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

Risk of Hospitalization Among Assisted Living Residents Dually Enrolled in Medicare and Medicaid

Dec 1, 2024
Objectives To examine how risk of hospitalization among assisted living (AL) residents differs by dual enrollment in Medicare and Medicaid and by the percent of dually enrolled individuals in an AL community. Design Retrospective cohort study. Setting and Participants We used Medicare data from 2008 to 2018 and a national directory of licensed AL communities […]

Risk of Hospitalization Among Assisted Living Residents Dually Enrolled in Medicare and Medicaid

by Lea Efird-Green

Objectives To examine how risk of hospitalization among assisted living (AL) residents differs by dual enrollment in Medicare and Medicaid and by the percent of dually enrolled individuals in an AL community. Design Retrospective cohort study. Setting and Participants We used Medicare data from 2008 to 2018 and a national directory of licensed AL communities […]

Transitions to Nursing Homes Among Residents of Assisted Living and Community-Dwelling Home Care Recipients

Dec 1, 2024
Objectives To examine transitions to a nursing home among residents of assisted living relative to community-dwelling home care recipients. Design Population-based retrospective cohort study emulating a target trial. Setting and Participants Linked, individual-level health system data were obtained from older adults (≥65 years of age) who made an incident application for a bed in a nursing […]

Transitions to Nursing Homes Among Residents of Assisted Living and Community-Dwelling Home Care Recipients

by Lea Efird-Green

Objectives To examine transitions to a nursing home among residents of assisted living relative to community-dwelling home care recipients. Design Population-based retrospective cohort study emulating a target trial. Setting and Participants Linked, individual-level health system data were obtained from older adults (≥65 years of age) who made an incident application for a bed in a nursing […]

Association Between Organizational Context and Resident Pain in Assisted Living: A Repeated Cross-Sectional Study

Nov 1, 2024
Objectives: Resident pain has been a common quality challenge in congregate care for older adults, and organizational context may explain variations in resident pain beyond resident-level factors. Most studies have focused on nursing homes (NHs), largely neglecting assisted living (AL). AL residents are at similar risk for pain as NH resident, but with AL providing fewer […]

Association Between Organizational Context and Resident Pain in Assisted Living: A Repeated Cross-Sectional Study

by Lea Efird-Green

Objectives: Resident pain has been a common quality challenge in congregate care for older adults, and organizational context may explain variations in resident pain beyond resident-level factors. Most studies have focused on nursing homes (NHs), largely neglecting assisted living (AL). AL residents are at similar risk for pain as NH resident, but with AL providing fewer […]

Effect of a Digital Two-Dimensional Animation Program on Attitude Toward Walking Aids, Performance, and Fall Avoidance Behaviors among Older Adults in Assisted Living Facilities

Nov 1, 2024
The study investigated the impact of a two-dimensional animation program on attitudes towards walking aids, performance, and fall avoidance behaviors among older adults in assisted living facilities. A quasi-experimental pretest-posttest control group study was conducted on 128 older adults aged 60 years and above. The intervention group showed more favorable attitudes towards walking aids, improved […]

Effect of a Digital Two-Dimensional Animation Program on Attitude Toward Walking Aids, Performance, and Fall Avoidance Behaviors among Older Adults in Assisted Living Facilities

by Lea Efird-Green

The study investigated the impact of a two-dimensional animation program on attitudes towards walking aids, performance, and fall avoidance behaviors among older adults in assisted living facilities. A quasi-experimental pretest-posttest control group study was conducted on 128 older adults aged 60 years and above. The intervention group showed more favorable attitudes towards walking aids, improved […]

Clinical and Sociodemographic Characteristics of New Residents of Assisted Living: A Nested Case-Control Study

Nov 1, 2024
Objective To examine transitions to an assisted living facility among community-dwelling older adults who received publicly funded home care services. Design Nested case-control study. Setting and Participants Linked, population-level health system administrative data were obtained from adults aged 65 years and older who received home care services in Ontario, Canada, from April 1, 2018, to December […]

Clinical and Sociodemographic Characteristics of New Residents of Assisted Living: A Nested Case-Control Study

by Lea Efird-Green

Objective To examine transitions to an assisted living facility among community-dwelling older adults who received publicly funded home care services. Design Nested case-control study. Setting and Participants Linked, population-level health system administrative data were obtained from adults aged 65 years and older who received home care services in Ontario, Canada, from April 1, 2018, to December […]

Factors Associated with Transfer from Assisted Living Facilities to a Nursing Home: National Health Aging Trends Study 2011-2019

