The investigators propose to determine the adverse medical outcomes (morality, morbidity, health service utilization) and change in health and functional status (cognitive, affective physical, instrumental, behavioral and social) for 1,320 randomly selected elderly persons aged 65 or older living in 276 randomly selected, geographically diverse residential care facilities (public housing, retirement community, and freestanding facilities), stratified by licensure status (yes/no) and size (small--2-10 beds, medium--11-50 beds, & large--51 beds or more). Outcomes will be related to structure of care (licensure, size, management, medical structure, environment), the process of care (services, psychotropic use, restraint use, philosophy), and the interaction between the two, and will control for baseline status. Assessments will occur at baseline and again at 3, 6, 9 (for medical outcomes) and 12 months (for change in health and functional status) following baseline. Findings will be compared to those from an ongoing study of residents in nursing homes (n = 4547).
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