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The Impact of Enhanced Programming on Aging in Place for People With Dementia in Assisted Living

Background: Assisted living (AL) is a growing and operationally diverse option in our nation's long-term care system. Many consumers view AL communities as a viable option to receive needed services and age in place. However, little is known about the factors that influence residents’ ability to age in place when experiencing cognitive decline. Objective: To estimate the association of resident and site characteristics to length of stay, reason for leaving and destination for residents with dementia in assisted living. In particular, this study sought to assess the impact of an ‘Enhanced’ Program intended to facilitate aging in place. Method: Data were gathered from a retrospective evaluation of residents’ clinical records (N = 312) in five dementia-specific ALs (3 with robust enhanced programs) in the Northeastern United States. Results: The time to 50% survival for the full cohort (N = 312) was 20.2 months. Both age at move-in and gender were statistically significant predictors of length of stay. Sites with robust support for aging in place exhibited a statistically significant longer length of stay compared to sites with limited support. Of the residents who left or died (N = 165) nearly one quarter (24%) were able to stay until the end of their lives, while 52% moved to a nursing home, primarily because of family, financial, or medical concerns. Few residents left these settings because of behavioral problems. Conclusion: AL sites with a more robust commitment to an aging in place model and a willingness to provide palliative care demonstrated a significantly longer length of stay.