Transcript Slide 1

DataBrief:
Trends in the Residential
Care Industry
Did you know…
In 2010, 25% of residential care
facilities had full-time registered
nurses on staff as compared to
40% in 1999?
DataBrief Series ● October 2012 ● No. 32
Differences in the Residential Care Industry,
1999 to 2010
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“Residential care” is an umbrella term for facilities that provide apartment-style housing and
support for activities of daily living (ADLs) and other needs for persons who cannot live
independently but are not necessarily nursing home eligible. Residential care facilities include
assisted living facilities, board and care homes, and other settings.
Residential care facilities are often promoted as a way to allow individuals to “age in place,”
which means that they can continue to reside in the facility even if their ADL needs increase or
their medical conditions worsen.1
Residents’ levels of functional impairment have increased over time; facility administrators
estimated that 36% of residents receiving similar assistance in 2010 as compared to 24% of
residents received assistance in 3 or more ADLs in 1999.1,2
Residential care facility admission and discharge policies have changed over time, as have the
availability of key services that support aging in place:
⁻ In 2010, 11% of facilities were likely to admit seniors with skilled nursing needs as compared
to 28% in 1999.
⁻ In 2010, facilities were also more likely to discharge residents who required skilled nursing
care than facilities reported in 1999 (83% vs. 72%, respectively).1,2
⁻ In 2010, facilities provided fewer nursing and other health services on average than in 1999,
including managing medications (92% in 1999 vs. 77% in 2010) and providing therapies (74%
in 1999 vs. 53% in 2010).1,2
1 Hawes,
Catherine, Miriam Rose and Charles Phillips. “A National Survey of Assisted Living for the Frail Elderly: Results of a National Survey of Facilities.”
Office of the Assistant Secretary for Planning and Evaluation, 1999.
2 Avalere Health, LLC. Analysis of the 2010 National Survey of Residential Care Facilities.
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Facilities in 2010 May Offer Fewer Services and Lower
Nurse Staffing Than in 1999
Key Characteristics of Residential Care Facilities (RCFs), 1999 and 2010
24%
Residents w/ 3+ ADL impairments
Had a full-time Registered Nurse
25%
36%
40%
Offered medication reminders
Would admit if needing regular nursing
11%
28%
47%
44%
Would admit w/ cognitive impairment
28%
30%
Would admit w/ behavioral problems
72%
Would discharge if needing regular nursing
Would discharge w/ cognitive impairment
48%
67%
0%
20%
40%
1999¹
83%
55%
Would discharge w/ behavioral problems
1
92%
77%
60%
76%
80%
100%
2010²
1999 Survey by the Office of the Assistant Secretary for Planning and Evaluation. N = 11,459 residential care facilities with 11 beds or more.
National Survey of Residential Care Facilities. N = 15,695 RCFs with 11 beds or more; 15,400 RCFs with 4-10 beds are excluded from this analysis.
2 2010
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About the data:
Data on residential facilities in 1999 is based
on a survey conducted by Catherine Hawes
and colleagues for the U.S. Department of
Health and Human Services, Assistant
Secretary for Planning and Evaluation. To be
included in this survey, facilities had to
identify themselves as assisted living
facilities, or provide at least 24-hour
supervision, 2 meals a day and help with
ADLs. This survey included facilities with 11
or more beds.
Data on residential care facilities in 2010 is
based on the National Survey of Residential
Care Facilities (NSRCF), published by the
National Center for Health Statistics. The
NSRCF collects information on the services
provided by facilities, and their level of nurse
staffing. To be in the NSRCF, facilities had to
provide at least 24-hour supervision of
residents, 2 meals a day and help with ADLs,
and have 4 or more beds. Facilities with 4 to
10 beds were removed for comparison with
the 1999 survey.
Avalere Health would like to acknowledge
Catherine Hawes’ invaluable assistance with
interpreting the results of the 1999 survey.
Analytics powered by Avalere Health LLC
A Clear Policy Connection
Residential care facilities serve a population that is older and has a higher
need for ADL assistance than individuals who reside in their own homes.
The average level of functional impairment among residential care
consumers grew from 1999 to 2010.1 At the same time, fewer facilities
currently offer medication management and therapy services than they
did 20 years ago.
Furthermore, in 2010, facilities were less willing to admit and retain
residents who need regular skilled nursing care than in 1999, and the
percentage of residential facilities with a full-time registered nurse
decreased. The more stringent admission and discharge policies as well
as shifts in the staffing mix over time may affect the extent to which
people with certain medical or functional support needs can access
residential care and remain in that setting over time.
Residential care facilities are an important part of the continuum of longterm services and supports. The opportunity exists now to examine
workforce issues and admission/discharge policies to create a viable
option for older adults who want to remain connected to the community
but are not able to live independently. The residential care industry is
regulated at the state level. State policymakers should consider if
regulation is necessary to ensure that residential care aligns with the new
paradigm of care integration and coordination.
1 Avalere
Health, LLC. Analysis of data from the 2010 National Survey on Residential Care
Facilities and Hawes et al, “A National Survey of Assisted Living for the Frail Elderly,” 1999.
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