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.

Quality Improvement

Are Online Reviews of Assisted Living Communities Associated with Patient-Centered Outcomes?

Dec 1, 2022
Background Existing literature on online reviews of healthcare providers generally portrays online reviews as a useful way to disseminate information on quality. However, it remains unknown whether online reviews for assisted living (AL) communities reflect AL care quality. This study examined the association between AL online review ratings and residents’ home time, a patient-centered outcome. […]

Are Online Reviews of Assisted Living Communities Associated with Patient-Centered Outcomes?

by Lea Efird-Green

Background Existing literature on online reviews of healthcare providers generally portrays online reviews as a useful way to disseminate information on quality. However, it remains unknown whether online reviews for assisted living (AL) communities reflect AL care quality. This study examined the association between AL online review ratings and residents’ home time, a patient-centered outcome. […]

Patient Safety Culture in Assisted Living: Staff Perceptions and Association with State Regulations

Dec 1, 2022
ObjectivesTo examine perceptions of patient safety culture (PSC) among assisted living (AL) administrators and direct care workers (DCWs), and their associations with state regulations. DesignWe conducted a survey using the PSC instrument developed by the Agency for Healthcare Research & Quality. Secondary data on ALs and residents were derived from the Medicare Master Beneficiary Summary […]

Patient Safety Culture in Assisted Living: Staff Perceptions and Association with State Regulations

by Lea Efird-Green

ObjectivesTo examine perceptions of patient safety culture (PSC) among assisted living (AL) administrators and direct care workers (DCWs), and their associations with state regulations. DesignWe conducted a survey using the PSC instrument developed by the Agency for Healthcare Research & Quality. Secondary data on ALs and residents were derived from the Medicare Master Beneficiary Summary […]

Survey Deficiencies as Quality Indicators in Oregon Assisted Living Communities

Oct 1, 2022
Background and Objectives License inspection data have commonly been used as a quality measure for nursing homes but have not yet been used to assess the quality of assisted living/residential care (AL/RC) communities. Drawing on resource dependency theory, we test the hypothesis that structural and environmental characteristics influence AL/RC quality as measured by deficiency citations […]

Survey Deficiencies as Quality Indicators in Oregon Assisted Living Communities

by Lea Efird-Green

Background and Objectives License inspection data have commonly been used as a quality measure for nursing homes but have not yet been used to assess the quality of assisted living/residential care (AL/RC) communities. Drawing on resource dependency theory, we test the hypothesis that structural and environmental characteristics influence AL/RC quality as measured by deficiency citations […]

Promoting Quality of Life and Safety in Assisted Living: A Survey of State Monitoring and Enforcement Agents

Oct 1, 2022
Our goal was to learn about monitoring and enforcement of state assisted living (AL) regulations. Using survey responses provided in 2019 from administrative agents across 48 states, we described state agency structures, accounted for operational processes concerning monitoring and enforcement, and documented data collecting and public reporting efforts. In half of the states, oversight of […]

Promoting Quality of Life and Safety in Assisted Living: A Survey of State Monitoring and Enforcement Agents

by Lea Efird-Green

Our goal was to learn about monitoring and enforcement of state assisted living (AL) regulations. Using survey responses provided in 2019 from administrative agents across 48 states, we described state agency structures, accounted for operational processes concerning monitoring and enforcement, and documented data collecting and public reporting efforts. In half of the states, oversight of […]

Recommendations for Medical and Mental Health Care in Assisted Living Based on an Expert Delphi Consensus Panel

Sep 1, 2022
Importance: Assisted living (AL) is the largest provider of residential long-term care in the US, and the morbidity of AL residents has been rising. However, AL is not a health care setting, and concern has been growing about residents’ medical and mental health needs. No guidance exists to inform this care. Objective: To identify consensus […]

Recommendations for Medical and Mental Health Care in Assisted Living Based on an Expert Delphi Consensus Panel

by Lea Efird-Green

Importance: Assisted living (AL) is the largest provider of residential long-term care in the US, and the morbidity of AL residents has been rising. However, AL is not a health care setting, and concern has been growing about residents’ medical and mental health needs. No guidance exists to inform this care. Objective: To identify consensus […]

Pilot Testing of the Promoting Positive Care Interactions Intervention in Assisted Living

Aug 1, 2022
The current study aimed to test the feasibility and preliminary efficacy of the Promoting Positive Care Interactions (PPCI) intervention designed to establish positive care interactions between staff and residents in assisted living (AL) using an online approach. PPCI was implemented in one AL community using a single group pre-/posttest design; 17 care staff were recruited […]

Pilot Testing of the Promoting Positive Care Interactions Intervention in Assisted Living

by Lea Efird-Green

The current study aimed to test the feasibility and preliminary efficacy of the Promoting Positive Care Interactions (PPCI) intervention designed to establish positive care interactions between staff and residents in assisted living (AL) using an online approach. PPCI was implemented in one AL community using a single group pre-/posttest design; 17 care staff were recruited […]

