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Improving Health Care for Assisted Living Residents

Correspondence: Address correspondence to Robert L. Kane, MD, University of Minnesota School of Public Health, D351 Mayo (MMC 197), 420 Delaware Street SE, Minneapolis, MN 55455. E-mail: kanex001{at}umn.edu

Purpose: The purpose of this article is to explore how medical care is delivered to older people in assisted living (AL) settings and to suggest ways for improving it. Design and Methods: We present a review of the limited research available on health care for older AL residents and on building testable models of better ways to organize primary health care and other health services for AL residents. Results: AL residents are frequently frail older persons who need good chronic care. The predominant care models today do not respond adequately to this challenge. Medical care for AL residents is currently practiced very much like that for persons living in the community. The potential for using the aggregation of patients has not been effectively tapped. We review some managed care models from other elements of long-term care to look for ways that might be adapted. However, the current funding approach emphasizes living settings rather than inherent client characteristics. Implications: A research agenda might include ways to improve communication between AL and medical providers and to get AL staff more actively involved in daily care. Research support might produce the data necessary to entice the Centers for Medicare & Medicaid Services into changing its current reimbursement policies to create a climate better suited to delivering good chronic disease care in AL facilities.

Key Words: Chronic care • Managed care • Nurse practitioners • Proactive primary care • Special needs populations