Connecting policy to licensed assisted living communities, introducing health services regulatory analysis

Lindsey Smith; Paula Carder; Taylor Bucy; Jaclyn Winfree; Joan F. Brazier; Brian Kaskie; Kali S. Thomas

doi:10.1111/1475-6773.13616

Connecting policy to licensed assisted living communities, introducing health services regulatory analysis

Lindsey Smith, Paula Carder, Taylor Bucy, Jaclyn Winfree, Joan F. Brazier, Brian Kaskie, Kali S. Thomas

Research output: Contribution to journal › Article › peer-review

32 Scopus citations

Abstract

Objective: To document dementia-relevant state assisted living regulations and their changes over time as they pertain to licensed care settings. Data Sources: For all states, current directories of licensed assisted living communities and state regulations for each year, 2007-2018, were obtained from state agency websites and Nexis Uni, respectively. Study Design: We identified multiple types of regulatory classifications for each state and documented the presence or absence of specific dementia care provisions in the regulations for each type by study year. Maps and summary statistics were used to compare results to previous research and document change longitudinally. Data Collection/Extraction Methods: We used a policy analysis approach to connect communities listed in directories to applicable regulatory text. Then, we employed policy surveillance and question-based coding to record the presence or absence of specific policies for each classification and study year. Principal Findings: Our team empirically documented provisions requiring dementia-specific training for administrators and direct care staff, and cognitive impairment screening for each study year. We found that 23 states added one or more of these requirements for one or more license types, but the states that had these provisions for all types of licensed assisted living declined from four to two. Conclusions: We identified significant, previously undocumented, within-state policy variation for assisted living licensed settings between 2007 and 2018. Using the regulatory classification instead of the state as the unit of analysis revealed that many policy adoptions were limited to dementia-designated settings. This suggests that people living with dementia in general assisted living are not afforded the same protections. We call our approach health services regulatory analysis and argue that it has the potential to identify gaps in existing policies, an important endeavor for health services research in assisted living and other care settings.

Original language	English (US)
Pages (from-to)	540-549
Number of pages	10
Journal	Health services research
Volume	56
Issue number	3
DOIs	https://doi.org/10.1111/1475-6773.13616
State	Published - Jun 2021

Bibliographical note

Funding Information:
The work presented in this paper was supported by the National Institute on Aging (R01AG057746 to KST) Do State Regulations Affect the Outcomes of Assisted Living Residents with Dementia? and the US Department of Veterans Affairs Health Services Research & Development (CDA 14‐422 to KST). Joint Acknowledgment/Disclosure Statement:

Funding Information:
Joint Acknowledgment/Disclosure Statement: The work presented in this paper was supported by the National Institute on Aging (R01AG057746 to KST) Do State Regulations Affect the Outcomes of Assisted Living Residents with Dementia? and the US Department of Veterans Affairs Health Services Research & Development (CDA 14-422 to KST). 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, Department of Veterans Affairs, or the United States government. We thank Laken Harrel and Christina Nguyen from the Oregon Health & Science University - Portland State University School of Public Health, Kaylin Dugle, May Swihart, and Margaret Mitzel of Portland State University, and Seamus Taylor and Delaney Bounds from the University of Iowa for their help sourcing and coding regulatory documents. Wenhan Zhang and Dr. Portia Cornell of Brown University provided guidance in defining the regulated setting types. We acknowledge Andrew Campbell of Temple University for providing policy surveillance training to our team. The authors have no other disclosures.

Publisher Copyright:
© Health Research and Educational Trust

Keywords

assisted living facilities
government regulation
health policy
health services
legal epidemiology
residential facilities

PubMed: MeSH publication types

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

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10.1111/1475-6773.13616

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title = "Connecting policy to licensed assisted living communities, introducing health services regulatory analysis",

abstract = "Objective: To document dementia-relevant state assisted living regulations and their changes over time as they pertain to licensed care settings. Data Sources: For all states, current directories of licensed assisted living communities and state regulations for each year, 2007-2018, were obtained from state agency websites and Nexis Uni, respectively. Study Design: We identified multiple types of regulatory classifications for each state and documented the presence or absence of specific dementia care provisions in the regulations for each type by study year. Maps and summary statistics were used to compare results to previous research and document change longitudinally. Data Collection/Extraction Methods: We used a policy analysis approach to connect communities listed in directories to applicable regulatory text. Then, we employed policy surveillance and question-based coding to record the presence or absence of specific policies for each classification and study year. Principal Findings: Our team empirically documented provisions requiring dementia-specific training for administrators and direct care staff, and cognitive impairment screening for each study year. We found that 23 states added one or more of these requirements for one or more license types, but the states that had these provisions for all types of licensed assisted living declined from four to two. Conclusions: We identified significant, previously undocumented, within-state policy variation for assisted living licensed settings between 2007 and 2018. Using the regulatory classification instead of the state as the unit of analysis revealed that many policy adoptions were limited to dementia-designated settings. This suggests that people living with dementia in general assisted living are not afforded the same protections. We call our approach health services regulatory analysis and argue that it has the potential to identify gaps in existing policies, an important endeavor for health services research in assisted living and other care settings.",

