Infection Prevention and Control Standards in Assisted Living Facilities: Are Residents' Needs Being Met?

Abstract

Background Assisted Living Facilities (ALFs) provide housing and care to persons unable to live independently, and who often have increasing medical needs. Disease outbreaks illustrate challenges of maintaining adequate resident protections in these facilities. Objectives Describe current state laws on assisted living admissions criteria, medical oversight, medication administration, vaccination requirements, and standards for infection control training. Methods We abstracted laws and regulations governing assisted living facilities for the 50 states using a structured abstraction tool. Selected characteristics were compared according to the time period in which the regulation took effect. Selected state health departments were queried regarding outbreaks identified in assisted living facilities. Results Of the 50 states, 84% specify health-based admissions criteria to assisted living facilities. 60% require licensed healthcare professionals to oversee medical care. 88% specifically allow subcontracting with outside entities to provide routine medical services onsite, and 64% address medication administration by assisted living facility staff. 54% specify requirements for some form of initial infection control training for all staff; 50% require reporting of disease outbreaks to the health department. 30% offered or required vaccines to staff; 15% of states offered or required vaccines to residents. Eleven states identified approximately 1500 outbreaks from 2010–2013, with influenza or norovirus infections predominating. Conclusions There is wide variation in how assisted living facilities are regulated in the United States. States may wish to consider regulatory changes that assure safe healthcare delivery, and minimize risks of infections, outbreaks of disease, and other forms of harm among assisted living residents.

Variation Across U.S. Assisted Living Facilities: Admissions, Resident Care Needs, and Staffing

“…The distinctions across ALFs by size also need further scrutiny. Because residential care facilities are gaining an increasing share of long‐term care residents in the United States (Kossover et al., ), more stringent monitoring and evaluation of ALF staff and outcomes are needed to assess care quality in these settings.…”

“…Finally, as the regulatory situation currently stands, there are no systematic quality data for these facilities, so there is no way to monitor ALF care outcomes. This is of great concern because ALFs are growing in number with little regulation in many states (Kossover et al., ). While a few states have implemented periodic surveys that mirror evaluation outcomes in nursing homes, state‐level deficiency databases are not widely available and there are no standardized ALF outcome definitions.…”

Outbreak of Human Metapneumovirus in a Nursing Home: A Clinical Perspective

“…Although no vaccination against hMPV currently exists, some organizational measures can be taken to prevent or contain outbreaks, such as reinforcing the nursing skills and better education of health care workers, 39,40 upgrading NH admission criteria for improved medical surveillance, and training in measures for infection control. 41 Kossover et al 41 showed some discrepancies in practices within the American facilities they studied. Harmonization may permit a better sharing of anti-infectious strategies, including the systematic use of masks by all health care workers and NH staff throughout this type of outbreak.…”

Transmission of novel Klebsiella pneumoniae carbapenemase-producing Escherichia coli sequence type 1193 among residents and caregivers in a community-based, residential care setting—Nevada, 2018

“…Screening assessments and bla KPC case finding. 1 No recent hospitalizations 2 Resided or worked in GH A from June 1st through October 26th, 2018. 3 One resident expired prior to screening.…”