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

Clinical Comorbidities and Transitions Between Care Settings Among Residents of Assisted Living Facilities: A Repeated Cross-Sectional Study

Jul 1, 2023
WHAT THIS MEANS FOR YOU: Administrative data from 2013-2019 in Ontario, Canada found a 34% increase in the resident population, and residents experienced increased instances of health conditions including renal disease, mental health issues, cardiac arrhythmias, diabetes, and cancer. Approximately 20% of residents still lived in an assisted living community at the end of the 6-year period, while 10% transitioned to nursing homes. In less than a decade, data revealed increasing medical complexity of assisted living residents, which must be considered for improved policy and practice.

Clinical Comorbidities and Transitions Between Care Settings Among Residents of Assisted Living Facilities: A Repeated Cross-Sectional Study

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Administrative data from 2013-2019 in Ontario, Canada found a 34% increase in the resident population, and residents experienced increased instances of health conditions including renal disease, mental health issues, cardiac arrhythmias, diabetes, and cancer. Approximately 20% of residents still lived in an assisted living community at the end of the 6-year period, while 10% transitioned to nursing homes. In less than a decade, data revealed increasing medical complexity of assisted living residents, which must be considered for improved policy and practice.

Turning It Over to God: African American Assisted Living Residents’ End-of-Life Preferences and Advance Care Planning

Jul 1, 2023
WHAT THIS MEANS FOR YOU: A qualitative study in a 100-bed assisted living community catering to African American residents found that a shared belief that God was ultimately in control related to end-of-life and advance care planning preferences, although this relationship was influenced by other individual-level factors like age, pain, function, health literacy, and past experiences with healthcare.

Turning It Over to God: African American Assisted Living Residents’ End-of-Life Preferences and Advance Care Planning

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: A qualitative study in a 100-bed assisted living community catering to African American residents found that a shared belief that God was ultimately in control related to end-of-life and advance care planning preferences, although this relationship was influenced by other individual-level factors like age, pain, function, health literacy, and past experiences with healthcare.

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

Jun 1, 2023
WHAT THIS MEANS FOR YOU: This study examined associations between end-of-life care transitions (meaning stays in hospitals and nursing homes in either the 7 or 30 days before death in this study) and state staffing and training requirements for nearly 114,000 Medicare beneficiaries who died in an assisted living community in 2018-2019. A higher proportion of transitions was associated with stricter regulations about licensed and direct care worker staffing, whereas a lower proportion was associated with more specific regulations about direct care worker training. Therefore, policymakers and practitioners may want to implement regulations that make staff training requirements more specific to better address end-of-life care.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study examined associations between end-of-life care transitions (meaning stays in hospitals and nursing homes in either the 7 or 30 days before death in this study) and state staffing and training requirements for nearly 114,000 Medicare beneficiaries who died in an assisted living community in 2018-2019. A higher proportion of transitions was associated with stricter regulations about licensed and direct care worker staffing, whereas a lower proportion was associated with more specific regulations about direct care worker training. Therefore, policymakers and practitioners may want to implement regulations that make staff training requirements more specific to better address end-of-life care.

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

Jun 1, 2023
WHAT THIS MEANS FOR YOU: In this study, almost 150,000 on-line consumer reviews from nearly 9,000 assisted living communities were analyzed in the context of community, county, and state variables (e.g., regulatory specificity, rurality). Communities with greater proportions of Medicare/Medicaid residents had lower odds of positive reviews, but communities in states with more direct care worker hours per week per bed had higher odds of positive reviews. Higher staffing may advantage positive consumer perceptions.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: In this study, almost 150,000 on-line consumer reviews from nearly 9,000 assisted living communities were analyzed in the context of community, county, and state variables (e.g., regulatory specificity, rurality). Communities with greater proportions of Medicare/Medicaid residents had lower odds of positive reviews, but communities in states with more direct care worker hours per week per bed had higher odds of positive reviews. Higher staffing may advantage positive consumer perceptions.

