Key Points Question Are patterns of medical aid in dying (MAID) use similar in Oregon and Washington? Findings In this cohort study of 3368 prescriptions for MAID in Oregon and Washington, most patients in both states were insured, non-Hispanic white individuals with some level of college education, with cancer being the most common underlying illness prompting MAID request. Annual percentage of patients per year who were prescribed medication and ingested it did not change in Oregon but increased over time in Washington, and in both states there were increasing deaths due to MAID per 1000 deaths over time. Meaning With the exception of use of prescribed medication, MAID patterns are similar in Oregon and Washington.

Objective: To document dementia-relevant state assisted living regulations and their changes over time as they pertain to licensed care settings.Data Sources: For all states, current directories of licensed assisted living communities and state regulations for each year, 2007-2018, were obtained from state agency websites and Nexis Uni, respectively. Study Design:We identified multiple types of regulatory classifications for each state and documented the presence or absence of specific dementia care provisions in the regulations for each type by study year. Maps and summary statistics were used to compare results to previous research and document change longitudinally. Data Collection/Extraction Methods:We used a policy analysis approach to connect communities listed in directories to applicable regulatory text. Then, we employed policy surveillance and question-based coding to record the presence or absence of specific policies for each classification and study year.Principal Findings: Our team empirically documented provisions requiring dementiaspecific training for administrators and direct care staff, and cognitive impairment screening for each study year. We found that 23 states added one or more of these requirements for one or more license types, but the states that had these provisions for all types of licensed assisted living declined from four to two. Conclusions:We identified significant, previously undocumented, within-state policy variation for assisted living licensed settings between 2007 and 2018. Using the regulatory classification instead of the state as the unit of analysis revealed that many policy adoptions were limited to dementia-designated settings. This suggests that people living with dementia in general assisted living are not afforded the same protections. We call our approach health services regulatory analysis and argue that it has the potential to identify gaps in existing policies, an important endeavor for health services research in assisted living and other care settings.

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Key PointsPatients with t-MDS are underrepresented in clinical trials when taking into account the prevalence of such patients. Eligibility criteria and sponsorship type may contribute to t-MDS patient exclusion.