Facilities need to adapt as older people get sick

This article was originally published at: CHN.

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

This is a clear call for change, inspired by the changing population profile that assisted living now serves.

According to data from the National Center for Health, residents are older, sicker, and more disabled than ever before: 55% are 85 years and older, 77% take a bath, 69% take a walk, and 49% needs help with toilet Statistics.

In addition, more than half of residents have high blood pressure and more than a third have heart disease or arthritis. About one-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, 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-Chapel Hill she.

The report fills this gap with 43 recommendations from experts, including patient advocates, assisted living providers, and medical, psychiatry and dementia care professionals, which Zimmerman says he hopes will become “a new standard of care.”

A number of recommendations are for staffing. The panel recommends determining the ratio of health aides to residents and having either a registered nurse or a licensed practitioner nurse in the field. (Before establishing specific requirements for the various types of communities, the panel recommended that more research be done on staffing requirements.)

Like nursing homes and home health institutions, assisted-living operators have struggled to hire or hire staff during the covid-19 outbreak. In a September 2021 survey, 82% reported a “moderate” or “high” level of staff shortages.

A geriatrician and professor of medicine at the University of California-San Francisco, Dr. Kenneth Covinsky witnessed staffing problems when his mother transitioned into assisted living at the age of 79. Someone to help him get up. In another incident, she waited in the bathroom for 30 minutes as overworked staff responded to buzzing pagers incessantly.

“The night scene was insane: it would have been one person for 30 to 40 residents,” said Covinsky, author of an editorial accompanying the consensus recommendations. He eventually had to move his mother to another facility.

The panel also recommended that workers receive training in managing dementia and mental illness, the side effects of medications, end-of-life care, tailoring care to the needs of individual residents, and infection control – a weakness highlighted at the height of the pandemic. When an estimated 17% more people die in assisted living in 2020 than in previous years.

“If I were placing my parent in assisted living, I would certainly be looking at actual staff training, not just staffing ratios,” said Robyn Stone, senior vice president of research and co-director of long-term services at LeadingAge. and the 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 work of the panel.

Professor of Psychiatry and Behavioral Sciences at UC Davis. Helen Kales said the more well-trained the staff, the more likely they are to provide high-quality care to residents and the less likely they are to feel frustrated and burnt out. Health.

This is particularly important for memory maintenance delivered in independent assisted living facilities or in a wing of a larger community. “We’ve seen places where a memory care unit charges more than $10,000 a month for ‘dementia care’, but there is little more than a locked door to prevent residents from leaving the unit, and there is no sensitive and personalized care that is advertised,” Covinsky and friend wrote. University of California-San Francisco colleague Dr. Kenneth Lam in the editorial.

Because dementia is such a common concern in assisted living, the panel recommended that residents receive formal cognitive assessments and establish policies to address aggression or other worrisome behaviors.

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

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

“We agree with most 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 was particularly concerned about the viability and cost of the recommendations. “We need to understand what the feasibility will be,” he said, and suggested that extensive research be done on these issues. Meanwhile, states should examine how they regulate assisted living, taking into account the growing needs of residents, Bethea said.

Because the country’s roughly 28,900 assisted living communities are regulated by states and there are no federal standards, practices vary widely and there is often less protection for residents than is found in nursing homes. Some assisted living facilities are small homes that accommodate at least four to six seniors; some are large residential complexes with around 600 older adults. About 919,000 people live in these communities.

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

Initially, assisted living was to be a “social” model: a home-like environment where older adults could interact with other residents while receiving assistance from staff with daily tasks such as bathing and dressing. But given the realities of today’s assisted living population, “the social care model is outdated,” said Tony Chicotel, a panel member and staff attorney at California Advocates for Nursing Home Reform.

Still, he and other panelists do not want assisted living to become a “medical” model like nursing homes.

“What is interesting is that you find that nursing homes are forcing the transition to a more home-like environment and assisted living needs to more adequately manage the medical needs of residents,” Chicotel told me, referring to the current pandemic-inspired reexamination of long-term care. “However, I don’t want assisted living facilities to look more like nursing homes. It’s not yet clear how all this will turn out.”

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

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