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

Jun 1, 2023
WHAT THIS MEANS FOR YOU: This study examined differences in who may be admitted to an assisted living community using regulatory data from 2018. Admission restrictions were categorized into 1) health-related conditions, 2) specified behavior, 3) mental health condition, and 4) cognitive impairment. Almost one-third (29%) of communities are governed by regulations limiting admission of individuals with only a health condition, and slightly fewer (24%) of communities have limitations based on all four categories. Just over 11% of AL communities have no restrictions on who may be admitted.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study examined differences in who may be admitted to an assisted living community using regulatory data from 2018. Admission restrictions were categorized into 1) health-related conditions, 2) specified behavior, 3) mental health condition, and 4) cognitive impairment. Almost one-third (29%) of communities are governed by regulations limiting admission of individuals with only a health condition, and slightly fewer (24%) of communities have limitations based on all four categories. Just over 11% of AL communities have no restrictions on who may be admitted.

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

Jun 1, 2023
WHAT THIS MEANS FOR YOU: The study examined potentially burdensome end-of-life transitions (e.g., repeated hospitalizations) in relation to state regulations, using Medicare claims data for over 129,000 assisted living residents in communities with 25 or more beds between 2017-2019. There were no associations between transitions and regulations about third-party services or staffing, and small associations between transitions and medication management regulations. These inconclusive results indicate that more research is needed to understand the wide variety of end-of-life outcomes experienced by assisted living residents.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: The study examined potentially burdensome end-of-life transitions (e.g., repeated hospitalizations) in relation to state regulations, using Medicare claims data for over 129,000 assisted living residents in communities with 25 or more beds between 2017-2019. There were no associations between transitions and regulations about third-party services or staffing, and small associations between transitions and medication management regulations. These inconclusive results indicate that more research is needed to understand the wide variety of end-of-life outcomes experienced by assisted living residents.

Hospital Proximity and Emergency Department Use among Assisted Living Residents

Jun 1, 2023
WHAT THIS MEANS FOR YOU: This study assessed if the distance between AL communities and the nearest hospital was associated with the frequency of emergency department (ED) visits. Almost 541,000 Medicare beneficiaries aged 55 or older residing in over 16,500 AL communities in 2018-2019 were included. The median distance to the nearest hospital was 2.5 miles. Distance was related to ED use, especially for non-critical, visits, such that communities 5 or more miles from a hospital had fewer ED visits than those that were closer to a hospital.

Hospital Proximity and Emergency Department Use among Assisted Living Residents

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study assessed if the distance between AL communities and the nearest hospital was associated with the frequency of emergency department (ED) visits. Almost 541,000 Medicare beneficiaries aged 55 or older residing in over 16,500 AL communities in 2018-2019 were included. The median distance to the nearest hospital was 2.5 miles. Distance was related to ED use, especially for non-critical, visits, such that communities 5 or more miles from a hospital had fewer ED visits than those that were closer to a hospital.

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

Jun 1, 2023
WHAT THIS MEANS FOR YOU: This study analyzed 170 psychotropic medication deficiency citations from 152 Oregon assisted living communities to determine discrepancies in state licensing and oversight of psychotropic medication use. It found most deficiencies involved documentation errors; there were unclear regulations for direct care workers who distribute medications; and there was a persistent disconnect about when to seek expertise before requesting psychotropic use.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study analyzed 170 psychotropic medication deficiency citations from 152 Oregon assisted living communities to determine discrepancies in state licensing and oversight of psychotropic medication use. It found most deficiencies involved documentation errors; there were unclear regulations for direct care workers who distribute medications; and there was a persistent disconnect about when to seek expertise before requesting psychotropic use.

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

Jun 1, 2023
WHAT THIS MEANS FOR YOU: This study investigated mental health needs and barriers among residents at Medicaid-funded AL communities. At one AL community in the Bronx, 13 residents completed questionnaires and interviews; analysis revealed patterns of mental health needs, feelings of losing control, mistrust of organizational staff, and lack of resources and support.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study investigated mental health needs and barriers among residents at Medicaid-funded AL communities. At one AL community in the Bronx, 13 residents completed questionnaires and interviews; analysis revealed patterns of mental health needs, feelings of losing control, mistrust of organizational staff, and lack of resources and support.

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

Jun 1, 2023
WHAT THIS MEANS FOR YOU: In this study, 19 support staff from 7 assisted living communities in Belgium were interviewed to understand about how adults with intellectual disabilities related to these staff. Themes revealed that staff often struggled finding a balance between supporting select attachment behaviors and maintaining a professional distance from residents to prevent negative impact on their work.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: In this study, 19 support staff from 7 assisted living communities in Belgium were interviewed to understand about how adults with intellectual disabilities related to these staff. Themes revealed that staff often struggled finding a balance between supporting select attachment behaviors and maintaining a professional distance from residents to prevent negative impact on their work.

