Team-Based Training Could Transform Care in America’s Assisted Living Facilities

Assisted living facilities across the United States are caring for residents far sicker than the system was ever designed to support, and a new opinion article argues that the fix may lie not in more staff or more beds, but in teaching the staff already there to work as a genuine team. Writing in Frontiers in Aging, researchers from Florida Gulf Coast University’s Shady Rest Institute on Positive Aging contend that interprofessional education and interprofessional collaborative practice, known respectively as IPE and IPCP, remain strikingly underused in assisted living despite their documented value in hospitals and other medically intensive settings. Their proposal arrives at a moment when the gap between what assisted living promises and what its residents actually need has never been wider.

The demographic backdrop alone is sobering. By 2050, projections cited in the article indicate that roughly 10,000 people will turn 65 every day in the United States, with older adults making up about 20 percent of the national population, while globally an additional 22 percent of people will be over 60. This surge is not merely a matter of numbers. It intensifies the clinical complexity of the people living in residential long-term care, because advanced age typically arrives bundled with multimorbidity, cognitive decline, and psychosocial fragility. Assisted living facilities first emerged in the 1980s as a person-centered alternative to nursing homes, offering hospitality-focused support with daily activities rather than continuous skilled nursing care. That positioning made them appealing, but it also left them structurally unprepared for what their resident populations have become.

The authors describe this mismatch with a term borrowed from the literature: acuity creep. Nearly 90 percent of assisted living residents now live with at least one chronic condition such as cancer, dementia, diabetes, or heart disease. More than half of residents are aged 85 or older, between one-third and half live with arthritis or heart disease, and almost half have moderate to severe cognitive impairment. More than half require assistance with three or more activities of daily living, including bathing, ambulation, and dressing. The regulatory framework governing assisted living, however, was built around basic supervision and personal care rather than skilled nursing, which means facilities operate with fewer federal staffing mandates even as the medical demands of their residents escalate year after year.

The clinical consequences of this gap are concrete and measurable. Residents with chronic obstructive pulmonary disease, for example, require approximately 105 additional minutes of direct care time compared to those without the disease. Polypharmacy compounds the risk, raising the likelihood of adverse drug events, drug-drug interactions, and adherence problems. Traditional single-disease clinical guidelines often fall short when applied to people with multiple coexisting conditions, and early signs of clinical deterioration can be subtle and easily missed, particularly in settings where care is delivered by staff with widely varying levels of training. Cognitive impairment adds another layer, with substantial proportions of residents experiencing mild cognitive impairment or dementia accompanied by agitation, confusion, wandering, and resistance to care, symptoms that demand behavioral strategies and environmental adaptations rather than medication alone.

Interprofessional education, as defined by the World Health Organization, occurs when professionals from two or more disciplines learn with, from, and about one another. In practice, the authors argue, this translates into a collaborative culture where nurses, nurses’ aides, social workers, physicians, prescribers, pharmacists, physical therapists, dietary staff, and administrators discuss clinical findings together, coordinate care plans, and develop a holistic, person-centered approach. The value proposition is straightforward: when disciplines understand how behaviors or symptoms may signal worsening illness, and when direct-care staff insights are not dismissed by professional hierarchies, the team can detect problems earlier and intervene before a resident’s condition spirals into an avoidable hospitalization.

The evidence base for this approach, while still maturing in assisted living specifically, is substantial elsewhere. The Interprofessional Curriculum for the Care of Older Adults, or iCCOA, has demonstrated that bringing interdisciplinary team members together improves their ability to deliver holistic, person-centered care. Systematic reviews and meta-analyses of interprofessional education show improvements in collaborative practice, clearer understanding of roles and responsibilities, enhanced teamwork dynamics, and better interprofessional communication. The authors are careful, however, to frame the anticipated benefits in assisted living as potential rather than established, noting that evidence directly linking IPCP implementation to clinical, physiological, and functional outcomes among assisted living residents remains limited, and calling for future empirical research to close that gap.

To move from theory to practice, the researchers propose an operational framework informed by Donabedian’s classic Structure-Process-Outcome model of quality assessment. The framework treats resident complexity and clinical risk, including multimorbidity, cognitive impairment, polypharmacy, functional decline, fall risk, and psychosocial needs, as contextual drivers that shape everything else. Organizational readiness, encompassing leadership support, adequate staffing, protected learning time, and a supportive culture, forms the structural foundation. Implementation then relies on low-burden strategies embedded into existing workflows: brief interprofessional learning sessions, resident case discussions, team huddles, joint problem-solving, simulation-based skills training, and structured reflection. These processes are designed to produce measurable outcomes, from medication optimization and earlier recognition of clinical deterioration to reduced fall risk, fewer avoidable hospital transfers, preserved functional capacity, and improved quality of life for residents and satisfaction for staff.

The barriers to implementation are real and the authors do not minimize them. Scheduling difficulties that prevent disciplines from learning together are described not as a simple inconvenience but as a systemic symptom of divergent responsibilities, schedules, and professional roles. The article suggests designating a specific person to coordinate learning activities and navigate schedules across disciplines, making face-to-face sessions possible. Institutional silos pose an equally stubborn challenge, as professional hierarchies and administrative cultures can stifle communication and cause valuable insights from direct care staff to be overlooked. Compounding everything is a workforce crisis: less than 5 percent of professionals working in geriatric settings hold certifications in geriatrics, a gap the authors frame as a critical opportunity for aging-focused interprofessional training.

Care transitions represent one of the highest-stakes arenas where collaboration could pay immediate dividends. Residents frequently move between hospitals, rehabilitation centers, and assisted living facilities, and these transitions are well-documented high-risk periods for medication errors, information loss, and adverse events. As facilities care for increasingly high-acuity populations, the ability to manage these handoffs safely has become a critical determinant of overall care quality. The authors also point to established competency frameworks from the American Interprofessional Health Collaborative and the Canadian Interprofessional Health Collaborative as ready-made scaffolds, with the Canadian framework’s emphasis on relationship-oriented care, team communication, role clarity, managing disagreement, and collaborative leadership being particularly salient for assisted living settings.

Ultimately, the article reframes interprofessional education not as an administrative nicety but as a clinically relevant intervention with the potential to influence physiological and functional outcomes in older adults. Because many residents present with atypical symptoms and are highly vulnerable to rapid deterioration, earlier multidisciplinary recognition of problems such as dehydration, infection, delirium, medication-related complications, or declining lung function could meaningfully reduce hospitalization risk and help residents age in place. The authors call for longitudinal studies combining quantitative and qualitative methods to determine how sustained IPE integration shapes team culture, communication, and resident-centered care over time. If their argument holds up under empirical scrutiny, the humble team huddle, the shared care plan, and the cross-disciplinary case discussion may prove to be among the most powerful tools available for rescuing a care model that has quietly outgrown its original design.

Subject of Research: Interprofessional collaborative practice as a strategy to improve care quality in assisted living facilities

Article Title: Opportunities to enhance assisted living facility care quality through interprofessional collaborative practice

Article References: Opportunities to enhance assisted living facility care quality through interprofessional collaborative practice. (n.d.). https://doi.org/10.3389/fragi.2026.1870661

Image Credits: AI Generated

DOI: 10.3389/fragi.2026.1870661

Keywords: assisted living, interprofessional education, interprofessional collaborative practice, long-term care, older adults, resident acuity, dementia care, chronic disease management, care transitions, Donabedian model, workforce training, quality improvement