A Profile of the Assisted Living Direct Care Workforce in the United States.

Background and Objectives: The purpose of this article was to develop a profile of direct care workers (DCWs) in assisted living (AL). Research Design and Methods: We used data from 2014 American Community Survey (ACS) to identify the demographic and employment characteristics of AL DCWs. We collected state training requirements for AL DCWs from the administrative rules of state agencies and interviews with state officials. Results: AL DCWs were more likely than other DCWs to be younger, male, White, English speaking, U.S.-born, never married, and to have attended college. Two Affordable Care Act (ACA)-designated training topics (self-care and the role of the personal care aide) were not required in any state. Discussion and Implications: AL has tapped a unique pool of workers (i.e., younger, male as well as female, and with some college education) but needs to address its workforce needs via training, improvements to overall job quality, and the development of career opportunities.

Black-White Disparities in Moves to Assisted Living and Nursing Homes Among Older Medicare Beneficiaries.

OBJECTIVES: Investigate black-white disparities in older adults' moves to assisted living and nursing homes and draw from the Andersen Healthcare Utilization Model to test explanations for any disparities. METHODS: Data are from a nationally representative sample of older community-dwelling Medicare beneficiaries from the 2015 (N = 5,212) National Health and Aging Trends Study (NHATS). We use stepwise multinomial logistic regression to examine black-white disparities in moves out of community housing to assisted living or a nursing home over 2 years, before and after adjusting for predisposing (age, gender), enabling (income, housing tenure, Medicaid, living arrangement) and need (activities of daily living [ADL] limitation, physical capacity, self-rated health, and dementia) factors. RESULTS: Black older adults are less likely to move to assisted living and are more likely to move to a nursing home compared to white older adults. Black-white disparities in moves to nursing homes are explained by black-white differences in enabling and need factors, whereas black-white disparities in moves to assisted living remain even after adjusting for enabling and need factors. DISCUSSION: Unmeasured factors related to systemic racism (e.g., residential racial segregation, racial discrimination) and/or black-white differences in care preferences might further explain black-white disparities in moves to assisted living and warrant further investigation.

Operating characteristics of residential care communities, by community bed size: United States, 2012.

In 2012, the majority of residential care communities had 4­25 beds, yet 71% of residents lived in communities with more than 50 beds. A lower percentage of communities with 4­25 beds were chain-affiliated, nonprofit, and in operation 10 years or more, compared with communities with 26­50 and more than 50 beds. Dementia-exclusive care or dementia care units were more common as community size increased. A higher percentage of communities with more than 50 beds screened for cognitive impairment and offered dementia-specific programming compared with communities with 4­25 and 26­50 beds. A higher percentage of communities with more than 50 beds screened for depression compared with communities with 4­25 beds. Compared with communities with 4­25 beds, a higher percentage of communities with 26­50 beds and more than 50 beds provided therapeutic, hospice, mental health, and dental services; but a lower percentage of communities with more than 50 beds provided skilled nursing services than did smaller communities. This report presents national estimates of residential care communities, using data from the first wave of NSLTCP. This brief profile of residential care communities provides useful information to policymakers, providers, researchers, and consumer advocates as they plan to meet the needs of an aging population. The findings also highlight the diversity of residential care communities across different sizes. Corresponding state estimates and their standard errors for the national figures in this data brief can be found on the NSLTCP website at http://www.cdc.gov/nchs/nsltcp/ nsltcp_products.htm. These national and state estimates establish a baseline for monitoring trends among residents living in residential care.

[Shared-housing arrangements for care-dependent persons. Legal frameworks and numbers in Germany]. / Ambulant betreute Wohngemeinschaften für Menschen mit Pflegebedarf. Versorgungsangebote und gesetzliche Rahmenbedingungen in Deutschland.

