Assisted Living Facilities Are Pressed to Prepare for Sicker Residents

The people who live in these facilities are requiring more and more medical care as a major segment of the population ages. However, a surprising number of assisted living facilities are missing the mark when it comes to caring for the people who live there. when it comes to providing both medical and mental health care.

The Medical and Mental Health Care in Assisted Living Based on an Expert Delphi Consensus Panel, which was convened earlier this year by Dr. Sheryl Zimmerman of the University of North Carolina, published 43 recommendations that they believe assisted living facilities should implement to provide better care to their residents.

The recommendations are grouped into categories such as the number and qualifications of the staff, the training they receive, and the policies and procedures that govern the facility and the caregivers. The guidelines also include a push for more providers to be present in these facilities as well.

“We want to make sure there is access to medical and mental health services for all who live in assisted living,” said Dr. Barbara Resnick, one of the panelists and a professor of nursing at the University of Maryland who specializes in organizational systems and adult health, in an interview with The Epoch Times. “Some do a great job of it, some not so great.”

Needs of Assisted Living Residents Are Changing

Unlike its similar but definitely different cousin—the nursing home—an assisted living facility is not considered a healthcare space.

They are not normally covered under traditional insurance plans and instead are self or private-pay. While some offer limited medical services, others do not, placing the burden of a resident’s medical care on their family. However, they do offer a more home-like environment and can offer those that live there more personalized services, as many are smaller.

They also usually cost less than if you had to pay out of pocket for a nursing home.

“Increasingly, people have aged in place, they’re sicker, they’re more cognitively impaired, so the type of person who is in assisted living has really changed over the years,” said Resnick.

This change in assisted living is driven by the demands of the residents. Many people don’t want to go to a nursing home, and some residents feel as though the assisted living facility feels more like home. Thus, they choose to stay where they are for as long as possible, even to their own detriment.

Life expectancy, Resnick said, also plays a part in the equation, which is forcing many assisted living facilities to stay filled at capacity with a group of people who are getting sicker.

Many assisted living facilities need to—many already are—offer services that 20 years ago were primarily found only in nursing homes, said Tony Chicotel, the senior staff attorney for the California Advocates for Nursing Home Reform, who also participated in the panel while speaking to The Epoch Times. 

But that means that the number of people who are sicker and are living in a residential facility has skyrocketed, thus placing more of a burden on these groups. 

Facilities All Operate Differently

These facilities are not regulated at the federal level, and what they offer and how they provide care are regulated differently from state to state. 

They’re all very, very different,” Resnick said. 

Some assisted living facilities are owned and staffed by large corporations, others are “mom-and-pop” operations.

They can be as small as one or two rooms, or as large as 100. 

And just like the size of the facility, the types of services offered differ from one location to the next. While some facilities have a registered nurse available 24 hours a day, others only have a nurse on-site once every month.

Because these facilities are mostly private-pay, there are facilities that are priced to meet different segments of the market. Residents often have months or even years to prepare to move in, allowing them time to visit different facilities to find one that fits their needs and budget.

Current Challenges

Implementing all of these recommendations could be challenging, especially for organizations that are already struggling to meet current guidelines with a skeleton staff.

“We’re a little bit in this crisis right now, but we’re working through it,” said Resnick, who explained that while many students enroll in nursing programs, assisted living facilities fight to attract new graduates. Much of this has to do with the relatively lower pay at an assisted living facility versus a major hospital, and the work is also notoriously challenging.

Assisted living facilities face the same challenges when trying to hire other categories of caregivers as well as healthcare providers. The result is a twisted and confusing web of medication and patient management spread across various organizations, such as the resident’s primary care doctor’s office, their immediate family, and their assisted living facility’s medication coordinator.

“Some families’ expectations exceed what the recommendations or the regulations require,” Resnick said. “Some families expect mom to be seen by a healthcare provider if they have a twinkle in the left eye … The family might have to come and take mom to the doctor. Because that’s the requirement.”

Several experts are concerned that there are many assisted living residents who are hospitalized as a result of insufficient medical and mental health care at their facility.

Facility budgets also play a factor in what is feasible to offer residents. However, Chicotel said that the panel took into consideration the cost to facilities when making their recommendations. 

Dementia Care Needs Special Attention

People living in these facilities who have dementia or other memory or mental impairments are at special risk. It’s something that those who are shopping around for the best facility to live in really need to pay special attention to.  

“Cognitive impairment is there, it’s a disease, it’s gonna happen, it’s gonna get worse,” said Resnick. “There is no drug or cure behaviorally, but there are ways to make the quality of life better. That really is the goal here.”

Both Chicotel and Resnick cautioned that assisted living facilities that promote specialized dementia care may or may not be following best memory care practices.  

“Sometimes it’s a legitimate description of the services provided, sometimes there’s staff that are more highly trained, more expert in providing care to people with memory care or cognitive impairment,” said Chicotel, “Other times I think it’s just a marketing gimmick, all it means is they lock the door or they have someone who sits by the door and makes sure no one leaves without being attended to.”

A Launching Pad

Despite the latticework of regulations, Chicotel and Resnick said they are hopeful these 43 recommendations will become a starting point for leaders of assisted living facilities to launch improvements from. 

“So much of it is just taking a little extra time here or there to communicate with the resident and resident’s family, both to provide and receive information,” said Chicotel. “A lot of what I saw on the recommendations were about being attentive and commutative, and that’s really a cultural thing in the facility.”

Chicotel said much of the change must come from within assisted living facilities at the leadership level. Others believe that more regulations are needed to bring these communities up to a higher standard.

And while many of these facilities have a lot of work to do, others are already providing outstanding care, Chicotel said the trick is finding which facility best suits the resident’s needs, and which facility delivers on their promises.

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