NCHS Data Brief ■ No. 78 ■ December 2011

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Residential Care Facilities: A Key Sector in the Spectrum of 

Long-term Care Providers in the United States

Eunice Park-Lee, Ph.D.; Christine Caffrey, Ph.D.; Manisha Sengupta, Ph.D.; Abigail J. Moss; 

Emily Rosenoff, M.P.A.; and Lauren D. Harris-Kojetin, Ph.D.

Residential care facilities (RCFs)—such as assisted living facilities and 

personal care homes—provide housing and supportive services to persons 

who cannot live independently but generally do not require the skilled level 

of care provided by nursing homes. RCFs are not federally regulated, and 

state approaches to RCF regulation vary widely (1). The ability to provide 

a comprehensive picture of the long-term care (LTC) industry has been 

hampered by the lack of data on RCFs (2,3). Previous estimates of the size of 

the RCF sector varied depending on how RCFs were defined (4,5). Using data 

from the first nationally representative survey of RCFs with four or more beds, 

this report presents national estimates of RCFs and compares characteristics 

and services by facility size.

Keywords: assisted living • long-term care • National Survey of Residential 

Care Facilities

In 2010, RCFs numbered 31,100, providing 971,900 beds.

• Approximately one-half of RCFs were small facilities with 4–10 beds 

(50%) (Figure 1). The rest were medium facilities with 11–25 beds (16%), 

large facilities with 26–100 beds (28%), and extra large facilities with more 

than 100 beds (7%).

Key findings

Data from the 2010 

National Survey of 

Residential Care Facilities

• In 2010, residential care 

facilities (RCFs) totaled 31,100, 

with 971,900 beds nationwide.

• About one-half of RCFs 

were small facilities with 4–10 

beds. The remainder comprised 

medium facilities with 11–25 

beds (16%), large facilities 

with 26–100 beds (28%), 

and extra large facilities with 

more than 100 beds (7%).

• One-tenth of all RCF 

residents lived in small RCFs 

and about that percentage 

(9%) lived in medium 

facilities, while the majority 

resided in large (52%) or 

extra large (29%) RCFs.

• About 4 in 10 RCFs had 

one or more residents who had 

some or all of their long-term 

care services paid by Medicaid. 

• Larger RCFs were more 

likely than small RCFs 

to be chain-affiliated and 

to provide occupational 

therapy, physical therapy, 

social services counseling, 

and case management. NOTE: Estimates may not add to totals because of rounding.

SOURCE: CDC/NCHS, National Survey of Residential Care Facilities, 2010.

Figure 1. Residential care facilities and residents, by facility size: United States, 2010

7% 2,100

10% 75,700

 9% 67,000

28%

8,700

16%

4,900

52%

381,800

29%

208,900

50%

15,400

Extra large (more than 100 beds)

Large (26–100 beds)

Medium (11–25 beds)

Small (4–10 beds)

Facilities Residents
NCHS Data Brief ■ No. 78 ■ December 2011

•	 When	the	number	of	residents	that	RCFs	were	serving	at	the	time	of	interview	was	compared	

by	facility	size,	small	facilities	were	found	to	serve	10%	of	all	residents	in	RCFs	and	medium	

facilities	served	9%	of	residents,	while	large	RCFs	served	52%	of	all	residents	in	RCFs	and	extra	

large	RCFs	served	29%.

Ownership type, chain affiliation, and geographic location of RCFs varied 

by facility size.

•	 Approximately	82%	of	RCFs	were	private,	for-profit	facilities	(Figure	2),	while	the	remaining	

18%	were	private,	nonprofit	facilities	or	were	owned	by	state,	city,	or	local	government	(data	not	

shown).	Small	RCFs	were	more	likely	to	be	for	profit	(91%)	than	larger	RCFs.	

•	 About	38%	of	RCFs	were	chain-affiliated.	As	facility	size	increased,	the	proportion	of	chainaffiliated	facilities	grew:	Extra	large	RCFs,	for	example,	were	almost	three	times	as	likely	(65%)	

as	small	RCFs	(23%)	to	be	owned	by	a	chain,	group,	or	multifacility	system.	

