scholarly journals Geographic Disparities in Access to Specialized Dementia Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 716-716
Author(s):  
Portia Cornell ◽  
Wenhan Zhang ◽  
Lindsey Smith ◽  
Shekinah Fashaw ◽  
Kali Thomas

Abstract With novel, previously undescribed data on the availability of dementia-specific assisted living communities (ALs), we analyzed variation among counties in the availability of this important service for persons with dementia. In twenty-one states, we identified 6,961 ALs (16%) with a dementia-specific license/certification. Counties with at least one AL providing dementia-specific care had substantially higher college attainment versus counties that had at least one AL, but no dementia-specific beds: 25% versus 18% (p<0.01). Counties with dementia care also had significantly greater median incomes ($54,000 vs. $46,400), and home values ($159,000 vs. $113,000), lower poverty rates (13.7 percent vs. 16.3 percent), and lower proportions of Black residents (7.8 percent vs. 8.7 percent). Our findings are suggestive of a mismatch in need and availability of residential care options for older adults with ADRD that are also low-income or racial/ethnic minorities. Part of a symposium sponsored by Assisted Living Interest Group.

2019 ◽  
Vol 40 (7) ◽  
pp. 1577-1593 ◽  
Author(s):  
Rachel V. Herron ◽  
L. M. Funk ◽  
D. Spencer ◽  
M. Wrathall

AbstractMost of the existing literature on inclusion and exclusion among older adults focuses on community-dwelling individuals. In this article, we draw on the results of a comparative case study to explore how older adults in two assisted living settings experience inclusion and exclusion. One site was a low-income facility and the other a higher-end facility in a mid-sized Canadian city. Bridging together geographies of encounter and gerontological approaches on social inclusion, we analyse interviews with tenants and key informants to explore when, where and in what ways these groups experience inclusion and exclusion in these particular settings. Tenants’ narratives reveal how their encounters, and in turn their experiences of exclusion and inclusion are shaped by experiences throughout their lifecourse, the organisation of assisted living spaces, communities beyond the facility, and pervasive discourses of ageism and ‘dementiaism’. We argue that addressing experiences of exclusion for older adults within these settings involves making more time and space for positive encounters and addressing pervasive discourses around ageism and ‘dementiaism’ among tenants and staff.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 528-528
Author(s):  
Portia Cornell

Abstract Assisted living (AL) communities with memory care licenses are disproportionately located in affluent and predominantly White communities and Black older adults are underrepresented in AL. But little is known about characteristics of AL that care for Black residents. We estimated the association of facility-level characteristics as proxy measures for AL resources, such as memory care designations and percentage of dual-eligible residents, across low (0-5%), medium (5-10%) and high (>10%) percentages of Black residents. We found broad differences among communities in the three levels of Black-resident prevalence. High percentage of Black residents was associated with large differences in the percentage of Medicaid-enrolled residents (high 54% duals [s.d.=34], med 28% [31], low=13% [22], p<0.001). ALs with high Black populations were less likely to have a memory-care designation than ALs with medium and low percentages of Black residents (high 4.7% memory care, med 11%, low 17%).


2021 ◽  
pp. 073346482110058
Author(s):  
Cameron J. Gettel ◽  
Kevin Chen ◽  
Elizabeth M. Goldberg

Objectives: We aimed to describe recent technologic advances in the three domains of dementia care, falls, and home supports; summarize existing literature on usability; and identify knowledge gaps. Methods: A comprehensive search of five databases for recent peer-reviewed publications was conducted in May 2020. Independent reviewers performed title/abstract review, full-text screening, data extraction, and study characteristic summarization. Results: Out of 2,696 citations, 151 articles were retrieved for full-text evaluation, after which 54 studies were included in this scoping review. For each domain, different technologies are available to enhance the health and well-being of older adults; many users deemed them usable and useful. Technologies targeted improving function, psychosocial and cognitive status, home safety, and caregiver burden. Barriers to widespread uptake include privacy concerns, suboptimal user experience, and willingness to accept assistance. Conclusion: Technologic innovations directed toward dementia care, fall detection, and ambient-assisted living can aid older adults “aging in place.”


2021 ◽  
Author(s):  
Derek R. Manis ◽  
Ahmad Rahim ◽  
Jeffrey W. Poss ◽  
Iwona A. Bielska ◽  
Susan E. Bronskill ◽  
...  

