Academic Publication

COVID-19 in Assisted Living: Protecting a Critical Long-Term Care Resource

Feb 16, 2022

WHAT THIS MEANS FOR YOU: This literature review explores how COVID-19 created challenges for both residents and staff in assisted living by providing an overview of its impact and suggesting actions to improve outcomes. Studies showed that residents experienced a decline in their health and happiness because of infection control measures, which made them feel lonely and isolated. Staff faced problems such as staff shortages, feeling overwhelmed and stressed, and dealing with emotional struggles. The article suggests solutions such as improving infection control, giving better training to staff, introducing Essential Caregiver programs, and encouraging residents to socialize more.

COVID-19 in Assisted Living: Protecting a Critical Long-Term Care Resource

February 16, 2022 by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This literature review explores how COVID-19 created challenges for both residents and staff in assisted living by providing an overview of its impact and suggesting actions to improve outcomes. Studies showed that residents experienced a decline in their health and happiness because of infection control measures, which made them feel lonely and isolated. Staff faced problems such as staff shortages, feeling overwhelmed and stressed, and dealing with emotional struggles. The article suggests solutions such as improving infection control, giving better training to staff, introducing Essential Caregiver programs, and encouraging residents to socialize more.

“Uncivilized Children” or “Victims of Dementia”: Interpretations of Aggression in Older Assisted Living Tenants

Feb 1, 2022

WHAT THIS MEANS FOR YOU: Researchers interviewed 13 AL residents and 19 care workers in two communities about resident aggression. Care workers reported physical and verbal aggression, while residents reported relational and sexual aggression from peers. Both groups often attributed aggression to communal living, aging, or dementia, suggesting that they normalized the behavior and often did not report it. Underreporting of resident aggression was more common for workers than residents.

“Uncivilized Children” or “Victims of Dementia”: Interpretations of Aggression in Older Assisted Living Tenants

February 1, 2022 by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Researchers interviewed 13 AL residents and 19 care workers in two communities about resident aggression. Care workers reported physical and verbal aggression, while residents reported relational and sexual aggression from peers. Both groups often attributed aggression to communal living, aging, or dementia, suggesting that they normalized the behavior and often did not report it. Underreporting of resident aggression was more common for workers than residents.

The Impact of Cognitive Impairment on Clinical Symptoms, Physical Activity and Care Interactions among Residents in Assisted Living Settings

Feb 1, 2022

WHAT THIS MEANS FOR YOU: This study included 550 AL residents from 59 communities, and assessed how cognitive impairment relates to physical activity, pain, and willingness to receive staff-assisted function-focused care. It found that cognitively impaired residents were less active, experienced more pain, and were less interested in staff-assisted function-focused care activities.

The Impact of Cognitive Impairment on Clinical Symptoms, Physical Activity and Care Interactions among Residents in Assisted Living Settings

February 1, 2022 by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study included 550 AL residents from 59 communities, and assessed how cognitive impairment relates to physical activity, pain, and willingness to receive staff-assisted function-focused care. It found that cognitively impaired residents were less active, experienced more pain, and were less interested in staff-assisted function-focused care activities.

Storage Issues in Assisted Living Facilities and Senior Living Communities

Feb 1, 2022

WHAT THIS MEANS FOR YOU: During the COVID-19 pandemic, AL communities faced hurdles obtaining vital supplies including masks and gloves; AL communities were often considered lower priority than other healthcare settings, leading to delays in receipt. When supplies were obtained, the quantity often overwhelmed available storage space, leading to unsafe supply storage. Solutions include improved emergency management, emphasizing proper storage, and optimizing delivery schedules.

Storage Issues in Assisted Living Facilities and Senior Living Communities

February 1, 2022 by Lea Efird-Green

WHAT THIS MEANS FOR YOU: During the COVID-19 pandemic, AL communities faced hurdles obtaining vital supplies including masks and gloves; AL communities were often considered lower priority than other healthcare settings, leading to delays in receipt. When supplies were obtained, the quantity often overwhelmed available storage space, leading to unsafe supply storage. Solutions include improved emergency management, emphasizing proper storage, and optimizing delivery schedules.

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

February 1, 2022 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.

Assisted Living Administrators’ Approaches to Advance Care Planning

Feb 1, 2022

WHAT THIS MEANS FOR YOU: Interviews with 27 AL administrators revealed different approaches to advanced care planning (ACP). They all acknowledged the importance of ACP and often discussed topics like “do-not-resuscitate” orders when new residents arrived. Challenges included insufficient ACP training for staff and administrators and some reluctance from residents and families to discuss ACP. Most communities lacked a systematic, structured ACP approach.

Assisted Living Administrators’ Approaches to Advance Care Planning

February 1, 2022 by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Interviews with 27 AL administrators revealed different approaches to advanced care planning (ACP). They all acknowledged the importance of ACP and often discussed topics like “do-not-resuscitate” orders when new residents arrived. Challenges included insufficient ACP training for staff and administrators and some reluctance from residents and families to discuss ACP. Most communities lacked a systematic, structured ACP approach.

Model Testing of the Factors that Influence Performance of Function Focused Care and Function among Assisted Living Residents

Feb 1, 2022

WHAT THIS MEANS FOR YOU: A study of 550 AL residents from 59 communities found that factors such as better physical and cognitive health, positive care interactions, and supportive environments were associated with increased participation in function-focused care. Additionally, for-profit communities had higher levels of function-focused care despite having residents with lower functioning.

Model Testing of the Factors that Influence Performance of Function Focused Care and Function among Assisted Living Residents

February 1, 2022 by Lea Efird-Green

WHAT THIS MEANS FOR YOU: A study of 550 AL residents from 59 communities found that factors such as better physical and cognitive health, positive care interactions, and supportive environments were associated with increased participation in function-focused care. Additionally, for-profit communities had higher levels of function-focused care despite having residents with lower functioning.

