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

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.

The Meaningful Engagement Assessment for Residents with Dementia in Assisted Living Settings

Jan 1, 2025
WHAT THIS MEANS FOR YOU: This study tested the Meaningful Engagement Assessment (MEA) tool with 31 residents with mild to severe dementia in two assisted living communities. The MEA is designed to create individualized care plannning for residents. With brief training, this pilot study revealed that the tool can feasibly be used by staff to promote meaningful activity for AL residents.

The Meaningful Engagement Assessment for Residents with Dementia in Assisted Living Settings

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study tested the Meaningful Engagement Assessment (MEA) tool with 31 residents with mild to severe dementia in two assisted living communities. The MEA is designed to create individualized care plannning for residents. With brief training, this pilot study revealed that the tool can feasibly be used by staff to promote meaningful activity for AL residents.

Assisted Living, Residential Care, and Memory Care Staffing Level Dynamics: Oregon, 2017-2023

Jan 1, 2025
WHAT THIS MEANS FOR YOU: This longitudinal study examined staffing levels, as measured by care hours per resident per day, from 535 long-term care communities in Oregon between 2017-2023. There was an increase in staff immediately after the pandemic and staffing levels were, on average, 28 minutes higher in 2023 than 2017. However, there was significant variation among AL communities' staffing levels, likely due to organizational-level factors like resource allocation, resident case mix, and operational structures.

Assisted Living, Residential Care, and Memory Care Staffing Level Dynamics: Oregon, 2017-2023

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This longitudinal study examined staffing levels, as measured by care hours per resident per day, from 535 long-term care communities in Oregon between 2017-2023. There was an increase in staff immediately after the pandemic and staffing levels were, on average, 28 minutes higher in 2023 than 2017. However, there was significant variation among AL communities’ staffing levels, likely due to organizational-level factors like resource allocation, resident case mix, and operational structures.

Understanding Urinary Incontinence and Urinary Tract Infections as Key Contributors to Falls in Assisted Living and Memory Care Communities

Jan 1, 2025
WHAT THIS MEANS FOR YOU: This editorial examined how urinary incontinence (UI) and urinary tract infections (UTIs) are contributors to falls for assisted living and memory care residents. Impacts on balance, stability, confusion, and fatigue all contribute to the increased risk. Future falls prevention approaches should consider UI and UTIs, structured toileting, and caregiver training to reduce risk.

Understanding Urinary Incontinence and Urinary Tract Infections as Key Contributors to Falls in Assisted Living and Memory Care Communities

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This editorial examined how urinary incontinence (UI) and urinary tract infections (UTIs) are contributors to falls for assisted living and memory care residents. Impacts on balance, stability, confusion, and fatigue all contribute to the increased risk. Future falls prevention approaches should consider UI and UTIs, structured toileting, and caregiver training to reduce risk.

The Impact of Enhanced Group Activity Kits (EGAKs) on Well-being of Persons with Dementia

Jan 1, 2025
WHAT THIS MEANS FOR YOU: This study examined 123 people living with dementia (PLwD) from 6 nursing centers and 4 adult day units in Israel to investigate the impact of group activities and whether group activity kits (EGAKs) enhanced activity quality. Use of EGAKs significantly improved resident well-being compared to activities without EGAKs, and participating in no activities at all significantly lowered well-being, supporting possible implementation of EGAKs to improve group activities for residents.

The Impact of Enhanced Group Activity Kits (EGAKs) on Well-being of Persons with Dementia

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study examined 123 people living with dementia (PLwD) from 6 nursing centers and 4 adult day units in Israel to investigate the impact of group activities and whether group activity kits (EGAKs) enhanced activity quality. Use of EGAKs significantly improved resident well-being compared to activities without EGAKs, and participating in no activities at all significantly lowered well-being, supporting possible implementation of EGAKs to improve group activities for residents.

