Changes in Long-Term Care Markets: Assisted Living Capacity and the Prevalence of Nursing Home Residents With...

To evaluate how changes in assisted living (AL) capacity influence the prevalence of nursing home (NH) residents with dementia.

This is a panel study. We used state AL licensing data for 2019, 2021, and 2023, linked with NH data from LTCFocus.org. The outcome was the percentage of residents with a dementia diagnosis in each NH. The main exposure variable was the number of AL beds within a 15-mile radius of a given NH.

11,030 NHs in the contiguous United States operating in 2019, 2021, and 2023 with data on residents' dementia diagnoses.

We used linear probability models with year and facility fixed effects to examine the relationship between changes in AL capacity and memory care AL capacity and the percentage of NH residents with dementia, adjusting for market and time-varying NH characteristics.

On average, dementia prevalence in NHs decreased from 50.8% (SD = 14.6) of residents to 44.6% (SD = 14.6) over the study period. Within markets, total AL beds increased averagely from 2897.8 to 3202.2 between 2019 and 2023; the average number of memory care beds increased from 993.3 to 1222.0. In the adjusted model, a 100-bed increase in AL capacity corresponded with a 0.1 (SE = 0.02)-percentage point reduction in the prevalence of NH residents with dementia (P < .001). A 100-bed increase in memory care AL capacity was associated with a lower, but not statistically significant, share of NH residents with dementia (β = -0.02, SE = 0.02; P = .2).

Findings suggest that increased AL capacity-but not memory care-may postpone entry or divert NH placement among people living with dementia. Future research should explore how AL expansion affects health outcomes, care quality, and lived experiences for individuals with dementia.