Likelihood of Assisted Living Residents Aging in Place as a Factor of Dual Medicare-Medicaid Eligibility at the End of Life

May 1, 2023
WHAT THIS MEANS FOR YOU: This study used Medicare enrollment and claims records to examine more than 142,000 AL residents’ ability to stay in their community in the last 30 days of life. Residents who were eligible for both Medicaid and Medicare (dual eligibles) were much less likely than those not eligible for Medicaid to remain in AL in their last 30 days of life or die there. However, this difference varies by state.

Likelihood of Assisted Living Residents Aging in Place as a Factor of Dual Medicare-Medicaid Eligibility at the End of Life

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study used Medicare enrollment and claims records to examine more than 142,000 AL residents’ ability to stay in their community in the last 30 days of life. Residents who were eligible for both Medicaid and Medicare (dual eligibles) were much less likely than those not eligible for Medicaid to remain in AL in their last 30 days of life or die there. However, this difference varies by state.

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

May 1, 2023
WHAT THIS MEANS FOR YOU: In this study, undergraduate nursing students implemented a 6-week Fall Prevention Care Management intervention for 25 residents in two AL communities. The intervention included individualized care using motivational interviewing and behavioral change related to fall prevention, as well as helping residents reflect on their perceptions of fall prevention. Qualitative analysis suggested that individualized support improved residents’ opinions of the intervention and facilitated participation for residents at high risk of falls.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: In this study, undergraduate nursing students implemented a 6-week Fall Prevention Care Management intervention for 25 residents in two AL communities. The intervention included individualized care using motivational interviewing and behavioral change related to fall prevention, as well as helping residents reflect on their perceptions of fall prevention. Qualitative analysis suggested that individualized support improved residents’ opinions of the intervention and facilitated participation for residents at high risk of falls.

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

May 1, 2023
WHAT THIS MEANS FOR YOU: This study used Medicare and CDC datasets to examine telemedicine primary care among 62,000 AL residents with dementia during the first year of the COVID-19 pandemic (2020). During the first three quarters of the pandemic, racially minoritized groups (Black, Hispanic) and Medicare-Medicaid dual eligibles were able to successfully use telemedicine at high rates. Gaps in primary care access between these groups and others (white, non-Medicaid eligible) were reduced due to telemedicine. This could inform CMS decisions about Medicare coverage for telemedicine primary care.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study used Medicare and CDC datasets to examine telemedicine primary care among 62,000 AL residents with dementia during the first year of the COVID-19 pandemic (2020). During the first three quarters of the pandemic, racially minoritized groups (Black, Hispanic) and Medicare-Medicaid dual eligibles were able to successfully use telemedicine at high rates. Gaps in primary care access between these groups and others (white, non-Medicaid eligible) were reduced due to telemedicine. This could inform CMS decisions about Medicare coverage for telemedicine primary care.

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

May 1, 2023
WHAT THIS MEANS FOR YOU: A new methodology was developed for identifying Medicare beneficiaries residing in licensed AL communities in the US using zip code data, Medicare enrollment data, and claims data, and exclusion based on AL capacity (licensing information). Results suggested that using licensing information makes identifying AL residents receiving Medicare more accurate, which could inform research and policy by providing new insights into the health of AL residents.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: A new methodology was developed for identifying Medicare beneficiaries residing in licensed AL communities in the US using zip code data, Medicare enrollment data, and claims data, and exclusion based on AL capacity (licensing information). Results suggested that using licensing information makes identifying AL residents receiving Medicare more accurate, which could inform research and policy by providing new insights into the health of AL residents.

Grief, Social Support, Spirituality, and Depressive Symptoms Among Older Adults in Assisted Living in Kansas

May 1, 2023
WHAT THIS MEANS FOR YOU: In a study of 316 residents from seven assisted living communities in Kansas, higher grief related to more depressive symptoms, while strong support from friends and spiritual coping related to fewer symptoms. Thus, bereavement, social support, and spiritual intervention programs may potentially alleviate depression symptoms in assisted living residents.

