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Assisted Living vs. Nursing Homes
In Iowa, Moves to Regulate Facilities Spark Controversy

Listen Listen to Joseph Shapiro's report.


Doreen Sparks, 92, lives in an assisted living facility in Iowa and has private assistants to help her with daily tasks. She faces eviction because of her advancing Alzheimer's disease.

Photo: Joseph Shapiro, NPR News

"You grasp that she worries about facing her own death. I dread it myself. I love my mother. I felt like to give her this extra little jolt would be unkind. This is her home. She's staying right here."

Carolyn McCoy, on the pending eviction of her mother Doreen Sparks from an assisted living facility.



Sunset Park Place
Sunset Park Place assisted living facility in Dubuque, Iowa. "It's dignity. It's independence. It's freedom to shape your own lifestyle," says Carolyn McCoy. "That's what assisted living is supposed to be about. It's not a nursing home."

Photo: Joseph Shapiro, NPR News


"Some of these assisted living programs are morphing into uncertified nursing homes, and that's not permitted within the state."

Steve Young of the Iowa Department of Inspections and Appeals.



McCoy and Sparks
Carolyn McCoy, left, and Doreen Sparks. "This is a nightmare," McCoy says. "This can't be happening to my mother in Iowa. Iowa."

Photo: Joseph Shapiro, NPR News


Nov. 12, 2002 -- For the nation's growing number of elderly, assisted living facilities have become popular alternatives to nursing homes. Residents get their own private apartment, with a full bathroom and kitchen. Some apartments are luxurious, looking more like a hotel suite than a heath care facility. Meals and light housekeeping are provided, too. And there's the security of support staff, and usually some nursing care if needed, too.

Most people move into assisted living when they need just a little care, or simply don't want to manage a house. But then people age, they get more frail, they develop Alzheimer's disease. And that's a problem for state regulators, who now are struggling to figure out how to set rules for who can live safely in assisted living, and who should leave -- most likely, into a nursing home.

As NPR's Joseph Shapiro reports from Iowa, a controversy there has pitted government officials against assisted living residents and their families.


Doreen Sparks, 92, is a resident of the Sunset Park Place assisted living facility in Dubuque. Her daughter, Carolyn McCoy, says assisted living allows her mother to live with a degree of comfort she could not find in a nursing home. "It's dignity. It's independence. It's freedom to shape your own lifestyle. That's what assisted living is supposed to be about. It's not a nursing home," she tells Shapiro.

McCoy agonizes over how to break the news to her mother that she's being evicted. Sparks has Alzheimer's disease, and the facility's administration recently informed McCoy, Sparks' only child, that the elderly woman's medical needs "exceeds the level of care we can provide as an assisted living community."

"This is a nightmare," McCoy says. "This can't be happening to my mother in Iowa. Iowa."

Nursing homes are heavily regulated in the state, but assisted living facilities aren't. And earlier this year, after a series of newspaper articles implied that poor care in assisted living facilities was going uncorrected, the governor moved to put the facilities under stricter scrutiny.

"Some of these assisted living programs are morphing into uncertified nursing homes, and that's not permitted within the state," says Steve Young of the Iowa Department of Inspections and Appeals.

Young has come under fire from angry family members at public meetings. And Dana Petrowsky of the Iowa Association of Homes and Services for the Aging -- a trade group of non-profit nursing homes and assisted living facilities -- says the inspectors overreacted.

"They interpreted what they were doing as rescuing these people, because they were inappropriately placed," Petrowsky says. "I think the people didn't want to be rescued."

Mark Haverland of Iowa's Department of Elder Affairs thinks that eventually, assisted living and nursing homes will merge. "I think the assisted living programs will be everything -- people will move into an assisted living facility and be allowed to stay there and age in place."

But until the state sorts out the details, McCoy is faced with a tough decision. Still, she avoids telling her mother the news about the eviction. "You grasp that she worries about facing her own death," she tells Shapiro. "I dread it myself. I love my mother. I felt like to give her this extra little jolt would be unkind. This is her home. She's staying right here."

"There are similar battles across the country," Shapiro concludes. "How they get resolved will determine whether assisted living can keep its promise to be both safe and homelike."

Other Resources

Assisted Living Federation of America

Consumer Consortium on Assisted Living

National Center for Assisted Living

American Association for Homes and Services for the Aging




Collison
Margaret Collison is an assisted living resident.
Photo: Joseph Shapiro, NPR News

from a letter written to Iowa Gov. Tom Vilsack by Margaret Collison's children:

We are writing you today with an urgent appeal. Our mother, Margaret Collison, is a resident of Bickford Cottage, an assisted-living facility in Marshalltown. In late April, Bickford Cottage became the first assisted-living facility in Iowa to be inspected by the Department of Inspections and Appeals (DIA), following the transfer of regulation from the Department of Elder Affairs. The DIA reported that seven residents of Bickford Cottage were "not appropriate" for assisted-living and demanded that they leave within 45 days. Our mother was one of those seven.

We do not understand why this ruling has been made. For three years, our mother has been a resident of Bickford Cottage. During that time, she has always received excellent care. Bickford Cottage is her home. The staff and residents in many ways have become her second family. And now, the state is forcing her to leave.

Bickford Cottage is a private facility; the cost of our mother's stay is paid entirely by our mother. She, her family, her two doctors, and Bickford staff and officials all want very much for our mother to continue living at Bickford Cottage. Her doctors have written letters supporting her stay and endorsing her excellent care at the facility. They fear for her health should she be forced to leave...

Please allow her the right to live where she chooses, where people genuinely and expertly care for her, and where she can continue to live her life with dignity and independence. She does not deserve such harsh treatment from the DIA; she has done nothing wrong but to grow older.

Dr. John Collison
Anne Collison Johnson
Elizabeth Collison


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