Variation Across U.S. Assisted Living Facilities: Admissions, Resident Care Needs, and Staffing
- 10 November 2016
- journal article
- Published by Wiley in Journal of Nursing Scholarship
- Vol. 49 (1), 24-32
- https://doi.org/10.1111/jnu.12262
Abstract
Though more people in the United States currently reside in assisted living facilities (ALFs) than nursing homes, little is known about ALF admission policies, resident care needs, and staffing characteristics. We therefore conducted this study using a nationwide sample of ALFs to examine these factors, along with comparison of ALFs by size. Cross-sectional secondary data analysis using data from the 2010 National Survey of Residential Care Facilities. Measures included nine admission policy items, seven items on the proportion of residents with selected conditions or care needs, and six items on staffing characteristics (e.g., access to licensed nurse, aide training). Facilities (n = 2,301) were divided into three categories by size: small, 4 to 10 beds; medium, 11 to 25 beds; and large, 26 or more beds. Analyses took complex sampling design effects into account to project national U.S. estimates. More than half of ALFs admitted residents with considerable healthcare needs and served populations that required nursing care, such as for transfers, medications, and eating or dressing. Staffing was largely composed of patient care aides, and fewer than half of ALFs had licensed care provider (registered nurse, licensed practical nurse) hours. Smaller facilities tended to have more inclusive admission policies and residents with more complex care needs (more mobility, eating and medication assistance required, short-term memory issues, p < .01) and less access to licensed nurses than larger ALFs (p < .01). This study suggests ALFs are caring for and admitting residents with considerable care needs, indicating potential overlap with nursing home populations. Despite this finding, ALF regulations lag far behind those in effect for nursing homes. In addition, measurement of care outcomes is critically needed to ensure appropriate ALF care quality. As more people choose ALFs, outcome measures for ALFs, which are now unavailable, should be developed to allow for oversight and monitoring of care quality.Keywords
Funding Information
- National Council of State Boards of Nursing (R60006, R81006)
This publication has 15 references indexed in Scilit:
- Infection Prevention and Control Standards in Assisted Living Facilities: Are Residents' Needs Being Met?Journal of the American Medical Directors Association, 2013
- Assisted Living Expansion and the Market for Nursing Home CareHealth Services Research, 2012
- “Meds are a Real Tricky Area”Journal of Applied Gerontology, 2010
- Medication Management in Assisted Living: A National Survey of Policies and PracticesJournal of the American Medical Directors Association, 2009
- Improving health care for assisted living residents.The Gerontologist, 2007
- Assisted Living as a New Place SchemaEnvironment and Behavior, 2007
- A comparison of small and large assisted living facilities for the diagnosis and care of dementia: the Maryland Assisted Living StudyInternational Journal of Geriatric Psychiatry, 2006
- Behavioral Symptoms in Residential Care/Assisted Living Facilities: Prevalence, Risk Factors, and Medication ManagementJournal of the American Geriatrics Society, 2004
- A National Survey of Assisted Living FacilitiesThe Gerontologist, 2003
- Distribution of African Americans in Residential Care/Assisted Living and Nursing Homes: More Evidence of Racial Disparity?American Journal of Public Health, 2002