Even with aging population,
smaller proportion of elderly, disabled live in nursing homes today
than 10
years ago
Even with the US population rapidly aging, a smaller proportion of
elderly and disabled people live in nursing homes today compared to
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.
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.
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
http://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.