CEAL@UNC recognizes the benefit of ongoing quality improvement in assisted living. Numerous feasible solutions have been suggested that may improve care and outcomes in assisted living, including those in this information sheet. Feel free to utilize and distribute this information sheet among your networks to advance the well-being of the people who live and work […]
Medicare/Medicaid
Home Time and State Regulations Among Medicare Beneficiaries in Assisted Living Communities
Home Time and State Regulations Among Medicare Beneficiaries in Assisted Living Communities
Background Home time is an important patient-centric quality metric, which has been largely unexamined among assisted living (AL) residents. Our objectives were to assess variation in home time among AL residents in the year following admission and to examine the associations with state regulations for direct care workers (DCW) training and staffing and for licensed […]
Characteristics and End-of-Life Care Pathways of Decedents From a National Cohort of Assisted Living Residents
Characteristics and End-of-Life Care Pathways of Decedents From a National Cohort of Assisted Living Residents
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. […]
Assisted Living or Nursing Home: Who is Moving In?
Assisted Living or Nursing Home: Who is Moving In?
Background Despite the rapid growth of assisted living (AL) communities and the increasing similarity between AL and nursing home (NH) populations, little is known about the characteristics of older adults at the time of AL admission and how these characteristics compare to individuals newly admitted to NH from the community. This study examined the individual, […]
Likelihood of Assisted Living Residents Aging in Place as a Factor of Dual Medicare-Medicaid Eligibility at the End of Life
Likelihood of Assisted Living Residents Aging in Place as a Factor of Dual Medicare-Medicaid Eligibility at the End of Life
WHAT THIS MEANS FOR YOU: This study used Medicare enrollment and claims records to examine more than 142,000 AL residents’ ability to stay in their community in the last 30 days of life. Residents who were eligible for both Medicaid and Medicare (dual eligibles) were much less likely than those not eligible for Medicaid to remain in AL in their last 30 days of life or die there. However, this difference varies by state.
Using Medicare Enrollment Data to Identify Beneficiaries in Assisted Living
Using Medicare Enrollment Data to Identify Beneficiaries in Assisted Living
WHAT THIS MEANS FOR YOU: Because AL is state-regulated, obtaining information about Medicare beneficiaries in AL can be difficult. This study identified AL Medicare beneficiaries using zip code files, Medicare databases, and other data sets, which can aid researchers and policymakers.
Association of Medicaid Financing and Concentration of Assisted Living Residents Dually Eligible for Medicare and Medicaid
Association of Medicaid Financing and Concentration of Assisted Living Residents Dually Eligible for Medicare and Medicaid
WHAT THIS MEANS FOR YOU: About 25% of Medicare beneficiaries in AL are also eligible for Medicaid, 78% of whom lived in 20% of AL communities nationally. This study analyzed 47 state policies, 5 of which had no Medicaid coverage for AL services (put abbreviations of the five states here). However, those states had the highest concentration of Medicaid-eligible people residing in AL, meaning that Medicaid coverage in those 5 states could benefit many residents.
State Transition Plans
State Transition Plans
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.
CMS HCBS Final Rule
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 […]
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 […]
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.
State Medicaid Financing and Access to Large Assisted Living Settings for Medicare–Medicaid Dual-Eligibles
State Medicaid Financing and Access to Large Assisted Living Settings for Medicare–Medicaid Dual-Eligibles
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.
Post-Acute Care Transitions and Outcomes among Medicare Beneficiaries in Assisted Living Communities
Post-Acute Care Transitions and Outcomes among Medicare Beneficiaries in Assisted Living Communities
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.