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.

COVID-19

Public Health Response to SARS-CoV-2 in Assisted Living Facilities in New York State: March 2020-December 2022

May 1, 2024
Context: Assisted living facility (ALF) residents are especially vulnerable to SARS-CoV-2 infection due to the age and comorbidities of the resident population and the social nature of these facilities. Objective: To collate all New York State Department of Health guidance and regulations to control transmission of SARS-CoV-2 infection within ALFs from March 2020 through December […]

Public Health Response to SARS-CoV-2 in Assisted Living Facilities in New York State: March 2020-December 2022

by Lea Efird-Green

Context: Assisted living facility (ALF) residents are especially vulnerable to SARS-CoV-2 infection due to the age and comorbidities of the resident population and the social nature of these facilities. Objective: To collate all New York State Department of Health guidance and regulations to control transmission of SARS-CoV-2 infection within ALFs from March 2020 through December […]

Excess Deaths in Assisted Living and Nursing Homes during the COVID-19 Pandemic in Alberta, Canada

May 1, 2024
Objectives Assisted living (AL) is a significant and growing congregate care option for vulnerable older adults designed to reduce the use of nursing homes (NHs). However, work on excess mortality in congregate care during the COVID-19 pandemic has primarily focused on NHs with only a few US studies examining AL. The objective of this study […]

Excess Deaths in Assisted Living and Nursing Homes during the COVID-19 Pandemic in Alberta, Canada

by Lea Efird-Green

Objectives Assisted living (AL) is a significant and growing congregate care option for vulnerable older adults designed to reduce the use of nursing homes (NHs). However, work on excess mortality in congregate care during the COVID-19 pandemic has primarily focused on NHs with only a few US studies examining AL. The objective of this study […]

Experiences of COVID-19 Restrictions on Physical Activity in Assisted Living

Apr 1, 2024
Physical activity is an important health behavior for older adults in assisted living, however the COVID-19 pandemic may have disrupted this behavior. This study examined the effects of the pandemic on physical activity experiences in this population. Semi-structured interviews were conducted and analyzed using thematic analysis. Participants described barriers to physical activity, transitions in their […]

Experiences of COVID-19 Restrictions on Physical Activity in Assisted Living

by Lea Efird-Green

Physical activity is an important health behavior for older adults in assisted living, however the COVID-19 pandemic may have disrupted this behavior. This study examined the effects of the pandemic on physical activity experiences in this population. Semi-structured interviews were conducted and analyzed using thematic analysis. Participants described barriers to physical activity, transitions in their […]

The Impact of Assisted Living Organizational Structure and Process Characteristics on Staff Absence During COVID-19

Apr 1, 2024
Quality of care in assisted living communities (ALCs) is important to consumers. The coronavirus disease of 2019 (COVID-19) pandemic and associated emergency policies have posed major challenges on staff recruitment and retention. This study aimed to examine the relationship between organizational characteristics of ALCs in Florida and challenges with staff absence during COVID-19 (N = 129 ALCs). […]

The Impact of Assisted Living Organizational Structure and Process Characteristics on Staff Absence During COVID-19

by Lea Efird-Green

Quality of care in assisted living communities (ALCs) is important to consumers. The coronavirus disease of 2019 (COVID-19) pandemic and associated emergency policies have posed major challenges on staff recruitment and retention. This study aimed to examine the relationship between organizational characteristics of ALCs in Florida and challenges with staff absence during COVID-19 (N = 129 ALCs). […]

Assisted Living Residents with Dementia: Disparities in Mental Health Services Pre and During COVID-19

Apr 1, 2024
Background Little is known about mental health among Medicare beneficiaries with Alzheimer’s disease or related dementias (ADRD) who reside in assisted living (AL) communities. The COVID-19 pandemic may have curtailed ambulatory care access for these residents, but telehealth may have expanded it. We examined in-person and telehealth use of ambulatory mental health visits among AL […]

Assisted Living Residents with Dementia: Disparities in Mental Health Services Pre and During COVID-19

by Lea Efird-Green

Background Little is known about mental health among Medicare beneficiaries with Alzheimer’s disease or related dementias (ADRD) who reside in assisted living (AL) communities. The COVID-19 pandemic may have curtailed ambulatory care access for these residents, but telehealth may have expanded it. We examined in-person and telehealth use of ambulatory mental health visits among AL […]

Psychotropic, Anticonvulsant, and Opioid Use in Assisted Living Residents Before and During the COVID-19 Pandemic

