Residents are older, more ill, and more compromised by their disabilities. 55% were over the age of 85, 77% needed assistance with bathing, 69% with walking and 49% with toileting. Data from the National Center for Health Statistics.
In addition, more than half of the residents have high blood pressure, 1/3 or more have heart disease or arthritis; 31% have been diagnosed with depression, at least 11% have a serious mental illness, and 42% have dementia or moderate to severe cognitive impairment.
“The nature of the customer receiving welfare has changed dramatically,” but there are no widely accepted standards for addressing physical and mental health needs. Sheryl Zimmerman, headed the panel. She is co-director of the Program on Aging, Disability, and Long-Term Care at the University of North Carolina at Chapel Hill.
The report addresses this gap with 43 recommendations from experts, including patient advocates, assisted living providers, medical, psychiatric and dementia care professionals, and Zimmermann said these He said he hopes it will become the “new standard of care”.
See nursing home staffing levels
One of the recommendations concerns staffing. The Commission proposes establishing a paramedical-to-resident ratio and making available registered nurses or licensed practicing nurses on site.
Like nursing homes and home health care organizations, operators of nursing homes have found it difficult to retain and hire staff during the pandemic.and September 2021 survey82% report staffing shortages at a ‘medium’ or ‘high’ level.
Kenneth KovinskyA geriatrician and professor of medicine at the University of California, San Francisco, he witnessed issues related to staffing when his mother moved into a nursing home at age 79. Get up. On another occasion she waited in the restroom for her 30 minutes.
Ultimately, co-author Kovinsky editorial Following consensus recommendations, it was decided to transfer the mother to another facility.
The committee also recommended that staff receive training on dementia and mental illness management, side effects of medications, end-of-life care, personalized care, and infection control. , when estimating 17% more people died Assisted living in 2020 compared to the previous year.
Training for long-term care providers makes a difference
“If I were to put a parent in a nursing home, I would look at actual staff training, not just staffing rates,” he said. Robin Stone, senior vice president of research at LeadingAge and co-director of the Center for Long-Term Services and Support at the University of Massachusetts, Boston. LeadingAge is a trade association representing non-profit long-term care providers. The organization generally supports the panel’s work, Stone said.
Better trained staff are more likely to provide high quality care to residents and are less likely to feel frustrated and burnt out. Helen KeylesDirector of the Division of Psychiatry and Behavioral Sciences, UC Davis Health, California.
This is especially important for memory care provided in assisted living facilities or as part of a larger community.
“I have seen places where there are memory care units that charge upwards of $10,000 a month for ‘dementia care,’ but they are nothing more than locked doors to keep residents from exiting the unit, not advertised. It’s not the delicate, individualized care you get,” write Covinsky and Kenneth. In an article by UCSF colleague Lam.
Because dementia is such a major concern in nursing homes, the committee recommends that residents undergo a formal cognitive assessment and establish policies to address aggression and other disturbing behavior. did.
Care plans should focus on the needs of individual residents
Further recommendations from the Commission emphasize the importance of regularly assessing residents’ needs, developing care plans, and including residents in this process.
“Residents need to really dictate what their goals are and how they want to provide care, but this doesn’t always happen.” Lori Smetanakaa panel member and executive director of the National Consumer Voice for Quality Long-Term Care, an advocacy group.
“We agree with many of these recommendations,” he said, noting that many caregiving communities are already following these practices. Rashuan BeteaExecutive Director of the National Center for Assisted Living, an industry association.
Nonetheless, she said her organization has concerns, particularly about the practicality and cost of the recommendations. “We have to figure out what the feasibility will be,” she said. Meanwhile, states need to consider how to regulate welfare given the growing needs of residents, she added Bethea.
Approximately 28,900 assisted-care communities in the country are regulated by state and, without federal standards, practices vary widely. Residents are generally less protected than in nursing homes.
Originally, assisted living was intended as a “social” model. In other words, it is a home environment where the elderly can interact with other residents while receiving assistance from staff with daily tasks such as bathing and dressing. But given the realities of today’s assisted living population, “the social model of care is outdated,” says Tony Chicotel, panel member and staff attorney for California Nursing Home Reform Advocates.
Still, he and other panelists don’t want nursing homes to become a “medical” model like nursing homes.
“What’s interesting is that nursing homes are looking for a more homely environment and assisted living that requires better management of the medical needs of their residents,” Chicotel said. “That said, I don’t want nursing homes to look like nursing homes. It’s not quite clear yet how this will play out.”
This article is Kaiser Health News, A program of the Kaiser Family Foundation, a non-profit organization that provides information on health issues to the public.
