State Regulatory Approaches for Dementia Care in Residential Care and Assisted Living

Carder, Paula

doi:10.1093/geront/gnw197

Cited by 53 publications

(89 citation statements)

References 33 publications

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“…The variation in states' regulations pertaining to dementia care may also be associated with variation in the prevalence of ADRD in AL across states. For example, some states require dementia-specific preadmission screening (14 states), consumer disclosure (33 states), and building design to accommodate the needs of residents with ADRD (29 states), 11 and these differences likely impact AL providers' willingness to accept residents with an ADRD diagnosis. Future research is needed to better understand the market and regulatory factors that may contribute to the state variability in the prevalence of ADRD among AL residents.…”

Section: Discussionmentioning

confidence: 99%

“…However, of the seven states with lower rates of hospitalization in AL, only Connecticut requires dementia care units to be licensed. 11 It is possible that states with more stringent rules for dementia care settings have provisions that result in differential rates of hospitalization or that they admit residents with differing levels of need. However, documentation of state variation in dementia care requirements for AL is limited.…”

Section: Discussionmentioning

confidence: 99%

“…1 With minimal federal oversight, state regulations dictate requirements for licensure and monitoring of AL. Previous work suggests that states vary widely in their regulations specific to the care of AL residents with ADRD [10][11][12][13][14] and their enforcement practices. 15 Regulation has also increased and diversified over time: in 2000, 28 states had at least one regulatory requirement for providing care to residents with ADRD in AL, 16 and by 2014, that number had increased to 49 states.…”

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confidence: 99%

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State Variability in the Prevalence and Healthcare Utilization of Assisted Living Residents with Dementia

Thomas

Zhang

Cornell

et al. 2020

J American Geriatrics Society

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OBJECTIVES: Almost 1 million older and disabled adults who require long-term care reside in assisted living (AL), approximately 40% of whom have a diagnosis of Alzheimer's disease and related dementias (ADRD). States vary in their regulations specific to dementia care that may influence the presence of residents with ADRD in AL and their outcomes. The objectives of this study were to describe the state variability in the prevalence of ADRD among Medicare beneficiaries residing in larger (25+ bed) ALs and their healthcare utilization. DESIGN: Retrospective observational national study. PARTICIPANTS: National cohort of 293,336 Medicare fee-for-service enrollees residing in larger (25+ bed) ALs in 2016 and 2017 including 88,867 (30.3%) residents with ADRD. We compared this cohort's characteristics and healthcare utilization with that of individuals with ADRD who resided in nursing homes (NHs; n = 602,521) and the community (n = 2,074,420). METHODS: Medicare enrollment data, claims, and the NH Minimum Data Set were used to describe differences among ADRD patients in AL, NHs, and the community. We present rates of NH admission and hospitalization, by state, adjusting for age, sex, race, dual eligibility, and chronic conditions. RESULTS: The prevalence of ADRD among AL residents varied by state, ranging from 24% to 47%. In 2017, AL residents with ADRD had higher rates of NH admission than their community-dwelling counterparts (adjusted national average = 24%, ranging from 14% to 35% among states). AL residents with ADRD had higher rates of hospitalization (38%) than populations in either NHs (29%) or the community (34%), and ranged from 29% to 45% of residents among states. CONCLUSION: These findings have implications for states as they regulate AL and for healthcare professionals whose patients reside in AL. Future work is needed to understand specific elements of states' regulatory environments and local markets that may impact access and outcomes for this vulnerable population of residents with ADRD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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State Variability in the Prevalence and Healthcare Utilization of Assisted Living Residents with Dementia

Thomas

Zhang

Cornell

et al. 2020

J American Geriatrics Society

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“…There are more than 30,000 assisted‐living facilities (ALFs) in the United States serving more than 1 million residents . Older adults who reside in ALFs typically do not require the skilled nursing care provided in nursing homes (NHs), but the prevalence of dementia and physical impairments in ALF residents suggests that ALFs and NHs may face similar challenges in ensuring quality of care . Studies have demonstrated that ALF and NH residents have comparable rates of falls and hospitalizations, which suggests that they share many of the same risk factors for these undesirable clinical outcomes …”

Section: Developing a Database Of Accurate Information: The Need For mentioning

confidence: 99%

A System for Managing Staff and Quality of Dementia Care in Assisted Living Facilities

Simmons

Coelho²,

Sandler³

et al. 2018

J American Geriatrics Society

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“…The primary data source for this study is the Compendium of Residential Care and Assisted Living Regulations and Policy, 2015 Edition, developed by Paula Carder, Janet O'Keeffe, and Christine O'Keeffe (Carder et al, 2015). Funded by the Office of the Assistant Secretary for Planning and Evaluation, the Compendium summarizes and compares the RCS regulations for each of the 50 states and the District of Columbia.…”

Section: Data Sourcesmentioning

confidence: 99%

State Regulatory Provisions for Residential Care Settings: An Overview of Staffing Requirements

Carder

O'Keefe²,

O’Keefe³

et al. 2016

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This PDF document was made available from www.rti.org as a public service of RTI International. More information about RTI Press can be found at http://www.rti.org/rtipress. RTI International is an independent, nonprofit research organization dedicated to improving the human condition by turning knowledge into practice. The RTI Press mission is to disseminate information about RTI research, analytic tools, and technical expertise to a national and international audience. RTI Press publications are peerreviewed by at least two independent substantive experts and one or more Press editors.

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State Regulatory Approaches for Dementia Care in Residential Care and Assisted Living

Abstract: This policy study provides a resource for researchers who do cross-state studies of dementia care in RC/AL settings and state policymakers who are updating RC/AL regulations, including those responding to a 2014 Centers for Medicare and Medicaid Services rule change.

Cited by 53 publications

References 33 publications

State Variability in the Prevalence and Healthcare Utilization of Assisted Living Residents with Dementia

State Variability in the Prevalence and Healthcare Utilization of Assisted Living Residents with Dementia

A System for Managing Staff and Quality of Dementia Care in Assisted Living Facilities

State Regulatory Provisions for Residential Care Settings: An Overview of Staffing Requirements

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