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Providers tend to respond to incidents like the one in Eagan by arguing that residents are always free to choose someplace else and move. But that isn't so easy for someone with Alzheimer's or dementia. The disorientation of moving can often be more harmful than simply staying put, even in a heavily understaffed facility. The Levangs kept Dolores at Alterra for as long as they could stand it. In February 2000, after 11 months, they gave up and moved Dolores into her own apartment with a full-time aide. Now 80, Dolores spends most of her time reading romance novels and doing crossword puzzles. She goes for lengthy strolls daily--without using her walker.
Alterra isn't doing nearly so well: the company, seeking to improve its cash flow, is selling more than 60 of its 481 facilities. But the care at the Eagan center appears to have improved significantly. A recent visit found 12 smiling women singing songs with a local preacher, two men sitting by the fireplace playing cards and the line to the beauty shop out the door. Families were raving about all the personal attention. There are now 32 residents--and, during the day, six full-time caregivers (an impressive 5-to-1 ratio). Good care, it seems, can't be done on the cheap.
--With reporting by Marc Hequet/Portage
TIME.com For more information and Web resources on assisted living, go to time.com/assistedliving.com