Do Services and Staffing in Residential Care Facilities Vary With Residential Needs?. 1. Introduction


Residential care facilities (RCFs) are an important part of the long-term services and supports system. In 2010, 31,100 RCFs served 733,300 residents of all ages and with a wide variety of physical and mental impairments (Caffrey et al., 2012; Park-Lee et al., 2011). By comparison, in the same year, the United States had 15,682 nursing homes serving 1,396,448 residents (Kaiser Family Foundation, 2012).

States vary in the degree to which they have developed an array of home and community-based services (HCBS) that includes a substantial role for RCFs (Stone & Reinhard, 2007). In some states, such as Oregon and Washington State, RCFs play an important role in the HCBS system, specifically to reduce nursing home use and to increase service options for individuals who want to live in the community (Kane & Cutler, 2008; Wiener & Lutsky, 2001). Thus, RCFs are a critical component of efforts to alter the balance between institutional and HCBS spending.

At its core, the key policy questions are where RCFs fit in the range of long-term services and supports and what role they should play. Some view RCFs as community-based residential settings for individuals who cannot be safely served at home for any number of reasons but do not yet need to be cared for in a nursing home. Others view RCFs as settings that can serve a more severely disabled population, substituting for nursing home care in some instances. This latter view is reflected in the provision of residential care services as part of Medicaid HCBS waivers (O'Keeffe et al., 2010).

An assessment of the current and future role of RCFs is complicated by the multitude of ways in which states regulate facilities (Mollica, Sims-Kastelein, & O'Keefe, 2007; Polzer, 2011; Wiener, Lux, Johnson, & Greene, 2010). Unlike nursing homes, there are no minimum federal standards as to what services RCFs must provide. Little is known about the health, functional, and cognitive characteristics of the people who live in the facilities; what services are offered by facilities and used by residents; and what levels and types of staffing are provided. Importantly, it is unknown whether the services offered by facilities and used by RCF residents and the staffing provided by these facilities match the health, functional, and cognitive needs of the residents. In other words, do residents with greater health, functional, and cognitive needs live in facilities that provide more services and higher levels of staffing? Until recently, little current, nationally representative data has been available to inform policy makers on these issues (Hawes, Phillips, & Rose, 2000; Stone & Reinhard, 2007). This report analyzes these issues using the most current and comprehensive data available, the 2010 National Survey of Residential Care Facilities (NSRCF).

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