The Role of Workday Characteristics on Perceived Stress and Time Pressure among Nurses in Finnish Long-Term Care – A Cross-Sectional Study

Dec 1, 2024
WHAT THIS MEANS FOR YOU: This study examined 503 nurses from 44 AL communities in Finland to examine the relationship between workday characteristics and perceived stress and time pressure. More care task events, clients with greater needs, reduced break times, and disruptions during the day were related to stress and time pressure for staff. Findings indicate that dividing workload evenly among nursing teams can help reduce stress and time pressure.

The Role of Workday Characteristics on Perceived Stress and Time Pressure among Nurses in Finnish Long-Term Care – A Cross-Sectional Study

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study examined 503 nurses from 44 AL communities in Finland to examine the relationship between workday characteristics and perceived stress and time pressure. More care task events, clients with greater needs, reduced break times, and disruptions during the day were related to stress and time pressure for staff. Findings indicate that dividing workload evenly among nursing teams can help reduce stress and time pressure.

Applications of Blockchain Technology in Long-Term Care: Use Cases, Potentials, and Barriers

Dec 1, 2024
WHAT THIS MEANS FOR YOU: This systematic review provides an overview of blockchain technology for assistive technologies, data security, and privacy issues in long-term care settings from 29 studies published from 2016-2023. There is interest in the utility of blockchain technology, but real-world studies are needed. Implementation barriers included technical immaturity, stakeholder cooperation, and access to appropriate infrastructure.

Applications of Blockchain Technology in Long-Term Care: Use Cases, Potentials, and Barriers

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This systematic review provides an overview of blockchain technology for assistive technologies, data security, and privacy issues in long-term care settings from 29 studies published from 2016-2023. There is interest in the utility of blockchain technology, but real-world studies are needed. Implementation barriers included technical immaturity, stakeholder cooperation, and access to appropriate infrastructure.

A New Measure of Professional Caregiver Coping in Long-Term Care: The LTC COPE

Dec 1, 2024
WHAT THIS MEANS FOR YOU: This study developed a new measure for how professional caregivers cope with stress. Data was collected from 391 caregivers in 13 long-term care communities across 3 states using the Long-Term Care Cope instrument. Coping strategies were found to be highly individual with many reporting using multiple strategies. Further testing of the scale is needed to understand and narrow the items in the subcomponents.

A New Measure of Professional Caregiver Coping in Long-Term Care: The LTC COPE

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study developed a new measure for how professional caregivers cope with stress. Data was collected from 391 caregivers in 13 long-term care communities across 3 states using the Long-Term Care Cope instrument. Coping strategies were found to be highly individual with many reporting using multiple strategies. Further testing of the scale is needed to understand and narrow the items in the subcomponents.

Stress-Related Coping and its Relationship to Well-Being in Nursing Assistants and Personal Care Aides in Nursing Homes and Assisted Living

Dec 1, 2024
WHAT THIS MEANS FOR YOU: This cross-sectional study used questionnaire data from 391 professional caregivers from 13 facilities in 3 states to examine coping and its relationship with demographic characteristics of direct caregivers in long-term care. Older staff used adaptive psychological strategies more than younger staff, and traditionally minoritized staff used more adaptive and less maladaptive psychological strategies than white staff. Using avoidance and maladaptive coping strategies was associated with depressive and anxiety symptoms, as well as burnout. Professional caregivers use a variety of coping mechanisms, and training on adaptive coping could improve outcomes for this population.

Stress-Related Coping and its Relationship to Well-Being in Nursing Assistants and Personal Care Aides in Nursing Homes and Assisted Living

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This cross-sectional study used questionnaire data from 391 professional caregivers from 13 facilities in 3 states to examine coping and its relationship with demographic characteristics of direct caregivers in long-term care. Older staff used adaptive psychological strategies more than younger staff, and traditionally minoritized staff used more adaptive and less maladaptive psychological strategies than white staff. Using avoidance and maladaptive coping strategies was associated with depressive and anxiety symptoms, as well as burnout. Professional caregivers use a variety of coping mechanisms, and training on adaptive coping could improve outcomes for this population.

