NCHS Data Brief ■ No. 299 ■ February 2018

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Variation in Residential Care Community Resident 

Characteristics, by Size of Community: United States, 2016

Christine Caffrey, Ph.D., and Manisha Sengupta, Ph.D.

Key findings

Data from the National 

Study of Long-Term

Care Providers

● More residents in residential

care communities with more

than 25 beds were aged 85 and

over compared with smaller

communities.

● A higher percentage of

residents in communities with

4–25 beds were receiving

Medicaid compared with

residents in larger communities.

● The prevalence of Alzheimer

disease and depression was

higher among residents of

communities with 4–25 beds

than in larger communities,

but the prevalence of

cardiovascular disease was

lower.

● The percentage of residents

needing assistance with

bathing, dressing, toileting,

transferring, walking, or eating

was highest in communities

with 4–25 beds.

● The percentage of residents

who had fallen in the previous

90 days increased with

increasing community bed size.

Residents of residential care communities are persons who cannot live 

independently but generally do not require the skilled care provided by nursing 

homes. On any given day in 2016, an estimated 811,500 residents were in 

residential care communities (1,2). As the population ages, the numbers in 

residential care communities will likely increase, creating a sizeable group 

within the long-term care population. This report presents national estimates 

of selected characteristics of residential care community residents in 2016 and 

compares them by community size. State-level estimates are available from: 

https://www.cdc.gov/nchs/nsltcp/nsltcp_products.htm.

Keywords: assisted living • long-term services and supports • National Study 

of Long-Term Care Providers 

In 2016, residents in larger communities were older than 

those in smaller communities.

Figure 1. Age distribution of residential care residents, by community size: United States, 2016

1

Significantly increasing linear trend by community size.

2

Significantly decreasing linear trend by community size. 

NOTES: Percentages are based on unrounded numbers; estimates may not add up to totals because of rounding. Access data 

table for Figure 1 at: https://www.cdc.gov/nchs/data/databriefs/db299_table.pdf#1. 

SOURCE: NCHS, National Study of Long-Term Care Providers, 2016. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
NCHS Data Brief ■ No. 299 ■ February 2018

■ 2 ■

● Overall, the majority of residents of residential care communities (52%) were aged 85 and 

over (Figure 1).

● In 2016, 16% of residents living in residential care communities with 4–25 beds were under 

age 65, compared with 4% in communities with more than 50 beds.

● Residents aged 85 and over made up a higher percentage in communities with more than 50 

beds (54%) than in communities with 4–25 beds (44%).

A higher percentage of residents in communities with 4–25 beds were 

receiving Medicaid compared with residents in larger communities. 

● The percentage of residents receiving Medicaid decreased with increasing bed size. 

Twenty-five percent of residents in communities with 4–25 beds had at least some

services paid by Medicaid, compared with 18% of residents in communities with 

26–50 beds and 14% in communities with more than 50 beds (Figure 2).

● Overall, 71% of residents in residential care communities were female. The percentage of 

females was lower in communities with 4–25 beds (67%) than in communities with 26–50 

beds (72%) or more than 50 beds (71%).

● Eighty percent of residents in communities with 4–25 beds or more than 50 beds were 

non-Hispanic white, compared with 88% in communities with 26–50 beds.

Figure 2. Selected characteristics of residential care residents, by community size: United States, 2016 

 

 

 

 

 

 

 

 

 

 

1

Significantly increasing linear trend by community size.

2

Significantly difference between communities with 26–50 beds and other community sizes (p < 0.05).

3

Significantly decreasing linear trend by community size

NOTES: For the Medicaid variable, cases with missing data are excluded; see "Data source and methods" for details. Access data table for Figure 2 at: 

https://www.cdc.gov/nchs/data/databriefs/db299_table.pdf#2. 

SOURCE: NCHS, National Study of Long-Term Care Providers, 2016.

 

 

 

 

 

 

 

 
NCHS Data Brief ■ No. 299 ■ February 2018

■ 3 ■

The prevalence of Alzheimer disease and depression was higher among 

residents in communities with 4–25 beds than in larger communities.

● Overall, about 4 in 10 residents were diagnosed with Alzheimer disease or other dementias 

(42%), about 3 in 10 were diagnosed with heart disease (34%) or depression (31%), and 

nearly 2 in 10 were diagnosed with diabetes (18%) (Figure 3).

● The percentage of residents with Alzheimer disease and other dementias decreased with 

increasing community size, from 51% of residents in communities with 4–25 beds to 44% in 

communities with 26–50 beds and to 39% in larger communities.

