Declining physical function most often is associated with increased care in assisted living, but other factors should be considered to address residents’ holistic care needs, according to the authors of a new study.
A rapidly aging population and direct care workforce shortages are creating challenges in the delivery of services for older adults, elevating the importance of optimally allocating care resources, according to a study published recently in BMC Geriatrics by researchers from the Finnish Institute for Health and Welfare.
In total, 1,538 assisted living residents and 1,477 home care clients from 61 communities participated in the study.
Physical functioning was the strongest predictor of received care in both care settings, although other contributing factors included policies and operations within different communities. A decline in functional ability also was associated with declines in other areas of functioning, further emphasizing the need to maintain or improve the ability for residents to participate in activities of daily living and instrumental activities of daily living, according to the investigators.
In assisted living, depression and higher staffing levels were tied to increased care time for residents. In home care, greater pain, more unstable health and higher team autonomy were associated with increased care times. Assisted living staffing levels, care resources allocated to home care, workforce shortages and community differences also could affect variances in care times, the authors said.
In Finland, care services for older adults have undergone several changes over the past few decades, with aging policy shifting to emphasize home care, whereas institutional care increasingly is being replaced by assisted living communities with 24-hour assistance.
The researchers noted that rehabilitation could help older adults maintain physical activities and reduce care needs in both settings. Providers also could focus on factors that could prevent cognitive decline to help residents maintain physical function, they suggested; such factors include exercise, a healthy diet and social activity. The authors also promoted social activity and personally meaningful activities that support person-centered care.
In assisted living, the researchers said, the study findings can highlight care policy, where the need for care is mainly determined based on the performance of daily activities, whereas cognitive and social aspects might only receive minor attention. The findings also can help in developing care services, allocating care resources and improving work practices, which can lead to improvements in the quality of care or efficiency of services for older adults, they said.
“Care needs of older people in home care and assisted living facilities are often complex, as factors such as cognitive decline, depressive mood and pain often appear simultaneously, affecting physical functioning,” researchers concluded. “Therefore, in addition to rehabilitation, there may be other potential interventions that improve functioning, including social activities.”