•	 Small	(89%)	and	extra	large	(93%)	RCFs	were	most	likely	to	be	in	a	metropolitan	statistical	

area	(MSA),	while	medium	RCFs	were	least	likely	to	be	in	an	MSA	(65%).	

■  2  ■

1

Small facilities are significantly different from all other facility sizes at p < 0.05. 2

A significant upward trend was observed with increasing facility size at p < 0.05. 3

All facility sizes are significantly different from each other in the percentage of facilities located in an MSA at p < 0.05. 

SOURCE: CDC/NCHS, National Survey of Residential Care Facilities, 2010.

Figure 2. Selected characteristics of residential care facilities, by facility size: United States, 2010

0

20

40

60

80

100

Extra large

(More than 100 beds)

Large

(26–100 beds)

Medium

(11–25 beds)

Small

(4–10 beds)

All facilities

Metropolitan statistical

area (MSA)3

Chain affiliated Private, for profit 2

Percent

82

72 74 72

38

23

38

57

65

81

89

65

75

1 93 91

The mix of facility sizes and the supply of residential care beds differed 

by region.

•	 RCFs	were	most	commonly	located	in	the	West	(42%	of	all	RCFs)	and	least	commonly	located	

in	the	Northeast	(8%)	(data	not	shown).

•	 RCFs	in	the	West	were	predominantly	small,	while	RCFs	in	the	Northeast	were	mostly	large.	

RCFs	in	the	Midwest	and	South	were	more	evenly	distributed	among	small,	medium,	and	large	

facilities	(Figure	3).

•	 In	the	United	States,	RCFs	provided	177	beds	per	1,000	persons	aged	85	and	over	(Figure	4).
NCHS Data Brief ■ No. 78 ■ December 2011

■  3  ■

• The West had the largest supply of RCF beds per 1,000 persons aged 85 and over (245 beds), 

and the Northeast had the smallest supply (131 beds). 

† Estimate does not meet standards of reliability or precision because the sample size is between 30 and 59, or the sample size is greater than 59 but has a 

relative standard error of 30% or more.

1

The Northeast is significantly different from all other regions in the percentage of large facilities at p < 0.05. The West is significantly different from the Midwest 

and the South in the percentage of large facilities at p < 0.05. 2

All regions are significantly different from each other in the percentage of medium facilities at p < 0.05. 3

 All regions are significantly different from each other in the percentage of small facilities at p < 0.05. 

NOTE: Estimates may not add to totals because of rounding. 

SOURCE: CDC/NCHS, National Survey of Residential Care Facilities, 2010.

Figure 3. Residential care facilities, by region and facility size: United States, 2010 Percent

0

20

40

60

80

100 Extra large (more than 100 beds)

Large1

 (26–100 beds)

Medium2

 (11–25 beds)

Small3

 (4–10 beds)

Northeast Midwest South West

†

16

†

6 †

8 †

5

14

7

55

35 35

18

39

75

29

31 21

8

1

All regions are significantly different from each other in the number of beds per 1,000 persons aged 85 and over at p < 0.05.

NOTE: Beds per 1,000 persons were calculated by dividing the number of residential care beds by the number of persons aged 85 and over, multiplied by 1,000.

SOURCE: CDC/NCHS, National Survey of Residential Care Facilities, 2010, and 2010 Census Summary File 1.

Figure 4. Residential care beds per 1,000 persons aged 85 and over, by region: United States, 2010

Beds per 1,000 persons1

0 50 100 150 200 250 300

Total

United States

Northeast

Midwest

South

West 245

164

177

131

177

About 4 in 10 RCFs served residents who were receiving LTC services paid 

by Medicaid. 

• Overall, 43% of RCFs had at least one resident who had some or all of his or her LTC services 

paid by Medicaid (Figure 5). 

• Similar proportions of small (45%) and large (40%) RCFs served residents who were receiving 

LTC services paid by Medicaid. 

• Extra large RCFs were least likely (32%) to serve residents whose LTC services were paid 

by Medicaid. 
NCHS Data Brief ■ No. 78 ■ December 2011

■  4  ■

1

Medium facilities are significantly different from large and extra large facilities at p < 0.05. 2

Large facilities are significantly different from medium and extra large facilities at p < 0.05. 3

Extra large facilities are significantly different from all other facility sizes at p < 0.05.

