Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2020 Jul;68(7):1504-1511.
doi: 10.1111/jgs.16410. Epub 2020 Mar 16.

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

Kali S Thomas  1 , Wenhan Zhang  2 , Portia Y Cornell  1 , Lindsey Smith  3 , Brian Kaskie  4 , Paula C Carder  3
Affiliations
Observational Study

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

Kali S Thomas et al. J Am Geriatr Soc. 2020 Jul.

Abstract

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. J Am Geriatr Soc 68:1504-1511, 2020.

Keywords: Alzheimer's disease and related dementias; assisted living; long-term care.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: The authors have declared no conflicts of interest for this article.

Figures

Figure 1.
Figure 1.
Geographic variability in the share of beneficiaries enrolled in traditional Medicare residing in assisted living with a diagnosis of Alzheimer’s disease and related dementias (ADRD) (2016). Data come from the 2016 Medicare Master Beneficiary Summary File and chronic conditions segment.
Figure 2.
Figure 2.
Adjusted* percentage of Medicare beneficiaries with Alzheimer’s disease and related dementias (ADRD) with a nursing home admission in 2017. *Percentage adjusted for age, race, sex, dual eligibility, chronic conditions, and the number of chronic conditions. Data come from the 2016 and 2017 Medicare Master Beneficiary Summary File and the Residential History File. Dashed lines indicate median values.
Figure 3.
Figure 3.
Adjusted* percentage of Medicare beneficiaries with Alzheimer’s disease and related dementias (ADRD) with a hospitalization in 2017. *Percentage adjusted for age, race, sex, dual eligibility, chronic conditions, and the number of chronic conditions. Hospitalizations occurred before moving to a nursing home. Data come from the 2016 and 2017 Medicare Master Beneficiary Summary File and the Residential History File. Dashed lines indicate median values.
See this image and copyright information in PMC

References

    1. Harris-Kojetin L,Sengupta M,Lendon JP, Rome V,Valverde R, Caffrey C.Long-term care providers and services users in the United States, 2015–2016. National Center for Health Statistics. Vital Health Stat. 2019;3(43). https://www.cdc.gov/nchs/data/series/sr_03/sr03_43-508.pdf. Accessed October 9, 2019. - PubMed
    1. Thomas KS, Dosa D, Gozalo PL, et al. A methodology to identify a cohortof Medicare beneficiaries residing in large assisted living facilities using administrative data. Med Care. 2018;56(2):e10–e15. - PMC - PubMed
    1. Zimmerman S, Sloane PD, Reed D. Dementia prevalence and care in assistedliving. Health Aff (Millwood). 2014. 33(4):658–666. - PubMed
    1. Magsi H, Malloy T. Under-recognition of cognitive impairment in assistedliving facilities. J Am Geriatr Soc. 2005;53(2):295–298. - PubMed
    1. Caffrey C, Sengupta M, Park-Lee E, Moss A, Rosenhoff E, Harris-Kojetin L.Residents living in residential care facilities: United States, 2010. NCHS Data Brief. 2012;(91):1–8. - PubMed

Publication types