Physical Qualifications for Assisted Living

When a senior becomes unable to care for their own needs it often leads loved ones on a search for a living solution that strikes a good balance between an enjoyable quality of life while also providing appropriate care needs. Oftentimes, the care needs can be in the form of medical care, and that may have an impact on a senior’s options.

Many families will turn toward the allure of the quality and personalized care that Assisted Living offers. With today’s assisted living options, many seem more like a resort than a senior facility. However, many seniors and their family members don’t realize that a senior must be able to physically qualify in order to be accepted into an assisted living facility. 

Below we will break down some of the most common disqualifications from assisted living. While some of the items may be conditions that are temporary, and, once cleared, would enable the senior to qualify, other conditions will remain or get worse so other living options would need to be considered instead.

A Senior’s Mobility is a Factor for Qualifying for Assisted Living

As we age mobility can be an issue. And while many seniors struggle with mobility issues, some specific issues may be cause for not being accepted at an assisted living facility. 

If a senior is capable of getting around to the areas of the facility required to meet their daily needs (like the bathroom and the dining room) then the senior is likely going to be accepted into the assisted living facility.

But most assisted living facilities do require that residents who need extra help transferring from one surface to another do so with minimal assistance (one-person assist); those requiring two-person transfers or mechanical lifts may not qualify.

One-Person Transfer Limitations

Many times seniors can get from place to place just fine with the help of a mobility device (like a walker, scooter or electric wheelchair) but find that they can’t transfer to and from a specific seat or object (like a toilet or bathtub) without aid. That’s when things start to get tricky.

Usually the staff at an assisted living facility will help seniors transfer to and from the things that they need to access. However, senior residents should not expect a dedicated helper to be present for this duty at all times and they will likely have to withstand some waiting in order to get the help they need.

Two-Person Transfers Requirements Can Be a Disqualifier

But some seniors’ circumstances can be more complicated and must have an additional set of hands for assistance. Usually when a senior requires a 2-person transfer they will have a more difficult time finding an assisted living facility that can care for them.

When 2-Person Transfers are Usually Required:

• Severe obesity where one caregiver cannot safely support the person's weight
• Advanced Parkinson's disease with significant rigidity and freezing
• Late-stage multiple sclerosis affecting trunk stability
• Advanced dementia with loss of ability to follow transfer instructions
• Severe arthritis or joint contractures limiting range of motion
• A stroke with paralysis 
• Severe osteoporosis with high fracture risk
• Spinal cord injuries affecting lower extremity function
• Inability to bear weight on legs
• Poor upper body strength combined with lower body weakness
• Severe balance impairment with risk of falling
• Minimal ability to assist with the transfer process
• Unpredictable movements during transfers
• Complete dependence on caregivers for positional changes

In an assisted living setting, 2-person transfers usually are not supported or are not supported often. If you require the assistance of two people to help you move from one surface to another, assisted living is likely not your best option.

Mechanical Lifts in Assisted Living

Most standard assisted living facilities don't accept residents requiring mechanical lifts because:

1. They lack sufficient trained staff to operate lifts safely
2. Their staff-to-resident ratios don't allow for the time needed for lift transfers
3. The physical environment may not accommodate lift equipment
4. There are liability concerns regarding safe lift operation

Some specialized assisted living facilities or those with enhanced care units might accommodate residents with these higher mobility needs, but they typically charge significantly higher rates and have specially trained staff.

 

How Open Wounds Affect Qualifying for Assisted Living

Open wounds requiring complex wound care typically disqualify residents from standard assisted living because those facilities usually don't have the nursing staff to provide that level of care.

While minor wounds that seem to be healing well should not prohibit acceptance into an assisted living facility, complex wound care most certainly can. Complex wound care refers to treatment protocols that require specialized nursing skills, equipment, and frequent monitoring beyond what standard assisted living facilities typically could provide.