Oct 1, 2023
Objectives To examine the associations between COVID-19 pandemic waves (1–4) and prevalent antipsychotic, antidepressant, benzodiazepine, anticonvulsant, and opioid use among assisted living (AL) residents, by setting (dementia care vs other). Design Population-based, repeated cross-sectional study. Setting and Participants Linked clinical and health administrative databases for residents of all publicly subsidized AL homes (N = 256) […]

Psychotropic, Anticonvulsant, and Opioid Use in Assisted Living Residents Before and During the COVID-19 Pandemic

by Lea Efird-Green

Objectives To examine the associations between COVID-19 pandemic waves (1–4) and prevalent antipsychotic, antidepressant, benzodiazepine, anticonvulsant, and opioid use among assisted living (AL) residents, by setting (dementia care vs other). Design Population-based, repeated cross-sectional study. Setting and Participants Linked clinical and health administrative databases for residents of all publicly subsidized AL homes (N = 256) […]

Effect of Quarantine on Body Weight Among Residents of Assisted Living Facilities During the COVID-19 Pandemic

Sep 1, 2023
Assisted living facility (ALF) residents are at greater risk of declining health and death from coronavirus disease 2019 (COVID-19) due to advanced age, frailty, chronic conditions, and transmission prevention methods. One method, room quarantine, can lead to isolation and potential weight changes. Continuous room quarantine was mandated by the state for all nursing home and […]

Effect of Quarantine on Body Weight Among Residents of Assisted Living Facilities During the COVID-19 Pandemic

by Lea Efird-Green

Assisted living facility (ALF) residents are at greater risk of declining health and death from coronavirus disease 2019 (COVID-19) due to advanced age, frailty, chronic conditions, and transmission prevention methods. One method, room quarantine, can lead to isolation and potential weight changes. Continuous room quarantine was mandated by the state for all nursing home and […]

Barriers to Infection Prevention and Control in Long-term Care/Assisted Living Settings in British Columbia During the COVID-19 Pandemic: A Cross-Sectional Survey

Aug 1, 2023
Background The COVID-19 pandemic disproportionately impacted long-term care and assisted living (LTC/AL) facilities in Canada, where infection prevention and control (IPAC) programs had been suboptimal. We aimed to identify barriers affecting healthcare workers’ (HCW) adherence to IPAC practices during the pandemic in British Columbia in LTC/AL compared to acute care settings. Methods We conducted a […]

Barriers to Infection Prevention and Control in Long-term Care/Assisted Living Settings in British Columbia During the COVID-19 Pandemic: A Cross-Sectional Survey

by Lea Efird-Green

Background The COVID-19 pandemic disproportionately impacted long-term care and assisted living (LTC/AL) facilities in Canada, where infection prevention and control (IPAC) programs had been suboptimal. We aimed to identify barriers affecting healthcare workers’ (HCW) adherence to IPAC practices during the pandemic in British Columbia in LTC/AL compared to acute care settings. Methods We conducted a […]

Comparing Quality of Care Outcomes Between Assisted Living and Nursing Homes Before and During the COVID-19 Pandemic

Jul 1, 2023
Background While assisted living (AL) and nursing home (NHs) residents in share vulnerabilities, AL provides fewer staffing resources and services. Research has largely neglected AL, especially during the COVID-19 pandemic. Our study compared trends of practice-sensitive, risk-adjusted quality indicators between AL and NHs, and changes in these trends after the start of the pandemic. Methods […]

Comparing Quality of Care Outcomes Between Assisted Living and Nursing Homes Before and During the COVID-19 Pandemic

by Lea Efird-Green

Background While assisted living (AL) and nursing home (NHs) residents in share vulnerabilities, AL provides fewer staffing resources and services. Research has largely neglected AL, especially during the COVID-19 pandemic. Our study compared trends of practice-sensitive, risk-adjusted quality indicators between AL and NHs, and changes in these trends after the start of the pandemic. Methods […]

Primary Care Telemedicine Use among Assisted Living Residents with Dementia during COVID-19: Race and Dual Enrollment Status

May 1, 2023
WHAT THIS MEANS FOR YOU: This study used Medicare and CDC datasets to examine telemedicine primary care among 62,000 AL residents with dementia during the first year of the COVID-19 pandemic (2020). During the first three quarters of the pandemic, racially minoritized groups (Black, Hispanic) and Medicare-Medicaid dual eligibles were able to successfully use telemedicine at high rates. Gaps in primary care access between these groups and others (white, non-Medicaid eligible) were reduced due to telemedicine. This could inform CMS decisions about Medicare coverage for telemedicine primary care.

