High rates of hospital admission among older residents in assisted living facilities: opportunities for intervention and impact on acute care.

Background: Little is known about health or service use outcomes for residents of Canadian assisted living facil­ ities. Our objectives were to estimate the incidence of admission to hospital over 1 year for residents of designated (i.e., publicly funded) assisted living (DAL) facilities in Alberta, to compare this rate with the rate among residents of long­term care facilities, and to identify individual and facility predictors of hospital admission for DAL residents. Methods: Participants were 1066 DAL residents (mean age ± standard deviation 84.9 ± 7.3 years) and 976 long­ term care residents (85.4 ± 7.6 years) from the Alberta Continuing Care Epidemiological Studies (ACCES). Research nurses completed a standardized comprehensive assessment for each resident and interviewed family caregivers at baseline (2006 to 2008) and 1 year later. We used standardized interviews with administrators to generate facil­ ity­level data. We determined hospital admissions through linkage with the Alberta Inpatient Discharge Abstract Database. We used multivariable Cox proportional hazards models to identify predictors of hospital admission. Results: The cumulative annual incidence of hospital admission was 38.9% (95% confidence interval [CI] 35.9%– 41.9%) for DAL residents and 13.7% (95% CI 11.5%–15.8%) for long-term care residents. The risk of hospital admis­ sion was significantly greater for DAL residents with greater health instability, fatigue, medication use (11 or more medications), and 2 or more hospital admissions in the preceding year. The risk of hospital admission was also significantly higher for residents from DAL facilities with a smaller number of spaces, no licensed practical and/ or registered nurses on site (or on site less than 24 hours a day, 7 days a week), no chain affiliation, and from select health regions. Interpretation: The incidence of hospital admission was about 3 times higher among DAL residents than among long-term care residents, and the risk of hospital admission was associated with a number of potentially modifi ­ able factors. These findings raise questions about the complement of services and staffing required within assisted living facilities and the potential impact on acute care of the shift from long­term care to assisted living for the facility­based care of vulnerable older people.