Staffing and Services in Residential Care Facilities

Residential care communities (RCCs), which are also known as assisted living facilities and residential care facilities, provide long-term services and supports in a residential setting. They provide care to both older and younger adults who need assistance due to disability or cognitive impairment. In 2016, more than 800,000 people lived in nearly 29,000 RCCs in the United States, and 41.9% of them were diagnosed with dementia.

RCCs are becoming increasingly important as a source of support for older Americans. The Centers for Medicare and Medicaid Services project that total spending on nursing and residential care facilities will increase from $156.8 billion in 2015 to $270.4 billion in 2030. RCCs vary in size from small homes with fewer than 10 beds to large communities with 100 or more beds; 60.9% had 25 or fewer beds in 2016.

The Bureau of Labor Statistics (BLS) estimated that facilities that provide care for the elderly, which includes both RCCs and nursing homes, employed 888,500 workers in 2021, and employment will surpass 1.03 million workers by 2031. Home care aides and nursing assistants accounted for more than 380,000 of these jobs. Average staff hours per resident day are higher in RCCs with more than 75% of their residents diagnosed with dementia compared with RCCs with small percentages of residents with dementia. An analysis of 2014 data found that staffing of licensed nurses was higher in RCCs located in states that required a licensed nurse be available or on staff; 38 states had such a requirement at that time.


Key Objectives

This project aims to:

  • Examine staffing patterns of residential care facilities in general, and how they vary by facility size, ownership type (chain, for-profit vs non-profit), resident demographics (age, race/ethnicity), and geographic location (Census region, rural vs. urban).
  • Examine staffing patterns associated with presence of a dedicated dementia/memory care unit and the percentage of residents diagnosed with dementia/Alzheimer’s disease.
  • Tabulate training required of and offered to aides, and how this varies by facility size, ownership type (chain, for-profit vs non-profit), resident demographics (age, race/ethnicity), geographic location (Census region, rural vs. urban), and prevalence of dementia/Alzheimer’s disease.
  • Assess whether state staffing regulations for RCCs are associated with different staffing patterns, holding other facility and resident characteristics constant.


For more information, contact Joanne Spetz.