NCHS Data Brief ■ No. 222 ■ November 2015

u.s. department of health and human services

Centers for Disease Control and Prevention

National Center for Health Statistics

Assisted living and similar residential care communities provide services 

to individuals who cannot live independently but generally do not require 

the skilled level of care provided by nursing homes. In 2014, there were 

30,200 residential care communities nationwide (1). This report presents 

the most current national estimates of residential care community operating 

characteristics and compares these characteristics by community bed size. 

State-level estimates for the characteristics presented in this report are 

available from http://www.cdc.gov/nchs/nsltcp/nsltcp_products.htm.

Keywords: assisted living • long-term care • long-term services and supports 

• National Study of Long-Term Care Providers

In 2014, more than 6 in 10 residential care communities had 

4–25 beds, but nearly 7 in 10 residents lived in communities 

with more than 50 beds.

Key findings

Data from the 2014 

National Study of 

Long-Term Care Providers

● More than 6 in 10 residential 

care communities had 4–25 

beds, but nearly 7 in 10 

residents lived in communities 

with more than 50 beds.

● As community bed size 

increased, chain affiliation 

increased.

● Compared with communities 

with more beds, a higher 

percentage of communities 

with 4–25 beds offered 

disease-specific programs 

for residents with diabetes, 

cardiovascular disease, and 

depression.

● The use of electronic health 

records and computerized 

support for any electronic 

health information exchange 

increased as community bed 

size increased.

 Variation in Operating Characteristics of Residential Care 

Communities, by Size of Community: United States, 2014 

Christine Caffrey, Ph.D.; Lauren Harris-Kojetin, Ph.D.; and Manisha Sengupta, Ph.D.

NOTES: Percentages are based on unrounded numbers. Estimates may not add up to totals because of rounding. 

SOURCE: CDC/NCHS, National Study of Long-Term Care Providers, 2014.

3.9

3.6*

Communities

30,200

More than 50 beds 26–50 beds 4–25 beds

Residents

835,200

24%

7,300

13%

4,000

63%

19,000

68%

565,700

14%

129,100

17%

140,400

Percent

0

20

60

40

100

80

Figure 1. Number and percentage of residential care communities and residents, by community 

bed size: United States, 2014
NCHS Data Brief ■ No. 222 ■ November 2015

■ 2  ■

● Sixty-three percent of communities had 4–25 beds, but these communities housed only 17% 

of all residents (Figure 1).

● Communities with more than 50 beds accounted for 24% of all providers but housed 68% of 

all residents. 

● The remaining 13% of communities, those with 26–50 beds, housed 14% of all residents. 

As community bed size increased, chain affiliation increased.

● Eighty-seven percent of communities with 4–25 beds were for-profit compared with 70% of 

communities with 26–50 beds and 76% of communities with more than 50 beds (Figure 2).

● Smaller communities tended to be newer than larger communities. More than three-fourths 

of communities with more than 50 beds (79%) and 26–50 beds (77%) had been in operation 

for 10 or more years compared with 50% of communities with 4–25 beds.

● Seventy-four percent of communities with more than 50 beds were chain-affiliated 

compared with 65% of communities with 26–50 beds and 47% of communities with 4–25 

beds.

Percent

1

Differences among communities with 4–25 beds, 26–50 beds, and more than 50 beds are significant at p < 0.05. 2

Differences between communities with 4–25 beds and the other community bed sizes are significant at p < 0.05. 3

Differences among communities with 4–25 beds, 26–50 beds, and more than 50 beds are significant at p < 0.05, and increase by bed size is statistically 

significant (p < 0.05) based on a weighted least-squares regression test.

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

SOURCE: CDC/NCHS, National Study of Long-Term Care Providers, 2014.

0

20

40

80

100

60

For-profit1 In operation for 10

or more years2

Chain-affiliated3

All communities 4–25 beds 26–50 beds More than 50 beds

82

87

70

76

61

50

77 79

56

47

65

74

Figure 2. Selected residential care community operating characteristics, by community bed size: United States, 2014
NCHS Data Brief ■ No. 222 ■ November 2015

■  3  ■

Compared with communities with more beds, a higher percentage of 

communities with 4–25 beds offered disease-specific programs for 

diabetes, cardiovascular disease, and depression.

● Sixty-seven percent of communities with more than 50 beds offered disease-specific 

programs for residents with Alzheimer’s disease and other dementias, whereas fewer 

communities with 26–50 beds (53%) and 4–25 beds (56%) did so (Figure 3). 

