HomeHealthMental HealthAssisted living residents are older and sicker than in the past

Assisted living residents are older and sicker than in the past

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Residential care communities all too often fail to meet the needs of the elderly and should focus more on residents’ medical and mental health concerns, according to a recent report by a diverse panel of experts.

It is a clarion call for change, inspired by the changed profile of the population now serving assisted living facilities.

Residents are older, sicker and more compromised by disability than in the past: 55 percent are 85 and older, 77 percent need help bathing, 69 percent walking and 49 percent using the toilet. data from the National Center for Health Statistics.

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

“The nature of the clientele in assisted living has changed dramatically,” but there are no widely accepted standards for addressing 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 addresses this gap with 43 recommendations from experts, including patient advocates, assisted living providers and specialists in medical, psychiatric and dementia care that Zimmerman said she hopes will become “a new standard of care.”

Look at the staffing in assisted living apartments

A set of recommendations is about staffing. The panel suggests establishing ratios of health assistants to residents and that either a Registered Nurse or a Registered Practical Nurse be available on site.

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Like nursing homes and home care agencies, assisted living facility operators have found it difficult to retain and hire staff during the pandemic. In a September 2021 survey82 percent reported a “moderate” or “high” staff shortage.

Kenneth Covinsky, a geriatrician and professor of medicine at the University of California San Francisco, witnessed staffing problems when his mother moved into assisted living at age 79. At one point she fell and had to wait about 25 minutes for someone to help her get up. On another occasion, she waited 30 minutes on the toilet as overworked staff members responded to pagers buzzing non-stop.

Ultimately, Covinsky, the co-author of an editorial accompanied by the consensus recommendations, eventually his mother moved to another institution.

The panel also recommended that staff receive training on managing dementia and mental illness, drug side effects, end-of-life care, tailoring care to the needs of individual residents and infection control – a weakness identified during the peak of the pandemic emerged. , when an estimate 17 percent more people died in assisted living in 2020 compared to previous years.

Long-term training for caregivers makes a difference

“If I were to place my parent in assisted living, I would certainly look not only at staffing ratios, but also at the actual training of staff,” said Robin Stone, senior vice president of research at LeadingAge and co-director of the Center for Long-Term Services and Support at the University of Massachusetts in Boston. LeadingAge is an industry association representing not-for-profit providers of long-term care. Stone said the organization generally supports the panel’s work.

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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 Kaleschair of the Department of Psychiatry and Behavioral Sciences at UC Davis Health in California.

This is especially important for memory care delivered in independent assisted living facilities or a wing of a larger community.

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

Because dementia is such a pervasive concern in assisted living, the panel recommended that residents receive formal cognitive assessments and that policies be put in place to address aggression or other behaviors of concern.

Care plans should focus on the needs of the individual resident

Further recommendations from the panel emphasize the importance of regularly assessing residents’ needs, developing care plans and involving residents in this process.

“The resident should really define what their goals are and how they want care, but this doesn’t always happen,” he said Lory Smetankaa panelist 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 homes already follow these practices, he said LaShuan Betheaexecutive director of the National Center for Assisted Living, an industry association.

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Nevertheless, she said her organization has concerns, especially about the feasibility and cost of the recommendations. “We need to understand what the feasibility would be,” she said. Meanwhile, states should explore how they regulate assisted living while taking into account the increased needs of residents, Bethea added.

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

Originally, assisted living was conceived as a ‘social’ model: a home environment where older people could interact with other residents while receiving help from staff with daily tasks such as bathing and dressing. But given the realities of today’s assisted living population, “the social model of care has become obsolete,” said Tony Chicotel, a panelist and human resources attorney with 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 you see nursing homes push for a more homelike environment and assisted living that should better manage residents’ medical needs,” Chicotel told me, referring to the current pandemic-inspired rethinking of long-term care. “Having said that, I don’t want assisted living homes to become more like nursing homes. It is not yet clear how this will all end.”

This article was produced by Kaiser health news, a program of the Kaiser Family Foundation, an endowed non-profit organization that provides information about health issues to the nation.

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