Nursing Staff Availability and Other Facility Characteristics in Relation to Assisted Living Care Deficiencies

Background: Assisted living facilities (ALFs), unlike nursing homes, have no federal regulations to monitor quality. States create their own regulations, and little is known about their impact on ALF care outcomes. Aim: The purpose of this study was to examine ALF care deficiencies from one state and explore the relationship among such deficiencies and facility characteristics. Methods: This study analyzed one state's ALF inspections data from 2015 through mid-2017, with documented violations of state regulations cited as deficiencies (N = 2,689 ALFs). Associations between severe deficiencies (defined by the state as those with potential for immediate harm to residents [e.g., assault by staff member] or causing a direct threat to resident health [e.g., an unsupervised meal for resident with swallowing difficulties, who then choked]) and facility characteristics (e.g., nursing staff availability, facility size, ownership, geographic location, and Medicaid participation) were explored using multivariate logistic regression analysis. Results: Six percent of ALFs reported at least one or more severe deficiencies. Larger ALFs (26–100 beds = large and > 100 beds = extra large) had greater odds of severe deficiencies compared to smaller ALFs (4–10 beds) (large versus small: OR = 2.09, 95% CI [1.37, 3.17]; extra large versus small: OR = 4.10, 95% CI [2.56, 6.55]). For all ALFs, only 31.5% had 24-hour nursing staff availability, which included unlicensed nurse aides, certified nursing assistants, licensed practical/vocational nurses, and/or registered nurses. Within large/extra-large facilities, those with part-time or no nursing staff availability had more than twice the odds of severe deficiencies compared to ALFs with 24-hour availability (OR = 2.35, 95% CI [1.31, 4.23]). Conclusion: Results support the importance of nursing staff availability to reduce deficiencies, especially in larger ALFs. Conducting periodic resident assessments could facilitate the availability of ALF outcomes data, which, along with detailed staffing information, are needed to evaluate and monitor quality. Universal regulations could improve ALF oversight and ensure that all states are evaluating ALF care using the same standards.