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

Adaptive Biking for Assisted Living Memory Care Residents and Staff: A Feasibility Study

Aug 1, 2024
WHAT THIS MEANS FOR YOU: This study paired 8 memory care residents and 7 staff members from an AL community to test a biking program as an intervention to improve health and well-being. The pairs completed eight 20-30 minute bike rides over 4 weeks. The rides gave residents and staff a chance to discuss issues around health and well-being. Qualitative results indicate further piloting of the program could be warranted given its acceptability and feasibility.

Adaptive Biking for Assisted Living Memory Care Residents and Staff: A Feasibility Study

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study paired 8 memory care residents and 7 staff members from an AL community to test a biking program as an intervention to improve health and well-being. The pairs completed eight 20-30 minute bike rides over 4 weeks. The rides gave residents and staff a chance to discuss issues around health and well-being. Qualitative results indicate further piloting of the program could be warranted given its acceptability and feasibility.

Family Involvement among Oregon Adult Foster Home Residents, 2018-2023

Aug 1, 2024
WHAT THIS MEANS FOR YOU: This study used cross-sectional data from 2017-2022 from Adult Foster Homes (AFHs) in Oregon to examine trends in family involvement and home and resident characteristics. Data showed declines in familial social visits and help with appointments in 2021/22 following COVID-19, but by 2023 social visits were back to pre-pandemic levels. However, there was less familial support in going on outings and getting to medical appointments, and there were disparities in that rural and Medicaid AFHs had less family support for residents in all areas. The continued decline in medical appointment and outings support presents concerns for resident socio-emotional well-being.

Family Involvement among Oregon Adult Foster Home Residents, 2018-2023

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study used cross-sectional data from 2017-2022 from Adult Foster Homes (AFHs) in Oregon to examine trends in family involvement and home and resident characteristics. Data showed declines in familial social visits and help with appointments in 2021/22 following COVID-19, but by 2023 social visits were back to pre-pandemic levels. However, there was less familial support in going on outings and getting to medical appointments, and there were disparities in that rural and Medicaid AFHs had less family support for residents in all areas. The continued decline in medical appointment and outings support presents concerns for resident socio-emotional well-being.

Variation in Hospice Aide Care by Residential Setting

Aug 1, 2024
WHAT THIS MEANS FOR YOU: This longitudinal cohort study examined data from 1,915 Medicare beneficiaries who died between 2010-2019 and had hospice claims in different residential settings to compare hospice aide use. Hospice aide visits were least common in community settings, followed by NHs and AL communities. However, analyzed factors associated with hospice aide visits were similar among settings, meaning that further research is needed to understand how to tailor hospice care appropriately for different settings.

Variation in Hospice Aide Care by Residential Setting

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This longitudinal cohort study examined data from 1,915 Medicare beneficiaries who died between 2010-2019 and had hospice claims in different residential settings to compare hospice aide use. Hospice aide visits were least common in community settings, followed by NHs and AL communities. However, analyzed factors associated with hospice aide visits were similar among settings, meaning that further research is needed to understand how to tailor hospice care appropriately for different settings.

Associations between Specialized Dementia Care, COVID-19 and Central Nervous System Medication Use in Assisted Living: A Population-Based Repeated Cross-Sectional Study

Aug 1, 2024
WHAT THIS MEANS FOR YOU: This cross-sectional study examined the associations between AL setting (general or memory care), COVID-19 waves, and drug use among residents with dementia in Alberta between 2018-2021. In waves 2-4, antipsychotic drug use increased in all AL communities, but in waves 3 and 4, this was more pronounced in dementia care units. Other drug type uses were similar, although gabapentinoid usage increased for dementia care residents only.

Associations between Specialized Dementia Care, COVID-19 and Central Nervous System Medication Use in Assisted Living: A Population-Based Repeated Cross-Sectional Study

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This cross-sectional study examined the associations between AL setting (general or memory care), COVID-19 waves, and drug use among residents with dementia in Alberta between 2018-2021. In waves 2-4, antipsychotic drug use increased in all AL communities, but in waves 3 and 4, this was more pronounced in dementia care units. Other drug type uses were similar, although gabapentinoid usage increased for dementia care residents only.

