When it comes to resident health, there is absolutely NO DIFFERENCE between Independent and Assisted Living – at least with respect to gender, age, and 12 of the most common chronic health conditions that cause seniors to seek these settings and that number among the leading causes of death of seniors.  That’s not my opinion.  Those are the data.

AL-IL Differences and Similarities

AL-IL Differences and Similarities

On the other hand, there ARE differences between Independent and Assisted Living when it comes to the prevalence of 5 important chronic health conditions of the residents (highlighted in yellow above):

  • Dementia
  • Depression
  • Gastrointestinal problems
  • Anxiety
  • Anemia

It is these 5 chronic health conditions that define the most important health differences between the residents of Independent and Assisted Living.  And it is these 5 chronic health conditions that may be the major contributors to the nearly 50% annual resident turnover rate in assisted living communities.

The implications of these data are important.  Just one example is in the area of unmet needs that is so prevalent for these residents.  If your community’s data tell you that you have a high proportion of residents with any of these 5 chronic health conditions, then THAT identifies a Quality Improvement Project for your managers.  The project would be to design pro-active interventions, services, or programs for this/these High Risk residents.  The outcomes would be: reduced resident turnover, increased length of stay, reduced ER trips, reduced hospitalizations, and increased resident and family satisfaction documented by surveys.  No doubt your managers would find other important outcomes to measure.  And these improved outcomes would lead to increased profitability for the communities.

Finally, a most important implication is the emphasis on an under-appreciated truth in the senior living industry:

“Only what gets measured, gets managed.”


ACRA (The Affinitas Center for Research and Analytics) uses a unique analytic system and research data base that seeks to provide state-of-the art senior living health analytics.  Our health analytics system was developed by a physician specifically for the senior living industry.  Our research data base is derived totally from physician health records using the de-identified health information of senior living residents.

January 2nd, 2015

Posted In: Uncategorized

Tags: , , , , , ,


  • David Levy says:

    Dr. While referencing the statistics you stated, “This isn’t my opinion. That’s the data.” I am unsure what is the distinction you are making within the two settings? One would expect to see dementia in assisted living and you do not define whether it was assisted living dementia care or just assisted living that those stats came from. Depression is the most underdiagnosed condition in the dementias and is typically linked (as with any chronic medical issue) as would be depression with the spousal caregiver as well. How does the knowledge of gastrointestinal issues change the focus of the assisted living setting? If the data came from the residents clinical record, than the scope of assisted living in this clinical analysis is limited by the clinical licensure of the ALF. I am sure there is a point to be made here, but it is unclear what it is. You clarification would be appreciated.

    • Hello David, and thank you for reading the article and your questions. Assisted Living and Independent Living are 2 separate and distinct residential settings with very different health options available. Families who search for health information about assisted living (what is the ability of a particular community to care for specific health conditions, what health conditions are managed in a community so that you know whether a community has the experience with your specific type of condition, what is the level of training of a community’s caregivers with respect to health conditions, etc.) have very little information available to them. These families must just “hope for the best” with the health management their loved one will receive. With respect to Independent Living, there is absolutely NO INFORMATION that documents the health characteristics of these residents. Thus, managers and owners of these communities have no standard on which to base any health services they may wish to offer.
      It is my goal for ACRA (the Affinitas Center for Research and Analytics) to be a source of health information for the AL/IL industry as well as prospective families. The more we know about resident health, the better we can manage resident health.

  • Dr. Fuller, do you have the reference/s? I don’t think the link is working. Thanks.

    • Hello Mike. So sorry for the difficulty with the links. There were several references I quoted, and the links are working on my end. If you’re still having difficulty, please send me an e-mail (sfuller@affinitaslife.com), and I will be happy to forward the sources to you.

