Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.
Institute on Aging, Portland State University, Portland, Oregon, USA.
Gerontologist. 2024 May 1;64(5). doi: 10.1093/geront/gnad109.
State-regulating agencies use 350 different licenses and certifications to govern assisted living (AL), resulting in significant variation in regulations governing health services, the scope of practice, and capacity. This lack of standardization makes it difficult to compare and contrast AL operations and residents' outcomes across similarly regulated communities.
We used qualitative and quantitative methods to empirically develop and describe a typology of state AL regulations that captures inter- and intrastate variation. Based on the rules governing health services, we created regulatory specificity scores for 5 thematic dimensions: medication administration, third-party care, skilled nursing, medication review, and licensed nurse staffing. With these scores, we conducted a K-means cluster analysis to identify groups of AL license types. To differentiate the regulatory types, we calculated standardized mean differences across structure, process, outcome, and resident characteristics of the AL communities licensed under each type.
We identified 6 types of AL differentiated by the regulatory provisions governing health services: Housing, Holistic, Hybrid, Hospitality, Healthcare, and Health Support. The types align with previous work and reflect tangible differences in resident characteristics, health service structures, processes, and outcomes.
This typology effectively captures differences across regulated dimensions and can inform and support quality of care. Researchers, policy-makers, and consumers may benefit from using this typology and acknowledging these differences in AL licensure when designing research studies, developing policies, and selecting an AL community.
州监管机构使用 350 种不同的许可证和认证来管理辅助生活（AL），导致管理健康服务、实践范围和能力的法规存在显著差异。这种缺乏标准化使得难以比较和对比在类似监管社区中运营的 AL 以及居民的结果。
我们使用定性和定量方法来实证开发和描述一种州 AL 法规的类型学，该类型学捕捉了州内和州际的差异。基于管理健康服务的规则，我们为 5 个主题维度创建了监管特定性评分：药物管理、第三方护理、熟练护理、药物审查和持照护士人员配备。利用这些分数，我们进行了 K-均值聚类分析，以确定 AL 许可证类型的群组。为了区分监管类型，我们计算了每种类型持照的 AL 社区在结构、过程、结果和居民特征方面的标准化均值差异。
我们确定了 6 种由管理健康服务的监管规定区分的 AL 类型：住房、整体、混合、酒店、医疗保健和健康支持。这些类型与之前的工作一致，并反映了居民特征、健康服务结构、过程和结果方面的明显差异。
这种类型学有效地捕捉了监管维度的差异，并可以为护理质量提供信息和支持。研究人员、政策制定者和消费者可能受益于使用这种类型学，并在设计研究、制定政策和选择 AL 社区时承认 AL 许可中的这些差异。
