Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA.
Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA.
J Am Med Dir Assoc. 2021 Aug;22(8):1714-1719.e2. doi: 10.1016/j.jamda.2020.10.014. Epub 2020 Nov 13.
We examined state variations in assisted living (AL) regulatory policies for admission/retention, staffing/training, medication management, and dementia care. Factors associated with domain-specific and overall regulatory stringency were identified.
This observational study used the following data sources: 2019 review of state AL regulations; 2019 national inventory of AL communities; 2014 Government Accountability Office survey of Medicaid agencies; 2016 Genworth Cost of Care Survey; and the 2018 Nursing Home Compare.
Final analyses included 46 states (excluding Alaska, Kentucky, Louisiana, and West Virginia) and the District of Columbia.
For each regulatory domain of interest (dependent variables), we generated policy scores by conducting content analysis of state regulatory databases. States were assigned points for presence of each policy (eg, staff training). The number of points assigned to each policy was divided by the total possible number of policy-related points, producing state stringency scores (between 0% and 100%) for each policy domain. Independent variables included market-level characteristics (eg, AL monthly cost), state generosity (eg, proportion of Medicaid aged using AL services), quality of care (eg, percent of nursing homes with few deficiencies), and others. Descriptive analyses and multivariable logistic regression models with stepwise selection were used.
We found significant variations in all policy domains across states. No single policy appeared to clearly dominate a state's rank. AL bed supply, monthly AL cost, proportion of Medicaid beneficiaries receiving AL services, and other variables were significantly associated with regulatory stringency of the domains examined.
There were substantial variations in regulatory stringency across states. Several market and state generosity measures were identified as potential determinants of stringency, but the direction of these associations appeared to depend on what was being regulated. Future studies should examine how regulatory stringency affects access to and care quality in ALs.
我们研究了辅助生活（AL）准入/保留、人员配备/培训、药物管理和痴呆症护理方面的监管政策在各州的差异。确定了与特定领域和整体监管严格程度相关的因素。
这项观察性研究使用了以下数据源：2019 年对州辅助生活法规的审查；2019 年全国辅助生活社区清单；2014 年政府问责局对医疗补助机构的调查；2016 年 Genworth 护理成本调查；以及 2018 年养老院比较。
最终分析包括 46 个州（不包括阿拉斯加、肯塔基州、路易斯安那州和西弗吉尼亚州）和哥伦比亚特区。
对于每个感兴趣的监管领域（因变量），我们通过对州监管数据库进行内容分析来生成政策评分。为每个政策的存在分配分数（例如，员工培训）。为每个政策分配的分数除以与政策相关的总分数，为每个政策领域产生州严格程度分数（0%至 100%）。自变量包括市场水平特征（例如，AL 每月费用）、州慷慨程度（例如，使用 AL 服务的 Medicaid 年龄人群的比例）、护理质量（例如，有少量缺陷的养老院比例）等。使用描述性分析和逐步选择的多变量逻辑回归模型。
我们发现各州在所有政策领域都存在显著差异。没有单一政策明显主导一个州的排名。AL 床位供应、每月 AL 费用、接受 AL 服务的 Medicaid 受益人的比例以及其他变量与所检查的领域的监管严格程度显著相关。
各州的监管严格程度存在很大差异。确定了一些市场和州慷慨程度措施作为严格程度的潜在决定因素，但这些关联的方向似乎取决于正在监管的内容。未来的研究应该研究监管严格程度如何影响辅助生活的准入和护理质量。
