Assisted Living in the United States

Because of their high cost and lack of public subsidies, ALRs are often unaffordable for persons with low or moderate incomes.

Assuring Quality in Assisted Living

In contrast to nursing homes, no federal quality standards exist for assisted living. Additionally, states vary significantly in their licensing requirements, quality standards, and monitoring and enforcement activities.

Recent media reports have brought attention to quality problems in assisted living, such as inadequately trained staff, too few staff, medication errors, and the admission and retention of individuals who need more care than the residence is equipped to provide.¹¹ One effort to address quality problems was the establishment of the Assisted Living Workgroup (ALW), formed at the request of the U.S. Senate Special Committee on Aging. In 2003, the ALW issued a report with recommendations for improving quality in assisted living.¹² To continue and expand the work of the ALW, 11 organizations that participated in the ALW have formed an organizing committee to develop a “Center for Excellence in Assisted Living” (CEAL). The CEAL will foster high quality, affordable assisted living by disseminating research and information and providing technical assistance.¹³

Growth of Assisted Living

ALRs began to appear in the United States in the mid-1980s and have grown rapidly, in spite of concerns about quality problems and affordability. From 1992 to 1998, the number of older persons living in ALRs and other residential care settings greatly increased (from 266,706 to 416,768), while the number in nursing homes declined somewhat (from 1,413,596 to 1,346,119).¹⁴

^* High privacy meant that at least 80 percent of residents' units were private. High service ALRs had a full-time RN on staff and provided the following: nursing care if needed, help with at least two activities of daily living, 24-hour staff, housekeeping, and at least two meals a day.