Skip to main content

Assisted Living and Residential Care

  • Chapter
  • First Online:
Post-Acute and Long-Term Care Medicine

Part of the book series: Current Clinical Practice ((CCP))

  • 254 Accesses

Abstract

Assisted living (AL) is an integral component of the long-term care (LTC) continuum for persons who neither require nor choose to avail themselves of nursing home services in preference for a less institutionalized care setting. Such an option as an assisted living community may also include a residential care facility (RC). As of 2016, there were an estimated 28,900 AL/RC communities in the USA with 996,100 licensed beds (Harris-Kojetin L et al., Vital Health Stat 3. 2019). This chapter provides an overview of AL, disaster preparedness and COVID-19, medical care, and a discussion on the future of AL and clinical suggestions for practitioners to optimize practice. Note that the definition and requirements of these facilities will differ from State to State in the USA and from one country to another.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Toolkit for person-centeredness in assisted living. UNC & CEAL. 2014.

    Google Scholar 

  2. The Assisted Living Workgroup. Assuring quality in assisted living: guidelines for federal and state policy, state regulation and operations. A report to the US Senate Special Committee on Aging. 2003.

    Google Scholar 

  3. Harris-Kojetin L, Sengupta M, Lendon JP, et al. Long-term care providers and services users in the United States, 2015–2016. National Center for Health Statistics. Vital Health Stat 3. 2019.

    Google Scholar 

  4. Argentum. 2020 largest providers report.

    Google Scholar 

  5. Zimmerman S, Sloane PD, Reed D. Dementia prevalence and care in assisted living. Health Aff (Millwood). 2014;33(4):658–66.

    Article  PubMed  Google Scholar 

  6. Alzheimer’s Association Campaign for Quality Residential Care. Dementia care practice: recommendations for assisted living residences and nursing homes.

    Google Scholar 

  7. Facts & Figures. AHCA & NCAL. 2020.

    Google Scholar 

  8. Thomas KS, Zhang W, Cornell PY, et al. State variability in the prevalence and healthcare utilization of assisted living residents with dementia. J Am Geriatr Soc. 2020;68(7):1504–11.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Toth M, Palmer L, Bercaw L, et al. Trends in the use of residential settings among older adults. J Gerontol B Psychol Sci Soc Sci. 2022;77(2):424–8.

    Article  PubMed  Google Scholar 

  10. Carder P, O’Keeffe J, O’Keeffe C. Compendium of residential care and assisted living regulation and policy: 2015 edition. Washington, DC: U.S. Department of Health & Human Services, Office of the Assistant Secretary for Planning and Evaluation; 2015.

    Google Scholar 

  11. Caffrey C. Residents living in residential care communities: United States, 2010. NCHS data brief no 91. Hyattsville: National Center for Health Statistics; 2012.

    Google Scholar 

  12. PharMerica. Medication management issues in assisted living. 2020.

    Google Scholar 

  13. The MacIntosh Company. Medication management in assisted living. 2019.

    Google Scholar 

  14. Genworth. Genworth cost of care survey 2020. https://pro.genworth.com/riiproweb/productinfo/pdf/282102.pdf. Accessed 24 Aug 2021.

  15. Managed long-term services and supports. Medicaid and CHIP Payment and Access Commission.

    Google Scholar 

  16. Travis LJ, Thomas KS, Clark MA, et al. Organizational characteristics of assisted living communities with policies supportive of admitting the retaining residents in need of end-of-life care. Am J Hosp Palliat Med. 2021;38(8):947–53.

    Article  Google Scholar 

  17. Dobbs D, Kaufman S, Meng H. The association between assisted living direct care worker end-of-life training and hospice use patterns. Gerontol Geriatr Med. 2018;4:2333721418765522.

    Article  PubMed  PubMed Central  Google Scholar 

  18. U.S. Department of Health and Human Services. State residential care and assisted living policy: 2004. 2005.

    Google Scholar 

  19. June JW, Meng H, Dobbs D, et al. Using deficiency data to measure quality in assisted living communities: a Florida statewide study. J Aging Social Policy. 2020;32(2):125–40.

    Article  Google Scholar 

  20. Dobbs D, June J Dosa D, Peterson LJ, Hyer K. Protecting frail older adults: long-term care administrators’ satisfaction with public emergency management organizations during hurricane Irma and COVID-19. Public Policy and Aging Report, 2021;31(4):145–150.

    Google Scholar 

  21. Peterson LJ, June J, Sakib N, Dobbs D, Dosa DM, Thomas KS, Jester DJ, Hyer K. Assisted living communities during Hurricane Irma: the decision to evacuate or shelter in place and resident acuity. J Am Med Dir Assoc. 2020;21(8):1148–52.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Zimmerman S, Katz P, Kunze M, O’Neil K, Resnick B. The need to include assisted living in responding to the COVID-19 pandemic. J Am Med Dir Assoc. 2020;21(5):572–3.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Curiskis A, Kelly C, Kissane E, Oehler K. What we know—and what we don’t know—about the impact of the pandemic on our most vulnerable community: the Atlantic Tracker Project. 2021. https://covidtracking.com/analysis-updates/what-we-know-about-the-impact-of-the-pandemic-on-our-most-vulnerable-community. Accessed 11 Sept 2021.

  24. Brown LM, Christensen JJ, Ialynytchev A, et al. Experiences of assisted living facility staff in evacuating and sheltering residents during hurricanes. Curr Psychol. 2015;34:506–14. https://doi.org/10.1007/s12144-015-9361-7.

