Gerontology Commons^™

Assisted Living, Residential Care, And Memory Care Staffing Level Dynamics: Oregon, 2017–2023, Sarah Dys, Ozcan Tunalilar

Institute on Aging Publications

Objectives

To examine changes in staffing levels over time in Oregon assisted living and residential care (AL/RC) communities between 2017 and 2023.

Design

Longitudinal study of licensed AL/RC communities.

Setting and Participants

A total of 1720 setting-year observations from 535 individual AL/RC communities in Oregon between 2017 and 2023.

Methods

Primary data were collected through the Oregon Community-Based Care (CBC) study. Staffing levels were estimated as care staff hours per resident per day and reported overall and by staff type, including registered nurses, licensed practical nurses, certified nursing assistants, certified medication aides, unlicensed care staff, life enrichment staff, and social …

Promoting Cultural Humility, Belonging, And Inclusion To Improve Well-Being Among Direct Care Staff In Oregon Assisted Living, Residential Care, And Memory Care Communities, 2024, Jacklyn Kohon, Dani Himes, Laura Rodriguez, Sarah Dys, Paula Carder, Diana Jacoby, Madeline Fox

Institute on Aging Publications

The voices and experiences of those working and living in assisted living, residential care, and memory care (AL/RC) settings in Oregon are highlighted in this study to understand cultural humility, belonging, inclusion, and intersectional experiences related to sustaining the workforce and promoting quality care. This qualitative study collected data through individual and focus group interviews with a total of 68 people, including 25 direct care staff, voice memos or interviews with 9 former direct care staff, interviews with 9 administrators, interviews with 7 management representatives (owner/operators, human resources specialists, directors of operations, among other titles), and interviews with 18 current …

Climate And Extreme Weather Event Impacts On Administrators, Direct Care Staff, And Residents In Oregon Assisted Living, Residential Care, And Memory Care Communities, 2024, Dani Himes, Jacklyn Kohon, Madeline Fox, Laura Rodriguez, Sarah Dys, Diana Jacoby, Paula Carder

Institute on Aging Publications

This brief report on AL/RC staff and resident experiences with climate events highlights the voices of AL/RC direct care staff, former direct care staff, residents, administrators, and management representatives to promote well-being in these care settings. This study can inform Oregon’s efforts to support long-term care workforce readiness for future climate emergencies and inform future quantitative data collection on AL/RC and other long-term care workers, including those employed in home health agencies, nursing facilities, and adult foster homes.

Prevalence And Correlates Of Antipsychotic Medication Use In Oregon Assisted Living, Sarah Dys, Ozcan Tunalilar, Paula Carder

Institute on Aging Publications

Objective

Investigate how assisted living and residential care (AL/RC) and memory care (MC) contexts are associated with the 90-day prevalence of antipsychotic medication use (APU), considered a quality measure in long-term care.

Design

All licensed AL/RC settings in Oregon received an annual mailed questionnaire to provide aggregate resident demographics, health acuity, health service use, payment type, and organizational policies. Organizational measures were collected from state websites.

Methods

Random intercepts regression models were estimated to assess organizational and resident population characteristics associated with 90-day APU prevalence over 3 study waves (2017-2019).

Setting and Participants

We examine 932 observations in 463 AL/RC …

2024 Adult Foster Home: Resident And Community Characteristics Report On Adult Foster Homes, Ozcan Tunalilar, Sarah Dys, Diana Jacoby, Wafi Albalawi, Minju Kim, Yuliana Levchenko, Paula C. Carder

Institute on Aging Publications

This year marks the 10th anniversary of the Resident and Community Characteristics Report on Adult Foster Homes as part of the Oregon Community Based Care project. The first of these reports was published in 2014 and looking back, one gets a sense of both stability and change. In this year’s report, we describe the results based on data we collected from AFHs licensed and monitored by the Aging and People with Disabilities program of the Oregon Department of Human Services (ODHS/APD). These are small residential settings that provide personal and health-related services for up to five residents. They are primarily …

2024 Community-Based Care. Resident And Community Characteristics Report On Assisted Living, Residential Care, And Memory Care Communities, Ozcan Tunalilar, Sarah Dys, Yuliana Levchenko, Diana Jacoby, Minju Kim, Wafi Albalawi, Paula Carder

