Residential care supply and cognitive and physical problem case mix in nursing homes

Objectives: A rapid evolution has occurred in state policy and industry pra ctices relative to assisted living and expanded use of residential care fac ilities for people with physical and cognitive frailty, yet relatively litt le is known about the interrelationship between this housing supply and nur sing-home case mix. Methods: The association between residential care suppl y and the proportion of cognitively and physically impaired nursing facilit y residents was examined in more than 1,500 facilities in five states. Resu lts: The proportion of nursing-home cases with only physical and cognitive impairment likely to be affected by emerging long-term care policy appears to be well under 10%. This effect is more persistent among admissions than continuing cases. Discussion: The findings raise caution about the optimist ic assumptions of the interplay between residential care/assisted living po licy and nursing-home use.