RETENTION OF DUALLY ELIGIBLE BENEFICIARIES IN ASSISTED LIVING AT THE END OF LIFE

To examine to what extent dually eligible beneficiaries (duals) residing in assisted living remain there toward the end of life, we conducted a prospective cohort study of 98,944 Medicare beneficiaries present at validated AL ZIP codes in January 2017, and who died during a two-year follow-up. The outcome was AL residence in the last 30 days of life. We compared decedents who were not duals (80,156 decedents), with those newly dually eligible in 2017-2018 (3,722 decedents), and those already dually eligible in 2016 (15,066 decedents). Only 36.7% of new dual decedents resided in AL in the last 30 days of life, compared to 66.2% among those dually eligible in 2016, and 84.5% of those without Medicaid. While 29 states retained over half of all decedents in AL until death, only 8 states retained a majority of dually eligible decedents.