Medicaid in Residential Care. Facility Characteristics

09/01/2013

Of the weighted 30,967 RCFs for which Medicaid participation data were available, 43 percent of facilities (13,358 facilities) had at least one Medicaid resident and 57 percent (17,609 facilities) had none. (We refer to these facilities as Medicaid and non-Medicaid facilities.)

Table 1a and Table 1b present facility characteristics by Medicaid status. Table 1a presents the data at the facility level, and Table 1b presents the same data at the resident level. There are significant differences between the Medicaid and non-Medicaid facilities on bed size. Specifically, Medicaid facilities are somewhat more likely to be smaller (4-25 beds) than non-Medicaid facilities; 69.4 percent of Medicaid facilities are of this size compared to 62.5 percent of non-Medicaid facilities. Although a large proportion of the RCFs are small, most residents live in large or extra-large facilities; 68.0 percent of Medicaid residents live in large or extra-large facilities compared to 83.5 percent of non-Medicaid residents.

At the facility level, ownership status and chain affiliation did not differ between Medicaid and non-Medicaid participation. However, at the resident level, a significantly higher proportion of non-Medicaid than Medicaid residents live in facilities that are chain-affiliated.

TABLE 1a. Facility Characteristics, by Medicaid Status: Facility Level
Residential Care Facilities Total RCF FacilitiesN=2,302 (%) Non-Medicaid FacilitiesN=1.292 (%) Facilities Serving Any Residentson MedicaidN=998 (%) Significance Test p-value

SOURCE: RTI analysis of the 2010 NSRCF.

NOTES:

  1. To determine whether a facility is part of a chain, the survey asks if the facility is owned by a chain, group, or multifacility system.
  2. For the facility-level table, percentage of each type of facility living quarters is calculated as the ratio of the total number of units for each type of living quarters for all facilities divided by the total number of units for all facilities.

**p<0.05, ***p<0.001, ns: not significant, p>0.1.

Size
   Small (4-10 beds) 49.6 48.3 51.3 ns
   Medium (11-25 beds) 15.9 14.2 18.1 **
   Large (26-100 beds) 27.8 29.3 25.6 **
   Extra-large (over 100 beds) 6.7 8.1 4.9 ***
Part of a chain1 37.7 38.9 36.1 ns
Ownership
   Private, for-profit 82.4 83.3 81.2 ns
   Private non-profit or state/county/local government 17.6 16.7 18.8 ns
Alzheimer's disease services
   Facility has a dementia or Alzheimer's special care unit or only serves adults with dementia or Alzheimer's disease   17.3 20.2 13.5 ***
Facility living quarters2
   Rooms or apartments that are rooms designed for one person 28.0 27.7 28.4 ns
   Rooms or apartments that are rooms designed for two or more persons 19.6 17.2 23.7 **
   Rooms or apartments that are studios or 1-3 bedroom apartments 52.5 55.1 47.9 ***

Only about a fifth of all RCFs (17.3 percent) have dementia or Alzheimer's special care units or only serve individuals with Alzheimer's disease. Statistically significant differences exist between Medicaid and non-Medicaid-participating facilities: 13.5 percent of Medicaid-participating facilities compared to 20.2 percent of non-Medicaid facilities have Alzheimer's disease special care units or only serve Alzheimer's disease residents. Likewise, a statistically significant difference exists between facilities where Medicaid and non-Medicaid residents live. Fewer Medicaid residents live in facilities with dementia or Alzheimer's special care units or facilities that only serve people with Alzheimer's disease: approximately 20 percent of Medicaid residents live in this type of facility whereas about 40 percent of non-Medicaid residents do.

TABLE 1b. Facility Characteristics, by Medicaid Status: Resident Level
Characteristics of Facilities Where Residents Live All ResidentsN=8,094 (%) Non-Medicaid ResidentsN=6,122 (%) Medicaid ResidentsN=1,904 (%) Significance Test p-value

SOURCE: RTI analysis of the 2010 NSRCF.

NOTES:

  1. To determine whether a facility is part of a chain, the survey asks if the facility is owned by a chain, group, or multifacility system.

*p<0.1, ***p<0.001, ns: not significant, p>0.1.

Size
   Small (4-10 beds) 10.3 8.7 17.2 ***
   Medium (11-25 beds) 9.1 7.8 14.9 ***
   Large (26-100 beds) 52.1 52.8 49.5 ns
   Extra-large (over 100 beds) 28.5 30.7 18.5 ***
Part of a chain1 56.0 58.3 47.2 ***
Ownership
   Private, for-profit 74.6 74.1 78.0 *
   Private non-profit or state/county/local government 25.4 25.9 22.0 *
Alzheimer's disease services
   Facility has a dementia or Alzheimer's special care unit or only serves adults with dementia or Alzheimer's disease   36.5 40.3 20.0 ***
Resident lives in a:
   Room designed for one person 31.6 32.8 26.6 ***
   Room designed for two or more persons 26.9 22.5 45.5 ***
   Studio or 1-3 bedroom apartment 41.5 44.7 27.9 ***

One of the policy concerns is whether RCFs offer the level of privacy one would expect in a "homelike" environment and whether the level of privacy offered differs by Medicaid status. For this analysis of living arrangements by payment status, facility units (i.e., rooms and apartments), rather than facilities, are the unit of analysis. The denominator is the number of rooms and apartments across all facilities and the numerator is the number of rooms and apartments across all facilities that are a particular type of living quarter. The majority of all units are apartments (52.5 percent) or rooms designed for one person (28 percent). The remainder of the units (19.6 percent) are living quarters designed for two or more people. Significant differences exist between the Medicaid and non-Medicaid facilities: apartments are less likely to be offered in Medicaid facilities. Approximately 47.9 percent of the units in Medicaid facilities are apartments compared to 55.1 percent of units in non-Medicaid facilities. Further, Medicaid residents live in places that offer less opportunity for privacy. Almost half of Medicaid residents (45.5 percent) live in rooms designed for two or more persons compared to about a quarter (22.5 percent) of non-Medicaid residents.

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