Trends in the Residential Care Industry

1. Trends in the Residential Care Industry DataBrief Series ● October 2012 ● No. 32 In 2010, 25% of residential care facilities had full-time registered nurses on staff as compared to 40% in 1999?

2. Differences in the Residential Care Industry, 1999 to 2010 • “Residential care” is an umbrella term for facilities that provide apartment-style housing and support for activities of daily living (ADLs) and other needs for persons who cannot live independently but are not necessarily nursing home eligible. Residential care facilities include assisted living facilities, board and care homes, and other settings. • Residential care facilities are often promoted as a way to allow individuals to “age in place,” which means that they can continue to reside in the facility even if their ADL needs increase or their medical conditions worsen.1 • Residents’ levels of functional impairment have increased over time; facility administrators estimated that 36% of residents receiving similar assistance in 2010 as compared to 24% of residents received assistance in 3 or more ADLs in 1999.1,2 • Residential care facility admission and discharge policies have changed over time, as have the availability of key services that support aging in place: • In 2010, 11% of facilities were likely to admit seniors with skilled nursing needs as compared to 28% in 1999. • In 2010, facilities were also more likely to discharge residents who required skilled nursing care than facilities reported in 1999 (83% vs. 72%, respectively).1,2 • In 2010, facilities provided fewer nursing and other health services on average than in 1999, including managing medications (92% in 1999 vs. 77% in 2010) and providing therapies (74% in 1999 vs. 53% in 2010).1,2 1 Hawes, Catherine, Miriam Rose and Charles Phillips. “A National Survey of Assisted Living for the Frail Elderly: Results of a National Survey of Facilities.” Office of the Assistant Secretary for Planning and Evaluation, 1999. 2 Avalere Health, LLC. Analysis of the 2010 National Survey of Residential Care Facilities. DataBrief (2012) ● No. 32

3. Facilities in 2010 May Offer Fewer Services and Lower Nurse Staffing Than in 1999 Key Characteristics of Residential Care Facilities (RCFs), 1999 and 2010 1 1999 Survey by the Office of the Assistant Secretary for Planning and Evaluation.N = 11,459 residential care facilities with 11 beds or more. 2 2010 National Survey of Residential Care Facilities. N = 15,695 RCFs with 11 beds or more; 15,400 RCFs with 4-10 beds are excluded from this analysis. DataBrief (2012) ● No. 32

4. A Clear Policy Connection Residential care facilities serve a population that is older and has a higher need for ADL assistance than individuals who reside in their own homes. The average level of functional impairment among residential care consumers grew from 1999 to 2010.1 At the same time, fewer facilities currently offer medication management and therapy services than they did 20 years ago. Furthermore, in 2010, facilities were less willing to admit and retain residents who need regular skilled nursing care than in 1999, and the percentage of residential facilities with a full-time registered nurse decreased. The more stringent admission and discharge policies as well as shifts in the staffing mix over time may affect the extent to which people with certain medical or functional support needs can access residential care and remain in that setting over time. Residential care facilities are an important part of the continuum of long-term services and supports. The opportunity exists now to examine workforce issues and admission/discharge policies to create a viable option for older adults who want to remain connected to the community but are not able to live independently. The residential care industry is regulated at the state level. State policymakers should consider if regulation is necessary to ensure that residential care aligns with the new paradigm of care integration and coordination. • Data on residential facilities in 1999 is based on a survey conducted by Catherine Hawes and colleagues for the U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation. To be included in this survey, facilities had to identify themselves as assisted living facilities, or provide at least 24-hour supervision, 2 meals a day and help with ADLs. This survey included facilities with 11 or more beds. • Data on residential care facilities in 2010 is based on the National Survey of Residential Care Facilities (NSRCF), published by the National Center for Health Statistics. The NSRCF collects information on the services provided by facilities, and their level of nurse staffing. To be in the NSRCF, facilities had to provide at least 24-hour supervision of residents, 2 meals a day and help with ADLs, and have 4 or more beds. Facilities with 4 to 10 beds were removed for comparison with the 1999 survey. • Avalere Health would like to acknowledge Catherine Hawes’ invaluable assistance with interpreting the results of the 1999 survey. 1 Avalere Health, LLC. Analysis of data from the 2010 National Survey on Residential Care Facilities and Hawes et al, “A National Survey of Assisted Living for the Frail Elderly,” 1999. DataBrief (2012) ● No. 32