● Sixty-one percent of communities with 4–25 beds offered diabetes-specific programming, 

whereas fewer communities with 26–50 beds (50%) and more than 50 beds (56%) did so.

● More than one-half of communities with 4–25 beds (56%) offered cardiovascular 

disease-specific programming, whereas fewer communities with 26–50 beds (45%) and 

more than 50 beds (46%) did so.

● The majority of communities with 4–25 beds (52%) offered depression-specific 

programming, whereas a minority of communities with 26–50 beds (39%) and more than 50 

beds (42%) did so.

Percent

1

Differences between communities with more than 50 beds and the other community bed sizes are significant at p < 0.05. 2

Differences among communities with 4–25 beds, 26–50 beds, and more than 50 beds are significant at p < 0.05. 3

Differences between communities with 4–25 beds and the other community bed sizes are significant at p < 0.05. 

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

SOURCE: CDC/NCHS, National Study of Long-Term Care Providers, 2014.

0

20

40

80

60

Alzheimer’s disease 

or other dementias1

Diabetes2 Cardiovascular

disease3

Depression3

58 56

53

67

58

61

50

56

52

56

45 46 48

52

39

42

All communities 4–25 beds 26–50 beds More than 50 beds

Figure 3. Disease-specific programs offered for selected conditions among residential care communities, by community 

bed size: United States, 2014
NCHS Data Brief ■ No. 222 ■ November 2015

■  4  ■

The use of electronic health records and computerized support for 

electronic health information exchange with physicians, pharmacies, or 

hospitals increased as community bed size increased.

● Almost one-third of communities with more than 50 beds (32%) used electronic health 

records compared with 26% of communities with 26–50 beds and 12% of communities with 

4–25 beds (Figure 4).

● Twenty-nine percent of communities with more than 50 beds had computerized support for 

electronic health information exchange with physicians, pharmacies, or hospitals compared 

with 21% of communities with 26–50 beds and 16% of communities with 4–25 beds.

Percent

1

Community's computerized system supports electronic health information exchange with physicians, pharmacies, or hospitals. 

NOTES: Differences among communities with 4–25 beds, 26–50 beds, and more than 50 beds are significant at p < 0.05, and increase by bed size is statistically 

significant (p < 0.05) based on a weighted least-squares regression test. Figure excludes cases with missing data; see "Data source and methods" for details. 

SOURCE: CDC/NCHS, National Study of Long-Term Care Providers, 2014.

0

5

10

15

25

20

35

30

Used electronic health records Support for any electronic health

information exchange1

All communities 4–25 beds 26–50 beds More than 50 beds

19

12

26

32

20

16

21

29

Figure 4. Use of electronic health records and support for electronic health information exchange among residential care 

communities, by community bed size: United States, 2014
NCHS Data Brief ■ No. 222 ■ November 2015

■ 5  ■

Summary 

In the United States in 2014, the majority of residential care communities had 4–25 beds, yet 68% 

of residents lived in communities with more than 50 beds. Chain affiliation was more common as 

community size increased. A higher percentage of communities with 4–25 beds offered diabetes, 

cardiovascular disease, and depression-specific programming compared with communities 

with more than 25 beds. The use of electronic health records and computerized support for any 

electronic health information exchange with physicians, pharmacies, or hospitals increased as 

community bed size increased.

This brief profile of residential care communities in 2014 provides useful information to 

policymakers, providers, researchers, and consumer advocates as they plan to meet the needs of 

an aging population. The findings also highlight the diversity of residential care communities 

across their different sizes. Corresponding state estimates and their standard errors for the national 

figures in this report can be found at http://www.cdc.gov/nchs/nsltcp/nsltcp_products.htm. 

Definitions

Chain affiliation: Ownership by a person, group, or organization owning or managing two or 

more residential care communities, including corporate chains.

Community bed size: Based on the number of licensed, registered, or certified residential care 

beds (both occupied and unoccupied) in a residential care community: 4–25 beds, 26–50 beds, 

and more than 50 beds. 

Disease-specific programs: Programs that target residents with a specific diagnosis and may 

include one or more of the following services: education, physical activity, diet or nutrition, 

medication management, and weight management.

Electronic health records: A computerized version of the resident’s health and personal 

information used in the management of the resident’s health care. 

