For all of these homes, the resident mix was quite complex (Exhibit 3-10). Approximately three-quarters of the homes reported having one or more residents with cognitive impairment. Over half of the homes reported having residents with a diagnosis of mental illness or prior stay in a psychiatric hospital. One-third reported having residents with mental retardation or developmental disabilities. Moreover, board and care homes also coped with more complex problems. Forty-two percent of homes reported having one or more residents with alcohol abuse problems, and 15 percent said they had residents with a past history of drug abuse problems.
Some homes also housed residents with significant health problems and functional impairments. Almost 30 percent of the homes reported having one or more residents who stayed in their room all day in bed or in a chair because of health problems, and almost 60 percent of the homes reported having residents with urinary incontinence.
|EXHIBIT 3-10. Resident Case Mix Characteristics for Facilities by Licensure and Regulatory Environment|
|Case Mix Characteristics||Total Population||Licensed Homes|
|Extensive States||States with Limited Regs|
|90%+ behavior problems||21||4.1||16||2.8||36||4.1|
|Other resident mix||23||2.8||22||3||29||4.1|
|Facility has residents who are/have|
|Incontinent of urine||59||2.4||66||4.1||44||4.6||c|
3.5.1 Differences by Regulatory Environment
Board and care homes differed in their mix of residents (Exhibit 3-10). Some homes had a mainly elderly mix of residents. Over 60 percent of the licensed homes in States with an extensive regulatory system reported that residents were primarily elderly (65 and older). Only 36 percent of the homes in States with limited systems had this elderly resident mix. Other homes, even though not specifically licensed as such, housed mainly persons with persistent mental illness or developmental disabilities (MR/DD). Sixteen percent of the licensed homes in States with extensive regulatory systems and almost 40 percent in States with limited systems reported having primarily nonelderly residents, most of whom had a chronic mental illness or MR/DD. Slightly over 20 percent of licensed “extensive” homes reported having a mixed population that included the frail elderly and persons with cognitive impairment, compared to 29 percent of facilities in “limited” States.
Licensed extensively regulated homes were more likely to house chairfast, cognitively impaired, and incontinent residents than were licensed homes in States with limited regulations.
3.5.2 Differences by Licensure Status
In spite of similarities in admission and discharge policies (discussed in Section 3.2.2), the resident care mix across licensure status was considerably different (see Table A-2). Small licensed facilities were more likely to house 90 percent or more elderly residents than were small unlicensed homes. Indeed, 70 percent of small licensed homes reported housing all elderly residents compared to half of small unlicensed homes. The opposite was true in large homes, with about 75 percent of large licensed facilities reporting a primarily elderly population compared to 88 percent of large unlicensed homes. No consistent differences in case mix indicators measuring functional level or frailty were observed, although small unlicensed homes were more likely to house some residents with psychiatric histories than were small unlicensed homes. Finally, compared to unlicensed homes, licensed homes, particularly small and large facilities, had significantly higher proportions of residents who were SSI recipients.