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.

Academic Publication

Understanding Digital Literacy of Persons With Dementia and Their Caregivers: A Scoping Review and an Evolutionary Concept Analysis of Empirical Studies

Jun 1, 2025
WHAT THIS MEANS FOR YOU: This scoping review of 22 studies examined digitial literacy for people with dementia and their caregivers across settings and aimed to understand antecedents, attributes, and consequences of digital literacy. Support systems, and individual and sociodemographic characteristics were identified as antecedents; technological and critical thinking skills are attributes; and technology acceptance, psychosocial impacts, and digital equity were consequences. These concepts could guide the development and implementation of digital interventions for people with dementia and their caregivers.

Understanding Digital Literacy of Persons With Dementia and Their Caregivers: A Scoping Review and an Evolutionary Concept Analysis of Empirical Studies

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This scoping review of 22 studies examined digitial literacy for people with dementia and their caregivers across settings and aimed to understand antecedents, attributes, and consequences of digital literacy. Support systems, and individual and sociodemographic characteristics were identified as antecedents; technological and critical thinking skills are attributes; and technology acceptance, psychosocial impacts, and digital equity were consequences. These concepts could guide the development and implementation of digital interventions for people with dementia and their caregivers.

Optimizing Ethical Care, Quality, and Safety in Long-Term Services and Supports: A Position Paper from the American College of Physicians

Jun 1, 2025
WHAT THIS MEANS FOR YOU: This position paper examines the ethical implications of current business models and practices of long-term services and supports (LTSS) in the United States, and their effects on vulnerable populations. The paper reports four positions that would improve outcomes for vulnerable populations: optimizing care quality and incentivizing patient preferences, respecting individuals, prioritizing improvements in LTSS, and increased transparency and accountability, all of which support person-centered care.

Optimizing Ethical Care, Quality, and Safety in Long-Term Services and Supports: A Position Paper from the American College of Physicians

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This position paper examines the ethical implications of current business models and practices of long-term services and supports (LTSS) in the United States, and their effects on vulnerable populations. The paper reports four positions that would improve outcomes for vulnerable populations: optimizing care quality and incentivizing patient preferences, respecting individuals, prioritizing improvements in LTSS, and increased transparency and accountability, all of which support person-centered care.

From Nursing Homes to Home Care: Examining the Impact of the COVID-19 Pandemic on Direct Care Worker Transitions

Jun 1, 2025
WHAT THIS MEANS FOR YOU: This study examined over 8,000 direct care workers employed in residential or long-term care (LTC) communities from 2016-2018 and from 2020-2022 to examine workers' exits from LTC settings and if hazard pay mediated the impact of the pandemic. Worker exits were highest in 2020, but in 2021-2022, worker exits decreased relative to prepandemic numbers, and if workers did switch jobs, they were more likely to remain in healthcare relative to prepandemic. Hazard pay or other wage support policies did not have an effect on worker decisions to exit LTC during or after the pandemic.

From Nursing Homes to Home Care: Examining the Impact of the COVID-19 Pandemic on Direct Care Worker Transitions

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study examined over 8,000 direct care workers employed in residential or long-term care (LTC) communities from 2016-2018 and from 2020-2022 to examine workers’ exits from LTC settings and if hazard pay mediated the impact of the pandemic. Worker exits were highest in 2020, but in 2021-2022, worker exits decreased relative to prepandemic numbers, and if workers did switch jobs, they were more likely to remain in healthcare relative to prepandemic. Hazard pay or other wage support policies did not have an effect on worker decisions to exit LTC during or after the pandemic.

Artificial Intelligence in Assisted Living and Memory Care: Enhancing Care or Increasing Exposure?

May 1, 2025
WHAT THIS MEANS FOR YOU: This editorial uses data from the CAN Aging Servces Claim Report to examine how artificial intelligence (AI) can alter care, liability, and decision-making in assisted living and memory care settings.

Artificial Intelligence in Assisted Living and Memory Care: Enhancing Care or Increasing Exposure?

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This editorial uses data from the CAN Aging Servces Claim Report to examine how artificial intelligence (AI) can alter care, liability, and decision-making in assisted living and memory care settings.

