“Rates of COVID-19 Among Residents and Staff Members in Nursing Homes — United States, May 25–November 22, 2020,” by Suparna Bagchi, Josephine Mak, Qunna Li, Edward Sheriff, Elisabeth Mungai, Angela Anttila, Minn Minn Soe, Jonathan R. Edwards, Andrea L. Benin, Daniel A. Pollock, Evan Shulman, Shari Ling, Jean Moody-Williams, Lee A. Fleisher, Arjun Srinivasan, and Jeneita M. Bell (Morbidity and Mortality Weekly Reports, Vol. 70, No. 2, January 15, 2021, .pdf and HTML format, p. 52-55).
January 14, 2021
CAAR – US Centers for Disease Control Article – January 14, 2021
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CAAR – Public Library of Science (PLoS) Articles – January 14, 2021
A. “Health conditions of potential risk for severe Covid-19 in institutionalized elderly people,” by Mayara Priscilla Dantas Araújo, Vilani Medeiros de Araújo Nunes, Larissa de Albuquerque Costa, Talita Araujo de Souza, Gilson de Vasconcelos Torres, and Thaiza Teixeira Xavier Nobre ( PLoS ONE 16(1): e0245432. doi.org/10.1371/journal.pone.0245432, XML, HTML, and .pdf format, 10p.).
journals.plos.org/plosone/article?id=10.1371/journal.pone.0245432
B. “#Caremongering: A community-led social movement to address health and social needs during COVID-19,” by Hsien Seow, Kayla McMillan, Margaret Civak, Daryl Bainbridge, Alison van der Wal, Christa Haanstra, Jodeme Goldhar, and Samantha Winemaker (PLoS ONE 16(1): e0245483. doi.org/10.1371/journal.pone.0245483, XML, HTML, and .pdf format, 11p.).
journals.plos.org/plosone/article?id=10.1371/journal.pone.0245483
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January 11, 2021
CAAR – National Bureau of Economic Research Working Papers – January 11, 2021
Links to an abstract are available. For full text availability check your organization’s library.
A. “Another brick on the Wall: On the Effects of Non-Contributory Pensions on Material and Subjective Well Being,” by Rosangela Bando, Sebastian Galiani & Paul Gertler (w28318, January 2021, .pdf format, 40p.).
B. “Robots and Labor in the Service Sector: Evidence from Nursing Homes,” by Karen Eggleston, Yong Suk Lee & Toshiaki Iizuka (w28322, January 2021, .pdf format, 38p.).
C. “The Behavioral Foundations of Default Effects: Theory and Evidence from Medicare Part D,” by Zarek C. Brot-Goldberg, Timothy Layton, Boris Vabson & Adelina Yanyue Wang (w28331, January 2021, .pdf format, 61p.).
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January 7, 2021
CAAR – Public Library of Science (PLoS) Article – January 7, 2021
“Nobody ever questions—Polypharmacy in care homes: A mixed methods evaluation of a multidisciplinary medicines optimisation initiative,” by Sue Jordan, Hayley Prout, Neil Carter, John Dicomidis, Jamie Hayes, Jeffrey Round, and Andrew Carson-Stevens (PLoS ONE 16(1): e0244519. doi.org/10.1371/journal.pone.0244519, XML, HTML, and .pdf format, 26p.).
journals.plos.org/plosone/article?id=10.1371/journal.pone.0244519
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January 6, 2021
CAAR – Proceedings of the National Academy of Sciences Article Abstracts – January 6, 2021
A. “Nursing home staff networks and COVID-19,” by M. Keith Chen, Judith A. Chevalier, and Elisa F. Long (Vol. 118, No. 1, January 5, 2021, e2015455118).
www.pnas.org/content/118/1/e2015455118.abstract?etoc
B. “The Parkinson’s disease-associated gene ITPKB protects against {alpha}-synuclein aggregation by regulating ER-to-mitochondria calcium release,” by Daniel J. Apicco, Evgeny Shlevkov, Catherine L. Nezich, David T. Tran, Edward Guilmette, Justin W. Nicholatos, Collin M. Bantle, Yi Chen, Kelly E. Glajch, Neeta A. Abraham, Lan T. Dang, G. Campbell Kaynor, Ellen A. Tsai, Khanh-Dung H. Nguyen, Joost Groot, YuTing Liu, Andreas Weihofen, Jessica A. Hurt, Heiko Runz, and Warren D. Hirst (Vol. 118, No. 1, January 5, 2021, e2006476118).
