Academic Publication

“I Have a Lotta Sad Feelin'” – Unaddressed Mental Health Needs and Self-Support Strategies in Medicaid-Funded Assisted Living

Jun 1, 2023

Objective To investigate mental health needs and barriers to seeking mental health support in Medicaid funded Assisted Living Facility (M-ALF). Design A multimethod, qualitative-dominant descriptive design using questionnaires and semistructured interviews. Setting and Participants The study occurred at a M-ALF in the Bronx, New York. A researcher in residence recruited 13 residents (11 Black or […]

“I Have a Lotta Sad Feelin'” – Unaddressed Mental Health Needs and Self-Support Strategies in Medicaid-Funded Assisted Living

June 1, 2023 by Lea Efird-Green

Objective To investigate mental health needs and barriers to seeking mental health support in Medicaid funded Assisted Living Facility (M-ALF). Design A multimethod, qualitative-dominant descriptive design using questionnaires and semistructured interviews. Setting and Participants The study occurred at a M-ALF in the Bronx, New York. A researcher in residence recruited 13 residents (11 Black or […]

End-of-Life Care Transitions in Assisted Living: Associations With State Staffing and Training Regulations

Jun 1, 2023

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 […]

End-of-Life Care Transitions in Assisted Living: Associations With State Staffing and Training Regulations

June 1, 2023 by Lea Efird-Green

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 […]

Online Customer Reviews of Assisted Living Communities: Association with Community, County, and State Factors

Jun 1, 2023

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 […]

Online Customer Reviews of Assisted Living Communities: Association with Community, County, and State Factors

June 1, 2023 by Lea Efird-Green

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 […]

Pathways into Assisted Living Communities: Admission Limitations and Assessment Requirements Across the United States

Jun 1, 2023

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 […]

Pathways into Assisted Living Communities: Admission Limitations and Assessment Requirements Across the United States

June 1, 2023 by Lea Efird-Green

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 […]

Attachment Behaviours in Adults with Intellectual Disabilities in Assisted Living Facilities: Representations from Direct-Care Staff

Jun 1, 2023

BACKGROUND Studies on individuals with intellectual disabilities (IDs) indicate that primary care staff are potential attachment figures. Therefore, the ability to interpret and respond to attachment behaviours with sensitivity is crucial for professionals working with adults with IDs. However, little is known regarding representations and understanding of these attachment behaviours among professionals. This study investigated […]

Attachment Behaviours in Adults with Intellectual Disabilities in Assisted Living Facilities: Representations from Direct-Care Staff

June 1, 2023 by Lea Efird-Green

BACKGROUND Studies on individuals with intellectual disabilities (IDs) indicate that primary care staff are potential attachment figures. Therefore, the ability to interpret and respond to attachment behaviours with sensitivity is crucial for professionals working with adults with IDs. However, little is known regarding representations and understanding of these attachment behaviours among professionals. This study investigated […]

State Regulations and Assisted Living Residents’ Potentially Burdensome Transitions at the End of Life

Jun 1, 2023

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 […]

State Regulations and Assisted Living Residents’ Potentially Burdensome Transitions at the End of Life

June 1, 2023 by Lea Efird-Green

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 […]

Hospital Proximity and Emergency Department Use among Assisted Living Residents

Jun 1, 2023

Objectives To examine the relationship between AL communities’ distance to the nearest hospital and residents’ rates of emergency department (ED) use. We hypothesize that when access to an ED is more convenient, as measured by a shorter distance, assisted living (AL)-to-ED transfers are more common, particularly for nonemergent conditions. Design Retrospective cohort study, where the […]

Hospital Proximity and Emergency Department Use among Assisted Living Residents

June 1, 2023 by Lea Efird-Green

Objectives To examine the relationship between AL communities’ distance to the nearest hospital and residents’ rates of emergency department (ED) use. We hypothesize that when access to an ED is more convenient, as measured by a shorter distance, assisted living (AL)-to-ED transfers are more common, particularly for nonemergent conditions. Design Retrospective cohort study, where the […]

Paperwork, Paradox, and PRN: Psychotropic Medication Deficiencies in Assisted Living

Jun 1, 2023

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 […]

Paperwork, Paradox, and PRN: Psychotropic Medication Deficiencies in Assisted Living