A Qualitative Analysis of Safety Culture in Minnesota’s Assisted Living Facilities

May 1, 2025
WHAT THIS MEANS FOR YOU: This qualitative analysis applied the Agency for Healthcare Research and Quality's safety domains to post-2019 health inspection reports from assisted living communities in Minnesota to better understand regulation and safety. Three themes emerged in survey violations that harmed patients: staffing, compliance, and communication. Improving policies and practices related to these domains could improve safety for residents in Minnesota AL communities.

A Qualitative Analysis of Safety Culture in Minnesota’s Assisted Living Facilities

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This qualitative analysis applied the Agency for Healthcare Research and Quality’s safety domains to post-2019 health inspection reports from assisted living communities in Minnesota to better understand regulation and safety. Three themes emerged in survey violations that harmed patients: staffing, compliance, and communication. Improving policies and practices related to these domains could improve safety for residents in Minnesota AL communities.

Differences in Quality of Care Interactions Across Care Tasks in Assisted Living

May 1, 2025
WHAT THIS MEANS FOR YOU: This descriptive study of four assisted living communities in Maryland examined 152 staff-resident interactions to understand if quality of care interactions differs by care task type. Different categories of care interactions were identified with positive care interactions being the most common (36%), and supportive care being the most common type of task (34%). Supportive/ambulatory care (i.e., distracting, transferring, and walking) interactions were more negative than intimate personal care (i.e., bathing, dressing, and toileting) interactions, suggesting improvements in care interaction quality may be needed for supportive care.

Differences in Quality of Care Interactions Across Care Tasks in Assisted Living

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This descriptive study of four assisted living communities in Maryland examined 152 staff-resident interactions to understand if quality of care interactions differs by care task type. Different categories of care interactions were identified with positive care interactions being the most common (36%), and supportive care being the most common type of task (34%). Supportive/ambulatory care (i.e., distracting, transferring, and walking) interactions were more negative than intimate personal care (i.e., bathing, dressing, and toileting) interactions, suggesting improvements in care interaction quality may be needed for supportive care.

The Importance of Nature and Wishes for Nature-Based Experiences Among Older Adults in Assisted Living Facilities

May 1, 2025
WHAT THIS MEANS FOR YOU: This cross-sectional study of 25 assisted living communities in Finland examined 854 residents' views of nature-based interventions. Only 24% of residents could move outdoors independently, and only 51% had the amount of nature exposure they wanted, although 96% consider nature important and 83% stated interest in nature-based interventions. Results indicate developing nature-based interventions could be appealing for older adults.

The Importance of Nature and Wishes for Nature-Based Experiences Among Older Adults in Assisted Living Facilities

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This cross-sectional study of 25 assisted living communities in Finland examined 854 residents’ views of nature-based interventions. Only 24% of residents could move outdoors independently, and only 51% had the amount of nature exposure they wanted, although 96% consider nature important and 83% stated interest in nature-based interventions. Results indicate developing nature-based interventions could be appealing for older adults.

Facility-Level Variation of Resident Loneliness in Assisted Living and Associated Organizational Context Factors: A Repeated Cross-Sectional Study

May 1, 2025
WHAT THIS MEANS FOR YOU: This Canadian cross-sectional study used quarterly data (2017-2021) from the Resident Assessment Instrument - Home Care to assess AL resident loneliness and factors associated with loneliness. At the systems level, loneliness did not change during the course of pandemic, but levels did vary between communities. Factors associated with reducing loneliness at the community level include caregiver involvement, essential visitor policies, and video calls with volunteers/spiritual leaders.

Facility-Level Variation of Resident Loneliness in Assisted Living and Associated Organizational Context Factors: A Repeated Cross-Sectional Study

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This Canadian cross-sectional study used quarterly data (2017-2021) from the Resident Assessment Instrument – Home Care to assess AL resident loneliness and factors associated with loneliness. At the systems level, loneliness did not change during the course of pandemic, but levels did vary between communities. Factors associated with reducing loneliness at the community level include caregiver involvement, essential visitor policies, and video calls with volunteers/spiritual leaders.