Electronic health information exchange system: A computerized system that supports electronic 

health information exchange with physicians, pharmacies, or hospitals. Faxing was excluded. 

Ownership type: Categorization of residential care communities into two ownership types: 

private, for-profit; and nonprofit. The private, for-profit category includes publicly traded 

communities and limited liability communities. Nonprofit includes private nonprofit, as well as 

federal, state, county, and local government ownership. 

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

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

that meet the study eligibility criteria provided in “Data source and methods.”

Residential care bed: Refers to licensed, registered, or certified residential care beds.
NCHS Data Brief ■ No. 222 ■ November 2015

■  6  ■

Data source and methods 

Data are from the residential care community survey component of the 2014 wave of the biennial 

National Study of Long-Term Care Providers (NSLTCP). To be eligible for the study, a residential 

care community must: be regulated by the state to provide room and board with at least two 

meals a day, around-the-clock onsite supervision, and help with personal care such as bathing and 

dressing or health-related services such as medication management; have four or more licensed, 

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

time of the survey; and, serve a predominantly adult population. Excluded were residential care 

communities licensed to exclusively serve individuals with severe mental illness or intellectual or 

developmental disability. Nursing homes were also excluded. The survey used a combination of 

probability sampling and taking a census. More details about the NSLTCP residential care survey 

design and outcomes are published elsewhere (1,2). 

The percentage of cases with missing data for variables in this report ranged from 1.7% for type 

of ownership to 7.4% for computerized support for electronic health information exchange with 

hospitals. These cases were excluded from the analyses on a variable-by-variable basis. 

Data analyses were performed using SAS version 9.3, SAS-callable SUDAAN version 11.0.0 

statistical package (RTI International, 2012), and STATA/SE 12.1 (StataCorp LP, 2013). 

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

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

between different community bed sizes. A weighted least-squares regression method was used to 

test the significance of linear trends in bed size. All significance tests were two-sided using 

p < 0.05 as the level of significance. The difference between any two estimates were mentioned in 

the text only if it was statistically significant. Lack of comment regarding the difference between 

any two statistics does not necessarily suggest that the difference was tested and found to be not 

statistically significant. The estimate of the number of residential care communities and residents 

varied among the 2010 National Survey of Residential Care Facilities, and the 2012 and 2014 

waves of NSLTCP (1–6). 
NCHS Data Brief ■ No. 222 ■ November 2015

■  7  ■

About the authors

Christine Caffrey, Lauren Harris-Kojetin, and Manisha Sengupta are with CDC’s National Center 

for Health Statistics, Division of Health Care Statistics.

References

1. NCHS. 2014 National Study of Long-Term Care Providers. Survey methodology and 

documentation. Available from: http://www.cdc.gov/nchs/data/nsltcp/NSLTCP_2014_survey_ 

methodology_and_documentation.pdf.

2. NCHS. 2014 National Study of Long-Term Care Providers residential care communities 

survey restricted data file data description and usage. Available from: http://www.cdc.gov/ 

nchs/data/nsltcp/NSLTCP_2014_RCC_Readme_RDC_Release.pdf.

3. Caffrey C, Harris-Kojetin L, Rome V, Sengupta M. Operating characteristics of residential 

care communities, by community bed size: United States, 2012. NCHS data brief, no 170. 

Hyattsville, MD: National Center for Health Statistics. 2014.

4. Caffrey C, Harris-Kojetin L, Rome V, Sengupta M. Characteristics of residents living in 

residential care communities, by community bed size: United States, 2012. NCHS data brief, 

no 171. Hyattsville, MD: National Center for Health Statistics. 2014. 

5. Park-Lee E, Caffrey C, Sengupta M, et al. 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.

6. Caffrey C, Sengupta M, Park-Lee E, et al. Residents living in residential care facilities: 

United States, 2010. NCHS data brief, no 91. Hyattsville, MD: National Center for Health 

Statistics. 2012.
NCHS Data Brief ■ No. 222 ■ November 2015

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Suggested citation 

Caffrey C, Harris-Kojetin L, Sengupta M. 

Variation in operating characteristics of 

residential care communities, by size of 

community: United States, 2014. NCHS 

data brief, no 222. Hyattsville, MD: National 

Center for Health Statistics. 2015.

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

Nathaniel Schenker, Ph.D., Deputy Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Care Statistics

Clarice Brown, M.S., Director

Alexander Strashny, Ph.D., Associate 

Director for Science