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Description
Quality of care has been a topic of concern in assisted living facilities, known as Residential Care Facilities for the Elderly (RCFEs) in California, for both policy makers and researchers. Research has shown that quality is difficult to measure and measurement systems implemented at a policy level are varied, and often insufficient for research purposes. Without knowledge on how policy impacts quality of care, it is difficult to identify and implement effective policies in assisted living facilities. This study examined how a 2004 policy change in California which reduced the number of unannounced inspection visits from once annually to once every five years, may have impacted quality of care in a sample of 83 RCFEs in San Diego County. Eight hundred eighty six facility inspection reports from a sample of 83 facilities in San Diego County were analyzed to find the number of deficiencies cited and the number of complaint investigation visits from January 2000 through December 2006. Complaint investigation visits and deficiencies were outcomes of interest in this analysis and proxies for quality of care measures. No significant differences were found in the frequency of complaint investigation visits for all facilities or for any individual facility characteristic before and after the policy change. The average number of complaint investigation visits increased overall after the policy change. Individual facility characteristics had varied outcomes, with frequency of complaint investigation visits increasing in some types of facilities and decreasing in others. Significant increases in cited deficiencies were found for facilities licensed 12 months or fewer before the policy change (p=0.040), facilities licensed longer than 37 months before the policy change (p=0.022), 7 to 15 bed facilities (p=0.024), and 50-99 bed facilities (p=0.045). A significant decrease in cited deficiencies was found for facilities with an ownership status of individual or sole proprietorship (p=0.012). Since quality of care is a complex concept to measure, it is recommended that the policy impact be researched further in order to assess why this shift in deficiencies and occurred for some types of facilities and not others.
