Medical and Mental Health Services in US Assisted Living Settings During COVID-19: Challenges and Opportunities


      The COVID-19 pandemic has disproportionately affected long-term care settings, staff, residents, and residents’ families across the US; related reports and recommendations highlight the confusion around where assisted living (AL) belongs within the context of “long-term care.” Although much attention has been paid to skilled nursing facilities in the context of COVID-19, AL and other residential care settings have rarely been singled out in media and empirical discourse. This study describes perceptions of medical and mental health care provisions within US AL communities in the COVID-19 context.


      We identified stakeholders with expertise in medical care, mental health services, and COVID-19 response in AL: AL operators, trade and healthcare association representatives, clinicians, dementia care experts, advocacy organizations, and state policymakers. Respondents participated in semi-structured interviews from July to October 2020 (n=41); they were asked to describe medical care, mental health care, and COVID-19 policies and practices applicable to AL. We analyzed the interviews using thematic analysis to derive key patterns and themes related to these and other topics identified by participants.


      Participants described how the COVID-19 pandemic has exacerbated existing systemic challenges associated with medical and mental health care access and services in AL. Recurring themes included: assessment/medication management, the role of nursing and medical directors, adequate staffing levels, quality of staff training and education, the impact of regulatory variation on scope of practice, and the lack of intersection between geriatric and mental health care, including residents’ biopsychosocial needs. COVID-19 introduced new opportunities and challenges related to telehealth, dementia care, social isolation, and balancing residents’ health-related needs with social model principles.


      COVID-19 has simultaneously exposed infrastructure limitations and presented an opportunity to rethink AL operations to best meet individual needs of residents to promote their health and safety. Policymakers, operators, and healthcare providers may benefit from understanding the nuanced context of AL within each state, including intra-state and operational variability. These contexts have implications for the scope of and access to services provided, and therefore the ability of AL to respond to blanket public health guidelines extended to other licensed health settings.


      This study was supported by the National Institute on Aging (R01 AG057746-01) awarded to Dr. Kali S. Thomas; All other authors have stated there are no financial disclosures to be made that are pertinent to this abstract.