Assisted living or nursing home: Who is moving in?

Abstract

Background: Despite the rapid growth of assisted living (AL) communities and the increasing similarity between AL and nursing home (NH) populations, little is known about the characteristics of older adults at the time of AL admission and how these characteristics compare to individuals newly admitted to NH from the community. This study examined the individual, facility, and geographic factors associated with new AL admission.

Methods: This retrospective descriptive study used data from the national Medicare enrollment and claims datasets, the Minimum Data Set, and the Medicare Provider Analysis and Review. The study cohort included 158,124 Medicare beneficiaries newly admitted to ALs and 715,261 newly admitted to NHs during 10/2017-10/2019. Multinomial logistic regression analysis and logistic regression analysis were conducted to examine factors associated with new admissions.

Results: Demographic, socioeconomic, and health service use characteristics were associated with new admission to long-term care. Specifically, Medicare fee-for-service beneficiaries, those age 75 years and older, male, having one skilled nursing facility (SNF) stay or any hospital stay in the past 6 months are more likely to be newly admitted to AL, whereas those who are dually eligible, racial/ethnic minorities, and having two or more SNF stays in the past 6 months are more likely to be admitted to an NH.

Conclusion: There are substantial differences between individuals who are newly admitted from the community to AL versus those to NH.

Keywords: Medicare; assisted living; new long-term care admissions; nursing home.

Figure 1.. Average share of long-term admissions to assisted living by county.

Note: In each county of our sample, we computed the share (%) of admissions to assisted living (# of assisted living admissions / [# of assisted living admissions + # of nursing home admissions]) over a 2-year time period (N=2,955 counties)

Figure 2.

Regression Analysis of New Assisted Living Versus Nursing Home Admission (FFS and MA beneficiaries).