Assisted Living May Potentially Put Vulnerable Older Adults at Risk of Preventable Hospitalizations

Older adults are increasingly turning to assisted living facilities for their care needs. Not only is assisted living more affordable than long-term care (i.e. nursing home care), it also provides a more homelike and autonomous setting, as well as secure housing, personal support, and limited health care. However, unlike traditional nursing homes, assisted living facilities have lower staffing levels and provide less professional services, which put vulnerable older adults at higher risk. Delayed identification of developing health problems and decreased ability to provide more intensive care could result in hazardous consequences for assisted living residents and, ultimately, greater need for acute care. US physicians who were asked to compare assisted living with long-term care reported diminished confidence in the abilities of assisted living staff, described less treatment options in this setting, and stated that they were more likely to move an assisted living resident with a medical issue to an emergency department.

A significant outcome of residents in assisted living facilities require staying overnight in an acute care setting. Although many of these hospitalizations are necessary, a significant portion is potentially preventable with appropriate and timely care and clinical management. A recent study estimated the incidence of hospitalization among residents of designated assisted living facilities over one year after each resident’s baseline assessment. Researchers of the study also compared this rate with the rate of long-term care residents from the same designated areas and follow-up period and identified characteristics of assisted living residents and facilities associated with a greater risk for hospital admissions.

Researchers found that the incidence of hospitalization was approximately three times greater among residents in assisted living facilities than among those in long-term care settings. Moreover, the risk of hospitalization was related to a number of potentially modifiable factors. These findings raise doubts about the level of services and staff required within assisted living facilities and the potential influence on acute care of the shift from long-term care to assisted living for the facility-based care of fragile older adults.