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CAAR – AARP Public Policy Institute Report – January 6, 2021
“LTSS Choices: Small-House Nursing Homes,” by Susan C. Reinhard and Edem Hado (January 2021, .pdf format, 11p.).
www.aarp.org/ppi/info-2021/ltss-choices-small-house-nursing-homes/
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December 28, 2020
CAAR – US Department of Health and Human Services, Office of Inspector General Reports – December 28, 2020
A. “Onsite Surveys of Nursing Homes During the COVID-19 Pandemic: March 23-May 30, 2020,” (OEI-01-20-00430, December 2020, .pdf format, 51p.).
oig.hhs.gov/oei/reports/OEI-01-20-00430.asp
B. “Despite Savings on Many Lab Tests in 2019, Total Medicare Spending Increased Slightly Because of Increased Utilization for Certain High-Priced Tests,” (OEI-09-20-00450,” December 2020, .pdf format, p.).
oig.hhs.gov/oei/reports/OEI-09-20-00450.asp
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December 14, 2020
CAAR – Public Library of Science (PLoS) Articles – December 14, 2020
A. “Geographic distribution of hospice, homecare, and nursing home facilities and access to end-of-life care among persons living with HIV/AIDS in Appalachia,” by Sadie P. Hutson, Ashley Golden, and Agricola Odoi (PLoS ONE 15(12): e0243814. doi.org/10.1371/journal.pone.0243814, XML, HTML, and .pdf format, 14p.).
journals.plos.org/plosone/article?id=10.1371/journal.pone.0243814
B. “Association between objectively measured walking steps and sleep in community-dwelling older adults: A prospective cohort study,” by Noriyuki Kimura, Yasuhiro Aso, Kenichi Yabuuchi, and Etsuro Matsubara (PLoS ONE 15(12): e0243910. doi.org/10.1371/journal.pone.0243910, XML, HTML, and .pdf format, 8p.).
journals.plos.org/plosone/article?id=10.1371/journal.pone.0243910
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December 10, 2020
CAAR – AARP Public Policy Institute Report – December 10, 2020
“LTSS Choices: COVID-19 and Nursing Home Residents,” by Susan C. Reinhard and Jane Tilly (December 2020, .pdf format, 17p.).
www.aarp.org/ppi/info-2020/covid-and-nursing-home-residents.html
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December 8, 2020
CAAR – Public Library of Science (PLoS) Articles – December 8, 2020
A. “An integrative systematic review of creative arts interventions for older informal caregivers of people with neurological conditions,” by J. Yoon Irons, Gulcan Garip, Ainslea J. Cross, David Sheffield, and Jamie Bird (PLoS ONE 15(12): e0243461. doi.org/10.1371/journal.pone.0243461, XML, HTML, and .pdf format, 25p.).
journals.plos.org/plosone/article?id=10.1371/journal.pone.0243461
B. “Time from dementia diagnosis to nursing-home admission and death among persons with dementia: A multistate survival analysis,” by Marit Mjørud, Geir Selbæk, Espen Bjertness, Trine Holt Edwin, Knut Engedal, Anne-Brita Knapskog, and Bjørn Heine Strand (PLoS ONE 15(12): e0243513. doi.org/10.1371/journal.pone.0243513, XML, HTML, and .pdf format, 15p.).
journals.plos.org/plosone/article?id=10.1371/journal.pone.0243513
C. “Socioeconomic and behavioral determinants of cardiovascular diseases among older adults in Belgium and France: A longitudinal analysis from the SHARE study,” by Hamid Yimam Hassen, Hilde Bastiaens, Kathleen Van Royen, and Steven Abrams (PLoS ONE 15(12): e0243422. doi.org/10.1371/journal.pone.0243422, XML, HTML, and .pdf format, 14p.).
journals.plos.org/plosone/article?id=10.1371/journal.pone.0243422
D. “Extent of aging across education and income subgroups in Thailand: Application of a characteristic-based age approach,” by Wiraporn Pothisiri, Orawan Prasitsiriphon, and Wichai Aekplakorn ( PLoS ONE 15(12): e0243081. doi.org/10.1371/journal.pone.0243081, XML, HTML, and .pdf format, 16p.).
journals.plos.org/plosone/article?id=10.1371/journal.pone.0243081
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December 7, 2020
CAAR – US National Center for Health Statistics Report – December 7, 2020
“Characteristics of Residential Care Communities by Percentage of Resident Population Diagnosed With Dementia: United States, 2016,” by Manisha Sengupta and Christine Caffrey (National Health Statistics Report No. 148, December 2020, .pdf format, 7p.).
