Opportunities to Improve End-of-Life Care in Assisted Living: Results From a National Survey of Administrators

This is the authors' abstract. We don't add key points for this paper.

OBJECTIVES: Assisted living is a common place of care for dying residents, with extensive variation in residents' outcomes such as hospice enrollment. This research aimed to gather national evidence about end-of-life care processes in assisted living. DESIGN: A national survey of administrators was conducted in 2021-2023, using a random sample proportional to the number of large assisted living communities (≥25 beds) across licenses and states. SETTING AND PARTICIPANTS: Administrators at eligible assisted living communities across the United States as listed in public state registries. METHODS: Standard measures from existing surveys of residential care were used or adapted from other long-term care settings after cognitive testing, including staffing and admission/retention policies, end-of-life care processes such as protocols for dying and deceased residents, and quality of hospice collaboration. Nonresponse adjusted sampling weights provide nationally representative estimates. RESULTS: Among 4796 eligible assisted living communities invited, 2084 administrators completed the survey from all 48 targeted states, a response rate of 43.4%. One in 5 (20.4%) administrators reported no residents dying in the past 12 months, and 15.3% of very large communities (≥100 beds) did not report decedents. Yet, among those caring for dying residents, less than one-third of administrators rated the quality of dying in their community as excellent. Among 1882 communities whose administrators reported collaborating with hospice, 32.0% also responded that hospice always assessed a resident within 24 hours of referral. CONCLUSIONS AND IMPLICATIONS: This national study of administrators highlights important opportunities to improve end-of-life care both as part of assisted living care processes for dying residents and through collaboration with hospice. These novel survey measures will help determine how end-of-life care processes vary along state regulations and shape residents' outcomes.