ill the resident is or they think calling hospice is somehow hastening death. They are fearful of losing the resident, when in fact it often is only with hospice care that their resident can remain at home. 

Because Assisted Living Communities are homes, not hospitals, they typically have a minimum of RNs on staff; aides provide most of the care. The hospice staff, which includes a physician, nurse, aides, social worker, chaplain and volunteers, often provide support that enhances what assisted living providers are contracted to do. Even at night, on weekends and holidays, VITAS staff are available for our patients.

VITAS’ Continuous Care can put a clinical staff member at the bedside up to 24 hours a day, depending on our patient’s needs. This is one more way VITAS ensures that the resident does not have to move from his or her home following a flare-up of symptoms or a spike in pain. As our assisted living partners know, residents who move to a hospital or nursing home too often don’t return to their community, thereby losing the comfort of being near friends and neighbors at a critical time of life.

VITAS staff also offer the community’s staff inservices to increase knowledge of end-of-life care and related issues. Grief and support groups are available to the staff, who become like family members to residents. We plan Family Nights, where we can explore advance directives and other end-of-life issues informally with residents and their families. The dialogues that begin at a Family Night can be a springboard to thoughts and feelings previously left unsaid among family members.

Open discussion, increased staff education, enhanced services to the community and ensuring that residents can age in place—all of these benefits increase the likelihood that hospice-appropriate residents will be referred sooner. If we can admit them to VITAS sooner, end-of-life care would look different.

There could be more time for a social worker to help a terminally ill resident communicate with family. A volunteer might become part of the resident’s weekly routine, brushing hair, reading or just visiting. A chaplain could arrange a bedside prayer or invite a leader of the resident’s faith to pay a visit. There might be time to enjoy a favorite meal, to reminisce, to record one’s life story for future generations, to make amends. There would be more opportunity for the VITAS team to focus on quality of life, rather than solely managing symptoms at the end of life.

Most important, this care would all take place in the home. The resident would have the comfort of their neighbors and community staff. He or she would age and die in place, which is what most of us want at the end of life.

Holli Hallmark, Senior Director of Clinical Services Development at VITAS Innovative Hospice Care®, can be reached at 1-800-93VITAS.