NCHS Data Brief ■ No. 134 ■ November 2013

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Dementia Special Care Units in Residential Care 

Communities: United States, 2010

Eunice Park-Lee, Manisha Sengupta, and Lauren D. Harris-Kojetin

Key findings

• In 2010, 17% of residential 

care communities had dementia 

special care units.

• Beds in dementia special 

care units accounted for 13% of 

all residential care beds. 

• Residential care communities 

with dementia special care 

units were more likely than 

those without to have more 

beds, be chain-affiliated, and be 

purposely built as a residential 

care community, and less likely 

to be certified or registered to 

participate in Medicaid.

• Residential care communities 

with dementia special care units 

were more likely than those 

without to be located in the 

Northeast and in a metropolitan 

statistical area, and less likely 

to be in the West.

Assisted living and similar residential care communities provide an alternative 

to nursing homes for individuals with dementia who can no longer live 

independently. In 2010, about 42% of individuals living in residential care 

communities had Alzheimer’s disease or other dementia (1). Individuals 

with dementia can live in residential care communities that have dementia 

special care units, or in a more traditional setting where these residents are 

integrated with residents without dementia (2). Many states require residential 

care communities with dementia special care units to have certain physical 

features (e.g., locked door) and specially trained staff to care for residents with 

dementia (3). This report compares residential care communities with and 

without dementia special care units. 

Keywords: dementia care • assisted living • long-term care • National Survey 

of Residential Care Facilities

Seventeen percent of residential care communities had 

dementia special care units. 

0

20

40

60

80

100

Figure 1. Number and percent distribution of residential care communities and beds, by

dementia special care unit status: United States, 2010

NOTES: Figure excludes cases with missing data; see "Data source and methods" for details. Estimates may not add to totals 

because of rounding. Percentages are based on the unrounded numbers. 

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

Communities

with dementia

special care

units

Beds not in

dementia special 

care units

Beds in dementia

special care units

Communities 

without dementia

special care units

Communities with

a unit, wing, or

floor designated

as a dementia

special care unit

Communities only

serving adults with

dementia

22% (216,100)

65% (629,100)

8% (77,100)

6% (2,000) 5% (49,600)

11% (3,400)

83% (25,700)

All communities

(31,100)

All beds

(971,900)
NCHS Data Brief ■ No. 134 ■ November 2013

■  2  ■

• Approximately 6% of residential care communities only served adults with Alzheimer’s 

disease or other dementia. Residential care communities that only served adults with 

dementia accounted for 36% of residential care communities with dementia special care 

units (Figure 1).

• About 11% of residential care communities had a distinct unit, wing, or floor designated 

as a dementia special care unit within the larger residential care community. Residential 

care communities with a distinct dementia special care unit within the larger community 

accounted for 64% of residential care communities with dementia special care units. 

• Beds in dementia special care units accounted for 13% of all residential care beds. 

• About one-quarter (26%) of the beds in communities with a distinct unit, wing, or floor 

designated as a dementia special care unit within the larger residential care community were 

in dementia special care units. 

Residential care communities with dementia special care units had special 

features for the care of residents with dementia. 

• Almost all dementia special care units offered dementia-specific activities and programming 

(91%) and had doors with alarms (90%) (Figure 2). 

• At least 7 out of 10 residential care communities with dementia special care units had 

features such as specially trained staff (88%), an enclosed courtyard (82%), doors with 

keypads or electronic keys (79%), and locked exit doors (76%).

• Less commonly available features in dementia special care units were personal monitoring 

devices (35%) and closed circuit TV monitoring (19%). 

Figure 2. Percentage of residential care communities with dementia special care units, by available feature:

United States, 2010

NOTES: Residential care communities with dementia special care units include communities that only serve adults with Alzheimer’s disease or other dementia, or 

those that have a distinct unit, wing, or floor designated as a dementia or Alzheimer’s special care unit within the residential care community building. Figure 

excludes cases with missing data; see "Data source and methods" for details. Percentages are based on the unrounded numbers. 

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

91

90

88

82

79

76

35

19

0 20 40 60 80 100

Closed circuit TV monitoring

Personal monitoring devices

Locked exit doors

Doors with keypads or

electronic keys

Enclosed courtyard

Specially trained staff

Doors with alarms

Dementia-specific activities

and programming

Percent
NCHS Data Brief ■ No. 134 ■ November 2013

■  3  ■

Residential care communities with dementia special care units differed 

from those without in size, chain affiliation, Medicaid participation, and 

whether the community was built as a residential care community.

• Seven out of 10 residential care communities with dementia special care units were 

large communities with 26–100 beds (50%) or extra large communities with over 100 

beds (21%), while 56% of communities without dementia special care units were small 

communities with 4–10 beds (Figure 3). 

• Over one-half of communities with dementia special care units were chain-affiliated (58%) 

and purposely built as a residential care community (79%) compared with 33% and 43% of 

communities without dementia special care units, respectively. 

• Communities with dementia special care units were less likely to be certified or registered to 

participate in Medicaid (37%) than those without dementia special care units (52%).

• Similar proportions of communities with and without dementia special care units were 

private, for-profit communities (81% compared with 82%).

Figure 3. Percentage of residential care communities, by select organizational characteristic and dementia special care

unit status: United States, 2010

* Estimate does not meet standards of reliability or precision because the sample size is between 30 and 59. 

1

Difference between communities with and without dementia special care unit is significant at p < 0.05. 

NOTES: Figure excludes cases with missing data; see "Data source and methods" for details. Estimates may not add to totals because of rounding. Percentages 

are based on the unrounded numbers. 

