Characterizing Emergency Department Use in Assisted Living

Area of Science:

• Gerontology
• Health Services Research
• Public Health

Background:

• Assisted living (AL) settings house nearly 1 million older adults, yet their emergency department (ED) utilization patterns are poorly understood.
• State regulations for AL facilities vary significantly, unlike federally regulated nursing homes, potentially impacting care quality and health outcomes.

Purpose of the Study:

• To investigate state-level variations in all-cause and injury-related emergency department (ED) visits among residents of assisted living (AL) facilities.
• To identify potential disparities in healthcare access and quality of care for older adults in AL across different states.

Main Methods:

• A retrospective cohort study analyzing traditional Medicare beneficiaries residing in larger AL communities (25+ beds).
• Utilized Medicare enrollment and claims data to identify and classify ED visits, distinguishing between all-cause and injury-related events.
• Calculated risk-adjusted rates of ED use per 100 person-years by state, controlling for demographic and clinical factors.

Main Results:

• Significant state-level variability was observed in risk-adjusted rates of all-cause ED visits, ranging from 100.9 to 162.3 per 100 AL person-years.
• Risk-adjusted rates for injury-related ED visits also showed substantial state variation, from 18.7 to 35.7 per 100 AL person-years.
• New Mexico and Rhode Island exhibited the lowest and highest rates of all-cause ED visits, respectively, while New Mexico and North Carolina showed the lowest and highest rates for injury-related visits.

Conclusions:

• There are considerable state-based differences in emergency department (ED) utilization for both general and injury-related reasons among assisted living residents.
• Further research is urgently needed to elucidate the drivers behind this observed state variability.
• Addressing the underlying causes of these disparities is essential for reducing avoidable ED visits and improving care for older adults in AL settings.