Examining Engagement Calendar Deviations in Assisted Living: A Focus on Residents With Dementia

Dec 1, 2024
WHAT THIS MEANS FOR YOU: This study used data from 3 AL communities over one year to examine deviations from scheduled activity programming, identify influential factors, and understand the outcomes on residents. The analysis showed general adherence to calendars, but deviations did occur. Staffing, capacity, programming guidance and support, staff attitudes, and unforeseen circumstances all influenced these deviations. Cancellations of programming were more detrimental to resident well-being than substitutions.

Examining Engagement Calendar Deviations in Assisted Living: A Focus on Residents With Dementia

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study used data from 3 AL communities over one year to examine deviations from scheduled activity programming, identify influential factors, and understand the outcomes on residents. The analysis showed general adherence to calendars, but deviations did occur. Staffing, capacity, programming guidance and support, staff attitudes, and unforeseen circumstances all influenced these deviations. Cancellations of programming were more detrimental to resident well-being than substitutions.

Medical Care Provider Involvement in Ontario Assisted Living Homes: A Descriptive Cross-Sectional Survey Analysis

Dec 1, 2024
WHAT THIS MEANS FOR YOU: This cross-sectional Canadian study examined 88 AL communities' survey responses to assess medical care provider involvement. A total of 54 AL communities had an established medical care provider, and doctors cared for more than 50 patients in 36% of homes and 46% visited homes weekly. Almost two-thirds of communities had nurses accompany physicians on rounds, and two-thirds provided residents with palliative care. Residents in homes with medical care providers were 76% less likely to seek care from a physician in the community.

Medical Care Provider Involvement in Ontario Assisted Living Homes: A Descriptive Cross-Sectional Survey Analysis

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This cross-sectional Canadian study examined 88 AL communities’ survey responses to assess medical care provider involvement. A total of 54 AL communities had an established medical care provider, and doctors cared for more than 50 patients in 36% of homes and 46% visited homes weekly. Almost two-thirds of communities had nurses accompany physicians on rounds, and two-thirds provided residents with palliative care. Residents in homes with medical care providers were 76% less likely to seek care from a physician in the community.

Transitions to Nursing Homes Among Residents of Assisted Living and Community-Dwelling Home Care Recipients

Dec 1, 2024
This Canadian cohort study included 10,012 AL residents and 131,679 home care recipients who applied for beds in nursing homes to examine the transition differences between the 2 groups. There were 6,049 transitions from AL residents and 85,190 from home care to nursing homes. Living in an AL, rather than in the community, led to a roughly 13% decrease in the 5-year risk of transition to nursing homes despite similar relative clinical complexity and healthcare needs, meaning that assisted living is an important part of the long-term care continuum.

Transitions to Nursing Homes Among Residents of Assisted Living and Community-Dwelling Home Care Recipients

by Lea Efird-Green

This Canadian cohort study included 10,012 AL residents and 131,679 home care recipients who applied for beds in nursing homes to examine the transition differences between the 2 groups. There were 6,049 transitions from AL residents and 85,190 from home care to nursing homes. Living in an AL, rather than in the community, led to a roughly 13% decrease in the 5-year risk of transition to nursing homes despite similar relative clinical complexity and healthcare needs, meaning that assisted living is an important part of the long-term care continuum.

The Efficacy of a Mobile-Based Multidomain Program on Cognitive Functioning of Residents in Assisted Living Facilities

Dec 1, 2024
WHAT THIS MEANS FOR YOU: This study of 20 AL residents who scored in the range of mild cognitive impairment on the MoCA was designed to test the efficacy of a mobile-based program on cognitive functioning (the Silvia program). The intervention group received the mobile program's lifestyle intervention for 50-60 mins, twice weekly, for 12 weeks. The intervention group showed significant improvement in MoCA scores (23.6 vs. 24.3) while the control group declined (22.0 vs. 21.7).

