Assisted living expansion and the market for nursing home care

Health Serv Res. 2012 Dec;47(6):2296-315. doi: 10.1111/j.1475-6773.2012.01425.x. Epub 2012 May 11.


Objective: To analyze the effect of market-level changes in assisted living supply on nursing home utilization and resident acuity.

Data sources: Primary data on the supply of assisted living over time were collected from 13 states from 1993 through 2007 and merged with nursing home-level data from the Online Survey Certification and Reporting System and market-level information from the Area Resource File.

Study design: Least squares regression specification incorporating market and time-fixed effects.

Principal findings: A 10 percent increase in assisted living capacity led to a 1.4 percent decline in private-pay nursing home occupancy and a 0.2-0.6 percent increase in patient acuity.

Conclusions: Assisted living serves as a potential substitute for nursing home care for some healthier individuals with greater financial resources, suggesting implications for policy makers, providers, and consumers.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Aged
  • Assisted Living Facilities / economics
  • Assisted Living Facilities / statistics & numerical data*
  • Diagnosis-Related Groups / statistics & numerical data
  • Homes for the Aged / economics
  • Homes for the Aged / statistics & numerical data*
  • Humans
  • Medical Assistance / economics
  • Medical Assistance / statistics & numerical data
  • Nursing Homes / economics
  • Nursing Homes / statistics & numerical data*
  • Ownership / statistics & numerical data
  • Residence Characteristics / statistics & numerical data