Recommendations for Medical and Mental Health Care in Assisted Living Based on an Expert Delphi Consensus Panel

Author:

Zimmerman Sheryl123,Sloane Philip D.14,Wretman Christopher J.5,Cao Kevin6,Silbersack Johanna1,Carder Paula7,Thomas Kali S.8,Allen Josh9,Butrum Kim10,Chicotel Tony11,Giorgio Pat12,Hernandez Mauro13,Kales Helen14,Katz Paul15,Klinger Juliet Holt16,Kunze Margo17,Laxton Christopher18,McNealley Vicki19,Meeks Suzanne20,O’Neil Kevin21,Pace Douglas22,Resnick Barbara23,Schwartz Lindsay24,Seitz Dallas25,Smetanka Lori26,Van Haitsma Kimberly27

Affiliation:

1. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill

2. School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill

3. Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill

4. Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill

5. Wretman Research, LLC, Hillsborough

6. School of Medicine, University of Illinois Chicago, Chicago

7. Portland State University, Portland, Oregon

8. Brown University, Providence, Rhode Island

9. Allen Flores Consulting Group, Searcy, Arkansas

10. Silverado, Irvine, California

11. California Advocates for Nursing Home Reform, Berkeley

12. Evergreen Estates, Clarkston, Washington

13. Hearth & Truss, Wilsonville, Oregon

14. Department of Psychiatry, University of Michigan, Ann Arbor

15. Department of Geriatrics, College of Medicine, Florida State University, Tallahassee

16. Brookdale Senior Living, Brentwood, Tennessee

17. American Assisted Living Nurses Association, Belmar, New Jersey

18. Society for Post-Acute and Long-Term Care Medicine, Columbia, Maryland

19. Washington Health Care Association, Tumwater

20. Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky

21. ALG Senior, Hickory, North Carolina

22. Alzheimer’s Association, Chicago, Illinois

23. University of Maryland School of Nursing, Baltimore

24. Workforce & Quality Innovations, LLC, Bear Creek, North Carolina

25. Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada

26. National Consumer Voice for Quality Long-Term Care, Washington, DC

27. College of Nursing, The Pennsylvania State University, University Park

Abstract

ImportanceAssisted living (AL) is the largest provider of residential long-term care in the US, and the morbidity of AL residents has been rising. However, AL is not a health care setting, and concern has been growing about residents’ medical and mental health needs. No guidance exists to inform this care.ObjectiveTo identify consensus recommendations for medical and mental health care in AL and determine whether they are pragmatic.Evidence ReviewA Delphi consensus statement study was conducted in 2021; as a separate effort, the extent to which the recommendations are reflected in practice was examined in data obtained from 2016 to 2021 (prepandemic). In the separate effort, data were from a 7-state study (Arkansas, Louisiana, New Jersey, New York, Oklahoma, Pennsylvania, Texas). The 19 Delphi panelists constituted nationally recognized experts in medical, nursing, and mental health needs of and care for older adults; dementia care; and AL and long-term care management, advocacy, regulation, and education. One invitee was unavailable and nominated an alternate. The primary outcome was identification of recommended practices based on consensus ratings of importance. Panelists rated 183 items regarding importance to care quality and feasibility.FindingsConsensus identified 43 recommendations in the areas of staff and staff training, nursing and related services, resident assessment and care planning, policies and practices, and medical and mental health clinicians and care. To determine the pragmatism of the recommendations, their prevalence was examined in the 7-state study and found that most were in practice. The items reflected the tenets of AL, the role of AL in providing dementia care, the need for pragmatism due to the diversity of AL, and workforce needs.Conclusions and RelevanceIn this consensus statement, 43 recommendations important to medical and mental health care in AL were delineated that are highly pragmatic as a guide for practice and policy.

Publisher

American Medical Association (AMA)

Subject

General Medicine

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