Well-Being Outcomes from the Delivery of RASCALs, a Group Activity Intervention Using Nature-Focused Livestream Broadcasts

Aug 1, 2024
WHAT THIS MEANS FOR YOU: This study pilot tested the effectiveness of RASCALs, a nature-based group activity program, to improve resident well-being in an AL community in Texas. The test group of 16 residents that lived in buildings that received RASCALs programming showed increased positive relations with others as measured by a wellbeing scale as compared to the 17 residents who did not receive programming.

Well-Being Outcomes from the Delivery of RASCALs, a Group Activity Intervention Using Nature-Focused Livestream Broadcasts

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study pilot tested the effectiveness of RASCALs, a nature-based group activity program, to improve resident well-being in an AL community in Texas. The test group of 16 residents that lived in buildings that received RASCALs programming showed increased positive relations with others as measured by a wellbeing scale as compared to the 17 residents who did not receive programming.

The Prevalence and Benefits of Self-Compassion Among Professional Caregivers

Aug 1, 2024
WHAT THIS MEANS FOR YOU: This cross-sectional study examined the relationship between self-compassion, anxiety and depressive symptoms, and job satisfaction from 391 caregivers across 13 nursing homes and assisted living communities in 3 states. Older caregivers, those with higher education, and those who were born outside the US reported highest self-compassion, while white caregivers reported the lowest. Self-compassion was negatively associated with mental health symptoms and positively associated with job satisfaction, meaning that its use could be beneficial as one method to address workforce issues in long-term care.

The Prevalence and Benefits of Self-Compassion Among Professional Caregivers

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This cross-sectional study examined the relationship between self-compassion, anxiety and depressive symptoms, and job satisfaction from 391 caregivers across 13 nursing homes and assisted living communities in 3 states. Older caregivers, those with higher education, and those who were born outside the US reported highest self-compassion, while white caregivers reported the lowest. Self-compassion was negatively associated with mental health symptoms and positively associated with job satisfaction, meaning that its use could be beneficial as one method to address workforce issues in long-term care.

Impact of Antecedent and Organizational Differences on Nurse-Social Worker Collaboration in a Retirement and Assisted Living Community with Skilled Nursing Care

Aug 1, 2024
WHAT THIS MEANS FOR YOU: This qualitative thematic study of 23 workers at a Midwestern AL community explored nurses' and social workers' collaborative experiences. Contrasts arose in responding to resident complexity and peer-to-peer work, with a main difference being social workers' focus on resident self-determination and nurses' focus on resident safety. Social workers showed greater openness to working with nurses while nurses showed greater separation, which has implications for teamwork in these settings.

Impact of Antecedent and Organizational Differences on Nurse-Social Worker Collaboration in a Retirement and Assisted Living Community with Skilled Nursing Care

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This qualitative thematic study of 23 workers at a Midwestern AL community explored nurses’ and social workers’ collaborative experiences. Contrasts arose in responding to resident complexity and peer-to-peer work, with a main difference being social workers’ focus on resident self-determination and nurses’ focus on resident safety. Social workers showed greater openness to working with nurses while nurses showed greater separation, which has implications for teamwork in these settings.

Admission and Discharge Practices Among Assisted Living Communities: The Role of State Regulations and Organizational Characteristics

Aug 1, 2024
WHAT THIS MEANS FOR YOU: This study examined state regulations and characteristics from 250 AL communities in 7 states related to admission and discharge practices and three activities of daily living (ADLs). State regulations were not associated with admission and discharge practices, but communities who were above the mean in staff-resident ratio were 17% more likely to admit residents with feeding difficulties and 25% less likely to discharge them. For-profit facilities were more likely to admit residents with bathing and feeding difficulties. These relationships mean that organizational characteristics may drive admission and discharge practices more than state regulations.

