Residents living in states with supportive regulations around hospice and home healthcare were more likely to die in their assisted living “homes” rather than transition to skilled nursing care at end of life, according to the results of a new study.
An examination of varying state regulations of third-party services in assisted living communities — namely hospice, home health services and the use of private care aides — by Brown University researchers found that support for such services led to a larger number of residents dying in place rather than transitioning elsewhere at end of life.
The retrospective study involved 168,000 Medicare beneficiaries residing in more than 8,300 assisted living communities during the last 12 months of their lives, who died between 2017 and 2019.
Their results, published in JAMA Health Forum, found that regulations of assisted living residences — from admission criteria to staffing requirements — vary from state to state. Researchers said that states that allowed third-party services — including hospice, home health services and private care aides — may play an important role in meeting the growing care needs of residents who want to die in place.
According to the study, 13 states support all third-party services across all licenses. Many states supported some third-party services, or their regulations varied between license types of classifications. In addition, six stats were silent on all third-party regulations across assisted living licenses.
Their results suggested that communities that support third-party services tended to retain a larger share of residents until death. A substantial variation was seen in the percentage of assisted living residents dying in place, from 18% in New York to 74% in Utah.
“With an increasing number of older adults calling assisted living ‘home’ and wishing to remain in place at the end of life, there is an increasing concern about the level of oversight needed to protect a vulnerable population of terminally ill residents,” the authors wrote.
The authors noted that despite evidence that older adults may prefer to avoid nursing home admission close to death, dying in an assisted living community does not guarantee high-quality end-of-life care — an area the authors said needs more study.
The investigators concluded that more research also is necessary to identify factors affecting place of death and quality of end-of-life care for assisted living residents. Supportive regulations for services that are important in meeting the increasing care needs of individuals approaching death, they added, may be a good place to start.
Researchers from Oregon Health & Sciences University and the US Department of Veterans Affairs Medical Center in Providence, RI, contributed to the study.
