New Study Examines Who’s Really Living in Assisted Living Communities

While the senior living industry tends to view “assisted living” as senior-facing, communities labeled as such cover a broad gamut of resident demographics and characteristics, reveals a new national study.

The study, which is the first of its kind, may have strong implications for policymakers and consumers, says Andrew Carle, executive-in-residence and director of George Mason University’s Program in Senior Housing Administration, which designed and completed the study.

“What we’ve documented for the first time is, ‘What’s going on at a national level?’ What surprised us somewhat was the disparity between traditional assisted living residents in large communities versus small ones,” he says of GMU researchers’ findings after analyzing data on more than 8,000 residents in 2,300 assisted living communities.


Using information gathered from the 2010 National Survey of Residential Care Facilities conducted by the Centers for Disease Control, researchers compared data for residents in communities categorized by the CDC as “small” (four to ten beds), “medium” (11-26 beds) or “large/extra large” (26 or more beds).

Small assisted living communities were nearly three times more likely to house “non-senior” residents under the age of 65, the study found, with more than 21% of residents falling into that age group compared to about 7% in larger communities.

However, the smallest communities were also more likely to house residents with Alzheimer’s disease or other memory care needs, at 53%, compared to 41% of large communities, even though those conditions are typically associated with the “oldest old,” or seniors aged 85-plus.


Still, larger assisted living communities were more likely to house older, “traditional” residents: nearly 85% were over the age of 75, while more than half (56%) were older than 85.

The study does not draw any conclusions on the quality of care between communities of different sizes, notes Carle, but it does highlight “very, very distinct” differences in residents of the largest and smallest communities.

“The care required by an older adult with chronic conditions and those who are younger, dealing with severe mental illness or a developmental disability, or those afflicted with Alzheimer’s, is simply different,” Carle says. “What we now know is these specialty populations are being more frequently served within the nation’s smaller communities.”

The CDC residential care facility study specifically excluded any community of any size that exclusively housed the severely mentally ill or developmentally disabled, Carle says, so by definition each community in the study had at least some residents that fit the “traditional” assisted living profile.

Some of the smallest assisted living communities might be completely composed of residents with Alzheimer’s disease and be functioning well, he says, but in theory, according to the study, people with Alzheimer’s are being co-housed with people with severe mental illness or developmental disabilities.

“That should be of significant interest to policymakers and families. At the end of the day you could raise significant questions over whether or not these people should be co-housed,” Carle says. “That’s a very complicated therapeutic milieu. That would require a significant level of expertise and resources to effectively manage.”

Medium-sized communities generally fell between the small and large ones in terms of resident characteristics.

“There is overwhelming evidence that assisted living is improving quality of life for seniors,” said Rick Grimes, president of the Assisted Living Federation of America, a trade group that sponsored the study. “We see this in the rapid growth in communities nationally and in numerous surveys indicating 90%-plus satisfaction among residents and family members. But there is also a need to document what the populations in these communities look like in order to ensure the right resident is receiving the right services to match their needs.”

With the results of the analysis as a foundation, GMU researchers plan on conducting a second phase of the study comparing specific quality of life indicators of an “average” assisted living resident to “peer acuity” seniors who choose to remain at home. This kind of study would represent the first formal comparison in a nation that’s looking at a rapidly aging population and escalating demand for housing and care.

“Where this helps is in separating what is thought of as a typical assisted living resident from the specialized groups, versus viewing all assisted living communities as the same,” said Carle.

Written by Alyssa Gerace

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