# ADVANCE: Assessment of Disparities and Variation for Alzheimer's disease in Nursing home Care at End of Life

> **NIH NIH R01** · HEBREW REHABILITATION CENTER FOR AGED · 2020 · $285,025

## Abstract

COVID-19 is a crisis in U.S. nursing homes (NHs), where residents with advanced dementia are at especially
high risk of acquiring and dying of the virus. There is an urgent need to understand how to compassionately and
effectively care for these residents, maintain communication with family members, and protect the safety of all
residents and staff. Prior quantitative research highlighted persistent regional and racial variation in the intensity
of care provided to NH residents with advanced dementia, and the pandemic is revealing profound racial
disparities in the general population. Little is known about the intersection of COVID-19, advanced dementia,
and disparities. ADVANCE (Assessment of Disparities and Variation for Alzheimer’s disease Nursing home Care
at End of life), is an ongoing qualitative study that seeks to understand the drivers of regional and racial disparities
in care provided to NH residents with advanced dementia. We have identified two high intensity and two low
intensity health referral regions (HRRs) (Rochester, NY, Boston, MA, Birmingham, AL, and Atlanta, GA) based
on tube-feeding and hospital transfers rates ascertained from recent Minimum DataSet data. Within each HRR,
two high and low intensity NHs relative to all NHs in that HRR (16 NHs total) were identified. To date, we have
recruited, conducted site visits, and collected extensive qualitative data in 11 of these NHs in 3 HRRs. We have
acquired a rich dataset and conducted extensive analysis to examine how NH organizational culture and staff
and proxies’ perceptions influence the care residents with advanced dementia receive. The objective of this
administrative supplement is to leverage the ADVANCE study infrastructure, with its established relationship to
a diverse cohort of NHs and proxies, to explore the experience of residents with advanced dementia during
COVID-19 from the lens of health care disparities. Qualitative data will be collected by interview with NH staff
and proxy decision makers for NH residents with advanced dementia. Aim 1, will use remote, semi-structured
qualitative interviews with NH staff (medical providers, senior administrators, nurses, nursing assistants, and
social workers) in the 11 ADVANCE NHs to explore their experiences caring for residents with advanced
dementia during COVID-19 focusing on: care processes (testing, controlling transmission, managing COVID-19
positive residents; connecting residents and families); decision-making processes (advance care planning,
hospital transfer, communication with proxies); organizational resources (staffing and personal protective
equipment); and personal experience (health, safety, and stress). Aim 2, will use remote, semi-structured
interviews with proxies of advanced dementia resident (11 Black and 11 White) about their experience during
COVID-19 focusing on: connecting with resident, NH response to the crisis, communicating with NH, decision
making (advance care planning, hospital transfer), ...

## Key facts

- **NIH application ID:** 10153984
- **Project number:** 3R01AG058539-03S1
- **Recipient organization:** HEBREW REHABILITATION CENTER FOR AGED
- **Principal Investigator:** Ruth Palan Lopez
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $285,025
- **Award type:** 3
- **Project period:** 2018-06-01 → 2021-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10153984

## Citation

> US National Institutes of Health, RePORTER application 10153984, ADVANCE: Assessment of Disparities and Variation for Alzheimer's disease in Nursing home Care at End of Life (3R01AG058539-03S1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10153984. Licensed CC0.

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