Determinants of the Rigor of State Protection Policies for Persons With Dementia in Assisted Living

Abstract

Continued growth in the number of individuals with dementia residing in assisted living (AL) facilities raises concerns about their safety and protection. However, unlike federally regulated nursing facilities, AL facilities are state-regulated and there is a high degree of variation among policies designed to protect persons with dementia. Despite the important role these protection policies have in shaping the quality of life of persons with dementia residing in AL facilities, little is known about their formation. In this research, we examined the adoption of AL protection policies pertaining to staffing, the physical environment, and the use of chemical restraints. For each protection policy type, we modeled policy rigor using an innovative point-in-time approach, incorporating variables associated with state contextual, institutional, political, and external factors. We found that the rate of state AL protection policy adoptions remained steady over the study period, with staffing policies becoming less rigorous over time. Variables reflecting institutional policy making, including legislative professionalism and bureaucratic oversight, were associated with the rigor of state AL dementia protection policies. As we continue to evaluate the mechanisms contributing to the rigor of AL protection policies, it seems that organized advocacy efforts might expand their role in educating state policy makers about the importance of protecting persons with dementia residing in AL facilities and moving to advance appropriate policies.

Do assisted living facilities that offer a dementia care program differ from those that do not? A population-level cross-sectional study in Ontario, Canada

“…Assisted living facilities provide congregate care in a residential setting to support independent living [ 11 , 12 ], and assisted living facilities are referred to as retirement homes in Ontario, Canada. Assisted living facilities and retirement homes in the United States and Canada are regulated at the state- or provincial-level [ 12 – 14 ]. Ontario is the only jurisdiction that regulates the sector through an independent, not-for-profit regulator (i.e., Retirement Homes Regulatory Authority [RHRA]) [ 15 ].…”

Do Assisted Living Facilities That Offer a Dementia Care Program Differ from Those That Do Not? A Population-Level Cross-Sectional Study in Ontario, Canada

“…8,10 Assisted living facilities are referred to as retirement homes in the province of Ontario, Canada. Similar to assisted living facilities in the United States that are regulated at the statelevel, 11 retirement homes are regulated by an independent, not-for-profit regulator (i.e., Retirement Homes Regulatory Authority [RHRA]) in Ontario since 2011. 12 The retirement home sector in Ontario has a resident capacity equivalent to that of its nursing home sector (i.e., more than 70,000 older adults), 12 which demonstrates that it is a sizeable, important sector providing supportive care to older adults.…”

“…[12][13][14] Much of the literature on dementia care in assisted living facilities addresses health service use among residents living with dementia, managing staff, and state-level regulations for dementia care. 1,11,[15][16][17] Studies explicitly investigating the characteristics of retirement homes or assisted living facilities that provide specialized care for dementia (i.e., a dementia care program), and how these characteristics compare to those that do not, are absent. The findings from such studies are important for identifying case mix and examining scope and breadth of care for older adults with complex care needs.…”

Factors Explaining State Differences in Applying for a Recent Long-Term Care Program that Promotes Aging in Place: Perspectives of Medicaid Administrators

“…Some of the variation in HCBS supports has been linked to characteristics of the state, including the percent of the population that is comprised of older or disabled persons, minority population, percent rural, income, number of home health agencies, and nursing home beds (Harrington et al, 2000; Kitchener et al, 2007; Miller, 2005; Miller et al, 2006). Political factors, including party leadership and whether the legislature is liberal or conservative, are also associated with HCBS spending (Harrington et al, 2000; Miller & Kirk, 2016; Nattinger & Kaskie, 2017). Finally, political and consumer advocacy groups are also important to HCBS policy development (Kitchener & Harrington, 2004).…”