Over one-third of all board and care residents self-report poor or fair health. As shown in Exhibit 6-6, the most prevalent health problem was arthritis/rheumatism, reported by 42 percent of residents. High blood pressure (28 percent), diabetes (11 percent), and asthma, emphysema, or chronic bronchitis (11 percent) were other frequently mentioned health conditions. Overall, residents reported an average of one and one-half health conditions.
The use of assistive devices by board and care residents provides additional insight into their physical status. Almost one-fourth of residents reported using a walker within the past week. Other assistive devices frequently mentioned were those associated with an over-whelming elderly population such as glasses (73 percent), dentures (50 percent), hearing aid (13 percent), and cane (19 percent). Although more intrusive devices such as a urinary catheter or ostomy were rarely cited, it is perhaps significant that even 1 percent of the residents reported these, given the lack of medical training of most board and care staff.
Because falls are responsible for many serious injuries to a frail elderly population, the high prevalence rate of falls among board and care residents (32 percent) raises serious concerns.
EXHIBIT 6-8. Resident Health Status by Regulatory Environment and Licensure Status
The differences in reported health conditions between residents in licensed homes and those in unlicensed facilities do not give a clear picture that one group of residents is more physically ill than the other (Exhibit 6-7). Although residents in unlicensed facilities were more likely to have chronic conditions such as arthritis/rheumatism and hypertension, licensed home residents were twice as likely to have recently suffered a stroke or heart attack. It is interesting that residents of large licensed homes were more likely to report poor health. On the other hand, the average number of reported health conditions was only greater in small licensed homes (Exhibit 6-8).
6.5.1 Health Care Use
Overall, most board and care residents appear to have access to some type of health care services. Almost 90 percent of residents reported a physician visit within the past year with three-fourths of residents having seen a doctor during the past 3 months (Exhibit 6-6). Additionally, more than one-fourth of the residents received treatment in a hospital emergency room. It is perhaps most disturbing that, although 41 percent of residents used some form of psychotropic medication, only 30 percent reported psychiatric treatment during the preceding 12 months.
Given the prevalence of both chronic and acute health conditions among survey respondents, it is perhaps not surprising that close to a third of all residents were hospitalized for at least one night during the preceding year. Over 10 percent had two or more hospital stays. Despite differences in reported health status, we observed no differences in the hospitalization or emergency room use rates as a function of licensure status, but did observe that residents of large licensed homes were more likely to have received psychiatric treatment and overall more physician visits than their unlicensed counterparts (Exhibit 6-9).
EXHIBIT 6-9. Residents who Received Psychiatric Treatment in the Past 12 Months by Facility Licensure Status