  • Very interesting! One thing to consider is balance and falls. Perhaps you will see a difference then:)

  • Mike Krabbendam R.N. / R.P.N. Adv. says:

    Statistically the changes and deterioration of a person’s health status, regardless of living arrangements. The real difference in care needs can be found in an Individual’s Intellectual Ability to make logical, sound decisions.
    Dementia is a progressive disease that slowly robs a person of their brain functioning. This results in a person’s in-ability to retain their memory, thus making it increasingly difficult to make logical decisions. In essence the brain is progressing from the age of 19 to the age of 0 over an average 10 year span.
    While the number of persons diagnosed with this type of disease will increase, the percentage of cases, based on population will remain the same.
    The challenge will be in providing the right kind of care, along with the ability to adequately fund the right kind of care. The use of a Quality Improvement Program will help to provide for organizational structured care, which can be of some benefit. However, organizational structured care has it’s problems, when attempting to achieve personalized individual care.
    The problem we as a society face, is helping a person with Dementia during the transition, from their Independent home environment, through Assisted Living and into a structured Nursing Home Care. This becomes more difficult when the Individual or their family member(s) firmly believe that they can and will continue to be able to live where they reside currently despite their Intellectual decline.

    • Hello Mike, and thank you for sharing your insight and expertise. I agree that dementia is a devastating disease which can evade easy or convenient solutions. So many families are overwhelmed and need help with caring for a loved one with dementia. A place to start is to document the magnitude of this problem in the communities (e.g. assisted living) that try to be a landing place for these individuals. Knowing the TRUE extent of the problem will help when investing in the resources needed to provide the care.

  • Joshua Armstrong says:

    “Only what gets measured, gets managed.”

    What about multimorbidity? Frailty?

    While it is important to examine the health data on a disease by disease basis, it is especially important to consider that older adults have multiple diseases and issues at the same time. For older adults, health issues are not independent from each other, and a disease by disease analyses may mask important characteristics of a study population.

    • Hello Joshua. Multiple health comorbidities is the major focus of the every day lives of many seniors. As you correctly emphasize, they must be taken as a group and managed as a group. However, our research (not shown yet herein), suggests that some of these health conditions are more important than others, and this can only be appreciated when information is ‘teased out’ and viewed singly. Also, frailty is extremely important but strangely, difficult to easily and objectively measure and therefore difficult to include in an analysis. I would welcome any suggestions or insight you might have.
      Thank you for your insight, Joshua.

  • Debra Habeck says:

    I worked for a big Senior Living company, one of my job responsibilities was to serve two AL and one Independent Living. Average age in the IL was 91. Most of the residents paid for assistance for: showers, dog walking, laundry, and medicine administration. This place was two stories with one elevator, stairs that where hard to navigate. I always worried what would happen on the event of a fire. The ambulance was over there daily. Most of the residents should have been in AL

    • Hello Debra, and thank you for sharing your experience. I agree that in many cases there is very little difference in the health of residents in assisted and independent living. Our research also bears this out. My goal is to provide formal documentation of this observation with the use of analytics that may help validate our observations.

      • Susan Motter says:

        We are the first of a kind IL in Fairbanks Alaska. We are 4 years old with a population that is increasingly seeing a large percentage our residents in various stages of dementia. Our RSC has done a great job of integrating memory and exercise services but our management believes we should look at new approaches. Grateful to find this discussion and would offer up our observation services in this study.

        • Hello Susan, and thank you for reading this article and your comments – from incredibly cold Fairbanks where it was -44 degrees F earlier today!
          Congratulations on being the 1st IL in Fairbanks. It is so important to thoroughly understand IL resident health, as most people are surprised to find such similarity with the health of assisted living residents. This means managing IL residents poses similar challenges as with AL residents – attention to assuring residents have close connections with their doctors, proactively facilitating physician appointments,identifying high risk residents and monitoring them closely, etc. We would be happy to provide Raven Landing with a health analytic profile of your community to help guide management and put your dormant resident health data to work for you.
          Thank you again for your comments and reading this article, Susan.

Leave a Reply

Your email address will not be published.