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Zimmerman S, Sloane PD, Preisser JS, Ward K, Wretman CJ, Davis SA, Figueiro MG. Feasibility of a Novel Lighting System to Reduce Nighttime Falls in Assisted Living Residents With Dementia. J Am Med Dir Assoc 2024:105227. [PMID: 39182511 DOI: 10.1016/j.jamda.2024.105227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 07/15/2024] [Accepted: 07/19/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVES To determine the feasibility of conducting a trial of a novel nighttime lighting system designed to support postural stability in assisted living (AL) residents, and to estimate intervention effectiveness by comparing the incidence of nighttime falls during the novel lighting condition to that in a control condition featuring a standard nightlight. DESIGN Randomized crossover trial. The intervention consisted of 3 custom-designed linear arrays of amber light-emitting diodes (LEDs) arranged in strips: 1 strip aligned horizontally across the top of the bathroom/entry doorframe containing 68 LEDs and 2 strips of 140 LEDs each aligned vertically down the sides of the doorframe. The control condition was 1 standard nightlight in the bedroom and 1 in the bathroom. Residents were randomized to treatment sequences, receiving each condition for 1-2 quarters. SETTING AND PARTICIPANTS Five AL communities serving exclusively residents with dementia or having separate units for residents with dementia, with at least 30 beds and at least 5 residents in private rooms. Residents were eligible if they had dementia, were ambulatory, did not share a bedroom, were not on hospice or expected to die within the year, and were not expected to transfer to another setting within the year. METHODS Outcomes included recruitment, retention, incident falls, and satisfaction. RESULTS Thirty-eight residents of the 5 communities participated (56% recruitment rate), and 24 family members completed surveys about their satisfaction with the lighting system. Cameras captured falls data for 92% of 8591 resident nights. The incidence density for falls was 34% lower in the intervention condition than the control condition (incidence density ratio 0.66, 95% CI 0.35, 1.22), which did not reach statistical significance (P = .18). CONCLUSIONS AND IMPLICATIONS This low-cost intervention was feasible with high satisfaction. Building on these results, the intervention is being evaluated in a larger clinical trial. A novel lighting system to reduce falls could ultimately benefit millions of older adults across all settings.
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Affiliation(s)
- Sheryl Zimmerman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Philip D Sloane
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John S Preisser
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Scott A Davis
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mariana G Figueiro
- Light and Health Research Center, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Mao Y, Li Y, McGarry B, Wang J, Temkin-Greener H. Home time and state regulations among Medicare beneficiaries in assisted living communities. J Am Geriatr Soc 2024; 72:742-752. [PMID: 38064278 PMCID: PMC10947931 DOI: 10.1111/jgs.18709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/06/2023] [Accepted: 11/12/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Home time is an important patient-centric quality metric, which has been largely unexamined among assisted living (AL) residents. Our objectives were to assess variation in home time among AL residents in the year following admission and to examine the associations with state regulations for direct care workers (DCW) training and staffing and for licensed nurse staffing. METHODS Medicare beneficiaries who entered AL communities in 2018 were identified, and their home time in the year following admission was measured. Home time was calculated as the percentage of time spent at home per day being alive. Resident characteristics and state regulations in DCW staffing, DCW training, and licensed staffing were measured. We used a multivariate linear regression model with AL-level fixed effects to estimate the relationship between person-level characteristics and home time. Linear regression models adjusting for resident characteristics were used to estimate the association between state regulations and residents' home time. RESULTS The study sample included 59,831 new Medicare beneficiary residents in 12,143 ALs. In the year following AL admission, residents spent 94% (standard deviation = 14.6) of their time at home. Several resident characteristics were associated with lower home time: Medicare-Medicaid dual eligibility, having more chronic conditions, and specific chronic conditions, for example, dementia. In states with greater regulatory specificity for DCW training and staffing, and lower specificity for licensed staffing, residents had longer adjusted home time. CONCLUSION/IMPLICATIONS Home time varied substantially among AL residents depending on resident characteristics and state-level regulatory specificity. AL residents eligible for Medicare and Medicaid had substantially shorter home time than the Medicare-only residents, largely due to longer time spent in nursing homes. State AL regulatory specificity for DCWs and licensed staff also impacted AL residents' home time. These findings may guide AL operators and state legislators in efforts to improve this important quality of life metric.
