Physician involvement in the care of assisted living residents is crucial, but their role often is unclear, according to a recent study.

Interprofessional teams increasingly are important to the care coordination that can help ensure senior living resident health and well-being, and a key member of such teams is the physician, who provides clinical oversight and care to residents, according to the research, recently published in the Journal of Gerontology and Geriatric Medicine.

Nationally, 29,000 assisted living and residential care communities serve more than 800,000 residents, compared with 15,600 skilled nursing facilities that serve 1.3 million residents, the authors noted. Medical directors are commonplace in federally regulated nursing homes, but physicians’ roles in assisted living may vary according to state regulation. They may serve as clinical services consultants, members of the interprofessional care team, medical directors or geriatric care managers. And their involvement in resident care can be just as varied, from resident move-in evaluations, to medical administration and review, to hospice orders and care transitions.

Proponents of assisted living promote the social model of care and home-like environment that supports resident choice through community operations, the authors said. With different state regulations, however, these communities can differ in their care offerings, staffing and policies, making their physician needs different, they noted.

In the United States, for instance, one in five assisted living communities had policies allowing admission of residents who need ongoing skilled nursing services (20%). Four out of five (82%) allow residents needing assistance with incontinence, daily glucose level or insulin monitoring (81%), cognitive impairment (55%) or assistant with transferring (33%). 

Staff mix within assisted living settings, meanwhile, can include registered nurses, licensed professional/vocational nurses, certified nursing assistants, certified medication aides, unlicensed direct care workers and administrators. The majority of the workforce in these settings are paraprofessionals, and there is no standard measure of “sufficient” staffing, the study authors said.

Lack of technology also can be an impediment to integrating physicians into assisted living, according to the authors. When it comes to electronic health records, the research found that as of 2016, only 26% of assisted living communities used them, compared with 79% of physicians, which could hamper information exchange and care coordination.

Issues also can arise during resident transitions related to cognitive decline and dementia progression, the authors said. They noted a study of assisted living and skilled nursing facility residents and their families that found that few were informed about the reason for hospital admissions; residents and families also had limited contact with physicians during hospitalization and expressed uncertainty about treatments and discharge planning. 

Physicians also play an important role in dementia diagnosis and management, as well as medication management and end-of-life care, they authors said, noting that 42% of assisted living residents have dementia, and 87% need assistance with medication management. 

Standardized communication and care planning, interprofessional cooperation, and person-centered, dementia-competent care are critical to residents’ health and wellbeing, and physician roles in assisted living must be clarified through research, policy and innovative practices, the authors said.