About

Cassandra Hua is an Adjunct Assistant Professor of Health Services, Policy and Practice at Brown University. Her role involves teaching and research within the field of health services and policy. The information provided indicates her affiliation with Brown University and her position as an adjunct faculty member, but does not include additional details about her research focus, background, or key contributions.

Research topics

• Sociology
• Gerontology
• Medicine
• Psychiatry
• Psychology
• Environmental health
• Nursing
• Demography
• Family medicine

Selected publications

• Changes in Long-Term Care Markets: Assisted Living Capacity and the Prevalence of Nursing Home Residents With Dementia From 2019 to 2023

  Journal of the American Medical Directors Association · 2026-01-19

  articleOpen access
  PublisherOA PDFDOI

• Measurement of Private Equity Ownership in Healthcare Research: Review and Opportunities

  Innovation in Aging · 2025-12-01

  articleOpen access

  Abstract Because ownership reporting requirements vary by healthcare entity types, PE ownership may not be publicly reported and researchers must rely on varying sources to measure PE ownership. We aim to understand measurement considerations relevant for examining PE in health care, including how researchers operationalize PE ownership of healthcare organizations, and to what extent the heterogeneity of private equity transaction (e.g., by boutique vs. general PE firms, different deal, or amount of debt financing) is studied in the literature. We systematically reviewed quantitative studies focused on PE and healthcare providers in the US published in years 2008-2023. We find that proprietary commercial databases and news/web searches are the two major approaches researchers used to identify private equity transitions. About 48% of the papers rely on commercial databases, and 14% of the papers use news releases and web searches to identify PE transitions. Additional 39% use a combination of commercial databases and news searches to construct their samples. Most papers often rely on a binary indicator of PE ownership, but do not study the heterogeneity effects of PE transitions. Overall, we find researchers increasingly rely on multiple commercial datasets to identify private equity transitions. However, most of the literature doesn’t discuss the potential discrepancy of PE definitions among data vendors. A more transparent and uniform database of PE and non-PE transactions, can facilitate studies on understanding nuance and heterogeneity that can facilitate a better design and regulation of PE transitions for all sectors of healthcare, including assisted living.

  PublisherOA PDFDOI

• Rates Of New ADRD Diagnosis Within 1 Year Of Entering Assisted Living Facilities: General Care Versus Memory Care

  Innovation in Aging · 2025-12-01

  articleOpen access

  Abstract Assisted living (AL) is a growing option for long-term residential care among older adults. Some ALs hold specialized licenses to provide memory care (MC) and are better equipped to support residents experiencing cognitive decline, making them more likely to attract individuals anticipating such needs, regardless of their diagnosis status. Using Medicare claims, we identified beneficiaries who newly moved to ALs during 2020 and 2021 across 34 states with available MC licensure data. We examined rates of new Alzheimer’s disease and related dementias (ADRD) diagnoses within a year from entry into AL. Residents with an existing ADRD diagnosis (no MC: 24%, MC: 27%) were excluded, resulting in a final cohort of 95,207 beneficiaries. We fit logistic regression models to examine whether having MC licensure was associated with higher probability of new ADRD diagnoses. Risks were derived from predictive margins after adjusting for demographics, co-morbidities, and prior health utilization. The adjusted risks showed on average 10.9% (95% CI: 10.6-11.1) of beneficiaries receive an ADRD diagnosis within a year of moving to an AL without MC compared to 11.7% (95% CI: 11.3-12.0) among those who move to AL with MC. The small difference was statistically significant (p < 0.001). These findings suggest that while individuals in ALs with MC are more likely to receive an ADRD diagnosis, the difference in rate of new diagnosis is small. Many ALs providing MC also offer general care and thus may have a sufficient population not at risk for ADRD.

