PROJECT SUMMARY Assisted living (AL) is a growing long-term care industry providing housing and supportive services to 800,000+ frail and functionally impaired older adults - over 40% of whom are living with Alzheimer's disease or a related dementia (ADRD). Demographic projections of increased demand for AL, and especially dementia care (also referred to as “memory care”), has attracted notice from private equity (PE) firms. PE ownership advocates argue that PE firms bring much needed capital, allowing providers to update facilities, invest in new technology, and gain economies of scale to enhance efficiency, increase profitability, and improve care quality. However, the growing concern is that some PE firms' focus on short-term profits may compromise the quality of care of AL residents, particularly those living with dementia. Research findings on the effects of PE acquisitions of nursing homes are mixed: while some studies found negative effects (e.g., decreased staffing, increased mortality) others have found no change in staffing or quality outcomes. However, unlike nursing homes, AL is most often paid for privately; and, there is no national framework of regulations, payment policies, or public reporting of care quality to work as “guardrails” against the possible negative impacts of PE acquisitions as there are in nursing homes. Therefore, the objective of this application is to understand the types of AL that PE firms invest in and how PE acquisitions impact the composition of residents with ADRD and residents' outcomes. Our working hypotheses are: 1) ALs that are part of a large chain, located in markets with more demand, and operating under licenses with less regulatory stringency are more likely to be purchased by PE firms; and 2) acquired ALs respond to changes in ownership by restructuring operations in ways that influence the composition of residents and ultimately residents' outcomes. These hypotheses will be tested in an exploratory/explanatory sequential mixed methods study with three specific aims: 1) Explore stakeholders' perceptions of PE firms' motives and the impact of PE investment on AL communities; 2) Compare ALs that were acquired or divested by PE firms between 2010 and 2019 to those that were not; 3) Estimate the causal effect of PE acquisitions on the prevalence of residents with ADRD in AL and residents' outcomes over a 10-year period. Under the first aim, the research team will leverage their existing networks and interview stakeholders to elicit different perspectives on the motives and impacts of PE acquisitions. Under the second aim, the team will apply the methods they developed and data they previously collected to understand which ALs are PE targets. The third aim will examine the welfare effects of PE acquisition on residents with and without ADRD applying an instrumental variable method. The results from this study will be the first to investigate PE acquisitions of AL. As policymakers are urged to consider o...