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.

Regulation/Monitoring

Governance of Assisted Living in Singapore: Lessons for Aging Countries

Jun 1, 2022
WHAT THIS MEANS FOR YOU: In Singapore, assisted living regulations relate to required physical infrastructure, admission assessments, and staffing requirements. They are primarily practice guidelines, with a plan to make them legislatively explicit and permanent by 2023. Other regulations remain missing, such as staff training requirements and a monitoring structure, and must be addressed if assisted living is to be a safe and viable option for quality care.

Governance of Assisted Living in Singapore: Lessons for Aging Countries

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: In Singapore, assisted living regulations relate to required physical infrastructure, admission assessments, and staffing requirements. They are primarily practice guidelines, with a plan to make them legislatively explicit and permanent by 2023. Other regulations remain missing, such as staff training requirements and a monitoring structure, and must be addressed if assisted living is to be a safe and viable option for quality care.

End-Of-Life Care In Assisted Living Communities: Race And Ethnicity, Dual Enrollment Status, And State Regulations

May 1, 2022
WHAT THIS MEANS FOR YOU: This study examined end-of-life care in assisted living – specifically whether residents died in the community or elsewhere and received hospice care -- and whether these were associated with select factors. Among 100,783 Medicare beneficiaries who died in 16,560 communities during 2018–2019, nearly 60% died in their community, with 84% receiving hospice care. Communities with more Medicare-Medicaid enrollment had more residents dying in the community, and white residents were more likely than Black ones to use hospice care. In states with less strict assisted living regulations (e.g., for dementia care, admission/retention, and staffing/training), residents were more likely to die outside of the community (e.g., in a hospital or nursing home).

End-Of-Life Care In Assisted Living Communities: Race And Ethnicity, Dual Enrollment Status, And State Regulations

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study examined end-of-life care in assisted living – specifically whether residents died in the community or elsewhere and received hospice care — and whether these were associated with select factors. Among 100,783 Medicare beneficiaries who died in 16,560 communities during 2018–2019, nearly 60% died in their community, with 84% receiving hospice care. Communities with more Medicare-Medicaid enrollment had more residents dying in the community, and white residents were more likely than Black ones to use hospice care. In states with less strict assisted living regulations (e.g., for dementia care, admission/retention, and staffing/training), residents were more likely to die outside of the community (e.g., in a hospital or nursing home).

Factors Associated With Assisted Living Facility Closure

Mar 1, 2022
WHAT THIS MEANS FOR YOU: This study analyzed almost 2,000 Florida assisted living communities to understand factors related to assisted living closure between 2013-2015. During this time, 7.3% of communities closed; those with increased odds of closing had fewer beds, did not accept Medicaid, and had more regulatory deficiencies.

Factors Associated With Assisted Living Facility Closure

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study analyzed almost 2,000 Florida assisted living communities to understand factors related to assisted living closure between 2013-2015. During this time, 7.3% of communities closed; those with increased odds of closing had fewer beds, did not accept Medicaid, and had more regulatory deficiencies.

State Variation in Potentially Burdensome Transitions among Assisted Living Residents at the End of Life

Feb 1, 2022
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 Variation in Potentially Burdensome Transitions among Assisted Living Residents at the End of Life

by Lea Efird-Green

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

Jan 1, 2022
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.

Prevalence and Persistency of Deficiency Citations in Florida Assisted Living Facilities

by Lea Efird-Green

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.