Private Equity Expansion in Assisted Living: Implications for Dementia Care

私募股权在辅助生活领域的扩张：对痴呆症护理的影响

• 批准号: 10738928
• 负责人: Md Momotazur Rahman
• 金额: $ 79.06万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10738928
• 关键词: Acceleration; Accident and Emergency department; Address; Adult; Advocate; Alzheimer' s Disease; Alzheimer' s disease related dementia; Assisted Living Facilities; Capital; Caring; Characteristics; Complex; Consensus; Data; Decision Making; Dementia; Disabled Persons; Elderly; Environment; Equity; Goals; Health; Health Care Sector; Heterogeneity; Hospitalization; Housing; Human Resources; Individual; Industry; Interview; Investments; Lawyers; Licensing; Literature; Long-Term Care; Marketing; Medicare; Methods; Monitor; Negative Finding; Nursing Homes; Outcome; Ownership; Patients; Perception; Personal Satisfaction; Persons; Policies; Policy Maker; Population; Prevalence; Privatization; Provider; Qualifying; Quality of Care; Regulation; Reporting; Research; Services; Structure; Testing; Update; Visit; Vulnerable Populations; Work; beneficiary; community living; dementia care; design; functional disability; improved; industry partner; insight; meetings; memory care; mortality; new technology; operation; payment; treatment effect; welfare

PROJECT SUMMARY Assisted living (AL) is a growing long-term care industry providing housing and supportive services to almost one million frail and functionally impaired older adults - 49% 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, there is no national framework of regulations, payment policies, or public reporting of care quality in AL 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, provide memory care, 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 new 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’ decision-making and the impact of PE investment on AL communities; 2) Compare ALs that were acquired or divested by PE firms 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. 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 the characteristics of ALs that 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 provide the first evidence on PE acquisitions of AL and how it impacts care for residents with ADRD. As policymakers are urged to consider ownership reporting and monitoring in other sectors, it is important to have insight into the less regulated AL industry that provides supportive services to vulnerable older and disabled adults, almost half of whom are living with dementia.

项目摘要 辅助生活（AL）是一个不断发展的长期护理行业，为几乎提供住房和支持服务 一百万个脆弱和功能障碍的老年人 - 其中49％患有阿尔茨海默氏病或 相关痴呆（ADRD）。人口统计学项目增加了对AL的需求，尤其是痴呆症护理 （也称为“内存护理”），引起了私募股权公司（PE）公司的注意。 PE所有权 拥护者认为，私募股权公司带来了急需的资金，使提供商可以更新设施，投资新 技术，并提高规模经济，以提高效率，提高盈利能力并提高护理质量。 但是，越来越关注的是，某些体育公司对短期利润的关注可能会损害质量 照顾AL居民，尤其是那些患有痴呆症的人。研究结果对PE的影响 对护士房屋的收购是混合的：虽然一些研究发现负面影响（例如，人员配备减少，但 死亡率提高）其他人发现人员配备或质量成果没有变化。但是，与护士不同 房屋，没有国家的法规，付款政策或公开报告AL中的护理质量框架 作为“护栏”收购可能像护士之家一样的负面影响的“护栏”。 因此，此应用的目的是了解PE公司投资的AL类型以及PE 收购会影响ADRD和居民成果的居民组成。我们的工作假设 是：1）ALS是大型链的一部分，提供内存护理，位于需求更多的市场中，并且 在监管严重程度较小的许可下运营的可能性更可能由PE公司购买；和2） 获得的ALS通过以影响组成的方式来恢复运营来对新所有权做出回应 居民以及最终的居民成果。这些假设将在探索性+解释性中进行检验 顺序混合方法研究具有三个具体目的：1）探索利益相关者对PE公司的看法 决策和PE投资对AL社区的影响； 2）比较获得的ALS或 被体育公司剥离给那些没有的公司； 3）估计收购对患病率的因果关系 AL和居民成果的ADRD的居民。在第一个目标下，研究团队将利用 他们现有的网络和采访利益相关者会引起对动机和影响的不同观点 PE收购。在第二个目标下，团队将应用他们开发的方法和数据 以前收集以了解PE目标ALS的特征。第三个目标将检查 PE获取对具有仪器变量的有或没有ADRD的居民的福利效应 方法。这项研究的结果将提供有关AL的PE收购及其如何影响的第一个证据 照顾Adrd的居民。由于敦促政策制定者考虑所有权报告和监控 其他领域，重要的是要深入了解不太受规定的行业，该行业提供支持性的行业 为弱势和残疾的成年人提供服务，其中几乎一半患有痴呆症。