title: Aging in place and negotiated risk agreements.
abstract: An assisted living community (i.e., residence [ALR]) that responds to a resident's changing needs by adjusting services and level of care criteria means that the resident is less likely to be discharged to a higher level of care, such as a nursing home, and will "age in place." A "managed" or negotiated risk agreement (NRA) can facilitate aging in place by accommodating a resident's choices and potential risks of remaining in the residence. Although more than half the states speak to aging-in-place in their assisted living regulations, far fewer provide guidelines for negotiated risk discussion and its influence on service plans. Managing decline and the risks to a resident's safety and well-being can perhaps be addressed by "upstream palliative care," a concept and practice that respects a resident's quality of life interests while meeting and supporting their physical, mental, and emotional needs. This article discusses these issues as well as the capacity of a cognitively impaired/demented resident to enter into an NRA and its continuance when resident understanding is questionable, and dying-in-place.
authors.affiliation: College of Nursing, New York University, New York, USA.
authors.forename: Ethel
authors.initials: E
authors.lastname: Mitty
authors.forename: Sandi
authors.initials: S
authors.lastname: Flores
mesh_terms: D000368:Aged / Q000502:physiology / Q000523:psychology; D040561:Assisted Living Facilities / Q000458:organization & administration*; D003266:Continuity of Patient Care / Q000458:organization & administration; D003657:Decision Making; D003704:Dementia / Q000523:psychology; D005161:Facility Regulation and Control / Q000458:organization & administration*; D015577:Geriatric Assessment / Q000379:methods*; D016852:Housing for the Elderly / Q000458:organization & administration; D006801:Humans; D016743:Mental Competency; D020380:Needs Assessment / Q000458:organization & administration*; D017008:Negotiating / Q000379:methods* / Q000523:psychology; D011788:Quality of Life / Q000523:psychology; D018570:Risk Assessment / Q000458:organization & administration*; D013727:Terminal Care / Q000458:organization & administration; D014481:United States