Health Care Use and Outcomes in Assisted Living Communities: Race, Ethnicity, and Dual Eligibility

Med Care Res Rev. 2022 Aug;79(4):500-510. doi: 10.1177/10775587211050189. Epub 2021 Oct 8.


Assisted Living (AL) has become an important residential long-term care option in the United States, yet very little is known about the nature and quality of care received in this setting by racial/ethnic minorities or residents dually eligible for Medicare and Medicaid. Using calendar year 2018 Medicare data, we identified 255,564 fee-for-service Medicare beneficiaries age 55+ who resided in 24,108 ALs across the United States. We fit several logistic regression models with individual-level covariates and AL-level fixed effects, to examine the association between race/ethnicity and dual status with inpatient hospital admission, 30-day readmission, emergency room use, and nursing home placement. Significant variations in these measures were found both within and across ALs for racial/ethnic minority and dual residents. Our results suggest that disparities in outcomes are most significant by dual eligibility status rather than by race/ethnicity alone. These findings provide important implications for providers, policy makers, and researchers.

Keywords: Assisted Living; disparities; duals; race/ethnicity.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Delivery of Health Care
  • Ethnicity*
  • Humans
  • Medicare*
  • Middle Aged
  • Minority Groups
  • Retrospective Studies
  • United States