Assisted Living Adapts to Changing Resident Acuity

As the assisted living resident demographic changes toward higher age and acuity, senior living providers are shifting care models with a clinical focus to accommodate emerging needs.

A majority of assisted living residents are female, 85 or older, and need help with at least one activity of daily living (ADL), according to the CDC’s 2010 National Survey of Residential Care FacilitiesLink Icon. Nearly 40% need help with three or more ADLs.

“Back in the day, we used to say our industry was hospitality with healthcare. I would say we’re becoming healthcare with hospitality,” says Gina D’Angelo, RN, vice president of health services at independent, assisted, and memory care provider Chelsea Senior Living, and Chair of ALFA’s Clinical Quality Executive Roundtable.


That doesn’t mean the halls of Chelsea’s 17 communities are traversed by medical professionals in white lab coats, she says, but it does make for a more clinical approach to senior living.

“We’re doing a lot to manage acuity,” agrees Terry Lawrence, vice president of health and wellness at New Perspective Senior Living, an independent living, assisted living, and memory care provider.

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One such initiative: rolling out an electronic medication administration (eMAR) system across New Perspective’s 12 senior living communities.

The roll-out—currently about one-third complete—will be done by the end of 2013. Planned next for 2014 is the implementation of an integrated electronic health record (EHR) system.

“The benefits of eMAR [include] streamlining workflow and processes to ensure we reduce medication error,” Lawrence says. “As for the advantages of EHR—integrating all ancillary services through one engine is the best and most efficient way to manage care.”

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Chelsea Senior Living is in the process of moving toward an electronic medical record (EMR) format, and it’s looking into ways to coordinate relationships between all the ancillary healthcare providers often present in assisted living communities.

“We are going to have to manage through electronic medical formats, with increased training and evaluation of our staffing models in order to meet the needs of the baby boomers coming down the pike,” D’Angelo says. “We’re going to have to work a lot more cohesively with those from whom residents receive their current medical care, in order to maintain a seamless medical process for them.”

Assisted living is a very segmented environment, in a clinical sense, she says. Residents have their own physicians along with access to a variety of other healthcare providers including therapy, dental, vision, podiatry, pharmacy, home health, and hospice.

“They all come into the building and take part in a resident’s health,” says D’Angelo. “We need to move into a direction where we begin to communicate with each other to take better care of our residents.”

Staffing Adjustments

That communication comes into play not just with third-party healthcare providers, but also the staff employed in each community.

Chelsea communities have full-time health service directors who are on call 24 hours a day, sharing this role with full- or part-time registered nurses (RNs). Communities also have med technicians specially trained on medication management and certified medication aides along with certified nursing aides.

Ongoing training and leadership and skills development have been a key focus, and Chelsea has taken steps to address higher acuity among residents.

“We’ve invested a lot of education in our health services directors, in terms of how we train them and the frequency of our communication with them,” says D’Angelo. “Because RNs have such a vital role in overall health and wellness of residents, it’s vital we have constant training for our health service directors.”

At New Perspective Senior Living, directors of wellness are available 24/7. RNs and licensed practical nurses are also on staff in accordance with state regulations.

While staffing is based on resident acuity and has remained consistent, the company has created some new positions; Lawrence’s was introduced in September 2011.

“To fully meet the needs of our growing acuity, we’ve layered in an area health and wellness director role to ensure that policy, procedures and training are up to date, and for quality assurance,” he says.

Some assisted living providers have been anticipating the shift in acuity and already have models that accommodate more medical-based services.

“Demographic change and average age change hasn’t affected us all that much,” says Tom Kelly, an executive director at a Brandywine Senior Living, which owns and operates 24 assisted living communities in five states.

Brandywine’s care model includes nurses onsite 24/7, and residents shape staffing patterns. Incoming residents go through a “solid” assessment that gathers information from family members and doctors.

“We gain a good handle [on their needs] then make the decision if we can care for them,” Kelly says.

Despite assisted living’s move toward a more medical model, Kelly believes it will retain its social aspects, especially as baby boomers approach retirement.

“The clinical climate for our residents is dramatically changed,” agrees D’Angelo.“It’s not the nursing home of tomorrow—assisted living will never go in that direction. But with the boomers coming and the need for more choice and fluidity in their lifestyles, clinically we have to prepare for that.”

Ed. note: A previous version of this article included an incorrect count of Chelsea Senior Living communities; they have 17, not 15.

Written by Alyssa Gerace

This article is sponsored by the Assisted Living Federation of America (ALFA) as part of its efforts to advance excellence and explore topics impacting the future of senior living. For more information about ALFA, visit

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