Examples of complex wound care that would preclude a senior from being accepted into assisted living would include issues like:

1. Pressure Sores: Pressure ulcers (bedsores) that expose deeper tissue layers, possibly including muscle, bone, or tendons are not permitted. Wounds of this nature usually require sterile dressing changes, possible debridement (removal of dead tissue), and specialized dressings.
2. Diabetic Wounds: Diabetic ulcers that won’t heal, that have become infected or are very slow to heal will disqualify a senior from being accepted into assisted living. Typically these wounds also require specialized dressings, frequent assessment, and possibly antibiotic therapy.
3. Open Incisions: Surgical wounds with complications such as a splitting open of the incision or those requiring vacuum-assisted closure (wound VAC) therapy can’t be managed within the scope of care that an assisted living facility can provide. However, once the wound has healed the patient would be a good candidate for assisted living if that was the only reason that they were denied.
4. Draining Wounds: Wounds with draining fistulas that require collection devices and specialized care need to be under the care of medical staff. These types of wounds are better suited for a skilled nursing rehab facility (SNF) or home health provider.
5. Circulation Ulcers: Arterial or venous ulcers that require compression therapy and advanced dressing materials tend to be on-going and repetitive. Treating the wound will not likely cure the issue because the underlying cause of the wound is from a circulation issue. Typically, if a senior has a circulation issue that is serious enough to lead to vein or arterial ulcers then medical intervention is necessary to provide care to address the circulation. So, assisted living will not be a good option for this type of patient.

 

Why Open Wounds are an Issue at Assisted Living Communities

Open wounds pose significant challenges in assisted living conditions due to several factors. 

Sterile Environment

The need for sterile environments is paramount to prevent infection and promote healing, which can be difficult to maintain in a communal setting or in a non-medical environment.

Dressing Concerns

Frequent dressing changes, often required daily, demand consistent attention from caregivers and can be time-consuming and resource intensive. These changes often require specialized dressings or equipment, which may not always be readily available in assisted living facilities. Moreover, staff at an assisted living facility are not normally trained to dress or manage complex wounds.

Medical Assessment

Regular assessment by a registered nurse is crucial to monitor the wound's progress and adjust treatment plans accordingly. Only trained medical practitioners can ascertain the healing progress and to make adjustments when healing is not occurring.

Pain Management

Pain management during dressing changes is a critical consideration, as the process can be uncomfortable or even painful for residents. Many complex wounds require careful handling and potentially the use of analgesics or other, stronger, pain medications. Trained staff adept at recognizing the need for pain measures that have the capability to prescribe treatments are not usually present as part of the full-time staff at an assisted living facility.

Monitoring

Vigilant monitoring for signs of infection or other complications is essential, as elderly residents may have compromised immune systems or comorbidities that can complicate wound healing. This requires specialized training for medical staff to recognize early warning signs along with the ability to respond appropriately to prevent serious health issues.

Assisted living facilities do not typically have nursing staff available 24/7 and normally can’t provide the level of care that complex wounds would require. Residents with these needs are typically better suited for skilled nursing facilities, Home Health or specialized Wound Care practitioners. 

As an option, if the senior was already a resident at an assisted living facility they may be able to arrange home health care to take place within the assisted living facility if the facility permits such arrangements. Many assisted living facilities will allow this arrangement if the wound is not an on-going concern.

Another option to assisted living is independent senior living. You can read more here about the pros and cons of selecting an independent senior living facility if your senior has complex wounds.

 

What Medical Conditions Are Allowed at Assisted Living?

Residents generally need to have stable, manageable medical conditions rather than those requiring intensive or regular medical intervention.

While seniors certainly do not have to be in prime health, in fact, most are expected to have some type of on-going health challenges, those health conditions must be stable. Stable, manageable medical conditions are conditions that can be managed by remedial treatments such as medications and other routine management efforts.