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November 3, 2020
CAAR – US Department of Health and Human Services, Office of Assistant Secretary for Policy and Evaluation Reports – November 3, 2020
A. “COVID-19 Intensifies Nursing Home Workforce Challenges,” by Noelle Denny-Brown, Denise Stone, Burke Hays, and Dayna Gallaghe (October 2020, .pdf format, 45p.).
aspe.hhs.gov/basic-report/covid-19-intensifies-nursing-home-workforce-challenges
B. “Changes In Home Health Care Use In Medicare Advantage Compared To Traditional Medicare, 2011-2016,” by Peter J. Huckfeldt, Stephen Zuckerman, Laura Skopec, Joshua Aarons, Robert A. Berenson, Judith Feder, and Douglas Wissoker (September 2020, .pdf format, 22p.).
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November 2, 2020
CAAR – National Bureau of Economic Research Working Papers – November 2, 2020
Links to an abstract are available. For full text availability check your organization’s library.
A. “Nursing Home Quality, COVID-19 Deaths, and Excess Mortality,” by Christopher J. Cronin & William N. Evans (w28012, October 2020, .pdf format, 47p.).
B. “The Age Profile of Life-satisfaction After Age 65 in the U.S.,” by Péter Hudomiet, Michael D. Hurd & Susann Rohwedder (w28037, October 2020, .pdf format, 29p.).
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October 30, 2020
CAAR – UK Office for National Statistics Statistical Bulletin – October 30, 2020
“Deaths in the care sector, England and Wales: 2019,” (October 2020, .pdf and HTML format, 25p.).
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October 27, 2020
CAAR – Kaiser Family Foundation Issue Briefs – October 27, 2020
A. “The pandemic’s effect on the widening gap in mortality rate between the U.S. and peer countries,” by Giorlando Ramirez, Krutika Amin, and Cynthia Cox (October 2020, HTML format).
B. “Racial and Ethnic Disparities in COVID-19 Cases and Deaths in Nursing Homes,” by Priya Chidambaram, Tricia Neuman, and Rachel Garfield (October 2020, HTML format).
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October 21, 2020
CAAR – Care Quality Commission [UK] Report – October 21, 2020
“The state of health care and adult social care in England 2019/20,” (October 2020, .pdf and HTML format, 108p.).
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October 20, 2020
CAAR – AARP Public Policy Institute Report – October 20, 2020
“AARP Nursing Home COVID-19 Dashboard,” (October 2020, .pdf format). Note: Data sheets available for each state.
www.aarp.org/ppi/issues/caregiving/info-2020/nursing-home-covid-dashboard.html
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September 25, 2020
CAAR – US Department of Health and Human Services, Office of the Inspector General Report – September 25, 2020
“States Continued To Fall Short in Meeting Required Timeframes for Investigating Nursing Home Complaints: 2016-2018,” (OEI-01-19-00421, September 2020, .pdf format, 32p.).
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September 8, 2020
CAAR – Australian Institute of Health and Welfare Reports – September 8, 2020
A. “Interfaces between the aged care and health systems in Australia—movements between aged care and hospital 2016–17,” (September 2020, .pdf format, 15p.).
www.aihw.gov.au/reports/aged-care/movements-between-aged-care-and-hospital/contents/summary
B. “Interfaces between the aged care and health systems in Australia—GP use by people living in permanent residential aged care 2012–13 to 2016–17,” (September 2020, .pdf format, 11p.).
www.aihw.gov.au/reports/aged-care/gp-use-by-people-in-permanent-residential-care/contents/summary
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September 2, 2020
CAAR – Kaiser Family Foundation Issue Briefs – September 2, 2020
A. “Overlooked and Undercounted: The Growing Impact of COVID-19 on Assisted Living Facilities,” by Sarah True, Nancy Ochieng, Juliette Cubanski, Priya Chidambaram, and Tricia Neuman (August 2020, HTML format).
