The opinions expressed in the position paper of the American Medical Directors Association1 state that assisted living facilities (ALF) are expanding rapidly and face many of the same challenges that confronted the skilled nursing facility (SNF) industry in the 1970s and 1980s. The American Geriatrics Society (AGS) position paper2 and other writings concur with the opinions expressed in the American Medical Directors Association position paper. As was the case in nursing facilities, there is great variation in assisted living operations across the U.S. with respect to staffing, size, options for care, and clinical support.3
As the AL industry has grown, the nursing facility population has changed, with an increasing percentage of individuals receiving nursing-intensive short-stay post-acute medical care in traditional skilled nursing facilities. Moreover, when we consider the demographics along the continuum of care for the elderly, there is an increasing utilization of formal supportive care at home. These shifts of care sites have enabled ALFs to fill a need previously met by skilled nursing facilities. Other reasons for the rise in ALFs include: geographic separation for potential caregivers, elders’ wishes to remain independent and not burden their children, social reasons that combat isolation, and the promise of support that will accommodate their increasing needs at the same site.
The growing population of dependent elderly needs primary care physicians (PCP) because of multiple comorbid conditions and complex medical treatment regimens.4 As residents in ALFs age, they may become ill and need hospitalization. As a result, the AL population may experience complications, functional decline, and avoidable unfavorable outcomes.
This evolution in AL resident characteristics and needs would seem to warrant oversight, regulation, and evidence-based care standards comparable to that governing nursing facilities. However, the AL industry as a whole continues to assert that ALFs are predominantly social models and should not be characterized as centers of medical care.