Private Equity Expansion in Assisted Living: Implications for Dementia Care

私募股权在辅助生活领域的扩张：对痴呆症护理的影响

• 批准号: 10738928
• 负责人: Md Momotazur Rahman
• 金额: $ 79.06万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10738928
• 关键词: Acceleration; Accident and Emergency department; Address; Adult; Advocate; Alzheimer' s Disease; Alzheimer' s disease related dementia; Assisted Living Facilities; Capital; Caring; Characteristics; Complex; Consensus; Data; Decision Making; Dementia; Disabled Persons; Elderly; Environment; Equity; Goals; Health; Health Care Sector; Heterogeneity; Hospitalization; Housing; Human Resources; Individual; Industry; Interview; Investments; Lawyers; Licensing; Literature; Long-Term Care; Marketing; Medicare; Methods; Monitor; Negative Finding; Nursing Homes; Outcome; Ownership; Patients; Perception; Personal Satisfaction; Persons; Policies; Policy Maker; Population; Prevalence; Privatization; Provider; Qualifying; Quality of Care; Regulation; Reporting; Research; Services; Structure; Testing; Update; Visit; Vulnerable Populations; Work; beneficiary; community living; dementia care; design; functional disability; improved; industry partner; insight; meetings; memory care; mortality; new technology; operation; payment; treatment effect; welfare

PROJECT SUMMARY Assisted living (AL) is a growing long-term care industry providing housing and supportive services to almost one million frail and functionally impaired older adults - 49% of whom are living with Alzheimer’s disease or a related dementia (ADRD). Demographic projections of increased demand for AL, and especially dementia care (also referred to as “memory care”), has attracted notice from private equity (PE) firms. PE ownership advocates argue that PE firms bring much needed capital, allowing providers to update facilities, invest in new technology, and gain economies of scale to enhance efficiency, increase profitability, and improve care quality. However, the growing concern is that some PE firms’ focus on short-term profits may compromise the quality of care of AL residents, particularly those living with dementia. Research findings on the effects of PE acquisitions of nursing homes are mixed: while some studies found negative effects (e.g., decreased staffing, increased mortality) others have found no change in staffing or quality outcomes. However, unlike nursing homes, there is no national framework of regulations, payment policies, or public reporting of care quality in AL to work as “guardrails” against the possible negative impacts of PE acquisitions as there are in nursing homes. Therefore, the objective of this application is to understand the types of AL that PE firms invest in and how PE acquisitions impact the composition of residents with ADRD and residents’ outcomes. Our working hypotheses are: 1) ALs that are part of a large chain, provide memory care, located in markets with more demand, and operating under licenses with less regulatory stringency are more likely to be purchased by PE firms; and 2) acquired ALs respond to new ownership by restructuring operations in ways that influence the composition of residents and ultimately residents’ outcomes. These hypotheses will be tested in an exploratory+explanatory sequential mixed methods study with three specific aims: 1) Explore stakeholders’ perceptions of PE firms’ decision-making and the impact of PE investment on AL communities; 2) Compare ALs that were acquired or divested by PE firms to those that were not; 3) Estimate the causal effect of PE acquisitions on the prevalence of residents with ADRD in AL and residents’ outcomes. Under the first aim, the research team will leverage their existing networks and interview stakeholders to elicit different perspectives on the motives and impacts of PE acquisitions. Under the second aim, the team will apply the methods they developed and data they previously collected to understand the characteristics of ALs that are PE targets. The third aim will examine the welfare effects of PE acquisition on residents with and without ADRD applying an instrumental variable method. The results from this study will provide the first evidence on PE acquisitions of AL and how it impacts care for residents with ADRD. As policymakers are urged to consider ownership reporting and monitoring in other sectors, it is important to have insight into the less regulated AL industry that provides supportive services to vulnerable older and disabled adults, almost half of whom are living with dementia.

项目摘要 辅助生活（AL）是一个不断发展的长期护理行业，为几乎所有的人提供住房和支持性服务。 100万体弱和功能受损的老年人-其中49%患有阿尔茨海默病或 相关性痴呆（ADRD）对AL需求增加的人口预测，尤其是痴呆症护理 (also被称为"记忆保健"），已经引起了私募股权（PE）公司的注意。PE所有权 支持者认为，私人股本公司带来了急需的资本，使供应商能够更新设施，投资于新的 技术，并获得规模经济，以提高效率，增加盈利能力，提高护理质量。 然而，越来越多的担忧是，一些私募股权公司对短期利润的关注可能会影响质量 照顾AL居民，特别是那些患有痴呆症的人。关于体育影响的研究结果 养老院的收购是混合的：虽然一些研究发现了负面影响（例如，人员减少， 死亡率增加），其他人则认为在人员配置或质量成果方面没有变化。与护理不同的是， 家庭，没有国家框架的法规，支付政策，或公共报告的护理质量在AL 作为“护栏”，防止私募股权收购可能产生的负面影响，就像养老院一样。 因此，本申请的目的是了解私募股权公司投资的AL类型以及私募股权公司如何 收购影响居民的ADRD和居民的结果的组成。我们的工作假设 1）作为大型链的一部分的AL，提供存储器护理，位于需求更多的市场，以及 在监管严格程度较低的许可证下运营更有可能被私募股权公司收购;以及2） 被收购的AL通过重组业务的方式对新的所有权做出反应， 居民和最终居民的结果。这些假设将在探索性+解释性的 序贯混合方法研究有三个具体目标：1）探索利益相关者对PE公司的看法， 决策和私募股权投资对AL社区的影响; 2）比较被收购或 3）估计私募股权收购对患病率的因果影响 和住院医师的结果。在第一个目标下，研究小组将利用 他们现有的网络和采访利益相关者，以了解不同的动机和影响的观点， PE收购。在第二个目标下，该团队将应用他们开发的方法和数据， 先前收集的数据，以了解作为PE目标的AL的特征。第三个目标将审查 应用工具变量研究体育对有无ADRD居民的福利效应 法这项研究的结果将提供关于私募股权收购AL及其影响的第一个证据 照顾ADRD患者。由于敦促决策者考虑所有权报告和监测， 其他行业，重要的是要深入了解监管较少的AL行业， 为脆弱的老年人和残疾人提供服务，其中近一半患有痴呆症。