ABSTRACT

This chapter addresses recognition and treatment of diabetes in assisted-living facilities, transitional-care, and post-acute-care facilities, and long-term care facilities, with particular emphasis on barriers to optimal care and suggestions for quality improvement systems implementation. Many programs for diabetes management exist in the community for ambulatory patients. The signs and symptoms of diabetes may be subtle and unrecognized by staff and caregivers. Long-term care facilities are chronically understaffed, and, as in post-acute care, the majority of direct care is performed by unlicensed staff. Diabetes management in chronic care settings has a unique set of challenges for physicians. Frailty and the existence of significant co morbidities are the main reasons for under treatment of diabetes in the long-term care setting. Diabetes is a significant diagnosis in long-term care facilities. Under diagnosis of diabetes is a significant problem, both in the community and in the long-term care setting.