Empowering Family Care Partners to Optimize Delirium Care for Persons Living with Dementia

May 1, 2025
WHAT THIS MEANS FOR YOU: This qualitative study interviewed twelve family care partners from an assisted living community in Virginia and a memory care clinic in Georgia to gain insight into intervention development for delirium superimposed on dementia (DSD). Themes such as education, proactive strategies, and empathetic communication emerged as relevant for improving outcomes for people with DSD. The study highlights the need for interventions targeting education and the mental and emotional needs of care partners.

Empowering Family Care Partners to Optimize Delirium Care for Persons Living with Dementia

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This qualitative study interviewed twelve family care partners from an assisted living community in Virginia and a memory care clinic in Georgia to gain insight into intervention development for delirium superimposed on dementia (DSD). Themes such as education, proactive strategies, and empathetic communication emerged as relevant for improving outcomes for people with DSD. The study highlights the need for interventions targeting education and the mental and emotional needs of care partners.

Inactivity Is Isolation: Insights from a Sedentary Time Intervention in Assisted Living

Apr 1, 2025
WHAT THIS MEANS FOR YOU: This exploratory study included 18 residents across three Canadian assisted living facilities who participated in a 12-week intervention to promote active aging. In post-intervention focus groups, 5 themes emerged: intervention effectiveness, physical and social engagement work together, influence of congregate living environment, environment supporting relationships, and personal preferences. The intervention was considered feasible and acceptable by participants, and could merit further testing.

Inactivity Is Isolation: Insights from a Sedentary Time Intervention in Assisted Living

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This exploratory study included 18 residents across three Canadian assisted living facilities who participated in a 12-week intervention to promote active aging. In post-intervention focus groups, 5 themes emerged: intervention effectiveness, physical and social engagement work together, influence of congregate living environment, environment supporting relationships, and personal preferences. The intervention was considered feasible and acceptable by participants, and could merit further testing.

Differing Realities Among Assisted Living Residents With Dementia: Understanding Care Partner Responses

Apr 1, 2025
WHAT THIS MEANS FOR YOU: This analysis of 73 residents with dementia and 103 care partners from eight assisted living communities in the Atlanta area examined differing realities of residents with dementia and their care partners' responses. A qualitative analysis revealed most residents experienced confusion, which led to reality management strategies deployed by care partners. These strategies ranged from ignoring or dismissing to correcting, redirecting, or joining the resident in their reality. Factors such as type of confusion and resident/care partner characteristics influenced which strategy was deployed.

Differing Realities Among Assisted Living Residents With Dementia: Understanding Care Partner Responses

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This analysis of 73 residents with dementia and 103 care partners from eight assisted living communities in the Atlanta area examined differing realities of residents with dementia and their care partners’ responses. A qualitative analysis revealed most residents experienced confusion, which led to reality management strategies deployed by care partners. These strategies ranged from ignoring or dismissing to correcting, redirecting, or joining the resident in their reality. Factors such as type of confusion and resident/care partner characteristics influenced which strategy was deployed.

Urinary Incontinence Is an Independent Risk Factor for Nursing Home Placement among Assisted Living Residents

Apr 1, 2025
WHAT THIS MEANS FOR YOU: This retrospective cohort study used 2019-2021 Medicare data to evaluate if urinary incontinence (UI) is an independent risk factor for assisted living residents' nursing home (NH) placement. Out of 247,010 residents, 20.5% had UI, and out of the 15.7% that were placed in NH, 21.7% had UI. The study confirmed that UI is an independent risk factor associated with NH placement, indicating education and early identification/treatment of UI will be helpful for avoiding/delaying NH placement.

Urinary Incontinence Is an Independent Risk Factor for Nursing Home Placement among Assisted Living Residents

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This retrospective cohort study used 2019-2021 Medicare data to evaluate if urinary incontinence (UI) is an independent risk factor for assisted living residents’ nursing home (NH) placement. Out of 247,010 residents, 20.5% had UI, and out of the 15.7% that were placed in NH, 21.7% had UI. The study confirmed that UI is an independent risk factor associated with NH placement, indicating education and early identification/treatment of UI will be helpful for avoiding/delaying NH placement.

