JB Tornatore, HSR&D PhD Post-doctoral Fellow; S Hedrick, HSR&D COE Acting Director; A Sales, HSR&D Investigator; J Sullivan, HSR&D Project Director, Special Projects; S Gray, Univ. of WA, Assistant Professor; M Curtis, CA Dept. of Aging, Data Interpretation Team

Objectives: Community residential services (CRS) (e.g., adult family homes, assisted living) are one option for long-term care of the elderly receiving growing attention, including in the VA. An estimated 40% of CRS residents nationwide have cognitive impairment. While a small number of CRSs are exclusively for those with dementia, most CRSs have both demented and non-demented residents, and must provide care for residents with different health care histories and needs. This study of CRS facilities in Washington State investigates differences in overall function and characteristics between residents with and without cognitive impairment, in order to understand differences in patterns of needed care and services.

Methods: The study population included all interested residents entering three types of community residential care: adult family homes (AFH), adult residential care (boarding homes) (ARC), and assisted living (AL) facilities on State (Medicaid) funding in a three county area. Information on the residents, their informal caregivers, the providers, and settings was collected at intake and 12 months later during 1998-2000.

Results: Of the 349 residents included in the study, 58% were in AFHs, 15% in ARCs, and 27% in ALs. AFH settings had a significantly higher percentage of residents with cognitively impairment (66%) than ALs (23%) or ARCs (11%). All CRS residents with cognitive impairment were less likely to have finished high school (59% vs 72%), were more likely to be married (19% vs 9%), were older (mean = 81 yrs vs. mean = 72 yrs), and reported a need for assistance on at least one ADL (51% vs. 29%). Whether examining self-reported or state case manager data, significantly more residents with cognitive impairment needed assistance with eating, dressing, and toileting than residents without impairment. Residents with cognitive impairment evidenced more behavioral problems, though only 6% of those with impairment and 3% of those without were reported to have had a problem within the past week. A higher percentage of residents without impairment than those with impairment rated three facility characteristics as important in their decision to move in to the residence: privacy (28% vs. 10%), medical care (15% vs 5%), and flexible routines and rules (11% vs. 2%).

Conclusions: Overall, it is clear that differences exist between CRS residents with and without cognitive impairment. The fact that the majority of residents in this study with cognitive difficulties live in AFHs, and so few in ARCs, has implications for placement of the elderly in CRSs. Facility resources, environment, and staffing need to reflect the needs and desires of residents.

Impact: Congress recently passed the Veterans Millennium Health Care and Benefits Act mandating evaluation of a pilot program that provides funding for eligible veterans in community residential facilities for up to 6 months The results of this study help to characterize the veteran population that is likely to enter these facilities, and to guide contracted service availability, rate setting, care planning, and evaluation of the new VA pilot program.