A National Study of Assisted Living for the Frail Elderly: Final Summary Report. Differences Based on Data From All ALFs


Previous reports, such as the initial telephone interviews with administrators demonstrated that there were differences between ALFs in terms of such characteristics as their affiliation, environment, staffing, and policies on admission and retention. For example, ALFs differed in both the proportion of private units and the proportion of apartments. The ALFs offering high privacy, both those that offered high services and those that provided low services, had higher proportions of resident units that were apartments than did the low privacy/low service ALFs.

There was also significant variation among different types of ALFs on staffing. By definition, ALFs providing high services had a full-time RN on staff. What is striking is the level of difference between these ALFS and those offering low services. Among both types of ALFs offering low service (i.e., low service/high privacy ALFs and low service/low privacy ALFs), only about one-third had a full or part-time RN on staff. By definition, all (100 percent) of the high service ALFs had a full-time RN on staff. Similarly, three-quarters of the high service ALFs also had an LPN on staff, while among the low service ALFs, half or fewer had an LPN on staff.

Administrators’ reports about their admission and retention policies also revealed significant diversity among different types of ALFs. Facilities offering a combination of high services with low privacy had the most expansive admission and retention policies, while the low service/high privacy ALFs had the most restrictive admission and retention policies. For example, both types of low service ALFs were less likely to admit or retain residents who needed any nursing care or monitoring, even temporarily. However, the high privacy/low service ALFs had the most restrictive retention policies. They were less likely to admit or retain residents with behavioral symptoms, urinary incontinence, or moderate to severe cognitive impairment, or who needed help with transfers.

The interviews with administrators also revealed that the low service/low privacy facilities, which comprised a significant proportion of all ALFs nationwide (i.e., 26.9 percent), were unlike the other ALFs on key dimensions. They were significantly less likely to offer private accommodations or apartments (with only 17 percent apartments and 83 percent rooms). They were significantly less likely to have any type of nurse staffing and also less likely to admit or retain residents who needed nursing care. Finally, their basic monthly price in multi-rate facilities was significantly lower than the average price across the industry as a whole.

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