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How Good Is Assisted Living? Findings and Implications From an Outcomes Study

¹ Cecil G. Sheps Center for Health Services Research
² School of Social Work
³ Department of Family Medicine, University of North Carolina at Chapel Hill.
⁴ Department of Sociology and Anthropology, University of Maryland, Baltimore County.
⁵ Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore.
⁶ Department of Health Policy and Administration, University of North Carolina at Chapel Hill.

Address correspondence to Dr. Sheryl Zimmerman, Program on Aging, Disability, and Long-Term Care, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Airport Rd., Campus Box 7590, Chapel Hill, NC 27599-7590. E-mail: Sheryl_Zimmerman{at}unc.edu

Objectives. The objective of this work was to determine 1-year medical outcomes, nursing home transfer, and functional change of assisted living (AL) residents and their relationship to care.

Methods. On-site interviews and observations regarding the status and care of 2,078 residents in 193 facilities across four states were conducted; follow-up was by telephone interview with care providers.

Results. Annual mortality and transfer rates were 14.4 and 21.3 per 100 residents. The probability of hospitalization and new/worsening morbidities over a standardized quarter per 100 residents was 12.7 and 22.7. Standardized change in function was notable among those who were transferred or died and small among others. Facility characteristics did not generally relate to medical outcomes and transfer, and those that related to functional change were small and occurred across multiple functions. Facilities that are affiliated with another level of care were more likely to transfer; nurse staffing was favorable for hospitalization but not transfer; and aide turnover was protective for mortality.

Discussion. No single component defines "good" AL care. Predictors and outcomes are inconsistent, and effect sizes are small. Therefore, practice and policy should not focus narrowly on any one area or restrict the type of care—this being welcome news that supports diversity to accommodate individual preferences.

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