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Association Between State Regulations Supportive of Third-party Services and Likelihood of Assisted Living Residents in the US Dying in Place

IMPORTANCE: Older adults are increasingly residing in assisted living residences during their last year of life. The regulations guiding these residential care settings differ between and within the states in the US, resulting in diverse policies that may support residents who wish to die in place....

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Autores principales: Belanger, Emmanuelle, Rosendaal, Nicole, Wang, Xiao (Joyce), Teno, Joan M., Dosa, David M., Gozalo, Pedro L., Carder, Paula, Thomas, Kali S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9547316/
https://www.ncbi.nlm.nih.gov/pubmed/36206007
http://dx.doi.org/10.1001/jamahealthforum.2022.3432
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author Belanger, Emmanuelle
Rosendaal, Nicole
Wang, Xiao (Joyce)
Teno, Joan M.
Dosa, David M.
Gozalo, Pedro L.
Carder, Paula
Thomas, Kali S.
author_facet Belanger, Emmanuelle
Rosendaal, Nicole
Wang, Xiao (Joyce)
Teno, Joan M.
Dosa, David M.
Gozalo, Pedro L.
Carder, Paula
Thomas, Kali S.
author_sort Belanger, Emmanuelle
collection PubMed
description IMPORTANCE: Older adults are increasingly residing in assisted living residences during their last year of life. The regulations guiding these residential care settings differ between and within the states in the US, resulting in diverse policies that may support residents who wish to die in place. OBJECTIVE: To examine the association between state regulations and the likelihood of assisted living residents dying in place. The study hypothesis was that regulations supporting third-party services, such as hospice, increase the likelihood of assisted living residents dying in place. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study combined data about assisted living residences in the US from state registries with an inventory of state regulations and administrative claims data. The study participants comprised 168 526 decedents who were Medicare beneficiaries, resided in 8315 large, assisted living residences (with ≥25 beds) across 301 hospital referral regions during the last 12 months of their lives, and died between 2017 and 2019. Descriptive analyses were performed at the state level, and 3-level multilevel models were estimated to examine the association between supportive third-party regulations and dying in place in assisted living residences. The data were analyzed from September 2021 to August 2022. EXPOSURES: Supportive (vs “silent,” ie, not explicitly mentioned in regulatory texts) state regulations regarding hospice care, private care aides, and home health services, as applicable to licensed/registered assisted living residences across the US. MAIN OUTCOMES AND MEASURES: Presence in assisted living residences on the date of death. RESULTS: The median (IQR) age of the 168 526 decedents included in the study was 90 (84-94) years. Of these, 110 143 (65.4%) were female and 158 491 (94.0%) were non-Hispanic White. Substantial variation in the percentage of assisted living residents dying in place was evident across states, from 18.0% (New York) to 73.7% (Utah). Supportive hospice and home health regulations were associated with a higher odds of residents dying in place (adjusted odds ratio [AOR], 1.38; 95% CI, 1.24-1.54; P < .001; and AOR, 1.21; 95% CI, 1.10-1.34; P < .001, respectively). In addition, hospice regulations remained significant in fully adjusted models (AOR, 1.46; 95% CI, 1.25-1.71). CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that a higher percentage of assisted living residents died in place in US states with regulations supportive of third-party services. In addition, assisted living residents in licensed settings with regulations supportive of hospice regulations were especially likely to die in place.
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spelling pubmed-95473162022-10-24 Association Between State Regulations Supportive of Third-party Services and Likelihood of Assisted Living Residents in the US Dying in Place Belanger, Emmanuelle Rosendaal, Nicole Wang, Xiao (Joyce) Teno, Joan M. Dosa, David M. Gozalo, Pedro L. Carder, Paula Thomas, Kali S. JAMA Health Forum Original Investigation IMPORTANCE: Older adults are increasingly residing in assisted living residences during their last year of life. The regulations guiding these residential care settings differ between and within the states in the US, resulting in diverse policies that may support residents who wish to die in place. OBJECTIVE: To examine the association between state regulations and the likelihood of assisted living residents dying in place. The study hypothesis was that regulations supporting third-party services, such as hospice, increase the likelihood of assisted living residents dying in place. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study combined data about assisted living residences in the US from state registries with an inventory of state regulations and administrative claims data. The study participants comprised 168 526 decedents who were Medicare beneficiaries, resided in 8315 large, assisted living residences (with ≥25 beds) across 301 hospital referral regions during the last 12 months of their lives, and died between 2017 and 2019. Descriptive analyses were performed at the state level, and 3-level multilevel models were estimated to examine the association between supportive third-party regulations and dying in place in assisted living residences. The data were analyzed from September 2021 to August 2022. EXPOSURES: Supportive (vs “silent,” ie, not explicitly mentioned in regulatory texts) state regulations regarding hospice care, private care aides, and home health services, as applicable to licensed/registered assisted living residences across the US. MAIN OUTCOMES AND MEASURES: Presence in assisted living residences on the date of death. RESULTS: The median (IQR) age of the 168 526 decedents included in the study was 90 (84-94) years. Of these, 110 143 (65.4%) were female and 158 491 (94.0%) were non-Hispanic White. Substantial variation in the percentage of assisted living residents dying in place was evident across states, from 18.0% (New York) to 73.7% (Utah). Supportive hospice and home health regulations were associated with a higher odds of residents dying in place (adjusted odds ratio [AOR], 1.38; 95% CI, 1.24-1.54; P < .001; and AOR, 1.21; 95% CI, 1.10-1.34; P < .001, respectively). In addition, hospice regulations remained significant in fully adjusted models (AOR, 1.46; 95% CI, 1.25-1.71). CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that a higher percentage of assisted living residents died in place in US states with regulations supportive of third-party services. In addition, assisted living residents in licensed settings with regulations supportive of hospice regulations were especially likely to die in place. American Medical Association 2022-10-07 /pmc/articles/PMC9547316/ /pubmed/36206007 http://dx.doi.org/10.1001/jamahealthforum.2022.3432 Text en Copyright 2022 Belanger E et al. JAMA Health Forum. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Belanger, Emmanuelle
Rosendaal, Nicole
Wang, Xiao (Joyce)
Teno, Joan M.
Dosa, David M.
Gozalo, Pedro L.
Carder, Paula
Thomas, Kali S.
Association Between State Regulations Supportive of Third-party Services and Likelihood of Assisted Living Residents in the US Dying in Place
title Association Between State Regulations Supportive of Third-party Services and Likelihood of Assisted Living Residents in the US Dying in Place
title_full Association Between State Regulations Supportive of Third-party Services and Likelihood of Assisted Living Residents in the US Dying in Place
title_fullStr Association Between State Regulations Supportive of Third-party Services and Likelihood of Assisted Living Residents in the US Dying in Place
title_full_unstemmed Association Between State Regulations Supportive of Third-party Services and Likelihood of Assisted Living Residents in the US Dying in Place
title_short Association Between State Regulations Supportive of Third-party Services and Likelihood of Assisted Living Residents in the US Dying in Place
title_sort association between state regulations supportive of third-party services and likelihood of assisted living residents in the us dying in place
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9547316/
https://www.ncbi.nlm.nih.gov/pubmed/36206007
http://dx.doi.org/10.1001/jamahealthforum.2022.3432
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