Recommendations for Medical and Mental Health Care in Assisted Living Based on an Expert Delphi Consensus Panel: A Consensus Statement.

Importance: Assisted living (AL) is the largest provider of residential long-term care in the US, and the morbidity of AL residents has been rising. However, AL is not a health care setting, and concern has been growing about residents' medical and mental health needs. No guidance exists to inform this care. Objective: To identify consensus recommendations for medical and mental health care in AL and determine whether they are pragmatic. Evidence Review: A Delphi consensus statement study was conducted in 2021; as a separate effort, the extent to which the recommendations are reflected in practice was examined in data obtained from 2016 to 2021 (prepandemic). In the separate effort, data were from a 7-state study (Arkansas, Louisiana, New Jersey, New York, Oklahoma, Pennsylvania, Texas). The 19 Delphi panelists constituted nationally recognized experts in medical, nursing, and mental health needs of and care for older adults; dementia care; and AL and long-term care management, advocacy, regulation, and education. One invitee was unavailable and nominated an alternate. The primary outcome was identification of recommended practices based on consensus ratings of importance. Panelists rated 183 items regarding importance to care quality and feasibility. Findings: Consensus identified 43 recommendations in the areas of staff and staff training, nursing and related services, resident assessment and care planning, policies and practices, and medical and mental health clinicians and care. To determine the pragmatism of the recommendations, their prevalence was examined in the 7-state study and found that most were in practice. The items reflected the tenets of AL, the role of AL in providing dementia care, the need for pragmatism due to the diversity of AL, and workforce needs. Conclusions and Relevance: In this consensus statement, 43 recommendations important to medical and mental health care in AL were delineated that are highly pragmatic as a guide for practice and policy.

The Imperative to Reimagine Assisted Living.

Assisted living (AL) has existed in the United States for decades, evolving in response to older adults' need for supportive care and distaste for nursing homes and older models of congregate care. AL is state-regulated, provides at least 2 meals a day, around-the-clock supervision, and help with personal care, but is not licensed as a nursing home. The key constructs of AL as originally conceived were to provide person-centered care and promote quality of life through supportive and responsive services to meet scheduled and unscheduled needs for assistance, an operating philosophy emphasizing resident choice, and a residential environment with homelike features. As AL has expanded to constitute half of all long-term care beds, the increasing involvement of the real estate, hospitality, and health care sectors has raised concerns about the variability of AL, the quality of AL, and standards for AL. Although the intent to promote person-centered care and quality of life has remained, those key constructs have become mired under tensions related to models of AL, regulation, financing, resident acuity, and the workforce. These tensions have resulted in a model of care that is not as intended, and which must be reimagined if it is to be an affordable care option truly providing quality, person-centered care in a suitable environment. Toward that end, 25 stakeholders representing diverse perspectives conferred during 2 half-day retreats to identify the key tensions in AL and discuss potential solutions. This article presents the background regarding those tensions, as well as potential solutions that have been borne out, paving the path to a better future of assisted living.

Collaborative Practice and Teaching in Perinatal Care: Certified Nurse-Midwives as Educators of Medical Residents.

INTRODUCTION: The goal of this study was to update understanding of the current roles and responsibilities of certified nurse-midwives (CNMs) in the education of resident physicians. Three subaims were to (1) examine the involvement of CNMs in the education of residents in obstetrics and gynecology and family medicine, (2) examine the typology of CNMs' collaboration with residents, and (3) describe CNMs' opinions regarding their educational roles and responsibilities. METHODS: This descriptive study used an electronic survey sent to CNMs involved in the education of medical residents. Survey participants were identified using an online directory of CNMs involved in academic midwifery practices in the United States. Survey items included both closed-ended and open-ended questions to generate quantitative and qualitative data, respectively. RESULTS: Of the 146 CNMs invited to participate, surveys were received from 85, a response rate of 58%. Seventy of the respondents fit inclusion criteria of working with family medicine and obstetrics and gynecology resident physician programs. Most of the midwives' educational roles included informal mentorship of residents, supervision and consultation of intrapartum care, and caring for either their own or residents' patients. All respondents agreed that incorporating CNMs into clinical teams and faculty roles improves resident education. The majority of respondents desired a greater degree of involvement in resident education, with 57% preferring a blended interaction model. DISCUSSION: The majority of CNM respondents reported a preference to have greater involvement in the education of residents. Although CNMs desire a blended interaction or fully integrated model of collaboration with resident physicians, the current state of CNM involvement does not fulfill this degree of collaboration. Opportunities exist for further research, including surveys of resident physicians who work with CNMs, leaders in midwifery, residency program directors, and policy makers.

Certified Nurse Midwives as Teachers of Family Medicine Residents.

BACKGROUND AND OBJECTIVES: The high quality of obstetric care provided by certified nurse midwives (CNMs) has led some to hypothesize that collaboration with CNMs may encourage more family medicine (FM) residents to subsequently practice maternity care. Our goal was to understand the current state of CNM involvement in FM resident education. METHODS: We conducted two surveys: one to a random sample of 180 FM program directors, and one to 147 CNMs involved in medical education. The surveys examined the nature, prevalence, and attitudes regarding CNM involvement in FM residency training. RESULTS: The surveys' response rate was 59% from FM program directors and 58% from CNMs. Thirty-six percent of FM directors reported no CNM involvement in their residency programs, 26% reported minimal interaction, and only 6% reported a fully integrated model with CNMs on faculty. Eighty-eight percent of CNMs and 64% of program directors reported a prefence for increased interaction. Programs with highly involved CNMs reported 33% of graduates subsequently practicing prenatal care, with only 13% of graduates practicing in programs with low CNM involvement (P<.003). However, there was no difference in those providing inpatient maternity care. Thirty-one percent of FM program directors and 25% of CNMs felt that physicians and CNMs have different ideas about how to treat patients; 26% of FM program directors who worked with midwives felt that CNMs should not be involved in residency curriculum planning. CONCLUSIONS: CNM participation in FM residency education is very limited. Our study identified a gap between the current state and the preferences of CNMs and FM program directors for greater educational collaboration. Residency program director attitudes may contribute to the low rate of collaboration between the two fields.