title: The Impact of Enhanced Programming on Aging in Place for People With Dementia in Assisted Living.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: Gerontology Institute, University of Massachusetts Boston, Boston, MA, USA joan.hyde@umb.edu.
authors: Joan
authors: J
authors: Hyde
authors: Center for Aging Studies, University of Maryland Baltimore County, Baltimore, MD, USA.
authors: Rosa
authors: R
authors: Perez
authors: Assistant Professor of Gerontology Department of Human Services Bowling Green State University Bowling Green, OH, USA.
authors: Patrick J
authors: PJ
authors: Doyle
authors: Director, Geriatric Mood Disorders Research Program McLean Hospital, Belmont, MA, USA Assistant Professor of Psychiatry, Harvard Medical School, Cambridge, MA, USA.
authors: Brent P
authors: BP
authors: Forester
authors: Biostatistics Solutions, Boston, MA, USA.
authors: Theodore H
authors: TH
authors: Whitfield
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities / Q000706:statistics & numerical data*; D003704:Dementia / Q000451:nursing*; D005260:Female; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D015397:Program Evaluation; D012189:Retrospective Studies; D012737:Sex Factors; D013727:Terminal Care / Q000706:statistics & numerical data*
keywords: aging in place; assisted living; end stage; length of stay