Institute on Aging Publications

This report marks the 10th anniversary of the Resident and Community Characteristics Report on Assisted Living (AL), Residential Care (RC), and Memory Care (MC) Communities as part of the Oregon Community Based Care project. This study includes rotating questions that focus on emerging areas of interest in the AL/RC/MC settings based on feedback from ODHS and interested parties alongside a core set of questions that are asked every year or every other year to allow comparisons over time. In this year’s study, we included information about various resident, community, and staff characteristics, including:

• Residents: sociodemographic characteristics (e.g., age, sex, …

Paperwork, Paradox, And Prn: Psychotropic Medication Deficiencies In Assisted Living, Sarah Dys, Paula Carder

Institute on Aging Publications

Individual state approaches to assisted living/residential care (AL/RC) licensing and oversight in the United States result in different practice standards and requirements, including psychotropic medication use. We examined 170 psychotropic medication deficiency citations issued to 152 Oregon AL/RC settings from 2015 to 2019. Applied thematic analysis resulted in the following themes: (1) documentation issues are primarily responsible for noncompliance, (2) unclear parameters place direct care workers in a role paradox, and (3) there is a persistent disconnect about when to seek qualified expertise before requesting psychotropic medications. AL/RC-specific mechanisms for medication prescription and administration are necessary to improve the structure …

Wage And Cost Study Of Oregon Assisted Living And Residential Care Providers, 2022, Ozcan Tunalilar, Sarah Dys, Paula Carder, Diana Jacoby

Institute on Aging Publications

Senate Bill 703 directed Oregon Department of Human Services (ODHS) to conduct a study of licensed residential care (RCF) and assisted living (ALF) facilities, including those with a memory care (MC) endorsement, to evaluate: a) Total cost to provide care to residents, b) the sufficiency of the Medicaid reimbursement paid to facilities to meet the total cost of care, and c) the average compensation paid to direct care workers by the facilities by geographic region. ODHS contracted with the Institute on Aging (IOA) at Portland State University (PSU) to conduct a study to achieve these three objectives. In the fall …

Direct Care Staff Experiences In Oregon Assisted Living, Residential Care And Memory Care Communities, 2022, Paula Carder, Sarah Dys, Lindsay Schwartz, Diana Jacoby, Jacklyn N. Kohon, Dani Himes, Madeleine Fox, Sheryl Elliott, Lauren Bouchard, Portland State University Institute On Aging

Institute on Aging Publications

Resident care assistants (e.g., direct care workers, caregivers, personal care aides) provide the majority of services to assisted living, residential care and memory care-endorsed (ALF/RCF) residents. They faced significant burdens during the COVID-19 pandemic, which amplified existing challenges in some ALF/RCF communities, yet little is known about their work experiences. This qualitative study collected data through focus group and individual interviews with 21 resident care assistants and 12 external colleagues who have experience hiring, training or managing resident care assistants and other ALF/RCF staff, including registered nurse consultants, staffing agency operators, state policy staff, ALF/RCF community operations managers, and advocates. …

Lifelong Instability And Perceived Risk Of Future Homelessness In Older Adults, Sarah Dys, Anna Steeves-Reece, Paula Carder

Institute on Aging Publications

Housing has long been considered a social determinant of individual and population health. Older adults with low incomes face several challenges to maintaining stable, affordable housing. Using data from a previous explanatory study of older adults waitlisted for housing assistance (n = 267), we explore individual characteristics and themes associated with older adults’ perceived housing instability and risk of future homelessness. This mixed-methods study identifies salient themes of financial insecurity, age discrimination, employment and health, interpersonal relationships, and trauma. Our analysis and findings highlight experiences of instability over the life course related to older adults’ current housing circumstances.

Validating The Resident View In Long-Term Care Settings: Final Report To Oregon Department Of Human Services, Aging & People With Disabilities Division, Diana L. White, Ozcan Tunalilar, Serena Hasworth, Jaclyn Winfree, Institute On Aging, Portland State University

Institute on Aging Publications

In 2015, Portland State University Institute on Aging (PSU/IOA) received a grant from the Quality Care Fund to develop the Resident VIEW (Voicing Importance, Experience, and Well-being), a measure of person-centered care (PCC) from the perspective of residents. Structured open-ended interviews were conducted with residents living in nursing homes (NH), assisted living (AL/RC), and adult foster homes (AFH) settings to learn more about their everyday concerns, values, and preferences. Each interview focused on one of eight domains of PCC. These domains had been identified from the literature and in prior research. Personhood, or as described by residents as being “treated …

