The following principles are essential to realizing the potential benefits of ALFs.
ALF’s have a responsibility to provide complete information to prospective residents to assure that an appropriate match is made between resident and facility.
Rationale: Consumers of ALF’s need to have detailed information regarding the services provided and any associated costs. In contrast to nursing facilities whose primary payor are the states through Medicaid, ALF payors tend to be the residents themselves. As a result, ALF’s need to disclose fully the services provided, the limitations of their facility, how much functional decline they can handle effectively and especially the criteria residents must continue to meet to remain in the ALF. In addition the staffing levels and expertise should be discussed with all potential, ALF residents.
Residents entering an ALF should have a baseline evaluation, completed within 30 days of their admission, of their physical, medical and psycho-social needs, and a detailed review of all medications, prescription, non-prescription, herbal and other remedies, completed by a qualified, licensed practitioner experienced in the care of older adults. This culturally sensitive evaluation should be the basis for the development of a care plan that indicates resident physical and psycho-social needs along with resident preferences for treatment and strategies for meeting identified needs. This care plan should be available to the resident and to the ALF staff. The ALF should clearly indicate, preferably prior to admission, the specific elements of the care plan that the ALF will meet and is willing to accommodate as well as the responsibility of the resident /family.
Rationale: A resident’s move to assisted living is a critical life event. This event offers a special opportunity for a comprehensive review of the resident’s health and social needs. This move to an ALF signals some medical, cognitive or functional need for the senior, which makes a comprehensive assessment all the more critical at this transition of care. It also offers the opportunity to provide optimum interventions designed to maintain independence and prevent pre-existing conditions from deteriorating.
ALF staff should be knowledgeable and skilled in carrying out important components of geriatric care, including but not limited to, safe medication administration, falls prevention, incontinence care, communication techniques, dementia care, skin care, and able to recognize the changes that can signal acute illness, delirium and depression.
Rationale: Staffing levels and expertise do vary between ALF’s. In a national study of ALF’s, 40% reported having full time registered nurse staff, 55% had a registered nurse either full or part time, and 71% had a registered nurse or license practical nurse on staff full or part time. About half (52%) used outside agencies to supply registered or licensed practical nurses. Staff working on-site should be sufficient in numbers and experience to meet the on-going needs of the residents at all times. Staff should be knowledgeable regarding safe medication administration, falls prevention, incontinence care, communication techniques, dementia care, skin care and recognition of the changes that can signal acute illness/delirium.
Ambulatory Geriatric Clinical Care and Services Position Statement. Developed by the AGS Health Care Systems Committee and approved May 2000 by the AGS Board of Directors. Journal of the American Geriatrics Society, 48: 845-846, 2000.4. A primary care provider (includes geriatric nurse practitioners as well as physicians) experienced in geriatrics care should be available within each ALF to help direct staff in optimizing outcomes for each resident
Rationale: The benefit of clinical leadership within LTC facilities was noted in 1978 in JAGS and later supported by a 1993 AGS position statement on the Physician’s Role in the Long-Term Care Facility, which illustrated the importance of this involvement. This benefit is true in all long-term care facilities, including ALF’s, extended care units, skilled nursing facilities, intermediate care facilities, and residential units caring for frail residents.
ALF’s need to become aligned with other facilities, providers and systems of care to produce optimum outcomes for seniors.
Rationale: A comprehensive system of care is able to accommodate seniors with varied needs as they traverse trough different levels of health and function in their aging lifetime. Key to coordination is communication at each transition of care.
ALF resources need to be within the reach of those living in rural and low-income communities
Rationale: the lack of non-institutional long-term care services in many rural areas may explain why residents of nursing homes in rural areas tend to be younger and less disabled than their urban counterparts. Part of this can be accomplished with continued funding of the 1915 (c) Home and Community Based /Services waiver program to provide needed services. The 1915 (c) Home and Community Services waiver is the primary Medicaid funding vehicle for low-income persons requiring assisted living services.
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