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The Embedded Model for Bridging Essential Delivery of Care in Assisted Living Facilities-EMBED-ALF
Heitor Tavares Santos1, Marie Dobrayel2, Edith Burns3
1Division of Geriatrics and Palliative Medicine, Department of Medicine, Lenox Hill Hospital, New York, NY, USA.
None:
Older adults residing in assisted living facilities (ALFs) often face fragmented medical care, especially when managing complex chronic conditions, cognitive impairment, or end-of-life needs. This article describes an interprofessional provider-led, integrated care model embedded within an ALF in a major metropolitan area that includes memory care and home hospice. The model integrates geriatrics and palliative medicine-trained providers into routine care, supported by structured communication, tele-emergency services, and collaboration with hospice and hospital teams. While formal outcomes are not yet available, this model offers a potentially replicable framework for integrating care delivery into ALFs and describes a possible payment and policy model that supports integrated medical care in noninstitutional long-term care settings.
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