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

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

Oct 1, 2022
WHAT THIS MEANS FOR YOU: Surveys from regulatory administrators in 48 states indicated that in more than half of states, regulatory monitoring was handled by at least three agencies with differing resources (e.g., budget, staffing) and methods (e.g., inspections). Less than half of the states compiled data from inspections, violations, and penalties, and fewer than 10 made this information easily available to the public.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Surveys from regulatory administrators in 48 states indicated that in more than half of states, regulatory monitoring was handled by at least three agencies with differing resources (e.g., budget, staffing) and methods (e.g., inspections). Less than half of the states compiled data from inspections, violations, and penalties, and fewer than 10 made this information easily available to the public.

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
WHAT THIS MEANS FOR YOU: Promoting Positive Care Interactions, a staff training program to establish positive care interactions with residents, was tested with 17 care staff in the memory care unit of one assisted living community. Although there were no significant changes in staff outcomes, participants’ perception of the community’s environment and policies improved, and staff showed good engagement throughout the study.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Promoting Positive Care Interactions, a staff training program to establish positive care interactions with residents, was tested with 17 care staff in the memory care unit of one assisted living community. Although there were no significant changes in staff outcomes, participants’ perception of the community’s environment and policies improved, and staff showed good engagement throughout the study.

The Impact of FFC-AL-EIT-D in Assisted Living during the COVID-19 Pandemic

Jun 1, 2022
WHAT THIS MEANS FOR YOU: Function Focused Care was tested in 51 assisted living communities in one state during the COVID-19 pandemic. Although there was no change in resident falls, emergency room visits, hospitalizations, or transfers to nursing homes, organizational policies and environments supporting physical activity for residents improved.

The Impact of FFC-AL-EIT-D in Assisted Living during the COVID-19 Pandemic

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Function Focused Care was tested in 51 assisted living communities in one state during the COVID-19 pandemic. Although there was no change in resident falls, emergency room visits, hospitalizations, or transfers to nursing homes, organizational policies and environments supporting physical activity for residents improved.

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

May 1, 2022
WHAT THIS MEANS FOR YOU: This study protocol describes the methods to be used in developing a toolkit for increased resident and family engagement in assisted living community safety planning; it includes a scoping review, qualitative interviews, and stakeholder meetings. The study’s goals include identifying, prioritizing, and evaluating existing engagement methods around safety concerns in assisted living and developing a toolkit that helps residents and families engage more frequently.

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

WHAT THIS MEANS FOR YOU: This study protocol describes the methods to be used in developing a toolkit for increased resident and family engagement in assisted living community safety planning; it includes a scoping review, qualitative interviews, and stakeholder meetings. The study’s goals include identifying, prioritizing, and evaluating existing engagement methods around safety concerns in assisted living and developing a toolkit that helps residents and families engage more frequently.

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

Apr 1, 2022
WHAT THIS MEANS FOR YOU: Drawing from existing research, theories, and case examples, this article highlighted moral complexities experienced in assisted living (e.g., privacy, sexual intimacy, safety and risk) and proposed a framework to identify and address these issues and promote more ethically sound practices. The proposed model centers on moral decision-making and interpersonal encounters and is intended to guide future research, policy, and practice.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Drawing from existing research, theories, and case examples, this article highlighted moral complexities experienced in assisted living (e.g., privacy, sexual intimacy, safety and risk) and proposed a framework to identify and address these issues and promote more ethically sound practices. The proposed model centers on moral decision-making and interpersonal encounters and is intended to guide future research, policy, and practice.

Monitoring Laboratory Parameters for Drug Toxicity in Assisted Living Facilities

Mar 1, 2022
WHAT THIS MEANS FOR YOU: This quality improvement project focused on performing recommended laboratory tests per FDA medication labeling in a 58-bed assisted living community. Before the project, almost 60% of resident records had gaps in lab monitoring of medications, which was worsened because of COVID-19 restrictions. The project focused on close provider collaboration to ensure labs were conducted; after the project, almost 90% of residents received necessary lab tests for their medications.

