Admission limitations in assisted living communities play a critical role in shaping the population mix of residents, according to the results of a new study.
Researchers documented variation across 165 licensure classifications in how all 50 states limit who assisted living communities can admit, as well as what assessments are required to make those determinations. The results were published in JAMDA, the Journal of Post-Acute and Long-Term Care Medicine.
The licensure classifications covered 31,840 assisted living communities housing 1.2 million residents.
According to the study, 29% of assisted living communities limit admissions based on a prospective resident’s health conditions due to state regulations. The next largest group of communities (23.6%) have regulations that limit admissions based on health, specific behavior, mental health conditions and cognitive impairment. Only 11.1% of licensed assisted living communities have no state regulations restricting admissions.
The researchers also found that more than 80% of licensed communities were required by state regulations to have residents complete a health assessment at admission, but less than half of those communities were required to complete a cognitive assessment.
“With more than four of 10 older assisted living residents living with [Alzheimer’s disease and related dementias], omission of a required cognitive assessment at time of admission is noteworthy,” the authors wrote, adding that the approach may reflect the idea of assisted living as market-based residential care facilities that facilitate resident self-direction. “The lack of a required cognitive assessment warrants further consideration, as some AL communities may admit residents with unobserved thinking and memory problems that soon manifest as care needs that cannot be fully met,” they added.
The variation in admission criteria, the investigators noted, implies that states have created multiple licensure classifications that sort types of residents into settings based on health, mental health or cognitive need.
The authors called for further investigation into the implications of this “regulatory diversity” and how it may contribute to substantive differences in resident composition and individual outcomes. They added that their findings may be helpful to clinicians, consumers and policymakers to better understand the options in their state and how various assisted living licensure classifications compare with one another.
The study was supported by the National Institute on Aging.
