NCHS Data Brief ■ No. 170 ■ November 2014

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Residential care, including assisted living, provides long-term supports and 

services to individuals who cannot live independently but generally do not 

require the skilled level of care provided by nursing homes. In 2012, there 

were 22,200 residential care communities nationwide (1). With the aging of 

the population, residential care will likely continue to be an important part 

of the long-term care system. Using data from the first wave of the National 

Study of Long-Term Care Providers (NSLTCP), this report presents the most 

current national estimates of residential care, and compares selected residential 

care community characteristics by bed size. State-level estimates for the 

characteristics presented in this data brief are available from: http://www.cdc.

gov/nchs/nsltcp/nsltcp_products.htm.

Keywords: assisted living • long-term care • National Study of Long-Term 

Care Providers

In 2012, nearly 6 in 10 residential care communities had 4–25 

beds, but more than 7 in 10 residents lived in communities 

with more than 50 beds.

Key findings 

Data from the National 

Study of Long-Term Care 

Providers, 2012

• In 2012, nearly 6 in 10 

residential care communities 

had 4–25 beds, but more than 

7 in 10 residents lived in 

communities with more than 

50 beds.

• A higher percentage of 

communities with 26–50 beds 

and more than 50 beds were 

chain-affiliated and in operation 

for 10 years or more compared 

with communities with 4–25 

beds.

• Compared with 

communities with 4–25 beds 

and 26–50 beds, a higher 

percentage of communities with 

more than 50 beds screened 

for cognitive impairment or 

provided dementia-specific 

programs. 

• A higher percentage of 

communities with 26–50 beds 

and more than 50 beds provided 

therapeutic, hospice, mental 

health, and dental services 

compared with communities 

with 4–25 beds.

Operating Characteristics of Residential Care Communities, 

by Community Bed Size: United States, 2012

Christine Caffrey, Ph.D.; Lauren Harris-Kojetin, Ph.D.; Vincent Rome, M.P.H.; 

and Manisha Sengupta, Ph.D.

Figure 1. Residential care communities and residents, by community bed size:

United States, 2012

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

SOURCE: National Study of Long-Term Care Providers, 2012. Percent

0

20

40

60

100

80

More than

50 beds

26–50 beds

4–25 beds

Residents

713,300

Communities

22,200

29%

6,400

15%

3,200

57%

12,600

71%

505,700

15%

107,200

14%

100,400
NCHS Data Brief ■ No. 170 ■ November 2014

■  2  ■

• About 57% of communities had 4–25 beds, but these communities housed only 14% of all 

residents (Figure 1).

• Communities with more than 50 beds accounted for 29% of all providers but housed 71% of 

all residents.

• The remaining 15% of communities, those with 26–50 beds, housed 15% of all residents.

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

beds were chain-affiliated, in operation for 10 years or more, and had 

special dementia units or only served dementia patients, compared 

with communities with 4–25 beds. But a smaller percentage of these 

communities were for profit. 

• Seventy-five percent of communities with more than 50 beds were chain-affiliated compared 

with 49% of communities with 4–25 beds (Figure 2).

• As the community size increased, the percentage of communities that were for profit 

decreased. Eighty-six percent of communities with 4–25 beds were for profit compared with 

68% of communities with 26–50 beds and 70% of communities with more than 50 beds. 

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

of communities with more than 50 beds (78%) and 26–50 beds (77%) had been in operation 

for 10 years or more, while 49% of communities with 4–25 beds had been in operation 10 

years or more.

• One-half of communities with more than 50 beds exclusively served residents with dementia 

or had a distinct dementia special care unit or wing, compared with 27% of communities 

with 26–50 beds and 14% of communities with 4–25 beds. 
NCHS Data Brief ■ No. 170 ■ November 2014

■  3  ■

Compared with communities with fewer beds, a higher percentage of 

communities with more than 50 beds screened for cognitive impairment 

and depression.

• Seventy-five percent of communities with more than 50 beds used a standardized tool to 

conduct a formal assessment of residents before or upon admission to identify anyone with 

a cognitive impairment. In comparison, 69% of communities with 26–50 beds and 65% of 

communities with 4–25 beds screened for cognitive impairment (Figure 3). 

• Seventy-six percent of communities with more than 50 beds offered disease-specific 

programs for residents with Alzheimer’s disease and other dementias. In comparsion, 63% 

of communities with 26–50 beds and 65% of communities with 4–25 beds offered dementiaspecific programs.

• A higher percentage of communities with more than 50 beds (22%) screened residents for 

depression with a standardized tool as part of the admission process compared with smaller 

communities with 4–25 beds (17%).

• Communities did not differ by size in their prevalence of offering disease-specific programs 

for residents with depression.

Percent

Figure 2. Selected characteristics among residential care communities, by community bed size: United States, 2012

1

Differences between all community sizes are significant at p < 0.05; increase by size is statistically significant (p < 0.05) based on a weighted least-squares 

regression test. 