ABSTRACTObjectiveTo identify the characteristics of licensed assisted living facilities that provide a dementia care program compared to assisted living facilities that do not provide such a program.Design, Setting, and ParticipantsPopulation-level cross-sectional study in Ontario, Canada on all licensed assisted living facilities in 2018 (n = 738).MethodsData on facility-level characteristics (e.g., resident and suite capacities, etc.) and the provision of other provincially regulated care services (e.g., pharmacist and medical services, skin and wound care, etc.) attributed to licensed assisted living facilities were examined. Multivariable Poisson regression with robust standard errors was used to model the characteristics of assisted living facilities associated with the provision of a dementia care program.ResultsThere were 123 (16.7%) assisted living facilities that provided a dementia care program. Nearly half of these facilities had a resident capacity exceeding 140 older adults (44.7%) and more than 115 suites (46.3%). All assisted living facilities that provided a dementia care program also provided nursing services, meals, assistance with bathing and hygiene, and administered medications. After adjusting for facility characteristics and other provincially regulated care services, the prevalence of a dementia care program was nearly three times greater in assisted living facilities that offered assistance with feeding than those that did not (Prevalence Ratio [PR] = 2.91, 95% Confidence Interval [CI] 1.98 to 4.29), and almost twice as great among assisted living facilities that provided medical services than those that did not (PR = 1.78, 95% CI 1.00 to 3.17).ConclusionsA dementia care program was more prevalent in assisted living facilities that housed many older adults, had many suites, and provided at least five of the other 12 regulated care services. These findings deepen the understanding of specialized care for dementia in assisted living facilities.BRIEF SUMMARYQuestionDo licensed assisted living facilities that provide a dementia care program differ from those that do not in Ontario, Canada?FindingsAssisted living facilities that provide a dementia care program house many older adults, have many suites, and offer at least five of the other 12 regulated care services.MeaningAssisted living facilities that provide a dementia care program are larger and provide an array of care services.DisclosuresWe have no perceived or actual conflicts, financial or otherwise, to disclose.Author ContributionsDRM and APC conceptualized the study. AR created the dataset, and DRM conducted the statistical analyses. DRM wrote the manuscript, and all authors critically read and contributed to it.Data AvailabilityThe dataset from this study is held securely in coded form at ICES. While data sharing agreements prohibit ICES from making the data set publicly available, access may be granted to those who meet pre-specified criteria for confidential access, available at www.ices.on.ca/DAS. The full data set creation plan and underlying analytic code are available from the corresponding author upon request, understanding that the programs may rely upon coding templates or macros that are unique to ICES.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Derek R. Manis ◽  
Ahmad Rahim ◽  
Jeffrey W. Poss ◽  
Iwona A. Bielska ◽  
Susan E. Bronskill ◽  
...  

Abstract Background Many residents of assisted living facilities live with dementia, but little is known about the characteristics of assisted living facilities that provide specialized care for older adults who live with dementia. In this study, we identify the characteristics of assisted living facilities that offer a dementia care program, compared to those that do not offer such a program. Methods We conducted a population-level cross-sectional study on all licensed assisted living facilities in Ontario, Canada in 2018 (n = 738). Facility-level characteristics (e.g., resident and suite capacities, etc.) and the provision of the other 12 provincially regulated care services (e.g., pharmacist and medical services, skin and wound care, etc.) attributed to assisted living facilities were examined. Multivariable Poisson regression with robust standard errors was used to model the characteristics of assisted living facilities associated with the provision of a dementia care program. Results There were 123 assisted living facilities that offered a dementia care program (16.7% versus 83.3% no dementia care). Nearly half of these facilities had a resident capacity exceeding 140 older adults (44.7% versus 21.6% no dementia care) and more than 115 suites (46.3% versus 20.8% no dementia care). All assisted living facilities that offered a dementia care program also offered nursing services, meals, assistance with bathing and hygiene, and administered medications. After adjustment for facility characteristics and other provincially regulated care services, the prevalence of a dementia care program was nearly three times greater in assisted living facilities that offered assistance with feeding (Prevalence Ratio [PR] 2.91, 95% Confidence Interval [CI] 1.98 to 4.29), and almost twice as great among assisted living facilities that offered medical services (PR 1.78, 95% CI 1.00 to 3.17), compared to those that did not. Conclusions A dementia care program was more prevalent in assisted living facilities that housed many older adults, had many suites, and offered at least five of the other 12 regulated care services. Our findings deepen the understanding of specialized care for dementia in assisted living facilities.


2012 ◽  
Author(s):  
J. Liang ◽  
X. Xu ◽  
A. R. Quinones ◽  
J. M. Bennett ◽  
W. Ye

2010 ◽  
Author(s):  
Mary E. Steers ◽  
Allison A. Jay ◽  
Sarah L. Anderson ◽  
Kaitlyn Eller ◽  
Leilani Feliciano

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 733-734
Author(s):  
Lindsay Peterson ◽  
David Dosa ◽  
Patricia D’Antonio

Abstract Preparedness of residents in long-term care (LTC) in the face of hurricane emergencies is a contested and largely unanswered question. Our prior work involving the U.S. Gulf Coast hurricanes of 2005-08 showed that exposure to various storms on nursing home (NH) residents resulted in significantly more deaths than reported by health care officials. This work also highlighted that evacuation of NH residents, compared to sheltering in place, was independently associated with morbidity and mortality. Hurricane Irma struck Florida on Sept. 10, 2017, prompting the evacuation of thousands of NH and assisted living community (ALC) residents. This symposium will discuss the effects of Hurricane Irma on vulnerable older adults residing in NHs and ALCs using mixed quantitative and qualitative methodologies. The first presentation will discuss morbidity and mortality of NH residents exposed to Hurricane Irma and will stratify by long stay/short stay status and hospice enrollment. The second presentation will discuss improvements and continued barriers to NH preparedness based on interviews with 30 administrators following Hurricane Irma. Using a novel methodology to identify residents of ALCs using secondary data sources, the third presentation will document AL resident morbidity and mortality risk following Hurricane Irma. The final presentation will highlight results of interviews with 70 stakeholders from small and large ALCs concerning the hurricane experiences of residents, including those with dementia. This symposium offers a multi-faceted view of a disaster’s effects on LTC residents across Florida, including novel data from the NH environment and lesser-examined ALCs.


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