User‐Generated Google Maps Ratings, State Staffing and Training Regulations, and the Quality of Hospice Care in Assisted Living Communities

Background Hospice services are growing among Medicare beneficiaries, yet concerns remain about the hospice quality for residents in assisted living (AL) communities. Little is known about how AL characteristics and state regulations are associated with hospice care in these settings. Objectives To examine (1) whether AL user‐generated google maps ratings (AL google maps ratings) and (2) state‐level regulations on AL staffing are associated with hospice ratings: Methods We conducted a cross‐sectional analysis of 15,947 AL communities. We included data on AL‐specific direct care worker (DCW) state staffing and staff training regulations. Logistic regression models were used to assess associations, adjusting for AL, hospice, and market‐level characteristics. Results A one‐star increase in an AL google maps rating was associated with 6% higher odds of being served by hospices with higher HIS scores (OR = 1.06, p = 0.032), but not with CAHPS scores. AL communities in states with higher regulatory specificity for DCW staffing had higher odds of being served by hospices with higher CAHPS (OR = 1.46, p < 0.001) and HIS scores (OR = 1.35, p < 0.001). ALs in states mandating more than 21 h of DCW training, AL communities were more likely to be served by hospices with higher CAHPS scores (OR = 1.33, p < 0.001). Conclusion Higher AL google maps ratings were associated with higher hospice HIS performance. DCW staffing regulations were associated with both CAHPS and HIS, and DCW training regulations were associated with CAHPS only. These findings underscore the role of organizational quality and state regulatory policies in guiding end‐of‐life care in AL communities.