2

Differences between communities with 4–25 beds and the other community sizes are significant at p < 0.05; increase or decrease by 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: National Study of Long-Term Care Providers, 2012.

0

20

40

60

80

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

Only serve residents with

dementia or have a distinct

unit, wing, or floor designated

for dementia special care1

In operation for

10 years or more2

For profit Chain-af 2 filiated1

59

49

67

75

78

86

68 70

61

77

49

78

26

14

27

50
NCHS Data Brief ■ No. 170 ■ November 2014

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

beds provided therapeutic, hospice, mental health, and dental services 

compared with communities with 4–25 beds, but a lower percentage of 

communities with more than 50 beds provided skilled nursing services 

than did communities with 4–25 beds. 

• A higher percentage of communities with 26–50 beds (92%) and more than 50 beds (94%) 

provided any therapeutic services compared with 85% of communities with 4–25 beds 

(Figure 4).

• A higher percentage of communities with 26–50 beds (91%) and more than 50 beds (95%) 

provided hospice services compared with 86% of communities with 4–25 beds. 

• A higher percentage of communities with 26–50 beds (80%) and more than 50 beds (86%) 

provided mental health services compared with 73% of communities with 4–25 beds.

• A higher percentage of communities with 26–50 beds (71%) and more than 50 beds (72%) 

provided routine and emergency dental services compared with 63% of communities with 

4–25 beds.

• A higher percentage of communities with 4–25 beds (77%) and 26–50 beds (78%) provided 

skilled nursing services compared with 73% of communities with more than 50 beds.

Percent

Figure 3. Screening and disease-specific programs for Alzheimer’s disease or other dementias and depression among 

residential care communities, by community bed size: United States, 2012

1

Differences between communities with more than 50 beds and the other community sizes are significant at p < 0.05; increase by size is statistically significant 

(p < 0.05) based on a weighted least-squares regression test. 2

Differences between communities with 4–25 beds and communities with more than 50 beds are significant at p < 0.05; increase by size is statistically significant 

(p < 0.05) based on a weighted least-squares regression test. 3

Differences between communities not significant at p < 0.05. 

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

SOURCE: National Study of Long-Term Care Providers, 2012.

Depression programs Alzheimer's or other Depression screening2 3

dementia programs1

Cognitive impairment

 screening1

0

20

40

60

80

100

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

65

69

75

68

65 63

76

19 17

20 22

57 58 57

54

68
NCHS Data Brief ■ No. 170 ■ November 2014

■  5  ■

Summary

In 2012, the majority of residential care communities had 4–25 beds, yet 71% of residents lived 

in communities with more than 50 beds. A lower percentage of communities with 4–25 beds 

were chain-affiliated, nonprofit, and in operation 10 years or more, compared with communities 

with 26–50 and more than 50 beds. Dementia-exclusive care or dementia care units were more 

common as community size increased. A higher percentage of communities with more than 50 

beds screened for cognitive impairment and offered dementia-specific programming compared 

with communities with 4–25 and 26–50 beds. A higher percentage of communities with more 

than 50 beds screened for depression compared with communities with 4–25 beds. Compared 

with communities with 4–25 beds, a higher percentage of communities with 26–50 beds and 

more than 50 beds provided therapeutic, hospice, mental health, and dental services; but a lower 

percentage of communities with more than 50 beds provided skilled nursing services than did 

smaller communities.

This report presents national estimates of residential care communities, using data from the first 

wave of NSLTCP. This brief profile of residential care communities 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 different sizes. Corresponding state estimates and their standard errors for the national 

Figure 4. Provision of selected services among residential care communities, by community bed size: United States, 2012

1

Differences between communities with 4–25 beds and the other community sizes are significant at p < 0.05; increase by size is statistically significant (p < 0.05) 

based on a weighted least-squares regression test. 

2

Differences between all community sizes are significant at p < 0.05; increase by size is statistically significant (p < 0.05) based on a weighted least-squares 

regression test. 

3

Differences between communities with more than 50 beds and the other community sizes are significant at p < 0.05; decrease by size is statistically significant

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

NOTES: Services could be provided directly by residential care community employees, by others through arrangement, or both. Figure excludes cases with 

missing data; see "Data source and methods" for details. 

SOURCE: National Study of Long-Term Care Providers, 2012.

More than

50 beds

26–50 beds

4–25 beds

All communities

Routine and

emergency

dental1

Therapeutic1

0 20 40 60 80 100

Hospice2

Mental health2

Skilled nursing3

89

85

92

94

89

86

91

95

78

73

80

86

76

77

78

73

67

63

71

72
NCHS Data Brief ■ No. 170 ■ November 2014

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figures in this data brief can be found on the NSLTCP website at http://www.cdc.gov/nchs/nsltcp/

nsltcp_products.htm. These national and state estimates establish a baseline for monitoring trends 

among residents living in residential care.

