Objectives Assisted living (AL) emerged over two decades ago as a preferred residential care option for older adults who require supportive care; however, as resident acuity increased, concern has been expressed whether AL sufficiently addresses health care needs. COVID-19 amplified those concerns, and an examination of recommendations to manage COVID-19 may shed light on the future of AL. This review summarizes recommendations from six key organizations related to preparation for and response to COVID-19 in assisted living (AL) in relation to resident health and quality of life; compares recommendations for AL with those for nursing homes (NH); and assesses implications for the future of AL. Design Nonsystematic review involving search of gray literature. Setting and Participants Recommendations from key governmental bodies and professional societies regarding COVID-19 in AL, long-term care facilities (LTCF) in general, and NHs. Measures We collected, categorized, and summarized these recommendations as they pertained to quality of life and health care. Results Many recommendations for AL and NHs were similar, but differences provided insight into ways the pandemic has recognized and challenged AL communities in particular: recommending more flexible visitation and group activities for AL, providing screening by AL staff or an outside provider, and suggesting that AL staff should access resources to facilitate advance care planning discussions. Recommendations were that AL integrate health care into offered services, including working with consulting clinicians who know both resident and LTC community. Conclusions and Implications Long-term care providers and policy makers have recognized the need to modify current long-term care options. Because COVID-19 recommendations suggest AL communities would benefit from the services and expertise of social workers, licensed nurses, and physicians, it may accelerate the integration and closer coordination of psychosocial and medical care into AL. Future research should investigate different models of integrated, interdisciplinary health care in AL.

Although the benefits of home- and community-based services (HCBS) to support the needs of older adults are well-established, researchers have persistently reported service underutilization by dementia caregivers to assist them with their caregiving responsibilities. Using the Health Behavior Model and Conservation of Resources Theory, the aim of the current study was to understand what barriers prevent caregivers from using HCBS and the toll it takes on them. Utilizing a sample of 122 rural family caregivers (74% female, 87% white, M age = 64.86 years) of persons living with dementia (PLwD), simultaneous ordinary least square regressions were employed to understand the association between barriers to service use and the current use of support services and personal services, and concurrently on caregiver role overload. Financial barriers, caregiver’s reluctance to use services, and their capability of seeking services were associated with lower use of support services. After controlling for need and enabling factors, caregivers who used more support services, and those who reported system complexities to using support services experienced higher role overload. Financial barriers, system complexities, and caregivers’ reluctance also affected the use of personal care services. Despite the use of personal services, caregivers of PLwD with greater needs and fewer enabling factors experienced higher role overload. Study findings suggest that reducing system complexities of HCBS and improving prevention and intervention efforts to facilitate caregivers’ awareness of HCBS are needed to address lack of service use and reduce caregiver overload. Supplementary Information The online version contains supplementary material available at 10.1007/s11121-022-01479-w.

Similar to nursing homes, COVID-19 has challenged assisted living (AL), given its congregate nature and vulnerable residents. However, COVID-19 recommendations have not consistently recognized differences between nursing homes and AL, and in so doing present implications for the future of AL. This project examined COVID-19 recommendations from six key organizations and compared them across nursing homes and AL. Differences include recommending more flexible visitation and group activities for AL, while similarities suggest that AL may best integrate health care into offered services (e.g., work with consulting clinicians who know residents and the AL community). Primary points to be discussed are that COVID-19 may accelerate the closer coordination of social work and medical care into AL, because recommendations suggest AL would benefit from the services and expertise of nurses, social workers, and physicians. There seems to be an unmet need to mitigate loneliness in AL, which warrants specific attention moving forward.

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Formal service use can help decrease caregiving burden for family members of persons with dementia; however, barriers related to service use are common. For example, driving distance can be problematic in rural areas with mountainous terrain, as in the Appalachian region of Virginia. The purpose of this study was to examine distance from family homes to services and its association with service use. Thirty-nine caregivers’ residences and 84 service locations were mapped, then driving distance to and distribution of services were analyzed using Service Area Solver and Closest Facility Solver in ArcGIS. Results suggest that services were unevenly distributed based on caregiver location. Specifically, of all services examined, food banks and medical facilities had the most facilities near caregiver locations, whereas adult day services, support groups, and educational programs for caregivers were sparse. Findings are discussed in light of identifying vulnerable caregivers as well as hot-spots for potential interventions.