● A higher percentage of residents in communities with 26–50 beds and more than 50 beds 

(35% each) had heart disease compared with residents in smaller communities (32%).

● A higher percentage of residents in communities with 4–25 beds had ever been diagnosed 

with depression (37%) compared with residents in communities with 26–50 beds (32%) or 

more than 50 beds (29%).

Figure 3. Selected diagnosed medical conditions among residential care residents, by community size: 

United States, 2016

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

Significantly decreasing linear trend by community size.

2

Significantly increasing linear trend by community size.

NOTES: Cases with missing data are excluded. Heart disease, depression, and diabetes each had 13% missing; see "Data source and methods" for details. 

Changes in question wording may have contributed to a difference in estimates from earlier National Study of Long-Term Care Providers surveys. Access data 

table for Figure 3 at: https://www.cdc.gov/nchs/data/databriefs/db299_table.pdf#3. 

SOURCE: NCHS, National Study of Long-Term Care Providers, 2016.
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■ 4 ■

The percentage of residents needing assistance with bathing, dressing, 

toileting, transferring, walking, or eating was highest in communities with 

4–25 beds. 

● Overall, 64% of residents needed assistance with bathing, the most frequent functional 

limitation among residents (Figure 4), and this percentage decreased with increasing 

community bed size. Of those in communities with 4–25 beds, 76% needed help with 

bathing compared with 60% of those in communities with more than 50 beds.

● The need for eating assistance decreased with increasing community bed size, from 34% 

of residents in communities with 4–25 beds to 16% of residents in communities with more 

than 50 beds.

● The need for assistance with walking, dressing, toileting, and transferring in or out of bed 

or a chair was higher for residents in communities with 4–25 beds compared with larger 

communities. 

Figure 4. Need for assistance with selected activities of daily living among residential care residents, by community 

size: United States, 2016

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

Significantly decreasing linear trend by community size.

NOTES: Cases with missing data are excluded; see "Data source and methods" for details. Changes in question wording may have contributed to a 

difference in estimates from earlier National Study of Long-Term Care Providers surveys. Access data table for Figure 4 at: 

https://www.cdc.gov/nchs/data/databriefs/db299_table.pdf#4. 

SOURCE: NCHS, National Study of Long-Term Care Providers, 2016.
NCHS Data Brief ■ No. 299 ■ February 2018

■ 5 ■

The percentage of residents who had fallen in the previous 90 days 

increased with increasing community bed size.

● Overall, about 2 in 10 residents in residential care communities had a fall in the previous 

90 days (22%). The percentage increased with increasing community bed size, from 12% 

of residents in communities with 4–25 beds to 24% in communities with more than 50 beds 

(Figure 5).

● Fourteen percent of residents in residential care communities visited a hospital emergency 

department in the previous 90 days.

● A slightly higher percentage of residents in communities with 26–50 beds and more than 

50 beds were discharged from overnight hospital stays in the previous 90 days (9% each) 

compared with residents in communities with 4–25 beds (7%). 

Figure 5. Falls, emergency department visits, and discharges from overnight hospital stays among residential care

residents, by community size: United States, 2016

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

Significantly increasing linear trend by community size.

NOTES: Cases with missing data are excluded; see "Data source and methods" for details. Access data table for Figure 5 at: 

https://www.cdc.gov/nchs/data/databriefs/db299_table.pdf#5. 

SOURCE: NCHS, National Study of Long-Term Care Providers, 2016.
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Summary

In 2016 in the United States, the resident population living in residential care communities with 

4–25 beds differed from the resident population living in larger residential care communities in a 

variety of sociodemographic, functional and health status, and service utilization characteristics. 

Compared with residents in communities with more than 25 beds, a higher percentage of residents 

in 4– to 25–bed communities were younger; receiving Medicaid; living with Alzheimer disease 

or other dementias, or depression; and needing assistance with each of the six activities of daily 

living examined. Conversely, compared with residents in communities with more than 25 beds, 

a lower percentage of residents in communities with 4–25 beds were female, living with heart 

disease, or had fallen or had an overnight hospital stay in the previous 90 days. 

This report presents the most current national estimates of selected characteristics of residents in 

residential care communities and compares these characteristics by bed size. This brief profile 

of residential care residents provides information to policy makers, providers, researchers, 

and consumer advocates as they plan how best to meet the needs of an aging population. 

Corresponding state estimates, and their standard errors, for the national figures in this data brief 

can be found at: https://www.cdc.gov/nchs/nsltcp/nsltcp_products.htm.