Grief, Social Support, Spirituality, and Depressive Symptoms Among Older Adults in Assisted Living in Kansas

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: In a study of 316 residents from seven assisted living communities in Kansas, higher grief related to more depressive symptoms, while strong support from friends and spiritual coping related to fewer symptoms. Thus, bereavement, social support, and spiritual intervention programs may potentially alleviate depression symptoms in assisted living residents.

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

Apr 1, 2023
WHAT THIS MEANS FOR YOU: Face-to-face interviews with healthcare professionals, group meetings, and participant observation were used to examine interprofessional care teamwork in one community that combines independent living, AL, and skilled nursing. Organizational context, care setting factors, and reimbursement programs like Medicare and Medicaid affected teamwork in different ways; for example, co-location of services in a building did not necessarily ensure teamwork among care providers. Additionally, mission-driven investment in care was not sufficient to ensure teamwork. Thus, teamwork in communities that have different levels of care must be specifically considered when creating organizational policies and procedures.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Face-to-face interviews with healthcare professionals, group meetings, and participant observation were used to examine interprofessional care teamwork in one community that combines independent living, AL, and skilled nursing. Organizational context, care setting factors, and reimbursement programs like Medicare and Medicaid affected teamwork in different ways; for example, co-location of services in a building did not necessarily ensure teamwork among care providers. Additionally, mission-driven investment in care was not sufficient to ensure teamwork. Thus, teamwork in communities that have different levels of care must be specifically considered when creating organizational policies and procedures.

State Variation in Antipsychotic Use Among Assisted Living Residents With Dementia

Apr 1, 2023
WHAT THIS MEANS FOR YOU: This study of almost 21,000 AL residents in 2017 revealed that those with dementia were prescribed antipsychotics during about 13% of their time residing in AL. This proportion varied by state, with Hawaii having the lowest prescription rate (8%), and Wyoming having the highest (21%). Variations may be due to state regulation of AL communities, but the study was not able to determine if prescription practices were appropriate and tied to health outcomes.

State Variation in Antipsychotic Use Among Assisted Living Residents With Dementia

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study of almost 21,000 AL residents in 2017 revealed that those with dementia were prescribed antipsychotics during about 13% of their time residing in AL. This proportion varied by state, with Hawaii having the lowest prescription rate (8%), and Wyoming having the highest (21%). Variations may be due to state regulation of AL communities, but the study was not able to determine if prescription practices were appropriate and tied to health outcomes.

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

Apr 1, 2023
WHAT THIS MEANS FOR YOU: A survey about AL family caregiver experiences in Western Canada was conducted before and during waves one (Mar to Jun 2020) and two (Oct 2020 to Feb 2021) of the COVID-19 pandemic. A total of 386 family caregivers representing 110 AL communities participated. In-person visits and caregiver involvement decreased significantly during wave one of the pandemic due to visitor restrictions. Caregivers’ concerns about their relatives significantly increased during both waves, especially when they did not feel well-informed or involved in their relative’s care.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: A survey about AL family caregiver experiences in Western Canada was conducted before and during waves one (Mar to Jun 2020) and two (Oct 2020 to Feb 2021) of the COVID-19 pandemic. A total of 386 family caregivers representing 110 AL communities participated. In-person visits and caregiver involvement decreased significantly during wave one of the pandemic due to visitor restrictions. Caregivers’ concerns about their relatives significantly increased during both waves, especially when they did not feel well-informed or involved in their relative’s care.

Experiences of Social Frailty Among Rural Community-Dwelling and Assisted-Living Older Adults: A Qualitative Study

Apr 1, 2023
WHAT THIS MEANS FOR YOU: Interviews were conducted with 38 older adults in rural villages and AL communities in the Netherlands to compare the effect of social frailty, measured by access to social resources and activities that fulfill social needs. Social frailty is the actual or potential loss of social resources and activities over time, leading to loneliness and isolation. Older adults who live independently in their own communities experienced self-reported loneliness, while those living in AL communities reported higher participation in social activities. Therefore, for some older adults, a residential setting may be preferable to aging in place to address loneliness and social frailty.

Experiences of Social Frailty Among Rural Community-Dwelling and Assisted-Living Older Adults: A Qualitative Study

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Interviews were conducted with 38 older adults in rural villages and AL communities in the Netherlands to compare the effect of social frailty, measured by access to social resources and activities that fulfill social needs. Social frailty is the actual or potential loss of social resources and activities over time, leading to loneliness and isolation. Older adults who live independently in their own communities experienced self-reported loneliness, while those living in AL communities reported higher participation in social activities. Therefore, for some older adults, a residential setting may be preferable to aging in place to address loneliness and social frailty.