State Of Aging In Portland, Alan Kenneth Delatorre, Richard Lycan, Margaret Neal

Institute on Aging Publications

Introduction

From 2006-2019, the Age-Friendly Portland Initiative operated as a city-university- community partnership that began in 2006, resulting from a global World Health Organization (WHO) research project. In 2010, the City of Portland joined the WHO Global Network of Age-Friendly Cities and Communities and in 2012, it also joined the AARP Network of Age-Friendly States and Communities. The Action Plan for an Age- friendly Portland was passed by Resolution by Portland City Council in 2013 (Resolution No. 37039) and contains 10 domains: (1) housing; (2) transportation; (3) outdoor spaces and buildings; (4) employment and the economy; (5) civic participation and …

Coronavirus Disease 2019 Regulatory Response In United States-Assisted Living Communities: Lessons Learned, Sarah Dys, Jaclyn Winfree, Paula Carder, Sheryl Zimmerman, Kali S. Thomas

Institute on Aging Publications

Coronavirus disease 2019 (COVID-19) has disproportionately affected residents, their families, staff, and operators of congregate care settings. Assisted living (AL) is a type of long-term care setting for older adults who need supportive care but not ongoing nursing care and emphasizes a social model of care provision. Because AL is a type of long-term care, it has at times been referenced along with nursing homes in discussions related to COVID-19 but not recognized for its different care practices that pose unique challenges related to COVID-19; in that manner, it has largely been left out of the COVID-19 discourse, although ~812,000 …

Connecting Policy To Licensed Assisted Living Communities, Introducing Health Services Regulatory Analysis., Lindsey Smith, Paula Carder, Taylor Bucy, Jaclyn Winfree, Joan F. Brazier, Brian Kaskie, Kali S. Thomas

Institute on Aging Publications

To document dementia-relevant state assisted living regulations and their changes over time as they pertain to licensed care settings.

Assisted Living Communities That Accept Medicaid Are Not Subject To Federal Oversight, Lindsey Smith, Sarah Dys, Paula Carder

Institute on Aging Publications

We commend Mauldin et al. (2020) for their recent article titled “Supports and gaps in federal policy for addressing racial and ethnic disparities among long-term care facility residents,” which addresses opportunities to mitigate racial and ethnic disparities in long-term care (LTC) through federal policies. However, we would like to clarify a statement regarding federal oversight of assisted living (AL) communities made by the authors.

Survey Deficiencies As Quality Indicators In Oregon Assisted Living Communities, Ozcan Tunalilar, Sunny C. Lin, Paula C. Carder

Institute on Aging Publications

Background and Objectives License inspection data have commonly been used as a quality measure for nursing homes but has not yet been used to assess the quality of assisted living/residential care (AL/RC) communities. Drawing on resource dependency theory, we test the hypothesis that structural and environmental characteristics influence AL/RC quality as measured by deficiency citations (“deficiencies”) issued during license inspections.

Research Design and Methods Using data from 526 licensed AL/RC communities in Oregon that received a license inspection visit between 2008 and 2016, we examined the prevalence of deficiencies by type and year. We estimated regression models to identify structural …

2021 Community-Based Care: Resident And Community Characteristics Report On Assisted Living, Residential Care, And Memory Care Communities, Ozcan Tunalilar, Paula Carder, Sheryl Elliott, Jason Z. Kyler-Yano, Sarah Dys, Minju Kim, Diana Cater, Ellis Jourdan Hews

Institute on Aging Publications

This report summarizes findings from the 7th annual study of Oregon assisted living (AL) and residential care (RC) facilities, including memory care (MC) communities. The purpose of this report is to inform Oregon Department of Human Services (ODHS), providers, consumers, and other interested parties about this sector of long-term services and supports (LTSS) and ensure data-informed policy decisions. The report contains information about various resident and community characteristics, including capacity and supply, resident demographics and health services use, and community services, policies, fees, and staffing. These data were collected between winter 2020 and spring 2021. This report constitutes the first …

Evaluation Of The Livewell Method: Final Report, Paula Carder, Serena Hasworth, Diana Cater

