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.

Importance of infection control and continence management plans in assisted living communities during the COVID-19 pandemic.

A robust and comprehensive infection control plan in a senior living community is a must. Delirium manifestations of Covid-19 and or Urinary Tract Infections, may be confused or misdiagnosed with dementia symptoms in memory care residents. A robust incontinence care program is a key pillar of infection control to reduce symptoms causing hospitalization. Misdiagnosis, transfer infections, acute treatment dementia challenges, worsening incontinence are all risks of residents being hospitalized. A comprehensive incontinence assessment, plan, and education program are all paramount to seeing a reduction in hospitalizations and misdiagnosis of Covid-19 and other symptoms.

Incontinence affects every aspect and stakeholder of an assisted living community.

A total incontinence management program will benefit a community's administration, nurses, caregivers, families and most importantly, residents. An incontinence program helps reduce the risk of incidences such as agitation, urinary tract infection, falls and skin complications which assisted living and memory care communities are trying to prevent. The correct evaluation tools increase the likelihood of successful outcomes because the program has to be the right program for the resident. After evaluation of the level of incontinence, the resident can then be enrolled. This article provides a practical toolkit for assessment of a resident in assisted living general or memory care populations in addition to the different types of programs a resident can enroll into after evaluation completed.