Academic Publication

Trends in Assisted Living and Memory Care Supply from 2019 to 2023

Dec 1, 2025

This study examined geographic variation in AL and memory care, and their correlation with county-level characteristics from 2019-2023. In 2023, counties with more AL and memory care were generally wealthier, higher in educational attainment, and urban. During the study period, 43% of counties had a decrease of AL supply ae, which was associated with a higher proportion of older adults in the population, lower income, and increased rurality as compared to those with an increase in supply. In the same period, 29% of counties had a decrease in memory care supply, which was associated with lower educational attainment, more poverty, and increased rurality than the 34% that had an increase in memory care supply. Overall, rural and poorer counties had less access to AL and memory care, showing the importance of increasing access to services in these counties.

Trends in Assisted Living and Memory Care Supply from 2019 to 2023

December 1, 2025 by Lea Efird-Green

This study examined geographic variation in AL and memory care, and their correlation with county-level characteristics from 2019-2023. In 2023, counties with more AL and memory care were generally wealthier, higher in educational attainment, and urban. During the study period, 43% of counties had a decrease of AL supply ae, which was associated with a higher proportion of older adults in the population, lower income, and increased rurality as compared to those with an increase in supply. In the same period, 29% of counties had a decrease in memory care supply, which was associated with lower educational attainment, more poverty, and increased rurality than the 34% that had an increase in memory care supply. Overall, rural and poorer counties had less access to AL and memory care, showing the importance of increasing access to services in these counties.

Vaccination Rates Among Long-Term Care Staff During the COVID-19 Pandemic

Dec 1, 2025

This study of nursing homes and AL communities (ALCs) in Florida compared over 5,200 staff's 2-dose COVID-19 vaccination rate by February 2021 to understand the differences between settings and organizational factors influencing vaccination rates. ALCs initially had lower rates, but by the end of the study period, rates had increased, especially smaller communities. Factors such as for-profit status and rural location were significant predictors of vaccine reception, with smaller, urban ALCs that accepted state funding having higher rates.

Vaccination Rates Among Long-Term Care Staff During the COVID-19 Pandemic

December 1, 2025 by Lea Efird-Green

This study of nursing homes and AL communities (ALCs) in Florida compared over 5,200 staff’s 2-dose COVID-19 vaccination rate by February 2021 to understand the differences between settings and organizational factors influencing vaccination rates. ALCs initially had lower rates, but by the end of the study period, rates had increased, especially smaller communities. Factors such as for-profit status and rural location were significant predictors of vaccine reception, with smaller, urban ALCs that accepted state funding having higher rates.

Exploring Safety Concerns in Assisted Living Communities: A Qualitative Comparison of Resident, Family, and Staff Perspectives

Dec 1, 2025

This qualitative study examined safety concerns from 32 residents, 34 family caregivers, and 38 staff members of AL communities across the US. Overall, 29 safety concerns emerged, with resident condition-related falls as the most commonly cited concern. Residents and family members were more likely than staff to report prompt use of assistive devices/technology, communication, and self-care as concerns, whereas staff were more likely to report environmental-related falls as a concern.

Exploring Safety Concerns in Assisted Living Communities: A Qualitative Comparison of Resident, Family, and Staff Perspectives

December 1, 2025 by Lea Efird-Green

This qualitative study examined safety concerns from 32 residents, 34 family caregivers, and 38 staff members of AL communities across the US. Overall, 29 safety concerns emerged, with resident condition-related falls as the most commonly cited concern. Residents and family members were more likely than staff to report prompt use of assistive devices/technology, communication, and self-care as concerns, whereas staff were more likely to report environmental-related falls as a concern.

Physical Activity and Sedentary Behavior in Assisted Living Residents: Feasibility and Acceptability of a Longitudinal Study

Dec 1, 2025

This study of 44 residents from 9 AL communities in Michigan examined the feasibility of a longitudinal study on physical activity and sedentary behavior. Over the six months, physical activity slightly decreased, which was more prominent in residents with cognitive change, and sedentary behaviors slightly increased. The study supported the feasibility of longitudinal testing to track these behavior changes.

