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

Abstract

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.

Figure 1:

Adjusted Healthcare Outcomes: By Race/Ethnicity and Dual Status Notes: Wald test^d for the effect of race and dual eligibility status combined, comparing the adjusted models to adjusted with FE