Stable Medical Conditions Examples

Below is an example of some very common stable medical conditions that are found often in residents that would be accepted by most assisted living communities:

3. Controlled diabetes: Diabetes that requires routine blood sugar monitoring but can be controlled through medication.
4. Hypertension: High blood pressure that can be managed by routine medication regimens.
5. Common Heart Disorders: This includes heart conditions like atrial fibrillation or heart failure that's managed by medication or other therapies and is not actively in a state of an acute episode.
6. Seizures: Seniors that have chronic disorders that lead to seizures but that can be managed with medication and/or other remedies are typically accepted into assisted living as long as there are infrequent episodes.
7. Mild Breathing Difficulties: Seniors that have mild to moderate COPD or asthma that can be controlled through routine medications and occasional rescue inhalers are usually good candidates for assisted living. However, each state and each facility will have its own requirements regarding oxygen therapy. Typically, an assisted living facility will have a limit to how many liters per minute (LPM) that they will allow. If you are on an oxygen concentrator you should make sure to discuss that with any assisted living communities that you are considering.
8. Early Stage Dementia: If a senior is just beginning to show signs of early stage dementia and can remain oriented enough for safety, then they may be accepted into assisted living. However, if the senior presents a safety or flight risk, they will need to seek residency in a memory care facility.
9. Parkinsons: Parkinson’s has a wide spectrum of symptoms, but many can be managed by medication and other therapies. Stable Parkinson's disease, where mobility is compromised but still manageable, is not usually a disqualifying condition.

Typical Disqualifying Medical Conditions for Assisted Living

• Uncontrolled Diabetes: Unstable diabetics that require frequent insulin adjustments or that have had recent episodes of severe hypoglycemia will likely not be accepted into assisted living.
• Heart Attack: Patients that have had a recent heart attack or that suffer from severe or very unstable angina and that require frequent medical assessments are not a good fit for assisted living.
• Serious Congestive Heart Failure (CHF): Seniors that have advanced heart failure that require IV medications or fluid retention removal or daily weight and fluid monitoring are not likely to medically qualify for assisted living.
• Unstable Respiratory Conditions: Seniors on a high level of oxygen therapy, that must live on oxygen at all times and/or at a high level, or seniors that have difficulty managing their O2 saturation rate do not make good candidates for assisted living.
• Cancer: Patients undergoing active cancer treatment requiring chemotherapy or radiation treatments will probably not qualify for assisted living. This, however, can vary depending on the severity of the cancer and the level of the treatment.
• Advanced Chronic Kidney Disease (CKD): Kidney failure requiring dialysis can be a disqualifying medical condition at some assisted living facilities. Although some facilities may accept the resident if transportation to a dialysis treatment center is pre-arranged.
• Emergency Requirements: Any senior that has a history of any condition, or combination of conditions that require frequent, unpredictable episodes of emergency intervention will not be accepted into an assisted living facility.
• Frequent or Severe Seizures: Seniors that suffer from frequent or severe seizure disorders or that have had a recent onset of seizures without a clear diagnosis may have to find other options aside from assisted living.
• Alzheimer’s/Dementia: Any senior that suffers from advanced dementia with significant memory or behavioral issues or that is a wandering risk would need to find a Special Care Assisted Living Facility (SCALF), which is also referred to as Memory Care.

 

Some Medication Needs Can Disqualify You from Assisted Living

While assisted living facilities can help with medication administration, residents requiring some medications or complex medication regimens may not qualify. Residents of an assisted living facility are usually encouraged to understand what medications they are given and it is also preferred that they are able to recognize if an incorrect medication or dosage is given. If they can’t manage their medications then they, at the very least, need to be able to recognize their name when staff are administering the dosing according to the instructions.

Generally speaking, the following medication needs may prevent a senior from being accepted into an assisted living facility:

IV (Intravenous) Medications:

Some IV Medication examples that would prevent a senior from being accepted into assisted living include: 

• IV antibiotics for serious infections
• IV diuretics like Lasix (furosemide) for severe edema or heart failure
• IV pain medications for patients unable to take oral medications
• Parenteral nutrition (IV feeding)
• IV chemotherapy agents
• IV hydration for patients unable to maintain oral hydration

Assisted living facilities simply do not have the staff or the capability to administer IV medication to their residents. Generally speaking, residents that require this level of care are better suited for either at Home Health or a long term skilled nursing facility (nursing home).

Complex Medication Regimens:

Some medication frequencies or modes are much too advanced to be handled at the assisted living level of care and would require the care of a trained medical professional either at home or in a skilled nursing facility. 

Here is an example of some complex medication regimens that would prevent a senior from being accepted into assisted living:

• Frequent Lab-based Dose Changes: Medications requiring frequent dosage adjustments based on lab results may be too difficult for an assisted living facility to manage.

