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assisted living; assisted living facilty; includes: rest home; domiciliary; retirement home; residential care facility; aged care facility

Not covered by Medicare or Medicaid. Not regulated by Centers for Medicare & Medicaid (CMS) Also see nursing home. Long-term care insurance may cover assisted living. [1] Comprises: 1) housing 2) personalized supportive services 3) health care for residents needing assistance with activities of daily living (ADL) Generally includes:* 1) 24 hour supervision 2) personal care 3) social services 4) medication management 5) meals 6) health promotion activities * does not include nursing services (GRS9) [1] May include locked-door facilities for residents with dementia - 1/3 of assisted-living residents have dementia [1] On admission: 1) assessment of physical & psychosocial needs 2) a service agreement is developed to coordinate delivery of services to each resident Regulation differs from state to state. Only some states require training & certification of staff. Demographics: 1) 80% of residents are women 2) median age of women is 80 years of age 3) median age of men is 82 years of age 4) median annual income is $25,000 5) median financial assets is $100,000 6) 26% of residents are completely independent in ADL 7) average need for 2 ADL 8) 80% need of accept assistance with medications 9) 45% are discharged to a nursing home* 10) average length of stay is 3 years 11) 25% of facilities have monthly rent of $1500-$2000 12) 90% of assisted living is paid with private funds * skilled nursing care & nursing care in general is not provided [1] - a nurse may be on staff & may oversee medications & monitor residents but does not provide nursing services [1] - nursing care in assisted living facilities may be provided by home health agency [1] Notes: - 43 items constituting expert consensus recommendations for medical & mental health care in assisted living, organized based on importance & grouped into 5 categories: [2] - staff & staff training - nursing & related services - resident assessment & care planning - policies & practices - medical & mental health clinicians & care - the item most recommended was in the domain of staff training: training on person-centered care [2] - the highest recommendations in the other domains were - provision of routine toenail care - resident present during assessment/care planning - has a policy/procedure regarding aggressive or other behaviors - all off-site medical or mental health visits include post-visit notes with findings [2] - alternative models of care vs usual care [3] - may not affect emergency department visits - may reduce unplanned hospital admissions - may not improve health-related quality of life - probably no effect on mortality

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health care setting

References

  1. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004 - Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  2. Matthews S Improving Medical, Mental Health Care for OAs in Assisted Living. Annals of Long-Term Care. 2022. Oct 3. https://www.hmpgloballearningnetwork.com/site/altc/news/improving-medical-mental-health-care-oas-assisted-living - Zimmerman S, Sloane PD, Wretman CJ et al. Recommendations for medical and mental health care in assisted living based on an expert Delphi consensus panel. JAMA Netw Open. 2022;5(9):e2233872 PMID: 36173637 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796840
  3. Putrik P, Grobler L, Lalor A, et al. Models for delivery and co-ordination of primary or secondary health care (or both) to older adults living in aged care facilities. Cochrane Database Syst Rev. 2024 Mar 1;3(3):CD013880.
  4. Assisted Living Facilities http://www.assistedlivingfacilities.org
  5. Assisted Living Federation of America (ALFA) http://www.alfa.org/alfa/default.asp