State regulations that support third-party services such as home health and hospice are linked to assisted living residents dying in the community where they live.
That’s according to a new study published Friday in the Journal of the American Medical Association. Researchers studied data on more than 8,300 assisted living communities from state registries and state regulations and administrative claims. In total, they tracked more than 168,000 Medicare beneficiaries and assisted living residents who died between 2017 and 2019.
The study’s authors found that states with supportive hospice and home health regulations were associated with a higher odds of residents dying in the assisted living community where they lived as opposed to a hospital or skilled nursing facility.
“The findings support our hypothesis that assisted living residents in settings operating under licenses that are supportive of third-party services may, on average, be more likely to die in place,” the study’s author wrote.
For senior living operators, the study comes as yet more evidence that offering some third-party services can improve quality of care and keep residents living in their communities for longer.
Supportive hospice regulations were “most important” to dying in place, according to the study.
The latest results are consistent with those from a recent Medicare Current Beneficiary Survey, which showed a higher proportion of residents died in place at community-based residential settings that allowed for clinical services between 2002 and 2018.
The study’s authors also noted a similar study from 2014 examining eight assisted living communities in Georgia that showed access to hospice services helped keep residents with deteriorating health conditions from needing to go to an acute care facility, a nursing home or an inpatient hospice facility.
Only 13 states supported all third-party services across all license types, according to the study. Many other state regulations were either supportive of only some third-party services or varied among license types or classifications.
A total of six states — Alaska, Hawaii, Minnesota, Mississippi, Montana and North Carolina — did not have third-party regulations for assisted living communities.
The number of residents dying in the assisted living community where they lived varied widely from state to state. For instance, while 18% of New York residents died in place between 2017 and 2019, almost three-quarters of assisted living residents in Utah died in place during that time.
Notable exceptions included Alaska and Montana, two states without regulations on third-party services that saw high rates of residents dying in the communities where they live.
The study’s author was careful to note that simply dying in an assisted living community is not a guarantee of high-quality end-of life care.
“There is also general agreement about the difficulty of predicting end-of-life disease trajectories among frail older adults, and especially the individuals with dementia, making the management of care transitions to and from assisted living particularly challenging near the end of life,” the study’s author wrote.
As such, further research is needed to show the determinants of quality of end-of-life care for assisted living residents, the study concluded.
“But supportive regulations for services that are important to meet the increasing care needs of individuals approaching death may be a good place to start among the many states where there is still regulatory uncertainty about these services,” the study’s author wrote.