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Affiliation(s)
- Yunjiao Mao
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Yue Li
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Brian McGarry
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Jinjiao Wang
- Elaine Hubbard Center for Nursing Research on Aging, University of Rochester School of Nursing, Rochester, New York, USA
| | - Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Manis DR, Katz P, Lane NE, Rochon PA, Sinha SK, Andel R, Heckman GA, Kirkwood D, Costa AP. Rates of Hospital-Based Care among Older Adults in the Community and Residential Care Facilities: A Repeated Cross-Sectional Study. J Am Med Dir Assoc 2023; 24:1341-1348. [PMID: 37549887 DOI: 10.1016/j.jamda.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE We examine annual rates of emergency department (ED) visits, hospital admissions, and alternate levels of care (ALC) days (ie, the number of days that an older adult remained in hospital when they could not be safely discharged to an appropriate setting in their community) among older adults. DESIGN Repeated cross-sectional study. SETTING AND PARTICIPANTS Linked, individual-level health system administrative data on community-dwelling persons, home care recipients, residents of assisted living facilities, and residents of nursing homes aged 65 years and older in Ontario, Canada, from January 1, 2013, to December 31, 2019. METHODS We calculated rates of ED visits, hospital admissions, and ALC days per 1000 individuals per older adult population per year. We used a generalized linear model with a gaussian distribution, log link, and year fixed effects to obtain rate ratios. RESULTS There were 1,655,656 older adults in the community, 237,574 home care recipients, 42,600 older adults in assisted living facilities, and 94,055 older adults in nursing homes in 2013; there were 2,129,690 older adults in the community, 281,028 home care recipients, 56,975 older adults in assisted living facilities, and 95,925 older adults in nursing homes in 2019. Residents of assisted living facilities had the highest rates of ED visits (1260.692019 vs 1174.912013), hospital admissions (482.632019 vs 480.192013), and ALC days (1905.572019 vs 1443.032013) per 1000 individuals. Residents of assisted living facilities also had significantly higher rates of ED visits [rate ratio (RR) 3.30, 95% CI 3.20, 3.41), hospital admissions (RR 6.24, 95% CI 6.01, 6.47), and ALC days (RR 25.68, 95% CI 23.27, 28.35) relative to community-dwelling older adults. CONCLUSIONS AND IMPLICATIONS The disproportionate use of ED visits, hospital admissions, and ALC days among residents of assisted living facilities may be attributed to the characteristics of the population and fragmented licensing and regulation of the sector, including variable models of care. The implementation of interdisciplinary, after-hours, team-based approaches to home and primary care in assisted living facilities may reduce the potentially avoidable use of ED visits, hospital admissions, and ALC days among this population and optimize resource allocation in health care systems.
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Affiliation(s)
- Derek R Manis
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; ICES, Toronto, ON, Canada.