NOTE: Figure excludes cases with missing data; see "Data sources and methods" for details. 

SOURCE: CDC/NCHS, National Survey of Residential Care Facilities, 2010.

Figure 5. Residential care facilities serving any resident receiving long-term care services paid by Medicaid, by facility 

size: United States, 2010 Percent

0

20

40

60

Extra large

(More than 100 beds)

Large

(26–100 beds)

Medium

(11–25 beds)

Small

(4–10 beds)

All facilities

43 45

1

49

2

40

3

32

The types of services offered at RCFs varied by facility size. 

• Nearly all RCFs provided basic health monitoring (96%), incontinence care (93%), social and 

recreational activities within the facility (99%), special diets (93%), and personal laundry services 

(99%) (data not shown). 

• The provision of occupational and physical therapy increased with size of facility, while the 

provision of skilled nursing services did not vary by facility size (Figure 6). 

• Small RCFs were less likely to provide social services counseling (24%) and case management 

(51%) than larger RCFs. Medium RCFs were also less likely to provide case management (57%) 

than larger RCFs.

• Extra large RCFs were most likely (91%) and medium RCFs were least likely (73%) to offer 

transportation to medical or dental appointments. 

1

A significant upward trend with increasing facility size was observed in the percentage of facilities providing occupational and physical therapy at p < 0.05. 2

Small facilities are significantly different from all other facility sizes at p < 0.05. 3

Medium facilities are significantly different from all other facility sizes at p < 0.05. 4

Extra large facilities are significantly different from all other facility sizes at p < 0.05. 

NOTE: Figure excludes cases with missing data; see "Data sources and methods" for details. 

SOURCE: CDC/NCHS, National Survey of Residential Care Facilities, 2010.

Figure 6. Provision of selected services, by facility size: United States, 2010 Percent

0

20

40

60

80

100

Small (4–10 beds) Medium (11–25 beds) Large (26–100 beds) Extra large (more than 100 beds)

Skilled nursing

services

Transportation to

medical or dental

appointments

Case

management

Social services

counseling

Physical

therapy1

Occupational

therapy1

30

41

53

61

35

44

56

63

42

46 48

66 66

81 82

38 41 38 40

2

24

2

51

3

57

3

73

4

91
NCHS Data Brief ■ No. 78 ■ December 2011

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Summary

RCFs in the United States totaled 31,100 in 2010, with 971,900 state-licensed, certified, or 

registered residential care beds. About one-half of RCFs were small facilities which served 

one-tenth of all RCF residents. The remaining RCFs were medium-sized facilities (16%) which 

served about one-tenth of all RCF residents, large facilities (28%) which served about one-half 

of all RCF residents, and extra large facilities (7%) which housed about three-tenths of all RCF 

residents. RCFs were predominantly for profit (82%), not part of a chain (62%), and located in an 

MSA (81%). Small RCFs were more likely to be for profit than larger RCFs. The proportion of 

chain-affiliated RCFs grew with increasing facility size. Small and extra large RCFs were most 

likely to be located in an MSA, while medium RCFs were least likely to be in an MSA. 

RCFs were most commonly located in the West. The mix of facility sizes varied by region. The 

West had almost twice as many residential care beds per 1,000 persons aged 85 and over as 

the Northeast (245 to 131). Comparing the supply of RCF beds with nursing home beds (data 

compiled by Centers for Medicare & Medicaid Services) shows that the supply of RCF beds 

(245) and nursing home beds (203) per 1,000 persons aged 85 and over was relatively comparable 

in the West, but nursing home beds far outnumbered RCF beds in all other regions. There were 

about twice as many nursing home beds as RCF beds per 1,000 persons aged 85 and over in the 

South (325 to 164), Midwest (390 to 177), and Northeast (303 to 131). More research is needed 

to identify and examine factors that may explain these regional differences in both the supply of 

residential care beds, including variations in state regulation and financing of different types of 

LTC providers, and in consumer preferences for different kinds of long-term services and support.

RCFs serve primarily a private-pay adult population (6). However, the use of Medicaid financing 

for services in residential care settings has gradually increased in recent years (7). About 4 out of 

10 RCFs had at least one resident who had some or all of their LTC services paid by Medicaid. 

The percentage of facilities having residents who received LTC services paid by Medicaid varied 

by facility size. 

