Study Highlights Differences Among Residents in the Nation’s Largest and Smallest Assisted Living Communities

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In the first of its kind, researchers at George Mason University have documented distinct differences among residents of the largest and smallest assisted living communities in the United States.
Using information gathered from the 2010 National Survey of Residential Care Facilities conducted by the Centers for Disease Control (CDC), Mason researchers’ analyzed data on 8,064 residents from 2,302 assisted living communities. The data were then compared for residents in communities that the CDC had categorized as “small” (4-10 beds), “medium” (11-26 beds), or “large/extra-large” (26+ beds).
Among the findings:

  • Small assisted living communities were nearly three times more likely to house “non-senior” residents (under the age of 65), with more than 21% of residents falling within this age group, compared to just more than 7% in larger communities. Likely a reflection of this younger population, the smallest communities housed nearly twice as many residents suffering from severe mental illness (13% vs. 6%), and nearly five times as many with a developmental disability (10% vs. 2%).
  • In a unique twist, the smallest communities were also more likely to house residents afflicted with Alzheimer’s disease and related dementia (53% vs. 41%), conditions typically associated with the “oldest” seniors (those 85 and older). While the CDC survey specifically excluded communities serving only those with severe mental illness or developmental disability, is unclear from the data whether individuals with Alzheimer’s/dementia are being housed in settings exclusively designed for such residents, co-housed with younger residents, or a combination of both.
  • Consistent with having a greater proportion of residents with severe mental illness, developmental disabilities, and Alzheimer’s/dementia, small communities reported a higher prevalence of resident behavioral issues than in larger communities, including rummaging (10% vs. 7%), being verbally threatening (14% vs. 10%), physical aggressiveness (13% vs. 7%), and creating disturbances (26% vs. 14%). Residents in small communities were also more likely to be prescribed medications to help control behavior (35% vs. 19%).
  • Larger assisted living communities were more likely to house older residents, with nearly 85% over the age of 75, and more than half (56%) over the age of 85. Likely a reflection of this older population, residents of larger communities were reported as having more chronic conditions than those in small communities, including congestive heart failure (36% vs. 25%), hypertension (58% vs. 50%), and osteoporosis (21% vs. 15%). Such residents were also more likely than those in small communities to have experienced a fall (16% vs. 9%), or emergency room visit (36% vs. 28%), during the past year.
  • Among all residents, those using Medicaid to pay for services were twice as likely to live in small, versus larger, assisted living communities (32% vs. 16%).
  •  In nearly all areas, medium size communities fell between the small and larger in terms of resident characteristics.
  • Overall, the study found that the majority of all assisted living residents were age 85+ (54%), female (70%), Caucasian (91%), widowed (62%), and had moved into the community from a private home or apartment (74%).

“It’s important to recognize we are not drawing conclusions on the quality of care between communities of different sizes”, says Andrew Carle, Executive-in-Residence and Director of the Program in Senior Housing Administration, which designed and completed the study. “The care required by an older adult with chronic conditions and those who are younger, dealing with severe mental illness or a developmental disability, or those afflicted with Alzheimer’s, is simply different. What we now know is these specialty populations are being more frequently served within the nation’s smaller communities.”
Such findings, according to Rick Grimes, President of the Assisted Living Federation of America, which sponsored the study, can be of value to both consumers and policy makers. “There is overwhelming evidence that assisted living is improving quality of life for seniors”, says Grimes. “We see this in the rapid growth in communities nationally and in numerous surveys indicating 90%+ satisfaction among residents and family members. But there is also a need to document what the populations in these communities look like in order to ensure the right resident is receiving the right services to match their needs.”
Using the results of this analysis, Mason researchers hope to conduct a second phase of the study, which will compare specific quality of life indicators of an “average” assisted living resident to “peer acuity” seniors who choose to remain at home. Such a study would represent the first formal comparison for a nation facing an aging population in need of both housing and care. Says Carle, “Where this helps is in separating what is thought of as a typical assisted living resident from the specialized groups, versus viewing all assisted living communities as the same.”

About George Mason University and the Program in Senior Housing Administration: George Mason University is an innovative, entrepreneurial institution with global distinction in a range of academic fields. Located in Northern Virginia near Washington, D.C., Mason provides students access to diverse cultural experiences and the most sought-after internships and employers in the country. The Program in Senior Housing Administration offers the nation’s first curricula dedicated exclusively to the rapidly growing seniors housing field. Researchers for the above study are John Cantiello – PhD (Co-Investigator), Andrew Carle – MHSA (Project Director), Gilbert Gimm – PhD (Principal Investigator), and Panagiota Kitsantas – PhD (Co-Investigator).
About ALFA: The Assisted Living Federation of America (ALFA) is the largest national association exclusively dedicated to professionally-managed, resident-centered senior living communities and the seniors and families they serve. Since 1990, ALFA has advocated for choice, accessibility, independence, dignity, and quality of life for all seniors. ALFA’s programs promote business and operational excellence through education, research, publications, professional networking and online tools designed to foster innovation and entrepreneurism in the field of senior living. Visit ALFA’s Web site at

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