A coalition of experts launched a new initiative on Wednesday with the aim of putting 43 recommendations for medical and mental health care in assisted living facilities into practice.
The “Be Well in AL” coalition was the subject of an in-depth virtual discussion led by Sheryl Zimmerman, PhD, co-director of the University of North Carolina at Chapel Hill’s program on aging, disability and care. long duration. The program was organized by the university, AMDA-The Society for Post-Acute and Long-Term Care Medicine and the Center for Excellence in Assisted Living (CEAL).
Assisted living, Zimmerman noted, is the nation’s largest residential long-term care provider — and 40% of assisted living residents live with Alzheimer’s disease or other dementias. But with the sector regulated at the state level, there are 350 different policy approaches to assisted living.
Reinventing the assisted living of the future
The coalition’s goal, Zimmerman said, is to reimagine assisted living for the future by effecting changes in practices and policies based on evidence and best practices.
To do this, the group will soon organize two action-oriented roundtables on operational and policy changes, and develop briefs and toolkits with previously published recommendations. The coalition plans to invite other stakeholders to the process, including policy makers; owners/operators; professional, provider, healthcare and advocacy organizations; residents and family members; and researchers.
“Stakeholders agree — and vehemently — that assisted living today is not as expected in the past, and needs to be redesigned in the future,” Zimmerman said, highlighting the findings of research on the subject published in the journal. JAMANetwork Open.
The recommendations fall into five categories: staffing and education, nursing and related services, resident assessment and care planning, policies and practices, and clinicians and medical and mental health care.
And while all of those areas need special attention, Zimmerman said the coalition is starting with residents and promoting person-centered care in assisted living. She said assisted living residents moved in with greater needs and the setting was the biggest provider of care and services for people with Alzheimer’s and other dementias.
But assisted living, across the board, has a limited presence of medical and nursing providers. Only 46% of communities employ a registered nurse or registered nurse practitioner, and few communities have primary care on site. And due to varying regulations governing the framework between states, less than 40% of states have specific minimum staff ratio requirements, and only 25% require staff to have at least 11 hours of training.
These variabilities have raised concerns about infection prevention, medication use, and miscommunication with staff when a change in the resident’s condition occurs.
“The field has evolved — there’s an increase in nursing presence and integrated medical care,” Zimmerman said. “The problem is that it’s not the data that drove the reform and what that evolution should look like.”
Zimmerman, who is working on a study of dementia, medical and mental health care in assisted living facilities, found that 77% of the recommendations are already being implemented in at least three-quarters of the communities involved in the new study.
“The bottom line is that these recommendations aren’t ambitious — they’re achievable and realistic,” Zimmerman said. “It gives us a great base from which to start.”
Changing the Assisted Living Model
Lindsay Schwartz, PhD, Chair of the Board of CEAL and Founder and Director of Workforce & Quality Innovations LLC, said that while the assisted living model focuses on person-centered care and quality of living in a family environment, extensive health care is provided.
“We have to recognize that healthcare happens in assisted living,” Schwartz said. “Gone are the terms social model versus medical model. Assisted living provides holistic care that includes physical and mental well-being, and could be a model for other long-term care facilities.
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