The Efficacy of a Mobile-Based Multidomain Program on Cognitive Functioning of Residents in Assisted Living Facilities

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study of 20 AL residents who scored in the range of mild cognitive impairment on the MoCA was designed to test the efficacy of a mobile-based program on cognitive functioning (the Silvia program). The intervention group received the mobile program’s lifestyle intervention for 50-60 mins, twice weekly, for 12 weeks. The intervention group showed significant improvement in MoCA scores (23.6 vs. 24.3) while the control group declined (22.0 vs. 21.7).

“What Does ‘Age-Friendly’ Mean to You?”: The Role of Microaggressions in a Retirement and Assisted Living Community

Dec 1, 2024
WHAT THIS MEANS FOR YOU: This case study compared four residents' perspectives on the age-friendliness of an AL in the Midwest using semi-structured interviews and observational data. Themes of built design vs. identity of age-friendliness, resident-resident microaggressions, and desired experiences of age-friendliness emerged. Visible diversity created experiences of ableism and racism, whereas invisible diversity did not have the same negative effects. Resident-resident microaggressions undermined the age-friendliness of the facility.

“What Does ‘Age-Friendly’ Mean to You?”: The Role of Microaggressions in a Retirement and Assisted Living Community

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This case study compared four residents’ perspectives on the age-friendliness of an AL in the Midwest using semi-structured interviews and observational data. Themes of built design vs. identity of age-friendliness, resident-resident microaggressions, and desired experiences of age-friendliness emerged. Visible diversity created experiences of ableism and racism, whereas invisible diversity did not have the same negative effects. Resident-resident microaggressions undermined the age-friendliness of the facility.

Risk of Hospitalization Among Assisted Living Residents Dually Enrolled in Medicare and Medicaid

Dec 1, 2024
WHAT THIS MEANS FOR YOU: This retrospective cohort study used Medicare data from 2008-2018 from 12,451 AL communities to examine the risk of hospitalization for Medicare-Medicaid dual eligibles. Out of 620,542 Medicare beneficiaries, the 1-year risk of hospitalization was higher for dually enrolled individuals. The risk was higher in high-dual AL communities than in low-dual AL communities for both dually enrolled (7.4%) and Medicare only (9.4%) individuals.

Risk of Hospitalization Among Assisted Living Residents Dually Enrolled in Medicare and Medicaid

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This retrospective cohort study used Medicare data from 2008-2018 from 12,451 AL communities to examine the risk of hospitalization for Medicare-Medicaid dual eligibles. Out of 620,542 Medicare beneficiaries, the 1-year risk of hospitalization was higher for dually enrolled individuals. The risk was higher in high-dual AL communities than in low-dual AL communities for both dually enrolled (7.4%) and Medicare only (9.4%) individuals.

Factors Associated with Transfer from Assisted Living Facilities to a Nursing Home: National Health Aging Trends Study 2011-2019

Nov 1, 2024
WHAT THIS MEANS FOR YOU: This analysis used the National Health Aging Trends Study to identify factors associated with transfer from an AL community to a nursing home. Data from 970 AL residents over seven years showed that those with better baseline physical performance and college education were at lower risk of transfer. Residents who maintained physical less and had less difficulty with basic activities of daily living (ADLs) were also at lower risk of transfer.

Factors Associated with Transfer from Assisted Living Facilities to a Nursing Home: National Health Aging Trends Study 2011-2019

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This analysis used the National Health Aging Trends Study to identify factors associated with transfer from an AL community to a nursing home. Data from 970 AL residents over seven years showed that those with better baseline physical performance and college education were at lower risk of transfer. Residents who maintained physical less and had less difficulty with basic activities of daily living (ADLs) were also at lower risk of transfer.