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More than half of assisted living facilities will not admit individuals who have moderate cognitive impairment or behavioral problems or need assistance with transfer

Throughout the 1990s, assisted living was the most rapidly growing form of senior housing. A 1998 study defined assisted living facilities (ALFs) as places with 10 or more beds that serve an older population and represent themselves as ALFs, provide 24-hour supervision and housekeeping, and provide at least minimal care.

Analyses of the nationally representative data in this study indicate that in 1998, there were an estimated 11,459 such ALFs nationwide, with 611,300 beds and 521,500 tenants. The study was sponsored by the Office of the Assistant Secretary for Planning and Evaluation of the Department of Health and Human Services, with additional support from the Agency for Healthcare Research and Quality (HS10606).

Many see ALFs as a residential setting offering only private accommodations. However, among the approximately 1,500 ALFs surveyed, only 31 percent had more than 79 percent private accommodations. Indeed, 28 percent of ALFs had at least one bedroom shared by three or more unrelated people.

Many ALFs were restrictive in their admission and retention policies. More than half of the study ALFs would not admit or retain individuals who had moderate cognitive impairment, behavioral problems, or who needed assistance with transfer (for example, from bed to chair). Though ALFs are considered places where people can age in place, 72 percent of study ALFs had, over a 6-month period, discharged one or more tenants because they needed nursing care.

ALFs are also expensive. In 1998, the average monthly charge for facilities that had a single rate was $1,710, but rates exceeding $6,000 per month were reported. Almost all tenants paid their ALF bill using private financial resources.

These characteristics and restrictions limit the ability of ALFs to provide service to the frail elderly population and those who depend on Medicaid, according to principal investigator Charles D. Phillips, Ph.D., M.P.H., of Texas A&M University System Health Science Center's School of Rural Public Health.

More details are in "A national survey of assisted living facilities," by Catherine Hawes, Ph.D., Dr. Phillips, Miriam Rose, M.Ed., and others, in the Gerontologist 43(6), pp. 875-882, 2003.

Editor's Note: Another AHRQ-funded study on a related topic examined State initiatives to measure resident satisfaction in nursing homes and assisted living facilities. For more details, see Lowe, T.J., Lucas, J.A., Castle, N.G., and others (2003). "Consumer satisfaction in long-term care: State initiatives in nursing homes and assisted living facilities" (AHRQ grant HS11825). Gerontologist 43(6), pp. 883-896.

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