| | - Paul Katz
- Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Natasha E Lane
- ICES, Toronto, ON, Canada; Department of Internal Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Paula A Rochon
- ICES, Toronto, ON, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Toronto, ON, Canada; Division of Geriatric Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Samir K Sinha
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada; Division of General Internal Medicine and Geriatrics, Sinai Health and University Health Network, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; National Institute on Ageing, Toronto Metropolitan University, Toronto, ON, Canada
| | - Ross Andel
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA; Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; ICES, Toronto, ON, Canada; Schlegel Research Institute for Aging, Waterloo, ON, Canada; Centre for Integrated Care, St. Joseph's Health System, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
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Boucaud-Maitre D, Letenneur L, Dramé M, Taubé-Teguo N, Dartigues JF, Amieva H, Tabué-Teguo M. Comparison of mortality and hospitalizations of older adults living in residential care facilities versus nursing homes or the community. A systematic review. PLoS One 2023; 18:e0286527. [PMID: 37256888 DOI: 10.1371/journal.pone.0286527] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023] Open
Abstract
Residential care facility may provide a transition between living at home and a nursing home for dependent older people or an alternative to nursing homes. The objective of this review was to compare mortality and hospitalizations of older adults living in residential care facilities with those living in nursing homes or in the community. We searched Medline, Scopus and Web of Science from inception to December 2022. Fifteen cohort studies with 6 months to 10 years of follow-up were included. The unadjusted relative risk (RR) of mortality was superior in nursing homes than in residential care facilities in 6 of 7 studies (from 1.3 to 1.68). Conversely, the unadjusted relative risk of hospitalizations was higher in residential care facilities in 6 studies (from 1.3 to 3.37). Studies conducted on persons with dementia found mixed results, the only study adjusted for co-morbidities observing no difference on these two endpoints. Compared with home, unadjusted relative risks were higher in residential care facilities for mortality in 4 studies (from 1.34 à 10.1) and hospitalizations in 3 studies (from 1.12 to 1.62). Conversely, the only study that followed older adults initially living at home over a 10-year period found a reduced risk of heavy hospital use (RR = 0.68) for those who temporarily resided in a residential care facilities. There is insufficient evidence to determine whether residential care facilities might be an alternative to nursing homes for older people with similar clinical characteristics (co-morbidities and dementia). Nevertheless, given the high rate of hospitalizations observed in residential care facilities, the medical needs of residents should be better explored.
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Affiliation(s)
- Denis Boucaud-Maitre
- Centre Hospitalier Le Vinatier, Bron, France
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique
| | - Luc Letenneur
- Inserm, U1219 Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France
| | - Moustapha Dramé
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique
- Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
| | - Nadine Taubé-Teguo
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique
- Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
| | | | - Hélène Amieva
- Inserm, U1219 Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France
| | - Maturin Tabué-Teguo
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique
- Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
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Boucaud-Maitre D, Meillon C, Letenneur L, Villeneuve R, Dartigues JF, Amieva H, Tabue-Teguo M. Health trajectories of elderly living in French senior housing: a longitudinal perspective. Sci Rep 2023; 13:5471. [PMID: 37015961 PMCID: PMC10073120 DOI: 10.1038/s41598-023-32429-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/27/2023] [Indexed: 04/06/2023] Open
Abstract
Senior housing for older adults could be an alternative or a transitional care model between home care and nursing home care. Using two longitudinal cohorts of community dwellers aged 65 years or older, we compared risks of mortality and of nursing homes admission between older adults who did or did not move to senior housing over time. In the 3C study (n = 2104, 17 years of follow-up), 143 (6.8%) participants moved into a senior housing during the follow-up. This move was associated with a lower risk of mortality (hazard ratio (HR): 0.64; 95% confidence interval (CI) 0.46-0.77) and a higher risk of nursing home admissions (HR: 1.54 (1.10-2.15)). The risks of hospitalizations (HR: 0.54 (0.40-0.73)) and falls (HR: 0.63 (0.50-0.79)) were lower. In the PAQUID study (n = 3777, 27 years of follow-up), 161 (4.3%) participants moved into a senior housing. This move was also associated with a lower mortality risk (HR: 0.72 (0.58-0.88)) and a higher risk of nursing home admissions (HR: 1.39 (1.05-1.86)). Our results showing lower risks of mortality suggest that senior housing may be a relevant model for vulnerable older adults.
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Affiliation(s)
- Denis Boucaud-Maitre
- Direction de la Recherche et de l'Innovation, Centre Hospitalier le Vinatier, Bron, France.
