Explore the vast range of titles available.

Our analysis of coronavirus disease prevalence in 9 long-term care facilities demonstrated a high proportion (40.7%) of asymptomatic infections among residents and staff members. Infection control measures in congregate settings should include mass testing-based strategies in concert with symptom screening for greater effectiveness in preventing the spread of severe acute respiratory syndrome coronavirus 2.

Assisted living residences have become prominent sites of long-term residential care for older adults with dementia. Estimates derived from national data indicate that seven out of ten residents in these residences have some form of cognitive impairment, with 29 percent having mild impairment, 23 percent moderate impairment, and 19 percent severe impairment. More than one-third of residents display behavioral symptoms, and of these, 57 percent have a medication prescribed for their symptoms. Only a minority of cognitively impaired residents reside in a dementia special care unit, where admission and discharge policies are more supportive of their needs. Policy-relevant recommendations from our study include the need to examine the use of psychotropic medications and cultures related to prescribing, better train assisted living staff to handle medications and provide nonpharmacological treatments, use best practices in caring for people with dementia, and promote consumer education regarding policies and practices in assisted living. Adapted from the source document.

Workforce needs are growing in older people care, exacerbated by the aging population. Technological solutions offer potential means to address this challenge. However, their effects on work and worktime management remain unclear, especially in the setting of assisted living services. Our aim was to assess the potential of two established technologies, automatic medicine dispensing and night-time monitoring, in alleviating workforce needs in Finnish assisted living facilities. The effects of the two technologies on workforce needs were studied using a convergent mixed-methods design, incorporating quantitative time and motion analysis and qualitative analysis of two open-ended survey questions. Linear regression analysis and data-driven thematic analysis were employed. The quantitative and qualitative results were integrated and compared afterward. Our quantitative results indicated that medicine dispensing technology can streamline medicine management and administration, but effects on direct care time were not found. Use of night-time monitoring technology was associated with more direct care during nights and reduced nightly staffing. The qualitative analysis highlighted medicine dispensers freeing up time for other work and night-time monitoring reducing the need for nightly rounds. However, several technology-related problems and a loss of medication competencies were perceived. Our results converged on several positive workforce effects, notably optimizing medication management and promoting individualized care during nights. Technology use could be promoted in assisted living services, when it demonstrably streamlines care work, increases work efficiency, allows for reduced staffing, or promotes individualized and patient-centered care. National care policy can incentivize the use of similar technologies, for example, through staffing level legislation. However, care unit management should prepare for potential technology-related errors and acute emergencies by upkeeping both technology and medication competencies of nurses and ensuring the presence of sufficient staff. Importantly, the potential efficiency gains must not come at the expense of quality or safety of care.

Purpose: Little is known about temporary agency staff (TAS) use in assisted living communities (ALCs) due to regulatory variation in state requirements. The current study compared TAS use in ALCs before and after the coronavirus disease 2019 pandemic. Method: Data were collected from a representative panel of the 2016 (n = 239) and 2023 (n = 298) waves of the Oregon Community-Based Care study. Results: Share of ALCs with any TAS use increased significantly between 2016 and 2023 (13.4% vs. 21.8%; p = .012). Most TAS were hired on a part-time basis (55% in 2016; 66% in 2023). We observed lower use of RNs and unlicensed direct care workers and higher use of licensed practical nurses and certified nursing assistants/medication aides in 2023 compared to 2016. Organizational characteristics were not significantly associated with ALC TAS use. Conclusion: A better understanding of how ALCs use TAS can inform policy debates around more stringent regulations for long-term care staffing.

Background Cognitive decline stands as a significant factor contributing to disability and dependency among older adults. Multi-domain lifestyle (MDL) interventions are widely recognized for their effectiveness in preserving cognitive functioning in older adults with dementia. However, little is known about MDL interventions using technology-based approaches in older adults residing in assisted living facilities. This qualitative study aimed to explore both the perceived health benefits and challenges of using a mobile-based multidomain Silvia Program among older adults residing in assisted living facilities. Methods We conducted semi-structured, in-depth interviews to capture the health-related benefits and perspectives of the Silvia Program after a 12-week period. Ten participants (70% female; age range 66–93), all at risk of dementia (with MoCA scores between 18 and 25), were recruited from two local community assisted living facilities in the Midwestern area. Interviews were transcribed and analyzed by using Creswell’s five-step qualitative data analysis. A constant comparative method was used to refine themes and ensure data saturation. Synthesized Member-Checking (SMC) and expert reviews were employed to validate findings. Findings We identified five salient themes resulting from Silvia Program participation. Participants reported three categories of perceived benefits: (a) Cognitive benefits, (b) psychological wellbeing, (c) Health-related behavior management, and two categories of challenges (d) Technology anxiety, and (e) Content issues. Conclusions The present study provided suggestive evidence for supporting cognitive engagement, activities supporting psychological wellbeing, and health behavior regulation among residents in ALFs. Early technology anxiety and content-related challenges highlight the need for program refinement and tailored support to enhance usability and engagement in ALF settings. These findings addressed a critical gap in literature by demonstrating the feasibility and perceived value of a mobile-based MDL intervention for ALF residents and providing insights to inform future controlled trials.

