# Do State Regulations Affect the Outcomes of Assisted Living Residents with Dementia?

> **NIH NIH R01** · BROWN UNIVERSITY · 2020 · $390,532

## Abstract

PROJECT SUMMARY/ABSTRACT
Approximately one million individuals, an estimated 40-72% with cognitive impairment or a diagnosis of
Alzheimer’s disease-related dementias (ADRD), reside in assisted living (AL); yet, little is known about their
experience or the quality of care offered. Unlike other forms of long-term care (LTC), such as nursing homes
that are federally regulated, the licensing, operating, and enforcement requirements for AL falls to the states,
which vary dramatically in their approaches to regulating this growing industry. As AL assumes an increased
role in providing LTC to vulnerable older adults with ADRD, there is an urgent need to understand the positive
and negative effects of state regulations on quality of care. Our long-term goal is to improve care outcomes for
AL residents, with a specific emphasis on residents with ADRD who often cannot advocate for themselves. The
overall objective of this application is to examine states’ AL regulatory environments and understand if and how
the health outcomes of AL residents with ADRD are impacted by states’ regulatory decisions. The central
hypothesis is that in order to survive, AL providers adhere to licensing requirements and respond to changes in
the regulatory environment, which ultimately impact AL residents’ outcomes. The rationale for the proposed
research is that better understanding the experiences of AL residents with ADRD and how they vary based on
a state’s approach to regulating this industry will help to inform policy and payment decisions and ultimately
improve the outcomes of older adults with ADRD needing LTC. Guided by strong preliminary data, this
hypothesis will be tested by pursuing three specific aims: 1) Characterize how states regulate AL as it relates
to the care of residents with ADRD; 2) Test the effect of regulations on providers’ responses and outcomes of
AL residents with ADRD; 3) Compare outcomes between residents with ADRD who reside in ALs licensed to
provide specialized dementia care to residents in non-specialized ALs. Under the first aim, investigators will
build on their previous efforts to identify and examine the history, oversight, and enforcement of states’ AL
regulations likely to impact outcomes of residents with ADRD. In the second aim, investigators will apply a
novel methodology they developed through an R21 from the National Institute on Aging (#R21AG047303) to
identify AL residents using Medicare data and with rigorous methods examine the effect of regulatory changes
on providers’ behaviors and residents’ outcomes over a 10-year period. Under the third aim, investigators will
apply an observational, quasi-experimental methodology to examine the effect of living in a dementia-
specialized AL on residents’ outcomes. This approach is innovative because it is the first to examine the
outcomes of AL residents with ADRD, nationally, and the impact of the widely varying AL regulations on
healthcare outcomes. The proposed research is significant ...

## Key facts

- **NIH application ID:** 10146751
- **Project number:** 3R01AG057746-03S1
- **Recipient organization:** BROWN UNIVERSITY
- **Principal Investigator:** Kali St. Marie Thomas
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $390,532
- **Award type:** 3
- **Project period:** 2018-01-15 → 2020-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10146751

## Citation

> US National Institutes of Health, RePORTER application 10146751, Do State Regulations Affect the Outcomes of Assisted Living Residents with Dementia? (3R01AG057746-03S1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10146751. Licensed CC0.

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