The widespread perception that board and care homes are small, “homelike” settings is misleading. The facilities in our study ranged in size from places with 2 beds to those with more than 1,400 and included family homes as well as multilevel facilities that also had congregate apartments and a skilled nursing home. More than 70 percent of the licensed and nearly 50 percent of the unlicensed homes were small (Exhibit 3-1). However, in licensed homes, 25 percent of the residents lived in medium-sized homes (11-50 beds), and 52 percent lived in large, licensed homes (51+ beds). Among residents of unlicensed homes, more than 80 percent lived in large facilities. These large unlicensed homes included assisted living facilities and retirement communities that provide meals, protective oversight, and some services.
EXHIBIT 3-1. Facility Size
3.1.2 Ownership and Affiliation
Less than 20 percent of all facilities were nonprofit, with licensed facilities being less likely to be nonprofit than unlicensed homes. Specifically, only 15 percent of small licensed homes were nonprofit compared to almost 40 percent of small unlicensed homes (Exhibit 3-2). In looking at licensed facilities, we observed that licensed homes in extensively regulated States are less likely to be nonprofit than those in States with limited regulations.
Overall, less than 10 percent of board and care homes were attached to nursing homes (Exhibit 3-3). Virtually no small homes reported affiliation to a nursing home compared to almost one-third of the large homes. However, licensed homes in States with limited regulations are twice as likely to be attached to nursing homes (see Table A-9).
Perhaps an indication of the rapid growth experienced by the board and care industry recently is the fact that about one-third of the operators reported owning or operating another board and care facility in addition to the one included in the study. Almost 10 percent reported owning or operating a nursing home.
EXHIBIT 3-2. Nonprofit Facilities by Licensure Status, Regulatory Environment, and Size
|EXHIBIT 3-3. Facility Affiliation with Nursing Homes and Ownership Patterns|
|Attached to a nursing home||7||1.5|
|Operator owns/operates another board and care facility||33||4.8|
|Operator owns/operates a nursing home||8||1.8|
3.1.3 Occupancy Rates and Revenue
We observed no consistent differences in occupancy rates across various types of facilities, with the average occupancy rate being about 80 percent. Although the occupancy rates were similar, we found that the average monthly revenue per resident in licensed extensively regulated homes was over $300 higher than in licensed homes in States with limited regulations. In particular, licensed small and medium homes had significantly higher average per-resident monthly revenue than did comparably sized unlicensed homes (Exhibit 3-4).
EXHIBIT 3-4. Facility Average Monthly Revenue per Resident by Size, Licensure, and Regulatory Environment