Comparing residential long-term care regulations between nursing homes and assisted living facilities

Trinkoff, Alison M.; Yoon, Jeongkoo; Storr, Carla L.; Lerner, Nancy; Yang, Bo; Han, Kihye

doi:10.1016/j.outlook.2019.06.015

Cited by 30 publications

(22 citation statements)

References 14 publications

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“…Most states do not require staffing levels for these workers to be proportionate to the number of residents, and more than half have no hourly requirements for staff training. 6 As these AL workers are not considered a "healthcare workforce," they receive little if any training on the use of personal protective equipment (PPE), such as masks or gloves, even though they assist the residents with daily personal care needs. ALs typically have little PPE on hand, and have been experiencing significant shortages during COVID-19.…”

Section: Introductionmentioning

confidence: 99%

COVID‐19 Pandemic in Assisted Living Communities: Results from Seven States

Temkin‐Greener

Guo

Mao

et al. 2020

J American Geriatrics Society

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Objective To describe variations in COVID‐19 confirmed cases and deaths among assisted living (AL) residents and examine their associations with key AL characteristics. Design Observational study employing data on confirmed COVID‐19 cases and deaths in ALs from seven states, through May 29, 2020. Setting Information on COVID‐19 cases/deaths in ALs was obtained from state government websites. A national inventory of ALs was used to identify communities with and without COVID‐19 cases/deaths. Medicare Beneficiary Summary File (MBSF) identifying AL residents was employed to develop AL characteristics. County‐level COVID‐19 lab‐confirmed cases/deaths were obtained from publicly available data. Participants We found 4,865 ALs (2,647 COVID‐19 cases and 777 deaths) in the 7 states. After excluding missing data the sample consisted of 3,994 ALs (82.1%) with 2,542 cases (96.0%) and 675 deaths (86.9%). Main Outcomes and Measures Outcomes were AL‐level counts of cases and deaths. Covariates were AL characteristics and county‐level confirmed COVID‐19 cases/deaths. Multivariable 2‐part models determined the associations of independent variables with the likelihood of at least one case and death in the AL, and with the count of cases (deaths). Results State case fatality ranged from 3.32% in North Carolina to 9.26% in Connecticut, but for ALs in these states it was 12.89% and 31.59%, respectively. Among ALs with at least 1 case, mid‐size communities had fewer cases (IRR=0.829; p=0.004), than very small ALs. ALs with higher proportions of racial/ethnic minorities had more COVID‐19 cases (IRR=1.08; p<0.001), as did communities with higher proportions of residents with dementia, COPD and obesity. Conclusions and Relevance ALs with a higher proportion of minorities had more COVID‐19 cases. Many of the previously identified individual risk factors are also present in this vulnerable population. The impact of COVID‐19 on ALs is as critical as that on nursing homes, and is worth equal attention from policy makers.

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Section: Introductionmentioning

confidence: 99%

COVID‐19 Pandemic in Assisted Living Communities: Results from Seven States

Temkin‐Greener

Guo

Mao

et al. 2020

J American Geriatrics Society

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“…There are primarily four modes of regulation in the governance of AL across the North American region-licensure or certification, agency review or on-site inspection, applying market-based tool in regulation, and regulatory inaction [4,6,19,20,22,[25][26][27]45,48,51,60,62,71,73,77].…”

Section: Alf Operational Authorisationmentioning

confidence: 99%

Governance of Assisted Living in Long-Term Care: A Systematic Literature Review

Poh

Tan

Lim

2021

IJERPH

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Assisted living (AL) is an emerging model of care in countries where long-term care needs are escalating, with emphasis given to promoting independence and autonomy among the residents to achieve active and healthy ageing. Unlike established nursing homes, the governance of AL is nebulous due to its novelty and diverse nature of operations in many jurisdictions. A comprehensive understanding of how AL is governed globally is important to inform regulatory policies as the adoption of AL increases. A systematic literature review was undertaken to understand the different levels of regulations that need to be instituted to govern AL effectively. A total of 65 studies, conducted between 1990 to 2020, identified from three major databases (PubMed, Medline, and Scopus), were included. Using a thematic synthesis analytical approach, we identified macro-level regulations (operational authorisation, care quality assessment and infrastructural requirements), meso-level regulations (operational management, staff management and distribution, service provision and care monitoring, and crisis management), and micro-level regulations (clear criteria for resident admission and staff hiring) that are important in the governance of AL. Large-scale adoption of AL without compromising the quality, equity and affordability would require clear provisions of micro-, meso- and macro-level regulations.

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“…It is important to understand issues specific to COVID-19 in AL because these settings differ from NHs in terms of regulatory oversight, staffing levels, direct care staff training, inspections and enforcement, and emergency preparedness regulations ( 8 , 9 ). Generally, AL is a supportive living environment with a philosophy of social engagement, lack of national regulations, high prevalence of dementia, limited medical and nursing provider presence and direct care staff training, and a reliance on family members to supplement care ( 10 ). AL residents vary regarding their care needs; some residents may be fairly independent, whereas others receive assistance with multiple activities of daily living and chronic health conditions ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Coronavirus Disease 2019 Regulatory Response in United States-Assisted Living Communities: Lessons Learned

Dys

Winfree

Carder

et al. 2021

Front. Public Health

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Coronavirus disease 2019 (COVID-19) has disproportionately affected residents, their families, staff, and operators of congregate care settings. Assisted living (AL) is a type of long-term care setting for older adults who need supportive care but not ongoing nursing care and emphasizes a social model of care provision. Because AL is a type of long-term care, it has at times been referenced along with nursing homes in discussions related to COVID-19 but not recognized for its different care practices that pose unique challenges related to COVID-19; in that manner, it has largely been left out of the COVID-19 discourse, although ~812,000 older adults live in AL. To identify COVID-19 issues specific to AL, stakeholders with expertise in AL operations, policy, practice, and research (n = 42) were recruited to participate in remote interviews between July and September 2020. Using a thematic analysis, we derived the following overarching themes: (1) Policymakers are disconnected from and lack an understanding of the AL context; (2) AL administrators were left to coordinate, communicate, and implement constantly changing guidelines with little support; (3) AL organizations faced limited knowledge of and disparate access to funding and resources; (4) state-level regulatory requirements conflicted with COVID-19 guidelines resulting in uncertainty about which rules to follow; and (5) AL operators struggled to balance public health priorities with promoting their residents' quality of life and well-being. To develop evidence-informed policy and avoid unintended consequences, AL operators, direct care workers, residents, and clinicians practicing in these settings should have opportunities to provide feedback throughout the policy development process, both state and national.

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Comparing residential long-term care regulations between nursing homes and assisted living facilities

Cited by 30 publications

References 14 publications

COVID‐19 Pandemic in Assisted Living Communities: Results from Seven States

COVID‐19 Pandemic in Assisted Living Communities: Results from Seven States

Governance of Assisted Living in Long-Term Care: A Systematic Literature Review

Coronavirus Disease 2019 Regulatory Response in United States-Assisted Living Communities: Lessons Learned

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