title: Variation Across U.S. Assisted Living Facilities: Admissions, Resident Care Needs, and Staffing.
abstract: Though more people in the United States currently reside in assisted living facilities (ALFs) than nursing homes, little is known about ALF admission policies, resident care needs, and staffing characteristics. We therefore conducted this study using a nationwide sample of ALFs to examine these factors, along with comparison of ALFs by size.
  
  
  
  Cross-sectional secondary data analysis using data from the 2010 National Survey of Residential Care Facilities.
  
  
  
  Measures included nine admission policy items, seven items on the proportion of residents with selected conditions or care needs, and six items on staffing characteristics (e.g., access to licensed nurse, aide training). Facilities (n = 2,301) were divided into three categories by size: small, 4 to 10 beds; medium, 11 to 25 beds; and large, 26 or more beds. Analyses took complex sampling design effects into account to project national U.S. estimates.
  
  
  
  More than half of ALFs admitted residents with considerable healthcare needs and served populations that required nursing care, such as for transfers, medications, and eating or dressing. Staffing was largely composed of patient care aides, and fewer than half of ALFs had licensed care provider (registered nurse, licensed practical nurse) hours. Smaller facilities tended to have more inclusive admission policies and residents with more complex care needs (more mobility, eating and medication assistance required, short-term memory issues, p < .01) and less access to licensed nurses than larger ALFs (p < .01).
  
  
  
  This study suggests ALFs are caring for and admitting residents with considerable care needs, indicating potential overlap with nursing home populations. Despite this finding, ALF regulations lag far behind those in effect for nursing homes. In addition, measurement of care outcomes is critically needed to ensure appropriate ALF care quality.
  
  
  
  As more people choose ALFs, outcome measures for ALFs, which are now unavailable, should be developed to allow for oversight and monitoring of care quality.
authors.affiliation: Lambda Alpha-at-Large, Assistant Professor, Chung-Ang University Red Cross College of Nursing, Seoul, South Korea.
authors.forename: Kihye
authors.initials: K
authors.lastname: Han
authors.affiliation: Pi, Professor, University of Maryland School of Nursing, Baltimore, MD, USA.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Trinkoff
authors.affiliation: Professor, University of Maryland School of Nursing, Baltimore, MD, USA.
authors.forename: Carla L
authors.initials: CL
authors.lastname: Storr
authors.affiliation: Pi, Assistant Professor, University of Maryland School of Nursing, Baltimore, MD, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Lerner
authors.affiliation: Pi, Doctoral Candidate, University of Maryland School of Nursing, Baltimore, MD, USA.
authors.forename: Bo Kyum
authors.initials: BK
authors.lastname: Yang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities / Q000458:organization & administration* / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006301:Health Services Needs and Demand; D006801:Humans; D016134:Organizational Policy; D010343:Patient Admission / Q000706:statistics & numerical data*; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D011787:Quality of Health Care; D014481:United States
keywords: Assisted living; United States; personal care aide; residential care needs; staffing