Nov 1, 2024
Background Residents of assisted living facilities (ALF) transfer to a nursing home when they require a higher level of care, but limited research has examined risk factors for transfer to a nursing home. The aims of this study were to identify (1) baseline factors associated with transfer to a nursing home and (2) time-varying factors […]

Factors Associated with Transfer from Assisted Living Facilities to a Nursing Home: National Health Aging Trends Study 2011-2019

by Lea Efird-Green

Background Residents of assisted living facilities (ALF) transfer to a nursing home when they require a higher level of care, but limited research has examined risk factors for transfer to a nursing home. The aims of this study were to identify (1) baseline factors associated with transfer to a nursing home and (2) time-varying factors […]

CEAL@UNC Guest Columns: McKnight’s Senior Living

Oct 29, 2024
Dr. Sheryl Zimmerman, Executive Director of CEAL@UNC, is a guest columnist for McKnight’s Senior Living. These regularly published articles reflect the perspectives of CEAL@UNC advisors, and address timely topics relevant to the well-being of the people who live and work in assisted living. View Articles

CEAL@UNC Guest Columns: McKnight’s Senior Living

by Lea Efird-Green

Dr. Sheryl Zimmerman, Executive Director of CEAL@UNC, is a guest columnist for McKnight’s Senior Living. These regularly published articles reflect the perspectives of CEAL@UNC advisors, and address timely topics relevant to the well-being of the people who live and work in assisted living. View Articles

Feasibility of a Novel Lighting System to Reduce Nighttime Falls in Assisted Living Residents With Dementia

Oct 1, 2024
Objectives To determine the feasibility of conducting a trial of a novel nighttime lighting system designed to support postural stability in assisted living (AL) residents, and to estimate intervention effectiveness by comparing the incidence of nighttime falls during the novel lighting condition to that in a control condition featuring a standard nightlight. Design Randomized crossover […]

Feasibility of a Novel Lighting System to Reduce Nighttime Falls in Assisted Living Residents With Dementia

by Lea Efird-Green

Objectives To determine the feasibility of conducting a trial of a novel nighttime lighting system designed to support postural stability in assisted living (AL) residents, and to estimate intervention effectiveness by comparing the incidence of nighttime falls during the novel lighting condition to that in a control condition featuring a standard nightlight. Design Randomized crossover […]

Managers’ Perspectives on their Role in Implementing Fall Prevention Interventions: A Qualitative Interview Study in Norwegian Homecare Services

Sep 1, 2024
Introduction: The implementation of fall prevention interventions in homecare services is crucial for reducing falls among older adults and effective leadership could determine success. Norwegian homecare services provide home nursing, rehabilitation, and practical assistance, to residents living in private homes or assisted living facilities. This study aims to explore how managers in Norwegian homecare services […]

Managers’ Perspectives on their Role in Implementing Fall Prevention Interventions: A Qualitative Interview Study in Norwegian Homecare Services

by Lea Efird-Green

Introduction: The implementation of fall prevention interventions in homecare services is crucial for reducing falls among older adults and effective leadership could determine success. Norwegian homecare services provide home nursing, rehabilitation, and practical assistance, to residents living in private homes or assisted living facilities. This study aims to explore how managers in Norwegian homecare services […]

Admission and Discharge Practices Among Assisted Living Communities: The Role of State Regulations and Organizational Characteristics

Aug 1, 2024
Background and Objectives: A better understanding of factors associated with assisted living admission and discharge practices can help identify communities that are more likely to allow residents to age in place. This study examined how state regulations and assisted living organizational characteristics related to community admission and discharge practices for bathing, getting out of bed, […]

Admission and Discharge Practices Among Assisted Living Communities: The Role of State Regulations and Organizational Characteristics

by Lea Efird-Green

Background and Objectives: A better understanding of factors associated with assisted living admission and discharge practices can help identify communities that are more likely to allow residents to age in place. This study examined how state regulations and assisted living organizational characteristics related to community admission and discharge practices for bathing, getting out of bed, […]

Revolutionizing Patient Surveillance in Assisted Living Facilities: Insights from AUGi Technology Implementation

Jul 1, 2024
In the face of escalating non-fatal fall-related expenses and an aging population, innovative solutions in assisted living facilities (ALFs) are imperative. This study evaluates the implementation of a remote-surveillance technology (AUGi) across three diverse ALFs, emphasizing its impact on falls and falls with injury across sites. Utilizing comprehensive data collection, AUGi facilitated an average reduction […]