Primary Care Telemedicine Use among Assisted Living Residents with Dementia during COVID-19: Race and Dual Enrollment Status

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study used Medicare and CDC datasets to examine telemedicine primary care among 62,000 AL residents with dementia during the first year of the COVID-19 pandemic (2020). During the first three quarters of the pandemic, racially minoritized groups (Black, Hispanic) and Medicare-Medicaid dual eligibles were able to successfully use telemedicine at high rates. Gaps in primary care access between these groups and others (white, non-Medicaid eligible) were reduced due to telemedicine. This could inform CMS decisions about Medicare coverage for telemedicine primary care.

Caregiver Involvement and Concerns with Care of Residents of Assisted Living Before and During the COVID-19 Pandemic

Apr 1, 2023
WHAT THIS MEANS FOR YOU: A survey about AL family caregiver experiences in Western Canada was conducted before and during waves one (Mar to Jun 2020) and two (Oct 2020 to Feb 2021) of the COVID-19 pandemic. A total of 386 family caregivers representing 110 AL communities participated. In-person visits and caregiver involvement decreased significantly during wave one of the pandemic due to visitor restrictions. Caregivers’ concerns about their relatives significantly increased during both waves, especially when they did not feel well-informed or involved in their relative’s care.

Caregiver Involvement and Concerns with Care of Residents of Assisted Living Before and During the COVID-19 Pandemic

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: A survey about AL family caregiver experiences in Western Canada was conducted before and during waves one (Mar to Jun 2020) and two (Oct 2020 to Feb 2021) of the COVID-19 pandemic. A total of 386 family caregivers representing 110 AL communities participated. In-person visits and caregiver involvement decreased significantly during wave one of the pandemic due to visitor restrictions. Caregivers’ concerns about their relatives significantly increased during both waves, especially when they did not feel well-informed or involved in their relative’s care.

Digital Immunization Tracking in Long-Term Care and Assisted Living Facilities

Feb 1, 2023
WHAT THIS MEANS FOR YOU: Vaccines are a part of the solution to infectious disease outbreaks like COVID-19, but not everyone is getting them, especially older adults. In a Canadian study, pneumonia vaccine uptake was improved by providing assisted living and long-term care communities with vaccine coverage data and providing automatic reminders for subsequent doses. Therefore, a cloud-based digital vaccination record is one solution to promote the uptake of adult vaccines for older adults, as well as tracking immunization records and sharing them with policymaking organizations. This can improve communication and inform policymakers to reduce the risk of infection in AL communities.

Digital Immunization Tracking in Long-Term Care and Assisted Living Facilities

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Vaccines are a part of the solution to infectious disease outbreaks like COVID-19, but not everyone is getting them, especially older adults. In a Canadian study, pneumonia vaccine uptake was improved by providing assisted living and long-term care communities with vaccine coverage data and providing automatic reminders for subsequent doses. Therefore, a cloud-based digital vaccination record is one solution to promote the uptake of adult vaccines for older adults, as well as tracking immunization records and sharing them with policymaking organizations. This can improve communication and inform policymakers to reduce the risk of infection in AL communities.

Preparedness and Response of Assisted Living Facilities Toward COVID-19 Infection Control in Houston, Texas, USA

Feb 1, 2023
WHAT THIS MEANS FOR YOU: The Houston Health Department conducted onsite assessments at AL communities to assess infection prevention and control practices. Larger AL communities better implemented CDC guidelines and were more proactive in their COVID-19 response activities. For example, many medium and small communities lacked access to COVID-19 PCR testing and had lower resident vaccination rates.

Preparedness and Response of Assisted Living Facilities Toward COVID-19 Infection Control in Houston, Texas, USA

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: The Houston Health Department conducted onsite assessments at AL communities to assess infection prevention and control practices. Larger AL communities better implemented CDC guidelines and were more proactive in their COVID-19 response activities. For example, many medium and small communities lacked access to COVID-19 PCR testing and had lower resident vaccination rates.

