Background: Assisted living (AL) is an increasingly common, place of care for dying persons. However, it remains unclear to what extent residents are able to age in place or if AL represents an additional transition before death. Objectives: Examine the sociodemographic characteristics, comorbidities, health care utilization, and end-of-life care pathways of AL residents before death. […]
End of Life
Turning It Over to God: African American Assisted Living Residents’ End-of-Life Preferences and Advance Care Planning
Turning It Over to God: African American Assisted Living Residents’ End-of-Life Preferences and Advance Care Planning
Objectives Assisted living (AL), a popular long-term care setting for older Americans, increasingly is a site for end-of-life care. Although most residents prefer AL to be their final home, relatively little is known about end-of-life preferences and advance care planning, especially among African American residents. Our research addresses this knowledge gap. Methods Informed by grounded […]
End-of-Life Care Transitions in Assisted Living: Associations With State Staffing and Training Regulations
End-of-Life Care Transitions in Assisted Living: Associations With State Staffing and Training Regulations
Objectives We examined the frequency and categories of end-of-life care transitions among assisted living community decedents and their associations with state staffing and training regulations. Design Cohort study. Setting and Participants Medicare beneficiaries who resided in assisted living facilities and had validated death dates in 2018-2019 (N = 113,662). Methods We used Medicare claims and assessment […]
State Regulations and Assisted Living Residents’ Potentially Burdensome Transitions at the End of Life
State Regulations and Assisted Living Residents’ Potentially Burdensome Transitions at the End of Life
Background Potentially burdensome transitions at the end of life (e.g., repeated hospitalizations toward the end of life and/or health care transitions in the last three days of life) are common among residential care/assisted living (RC/AL) residents, and are associated with lower quality of end of-life care reported by bereaved family members. We examined the association […]
“You Gotta Have Your Cry”: Administrator and Direct Care Worker Experiences of Death in Assisted Living
“You Gotta Have Your Cry”: Administrator and Direct Care Worker Experiences of Death in Assisted Living
Assisted living (AL) is increasingly a site of end-of-life care and a long-term care location where growing numbers of people are aging in place and dying. Despite these trends, limited research focuses on how death and grief impact the work environment in AL. This grounded theory analysis examined qualitative data collected from 27 administrators and […]
Association between State Regulations Supportive of Third-Party Services and Likelihood of Assisted Living Residents in the US Dying in Place
Association between State Regulations Supportive of Third-Party Services and Likelihood of Assisted Living Residents in the US Dying in Place
Importance: Older adults are increasingly residing in assisted living residences during their last year of life. The regulations guiding these residential care settings differ between and within the states in the US, resulting in diverse policies that may support residents who wish to die in place. Objective: To examine the association between state regulations and […]
Successful Aging in Assisted Living: The Importance of Near Visual Acuity
Successful Aging in Assisted Living: The Importance of Near Visual Acuity
Successful aging among independent community-dwelling older adults and those in residential settings is paramount to aging in place. The purpose of the current study was to explore how sensory, cognitive, and functional impairments affect successful aging in assisted living (AL) settings. Vision compromise was noted for near visual acuity (NVA) (14.3%) and distance visual acuity […]
State Regulations and Hospice Utilization in Assisted Living during the Last Month of Life
State Regulations and Hospice Utilization in Assisted Living during the Last Month of Life
Objectives: To examine the association between hospice/staffing regulations in residential care or assisted living (RC/AL) and hospice utilization among a national cohort of Medicare decedents residing in RC/AL at least 1 day during the last month of life, and to describe patterns of hospice utilization. Design: Retrospective cohort study of fee-for-service Medicare beneficiaries who died […]
End-Of-Life Care In Assisted Living Communities: Race And Ethnicity, Dual Enrollment Status, And State Regulations
End-Of-Life Care In Assisted Living Communities: Race And Ethnicity, Dual Enrollment Status, And State Regulations
Assisted living communities are the final home for many of their residents, most of whom are older, frail, and cognitively or functionally impaired. Yet little is known about end-of-life care in this setting. We examined associations of both death at home and home hospice care with individual characteristics, such as race or ethnicity and dual […]
Ethics of Health Information Sharing and Social Relationships at End of Life in Assisted Living
Ethics of Health Information Sharing and Social Relationships at End of Life in Assisted Living
Given an observed tension between perceived privacy restrictions and meaningful social connection in assisted living (AL) and using a relational perspective, we conducted a secondary thematic analysis of health information sharing practices among residents and their care partners in one large urban AL community in metropolitan Atlanta. Data included in-depth interviews with residents (n = […]
“You Lose Some Good Friends”: Death and Grief in Assisted Living
“You Lose Some Good Friends”: Death and Grief in Assisted Living
The purpose of this study was to investigate responses to death at multiple levels within the assisted living (AL) system and to characterize the psychosocial impact of death on surviving residents. This study used secondary thematic analysis of multiple data sources collected as part of a larger quantitative-focused study with 21 ALs. Data sources included: […]
State Variation in Potentially Burdensome Transitions among Assisted Living Residents at the End of Life
State Variation in Potentially Burdensome Transitions among Assisted Living Residents at the End of Life
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.
Assisted Living Administrators’ Approaches to Advance Care Planning
Assisted Living Administrators’ Approaches to Advance Care Planning
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.