Revolutionizing Patient Surveillance in Assisted Living Facilities: Insights from AUGi Technology Implementation

by Lea Efird-Green

In the face of escalating non-fatal fall-related expenses and an aging population, innovative solutions in assisted living facilities (ALFs) are imperative. This study evaluates the implementation of a remote-surveillance technology (AUGi) across three diverse ALFs, emphasizing its impact on falls and falls with injury across sites. Utilizing comprehensive data collection, AUGi facilitated an average reduction […]

Be Well in AL Recommendations: Resident/Family Checklist

Jun 10, 2024
CEAL@UNC recognizes the benefit of ongoing quality improvement in assisted living, including through the implementation of consensus medical and mental health care recommendations disseminated through the Be Well in AL Initiative. This checklist, to be used by residents and their families considering or residing in assisted living, is a helpful tool to understand recommended care […]

Be Well in AL Recommendations: Resident/Family Checklist

by Lea Efird-Green

CEAL@UNC recognizes the benefit of ongoing quality improvement in assisted living, including through the implementation of consensus medical and mental health care recommendations disseminated through the Be Well in AL Initiative. This checklist, to be used by residents and their families considering or residing in assisted living, is a helpful tool to understand recommended care […]

Does Assisted Living Provide Assistance And Promote Living?

May 1, 2024
Assisted living has promised assistance and quality of living to older adults for more than eighty years. It is the largest residential provider of long-term care in the United States, serving more than 918,000 older adults as of 2018. As assisted living has evolved, the needs of residents have become more challenging; staffing shortages have […]

Does Assisted Living Provide Assistance And Promote Living?

by Lea Efird-Green

Assisted living has promised assistance and quality of living to older adults for more than eighty years. It is the largest residential provider of long-term care in the United States, serving more than 918,000 older adults as of 2018. As assisted living has evolved, the needs of residents have become more challenging; staffing shortages have […]

Bioethics in Gerontology: Developing a Typology of Ethical Issues in Assisted Living

May 1, 2024
Assisted living (AL) simultaneously is home to older adults who cannot live independently and a place where people work and visit and, therefore, where value conflicts are apt to arise. In this report we present the “Typology of Ethical Issues in Assisted Living” with emphasis on its development. The typology derives from a synthesis of […]

Bioethics in Gerontology: Developing a Typology of Ethical Issues in Assisted Living

by Lea Efird-Green

Assisted living (AL) simultaneously is home to older adults who cannot live independently and a place where people work and visit and, therefore, where value conflicts are apt to arise. In this report we present the “Typology of Ethical Issues in Assisted Living” with emphasis on its development. The typology derives from a synthesis of […]

Potential Actions to Advance Well-being in Assisted Living

Apr 23, 2024
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 […]

Potential Actions to Advance Well-being in Assisted Living

by Lea Efird-Green

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 […]

A Step Toward Better Care: Understanding What Caregivers and Residents in Assisted Living Facilities Value in Health Monitoring Systems

Apr 1, 2024
The past several decades have seen significant advances in monitoring older adults’ health and well-being. However, creating viable, practical monitoring systems for informing caregivers requires understanding which behaviors and signs to track and what approaches best present that information. To investigate how technology can be leveraged to better augment caregivers’ workflows, we take a multi-stage, […]

A Step Toward Better Care: Understanding What Caregivers and Residents in Assisted Living Facilities Value in Health Monitoring Systems

by Lea Efird-Green

The past several decades have seen significant advances in monitoring older adults’ health and well-being. However, creating viable, practical monitoring systems for informing caregivers requires understanding which behaviors and signs to track and what approaches best present that information. To investigate how technology can be leveraged to better augment caregivers’ workflows, we take a multi-stage, […]

Quality of Life in Assisted Living Facilities for Seniors: A Descriptive Exploratory Study

Mar 1, 2024
Introduction Promoting individuals’ health across different life spans has always been key to a holistic nursing practice. Seniors are a diverse population who go through many physical and mental changes as they age. During the last decade, assisted living facilities (ALFs) have dramatically increased in numbers to provide care and living services in a home-like […]

Quality of Life in Assisted Living Facilities for Seniors: A Descriptive Exploratory Study

by Lea Efird-Green

Introduction Promoting individuals’ health across different life spans has always been key to a holistic nursing practice. Seniors are a diverse population who go through many physical and mental changes as they age. During the last decade, assisted living facilities (ALFs) have dramatically increased in numbers to provide care and living services in a home-like […]

A Collaborative Approach to Improving Care Outcomes for Residents in Assisted Living

Jan 1, 2024
Purpose: Assisted Living (AL) residents are embedded in “care convoys” comprised of a dynamic network of formal and informal care partners. Using the convoys of care model—a multi-level framework connecting care convoy properties to resident outcomes—we examined healthcare management and communication between convoy members. We recommend strategies to engage primary care in supporting collaboration, communication, […]

