The Relationship Between States' Staffing Regulations and Hospitalizations of Assisted Living Residents
This research was presented at the AcademyHealth Annual Research Meeting (virtual), June 14–17, 2021. This research was supported by a grant to Kali Thomas from the National Institute on Aging (Grant No. R01AG057746). The authors acknowledge Joan Brazier for her excellent project management and Jaclyn Winfree for her contributions sourcing the policy information. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the National Institutes of Health, the Department of Veterans Affairs, or the United States government.
Health Affairs (project Hope)
Assisted living provides housing and long-term care services to more than 811,000 older adults in the United States daily and is regulated by the states. This article describes changes in the specificity of state regulations governing the staffing in assisted living settings (that is, requirements for sufficient staffing or staffing ratios or levels) between 2007 and 2018 and the association between these changes and rates of hospitalization among a national sample of assisted living residents, including a subgroup with dementia. We found that increased regulatory specificity for direct care workers (for example, a change from requiring "sufficient" direct care worker staffing to requiring a specific staffing ratio or level) was associated with a 4 percent reduction in the monthly risk for hospitalization among residents in our sample and a 6 percent reduction among the subgroup with dementia. However, an increase in regulatory specificity for licensed practical nurses was associated with a 2.5 percent increase in the monthly risk for hospitalization and a 5 percent increase among the subgroup with dementia. Given that no federal requirements exist for the number of staff members or composition of staff in assisted living, these findings can inform states' policy decisions about staffing requirements for assisted living settings.
© 2021 Project HOPE—The People-to-People Health Foundation, Inc.
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Thomas, K. S., Cornell, P. Y., Zhang, W., Smith, L., Hua, C., Kaskie, B., & Carder, P. (2021). The Relationship Between States’ Staffing Regulations And Hospitalizations Of Assisted Living Residents. Health Affairs, 40(9), 1377–1385. https://doi.org/10.1377/hlthaff.2021.00598