Assisted living communities that provide memory care services may attract residents closer to the end of life or promote hospice use at the end of life compared with assisted living communities without such services, according to the findings of a new study.
Assisted living communities increasingly are becoming a common place for end-of-life care for people living with Alzheimer’s disease or another form of dementia, with approximately 22% of such communities providing specialized memory care, according to a study published recently in the Journal of the American Geriatrics Society.
Researchers from the Brown University School of Public Health, the University of Melbourne and the Johns Hopkins University School of Nursing examined whether end-of-life outcomes — mortality and hospice use — differed between assisted living facilities with and without memory care services among 15,152 residents who moved into larger communities between 2016 and 2018.
The results showed a 9.7% higher mortality rate among fee-for-service Medicare beneficiaries living with Alzheimer’s disease and related dementia who moved to memory care assisted living, compared with residents of assisted living communities without memory care. The findings also showed a 17.5% higher rate of hospice use, as well as 1.4 more days of hospice care in the last month of life, among memory care assisted living residents compared with residents living in assisted living without memory care.
The researchers said that understanding how end-of-life outcomes compare between memory care and non-memory care assisted living settings could help consumers make decisions about assisted living settings and guide policymakers in decisions about assisted living regulations, ultimately facilitating aging and dying in place.
Although memory care assisted living residents had a higher mortality rate and higher rate of hospice use, the investigators said that the difference doesn’t necessarily indicate lower care quality. Rather, they said, residents who choose memory care assisted living communities might have greater cognitive impairments or behavioral issues, as well as physical declines, prompting a choice for quality of life over life extension.
Higher rates of hospice use at end of life also could be attributed to higher-quality end-of-life care provided in memory care assisted living communities due to staff members trained in dementia care and end-of-life care, they said.
“Our study calls for more work to examine how staffing levels, specialization, care processes, policies and regulations that are relevant to end-of-life care differences between memory care and general residential care /assisted living, and how these differences might impact end-of-life outcomes for residents with [Alzheimer’s disease and related dementias],” the researchers concluded.
They also called for more research into understanding how end-of-life outcomes differ by assisted living organizational and structural characteristics — such as affiliation with nursing homes — or care coordination processes, including collaboration with hospice agencies.
“The lack of evidence on end-of-life outcomes in residential care / assisted livings and how they differ by memory care prevents consumers and their families from being able to make informed choices regarding residential care /assisted living that meets their end-of-life care needs and preferences,” the researchers said. “Furthermore, residential care / assisted living providers and state regulators need more evidence to identify best end-of-life care practices and informed policymaking to ensure high-quality end-of-life care delivery.”
