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Comparing new assisted living community and nursing home admissions, researchers who conducted a recently published study found “substantial differences” related to demographic and socioeconomic factors, leading them to recommend programs and policies to improve health equity in residential living and care options.

The investigators, led by Jinjiao Wang, PhD, RN, from the University of Rochester, examined the individual, facility and geographic factors associated with Medicare beneficiaries newly admitted to assisted living communities versus nursing homes. The study, published recently in the Journal of the American Geriatrics Society, was among the first to compare the characteristics of Medicare beneficiaries newly admitted to those settings, they said.

“Because the AL is the fastest-growing residential care provider in the United States, it is important for consumers — older persons — to understand the factors associated with admission to AL vs. NH in order to make informed decisions given their need for care and available services in different settings,” the authors wrote. “Given that some ALs allow nursing home-level residents to enter and stay, it is important that ALs conduct accurate admission and regular follow-up assessments to closely follow residents’ needs trajectory to fully meet their care needs and/or initiate timely transfer to higher levels of care when appropriate.”

The retrospective study included 158,124 Medicare beneficiaries who had moved into assisted living communities and 715,261 individuals admitted to nursing homes during a two-year period, 2017 to 2019.

The researchers said that the results suggested that socioeconomic factors, such as dual-eligible status, along with demographic and health service use characteristics, are important in determining where someone receives residential care services.

The data showed that male, non-Hispanic white Medicare beneficiaries aged 75 or more years who had had one skilled nursing facility or hospital stay in the past six months were more likely to move into an assisted living community. New nursing home residents, on the other hand, typically were dually eligible individuals, members of racial or ethnic minority groups, and had experienced two or more skilled nursing stays in the past six months. 

The researchers said that evidence exists that nursing home and assisted living residents are similar in many ways, including the prevalence of chronic conditions: hypertension, diabetes, arthritis, cognitive impairment, functional impairment, depression and pain. But there are stark differences between the two settings, too, including the types of services provided, as well as costs and financing.

Although nursing home admission criteria are regulated at both the state and federal level and largely are based on level of impairment in activities of daily living and cognitive function, assisted living communities primarily are regulated at the state level, and admission criteria vary by state. 

Assisted living communities, they said, have less stringent admission and retention criteria and may accept high-needs residents typically cared for in a nursing home setting, regardless of a community’s ability to fully meet those residents’ needs. The investigators pointed to evidence that 42% of assisted living residents have substantial unmet needs, including the need for help with household, self-care or mobility activities.

The researchers said their findings have significant implications for clinical practice and policymaking in long-term care. They recommended that more programs and policies be developed to improve the health equity in senior housing and care options and support socially vulnerable older adults in accessing the appropriate long-term care option.

The study was funded by the US Department of Health and Human Services’ Agency for Healthcare Research and Quality.