Even with the
U.S. population rapidly aging, a smaller proportion of elderly and
disabled people live in nursing homes today compared to 1990. Instead,
far more depend on assisted living residences or receive care in their
homes, according to a study published in the August 2005 issue of
the Journal of Applied Gerontology.
Residential care
and assisted living facilities are designed to meet the needs of older
people and people with disabilities who need some assistance with
activities of daily living, meals and other support services. According
to study findings, the capacity for this type of care nearly doubled
in the 12 years from 1990 to 2002, to more than 1 million beds nationwide.
When the growth of the population is taken into account, the number
of such beds grew from 20.9 to 35.6 per 10,000 people.
In contrast, while
the majority of people who need long-term care still live in nursing
homes, the proportion of nursing home beds declined from 66.7 to 61.4
per 10,000 population.
« These changing
trends in the supply of long-term care can be expected to continue
because the demand for home and community based services is growing, »
said Charlene Harrington, RN, PhD, lead author of the study. She is
a professor of social and behavioral sciences in the UCSF School of
Nursing at the University of California, San Francisco.
Harrington and
colleagues studied trends in all types of long-term residential care
facilities from 1990 to 2002. While the proportion of nursing home
beds to population declined, the actual number of licensed nursing
home beds increased modestly, by 7 percent. The actual number of residential
care and assisted living beds increased by 97 percent. Overall, the
number of all types of long-term care beds increased by 7.8 percent,
from 2.3 million in 1990 to 2.9 million in 2002.
There are, however,
wide variations in the availability of facilities and beds across
states, Harrington found. Nebraska has the highest number of total
beds per population in nursing homes and residential care/assisted
living, while Alaska has the lowest number. California ranks 14th
in total number of beds per population, and the state has more residential
care/assisted living beds (151,000) than nursing home beds (133,000).
California has the highest number of residential care and assisted
living beds in the nation. The trends reflect changes in long-term
care policy, Harrington said. State Medicaid programs have been active
in expanding their home and community based services and many states
are starting to pay for personal care (assistance with bathing, dressing,
eating, and other activities) in residential care and assisted living
facilities. Medicaid home and community based service programs are
popular with many individuals who want to live at home and in the
community and who are hoping to avoid nursing home care.
The authors point
out that the lines between residential care and assisted living facilities
compared with nursing home care are becoming blurred as residential
care/assisted living facilities accept residents with high care needs
and allow individuals to arrange for their own personal care services
in the facilities.
Harrington said
that residential care and assisted living can substitute for nursing
homes in some cases and may delay the admission to nursing homes for
many patients. The decline in nursing home beds is probably related
to a number of factors including recent reports of quality problems
in nursing homes, she noted.
The study was
conducted at the national Center for Personal Assistance Services,
based at UCSF, which is supported by the National Center on Disability
and Rehabilitation Research. The PAS Center tracks information about
home and community based services on its website at www.pascenter.org.
In addition to
Harrington, co-authors of the paper include Susan Chapman, PhD; Elaine
Miller, BA, and Robert Newcomer, PhD, all at UCSF, and Nancy Miller,
PhD, at the University of Maryland, Baltimore County.
The research was
funded by the U.S. Health Services and Resources Administration, Bureau
of Health Professions, the University of Maryland and the U.S. Department
of Education.