• Vital Sign Dosage: Medications requiring regular vital sign monitoring before administration (like some blood pressure or heart medications) need to be administered by medical staff to avoid giving too big or too small of a dose. Since medical staff are not always present in an assisted living facility, seniors that depend on these regimens will likely not be good candidates for assisted living.
• Variable Insulin Doses: Multiple daily insulin injections with dosing based on blood glucose readings and carbohydrate intake can be complex and can’t be administered from non-medical staff. Typically, assisted living can’t help with this level of care.
• Breakthrough Pain Medication: Pain management protocols with breakthrough dosing is sometimes the backbone of comfort care in those seniors managing the final stages of a painful disease. However, the treatment of breakthrough pain must be administered by medical professionals skilled in pain management. Usually a pain management center or a hospice provider would be required in order to administer this type of therapy. Please keep in mind that many assisted living facilities do work hand-in-hand with hospice providers and, in that case, if a resident needed this type of therapy, as long as it was provided by the practitioner, the resident may be allowed to remain.
• Breathing Treatments: Medications requiring specialized administration techniques like nebulizers or non-invasive ventilators that staff must set up and monitor are beyond the capabilities of a typical assisted living facility.
• Medication Reaction Monitoring: Medications with significant risk profiles requiring close monitoring for adverse effects are not able to be administered in an assisted living environment.
• Precise Timing: Medications that must be given at precise times or under specific conditions (not just "morning" or "evening") are too difficult to manage for assisted living personnel.
• Many Times a Day: Complicated medication schedules with more than 12-15 medications at varying times throughout the day go beyond what most assisted living facilities will provide.
• Injections: Typically injections must be self-administered and can’t be provided by the staff at an assisted living facility.

Most assisted living facilities simply do not have the trained medical staff or the medical equipment needed to manage complex medication requirements. If you or your loved one is on any special type of medication or medication regimen, make sure to discuss this with the assisted living facility to ensure that your care requirements can be provided at that facility.

 

Advanced Medical Care Needs Not Covered in Assisted Living

While the list is exhaustive, many seniors suffer from advanced medical needs that simply can’t be fulfilled within the walls of an assisted living facility.

Here are just a few conditions not accepted in assisted living:

1. Catheter Care
2. Tracheostomy Care
3. Feeding Tubes
4. Central Line Care
5. Ostomy Care
6. Pain Pump Management

 

How Assisted Living Facilities Make Their Determinations

Assisted living facilities (ALFs) regularly evaluate residents to make sure they can provide the right level of care. This is important because ALFs typically have caregivers with limited medical training and not many nurses on staff. 

One challenge is the frequency of medical assessments. Some residents need to be checked daily, which can be hard for ALFs to manage. In general, ALFs are not set up to handle daily medical checks like a hospital or nursing home would.

Another issue is the complexity of care. ALFs don't have enough nursing staff to handle complicated medical plans. This means they might struggle to care for residents who need a lot of specialized care.

ALFs also consider how predictable a resident's condition is. If someone's health is unstable and changes often, it can be difficult for an ALF to keep up with their needs. For example, if a resident has a condition that suddenly gets worse, the ALF might not be able to provide the right care quickly enough.

Lastly, ALFs look at the risk level of a resident's condition. If someone's health could suddenly get much worse, they might need a more intensive care setting than an ALF can offer. This is because ALFs are not equipped to handle emergencies like a hospital would.

These factors are important for ALFs to consider because they need to make sure they can provide the right care for their residents. If an ALF can't meet a resident's needs, then it is usually better for the resident to live somewhere where their required level of support is provided.

 

Do All Assisted Living Facilities Follow the Same Practices?

While assisted living facilities are regulated by each state independently, many also adopt in-house policies based on the specific type of care that they plan on providing. This is generally due to the staffing plans and overall goals within each specific company. Some assisted living facilities will provide more robust care than others, but, generally speaking, most are very similar in nature.

When you are trying to determine the best assisted living facility for you it is best to first determine IF assisted living is best for you. Understanding its regulations and policies can help you to not only understand what they will do for you; it will help you to better understand what they can’t do for you.