Admission and Discharge Practices Among Assisted Living Communities: The Role of State Regulations and Organizational Characteristics

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study examined state regulations and characteristics from 250 AL communities in 7 states related to admission and discharge practices and three activities of daily living (ADLs). State regulations were not associated with admission and discharge practices, but communities who were above the mean in staff-resident ratio were 17% more likely to admit residents with feeding difficulties and 25% less likely to discharge them. For-profit facilities were more likely to admit residents with bathing and feeding difficulties. These relationships mean that organizational characteristics may drive admission and discharge practices more than state regulations.

Revolutionizing Patient Surveillance in Assisted Living Facilities: Insights from AUGi Technology Implementation

Jul 1, 2024
WHAT THIS MEANS FOR YOU: The study examined the effectiveness of a remote-surveillance technology (AUGi) to enhance falls surveillance, conduct remote assessments and send out alerts in 3 AL communities in 3 different states. Using data collection, AUGi facilitated a 64% average reduction in falls and had success enhancing nurse surveillance by providing falls notifications.

Revolutionizing Patient Surveillance in Assisted Living Facilities: Insights from AUGi Technology Implementation

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: The study examined the effectiveness of a remote-surveillance technology (AUGi) to enhance falls surveillance, conduct remote assessments and send out alerts in 3 AL communities in 3 different states. Using data collection, AUGi facilitated a 64% average reduction in falls and had success enhancing nurse surveillance by providing falls notifications.

Assessing the Potential of Technology to Describe Resident and Staff Interactions in Assisted Living Facilities

Jul 1, 2024
WHAT THIS MEANS FOR YOU: This study examined 83 staff at an AL community in New York using a remote surveillance technology to assess nurse-resident interactions and improve falls prevention over 170 days. Data showed that staff visited residents an average of 20.7 times a day. As compared to traditional in-person methods, staff responded faster through the app (2.7 minutes via app vs. 3.3 minutes via in-person call requests) to urgent alerts.

Assessing the Potential of Technology to Describe Resident and Staff Interactions in Assisted Living Facilities

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study examined 83 staff at an AL community in New York using a remote surveillance technology to assess nurse-resident interactions and improve falls prevention over 170 days. Data showed that staff visited residents an average of 20.7 times a day. As compared to traditional in-person methods, staff responded faster through the app (2.7 minutes via app vs. 3.3 minutes via in-person call requests) to urgent alerts.

Comparison of Hospitalization Events among Residents of Assisted Living and Nursing Homes during COVID-19: Do Settings Respond Differently during Public Health Crises?

Jul 1, 2024
WHAT THIS MEANS FOR YOU: This cross-sectional study compared hospitalization events in nursing homes (NHs) and AL communities in Alberta across 4 waves of the COVID-19 pandemic. In both NHs and AL communities, hospitalizations decreased during waves 1 and 4, and both showed increased hospitalizations with death during wave 2, although the increase was larger in AL communities. Unlike AL communities, NHs had increased hospitalizations with delayed discharge during and after wave 1.

Comparison of Hospitalization Events among Residents of Assisted Living and Nursing Homes during COVID-19: Do Settings Respond Differently during Public Health Crises?

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This cross-sectional study compared hospitalization events in nursing homes (NHs) and AL communities in Alberta across 4 waves of the COVID-19 pandemic. In both NHs and AL communities, hospitalizations decreased during waves 1 and 4, and both showed increased hospitalizations with death during wave 2, although the increase was larger in AL communities. Unlike AL communities, NHs had increased hospitalizations with delayed discharge during and after wave 1.

A Qualitative Study of a Sporting Memories Program in South Australia: Belonging, Participation, and Social Connection

Jul 1, 2024
WHAT THIS MEANS FOR YOU: This study examined 16 participants' opinions on the Sporting Memories program in South Australia using focus groups. The Sporting Memory program utilizes reminiscing about sports to achieve social benefits. Themes of feeling free to talk, not feeling left out, and a chance to share and learn emerged, and participants did indeed feel that they built social connections.

A Qualitative Study of a Sporting Memories Program in South Australia: Belonging, Participation, and Social Connection

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study examined 16 participants’ opinions on the Sporting Memories program in South Australia using focus groups. The Sporting Memory program utilizes reminiscing about sports to achieve social benefits. Themes of feeling free to talk, not feeling left out, and a chance to share and learn emerged, and participants did indeed feel that they built social connections.