Physical Activity and Sedentary Behavior in Assisted Living Residents: Feasibility and Acceptability of a Longitudinal Study

December 1, 2025 by Lea Efird-Green

This study of 44 residents from 9 AL communities in Michigan examined the feasibility of a longitudinal study on physical activity and sedentary behavior. Over the six months, physical activity slightly decreased, which was more prominent in residents with cognitive change, and sedentary behaviors slightly increased. The study supported the feasibility of longitudinal testing to track these behavior changes.

End-of-Life Outcomes and Staff Visits for Hospice Recipients Residing in Assisted Living

Dec 1, 2025

This study used 2018 to 2019 Medicare claims data from over 42,000 AL residents to examine whether hospice staff visits were associated with end-of-life transitions, place of death, and discharges, and whether state AL regulations influence these outcomes. More frequent visits were associated with less end-of-life transitions, discharges, and increased likelihood of dying in place. Regulations requiring on-site staffing and medication delegation were also associated with fewer transitions and increased dying in place, highlighting the role that both organizational and regulatory policies in shaping end-of-life outcomes.

End-of-Life Outcomes and Staff Visits for Hospice Recipients Residing in Assisted Living

December 1, 2025 by Lea Efird-Green

This study used 2018 to 2019 Medicare claims data from over 42,000 AL residents to examine whether hospice staff visits were associated with end-of-life transitions, place of death, and discharges, and whether state AL regulations influence these outcomes. More frequent visits were associated with less end-of-life transitions, discharges, and increased likelihood of dying in place. Regulations requiring on-site staffing and medication delegation were also associated with fewer transitions and increased dying in place, highlighting the role that both organizational and regulatory policies in shaping end-of-life outcomes.

Barriers and Facilitators to Physical Activity Among Older Adults in Residential Aged Care Facilities: A Mixed Methods Systematic Review Using the Social Ecological Model

Dec 1, 2025

This systematic review of 67 studies examined the barriers and facilitators to physical activity in long-term care settings from the perspectives of residents, staff, and family members. Using thematic synthesis, 51 themes emerged, 27 relating to facilitators and 24 to barriers. Interpersonal factors, such as social support, were the most commonly cited facilitator and intrapersonal factors, such as health, were the most commonly cited barrier.

Barriers and Facilitators to Physical Activity Among Older Adults in Residential Aged Care Facilities: A Mixed Methods Systematic Review Using the Social Ecological Model

December 1, 2025 by Lea Efird-Green

This systematic review of 67 studies examined the barriers and facilitators to physical activity in long-term care settings from the perspectives of residents, staff, and family members. Using thematic synthesis, 51 themes emerged, 27 relating to facilitators and 24 to barriers. Interpersonal factors, such as social support, were the most commonly cited facilitator and intrapersonal factors, such as health, were the most commonly cited barrier.

Vision Impairment is a Risk Factor for Malnutrition in Older Long-Term Care Residents

Dec 1, 2025

This Finnish study of over 2,500 residents from 47 AL communities and 7 nursing homes examined the relationship between vision and nutrition. Overall, 18% of participants had vision impairment; impairment was associated with malnutrition, as were chewing problems and Clinical Dementia Rating.

Vision Impairment is a Risk Factor for Malnutrition in Older Long-Term Care Residents

December 1, 2025 by Lea Efird-Green

This Finnish study of over 2,500 residents from 47 AL communities and 7 nursing homes examined the relationship between vision and nutrition. Overall, 18% of participants had vision impairment; impairment was associated with malnutrition, as were chewing problems and Clinical Dementia Rating.

