About

Emily Aurora Gadbois, PhD, is an Associate Professor of Health Services, Policy and Practice at Brown University School of Public Health and a member of the Center for Gerontology and Healthcare Research. Her research focuses on how to optimally structure the healthcare system for older adults, with particular emphasis on long-term services and supports. She employs qualitative and community-engaged methods to learn directly from older adults, healthcare providers, and payers, aiming to advance healthcare payment and delivery solutions that improve access, equity, and outcomes for older populations. Dr. Gadbois's work encompasses a broad portfolio of topics including gerontology, health services research, home and community-based services, long-term care, Medicare, and post-acute care. She is actively involved in mentoring pre- and post-doctoral trainees and collaborates with others interested in her research areas.

Research topics

• Sociology
• Political Science
• Business
• Medicine
• Psychology
• Marketing
• Family medicine
• Economics
• Social psychology
• Public relations
• Nursing
• Actuarial science
• Gerontology
• Economic growth

Selected publications

• Nursing Home Administrators' Experiences Communicating With Residents' Families During COVID-19

  Journal of the American Medical Directors Association · 2026-05-05

  articleOpen accessSenior author

  OBJECTIVES: To understand how the COVID-19 pandemic created obstacles for nursing home staff to communicate effectively with family members of residents and how administrators navigated new communication methods. DESIGN: A qualitative analysis of 156 interviews with nursing home administrators in the United States. SETTING AND PARTICIPANTS: Nursing home administrators in the United States. METHODS: Communication methods used during the pandemic, and their effectiveness, were identified and discussed in this study that included 156 qualitative interviews with administrators at 40 nursing homes across the United States. RESULTS: This analysis suggests that existing communication systems were often reactive and ineffective during the pandemic because of the added workload placed on staff, leading to many nursing homes adopting more proactive and mass communication strategies. In addition, some nursing homes were able to implement communication methods that included individualizing communication for residents and families. CONCLUSIONS AND IMPLICATIONS: Proactive, mass communication methods lessened the burden on staff, whereas individualized communication increased staff burden. Communication methods should be adapted based on nursing home staffing levels. Future research should further examine individualized and mass communication methods to optimize communication strategies in informing families effectively and enhancing relationships, while also acknowledging staff capacity.

  PublisherOA PDFDOI

• Nursing Home Administrator Experiences Navigating the Changing Regulatory Environment During the COVID-19 Pandemic

  Journal of Aging & Social Policy · 2026-01-13 · 1 citations

  articleSenior author

  = 156) with administrators of 40 nursing homes across the U.S. between July 2020 and December 2021 to better understand their experiences with governmental agencies amid shifting regulatory standards, frequent inspections, and possible enforcement actions. Administrators highlighted confusion due to the evolving and sometimes conflicting guidance between state and federal agencies, although some states offered valuable COVID-19-specific assistance. They also described challenges in understanding and implementing new, frequently changing requirements, resulting in potential inspection deficiencies. Although enforcement actions, including financial penalties, are intended to deter noncompliance, administrators expressed concerns about added resource strain. Recommendations included increasing collaboration and data collection between regulatory agencies; reducing administrative burden during outbreaks and incorporating feedback from centers during regulatory changes; and increasing reimbursement to support compliance. Continued changes to oversight, including increased penalization and risk-based survey prioritization, should be evaluated to determine differential impacts on nursing home operations and resident care.

  PublisherDOI

• Nursing Home Administrator Perspectives on the Role of State Guidance and Assistance in COVID-19 Response: A Rhode Island Case Study.

  PubMed · 2026-04-01

  articleSenior author

  OBJECTIVE: The COVID-19 pandemic significantly impacted nursing homes in the United States. The Departments of Health within each state played a substantial role in providing guidance, issuing regulations, and supplying resources to help organizations respond to this health emergency. This research characterizes nursing home administrator perspectives on the role of Rhode Island's state agencies during the COVID-19 pandemic. DESIGN AND METHODS: This qualitative case study includes data from 19 repeated interviews with administrators of six nursing homes, conducted from July 2020-December 2021. In-depth, semi-structured interviews focused on their COVID-19 response, including infection control, vaccination, and interactions with state agencies, among other topics. Interview transcripts were qualitatively analyzed to determine overarching themes. RESULTS: Three themes emerged from analysis of interview transcripts: 1. Nursing home administrators described the regulatory guidance and communications from Rhode Island's Department of Health, which shaped their COVID-19 response. 2. Administrators discussed the tangible resources and support, such as personal protective equipment and staffing support, they received from the state. 3. Administrators identified the strengths and challenges in collaborating with state agencies and noted areas for improvement. CONCLUSIONS: Study findings have implications for how states help nursing homes respond during emergencies. While the vaccine has reduced the impact of COVID-19 on nursing home residents and staff, insights provided by administrators in this case study suggest best practices for improving future health emergency communications around guidance and regulations, and suggestions for necessary resources.

