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Resident Turnover
Why Residents Move-Out of Assisted Living

Residential turnover in assisted living facilities increased in years 2009 and 2010, making the average length of stay about 22 months.

According to a study called The State of Seniors Housing 2011 report, a collaborative research project between the American Seniors Housing Association, National Investment Center for the Seniors Housing and Care Industry, LeadingAge, Assisted Living Federation of America, and National Center for Assisted Living, the median annual resident turnover across all assisted living residences increased to 46.8% in 2010, up from 42% in 2009.

Why Residency Changes

Assisted living had a growth spurt in the 1990s because major corporations built and bought facilities, but senior care advocacy groups and scientists have warned that the communities offer appealing attractions - but the care they give is mediocre at best.

Critics point out that many communities fail to hire and retain trained staff to support the increasingly old and frail residents, who are not the active younger senior. The median age for residents is mid 80s with multiple health problems and high rates of cognitive loss.

Because assisted living facilities are not regulated by the federal government, like nursing homes, they're governed by state laws that give some supervision.

In 2010, The Center for Disease Control (CDC) surveyed residential care facilities asking: How many residents moved into this facility over the past 12 months? Many - 48% - of the facilities say they had between 1 and 4 new move-ins over the last 12 months, but also 30% of the facilities reported 11 or more move-ins during the same period.

How many residents moved into this facility over the past 12 months? Count each couple as 2 residents. Exclude someone returning from a hospital stay if this facility held the bed for the resident.
Responses of refusal (< 1%), and don't know (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

When asked: In the last 12 months, how many residents died in the last 12 months, 51% of the facilities surveyed said that a zero to one had died while 19% reported 6 or more deaths.

In the last 12 months, how many residents died?
Responses of don't know (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Changing Demands of Care

As care needs change and become demanding, assisted living staff has a hard time meeting those needs. Residents find that they need a different type of care home.

Sometimes an assisted living facility evict residents whose medical care needs exceed the level of care that the facility can provide. That's when a resident needs a nursing home level of care, the facility arranges the move to a suitable care home.

Care Needs Change
Care Needs Change

Sometimes a resident moves in with the hopes that Medicaid will pay the bill. But facility representatives will require them to pay privately for a year before going on Medicaid. It's called a "duration of stay" contract and it is neither allowed nor enforceable under the Medicaid rules. While not all assisted living and residential care facilities take part in the Medicaid program, those that do must follow state rules.

If the resident's private or Medicaid funds run out, a facility has the legal right to evict a resident for non-payment. This applies to a nursing home as well as an assisted living facility.

When asked by CDC: How many residents moved out of the residential care facility over the past 12 months? 41% of them said 1 resident moved out, 23% of the facilities reported 2 to 3 residents moved out, while 20% of them reported 11 or residents moved out in 12 months.

Over the last 12 months, how many residents moved out of this facility? Exclude someone who has moved out if the facility is currently holding a bed for the resident. Exclude deaths.
Responses of refusal (< 1%), and don't know (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

In the case of eviction: While there are variations from state to state, generally the facility must do all of the following before they can evict a resident:

  • Prepare a summary of the resident's mental and physical health status
  • Prepare a post-discharge plan of care for the resident which will assist the resident to adjust to his or her new living environment
  • Notify the resident and a family member or legal representative of the pending discharge at least 30 days before the discharge, letting them know of the resident's right to appeal the discharge action to the state.

If they don't like you, you're out

Before you move-in, know the care limits of a facility and the thresholds of behavior or health that will lead to eviction. Don't take what's in the contract at face value, find out who decides when those thresholds max out. If it's not you or your doctor, then it's management.

Residents asked to leave because they are disagreeable, their health needs are unpleasant, or they're transitioning to a less lucrative payment source (Medicaid). If Medicaid is the reason, a facility will claim that it can no longer care for an individual, whether or not it is true.

Where did Residents go After They Moved Out?

The Center for Disease Control asked Residential Care Facilities: Where did residents go after moving out? The facilities reported that 10% of the residents went to a hospital, 35% went to a nursing home, 20% went to a residential care facility, and 20% went to a private residence.

After moving out, where do residents go?

Approximately 30% of residents had a legitimate reason to skip this question. Those residents are not included in these responses.

The data in this chart has been rounded and simplified.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Is Cost a Factor?

The Center for Disease Control asked Residential Care Facilities: Where did residents go after moving out? The facilities reported that very few of the residents moved out over the last 12 months because of the cost of care.

If you had residents move out over the last 12 months, what percent because of the cost of care?
Responses of legitimate skip (29%), refusal (< 1%), don't know (< 1%), and not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Before making a move to assisted living, it's important to take tours, visit more than once, and at different times of the day and days of the week. As you visit, talk with residents and family members to see how satisfied they are with the care they've received.

Get information from your State regulatory agency and independent long-term care advocate, or a long-term care ombudsman.

Carol Marak
Carol Marak

After seven years of helping her aging parents, Carol Marak has become a dedicated senior care writer. Since 2007, she has been doing the research to find answers to common concerns: housing, aging and health, staying safe and independent, and planning long-term.