Assisted Living

One of the innovations of assisted living is the focus on consumer control and decisionmaking. At times, residents express preferences that raise concerns among facility staff. To mediate these differences, eighteen states use a negotiated-risk process to involve residents in care planning and to respect resident preferences that may pose a risk to the resident or other residents. Residents, family members, and staff meet to review issues about which there is disagreement. During this process, the parties define the services that will be provided to the resident with consideration for their preferences. The resulting agreement lists needs and preferences for a range of services and specific areas of activity under each service. To many regulators, negotiated service agreements are part of a philosophy that stresses consumer choice, autonomy, and independence, as opposed to a facility-determined regimen that includes fixed schedules of activities and tasks, which might be more convenient for staff and management. Placing the residents' needs and preferences ahead of the staff and administrators helps turn a "facility" into a home.