Dementia and Occupational Therapy - Home caregiver and senior adult woman
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Forty-three recommendations stemming from a new study represent “an initial step” to filling a gap in guidance regarding medical and mental healthcare in assisted living, according to the study’s authors, who said that such guidance “has been long-awaited.”

“The recommendations provide a guide for practice and policy,” said Sheryl Zimmerman, PhD, the University of North Carolina at Chapel Hill faculty member who led the research effort. “They’re also largely feasible and pragmatic, because data show many are already in practice.”

Zimmerman was among the 19 experts who made the recommendations after rating 183 items of potential importance to medical and mental healthcare in assisted living. Their findings were published Thursday in the journal JAMA Network Open.

The recommendations were grouped into five categories:

  • Staffing and staff training,
  • Nursing and related services,
  • Resident assessment and care planning,
  • Policies and practices, and
  • Medical and mental health clinicians and care.

The most-recommended item came in the area of staff training: provide training in person-centered care.

The highest-scoring recommendations in the other categories, respectively: provide routine toenail care on-site, have residents present during assessment and care planning, have a policy/procedure regarding aggressive or other behaviors, and include post-visit notes for all off-site medical and mental healthcare visits.

“Assisted living is the largest residential provider of long-term dementia care, so we’re pleased that these recommendations reflect the specific needs of these individuals,” said panelist Douglas Pace, senior director of long-term and community-based care for the Alzheimer’s Association. The authors also noted that assisted living is the largest provider of residential long-term care in general in the United States.

As the field has grown, the medical and mental healthcare needs of assisted living residents have been increasing, according to the research. That assisted living residents have major healthcare needs is a point that was reinforced by a separate recent study by NORC at the University of Chicago that was funded by the National Investment Center for Seniors Housing & Care.

The NORC study found a mean of 14.4 chronic medical conditions among assisted living residents. It also found that 71% of assisted living residents have a mental or behavioral health diagnosis, which NORC researchers defined as attention-deficit/hyperactivity disorder and other conduct disorders, autism, schizophrenia and other psychiatric disorders, mood disorders (bipolar disorder, depression, major depressive affective disorder), anxiety disorders (anxiety, post-traumatic stress disorder), personality disorders, and substance use disorders (drug use disorder, opioid use disorder, tobacco use disorder, alcohol use disorder).

The 43 new recommendations, said panelist Christopher Laxton, CAE, executive director of AMDA–The Society for Post-Acute and Long-Term Care Medicine, will help ensure consistency in medical and mental healthcare across assisted living communities, which “have enormous variability in terms of size and variety of services.”

Lindsay Schwartz, PhD, board chair of the Center for Excellence in Assisted Living and founder and principal of Workforce & Quality Innovations LLC, said that the new recommendations will help CEAL promote person-centered care in assisted living.

Among the other experts on the 19-member panel:

  • Kim Butrum, RN, MS, senior vice president of clinical services at Silverado;
  • Pat Giorgio, MPS, president and CEO of Evergreen Estates and former board chair of the National Center for Assisted Living;
  • Juliet Holt Klinger, MA, senior director of dementia care and programs for Brookdale Senior Living and 2021 McKnight’s Women of Distinction honoree;
  • Margo Kunze, RN, treasurer and secretary of the American Assisted Living Nurses Association;
  • Vicki McNealy, PhD, MN, RN, director of assisted living for the Washington Health Care Association, a state affiliate of NCAL and a state partner of Argentum; and
  • Kevin O’Neil, MD, chief medical officer at ALG Senior.

The work was funded by the National Institute on Aging.