Telemedicine Use Among Assisted Living Residents with ADRD: Assisted Living, Market, and State Regulatory Factors

Project summary: Today, assisted living communities (ALs) are a popular choice for older adults who can no longer maintain an independent lifestyle at home. However, ALs generally do not offer medical services on- site. This may be challenging, especially for the more than 40% of AL residents with ADRD, who often have

complex health conditions and require regular outpatient primary and specialty services (e.g., mental health) to manage their health needs. Accessing and arranging transportation for these necessary services may be difficult and burdensome for these residents due to their physical and cognitive impairments, and due to the

limited availability of some services. Telemedicine, which has expanded greatly since the pandemic, may provide an opportunity to improve access to care for AL residents with ADRD. However, the impact of the telemedicine policy may vary across ALs and be influenced by market- and state-level factors. Effective

telemedicine utilization may require resources, such as infrastructure (e.g., high-speed internet) and a sufficient and well-trained workforce. Direct care workers (DCWs) are the main care providers in ALs and play a crucial role in supporting residents with ADRD. Several factors, including AL-level resources, market-level

direct care workforce, and state AL regulations, may affect AL infrastructure, staffing and training, and, consequently, effective telemedicine use in ALs. To date, there is very limited empirical evidence on the potential impact of the CMS’ telemedicine policy on AL residents. Thus, the objective of this study is to use a

mixed-method approach to understand multi-level factors at AL- (SA1), market- (SA2), and state-level (SA3) that may influence the impact of telemedicine policy on AL residents with ADRD. By using 2018-2024 data, we will examine telemedicine and all visits (including in-person) for different types of outpatient services (e.g.,

mental health, primary care), as well as the use of other health services (e.g., hospitalizations and long-term nursing home [NH] placement) that may be affected by regular outpatient services. We hypothesize that residents with ADRD in ALs with fewer resources, in markets with lower wages of DCWs, or in states with less

specific regulations are less likely to “benefit” from the policy - that is, they are less likely to use telemedicine outpatient services and more likely to have hospitalization, emergency room visits, and NH placement, accounting for the differences in these events before the pandemic. We will also collect primary data (through

interviews) to explore how key AL, staff, and resident/family characteristics vary in ALs and their potential associations with telemedicine use (SA4). The study is innovative because it will be the first to address the proposed research objectives. This study is significant because it will provide important findings on potential

benefits/challenges to telemedicine use in ALs for residents with ADRD. Findings will also shed light on regulatory policies that may create barriers to and exacerbate disparities in receiving appropriate care in this population. This study will provide important and timely insights into the CMS’ telemedicine policy decisions.