Norma Evans describes her 59-year marriage to her husband Frank as "the most wonderful life."
Frank Evans was a Navy man during World War II and then spent 35 years working for the local phone company before "retiring" to a job running a credit union.
Norma Evans stayed at home to raise their three children. As a couple, and later with their children, the Evans' spent their recreation time in Utah's mountains. They loved camping and fishing and "wore out two boats," Norma Evans said.
But three years ago, Norma Evans began to notice a change in her husband. He was forgetful, disoriented and began to need help caring for himself. Doctors diagnosed Alzheimer's. Last February, after trying to manage on her own, Norma Evans decided to move her 80-year-old husband to an assisted-living facility in Murray called Silverado.
"I was trying to take care of him, but it was wrong, wrong, wrong," the 81-year-old woman said. "My health was starting to suffer, and my kids said "Mom, you can't do this alone."
As the senior population ages, families like the Evans' struggle every day to determine how best to care for them. Spouses can be too frail, burdened by their own physical problems. In most cases, the children have families of their own and wrestle with a balancing act of caring for their parents while caring for their own kids, a challenge that has labeled them the "sandwich generation."
The dilemma has spawned a new option in senior care called assisted living. The concept offers seniors a campuslike living environment where they can participate in social activities and communal dining, while maintaining as much of their independence as possible.
Care levels vary from almost no assistance from center staff to basic support like medication reminders. At the next level, residents will get assistance with bathing, dressing and incontinence problems.
All facilities offer 24-hour staffing and emergency assistance. Some, like the one Norma Evans chose for her husband, have specialized, secure units for patients with memory loss or Alzheimer's.
Care staff is generally made up of mostly licensed vocational nurses or certified nursing aides, with some registered nurses on site part time or on call. Most facilities also have a doctor who serves as medical director.
Some, but not all, have doctors on site who make rounds and work with a resident's primary-care physician.
"We are not nursing homes. We don't want to be a nursing home, " said Denell Bredsguard, an administrator at Heritage Place in Bountiful. "Often, people come in with that misconception."
And they are surprised by what they find. Assisted-living communities are designed to look more like a residential living room than a hospital-like institution.
There are easy chairs, couches around fireplaces and entertainment centers. Some have exercise rooms and pools for water aerobics classes, and most have organized social activities including sing-alongs, bingo, cards and even dances. Some have hair salons, hobby shops and religious services.
Others allow residents to bring a beloved family pet to live with them or to play with the resident dogs, cats or birds.
Living arrangements vary from studio-type apartments with kitchenettes, for the most independent, to more traditional institution-style rooms. Married couples can move in together, and most facilities offer both private and shared-room options.
"Most people are pleasantly surprised at how nice an environment it is," Bredsguard said. "They like that they can be independent and make their own choices but also have the option to socialize and participate in activities."
Many seniors actually thrive after moving into an assisted-living community, she said. "So many of them have been isolated at home because they were unable to get out and do things like they used to," said Bredsguard. "Many of them just needed social outlets and good nutrition."
Assisted living can also be good for a resident's family members.
"They don't have to feel guilty about getting help. Many of them have promised (they) wouldn't put Mom in a nursing home, " Bredsguard said.
"This is a good way to make the first break and still be a good (child) and know that Mom is taken care of, and you don't have to worry."
The picture isn't all rosy, however.
Assisted living, which the state licenses, is expensive. Nationally, the average monthly cost of room, board and basic care is about $2,500. Medicare, Medicaid and most insurance companies do not cover the costs.
Along the Wasatch Front, a resident can pay as little as $1,100 monthly for a shared room with basic care to more than $5,400 for a private room. Fees generally cover basic 24-hour assistance, meals and fresh linens, but amenities like additional housekeeping, private laundry services or even special diet needs are typically offered on a fee-for-service basis.
Rapid growth has also made the industry highly competitive, with companies doing all they can to fill resident beds and then keep residents in place as long as possible, even when their care needs exceed the capabilities of staff.
Research from the American Association for Retired Persons calls the industry the "fastest growing type of senior housing in the United States." Recent estimates show that some 600,000 seniors are living in about 30,000 assisted-living communities.
In Utah, which licenses assisted-living communities at two levels, Level I for basic care and Level II for more assistance, the growth has also been rapid.
In 1998, there were 117 licensed facilities with about 2,300 available beds. Today, there are 145 facilities and 3,724 available beds, according to the state health department's Bureau of Licensing.
That growth raises concerns for state monitoring offices and should raise questions for consumers, licensing bureau director Deb Wyncoop said. The health department, which typically reviews health-care licensing every five years, shortened that period to 18 months for assisted-living communities and just ended a yearlong regulations rewrite process.
The new regulations should open for public review and comment soon and go into effect sometime next year.
"We started to see a large increase in the number of deficiencies. A large increase in the number of inadequate resident service plans and poor assessments by nursing staff," Wyncoop said.
"I think the new regulations we have will be more clear. They will require that (facilities) get an assessment every six months instead of every year and to have somebody not affiliated with the facility do it. It will be a little more objective."
The new regulations will also provide better state definitions of care levels and more clear directives on when "nursing-type" services can be delegated to nurses assistants or other staff.
Wyncoop and Bredsguard, who sat on the review committee, agree that more clearly defined rules will help both assisted-living communities provide better service and protect consumers.
"It's really important that people read through the contract," said Wyncoop, who gives the industry a grade of "B" for overall quality and responsiveness to residents. "Know what you're getting, ask questions and try to foresee the problems that might arise as your family member ages."
Wyncoop said her biggest concern about the industry is its rapid growth and how the competition to fill resident beds may mean some residents stay in assisted living longer than they should.
Many facilities market themselves as communities where the elderly can "age in place," but that's not always appropriate, she said. In most cases, once a person requires "skilled nursing" services, they have to move out of assisted-living units. Residents typically don't die in an assisted-living facility.
Bredsguard agrees.
"I think there are some companies out there that are more concerned with keeping resident dollars than they are in providing quality care," she said. "That does have to do with rapid growth. As an industry, we don't want that kind of black eye. That's exactly what happened to nursing homes."
The two women also agree that rapid growth, which will continue because of the aging baby boomer population, will likely leave the senior care industry with a shortage of qualified, skilled caregivers. That could result in further quality of care issues, Bredsguard said.
But the Utah Office of Aging ombudsman, Chad McNiven, said complaints about assisted-living communities are rare. Both McNiven's office and the state health department offer consumer guides to selecting care facilities for the elderly.
"We get a lot of questions as to where (assisted living) fits into the continuum of care," McNiven said. "We do have some complaints, but overall, it seems that (assisted-living communities) are far more responsive to the market, I guess because it's a private pay issue. We get a lot more complaints about nursing homes."
McNiven, who also sat on the regulation review committee, said he thinks the state and care providers are doing a good job of working together to keep consumer costs down while providing good care.
For Norma and Frank Evans, the move to Silverado has worked out well. Frank Evans seems happy and remains active, although he can't remember a lot of things. Norma Evans, who lives just 10 minutes away, makes frequent visits. Her health has improved, and she said she worries a lot less.
"They're just so wonderful to him," she said. "It really couldn't have worked out better. But you can't imagine how much I miss him."
E-mail: dobner@desnews.com