# Patient Safety Culture in Assisted Living:  Association with Outcomes

> **NIH AHRQ R01** · UNIVERSITY OF ROCHESTER · 2021 · $388,823

## Abstract

Project Summary/Abstract
 Assisted living (AL) communities in the U.S. were largely designed to fill the gap between independent living
and nursing home by providing housing and support services. The acuity of persons living in AL has increased
over the last two decades, and today more than 50% of AL residents require supportive care such as help with
medications and assistance in activities of daily living (ADLs), 40% have moderate to severe dementia, and 90%
some degree of cognitive impairment. The rapid growth of AL communities has occurred largely without federal
financing or oversight and with variable state regulatory efforts and stringency. Consequently, relatively little is
known about the safety culture of the AL environment and its impact on residents' safety and health outcomes.
 The 1999 Institute of Medicine (IOM) report “To Err is Human” prompted many healthcare organizations to
focus on “patient safety culture” and the need to organize their care processes so as to minimize care delivery
errors and improve the provision of patient care. In the last decade, significant progress to improve safety culture
(e.g. teamwork, management support for patient safety) in acute care hospitals, and to some extent in nursing
homes, has been made and the literature shows that improved safety culture is associated with better patient
outcomes. By comparison AL communities, which are state-regulated, receive no or little scrutiny from federal
policy makers, the state oversight of these organizations vary widely, and even less is known about their safety
culture. AL communities have substantially fewer reporting requirements than nursing homes yet to a large extent
serve residents with similar care needs. It is not known if and to what extent the stringency of state AL regulations
impacts the development of safety culture practices in this care setting, and how both of these forces influence
residents' outcomes. To address these significant gaps in knowledge our proposed project will examine the
variation in AL patient safety culture, its relationship to residents' health outcomes, and the potential impact of state
regulations on safety culture and outcomes.
 We propose to survey administrators and direct care workers in a large, nationally representative sample of
ALs using an adapted version of the AHRQ patient safety survey instrument. We will employ existing databases of
state ALR regulations and policies. We will use Medicare administrative and claims data to identify AL residents
and to define risk-adjusted outcomes. We will also employ public use data to define other needed covariates.
These data will be used to construct AL patient safety culture measures, measures of state stringency, measures
of residents' risk-adjusted outcomes, and facility, market and state covariates. Hypotheses will be tested using
multivariable regressions. The information generated through this study will increase knowledge of AL communities
and their ability to adeq...

## Key facts

- **NIH application ID:** 10140316
- **Project number:** 5R01HS026893-03
- **Recipient organization:** UNIVERSITY OF ROCHESTER
- **Principal Investigator:** HELENA TEMKIN-GREENER
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $388,823
- **Award type:** 5
- **Project period:** 2019-07-01 → 2023-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10140316

## Citation

> US National Institutes of Health, RePORTER application 10140316, Patient Safety Culture in Assisted Living:  Association with Outcomes (5R01HS026893-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10140316. Licensed CC0.

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