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 […]
Regulation/Monitoring
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 […]
A National Typology of Health Service Regulation in Assisted Living
A National Typology of Health Service Regulation in Assisted Living
Background and Objectives State-regulating agencies use 350 different licenses and certifications to govern assisted living (AL), resulting in significant variation in regulations governing health services, the scope of practice, and capacity. This lack of standardization makes it difficult to compare and contrast AL operations and residents’ outcomes across similarly regulated communities. Research Design and Methods […]
End-of-Life Care Transitions in Assisted Living: Associations With State Staffing and Training Regulations
End-of-Life Care Transitions in Assisted Living: Associations With State Staffing and Training Regulations
Objectives We examined the frequency and categories of end-of-life care transitions among assisted living community decedents and their associations with state staffing and training regulations. Design Cohort study. Setting and Participants Medicare beneficiaries who resided in assisted living facilities and had validated death dates in 2018-2019 (N = 113,662). Methods We used Medicare claims and assessment […]
Paperwork, Paradox, and PRN: Psychotropic Medication Deficiencies in Assisted Living
Paperwork, Paradox, and PRN: Psychotropic Medication Deficiencies in Assisted Living
Individual state approaches to assisted living/residential care (AL/RC) licensing and oversight in the United States result in different practice standards and requirements, including psychotropic medication use. We examined 170 psychotropic medication deficiency citations issued to 152 Oregon AL/RC settings from 2015 to 2019. Applied thematic analysis resulted in the following themes: (1) documentation issues are […]
State Regulations and Assisted Living Residents’ Potentially Burdensome Transitions at the End of Life
State Regulations and Assisted Living Residents’ Potentially Burdensome Transitions at the End of Life
Background Potentially burdensome transitions at the end of life (e.g., repeated hospitalizations toward the end of life and/or health care transitions in the last three days of life) are common among residential care/assisted living (RC/AL) residents, and are associated with lower quality of end of-life care reported by bereaved family members. We examined the association […]
Pathways into Assisted Living Communities: Admission Limitations and Assessment Requirements Across the United States
Pathways into Assisted Living Communities: Admission Limitations and Assessment Requirements Across the United States
Objectives Limitations to admission play a critical role in shaping the composition of residents residing within licensed assisted living (AL) communities. Design We document variation across 165 licensure classifications in how state agencies limit who AL communities may admit and what assessments are required to make those determinations. Setting and Participants AL regulations and licensed […]
Online Customer Reviews of Assisted Living Communities: Association with Community, County, and State Factors
Online Customer Reviews of Assisted Living Communities: Association with Community, County, and State Factors
Objectives Online reviews provided by users of assisted living communities may offer a unique source of heretofore unexamined data. We explored online reviews as a possible source of information about these communities and examined the association between the reviews and aspects of state regulations, while controlling for assisted living, county, and state market-level factors. Design […]
State Variation in Antipsychotic Use Among Assisted Living Residents With Dementia
State Variation in Antipsychotic Use Among Assisted Living Residents With Dementia
WHAT THIS MEANS FOR YOU: This study of almost 21,000 AL residents in 2017 revealed that those with dementia were prescribed antipsychotics during about 13% of their time residing in AL. This proportion varied by state, with Hawaii having the lowest prescription rate (8%), and Wyoming having the highest (21%). Variations may be due to state regulation of AL communities, but the study was not able to determine if prescription practices were appropriate and tied to health outcomes.
Preparedness and Response of Assisted Living Facilities Toward COVID-19 Infection Control in Houston, Texas, USA
Preparedness and Response of Assisted Living Facilities Toward COVID-19 Infection Control in Houston, Texas, USA
WHAT THIS MEANS FOR YOU: The Houston Health Department conducted onsite assessments at AL communities to assess infection prevention and control practices. Larger AL communities better implemented CDC guidelines and were more proactive in their COVID-19 response activities. For example, many medium and small communities lacked access to COVID-19 PCR testing and had lower resident vaccination rates.