June 1, 2023 by Lea Efird-Green

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 […]

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

May 1, 2023

Background Accidental falls are common among older adults and may lead to devastating consequences. One promising approach to reduce falls is to engage older adults in fall risk reduction through care management. Purpose This article describes the implementation by undergraduate nursing students of a 6 week interdisciplinary Fall Prevention Care Management (FPCM) intervention to improve […]

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

May 1, 2023 by Lea Efird-Green

Background Accidental falls are common among older adults and may lead to devastating consequences. One promising approach to reduce falls is to engage older adults in fall risk reduction through care management. Purpose This article describes the implementation by undergraduate nursing students of a 6 week interdisciplinary Fall Prevention Care Management (FPCM) intervention to improve […]

Primary Care Telemedicine Use among Assisted Living Residents with Dementia during COVID-19: Race and Dual Enrollment Status

May 1, 2023

In 2023-03-01 12:00:00 2020, restrictions on telemedicine were waived, allowing services to be delivered through video-conferencing or telephone.1,2 Telemedicine offered a way to stay connected with primary care providers during the COVID-19 pandemic,3 which may be particularly suitable for assisted living facility (AL) residents with dementia who have high care needs. Expansion, however, raised concerns […]

Primary Care Telemedicine Use among Assisted Living Residents with Dementia during COVID-19: Race and Dual Enrollment Status

May 1, 2023 by Lea Efird-Green

In 2023-03-01 12:00:00 2020, restrictions on telemedicine were waived, allowing services to be delivered through video-conferencing or telephone.1,2 Telemedicine offered a way to stay connected with primary care providers during the COVID-19 pandemic,3 which may be particularly suitable for assisted living facility (AL) residents with dementia who have high care needs. Expansion, however, raised concerns […]

Likelihood of assisted living residents aging in place as a factor of dual Medicare-Medicaid eligibility at the end of life

May 1, 2023

States vary in their coverage of services in assisted living (AL) settings which may impact whether AL residents can remain in what they consider their home. Previous research found an association between state Medicaid financing and access to AL for beneficiaries dually eligible for Medicare and Medicaid. In addition, research found that among AL residents […]

Likelihood of assisted living residents aging in place as a factor of dual Medicare-Medicaid eligibility at the end of life

May 1, 2023 by Lea Efird-Green

States vary in their coverage of services in assisted living (AL) settings which may impact whether AL residents can remain in what they consider their home. Previous research found an association between state Medicaid financing and access to AL for beneficiaries dually eligible for Medicare and Medicaid. In addition, research found that among AL residents […]

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

May 1, 2023

Objective Present an updated approach to identifying Medicare beneficiaries residing in licensed assisted living (AL) settings in the United States. Design Retrospective cohort study using a national list of licensed AL settings, US Postal Service (USPS) data, and enrollment, claims, and assessment data from the Centers for Medicare and Medicaid Services. Setting and Participants A […]

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

May 1, 2023 by Lea Efird-Green

Objective Present an updated approach to identifying Medicare beneficiaries residing in licensed assisted living (AL) settings in the United States. Design Retrospective cohort study using a national list of licensed AL settings, US Postal Service (USPS) data, and enrollment, claims, and assessment data from the Centers for Medicare and Medicaid Services. Setting and Participants A […]

Interprofessional care in a retirement and assisted living community: the complexity of teamwork

Apr 1, 2023

Teamwork is an aspiration in the delivery of interprofessional care to older adults, but how does it play out in residential settings that combine independent living, assisted living, and skilled nursing care? This study investigated teamwork as an organic part of a retirement and assisted living community immersed in mission-driven care. Drawing on 44 in-depth […]

Interprofessional care in a retirement and assisted living community: the complexity of teamwork

April 1, 2023 by Lea Efird-Green

Teamwork is an aspiration in the delivery of interprofessional care to older adults, but how does it play out in residential settings that combine independent living, assisted living, and skilled nursing care? This study investigated teamwork as an organic part of a retirement and assisted living community immersed in mission-driven care. Drawing on 44 in-depth […]

State Variation in Antipsychotic Use Among Assisted Living Residents With Dementia

