January 05, 2010
12:01 a.m. Pacific Time
Assisted Living Facilities More Likely In Areas With Higher Income, Education Level
First nationwide snapshot of assisted living shows option not available to everyone
Bethesda, MD - Assisted living facilities are disproportionately located in areas where people have higher levels of income and education and where home values are higher, according to the first nationwide county-level analysis of supportive housing, published today in the journal Health Affairs. Low-income people, minorities, and people living in rural areas have relatively little access to this housing and long-term care option, the authors report.
The paper is one of a series of articles related to long-term care and related services and supports in the January 2010 edition of the journal Health Affairs, which is now published monthly. The paper also includes a color map showing the distribution of assisted living facilities across the country.
"The growth of assisted living has been fueled mostly with private dollars, and the distribution of facilities nationally reflects this fact," says lead researcher David Stevenson, an assistant professor of health policy at Harvard Medical School. "States have been cautious to date in expanding Medicaid coverage for care in assisted living. If this changes in the future and more public dollars flow into this sector, however, policymakers will have to address important issues related to access to services, financing, and oversight of care," he adds.
Assisted living facilities have emerged rapidly as an important care and housing option for older Americans over the past few decades. The latest data show that there are almost one million assisted living beds nationwide. Whereas nursing homes are heavily regulated and rely heavily on public financing -- Medicaid, for example, pays about half the nation's nursing home bill -- there is little government financing or regulation of the assisted living sector, and most of those in assisted living pay their own way. In addition, there is wide variation across states in the nature of these facilities and the services that they can provide.
Using county-level data, Stevenson and Harvard associate professor David Grabowski compared the penetration of these facilities nationally with county data on education, median household income, other economic indicators, and racial/ethnic composition.
They found wide variation in assisted living facilities across states. Minnesota, Oregon, and Virginia had the highest penetration of facilities, with more than 40 facilities per 1,000 people who are age 65 and older. Connecticut, Hawaii, and West Virginia had the lowest, with fewer than 10 facilities per 1,000 elderly people.
Specific findings of the study include the following:
• Rural counties were more likely than urban counties to lack an assisted living facility.
• Counties with no assisted living options had lower rates of people who had a college education (13.8 percent) than counties with the highest penetration of assisted living facilities, where almost 20 percent of residents had a college education.
• Median household incomes were lower ($35,379 vs. $43,034) and median home values ($69,560 vs. $98,541) were lower in areas with no assisted living facilities relative to those with the highest penetration of facilities.
• Counties without assisted living options were more likely to have more minorities (17.1 percent versus 12.8 percent) than counties with more facilities.
The authors also found that areas with higher assisted living penetration had fewer nursing home residents who relied on Medicaid to finance their care and more people paying their own way. In addition, states with a higher penetration of assisted living facilities had higher levels of people ages 45-65 with long-term care insurance. These states were also more likely to have a greater portion of Medicaid long-term care spending going toward home and community-based services than states with a lower penetration of assisted living facilities.
All articles are available to reporters upon request. To access a full table of contents from the issue, please click here: http://www.healthaffairs.org/press/Jan10_TOC.pdf
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