Prevalence Rates of Diabetic Retinopathy and Undiagnosed Diabetes Among Delaware Nursing Home and Assisted Living Facility Residents

Jul 1, 2024
WHAT THIS MEANS FOR YOU: This cross-sectional study examined eye test data from 2005-2009 in 22 facilities in Delaware to find prevalence of undiagnosed diabetes in assisted living and nursing home residents. A total of 3.6% of residents had hemorrhages in at least one eye, and of these residents, only 56.8% had a diabetes diagnosis, which is connected to eye hemorrhages. The results suggest a need for regular eye care for diabetic and non-diabetic residents to prevent adverse outcomes.

Prevalence Rates of Diabetic Retinopathy and Undiagnosed Diabetes Among Delaware Nursing Home and Assisted Living Facility Residents

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This cross-sectional study examined eye test data from 2005-2009 in 22 facilities in Delaware to find prevalence of undiagnosed diabetes in assisted living and nursing home residents. A total of 3.6% of residents had hemorrhages in at least one eye, and of these residents, only 56.8% had a diabetes diagnosis, which is connected to eye hemorrhages. The results suggest a need for regular eye care for diabetic and non-diabetic residents to prevent adverse outcomes.

Prevalence and Correlates of Antipsychotic Medication Use in Oregon Assisted Living

Jun 1, 2024
WHAT THIS MEANS FOR YOU: An analysis of data from 463 AL communities in Oregon from 2017-2019 revealed that on average, 30.7% of residents had received antipsychotics in the past 90 days. Nonprofit settings had lower usage compared to for-profit settings, while communities with more residents using Medicaid had higher rates of antipsychotic usage. Residents in memory care were more likely to receive these medications than residents in general AL settings.

Prevalence and Correlates of Antipsychotic Medication Use in Oregon Assisted Living

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: An analysis of data from 463 AL communities in Oregon from 2017-2019 revealed that on average, 30.7% of residents had received antipsychotics in the past 90 days. Nonprofit settings had lower usage compared to for-profit settings, while communities with more residents using Medicaid had higher rates of antipsychotic usage. Residents in memory care were more likely to receive these medications than residents in general AL settings.

Changes in Nursing Staff Levels and Injury-Related Emergency Department Visits among Assisted Living Residents with Alzheimers Disease and Related Dementias

Jun 1, 2024
WHAT THIS MEANS FOR YOU: An analysis of 2007-2015 Medicare data for over 12,000 AL residents with ADRD in 455 Ohio AL communities showed that higher levels of RN staffing hours per resident per day led to a 53% decrease in injury-related emergency department visits.

Changes in Nursing Staff Levels and Injury-Related Emergency Department Visits among Assisted Living Residents with Alzheimers Disease and Related Dementias

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: An analysis of 2007-2015 Medicare data for over 12,000 AL residents with ADRD in 455 Ohio AL communities showed that higher levels of RN staffing hours per resident per day led to a 53% decrease in injury-related emergency department visits.

The Experiences of Routine Powered Mobility Users in an Assisted Living Facility: A Case Study

Jun 1, 2024
WHAT THIS MEANS FOR YOU: A case study of 2 powered mobility device (PMD) users in the same AL community in Ohio used interviews, observational data, and digital image profiling to understand their experiences. The main themes to emerge were initial disapproval of needing a PMD, the actual need for PMD to enable movement, its impact on independence, and training – or a lack thereof – for using the PMD.

The Experiences of Routine Powered Mobility Users in an Assisted Living Facility: A Case Study

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: A case study of 2 powered mobility device (PMD) users in the same AL community in Ohio used interviews, observational data, and digital image profiling to understand their experiences. The main themes to emerge were initial disapproval of needing a PMD, the actual need for PMD to enable movement, its impact on independence, and training – or a lack thereof – for using the PMD.

Does Assisted Living Provide Assistance And Promote Living?

