staffing issues - assisted living facilities
Many frail elderly people who live in assisted living
facilities (ALFs) eventually have to leave that facility for a
nursing home. According to a recent study involving a national
sample of ALFs, over three-fourths (78 percent) of elderly
individuals leaving their ALF did so because they needed more
care, while 31 percent left because of dissatisfaction with some
aspect of the facility.
Residents who had severe cognitive impairment were over twice
as likely to enter a nursing home as those who were cognitively
intact or had only mild impairment. Also, those who received
assistance or supervision with bathing, dressing, or other
activities of daily living (ADLs) were significantly more likely
to enter a nursing home or to die than those who needed no ADL
assistance in the assisted living facility.
Facility characteristics also influenced the likelihood of
leaving the ALF for a nursing home. Residents of ALFs with a
full-time registered nurse (RN) had less than half the odds of
moving to a nursing home compared with residents in facilities
that were staffed differently. For people who want to avoid or
delay nursing home placement, seeking out an ALF that has
full-time RNs on staff may be a good choice in an ALF, suggests
Charles D. Phillips, Ph.D., M.P.H., of the School of Rural Public
Health at the Texas A & M University System Health Science Center.
The research team—which included William Spector, Ph.D., of the
Center for Delivery, Organization, and Markets, Agency for
Healthcare Research and Quality—defined ALFs as facilities that
provided 24-hour supervision, at least two meals a day, and help
in at least two of the following areas of personal need: bathing,
medications, or dressing. To explore the impact of resident and
facility characteristics on exit from ALFs to nursing homes, the
researchers analyzed data on 1,483 residents in a nationally
representative sample of 278 ALFs in 1998 and 1999.
In the period between baseline interviews and followup contacts
(an average of 7 months), 19 percent of those interviewed died or
changed location, whereas 81 percent remained in the same facility
in which they resided at baseline. Most surviving residents who
left an ALF resided in a nursing facility at followup. The next
most common site was another ALF or some other residential care
setting.
More details are in "Effects of facility characteristics on
departures from assisted living: Results from a national study,"
by Dr. Phillips, Yolanda Munoz, M.S., Michael Sherman, Ph.D., and
others, in the October 2003 Gerontologist 43(5), pp.
690-696.
Reprints (AHRQ Publication No. 04-R019) are available from AHRQ
Publications Clearinghouse.
Reprints available from the AHRQ Publications Clearinghouse.
These are excerpts from the AHRQ Research Activities,
you can read the full report at
http://www.ahrq.gov/research/jan04/0104RA20.htm |