February 01, 2011

 By David Kyllo

Does the following sound like a portrait of the American nursing home population? The average age of an incoming resident is 85 years. He or she typically has hypertension, arthritis, coronary heart disease, osteoporosis, depression, bladder incontinence, or a combination of several of these conditions. Nearly 40% have a diagnosis of Alzheimer's disease or other dementia. Each, on average, will need help with 1.6 activities of daily living.

It's not. This is the profile of people entering assisted living (AL) communities today, according to “2009 Overview of Assisted Living” from the various associations representing the AL industry.

Mr. Kyllo

Many of the nearly 1 million AL residents across this country may need the same kind of care that you, the medical care provider, have traditionally given your patients in nursing homes. AL, and the transitioning of residents between care settings, increasingly depends on health care professionals in many ways.

Most people in AL need help with medication management. The typical resident takes approximately eight prescriptions and two over-the-counter medications daily. A facility's medication system often has specific packaging preferences, and states may set packaging requirements for AL. Regardless, knowing an AL community's policies or providing seniors or their family members with information about a community's medication protocols is important to ensure that medication regimens are not interrupted.

Likewise, it is important for physicians to understand the scope of care and services that can be provided by AL communities in their areas. State rules for assisted living vary, and there are different AL models within states. Physician orders that cannot be carried out in AL settings because of state regulations or operational limitations can be frustrating for all those involved, but the rules must be observed.

Setting realistic expectations for seniors and their families, especially during transitions, is also important. Disease progression does not stop by moving into AL, nor do symptoms miraculously disappear. For example, it is not uncommon to hear residents and families say that they believe that a senior with a history of falls will automatically stop falling when the person moves into AL. Facilities need your help in informing families that seniors may continue to fall. What is different is that help will be available when they do fall.

 

Open discussions about diseases and prognoses are critically important for seniors and families to gain a sense of what the future might hold and to make informed decisions accordingly. Approximately one-third of all residents will die in an AL community. Of the remaining two-thirds, about 60% will move to a nursing home when they need a higher level of care. This percentage has remained relatively constant for more than a decade, despite the ever-increasing acuity levels of residents in both nursing homes and AL communities and despite the increased use of home care and hospice services.

Seniors and their families might resist discussions about moving to a higher level of care because it is difficult to acknowledge that a disease is progressing or that a loved one is declining. The higher cost of skilled nursing care and its potential impact on family finances now and in the future can frighten residents as well as their spouses and children.

This is where you can come in. Providing easy-to-understand information on how the senior would benefit from a move to a different level of care can reduce the anxiety surrounding the move into a nursing home from AL.

Moving into AL in the first place isn't easy for your patients. About 70% of new residents come from their private homes. While moving into an AL community can be a relief when managing daily activities has become overwhelming, for most people, it is the type of major life change that is difficult.

Many people who move into AL have recently had a traumatic experience in their lives, such as an acute health episode that someone like you has seen them through. An increasing number have experienced slow declines in their physical or mental health, marked by repeated falls or forgotten medicines. Others have lost a spouse, sibling, or adult child who provided the necessary help and oversight at home.

It is easy to understand how new AL residents can feel overwhelmed. Asking questions to build an understanding of each individual's situation is a key to a successful transition and an elderly person coping physically, mentally, and emotionally.

 

New AL residents and their families frequently report being fatigued by the physical activity associated with moving and by the emotional challenges they face adjusting to new surroundings and building new daily routines. Scheduling physician visits, routine lab work, or tests on or around moving day should be avoided when possible.

The National Center for Assisted Living has a number of resources on choosing an AL community and making a successful transition into AL life that you can offer to your patients. These materials can be downloaded free of charge at www.ncal.org

 

David Kyllo is executive director of the National Center for Assisted Living, the assisted living voice of the American Health Care Association. Bill Kubat, LNHA, director of mission integration for the Evangelical Lutheran Good Samaritan Society, coordinates this column.

 

 

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