Characterizing Emergency Department Use in Assisted Living.
Cassandra L Hua, Wenhan Zhang, Portia Y Cornell and 3 others
PMID 32646819WHAT IT FOUND
About 49% of Medicare fee-for-service assisted living residents visited an emergency department in one year.
About 17% had injury-related visits, and these visits were more frequent in residents with dementia or six or more chronic conditions. State rates varied widely.
Key findings
01During the year, about 49% of assisted living residents visited the emergency department at least once, and about 17% had an injury-related emergency visit.
02Among residents with an injury-related emergency visit, approximately 42% had Alzheimer's disease and related dementia; among residents with 6 or more chronic conditions, approximately 29% had an injury-related emergency visit.
03State risk-adjusted emergency department rates varied widely: all-cause rates ranged from 102.3 to 167.2 visits per 100 assisted living person-years, and injury-related rates ranged from 19.8 to 36.8.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only traditional Medicare fee-for-service beneficiaries in assisted living communities with 25 or more beds were included, so findings do not apply to Medicare Advantage beneficiaries, residents not enrolled in Medicare, or smaller assisted living communities. The study is an observational cross-section and did not formally test state regulations, enforcement, or market factors, so it cannot show why state emergency department rates differ. It did not examine assisted living community-level characteristics or other state-level practice patterns, such as transport rules for falls.
Declared interests
The supplied text lists research support from the National Institutes of Health and U.S. government. It does not include an author conflict-of-interest declaration or statement that a sponsor designed or wrote the manuscript.
The easy way to misread this
Do not read the state variability as evidence that assisted living nursing staffing or regulations caused more emergency department visits. The study is an observational cross-section of Medicare claims, did not formally test state regulations, and excluded Medicare Advantage beneficiaries and smaller assisted living facilities.