Center for Excellence in Assisted Living CEAL@UNC

Advancing the well-being of the people who live and work in assisted living through research, practice, and policy.

Journal of Palliative Medicine

“There Should Be a Nurse on Call”: Complex Care Needs of Low-Income Older Adults in Medicaid-Supported Assisted Living

Aug 1, 2025
This qualitative study explored the care needs and serious illness communication challenges of 17 residents of a Medicaid-supported AL community in New York. Four themes emerged: decreased quality of life, high burden from symptoms and low access to care, feeling unheard due to healthcare communication gaps, and uncoordinated care adding to feelings of distrust in the health system, indicating a need for policy changes related to care access and communication.

“There Should Be a Nurse on Call”: Complex Care Needs of Low-Income Older Adults in Medicaid-Supported Assisted Living

by Lea Efird-Green

This qualitative study explored the care needs and serious illness communication challenges of 17 residents of a Medicaid-supported AL community in New York. Four themes emerged: decreased quality of life, high burden from symptoms and low access to care, feeling unheard due to healthcare communication gaps, and uncoordinated care adding to feelings of distrust in the health system, indicating a need for policy changes related to care access and communication.

Variation in Hospice Aide Care by Residential Setting

Aug 1, 2024
WHAT THIS MEANS FOR YOU: This longitudinal cohort study examined data from 1,915 Medicare beneficiaries who died between 2010-2019 and had hospice claims in different residential settings to compare hospice aide use. Hospice aide visits were least common in community settings, followed by NHs and AL communities. However, analyzed factors associated with hospice aide visits were similar among settings, meaning that further research is needed to understand how to tailor hospice care appropriately for different settings.

Variation in Hospice Aide Care by Residential Setting

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This longitudinal cohort study examined data from 1,915 Medicare beneficiaries who died between 2010-2019 and had hospice claims in different residential settings to compare hospice aide use. Hospice aide visits were least common in community settings, followed by NHs and AL communities. However, analyzed factors associated with hospice aide visits were similar among settings, meaning that further research is needed to understand how to tailor hospice care appropriately for different settings.

State Regulations and Assisted Living Residents’ Potentially Burdensome Transitions at the End of Life

Jun 1, 2023
WHAT THIS MEANS FOR YOU: The study examined potentially burdensome end-of-life transitions (e.g., repeated hospitalizations) in relation to state regulations, using Medicare claims data for over 129,000 assisted living residents in communities with 25 or more beds between 2017-2019. There were no associations between transitions and regulations about third-party services or staffing, and small associations between transitions and medication management regulations. These inconclusive results indicate that more research is needed to understand the wide variety of end-of-life outcomes experienced by assisted living residents.

State Regulations and Assisted Living Residents’ Potentially Burdensome Transitions at the End of Life

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: The study examined potentially burdensome end-of-life transitions (e.g., repeated hospitalizations) in relation to state regulations, using Medicare claims data for over 129,000 assisted living residents in communities with 25 or more beds between 2017-2019. There were no associations between transitions and regulations about third-party services or staffing, and small associations between transitions and medication management regulations. These inconclusive results indicate that more research is needed to understand the wide variety of end-of-life outcomes experienced by assisted living residents.