A National Study of Assisted Living for the Frail Elderly: Final Summary Report. NOTES


  1. The third stage involved selection of the resident and staff samples for in-person interviews.

  2. Nearly half the states lacked a licensure category known as “assisted living” or classified such facilities together with traditional “board and care” homes during the period in which we attempted to enumerate a list of ALFs.

  3. The second reason for first selecting a limited number of geographic areas as FSUs was that it facilitated cost-effective data collection on-site in sample facilities, a subsequent data collection task.

  4. For example, the California Association of Homes and Services for the Aging posted a statewide list of places offering housing with supportive services.

  5. Some sources, such as most state licensure lists, identified the county, while other lists (e.g., telephone book yellow pages) did not.

  6. This was particularly complex because of the large number of multi-facility systems that might list only the administrative office address in a particular city for all the facilities on the list for an FSU. In addition, we found high prevalence of multi-level campus settings that often housed two or more places that met study eligibility criteria. For example, Menorah Park Center for Senior Living has two different residential settings (i.e., Stone Gardens Assisted Living and The R.H. Myers Congregate Apartments) that met study eligibility criteria, although only one self-identifies as assisted living. Both are on the same campus and are listed at the same address.

  7. Facility candidates with unknown size were undersampled to improve the cost-effectiveness of the telephone screening. The fact that they appeared, for the most part, on only one list, suggested that they were small and less likely to meet study eligibility criteria. And indeed, only 8 percent of the places with unknown size were found to be eligible during the telephone screening and survey. Again, weighting the final sample adjusted for this undersampling and generated valid estimates about the universe of ALFs.

  8. Many facilities had idiosyncratic policies about admission and retention. That is, the administrators responded “it depends” when asked about whether the facility would admit or retain residents with a specified condition. For example, 33 percent of the administrators responded “it depends” when asked whether they would admit a resident with moderate to severe cognitive impairment. One-third (33 percent) reported that “it depends” when asked whether they would retain a resident with moderate to severe cognitive impairment. When the “it depends” response was given, it was counted as a “no” since residents and families could not rely on either admission or retention in such instances.

  9. Numbers may not total 100 percent due to rounding.

  10. The differences between facilities that had a full-time RN and provided nursing care with their own staff and those that did not have a full-time RN on staff but were willing to provide or arrange nursing care are discussed at greater length in the report on discharged residents.

  11. U.S. Bureau of the Census, published data from the 1998 Current Population Survey, “Money Income in the United States, 1997” (series P60-200), Table 8, Income Distribution of Older Persons, 1997.

  12. This is based on estimates of annual income. More people could afford assisted living for some period of time by selling their assets, such as a family home, and using those funds to pay the monthly charges for assisted living. Alternatively, families could supplement the income available to the elderly, although this is rare for most community-dwelling elders.

  13. These data come from the staff interviews, and nearly all the staff interviewed worked the day shift. Information on staffing by shift appears in the full report.

  14. Some “unmeasured” facility characteristic that is very highly correlated with our service measure (i.e., a full-time RN who does direct care) may be driving this relationship, either wholly or partially. However, this relationship does not appear when one uses other service measures, so any unobserved variable must be correlated with this specific measure and not with overall RN staffing, aide staffing, the willingness to arrange for RN care, or simply having an RN on staff. Such a characteristic is relatively hard to conceive of, so the authors’ best judgment, until other evidence is provided, is that the observed relationship is driven by the measured characteristic -- the presence of a full-time RN providing direct care.

  15. In these earlier analyses, for all comparisons involving the various facility types, the statistical significance of the prevalence in each type of facility was compared with that in the population as a whole, using a series of logistic regressions in which the independent variables were the facility types. Later analyses specifically compared the three facility types with each other.

  16. The effect of this service or staffing variable did not vary depending on the specific characteristics of the resident. For example, no significant interaction was observed between this service indicator and a resident’s level of cognitive impairment.

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