Although nearly all RCFs provided basic health monitoring (96%) and incontinence care (93%), 

larger RCFs were more likely than smaller RCFs to offer occupational and physical therapy. 

Larger RCFs were also more likely than small RCFs to provide social services counseling and 

case management. The provision of skilled nursing services did not vary by facility size. 

This report presents national estimates of RCFs using data from the first-ever national probability 

sample survey of RCFs with four or more beds. Findings on differences in selected characteristics 

and services offered by facility size and on regional variations in the supply of beds provide 

useful information to policymakers, LTC providers, and consumer advocates as they plan to meet 

the needs of an aging population. Moreover, these findings establish baseline national estimates as 

researchers continue to track growth and changes in the residential care industry.

Definitions

Facility size: Categorized by four sizes, based on the number of licensed, registered, or certified 

residential care beds (both occupied and unoccupied) in a facility: small (4–10 beds), medium 

(11–25 beds), large (26–100 beds), and extra large (more than 100 beds). 
NCHS Data Brief ■ No. 78 ■ December 2011

■  6  ■

Ownership type: Categorized by two types: 1) private, for profit, and 2) other, which includes 

private nonprofit and state, county, or local government ownership. The private, for-profit 

category includes publicly traded facilities. 

Chain affiliation: Describes facilities owned by a chain, group, or multifacility system. A chain 

is more than one facility under common ownership or management, and may include facilities 

within state or across multiple states. 

Metropolitan statistical area (MSA): Designates a county or group of contiguous counties that 

contains at least one urbanized area of 50,000 or more population. An MSA may contain other 

counties that are economically and socially integrated with the central county, as measured 

by commuting. 

Region: Created by grouping conterminous states into geographic areas corresponding to groups 

used by the U.S. Census Bureau. A listing of states included in each of the four U.S. Census 

regions is available from: http://www.census.gov/geo/www/us_regdiv.pdf. 

Residential care bed: Refers to licensed, registered, or certified residential care beds. The number 

of residential care beds used to calculate beds per 1,000 persons aged 85 and over include both 

occupied and unoccupied beds.

Residents whose long-term care (LTC) services were paid by Medicaid: Residents who had some 

or all of their LTC services paid by Medicaid during the last 30 days. If facilities reported not 

being certified or registered to participate in Medicaid, the facility is coded as having no residents 

receiving LTC services paid by Medicaid.

Skilled nursing services: Services essential to the maintenance or restoration of health that are 

provided to sick or disabled persons by a registered nurse or licensed practical nurse.

Basic health monitoring: Monitoring for a health condition or status like blood pressure, blood 

sugar, and weight.

Social services counseling: Counseling related to obtaining and keeping benefits provided by 

programs such as Supplemental Security Income, Social Security, and Medicaid.

Case management: A process of assessing, planning, and facilitating options and services for 

a person.

Data sources and methods

Facility data from the 2010 National Survey of Residential Care Facilities (NSRCF), conducted 

by the Centers for Disease Control and Prevention’s National Center for Health Statistics, 

Division of Health Care Statistics, were used for these analyses. To be eligible for the study, 

RCFs must be licensed, registered, listed, certified, or otherwise regulated by the state; have 

four or more licensed, certified, or registered beds; have at least one resident currently living in 

the facility; and provide room and board with at least two meals a day, around-the-clock on-site 

supervision, and help with personal care such as bathing and dressing or health-related services 

such as medication management. These facilities serve a predominantly adult population. 

Facilities licensed to serve the mentally ill or developmentally disabled populations exclusively 
NCHS Data Brief ■ No. 78 ■ December 2011

■  7  ■

are excluded. Nursing homes are also excluded unless they have a unit or wing meeting the above 

definition and residents can be separately enumerated.

The 2010 NSRCF used a stratified two-stage probability sample design. The first stage was the 

selection of RCFs from the sampling frame representing the universe of RCFs. The second stage 

was the selection of current residents. For the 2010 NSRCF, 3,605 RCFs were sampled with 

probability proportional to facility size. Interviews were completed with 2,302 facilities, for a 

first-stage facility unweighted response rate of 79% and a weighted response rate (for differential 

probabilities of selection) of 81%. Highlights about residents in RCFs will be provided in 

a forthcoming report. More details about sampling design and data collection are available 

elsewhere (8).

