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Simulation analyses quantify admission and continuing physical and cognitive impairment patient case-mix changes under two scenarios: with increases in residential care supply and with all nursing homes licensed only as skilled care facilities. Findings raise caution about the assumed interplay between residential care supply and nursing home use. The proportion of nursing home patients with only physical and cognitive impairment likely to be affected by current and emerging long-- term care (LTC) policy was well under 25 percent of the nursing home population in each of the four study States. States varied in LTC supply and utilization controls.
INTRODUCTION
Consumers, private investment, and many State governments view the residential care industry, particularly that sector known as assisted living, as a viable alternative for nursing homes for many persons. Residents in this housing have access to meal and maid services and assistance with such tasks as using medications, dressing, grooming, eating, bathing, and transferring. Increasingly too, States have begun to permit those living in residential care facilities (RCFs) to receive extended periods of skilled nursing care and to remain in these facilities even if they become non-ambulatory or if they are receiving hospice care (Mollica, 1998).
Arguments favoring the growth and expanded role of assisted living or other forms of RCFs in serving the needs of the frail elderly population include consumer preference, affordability relative to nursing homes, and potential reductions in State Medicaid expenditures (Wilson, 1993). Even when accepting these arguments on face value, there is little empirical basis to guide State governments in how to achieve the substitution of supportive housing for nursing home care. Should States further constrain the growth of nursing homes, stimulate the growth of residential care beds, extend access to assisted living by reshaping the eligibility criteria about those who can remain in supportive house ing, or provide financial reimbursement for the home and community-based care (HCBC) (e.g., homemakers, personal care aides) that may be needed in such house ing? In the absence of their own experience, States look to other States to resolve such questions. Such mimicking may focus on specific policies (e.g., eligibility criteria), while ignoring essential contextual influences (the prevailing ratio of nursing home beds to population), or multiple interactive policies (e.g., reimbursement for RCF...