What Factors Impact Resident Satisfaction in Assisted Living?

Many factors impact resident satisfaction in assisted living: care staff, quality of food, activities, and relationships with other residents are just a few. Resident satisfaction in assisted living can be challenging for communities facing staffing concerns and rising operational costs.

With monthly rents for assisted living communities starting around $3500 will affordability eventually be out of range for aging adults? Due to the ups and downs in the housing market for home sellers and buyers, will more older adults choose to remain in their homes longer?

At what point do consumers have to make a decision about staying in their homes versus moving to an assisted living community? How does the availability, or lack of, family caregivers impact this decision?

Aging population statistics indicate that the number of individuals diagnosed with memory loss will increase. Will the increase in persons with dementia or Alzheimer’s result in more investment in building memory care focused ommunities? Or will assisted living communities continue to compete with memory care in attempting to balance the needs of persons with memory loss who are not yet that far along in their needs?

Factors That Affect Change for Assisted Living

While research and statistics guide many decisions relative to future planning, what are other factors that result in change for assisted living communities? According to research, stability in assisted living is not the norm. Changes occur at multiple levels of persons (residents, family members, staff, or managers), collectives (groups or types of residents, staff, or managers), organizations (owners or corporations), and external environments (economies or competitors).1

How do families perceive these changes? How will community owners respond to these factors while managing resident satisfaction in assisted living?

Is Aging in Place Possible?

While the care industry speaks about the value of “aging in place,” this is not always practical. Residents in assisted living communities may eventually need complex medical care or care specific to address memory loss.

Persons with dementia can exhibit challenging behaviors that make them no longer appropriate residents in assisted living communities. Multiple factors can mean that an individual, at some point, will be transferred to a higher level of care.

So the promise of aging in place becomes a transitory situation as change and the next move is necessary. “The progression of physical or cognitive decline, resulting in growing care needs, is responsible for most departures from assisted living.” ²

A challenge for communities is that many residents age in place over time. This factor means that families touring communities with a physically active parent may see residents using walkers or wheelchairs. Residents who have lived in the community for some time may be seen as “too old or too frail.” to be attractive companions for a younger and more able individual.

This can mean that communities with increasingly frail residents may attract residents who are in similar situations and who need more care. The need for more hands-on care can be a burden on care staff who are tasked to schedule and complete care for a certain number of residents in a set amount of time.

Barriers to Resident Satisfaction in Assisted Living

Consistent availability of care staff increases resident satisfaction in assisted living. Established relationships between staff and residents support better overall care.

Care staff positions are typically low paying and require a very basic skill level. During COVID many working in the care industry transitioned to positions paying competitive wages in other industries like food service and retail.

Additionally, stress, related to the availability of supervisor support, can enhance or decrease job satisfaction. Without commitment by organizations to offer continued training and support, high turnover, often in the range of 20-50% occurs.

By supporting care staff and instilling a sense of belonging or commitment, organizations may be able to reduce high turnover rates and in turn, increase the quality and consistency of client care.

Consistent staff increases family satisfaction by instilling confidence that loved ones receive care from someone familiar with their needs. This benefit extends beyond daily care staff to the executive director, operations manager, marketing, and activity staff with whom residents interact on a regular basis.

Relationship Attachments

Assisted living residents become emotionally attached to staff just as the care staff becomes emotionally attached to residents. When residents move or pass away, assisted living staff grieve these losses.

While residents and their families may become dissatisfied with changes in care staff or instability in upper management, many remain because the thought of moving to another community is more stressful.

Care communities experiencing frequent changes are best to be proactive in communicating staff changes and providing assurances to families that loved ones will continue to receive beneficial care.

The Effect of the Pandemic and Economic Considerations

The effect of the pandemic, rising costs, and other economic considerations can mean that assisted living communities must respond to decreases or increases in the resident population. Rising food costs, the necessity of pandemic-related supplies like masks and gloves, and other factors can result in price increases that are passed along to residents.

Some communities seeking to fill more apartments may choose to accept residents who require higher care levels or temporarily change fee structures to incentivize new resident move-ins. This change in approach allows longstanding care communities to remain financially viable as new assisted living communities may be built nearby.

Resident Mix

Changes in resident background or needs may be unnerving to longstanding community residents when they see new move-ins admitted who have physical disabilities or memory issues. By mixing high-care-need residents with those who are more independent, the activities offered may shift.

Dining room experiences may also shift when residents sit with others who need more care. The challenge in assisted living is that there is little separation from neighbors.

If you live in a private household you control how much you interact with neighbors on either side of your home. Life in assisted living is community living, like a college dorm where everyone comes together at one point or another for meals or activities.

Care communities transitioning to a mixed resident care profile should be mindful to meet the needs of longstanding and newer residents to maintain resident satisfaction in assisted living.

Family Perceptions

The website of an assisted living community can sway family perceptions about care staff and the services and amenities offered. Families compare communities online before deciding to visit.

This can mean that communities offering great care are overlooked if they can’t compete virtually. The next hurdle for communities is touring families at an appropriate time when residents are out and about actively participating in the community.

For example:

• A community received negative feedback from potential family members visiting in the afternoon who identified that all residents were still wearing pajamas at 2 pm and questioned the support of the care staff
• Other family members, looking for a high-energy residence, visited to find residents propped up in wheelchairs sitting in front of the television

A lack of activities is concerning to many family members who hope that their loved ones will become more engaged and active, rather than remain isolated as the result of a move to assisted living. While resident satisfaction in assisted living depends on the level of interest by elderly parents or others to participate, other considerations like the quality of food can be a negative or positive factor.

As the assisted living industry continues to change due to economic, external, and internal factors assisted living providers will be challenged to balance necessary changes while meeting the needs of prospective and current residents.

Ongoing communication with families and residents regarding changes is critical to maintaining positive relationships and providing confidence to family members that their loved ones will receive beneficial and necessary care.

Looking for more resources to build your caregiving skills? Check out Pamela’s complimentary online webinar program about caring for elderly loved ones.

Sources:

1 Morgan, L.A., et. al. (2014) The façade of stability in assisted living. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 69(3), 431-441. Doi:10.1093/geronb/gbu019 March 18, 2014.

2 Assisted Living Federation of America (ALFA) (2009) Overview of assisted living: American Senior Housing Association (ASHA), American Association of Homes and Services for the Aging (AAHSA), National Center for Assisted Living (NCAL), and National Investment Center (NIC). Retrieved June 16, 2012, from http://www.alfa.org/Mall/StoreHome.asp? MODE=VIEW&STID=1&LID=0&PRODID=16

3 Karantzas, Gery C. et. al., (2012) Intentions to quit work among care staff working in the aged care sector. The gerontologist Vol. 52 No. 4, 506-516, doi:10:1093/geront/gnr161 March 7, 2012.

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