An increasing number of older adults reside in assisted living (AL) toward the end of life, and it remains unclear if this trend represents an additional place of care and end-of-life transition before eventual nursing home admission. Our objective was to examine the characteristics and healthcare utilization of AL residents who died during a two-year follow-up. We conducted a prospective cohort study of Medicare beneficiaries residing in large AL communities (25+ beds) in January 2017, and followed them until the end of 2018 using a variety of administrative healthcare claims data. The national population of Medicare beneficiaries in AL included 273,722 fee-for-service (FFS) beneficiaries, and 143,258 Medicare Advantage beneficiaries. From 2017 to the end of 2018, 23.7% of residents died. Of the 66,605 FFS Medicare beneficiaries who died during follow-up, 77.0% were 85 years old or older, 72.2% were diagnosed with Alzheimer’s disease and related dementia (ADRD) and 80.8% were diagnosed with heart failure or chronic obstructive pulmonary disease. Most FFS decedents (97.3%) resided in AL during their last 12 months of life, with 23.0% leaving AL before the last month of life. Half of FFS decedents died in AL, while another 24.1% died in a nursing home. AL communities represent an increasingly common place of end-of-life care for dying Medicare beneficiaries. These findings point to the need for state and federal policies to protect a growing population of frail and vulnerable AL residents.