Two other data sources were used to compare the supply of residential care beds with that of 

nursing home beds per 1,000 persons aged 85 and over included in the Summary. 2010 Census 

Summary File 1 was used to estimate the number of persons aged 85 and over in the United 

States. Centers for Medicare & Medicaid Services Online Survey, Certification and Reporting 

(CMS OSCAR) data of December 2010 were used for the number of nursing home beds in the 

United States.

Differences among subgroups were evaluated using chi-square and t tests. If chi-square tests were 

statistically significant, a post hoc t-test procedure was used to make pairwise comparisons of 

different facility sizes (Figures 1–3, 5, and 6). Significant results from the post hoc procedure are 

reported here. Differences between regions were evaluated with t tests for rates per 1,000 persons 

aged 85 and over (Figure 4). All significance tests were two-sided using p < 0.05 as the level of 

significance. Terms such as “no significant differences” are used to denote that the estimates being 

compared are not significantly different statistically. The difference between any two estimates 

is mentioned in the text only if it is statistically significant. Lack of comment regarding the 

difference between any two statistics does not necessarily suggest that the difference was tested 

and found not to be statistically significant. In addition, a weighted least-squares technique was 

used (9) to test linear trends across four facility sizes. A downward or upward trend is mentioned 

if it is statistically significant. Data analyses were performed using the SAS-callable SUDAAN 

version 10.0 statistical package (10). Cases with missing data were excluded from the analyses on 

a variable-by-variable basis. Variables used in this report had a weighted percentage of cases with 

missing data between 0.1% and 0.6%. Because estimates were rounded, individual estimates may 

not sum to totals.

About the authors

Eunice Park-Lee, Christine Caffrey, Manisha Sengupta, Abigail J. Moss, and Lauren D. 

Harris-Kojetin are with the Centers for Disease Control and Prevention’s National Center for 

Health Statistics, Division of Health Care Statistics. Emily Rosenoff is with the Department 

of Health and Human Services, Assistant Secretary for Planning and Evaluation’s Office of 

Disability, Aging, and Long-Term Care Policy. 

References

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Assisted Living. 2011.
NCHS Data Brief ■ No. 78 ■ December 2011

2. Spillman BC, Black KJ. The size and characteristics of the residential 

care population: Evidence from three national surveys. Prepared for U.S. 

Department of Health and Human Services, Assistant Secretary for Planning 

and Evaluation, Office of Disability, Aging, and Long-Term Care Policy. 

Washington, DC: The Urban Institute. 2006.

3. Spillman BC, Black KJ. The size of the long-term care population in 

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and Evaluation, Office of Disability, Aging, and Long-Term Care Policy. 

Washington, DC: The Urban Institute. 2005.

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of Disability, Aging, and Long-Term Care Policy. Washington, DC: RTI 

International. 2007.

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Health Aff 29(1):35–43. 2010.

6. Hawes C, Phillips CD, Rose M, Holan S, Sherman M. A national survey 

of assisted living facilities. Gerontologist 43(6):875–82. 2003.

7. Mollica RL. State Medicaid reimbursement policies and practices in 

assisted living. Prepared for National Center for Assisted Living, American 

Health Care Association. Washington, DC. 2009.

8. Moss AJ, Harris-Kojetin LD, Sengupta M, et al. Design and operation of 

the 2010 National Survey of Residential Care Facilities. National Center for 

Health Statistics. Vital Health Stat 1(54). 2011.

9. Sirken MG, Shimizu BI, French DK, et al. Manual on standards and 

procedures for reviewing statistical reports. Hyattsville, MD: National Center 

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10. SUDAAN, release 10.0 [computer software]. Research Triangle Park, 

NC: RTI International. 2008.

Suggested citation

Park-Lee E, Caffrey C, Sengupta M, 

Moss AJ, Rosenoff E, Harris-Kojetin LD. 

Residential care facilities: A key sector in 

the spectrum of long-term care providers in 

the United States. NCHS data brief, no 78. 

Hyattsville, MD: National Center for Health 

Statistics. 2011.

Copyright information

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the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Edward J. Sondik, Ph.D., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Care Statistics

Clarice Brown, M.S., Director

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