As an increasing number of older adults in the U.S. seek out assisted living services, there is a continued need to comprehensively assess quality within assisted living facilities to ensure consumers are well-informed when deciding where to seek care, and to assist quality improvement efforts within facilities. The current study aimed to develop, test, and validate a questionnaire to holistically measure quality of life among assisted living residents, which is one metric for quality in assisted living. The questionnaire development, testing, and validation process included three phases. First, informed by existing literature, an item bank was created and then refined based on stakeholder feedback and cognitive interviews with assisted living residents. Second, targeted pilot testing was completed via mailed questionnaires and in-person cognitive interviews with assisted living residents in memory care units. Third, pilot testing across Minnesota, via in-person, phone, and mail administration, was conducted to test the reliability and validity of the measure. Factor analysis results revealed five subscales: The People Who Work Here; Food; Security, Safety & Privacy; Choice/Autonomy; Religion/Spirituality. Two additional sub-domains were identified: Activities and Finances. All sub-scales indicated adequate to high internal consistency and were positively correlated with other indicators of resident satisfaction in expected ways. Measurement equivalence across administration modes (mail, phone, in-person) suggests inter-changeability. The questionnaire developed and tested in this study to measure resident quality of life in assisted living facilities is a valid and reliable tool that can be used in large-scale measurement efforts to capture one aspect of quality at the facility level.

Background: Discharge to the home/community following a skilled nursing facility (SNF) stay is a key metric of high-quality care. However, achieving this in this domain remains challenging, especially for distinctly complex patients. Little research to date has examined within-group variation in discharge outcomes for persons with SMI, a population that reflects a growing proportion of SNF consumers in the U.S. Methods: We leveraged a 4-year (2016–2019) 100% sample of Medicare claims data to examine individual- and organization-level predictors of SNF discharge location for persons with SMI. We first describe within-group differences for persons with SMI at the bivariate level. We then test linear probability models fully adjusted for individual and organization-level covariates, allowing for calculation of post-estimation marginal effects. Results: We identified 118,325 unique SNF stays for people with SMI; 54% ended in discharge to the home/community. Patients with SMI who were discharged to the home/community (versus not) were significantly younger, more likely to be female, and were less likely to be dual-eligible or to have co-occurring ADRD. SMI patients discharged to the home/community were also significantly more likely to receive care in SNFs that were more integrated, higher quality, and saw a smaller share of SMI patients overall. These findings were reinforced by our fully adjusted regression analyses. Discussion: This work finds within-group differences in characteristics associated with SNF discharge outcomes among the population of patients with SMI at both the person- and organization-levels. Policymakers should consider how to leverage value-based payment (VBP) programs, including new SNF-VBP requirements, in a way that more realistically accounts for the resources (e.g., time, staffing) required to coordinate care for this population. Similarly, an explicit focus on investments along the continuum should center around services that facilitate community retention (e.g., home- and community-based services).

Background: Discharge to the home/community following a skilled nursing facility (SNF) stay is a key metric of high-quality care. However, achieving this in this domain remains challenging, especially for distinctly complex patients. Little research to date has examined within-group variation in discharge outcomes for persons with SMI, a population that reflects a growing proportion of SNF consumers in the U.S. Methods: We leveraged a 4-year (2016–2019) 100% sample of Medicare claims data to examine individual- and organization-level predictors of SNF discharge location for persons with SMI. We first describe within-group differences for persons with SMI at the bivariate level. We then test linear probability models fully adjusted for individual and organization-level covariates, allowing for calculation of post-estimation marginal effects. Results: We identified 118,325 unique SNF stays for people with SMI; 54% ended in discharge to the home/community. Patients with SMI who were discharged to the home/community (versus not) were significantly younger, more likely to be female, and were less likely to be dual-eligible or to have co-occurring ADRD. SMI patients discharged to the home/community were also significantly more likely to receive care in SNFs that were more integrated, higher quality, and saw a smaller share of SMI patients overall. These findings were reinforced by our fully adjusted regression analyses. Discussion: This work finds within-group differences in characteristics associated with SNF discharge outcomes among the population of patients with SMI at both the person- and organization-levels. Policymakers should consider how to leverage value-based payment (VBP) programs, including new SNF-VBP requirements, in a way that more realistically accounts for the resources (e.g., time, staffing) required to coordinate care for this population. Similarly, an explicit focus on investments along the continuum should center around services that facilitate community retention (e.g., home- and community-based services).