  Publisher

• Staffing Conditions In US Nursing Homes Before, During, And After The COVID-19 Pandemic

  Health Affairs · 2026-02-01

  article

  The COVID-19 pandemic exacerbated long-standing challenges in US nursing homes around staffing conditions, with nearly one in five nursing homes reporting severe staffing shortages during the early months of the pandemic in 2020. However, less is known about how nursing home staffing has evolved since the early part of the pandemic. This study used Payroll-Based Journal daily staffing data from the second quarter of 2018 through the fourth quarter of 2024 and other administrative data to examine trends in nursing home staffing levels and turnover before, during, and after the COVID-19 pandemic. Since the start of the pandemic, staffing hours per resident day decreased for all nurse types, especially in nursing homes associated with private equity funds or real estate investment trusts, during the late pandemic and postpandemic periods. Staff turnover decreased slightly during the pandemic and postpandemic periods for all nurse types. Policy makers should consider additional measures to ensure appropriate nursing home staffing levels going forward.

  PublisherDOI

• A Mixed-Methods Study of End-of-Life Care in Assisted Living During the COVID-19 Pandemic: National Survey of Administrators and In-Depth Interviews With Bereaved Next of Kin

  Journal of Applied Gerontology · 2026-02-09

  articleOpen access

  = 30), we describe policies administrators reported complying with at the worst of the COVID-19 pandemic and explore relationships between COVID-19-related policies and bereaved next-of-kin's perceptions of end-of-life care quality, integrating findings to develop a comprehensive examination of end-of-life care in assisted living. During the pandemic, most administrators reported allowing compassionate care visits and hospice services. Next of kin described limited visitation and external care services and declines in residents' physical, mental, and social well-being, emphasizing the difficulty of missing precious time together. This study examines next-of-kin experiences of residents who died during the COVID-19 pandemic, providing evidence to inform future infection control policies.

  PublisherDOI

• Expansion and Marketing of Medicare Advantage to Persons With End-Stage Kidney Disease

  JAMA Network Open · 2025-06-17 · 1 citations

  articleOpen accessSenior author

  Importance: The 21st Century Cures Act expanded Medicare Advantage (MA) to include persons with kidney failure. Little is known about the impact of increased MA marketing for persons with end-stage kidney disease (ESKD). Objective: To examine varied perspectives on the expansion of MA to include persons with ESKD and associated marketing strategies. Design, Setting, and Participants: This qualitative study of interviews conducted from January 21, 2022, to May 1, 2024, used a modified grounded theory and content analysis approach to analyze transcripts. Interviewees included executives from 8 MA plans, clinical leadership of 5 kidney care management companies, and leadership and staff of 6 dialysis organizations that varied in size (enrollment) from all US Census regions. Exposure: One-time, semistructured interviews. Interview questions focused on the perceived effects of the expansion of MA to include persons with kidney failure. Main Outcomes and Measures: Thematic description of participant perspectives on the expansion of MA and associated marketing practices. Results: A total of 48 interviews with 56 executives and staff from MA plans, kidney care management companies, and dialysis organizations were completed. Analysis found 3 major themes. First, organizations used various outreach approaches to inform persons with kidney failure of their expanded insurance options. Participants recognized that personal choice without undue influence is paramount when older or chronically ill adults are selecting their insurance coverage. Second, MA has potential benefits for persons with ESKD, and organizations expanded partnerships with brokers and/or agencies to provide additional insurance-related resources. Third, the mass marketing approach used to advertise MA was ubiquitous and often reported as deceptive for older or chronically ill adults. Kidney health care professionals noted that constraints on eligibility, restricted health care networks, and limited benefits and services were frequently inadequate for the complex social and medical needs of their patient population. Conclusions and Relevance: In this qualitative study, findings show that MA marketing to increase enrollment is pervasive and intensifies during open enrollment. Policymakers and industry experts should consider the complexity of insurance selection decisions and monitor accuracy of MA marketing of ESKD-specific benefits.

  PublisherOA PDFDOI

• Home-Delivered Nutrition Services for Older Adults Under the Older Americans Act

  JAMA Network Open · 2025-09-30 · 3 citations

  articleOpen access

  Importance: The Older Americans Act Nutrition Program is essential to supporting older adults and their ability to maintain their quality of life. Despite this, such services are underfunded and are at risk of further cuts. Objective: To characterize the benefits of home-delivered meals programs as reported by older adult recipients. Design, Setting, and Participants: This qualitative study is a substudy within a randomized clinical trial, Deliver-EE, which evaluates the comparative effectiveness of 2 modes of meal delivery. Participants were randomized to 1 of 2 study groups: daily-delivered meals or frozen, bulk-shipped meals. Between August 2022 and March 2024, in-depth, semistructured telephone interviews with older adults receiving home-delivered meals were conducted. Interviews were conducted with participants living in California, Florida, North Carolina, South Carolina, and Texas. The interview guide was designed in collaboration with 2 advisory panels. The guide covered the quality and impact of meals. Exposure: Receipt of home-delivered meals. Main Outcomes and Measures: The primary outcome was to examine the benefits of home-delivered meals programs. Interview transcripts were analyzed using modified grounded theory and thematic analysis. Results: According to interviews with 54 participants (mean [SD] age, 75.9 [6.8] years; 30 female [55.6%]), home-delivered meals met the stated goals of the Older Americans Act Nutrition Program (to reduce hunger, food insecurity, and malnutrition; to promote socialization; and to promote the health and well-being of older adults). Participants said that home-delivered meals provided much-needed nutritional stability and that they had positive interactions with delivery drivers. Meals also relieved their stress, including by eliminating their need to cook for themselves, which can be physically taxing. In addition, participants said home-delivered meals improved the health, well-being, and finances of their caregivers. Conclusions and Relevance: The findings of this qualitative study of home-delivered nutrition services for older adults suggest that home-delivered meals programs achieved their intended outcomes and yielded meaningful benefits beyond their stated purpose that remain to be quantified. The findings also support funding the Older Americans Act Nutrition Program.