Institute on Aging Publications

The LiveWell Method uses a practice-based framework to improve the quality of life for people living and working in long-term care settings, including assisted living and memory care. It is designed to improve teamwork, communication, and morale by helping staff organize, track, measure, and improve daily operations. This evaluation is informed by the LiveWell Method’s “bottom-up and top enabled” approach, which engages and empowers direct care staff and administrators to create a more democratic and transparent workplace. In addition, the evaluation included questions to assess LiveWell’s core values, such as creating care innovations, nurturing dignity, creating community, and honoring elders, …

Mitigating The Impact Of The Covid-19 Outbreak: A Review Of International Measures To Support Community-Based Care, Walter D. Dawson, Elizabeth C. Ashcroft, Klara Lorenz-Dant, Adelina Comas-Herrera

Institute on Aging Publications

Key findings

• Community-based care faces unique challenges during the COVID-19 pandemic compared to other parts of the long-term care continuum.
• Several countries have taken steps to prevent the spread of COVID-19 infections in community-based care including the closure of adult day centres and other service providers.
• Continuity of care is of upmost importance. A disruption of care and support could have serious negative impacts on individual health and well-being due to increased risk of loneliness and social isolation.
• The dispersed nature of community based care suggests that direct governmental action and oversight may be more difficult to provide than for …

Brain Health Innovation Diplomacy: A Model Binding Diverse Disciplines To Manage The Promise And Perils Of Technological Innovation, Kylie Ternes, Vijeth Iyengar, Helen Lavretsky, Walter D. Dawson, Laura Booi, Agustin Ibanez, Ipsit Vahia, Charles Reynolds, Steven Dekosky, Jeffrey Cummings, Bruce Miller, Carla Perissinotto, Jeffrey Kaye, Harris A. Eyre

Institute on Aging Publications

Background: Brain health diplomacy aims to influence the global policy environment for brain health (i.e. dementia, depression, and other mind/brain disorders) and bridges the disciplines of global brain health, international affairs, management, law, and economics. Determinants of brain health include educational attainment, diet, access to health care, physical activity, social support, and environmental exposures, as well as chronic brain disorders and treatment. Global challenges associated with these determinants include large-scale conflicts and consequent mass migration, chemical contaminants, air quality, socioeconomic status, climate change, and global population aging. Given the rapidly advancing technological innovations impacting brain health, it is paramount to …

Oregon Community-Based Care Survey: Assisted Living, Residential Care, And Memory Care, Paula C. Carder, Ozcan Tunalilar, Sheryl Dejoy Elliott, Sarah Dys, Margaret B. Neal

Institute on Aging Publications

In Oregon, community-based care (CBC) communities include assisted living (AL), residential care (RC), and memory care (MC) communities. These settings provide residential, personal care, and health-related services, primarily to older adults. As the population of Oregonians aged 65 and older is estimated to increase from 16 percent in 2015 to nearly 23 percent in 20501, the availability of CBC settings will continue to be an important source of long-term services and supports.

This report provides an in-depth look at Oregon’s CBC settings. Because no central dataset of CBC services, staff, and residents is available, as opposed to nursing facilities, information …

Oregon Community-Based Care Survey: Adult Foster Homes, Paula C. Carder, Sheryl Dejoy Elliott, Ozcan Tunalilar, Sarah Dys, Margaret B. Neal

Institute on Aging Publications

Adult foster homes (AFH) offer long-term services and supports to older adults and people with disabilities who wish to remain in the community but need assistance with personal care and health-related tasks. This report focuses on Oregon AFHs that are licensed to care for individuals aged 65 and older and younger adults with disabilities. Homes may be licensed for one to five residents and must be staffed 24-hours daily to respond to residents’ scheduled and unscheduled needs or requests.

This report provides an in-depth look at a sample of Oregon AFHs. Since no central dataset of AFH services, staff, and …

Housing With Services, Paula C. Carder

Institute on Aging Publications

This report describes findings of an evaluation of the Housing with Services project in Portland, OR.

This evaluation was designed to assess the implementation process and impacts of a novel program of coordinated health and social services on behalf of over 1,400 residents of 11 affordable housing properties in Portland, Oregon. Affordable housing for older adults and persons with disabilities provides an important financial subsidy for persons with low incomes. To qualify for the affordable housing described in this report, individuals must have incomes of no more than $15,450 for a single person. In the U.S., over one million older …

Oregon Community-Based Care Survey 2016: Adult Foster Homes, Paula C. Carder, Jacklyn Nicole Kohon, Aubrey Limburg, Amanuel Zimam, Megan Rushkin, Margaret B. Neal

Institute on Aging Publications

This report describes adult foster homes in Oregon. An adult foster home (AFH) is a type of licensed community-based care (CBC) setting that provides residential, personal care, and health-related services, primarily to older adults. The study collected information from adult foster homes to achieve the following four main goals.

