As Assisted Living Options Increase, Nursing Home Occupancy Declines
Assisted living poorly defined, typically includes a broad range of options with varying levels of care; offers
alternatives to nursing home care for some
By Katherine Kahn, Contributing Writer
July 10, 2012 - A new study finds an association between an increase in assisted living options, which provide older
adults with an array of services such as help with everyday tasks in homelike settings, and a decline in nursing home occupancy. This shift in
delivery of care has both positive and negative implications for seniors.
The study appears in the upcoming issue of Health Services Research.
Data on assisted living is patchy, primarily because the assisted living industry is not widely regulated and receives
little government financing. Additionally, what constitutes assisted living is poorly defined and typically includes a broad range of housing
options with varying levels of care.
“Assisted living has, in general, not been very well understood or studied in its role in the broader long-term care
marketplace,” said the study’s lead researcher, David Grabowski, Ph.D., professor of health care policy at Harvard Medical School.
To collect data on assisted living, Grabowski and his colleagues contacted each state; however, only 13 states had
long-term data available, from 1993 to 2007. Data for nursing homes was gathered from the Centers for Medicare and Medicaid Services, which
represents over 95 percent of all nursing home facilities in the U.S., and from Brown University’s Minimum Data Set (MDS) on long term care.
“We found that a 10 percent increase in assisted living capacity led to a 1.4 percent decline in private-pay nursing home
occupancy,” Grabowski said. “It’s not a huge effect and it’s not a one-to-one substitution, but I think this is a pretty sizable
Since most individuals in assisted living are private-paying residents, researchers accurately predicted that assisted
living expansion would have little impact on occupancy of Medicaid nursing home residents or Medicare-eligible patients who were in nursing
homes for short-term care after a hospitalization.
Robert L. Kane, M.D., director of the Center on Aging and the Minnesota Area Geriatric Education Center at the University
of Minnesota commented that growth in assisted living may not be the only reason for nursing home occupancy decline.
“This phenomenon has been
known for a long time…the problem is it’s not the only phenomenon in town. For example, there’s been a huge growth in home- and
community-based services under Medicaid and it may well be that places that were growing in assisted living were also growing in these
Grabowski and researchers also found that as assisted living expanded, there was a small but significant increase in the
level of care needed among nursing home residents. “This suggests that there is a healthier segment of the potential nursing home population
that is being siphoned off and entering assisted living instead,” Grabowski said.
Since nursing homes generally prefer private-pay patients and Medicare patients over Medicaid patients, this trend could
have negative financial effects for nursing homes, Grabowski speculated. “Assisted living may be a really attractive option for private paying
individuals, but it has implications for Medicaid as well in that nursing homes can no longer depend on cross subsidies from private-paying
residents since there’s maybe fewer of these individuals in that marketplace.” The result could be fewer resources for direct patient care of
all nursing home residents.
Research Source: Health Services Research, Health Behavior News Service
This news story is from the latest peer-reviewed research, it is not intended to provide medical advice or treatment
recommendations. For medical questions or concerns, please consult a health care provider.
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