Assisted Living and Nursing Homes: Apples and Oranges?

TLDR

The study situates assisted‑living and nursing homes within the evolving U.S. residential long‑term‑care system, noting ongoing efforts to clarify their distinct roles. The authors aim to describe the current state of assisted‑living and nursing‑home care, identify facility and resident subtypes, and examine how case‑mix variation reflects differences in care provision and consumer preferences. Using data from the Collaborative Studies of Long‑Term Care, the authors performed multivariate analyses of ten process‑of‑care measures across facility types and generalized estimating equation models to assess resident case‑mix differences among 193 assisted‑living facilities and 40 nursing homes.

Abstract

Purpose:The goals of this study are to describe the current state of residential care/assisted living (RC/AL) care and residents in comparison with nursing home (NH) care and residents, identify different types of RC/AL care and residents, and consider how variation in RC/AL case-mix reflects differences in care provision and/or consumer preference.Design and Methods:Data were derived from the Collaborative Studies of Long-Term Care, a four-state study of 193 RC/AL facilities and 40 NHs. Multivariate analyses examined differences in ten process of care measures between RC/AL facilities with less than 16 beds; traditional RC/AL with 16 or more beds; new-model RC/AL; and NHs. Generalized estimating equation models determined differences in resident case-mix across RC/AL facilities using data for 2,078 residents.Results:NHs report provision of significantly more health services and have significantly more lenient admission policies than RC/AL facilities, but provide less privacy. They do not differ from larger RC/AL facilities in policy clarity or resident control. Differences within RC/AL types are evident, with smaller and for-profit facilities scoring lower than other facilities across multiple process measures, including those related to individual freedom and institutional order. Resident impairment is substantial in both NHs and RC/AL settings, but differs by RC/AL facility characteristics.Implications:Differences in process of care and resident characteristics by facility type highlight the importance of considering: (1) the adequacy of existing process measures for evaluating smaller facilities; (2) resident case-mix when comparing facility types and outcomes; and (3) the complexity of understanding the implication of the process of care, given the importance of person–environment fit. Work is continuing to clarify the role of RC/AL vis-à-vis NHs in our nation's system of residential long-term care.