Kevin O'Neil, M.D.

Rehospitalizations, falls with serious injury and antipsychotic drug use are the top three clinical areas on which assisted living providers need to focus, according to the Assisted Living Committee of AMDAThe Society for Post-Acute and Long-Term Care Medicine.

The quality improvement priorities are based on a survey of members, Kevin O’Neil, M.D., the committee’s chairman, told McKnight’s Senior Living. AMDA sent 5,200 surveys and received 106 responses. Although the percentage of participants was not high, those who did participate likely were the most engaged in assisted living settings, he said.

The organization is taking several steps to help assisted living communities address the priorities, added O’Neil, who is the chief medical officer for Brookdale Senior Living.

“AMDA has convened two summits of professional, academic and industry organizations to explore opportunities to collaborate and to make recommendations regarding quality measures,” he said. “You can’t improve what you can’t measure.” Representatives from Argentum, the National Center for Assisted Living, the Center for Excellence in Assisted Living and LeadingAge participated in the summits, O’Neil said.

“We are planning on publishing a position paper within the next year on quality measures in assisted living and updating a position paper on the role of physicians in assisted living,” he added.

Most of the respondents to AMDA’s survey (about 85%) identified themselves as physicians or nurse practitioners (about 8.5%).

Other issues that respondents said were important to them:

  • staffing — for instance, ensuring appropriate staffing levels of nurses and staff-to-resident ratios;
  • regulation — for instance, meeting surveyor expectations, exploring the benefits of federal versus state oversight, or standardization of regulation;
  • the provision of care — for instance, controlling infections, limiting polypharmacy, implementing preventive medicine and wellness programs, improving the timing of transitions to other levels of care, and providing aging-in-place, hospital and end-of-life care;
  • helping residents engage in social and physical activities; and
  • developing education programs for staff and families.

“There are a number of other key areas that are important,” O’Neil said, adding that committee members believe that focusing on three areas at first will help them help communities meet the challenges well. “Of course, if we are doing advance care planning and resident-centered care well, we likely would not have so many avoidable hospitalizations and readmissions,” he added.