  PublisherOA PDFDOI

• The Role of Food Insecurity in Relation to Meals on Wheels Participation

  Innovation in Aging · 2025-12-01

  articleOpen access

  Abstract Deliver-EE participants have a five-fold higher risk of food insecurity than typical U.S. older adults (47% vs. 9% based on 2023 national data), defined as the inability to afford a consistently balanced diet. This is notable because food insecurity is associated with adverse outcomes including health care spending and dementia risk. Based on subgroup data (n = 376), 93% of participants have financial strain where they had either “just enough” or “not enough” money to make ends meet. This study explored the reasons for enrolling in Meals on Wheels using semi-structured interviews among 31 participants experiencing food insecurity or financial strain. Preliminary findings found many enrolled because they couldn’t afford food and/or transportation, as evidenced by one participant, “I just didn’t have the money.” Others described how financial strain in the presence of functional difficulties with shopping and/or cooking led them to seek meals, including one who said “So it’s kind of hard to get out and shop. Plus, we’re both low income, and we’re seniors.”. Notably, 37% with food insecurity had Activities in Daily Living (ADL) limitations and 72% had Instrumental ADL limitations, highlighting the co-occurrence of food insecurity and functional limitations. Participants also discussed that prepared foods are typically more expensive and less nutritious than food cooked at home; many said that they enrolled because they wanted a balanced and affordable diet that included hot food. These results suggest that Meals on Wheels meets a critical nutrition gap for food insecure older adults, especially those with functional limitations.

  PublisherOA PDFDOI

• Dialysis Facility Participation In Medicare Advantage Networks Was Highest For Large Dialysis Organizations In 2021

  Health Affairs · 2025-03-01 · 1 citations

  article

  The share of patients with kidney failure enrolled in Medicare Advantage (MA) increased from 27 percent to 47 percent after the implementation of the 21st Century Cures Act, which expanded MA eligibility to all kidney failure patients. In this mixed-methods study, we examined the characteristics of dialysis facilities participating in MA contracts in 2021, and we supplemented the findings with data from qualitative interviews with representatives from MA plans and dialysis provider organizations. In 2021, dialysis facilities contracted with approximately 60 percent of MA plans offered in their and neighboring counties. In adjusted analyses, facilities affiliated with the two large dialysis organizations had 33-40 percentage points higher participation in MA networks compared with independent, not-for-profit facilities. Interviews suggest that large dialysis organizations had a unique advantage in their negotiations with MA plans. It is important for policy makers to understand how MA enrollment growth among people with kidney failure may be accelerating consolidation in the dialysis market.

  PublisherDOI

• Immigrant Staff in Nursing Homes: Mitigating Staffing Shortages During the COVID-19 Pandemic

  Medical Care Research and Review · 2025-06-29 · 1 citations

  article

  The COVID-19 pandemic exacerbated staffing shortages in U.S. nursing homes. Staff who are immigrants may have stronger tendencies to remain in their jobs than U.S.-born staff, but evidence is lacking. In this study, we predicted the share of immigrant staff and used a difference-in-differences regression to investigate whether nursing homes with a higher vs. lower proportion of immigrant certified nursing assistants (CNAs) experienced lesser declines in staff hours per resident day (HPRD) during the pandemic. We found that facilities with a larger-than-median predicted share of immigrant staff exhibited a relatively smaller decrease in CNA HPRD by 0.03 HPRD, equivalent to a 1.4% difference of the sample mean. We further found that CNA turnover rates during the pandemic were lower in facilities with relatively higher shares of immigrant staff. Our findings suggest that nursing homes with more immigrant staff may be more resilient in meeting staffing needs during crises.

  PublisherDOI

Recent grants

• Data Management and Methods Core

  NIH · $54.2M · 2007–2029

Frequent coauthors

• Renée R. Shield

  Providence College

  169 shared

• Denise Tyler

  RTI International

  104 shared

• Vincent Mor

  Providence College

  93 shared

• John McHugh

  Columbia University

  86 shared

• Kali S. Thomas

  Johns Hopkins University

  79 shared

• Sneha Soni

  64 shared

• Jacqueline Zinn

  Temple University

  64 shared

• Joan F. Brazier

  Providence College

  63 shared

Education

• Ph.D., Health Services, Policy and Practice

  Brown University

• M.S., Health Services, Policy and Practice

  Brown University

• B.A., Public Health

  Brown University