Assisted Living Capacity & Dementia in Nursing Homes (2019โ2021)
๐ง Study Overview
This project examines how assisted living (AL) capacity โ particularly within a 15-mile radius of nursing homes (NHs) โ is associated with the prevalence of dementia among NH residents across the contiguous U.S. from 2019 to 2021.
๐งช Hypothesis
Increasing AL capacity โ especially general AL โ may divert or delay individuals with dementia from entering nursing homes.
๐ Methods
- Data Sources: AL licensing data (2019 & 2021) + NH data from LTCFocus.org
- Sample: 12,261 NHs operating in both years
- Exposure: Number of AL beds within 15 miles of each NH
- Outcome: % of NH residents with a dementia diagnosis
- Covariates: NH size, occupancy, ownership, payer mix, market characteristics
- Model: Fixed-effects linear regression (by year and facility)
๐ Key Findings
| Finding | Result |
|---|---|
| Avg. NH dementia prevalence | โ from 50.7% (2019) to 48.6% (2021) |
| Avg. AL beds per market | โ from 2,769 to 2,966 |
| 100-bed โ in all AL capacity | โ 0.08 pp in NH dementia prevalence (p < 0.001) |
| Memory care AL (100-bed โ) | No significant effect (p = 0.63) |
๐ฌ Interpretation
- Main analysis shows that increasing general AL capacity is modestly associated with lower dementia prevalence in NHs.
- Memory care AL, while directionally similar, is not statistically significant โ possibly because it is ~25% more expensive, making it less accessible to many families.
- These results suggest general AL may be more effective at diverting or delaying NH entry for people with dementia.
๐งญ Policy & Practice Implications
- Support for expanding affordable AL options in dementia care.
- Need to evaluate the differential roles of general vs. memory care AL.
- Consider how cost, licensing, and state policy affect long-term care pathways.
๐ซ Contact
Erh-Chi Hsu
๐ง ehsu8@jh.edu
Johns Hopkins School of Nursing
Co-authors: Gauri Gadkari, Jennifer Bunker, Lindsey Smith, Cassandra Hua, Eric Jutkowitz, Kali S. Thomas
Funding: NIH/NIA Grant 7RF1AG082308-02