Assisted living too often fails in older, sicker residents, report says

Assisted living too often fails in older, sicker residents, report says


Assisted living communities too often fail to meet the needs of older people and should focus more on residents’ medical and mental health issues, according to a recent report from a diverse panel of experts.

This is a clear call for change inspired by the changed profile of the population served by assisted living facilities.

Residents are older, sicker and more compromised by impairments than in the past: 55% are 85 and over, 77% need help bathing, 69% walking and 49% going to the toilet, according to data from the National Center for Health Statistics.

Additionally, more than half of the residents suffer from high blood pressure and a third or more suffer from heart disease or arthritis. Thirty-one percent have been diagnosed with depression, at least 11% have a serious mental illness, and 42% have dementia or moderate to severe cognitive impairment.

“The nature of the assisted living clientele has changed dramatically,” but there are no widely accepted standards for meeting their physical and mental health needs, said Sheryl Zimmerman, who led the panel. She is Co-Director of the Aging, Disability, and Long-Term Care Program at the University of North Carolina at Chapel Hill.

The report fills that gap with 43 recommendations from experts, including patient advocates, assisted living providers, and specialists in medical, psychiatric and dementia care, which Zimmerman says will become “a new standard of care”.

Look at staffing levels in assisted living facilities

A series of recommendations relate to staffing. The committee proposes that ratios of health care aides for residents be established and that a registered nurse or a licensed practical nurse be available on site.

Like nursing homes and home health agencies, assisted living operators have struggled to retain and hire staff during the pandemic. In a September 2021 survey, 82% reported a “moderate” or “high” level of staff shortages.

Kenneth Covinsky, a geriatrician and professor of medicine at the University of California, San Francisco, witnessed staffing issues when his mother moved into an assisted living facility at the age of 79. At one point she fell and had to wait about 25 minutes for someone to help her up. On another occasion, she waited 30 minutes in the bathroom as overworked staff members answered pagers that buzzed nonstop.

Eventually, Covinsky, the co-author of an editorial accompanying the consensus recommendations, ended up moving his mother to another facility.

The panel also recommended that staff members receive training on managing dementia and mental illness, medication side effects, end-of-life care, tailoring care to the individual needs of residents and on infection control – a weakness highlighted at the height of the pandemic. , when around 17% more people died in assisted living facilities in 2020 compared to previous years.

Training long-term care providers makes a difference

“If I was putting my parents in assisted living, I would definitely not just be looking at staffing ratios, but actual staff training,” said Robyn Stone, senior vice president of research at LeadingAge and co-director of its long-term services. and supports the center at the University of Massachusetts in Boston. LeadingAge is an industry organization representing not-for-profit long-term care providers. Stone said the organization is generally supportive of the panel’s work.

The better trained staff are, the more likely they are to provide high-quality care to residents and the less likely they are to feel frustrated and burnt out, said Helen Kales, chair of the department of psychiatry and behavioral sciences at UC Davis. Health. in California.

This is particularly important for memory care provided in self-contained assisted living facilities or a wing of a larger community.

“We’ve seen places where a memory care unit charges over $10,000 a month for ‘dementia care,’ but is little more than a locked door to keep residents from leaving the facility. unit and not the sensitive and personalized care advertised,” Covinsky and Kenneth wrote. Lam, his UCSF colleague, in their editorial.

Because dementia is such a prevalent concern in assisted living facilities, the committee recommended that residents obtain formal cognitive assessments and that policies be established to address aggression or other disturbing behaviors.

Care plans should be focused on the individual needs of residents

Other committee recommendations emphasize the importance of regularly assessing residents’ needs, developing care plans and including residents in this process.

“The resident really should be directing their goals and how they want care delivered, but that doesn’t always happen,” said Lori Smetanka, panel member and executive director of the National Consumer Voice for Quality Long-Term. Care, an advocacy organization.

“We agree with many of these recommendations” and many assisted living communities are already following these practices, said LaShuan Bethea, executive director of the National Center for Assisted Living, an industry organization.

Nonetheless, she said her organization had concerns, particularly about the practicality and cost of the recommendations. “We need to understand what the feasibility would be,” she said. Meanwhile, states should consider how they regulate assisted living, taking into account the increased needs of residents, Bethea added.

Because the country’s approximately 28,900 assisted living communities are regulated by the states and there are no federal standards, practices vary widely. Generally, there are fewer protections for residents than in nursing homes.

Originally, assisted living was meant to be a “social” model: a home setting where seniors could interact with other residents while receiving assistance from staff with daily tasks such as wash and dress. But given the realities of today’s assisted population, “the social model of care is outdated,” said Tony Chicotel, panel member and attorney for California Advocates for Nursing Home Reform.

Still, he and other panelists don’t want assisted living to become a “medical” model, like nursing homes.

“What’s interesting is that you see nursing homes pushing for a more home-like environment and assisted living that needs to more adequately manage the medical needs of residents,” Chicotel told me, referring to the current re-examination of long-term care inspired by the pandemic. “That said, I don’t want assisted living facilities to look more like nursing homes. How this will all play out is still not at all clear.

This article was produced by Kaiser Health News, a program of the Kaiser Family Foundation, an endowed nonprofit organization that provides information on health issues to the nation.

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