Memory Care in Assisted Living: Does it Improve Quality Outcomes?

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PROJECT ABSTRACT Of the nearly one million people who reside in assisted living (AL), up to 70% have some form of cognitive impairment and 40% have a diagnosis of Alzheimer's Disease and Alzheimer's Disease-Related Dementias (AD/ADRD). AL staff provide services including help with dressing and meals, and nearly 25% of ALs provide specialized care for people living with AD/ADRD (also known as “memory care”). Very little is known about the quality of memory care. To improve AD/ADRD care, consumers must understand whether the quality provided in memory care settings, at a surcharge of almost 36% compared to a room in general AL, is worth the cost. The objective of this application is to examine variation in the quality of care for AL residents with AD/ADRD. It is hypothesized that residents with AD/ADRD in ALs that provide memory care receive higher quality care than their counterparts in ALs that do not provide memory care (“between” AL effects). Also, it is hypothesized that residents with AD/ADRD in ALs without memory care experience poorer quality of care than residents without AD/ADRD (“within” AL effects). Conversely, residents with AD/ADRD in ALs with memory care experience similar quality of care compared to residents without AD/ADRD. To test these hypotheses, the research team will leverage the data and methods that they have developed to 1) identify Medicare beneficiaries residing in ALs; 2) connect policy data to specific AL communities; and 3) combine more than 2,000 AL communities’ employee and resident/family satisfaction surveys with national, administrative data. In response to NOT-AG-21-046, the project has the following specific aims: 1. Compare quality outcomes (i.e., worker satisfaction, resident/family satisfaction, healthcare utilization) between ALs that do and do not provide memory care. Working hypothesis: ALs that provide memory care will have better quality outcomes than ALs that do not provide memory care. This aim looks at how quality varies between ALs. 2. Compare the difference in quality outcomes of residents with and without AD/ADRD within ALs that do and do not provide memory care. Working hypotheses: 2a) within general ALs, residents with AD/ADRD will have poorer outcomes than residents without AD/ADRD; 2b) within memory care ALs, there will not be a significant difference in quality outcomes between residents with and without AD/ADRD. This aim looks at how quality varies within ALs. 3. Understand the processes of care that contribute to quality outcomes for residents with AD/ADRD among ALs that do and do not provide memory care. Semi-structured interviews and on- site observations in ALs that do and do not provide memory care will identify the processes of care that are associated with satisfaction and experience of care for residents with AD/ADRD. The project is significant because it will provide national data about AL care for people living with AD/ADRD.