Do Services and Staffing in Residential Care Facilities Vary With Residential Needs?. 1.1. What Is the Health, Functional, and Cognitive Status of Residential Care Facility Residents?


Although most research on RCF residents is quite old, some studies found that RCF residents are less impaired than nursing home residents, and others found that RCF residents have substantial impairment (Zimmerman et al., 2003), in some cases similar to that found in nursing home residents. A more impaired RCF population may result from both allowing residents to "age in place" and admitting more impaired residents (Stone & Reinhard, 2007). A study of primarily elderly residents of RCFs with 11 or more beds in the late 1990s also found that RCF residents were generally healthier and had less impairment than nursing home residents. This study indicated that, on average, 23.6 percent of residents of assisted living facilities, which are a subset of RCFs, were considered by administrators to be "heavy care" (i.e., they received assistance with three or more activities of daily living [ADLs]), and 34 percent had moderate to severe cognitive impairment (Hawes, Phillips, Rose, Holan, & Sherman, 2003). In a more recent study using the 2010 NSRCF, 38 percent of RCF residents received assistance with three or more ADLs (Caffrey et al., 2012).

RCFs are major providers of services to people with Alzheimer's disease and related dementias. Analysis of data from the 2010 NSRCF found that 42 percent of RCF residents had Alzheimer's disease (Caffrey et al., 2012). The findings of several studies indicate that about half of all elderly RCF residents had Alzheimer's disease, another condition that causes dementia, or cognitive impairment (Hawes et al., 2003; Rosenblatt et al., 2004; Sloane, Zimmerman, & Ory, 2001). One study suggested cognitive impairment rates in RCFs ranging from 45 percent to 63 percent (Morgan, Gruber-Baldini, & Magaziner, 2001). A study of 192 residents in 22 RCFs in Maryland found that the prevalence of dementia ranged from 63 percent to 81 percent, with facilities of 16 or fewer beds having a higher percentage of residents with dementia (Leroi et al., 2007).

Other studies compared RCF residents with residents in nursing facilities. One study comparing Medicare beneficiaries living in either nursing homes or RCFs found that RCF residents are generally less impaired than nursing home residents and have a lower prevalence of chronic diseases (Spillman, Liu, & McGilliard, 2002). A set of studies of 347 residents with dementia in 45 RCFs and nursing homes in four states found that: (1) 56 percent of RCF residents had behavioral symptoms related to dementia, compared with 66 percent of nursing home residents (Boustani et al., 2005); and (2) 24 percent of RCF residents had depression, compared with 27 percent of nursing home residents (Gruber-Baldini et al., 2005). A study using the same data found that 49 percent of RCF residents had moderate to high mobility impairments, compared with 53 percent of nursing home residents (Williams et al., 2005). In these studies of four states, although the results show that RCF residents had lower rates of these conditions than nursing home residents, the differences between the two populations were not large.

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