Personal Care Aide Staffing in U.S. Residential Care Communities: The Role of Aide Training Hours, Training Reimbursement, and Organizational Structures

Dec 1, 2025

This study investigated residential care communities (RCCs) characteristics associated with care aide hours per resident day using data from 518 RCCs in the 2022 National Post-acute and Long-term Care Study. Factors related to higher staffing hours included reimbursement for training and occupancy greater than 85%, whereas factors such as initial training of more than 60 hours, increased Medicaid involement, and being a larger community were associated with lower staffing hours.

Personal Care Aide Staffing in U.S. Residential Care Communities: The Role of Aide Training Hours, Training Reimbursement, and Organizational Structures

December 1, 2025 by Lea Efird-Green

This study investigated residential care communities (RCCs) characteristics associated with care aide hours per resident day using data from 518 RCCs in the 2022 National Post-acute and Long-term Care Study. Factors related to higher staffing hours included reimbursement for training and occupancy greater than 85%, whereas factors such as initial training of more than 60 hours, increased Medicaid involement, and being a larger community were associated with lower staffing hours.

Implementation and Acceptance of Oral Health Assessment Tools in Residential Aged Care Facilities: A Scoping Review

Dec 1, 2025

This scoping review of 26 studies examined the implementation and acceptance of oral health assessment tools in long-term care communities. For non-dental professionals, barriers to implementing tools included insufficient training, high staff turnover, and inconsistent prioritizing of oral health, while facilitators included targeted training and the presence of oral health supporters. None of the included studies used an implementation science framework, despite the variety of tools identified in the review, indicating a gap in the clinical translation of the tools.

Implementation and Acceptance of Oral Health Assessment Tools in Residential Aged Care Facilities: A Scoping Review

December 1, 2025 by Lea Efird-Green

This scoping review of 26 studies examined the implementation and acceptance of oral health assessment tools in long-term care communities. For non-dental professionals, barriers to implementing tools included insufficient training, high staff turnover, and inconsistent prioritizing of oral health, while facilitators included targeted training and the presence of oral health supporters. None of the included studies used an implementation science framework, despite the variety of tools identified in the review, indicating a gap in the clinical translation of the tools.

Analysis of Exercise Programs in Assisted Living Facilities – A Cross-Sectional Study

Nov 1, 2025

This descriptive study examined exercise programs in 12 AL communities using data form 216 residents. Overall, 55% of participants used assistive devices, but only 17% had their devices assessed by a healthcare professional within the last 12 months; all facilities offered seated exercises, and four also included standing exercises. Exercise programs focused on a range of motion, some combined with resistance or functional training, but there was a predominance of low-intensity regimens. The findings indicated a need for better training for activity directors in moderate and high intensity exercises, and need for engaging more of a community's residents in physical activity.

Analysis of Exercise Programs in Assisted Living Facilities – A Cross-Sectional Study

November 1, 2025 by Lea Efird-Green

This descriptive study examined exercise programs in 12 AL communities using data form 216 residents. Overall, 55% of participants used assistive devices, but only 17% had their devices assessed by a healthcare professional within the last 12 months; all facilities offered seated exercises, and four also included standing exercises. Exercise programs focused on a range of motion, some combined with resistance or functional training, but there was a predominance of low-intensity regimens. The findings indicated a need for better training for activity directors in moderate and high intensity exercises, and need for engaging more of a community’s residents in physical activity.

Trends in Private Equity Acquisitions of Assisted Living Facilities

Nov 1, 2025

This study examined trends in private equity (PE) acquisitions of AL communities (ALCs) from 2006-2023. They found a total of 252 PE acquisitions of 912 ALCs. Although acquisitions occurred in 47 states, more than one third of them were in Florida. Rates of acquisition increased after 2013, with the highest adjusted value occurring in 2019. Since PE acquisitions are likely to continue, future research should examine PE-involved ALCs' impacts on residents and their access to AL.

