Health and functional outcomes and health care utilization of persons with dementia in residential care and assisted living facilities: comparison with nursing homes

PURPOSE: This study compares health and functional outcomes and health care utilization of persons with dementia residing in residential care/assisted living (RC/AL) facilities and nursing homes. DESIGN AND METHODS: The study uses data from a longitudinal cohort study of 1,252 residents with dementia in 106 RC/AL facilities and 40 nursing homes in four states. RESULTS: Rates of mortality; new or worsening morbidity; and change in activities of daily living, cognition, behavioral problems, depressive symptoms, social function, and withdrawal did not differ between the two settings. However, because of death or transfer, only about one half of the persons with mild dementia and one third of those with moderate to severe dementia remained in RC/AL facilities 1 year after enrollment. In addition, hospitalization rates were greater among individuals with mild dementia in RC/AL facilities, largely because of a medically unstable subgroup with high nursing-home-transfer rates. IMPLICATIONS: Many persons with dementia can be served equally well in either setting; however, those with major medical care needs may benefit from nursing home residence.