Understanding the Experience of Employees in Assisted Living Facilities during the COVID-19 Pandemic: A Qualitative Case Study

Apr 1, 2025
WHAT THIS MEANS FOR YOU: This study involved interviews with 29 employees at an assisted living community in Oregon to assess challenges employees faced during the pandemic. The main theme that emerged was staff's need to balance "policing" residents, their families, and themselves to comply with state COVID-19-related policies, although this was often counter to their training. This issue often led to increased stress for employees, highlighting the need for policies that support AL staff during emergencies.

Understanding the Experience of Employees in Assisted Living Facilities during the COVID-19 Pandemic: A Qualitative Case Study

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study involved interviews with 29 employees at an assisted living community in Oregon to assess challenges employees faced during the pandemic. The main theme that emerged was staff’s need to balance “policing” residents, their families, and themselves to comply with state COVID-19-related policies, although this was often counter to their training. This issue often led to increased stress for employees, highlighting the need for policies that support AL staff during emergencies.

Salutogenic Architecture, Non-Therapeutic Environments and the Health of the Elderly: A Systematic Review

Apr 1, 2025
WHAT THIS MEANS FOR YOU: This systematic review of 26 articles aimed to identify architectural elements that can achieve salutogenic (positive wellbeing) goals for older adults, and how architectural design can bring salutogenic theory to life. Physical elements such as porches, balconies, and above-grade entrances are key elements in individuals' homes, while walls were identified as key elements in assisted living communities for supporting coherence due to their role in creating a personal, distinct space for residents.

Salutogenic Architecture, Non-Therapeutic Environments and the Health of the Elderly: A Systematic Review

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This systematic review of 26 articles aimed to identify architectural elements that can achieve salutogenic (positive wellbeing) goals for older adults, and how architectural design can bring salutogenic theory to life. Physical elements such as porches, balconies, and above-grade entrances are key elements in individuals’ homes, while walls were identified as key elements in assisted living communities for supporting coherence due to their role in creating a personal, distinct space for residents.

Trends in the Use of Medicare Home Health Care among Congregate Living Residents

Apr 1, 2025
WHAT THIS MEANS FOR YOU: This cohort study examined trends in home health care (HHC) of nearly 10 million Medicare patients across congregate and non-congregate care settings between 2014-2019. Of all HHC episodes, 15.9% happened in congregate care, and traditional Medicare beneficiaries in congregate care used HHC more frequently and were more likely to use high-quality agencies than those in other settings. However, dual-eligible and minoritized populations were less likely to receive high quality HHC services.

Trends in the Use of Medicare Home Health Care among Congregate Living Residents

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This cohort study examined trends in home health care (HHC) of nearly 10 million Medicare patients across congregate and non-congregate care settings between 2014-2019. Of all HHC episodes, 15.9% happened in congregate care, and traditional Medicare beneficiaries in congregate care used HHC more frequently and were more likely to use high-quality agencies than those in other settings. However, dual-eligible and minoritized populations were less likely to receive high quality HHC services.

Keeping Assisted Living Communities Secure: A Comprehensive Approach from the Perimeter to the Interior

Mar 1, 2025
WHAT THIS MEANS FOR YOU: This article highlights the importance of physical and cybersecurity in assisted living using the People, Programs, Training, and Technology (P2T2) system. For the system to be effective, staff training, resident education, and collaboration with law enforcement are integral. Best practices like checklists can be implemented so that physical security, technological solutions, and emergency preparedness can be addressed for quality assurance.

Keeping Assisted Living Communities Secure: A Comprehensive Approach from the Perimeter to the Interior

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This article highlights the importance of physical and cybersecurity in assisted living using the People, Programs, Training, and Technology (P2T2) system. For the system to be effective, staff training, resident education, and collaboration with law enforcement are integral. Best practices like checklists can be implemented so that physical security, technological solutions, and emergency preparedness can be addressed for quality assurance.

