Annals of Long Term Care

BACKGROUND

The American Geriatrics Society (AGS) believes that Assisted Living Facilities (ALFs) can offer seniors an environment that could enhance their health status over other possible living arrangements. This Position Statement is to provide policymakers, administrators, health care professionals, and consumers with guidance for achieving optimum outcomes with regards to ALFs.

POSITIONS

The following principles are essential to realizing the potential benefits of ALFs:

1. ALFs have a responsibility to provide complete information to prospective residents to assure that an appropriate match is made between resident and facility.

Rationale: Consumers of ALFs need to have detailed information regarding the services provided and any associated costs. In contrast to nursing facilities whose primary payor are the states through Medicaid, ALF payors tend to be the residents themselves. As a result, ALFs are subject to less state and federal regulation and are more affected by market pressures. In order for consumers to make optimal decisions, ALFs need to disclose fully the services provided, the limitations of their facility, how much functional decline they can handle effectively, and especially the criteria residents must continue to meet to remain in the ALF. In addition, the staffing levels and expertise should be discussed with all potential ALF residents.

Reference: Hawes C, Phillips C, Rose M. (2000) High Service or High Privacy Assisted Living Facilities, their Residents and Staff: Results from a National Survey. Miriam Rose, Myers Research Institute. U.S Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Disability, Aging, and Long-Term Care Policy (ASPE) and Research Triangle Institute, November.

2. Residents entering an ALF should have a baseline evaluation, completed within 30 days of their admission, of their physical, medical and psycho-social needs, and a detailed review of all medications, prescription, non-prescription, herbal and other remedies, completed by a qualified, licensed practitioner experienced in the care of older adults. This culturally sensitive evaluation should be the basis for the development of a care plan that indicates resident physical and psycho-social needs along with resident preferences for treatment and strategies for meeting identified needs. This care plan should be available to the resident and to the ALF staff. The ALF should clearly indicate, preferably prior to admission, the specific elements of the care plan that the ALF will meet and is willing to accommodate as well as the responsibility of the resident/family.

Rationale: A resident’s move to assisted living is a critical life change event. This event offers a special opportunity for a comprehensive review of the resident’s health and social needs. This move to an ALF often signals some medical, cognitive or functional need for the senior, which makes a comprehensive assessment all the more crucial at this transition of care. It also offers the opportunity to provide optimum interventions designed to maintain independence and prevent pre-existing conditions from deteriorating.

3. ALF staff should be knowledgeable and skilled in carrying out important components of geriatric care, including, but not limited to, safe medication administration, falls prevention, incontinence care, communication techniques, dementia care, skin care, and able to recognize the changes that can signal acute illness, delirium, and depression.

Rationale: Staffing levels and expertise do vary between ALFs. In a national study of ALFs, 40% reported having full time registered nurse staff, 55% had a registered nurse either full or part time, and 71% had a registered nurse or licensed practical nurse on staff full or part time. About half (52%) used outside agencies to supply registered or licensed practical nurses.