  PublisherOA PDFDOI

• Differentiating Memory Care: Regulatory Differences for Memory Care in Assisted Living

  Innovation in Aging · 2025-12-01

  articleOpen access

  Abstract While prior research has categorized regulatory oversight of AL, we lack a clear understanding of what regulations differ for dementia-specific compared to general AL. Using a health services regulatory analysis of 2023 AL regulations, we examine how dementia care is regulated across the 45 states with dementia-specific AL policies. States most often add memory care-specific rules beyond general AL, including allowing provision of dementia-specific services (18 states), advertising such services (14), requiring controlled egress (13), addressing dementia-related behaviors (13), limiting admission to people living with dementia (12), requiring a dementia-specific activity program (12), mandating dementia-specific staff training where not required in general AL (10), applying certification to only part of a campus (9), requiring a secured outdoor space (9), involving family in care (8), having defined methods for identifying dementia (8), requiring staffing ratios (7), and cognitive impairment screening at admission (5). These requirements highlight substantial variation in how states define and regulate dementia care in AL. Understanding these regulatory differences is important for assessing how they impact care quality, resident safety, and access to memory care—and can inform decision-making for residents, families, and policymakers.

  PublisherOA PDFDOI

• Identifying Corporate Ownership in Assisted Living: Linking Communities to Parent Companies

  Innovation in Aging · 2025-12-01

  articleOpen access

  Abstract Corporate ownership in assisted living (AL), including private equity investment, has drawn increasing attention due to potential implications for care quality, financial practices, and resident outcomes. However, ownership data for AL communities is complex and fragmented, as different companies often own the property, manage the AL, and operate the AL. This makes it difficult to study how corporate structures shape operations. We developed and validated a method for systematically linking AL communities to corporate owners, operators, and managers–resulting in the first database linking AL communities to corporate ownership structures. We compiled a dataset of 14,866 AL communities (25+ units) from 2023 state licensing data and merged it with business records from Data Axle (n = 181,797), the National Investment Center for Senior Housing (n = 20,805), and corporate hierarchies from Duns & Bradstreet (n = 19,955 businesses linked to 307 parent companies). Using natural language processing (TF-IDF, Levenshtein distance, Jaccard index) and geospatial methods (geocoding, spatial joins) we matched 97% of AL communities to business characteristics and 86% to corporate ownership. A manual review of a random 10% sample confirmed 98% match accuracy. This approach provides a systematic way to study private equity and other ownership trends in AL, improving data reliability and reproducibility. Our findings highlight the need for transparency in ownership data and offer groundwork for evaluating how financial structures affect AL communities on a national scale. These approaches may be useful for studying ownership in other healthcare settings and for policymakers considering approaches to oversight and regulation.

  PublisherOA PDFDOI

• Characteristics and Geographic Variability of United States Assisted Living Communities by Chain Status

  Innovation in Aging · 2025-12-01

  articleOpen access1st authorCorresponding

  Abstract Previous studies indicate chains operate nursing homes with wealthier, higher-acuity residents, though state policies like Medicaid generosity create variation. We analyzed the distribution and characteristics of chain-affiliated versus non-chain ALs. We connected AL chain status (2021 data from National Investment Center, Argentum, and Dun & Bradstreet) to community characteristics (American Community Survey) and AL resident characteristics (Medicare enrollment and claims). In state-level analysis, we compared the number of chain vs. nonchain ALs per 100,000 adults aged 65+ using a scatterplot and Pearson’s r. In AL-level analysis, we compared characteristics by chain status using t-tests and chi-squared tests. Our sample included ALs with a capacity of 25+ beds with at least 10 fee-for-service Medicare beneficiaries, including 6,409 ALs across the 48 contiguous U.S. states. We found a modest correlation between the number of chain and nonchain AL beds per 100,000 older adults in each state (r = 0.29, p = 0.047). Some states, including Utah, Indiana, and Idaho, were “chain dominant.” Utah, for example, had 1,480 chain operated AL beds per 100,000 older adults compared to just 16 nonchain beds. Residents in chain-owned ALs were more likely to have dementia than those in nonchain ALs (36% vs. 30%, p < 0.001). Significantly more residents in nonchain ALs were dually eligible for Medicare and Medicaid (40% vs. 21%, p < 0.001). County characteristics (e.g., median income) did not differ significantly by chain status. Findings suggest that, similar to nursing homes, chains may serve residents with greater care needs and less financial disadvantage.