“Nobody Can Be Equipped for This”: Advice from New Residents of Long-Term Care Facilities

Mar 1, 2025
WHAT THIS MEANS FOR YOU: This study involved interviews with 14 residents from a community offering assisted living (AL) and nursing home (NH) levels of care in California to understand residents' perspectives on moving into a long-term care community. Moving due to unexpected health crises was common. Advice for future residents included preparing for moving, avoiding moving, and acceptance of moving. Staff should be prepared to care for residents who often move due to unforseen/unwanted circumstances.

“Nobody Can Be Equipped for This”: Advice from New Residents of Long-Term Care Facilities

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study involved interviews with 14 residents from a community offering assisted living (AL) and nursing home (NH) levels of care in California to understand residents’ perspectives on moving into a long-term care community. Moving due to unexpected health crises was common. Advice for future residents included preparing for moving, avoiding moving, and acceptance of moving. Staff should be prepared to care for residents who often move due to unforseen/unwanted circumstances.

Understanding and Mapping the Antibiotic Prescribing and Administration Process in Assisted Living Facilities

Feb 1, 2025
WHAT THIS MEANS FOR YOU: This descriptive study of seven interviews with staff from five AL communities in the Midwest aimed to map the process for antibiotic prescription and administration for residents. This mapping analysis revealed a 33-step process, grouped into 5 sections: admission, resident change in condition, prescribing, obtaining the prescription, and administration/follow-up. Given concerns about inappropriate antibiotic prescribing in AL, this study's insights revealed pharmacies can play an important role in regulating antibiotic use.

Understanding and Mapping the Antibiotic Prescribing and Administration Process in Assisted Living Facilities

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This descriptive study of seven interviews with staff from five AL communities in the Midwest aimed to map the process for antibiotic prescription and administration for residents. This mapping analysis revealed a 33-step process, grouped into 5 sections: admission, resident change in condition, prescribing, obtaining the prescription, and administration/follow-up. Given concerns about inappropriate antibiotic prescribing in AL, this study’s insights revealed pharmacies can play an important role in regulating antibiotic use.

What Happens Behind Closed Doors? Investigating Care Practices in Nursing Home and Assisted Living Memory Care Units

Feb 1, 2025
WHAT THIS MEANS FOR YOU: This study investigated care practices in memory care units using data from the 2021 Biennial Survey of Ohio Long-Term Care Facilities. Analysis revealed that about 20% of nursing homes and AL communities had memory care units, and that physician monitoring, staffing, and adoption of practices and policies were similar in both settings, but that psychotropic medications were used more frequently in NH memory care units. This analysis indicates that improving memory care may require different interventions in NH vs. AL settings.

What Happens Behind Closed Doors? Investigating Care Practices in Nursing Home and Assisted Living Memory Care Units

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study investigated care practices in memory care units using data from the 2021 Biennial Survey of Ohio Long-Term Care Facilities. Analysis revealed that about 20% of nursing homes and AL communities had memory care units, and that physician monitoring, staffing, and adoption of practices and policies were similar in both settings, but that psychotropic medications were used more frequently in NH memory care units. This analysis indicates that improving memory care may require different interventions in NH vs. AL settings.

Considerations for Use of the Cornell Scale for Depression in Dementia Among Assisted Living Residents: Factor Analysis Results

Feb 1, 2025
WHAT THIS MEANS FOR YOU: This study tested the Cornell Scale for Depression in Dementia (CSDD) with 511 residents from 85 assisted living (AL) communities in three states to understand if it is an appropriate scale for assessing depression in AL residents. Measure-related analysis led to three items being removed from the scale and a five-factor model showed a better fit than the four-factor model, although both showed poor fit. Although a modified CSDD is partially supported for use with this population, future research should explore more appropriate measures for measuring depression in AL residents.

Considerations for Use of the Cornell Scale for Depression in Dementia Among Assisted Living Residents: Factor Analysis Results

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study tested the Cornell Scale for Depression in Dementia (CSDD) with 511 residents from 85 assisted living (AL) communities in three states to understand if it is an appropriate scale for assessing depression in AL residents. Measure-related analysis led to three items being removed from the scale and a five-factor model showed a better fit than the four-factor model, although both showed poor fit. Although a modified CSDD is partially supported for use with this population, future research should explore more appropriate measures for measuring depression in AL residents.

