Reasons Residents with Dementia Transfer to Acute Care from Assisted Living
Rationale: AL communities are a growing source of housing for older adults in the United States. It is estimated that over 50% of the residents in AL have some form of cognitive impairment. Many AL communities do not employ registered nurses who can assess residents who have an acute health care need. As a result, residents may be transferred to the emergency department if they suffer a minor injury or change in condition. Emergency departments are frequently overcrowded and can be a disruptive and confusing place for residents with dementia.
Methods: The setting for this mixed-methods research study was two dementia-only AL communities in California. Incident data on the number and reason of resident falls, illnesses, changes in condition, and emergency department or acute care visits were collected over six months. Participant observation and interviews were conducted with employees and family members. The qualitative data were analyzed for themes regarding how employees in AL provide for residents’ transitions to and from acute care.
Results: The 63 residents experienced a total of 206 incidents resulting in 77 visits to the emergency department over six months. Only 32% of the emergency department visits resulted in admission to acute care. 60% of the visits were because of falls, followed by infections (25%). Of the 63 residents, eight were responsible for about half of the acute care visits (52%) and falls (47%), who were readmitted an average of six times in six months. Qualitative data were also analyzed, and the prominent themes expressed by the employees and family members included helplessness, frustration, and confusion about their frequent transitions to and from the hospital.
Implications: Over two-thirds (68%) of the emergency department visits were unnecessary as the residents were discharged back to the AL communities without a change in treatment. The difficulties in transitions from acute care observed in these facilities demonstrate the need for improved supervision and education for the employees. Studies using registered nurses to supervise transitional care in other settings showed improved patient outcomes which warrants further investigation in assisted living.