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique.
| | - Céline Meillon
- Univ. Bordeaux, Inserm, U1219 Bordeaux Population Health Center, Bordeaux, France
| | - Luc Letenneur
- Univ. Bordeaux, Inserm, U1219 Bordeaux Population Health Center, Bordeaux, France
| | - Roxane Villeneuve
- Univ. Bordeaux, Inserm, U1219 Bordeaux Population Health Center, Bordeaux, France
| | | | - Hélène Amieva
- Univ. Bordeaux, Inserm, U1219 Bordeaux Population Health Center, Bordeaux, France
| | - Maturin Tabue-Teguo
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique
- Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
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Lam K, Cenzer I, Covinsky KE. Return to community living and mortality after moving to a long-term care facility: A nationally representative cohort study. J Am Geriatr Soc 2023; 71:569-576. [PMID: 36420717 PMCID: PMC9957796 DOI: 10.1111/jgs.18144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/10/2022] [Accepted: 10/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent long-term care facility (LTCF) policy has focused on transitioning nursing home (NH) residents back to community settings, yet we lack recent descriptions of this phenomenon and how it compares in assisted living (AL). METHODS Using the National Health and Aging Trends Study, we studied adults over age 65 who had moved from community living into an LTCF between 2011 and 2018. Persons or their proxies reported residence in annual interviews. NH was defined by facility staff. ALs were multi-unit buildings helping with activities of daily living. We excluded temporary short-stay NH patients and independent AL residents. Our primary outcome was cumulative incidence of return to community living, with death as co-primary outcome and modeled as a competing risk, stratified by NH versus AL entry. We identified covariates (age, gender, race/ethnicity, dementia, activity limitations, and prior living arrangement) associated with return to community living through bivariate and multivariable logistic regression. RESULTS Among 739 participants, weighted mean age was 84 years (SD 7.5), 66% were women, 13% were non-White, 57% had dementia, and 41% entered NH. At 1, 2, and 4 years, the cumulative incidence of return to community living was 2.9% (95% CIs: 1.9%-4.3%), 6.4% (4.7%-8.4%), and 7.4% (5.5%-9.8%); the cumulative incidence of death was 28% (95% CIs: 24%-31%), 44% (40%-48%) and 66% (61%-70%). Outcomes were similar in persons entering NH versus AL. Older persons (aOR 0.88, 95% CI 0.83-0.94), those with dementia (aOR 0.33, 95% CI 0.12-0.88), and those previously living alone (aOR 0.39, 95% CI 0.17-0.89) were less likely to return. CONCLUSIONS Few returned to community living after entering either NH or AL. Mortality was similar. Results highlight limits in transitioning persons out of LTCFs and the need to observe AL use to ensure policies do not merely displace persons between institutional care sectors.
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Affiliation(s)
- Kenneth Lam
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - Irena Cenzer
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - Kenneth E. Covinsky
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
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Wang Z, Shepley M. The Relationship of Neighborhood Walking Behavior to Duration of Aging in Place-A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16428. [PMID: 36554309 PMCID: PMC9778538 DOI: 10.3390/ijerph192416428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
The benefits of physical activity on health are widely known. However, the impact of physical activity on aging-in-place at home for older adults is unclear. Focusing on older adults who recently moved from home to a senior-living facility, this research explored the impact of walking on the ability to age-in-place. Data were collected through a questionnaire survey completed by residents in 12 assisted-living facilities in Houston, Texas. Controlling for significant personal factors, ANOVAs were applied. Non-Hispanic White older adults (N = 124) who used canes or no aids and engaged in 30 min to 1 h of walking per occurrence were able to remain in their homes for an average of 17.84 years after age 65, 1.85 years longer than their counterparts who walked less than 30 min per occurrence. Those who walked for more than an hour per occurrence remained at home for 22.71 years on average, 6.72 years longer than their counterparts (p ≤ 0.05). Engaging in neighborhood walking may help older adults maintain more years of aging-in-place at home. The findings have a direct impact on both public health programs and community design and planning strategies promoting aging-in-place.
