As older people get sick, facilities must adapt

This article originally appeared on KHN.

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

It is a clarion call for change inspired by the altered profile of the population now served by assisted living.

Residents are older, sicker, and more affected by disabilities than in the past: 55% are 85 or older, 77% need help bathing, 69% walking, and 49% using the bathroom, according to data from the National Center for Health Statistics.

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

“The nature of clients in assisted living has changed dramatically,” yet there are no widely accepted standards to address their physical and mental health needs, said Sheryl Zimmerman, who led the panel. She is co-director of the Program on Aging, Disability and Long-Term Care at the University of North Carolina-Chapel Hill.

The report addresses this gap with 43 recommendations from experts, including patient advocates, assisted living providers, and medical, psychiatric and dementia care specialists that Zimmerman said he hopes will become “a new standard of care.”

One set of recommendations addresses staffing. The panel proposes that health aide to resident ratios be established and that a registered nurse or licensed practical nurse be available on-site. (Before establishing specific requirements for various types of communities, the panel suggested that further research on staffing requirements was necessary.)

Like nursing homes and home health agencies, assisted living operators have found it difficult to retain or hire staff during the covid-19 pandemic. In a September 2021 survey, 82% reported a “moderate” or “high” level of staffing 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 assisted living at age 79. At one point, she fell and had to wait about 25 minutes for someone to help her up. On another occasion, he waited for 30 minutes in the bathroom while overworked employees responded to buzzing pagers.

“The night scene was crazy — there would be one person for 30 or 40 residents,” said Covinsky, author of an editorial accompanying the consensus recommendations. Eventually, he ended up moving her mother to another facility.

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

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

The better trained the staff are, the more likely they are to provide high-quality care to residents and the less likely they are to become frustrated and burned out, said Dr. Helen Kales, chair of the UC Davis Department of Psychiatry and Behavioral Sciences. Health.

This is especially important for memory care that is provided in stand-alone assisted living facilities or a wing of a larger community. “We’ve seen places where a memory care unit charges upwards of $10,000 a month for ‘dementia care,’ but it’s little more than a locked door to prevent residents from leaving the unit and not the sensitive, personalized care that is announces,” Covinsky and his team wrote. University of California-San Francisco colleague Dr. Kenneth Lam in his editorial.

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

One such policy could be to try non-pharmaceutical strategies — examples include aromatherapy or music therapy — to calm people with dementia before turning to prescription drugs, Kales said. Another might be to request a medical or psychiatric evaluation if a resident’s behavior changes dramatically and suddenly.

Other panel recommendations emphasize the importance of regularly assessing resident needs, developing care plans, and involving residents in this process. “The resident really should be directing what their goals are and how they want their care delivered, but that doesn’t always happen,” said Lori Smetanka, panel member and executive director of National Consumer Voice for Quality Long-Term Care, a defense 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.

However, he said his organization has concerns, especially about the practicality and cost of the recommendations. “We need to understand what the feasibility would be,” she said, suggesting that a large study look at those issues. In the meantime, states need to examine how they regulate assisted living, keeping in mind the growing needs of residents, Bethea said.

Because the nation’s approximately 28,900 assisted living communities are regulated by states and there are no federal standards, practices vary widely and generally there are fewer protections for residents than those found in nursing homes. Some assisted living facilities are small homes that house as few as four to six seniors; some are large housing complexes with close to 600 older adults. About 919,000 people live in these communities.

“There are many different flavors of assisted living, and I think we need to be more determined in naming what they are and who they are best suited to care for,” said Kali Thomas, a panel member and associate professor of health services. , Policy, and Practice at Brown University.

Originally, assisted living was intended to be a “social” model: a home environment where older adults could interact with other residents while receiving help from staff with daily tasks like bathing and dressing. But given the realities of today’s assisted living population, “the social model of care is out of date,” said Tony Chicotel, panel member and 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 that nursing homes are pushing for a more home-like environment and assisted living needs to better manage the medical needs of residents,” Chicotel told me, referring to the current reassessment of nursing home care. long term inspired by the pandemic. “That being said, I don’t want assisted living facilities to look more like nursing homes. How this will all play out is still not entirely clear.”

KHN (Kaiser Health News) is a national newsroom that produces detailed journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization that provides information on health issues to the nation.

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