Measurement of Quality in Assisted Living in the United States of America: A Scoping Review

Objectives: To identify different approaches (unique domains) and indicators to evaluate quality in assisted living communities in the United States. Design: Scoping review supplemented with key informant and technical panel guidance. Setting and Participants: Assisted living settings and residents. Methods: We obtained feedback on our review protocol and search strategy from key informants with expertise in AL quality, including feedback on a supplementary gray literature search for relevant non–peer-reviewed literature (such as nonempirical policy briefs). We scanned MEDLINE and CINAHL databases for peer-reviewed literature published from 2009 through 2019 assessing quality in assisted living in the United States. We synthesized evidence using the Donabedian framework and presented our analyses in 2 expert panel discussions for additional insights. Results: We screened 833 abstracts, of which 49 studies met our selection criteria. Gray literature search yielded an additional 45 non–peer-reviewed sources. Nine unique domains were assessed: (1) resident quality of life, (2) resident and family satisfaction, (3) staffing and staff-related outcomes, (4) resident safety, (5) resident health outcomes, (6) care planning and integration, (7) physical and social environment, (8) service availability, and (9) core values and philosophy. Resident quality of life and satisfaction were the most prioritized domains in published literature, key informant interviews, and expert panel discussions. Domains such as staffing, safety, resident health outcomes, care planning, and integration were identified as vitally important for the increasing clinical and sociodemographic heterogeneity in the resident population. Expert panels emphasized the importance of including residents’ voice in the quality measures development process. Conclusions and Implications: Lack of standardized measurement of quality impedes provision of person-centered, value-based care in US-based assisted living settings. Our comprehensive list of domains and indicators should inform future concerted efforts to develop and incorporate standardized quality measurement as part of routine practice in assisted living communities in the United States.