Apr 1, 2023

Objectives More than two-thirds of assisted living (AL) residents have dementia or cognitive impairment and antipsychotics are commonly prescribed for behavioral disturbances. As AL communities are regulated by state-level policies, which vary significantly regarding the care for people with dementia, we examined how antipsychotic prescribing varied across states among AL residents with dementia. Design This […]

State Variation in Antipsychotic Use Among Assisted Living Residents With Dementia

April 1, 2023 by Lea Efird-Green

Objectives More than two-thirds of assisted living (AL) residents have dementia or cognitive impairment and antipsychotics are commonly prescribed for behavioral disturbances. As AL communities are regulated by state-level policies, which vary significantly regarding the care for people with dementia, we examined how antipsychotic prescribing varied across states among AL residents with dementia. Design This […]

Caregiver Involvement and Concerns with Care of Residents of Assisted Living Before and During the COVID-19 Pandemic

Apr 1, 2023

Introduction Family/friend caregivers play an essential role in promoting the physical and mental health of older adults in need of care – especially during the COVID-19 pandemic and especially in assisted living (AL) homes, were resident care needs are similarly complex as in long-term care homes but fewer staffing resources and services are available. However, […]

Caregiver Involvement and Concerns with Care of Residents of Assisted Living Before and During the COVID-19 Pandemic

April 1, 2023 by Lea Efird-Green

Introduction Family/friend caregivers play an essential role in promoting the physical and mental health of older adults in need of care – especially during the COVID-19 pandemic and especially in assisted living (AL) homes, were resident care needs are similarly complex as in long-term care homes but fewer staffing resources and services are available. However, […]

Robots in Assisted Living Facilities: Scoping Review

Mar 1, 2023

Background Various technological interventions have been proposed and studied to address the growing demand for care of residents in assisted living facilities, in which a preexisting shortage of professional caregivers has been exacerbated by the COVID-19 pandemic. Care robots are one such intervention with the potential to improve both the care of older adults and […]

Robots in Assisted Living Facilities: Scoping Review

March 1, 2023 by Lea Efird-Green

Background Various technological interventions have been proposed and studied to address the growing demand for care of residents in assisted living facilities, in which a preexisting shortage of professional caregivers has been exacerbated by the COVID-19 pandemic. Care robots are one such intervention with the potential to improve both the care of older adults and […]

Using Medicare Enrollment Data to Identify Beneficiaries in Assisted Living

Mar 1, 2023

Objectives Develop an approach for identifying Medicare beneficiaries residing in US assisted living (AL) communities in calendar year 2018. Design We used the following data sources: national directory of licensed ALs, file of US addresses and their associated 9-digit ZIP codes (ZIP+4), Medicare Enrollment Database (EDB), Master Beneficiary Summary File (MBSF), and the Minimum Data Set […]

Using Medicare Enrollment Data to Identify Beneficiaries in Assisted Living

March 1, 2023 by Lea Efird-Green

Objectives Develop an approach for identifying Medicare beneficiaries residing in US assisted living (AL) communities in calendar year 2018. Design We used the following data sources: national directory of licensed ALs, file of US addresses and their associated 9-digit ZIP codes (ZIP+4), Medicare Enrollment Database (EDB), Master Beneficiary Summary File (MBSF), and the Minimum Data Set […]

Feasibility of the Palliative Care Education in Assisted Living Intervention for Dementia Care Providers: A Cluster Randomized Trial

Feb 1, 2023

BACKGROUND AND OBJECTIVES: Alzheimer’s disease or related dementia are a major cause of death in the United States. While effective interventions have been developed to deliver palliative care to nursing home residents with ADRD, little work has identified effective interventions to reach assisted living (AL) residents with dementia. RESEARCH DESIGN AND METHODS: 118 AL residents […]

Feasibility of the Palliative Care Education in Assisted Living Intervention for Dementia Care Providers: A Cluster Randomized Trial

February 1, 2023 by Lea Efird-Green

BACKGROUND AND OBJECTIVES: Alzheimer’s disease or related dementia are a major cause of death in the United States. While effective interventions have been developed to deliver palliative care to nursing home residents with ADRD, little work has identified effective interventions to reach assisted living (AL) residents with dementia. RESEARCH DESIGN AND METHODS: 118 AL residents […]

Well-being of professional older adults’ caregivers in Alberta’s assisted living and long-term care facilities: a cross-sectional study