  PublisherOA PDFDOI

• Trends in Assisted Living and Memory Care Supply From 2019 to 2023

  Journal of the American Medical Directors Association · 2025-10-08 · 2 citations

  article
  PublisherDOI

• Vaccination Rates Among Long-Term Care Staff During the COVID-19 Pandemic

  Journal of the American Medical Directors Association · 2025-10-25

  article
  PublisherDOI

• Polypharmacy and Depressive Symptoms in Older Adults: Does Gender Matter?

  Clinical Gerontologist · 2025-07-14 · 1 citations

  article

  OBJECTIVES: This study examined the relationship between polypharmacy and depressive symptoms among U.S. community-dwelling older adults and whether it varied by gender. METHODS: We conducted a retrospective population-based analysis of 3,354 adults aged 65 and older using data from the 2009 Health and Retirement Study Health and Well-Being Study. Polypharmacy was defined as the use of five or more prescription medications. Depressive symptoms were measured using the 8-item Center for Epidemiologic Studies Depression Scale (CESD-8). Negative binomial regression models assessed associations between polypharmacy and depressive symptoms and whether the relationship varied by gender. RESULTS: > .05). There were no significant gender differences in unadjusted or adjusted models in the relationship between polypharmacy and depressive symptoms. CONCLUSIONS: Polypharmacy was not related to depressive symptoms among older women or men. CLINICAL IMPLICATIONS: Interventions to address physical health may be more salient to depression management than polypharmacy regardless of gender.

  PublisherDOI

• Mixed Methods Analysis of State Policies on Care Planning and Family Engagement in Assisted Living

  Innovation in Aging · 2025-12-01

  articleOpen access

  Abstract Involving family in care planning is a person-centered care strategy that enhances assisted living (AL) residents, families, and staff well-being. This study analyzes AL care planning and family engagement requirements through a health services regulatory analysis of 256 AL licenses across all 50 states and DC associated with 37190 ALs in 2023. Using a mixed methods approach, we examined license requirements for the presence and qualitative context of family engagement in care planning, staff training on family involvement, and person-centered care. Nearly 80% of ALs were required to have care plans. A larger share of ALs designated for memory care (MC) had family engagement requirements (47%) compared to non-memory care ALs (32.1%). Half of licenses encourage family engagement in care planning, while the remainder used passive language about ensuring family roles or encouraging involvement in activities. Person-centered care policies were less common, appearing more often in MC licenses. Only licenses in 3 states emphasized respecting individuals’ cultural and ethnic values in care planning and staff training. Qualitative analysis identified the following categories in family engagement: providing direct care, and involvement in care planning and legal aspects (e.g., lease, payment). Person-centeredness was described in the context of care planning and staff training. The level of specificity and stringency of these categories ranged from passive to detailed and directive. These findings provide the first comprehensive profile of AL care planning requirements, establishing baseline data for future outcome evaluations.

  PublisherOA PDFDOI

Frequent coauthors

• Kali S. Thomas

  Johns Hopkins University

  125 shared

• Portia Y. Cornell

  Brown University

  112 shared

• Lindsey Smith

  Oregon Health & Science University

  44 shared

• David Dosa

  Brown University

  35 shared

• Momotazur Rahman

  Brown University

  32 shared

• Paula Carder

  Portland State University

  31 shared

• Gauri Gadkari

  Brown University

  23 shared

• J. Scott Brown

  Miami University

  20 shared

Education

• PhD, Sociology and Gerontology

  Miami University

  2019

• MGS, Sociology and Gerontology

  Miami University

  2014

• Gerontology, Gerontology

  University of South Florida

  2012