Physician Perspectives on Medical Care Delivery in Assisted Living

Abstract

OBJECTIVES To describe the provision of medical care in assisted living (AL) as provided by physicians who are especially active in providing care to older adults and AL residents; to identify characteristics associated with physician confidence in AL staff; and to ask physicians a variety of questions about their experience providing care to AL residents and how it compares with providing care in the nursing home and home care settings. DESIGN Cross-sectional descriptive study. SETTING AL communities in 27 states. PARTICIPANTS One hundred sixty-five physicians and administrators of 125 AL settings in which they had patients. MEASUREMENTS Interviews and questionnaires containing open- and close-ended questions regarding demographics, care arrangements, attitudes, and behaviors in managing medical problems. RESULTS Most respondents were certified in internal medicine (46%) or family medicine (47%); 32% were certified in geriatrics and 30% in medical directorship. In this select sample, 48% visited the AL setting once a year or less, and 19% visited once a week or more. Mean physician confidence in AL staff was 3.3 (somewhat confident), with greater confidence associated with smaller AL community size, nursing presence, and the physician being the medical director. Qualitative analyses identified differences between settings including lack of vital sign assessment in the home setting, concern about the ability of AL staff to assess and monitor problems, and greater administrative and regulatory requirements in AL than in the other settings. CONCLUSION Providing medical care for AL residents presents unique challenges and opportunities for physicians. Nursing presence and physician oversight and familiarity and communicating with AL staff who are highly familiar with a given resident and can monitor care may facilitate care.

The impact of complex chronic diseases on care utilization among assisted living residents

“…2,7–14 Because these clinical situations are under increasing scrutiny by health regulators, there will be more interest in the ability of AL to enhance care coordination and improve outcomes. This could lead to greater expectations for AL staff to monitor these conditions and alert providers when interventions are appropriate.…”

“…1,2 Although the most common reasons for entering AL are dementia 3 and functional impairment, 4 most residents (94%) have at least one chronic medical condition, with over three quarters (76%) having two or more chronic conditions. 5,6 Alzheimer’s disease and other dementias (42%), heart disease (34%), depression (28%), diabetes (17%), and COPD (15%) are in the top 10 most common chronic conditions.…”

Mental Illness in Assisted Living: Challenges for Quality of Life and Care

“…A multi-state AL sample found 34% of residents evidencing one or more challenging behaviors due to mental illness, dementia or both (Gruber-Baldini, Boustani, Sloane & Zimmerman, 2004). The presence or emergence of problematic behaviors has been identified as precipitating residents’ transfers out of AL, but the extent to which these behaviors overall were due to dementia vs. SMI is unknown (Ball et al, 2004; Bernard, Zimmerman & Eckert, 2001; Hawes et al, 2003; Sloane et al, 2011, Zimmerman et al, 2001). Dobbs and colleagues (2006) found, however, that having a diagnosis of mental illness was associated with lower odds of a resident aging in place in AL.…”

Correlates of Attitudes Toward Personal Aging in Older Assisted Living Residents

“…These settings, in general, provide to individuals a room, at least two meals a day, assistance with activities of daily living, and the ability to provide support with unscheduled needs (Eckert, Carder, Morgan, Frankowski, & Roth, 2009;Park, Zimmerman, Sloane, Gruber-Baldini, & Eckert, 2006). Older adults who move into an AL community do so primarily for self-care needs, as they historically have been in poorer health than those still living in their own homes (Golant, 2004;McNabney et al, 2014;Sloane et al, 2011). A recent report by the National Center for Health Statistics highlights this, reporting that approximately 40% of older residents in AL communities require assistance with three or more activities of daily living (Caffrey et al, 2012).…”