Dementia in Assisted Living: Important Differences, Important Challenges

Background: Assisted living (AL) has become a leading provider of long-term care for older adults with dementia. Recent research suggests that as many as seven out of ten residents in AL settings have cognitive impairment or dementia. The ability to “age in place” is important in AL settings; however, little is known about the factors that may contribute to length of stay in these settings, particularly for residents with dementia. The purpose of this study was to compare the length of stay of AL residents with and without a dementia diagnosis by focusing on psychosocial factors that may create unique challenges for residents with dementia, including social isolation.  

Methods: Data were obtained from a retrospective chart review of psychosocial related variables from residents admitted between 2006-2011 in three ALs located in Ohio (N =218). Administrative records included AL residents’ demographic data, healthcare needs, and level of physical functioning. Psychosocial variables included resident/family involvement in the admission process and observations of behavior and affect upon admission. About half of the residents were diagnosed with dementia.  Length of stay (LOS) was measured in days, months and years while social isolation was assessed based on observations of and their families’ involvement with the facilities. Ordinal least squares were conducted separately for the dementia and nondementia residents to identify the most salient factors associated with LOS while logistic regressions were used to assess residents’ involvement or isolation. 

Results: Important differences were found between the residents with and without dementia, particularly in regard to marital status and resident involvement. First, while high needs for assistance with mobility and other activities of daily living were associated with reduced LOS among residents with dementia, marital status was the most important variable associated with LOS among residents without dementia in the regression analyses.  The married residents who were not diagnosed with dementia had shorter LOS than the unmarried residents.  Residents without dementia who did not have spouses were more likely to spend more years in ALs than were residents without dementia who were married.  Second, residents with dementia were significantly more likely to be socially isolated, e.g., uninvolved with other residents or family members, than residents without dementia in ALs and this association was maintained even when controlling for whether or not a resident was in a memory care unit within the AL.  Thus, even when persons with dementia resided in special care units, they still were more socially isolated than residents without dementia.

Implications: These findings support the need for social workers in ALs to assess the psychosocial needs of AL residents with dementia differently from those without dementia and findings identify vulnerable residents for whom social workers should create programs that will reduce their isolation. The findings also underscore the importance of a psychoeducational intervention to enhance family involvement with residents with dementia. The relationship between marital status and LOS in AL corroborate recent trends that many families are using ALs for respite until less costly alternatives for care are found in the community.