A National Study of Assisted Living for the Frail Elderly: Final Summary Report. Selecting the Sample for the Telephone Screening and Survey

11/01/2000

The next task was to select a sample of facilities from the remaining 10,720 candidates on the combined listing (e.g., after eliminating the 7,578 places with 10 or fewer beds).

In selecting the sample to be screened by telephone, project staff oversampled the larger facilities (>51 beds) in order to increase the likelihood of encountering ALFs offering a high level of services. This was based on an earlier study of residential care that found that larger facilities were more likely to have nurse staffing and to offer more services (Hawes et al., 1995a and 1995b). Thus, project staff’s assumption at this stage was that larger facilities would have greater capacity to offer more services. Further, this approach would improve the sampling efficiency at later stages (i.e., when the resident sample was selected, since most residents lived in large ALFs). This oversampling did not affect final estimates about the prevalence of various types of ALFs (including various sizes), since data were weighted to account for the oversampling.7 From this list of 10,720 potential candidate facilities, project staff selected a stratified (by size), random sample of 2,945 facilities for the telephone survey.

The administrators of a sample of these candidate facilities were then surveyed by telephone during 1998. If the candidate facility met the study eligibility criteria specified in a set of screening questions, then the administrator was asked to respond to questions about the facility, its size, occupancy, accommodations, services, price and basic admission and discharge criteria. A total of 1,251 facilities was contacted, found to be eligible, and interviewed. These interviews were the basis for the first project report, and data from these interviews were also used in subsequent reports.

Our second report presents data from a series of in-person and telephone interviews with administrators, staff, residents and family members in a subset of these eligible 1,251 facilities. The subset of ALFs involved in this data collection represented that group of ALFs that offered a mix of services and privacy thought to approximate most closely key aspects of the philosophy of assisted living.

To identify this subset of ALFs, the facilities in the original sample were divided into groups, based on the level of privacy (i.e., high, low or minimal) and the level of service (i.e., high, low or minimal) that they provided. An explanation of the way in which these groups were defined is discussed in detail in Report 1 ("Results of a National Survey of Facilities") and Report 2 ("High Service or High Privacy Assisted Living Facilities, Their Residents and Staff") of this report. Facilities that offered either minimal services or minimal privacy were combined with the ALFs that provided a combination of low services and low privacy. These ALFs were excluded from any on-site data collection. Facilities in three of these groups (i.e., high service & high privacy, high service & low privacy, low service & high privacy) were chosen for further study through site visits that included more detailed data collection. The site visits included interviews with facility administrators, staff, residents, and family members, as well as a “walk-through” evaluation of the facility environment. The 300 facilities involved in the site visits represented a population of 4,383 ALFs across the nation -- or all those that met the definition of a facility that offered either high services or high privacy.

TABLE ES.1: Distribution of ALFs Nationwide and Those Included in Site Visits
  High Services Low Services
High Privacy   11% of all ALFs
Included
18% of all ALFs
Included
Low Privacy   12% of all ALFs
Included
59% of all ALFs
EXCLUDED


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