UF Study: Dearth Of Affordable Assisted Living Units Often Found

February 10, 2005

GAINESVILLE, Fla. — Elderly people of modest means have few choices when it comes to finding an affordable assisted living facility in many communities, according to a new University of Florida study that shows a huge disparity in the availability of this popular long-term care alternative.

Although the gap was found in Florida, the inequities likely are even more pronounced nationwide, said Stephen Golant, a UF gerontologist and geography professor who did the study with Jennifer Salmon, a professor in the University of South Florida’s School of Aging Studies.

Eighty-four percent of Florida’s affordable assisted living units are concentrated in only 20 percent of the state’s counties, reported the authors, whose study was published in the December issue of the Journal of Applied Gerontology.

As a result, more than one-third – 36.6 percent — of Florida’s more than 210,000 frail and low-income elderly residents live in counties that are “especially underserved” by affordable assisted living units, while 17 percent live in counties with an oversupply, he said.

“Other states are likely to have even more dramatic locational inequities than Florida because their overall supply of affordable assisted living units is much less than what would be expected given the size of their overall low-income frail older adult population,” he said. “There are simply fewer units around to reach the pockets of need.”

Respondents were considered frail if they had limited mobility or ability to care for themselves, based on Census data.

Assisted living facilities, which emerged in the 1980s, are the fastest-growing long-term care alternative to nursing homes for the nation’s elderly but are primarily targeted to wealthier seniors, Golant said. Previous studies have documented the shortage of affordable assisted living but have not distinguished where the unmet need is the greatest, he said.

“When older persons move, they usually relocate within a small geographic area — often the same county. They choose to live in a familiar place,” he said. “Unfortunately, the findings of our study suggest that many low-income, frail older adults will have to travel miles away if they want to find an affordable assisted living residence.”

This may be especially troublesome to their grown children who want to maintain close contact, Golant said. “Research in nursing homes has shown that their staff is more likely to be vigilant when they know there is a family member around who is looking out for their older parent – sometimes referred to as the ‘baby-sitting factor,’” Golant said.

Robyn Stone, executive director of the Institute for the Future of Aging Services, said the study “should be a wake-up call for policymakers, city and regional planners, developers and providers about the need for more affordable assisted living, particularly in areas of Florida that are currently severely underserved. This important work underscores the need for better local market analysis so that we can ensure a more equitable use of resources to meet the needs of our most vulnerable seniors.”

Golant and Salmon compared the county locations of affordable assisted living facilities in Florida with the county locations of low-income, frail elderly people. They used statistical measures called the Index of Dissimilarity and the Location Quotient to determine whether affordable assisted living units were distributed where the need was greatest.

Although assisted living facilities are primarily geared toward elderly consumers with higher incomes, in Florida, some facilities can receive state subsidies if their residents are also eligible for Supplemental Security Income benefits, which would make them affordable, Golant said.

The two researchers also studied the location of Medicaid nursing home beds and found they were closer to the population of frail and low-income elderly.

“Thirty-three percent of affordable assisted living units would have to be relocated to achieve a county distribution similar to the vulnerable and poor older population,” Golant said. “In contrast, only 15 percent of Medicaid nursing home beds would need to be shifted.”

One reason for the disparity is that nursing home locations are constrained by a certificate-of-need process and are located where the demand for private-pay or Medicaid beds is believed to be greatest. Assisted living facilities are built on a free market basis, Golant said.

In building assisted living facilities where the numbers of elderly are greatest, developers often fail to account for the units that already exist, resulting in some counties having an oversupply, Golant said. The dilemma is that counties with a large share of needy elderly are often less populated, he said.

The study also found that assisted living facilities were less likely to be found in those counties that had higher concentrations of Medicaid nursing home beds, Golant said.

In these counties, children may be forced to place their parents in Medicaid beds, even though they don’t need the advanced level of care, rather than move them miles away to an assisted living facility in another community, Golant said. Because nursing home care is more expensive, these inequitable assisted living locations end up costing taxpayers more money, he said.

“At the very least state governments should have some kind of plan to identify which counties in their states are especially undersupplied with affordable assisted living units relative to the at-risk population needing that long-term care,” he said.