Abstract
Objectives
Online reviews provided by users of assisted living communities may offer a unique
source of heretofore unexamined data. We explored online reviews as a possible source
of information about these communities and examined the association between the reviews
and aspects of state regulations, while controlling for assisted living, county, and
state market-level factors.
Design
Cross-sectional, observational study.
Setting and Participants
Sample included 149,265 reviews for 8828 communities.
Methods
Primary (eg, state regulations) and secondary (eg, Medicare Beneficiary Summary Files)
data were used. County-level factors were derived from the Area Health Resource Files,
and state-level factors from the integrated Public Use Microdata series. Information
on state regulations was obtained from a previously compiled regulatory dataset. Average
assisted living rating score, calculated as the mean of posted online reviews, was
the outcome of interest, with a higher score indicating a more positive review. We
used word cloud to visualize how often words appeared in 1-star and 5-star reviews.
Logistic regression models were used to determine the association between online rating
and a set of community, county, and state variables. Models were weighted by the number
of reviews per assisted living bed.
Results
Overall, 76% of communities had online reviews. We found lower odds of positive reviews
in communities with greater proportions of Medicare/Medicaid residents [odds ratio
(OR) = 0.986; P < .001], whereas communities located in micropolitan areas (compared with urban),
and those in states with more direct care worker hours (per week per bed) had greater
odds of high rating (OR = 1.722; P < .001 and OR = 1.018, P < .05, respectively).
Conclusions and Implications
Online reviews are increasingly common, including in long-term care. These reviews
are a promising source of information about important aspects of satisfaction, particularly
in care settings that lack a public reporting infrastructure. We found several significant
associations between online ratings and community-level factors, suggesting these
reviews may be a valuable source of information to consumers and policy makers.
Keywords
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Article info
Publication history
Published online: March 16, 2023
Publication stage
In Press Corrected ProofFootnotes
This study was supported by a grant from the Agency for Healthcare Research and Quality (R01HS026893 [HTG]). The funders had no role in the study design, data collection and analysis, decision to publish, or in the preparation of the manuscript.
The authors declare no conflicts of interest.
Identification
Copyright
© 2023 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