Definitions

Any therapeutic services: Includes physical, occupational, or speech therapy. 

Chain affiliation: Having more than one residential care community under common ownership 

or management. This may include communities in the same state or across multiple states. If 

communities were owned by a chain, group, or multicenter system, they were coded as chainaffiliated.

Cognitive impairment screening: Before or upon admission, the residential care community uses 

a standardized tool to conduct a formal assessment of its residents to identify anyone with a 

cognitive impairment.

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, 26–50, and more 

than 50 beds. 

Depression screening: Refers to whether, as part of the admission process, the residential care 

community screens residents for depression with a standardized tool, such as the Geriatric 

Depression Scale, Beck Depression Inventory, or the Center for Epidemiological StudiesDepression scale.

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

include one or more of the following services: medication management, educational, physical 

activity, diet or nutrition, and weight management programs.

Mental health services: Services that target residents’ mental, emotional, psychological, or 

psychiatric well-being and include diagnosing, describing, evaluating, and treating mental 

conditions.

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. 

Provision of services: Refers to whether residential care communities provided therapeutic, 

hospice, mental health, skilled nursing, and dental services. These services could be provided by 

residential care community employees, by others through arrangement, or by both. 

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

(e.g., personal care homes, adult care homes, board care homes, and adult foster care) that meet 

the study eligibility criteria; see “Data source and methods.”

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

Skilled nursing services: Services that must be performed by a registered nurse or a licensed 

practical nurse and are medical in nature.
NCHS Data Brief ■ No. 170 ■ November 2014

■  7  ■

Data source and methods

These analyses used data from the residential care community component of the 2012 NSLTCP, 

which is conducted by the Centers for Disease Control and Prevention’s National Center for 

Health Statistics (NCHS). NCHS intends to conduct NSLTCP every 2 years.

To be eligible for the study, a residential care community must have:

• Been licensed, registered, listed, certified, or otherwise regulated by the state to: 

• Provide room and board with at least two meals a day and around-the-clock, onsite 

supervision

• Help with personal care such as bathing and dressing or health-related services such as 

medication management

• Had four or more licensed, certified, or registered beds

• Had at least one resident currently living in the community

• Served a predominantly adult population 

Residential care communities licensed to exclusively serve individuals with severe mental illness 

or intellectual or developmental disabilities were excluded. Nursing homes were also excluded. 

The 2012 NSLTCP used a combination of probability sampling and census-taking. Probability 

samples were selected in the states that had sufficient numbers of residential care communities to 

enable state-level, sample-based estimation. A census was taken of residential care communities 

in the states that did not have sufficient numbers of communities or where the number of 

communities needed for a sample was very close to the total number of communities. From 

39,779 communities in the sampling frame, 11,690 residential care communities were sampled 

and stratified by state and facility bed size. Data were collected through three modes: selfadministered, hard-copy questionnaires; self-administered Web questionnaires; and computerassisted telephone interviews conducted by interviewers. The questionnaire was completed for 

4,694 communities, for a weighted response rate (for differential probabilities of selection) of 

55.4%. State-level response rates ranged from 40.4% in Michigan to 84.0% in Wyoming.

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. Significant results from the post hoc procedure are reported here. 

A weighted least-squares regression method was used to test the significance of trends. All 

significance tests were two-sided using p < 0.05 as the level of significance. The difference 

between any two estimates is mentioned in the text only if it is statistically significant. 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 LLP, 2013). 

Cases with missing data were excluded from the analyses on a variable-by-variable basis. The 

percent missing ranged from 0.2% for chain affiliation to 6.4% for depression screening. Because 

estimates were rounded, individual estimates may not sum to totals.
NCHS Data Brief ■ No. 170 ■ November 2014

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For more NCHS Data Briefs, visit:

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The estimate of the number of residential care communities varied between 

the 2010 National Survey of Residential Care Facilities and the 2012 

NSLTCP (2). For more details, see Chapter 5 of “Long-Term Care Services 

in the United States: 2013 Overview” at http://www.cdc.gov/nchs/data/

nsltcp/long_term_care_services_2013.pdf.

About the authors

Christine Caffrey, Lauren Harris-Kojetin, Vincent Rome, and Manisha 

Sengupta are with CDC’s National Center for Health Statistics, Division of 

Health Care Statistics. 

References

1. Harris-Kojetin L, Sengupta M, Park-Lee E, Valverde, R. Long-term care 

services in the United States: 2013 overview. National health care statistics 

reports; no 1. Hyattsville, MD: National Center for Health Statistics. 2013.

2. Park-Lee E, Caffrey C, Sengupta M, Moss AJ, Rosenoff E, HarrisKojetin LD. Residential care facilities: A key sector in the spectrum of longterm care providers in the United States. NCHS data brief, no 78. Hyattsville, 

MD: National Center for Health Statistics. 2011.

Suggested citation

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.

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

Clarice Brown, M.S., Director