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Assisted Living Facilities Must Identify Preventable Causes for Hospitalization for Residents with Dementia

The prevalence of older adults with dementia disorders is rising and presents significant difficulties to care providers and policy makers aiming to ensure cost-effective, high quality care for those that are aging. Assisted living facilities (ALFs) are increasingly admitting older adults with dementia, and who often have significant comorbidity. Currently, between 40% and 60% of residents in ALFs across the United States have been diagnosed with dementia. The rapid growth of ALFs over the past few years reflects the more affordable cost of this residential option compared to long-term (i.e. nursing home) care (LTC), as well as individual preferences for more comfortable, home-like environments.

Often viewed as a substitute to long-term care, ALFs aim to provide secure housing, personal support, and limited health care while encouraging choice, autonomy, privacy, and independence. However, due to lower staffing levels with the majority consisting of nonprofessional care providers and few ancillary services within ALFs compared to LTCs, concerns have been raised about vulnerable residents having an increased risk of unfavorable health outcomes and not having their care needs met. The ALF care setting promotes delayed detection of emerging health issues, inadequate medication management, and challenges to improving care that could result in increased use of hospital care and expenses. These concerns are augmented for residents with dementia who are prone to exhibit significant comorbidity, abnormal disease presentation, and challenges in communicating their symptoms and needs.

A recent study showed a considerably higher 1-year hospitalization rate for ALF residents with dementia compared with those receiving LTC. This finding reflects the challenges ALFs face in caring for cognitively vulnerable older adults with significant and often unstable medical and nursing needs.

Hospitalization is an outcome that indicates not only potential quality of care issues for ALFs but also for health risks older adults with dementia who undergo acute care admission are prone to. Studies consistently have shown that people with dementia are at significantly higher risk of being hospitalized (often for reasons that could have been prevented), having longer durations of stay, and having higher health care costs. These individuals are also at higher risk of having poorer health and functional outcomes during and after hospitalization.

Another recent study investigated the incidence of hospitalization among ALF residents with dementia compared to the incidence among LTC residents with dementia. The study also identified ALF resident and facility characteristics that influence the risk of hospitalization. The results of the study revealed that residents with dementia receiving care in ALFs showed a cumulative incidence of hospitalization about 4 times higher than those in LTC. The duration of hospital stay was also considerably longer among ALF residents compared with those in LTC.

Vulnerable ALF residents with dementia may benefit from receiving end-of-life care that includes enhanced access to palliative care services within ALFs. This could significantly decrease the likelihood of hospitalization and LTC admissions, while increasing quality of care.