B. “Key Questions About the Impact of Coronavirus on Long-Term Care Facilities Over Time,” by Priya Chidambaram (August 2020, .pdf format).
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August 18, 2020
CAAR – Journal of the American Medical Association Research Letter Abstract – August 18, 2020
“Prevalence of Psychotropic and Opioid Prescription Fills Among Community-Dwelling Older Adults With Dementia in the US,” by Donovan T. Maust, Julie Strominger, Julie P. W. Bynum, Kenneth M. Langa, Lauren B. Gerlach, Kara Zivin, and Steven C. Marcus (Vol. 324, No. 7, August 18, 2020, p. 706-708).
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August 17, 2020
CAAR – US Centers for Disease Control Article – August 17, 2020
“Facility-Wide Teting for SARS-CoV-2 in Nursing Homes — Seven U.S. Jurisdictions, March–June 2020,” by Kelly M. Hatfield, Sujan C. Reddy, Kaitlin Forsberg, Lauren Korhonen, Kelley Garner, Trent Gulley, Allison James, Naveen Patil, Carla Bezold, Najibah Rehman, Marla Sievers, Benjamin Schram, Tracy K. Miller, Molly Howell, Claire Youngblood, Hannah Ruegner, Rachel Radcliffe, Allyn Nakashima, Michael Torre, Kayla Donohue, Paul Meddaugh, Mallory Staskus, Brandon Attell, Caitlin Biedron, Peter Boersma, Lauren Epstein, Denise Hughes; Meghan Lyman, Leigh E. Preston, Guillermo V. Sanchez, Sukarma Tanwar, Nicola D. Thompson, Snigdha Vallabhaneni, Amber Vasquez, and John A. Jernigan (Morbidity and Mortality Weekly Reports, Vol. 69, No. 32, August 14, 2020, .pdf and HTML format, p. 1095-1099).
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August 13, 2020
CAAR – Canadian Institute for Health Information/Institut Canadien D’information Sur La Sante Report – August 13, 2020
“Seniors in Transition: Exploring Pathways Across the Care Continuum,” (August 2020, .pdf format, 44p.).
www.cihi.ca/en/seniors-in-transition-exploring-pathways-across-the-care-continuum
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August 7, 2020
CAAR – Kaiser Family Foundation Issue Brief – August 7, 2020
“Key Questions About Nursing Home Regulation and Oversight in the Wake of COVID-19,” by MaryBeth Musumeci and Priya Chidambaram (August 2020, HTML format).
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August 6, 2020
CAAR – US Department of Health and Human Service, Office of Inspector General Report – August 6, 2020
“Some Nursing Homes’ Reported Staffing Levels in 2018 Raise Concerns; Consumer Transparency Could Be Increased,” (OEI-04-18-00450, August 2020, .pdf format, 37p.).
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August 4, 2020
CAAR – Public Library of Science (PLoS) Articles – August 4, 2020
A. “Older adults with dual sensory loss in rehabilitation show high functioning and may fare better than those with single sensory loss,” by Andrea Urqueta Alfaro, Dawn M. Guthrie, Cathy McGraw, and Walter Wittich (PLoS ONE 15(8): e0237152. doi.org/10.1371/journal.pone.0237152, HTML, XML, and .pdf format, 22p.).
journals.plos.org/plosone/article?id=10.1371/journal.pone.0237152
B. “Factors associated with follow-up difficulty in longitudinal studies involving community-dwelling older adults,” by Hisashi Kawai, Manami Ejiri, Harukazu Tsuruta, Yukie Masui, Yutaka Watanabe, Hirohiko Hirano, Yoshinori Fujiwara, Kazushige Ihara, Masashi Tanaka, and Shuichi Obuchi (PLoS ONE 15(8): e0237166. doi.org/10.1371/journal.pone.0237166, HTML, XML, and .pdf format, 10p.).
journals.plos.org/plosone/article?id=10.1371/journal.pone.0237166
C. “Drug related problems in older adults living with dementia,” by Sirasa Ruangritchankul, Nancye M. Peel, Leila Shafiee Hanjani, and Leonard C. Gray (PLoS ONE 15(7): e0236830. doi.org/10.1371/journal.pone.0236830, HTML, XML, and .pdf format, 22p.).
