Nattinger Matthew C, Kaskie Brian
a Analyst, U. S. Government Accountability Office , Chicago , Illinois , USA.
b Associate Professor, Department of Health Management and Policy , University of Iowa , Iowa City , Iowa , USA.
J Aging Soc Policy. 2017 Mar-Apr;29(2):123-142. doi: 10.1080/08959420.2016.1236324. Epub 2016 Sep 20.
Continued growth in the number of individuals with dementia residing in assisted living (AL) facilities raises concerns about their safety and protection. However, unlike federally regulated nursing facilities, AL facilities are state-regulated and there is a high degree of variation among policies designed to protect persons with dementia. Despite the important role these protection policies have in shaping the quality of life of persons with dementia residing in AL facilities, little is known about their formation. In this research, we examined the adoption of AL protection policies pertaining to staffing, the physical environment, and the use of chemical restraints. For each protection policy type, we modeled policy rigor using an innovative point-in-time approach, incorporating variables associated with state contextual, institutional, political, and external factors. We found that the rate of state AL protection policy adoptions remained steady over the study period, with staffing policies becoming less rigorous over time. Variables reflecting institutional policy making, including legislative professionalism and bureaucratic oversight, were associated with the rigor of state AL dementia protection policies. As we continue to evaluate the mechanisms contributing to the rigor of AL protection policies, it seems that organized advocacy efforts might expand their role in educating state policy makers about the importance of protecting persons with dementia residing in AL facilities and moving to advance appropriate policies.
居住在辅助生活（AL）设施中的痴呆症患者数量持续增长，这引发了人们对他们安全与保护的担忧。然而，与联邦监管的护理机构不同，AL设施由州政府监管，旨在保护痴呆症患者的政策存在很大差异。尽管这些保护政策在塑造居住在AL设施中的痴呆症患者的生活质量方面发挥着重要作用，但人们对其形成过程知之甚少。在这项研究中，我们考察了与人员配备、物理环境和化学约束使用相关的AL保护政策的采用情况。对于每种保护政策类型，我们采用一种创新的时间点方法对政策严格程度进行建模，纳入与州背景、机构、政治和外部因素相关的变量。我们发现，在研究期间，州AL保护政策的采用率保持稳定，随着时间的推移，人员配备政策的严格程度有所降低。反映机构政策制定的变量，包括立法专业性和官僚监督，与州AL痴呆症保护政策的严格程度相关。随着我们继续评估影响AL保护政策严格程度的机制，有组织的宣传努力似乎可能会扩大其在教育州政策制定者认识到保护居住在AL设施中的痴呆症患者的重要性以及推动适当政策方面的作用。