Trends in Private Equity Acquisitions of Assisted Living Facilities

November 1, 2025 by Lea Efird-Green

This study examined trends in private equity (PE) acquisitions of AL communities (ALCs) from 2006-2023. They found a total of 252 PE acquisitions of 912 ALCs. Although acquisitions occurred in 47 states, more than one third of them were in Florida. Rates of acquisition increased after 2013, with the highest adjusted value occurring in 2019. Since PE acquisitions are likely to continue, future research should examine PE-involved ALCs’ impacts on residents and their access to AL.

Prevalence of Suicidal Behaviors in Residents of Long-Term Care Facilities: A Systematic Review and Meta-Analysis

Nov 1, 2025

This systematic review of 20 studies examined the prevalence of suicidal behaviors of long-term care residents. The prevalence of worldwide suicidal behavior was just over 6%, putting residents at higher risk than the general population. Physical health and psychological concerns were related to suicide risk, suggesting areas for potential prevention strategies.

Prevalence of Suicidal Behaviors in Residents of Long-Term Care Facilities: A Systematic Review and Meta-Analysis

November 1, 2025 by Lea Efird-Green

This systematic review of 20 studies examined the prevalence of suicidal behaviors of long-term care residents. The prevalence of worldwide suicidal behavior was just over 6%, putting residents at higher risk than the general population. Physical health and psychological concerns were related to suicide risk, suggesting areas for potential prevention strategies.

Virtual House Calls: Using Digital Health Technology for Populations in Assisted Living

Nov 1, 2025

This case study assessed the use of mobile telehealth technology during home visits in Canada. The case highlights potential to reduce care burden and enhance patient care by integrating multiple digital health technologies into house calls. However, barriers such as inconsistent access to funding and the need for consistent high-speed internet mean that the innovation may not be applicable to all assisted living residents.

Virtual House Calls: Using Digital Health Technology for Populations in Assisted Living

November 1, 2025 by Lea Efird-Green

This case study assessed the use of mobile telehealth technology during home visits in Canada. The case highlights potential to reduce care burden and enhance patient care by integrating multiple digital health technologies into house calls. However, barriers such as inconsistent access to funding and the need for consistent high-speed internet mean that the innovation may not be applicable to all assisted living residents.

The National Dementia Workforce Study: Perspective From the National Institute on Aging

Nov 1, 2025

This article discusses the goals, data collection, and data release of the National Dementia Workforce Study (NDWS), a longitudinal study that will help track workforce changes over time in community-based medical practices, nursing homes, AL communities, and home care. The NDWS is the first nationally representative study of this workforce, including information on knowledge, skills, experiences, challenges, job retention, and financial struggles.

The National Dementia Workforce Study: Perspective From the National Institute on Aging

November 1, 2025 by Lea Efird-Green

This article discusses the goals, data collection, and data release of the National Dementia Workforce Study (NDWS), a longitudinal study that will help track workforce changes over time in community-based medical practices, nursing homes, AL communities, and home care. The NDWS is the first nationally representative study of this workforce, including information on knowledge, skills, experiences, challenges, job retention, and financial struggles.

The National Dementia Workforce Study: Development of Questionnaires for Home Care, Assisted Living, and Nursing Home Settings

Nov 1, 2025

This report describes the design of the National Dementia Workforce Study (NDWS) initial questionnaire. The process involved integrating literature reviews, validated questionnaire items, expert consultations, and cognitive interviews to ensure reliability and validity. The resulting data from the NDWS will be available to researchers to better understand the workforce serving people living with dementia.

The National Dementia Workforce Study: Development of Questionnaires for Home Care, Assisted Living, and Nursing Home Settings

November 1, 2025 by Lea Efird-Green

This report describes the design of the National Dementia Workforce Study (NDWS) initial questionnaire. The process involved integrating literature reviews, validated questionnaire items, expert consultations, and cognitive interviews to ensure reliability and validity. The resulting data from the NDWS will be available to researchers to better understand the workforce serving people living with dementia.

