The Quality of Care in Residential Care Facilities for the Elderly

This dissertation research examines Residential Care Facilities for the Elderly (RCFEs), often referred to as Assisted Living (AL), by considering policy and regulation, state licensing and monitoring systems and concerns regarding quality of care. The first study examines the intended and unintended consequences of federal and state policy and regulation affecting the Residential Care/Assisted Living industry. An economic framework forms the basis for the examination of two broad effects of policy: the availability of assisted living facilities, and residents' ability to afford those services. The conceptual framework is described and progresses through a description of illustrative policy domains and intended and unintended consequences are discussed. The second study proposes an adaptation of the Donabedian structure-process-outcome theory as a framework for designing and more effectively using the administrative data collected in the licensing and regulation of Residential Care/Assisted Living facilities. Structural components are represented by facility, staff and resident characteristics. Process components include the types of services available and safety and injury prevention. Possible outcome measures include deficiencies and complaints, changes of resident health status and quality indicators, and discharge and medical event data. Emphasis is on measures available in administrative records. The last study was designed to evaluate the applicability of adapting the State of California administrative data regarding Residential Care Facilities for the Elderly (RCFEs) into a statewide system to monitor the quality of care provided. A randomly selected sample of 340 facilities was identified from the 3349 facilities licensed in Northern and Central California. Stratification of the sample was by facility capacity and State district office. Data collection consisted of a five-year retrospective review of the public files maintained across offices. A conceptual framework was developed to identify components thought to be indicative of quality of care. Such information was abstracted from the public files for data analyses. Collected data were analyzed using various descriptive statistics. Findings suggest that substantial limitations in current State data sources exist, as do concerns regarding quality of care. Suggestions are made to inform future researchers to further evaluate and improve the current monitoring system and develop a comprehensive, accessible information system