    Article  Google Scholar 

  25. Utz R. Assisted living: the philosophical challenges of everyday practice. J Appl Gerontol. 2003;22:379–404.

    Article  Google Scholar 

  26. Schumacher J. Assisted living communities and medical care providers: establishing proactive relationships. Seniors Hous Care J. 2005;13(1):35–48.

    Google Scholar 

  27. Vance J. Proceedings of the AMDA assisted living consensus conference, Washington, DC October 24, 2006. J Am Med Dir Assoc. 2008;9(6):378–82.

    Article  PubMed  Google Scholar 

  28. AGS 2012 Beers Criteria Update Expert Panel. AGS updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60:616–31.

    Article  Google Scholar 

  29. Sloane PD, et al. Medication undertreatment in assisted living settings. Arch Intern Med. 2004;164:2031–7.

    Article  PubMed  Google Scholar 

  30. Zimmerman S, Love K, Sloane PD, Cohen LW, Reed D, Carder PC, Center for Excellence in Assisted Living-University of North Carolina Collaborative. Medication administration errors in assisted living: scope, characteristics, and the importance of staff training. J Am Geriatr Soc. 2011;59(6):1060–8.

    Article  PubMed  Google Scholar 

  31. Beeber AS, Zimmerman S, Madeline Mitchell C, Reed D. Staffing and service availability in assisted living: the importance of nurse delegation policies. J Am Geriatr Soc. 2018;66(11):2158–66.

    Article  PubMed  Google Scholar 

  32. Sloane P, et al. Physician perspectives on medical care delivery in assisted living. J Am Geriatr Soc. 2011;59:2326–31.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Unruh MA, Qian Y, Casalino LP, Katz PR, Ryskina KL, Jung HY. The prevalence and characteristics of clinicians who provide care in assisted living facilities, 2014–2017. J Gen Intern Med. 2021;36(8):2514–6.

    Article  PubMed  Google Scholar 

  34. Caffrey C, Cairns C, Rome V. Trends in electronic health record use among residential care communities: United States, 2012, 2014, and 2016. National Health Statistics Reports; no 140. Hyattsville: National Center for Health Statistics. 2020.

    Google Scholar 

  35. Rashidi P, Mihailidis A. A survey on ambient-assisted living tools for older adults. IEEE J Biomed Health Informatics. 2012;17(3):579–90.

    Article  Google Scholar 

  36. ACOs and long-term care: don’t get left behind. Duane Morris LLP & Affiliates. 2012.

    Google Scholar 

  37. Baxter A. 4 steps assisted living can take toward ACO status. Senior Housing News. 2016.

    Google Scholar 

  38. James JT. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf. 2013;9(3):122–8.

    Article  PubMed  Google Scholar 

  39. Vipperman A, Zimmerman S, Sloane PD. COVID-19 recommendations for assisted living: implications for the future. J Am Med Dir Assoc. 2021;22(5):933–938.e5. https://doi.org/10.1016/j.jamda.2021.02.021. Epub 2021 Feb 25. PMID: 33773962; PMCID: PMC7904515.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Medicare hospice provider compliance audit: suncoast hospice. U.S. Department of Health & Human Services. Report. No. A-02-18-01001.

    Google Scholar 

  41. Zimmerman S, Carder P, Schwartz L, Silbersack J, Temkin-Greener H, Thomas KS, Ward K, Jenkens R, Jensen L, Johnson AC, Johnson J, Johnston T, Kaes L, Katz P, Holt Klinger J, Lieblich C, Mace B, O’Neil K, Pace DP, Scales K, Stone RI, Thomas S, Williams PJ, Williams KB. The imperative to reimagine assisted living. J Am Med Dir Assoc. 2022;23(2):225–34.

    Article  PubMed  Google Scholar 

  42. Anderson EG. Nursing home practice: 10 tips to simplify patient care. Geriatrics. 1993;48:61–3.

    CAS  PubMed  Google Scholar 

  43. Schumacher J. Examining the physician’s role with assisted living residents. J Am Med Dir Assoc. 2006;7(6):377–82.

    Article  PubMed  Google Scholar 

  44. Zimmerman S, et al. A measure of person-centered practices in assisted living: the PC-PAL. J Am Med Dir Assoc. 2015;16:132–7.

    Article  PubMed  Google Scholar 

  45. Mitty E. Medication management in assisted living: a national survey of policies and practices. J Am Med Dir Assoc. 2009;10(2):107–14.

    Article  PubMed  Google Scholar 

  46. Pruchnicki A. Full time primary care in an assisted living community. AMDA poster submission, annual symposium. 2005.

    Google Scholar 

  47. Schumacher J. Physicians and their assisted living residents: adventures in falls (mis) communication. AMDA annual symposium presentation, 2009.

    Google Scholar 

Download references

Acknowledgments

We want to acknowledge Kathryn Hyer, who made immense contributions to the field of assisted living before her untimely death in January 2021.

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Dobbs, D., Vogel, C.E., Haimowitz, D., Zimmerman, S. (2023). Assisted Living and Residential Care. In: Winn, P., Fenstemacher, P.A., Stefanacci, R.G., DeLong, R.S. (eds) Post-Acute and Long-Term Care Medicine. Current Clinical Practice. Humana, Cham. https://doi.org/10.1007/978-3-031-28628-5_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-28628-5_3

  • Published:

  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-031-28627-8

  • Online ISBN: 978-3-031-28628-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics