By Judith Graham
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. Almost a third have been diagnosed with depression and at least 11% have a serious mental illness. No less than 42% suffer from 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-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”.
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. (Before establishing specific requirements for various types of communities, the panel suggested that further research into staffing needs was needed.)
Like nursing homes and home health agencies, assisted living operators have struggled to retain or hire staff during the covid-19 pandemic. In a September 2021 survey, 82% reported a “moderate” or “high” level of staff shortages.
Dr. 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 restroom as overworked employees answered pagers that buzzed nonstop.
“The night scene was crazy: there would be one person for every 30 to 40 people,” said Covinsky, the author of an op-ed accompanying the consensus recommendations. Eventually, he 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 needs of each resident 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.
“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 University of Massachusetts-Boston Center. 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 Dr. Helen Kales, chair of the Department of Psychiatry and Behavioral Sciences at UC Davis. Health.
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 his University of California San Francisco colleague Dr. Kenneth Lam wrote in their op-ed.
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.
One such policy could be to try non-pharmaceutical strategies (eg, aromatherapy or music therapy) to calm people with dementia before resorting to prescribed medications, Kales said. Another might request a medical or psychiatric evaluation if a resident’s behavior changes drastically and suddenly.
Other committee recommendations emphasize the importance of regularly assessing residents’ needs, developing care plans and including residents in this process. “The resident should really direct 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, and suggested that a large study look at these questions. In the meantime, states should consider how they regulate assisted living, taking into account the increased needs of residents, Bethea said.
Because the nation’s roughly 28,900 assisted living communities are state-regulated and there are no federal standards, practices vary widely and there are generally fewer protections for residents than in assisted living homes. retirement. Some assisted living facilities are small homes housing as few as four to six seniors; some are large housing complexes with nearly 600 seniors. Nearly 919,000 people live in these communities.
“There are many different flavors of assisted living, and I think we need to be more determined to name what they are and who they are best suited to,” said Kali Thomas, panel member and associate professor of health care services. health. , Policy, and Practice at Brown University.
Originally, assisted living was meant to be a “social” model: a home-like setting where seniors could interact with other residents while receiving assistance from staff with daily tasks such as than washing and dressing. 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.
We look forward to hearing from readers about the questions you’d like answered, the issues you’ve had with your care, and the advice you need for dealing with the health care system. Visit khn.org/columnists to submit your requests or advice.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polls, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.
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