The National Dementia Workforce Study: The Plan for Organization Sample Frames and Data Collection

Nov 1, 2025

This article outlines the plan for developing organization sample frames and data collection methods for the National Dementia Workforce Study (NDWS). Since no national sampling frames for this workforce exist, a two-stage sampling framework was developed: stage 1 involved identifying organizations, inviting them to participate in a survey, and asking them to provide staff information; and stage 2 involved recruiting individual staff for the NDWS survey.

The National Dementia Workforce Study: The Plan for Organization Sample Frames and Data Collection

November 1, 2025 by Lea Efird-Green

This article outlines the plan for developing organization sample frames and data collection methods for the National Dementia Workforce Study (NDWS). Since no national sampling frames for this workforce exist, a two-stage sampling framework was developed: stage 1 involved identifying organizations, inviting them to participate in a survey, and asking them to provide staff information; and stage 2 involved recruiting individual staff for the NDWS survey.

A Person-Centred Approach to Further Develop a Digital Tool (KOKU-Nut) by Developing a Nutrition Game for Older Adults Living in the Community

Nov 1, 2025

This qualitative study involved developing and testing Keep on Keep up (KOKU), a well-being app, through focus groups with 33 older adults in AL communities in the UK. The focus groups focused on nutrition and four themes emerged that helped develop the nutrition game: change in diet due to different aspects of aging, perception of food, choice of food, and perspectives about digital tools to support nutrition. The majority of participants had positive attitudes towards KOKU, and feeback from the testing group was generally positive, with high scores for usability.

A Person-Centred Approach to Further Develop a Digital Tool (KOKU-Nut) by Developing a Nutrition Game for Older Adults Living in the Community

November 1, 2025 by Lea Efird-Green

This qualitative study involved developing and testing Keep on Keep up (KOKU), a well-being app, through focus groups with 33 older adults in AL communities in the UK. The focus groups focused on nutrition and four themes emerged that helped develop the nutrition game: change in diet due to different aspects of aging, perception of food, choice of food, and perspectives about digital tools to support nutrition. The majority of participants had positive attitudes towards KOKU, and feeback from the testing group was generally positive, with high scores for usability.

Factors Associated with the Variation in Drug Prescription of Antipsychotics in Long-Term Care Facilities: A Systematic Review

Nov 1, 2025

This systematic review of 14 studies examined the factors involved in antispsychotic prescribing in long-term care (LTC) communities. Findings showed that better staff training and increased availability of nurses were associated with lower antipsychotic use, while nonprofit and government communities had lower antipsychotic prevalence and better quality of care. Increased collaboration across health disciplines and developing guidelines to alleviate the current variability in prescribing practices are important steps to take to reduce antispychotic use in LTC settings.

Factors Associated with the Variation in Drug Prescription of Antipsychotics in Long-Term Care Facilities: A Systematic Review

November 1, 2025 by Lea Efird-Green

This systematic review of 14 studies examined the factors involved in antispsychotic prescribing in long-term care (LTC) communities. Findings showed that better staff training and increased availability of nurses were associated with lower antipsychotic use, while nonprofit and government communities had lower antipsychotic prevalence and better quality of care. Increased collaboration across health disciplines and developing guidelines to alleviate the current variability in prescribing practices are important steps to take to reduce antispychotic use in LTC settings.

Comparing Outcomes Among Medicaid Home and Community-Based Service Users: Private Homes vs. Assisted Living Facilities

Oct 1, 2025

This study used 2016-2019 Medicare Claims data to compare outcomes (hospitalizations, emergency department visits, days at home, and Medicare spending) between 380,000 Medicare-Medicaid dual eligibles in two settings: home and community-based services (HCBS) users in private homes, and in AL communities (ALCs). Of these individuals, 85% were home-dwelling and 15% were in ALCs. In-home HCBS users worse outcomes; they had a higher likelihood of hospitalizations and emergency department visits and fewer days at home, as well as higher Medicaid spending as compared with ALC residents.

