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.

Medicare/Medicaid

Likelihood of assisted living residents aging in place as a factor of dual Medicare-Medicaid eligibility at the end of life

May 1, 2023
States vary in their coverage of services in assisted living (AL) settings which may impact whether AL residents can remain in what they consider their home. Previous research found an association between state Medicaid financing and access to AL for beneficiaries dually eligible for Medicare and Medicaid. In addition, research found that among AL residents […]

Likelihood of assisted living residents aging in place as a factor of dual Medicare-Medicaid eligibility at the end of life

by Lea Efird-Green

States vary in their coverage of services in assisted living (AL) settings which may impact whether AL residents can remain in what they consider their home. Previous research found an association between state Medicaid financing and access to AL for beneficiaries dually eligible for Medicare and Medicaid. In addition, research found that among AL residents […]

Using Medicare Enrollment Data to Identify Beneficiaries in Assisted Living

Mar 1, 2023
Objectives Develop an approach for identifying Medicare beneficiaries residing in US assisted living (AL) communities in calendar year 2018. Design We used the following data sources: national directory of licensed ALs, file of US addresses and their associated 9-digit ZIP codes (ZIP+4), Medicare Enrollment Database (EDB), Master Beneficiary Summary File (MBSF), and the Minimum Data Set […]

Using Medicare Enrollment Data to Identify Beneficiaries in Assisted Living

by Lea Efird-Green

Objectives Develop an approach for identifying Medicare beneficiaries residing in US assisted living (AL) communities in calendar year 2018. Design We used the following data sources: national directory of licensed ALs, file of US addresses and their associated 9-digit ZIP codes (ZIP+4), Medicare Enrollment Database (EDB), Master Beneficiary Summary File (MBSF), and the Minimum Data Set […]

Association of Medicaid Financing and Concentration of Assisted Living Residents Dually Eligible for Medicare and Medicaid

Feb 1, 2023
Almost 1 in 5 assisted living (AL) residents rely on Medicaid to pay for personal care and supportive services. High concentrations of residents dually eligible for Medicare and Medicaid in nursing homes are associated with lower staffing levels and more state-identified deficiencies. This study assessed the concentration of individuals dually eligible for Medicare and Medicaid […]

Association of Medicaid Financing and Concentration of Assisted Living Residents Dually Eligible for Medicare and Medicaid

by Lea Efird-Green

Almost 1 in 5 assisted living (AL) residents rely on Medicaid to pay for personal care and supportive services. High concentrations of residents dually eligible for Medicare and Medicaid in nursing homes are associated with lower staffing levels and more state-identified deficiencies. This study assessed the concentration of individuals dually eligible for Medicare and Medicaid […]

State Transition Plans

Jan 11, 2023
This interactive map provides a high-level summary of Statewide Transition Plans (STP) with Final Approval from the Centers for Medicare & Medicaid Services (CMS). The map is updated as CMS updates the states’ approval status. 

State Transition Plans

by Lea Efird-Green

This interactive map provides a high-level summary of Statewide Transition Plans (STP) with Final Approval from the Centers for Medicare & Medicaid Services (CMS). The map is updated as CMS updates the states’ approval status. 

Association between State Regulations Supportive of Third-Party Services and Likelihood of Assisted Living Residents in the US Dying in Place

Oct 1, 2022
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 […]

Association between State Regulations Supportive of Third-Party Services and Likelihood of Assisted Living Residents in the US Dying in Place

by Lea Efird-Green

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 […]

End-Of-Life Care In Assisted Living Communities: Race And Ethnicity, Dual Enrollment Status, And State Regulations

May 1, 2022
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 […]

End-Of-Life Care In Assisted Living Communities: Race And Ethnicity, Dual Enrollment Status, And State Regulations

by Lea Efird-Green

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 […]

State Variation in Potentially Burdensome Transitions among Assisted Living Residents at the End of Life

Feb 1, 2022
This cohort study uses Medicare administrative claims data to describe potentially burdensome transitions among assisted living residents at the end of life and assesses variations by US state.

State Variation in Potentially Burdensome Transitions among Assisted Living Residents at the End of Life

by Lea Efird-Green

This cohort study uses Medicare administrative claims data to describe potentially burdensome transitions among assisted living residents at the end of life and assesses variations by US state.

Using Medicare Enrollment Data to Identify Beneficiaries in Assisted Living

Feb 1, 2022
Objectives: Develop an approach for identifying Medicare beneficiaries residing in US assisted living (AL) communities in calendar year 2018. Design: We used the following data sources: national directory of licensed ALs, file of US addresses and their associated 9-digit ZIP codes (ZIP+4), Medicare Enrollment Database (EDB), Master Beneficiary Summary File (MBSF), and the Minimum Data […]

Using Medicare Enrollment Data to Identify Beneficiaries in Assisted Living

by Lea Efird-Green

Objectives: Develop an approach for identifying Medicare beneficiaries residing in US assisted living (AL) communities in calendar year 2018. Design: We used the following data sources: national directory of licensed ALs, file of US addresses and their associated 9-digit ZIP codes (ZIP+4), Medicare Enrollment Database (EDB), Master Beneficiary Summary File (MBSF), and the Minimum Data […]

State Medicaid Financing and Access to Large Assisted Living Settings for Medicare–Medicaid Dual-Eligibles

Feb 1, 2022
Assisted living has become more widely used by dual-eligible Medicare beneficiaries as states try to rebalance their long-term services and supports away from institutional (nursing home) care. In an analysis of 2014 Medicare data for 506,193 adults who live in large (25+ beds) assisted living communities, we found wide variability among states in the share […]

State Medicaid Financing and Access to Large Assisted Living Settings for Medicare–Medicaid Dual-Eligibles

by Lea Efird-Green

Assisted living has become more widely used by dual-eligible Medicare beneficiaries as states try to rebalance their long-term services and supports away from institutional (nursing home) care. In an analysis of 2014 Medicare data for 506,193 adults who live in large (25+ beds) assisted living communities, we found wide variability among states in the share […]

Post-Acute Care Transitions and Outcomes among Medicare Beneficiaries in Assisted Living Communities

Jan 1, 2022
Background Despite the rapid growth of assisted living (AL) and frequent hospitalizations among AL residents, little is known about their patterns of post-acute care transitions and outcomes. This study examined the post-acute care transitions among AL residents and their association with outcomes in the first 30 and 60 days after hospital discharge. Methods This study used […]

Post-Acute Care Transitions and Outcomes among Medicare Beneficiaries in Assisted Living Communities

by Lea Efird-Green

Background Despite the rapid growth of assisted living (AL) and frequent hospitalizations among AL residents, little is known about their patterns of post-acute care transitions and outcomes. This study examined the post-acute care transitions among AL residents and their association with outcomes in the first 30 and 60 days after hospital discharge. Methods This study used […]