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Nursing Home Residents Decline as Assisted Living,
In-Home Care Boom
Aug. 6, 2005 – A smaller proportion of elderly and
disabled Americans live in nursing homes today than in 1990. Instead,
far more depend on assisted living residences or receive care in their
homes, according to a study published in the August 2005 issue of the
Journal of Applied Gerontology.
Residential care and assisted living facilities are
designed to meet the needs of older people and people with disabilities
who need some assistance with activities of daily living, meals and
other support services. According to study findings, the capacity for
this type of care nearly doubled in the 12 years from 1990 to 2002, to
more than 1 million beds nationwide. When the growth of the population
is taken into account, the number of such beds grew from 20.9 to 35.6
per 10,000 people.
In contrast, while the majority of people who need
long-term care still live in nursing homes, the proportion of nursing
home beds declined from 66.7 to 61.4 per 10,000 population.
"These changing trends in the supply of long-term
care can be expected to continue because the demand for home and
community based services is growing," said Charlene Harrington, RN, PhD,
lead author of the study. She is a professor of social and behavioral
sciences in the UCSF School of Nursing at the University of California,
San Francisco.
Harrington and colleagues studied trends in all
types of long-term residential care facilities from 1990 to 2002. While
the proportion of nursing home beds to population declined, the actual
number of licensed nursing home beds increased modestly, by 7 percent.
The actual number of residential care and assisted living beds increased
by 97 percent. Overall, the number of all types of long-term care beds
increased by 7.8 percent, from 2.3 million in 1990 to 2.9 million in
2002.
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There are, however, wide variations in the
availability of facilities and beds across states, Harrington found.
Nebraska has the highest number of total beds per population in nursing
homes and residential care/assisted living, while Alaska has the lowest
number. California ranks 14th in total number of beds per population,
and the state has more residential care/assisted living beds (151,000)
than nursing home beds (133,000). California has the highest number of
residential care and assisted living beds in the nation.
The trends reflect changes in long-term care
policy, Harrington said. State Medicaid programs have been active in
expanding their home and community based services and many states are
starting to pay for personal care (assistance with bathing, dressing,
eating, and other activities) in residential care and assisted living
facilities. Medicaid home and community based service programs are
popular with many individuals who want to live at home and in the
community and who are hoping to avoid nursing home care.
The authors point out that the lines between
residential care and assisted living facilities compared with nursing
home care are becoming blurred as residential care/assisted living
facilities accept residents with high care needs and allow individuals
to arrange for their own personal care services in the facilities.
Harrington said that residential care and assisted
living can substitute for nursing homes in some cases and may delay the
admission to nursing homes for many patients. The decline in nursing
home beds is probably related to a number of factors including recent
reports of quality problems in nursing homes, she noted.
About the study
The study was conducted at the national Center for
Personal Assistance Services, based at UCSF, which is supported by the
National Center on Disability and Rehabilitation Research. The PAS
Center tracks information about home and community based services on its
website at
www.pascenter.org.
In addition to Harrington, co-authors of the paper
include Susan Chapman, PhD; Elaine Miller, BA, and Robert Newcomer, PhD,
all at UCSF, and Nancy Miller, PhD, at the University of Maryland,
Baltimore County.
The research was funded by the U.S. Health Services
and Resources Administration, Bureau of Health Professions, the
University of Maryland and the U.S. Department of Education.
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