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"With the nation's rapidly growing elderly population, it's important that we have information on the long-term care options that are available for our grandparents, our parents and ourselves," said HHS Secretary Tommy G. Thompson. "This study provides the first comprehensive look at the most rapidly growing form of senior housing - assisted living."

Today's report, High Service or High Privacy Assisted Living Facilities, Their Residents and Staff: Results from a National Survey, looks at assisted living facilities that provide either a high level of service (such as a full-time registered nurse, personal assistance and other services) or a high level of resident privacy. The facilities were profiled in the areas of residents, staffing, walk-through observations, and facilities and administration. These facilities represent approximately 41 percent of the assisted living industry.

The National Study of Assisted Living Facilities has been underway since 1994. Because there is no commonly agreed upon national definition of assisted living, researchers developed a consensus definition of "assisted living facilities" to use in conducting surveys. Previously published reports from the National Study provided a descriptive overview of assisted living facilities and examined rates of discharge from the facilities to nursing homes.

Major findings of the new report include:

Residents - One-half of the residents were aged 85 or older; most were educated and relatively affluent. Nearly one-fourth of the residents had significant cognitive impairment and one in five required assistance with activities of daily living. Residents generally felt they were treated with respect, affection and dignity. However, residents were relatively concerned about staffing levels and turnover.

Staff - Surveyed staff were knowledgeable about many care issues but were less knowledgeable about dementia care and were uninformed about normal characteristics of aging. Staff appeared satisfied with most aspects of their work except for salary and advancement opportunities.

Walk-Through Observations - Observers found the visited facilities to be largely well maintained, clean, relatively homelike settings for frail elderly with a wide range of social and recreational resources. Most of the facilities were located in suburban areas.

Facilities and Administration - Half of the facilities surveyed were for-profit and half were not-for-profit. The median price of the facilities was $1,800 per month; there was a wide variation in which services were covered by the base rate.

Assisted living facilities are often viewed as providing an alternative to nursing home care. The National Study established that, on average, residents of these facilities are less severely disabled than residents of nursing homes. The study also found that facilities with licensed nurses on staff are better able than those without nurses to meet the needs of residents who might otherwise require nursing home care if they become more disabled or their health status declines over time. These "high service" assisted living facilities, which represented 23 percent of all facilities, had significantly lower rates of discharge to nursing homes. The National Study also found that most residents of assisted living facilities do have more privacy and choice than residents of nursing homes. However, a minority of facilities surveyed (29 percent) offered "high privacy," defined as more than 80 percent private accommodations.

As of 1997, there were an estimated 11,459 assisted living facilities nationwide, with approximately 611,300 beds and 521,500 residents. The average facility size was 53 beds. Nearly three-fifths of the facilities had been in business for 10 years or less.

High Service or High Privacy Assisted Living Facilities, Their Residents and Staff: Results from a National Survey is available online at aspe.hhs.gov/daltcp/reports/hshp.htm. Previously released reports from the National Study of Assisted Living for the Frail Elderly, are available on the Web at aspe.hhs.gov/daltcp/ltclist.htm under "Reports."

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