Background

For this report, board and care homes are non-medical community-based facilities that provide at least two meals a day and/or routine protective oversight to one or more residents with limitations in two or more daily living activities. Locally, these facilities go by many names such as group homes, domiciliary care homes and similar terms. There is enormous variation among these homes in size, resident mix, daily charges and services. Similarly, the amount, type and extent of board and care regulation varies greatly at the State level (Lewin/ICF, 1990; Hawes et al., 1992).

The Federal role in board and care regulation is primarily defined by the 1976 Keys Amendment. Substandard homes are subject to having the Federal Supplemental Security Income (SSI) payments reduced "by the amount of the State supplement paid to SSI recipients for 'medical or remedial care'" (U.S. General Accounting Office, 1989:34). Such a sanction is widely seen as virtually unworkable in practice and has never been enforced.

The development of policy options regarding board and care has been hampered by the lack of good national data on the industry. The Office of the Assistant Secretary for Planning and Evaluation (ASPE) with additional support from the National Institute on Aging (NIA) funded the inclusion of licensed board and care homes in the 1991 National Health Provider Inventory (NHPI).

National Health Provider Inventory

The 1991 NHPI consists of basic information about providers of long-term care services, including licensed board and care homes. As a national inventory, it is large enough to serve as a sampling frame for future sample surveys of board and care homes. While its coverage is extensive, the NHPI does not include all licensed board and care homes. Because of budget constraints, the Census Bureau, which carried out the data collection for the National Center for Health Statistics, was not able to reach an estimated 10-15% of these homes. The remaining 85-90% constitute the most complete data base so far assembled. Estimates of the number of homes will vary with the method used in defining them.

The data we present are unweighted. However, it is not likely that findings based on final weighted estimates will be significantly different, given the extent of NHPI coverage.

Finally, there are also an unknown number of unlicensed board and care homes not included in the NHPI. In most States, these tend to be smaller homes (with one to six residents, depending on the State licensing requirements). Some observers think that this is the fastest growing segment of the board and care industry.

Findings

An estimated 28,188 licensed board and care homes are on the NHPI. Over 90% are in the private sector, either for-profit or non-profit. Over three out of five homes (63.5%) are run on a for-profit basis. (See Table 1.)

Of licensed board and care homes about 32 percent serve primarily the mentally retarded/developmentally disabled (MR/DD) population. About the same percentage serve a varied disabled population. The remainder serve the mentally ill (13.7%), other physically or cognitively impaired persons (18.0%), alcohol or drug abusers (0.2%), or did not report their primary clientele (4.7%). (See Table 2.)

Licensed board and care homes serve over 500,000 persons. (See Figure.) It has long been held that the majority of board and care residents are elderly. The NHPI data bear out this belief. Nearly two-thirds of all board and care residents (64.5%) are age 65 or over. Fully a quarter are age 85 or over. Nearly two-thirds of board and care residents are female (64.8%).

Summary and Conclusion

The 1991 National Health Provider Inventory provides the first opportunity to examine the nation's board and care industry. Preliminary findings indicate that there were about 30,000 li- censed board and care homes in 1991, serving over half a million persons. Nearly two-thirds of these persons are elderly and nearly two-thirds are female. The oldest old (persons age 85 or over) make up over a quarter of the board and care resident population. The 1991 NHPI data confirm that the board and care industry plays a significant role in the housing and care of the frail elderly and other functionally disabled populations.

References

American Association for Retired Persons, The Board and Care System: A Regulatory Jungle. Washington, D.C.: AARP, 1989.

Dittmar, Nancy D. et al., Board and Care for Elderly and Mentally Disabled Populations. Denver, CO: Denver Research Institute, March 1983. DHEW Contract 100-79-0117.

Hawes, C., J. Wildfire, and L. Lux, Board and Care: National Summary of a Fifty State Survey. Washington, DC: AARP, 1992.

*Lewin/ICF and James Bell Associates, Descriptions and Supplemental Information on Board and Care Homes Included in the Update of the National Health Provider Inventory. Washington, DC: Lewin/ICF, August 1990. Contract No. HHS-100-86-0051. [http://aspe.hhs.gov/daltcp/reports/dessupes.htm]

McCoy, John L. and Ronald W. Conley, "Surveying Board and Care Homes: Issues and Data Collection Problems." The Gerontologist, April 1990, 30(2):147-153.

Moon, M., G. Gaberlavage, and S. Newman, eds., Preserving Independence, Supporting Needs: The Role of Board and Care Homes. Washington, DC: AARP, 1989.

U.S. Department of Health and Human Services, Office of the Inspector General, Board and Care. Washington, DC: OIG, March 1990. Report OEI-02-89-01860.

U.S. General Accounting Office, Board and Care: Insufficient Assurances that Residents' Needs are Being Met. Washington, DC: USGAO, 1989, Report No. GAO/HRD-89-50.

U.S. House of Representatives, Select Committee on Aging, Board and Care Homes in America: A National Tragedy. Washington, DC: U.S.GAO, 1989. Comm. Pub. 101-711.

CONTACT PERSONS:       Robert F. Clark, Office of Family, Community and Long-Term Care Policy      Joan Turek-Brezina, Office of Program Systems

ASPE Research Notes is circulated periodically to the Department of Health and Human Services by the Office of the Assistant Secretary for Planning and Evaluation. This paper reflects only the views of its authors and does not necessarily represent the position of the U.S. Department of Health and Human Services. For further information on long-term care issues, call Mary Harahan, Office of Family, Community, and Long-Term Care Policy at 202-245-6443. To obtain asterisked reports referenced, contact Brenda Veazey, DHHS/OS/ASPE/OFCLCP, Room 424E, HHH Building, 200 Independence Avenue, S.W., Washington, DC 20201.

FIGURE 1: Board and Care Residents by Age: USA (1991)   (Percent)

100% = 538,929 Persons SOURCE: 1991 NHPI

ASPE RESEARCH NOTES ARTICLES AVAILABLE

Cost of Teenage Childbearing: Current Trends (August 1992)

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Counting Persons in Poverty on the Current Population Survey (August 1998)

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Disability Among Children (January 1995)

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Eldercare: The Impact of Family Caregivers' Employment on Formal and Informal Helper Hours (August 1995)

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Estimating Eligibility for Publicly-Financed Home Care: Not a Simple Task… (April 1992)

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Health Insurance in 1994 from the Current Population Survey: Measurement Difficulties (November 1996)

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Informal Caregiver "Burnout": Predictors and Prevention (April 1993)

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Licensed Board and Care Homes: Preliminary Findings from the 1991 National Health Provider Inventory (May 1993)

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March 1992 Current Population Survey Shows Health Insurance Coverage Up in 1991: Number of Medicaid Recipients Also Rises (February 1993)

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March 1993 Current Population Survey Re-Benchmarked on 1990 Census (March 1995)

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Number of Medicaid Recipients Up: CPS Shows the Number of Uninsured Also Rises (April 1992)

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Population Estimates of Disability and Long-Term Care (February 1995)

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Research and Other Developments of Interest in Employer Group Long-Term Care Insurance ( )

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The Elderly with Disabilities: At Risk for High Health Care Costs (February 1994)

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The Medicaid Personal Care Services Option Part I: Cross-State Variations and Trends Over Time (November 1993)

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The Medicaid Personal Care Services Option Part II: Consumer-Directed Models of Care (December 1994)

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Trends in AFDC and Food Stamp Benfits: 1972-1994 (May 1995)

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Understanding Estimates of Uninsured Children: Putting the Differences in Context (January 1999)

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To obtain a printed copy of this report, send the full report title and your mailing information to:

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