A Collaborative Approach to Improving Care Outcomes for Residents in Assisted Living

by Lea Efird-Green

Purpose: Assisted Living (AL) residents are embedded in “care convoys” comprised of a dynamic network of formal and informal care partners. Using the convoys of care model—a multi-level framework connecting care convoy properties to resident outcomes—we examined healthcare management and communication between convoy members. We recommend strategies to engage primary care in supporting collaboration, communication, […]

Measuring Older Adults’ Wellbeing When Transitioning into Assisted Living Facilities: A Confirmatory Factor Analysis of the Mueller Assessment of Transition (MAT)

Dec 1, 2023
WHAT THIS MEANS FOR YOU: A study of the Mueller Assessment of Transition (MAT) tool in108 older adults in the U.S. who were transitioning into assisted living communities found that the MAT effectively measured wellbeing impact across regions and was internally consistent. Results suggests that the MAT could be a valuable tool for assessing the wellbeing of older adults during the transition to assisted living.

Measuring Older Adults’ Wellbeing When Transitioning into Assisted Living Facilities: A Confirmatory Factor Analysis of the Mueller Assessment of Transition (MAT)

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: A study of the Mueller Assessment of Transition (MAT) tool in108 older adults in the U.S. who were transitioning into assisted living communities found that the MAT effectively measured wellbeing impact across regions and was internally consistent. Results suggests that the MAT could be a valuable tool for assessing the wellbeing of older adults during the transition to assisted living.

Older Adults’ Experiences of Participation in Daily Activities in Swedish Assisted Living

Nov 1, 2023
WHAT THIS MEANS FOR YOU: Eleven older adults interviewed in two assisted living communities in Sweden reported their feelings regarding participation and decision-making in daily activities, such as routine personal and medical care. In a qualitative analysis, residents actively participating in these activities reported they led to feelings of happiness, connection, involvement and safety. However, the organization and work environment dictated the ability of care and nursing staff to involve residents in daily activities, a challenge of which the residents were also aware.

Older Adults’ Experiences of Participation in Daily Activities in Swedish Assisted Living

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Eleven older adults interviewed in two assisted living communities in Sweden reported their feelings regarding participation and decision-making in daily activities, such as routine personal and medical care. In a qualitative analysis, residents actively participating in these activities reported they led to feelings of happiness, connection, involvement and safety. However, the organization and work environment dictated the ability of care and nursing staff to involve residents in daily activities, a challenge of which the residents were also aware.

Fall Prevention Care Management: Implementation and Outcomes of a Project to Reduce Fall Risks of Older Adults in Assisted Living Facilities

May 1, 2023
WHAT THIS MEANS FOR YOU: In this study, undergraduate nursing students implemented a 6-week Fall Prevention Care Management intervention for 25 residents in two AL communities. The intervention included individualized care using motivational interviewing and behavioral change related to fall prevention, as well as helping residents reflect on their perceptions of fall prevention. Qualitative analysis suggested that individualized support improved residents’ opinions of the intervention and facilitated participation for residents at high risk of falls.

Fall Prevention Care Management: Implementation and Outcomes of a Project to Reduce Fall Risks of Older Adults in Assisted Living Facilities

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: In this study, undergraduate nursing students implemented a 6-week Fall Prevention Care Management intervention for 25 residents in two AL communities. The intervention included individualized care using motivational interviewing and behavioral change related to fall prevention, as well as helping residents reflect on their perceptions of fall prevention. Qualitative analysis suggested that individualized support improved residents’ opinions of the intervention and facilitated participation for residents at high risk of falls.

Identifying a National Cohort of Medicare Beneficiaries Residing in Assisted Living Settings: An Updated Method

May 1, 2023
WHAT THIS MEANS FOR YOU: A new methodology was developed for identifying Medicare beneficiaries residing in licensed AL communities in the US using zip code data, Medicare enrollment data, and claims data, and exclusion based on AL capacity (licensing information). Results suggested that using licensing information makes identifying AL residents receiving Medicare more accurate, which could inform research and policy by providing new insights into the health of AL residents.

Identifying a National Cohort of Medicare Beneficiaries Residing in Assisted Living Settings: An Updated Method

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: A new methodology was developed for identifying Medicare beneficiaries residing in licensed AL communities in the US using zip code data, Medicare enrollment data, and claims data, and exclusion based on AL capacity (licensing information). Results suggested that using licensing information makes identifying AL residents receiving Medicare more accurate, which could inform research and policy by providing new insights into the health of AL residents.