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Assisted Living in the United States

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Table of Contents:

  • Definition and Philosophy of Assisted Living
  • Resident Characteristics
  • Length of Stay and Reasons for Leaving
  • Costs and Sources of Payment
  • Assuring Quality in Assisted Living
  • Growth of Assisted Living


Definition and Philosophy of Assisted Living

States, accrediting organizations, providers, consumer advocates, and researchers use varying definitions of assisted living. Most definitions include 24-hour supervision, housekeeping, meal preparation, and assistance with activities of daily living.1

Many definitions embrace a philosophy of assisted living that includes: meeting a resident's scheduled and unscheduled needs; maximizing a resident's independence, privacy, autonomy, and dignity; minimizing the need for a resident to move when his or her needs change; and providing a homelike environment.2

The lack of agreement on a definition makes it difficult to obtain consistent data on assisted living. Studies of assisted living use varying definitions, and some of these definitions include a broader range of residential care settings. Most of the studies referred to in this report use a relatively narrow definition of assisted living, consistent with the philosophy and definition described above.

Resident Characteristics

In a 2000 study of assisted living residences (ALRs) that provided high services, high privacy, or both,* the average age of residents was 85.3 Women made up 79% of residents, and 99% of residents were White. Assisted living residents needed assistance with an average of 2.3 activities of daily living, compared to an average of 3.8 for nursing home residents.4 Approximately 52% of assisted living residents had some form of cognitive impairment. Table 1 shows the proportion of assisted living residents needing assistance with various activities.

Length of Stay and Reasons for Leaving

Estimates of the average length of stay in an ALR range from approximately 2.5 to 3 years.5 Residents who leave typically do so because they need to move to a nursing home for more care or because of death. A 2000 study found that, among those who moved to another setting, the need for more care was the most commonly cited reason for leaving (see Table 2).6

Costs and Sources of Payment

An April 2004 review by Health Policy Tracking Services found that estimates of the average cost of assisted living ranged from approximately $2,100 to $2,900 a month.7 In addition, some ALRs may charge an admission fee. Rates vary considerably depending on the location of the residence, the type of accommodations (e.g., private or shared room), and the services the resident needs or wants.

Medicaid coverage of assisted living services is increasing gradually. In 2002, Medicaid helped pay for services for approximately 11% of assisted living residents in 41 states.8 In contrast, Medicaid is the primary source of payment for 58% of nursing home residents.9

Assisted living remains primarily private pay. As of 2000, 67% of assisted living residents paid with their own funds and 8% received support from family members.10 2% paid with long-term care insurance.

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