Profit Status, Quality, and Cost of Care in U.S. Residential Care Facilities

Residential care facilities (RCFs) have become an important community care setting for the aging population. However, limited information exists regarding facility characteristics related to the quality and cost of RCFs. The purpose of this study is to examine the relationship among facility profit status, quality indicators, and resident departure due to cost in U.S. RCFs. We used data from the National Survey of Residential Care Facilities (NSRCF), which contain information on 2,302 RCFs in 2010. Variables included facility level physical and organizational environment, processes of care and services offered, resident profiles, staffing, and costs of care. Affordability was measured by the percent of residents that moved out of the facilities during the past 12 months because of cost. Low affordability facilities were defined as facilities with 33.3% or more residents that were discharged due to cost. We used multivariate logistic regression model to examine predictors of RCF affordability while controlling for confounding variables. We identified the following significant predictors of residents discharged due to costs: proportion of older residents, proportion of minorities, percent residents with memory problems, percent residents receiving support from Medicaid, facility size, ownership, chain membership, occupancy level, and health monitoring services provided by the facility. Results showed that for-profit facilities are slightly more likely to have low affordability. However, the difference was not statistically significant (OR=1.09, p=0.60). The findings suggest that RCFs vary greatly in services, quality, and costs. More information about RCFs should be made available to consumers to promote informed choice and affordability.