(P73) Potential Drivers of Admissions and Discharges in Assisted Living

Introduction/

Objective: Individuals prefer to age in place within their homes, which increasingly include assisted living (AL) communities. These communities have different requirements for admission and discharge, which relate in part to state regulations. To identify barriers and facilitators of aging-in-place in AL, this study examined the association between regulations as well as AL organizational characteristics to admission and retention practices.

Design/Methodology: Organizational data were derived from a study of 250 AL communities in 7 states (AR, LA, NJ, NY, OK, PA, TX) conducted 2016-2018. Data on regulations pertaining to admission and discharge criteria in 2018 were obtained from a database of regulations sourced using the LexisNexis legal database. Descriptive statistics explored unadjusted differences in admission and discharge policies in relation to state regulations and organizational characteristics. Multilevel linear probability models with a random intercept at the license type level examined regulatory and organizational correlates of AL admission and discharge practices for three activities of daily living related to different levels of resident need (bathing, getting out of bed, and eating). Data on sampled communities were scaled to represent the population of AL communities with at least 4 beds within each sampled state.

Results: States with the least flexible regulations regarding admission evidenced a 20% lower probability of admitting residents who needed assistance getting out of bed (p <.05). For-profit communities had a 59% higher probability of admitting residents who needed assistance with eating (p <.05). Being affiliated with a continuing care retirement community (CCRC) or nursing home was associated with a higher probability of discharging residents who needed assistance with bathing (55% higher probability) and eating (44% higher probability) (p <.05). Direct care staffing ratios and the availability of licensed nurses were not associated with admission and discharge practices.

Conclusion/

Discussion: In addition to regulations, AL admission and discharge practices may be driven in part by financial motivations including profit status and joint operations with facilities providing additional levels of care. There is a need to consider whether admission and discharge practices could be better aligned with the care needs of AL residents.