Background: Asian American sexual and gender diverse youth experience bias-based stressors rooted in stereotypes and forms of oppression, which can contribute to coping behaviors like alcohol use. Few studies examine lifetime alcohol use with a focus on understanding heterogeneity within Asian American adolescents. Methods: The analytic sample included Asian American youth in 9th through 12th grade (N = 86,799) who completed the 2017-2019 California Healthy Kids Survey, a statewide, school-based survey. Exhaustive Chi-square automatic interaction detection was conducted using SPSS. Variables included exposure to sexual orientation and gender identity-based (SOGI) and race-based bullying and different social identities (ethnic, sexual, and gender identities and sex assigned at birth). Results: Past-year SOGI-based bullying was reported by 11.2% of students and race-based bullying was reported by 18.8% of students. 19.6% of students indicated lifetime alcohol use, with higher rates among those in older grades (13.1% 9th grade to 31.8% 12th grade). Lowest lifetime alcohol use prevalence were among monoracial Asian American youth who were not the targets of bias-based bullying, while highest lifetime alcohol use rates were among youth identifying as multiracial and/or with a minoritized sexual orientation and experiencing bias-based bullying. Conclusions: Findings suggest bias-based victimization may lead youth to cope or attempt to fit in through alcohol use. Bisexual and multiracial youth, who are often marginalized from monoracial and monosexual communities also had high lifetime alcohol use prevalence. Future research should identify intersectionality-informed strategies to address the nuanced bias-based bullying experiences of Asian American sexual and gender diverse youth, particularly in school settings.

Background: Adolescent suicidality has become an alarming public health concern. Perceived gender nonconformity has been identified as a risk factor for suicidality. Several factors (e. g. bullying and depression) have been posited as potential mechanisms through which perceived gender nonconformity is associated with suicidality; however, nascent research indicates instability in these associates due to youth’s exposure to intersectional forms of marginalization. This study aimed to examine an intersectional serial mediation model of adolescent suicidality by investigating the consistency of bullying and depression as prominent potential mediating mechanisms. Methods: Hypotheses were tested using data derived from youths who participated in the 2019 Youth Risk Behavior Surveillance System (n = 70,047). We constructed an initial serial multiple mediation model that included all participants to examine whether the association of perceived gender nonconformity with suicidality among youth was mediated by bullying and/or depression. The goal of this model was to investigate the total and direct effects, reflected by the standardized regression coefficient and significance among the independent and dependent variables, and to assess 3 indirect effects, which that showed a change in suicidality for every 1-unit change in perceived gender nonconformity that the potential mediator mediated. We then conducted a multigroup analysis, using youth’s intersectional identities as a group variable. Results: Overall, perceived gender nonconformity was positively associated with suicidality. This association was serially mediated by bullying and depression; however, these effects varied by youth’s intersectional social location. The direct association between perceived gender nonconformity and suicidality consistently emerged among all straight youth groups, with Black Straight Females and Males being notable exceptions. The full hypothesized serial mediation model could only be reproduced among Hispanic Straight Males; however, a partial mediation via bullying was demonstrated among White Bisexual Males. Conclusions: This research has implications for understanding the potential underlying mechanisms that link perceived gender nonconformity to suicidality among adolescents. The hypothesized cascade of contextual risk factors for adolescent suicidality seems to be more harmful among Hispanic Straight Males. Studying contextual mechanisms can help develop therapeutic interventions that target adolescents most at-risk of suicidality.

