Are assisted living residents moving in too early or too late?

LONDON: A new study provides fresh insights into assisted living residents at move-in and a couple of years later and suggests questions to contemplate about the future of the setting.

Kenneth Lam, MD, an assistant professor of geriatric medicine at the University of Colorado School of Medicine, and his co-authors set out to provide data related to how independent people are before they move into an assisted living community or nursing home; how much help they tend to get, and for what; and what the process leading up to a move looks like. They used data from the National Health and Aging Trends Study, from 2011 to 2020, as the basis for the research.

What Lam and his colleagues learned is that the mean age of an older adult moving into assisted living is 85 (by comparison, it’s 82 for independent living and 83 for nursing homes), a finding that aligns with the results of other research.

Older adults moving into assisted living are less likely to be severely disabled (10% were) compared with people moving into nursing homes (49%), but they are receiving 18 hours of care a week for at least a month at home before move-in (compared with 27 hours per week for people moving into nursing homes), according to the study. Lam said that the difference “might reflect the sociodemographic advantages of people who tend to move into assisted living facilities.”

At move-in, the new assisted living residents rated their health as excellent (8%), very good (27%), good (27%), fair (28%) or poor (10%), and 53% had dementia. The group had a mean of 1.3 chronic conditions, such as heart disease, arthritis, diabetes, lung cancer, stroke or cancer.

As far as activities of daily living, the people studied who were moving into assisted living needed help dressing (33%), bathing (27%), getting around inside (22%), eating (20%), getting out of bed (14%) or toileting (13%), according to the research.

Within one to two years of moving into assisted living communities, however, residents’ levels of severe disability approached those of nursing home residents, the investigators found.

This finding, Lam said, “leads to more questions: Should people stay at assisted living facilities forever, or do we need to have upfront conversations about what care might look like in those places a couple of years down the line?”

What do you think?

Lam said he hopes his research provides a starting point for clinicians, residents and their families to weigh long-term care options. What could be considered moving in too early or too late varies by individual, he said, but the study sets a bar around which such conversations can begin.

He said he will follow up this study by interviewing people who recently have moved into assisted living communities or nursing homes to try to better understand the circumstances of their entry, the effects it had on their social lives, and what advice they would give to other people in the same situation. Lam said he also is looking at the role of dementia in long-term care move-in decisions.

“Now we know at what age people move in, on average, and from there you can start to define what it means to move in early or move in late. The next step is to figure out if moving in early or moving in late makes a difference, and if so, a difference in what?” he said. “That is an important and different question. It’s a tricky problem, and this paper is trying to open up the discussion around it.”