Senior Care Staffing Patterns Hold Steady

There were 30,200 assisted living and similar residential care communities providing services in the United States as of 2014, with the highest concentration in western states, according to a newly released report form the Centers for Disease Control and Prevention (CDC). Staffing patterns in these settings, as measured by average hours per resident day, remained consistent with previous findings.

About 45% of all long-term care service providers in the country as fell in the assisted living/residential care community category as of 2014, according to the report. That was the largest category of service provider, followed by nursing homes (23%), home health agencies (19%), adult day centers (7%), and hospices (6%).

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The report—Long-Term Care Providers and Services Users in the United States: Data from the National Study of Long-Term Care Providers—draws from multiple sources, including National Center for Health Statistics surveys of assisted living/residential care communities. The data covers the years 2013 and 2014. The report provides information about long-term care service providers and users, including staffing information, services provided, and health characteristics of residents.

The previous version of this report showed that in 2012 there were approximately 22,200 assisted living and residential care communities. That amounts to a 36% increase in two years.

The jump may be attributed to a methodological issue. Some respondents in 2012, particularly providers with few beds, may not have understood one of the eligibility questions, and therefore erroneously screened themselves out of the study, according to technical notes in the new report.


An even earlier report shows that in 2010, there were around 31,100 assisted living/residential care communities, according to the CDC. That’s lightly higher than the 2014 figures.

Meanwhile, the number of nursing homes nationwide has remained essentially unchanged, from about 15,700 in 2012 to 15,600 in 2014.

In terms of organizational characteristics, about 82% of assisted living/residential care communities were for-profit as of 2014, and 56% were chain-affiliated. Yet, this sector of long-term care still is dominated by small-scale operations, as 67% of these facilities served between one and 25 people each day. Only about 5% served 101 or more people daily.

Staffing, Service Trends

Aides in assisted living/residential care communities averaged 2.16 hours per resident day in 2014, which was the same as in 2012. Registered nurses and licensed practical or vocational nurses also clocked essentially the same average hours per resident day in this report and the last one.

This report provided a new stat: average hours per resident day for activities director or staff. That came in at 0.33 hours for residential care communities, compared with 0.19 for nursing homes.

About 60% of assisted living/residential care communities employed full-time activities director or staff, while about 11% employed a full-time social worker.

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Other stats regarding services offered by assisted living/residential care communities in 2014:

  • 48% offered social work services
  • 52% offered mental health/counseling services
  • 69% offered some type of therapeutic services
  • 59% offered skilled nursing

Additionally, 14.8% of nursing homes and 12.1% of residential care communities in 2014 offered a dementia care unit within a larger facility or community, the report said. A total of 10.1% of residential care communities served just residents with dementia, compared with only 0.4% of nursing homes.

As for resident profile, about 40% of assisted living/residential care community residents had Alzheimer’s disease or other dementias, 23% had depression, and 17% had diabetes. Bathing was the most common activity of daily living that they required assistance with, followed by dressing, toileting, and transferring in and out of bed.

Written by Tim Mullaney

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