journals.plos.org/plosone/article?id=10.1371/journal.pone.0236830
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July 30, 2020
CAAR – Institute for the Study of Labor (IZA) [University of Bonn, Germany] Working Paper – July 30, 2020
“Does Immigration Improve Quality of Care in Nursing Homes?” by Delia Furtado and Francesc Ortega (Disucssion Paper No. 13552, July 2020, .pdf format, 39p.). Note: A link to the abstract and the full-text of this paper is available at:
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July 24, 2020
CAAR – Scripps Gerontology Center [Miami University, Ohio] Report – July 24, 2020
“The family experience in long-term care during the COVID-19 visitation restriction,” by Jane K. Straker and Mi Sun Choi (July 2020, .pdf format, 10p.).
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July 23, 2020
CAAR – US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation Report – July 23, 2020
“Impacts of Minimum Wage Increases on Nursing Homes: Final Report,” (June 2020, .pdf format, 34p.).
aspe.hhs.gov/pdf-report/impacts-minimum-wage-increases-nursing-homes-final-report
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July 15, 2020
CAAR – Institute for the Study of Labor (IZA) [University of Bonn, Germany] Working Paper – July 15, 2020
“Exploring the Relationship between Care Homes and Excess Deaths in the COVID-19 Pandemic: Evidence from Italy,” by Caterina Alacevich, Nicolò Cavalli, Osea Giuntella, Raffaele Lagravinese, Francesco Moscone, and Catia Nicodemo (Discussion Paper No. 13492, July 2020, .pdf format, 16p.). Note: Links to the abstract and the full text of this paper available at:
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June 30, 2020
CAAR – European Centre for Social Welfare Policy and Research Issue Brief – June 30, 2020
“Co-financing residential care for older people: models and equity implications,” by Cassandra Simmons, Kai Leichsenring, and Ricardo Rodrigues (2020, .pdf format, 15p.).
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June 25, 2020
CAAR – US House Ways and Means Committee, Subcommittee on Health Hearing Testimony – June 25, 2020
“Examining the COVID-19 Nursing Home Crisis,” a hearing held June 25, 2020 (witness statement available in .pdf format, video of the full hearing available at the site, running time 3 hours 7 minutes). Note: Hearing begins at the 6:20 mark
waysandmeans.house.gov/legislation/hearings/examining-covid-19-nursing-home-crisis
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June 11, 2020
CAAR – US House Committee on Oversight and Reform, Select Subcommittee on the Coronavirus Crisis Briefing – June 11, 2020
“The Devastating Impact of the Coronavirus Crisis in America’s Nursing Homes,” held June 11, 2020 (video of the full briefing available at the Subcommittee website, running time 2 hours 8 minutes). Note: Briefing begins at the 1:40 mark.
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June 8, 2020
CAAR – US Centers for Medicare and Medicaid Services Data Release – June 8, 2020
“COVID-19 Nursing Home Data,” (June 2020, data can be downloaded in CSV, KML, or Shapefile format).
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June 2, 2020
CAAR – US Centers for Medicare and Medicaid Services Data Release – June 2, 2020
“Nursing Home COVID-19 Data,” (May 2020, .pdf format, 1p.).
www.cms.gov/files/document/6120-nursing-home-covid-19-data.pdf
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May 28, 2020
CAAR – The Irish Longitudinal Study on Ageing/Staidear Fadaimseartha na h Eireann um Dhul in Aois [TILDA] (Trinity College, Ireland] Report – May 28, 2020
“TILDA Nursing Home Data: A Short Report To Inform COVID-19 Responses For Our Most Vulnerable 2020,” by Roman Romero-Ortuno, Peter May, Minjuan Wang, Siobhan Scarlett, Ann Hever and Rose Anne Kenny (May 2020, .pdf format, 4p.).
tilda.tcd.ie/publications/reports/Covid19NursingHomes/index.php
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May 21, 2020
CAAR – US Government Accountability Office Reports – May 21, 2020
A. “Medicare: CMS Should Provide Beneficiaries More Information about Substance Use Disorder Coverage,” (GAO-20-408, May 2020, .pdf format, 37p.).
www.gao.gov/products/GAO-20-408
B. “Infection Control Deficiencies Were Widespread and Persistent in Nursing Homes Prior to COVID-19 Pandemic,” (GAO-20-576R, May 2020, .pdf format, 15p.).