Implementation of an Emergency Power Rule: Compliance of Florida Nursing Homes and Assisted Living Facilities
Implementation of an Emergency Power Rule: Compliance of Florida Nursing Homes and Assisted Living Facilities
WHAT THIS MEANS FOR YOU: Data from 680 nursing homes (NHs) and 2940 AL communities in Florida examined compliance with an emergency power rule to have a secondary power source. The rule had higher implementation rates in AL than NH. AL communities were more likely to implement the new policy if they were smaller, did not offer memory care, accepted Medicaid, and had a mental health specialty license. Therefore, organizational characteristics and policies may help or hinder implementing new regulations.
Now You’re Tax‐Exempt, Now You’re Not: Property Taxation of Assisted Living Facilities
Now You’re Tax‐Exempt, Now You’re Not: Property Taxation of Assisted Living Facilities
WHAT THIS MEANS FOR YOU: Nonprofit AL communities in Florida lost their tax-exempt status in 2006 and regained it in 2017. Even when nonprofit AL communities had to pay property taxes, they provided higher-quality services than for-profit communities: more nursing staff, residents, and variety in care. In contrast, for-profit AL communities had more substantiated complaints and deficiencies, faced more sanctions after inspections, and incurred higher fines on average.
Patient Safety Culture in Assisted Living: Staff Perceptions and Association with State Regulations
Patient Safety Culture in Assisted Living: Staff Perceptions and Association with State Regulations
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 […]
Promoting Quality of Life and Safety in Assisted Living: A Survey of State Monitoring and Enforcement Agents
Promoting Quality of Life and Safety in Assisted Living: A Survey of State Monitoring and Enforcement Agents
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 […]
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 […]
State Regulations and Hospice Utilization in Assisted Living during the Last Month of Life
State Regulations and Hospice Utilization in Assisted Living during the Last Month of Life
Objectives: To examine the association between hospice/staffing regulations in residential care or assisted living (RC/AL) and hospice utilization among a national cohort of Medicare decedents residing in RC/AL at least 1 day during the last month of life, and to describe patterns of hospice utilization. Design: Retrospective cohort study of fee-for-service Medicare beneficiaries who died […]
Coronavirus Disease 2019 (COVID-19) in Assisted Living Communities: Neighborhood Deprivation and State Social Distancing Policies Matter
Coronavirus Disease 2019 (COVID-19) in Assisted Living Communities: Neighborhood Deprivation and State Social Distancing Policies Matter
Background: Residents of long-term care facilities face significantly greater risk of contracting or dying from coronavirus disease 2019 (COVID-19). However, little is known about COVID-19 in assisted living communities (ALCs) and the potential determinants of its spread. We examined the association between COVID-19 cases in ALCs and the proportion of Medicare-Medicaid (dual) eligible minority residents, […]
Class and Culture in the Making of an Assisted Living Market
Class and Culture in the Making of an Assisted Living Market
This article examines the growing industry of elite assisted living in Chile, which represents a break with a longstanding culture of care provided at home by family members and domestic workers. How does this market, locally associated with deprivation, abandonment and standardization, become a legitimate option for the rich clientele it caters to? Drawing on […]
Governance of Assisted Living in Singapore: Lessons for Aging Countries
Governance of Assisted Living in Singapore: Lessons for Aging Countries
A global trend toward aging populations means that the challenge of providing adequate long-term care to older people looms large in many countries. In Singapore, a public discourse revolving around the expansion of assisted living to create age-friendly environments in long-term care has emerged. This study examines Singapore’s experience in developing regulations for assisted living […]
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 […]
Factors Associated With Assisted Living Facility Closure
Factors Associated With Assisted Living Facility Closure
Background and Objectives Assisted living facilities (ALFs) have experienced rapid growth in the past few decades. The expansion in the number of ALFs may cause markets to become oversaturated, and a greater risk of unprofitable ALFs to close. However, no studies have investigated ALF closure. This study adapted a model developed for the nursing home […]
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.
Prevalence and Persistency of Deficiency Citations in Florida Assisted Living Facilities
Prevalence and Persistency of Deficiency Citations in Florida Assisted Living Facilities
WHAT THIS MEANS FOR YOU: State inspection data from 957 large assisted living communities in Florida showed that 87% were cited one or more times from 2012 to 2018. For-profit communities, those with more than 100 beds, and those with a limited mental health license were cited more often. Over 40% of communities were cited in two or more years for the same deficiency category, meaning that repeat citations are common.