It’s not just Assisted Living…it’s living with assistance : Part 1

The words “assisted living” have been around for over thirty years – since around 1990 - when the first AFL’s (assisted living facilities) started popping up throughout the United States.  They were in different shapes and sizes, but many times two and three-story buildings, which from the outside looked like upscale apartment buildings. 


Since then, many senior living communities call themselves “assisted living” or say they offer “assisted living.”  But what is it really? Is it a bit lighter care than nursing care in a nursing home?  Does it included caring for those who have Alzheimer’s Disease or who have dementia – or  “memory care” as some people call it? And in Michigan, is it a licensed community – an “AFC,” or “HFA”? 


In this article, and subsequent articles to come, I will explain everything you need to know about “assisted living”  - as well as “memory care,” and the differences between assisted living, memory care, nursing care, and independent living . I hope then you can more accurately determine exactly which type of living situation a loved one who is beginning to need some type of senior living care may need, especially if it is in the assisted living world.  


And as the title of the article implies, I will also discuss the concept of  “living with assistance,” which is what we call what we do at Orion Oaks Assisted Living and Memory Care in Lake Orion. Just people living their lives, with a little or a lot of assistance.  But more on that later. 


I will also be giving the reader some senior living  “hints” along the way…inside scoops about senior living that only those working in the industry really know.  I always like to know those kind of things about industries that  I’m not that familiar with. 


(Hint # 1)  watch out for people or places that use institutional words like “facility,” or “assisted living  facility.”  Who wants to live in a “facility?” Using words like senior living “community” or “residence” shows an awareness of trying to get away from providing “institutional” living and providing a more “residential” environment, which is more and humanistic in general, seeing the whole person.  


The first thing you have to know – is that the term assisted living is NOT a legal term in the State of Michigan, like it is in some states.  In Michigan, it is strictly a descriptive term, and is generally understood by the public to mean that the senior community provides some level of personal care, such as bathing, dressing, medication dispensing, and in the more comprehensive places, helping with eating and walking (ambulating)  as well. 


Hint #2.  These are known in the business as “activities of daily living.” 


This is important to know because some “assisted living” takes place in licensed communities, and some take place in “unlicensed” communities.  You need to know the difference.  


Unlicensed communities are usually independent living communities, which offer no personal care, but who may offer a little bit of supportive care, but call it assisted living.  These unlicensed communities are not regulated by the State, and in reality they are offering these services to their independent living residents so they don’t move out when they do need a little care. This is fine.  However, when a person needs more than a little care, then you can run into problems as that is not what that senior community is built for. 


 The care in licensed communities is generally much more comprehensive, are run by senior living professionals,  and are monitored by the State. For the sake of transparency, I’m a licensed guy, and feel the care in licensed communities is superior to those in unlicensed ones.   


Hint #3. Licensed communities in Michigan are called either an AFC (Adult Foster Care) which are 20 units or lower, or an HFA (Home for the Aged) which are 21 units are more.  (Personally, I hate those names, and as the former Chair of one of the State Assisted Living trade organizations, have fought to change the names of those licensed to “assisted living” for years.)     


One last thing.  As a consumer,  you have to watch out for how a community focuses on the quality of life of an individual, and much as the quality of care they provide.  Some unlicensed communities that offer independent living have a good quality of life, but the quality of personal care they provide is weak.  


Hint #4.  (Watch out!  Independent living communities  may offer a great quality of life to its independent residents, but may not offer proper, professional care.) 


On the other hand, some licensed communities (who may call themselves facilities – again, look out for that) may have great quality of personal care they provide, but many times are not focused on each person’s quality of life.  


In my opinion, what’s the use of great personal care, if at ten o’clock in the morning, after one is cared for – bathed, dressed, they have eaten and taken their medications –  they don’t have a good quality of life?  We don’t want people to just survive – we want them to thrive! 


So what you want to do - if you or a loved one needs assisted living - is to try and find a senior community that has both!   One that provides a great quality of care, and offers older seniors a chance for a wonderful quality of life as well. To me, that’s just good common sense. 


I hope that helps! In my next article, I will write more about Memory Care and dementia care, and where that fits into the senior living spectrum.  


Hint #5   (You can find memory care and dementia care in both assisted living and nursing homes.)


Until then, have a great summer, and keep living, learning and loving!



Dean Solden is the CEO of Creative Senior Solutions (CSS), a management and development company specializing in senior living.  CSS currently manages Orion Oaks Assisted Living and Memory Care in Lake Orion, Michigan.  (  You can reach Dean at (734) 260-3600 or  


The Senior Living Continuum  

  1. Independent Living – a senior living community where NO personal care is needed, but generally the community offers other amenities such as housekeeping, laundry, and sometimes offers meal services – from 1-3 meals per day.  Of course they also mow the lawn and plow the snow!  Some senior communities also offer beginning level personal care on an “a la carte” basis, and may even have a home health care company with an office in their community.  These are “unlicensed” communities, and not regulated by the State of Michigan. 


