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Who Receives Care at Assisted Living Facilities?

As the population of Americans over 65 grows, the healthcare industry must respond to increased demands for affordable, comprehensive long-term care. Assisted Living Facilities (ALFs) are playing a specialized role in the long-term care industry for older Americans seeking to live independently while also having access to limited daily assistance and on-call medical care.

Assisted Living Facilities (ALFs) are unique in the field of long-term care. ALFs are optimal for those who would like assistance with activities of daily living (ADLs), but are able to complete most necessary tasks and activities on their own. Residents live in single or shared apartments with private bathrooms and kitchenettes, able to live as independently as they like with the option for assistance with ADLs like medication monitoring, dressing, and arrangement of transportation.

The most popular long-term care options are ALFs, nursing homes, and home health agencies (HHAs). Each option caters to unique resident care needs and offers distinct advantages. Living in an ALF includes many of the benefits of homeownership without concerns over mortgage payments and property management. ALF residents can take advantage of exercise, social, and other health programs in communal living areas, as well as community outdoor spaces. Meal provisions are also included in ALF residence, and most facilities provide two or three hot meals per day.

Top 10 Largest Assisted Living Facility Corporations by Bed Count

ALF Name Bed Count % Population Aged 65+
Atria Senior Living 15,351 7.8%
Enlivant 7,529 8.8%
Elmcroft Senior Living 7,302 20.1%
Capital Senior Living 5,748 3.8%
Milestone Retirement Communities 4,999 10.1%
Pacifica Senior Living 4,898 22.2%
Frontier Management 3,988 3.1%
Americare 3,793 13.1%
SRG Senior Living 3,554 14.9%
Belmont Village Senior Living 3,278 25.6%

Fig 1 Data from Definitive Healthcare

While ALFs primarily cater to people aged 65 and older, they are also viable options for adults with physical or cognitive disabilities. There is 24-hour access to medical personnel, and the facility offers a safe and secure living environment with few restrictions on access to communal and outdoor spaces. ALFs are regulated by state policies, and individual facility records are easily accessible in most states. Currently, Definitive Healthcare tracks financial, affiliation, and demographic data on nearly 38,000 ALFs.

Nursing homes are another option for those requiring assistance with daily living. Often confused with ALFs and skilled nursing facilities (SNFs), nursing homes are actually an entirely separate entity. Nursing homes are better alternatives for people who struggle with mobility or cognitive function, like those with Alzheimer’s or dementia, and need significant assistance with ADLs such as bathing, dressing, and eating. Unlike ALFs, nursing homes are better equipped to provide constant nursing and medical care, particularly for patients who frequently experience emotional distress or exhibit behavioral issues.

Rather than living in apartments, nursing home residents live in single or shared rooms, with access to communal areas and outdoor space that is more restricted than at ALFs. These facilities are almost exclusively for residents aged 65 and older. Nursing homes are neither federally nor state regulated. Instead, they are subject to regular inspections to ensure patient health and safety.

Top 10 Assisted Living Facilities with Greatest CBSA* Population Increase from 2015

ALF Name % Population Increase CBSA Population
Sante Assisted Living – Heber 4.6% 30,528
The Abbington Assisted Living and Memory Care Community 4.6% 30,528
The Willows at Wildwood 4.3% 123,996
Serenades in the Villages 4.3% 123,996
Buffalo Crossings Assisted Living Facility 4.3% 123,996
Generations Senior Living at Lake Miona 4.3% 123,996
Mission Oaks 4.3% 123,996
Shady Acres Assisted Living Facility 4.3% 123,996
Sumter Place in the Villages 4.3% 123,996
Ashley Manor – Meadow Lakes 4.2% 22,570

Fig 2 Data from Definitive Healthcare

SNFs and nursing homes are often referred to interchangeably, but are very different in terms of regulations and patient length of stay. SNFs are primarily for short-term nursing and rehabilitation. Doctors and surgeons refer patients to SNFs after discharge, and long-term residence at a SNF requires a physician’s approval. Unlike ALFs and nursing homes, SNFs offer a full range of speech pathologists, physical and occupational therapists. Additionally, while SNFs emphasize treatment and recovery from an illness or procedure, nursing homes focus on long-term medical needs of patients.

Because of their focus on recovery and overall medical needs, SNFs employ RNs, LPNs, and CNAs in addition to staff who aid patients in ADLs. Though some ALFs do have nurses and medical professionals on-call, they are not consistently on-site to assist with regular medical needs. All SNFs are federally regulated by the US Department of Health and the Centers for Medicare and Medicaid Services (CMS), and accept Medicaid and Medicare insurances. Definitive Healthcare tracks more than 18,200 SNFs across the United States.

For those who wish to remain at home while receiving medical care, home health agencies (HHAs) offer an inexpensive and convenient alternative to residential care facilities. HHAs employ RNs and LPNs to assist patients with medical needs as well as ADLs. Services offered by HHAs can include wound care, patient/caregiver health education, injections, nutrition therapy, and monitoring of chronic or unstable health conditions. HHAs are a middle ground for those who need rehabilitative services or require assistance with medical care, but are able to live on their own or with family members.

Comparison: Home Health Agencies, Assisted Living Facilities, Skilled Nursing Facilities 

Fig 3 Data from Definitive Healthcare and Aging Care

Rather than focusing on treatment of a specific condition, HHA caregivers aim to rehabilitate patients so they can regain their independence. This kind of specialized care does require physician approval, and home health care providers maintain contact with a patient’s physician to ensure coordinated care. Home health care can also be a stepping stone for patients living on their own transitioning into a residential facility.

Of all the long-term care options, assisted living facilities are unique in that they offer independence and minimal supervision. Resident experience is customizable, from occasional assistance in the form of meal and medication provision to regular assistance with ADLs like bathing and transportation. The costs associated with ALFs depend on the services provided and the size of a resident’s apartment, and usually include utilities and meals in addition to communal areas and events.

*Core Based Statistical Area: geographic region anchored by a metropolitan or micropolitan area defined by the Office of Management and Budget for use in the U.S. Census.

Visit the Definitive Blog to read more about Skilled Nursing Facility and Home Health Agency funding.

Definitive Healthcare offers the most up-to-date, comprehensive, and integrated data on providers, payors, and CMS programs. Our database tracks financial and clinical metrics on over 8,800 hospitals, 1.5 million physicians, and 37,000 assisted living facilities.

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