1. Describe adult foster home characteristics, including staffing types and levels, policies, and monthly charges and fees
2. Describe current residents’ health and social characteristics
3. Compare current results to prior Oregon surveys and to national studies of similar setting types to identify changes and possible trends
4. Compare setting types for differences that might …

Oregon Community-Based Care Survey: Assisted Living, Residential Care, And Memory Care, Paula C. Carder, Jacklyn Nicole Kohon, Aubrey Limburg, Amanuel Zimam, Megan Rushkin, Margaret B. Neal

Institute on Aging Publications

This report, prepared by the Institute on Aging (IOA) at Portland State University (PSU) in collaboration with the Oregon Department of Human Services, describes community-based care (CBC) settings that provide residential, personal care, and health-related services, primarily to older adults. The study collected information from assisted living, residential care, and memory care communities to achieve the following four main goals.

1. Describe assisted living, residential care, and memory care community characteristics, including staffing types and levels, policies, and monthly charges and fees
2. Describe current residents’ health and social characteristics
3. Compare current results to prior Oregon surveys and to national studies of …

Differential Health And Social Needs Of Older Adults Waitlisted For Public Housing Or Housing Choice Vouchers, Paula C. Carder, Gretchen Luhr, Jacklyn Nicole Kohon

Institute on Aging Publications

Affordable housing is an important form of income security for low-income older persons. This article describes characteristics of older persons waitlisted for either public housing or a housing choice voucher (HCV) (previously Section 8) in Portland, Oregon. 358 persons (32% response rate) completed a mailed survey with questions about demographics, health and housing status, food insecurity, and preference for housing with services. Findings indicate that many waitlisted older persons experienced homelessness or housing instability, poor health, high hospital use, and food insecurity. Public housing applicants were significantly more likely to report lower incomes, homelessness, and food insecurity than HCV applicants. …

The Case For Age-Friendly Communities, Margaret Neal, Alan Kenneth Delatorre

Institute on Aging Publications

The report was funded by Grantmakers In Aging, an organization dedicated to promoting and strengthening grantmaking for an aging society. The movement toward age-friendly communities is growing, with the key impetus being population aging. Beyond what individuals themselves can do to age optimally, the movement to create communities that are age friendly focuses on how the economic, physical, and social environments can be improved to address not only the needs but also maximize the assets of an aging population, for the benefit of all.

Building A State For All Ages: Tapping The Potential Of Older Oregonians, Stephen Percy, Judith A. Ramaley, John Tapogna, Margaret B. Neal, Jay Bloom, Alexandra Reece

Institute on Aging Publications

This report explores how the aging population—including native Oregonians and senior adults moving to the state—represent an asset to Oregon. Aging in America has often been viewed from a perspective of deficit and decline. We wholeheartedly challenge this perspective. This report identifies how older adults can play vital roles in the workforce, entrepreneurship and innovation, and supporting community revitalization through volunteering of time and talent.

Enhancing Equity For An Aging Region, Alan Delatorre, Lee Girard, Bobby Weinstock, Richard Lycan

Institute on Aging Publications

Presentations on "Aging and Equity in the Region" from the Institute on Aging - Drs. Alan DeLaTorre and Richard Lycan - with community partners Bobby Weinstock (NW Pilot Project) and Lee Girard (Multnomah County Aging and Disability Services).

Housing With Services: Year 1 Evaluation, October 2014, Paula C. Carder

Institute on Aging Publications

This report describes the initial findings of an on-going evaluation of the Housing with Services project based in Portland, OR. Housing with Services was supported, in part, with funding from Oregon’s State Innovation Model (SIM) project grant from the Center for Medicare and Medicaid Innovations to Cedar Sinai Park.

Housing with Services, LLC is a collaborative model of supportive services delivered or made available to low-income residents of affordable housing. The SIM grant helped to establish the project and funded the evaluation of the program implementation and resident- and system-level outcomes.

The collaborative model includes partnerships between health plans, coordinated …