Assisted living and nursing homes: apples and oranges?
OBJECTIVE
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.


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.


CONCLUSIONS
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.
Zimmerman
Sheryl
S
Program on Aging, Disability, and Long-Term Care, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Airport Road, Campus Box 7590, Chapel Hill, NC 27599-7590, USA. Sheryl_Zimmerman@unc.edu
Gruber-Baldini
Ann L
AL
Sloane
Philip D
PD
Eckert
J Kevin
JK
Hebel
J Richard
JR
Morgan
Leslie A
LA
Stearns
Sally C
SC
Wildfire
Judith
J
Magaziner
Jay
J
Chen
Cory
C
Konrad
Thomas R
TR
D000368:Aged; D040561:Assisted Living Facilities / Q000592:standards*; D003953:Diagnosis-Related Groups; D006801:Humans; D009735:Nursing Homes / Q000592:standards*; D014481:United States