Assisted Living Small or Large facility?

How is a small residential care home different from larger assisted living facilities?

In comparison with larger assisted living complexes, there are distinguishing benefits for smaller 2-6 bed facilities. These smaller facilities are Board and Care facilities and are also called Residential Care homes. The comparisons look at issues such as logistical operation of business in elder care, staff policies, personal attention given to resident, and cost.  This report is a collection of many internet reports comparing different type of facilities based on size.

Like any large assisted living facilities, Residential Care Homes are subjected to state licensing laws, and are held to recognized standards of care because of the government’s regulation.

A Nursing Home is for people who require daily supervision and care provided by medical professionals such as registered nurses and certified nurse assistants, under the supervision of licensed physician.  A large assisted living facility is a step down from required services needed.

Residential Care Homes can also provide continuous monitoring of health condition such as hospice, bedridden, dementia, post stoke conditions or those with Parkinson disease.  Even though the regulation does not require medical professional as a caregiver in a small residential care home, most likely administrator or caregiver have previous experiences in a medical field as a registered nurse or certified nurse assistant as well.  In the Bird of Paradise home, our administrator has experience as a physician assistant.  He and our caregiver work with the family or the resident’s physician to meet the needs of the resident.

At large facilities, there are usually three shifts that staff the facility.  Each shift could have different staff members each day.  Also, larger facilities have a high call-in and turnover rate, so there are strange new faces continuously.  Another disadvantage of the larger facility is the high resident-to-staff ration.

In residential care home, residents see the caregiver when they wake up, and the caregivers are the last ones whom the residents see before going to sleep.  This creates a family atmosphere and provides sense of security for the residents.  Turnover of staff is often not a problem because the caregiver is the business owner.  At the Bird of Paradise home, we create a more intimate and nurturing setting that resident would feel more personal.

The larger the facility, the care is less personalized and less suited for the dementia resident.  With the hotel-style living, the resident’s awareness level needs to be high in order to remember the floor, the wing, and then his or her room number.  Larger facilities required seniors to be capable of getting to the dining hall for meals, and be independent in most activities.  Typical large facilities offered little in the way of personal assistance.

Residential care homes often did a lot more for the residents, such as assistance with dressing toileting and getting around.  Many of them have special licenses qualifying them to perform those extra personal services.  Typically, residential care homes fit senior citizen who are becoming frail and find the responsibilities of homemaking an increasing burden, or too difficult to do consistently, seniors with chronic illnesses who need daily assistance with cooking, cleaning and monitoring medication, seniors who have difficulties coordinating rental payment, grocery and meal purchasing, and managing expenses for the household supplies.

Depending on the location of the facility, the size of the living space, and the amount of privacy and the amenities provided, larger facility cost average of $4000.  Most services in larger facilities are an extra charge to the monthly rate.  If the level of care is increased, there is also an increase in monthly fee.

The monthly service for small residential home is varied by one owner to the next and also by the location.  The Bird of Paradise home has been found to charge less than any other residential care facilities even though it is located in a very prestige neighborhood of Morgan Hill, Temecula with amenities of a club house and maintain a top quality services.

A nursing home, both skilled and non-skilled nursing care, is institutionalized.  Sometimes it is called “hospital for the old”.  The care provided is done with rigid structure and it is scheduled so to be able to provide all the care needed for such a large population.  The schedules are developed around the staff and services provided, not the residents.  Many places still view residents as patients.  It is much more difficult to receive individual attention from the staff.  For example, because of time constraints, the staff is more likely to do the grooming of the resident instead of taking the time to let the resident do for his or herself.  This takes away the resident’s sense of independence and loss opportunities to be more mobile.

In contrast, all aspects of care provided by small residential care are scheduled around the individual’s own routine that has been established for many years.  At our Bird of Paradise home, services are personalized to resident’s individual needs.  The staff is aware of each resident’s level of ability, and they work toward maintaining or improving that level.

More and more elderly people try to stay in their own home as long as they can because mostly they fear of new place, new and unrecognized item.  They would feel embarrass of their appearance and their needs in front of strange people whether a staff or visitor who come in and out through the hallway to see other residents.  These make the transition and the adjustment to a new living environment for elderly people more difficult.

Moving to a smaller residential care home eases this transition.  At the Bird of Paradise home, there are only six residents who live not as neighbors but as family members.  This advantage is taken from the feeling of living in a home rather than in a hotel-style facility.  The home-like environment with bedroom, kitchen, bathroom and living room that is similar to their own home makes it a lot easier to continue their daily function as they would have stay in their own home.  At the Bird of Paradise home, we even evaluate the emotional symptom and provide psychological counseling to resident and their family during this beginning phase of their resettlement.  This is done by a Ph.D. psychologist.

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