Private Equity Expansion in Assisted Living: Implications for Dementia Care

项目总结 辅助生活(AL)是一个不断发展的长期护理行业，为几乎所有人提供住房和支持性服务 100万虚弱和功能受损的老年人-其中49%患有阿尔茨海默病或 相关痴呆症(ADRD)。对AL，特别是痴呆症护理需求增加的人口预测 (也被称为“记忆护理”)，已经引起了私募股权公司的注意。PE所有权 倡导者认为，私募股权公司带来了亟需的资本，使提供商能够更新设施，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，并改善护理质量。 然而，越来越令人担忧的是，一些私募股权公司对短期利润的关注可能会损害质量 照顾AL居民，特别是那些患有痴呆症的人。体育锻炼效果的研究成果 收购养老院的情况好坏参半：虽然一些研究发现了负面影响(例如，减少人员配备， 死亡率增加)，其他国家则没有发现人员配置或质量成果方面的变化。然而，与护理不同的是 家庭，没有关于AL护理质量的法规、支付政策或公开报告的国家框架 像在疗养院一样，发挥“护栏”的作用，抵御收购私募股权可能带来的负面影响。 因此，本应用程序的目的是了解私募股权投资公司投资的AL的类型以及PE如何 收购影响患有ADRD的居民的构成和居民的结局。我们的工作假说 是：1)作为大型连锁企业的一部分，提供记忆护理的ALS位于需求更大的市场，以及 在监管不那么严格的牌照下运营更有可能被私募股权公司购买；以及2) 收购的AL通过重组运营来应对新的所有权，重组的方式影响到 居民以及最终居民的结果。这些假设将以探索性+解释性的方式进行检验 顺序混合方法研究有三个具体目的：1)探讨利益相关者对私募股权投资公司的认知 决策和私募股权投资对AL社区的影响；2)比较收购或 被私募股权公司剥离；3)估计私募股权收购对流行率的因果影响 AL中ADRD的居民和居民的转归。在第一个目标下，研究团队将利用 他们现有的网络和采访利益攸关方，以引起对动机和影响的不同观点 PE收购。在第二个目标下，团队将应用他们开发的方法和他们的数据 以前收集的，以了解作为PE靶点的ALS的特征。第三个目标将审查 应用工具变量对有无ADRD的居民获得体育锻炼的福利效应 方法。这项研究的结果将为私募股权公司收购AL及其影响提供第一个证据 关心患有ADRD的居民。由于敦促政策制定者考虑所有权报告和监测， 在其他行业，重要的是要深入了解监管较少的AL行业，这些行业提供了支持 为易受伤害的老年人和残疾人提供服务，其中近一半人患有痴呆症。

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.