MCBS Highlights: Growth in Residential Alternatives to Nursing Homes: 2001

Demographic projections made in the 1980s suggested that the aging of the population would produce a surge in the number of persons needing long-term facility care as we approached the year 2000. Based on the existing stock of nursing home beds, it appeared that there would be a shortage of beds to accommodate these persons. However, this expected large increase in the number of nursing home patients did not materialize. Findings from the National Nursing Home Survey (National Center for Health Statistics, 2003) suggested that elderly use of nursing homes actually declined between 1985 and 1995 (Bishop, 1999). One explanation for this decline seems to lie in an important supply side trend occurring in the U.S. long-term care (LTC) system. During the past 10 to 15 years, an increasing number of elderly persons began living in settings that are neither traditional home settings nor traditional nursing homes. There has been a proliferation of facility-like residential alternatives to nursing homes. These settings go by various names including assisted living facilities, continuing care facilities, retirement communities, staged living communities, age-limited communities, etc. For simplicity in this article we will refer to all these types of living arrangements as elderly group residential arrangements (EGRAs). Because of the way that traditional LTC facility survey samples have been selected, persons living in these EGRAs were often counted as community residents, not LTC facility residents. If an increasing proportion of the elderly are entering a new class of residential alternatives to the nursing home, and these new facilities are falling outside the traditional LTC facility sampling frameworks, it seems to explain why we are seeing a lesser number of persons in traditional nursing homes.