Characteristics, services, and infection control practices of New York City assisted living facilities, 2010

Chronic conditions in elders in assisted living facilities: associations with daily functioning, self-assessed health, and depressive symptoms

BACKGROUND

The increasing life expectancy of older adults has prompted an increase in chronic conditions that may interfere with their daily living and impact physical and mental health.

OBJECTIVES

This study examined associations between commonly reported chronic conditions, daily functioning, self-assessed health, and depressive symptoms of elders.

METHODS/DESIGN

A secondary analysis of existing data from 314 elderly residents of 29 facilities was conducted.

RESULTS

The most frequently reported conditions were arthritis (64%), hypertension (47%), and heart problems (35%). Elders who reported having all three of these most frequently reported conditions differed significantly from those who reported none or one of the three conditions (p<.001) on their perception of interference with daily functioning and self-assessed health. Although differences on depressive symptoms were found between groups defined by number and combinations of conditions, specific trends in the data were not detected. Elder's rating of interference of their chronic conditions on daily functioning was moderately associated with their self-assessed health (r=-.50, p<.001) and depressive symptoms (r=.41, p<.001).

CONCLUSION

While chronic conditions may be unavoidable, assessing their comorbidity in elders is important for developing interventions to preserve their daily functioning and promote their optimal health.

Infection prevention and control standards in assisted living facilities: are residents' needs being met?

BACKGROUND

Assisted living facilities (ALFs) provide housing and care to persons unable to live independently, and who often have increasing medical needs. Disease outbreaks illustrate challenges of maintaining adequate resident protections in these facilities.

OBJECTIVES

Describe current state laws on assisted living admissions criteria, medical oversight, medication administration, vaccination requirements, and standards for infection control training.

METHODS

We abstracted laws and regulations governing assisted living facilities for the 50 states using a structured abstraction tool. Selected characteristics were compared according to the time period in which the regulation took effect. Selected state health departments were queried regarding outbreaks identified in assisted living facilities.

RESULTS

Of the 50 states, 84% specify health-based admissions criteria to assisted living facilities; 60% require licensed health care professionals to oversee medical care; 88% specifically allow subcontracting with outside entities to provide routine medical services onsite; 64% address medication administration by assisted living facility staff; 54% specify requirements for some form of initial infection control training for all staff; 50% require reporting of disease outbreaks to the health department; 18% specify requirements to offer or require vaccines to staff; 30% specify requirements to offer or require vaccines to residents. Twelve states identified approximately 1600 outbreaks from 2010 to 2013, with influenza or norovirus infections predominating.

CONCLUSIONS

There is wide variation in how assisted living facilities are regulated in the United States. States may wish to consider regulatory changes that ensure safe health care delivery, and minimize risks of infections, outbreaks of disease, and other forms of harm among assisted living residents.