Large efforts in research and policy have been driven by the fact that in segregated American cities there is a high concentration of poor Black residents in neighborhoods with the lowest socioeconomic status (SES). This concentration has witnessed a massive decline over the past decade as measured in the American Community Survey (ACS). This decline is not due to changes in Census tract boundaries. This decline could be due to changes in the neighborhood SES of poor Black Americans, but we show that it could also be due to changes in the Census Bureau's measurement of race.

<h2>Abstract</h2><h3>Objectives</h3><p>Previous studies examining biases in pain reporting among nursing home (NH) residents have excluded short-stay residents (NH stay <100 days). This study of short-stay NH residents in the United States estimates pain prevalence under self-reported and staff-reported assessment in the Minimum Data Set (MDS) 3.0 and estimates whether there are differences by dementia/cognitive status, and racial/ethnic identity.</p><h3>Design</h3><p>Cross-sectional study.</p><h3>Setting and Participants</h3><p>Short-stay NH residents in the United States with pain assessments from MDS 3.0 in the first two quarters of 2019, shortly after new pain measures were introduced.</p><h3>Methods</h3><p>In 2 independent samples of short-stay residents with either self-reported pain assessment (n = 858,646 residents) or staff-reported pain assessment (n = 29,538 residents), we calculated the odds of reporting significant pain using mixed effects logistic models adjusted for key resident and facility characteristics.</p><h3>Results</h3><p>Overall, 9.60% of short-stay residents self-reported moderate to severe pain and 34.04% of staff-reported residents. In both samples, in the fully adjusted model, the odds of reporting pain were significantly lower among residents with (vs without) diagnosed dementia, with moderate to severe cognitive impairment (vs cognitively intact), and with minoritized racial/ethnic identities (vs White) [odds ratios ranging from 0.37 to 0.93; <i>P</i> < .001], after adjusting for the ability to understand, unclear speech, poor hearing, length of stay, functional capacity, mental illness, other comorbidities, age, and facility characteristics.</p><h3>Conclusions and Implications</h3><p>Among short-stay NH residents, disparities in pain reporting for residents with cognitive impairment, dementia, and minoritized racial/ethnic identity exist in both self-reported and staff-reported samples. Our study identifies potential underreporting of pain by cognitive status and racial/ethnic identity. Future work should explore whether lower rates of reporting pain reflect actual differences in experienced pain or bias due to measurement error.</p>

<h2>Abstract</h2><h3>Objectives</h3><p>Previous studies examining biases in pain reporting among nursing home (NH) residents have excluded short-stay residents (NH stay <100 days). This study of short-stay NH residents in the United States estimates pain prevalence under self-reported and staff-reported assessment in the Minimum Data Set (MDS) 3.0 and estimates whether there are differences by dementia/cognitive status, and racial/ethnic identity.</p><h3>Design</h3><p>Cross-sectional study.</p><h3>Setting and Participants</h3><p>Short-stay NH residents in the United States with pain assessments from MDS 3.0 in the first two quarters of 2019, shortly after new pain measures were introduced.</p><h3>Methods</h3><p>In 2 independent samples of short-stay residents with either self-reported pain assessment (n = 858,646 residents) or staff-reported pain assessment (n = 29,538 residents), we calculated the odds of reporting significant pain using mixed effects logistic models adjusted for key resident and facility characteristics.</p><h3>Results</h3><p>Overall, 9.60% of short-stay residents self-reported moderate to severe pain and 34.04% of staff-reported residents. In both samples, in the fully adjusted model, the odds of reporting pain were significantly lower among residents with (vs without) diagnosed dementia, with moderate to severe cognitive impairment (vs cognitively intact), and with minoritized racial/ethnic identities (vs White) [odds ratios ranging from 0.37 to 0.93; <i>P</i> < .001], after adjusting for the ability to understand, unclear speech, poor hearing, length of stay, functional capacity, mental illness, other comorbidities, age, and facility characteristics.</p><h3>Conclusions and Implications</h3><p>Among short-stay NH residents, disparities in pain reporting for residents with cognitive impairment, dementia, and minoritized racial/ethnic identity exist in both self-reported and staff-reported samples. Our study identifies potential underreporting of pain by cognitive status and racial/ethnic identity. Future work should explore whether lower rates of reporting pain reflect actual differences in experienced pain or bias due to measurement error.</p>