Comparing Outcomes Among Medicaid Home and Community-Based Service Users: Private Homes vs. Assisted Living Facilities

October 1, 2025 by Lea Efird-Green

This study used 2016-2019 Medicare Claims data to compare outcomes (hospitalizations, emergency department visits, days at home, and Medicare spending) between 380,000 Medicare-Medicaid dual eligibles in two settings: home and community-based services (HCBS) users in private homes, and in AL communities (ALCs). Of these individuals, 85% were home-dwelling and 15% were in ALCs. In-home HCBS users worse outcomes; they had a higher likelihood of hospitalizations and emergency department visits and fewer days at home, as well as higher Medicaid spending as compared with ALC residents.

Dialectical Behavioral Therapy Skills Training in Assisted Living: Transdiagnostic Effects on Goal Attainment, Self-Efficacy, and Symptom Severity

Oct 1, 2025

This Austrian study of 52 residents from 4 AL communities examined an 8-week dialectical behavioral therapy skills training intervention's effects on residents' self-efficacy, goal attainment, and psychological distress. Goal attainment and psychological distress scores showed initial improvement, but they were not statistically significant and did not further improve at follow-up, meaning that the intervention may need to be better adapted to the AL setting to be effective.

Dialectical Behavioral Therapy Skills Training in Assisted Living: Transdiagnostic Effects on Goal Attainment, Self-Efficacy, and Symptom Severity

October 1, 2025 by Lea Efird-Green

This Austrian study of 52 residents from 4 AL communities examined an 8-week dialectical behavioral therapy skills training intervention’s effects on residents’ self-efficacy, goal attainment, and psychological distress. Goal attainment and psychological distress scores showed initial improvement, but they were not statistically significant and did not further improve at follow-up, meaning that the intervention may need to be better adapted to the AL setting to be effective.

The Relationship Between Home and Community-Based Services Utilization and Self-Reported Quality of Life for Community-Dwelling and Assisted Living Residents with and without Dementia

Oct 1, 2025

This study of 1413 respondents from the 2018 Minnesota National Core Indicators-Aging and Disability survey examined the relationship between specific home and community-based services and quality of life. On average, respondents with dementia reported lower quality of life scores than respondents without dementia. Using personal care assistants was most significantly correlated with increased quality of life, while services such as home health care and adult day services were not significantly associated with quality of life.

The Relationship Between Home and Community-Based Services Utilization and Self-Reported Quality of Life for Community-Dwelling and Assisted Living Residents with and without Dementia

October 1, 2025 by Lea Efird-Green

This study of 1413 respondents from the 2018 Minnesota National Core Indicators-Aging and Disability survey examined the relationship between specific home and community-based services and quality of life. On average, respondents with dementia reported lower quality of life scores than respondents without dementia. Using personal care assistants was most significantly correlated with increased quality of life, while services such as home health care and adult day services were not significantly associated with quality of life.

“What Good Is That?”-Perspectives of Using Telehealth to Discuss Serious Illness with Urban-Dwelling Low-Income Older Adults in Assisted Living

Oct 1, 2025

This qualitative study of 46 residents from 3 Medicaid-funded AL communities examined telehealth acceptance among low-income residents. Four themes emerged: the primary benefit (convenience), barrier (technology access and literacy), resident preference (ranging from enthusiasm to skepticism, but generally distasteful), and concerns (mistrust of providers). Overall, telehealth can improve convenience, but additional supports are needed to foster trust and effective therapeutic relationships.

“What Good Is That?”-Perspectives of Using Telehealth to Discuss Serious Illness with Urban-Dwelling Low-Income Older Adults in Assisted Living

October 1, 2025 by Lea Efird-Green

This qualitative study of 46 residents from 3 Medicaid-funded AL communities examined telehealth acceptance among low-income residents. Four themes emerged: the primary benefit (convenience), barrier (technology access and literacy), resident preference (ranging from enthusiasm to skepticism, but generally distasteful), and concerns (mistrust of providers). Overall, telehealth can improve convenience, but additional supports are needed to foster trust and effective therapeutic relationships.