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 […]

Developing a Toolkit to Improve Resident and Family Engagement in the Safety of Assisted Living: Engage – A Stakeholder-Engaged Research Protocol

May 1, 2022
Assisted living (AL) communities are experiencing rising levels of resident acuity, challenging efforts to balance person-centered care—which prioritizes personhood, autonomy, and relationship-based care practices—with efforts to keep residents safe. Safety is a broad-scale problem in AL that encompasses care concerns (e.g., abuse/neglect, medication errors, inadequate staffing, and infection management) as well as resident issues (e.g., […]

Developing a Toolkit to Improve Resident and Family Engagement in the Safety of Assisted Living: Engage – A Stakeholder-Engaged Research Protocol

by Lea Efird-Green

Assisted living (AL) communities are experiencing rising levels of resident acuity, challenging efforts to balance person-centered care—which prioritizes personhood, autonomy, and relationship-based care practices—with efforts to keep residents safe. Safety is a broad-scale problem in AL that encompasses care concerns (e.g., abuse/neglect, medication errors, inadequate staffing, and infection management) as well as resident issues (e.g., […]

The Ethics in Long-Term Care Model: Everyday Ethics and the Unseen Moral Landscape of Assisted Living

Apr 1, 2022
Assisted living (AL) communities are long-term care settings where people live, work, and visit, and where social relationships and care, including end-of-life care, are negotiated. Assisted living is fraught with uncertainty and conflict about values, especially given residents’ cognitive and physical frailty. These value-laden issues have implications for both resident and care partners’ experiences. Yet, […]

The Ethics in Long-Term Care Model: Everyday Ethics and the Unseen Moral Landscape of Assisted Living

by Lea Efird-Green

Assisted living (AL) communities are long-term care settings where people live, work, and visit, and where social relationships and care, including end-of-life care, are negotiated. Assisted living is fraught with uncertainty and conflict about values, especially given residents’ cognitive and physical frailty. These value-laden issues have implications for both resident and care partners’ experiences. Yet, […]

Implementing Large-Scale Data-Driven Quality Improvement in Assisted Living

Feb 1, 2022
Objectives Develop and evaluate the implementation of a proposed model for large-scale data-driven quality improvement in assisted living. Design We conducted a mixed-methods evaluation of the implementation of a large-scale data-driven quality improvement collaborative of Wisconsin assisted living communities (ALCs). Setting and Participants The model has been voluntarily implemented by 810 Wisconsin-licensed ALCs serving >20,000 […]

Implementing Large-Scale Data-Driven Quality Improvement in Assisted Living

by Lea Efird-Green

Objectives Develop and evaluate the implementation of a proposed model for large-scale data-driven quality improvement in assisted living. Design We conducted a mixed-methods evaluation of the implementation of a large-scale data-driven quality improvement collaborative of Wisconsin assisted living communities (ALCs). Setting and Participants The model has been voluntarily implemented by 810 Wisconsin-licensed ALCs serving >20,000 […]

Rapid Adoption of Electronic Health Record and Health Information Exchange among Assisted Living Communities, 2010–2018 

Feb 1, 2022
Adoption of electronic health records (EHRs) and health information exchange (HIE) is a key tool to improving the quality of care in assisted living communities (ALC). We examined whether EHRs were being used in ALC to support HIE in 2010 and 2018. We found that adoption of EHR and HIE functions increased substantially over the […]

Rapid Adoption of Electronic Health Record and Health Information Exchange among Assisted Living Communities, 2010–2018 

by Lea Efird-Green

Adoption of electronic health records (EHRs) and health information exchange (HIE) is a key tool to improving the quality of care in assisted living communities (ALC). We examined whether EHRs were being used in ALC to support HIE in 2010 and 2018. We found that adoption of EHR and HIE functions increased substantially over the […]

Memory Care Reduces Nursing Home Admissions among Assisted-Living Residents with Dementia

Jan 1, 2022
Introduction We compare nursing-home and hospital admissions among residents with Alzheimer’s disease and related dementias (ADRD) in memory-care assisted living to those in general assisted living. Methods Retrospective study of Medicare beneficiaries with ADRD in large (>25 bed) assisted-living communities. We compared admission to a hospital, to a nursing home, and long-term (>90 day) admission […]

Memory Care Reduces Nursing Home Admissions among Assisted-Living Residents with Dementia

by Lea Efird-Green

Introduction We compare nursing-home and hospital admissions among residents with Alzheimer’s disease and related dementias (ADRD) in memory-care assisted living to those in general assisted living. Methods Retrospective study of Medicare beneficiaries with ADRD in large (>25 bed) assisted-living communities. We compared admission to a hospital, to a nursing home, and long-term (>90 day) admission […]