May 1, 2024
WHAT THIS MEANS FOR YOU: AL communities in the United States serve more than 918,000 older adults as of 2018. In this commentary, the authors examined how workforce limitations, the complexity of regulations, consumer needs, and lack of financing contribute to negative consequences for aging in place and well-being. They suggest policy changes in those four areas, such as increased staffing, boosting wages and training, encouraging uniform data reporting, and making community disclosure statements more accessible.

Does Assisted Living Provide Assistance And Promote Living?

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: AL communities in the United States serve more than 918,000 older adults as of 2018. In this commentary, the authors examined how workforce limitations, the complexity of regulations, consumer needs, and lack of financing contribute to negative consequences for aging in place and well-being. They suggest policy changes in those four areas, such as increased staffing, boosting wages and training, encouraging uniform data reporting, and making community disclosure statements more accessible.

Estimated Prevalence of Resident-to-Resident Aggression in Assisted Living

May 1, 2024
WHAT THIS MEANS FOR YOU: Observational data from 930 participants in a cross-sectional study over a 1-month period assessed resident-to-resident aggression in 14 New York AL communities. Approximately 15% of residents were found to have engaged in resident-to-resident aggression, with the two most common types being verbal and physical aggression. Intervention research on the prevention of resident-to-resident aggression is recommended to address its prevalence and negative impacts on residents’ physical and psychological health.

Estimated Prevalence of Resident-to-Resident Aggression in Assisted Living

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Observational data from 930 participants in a cross-sectional study over a 1-month period assessed resident-to-resident aggression in 14 New York AL communities. Approximately 15% of residents were found to have engaged in resident-to-resident aggression, with the two most common types being verbal and physical aggression. Intervention research on the prevention of resident-to-resident aggression is recommended to address its prevalence and negative impacts on residents’ physical and psychological health.

Bioethics in Gerontology: Developing a Typology of Ethical Issues in Assisted Living

May 1, 2024
WHAT THIS MEANS FOR YOU: A team of researchers developed a typology of the ethical conflicts that are likely to exist within AL communities. Drawing on data from a 5-year qualitative study in four ALs for validation, this typology aims to help families, staff, and residents identify and understand ethical best practices in AL communities.

Bioethics in Gerontology: Developing a Typology of Ethical Issues in Assisted Living

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: A team of researchers developed a typology of the ethical conflicts that are likely to exist within AL communities. Drawing on data from a 5-year qualitative study in four ALs for validation, this typology aims to help families, staff, and residents identify and understand ethical best practices in AL communities.

Serious Mental Illness in Assisted Living Communities: Association with Nursing Home Placement

May 1, 2024
WHAT THIS MEANS FOR YOU: An analysis of data from over 289,000 Medicare beneficiaries in 17,265 ALs from 2018 to 2019 revealed that over half of AL residents had at least one serious mental illness diagnosis, with major depression being the most common (93%). Residents with schizophrenia or bipolar disorder were statistically significantly less likely to be permanently placed in NHs (as opposed to continued AL residency) respective to the average rate of placement for all residents in the analysis. However, the risk of permanent NH placement was higher for residents with ADRD, including residents with a schizophrenia or bipolar disorder diagnosis.

Serious Mental Illness in Assisted Living Communities: Association with Nursing Home Placement

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: An analysis of data from over 289,000 Medicare beneficiaries in 17,265 ALs from 2018 to 2019 revealed that over half of AL residents had at least one serious mental illness diagnosis, with major depression being the most common (93%). Residents with schizophrenia or bipolar disorder were statistically significantly less likely to be permanently placed in NHs (as opposed to continued AL residency) respective to the average rate of placement for all residents in the analysis. However, the risk of permanent NH placement was higher for residents with ADRD, including residents with a schizophrenia or bipolar disorder diagnosis.

Excess Deaths in Assisted Living and Nursing Homes during the COVID-19 Pandemic in Alberta, Canada

May 1, 2024
WHAT THIS MEANS FOR YOU: This retrospective cohort study used health records from residents in publicly funded AL communities and nursing homes (NHs) in Alberta, Canada from 2017 to 2021 to examine excess deaths during the first two years of the pandemic. Excess deaths were higher in AL communities compared to NHs, especially during weeks identified as pandemic waves (i.e., a surge in COVID-19 infections). The risk of excess death was also greater among residents with dementia or significant cognitive impairment in both AL communities and NHs.