Monitoring Laboratory Parameters for Drug Toxicity in Assisted Living Facilities

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This quality improvement project focused on performing recommended laboratory tests per FDA medication labeling in a 58-bed assisted living community. Before the project, almost 60% of resident records had gaps in lab monitoring of medications, which was worsened because of COVID-19 restrictions. The project focused on close provider collaboration to ensure labs were conducted; after the project, almost 90% of residents received necessary lab tests for their medications.

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

Feb 1, 2022
WHAT THIS MEANS FOR YOU: A quality improvement initiative implemented by 810 Wisconsin assisted living communities serving over 20,000 residents found that most communities (88%) were able to comply with membership requirements and 71% remained enrolled for more than 2 years. This model could be reproduced in other states to improve quality.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: A quality improvement initiative implemented by 810 Wisconsin assisted living communities serving over 20,000 residents found that most communities (88%) were able to comply with membership requirements and 71% remained enrolled for more than 2 years. This model could be reproduced in other states to improve quality.

Reimagining Medical Care in Assisted Living

Feb 1, 2022
WHAT THIS MEANS FOR YOU: Three industry-wide proposals were recommended to enhance medical care quality for AL residents: regular on-site medical visits; employing experienced professionals in long-term and end-of-life care; and the introduction of an AL medical director role to establish rules, staff qualifications, and collaboration. The researchers acknowledge that adaptations may be necessary to adhere to these recommendations due to community size and availability of resources.

Reimagining Medical Care in Assisted Living

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Three industry-wide proposals were recommended to enhance medical care quality for AL residents: regular on-site medical visits; employing experienced professionals in long-term and end-of-life care; and the introduction of an AL medical director role to establish rules, staff qualifications, and collaboration. The researchers acknowledge that adaptations may be necessary to adhere to these recommendations due to community size and availability of resources.

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

Feb 1, 2022
WHAT THIS MEANS FOR YOU: This study examined the use of electronic health records (EHRs) and health information exchange (HIE) in AL between 2010 and 2018. Use varied based on AL size and ownership, with larger (26+ beds) and chain-owned communities more likely to use these technologies. Overall, adoption of these technologies increased from 2010 to 2018, but smaller communities had lower adoption rates.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study examined the use of electronic health records (EHRs) and health information exchange (HIE) in AL between 2010 and 2018. Use varied based on AL size and ownership, with larger (26+ beds) and chain-owned communities more likely to use these technologies. Overall, adoption of these technologies increased from 2010 to 2018, but smaller communities had lower adoption rates.

Storage Issues in Assisted Living Facilities and Senior Living Communities

Feb 1, 2022
WHAT THIS MEANS FOR YOU: During the COVID-19 pandemic, AL communities faced hurdles obtaining vital supplies including masks and gloves; AL communities were often considered lower priority than other healthcare settings, leading to delays in receipt. When supplies were obtained, the quantity often overwhelmed available storage space, leading to unsafe supply storage. Solutions include improved emergency management, emphasizing proper storage, and optimizing delivery schedules.

Storage Issues in Assisted Living Facilities and Senior Living Communities

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: During the COVID-19 pandemic, AL communities faced hurdles obtaining vital supplies including masks and gloves; AL communities were often considered lower priority than other healthcare settings, leading to delays in receipt. When supplies were obtained, the quantity often overwhelmed available storage space, leading to unsafe supply storage. Solutions include improved emergency management, emphasizing proper storage, and optimizing delivery schedules.

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

Jan 1, 2022
WHAT THIS MEANS FOR YOU: Medicare data for over 20,600 assisted living residents with Alzheimer's disease and related dementias (ADRD) indicate that residents of memory care had a significantly lower risk of hospitalization, nursing home admission, and long-term nursing home stays compared to those in general communities.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Medicare data for over 20,600 assisted living residents with Alzheimer’s disease and related dementias (ADRD) indicate that residents of memory care had a significantly lower risk of hospitalization, nursing home admission, and long-term nursing home stays compared to those in general communities.