Assisted living residents receiving Medicare home health services have an increased risk of hospitalization when care-partner support is lacking, according to a new study.
The study in the Journal of the American Geriatrics Society is the first to examine care-partner support in assisted living residents during care transitions, according to the authors. They looked at support for activities of daily living, instrumental activities of daily living (housekeeping, laundry, meal preparation), medication management, treatment (wound care, catheters, blood glucose measurement), medical equipment, home safety and transportation / advocacy.
Approximately 53 million Americans were caring for a family member or friend in 2020, according to reports from the AARP and the National Alliance for Caregiving. These family caregivers are conducting complicated and medically related tasks on older adults with increasingly complex care needs, all with little or no training or support from health professionals.
The authors’ analysis of national data found that assisted living residents who had inadequate support from staff, family or home health aides were more likely to be hospitalized for medication administration (41%), treatment assistance and medical equipment management — areas requiring skilled care. The authors noted that assisted living residents commonly use home health services during post-acute care transitions but that care is provided only intermittently — such as during two to three visits weekly.
Findings from this study “provide clear implications and priorities” for future programs to enhance resident outcomes in assisted living communities, including support for care-partners with medication administration, treatment adherence and access to and follow-up with medical appointments, they said.
The conclusion from the authors is that “targeted collaboration” between short-term home health clinicians and assisted living care-partners is necessary to bridge the support gap to meet resident needs in post-acute care transitions. These efforts can reduce the risk of hospitalization up to 27%, they said.
The study points to previous research showing that assisted living communities with more licensed staff have lower rates of hospitalization and nursing home placement. Data from the National Survey of Residential Care Facilities and the National Study of Long-Term Care Providers, however, show that less than half of all assisted living communities had licensed staff (registered and licensed practical nurses). On average, each assisted living community has 6.1% of staff members who are licensed as RNs or LPNs, according to the study.
A lack of federal regulations for assisted living care and staffing, along with “substantial” state variation in regulation, complicates the situation, the authors said.
“It is important that potentially unmet needs in skilled care among AL residents be screened and met, particularly during care transitions, such as after an acute hospitalization,” they wrote.