keywords = "assisted living facilities, government regulation, health policy, health services, legal epidemiology, residential facilities",

author = "Lindsey Smith and Paula Carder and Taylor Bucy and Jaclyn Winfree and Brazier, {Joan F.} and Brian Kaskie and Thomas, {Kali S.}",

note = "Funding Information: The work presented in this paper was supported by the National Institute on Aging (R01AG057746 to KST) Do State Regulations Affect the Outcomes of Assisted Living Residents with Dementia? and the US Department of Veterans Affairs Health Services Research & Development (CDA 14‐422 to KST). Joint Acknowledgment/Disclosure Statement: Funding Information: Joint Acknowledgment/Disclosure Statement: The work presented in this paper was supported by the National Institute on Aging (R01AG057746 to KST) Do State Regulations Affect the Outcomes of Assisted Living Residents with Dementia? and the US Department of Veterans Affairs Health Services Research & Development (CDA 14-422 to KST). 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, Department of Veterans Affairs, or the United States government. We thank Laken Harrel and Christina Nguyen from the Oregon Health & Science University - Portland State University School of Public Health, Kaylin Dugle, May Swihart, and Margaret Mitzel of Portland State University, and Seamus Taylor and Delaney Bounds from the University of Iowa for their help sourcing and coding regulatory documents. Wenhan Zhang and Dr. Portia Cornell of Brown University provided guidance in defining the regulated setting types. We acknowledge Andrew Campbell of Temple University for providing policy surveillance training to our team. The authors have no other disclosures. Publisher Copyright: {\textcopyright} Health Research and Educational Trust",

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AU - Bucy, Taylor

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AU - Thomas, Kali S.

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N2 - Objective: To document dementia-relevant state assisted living regulations and their changes over time as they pertain to licensed care settings. Data Sources: For all states, current directories of licensed assisted living communities and state regulations for each year, 2007-2018, were obtained from state agency websites and Nexis Uni, respectively. Study Design: We identified multiple types of regulatory classifications for each state and documented the presence or absence of specific dementia care provisions in the regulations for each type by study year. Maps and summary statistics were used to compare results to previous research and document change longitudinally. Data Collection/Extraction Methods: We used a policy analysis approach to connect communities listed in directories to applicable regulatory text. Then, we employed policy surveillance and question-based coding to record the presence or absence of specific policies for each classification and study year. Principal Findings: Our team empirically documented provisions requiring dementia-specific training for administrators and direct care staff, and cognitive impairment screening for each study year. We found that 23 states added one or more of these requirements for one or more license types, but the states that had these provisions for all types of licensed assisted living declined from four to two. Conclusions: We identified significant, previously undocumented, within-state policy variation for assisted living licensed settings between 2007 and 2018. Using the regulatory classification instead of the state as the unit of analysis revealed that many policy adoptions were limited to dementia-designated settings. This suggests that people living with dementia in general assisted living are not afforded the same protections. We call our approach health services regulatory analysis and argue that it has the potential to identify gaps in existing policies, an important endeavor for health services research in assisted living and other care settings.

AB - Objective: To document dementia-relevant state assisted living regulations and their changes over time as they pertain to licensed care settings. Data Sources: For all states, current directories of licensed assisted living communities and state regulations for each year, 2007-2018, were obtained from state agency websites and Nexis Uni, respectively. Study Design: We identified multiple types of regulatory classifications for each state and documented the presence or absence of specific dementia care provisions in the regulations for each type by study year. Maps and summary statistics were used to compare results to previous research and document change longitudinally. Data Collection/Extraction Methods: We used a policy analysis approach to connect communities listed in directories to applicable regulatory text. Then, we employed policy surveillance and question-based coding to record the presence or absence of specific policies for each classification and study year. Principal Findings: Our team empirically documented provisions requiring dementia-specific training for administrators and direct care staff, and cognitive impairment screening for each study year. We found that 23 states added one or more of these requirements for one or more license types, but the states that had these provisions for all types of licensed assisted living declined from four to two. Conclusions: We identified significant, previously undocumented, within-state policy variation for assisted living licensed settings between 2007 and 2018. Using the regulatory classification instead of the state as the unit of analysis revealed that many policy adoptions were limited to dementia-designated settings. This suggests that people living with dementia in general assisted living are not afforded the same protections. We call our approach health services regulatory analysis and argue that it has the potential to identify gaps in existing policies, an important endeavor for health services research in assisted living and other care settings.

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Connecting policy to licensed assisted living communities, introducing health services regulatory analysis

Abstract

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Keywords

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