American Geriatrics Society (AGS ) Policy Brief

COVID-19 and Assisted Living Facilities

J Am Geriatr Soc. 2020;68(6):1131-1135. 

In This Article

Abstract and Introduction

Abstract

This policy brief sets forth the American Geriatrics Society's (AGS's) recommendations to guide federal, state, and local governments when making decisions about care for older adults in assisted living facilities (ALFs) during the coronavirus disease 2019 (COVID-19) pandemic. It focuses on the need for personal protective equipment, access to testing, public health support for infection control, and workforce training. The AGS continues to review guidance set forth in peer-reviewed articles, as well as ongoing and updated guidance from the US Department of Health and Human Services, the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, and other key agencies. This brief is based on the situation and any federal guidance or actions as of April 15, 2020. Joining a separate AGS policy brief on COVID-19 in nursing homes (DOI: 10.1111/jgs.16477), this brief is focused on ALFs, given that varied structure and staffing can impact their response to COVID-19.

Introduction

This policy brief sets forth the American Geriatrics Society's (AGS's) recommendations to guide federal, state, and local governments when making decisions about how best to care for all older adults residing in assisted living facilities (ALFs) during the coronavirus disease 2019 (COVID-19) pandemic. It focuses on the need for personal protective equipment (PPE), access to testing, public health support for infection control, and workforce training. The AGS continues to review guidance set forth in peer-reviewed articles, as well as updated guidance from the US Department of Health and Human Services, the Centers for Medicare and Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), and other key agencies to inform AGS policies and recommendations. This brief is based on the situation and any federal guidance or actions as of April 15, 2020.

Assisted Living Facilities

ALFs do not provide round-the-clock skilled nursing care and are neither considered nor licensed as medical facilities. They are residential settings that generally provide or coordinate personal and healthcare services to residents who live independently in their own homes in the building or complex. Most ALFs are apartment-type buildings where each resident leases an apartment or room and the rental package includes a limited number of services (eg, meals, cleaning). Residents typically pay for additional services to be provided in their home (eg, assistance with bathing, dressing) as their needs dictate. ALFs have emerged as an attractive option for older adults and their families because they typically offer group dining, transportation, and recreational activities (eg, weekly social hours, day trips, and clubs), in addition to a menu of supportive services that help older adults to remain at home and independent.

ALFs vary widely in the structure of available services; these may include 24-hour on-call assistance with activities of daily living and on-call nursing assistance. Residents may also hire personal care assistants externally, and some ALFs coordinate care with external home health agencies (eg, visiting nurse), depending on a resident's needs. This structure is not as conducive as nursing homes (NHs) to cohort residents. While residents could be restricted to their rooms, it would require significant staff to provide needed care, and residents would need to agree to adhere to such restrictions, which makes it difficult to enforce such universal precautions. Some ALFs specialize in the care of people with various forms of cognitive impairment and dementia, which might make isolating and cohorting even more challenging. "Memory care" units or facilities have the added challenges that residents are often unable to follow physical distancing instructions, or are unable to adhere to interventions such as the wearing of masks or gloves.

The vast majority of ALFs are private pay, although increasing numbers of stays are being paid through Medicaid waiver programs. ALFs vary in cost and size, and there are no federal regulations that are specific and state regulations vary. Unlike NHs, there are no requirements for a medical director, an admitting physician, or regular visits by a physician, advance practice clinician (eg, a nurse practitioner), or other health professional staff. Some ALFs have primary care clinicians come to visit residents, but this is the exception rather than the rule. The availability of nurses in ALFs varies considerably. There are also no standard requirements for infection control or an infection control practitioner, as there are in NHs. ALFs also differ widely in the amount of health information they collect from residents and the types of personal care, therapeutic, and health services they offer as part of their service menus.

Given how the vast majority of ALFs are structured and staffed, ALFs are not as well resourced to respond to the COVID-19 outbreak as other care settings. Though CMS official guidance for NHs contains elements that ALFs could adopt, ALFs may have difficulty implementing much of this guidance.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....