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May 18, 2020
CAAR – UK Office for National Statistics Statistical Bulletin – May 18, 2020
“Deaths involving COVID-19 in the care sector, England and Wales: deaths occurring up to 1 May 2020 and registered up to 9 May 2020 (provisional),” (May 2020, .pdf and HTML format, 20p.).
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April 28, 2020
CAAR – Kaiser Family Foundation Data Note – April 28, 2020
“Requirements for Nursing Homes and Assisted Living Facilities in Response to COVID-19 Vary Across States,” by Sarah True, Tricia Neuman, Juliette Cubanski, Nancy Ochieng, and Wyatt Koma (April 2020, HTML format).
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March 9, 2020
CAAR – US National Center for Health Statistics Report – March 9, 2020
“Trends in Electronic Health Record Use Among Residential Care Communities: United States, 2012, 2014, and 2016,” by Christine Caffrey, Christopher Cairns, and Vincent Rome (National Health Statistics Reports No. 140, March 2020, .pdf format, 9p.).
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February 10, 2020
CAAR – Kaiser Family Foundation Issue Briefs – February 10, 2020
A. “Medicaid Home and Community-Based Services Enrollment and Spending,” by Molly O’Malley Watts, MaryBeth Musumeci, and Priya Chidambaram (February 2020, .pdf and HTML format, 23p.).
www.kff.org/medicaid/issue-brief/medicaid-home-and-community-based-services-enrollment-and-spending/
B. “Key State Policy Choices About Medicaid Home and Community-Based Services,” by MaryBeth Musumeci, Molly O’Malley Watts, and Priya Chidambaram (February 2020, .pdf and HTML format, 58p.).
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November 25, 2019
November 20, 2019
CAAR – Genworth Financial Report – November 20, 2019
“Cost of Care Survey 2019,” (November 2019, .pdf format).
– Home Page:
www.genworth.com/aging-and-you/finances/cost-of-care.html
– National and State Tables (.pdf format, 7p.).
pro.genworth.com/riiproweb/productinfo/pdf/282102.pdf
– Key Findings and Methodology (.pdf format, 5p.).
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November 19, 2019
CAAR – US House Committee on Ways and Means Hearing Testimony – November 19, 2019
“Caring for Aging Americans,” a hearing held November 14, 2019 (witness statements available in .pdf format, video of the full hearing available at the Committee’s YouTube channel, running time 3 hours 35 minutes). Note: Hearing begins at the 8:45 mark.
waysandmeans.house.gov/legislation/hearings/caring-aging-americans
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November 14, 2019
CAAR – US Government Accountability Office Report – November 14, 2019
“Nursing Homes: Better Oversight Needed to Protect Residents from Abuse,” (GAO-20-259T, November 2019, .pdf format, 19p.).
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November 11, 2019
CAAR – Institute for Social and Economic Research (ISER) [University of Essex, Colchester, UK] Working Paper – November 11, 2019
“Market concentration, supply, quality and prices paid by local authorities in the English care home market,” by Ferran Espuny Pujol, Ruth Hancock, Morten Hviid, Marcello Morciano, and Stephen Pudney (ISER Working Paper No. 2019-10, November 2019, .pdf format, 26p.). Note: Links to the abstract and the full text of this paper available at:
www.iser.essex.ac.uk/research/publications/working-papers/iser/2019-10
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October 29, 2019
CAAR – University of Michigan Retirement and Disability Research Center Working Paper – October 29, 2019
“The Growth and Geographical Variation of Nursing Home Self-Pay Prices,” by Sean Shenghsiu Huang, Richard Hirth, Jane Banaszak-Holl, and Stephanie Yuan (WP 2019-397, 2019, .pdf format, 22p.). Note: Links to the abstract and the full text of this paper available at:
mrdrc.isr.umich.edu/pubs/the-growth-and-geographical-variation-of-nursing-home-self-pay-prices/
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October 23, 2019
CAAR – US Department of Health and Human Services, Office of Inspector General Data Release – October 23, 2019
“Trends in Nursing Home Complaints (2016-2018),” (October 2019, HTML format).
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September 19, 2019
CAAR – US Government Accountability Office Report – September 19, 2019
“Elder Abuse: Federal Requirements for Oversight in Nursing Homes and Assisted Living Facilities Differ,” (GAO-19-599, August 2019, .pdf format, 34p.).
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