End-of-Life Care Transitions in Assisted Living: Associations With State Staffing and Training Regulations.
Assisted living
end-of-life
staffing
state regulations
transition
Journal
Journal of the American Medical Directors Association
ISSN: 1538-9375
Titre abrégé: J Am Med Dir Assoc
Pays: United States
ID NLM: 100893243
Informations de publication
Date de publication:
06 2023
06 2023
Historique:
received:
29
08
2022
revised:
19
12
2022
accepted:
03
02
2023
pmc-release:
01
06
2024
medline:
2
6
2023
pubmed:
14
3
2023
entrez:
13
3
2023
Statut:
ppublish
Résumé
We examined the frequency and categories of end-of-life care transitions among assisted living community decedents and their associations with state staffing and training regulations. Cohort study. Medicare beneficiaries who resided in assisted living facilities and had validated death dates in 2018-2019 (N = 113,662). We used Medicare claims and assessment data for a cohort of assisted living decedents. Generalized linear models were used to examine the associations between state staffing and training requirements and end-of-life care transitions. The frequency of end-of-life care transitions was the outcome of interest. State staffing and training regulations were the key covariates. We controlled for individual, assisted living, and area-level characteristics. End-of-life care transitions were observed among 34.89% of our study sample in the last 30 days before death, and among 17.25% in the last 7 days. Higher frequency of care transitions in the last 7 days of life was associated with higher regulatory specificity of licensed [incidence risk ratio (IRR) = 1.08; P = .002] and direct care worker staffing (IRR = 1.22; P < .0001). Greater regulatory specificity of direct care worker training (IRR = 0.75; P < .0001) was associated with fewer transitions. Similar associations were found for direct care worker staffing (IRR = 1.15; P < .0001) and training (IRR = 0.79; P < .001) and transitions within 30 days of death. There were significant variations in the number of care transitions across states. The frequency of end-of-life care transitions among assisted living decedents during the last 7 or 30 days of life was associated with state regulatory specificity for staffing and staff training. State governments and assisted living administrators may wish to set more explicit guidelines for assisted living staffing and training to help improve end-of-life quality of care.
Identifiants
pubmed: 36913979
pii: S1525-8610(23)00110-X
doi: 10.1016/j.jamda.2023.02.002
pmc: PMC10238640
mid: NIHMS1874467
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
827-832.e3Subventions
Organisme : AHRQ HHS
ID : R01 HS026893
Pays : United States
Organisme : NIA NIH HHS
ID : RF1 AG063811
Pays : United States
Informations de copyright
Copyright © 2023 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
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