Definitions

Assistance with selected activities of daily living (ADLs): Refers to residents needing any help 

or supervision from another person, or use of assistive devices, with up to six limitations in 

ADLs (bathing; walking or locomotion—includes using a cane, walker, or wheelchair, or help 

from another person; dressing; transferring in and out of a bed or chair; toileting; and eating) that 

reflect a resident’s capacity for self-care.

Community bed size: Residents were grouped based on the number of licensed, registered, or 

certified residential care beds (both occupied and unoccupied) in their residential care community: 

4–25 beds, 26–50 beds, and more than 50 beds. 

Emergency department visits: Includes residents who were treated at least once in a hospital 

emergency department in the 90 days prior to the survey.

Falls: Includes residents with at least one on-site or off-site fall in the 90 days prior to the survey. 

Heart disease: Includes conditions such as congestive heart failure, coronary or ischemic heart 

disease, heart attack, and stroke.

Overnight hospital stays: Includes residents with at least one discharge from an overnight hospital 

stay in the 90 days prior to the survey. Trips to the emergency department that did not result in a 

discharge from an overnight hospital stay were excluded.

Residential care communities: Includes assisted living communities and other residential care 

communities (e.g., personal care homes, adult care homes, board care homes, or adult foster care) 

that meet the study eligibility criteria described in “Data source and methods.”
NCHS Data Brief ■ No. 299 ■ February 2018

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Residents with some or all long-term care services paid by Medicaid: Refers to residents who 

had some or all of their long-term care services paid by Medicaid during the 30 days prior to the 

survey. 

Data source and methods

Data for this report are from the Residential Care Community Survey component of the 2016 

wave of the biennial National Study of Long-Term Care Providers (NSLTCP), conducted by the 

National Center for Health Statistics. To be eligible for the study, a residential care community 

must (a) be regulated by the state to 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 with health-related services such as medication management; (b) have four or more licensed, 

certified, or registered beds; (c) have at least one resident currently living in the community 

at the time of the survey; and (d) serve a predominantly adult population. The survey used a 

combination of probability sampling and taking a census. More details about the NSLTCP design 

and outcomes are available elsewhere (1,2). The percentage of cases with missing data for 

variables in this report ranged from 2.7% for receiving Medicaid to about 13% for heart disease, 

depression, and diabetes. These cases were excluded from the analyses on a variable-by-variable 

basis. If the percentage missing was higher than 10%, it is noted in the data. 

Data analyses were performed using the following statistical packages: SAS, version 9.3 (SAS 

Institute, Cary, N.C.); SAS-callable SUDAAN, version 11.0.0 (RTI International, Research 

Triangle Park, N.C., 2012); and STATA/SE, version 12.1 (StataCorp, College Station, Texas, 

2013). Statements of differences among subgroups are based on two-tailed chi-square and t tests 

with significance at the p < 0.05 level. If a chi-square test was statistically significant, a post hoc 

t test procedure was used to make pairwise comparisons among different community bed sizes. A

weighted least-squares regression method was used to test the significance of linear trends in bed 

size. The estimate of the number of residential care communities and residents varied among the 

2010 National Survey of Residential Care Facilities and the 2012–2016 waves of NSLTCP (1,2). 

About the authors

Christine Caffrey and Manisha Sengupta are with the National Center for Health Statistics, 

Division of Health Care Statistics, Long-Term Care Statistics Branch.

References

1. National Center for Health Statistics. 2016 National Study of Long-Term Care Providers 

survey methodology for the Adult Day Services Center and Residential Care Community 

components. Hyattsville, MD. 2017. Available from: https://www.cdc.gov/nchs/data/nsltcp/

NSLTCP_2016_survey_methodology_documentation.pdf. 

2. National Center for Health Statistics. 2016 National Study of Long-Term Care Providers 

(NSLTCP) Residential Care Communities Survey restricted data file: Data description and 

usage (readme). Hyattsville, MD. 2017. Available from: https://www.cdc.gov/nchs/data/nsltcp/

NSLTCP_2016_RCC_Readme_RDC.pdf. 
NCHS Data Brief ■ No. 299 ■ February 2018

Suggested citation

Caffrey C, Sengupta M. Variation in 

residential care community resident 

characteristics, by size of community: 

United States, 2016. NCHS Data Brief, no 

299. Hyattsville, MD: National Center for 

Health Statistics. 2018.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Care Statistics

Denys T. Lau, Ph.D., Acting Director

Alexander Strashny, Ph.D., Associate 

Director for Science

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