Table 5.
The Association Between Residential Care/Assisted Living Regulations and Potentially Burdensome Transitions Among Residential Care/Assisted Living Decedents, A Subgroup of Decedents with Medicare Fee-For-Service Enrollment (N = 87,970, Adjusted Odds Ratio, 95% Confidence Interval)
| Model 1a | Model 2b | Model 3c | |
|---|---|---|---|
| Third-party services | |||
| Allow hospice services (ref: silent) | 0.99 (0.94, 1.04) | 0.98 (0.93, 1.03) | 0.97 (0.88, 1.06) |
| Allow home health services (ref: silent) | 1.01 (0.96, 1.06) | 1.00 (0.96, 1.05) | 1.00 (0.92, 1.08) |
| Allow private care aide services (ref: silent) | 0.97 (0.93, 1.01) | 0.97 (0.93, 1.01) | 1.00 (0.94, 1.06) |
| Staffing | |||
| Require RNs (ref: silent) | 0.99 (0.95, 1.02) | 0.99 (0.95, 1.03) | 1.04 (0.98, 1.09) |
| Require LPN/LVNs (ref: silent) | 1.01 (0.96, 1.05) | 0.99 (0.95, 1.03) | 0.97 (0.92, 1.04) |
| Require minimum ratios/levels for DCWs (ref: other requirements or silent) | 1.05* (1.01, 1.10) | 1.03 (0.98, 1.08) | 1.08* (1.01, 1.15) |
| Medication management | |||
| Require regular medication reviews (ref: silent) | 0.91* (0.87, 0.94) | 0.95* (0.91, 0.99) | 0.99 (0.94, 1.03) |
| Require RN/LPN/LVNs to administer oral medication | |||
| Require (ref: silent) | 1.13* (1.08, 1.18) | 1.09* (1.04, 1.14) | 1.04 (0.98, 1.11) |
| Not require (ref: silent) | 1.05 (0.98, 1.13) | 1.01 (0.93, 1.08) | 0.93 (0.81, 1.06) |
| Permit DCWsd to assist with oral medication administration | |||
| Permit (ref: silent) | 0.93* (0.87, 0.99) | 0.95 (0.88, 1.01) | 0.94 (0.87, 1.02) |
| Prohibit (ref: silent) | 1.05 (0.95, 1.15) | 1.02 (0.93, 1.12) | 0.90 (0.77, 1.04) |
| Require RN/LPN/LVNs to administer injections | |||
| Require (ref: silent) | 1.05* (1.01, 1.10) | 1.05* (1.01, 1.10) | 1.11* (1.03, 1.20) |
| Not require (ref: silent) | 1.12* (1.05, 1.20) | 1.08* (1.01, 1.16) | 1.26* (1.11, 1.45) |
| Permit DCWs to administer injections | |||
| Permit (ref: silent) | 0.89* (0.84, 0.94) | 0.90* (0.85, 0.95) | 0.88* (0.81, 0.94) |
| Prohibit (ref: silent) | 1.02 (0.98, 1.06) | 1.01 (0.97, 1.05) | 0.95 (0.89, 1.02) |
Indicates statistical significance lower than 0.05.
Medicare FFS enrollment is defined as being enrolled as a Medicare FFS beneficiary for at least 12 months before death.
Model 1 reports regression model results of the association between each RC/AL regulation and potentially burdensome transitions without including comorbidities. Each model included the same set of covariates: RC/AL decedent sociodemographic characteristics (i.e., age, sex, race/ethnicity, dual eligibility), Medicare Advantage enrollment, early hospice enrollment, length-of-stay in RC/ALs, HSA hospitalization rate, and HSA random intercepts.
Model 2 reports regression model results of the association between each RC/AL regulation and potentially burdensome transitions, after controlling for comorbidities. Each model included comorbidities and the same set of covariates as specified in Model 1. Comorbidities were obtained from the Chronic Condition Warehouse, including Alzheimer's Disease and Related Dementia, Acute Myocardial Infarction, Asthma, Atrial Fibrillation, Congested Heart Failure, Hip Fracture, Chronic Obstructive Pulmonary Disease, Chronic Kidney Disease, Diabetes, Ischemic Heart Disease, Stroke, and a dummy variable indicating whether the individual had more than 5 chronic conditions.
Model 3 reports multivariable regression results of all RC/AL regulations and potentially burdensome transitions. The model included the same set of covariates as specified in Model 2.
DCWs refer to DCWs with minimal training, not including certified nurse aides or medication aides.
FFS, fee-for-service.