Even with the U.S. population rapidly aging, a smaller proportion of elderly and disabled people live in nursing homes today compared to 1990. Instead, far more depend on assisted living residences or receive care in their homes, according to an article published in the August, 2005 issue of the Journal of Applied Gerontology.

Residential care and assisted living facilities are designed to meet the needs of older people and people with disabilities who need some assistance with activities of daily living, meals and other support services. The capacity for this type of care nearly doubled in the 12 years from 1990 to 2002, to more than 1 million beds nationwide. When the growth of the population is taken into account, the number of such beds grew from 20.9 to 35.6 per 10,000 population.

In contrast, while the majority of people who need long-term care still live in nursing homes, the proportion of nursing home beds declined from 66.7 to 61.4 per 10,000 population.

"These changing trends in the supply of long term care can be expected to continue because the demand for home and community based services is growing," said Charlene Harrington, RN, PhD, lead author of the study. She is a professor of social and behavioral sciences in the UCSF School of Nursing at the University of California, San Francisco.

Harrington and colleagues studied trends in all types of long-term residential care facilities over the 12-year period from 1990 to 2002. While the proportion of nursing home beds to population declined, the actual number of licensed nursing home beds increased modestly, by 7 percent. The actual number of residential care and assisted living beds increased by 97 percent. Overall, the number of all types of long-term care beds increased by 7.8 percent, from 2.3 million in 1990 to 2.9 million in 2002.

There are, however, wide variations in the availability of facilities and beds across states. Nebraska has the highest number of total beds per population in nursing homes and residential care/assisted living while Alaska has the lowest number. California ranks 14th in total number of beds per population and the state has more residential care/assisted living beds (151,000) than nursing home beds (133,000). California has the highest number of residential care and assisted living beds in the nation.

The trends reflect changes in long-term care policy, Harrington said. State Medicaid programs have been active in expanding their home and community based services and many states are starting to pay for personal care (assistance with bathing, dressing, eating, and other activities) in residential care and assisted living facilities. Medicaid home and community based service programs are popular with many individuals who want to live at home and in the community and who are hoping to avoid nursing home care.

The authors point out that the lines between residential care and assisted living facilities compared with nursing home care are becoming blurred as residential care/assisted living facilities accept residents with high care needs and allow individuals to arrange for their own personal care services in the facilities.

Harrington said that residential care and assisted living can substitute for nursing homes in some cases and may delay the admission to nursing homes for many patients. The decline in nursing home beds is probably related to a number of factors including recent reports of quality problems in nursing homes, she noted.

The study was conducted at the national Center for Personal Assistance Services, based at UCSF. It was funded by the National Center on Disability and Rehabilitation Research. The PAS Center tracks information about home and community based services on its website at www.pascenter.org.

In addition to Harrington, co-authors of the paper include Susan Chapman, PhD, Elaine Miller, BA, and Robert Newcomer, PhD, at the University of California, San Francisco and Nancy Miller, PhD, at the University of Maryland, Baltimore County.

Their research was funded by the U.S. Health Services and Resources Administration, Bureau of Health Professions, the University of Maryland and the U.S. Department of Education.