Background Previous research highlights the importance of staff involvement in psychosocial interventions targeting neuropsychiatric symptoms of dementia. Music therapy has shown potential effects, but it is not clear how this intervention can be programmed to involve care staff within the delivery of patients’ care. This study reports initial feasibility and outcomes from a five month music therapy programme including weekly individual active music therapy for people with dementia and weekly post-therapy video presentations for their carers in care homes. Methods 17 care home residents and 10 care staff were randomised to the music therapy intervention group or standard care control group. The cluster randomised, controlled trial included baseline, 3-month, 5-month and post-intervention 7-month measures of residents’ symptoms and well-being. Carer-resident interactions were also assessed. Feasibility was based on carers’ feedback through semi-structured interviews, programme evaluations and track records of the study. Results The music therapy programme appeared to be a practicable and acceptable intervention for care home residents and staff in managing dementia symptoms. Recruitment and retention data indicated feasibility but also challenges. Preliminary outcomes indicated differences in symptoms (13.42, 95 % CI: [4.78 to 22.07; p  = 0.006]) and in levels of wellbeing (−0.74, 95 % CI: [−1.15 to −0.33; p  = 0.003]) between the two groups, indicating that residents receiving music therapy improved. Staff in the intervention group reported enhanced caregiving techniques as a result of the programme. Conclusion The data supports the value of developing a music therapy programme involving weekly active individual music therapy sessions and music therapist-carer communication. The intervention is feasible with modifications in a more rigorous evaluation of a larger sample size. Trial registration Clinicaltrials.gov, number NCT01744600 .

Purpose Though more people in the United States currently reside in assisted living facilities (ALFs) than nursing homes, little is known about ALF admission policies, resident care needs, and staffing characteristics. We therefore conducted this study using a nationwide sample of ALFs to examine these factors, along with comparison of ALFs by size. Design Cross‐sectional secondary data analysis using data from the 2010 National Survey of Residential Care Facilities. Methods Measures included nine admission policy items, seven items on the proportion of residents with selected conditions or care needs, and six items on staffing characteristics (e.g., access to licensed nurse, aide training). Facilities (n = 2,301) were divided into three categories by size: small, 4 to 10 beds; medium, 11 to 25 beds; and large, 26 or more beds. Analyses took complex sampling design effects into account to project national U.S. estimates. Findings More than half of ALFs admitted residents with considerable healthcare needs and served populations that required nursing care, such as for transfers, medications, and eating or dressing. Staffing was largely composed of patient care aides, and fewer than half of ALFs had licensed care provider (registered nurse, licensed practical nurse) hours. Smaller facilities tended to have more inclusive admission policies and residents with more complex care needs (more mobility, eating and medication assistance required, short‐term memory issues, p < .01) and less access to licensed nurses than larger ALFs (p < .01). Conclusions This study suggests ALFs are caring for and admitting residents with considerable care needs, indicating potential overlap with nursing home populations. Despite this finding, ALF regulations lag far behind those in effect for nursing homes. In addition, measurement of care outcomes is critically needed to ensure appropriate ALF care quality. Clinical Relevance As more people choose ALFs, outcome measures for ALFs, which are now unavailable, should be developed to allow for oversight and monitoring of care quality.

Assisted living has emerged as an important housing and long-term care option for older Americans. To date, development of this sector has occurred largely without government financing or regulation. In this study we used primary data that we collected on county-level assisted living supply to gain a fuller understanding of this sector nationally. Reflecting their reliance on private resources, assisted living facilities are located disproportionately in areas with higher educational attainment, income, and housing wealth. As this sector evolves, policymakers will have to contend with issues related to access to services, public financing, quality of care, and regulatory oversight. [PUBLICATION ABSTRACT]

BACKGROUND:Assisted living is a popular option for housing and long-term care. OBJECTIVE:To develop and test a methodology to identify Medicare beneficiaries residing in assisted living facilities (ALFs). RESEARCH DESIGN:We compiled a finder file of 9-digit ZIP codes representing large ALFs (25+ beds) by matching Outcome and Assessment Information Set (OASIS) assessments and Medicare Part B Claims to the Medicare enrollment records and addresses of 11,751 ALFs. Using this finder file, we identified 738,567 beneficiaries residing in validated ALF ZIP codes in 2007–2009. We compared characteristics of this cohort to those of ALF residents in the National Survey of Residential Care Facilities (n=3009), a sample of community-dwelling Medicare beneficiaries (n=33,025,690), and long-stay nursing home residents (n=1,287,572). DATA SOURCES:A national list of licensed ALFs, Medicare enrollment records, and administrative health care databases. RESULTS:The ALF cohort we identified had good construct validity based on their demographic characteristics, health, and health care utilization when compared with ALF residents in the National Survey of Residential Care Facilities, community-dwelling Medicare beneficiaries, and long-stay nursing home residents. CONCLUSIONS:Our finder file of 9-digit ZIP codes enables identification of ALF residents using administrative data. This approach will allow researchers to examine questions related to the quality of care, health care utilization, and outcomes of residents in this growing sector of long-term care.

Exergames (exercise-based videogames) for delivering strength and balance exercise for older people are growing in popularity with the emergence of new Kinect-based technologies; however, little is known about the factors affecting their uptake and usage by older people. The aim of this study was to determine the factors that may influence the motivation of older people to use exergames to improve their physical function and reduce fall risk. Mixed methods were employed in which 14 semistructured interviews were conducted with older people (n=12, aged 59-91 years) from 2 assisted living facilities in the North West of the United Kingdom. The older people participated in a 6-week trial of exergames along with one manager and one physiotherapist; 81 h of observation and Technology Acceptance Model questionnaires were conducted. The findings suggest that the participants were intrinsically motivated to participate in the exergames because of the enjoyment experienced when playing the exergames and perceived improvements in their physical and mental health and social confidence. The social interaction provided in this study was an important extrinsic motivator that increased the intrinsic motivation to adhere to the exergame program. The findings of this study suggest that exergames may be a promising tool for delivering falls prevention exercises and increasing adherence to exercise in older people. Understanding the motivation of older people to use exergames may assist in the process of implementation.