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Assisted living must be reimagined as an affordable care option providing quality, person-centered care that melds social and medical models, according to industry experts.

The industry is at a crossroads, Sheryl Zimmerman, Ph.D., co-director of the Program on Aging, Disability and Long-Term Care at the University of North Carolina at Chapel Hill, told McKnight’s Senior Living.

“The original central tenets of assisted living — services that are supportive of and responsive to care needs, an operating philosophy emphasizing choice, and a residential environment with features of home, all intending to provide person-centered care and promote quality of life — have taken a back seat to tensions arising from models of assisted living, regulation, financing, resident acuity and the workforce,” she said.

Zimmerman was part of a diverse group of 25 national experts representing providers and provider organizations, the workforce, regulation, quality improvement and advocacy who met for two days to identify key tensions and discuss potential changes to the current assisted living model.

The result was a paper outlining 20 actionable recommendations to reimagine assisted living and an accompanying editorial published in a special issue of JAMDA, the journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. The research paper, of which Zimmerman is the lead author, is among several in the special issue focusing on reimagining the long-term care workforce, societal issue, models of care, financing, payment, regulation and services.

Assisted living has been evolving in response to the changing needs of older adults looking for supportive care in a non-nursing home setting and older models of congregate care, the authors said. Despite some innovative and promising models of assisted living, however, there is a general consensus that, overall, the “current model of assisted living has been taken as far as it can go,” they added.

“As a society, we are asking AL to be a product very different than its original roots,” the authors wrote. “Today’s AL is not meeting the demands being placed upon it, and attending to the tensions described in this paper may result in better care and housing options.”

The group’s recommendations about the future of assisted living:

  • Models: promote consumer education, endorse standardized reporting, decouple services from housing, create person-centered models, and adopt quality measures that address social and health components.
  • Regulation: create regulations in partnership with stakeholders, encourage quality improvement initiatives, and examine outcomes related to regulations.
  • Financing: provide tax incentives and public subsidies, develop partnerships, and expand Medicaid coverage.
  • Residents: coordinate healthcare based on resident acuity, train all staff members on dementia care practices, reconsider segregated memory care, and prepare for increased resident diversity.
  • Workforce: embrace nursing home strategies, address training specific to assisted living, and establish acuity-based staffing recommendations.

A focus on quality, stakeholder involvement and a willingness to lead change — similar to the Green House model that evolved through nursing homes — is necessary, the authors said. Today, experts are calling for a holistic, blended model that includes social and medical elements, especially as resident care needs have increased.

The research was supported by grants from the National Institute on Aging and the Agency for Healthcare Research and Quality. Participants included representatives from ALG Senior, the American Health Care Association / National Center for Assisted Living, Aging2.0,  Alzheimer’s Association, Argentum, CARF International, SAGE, the American Assisted Living Nurses Association, Brookdale Senior Living, the Pioneer Network, the National Investment Center for Seniors Housing & Care, PHI and LeadingAge.

Blending medical, social models ‘inevitable’

In an editorial in the same issue, researchers said a structured medical staff led by a medical director “has the potential to accommodate the changing needs of assisted living residents and ensure high quality care.”

Acknowledging that the proposed model is a move toward “nursing home-like practice,” the authors said the need for blending medical and social models “seems inevitable.”

The editorial writers encouraged additional research, including launching case studies, defining optimum physician-to-resident ratios, identifying visit frequency or determining cost effectiveness of employing providers, and determining the responsibility for setting medical standards in assisted living.

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