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. 2022 Sep 1;5(9):e2233872.
doi: 10.1001/jamanetworkopen.2022.33872.

Recommendations for Medical and Mental Health Care in Assisted Living Based on an Expert Delphi Consensus Panel: A Consensus Statement

Sheryl Zimmerman  1   2   3 , Philip D Sloane  1   4 , Christopher J Wretman  5 , Kevin Cao  6 , Johanna Silbersack  1 , Paula Carder  7 , Kali S Thomas  8 , Josh Allen  9 , Kim Butrum  10 , Tony Chicotel  11 , Pat Giorgio  12 , Mauro Hernandez  13 , Helen Kales  14 , Paul Katz  15 , Juliet Holt Klinger  16 , Margo Kunze  17 , Christopher Laxton  18 , Vicki McNealley  19 , Suzanne Meeks  20 , Kevin O'Neil  21 , Douglas Pace  22 , Barbara Resnick  23 , Lindsay Schwartz  24 , Dallas Seitz  25 , Lori Smetanka  26 , Kimberly Van Haitsma  27
Affiliations

Recommendations for Medical and Mental Health Care in Assisted Living Based on an Expert Delphi Consensus Panel: A Consensus Statement

Sheryl Zimmerman et al. JAMA Netw Open. .

Abstract

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.

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Conflict of interest statement

Conflict of Interest Disclosures: No other disclosures were reported.

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