LAUSR

OBJECTIVES Little is known about emergency department (ED) utilization among the nearly 1 million older adults residing in assisted living (AL) settings. Unlike federally regulated nursing homes, states create and enforce AL regulations with great variability, which may affect the quality of care provided. The objective of this study was to examine state variability in all-cause and injury-related ED use among residents in AL. DESIGN Observational retrospective cohort study. SETTING AND PARTICIPANTS We identified a cohort of 293,336 traditional Medicare beneficiaries residing in larger AL communities (25+ beds). METHODS With Medicare enrollment and claims data, we identified ED visits and classified those because of injury. We present rates of all-cause and injury-related ED use per 100 person-years in AL, by state, adjusting for age, sex, race, dual-eligibility, and chronic conditions. RESULTS Risk-adjusted state rates of all-cause ED visits ranged from 102.3 visits/100 AL person-years [95% confidence interval (CI) 95.3, 111.6/100 AL person-years] in New Mexico to 167.2 visits/100 AL person-years (95% CI 157.6, 179.6) in Rhode Island. The risk-adjusted rate of injury-related ED visits ranged from 19.8 visits/100 AL person-years (95% CI 18.3, 21.6) in New Mexico to 36.8 visits/100 AL person-years (95% CI 36.0, 38.1) in North Carolina. CONCLUSIONS AND IMPLICATIONS We observed significant variability among states in all-cause and injury-related ED use among AL residents. There is an urgent need to better understand why this variability is occurring to prevent avoidable visits to the ED.