Observational studyJournal of the American Medical Directors Association2021
Variability and Potential Determinants of Assisted Living State Regulatory Stringency.
Observational study in Journal of the American Medical Directors Association, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it, 33 citations in OpenAlex.
- Governance of Assisted Living in Long-Term Care: A Systematic Literature Review.International journal of environmental research and public health · 2021Pooled it
- User-Generated Google Maps Ratings, State Staffing and Training Regulations, and the Quality of Hospice Care in Assisted Living Communities.Journal of the American Geriatrics Society · 2026Article
- How do US states define person-centered and family-involved care in assisted living regulations.Frontiers in dementia · 2026Article
- Variation in Hospice Aide Care by Residential Setting.Journal of palliative medicine · 2024Article
- Admission and Discharge Practices Among Assisted Living Communities: The Role of State Regulations and Organizational Characteristics.The Gerontologist · 2024Article
- Assisted living residents with dementia: Disparities in mental health services pre and during COVID-19.Journal of the American Geriatrics Society · 2024Article
- Serious Mental Illness in Assisted Living Communities: Association with Nursing Home Placement.Journal of the American Medical Directors Association · 2024Article
- A National Typology of Health Service Regulation in Assisted Living.The Gerontologist · 2024Article
- Home time and state regulations among Medicare beneficiaries in assisted living communities.Journal of the American Geriatrics Society · 2024Article
- Assisted living or nursing home: Who is moving in?Journal of the American Geriatrics Society · 2023Article
- Hospital Proximity and Emergency Department Use among Assisted Living Residents.Journal of the American Medical Directors Association · 2023Article
- Online Customer Reviews of Assisted Living Communities: Association with Community, County, and State Factors.Journal of the American Medical Directors Association · 2023Observational
- Pathways into Assisted Living Communities: Admission Limitations and Assessment Requirements Across the United States.Journal of the American Medical Directors Association · 2023Article
- End-of-Life Care Transitions in Assisted Living: Associations With State Staffing and Training Regulations.Journal of the American Medical Directors Association · 2023Article
- Using Medicare Enrollment Data to Identify Beneficiaries in Assisted Living.Journal of the American Medical Directors Association · 2023Article
- Return to community living and mortality after moving to a long-term care facility: A nationally representative cohort study.Journal of the American Geriatrics Society · 2023Article
- Patient Safety Culture in Assisted Living: Staff Perceptions and Association with State Regulations.Journal of the American Medical Directors Association · 2022Article
- Rates of health services use among residents of retirement homes in Ontario: a population-based cohort study.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2022Article
- The Imperative to Reimagine Assisted Living.Journal of the American Medical Directors Association · 2022Article
- Implementing Large-Scale Data-Driven Quality Improvement in Assisted Living.Journal of the American Medical Directors Association · 2022Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesWe examined state variations in assisted living (AL) regulatory policies for admission/retention, staffing/training, medication management, and dementia care. Factors associated with domain-specific and overall regulatory stringency were identified.
designThis observational study used the following data sources: 2019 review of state AL regulations; 2019 national inventory of AL communities; 2014 Government Accountability Office survey of Medicaid agencies; 2016 Genworth Cost of Care Survey; and the 2018 Nursing Home Compare. SETTING AND
participantsFinal analyses included 46 states (excluding Alaska, Kentucky, Louisiana, and West Virginia) and the District of Columbia.
methodsFor each regulatory domain of interest (dependent variables), we generated policy scores by conducting content analysis of state regulatory databases. States were assigned points for presence of each policy (eg, staff training). The number of points assigned to each policy was divided by the total possible number of policy-related points, producing state stringency scores (between 0% and 100%) for each policy domain. Independent variables included market-level characteristics (eg, AL monthly cost), state generosity (eg, proportion of Medicaid aged using AL services), quality of care (eg, percent of nursing homes with few deficiencies), and others. Descriptive analyses and multivariable logistic regression models with stepwise selection were used.
resultsWe found significant variations in all policy domains across states. No single policy appeared to clearly dominate a state's rank. AL bed supply, monthly AL cost, proportion of Medicaid beneficiaries receiving AL services, and other variables were significantly associated with regulatory stringency of the domains examined. CONCLUSIONS AND IMPLICATIONS: There were substantial variations in regulatory stringency across states. Several market and state generosity measures were identified as potential determinants of stringency, but the direction of these associations appeared to depend on what was being regulated. Future studies should examine how regulatory stringency affects access to and care quality in ALs.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.