Current State of Healthcare Robots for Older Adults in Care Facilities in Japan and the Related Ethical Issues for Nurses

Feb 1, 2025
WHAT THIS MEANS FOR YOU: This review of healthcare robots in Japan examined their introduction from a nursing ethics perspective. Healthcare robots have the potential to help staff with tasks, but ethical concerns need to be considered and weighed against the six principles of nursing ethics. Patients' rights and are the most important thing for nurses to consider when working with healthcare robots.

Current State of Healthcare Robots for Older Adults in Care Facilities in Japan and the Related Ethical Issues for Nurses

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This review of healthcare robots in Japan examined their introduction from a nursing ethics perspective. Healthcare robots have the potential to help staff with tasks, but ethical concerns need to be considered and weighed against the six principles of nursing ethics. Patients’ rights and are the most important thing for nurses to consider when working with healthcare robots.

Two New Positive Psychosocial Measures for Persons Living with Dementia

Feb 1, 2025
WHAT THIS MEANS FOR YOU: Two pilot studies created and tested two new instruments for evaluating wellbeing for people living with dementia, the Living Well Inventory for Dementia (LWI-D) and the Quality of Day Scale (QODS). Seventeen individuals with early-stage dementia tested the LWI-D, and 30 care dyads tested the QODS. Both measures were supported for acceptability and feasibility, with initial support for reliability and validity; further testing of the instruments is recommended.

Two New Positive Psychosocial Measures for Persons Living with Dementia

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Two pilot studies created and tested two new instruments for evaluating wellbeing for people living with dementia, the Living Well Inventory for Dementia (LWI-D) and the Quality of Day Scale (QODS). Seventeen individuals with early-stage dementia tested the LWI-D, and 30 care dyads tested the QODS. Both measures were supported for acceptability and feasibility, with initial support for reliability and validity; further testing of the instruments is recommended.

A Cluster Randomized Controlled Trial of Visual Cues, Signage, and Spaced Retrieval for Wayfinding Within Long-Term Care Communities

Feb 1, 2025
WHAT THIS MEANS FOR YOU: This randomized control trial of 172 residents in 15 long-term care communities in two midwestern states to examine the impact of cues and signage, with or without spaced retrieval (SR), a memory strategy to improve wayfinding within communities. For simple routes, cues improved wayfinding. SR with cues reduced the number of errors participants made the most, but cues alone also lowered errors in wayfinding, supporting the potential implementation of cues and signage to reduce wayfinding errors in communities.

A Cluster Randomized Controlled Trial of Visual Cues, Signage, and Spaced Retrieval for Wayfinding Within Long-Term Care Communities

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This randomized control trial of 172 residents in 15 long-term care communities in two midwestern states to examine the impact of cues and signage, with or without spaced retrieval (SR), a memory strategy to improve wayfinding within communities. For simple routes, cues improved wayfinding. SR with cues reduced the number of errors participants made the most, but cues alone also lowered errors in wayfinding, supporting the potential implementation of cues and signage to reduce wayfinding errors in communities.

Measurement of Quality in Assisted Living in the United States of America: A Scoping Review

Jan 1, 2025
WHAT THIS MEANS FOR YOU: This scoping review examined 49 peer-reviewed and 45 gray literature articles from 2009-2019 to assess approaches to, and indicators of, quality in assisted living. After thematic analysis, nine domains emerged, with resident qualiy of life and satisfaction being the most prioritized. These nine domains may help inform future standardized quality measurement for AL settings.

Measurement of Quality in Assisted Living in the United States of America: A Scoping Review

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This scoping review examined 49 peer-reviewed and 45 gray literature articles from 2009-2019 to assess approaches to, and indicators of, quality in assisted living. After thematic analysis, nine domains emerged, with resident qualiy of life and satisfaction being the most prioritized. These nine domains may help inform future standardized quality measurement for AL settings.