Developments in the Market for Assisted Living: Residential Care Availability in 2017

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Journal of the American Medical Directors Association

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Describe how the availability of assisted living (AL) and dementia-specific AL vary across counties and correlate with demographic and socioeconomic characteristics.


Maps, univariate statistics, and standardized mean differences show the differences between counties with high and low levels of AL market penetration, and between counties with and without dementia-specific AL.

Setting and Participants

Data collected from state agencies on licensed AL communities, capacity, and geographic location, and population characteristics from the Area Health Resource file. We include novel and previously undescribed data on dementia-specific AL licenses in 21 states.


AL market penetration is reported as the number of AL units or beds per 1000 persons over age 65 years in a county.


In comparison to counties with the lowest AL penetration, high-penetration counties had higher high school and college education attainment (mean 25.3% vs 18.5%) and median annual income ($56,000 vs $46,800), and lower poverty (12.8% vs 17.3%) and unemployment rates (3.9% vs 5.1%). Compared to counties with AL but no dementia-specific care, counties with dementia care had substantially higher college attainment (24.6% vs 17.7%) and had higher urbanity index (3.8 vs 5.6 on a 1-9 scale, 1 most urban). Counties with dementia care also had, on average, 16% more in median household income ($54,200 vs $46,400) and 40% greater home value ($159,800 vs. $113,600).

Conclusions and Implications

Large socioeconomic disparities persist among counties without any AL or low penetration of AL in their borders in comparison to those with high AL penetration, as well as between counties with and without dementia-specific AL communities. There may be a mismatch in need and availability of residential care options for older adults with Alzheimer's disease and related dementias that contributes to the disproportionate share of racial/ethnic minorities with dementia in nursing homes. Lack of available AL beds in the communities where Medicaid individuals reside could make rebalancing efforts doubly difficult, in that Medicaid enrollees may be reluctant to move out of their neighborhoods.


Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.



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