Variability and Potential Determinants of Assisted Living State Regulatory Stringency

Area of Science:

• Gerontology
• Health Policy
• Healthcare Administration

Background:

• Assisted living (AL) facilities provide crucial long-term care services.
• Regulatory policies aim to ensure quality and safety in AL settings.
• Significant state-level variations in AL regulations are suspected.

Purpose of the Study:

• To examine state variations in assisted living (AL) regulatory policies.
• To identify factors associated with domain-specific and overall regulatory stringency.

Main Methods:

• Observational study analyzing 2019 state AL regulations and other national data.
• Content analysis of state regulatory databases to generate policy stringency scores (0-100%).
• Multivariable logistic regression used to identify associations between market/state characteristics and regulatory stringency.

Main Results:

• Substantial variations in regulatory stringency were found across 46 states and DC.
• No single policy consistently determined a state's regulatory rank.
• AL bed supply, monthly AL cost, and Medicaid beneficiary utilization were associated with regulatory stringency.

Conclusions:

• Significant disparities exist in state-level assisted living regulations.
• Market and state generosity factors influence regulatory stringency, with complex associations.
• Further research is needed to understand the impact of regulatory stringency on AL access and care quality.