Assisted living communities are caring for residents with more complex health care needs than just a few years ago and keeping staff realistic about their caregiving capacities, and implementing protocols to manage these higher-care needs can help lower the community’s liability risk and increase their capacity to retain residents, says an expert in nursing and clinical issues.
Josh Allen, RN, C-AL, chair of the American Assisted Living Nurses Association (AALNA), presented these ideas during a recent webinar, sponsored by the National Center for Assisted Living (NCAL) titled, “Higher Acuity in Assisted Living: Risk or Reward?”
Allen cited statistics from the 2010 National Survey of Residential Care Facilities. The survey revealed that 50 percent of the nation’s assisted living residents have three or more chronic conditions, and 42 percent of them have Alzheimer’s disease or other forms of dementia.
In addition, NCAL’s 2012 Performance Measures report found that of the respondents, 94 percent had access to a registered nurse.

“We know acuity is on the rise. It sounds like a cliché, but many of the residents of assisted living today were in nursing facilities five years ago,” Allen says. “There is more direct caregiving being delivered.”
To determine if the reward is worth the risk, Allen recommends that staff in an organization evaluate their caregiving capabilities and develop protocols for those residents with more chronic health care conditions.
“Have you sat down as an organization and really talked about higher acuity?” he says. “Have you talked about who are the residents you are going to care for and what kinds of residents are you going to be able to accommodate?”

Review The Top 10 Health Conditions

Allen suggested organizations review the top 10 chronic health conditions found in the national survey, evaluating their caregiving capacity by asking the following questions for each condition:
1. Can we accommodate this condition?
2. How are we managing this condition?
3. Are we capable of addressing this condition?
4. Are we prepared?
5. Do we need to partner with a home health agency, physician, or physical or occupational therapist?
Next, he encouraged communities to get nurses and marketers to work together to overcome any distrust between the departments.
Often nurses believe marketers oversell staff’s caregiving capabilities, and marketers believe nurses curb their sales efforts. To counteract those perceptions, Allen recommends having sales and nursing staff meet daily to review each resident’s health care conditions—including residents moving in and those at risk of moving out. This daily meeting builds a relationship and trust amongst department members.

Develop Elopement Checklist

Turning to specific health care conditions, Allen discussed managing residents with Alzheimer’s and other forms of dementia.
Allen said research has found that the only true indicator of a resident being at risk of eloping is if the resident has actually wandered out of a community before. There are limited methods of determining which residents with Alzheimer’s disease who haven’t walked out of a building will, in fact, walk out of a building.
Allen suggested all assisted living communities develop an elopement procedure checklist that includes steps for staff to complete when looking for a resident who has eloped.
“Just like fire evacuation procedures, you want to have the same thing for an elopement, mainly because you panic,” he said.
“Having that checklist helps focus your person’s energy on doing the steps.”