Wage and Cost Study of Oregon Assisted Living and Residential Care Providers, 2022

Senate Bill 703 directed Oregon Department of Human Services (ODHS) to conduct a study of licensed residential care (RCF) and assisted living (ALF) facilities, including those with a memory care (MC) endorsement, to evaluate: a) Total cost to provide care to residents, b) the sufficiency of the Medicaid reimbursement paid to facilities to meet the total cost of care, and c) the average compensation paid to direct care workers by the facilities by geographic region. ODHS contracted with the Institute on Aging (IOA) at Portland State University (PSU) to conduct a study to achieve these three objectives. In the fall of 2022, IOA developed and conducted the study in collaboration with ODHS staff, with multiple opportunities for input from community partners, including consumer advocates and direct care worker partners, long term care trade associations, and attendees of the Long-Term Care Facility Provider Workforce Recovery Workgroup. This report describes the findings of the resulting study, which uses multiple data sources, including data collected by IOA from over 150 ALF/RCF providers and Medicaid reimbursement data provided to IOA by ODHS. Prepared for: Oregon Department of Human Services Office of Aging and People with Disabilities A study completed by the Institute on Aging at Portland State University with funding from and in partnership with Oregon Department of Human Service

The Resident VIEW in Nursing Homes

This article presents the Resident VIEW (Voicing Importance, Experience, and Well-Being), a measure designed to learn directly from long-term care residents the extent to which they experience support that matters most to them. The Resident VIEW contains 63 items across eight domains developed through cognitive interviews with residents in different types of residential settings (e.g., nursing homes, assisted living, and adult foster care). Residents rate items on both importance and their experience. In total, 258 nursing home residents living in 32 Oregon nursing homes were selected through a two-stage random sampling design and participated in the study. Results demonstrate that what matters most to residents varies, emphasizing the value of asking residents directly about their preferences. The relationship between importance and experience differed by item. Residents who experienced support rated very important within some domains, reported better quality of life and reported lower levels of depressive symptoms than those who did not experience these things. The interaction between importance and experience, however, did not reach statistical significance, suggesting that positive experiences may provide benefit even in some areas that are not perceived as important by residents. Results underscore the value of incorporating the resident perspective into measure development in long-term care

The Resident VIEW in Community- Based Care Residential Settings

The Resident VIEW is a measure of person-centered care (PCC) from residents’ perspectives and was previously studied in nursing homes. The current study presents descriptive data for the Resident VIEW in community-based care settings including assisted living, residential care (AL/RC), and adult foster homes (AFH). Using a two-stage sampling design, we recruited 31 AL/RC and 119 AFH in Oregon and completed face-to-face structured interviews with 227 and 195 residents, respectively. Residents provided ratings for both the importance of and their experience with 66 items that tapped into PCC practices in eight domains. Results are provided for each item, many of which are significantly associated with greater quality of life, better resident satisfaction, and fewer depressive symptoms, especially in the domains of personalized care and being treated like a person. Incongruence between importance and experience ratings indicate many residents experience unmet needs across multiple domains. The Resident VIEW performed well in different types of settings, providing an important tool for researchers and providers who wish to learn about the PCC experience from residents’ points of view

Oregon Community-Based Care Survey: Assisted Living, Residential Care, and Memory Care

In Oregon, community-based care (CBC) communities include assisted living (AL), residential care (RC), and memory care (MC) communities. These settings provide residential, personal care, and health-related services, primarily to older adults. As the population of Oregonians aged 65 and older is estimated to increase from 16 percent in 2015 to nearly 23 percent in 20501, the availability of CBC settings will continue to be an important source of long-term services and supports. This report provides an in-depth look at Oregon’s CBC settings. Because no central dataset of CBC services, staff, and residents is available, as opposed to nursing facilities, information for this report was collected using a questionnaire that CBC providers (e.g., administrators, directors) were asked to complete. CBC settings provide long-term services and supports to many older Oregonians and their families. These services include daily meals, housekeeping and laundry, assistance with personal care needs, medication administration, monitoring of health conditions, communication with residents’ health care providers, and social and recreational activities. Of the 517 AL, RC, and MC communities licensed as of fall 2016, 60 percent (308) returned a questionnaire. The data described in this report are based upon these 308 communities unless noted otherwise. The goals of the project described in this report included: Describe assisted living, residential care, and memory care community characteristics, including staffing types and levels, policies, and monthly charges and fees Describe current residents’ health and social characteristics Compare current results with prior Oregon surveys and national studies of similar setting types to identify changes and possible trends Compare setting types for differences that might affect access, quality, or cost

2020 Community-Based Care Resident and Community Characteristics Report On Assisted Living, Residential Care, and Memory Care Communities

This report summarizes findings from the 6th annual study of Oregon community-based care settings, including assisted living and residential care facilities, and memory care communities. This study was conducted during fall 2019 and winter 2020

2022 Adult Foster Home Resident and Community Characteristics Report on Adult Foster Homes

This report describes results from a study of Oregon adult foster homes (AFH), including home and owner characteristics; monthly charges and payment sources; resident characteristics, personal and health-related needs; and owners’ experiences with supports and challenges due to the COVID-19 pandemic. The study’s purpose was to collect and report data that can inform and advise policymakers, state and county agency staff, aging advocates and AFH owners about the status of AFHs in Oregon. The report includes information collected between December 2021 and March 2022 and, where possible, compares it to findings from prior years of this study and to other reports and articles about AFHs and other types of community-based care

2022 Community-Based Care: Resident and Community Characteristics Report on Assisted Living, Residential Care, and Memory Care Communities

This report summarizes findings from the 8th annual study of Oregon community-based care settings, including assisted living and residential care facilities, and memory care communities. This study was conducted during fall 2021 and winter 2022

Administrator Turnover in Oregon Assisted Living and Residential Care Communities, March 2020-February 2021

The impact of the COVID-19 pandemic on residents and staff of assisted living and residential care (AL/RC) facilities has been sizable, yet little is known about how the pandemic affected their administrators and their job stability. Considering the crucial role that administrators play in the delivery of high-quality care and staffing in residential long-term settings, this research letter describes the turnover experience among Oregon AL/RC administrators and its organizational and structural correlates during the first year of the COVID-19 pandemic (March 2020–February 2021)

Survey Deficiencies as Quality Indicators in Oregon Assisted Living Communities

Background and Objectives License inspection data have commonly been used as a quality measure for nursing homes but has not yet been used to assess the quality of assisted living/residential care (AL/RC) communities. Drawing on resource dependency theory, we test the hypothesis that structural and environmental characteristics influence AL/RC quality as measured by deficiency citations (“deficiencies”) issued during license inspections. Research Design and Methods Using data from 526 licensed AL/RC communities in Oregon that received a license inspection visit between 2008 and 2016, we examined the prevalence of deficiencies by type and year. We estimated regression models to identify structural and environmental characteristics associated with the number of deficiencies. Results Most (79%) inspections resulted in at least one deficiency. The most common deficiencies concerned medications and treatments (57%), change of condition and monitoring (48%), and resident health services (45%). Structural characteristics associated with higher odds of receiving one or more deficiencies included: larger size, memory care designation, shorter administrative tenure, and for-profit status. Environmental characteristics associated with higher odds of receiving one or more deficiencies included: rural location, lower unemployment, and market concentration. The number and likelihood of a given community receiving a deficiency decreased over time. Discussion and Implications Resource dependency theory constitutes a useful framework to consider the role of structural and environmental factors that affect AL/RC quality, including resident needs, institutional knowledge, resource availability, and market pressure. License inspection data are a viable option for assessing the quality of AL/RC communities