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A changing environment
Assisted living in Oklahoma has evolved from residential care programs that offered rooms and medicine assistance to programs that offer a seamless transition from independent-living apartments to assisted living to nursing home care at the same location.
"It's going to do nothing but grow even more," said Mary Brinkley, executive director of the Oklahoma Association of Homes and Services for the Aging.
Hoffman compared the industry to the banking industry. "People expect more service," he said.
About 6,000 Oklahomans are in assisted-living programs. Statewide, there are 127 such programs, 12 of which offer levels of care, according to the state Health Department.
Although programs may set admission criteria to qualify for assisted living, residents typically must be mobile and not require 24-hour care. Anything more, and they are better cared for in nursing homes.
Franciscan Villa provides meals, security, around-the-clock access to nurses and activities.
"One of the state's newest and nicest such programs is Tulsa's Montereau in Warren Woods, a nearly $100 million hilltop complex. The Rev. Henry B. Spielmann, 95, moved into Montereau's assisted-living unit in May.
Spielmann, a Catholic priest who taught and worked for more than a half-century at Tulsa's Cascia Hall Preparatory School where he lived in a monastery, appreciates his apartment and the treatment he has received.
"They look after your medical needs. They check on you every night," he said.
As Spielmann's heart troubles worsened, he needed attention he couldn't receive at the monastery, where residents live independently.
James Joslin, who oversees long-term care licensure for the state Health Department, said assisted living is struggling to figure out the appropriate level of care to provide before moving residents to environments that are more intensive.
One "hot issue," he said, is building permits. As people live longer and assisted-living programs want to keep them, whether construction meets the fire code can become problematic.
"Is the building designed for residents who can't evacuate?" he said, noting that many were not built to house nonmobile residents. A law that passed last year allows assisted-living programs to keep some residents who would otherwise be moved to nursing.
Huser said complaints have increased slightly.
"I believe that what we are finding that's of concern to us is medical issues. That is sort of the source of our concern at this point in time," she said, explaining that family members may not understand that nurse oversight often isn't 24-7.
"It becomes a real head-scratcher: How do you provide quality care for very cognitively impaired seniors in an assisted living environment?" said Richard Woodard, president and chief executive of Oklahoma City's 400-resident Epworth Villa, which offers independent living, assisted living and nursing home care.
At Epworth Villa, residents at one time lived in assisted living for 19 to 20 months.
Now, the average stay has climbed to two years. Woodard said wellness programs and a focus on nutrition and helping residents maintain their independence were part of the reason.
In 1990, the average person coming in was 77 years old; now the average age at admission is 84.
"There's no question that people ... are waiting longer to make that decision," he said.