Assisted Living: New Initiatives, Brighter Future

Assisted living (AL) has now surpassed nursing homes in terms of the number long-term care residents who reside there (J Am Med Dir Assoc 2022;23:225–234). Yet as this happened — and comorbidities, frailty, need for activities daily assistance AL have increased amount staffing medical communities not risen proportionally. This issue is fairly well-known among health professionals but been significantly addressed. Could be time? The industry historically claimed that it a “social model,” where older adults live homelike setting while receiving limited assistance. However, stressed social model intended to suggest lack focus, would appear focus on issues greatly benefit today’s residents. Historically, AMDA – Society Post-Acute Long-Term Care Medicine cognizant AL. Society’s Living Subcommittee, under leadership Sarah Howd, MD, CMD, Barbara Resnick, PhD, RN, CRNP, FAAN, FAANP, advocated attention requiring can travel outside see provider, may visit with provider within community, or get services via house call programs. Some contract providers offer services. also opt director, subcommittee worked establishing guidance directors’ contracts They’ve produced infectious disease guidance, educational materials podcasts, survey membership practice. Much subcommittee’s current informed by “Recommendations Medical Mental Health Based an Expert Delphi Consensus Panel, A Statement” (JAMA Netw Open 2022;5:e2233872), which was led Sheryl Zimmerman, University North Carolina at Chapel Hill. items most recommended included:•Providing training person-centered staff.•Offering routine toenail residents.•Including assessment/care planning sessions.•Having policies procedures place aggressive other behaviors.•Maintaining post-visit practitioner notes findings all off-site mental visits. Many members participated Workgroup (ALW), national initiative 2003 establish best-practices through consensus. ALW establishment Center Excellence (CEAL). CEAL comprises multiple organizations, including Society. recently transitioned Carolina; called [email protected], Dr. Zimmerman its executive director. Society, organizations are forming coalition named “Be Well AL” develop framework will integrate recommendations from consensus panel improve resident care. Smaller equally motivated groups helping world. Early pandemic, California Association Long Term (CALTCM) established group/email discussion list focused COVID-19 An offshoot effort specifically began fall 2020. Their project doesn’t meet strict “Delphi” definition, observes similar principles having multidisciplinary (including advocates) deciding projects challengingly large group topics. “small mighty” had many accomplishments: working Department Social Services resources best practices infection prevention basics AL, collaborating American Consultant Pharmacists (ASCP) vaccinations publishing guidelines position papers, “CALTCM Visitation” (Jan. 20, 2022) “Assisted Medication Optimization White Paper” (Oct. 1, 2022), both available CALTCM website (https://www.caltcm.org/). Currently focusing wider dissemination medication optimization paper ASCP ideal role consultant pharmacist (The meets twice monthly; anyone interested joining contact author.) National advocacy difficult because no federal regulations generally opposed oversight, fearing burdensome onerous those home ensue (e.g., McKnight’s Senior Living, May 27, 2021, https://bit.ly/3LLTkDZ). Despite reluctance, such Argentum initiatives bring their voices Capitol Hill (see “Federal Advocacy,” Argentum, https://www.argentum.org/advocacy/federal-advocacy/). resolution supported standardizing nomenclature nationally (“Streamlining Communities,” A22, April 2022, https://bit.ly/3LMDCbn). State-Based Policy Advocacy further discussed formulating policy plan across states. goals often overlap For instance, seven topics Academies Sciences, Engineering (NASEM) report, Imperative Improve Nursing Home Quality (National Press, https://bit.ly/3Oa6kBQ), these same areas inform Moving Forward Coalition (https://movingforwardcoalition.org/):1.Person-centered, equitable care2.A well-trained compensated workforce3.Increased transparency around finance, operations, ownership4.Creation better financing systems5.Creation systems quality assurance6.Expanded enhanced measurement improvement7.Use information technology Ideally next step after “fixing” could address After years, appears improved getting well-deserved attention. It’s time end era hospital emergency departments only recognizing “nursing homes” “home” nothing between, arguments “social” “medical” models exist. integral part developing actionable solutions, interest become involved. Haimowitz board-certified internist geriatrician multifacility director Levittown, PA. He serves editorial advisory board Caring Ages.