Coping Behaviors and Health Status during the COVID-19 Pandemic among Caregivers of Assisted Living Residents in Western Canada

Dec 1, 2022
Objectives To examine the prevalence of coping behaviors during the first 2 waves of the COVID-19 pandemic among caregivers of assisted living residents and variation in these behaviors by caregiver gender and mental health. Design Cross-sectional and longitudinal survey. Setting and Participants Family/friend caregivers of assisted living residents in Alberta and British Columbia. Methods A […]

Coping Behaviors and Health Status during the COVID-19 Pandemic among Caregivers of Assisted Living Residents in Western Canada

by Lea Efird-Green

Objectives To examine the prevalence of coping behaviors during the first 2 waves of the COVID-19 pandemic among caregivers of assisted living residents and variation in these behaviors by caregiver gender and mental health. Design Cross-sectional and longitudinal survey. Setting and Participants Family/friend caregivers of assisted living residents in Alberta and British Columbia. Methods A […]

Excess Mortality Among Assisted Living Residents with Dementia during the COVID-19 Pandemic

Oct 1, 2022
Objective To evaluate whether assisted living (AL) residents with Alzheimer’s disease and related dementias (ADRD) experienced a greater rate of excess all-cause mortality during the first several months of the COVID-19 pandemic compared to residents without ADRD, and to compare excess all-cause mortality rates in memory care vs general AL among residents with ADRD. Design […]

Excess Mortality Among Assisted Living Residents with Dementia during the COVID-19 Pandemic

by Lea Efird-Green

Objective To evaluate whether assisted living (AL) residents with Alzheimer’s disease and related dementias (ADRD) experienced a greater rate of excess all-cause mortality during the first several months of the COVID-19 pandemic compared to residents without ADRD, and to compare excess all-cause mortality rates in memory care vs general AL among residents with ADRD. Design […]

Caregivers’ Concerns about Assisted Living Residents’ Mental Health during the COVID-19 Pandemic: A Cross-Sectional Survey Study

Sep 1, 2022
Family or friend caregivers’ concerns about assisted living (AL) residents’ mental health are reflective of poor resident and caregiver mental health. COVID-19-related visiting restrictions increased caregiver concerns, but research on these issues in AL is limited. Using web-based surveys with 673 caregivers of AL residents in Western Canada, we assessed the prevalence and correlates of […]

Caregivers’ Concerns about Assisted Living Residents’ Mental Health during the COVID-19 Pandemic: A Cross-Sectional Survey Study

by Lea Efird-Green

Family or friend caregivers’ concerns about assisted living (AL) residents’ mental health are reflective of poor resident and caregiver mental health. COVID-19-related visiting restrictions increased caregiver concerns, but research on these issues in AL is limited. Using web-based surveys with 673 caregivers of AL residents in Western Canada, we assessed the prevalence and correlates of […]

Coronavirus Disease 2019 (COVID-19) in Assisted Living Communities: Neighborhood Deprivation and State Social Distancing Policies Matter

Aug 1, 2022
Background: Residents of long-term care facilities face significantly greater risk of contracting or dying from coronavirus disease 2019 (COVID-19). However, little is known about COVID-19 in assisted living communities (ALCs) and the potential determinants of its spread. We examined the association between COVID-19 cases in ALCs and the proportion of Medicare-Medicaid (dual) eligible minority residents, […]

Coronavirus Disease 2019 (COVID-19) in Assisted Living Communities: Neighborhood Deprivation and State Social Distancing Policies Matter

by Lea Efird-Green

Background: Residents of long-term care facilities face significantly greater risk of contracting or dying from coronavirus disease 2019 (COVID-19). However, little is known about COVID-19 in assisted living communities (ALCs) and the potential determinants of its spread. We examined the association between COVID-19 cases in ALCs and the proportion of Medicare-Medicaid (dual) eligible minority residents, […]

Prevalence and Correlates of Anxiety and Depression in Caregivers to Assisted Living Residents during COVID-19: A Cross-Sectional Study

Aug 1, 2022
Background Family and friend caregivers play significant roles in advocating for and ensuring quality health and social care of residents in Assisted Living (AL) homes. However, little is known about how the COVID-19 pandemic and related visitor restrictions affected their health and mental well-being. We examined the prevalence and correlates of anxiety and depressive symptoms […]

Prevalence and Correlates of Anxiety and Depression in Caregivers to Assisted Living Residents during COVID-19: A Cross-Sectional Study

by Lea Efird-Green

Background Family and friend caregivers play significant roles in advocating for and ensuring quality health and social care of residents in Assisted Living (AL) homes. However, little is known about how the COVID-19 pandemic and related visitor restrictions affected their health and mental well-being. We examined the prevalence and correlates of anxiety and depressive symptoms […]

The Impact of FFC-AL-EIT-D in Assisted Living during the COVID-19 Pandemic

Jun 1, 2022
The purpose of this study was to test the preliminary effectiveness and feasibility of implementation of Function Focused Care for Assisted Living Using the Evidence Integration Triangle in Assisted Living Communities with Residents with Dementia (FFC-AL-EIT-D) during the pandemic. This was a single group pre-post study design including 51 communities in a single state. The […]

