The number of people living in assisted-living facilities nationwide is approaching 1 million. Yet, for the most part, people who move into such facilities here hadnt planned on doing so, say elder-care experts.


When it comes to taking a look at an assisted-living facility, its family members, such as sons and daughters, who initiate the vast majority of inquiries, rather than the person who ends up living there, says Becky Monday, marketing director for Orchard Crest Retirement & Assisted Living Community, in Spokane Valley.


The transition to an assisted-living facility, which provides assistance with daily living activities, often occurs when a retired person has an emerging need or medical problem, as opposed to a move to independent-living housing, which usually is a lifestyle choice that may involve years of planning, Monday says.


The move to assisted living is often one to four weeks from the first inquiry, she says.


Services provided by assisted-living facilities vary from facility to facility and can be tailored to an individuals needs. They typically include checking on a residents safety, one to three meals a day, housekeeping services, medication management, and laundry services, says Lynette Hansen, marketing director at Harbor Crest Retirement Community, of Spokane, an assisted-living facility.


Assisted-living facilities generally provide assistance with bathing, dressing, and walking, Hansen adds. Many facilities also provide social activities and health-promotion programs, and some include transportation and access to medical services.


Hansen, too, says its usually adult children who initiate inquiries about assisted living on behalf of aging parents.


They start looking and start touring facilities, she says. Then they bring mom or dad in.


Such inquiries often are triggered by a health crisis or an overwhelmed family member who cant continue to provide the level of care an aging person needs, Hansen says.


Assisted-living facilities usually charge residents $2,800 to $3,200 per month in the Spokane area, she says.


Pam Sloan, director of Elder Services, a nonprofit program of Spokane Mental Health, works with the elderly with the initial goal of keeping them in their homes as long as possible.


She often, however, fields inquiries from family members who are trying to learn more about assisted living on behalf of aging parents with acute or chronic illnesses, such as heart disease or diabetes, who require attention, Sloan says.


If the condition is complicated enough that they cant manage it by themselves, maybe they shouldnt be by themselves, she says.


Warning signsOther signs that someone could benefit from assisted living include lifestyle changes that arent for the better, Sloan says. For instance, if a person who has always been tidy stops keeping the house neat, or if pets arent being taken care of properly, something is wrong, Sloan says.


Negative changes usually happen over time. Because of that, older people build up denial that its going on and will have a rationalization for whats happening, she says.


Hansen says memory loss that seems more extreme than age-related forgetfulness also is a warning sign that someone may need assisted-living help. Services offered by assisted-living facilities can help ensure that residents get their meals and take their correct doses of medications, Hansen says.


Sloan says lack of mobility is a common age-related problem.


With age, people lose flexibility and strength, which can hinder their ability to walk, climb stairs, or lift items, she says. Their risk of falling also increases.


If someone falls and gets hurt, they could lose their independence and their quality of life might be lower, Sloan says.


Also, as a persons hearing or vision deteriorates, theyre at greater risk, especially when driving, Sloan says. Changes in cognition and reflexes also may limit a persons ability to drive.


When a person cant drive, thats the most dramatic change, because it could be the first time a person faces having to depend on others for help, Sloan says. Maybe thats the critical piece in the decision to go into an assisted-living setting.


Weight loss could mean a retired person cant or doesnt desire to cook meals.


Cooking requires multitasking, Sloan says. It gets harder to move around the kitchen and manage several things at once.


The act of opening jars and other packaging also can become challenging with age-related loss of strength and flexibility.


Weight loss can be a sign of depression or loneliness. Someone who thinks of eating as a social activity might not get hungry when they are by themselves, Sloan says.


Becky Tiller, owner of Tiller Care Strategies LLC, of Spokane, helps match adult and geriatric people with appropriate levels of care, ranging from in-home assistance to nursing-home care.


Tiller recommends that people who need some assistance with daily activities, but who are afraid of losing their independence, visit assisted-living centers and see what they are all about.


Assisted-living facilities have some built-in services like meal and laundry service, but residents can still be independent, she says.


A lot of residents still drive, Tiller says.


Social interaction between residents and staff members helps prevent depression, and also helps stave off or slow mental and physical decline associated with isolation.


For someone who has become socially isolated, assisted living can make all the difference in the world, she says.


More than 900,000 people nationwide live in assisted-living settings, according to the National Center for Assisted Living. Nearly three-quarters are female, it says.


The average age of residents in assisted-living facilities in 2006 was 85, and they typically need help with at least two daily activities, such as bathing, dressing, walking, and eating, the center says.


Choosing a facilityMore than 60 Inland Northwest facilities are listed under the heading of assisted-living facilities in the Spokane-area phone book.


Tiller says there are many variations of the level of service provided. Its important to find the right one for the right person, she says.


She recommends visiting several facilities to become familiar with their services.


Make appointments to hear dog-and-pony shows about the facilities, Tiller says. Then follow up the appointments with unannounced visits, ask residents how they like the facility, and visit at night to see how the place is operated during a different shift, she adds.


If the staff is defensive about unannounced visits, that should be a red flag, Tiller says.


Ask for the last survey conducted by the Washington state Department of Social and Health Services, she says. The survey will have an assessment of safety, staffing, and medical care provided by the facilities.


Tiller recommends inquiring about whether facilities monitor residents health conditions. For people with memory issues and certain other health conditions, it might be important that there is an awake staff at all hours, she says.


Things dont always happen between 8 a.m. and 5 p.m., she says.


Tiller also advises people to check price variance for levels of care. Some facilities offer services a la carte, while others have more of a package deal, she says.


Try the food, she advises, adding, Eat two different meals before making a decision.


Check for transportation services, she says. Some facilities offer residents transportation for medical appointments, pharmacy visits, and shopping. Others have access to public transportation.


Look into the activities facilities offer, she says, adding, Some people want a choice of activities throughout the day.


For some people, not being allowed to bring pets to an assisted-living facility is a deal breaker, Tiller says. Others dont want to be in a setting with animals around.


Compare resident-to-staff ratios of each facility and try to determine whether employees have interactive relationships with residents rather than sterile relationships, she says.


Contact Mike McLean at (509) 344-1266 or via e-mail at mikem@spokanejournal.com.