Excess Deaths in Assisted Living and Nursing Homes during the COVID-19 Pandemic in Alberta, Canada

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This retrospective cohort study used health records from residents in publicly funded AL communities and nursing homes (NHs) in Alberta, Canada from 2017 to 2021 to examine excess deaths during the first two years of the pandemic. Excess deaths were higher in AL communities compared to NHs, especially during weeks identified as pandemic waves (i.e., a surge in COVID-19 infections). The risk of excess death was also greater among residents with dementia or significant cognitive impairment in both AL communities and NHs.

Public Health Response to SARS-CoV-2 in Assisted Living Facilities in New York State: March 2020-December 2022

May 1, 2024
WHAT THIS MEANS FOR YOU: This narrative review examined New York state regulation and guidance related to COVID-19 in AL communities from March 2020 to December 2022. Early in the pandemic, strict lockdowns were put in place; then, the vaccine was authorized and implemented during phased reopening of communities. About 90% of New York AL residents were vaccinated by early 2021. As communities reopened, booster shots were required to keep residents protected, especially with new COVID-19 variants. These regulatory efforts were crucial in keeping vulnerable AL residents safe, but they led to social isolation and other psychological impacts; this highlights the complexity of AL regulatory responses in emergency situations.

Public Health Response to SARS-CoV-2 in Assisted Living Facilities in New York State: March 2020-December 2022

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This narrative review examined New York state regulation and guidance related to COVID-19 in AL communities from March 2020 to December 2022. Early in the pandemic, strict lockdowns were put in place; then, the vaccine was authorized and implemented during phased reopening of communities. About 90% of New York AL residents were vaccinated by early 2021. As communities reopened, booster shots were required to keep residents protected, especially with new COVID-19 variants. These regulatory efforts were crucial in keeping vulnerable AL residents safe, but they led to social isolation and other psychological impacts; this highlights the complexity of AL regulatory responses in emergency situations.

Know the Resident: Unlocking Value and Positive Outcomes in Assisted Living Nursing

May 1, 2024
WHAT THIS MEANS FOR YOU: In this editorial, the authors emphasize that addressing social determinants of health in AL communities is crucial for improving residents' well-being and can be accomplished in part through nurse leadership. It presents a framework to address residents’ social needs, focusing on a proactive and holistic approach to care.

Know the Resident: Unlocking Value and Positive Outcomes in Assisted Living Nursing

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: In this editorial, the authors emphasize that addressing social determinants of health in AL communities is crucial for improving residents’ well-being and can be accomplished in part through nurse leadership. It presents a framework to address residents’ social needs, focusing on a proactive and holistic approach to care.

Assisted Living Residents with Dementia: Disparities in Mental Health Services Pre and During COVID-19

Apr 1, 2024
WHAT THIS MEANS FOR YOU: The in-person and telehealth mental health visits of over 102,000 Medicare beneficiaries living with ADRD in 13,400 AL communities were analyzed using CMS data from 2019 and 2020. Use of these services is low in this population, but it was found that Black residents and those with dual Medicare/Medicaid eligibility were significantly less likely to use these services pre-, and during, the COVID-19 pandemic; however, there were no significant differences in visits via telemedicine (vs. in-person) for any racial or ethnic group or dual eligibles.

Assisted Living Residents with Dementia: Disparities in Mental Health Services Pre and During COVID-19

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: The in-person and telehealth mental health visits of over 102,000 Medicare beneficiaries living with ADRD in 13,400 AL communities were analyzed using CMS data from 2019 and 2020. Use of these services is low in this population, but it was found that Black residents and those with dual Medicare/Medicaid eligibility were significantly less likely to use these services pre-, and during, the COVID-19 pandemic; however, there were no significant differences in visits via telemedicine (vs. in-person) for any racial or ethnic group or dual eligibles.