(Hint #2 – some communities call this a la carte care “assisted living” or say they offer “assisted living services.  Beware.  This is not true “assisted living.”  It is just some extra support – which may be good for those with just a little need for care.  But it is not  comprehensive assisted living services or an assisted living community. )


  1. Assisted Living Community.  (some still call this an assisted living facility.  As in Hint #1. be careful about that).  A true Assisted Living community is a licensed community by the State of Michigan,  under the AFC (Adult Foster Care) or HFA (Home for the Aged) license.  The only thing you really need to know about licensing 



Resident assistant is a preferred word, but we call persons who provide care just “people”, (isn’t everyone just a person) or “Carefriends” when we refer to them professionally. If people use institutional words, they tend to provide institutional care.  If they use more humanist words, they tend to see the bigger picture and understand the gestalt of the entire person’s quality of life within the need of also providing professional personal care.  More on that later). 


Living with Assistance is a breakthrough philosophy in the Senior Living Industry. Simply stated, it changes the initial point of focus in a senior living community from thinking primary about providing professional, loving care to people who need assistance -  to thinking about how those people can also consistently have a great life  throughout the day.  In other words, the focus on quality of life equals to the actual quality of care.  


This in no way changes the professional level at which professional organizations provide excellent care to its people. That should stay the same or hopefully become even better.  But it changes the consciousness of all staff and families adding the concept of having people have a high quality of life as much as possible,  while at the same time receiving professional quality care.  


If you are a staff member, think about your brain and how you usually think about getting all your tasks done during the day  - helping people bath, get dressed, eat, walk, take medications, toileting – that’s a lot to think about.   Now picture all of those things on just one side of your brain.  Now picture the other side of your brain, at the same time, thinking about how during those care times, and also during people’s free time, people can have the highest quality of life possible.  Hopefully, it will change the way you think.  


Then, people aren’t just getting assistance, but instead, they are “living with assistance.” 


Vibrant Life saying: “  In living with assistance, living is first, and the care is professionally done in the background.”  


  1. How did we get here? 


How did we get to this place where we have 1.5 million people in nursing homes and 1.5 million people in assisted living communities and we still aren’t focusing on their quality of life?  

How did we get to a place where all of our energies are focused on the care people need and not their enjoyment of life, their daily fulfillment, their sense of purpose, and their happiness?  

It is because the underlying basis of the long-term care system we have today was set up over 60 years ago  - and we still haven’t changed it very much.  It is a history of hospitals, nursing homes, and assisted living facilities that began about 1960.  

It started in 1960 with nursing homes, and evolved in 1990 to assisted living communities.  And I predict, in the near future, at least by 2025, there will be  another change. Some people now call it “person-centered care.”  I call it “living with assistance.” And some people are starting to do it now. 

In hospitals throughout the 20th century, we placed the medicine over people. We were trying to fix a problem, the disease within a person.  And still today, we don’t look at each person’s medical problems holistically, but we try to fix only the specific problem, without looking at the whole human being.    

In 1960, with the coming forth of nursing homes, we were still fixing a problem.  Elderly people needed to be cared for or supervised, and the families couldn’t do it their homes anymore, for a variety of reasons we will get into later.   They created the nursing home.  And they made the same mistake hospitals have done, because they followed the hospital model.  As a result, they put the nursing care ahead of the patient’s emotional  and personal well-being, or simply, ahead of the person’s life.   We all know how that has worked out. Not good. 

In 1990, with the evolution of assisted living, and despite all the improvements of assisted living over nursing home care, we have continued this pattern.  People still had a problem. They still couldn’t care for themselves.  So we went about fixing the problem.   We took care of all things they couldn’t do for themselves.  We helped them get dressed, bath, go to the bathroom, eat, walk and take medications.  But now we were fixing one problem and creating another.  The purpose of dressing, bathing, going to the bathroom, eating, walking and taking medications is not to just get all those things done.  Those are just the basics so we can LIVE!   The industry forgot that Living is the purpose of it all, not just getting all the basics of life done - or as they call them “activities of daily living” or ADL’s.  (I call them ADS’s – activities of daily survival.  Activities of daily living would be laughing, learning, and loving.)  The industry was and has been too used to the hospital and nursing home mentality of fixing the physical problem.  In doing so, they created a new problem.  Boredom, lonliness, depression.  They forgot that people need a purpose to Live.   

That is why I propose we move from assisted living to Living with Assistance.   

But to fully understand where we need to go, you need to know where we came from.  So read on about the history of nursing homes and assisted living communities.  I promise you, it won’t be too boring.  


Vibrant Life saying: “  we paved Paradise and we put up a Parking Lot.”  (Joni Mitchell)