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.

项目概要 辅助生活 (AL) 是一个不断发展的长期护理行业，为几乎所有人群提供住房和支持服务 100 万体弱且功能受损的老年人 - 其中 49% 患有阿尔茨海默病或 相关痴呆症 (ADRD) 的人口统计预测对 AL 的需求增加，尤其是痴呆症护理。 （也称为“记忆护理”）已引起私募股权（PE）公司的关注。 支持者认为，私募股权公司带来了急需的资本，使提供商能够更新设施、投资新产品 技术，并获得规模经济，以提高效率、增加盈利能力并提高护理质量。 然而，越来越多的担忧是，一些PE公司对短期利润的关注可能会损害质量 AL 居民的护理，特别是那些患有痴呆症的人 关于 PE 影响的研究结果。 收购疗养院的情况好坏参半：虽然一些研究发现了负面影响（例如，人员配备减少， 死亡率增加）其他人则发现人员配置或质量结果没有变化。 阿拉巴马州没有国家监管框架、支付政策或护理质量公开报告 充当“护栏”，防止私募股权收购可能带来的负面影响，就像疗养院那样。 因此，本申请的目的是了解 PE 公司投资的 AL 类型以及 PE 如何投资 收购会影响患有 ADRD 的居民的构成和我们的工作假设。 是： 1) 属于大型连锁店一部分的 AL，提供记忆护理，位于需求较多的市场，以及 监管严格程度较低的许可证更有可能被私募股权公司收购；2) 被收购的 AL 会通过重组业务来应对新的所有权，从而影响 AL 的构成 居民以及最终居民的结果将在探索性+解释性的过程中得到检验。 序贯混合方法研究具有三个具体目标：1）探索利益相关者对私募股权公司的看法 决策以及 PE 投资对 AL 社区的影响； 2) 比较所收购的 AL 或 3) 估计私募股权收购对患病率的因果影响 在第一个目标下，研究团队将利用 AL 中患有 ADRD 的居民的比例和居民的结果。 他们现有的网络并采访利益相关者，以征求对动机和影响的不同观点 在第二个目标下，团队将应用他们开发的方法和数据。 之前收集的信息是为了了解作为 PE 目标的 AL 的特征。 应用工具变量，购买 PE 对有和没有 ADRD 的居民的福利影响 这项研究的结果将为 PE 收购 AL 及其影响提供第一个证据。 政策制定者被敦促考虑所有权报告和监测。 其他行业，重要的是要深入了解监管较少的 AL 行业，该行业可以提供支持 为弱势老年人和残疾人提供服务，其中近一半患有痴呆症。