Implementing Large-Scale Data-Driven Quality Improvement in Assisted Living

Feb 1, 2022

WHAT THIS MEANS FOR YOU: A quality improvement initiative implemented by 810 Wisconsin assisted living communities serving over 20,000 residents found that most communities (88%) were able to comply with membership requirements and 71% remained enrolled for more than 2 years. This model could be reproduced in other states to improve quality.

Implementing Large-Scale Data-Driven Quality Improvement in Assisted Living

February 1, 2022 by Lea Efird-Green

WHAT THIS MEANS FOR YOU: A quality improvement initiative implemented by 810 Wisconsin assisted living communities serving over 20,000 residents found that most communities (88%) were able to comply with membership requirements and 71% remained enrolled for more than 2 years. This model could be reproduced in other states to improve quality.

Reimagining Medical Care in Assisted Living

Feb 1, 2022

WHAT THIS MEANS FOR YOU: Three industry-wide proposals were recommended to enhance medical care quality for AL residents: regular on-site medical visits; employing experienced professionals in long-term and end-of-life care; and the introduction of an AL medical director role to establish rules, staff qualifications, and collaboration. The researchers acknowledge that adaptations may be necessary to adhere to these recommendations due to community size and availability of resources.

Reimagining Medical Care in Assisted Living

February 1, 2022 by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Three industry-wide proposals were recommended to enhance medical care quality for AL residents: regular on-site medical visits; employing experienced professionals in long-term and end-of-life care; and the introduction of an AL medical director role to establish rules, staff qualifications, and collaboration. The researchers acknowledge that adaptations may be necessary to adhere to these recommendations due to community size and availability of resources.

Rapid Adoption of Electronic Health Record and Health Information Exchange among Assisted Living Communities, 2010–2018

Feb 1, 2022

WHAT THIS MEANS FOR YOU: This study examined the use of electronic health records (EHRs) and health information exchange (HIE) in AL between 2010 and 2018. Use varied based on AL size and ownership, with larger (26+ beds) and chain-owned communities more likely to use these technologies. Overall, adoption of these technologies increased from 2010 to 2018, but smaller communities had lower adoption rates.

Rapid Adoption of Electronic Health Record and Health Information Exchange among Assisted Living Communities, 2010–2018

February 1, 2022 by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study examined the use of electronic health records (EHRs) and health information exchange (HIE) in AL between 2010 and 2018. Use varied based on AL size and ownership, with larger (26+ beds) and chain-owned communities more likely to use these technologies. Overall, adoption of these technologies increased from 2010 to 2018, but smaller communities had lower adoption rates.

State Medicaid Financing and Access to Large Assisted Living Settings for Medicare–Medicaid Dual-Eligibles

Feb 1, 2022

WHAT THIS MEANS FOR YOU: This study examined two groups of Medicare beneficiaries residing in large (25+ beds) AL communities in 2014: dual Medicare and Medicaid beneficiaries, and Medicare-only beneficiaries. Among 506,193 beneficiaries, 18% were dually eligible; they tended to be younger, minority, and have more chronic health conditions. The share of dual-eligibles by state varied widely; states with Medicaid financing for AL had more dual-eligibles, but variation in state room and board regulations did not have a significant relationship to dual-eligible rates.

State Medicaid Financing and Access to Large Assisted Living Settings for Medicare–Medicaid Dual-Eligibles

February 1, 2022 by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study examined two groups of Medicare beneficiaries residing in large (25+ beds) AL communities in 2014: dual Medicare and Medicaid beneficiaries, and Medicare-only beneficiaries. Among 506,193 beneficiaries, 18% were dually eligible; they tended to be younger, minority, and have more chronic health conditions. The share of dual-eligibles by state varied widely; states with Medicaid financing for AL had more dual-eligibles, but variation in state room and board regulations did not have a significant relationship to dual-eligible rates.

Memory Care Reduces Nursing Home Admissions among Assisted-Living Residents with Dementia

Jan 1, 2022

WHAT THIS MEANS FOR YOU: Medicare data for over 20,600 assisted living residents with Alzheimer's disease and related dementias (ADRD) indicate that residents of memory care had a significantly lower risk of hospitalization, nursing home admission, and long-term nursing home stays compared to those in general communities.

Memory Care Reduces Nursing Home Admissions among Assisted-Living Residents with Dementia

January 1, 2022 by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Medicare data for over 20,600 assisted living residents with Alzheimer’s disease and related dementias (ADRD) indicate that residents of memory care had a significantly lower risk of hospitalization, nursing home admission, and long-term nursing home stays compared to those in general communities.

Post-Acute Care Transitions and Outcomes among Medicare Beneficiaries in Assisted Living Communities

Jan 1, 2022

WHAT THIS MEANS FOR YOU: Medicare data were used to analyze post-acute care referrals for over 104,000 assisted living residents. The most common referral after hospitalizations was to skilled nursing. Referrals to skilled nursing were associated with a lower likelihood of emergency department visits and hospital readmissions; however, there was higher likelihood of long-term skilled nursing placement and death.

Post-Acute Care Transitions and Outcomes among Medicare Beneficiaries in Assisted Living Communities

January 1, 2022 by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Medicare data were used to analyze post-acute care referrals for over 104,000 assisted living residents. The most common referral after hospitalizations was to skilled nursing. Referrals to skilled nursing were associated with a lower likelihood of emergency department visits and hospital readmissions; however, there was higher likelihood of long-term skilled nursing placement and death.

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

January 1, 2022 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.