] This research will examine how the characteristics of assisted living facilities (ALFs) affect the ways in which ALF residents interact with the health and long-term care systems, specifically their utilization of Medicare-covered health services and transitions to other care settings. One of the most dramatic expansions in long-term care services in the last decade has been the expansion in the role and supply of """"""""assisted living,"""""""" a residential setting that provides 24-hour supervision and some personal care services. The last five years have seen a dramatic expansion in State regulation and payment for assisted living, in no small measure because States believe ALFs can be a cost-effective alternative to nursing home care. Despite this hope, there is relatively little empirical information about the role ALFs play in meeting the needs of the frail elderly. In addition, there is no information about the effects of variations among ALF organizational features that may affect the degree to which residents use other health care services. Thus, the four specific aims of the proposed research are:
Aim #1 : To describe the ALF residents' health service utilization.
Aim #2 : To investigate the association between specific organizational characteristics of ALFs and residents' health service use.
Aim #3 : To describe the patterns of transitions in living arrangements experienced by ALF residents who leave assisted living.
Aim #4 : To investigate the association between residents' transitions to nursing homes and the organizational characteristics of ALFs. These issues will be investigated with data from the only nationally representative sample of ALFs, their staff, and their residents. The results of the proposed research should be of considerable interest to consumers, providers, policymakers at both the State and Federal levels, and to health services researchers.
