Facts & Figures

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​There are many different sources with data on assisted living communities. These sources include information on communities such as types of services offered, financial trends, residents, and the workforce. NCAL gathers much of this information into one place to offer providers, policymakers and consumers an opportunity to learn more about the profession through facts and figures.​


 Communities

​COMMUNITIES

Number and Size of Communities

​T​here are approximately 28,900 assisted living communities with nearly 1 million licensed beds in the United States today. 

The average size of an assisted living community is 33 licensed beds.

(See state estimates for sizes of AL communities.)

Communities Makeup

Regional Distribution

  • 8.6% Northeast
  • 22.6% Midwest
  • 28.0% South
  • 40.8% West

Ownership​

  • 56% are chain-affiliated (an organization with two or more communities)
  • 42% are independently-owned

Operations

​Typical Services:

  • 24-hour supervision and assistance
  • exercise, health and wellness programs
  • housekeeping and maintenance
  • meals and dining services
  • medication management or assistance
  • personal care services (such as Activities of Daily Living [ADLs])
  • transportation

Tailored Communities

​Some assisted living communities specialize in serving individuals with specific needs. These may include, but are not limited to, Alzheimer's disease or other forms of dementia (such as memory care units), intellectual and developmental disabilities, and particular medical conditions (e.g., Parkinson's disease) or other needs.

Percentage of assis​ted living co​mmunities that provide Alzheimer's disease or other dementias-specific programs:
  • 14.3% have a dementia care unit, wing or floor designated
  • 8.7% only serve adults with dementia 

Health Care Services

​​​Percentage of assisted living communities that provide (by employees or arranged with an outside service provider) certain health care services: 

  • 83.6% pharmacy/pharmacist
  • 82.8% dietary and nutritional
  • 71.4% therapy (physical, occupational or speech)
  • 67.7% hospice
  • 66.1% skilled nursing
  • 55.0% mental health or counseling
  • 51.1% social work services​


 Residents

RESIDENTS ​​


​There are more than 800,000 Americans residing in assisted living. The majority of these residents are the "oldest old," or age 85 and older, female, and non-Hispanic white. 


Residents often need help with only a few activities of daily living and do not require 24-7 skilled nursing care. The most common activity of daily living that residents need assistance with is bathing, then walking. More than half of all residents have high blood pressure, and 4 in 10 are living with Alzheimer’s disease or other dementias. 

After a median stay around 22 months, roughly 60% of residents will move out of assisted living to transition to a skilled nursing center.​

Activities​ of Daily Living

ADLs: 62% need help bathing, 47% dressing, 39% bathroom, 20% eating, 30% bed transfer; median stay is 22 months

Common Resident Conditions

40% have Alzheimer's or dementia, 46% have cardiovascular disease, 23% have depression, 17% have diabetes 
 

 Finance

FINANCE

​The majority of assisted living residents use some form of private pay (e.g., long term care insurance, personal finances) to cover the cost of their assisted living services.

Cost of Care

The national median rates for assisted living services are $4,000 monthly and $48,000 annuallyView cost estimates by state.


Annual Median Cost of Long Term Care in the Nation

Provider ​Annual Cost
​Home Health Care
​  --Homemaker Services ​$48,048
  ​--Home Health Aide ​$50,336
​Adult Day Health Care ​$18,720
Assisted Living Community​​ ​$48,000
​Nursing Home Care
​  --Semi-Private Room ​$89,297
  --​Private Room ​$100,375

​ 

Medicaid

Low-income individuals m​ay be able to utilize Medicaid to help cover the cost of services, depending on their state's Medicaid program. Almost 1 in 6 residents relies on Medicaid to pay for daily services (16.5%).

State Medicaid programs can cover home and community-based services (HCBS) such as personal care and supportive services provided in assisted living communities. Medicaid does not pay for room and board costs.

States can use several different Medicaid authorities to cove​​r such services in assisted living:

  •  Medicaid state plan authorities,
  • § 1915(c) HCBS waiver,
  • concurrent § 1915(b) managed care waiver, or
  • §1115 research or demonstration programs. 

Note, a small minority of state Medicaid programs do not cover services in assisted living. 

Over time, spending on Medicaid long-term services and supports (LTSS) has shifted from traditional settings of care towards HCBS settings.

  • 57% ($94 billion) of Medicaid long term care services and supports spending was on HCBS in FY 2016
    • HCBS spending increased 10% from FY 2015 to FY 2016
  • Of the total Medicaid HCBS spending, 51.1% was through 1915(c) waiver programs.​ 

Medicare 

M​edicare does not cover long term care services and supports, and therefore, assisted living services. However, the majority of assisted living residents are Medicare beneficiaries. Thus, assisted living providers are interested in many issues related to the delivery of Medicare services, such as:

  • hospital readmissions
  • off-label use of antipsychotic medications
  • access to Medicare Part B therapy
  • Medicare beneficiaries three-day stay requirement for skilled nursing care
  • Bundled Payment Initiatives
  • Medicare Advantage

 Workforce

WORKFORCE


​​Assisted living communities play an important part in local economies, offering jobs to hundreds of thousands. As of January 2019, there were nearly 453,000 total employees in the assisted living profession.​

Total Workforce​

Workforce.png 
(as of January 2019)​

​​​Nursing Staff​

​Among the 1.46 million full-time nursing and 35,000 social work employees in long term care, about one-fifth (20%), or 298,800 are employed full-time at an assisted living community.
 
The breakdown of these full-time nursing and social work employees is below. Assisted living communities may also hire part-time nursing and social work employees, and/or contract with other organizations to coordinate nursing and social work services in the community.
  • ​83.3% aide
  • 9.9% licensed practical or vocational nurse 
  • 6.1% registered nurse
  • 0.8% social worker   ​

Economic Impact

​Economic Activity

  • Direct: $32 billion
  • Total: $76 billion 

Tax Revenue

  • State/Local: $3.5 billion 
  • Federal: $6 billion 
  • Total: $9.5 billion
Source: FY 2018 Quarterly Census of Employment and Wages, Bureau of Labor Statistics; IMPLAN Group LLC, IMPLAN System (data and software); FY 2018 State GDPs by Bureau of Economic Analysis, US Dept. of Commerce 

 State Fast Facts

​​​​​​​​​Download our one page state fact sheets, summarizing key data on assisted living residents and communities in each state, as well as the profession's economic impact. The data comes from the CDC's National Center for Health Statistics and AHCA/NCAL analysis of data from the U.S. Bureau of Labor Statistics.