Association between Organizational Characteristics and Provision of Clinical Services in Assisted Living Facilities

Objective: Residential Care Facilities (RCFs) cater to the chronically ill and aging population. The objective of this study is to assess the organizational characteristics of RCFs associated with the provision of four clinical services: skilled nursing, medication review, physical therapy and occupational therapy.

Methods: This is a cross-sectional observational study. The unit of analysis is the individual RCF from the 2010 National Survey of Residential Care Facilities (NSRCF). Four multivariate logistic regression models were used to analyze the association between organizational characteristics of RCFs (facility, staff and director, and resident characteristics) and the provision of each clinical service.

Results: Among all the RCFs in the U.S., 38.8% provide skilled nursing services, 67.6% provide medication review, 43.9% provide physical therapy, 40% provide occupational therapy and only 18.9% provide all four services. Medicaid-certified RCFs were more likely to provide all four services. Private, for-profit RCFs were less likely to provide skilled nursing, physical therapy and occupational therapy. Larger-sized RCFs, those with a licensed director, those who used volunteers and had higher personal care aide working hours were more likely to provide some services. RCFs with a higher percentage of white residents were more likely to provide physical therapy and those with chain affiliation were more likely to provide occupational therapy.

Conclusions: Less than half the RCFs provide three of the four clinical services analyzed in this study. With the increasingly complex needs of the aging population, such clinical services may improve the quality of care for the residents in the RCFs.