Original Study - Brief Report|Articles in Press

Online Customer Reviews of Assisted Living Communities: Association with Community, County, and State Factors

  • Helena Temkin-Greener
    Address correspondence to Helena Temkin-Greener, PhD, Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, 265 Crittenden Boulevard, Rochester, NY 14642.
    Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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  • Yunjiao Mao
    Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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  • Brian McGarry
    Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

    Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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      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.


      Cross-sectional, observational study.

      Setting and Participants

      Sample included 149,265 reviews for 8828 communities.


      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.


      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.


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