A National Study of Assisted Living for the Frail Elderly: Final Summary Report. C. Overall Study Methods


The individual reports discussed in this Final Report (which are all available from ASPE) have extensive research methods sections that provide relevant detail. The discussion of study methods here provides a general overview, emphasizing the sampling strategy and is intended to allow readers to better understand the results discussed in this summary.

In order to obtain generalizable results, the project staff implemented a complex, multi-stage sampling design. At the first stage, project staff selected a random sample of 60 geographic areas across the nation, known as first-stage sampling units (FSUs). These 60 FSUs were comprised of 1,086 counties in 34 states. At the second stage of sampling, staff selected a sample of facilities in those FSUs.1

The sample design called for selection of a set of geographic areas or FSUs prior to selecting the facility sample for several reasons. First, in order to conduct the survey, staff had to construct a listing of ALFs. There is no national list that is comprehensive and exhaustive. Moreover, definitions of assisted living vary across the states. In some states, there are no limits on the types of facilities that may call themselves “assisted living” or advertise that they provide assisted living, regardless of the kind of services and accommodations they provide. Further, some states did not have a licensure category known as “assisted living” or included all types of residential care facilities in the category called “assisted living” (Mollica and Snow, 1996; Mollica, 1998).2 As a result, the study could not rely on state licensure lists to provide a comprehensive and exhaustive listing of ALFs. Some places meeting study criteria would have been missed, while other facilities licensed under the category of “assisted living” might not have met more commonly understood definitions of assisted living.

Lists from established trade associations were also insufficient as a sampling frame. First, while there are multiple trade associations, their combined membership accounts for an unknown proportion of the total number of ALFs in operation. Second,ALFA merged with the association that represented board and care homes (i.e., the National Association of Residential Care Facilities). As a result, the membership of ALFA was expected to include both ALFs and places that were more traditionally thought of as board and care homes, some of which would meet study criteria and some which might not.

Finally, the study could not rely solely on retirement directories or local advertisements, since they appeared to have differing definitions (or no criteria) for what should be classified as assisted living. Similarly, in many localities, there were no restrictions on the kinds of places that could call themselves “assisted living.”

As a result, a crucial aspect of the sampling design was the development of an enumeration strategy that would enable selection of a nationally representative sample of ALFs. However, because of the extensive level of effort involved, creating a comprehensive list at the national level (i.e., in each of the >3,000 counties in the country) would have been prohibitively expensive for this project. Thus, project staff decided to select a random sample of geographic areas across the country in which to enumerate an exhaustive list of facilities.3 This involved a two-stage enumeration and screening process to provide comprehensive coverage of the target population of ALFs.

View full report


"finales.pdf" (pdf, 907.67Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®