The Availability of Assisted Living for Low Income Older Adults

By Scott King

In this study, University of Kansas researchers Rosemary Chapin, Ann Marie Hickey, Roxanne Rachlin, and Doreen Higgins examined the availability of Assisted Living (AL) as a residential option for low income older adults. They analyzed state-level data from Kansas from 1999 to 2004, and focused on older adults who received a Medicaid Home and Community-Based Services for Frail Elderly (HCBS-FE) waiver, which pays for services related to long-term care outside of traditional nursing facilities.

Chapin and colleagues mailed a survey to all AL administrators in Kansas between the years of 1999 and 2004. A total of 168 (out of 247 possible) administrators answered the survey, representing 70.3% of total AL beds in Kansas. Based on their responses, the researchers sought to answer the following questions: 1) Did AL access increase from 1999 to 2004 for low income older adults using a HCBS-FE waiver? 2) What is the relationship between characteristics of AL facilities and admission of older adults with HCBS-FE waivers? 3) Are there barriers that hinder AL facilities' ability to admit potential residents with HCBS-FE waivers?

The results showed that the number of AL facilities accepting Medicaid increased by 7% from 1999 to 2004, but this difference was not statistically significant. Within those facilities, the number of adults with HCBS-FE waivers showed a statistically relevant increase of 48%, but the percentage of total residents who were waiver recipients decreased slightly (19% to 18.4%) from 1999 to 2004.

Facilities accepting and not accepting Medicaid customers were equally likely to be freestanding and for-profit, but differed in location and size: AL facilities in rural or suburban areas were more likely to accept Medicaid customers than were AL facilities in metropolitan areas. Based on a logistic regression analysis, the researchers found that facilities located in a metropolitan area were only 25% as likely as those in non-metro areas to accept Medicaid-eligible customers. Small- and medium-sized facilities were more likely to accept Medicaid customers than were larger (60+ beds) facilities, but this difference was mostly contained within the metropolitan versus non-metropolitan area comparison.

Administrators at facilities not accepting Medicaid customers were asked to explain why their facilities did not participate in the waiver program. The most common response (71%) was low reimbursement rates, while 44% chose not to participate because of the bureaucracy involved, noting "paperwork and red tape" as distracters. Other responses cited lack of adequate staff and being unaware that the waiver program existed.

In conclusion, the researchers acknowledge the need for effective ways to address barriers preventing low income adults from moving into AL instead of nursing facilities, and highlight the promise of innovative models such as the Robert Wood Johnson Foundation's Coming Home Program.

To obtain a copy of this article, contact Scott King at sking@matherlifeways.com.

Source: Chapin, R., Hickey, A. M., Rachlin, R., & Higgins, D. (2008). Assisted Living and low income older adults: Has access increased? Seniors Housing & Care Journal, 16, 53–65.

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