Performance Improvement 2007. Who Lives in Residential Care Facilities and How Disabled Are They?



This study examined estimates from three major national surveys of the number of persons living in residential care facilities, often called "assisted living facilities." The surveys identified such facilities through a number of questions about housing and services provided. Estimates from the surveys of the older population examined were in substantial agreement. About 6.5 percent of persons 65 or older, about 2.2 million persons, lived in some type of residential care other than settings for special populations (such as persons with mental illness or intellectual disabilities). The estimates indicated that most, about 1.45 million, lived in nursing homes, but more than 750,000 lived in alternative residential care settings.

In recent years, an increasing number of persons with disabilities have chosen to live in residential care settings. For the elderly, these facilities offer help with activities of daily living (bathing, taking medication, etc.) as well as providing oversight and opportunities for social activities and interaction. It has been hypothesized that people in these facilities, which range in size from small homes to large campuses, were more disabled than persons living in traditional houses or apartments, but were less disabled than persons living in nursing homes. However, relatively little has been known about the characteristics of persons in these facilities for three reasons: (1) the national Census Bureau classifies such persons as living in housing units and no data are collected to indicate that they are receiving services; (2) people typically pay for their care themselves, so there is no record of their care in a government database, as there would be in the case of a nursing home; and (3) if the facilities are regulated at all, they are regulated by the states, and each state has its own system.

The three surveys provided a consistent picture of the characteristics of the residential care population. Persons living in residential care facilities were more likely to be over age 85, female, and widowed, than were persons residing in their own homes. Residential care facilities served a broad income range. Persons living in those facilities were more likely to have incomes below $10,000, roughly approximating the federal poverty level for older couples. Relative to older persons remaining in traditional private housing, the residential care population was far more likely to receive help with activities of daily living, and to suffer from Alzheimer's disease or other dementias. Estimates from the two surveys that included the facility or institutional population, indicated that the prevalence of disability and dementias was dramatically higher among those living in residential care facilities than in community care settings, and highest in nursing homes.

Report Title: The Size and Characteristics of the Residential Care Population: Evidence from Three National Surveys
Agency Sponsor: ASPE, Office of the Assistant Secretary for Planning and Evaluation
Federal Contact: Drabek, John, 202-690-6443
Performer: Urban Institute; Washington, DC
PIC ID: 8347

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"PerformanceImprovement2007.pdf" (pdf, 717.63Kb)

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