WHAT THIS MEANS FOR YOU: Medicare data for over 20,600 assisted living residents with Alzheimer's disease and related dementias (ADRD) indicate that residents of memory care had a significantly lower risk of hospitalization, nursing home admission, and long-term nursing home stays compared to those in general communities.

WHAT THIS MEANS FOR YOU: A systematic review showed that from 2015 to 2020, older adults in AL or retirement communities who had stronger social connections experienced improved health, and that over-reliance on only family for social interactions was associated with loneliness. Related recommendations to reduce loneliness include fostering diverse social networks and overcoming barriers like the inability to select roommates, lack of phone access, and potentially isolating community layouts.

WHAT THIS MEANS FOR YOU: Medicare data were used to analyze post-acute care referrals for over 104,000 assisted living residents. The most common referral after hospitalizations was to skilled nursing. Referrals to skilled nursing were associated with a lower likelihood of emergency department visits and hospital readmissions; however, there was higher likelihood of long-term skilled nursing placement and death.

WHAT THIS MEANS FOR YOU: State inspection data from 957 large assisted living communities in Florida showed that 87% were cited one or more times from 2012 to 2018. For-profit communities, those with more than 100 beds, and those with a limited mental health license were cited more often. Over 40% of communities were cited in two or more years for the same deficiency category, meaning that repeat citations are common.

WHAT THIS MEANS FOR YOU: Researchers interviewed 13 AL residents and 19 care workers in two communities about resident aggression. Care workers reported physical and verbal aggression, while residents reported relational and sexual aggression from peers. Both groups often attributed aggression to communal living, aging, or dementia, suggesting that they normalized the behavior and often did not report it. Underreporting of resident aggression was more common for workers than residents.

WHAT THIS MEANS FOR YOU: This study included 550 AL residents from 59 communities, and assessed how cognitive impairment relates to physical activity, pain, and willingness to receive staff-assisted function-focused care. It found that cognitively impaired residents were less active, experienced more pain, and were less interested in staff-assisted function-focused care activities.

WHAT THIS MEANS FOR YOU: During the COVID-19 pandemic, AL communities faced hurdles obtaining vital supplies including masks and gloves; AL communities were often considered lower priority than other healthcare settings, leading to delays in receipt. When supplies were obtained, the quantity often overwhelmed available storage space, leading to unsafe supply storage. Solutions include improved emergency management, emphasizing proper storage, and optimizing delivery schedules.

WHAT THIS MEANS FOR YOU: There are significant differences in the quality of end-of-life care in AL. Research on 37,668 deceased Medicare beneficiaries who lived in AL found that 1 in 5 experienced challenging transitions including frequent hospitalizations before their death. Burdensome transitions, especially in the last three days of life, varied widely among states, which may be associated with state-level regulations.

WHAT THIS MEANS FOR YOU: Interviews with 27 AL administrators revealed different approaches to advanced care planning (ACP). They all acknowledged the importance of ACP and often discussed topics like “do-not-resuscitate” orders when new residents arrived. Challenges included insufficient ACP training for staff and administrators and some reluctance from residents and families to discuss ACP. Most communities lacked a systematic, structured ACP approach.

WHAT THIS MEANS FOR YOU: A study of 550 AL residents from 59 communities found that factors such as better physical and cognitive health, positive care interactions, and supportive environments were associated with increased participation in function-focused care. Additionally, for-profit communities had higher levels of function-focused care despite having residents with lower functioning.

WHAT THIS MEANS FOR YOU: A quality improvement initiative implemented by 810 Wisconsin assisted living communities serving over 20,000 residents found that most communities (88%) were able to comply with membership requirements and 71% remained enrolled for more than 2 years. This model could be reproduced in other states to improve quality.

WHAT THIS MEANS FOR YOU: Three industry-wide proposals were recommended to enhance medical care quality for AL residents: regular on-site medical visits; employing experienced professionals in long-term and end-of-life care; and the introduction of an AL medical director role to establish rules, staff qualifications, and collaboration. The researchers acknowledge that adaptations may be necessary to adhere to these recommendations due to community size and availability of resources.

WHAT THIS MEANS FOR YOU: This study examined the use of electronic health records (EHRs) and health information exchange (HIE) in AL between 2010 and 2018. Use varied based on AL size and ownership, with larger (26+ beds) and chain-owned communities more likely to use these technologies. Overall, adoption of these technologies increased from 2010 to 2018, but smaller communities had lower adoption rates.

WHAT THIS MEANS FOR YOU: This study examined two groups of Medicare beneficiaries residing in large (25+ beds) AL communities in 2014: dual Medicare and Medicaid beneficiaries, and Medicare-only beneficiaries. Among 506,193 beneficiaries, 18% were dually eligible; they tended to be younger, minority, and have more chronic health conditions. The share of dual-eligibles by state varied widely; states with Medicaid financing for AL had more dual-eligibles, but variation in state room and board regulations did not have a significant relationship to dual-eligible rates.

WHAT THIS MEANS FOR YOU: This literature review explores how COVID-19 created challenges for both residents and staff in assisted living by providing an overview of its impact and suggesting actions to improve outcomes. Studies showed that residents experienced a decline in their health and happiness because of infection control measures, which made them feel lonely and isolated. Staff faced problems such as staff shortages, feeling overwhelmed and stressed, and dealing with emotional struggles. The article suggests solutions such as improving infection control, giving better training to staff, introducing Essential Caregiver programs, and encouraging residents to socialize more.

WHAT THIS MEANS FOR YOU: This study examined the use of antipsychotic medications among residents with dementia in 91 AL communities across seven states. The prevalence of potential side effects was high (93%) and of possible adverse events low, (6%), potentially associated with medication side effects. Quetiapine (Seroquel) and risperidone (Risperdal) were the most frequently prescribed antipsychotics. Most, but not all, residents’ family members were aware of their relative’s antipsychotic use.

WHAT THIS MEANS FOR YOU: A 20-bed AL community in rural North Carolina implemented a sit-to-stand exercise program (i.e., having residents rise from a sitting position and then sit back down). A total of 13 residents participated in the program which was offered twice daily over 82 days. The average attendance rate for participants for all sessions was over 90%, and each participant was able to complete all 5 exercises during each session. Over the course of the program participants saw modest increases in average activities of daily living independence scores; however, these changes were not statistically significant. Activities that were measured included toileting, bathing, dressing, transferring, and continence.

WHAT THIS MEANS FOR YOU: A pilot study investigated the effectiveness of virtual compassionate presence (CP) sessions in reducing loneliness and isolation among older adults in AL when facilitated by college students trained in CP. CP involves deep, attentive, and nonjudgmental listening while being fully present. Eighteen older adults participated in CP sessions over 10 weeks and were interviewed 2 months after the last session. Semi-structured interview results revealed a self-reported decrease in participants’ feelings of isolation and loneliness and an increase in overall mood.

WHAT THIS MEANS FOR YOU: In a qualitative study including interviews with 18 residents in 21 assisted living communities, as well as reviews of community documents and observational field notes, residents reported that staff communication and community-level memorials following residents’ death were not consistent with a “family-like” atmosphere, and residents’ grief took many forms.

WHAT THIS MEANS FOR YOU: This study focused on the potential impact of COVID-19 on the prescription of psychotropic and pain medication in nursing homes and assisted living. Nationally, there was relatively no change in the use of psychotropic and pain medications between pre- and post-COVID periods. However, there was increased use among individuals newly admitted during the pandemic, the cause of which was uncertain.