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Affiliation(s)
- Zhe Wang
- Department of Architecture, School of Civil and Architectural Engineering, Henan University, Kaifeng 475001, China
| | - Mardelle Shepley
- Department of Human Centered Design, College of Human Ecology, Cornell University, Ithaca, NY 14853, USA
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Lin SC, Tunalilar O. Rapid adoption of electronic health record and health information exchange among assisted living communities, 2010-2018. J Am Med Inform Assoc 2022; 29:953-957. [PMID: 35187569 PMCID: PMC9006709 DOI: 10.1093/jamia/ocac021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/21/2022] [Accepted: 02/08/2022] [Indexed: 11/12/2022] Open
Abstract
Adoption of electronic health records (EHRs) and health information exchange (HIE) is a key tool to improving the quality of care in assisted living communities (ALC). We examined whether EHRs were being used in ALC to support HIE in 2010 and 2018. We found that adoption of EHR and HIE functions increased substantially over the study period. However, adoption of HIE functions lagged significantly behind EHR functions in both 2010 and 2018 and was accompanied by growing disparities in the adoption of EHR functions among smaller, nonchain, and for-profit communities. To improve the quality of care for this important and growing population, targeted policies are needed to support the adoption of both EHR and HIE functions in ALC.
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Affiliation(s)
- Sunny C Lin
- Corresponding Author: Sunny C. Lin, PhD, MS, Washington University in St. Louis, 4523 Clayton Avenue, Campus Box 800, St. Louis, MO 63110, USA;
| | - Ozcan Tunalilar
- Nohad A. Toulan School of Urban Studies and Planning, Portland State University, Portland, Oregon, USA,Institute on Aging, Portland State University, Portland, Oregon, USA
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9
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Wang J, Mao Y, McGarry B, Temkin‐Greener H. Post‐acute care transitions and outcomes among medicare beneficiaries in assisted living communities. J Am Geriatr Soc 2022; 70:1429-1441. [DOI: 10.1111/jgs.17669] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/30/2021] [Accepted: 12/19/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Jinjiao Wang
- Elaine Hubbard Center for Nursing Research on Aging University of Rochester School of Nursing Rochester New York USA
| | - Yunjiao Mao
- Department of Public Health Sciences University of Rochester Medical Center Rochester New York USA
| | - Brian McGarry
- Department of Public Health Sciences University of Rochester Medical Center Rochester New York USA
- Division of Geriatrics and Aging, Department of Medicine University of Rochester Medical Center Rochester New York USA
| | - Helena Temkin‐Greener
- Department of Public Health Sciences University of Rochester Medical Center Rochester New York USA
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Temkin-Greener H, Mao Y, McGarry B, Zimmerman S, Li Y. Health Care Use and Outcomes in Assisted Living Communities: Race, Ethnicity, and Dual Eligibility. Med Care Res Rev 2021; 79:500-510. [PMID: 34623210 DOI: 10.1177/10775587211050189] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Assisted Living (AL) has become an important residential long-term care option in the United States, yet very little is known about the nature and quality of care received in this setting by racial/ethnic minorities or residents dually eligible for Medicare and Medicaid. Using calendar year 2018 Medicare data, we identified 255,564 fee-for-service Medicare beneficiaries age 55+ who resided in 24,108 ALs across the United States. We fit several logistic regression models with individual-level covariates and AL-level fixed effects, to examine the association between race/ethnicity and dual status with inpatient hospital admission, 30-day readmission, emergency room use, and nursing home placement. Significant variations in these measures were found both within and across ALs for racial/ethnic minority and dual residents. Our results suggest that disparities in outcomes are most significant by dual eligibility status rather than by race/ethnicity alone. These findings provide important implications for providers, policy makers, and researchers.
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Affiliation(s)
| | | | | | | | - Yue Li
- University of Rochester, NY, USA
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