End-of-Life Care Transitions in Assisted Living: Associations With State Staffing and Training Regulations.
Wenhan Guo, Shubing Cai, Thomas Caprio and 2 others
PMID 36913979WHAT IT FOUND
Among assisted living residents who died, hospice enrollment was associated with fewer last-week end-of-life moves.
More specific staff training rules linked to fewer moves, but more specific staffing rules linked to more.
Key findings
01Hospice enrollees had significantly fewer transitions in the last 7 days (IRR=0.05).
02More specific state rules for direct care worker training were associated with 25% fewer end-of-life transitions (IRR=0.75).
03More specific state rules for licensed and direct care worker staffing were associated with higher frequency of transitions in the last 7 days (licensed IRR=1.08; direct care worker IRR=1.22).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
It is observational, so it cannot show that state regulations, hospice enrollment, or training caused fewer or more transitions. The main analysis could not include emergency department visits for Medicare Advantage enrollees, and the final sample excluded 46,437 people who died outside an assisted living community. The data lacked resident functional status, so differences in illness severity or care needs may explain some associations. The 7-day and 30-day outcome windows were chosen by the researchers, and the authors called them somewhat arbitrary.
Declared interests
The authors declared no conflicts of interest. The article text does not report a funding source.
The easy way to misread this
Do not conclude that stricter staffing rules improve end-of-life care or that hospice enrollment prevents moves. This observational study reports associations among residents who died in assisted living, and more specific staffing rules were linked to more last-week moves.