Do State Regulations Affect the Outcomes of Assisted Living Residents with Dementia?

项目总结/摘要 大约有100万人，估计40-72%患有认知障碍或诊断为 阿尔茨海默病相关痴呆（ADRD），居住在辅助生活（AL）;然而，对他们的生活知之甚少。 经验或提供的护理质量。与其他形式的长期护理（LTC）不同，例如养老院 由联邦政府监管，AL福尔斯的许可、运营和执法要求由各州负责， 在监管这一不断发展的行业方面，各国的做法大相径庭。由于假设增加了 在为患有ADRD的弱势老年人提供LTC方面的作用，迫切需要了解LTC的积极作用。 以及国家法规对护理质量的负面影响。我们的长期目标是改善护理结果， AL居民，特别强调患有ADRD的居民，他们往往不能为自己辩护。的 本申请的总体目标是检查各州的AL监管环境，并了解是否以及如何 患有ADRD的AL居民的健康结果受到各州监管决定的影响。中央 假设是，为了生存，AL提供商坚持许可要求，并对 监管环境，最终影响AL居民的结果。建议的理由 更好地了解AL居民的ADRD经历以及他们如何根据 一个州对该行业的监管方法将有助于为政策和支付决策提供信息， 改善需要LTC的ADRD老年人的结局。在强大的初步数据指导下， 假设将通过追求三个具体目标进行测试：1）描述国家如何调节AL，因为它涉及 2）测试法规对提供者的反应和结果的影响， 患有ADRD的AL居民; 3）比较居住在获得许可的AL中的ADRD居民之间的结果， 为非专业化AL的居民提供专业化的痴呆症护理。根据第一个目标，调查人员将 在他们以前努力确定和审查州AL的历史、监督和执行的基础上， 可能影响ADRD患者结局的法规。在第二个目标中，研究人员将采用 他们通过国家老龄化研究所的R21（#R21AG047303）开发了一种新的方法， 使用医疗保险数据确定AL居民，并采用严格的方法检查监管变化的影响 提供者的行为和居民在10年内的结果。根据第三个目标，调查人员将 应用观察，准实验方法来检查生活在痴呆症的影响- 对住院医生的治疗效果进行评估这种方法是创新的，因为它是第一个审查 AL居民与ADRD的结果，全国范围内，和广泛不同的AL法规的影响， 医疗结果。这项拟议中的研究意义重大，因为它将提供有价值的信息， 他们正在寻求最有效的方法来监管这个不断增长的行业。最终，这些信息 改善使用AL的ADRD弱势老年人结局的潜力。

PROJECT SUMMARY/ABSTRACT Approximately one million individuals, an estimated 40-72% with cognitive impairment or a diagnosis of Alzheimer’s disease-related dementias (ADRD), reside in assisted living (AL); yet, little is known about their experience or the quality of care offered. Unlike other forms of long-term care (LTC), such as nursing homes that are federally regulated, the licensing, operating, and enforcement requirements for AL falls to the states, which vary dramatically in their approaches to regulating this growing industry. As AL assumes an increased role in providing LTC to vulnerable older adults with ADRD, there is an urgent need to understand the positive and negative effects of state regulations on quality of care. Our long-term goal is to improve care outcomes for AL residents, with a specific emphasis on residents with ADRD who often cannot advocate for themselves. The overall objective of this application is to examine states’ AL regulatory environments and understand if and how the health outcomes of AL residents with ADRD are impacted by states’ regulatory decisions. The central hypothesis is that in order to survive, AL providers adhere to licensing requirements and respond to changes in the regulatory environment, which ultimately impact AL residents’ outcomes. The rationale for the proposed research is that better understanding the experiences of AL residents with ADRD and how they vary based on a state’s approach to regulating this industry will help to inform policy and payment decisions and ultimately improve the outcomes of older adults with ADRD needing LTC. Guided by strong preliminary data, this hypothesis will be tested by pursuing three specific aims: 1) Characterize how states regulate AL as it relates to the care of residents with ADRD; 2) Test the effect of regulations on providers’ responses and outcomes of AL residents with ADRD; 3) Compare outcomes between residents with ADRD who reside in ALs licensed to provide specialized dementia care to residents in non-specialized ALs. Under the first aim, investigators will build on their previous efforts to identify and examine the history, oversight, and enforcement of states’ AL regulations likely to impact outcomes of residents with ADRD. In the second aim, investigators will apply a novel methodology they developed through an R21 from the National Institute on Aging (#R21AG047303) to identify AL residents using Medicare data and with rigorous methods examine the effect of regulatory changes on providers’ behaviors and residents’ outcomes over a 10-year period. Under the third aim, investigators will apply an observational, quasi-experimental methodology to examine the effect of living in a dementia- specialized AL on residents’ outcomes. This approach is innovative because it is the first to examine the outcomes of AL residents with ADRD, nationally, and the impact of the widely varying AL regulations on healthcare outcomes. The proposed research is significant because it will provide valuable information to states as they seek the most effective ways to regulate this growing industry. Ultimately, such information has the potential to improve the outcomes of vulnerable older adults with ADRD who utilize AL.