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

项目摘要/摘要 大约一百万人，估计有40%-72%的人患有认知障碍或被诊断为 阿尔茨海默病相关痴呆(ADRD)，存在于辅助生活(AL)中；然而，人们对他们的情况知之甚少 体验或提供的护理质量。与其他形式的长期护理(LTC)不同，如疗养院 受联邦监管，AL的许可、运营和执法要求落在各州手中， 这两家公司在监管这一不断增长的行业的方法上存在巨大差异。因为AL假设增加了 在为患有ADRD的弱势老年人提供LTC方面的作用，迫切需要了解积极的 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患者的护理结果 Al居民，特别强调患有ADRD的居民，他们往往不能为自己辩护。这个 此应用程序的总体目标是检查各州的AL法规环境，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。中环 假设是，为了生存，AL提供商遵守许可要求，并对 监管环境，最终影响AL居民的结果。建议的理由是 研究表明，更好地了解AL居民患有ADRD的经历以及它们如何根据 一个州对这一行业的监管方法将有助于为政策和支付决定提供信息，并最终 改善ADRD需要LTC的老年人的结局。在强劲的初步数据指引下，这 假说将通过追求三个具体目标来检验：1)描述各州如何在相关情况下监管AL 对ADRD患者的护理；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ALS的ADRD居民之间的结果 为非专科肌萎缩侧索硬化症患者提供专门的痴呆症护理。在第一个目标下，调查人员将 在以前努力的基础上，确定和检查各州AL的历史、监督和执行情况 法规可能会影响患有ADRD的居民的结局。在第二个目标中，调查人员将应用 他们通过国家老龄研究所的R21(#R21AG047303)开发了新的方法，以 使用联邦医疗保险数据识别AL居民，并使用严格的方法检查监管变化的影响 关于提供者的行为和居民在10年内的结果。在第三个目标下，调查人员将 应用观察性的、准实验的方法来检查生活在痴呆症中的影响- 关于住院医生结果的专门AL。这种方法是创新的，因为它是第一个检查 全国AL居民ADRD的结果，以及差异很大的AL法规对 医疗保健结果。这项拟议的研究具有重要意义，因为它将为 各国正在寻找最有效的方法来监管这一不断增长的行业。最终，这样的信息会 改善使用AL的患有ADRD的脆弱老年人结局的潜力。

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.