The resident demographic in assisted living is undergoing significant changes. While it could have been easily and more narrowly defined as homogenous in the decades since its birth in the 1950s, that’s no longer the case.
The diversity of the assisted living resident population is more aptly defined by its general health – both physical and mental — and nowhere is that more evident today than in memory care, which is building a presence of its own in this segment of the long-term care market.
Statistics from NCAL, the National Center for Assisted Living, show how deeply entrenched memory care has become in this segment.
Of the 30,200 assisted living communities across the United States, more than 12,000, or 40%, offer programs around dementia or Alzheimer’s disease – more than depression or diabetes. About 12% of assisted living communities have dedicated wings or floors set up for memory care. And perhaps more surprising than all: about 10% of assisted living communities only serve adults with dementia.
So-called “special care units,” or SCUs, provide dedicated care in dementia. These units typically provide around-the-clock supervised care as well. And many are known, or differentiate themselves, by offering unique programs with activities designed to rekindle memories and repair cognitive function to some extent. One NCAL member, Curry House in Cadillac, MI, provides “Second Wind Dreams virtual dementia tours” for staff and visitors as a means for imbuing greater patient empathy among cognitively healthy individuals.
NCAL asserts that assisted living memory care facilities are particularly well suited to provide care for early-to-middle stage dementia and Alzheimer’s residents, including much needed help with Instrumental Activities of Daily Living (IADLs). Those with more advanced stages of the disease typically have private studio, private apartment, or a shared apartment amenities on assisted living campuses, along with 24-hour supervision.
Thanks in large part to modern medicine and university research, most cognitively impaired assisted living residents are able to lead comfortable lives while under the watchful supervision of staff.
But change is afoot in the form of regulations around the use of antipsychotics. When cases began surfacing that uncovered abusive administration practices in dementia residents in skilled nursing care, some of which resulted in actual physical harm, a series of initiatives, many self-imposed, were taken to stem the use of antipsychotics, if not outright ban their use.
Meanwhile, recent investigations have uncovered a disturbing trend in antipsychotic use in assisted living memory care.
As reported by McKnight’s Senior Living in the spring of 2018, off-label use of antipsychotic medications in those with dementia is on the rise among those afflicted by it in assisted living communities or at home. The opposite is happening among dementia patients in nursing homes, however. The results were uncovered during an analysis of insurance claims data released by the AARP Public Policy Institute.
These costly drugs have been shown to increase the risk of death, falls and fractures, hospitalizations, and other complications, resulting in poor health. As NCAL has often argued, use of antipsychotics to modify behavior in dementia patients is not sanctioned by the FDA, and is considered as an off-label use by the agency. The FDA actually issued a so-called “black box” warning for the elderly with dementia.
Other kinds of medications like opioids and antibiotics, while not exclusive to memory care, are also under critical review.
All told, senior living pharmacy services are undergoing significant change to reflect these and other kinds of practice issues everyone in the industry find common ground with. Numerous experts point out that efforts around consultation, compliance management, risk reduction, medication reviews and more are becoming the norm.
In tandem with medical science, technology vendors are feverishly developing myriad new devices to serve the memory care market in assisted living.
Many of the innovations are centered in areas around elopement. More than 34,000 Alzheimer patients wander out of their homes or facilities each year, according to the National Council of Certified Dementia Practitioners. The group has estimated that up to 24% of institutionalized dementia patients wander.
Whether by design or happenstance, these kinds of technologies are offering bonus benefits that are helping ease staffing issues and clinical vacuums that so many assisted living communities grappled with today.
GPS and geo-fencing technology installed in or around memory care wings allow staff to be alerted whenever residents stray.
Emergency call systems are now common, and allow residents to quickly summon medical help, some passively and others through the touch of a button. Technology like facial recognition and artificial intelligence are now becoming increasingly common in such devices. Sophisticated sensors are now able to predict and in some cases, prevent falls among cognitively impaired residents whose visual acuity is often disturbed by colors, patterns and textures.
Most memory care technology has become a relatively easy sell. There are exceptions. As one vendor observed, “We recommended a resident wandering solution for a community with a memory care wing but they decided that the price of the system was too high and that they would forgo the installation. Within the next two weeks of our initial site survey, one of their residents managed to escape and was found wandering down the road by a car wash. Luckily this resident was found unharmed and the incident swayed the community to install the system.”
Technology is also being used in novel ways by therapists. One therapist said electronic health record systems can employ interactive media for mental stimulation to improve cognitive function and innovative community design to improve both comfort and safety levels for residents.
So-called multi-sensory approaches like “Snoezelen,” bright light therapy, Montessori-based learning, animal-assisted therapy and simulated presence therapy (in which loved ones provide scripted discussions on tape) are reportedly showing promise in slowing disease progression and improving cognitive ability.
Meanwhile, Front Porch retirement communities in California have explored therapy robots, or robotic pets, as promising tools to decrease wandering and anxiety-related behaviors in memory care residents, as reported by McKnight’s.
As memory care populations in assisted living communities rise, changing practices in terms of antipsychotic use and opioids for dementia patients are under critical review and regulation may be on the way. ValueMed can help you stay in compliance and offer medication reviews and pharmacy consultations to help you deliver better care. Contact us at ValueMed@PharMerica.com or 866-628-2583 to learn more.Download PDF