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For older adults who can no longer care for themselves at home, but don't need nursing home care, assisted living facilities (ALFs) are an increasingly popular option.

These facilities provide residents with their own apartment-like living spaces, as well as 24-hour staff, help with activities of daily living (ADLs) such as bathing or feeding, social services, meals, housekeeping and laundry services, recreational activities, transportation, and getting health care.

For those without memory problems, however, there may be another alternative: a cruise ship.

New Report in the Journal of the American Geriatrics Society

Comparing ALFs and cruise ships, researchers at Northwestern University's Feinberg School of Medicine found that ships actually offer more services than some ALFs. In addition to providing three meals a day, escorts to meals, housekeeping and laundry services, and recreational opportunities, the ships have physicians and nurses on site and available 'round the clock'. (Some ALFs have medical staff on hand only during certain hours.) In addition, many ships also have "medic areas" that resemble tiny hospitals. If a passenger becomes very ill, physicians onboard can stabilize him or her, then have the passenger transferred to a hospital at the next port, or airlifted to a hospital via helicopter.

Like ALFs, cruise ships offer handicapped-accessible rooms. Ship hallways and guest rooms are fitted with handrails, making them easier to navigate. Although the rooms on cruise ships are smaller than those in ALFs, the average ship - with dens, libraries, and other public spaces-is actually more spacious than the average ALF.

In addition, the number of employees on the average cruise ship exceeds the number at the average ALF. Cruise lines such as Royal Caribbean and Norwegian Cruise Lines typically have one employee for every two to three passengers. Cruise ship "room attendants" might be trained to help older adults with ADLs, the researchers write, reporting their findings in the November 2004 issue of the Journal of the American Geriatrics Society. In the same way, cruise ship waiters - who usually memorize passengers' drink preferences and have their favorite beverages waiting at their tables - might be able to dispense older passengers' medications.

What about the cost?

Since Medicare and Medicaid do not usually cover the cost of ALFs, most older adults in assisted living, or their families, pay the tab. (A small number of older people have long-tem care insurance, which may cover the cost.) The tab at an ALF, it turns out, is not much different than the tab aboard ship. The average ALF costs roughly $29,000 a year, the researchers found. By comparison, a year aboard the Royal Caribbean's Majesty of the Seas, comes to about $33,000.

The researchers conclude "cruise ship care" is a viable alternative to ALFs.

What Should I Do?

If you or a loved one needs help with ADLs, talk to a health care provider about options. Cruise ship care, say the researchers who conducted the study, would be most suitable for older adults who don't have dementia or other mental impairments, need help with just a few ADLs, and, of course, enjoy traveling.

The summary above is from the full report titled, "Cruise Ship Care: A Proposed Alternative to Assisted Living Facilities." It is in the November 2004 issue of the Journal of the American Geriatrics Society (Volume 52, Issue 11, pages 1951-1954). The report is authored by Lee A. Lindquist, MD, and Robert M. Golub, MD, of Northwestern University's Feinberg School of Medicine in Chicago.