Abstract
Little is known about the quality of end-of-life care in assisted living (AL), particularly transitions at end of life. This study aims to provide a first national look at potentially burdensome transitions at end of life among AL residents and to examine how those vary by state. This is a retrospective cohort study of Medicare beneficiaries who died in 2018 and resided at a validated 9-digit ZIP code for an AL with 25 or more beds4 on the 120th day before death (N=37,668). Three types of potentially burdensome transitions were considered: 1) healthcare transitions during last 3 days of life, 2) three or more all-cause hospitalizations during the last 90 days of life, and 3) two or more hospitalizations for urinary tract infections, sepsis, pneumonia, and dehydration during last 120 days of life. Hospitalizations and decedents’ locations were obtained from multiple administrative claims records. Out of the 37,668 AL decedents, 7,015 (18.6%, 95% CI: 18.2%-19.0%) experienced at least one potentially burdensome transition. States varied widely in the rate of burdensome transitions, ranging from 30.9% in North Dakota to 8.9% in Wyoming. Our results support quality concerns for end-of-life care among AL residents. Future studies are needed to explain state variation and how it relates to factors such as residents’ co-morbidities, end-of-life care practices in AL, and state regulations. This study had two limitations. First, multiple hospitalizations for Medicare Advantage beneficiaries might be under-reported. Second, the results are not generalizable to persons in ALs with fewer than 25 beds.
State Variation in Potentially Burdensome Transitions among Assisted Living Residents at End of Life
