Comparing quality of care outcomes between assisted living and nursing homes before and during the COVID‐19 pandemic

Abstract

BackgroundWhile assisted living (AL) and nursing home (NHs) residents in share vulnerabilities, AL provides fewer staffing resources and services. Research has largely neglected AL, especially during the COVID‐19 pandemic. Our study compared trends of practice‐sensitive, risk‐adjusted quality indicators between AL and NHs, and changes in these trends after the start of the pandemic.MethodsThis repeated cross‐sectional study used population‐based resident data in Alberta, Canada. Using Resident Assessment Instrument data (01/2017–12/2021), we created quarterly cohorts, using each resident's latest assessment in each quarter. We applied validated inclusion/exclusion criteria and risk‐adjustments to create nine quality indicators and their 95% confidence intervals (CIs): potentially inappropriate antipsychotic use, pain, depressive symptoms, total dependency in late‐loss activities of daily living, physical restraint use, pressure ulcers, delirium, weight loss, urinary tract infections. Run charts compared quality indicators between AL and NHs over time and segmented regressions assessed whether these trends changed after the start of the pandemic.ResultsQuarterly samples included 2015–2710 AL residents and 12,881–13,807 NH residents. Antipsychotic use (21%–26%), pain (20%–24%), and depressive symptoms (17%–25%) were most common in AL. In NHs, they were physical dependency (33%–36%), depressive symptoms (26%–32%), and antipsychotic use (17%–22%). Antipsychotic use and pain were consistently higher in AL. Depressive symptoms, physical dependency, physical restraint use, delirium, weight loss were consistently lower in AL. The most notable segmented regression findings were an increase in antipsychotic use during the pandemic in both settings (AL: change in slope = 0.6% [95% CI: 0.1%–1.0%], p = 0.0140; NHs: change in slope = 0.4% [95% CI: 0.3%–0.5%], p < 0.0001), and an increase in physical dependency in AL only (change in slope = 0.5% [95% CI: 0.1%–0.8%], p = 0.0222).ConclusionsQIs differed significantly between AL and NHs before and during the pandemic. Any changes implemented to address deficiencies in either setting need to account for these differences and require monitoring to assess their impact.

The (un)caring experienced by racialized and/or ethnoculturally diverse residents in supportive living: a qualitative study

“…Frustration with communication issues could be perceived as agitation and managed with medication. A recent study in Alberta (where this study was conducted) compared quality indicators for residents in SL and NH and found that antipsychotic use was consistently higher in SL residents than NH residents; this increased during the COVID-19 pandemic [ 30 ]. The focus of this study was not on the quality of clinical care that racialized and ethnoculturally diverse SL residents received; however, our findings do point to specific areas that warrant further qualitative research in tandem with an examination of available administrative health data.…”

“…What little research there is on SL in Canada has found that SL residents are similar to NH residents in terms of age, cognitive impairment, chronic conditions, and functional limitations, yet SL facilities have fewer services and less staffing resources lack the staffing resources of NHs [ 23 , 25 – 29 ]. Recent studies comparing NH and SL in Alberta before and during the COVID-19 pandemic found troubling differences in the settings, including higher rates of antipsychotic use, pain, and depressive symptoms in SL compared to NHs [ 30 ]. A recent literature review examined the needs of older people with dementia from culturally and linguistically diverse backgrounds but none of the included studies specifically examined residents in SL facilities [ 31 ].…”

Acknowledging the Complexity of Antipsychotic Use in Long-Term Care During the COVID-19 Pandemic

“…Our analysis was a comparison of the pandemic period against the 2 most recent historical years and did not test for year-over-year trends. Interrupted time series analysis by Hoben et al 3 supports Dr. Quail’s argument that the inappropriate use of antipsychotic medications increased in the years leading up to the pandemic in Alberta. However, in alignment with our own findings, the rate of that increase accelerated significantly during the pandemic period.…”

Outpatient Mental Health Care During the First Three High Incidence Phases of the COVID-19 Pandemic in Germany - Results from the COVID Ψ Outpatient Survey

“…Reports that inhabitants of nursing homes were one of the neglected groups of the pandemic, with high COVID-19-associated mortality and social isolation rates [53][54][55]. The indicated reductions in on-site visits of inhabitants of nursing homes and assisted living institutions hint at a reduced quality of psychiatric care.…”