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

*

17

56

11

17

50

23

21

4

81

82

58

33

79

43

37

52

Percent

0 20 40 60 80 100

Communities without

dementia special

care units

Communities with

dementia special

care units

Certified or registered to

participate in Medicaid1

Purposely built as residential

care community1

Chain-affiliated1

Private, for-profit

Extra large (over 100 beds)1

Large (26–100 beds)1

Medium (11–25 beds)1

Small (4–10 beds)1
NCHS Data Brief ■ No. 134 ■ November 2013

■  4  ■

Residential care communities with dementia special care units differed 

from those without in geographical location.

• Communities with dementia special care units were more likely than those without dementia 

special care units to be located in the Northeast (12% compared with 8%), and less likely to 

be in the West (36% compared with 44%) (Figure 4). 

• Communities with dementia special care units were more likely to be in a metropolitan 

statistical area (MSA) (86%) than those without dementia special care units (80%). 

Figure 4. Percentage of residential care communities, by geographical characteristic and dementia special care unit

status: United States, 2010

1

Difference between communities with and without dementia special care units is significant at p < 0.05. 

NOTES: Figure excludes cases with missing data; see "Data source and methods" for details. Estimates may not add to totals because of rounding. Percentages 

are based on the unrounded numbers. 

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

12

8

23

22

30

26

36

44

86

80

0 20 40 60 80 100

Metropolitan statistical area1

West1

South

Midwest

Northeast1

Percent

Communities without

dementia special

care units

Communities with

dementia special

care units
NCHS Data Brief ■ No. 134 ■ November 2013

■  5  ■

Summary

In 2010, almost 2 out of 10 residential care communities had dementia special care units. Beds 

in dementia special care units represented 13% of all residential care beds. At least 90% of 

residential care communities with dementia special care units had dementia-specific activities 

and programming, while only 19% had closed circuit TV monitoring. When organizational 

characteristics were compared, communities with dementia special care units were more 

likely than those without dementia special care units to be large (26–100 beds) and extra large 

communities (over 100 beds), while communities without dementia special care units were 

more likely to be smaller communities with 4–25 beds. Communities with dementia special care 

units were more likely than those without dementia special care units to be chain-affiliated and 

purposely built as a residential care community, and less likely to be certified or registered to 

participate in Medicaid. In addition, communities with dementia special care units were more 

likely than those without dementia special care units to be located in the Northeast and in an 

MSA, and less likely to be in the West. 
NCHS Data Brief ■ No. 134 ■ November 2013

■  6  ■

Definitions

Dementia special care units: A distinct unit, wing, or floor designated as a dementia or 

Alzheimer’s special care unit within the residential care community, or residential care 

communities that only serve adults with Alzheimer’s disease or other dementia. 

Residential care communities: Include assisted living facilities and similar 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 communities with dementia special care units: Refer to communities that only 

serve adults with Alzheimer’s disease or other dementia, or those that have a distinct unit, wing, 

or floor designated as a dementia or Alzheimer’s special care unit within the residential care 

community building. 

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

Size: Based on the number of licensed, registered, or certified residential care beds (both occupied 

and unoccupied) in a residential care community: small (4–10 beds), medium (11–25 beds), large 

(26–100 beds), and extra large (more than 100 beds). 

Ownership type: Categorized by two types: (a) private, for-profit, and (b) other, which includes 

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

category includes publicly traded facilities.

Chain affiliation: Describes communities owned by a chain, group, or multicommunity system. A 

chain is more than one community under common ownership or management, and may include 

communities within a state or across multiple states. 

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

used by the U.S. Census Bureau. The U.S. Census Bureau’s Website provides a listing of states 

included in each of the four U.S. Census regions: http://www.census.gov/geo/maps-data/maps/

pdfs/reference/us_regdiv.pdf.

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.
NCHS Data Brief ■ No. 134 ■ November 2013

■  7  ■

Data source and methods

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

the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics 

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

study, residential care communities must be licensed, registered, listed, certified, or otherwise 

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; and have at least one resident currently living in the community. These communities 

serve a predominantly adult population. Communities licensed to serve the mentally ill or the 

developmentally disabled populations exclusively 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 sampling design. The first stage was 

the selection of residential care communities from the sampling frame representing the universe 

of residential care communities. The second stage was the selection of current residents. For the 

2010 NSRCF, 3,605 residential care communities were sampled with probability proportional to 

size. Interviews were completed with 2,302 communities, for a first-stage community unweighted 

response rate of 79% and a weighted response rate (for differential probabilities of selection) of 

81%. More details about sampling design and data collection are available elsewhere (4). 

Differences between communities with dementia special care units and those without dementia 

special care units were evaluated using chi-square and t tests. 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 

the SAS-callable SUDAAN (5). 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 0.11% (n = 1) and 0.35% (n = 13). Because estimates were rounded, 

individual estimates may not sum to totals. Percentages are based on the unrounded numbers.

About the authors

Eunice Park-Lee, Manisha Sengupta, and Lauren D. Harris-Kojetin are with CDC’s NCHS, 

Division of Health Care Statistics.
NCHS Data Brief ■ No. 134 ■ November 2013

References

1. 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.

2. Hyde J, Perez R, Forester B. Dementia and assisted living. Gerontologist 

47 Spec No 3:51–67. 2007.

3. National Center for Assisted Living. Assisted living state regulatory 

review 2012. Available from: http://www.ahcancal.org/ncal/resources/

Documents/Final%2012%20Reg%20Review.pdf.

4. 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. 

5. RTI International. SUDAAN (Release 11.0.0) [computer software]. 2012. 

Suggested citation

Park-Lee E, Sengupta M, Harris-Kojetin 

LD. Dementia special care units in 

residential care communities: United States, 

2010. NCHS data brief, no 134. Hyattsville, 

MD: National Center for Health Statistics. 

2013.

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., Acting Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Care Statistics

Clarice Brown, M.S., Director

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