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Book Reviews   |    
Assisted Living: Sobering Realities
Reviewed by Marion Zucker Goldstein, M.D.
Psychiatric Services 2003; doi: 10.1176/appi.ps.54.7.1051
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edited by Benyamin Schwarz; New York, Haworth Press, 2001, 134 pages, $22.95 softcover

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The burgeoning assisted-living industry has generated much concern among mental health professionals, residents, and caregivers about the lack of appropriate individualized care for the very heterogeneous aging population living in assisted living facilities, as well as the lack of research, standards, and oversight associated with such care. Data on the total number of assisted living facilities are apparently difficult to obtain, but in the introduction to Assisted Living: Sobering Realities, the number is said to range from 30,000 to 40,000; one of the articles in the book lists the total as 11,459. The overall number of residents in assisted living facilities is not known, increases each year, and depends on the definition used.

In this compendium of eight papers, authored by 17 multidisciplinary gerontologic contributors and published simultaneously in the Journal of Housing for the Elderly, many concerns are identified, clearly defined in terms of meaning to elderly residents and their friends and family members, along with relevant characteristics of the owner of the housing complex, the community, and state government agencies. Issues such as "aging in place," avoiding institutionalization, searching and creating "home-iness," and addressing unmet needs—both chronic and acute—for all levels of income, including the poor elderly, are addressed in theory and discussions of research results.

The issues addressed and the scholarly nature of this book bring the knowledge base about the assisted living arena to considerably higher levels than before. This volume is very informative and has the potential to contribute to future policies for improving quality of life among older persons. Threatened and actual relocation when independence and autonomy decline, when frailty increases, and when one's living situation provides no opportunities for a role in life nor provides for adequate care is one of the "sobering realities" discussed in these articles. Another sobering reality is the distress that residents of assisted living facilities experience as a result of the incompatible mix of people, at various stages of decline, whom they have to live with as a result of individualized admission and discharge criteria.

Although, for the most part, the research results presented in this book are not generalizable and may be unique to the particular population or sites of the studies, the fact that this research took place at all is most commendable. The authors seem well aware of the limitations of their methods and samples and are attentive to the scientific merit of their research. This collection of articles is an important contribution to the field and will be of interest to professionals in all disciplines dealing with the ever-increasing elderly population who face the possibility of no longer being able or willing to care for themselves in their own homes. Clinicians, students, educators, researchers, and policy makers will find Assisted Living: Sobering Realities enlightening.

Dr. Goldstein is director of the division of geriatric psychiatry and associate professor in the department of psychiatry of the School of Medicine and Biomedical Sciences of the State University of New York at Buffalo.

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