Robots in Assisted Living Facilities: Scoping Review

Mar 1, 2023
WHAT THIS MEANS FOR YOU: There is a persisting staffing shortage in long-term care, and the use of robots in AL shows promise in relieving some staffing pressures. This systematic review found benefits of using robots to improve social interaction, emotional regulation, and fall prevention; however, some studies found barriers to robot use and inconclusive results. Overall, the quality of many of the studies was questionable, and more rigorous studies are needed to understand the impact of robots on AL staff and residents.

Robots in Assisted Living Facilities: Scoping Review

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: There is a persisting staffing shortage in long-term care, and the use of robots in AL shows promise in relieving some staffing pressures. This systematic review found benefits of using robots to improve social interaction, emotional regulation, and fall prevention; however, some studies found barriers to robot use and inconclusive results. Overall, the quality of many of the studies was questionable, and more rigorous studies are needed to understand the impact of robots on AL staff and residents.

Using Medicare Enrollment Data to Identify Beneficiaries in Assisted Living

Mar 1, 2023
WHAT THIS MEANS FOR YOU: Because AL is state-regulated, obtaining information about Medicare beneficiaries in AL can be difficult. This study identified AL Medicare beneficiaries using zip code files, Medicare databases, and other data sets, which can aid researchers and policymakers.

Using Medicare Enrollment Data to Identify Beneficiaries in Assisted Living

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Because AL is state-regulated, obtaining information about Medicare beneficiaries in AL can be difficult. This study identified AL Medicare beneficiaries using zip code files, Medicare databases, and other data sets, which can aid researchers and policymakers.

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

Feb 1, 2023
WHAT THIS MEANS FOR YOU: Vaccines are a part of the solution to infectious disease outbreaks like COVID-19, but not everyone is getting them, especially older adults. In a Canadian study, pneumonia vaccine uptake was improved by providing assisted living and long-term care communities with vaccine coverage data and providing automatic reminders for subsequent doses. Therefore, a cloud-based digital vaccination record is one solution to promote the uptake of adult vaccines for older adults, as well as tracking immunization records and sharing them with policymaking organizations. This can improve communication and inform policymakers to reduce the risk of infection in AL communities.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Vaccines are a part of the solution to infectious disease outbreaks like COVID-19, but not everyone is getting them, especially older adults. In a Canadian study, pneumonia vaccine uptake was improved by providing assisted living and long-term care communities with vaccine coverage data and providing automatic reminders for subsequent doses. Therefore, a cloud-based digital vaccination record is one solution to promote the uptake of adult vaccines for older adults, as well as tracking immunization records and sharing them with policymaking organizations. This can improve communication and inform policymakers to reduce the risk of infection in AL communities.

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

Feb 1, 2023
WHAT THIS MEANS FOR YOU: In a study gathering recommendations from AL residents about a program to increase physical activity. most residents were interested in increasing their activity and thought of it as being important. However, they had concerns about the program’s level of difficulty, the length of sessions, and how the end goals were framed. Thus, it is vital to elicit feedback from residents when designing a new program in AL.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: In a study gathering recommendations from AL residents about a program to increase physical activity. most residents were interested in increasing their activity and thought of it as being important. However, they had concerns about the program’s level of difficulty, the length of sessions, and how the end goals were framed. Thus, it is vital to elicit feedback from residents when designing a new program in AL.

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

Feb 1, 2023
WHAT THIS MEANS FOR YOU: About 25% of Medicare beneficiaries in AL are also eligible for Medicaid, 78% of whom lived in 20% of AL communities nationally. This study analyzed 47 state policies, 5 of which had no Medicaid coverage for AL services (put abbreviations of the five states here). However, those states had the highest concentration of Medicaid-eligible people residing in AL, meaning that Medicaid coverage in those 5 states could benefit many residents.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: About 25% of Medicare beneficiaries in AL are also eligible for Medicaid, 78% of whom lived in 20% of AL communities nationally. This study analyzed 47 state policies, 5 of which had no Medicaid coverage for AL services (put abbreviations of the five states here). However, those states had the highest concentration of Medicaid-eligible people residing in AL, meaning that Medicaid coverage in those 5 states could benefit many residents.