The national Center for Excellence in Assisted Living was begun to advance the well-being of those who live and work in assisted living through research, practice and policy. Last year, CEAL@UNC ushered in a new era for the organization, expanding its capacity to do that work. Sheryl Zimmerman, MSW, PhD, executive director of the newly established CEAL@UNC, recently spent a few minutes with McKnight’s Senior Living to discuss how the organization is working to develop evidence, bolster the workforce and promote evidence-based practices and policies in assisted living.
Q: In 2023, the national Center for Excellence in Assisted Living expanded and transitioned into CEAL@UNC. What benefits have you seen in moving CEAL to the University of North Carolina at Chapel Hill?
A: We have more capacity. The Center for Excellence in Assisted Living began in 2003 as a result of the first recommendation in the landmark Assisted Living Workgroup report, delivered to the US Senate Special Committee on Aging. I wanted to know what was happening with assisted living and all these records. That still exists now in partnerships with UNC. We do bring this additional capacity now. CEAL had a management company that was helping all of these volunteers to undertake all the initiatives that they did. Now, with the capacity of UNC and myself as the executive director, we have established oversight and expertise that is broader than just the volunteer efforts of all the people who are still part of CEAL.
Q: Can you highlight some of the work going on at CEAL@UNC right now?
A: There are three initiatives going on, one of which is a continuation from when CEAL@UNC was CEAL. CEAL had already started compiling all of the state transition plans associated with the HCBS settings final rule in a standardized manner. CEAL@UNC is starting to finish out that effort on the CEAL@UNC website. We’ll be making sure their availability is largely disseminated and probably will write some synthesis on those.
Another effort that began before CEAL became CEAL@UNC: last year, recommendations for medical and mental healthcare were published in JAMA. Many organizations put together a coalition to share the recommendations outside of a published paper in JAMA and give people tools about them. They are very feasible recommendations. Something CEAL@ UNC is moving forward is the Be Well in AL coalition, which is developing toolkits, and we will be making them publicly available.
The third initiative: I’ve been doing research in assisted living for 30 years now, and there are thousands of articles available on assisted living, most of them behind paywalls. We’ve got a component on our website; we just started with the 2022 calendar year. We are posting the abstracts and a short synthesis. You can go to all the abstracts of resources published in the past year, for every paper published by researchers that has the word assisted living in the title. You go to our website — they’re all right there — and we’re writing a short synopsis so people who need the information really know what it says. They are very short translations that I hope will help providers, policymakers and advocates and the people who need them.
We all know that researchers know the research. We work to understand regulations and talk to regulators and try to talk with consumers on a regular basis. But there’s no organized way to do that.
At CEAL@UNC, we’re developing national cores. We already started with the research one, and we’re still building out the provider core, the policy core and the consumer core. These will be individuals and organizations who want to participate in or learn about these areas. In developing these cores, we anticipate we are all going to work with each other really to benefit the work that people are already doing. We see ourselves bringing together constituencies. We just started that, but it will be a wonderful contribution to the whole field of assisted living, to serve as the infrastructure to help people do what they are already doing, but more efficiently, and all capitalizing on each other’s expertise and efforts.
Q: Is there a timeline on these cores, and how can people get involved?
A: We already built out the research core, inviting over 300 people to come to a meeting. Soon, we will work on how best to build out the other cores. Anyone interested in the other cores can go to the website and contact us about getting involved. We are still in a formative phase at CEAL@UNC, but we may always be in a formative phase. We’re here for the well-being of everyone involved in the whole enterprise of assisted living.
Q: Are there any research projects that you are working on, whether they involve your work with CEAL?
A: I’m proud that assisted living has been called out as a key important setting of care. Recently, the National Institute on Aging gave an $81 million grant to Michigan and California to do five years of surveys of the national dementia care workforce to really understand what the workforce is like, what their needs are, and this includes clinicians, nursing homes, home care and assisted living. Because of my own background and affiliation with CEAL, I’m the expert on the assisted living side. That can have a huge impact.
Information was solicited for phase one of the surveys until Dec. 15, but that’s just the first wave. There will be four more waves.
We’re always receptive to topics. This will have huge implications.
Q: CEAL launched in 2003, which happens to be the same year that McKnight’s Senior Living — which then was known as McKnight’s Assisted Living — launched. What, in your opinion, are the major ways that assisted living has changed over time?
A: A couple of changes come to mind. Affordable assisted living and public dollars — Medicaid — is a change.
Assisted living, or the way we think about assisted living, it was … the upscale site. There were other models of service that existed, but we are talking more about accessibility than we did.
Regulations didn’t exist, so that’s been a big change.
The third thing that comes to mind is how the social model of care is important, and quality of life is important, but now we’ve all come to recognize that people who lived in assisted living have always had healthcare needs. Now it’s moving away from just saying it’s just a social model of care and recognizing the totality of the care needs of people who are getting supportive care in residential communities that aren’t nursing homes.
Q: What trends in assisted living do you see for 2024?
A: One thing is the Be Well In AL initiative. We’ve got to be more mindful in a practical, pragmatic, feasible way across the whole scope of assisted living — small to large, private to non-private — about how we’re addressing care needs in feasible, practical ways. Recently, issues have come out about cost — that needs to be addressed, which goes back to accessibility.
Regulations are evolving in a way that’s timely for what the care needs are and how the settings are operated.
And none of us can have a conversation without talking about workforce. Some have talked about not just training and ensuring training, but how we think about competencies and how we do this in a sustainable way.
One thing I love about this field is all the organizations that are touching it in some way, shape or form. Big, national organizations — like PHI and the National Center for Assisted Living and Argentum — and provider and professional organizations, like AMDA–The Society for Post-Acute and Long-Term Care Medicine. What I love is that these organizations are very much talking to each other, which is what CEAL likes to see. There’s going to be more need for that going forward.
Assisted living is the largest provider of residential long-term care in the country. When you look at long-term care and how nursing homes have been evolving, assisted living is the largest provider of residential long-term care, including for persons with dementia. We just all need to be working together and talking about the care needs, and having things move forward purposefully and not just by happenstance, which sometimes happens.
CEAL is still CEAL. CEAL@UNC means we have an established infrastructure to be responsive to needs and to bring research to practice and policy. We welcome input. We welcome anyone who wants to be part of this broad mission.
This interview has been edited for clarity and other considerations. It is longer than the version that appeared in print. Listen to a podcast version of this interview here.
