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A coalition of experts launched a new initiative Wednesday with the goal of getting  43 recommendations for medical and mental healthcare in assisted living put into practice.

The “Be Well in AL” coalition was the focus of an in-depth virtual discussion led by Sheryl Zimmerman, PhD, co-director of the University of North Carolina at Chapel Hill Program on Aging, Disability and Long-Term Care. The program was hosted by the university, AMDA-The Society for Post-Acute and Long-Term Care Medicine and the Center for Excellence in Assisted Living (CEAL).

Assisted living, Zimmerman noted, is the largest provider of residential long-term care in the nation — and 40% of assisted living residents are living with Alzheimer’s disease or other dementias. But with the sector regulated at the state level, there are 350 different policy approaches to assisted living.

Reimagining future assisted living

The goal of the coalition, Zimmerman said, is to reimagine assisted living for the future by effecting change in practice and policy based on evidence and best practices.

To accomplish that, the group will convene two action-oriented roundtables in the near future on operational and policy changes, and develop information briefs and toolkits with the previously published recommendations. The coalition plans to invite additional stakeholders to the process, including policymakers; owners/operators; professional, provider, healthcare and advocacy organizations; residents and family members; and researchers.

“Stakeholders agree — and vehemently so — that today’s assisted living is not as intended in the past, and it must be reimagined in the future,” Zimmerman said, pointing to the findings of research on the topic published in the journal JAMANetwork Open.

The recommendations fall into five categories: staffing and staff training, nursing and related services, resident assessment and care planning, policies and practices, and medical and mental health clinicians and care.

And while all of these areas need attention, Zimmerman said the coalition is starting with residents and the promotion of person-centered care in assisted living. She said assisted living residents are moving in with higher needs, and the setting is the largest provider of care and services for individuals with Alzheimer’s disease and other dementias.

But assisted living, across the board, has a limited medical and nursing provider presence. Only 46% of communities employ a registered nurse or licensed practice nurse, and few communities have onsite primary care. And due to the variability of regulations governing the setting across states, less than 40% of states have specific minimum staffing ratio requirements, and only 25% require staff to have at least 11 hours of training.

Those variabilities have led to concerns regarding infection prevention, medication use and poor communication with staff when a change in resident condition occurs.

“The field has evolved — there is an increase in nursing presence and some integrated medical care,” Zimmerman said. “The problem is it has not been data driving reform and what that evolution should look like.”

Zimmerman, who is working on a study of dementia, medical and mental healthcare in assisted living, found that 77% of the recommendations already are being practiced in at least three-quarters of communities involved in the new study.

“The bottom line is these recommendations are not aspirational — they are feasible and realistic,” Zimmerman said. “This gives us excellent grounding from which to start.”

Changing the assisted living model

Lindsay Schwartz, PhD, CEAL board chair and founder and principal of Workforce & Quality Innovations LLC, said while the assisted living model focuses on person-centered care and quality of life in a homelike environment, a lot of healthcare is being provided.

“We have to acknowledge healthcare is happening in assisted living,” Schwartz said. “Gone are the terms of social versus the medical model. Assisted living provides holistic care that includes physical and mental wellbeing, and could be a model for other long-term care settings.”

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