The Impact of FFC-AL-EIT-D in Assisted Living during the COVID-19 Pandemic

by Lea Efird-Green

The purpose of this study was to test the preliminary effectiveness and feasibility of implementation of Function Focused Care for Assisted Living Using the Evidence Integration Triangle in Assisted Living Communities with Residents with Dementia (FFC-AL-EIT-D) during the pandemic. This was a single group pre-post study design including 51 communities in a single state. The […]

Dementia and COVID-19 Infection Control in Assisted Living in Seven States

Jun 1, 2022
WHAT THIS MEANS FOR YOU: The study examined how 119 assisted living administrators in 7 states implemented COVID-19 infection control practices from July 2020 to September 2021, including the feasibility of select infection control practices. Results indicated that although there were infection control challenges across all community types, dementia-specific communities faced the most difficulties. Less than half of administrators found it feasible to close indoor common areas, and residents, especially in dementia-specific communities, were less likely to wear masks and -wearing and physical distancing.

Dementia and COVID-19 Infection Control in Assisted Living in Seven States

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: The study examined how 119 assisted living administrators in 7 states implemented COVID-19 infection control practices from July 2020 to September 2021, including the feasibility of select infection control practices. Results indicated that although there were infection control challenges across all community types, dementia-specific communities faced the most difficulties. Less than half of administrators found it feasible to close indoor common areas, and residents, especially in dementia-specific communities, were less likely to wear masks and -wearing and physical distancing.

“We Weathered the Storm”: A Qualitative Phenomenological Study of the Lived Experience of Assisted Living Administrators during the COVID-19 Pandemic

May 1, 2022
The purpose of the current qualitative phenomenological study is to learn about the lived experiences of assisted living (AL) community administrators during the coronavirus disease 2019 (COVID-19) pandemic. Little is known about how administrators coped with the ever-changing mandates (e.g., visitation, testing, communal activities, acceptance of COVID-positive residents). Semi-structured interviews with AL administrators were conducted, […]

“We Weathered the Storm”: A Qualitative Phenomenological Study of the Lived Experience of Assisted Living Administrators during the COVID-19 Pandemic

by Lea Efird-Green

The purpose of the current qualitative phenomenological study is to learn about the lived experiences of assisted living (AL) community administrators during the coronavirus disease 2019 (COVID-19) pandemic. Little is known about how administrators coped with the ever-changing mandates (e.g., visitation, testing, communal activities, acceptance of COVID-positive residents). Semi-structured interviews with AL administrators were conducted, […]

SARS-CoV-2 in Assisted Living: Mortality and Asymptomatic Infection

Apr 1, 2022
In response to a rapid rise in mortality within assisted living, facility-wide resident testing found 42% of 182 residents had SARS-CoV-2 infection; 68% of which were asymptomatic for 14 days before and after testing. Resident testing was a critical infection control measure needed to control transmission of SARS-CoV-2 infection.

SARS-CoV-2 in Assisted Living: Mortality and Asymptomatic Infection

by Lea Efird-Green

In response to a rapid rise in mortality within assisted living, facility-wide resident testing found 42% of 182 residents had SARS-CoV-2 infection; 68% of which were asymptomatic for 14 days before and after testing. Resident testing was a critical infection control measure needed to control transmission of SARS-CoV-2 infection.

Does Service Provider Matter during a Pandemic? COVID-19 Cases and Deaths among Nonprofit vs. For-Profit Assisted Living Facilities in Florida

Apr 1, 2022
WHAT THIS MEANS FOR YOU: This study investigated the relationship of ownership (nonprofit vs. for-profit) to Florida assisted living communities’ responses to COVID-19. In total, 672 of 3,019 communities reported at least one positive case by June 2020. Nonprofit communities had fewer cases, although there was no significant difference in resident deaths. Additionally, whether nursing services were provided in the community mattered in protecting residents from COVID-19 infections (i.e., not providing any nursing services was associated with more infections).

Does Service Provider Matter during a Pandemic? COVID-19 Cases and Deaths among Nonprofit vs. For-Profit Assisted Living Facilities in Florida

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study investigated the relationship of ownership (nonprofit vs. for-profit) to Florida assisted living communities’ responses to COVID-19. In total, 672 of 3,019 communities reported at least one positive case by June 2020. Nonprofit communities had fewer cases, although there was no significant difference in resident deaths. Additionally, whether nursing services were provided in the community mattered in protecting residents from COVID-19 infections (i.e., not providing any nursing services was associated with more infections).