Ensuring high-quality care in assisted living (AL) is a growing priority, yet little is known about factors shaping resident-reported quality of life (QoL). Minnesota recently implemented statewide measurement and public reporting of QoL, providing a unique opportunity to examine predictors of resident experiences. This study evaluated resident- and facility-level factors associated with seven QoL domains: staff, environment, food, engagement, autonomy, culture, and security. We analyzed cross-sectional data from 11,684 AL residents in facilities with more than five beds who participated in the 2024 state QoL survey (90% aged ≥65 years, 66% female, 84% White). Using multivariable linear mixed regression with a facility-level random intercept, we accounted for facility-level clustering. Mean QoL scores ranged from 1.6 to 1.9 out of 2, with food and engagement rated lowest and environment highest. Older residents reported higher scores across most QoL domains (β, 0.02–0.08; p &lt; 0.05). Women rated food and security lower (β, -0.04 and -0.02; p &lt; 0.05), while American Indian/Alaskan Native residents reported lower scores in culture, security, staff, and environment (β, -0.05 to -0.10; p &lt; 0.05). Smaller facilities (&lt; 25 beds) had higher scores in food, staff, and autonomy (β, 0.02–0.07; p &lt; 0.05). Facilities with dementia care unit licensure had higher food scores but lower autonomy, staff, and security scores (β, -0.02 to -0.03; p &lt; 0.05). Findings highlight disparities in resident QoL, underscoring the need for targeted interventions and policy efforts to enhance resident well-being in AL.

Discharge to the community following a skilled nursing facility (SNF) stay is a key metric of high-quality care. This aligns with preferences around aging-in-place, yet significant fragmentation across service providers has made achieving this outcome challenging. This is especially true for people with serious mental illness (SMI) (i.e. schizophrenia, bipolar disorder) who represent a growing proportion of U.S. long-term care residents. We use a 4-year (2016-2019), 100% sample of traditional Medicare data to examine individual- and organization-level predictors of SNF discharge location (community vs other) for persons with SMI. Of the 118,325 unique SNF stays for people with SMI, 54% ended in discharge to the community. Patients with SMI who were discharged to the community (vs not) were significantly younger (69 vs 72 y/o), more likely to be female (61% vs 56%), and were less likely to be dual-eligible (51% vs 71%) or to have co-occurring ADRD (33% vs 51%). SMI patients discharged to the community were also significantly more likely to receive care in smaller, urban SNFs, that were more integrated, higher quality, and saw a smaller share of SMI patients overall. These findings were reinforced by our fully adjusted regression models. While many socioenvironmental factors restrict patients’ ability to return home following a SNF stay, better positioning SNFs to achieve good outcomes requires significant investments along the continuum. Policymakers should consider how to leverage value-based payment programs in a way that better accounts for the resources required to coordinate care for this population, including partnership with community-based providers.