Feb 1, 2023

Background For the care need of older adults, long-term care (LTC) and assisted living (AL) facilities are expanding in Alberta, but little is known about the caregivers’ well-being. The purpose of the study was to investigate the physical health conditions, mental and emotional health (MEH), health behaviour, stress levels, quality of life (QOL), and turnover […]

Well-being of professional older adults’ caregivers in Alberta’s assisted living and long-term care facilities: a cross-sectional study

February 1, 2023 by Lea Efird-Green

Background For the care need of older adults, long-term care (LTC) and assisted living (AL) facilities are expanding in Alberta, but little is known about the caregivers’ well-being. The purpose of the study was to investigate the physical health conditions, mental and emotional health (MEH), health behaviour, stress levels, quality of life (QOL), and turnover […]

Digital Immunization Tracking in Long-Term Care and Assisted Living Facilities

Feb 1, 2023

A disproportionate share of the health impacts of COVID-19 has been borne by older adults, particularly those in long-term care facilities (LTCs). Vaccination has been critical to efforts to combat this issue, but as we begin to emerge from this pandemic, questions remain about how to protect the health of residents of LTC and assisted […]

Digital Immunization Tracking in Long-Term Care and Assisted Living Facilities

February 1, 2023 by Lea Efird-Green

A disproportionate share of the health impacts of COVID-19 has been borne by older adults, particularly those in long-term care facilities (LTCs). Vaccination has been critical to efforts to combat this issue, but as we begin to emerge from this pandemic, questions remain about how to protect the health of residents of LTC and assisted […]

Preparedness and Response of Assisted Living Facilities Toward COVID-19 Infection Control in Houston, Texas, USA

Feb 1, 2023

Background Long-term care facilities (LTCFs) including assisted living facilities (ALFs) are hubs for high transmission and poor prognosis of COVID-19 among the residents who are more susceptible due to old age and comorbidities. Aim Houston Health Department conducted assessments of ALFs within the City of Houston to determine preparedness and existing preventive measures at the […]

Preparedness and Response of Assisted Living Facilities Toward COVID-19 Infection Control in Houston, Texas, USA

February 1, 2023 by Lea Efird-Green

Background Long-term care facilities (LTCFs) including assisted living facilities (ALFs) are hubs for high transmission and poor prognosis of COVID-19 among the residents who are more susceptible due to old age and comorbidities. Aim Houston Health Department conducted assessments of ALFs within the City of Houston to determine preparedness and existing preventive measures at the […]

Physical Activity Programming for Older Adults in Assisted Living: Residents’ Perspectives

Feb 1, 2023

Decreasing sedentary behavior and increasing light physical activity could promote the maintenance of functional abilities for older adults in assisted living (AL). The purpose of this qualitative study was to gather residents’ recommendations about a proposed self-efficacy enhancing intervention to replace sedentary behavior with light physical activity. We interviewed 20 residents (mean age 83.1; 60% […]

Physical Activity Programming for Older Adults in Assisted Living: Residents’ Perspectives

February 1, 2023 by Lea Efird-Green

Decreasing sedentary behavior and increasing light physical activity could promote the maintenance of functional abilities for older adults in assisted living (AL). The purpose of this qualitative study was to gather residents’ recommendations about a proposed self-efficacy enhancing intervention to replace sedentary behavior with light physical activity. We interviewed 20 residents (mean age 83.1; 60% […]

Association of Medicaid Financing and Concentration of Assisted Living Residents Dually Eligible for Medicare and Medicaid

Feb 1, 2023

Almost 1 in 5 assisted living (AL) residents rely on Medicaid to pay for personal care and supportive services. High concentrations of residents dually eligible for Medicare and Medicaid in nursing homes are associated with lower staffing levels and more state-identified deficiencies. This study assessed the concentration of individuals dually eligible for Medicare and Medicaid […]

Association of Medicaid Financing and Concentration of Assisted Living Residents Dually Eligible for Medicare and Medicaid

February 1, 2023 by Lea Efird-Green

Almost 1 in 5 assisted living (AL) residents rely on Medicaid to pay for personal care and supportive services. High concentrations of residents dually eligible for Medicare and Medicaid in nursing homes are associated with lower staffing levels and more state-identified deficiencies. This study assessed the concentration of individuals dually eligible for Medicare and Medicaid […]