Assisted Living Needs More Chronic Health Monitoring Services

August 8, 2014

Guest blog by Carol Marak - a contributor for the senior living and health care market

In 2003, Health Affairs discovered that the U.S. spent $1.3 trillion treating people with at least one chronic disease. That cost figure projects to increase to $4.3 trillion by 2023.

Chronic diseases account for about three-quarters of all healthcare spending in the U.S. and is not expected to decrease anytime soon. 

The average Medicare patient with one chronic condition sees four physicians a year, while those with five or more chronic conditions see fourteen different physicians a year. (Health Affairs Study)

Medicare beneficiaries with five or more chronic conditions account for 76 percent of Medicare costs.

The population over age eighty-five, the group with the highest proportion of people with multiple chronic conditions, is projected to grow to twenty-one million in 2050, ensuring a major increase in the number of very-high-cost patients.

When managing these complex chronic diseases in the assisted living environment, caregivers face big challenges.

Medical providers are very aware of care guidelines for certain diseases. Diabetes Mellitis (or diabetes), congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) are top of the list that present challenges for caregivers.

These diseases can cause high rates of hospitalization and death, as compared to other chronic diseases like arthritis and osteoporosis and dementia.

The supervision and assistance offered in assisted living facilities usually consist of help with activities of daily living and needs. Residents are monitored by health care assistants and staff that makes sure the resident is safe and healthy.

For assisted living facilities to sustain their residential occupancy and minimize the need for one to relocate or move to an acute care facility as a disease worsens, then chronic care options must be included in their personal care service offerings, especially for the facilities that provide a more socially-centered model.

In a recent national survey of over 2,200 residential care facilities, the Center for Disease and Prevention (CDC) found that 98 percent of care facilities offer basic health monitoring such as blood pressure and weight checks.

85 percent of the basic health that’s monitored is performed by the facility’s employees like care aides or health care workers directly caring for the resident. The types of monitoring services measure:

  • Heart rate
  • Blood pressure
  • Weight
  • Oxygen saturation
  • Temperature

View illustrations of the CDC study on basic health services

The issue being most assisted living facilities are not licensed as a "medical" facility and for resident’s requiring more intensive monitoring needs a facility that gives 24-hour nursing care.

A few assisted living facilities have permits to have "campuses" with skilled nursing buildings or wings or beds available to provide more hands-on skilled nursing care.

Administrators and operators in assisted living facilities should continue to reassess their staffs’ ability to provide safe and appropriate care, and at the same time they should constantly reassess the complexity of their residents’ medical needs.

As reported by CDC, assisted living administrators and staff in larger facilities hire full-time nurses to supervise certified nurse assistants, aides and personal care assistants. On-site nurses provide monitoring and oversight of residents needing specialized care.

The smaller assisted living facilities hire visiting nurses or part-time registered nurses to supervise nurse assistants and to monitor a resident's specialized care.

Even though the facilities might have a nurse on staff, the CDC survey revealed that registered nurses did not put in many hours. However, some facilities reported that RNs worked 40 hours the same 7 days.

When one offers more complex monitoring services, then the ALF is the perfect place for older adults with complex medical diseases, the illnesses that are chronic but stable.

ALFs need to establish and maintain appropriate processes and quality checks for how they monitor and communicate with medical providers.

Carol Marak is a contributor for the senior living and health care market. Carol writes on tough topics that older adults and family caregivers face. Her work is found on and Contact Carol at