Background and Objectives: Sexual and gender minority (SGM) older adults are more likely to

Background and Objectives: Sexual and gender minority (SGM) older adults are more likely to

The Immigrant Memory Collaborative is a community university partnership that leveraged community needs and asset assessment to develop a culturally tailored dementia education program with the African immigrant community in Minnesota. Guided by a project advisory board, key informant interviews and community conversations informed the content of African MaDE: Memory and Dementia Education, by and for the African community. This presentation will describe the community engagement approach used to pilot test African MaDE with the community and pre-post evaluation. In addition to the primary partner, the team leveraged its network to collaborate with community organizations to host education sessions for 187 unique attendees at 11 events in person and remotely. Of these, 77 participants completed pre- and post-dementia knowledge questions. Most (55) attendees were first-generation (born outside the United States). Most of these participants were neither current nor past care partners and had never provided care for a person living with dementia in a professional capacity. Preliminary findings show a statistically significant 0.9-point improvement in dementia knowledge from pre- to post-education. Qualitative comments also reveal that participants appreciate the presentation and content. African MaDE is feasible and acceptable to the African community. We are currently using a community-engaged approach to conduct large-scale dissemination of this program. In addition to describing our process, we will present lessons learned in this community-engaged education development that can inform the development of similar programs in other communities.

Telehealth was essential for maintaining care continuity during the COVID-19 pandemic, leading to its rapid expansion and adoption in the United States. Since then, telehealth has been increasingly viewed as a strategy to reduce health disparities among vulnerable populations. However, data on telehealth use among socially and financially vulnerable older adults are limited, leaving unanswered questions about the role of telehealth in promoting health equity for older Americans. This study examined individual and structural factors associated with post-pandemic telehealth use among older recipients of publicly funded home- and community-based services (HCBS; an indicator of social and financial vulnerability). Using cross-sectional data from the 2021–2022 National Core Indicators-Aging and Disability Adult Consumer Survey, the analytic sample included 3,680 HCBS users aged ≥ 65 years without intellectual or developmental disability, 40% of whom used telehealth. Complete-case multivariable logistic regression, adjusting for sociodemographic and health-related factors with state-level random intercepts, revealed significantly lower odds of telehealth use associated with older age, male gender, Black race, non-metropolitan residence, and receipt of Older Americans Act services. Individuals with dementia had higher odds of telehealth use (OR, 1.33, p &lt; .05). Home internet access was strongly associated with telehealth use (OR, 2.51, p &lt; .001). Follow-up bivariate analyses showed younger age, female gender, and White race were associated with higher internet access. These findings highlight differences in telehealth use among older HCBS users associated with both individual and structural factors, offering valuable insights for efforts aimed at addressing barriers to telehealth adoption among vulnerable older adults.

Workforce shortages in home- and community-based services (HCBS) were exacerbated during the COVID-19 pandemic. We evaluated changes in HCBS use and consumer-reported unmet HCBS needs for (1) personal care aide (PCA) and (2) caregiver support/respite (CS/R) in 2021-2022 (during the pandemic) versus 2018-2019 (pre-pandemic), in the US National Core Indicators- Aging & Disability Adult Consumer Survey. We included 7143 community-dwelling HCBS consumers (age, ≥65 years, from 11 states). We calculated adjusted odds ratios (aOR) and 95% confidence interval (CI) for HCBS use and consumer-reported unmet HCBS needs for PCA and CS/R using logistic regression, adjusting for sociodemographic and health-related variables (fixed effects), with random intercept for state (to account for clustering by state). For PCA, compared to 2018-2019, during 2021-2022, there was a significant increase in the odds of both PCA use (aOR, 1.24; 95% CI, 1.09, 1.40) and unmet PCA needs (aOR, 1.23; 95% CI, 1.03, 1.46), suggesting that pandemic policy efforts to mitigate service disruptions were insufficient to decrease unmet PCA needs. For CS/R, during 2021-2022, there was a significant increase in the odds of CS/R use (aOR, 1.24; 95% CI, 1.09, 1.40) and a simultaneous significant decrease in the odds of unmet CS/R needs (aOR, 0.49; 95% CI, 0.35, 0.70), suggesting that temporary pandemic policies for CS/R may have successfully abated consumers-reported unmet CS/R service needs. These cross-sectional findings call for more rigorous investigation to identify which temporary pandemic-related CS/R policies were effective; to inform disaster preparedness efforts for mitigating HCBS disruptions during future public health emergencies.