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).

<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.

Planning for discharge is common among nursing-home residents who enter the facility for a short-term rehabilitative stay. More challenging is community discharge among long-stay residents who have been in a nursing-home beyond the Medicare funded rehabilitation period. The current manuscript describes an analysis of interviews conducted with 42 nursing-home discharge planners in the context of a statewide policy to promote nursing-home to community discharge among long-stay residents. Identified themes from the analysis include a focus on newly admitted residents, starting early, multi-disciplinary planning, lack of available community services, financial concerns, and balancing resident safety with the desire to return home.

Background: Learning health systems (LHSs) iteratively generate evidence that can

ObjectivesDespite an increased policy focused on home- and community-based services (HCBS), little is known about their quality of life (QoL)—a key measure of person-centered care. This paper addre...

ObjectivesDespite an increased policy focused on home- and community-based services (HCBS), little is known about their quality of life (QoL)—a key measure of person-centered care. This paper addre...

Background:The overdose crisis is increasingly characterized by opioid and stimulant co-use. Despite effective pharmacologic treatment for both opioid use disorder (OUD) and contingency management ...

Racial disparities in nursing home (NH) quality of life (QOL) are well established, yet, little is understood about actual experiences shaping QOL for Black, indigenous, and people of color (BIPOC) residents in NHs. This gap extends to BIPOC residents with limited English proficiency (LEP). Drawing on Kane’s (2001) and Zubristky’s (2013) QOL frameworks, this case study examined QOL experiences for Hmong NH residents, an ethnic and refugee group from Southeast Asia, in a NH with a high proportion of BIPOC residents. Methods include four months of observation, interviews with eight Hmong residents and five NH staff, and one community focus group. Thematic analysis revealed significant challenges in QOL. Exacerbated by language barriers and racism, many residents reported neglect, limited relationships, lack of meaningful activities, and dissatisfaction with food. These experiences fostered a sense of resignation and diminished QOL among Hmong residents, highlighting the need for additional supports for this group.