BACKGROUND: Since the mid-1990s, supervised shared-housing arrangements (SHA; assisted living facilities) have developed as a specific type of small-scale living facility for elderly care-dependent persons with dementia in Germany, offering services different than those in residential care. Neither a uniform and binding definition of SHA nor reliable estimates concerning numbers currently exist. Since January 2013, SHA have been promoted nationwide in Germany by law. MATERIALS AND METHODS: In a cross-sectional study funded by the National Association of Statutory Health Insurance Funds numbers as well as legal and financial frameworks of SHA in Germany were surveyed. RESULTS: As of February 2013, almost all German "Bundesländer" (federal states) have created special legal regulations for supervised SHA. The results of the present study show at least 1,420 SHA with 10,590 care places for adults in Germany. The regional distribution differs greatly. CONCLUSION: Supervised SHA are increasingly an established care offer among the various long-term care offers in Germany. Different care and support offers help ensure individualized and high quality care for elderly care-dependent persons with dementia.

[Assistance systems for the elderly: the SmartSenior project]. / Gesundheitstechnik für die alternde Bevölkerung: Das Beispiel "SmartSenior".

Demographic change is posing an enormous challenge for societies in industrialized countries: the number of elderly and chronically ill is on the rise, whereas the number of people in the work force is declining. Assistive technology can be an important factor in this process and will help to alleviate shortcomings of the present system. The following example of the joint research program "SmartSenior", which began in mid 2009, shows the stakeholders, challenges, and future trends of assistive technology for the elderly. There is potential for the application of modern technology in three areas: in the training of senior citizens' abilities and skills, in supporting the activities of daily life, and in the continuous monitoring of vital functions.

Assisted living and residential care in Oregon: two decades of state policy, supply, and Medicaid participation trends.

PURPOSE: The study describes Oregon state policy and supply developments for licensed long-term-care settings, particularly apartment-style assisted living facilities and more traditional residential care facilities. DESIGN AND METHODS: Data came from a variety of sources, including state agency administrative records, other secondary data sources, and key informant interviews. Descriptive statistics examined public financing, Medicaid reimbursement, and licensed bed supply trends from 1986 to 2004, as well as Medicaid resident use between 1990 and 2004. RESULTS: Residential care expansion, combined with nursing facility contraction, has transformed Oregon's supply of licensed long-term-care settings in favor of less institutional options. State financing, reimbursement, and licensing policies varied across provider type, with greater public resources supporting growth of assisted living facilities. By 2004, such settings were more likely to be Medicaid providers than residential care facilities and had a higher proportion of Medicaid residents relative to available bed supply. IMPLICATIONS: State financing and reimbursement policies may play a role in stimulating the supply of apartment-style assisted living available to low-income and/or rural service users. Less favorable policy conditions may have unintended consequences for the supply and use of other residential care settings.

Assisted living in rural America: results from a national survey.

CONTEXT: Expanding the availability of long-term care (LTC) services and making them more responsive to consumer preferences is an important goal, particularly for elderly people living in rural areas who tend to be older and have greater functional limitations but less access to the range of LTC options available in metropolitan areas. One option that has been growing in popularity is assisted-living facilities (ALFs). PURPOSE AND METHODS: This paper describes rural ALFs and compares them with metropolitan ALFs. Data were collected using a multistage sample design that yielded a nationally representative sample of ALFs. Telephone interviews were completed with administrators of 1,251 ALFs in 1998. FINDINGS: Nationwide, assisted living was largely administered by private payment, and there was an undersupply in rural areas. Compared with metropolitan ALFs, rural ALFs were smaller and less likely to offer the types of services and accommodations associated with the philosophy of assisted living. They were more likely to offer accommodations with little privacy, and while similar in the services they offered, rural ALFs were less likely to have nurses on staff, particularly licensed practical nurses. Moreover, they were less likely to offer a combination of high services and high privacy. Finally, rural ALFs charged lower prices than urban ALFs; however, the average price was still unaffordable for most elderly rural residents. CONCLUSIONS: These findings suggest that assisted living, as currently structured, will make only a marginal contribution to meeting the needs of frail elders in rural areas.