The Centers for Disease Control and Prevention released in December the “first nationally representative survey” of residential care facilities to provide an overview of their role in the long-term care industry.
“The ability to provide a comprehensive picture of the long-term care industry has been hampered by the lack of data on RCFs,” according to the report. “Previous estimates of the size of the RCF sector varied depending on how RCFs were defined.”
The survey, "Residential Care Facilities: A Key Sector in the Spectrum of Long-term Care Providers in the United States," defines RCFs as facilities that provide housing and supportive services to patients who can’t live on their own, but who don’t require the “skilled level of care provided by nursing homes.” Data for the survey was taken from the 2010 National Survey of Residential Care Facilities, conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics, Division of Health Care Statistics. The survey excluded nursing homes unless they had a dedicated RCF wing, as well as facilities licensed to exclusively serve mentally ill or developmentally disabled patients.
In 2010, there were 31,100 RCFs that provided a total of 971,900 beds. While half of those facilities were small operations with between four and 10 beds, just 10% of residents in a care facility were in a small RCF. The majority of residents (52%) were in a large facility that had between 26 and 100 beds. While extra-large facilities, those with more than 100 beds, accounted for the smallest percentage of RCFs in 2010 (7%), they housed 29% of residents.
Over 80% of facilities, especially small facilities, are private, for-profit RCFs. Facilities with more than 100 beds are most likely to be part of a chain of RCFs.
At 43% of all facilities, at least one patient uses Medicaid to cover all or some of their long-term care costs. Medium-size facilities, those with between 11 and 25 beds, were the most likely to have a patient who depended on Medicaid with 49%.
Basic care like health monitoring, incontinence care, social and recreational activities, special diets and personal laundry services were almost universally provided by facilities regardless of size. Likewise, skilled nursing services did not vary by size. However, the likelihood of more specialized care like occupational and physical therapy increased with size of facility.
The survey also identified regional differences in the number of beds offered in an RCF compared to the number offered in a nursing home. Western states have more beds in RCFs than states in other regions, and maintained a comparable supply of RCF and nursing home beds.
In the South, Midwest and Northeast, however, there are nearly twice as many nursing home beds as there are RCF beds. The report notes that more research is needed to explain these regional differences, but cites “variations in state regulation and financing of different types of LTC providers, and in consumer preferences for different kinds of long-term services and support” as factors.