There are nearly 40,000 assisted living facilities across the country, but depending on where you live you may be hard-pressed to find one. A new report from Harvard Medical School researchers shows that the availability of assisted living facilities largely depends on socioeconomic demographic information like wealth and home value.
In Sizing Up the Market for Assisted Living, a report published in Health Affairs, authors David Stevenson and David Grabowski have scoured state and regional locations to provide a comprehensive look into the assisted living landscape—what has been a sorely understudied area despite the booming popularity of the services themselves.
From 1999 to 2007, which is the most recent year of available data, the number of facilities has increased roughly threefold, from 12,000 to more than 38,000. The number of beds hover around 1 million. While assisted living facilities have not displaced nursing homes, they are eating up market share, and the majority of consumers reportedly prefer them over the less formalized nursing homes, according to one study.
In spite of this rapid expansion and consumer taste, some areas of the country remain without the assisted living facilities for their aging population. (Note: The study compiled data on facilities with more than 25 beds, a fact that the image reflects. However, the total number mentioned above includes all sizes.) Large portions of Nevada, Texas and Utah, for example, do not contain assisted living facilities, which stands in contrast to other areas that see more than 32 facilities per 1,000 seniors. According to Stevenson, the variability of these numbers has a lot to do with how they are financed.
“Given that it’s largely a private-pay clientele, [assisted living facilities] go, in some ways, where the money is,” he says. “That’s why we see assisted living facilities in the higher-end areas.”
Overall, Minnesota, Oregon and Virginia have the largest ratio of facilities per senior at more than 40 facilities per 1,000 individuals over 65. The three states on the opposite end—Connecticut, Hawaii and West Virginia—harbor less than 10 facilities per 1,000 seniors. Specific demographic findings include:
1. Education. Areas with higher rates of college-educated populations have more assisted living facilities than areas where there is a less education populace. In counties without assisted living facilities, 14 percent of the population hold a college degree, compared to roughly 20 percent in areas most dense with assisted living options.
2. Income. The higher the income, the more facilities, says the research. Areas with the most facilities show median household income as more than $43,000, compared to a median income level of $35,000 where there are no facilities.
3. Home value. Where there are the most facilities, median home value is $99,000. Where there are none it is $70,000.
4. Race and environment. Areas without facilities are prone to have a greater minority population (17 percent) than areas that do (13 percent). Additionally, rural areas are less likely to have assisted living.
Prior to this study, a gap existed in the national point of view. “There’s no national repository for these data,” says Stevenson. “But the result is, now we have a pretty good data set.”
One of the reasons for the lack of research has to do with the reason behind the disparity in assisted living prevalence: not many public dollars reach them. And despite their relative low cost, Medicare and in turn many private insurance companies have not gotten involved. Mainly, they serve individuals who are paying out of pocket, according to Stevenson.
Despite that, the market continues to expand, bolstered by an individualized mix of service options and nonrestrictive settings. “People who need assistance in performing everyday activities such as bathing, eating, or dressing prefer to receive supportive services in the least institutional and most homelike setting possible,” reads one section of the study. According to findings from Genworth Financial, the average annual cost of assisted living care stood at $34,000 in 2009. Yet cost structures can vary wildly based on the extent of services needed or desired. The adaptability of assisted living has helped make it a popular choice for seniors. According to Stevenson, both the age of residents and their levels of disability have increased in recent years.
“It can vary a lot across facilities, but a number of people who live in assisted living facilities have pretty substantial disabilities and they can certainly benefit from those types of services,” he says.