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As adults age, they often require more assistance with physical and cognitive tasks. As mentioned in Chapter 18, “The Social Context of Older Adults,” long-term services and supports encompass services that provide assistance (at home or other settings) such as caregivers, adult day services, home health nursing or therapy, or hospice. With functional decline, some older adults may decide to remain at home with this added support while others may choose to live long term in another setting with additional assistance, such as assisted living facilities or residential care homes. Residential care facilities continue to expand in popularity. As of 2014, there were 30,200 assisted living and residential care facilities in the United States housing 835,200 individuals, as compared with 15,600 nursing homes housing 1.4 million individuals (Figure 31–1). This chapter focuses on residential care and assisted living facilities. It describes their services, financing, medical care, and other considerations for individuals and families when selecting a long-term residential facility.

Figure 31–1.

Individuals receiving long-term care services through adult day services centers (which provide therapeutic, social, and health services to adults for some part of the day), nursing homes, and residential care settings in 2014. (Data from Harris-Kojetin L, Sengupta M, Park-Lee E, et al. Long-Term Care Providers and services users in the United States: data from the National Study of Long-Term Care Providers, 2013-2014, Vital Health Stat 3 2016 Feb;(38):x-xii; 1-105.)



Many older adults reside in residential care facilities. While no one definition exists, typically these facilities aim to serve individuals who are largely independent but require assistance with some instrumental activities of daily living and activities of daily living. The terminology “residential care facility” differs from state to state, and facilities can choose what services they offer. Some terms that may denote the same level of care include residential care, assisted living, and adult group home (Table 31–1). Subtle differences may exist among these, but this chapter will address broad considerations that apply to all facilities that fall under the heading of “residential care.” In general, the state regulatory requirements are similar for all facilities in this category.

Table 31–1.Facility types and levels of care.

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