Assisted Living and Nursing Homes: Apples and Oranges?

• Published in: The Gerontologist 2003-04, Vol.43 (suppl-2), p.107-117
• Main Authors: Zimmerman, Sheryl, Gruber-Baldini, Ann L., Sloane, Philip D., Kevin Eckert, J., Richard Hebel, J., Morgan, Leslie A., Stearns, Sally C., Wildfire, Judith, Magaziner, Jay, Chen, Cory, Konrad, Thomas R.
• Format: Article
• Language: English
• Subjects: Aged; Assisted living facilities; Assisted Living Facilities - standards; Diagnosis-Related Groups; Elder care; Humans; Nursing homes; Nursing Homes - standards; Process of care; Resident case-mix; Residential care; United States
• ISSN: 0016-9013; 1758-5341
• DOI: 10.1093/geront/43.suppl_2.107

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.