Low-care Nursing Home Residents

Low-care Nursing Home Residents in United States

United States

There were nearly 1.2 million people residing in nursing homes in the United States in 2022. Nursing homes provide housing and care for those unable to take care of themselves. However, some nursing home residents are considered low care, meaning they require no physical assistance in bed mobility, transferring, toileting or eating. 

Low-care nursing home residents may be able to live in a less restrictive environment where they can receive less intensive care through home- or community-based services, or in alternative settings such as assisted living facilities. In a 2021 AARP survey, 77% of older adults said they wanted to live in their current residence for as long as possible. Aging in place has been shown to have physical, social and emotional benefits resulting in better health outcomes than nursing homes.

Not only are nursing homes restrictive for people who do not need them, but they are also expensive compared with other care options. The cost of a private room in a U.S. nursing home averages $253 per day, or $7,698 per month.

Older adults who are more likely to enter nursing homes despite low-care needs include:

• Those diagnosed with anxiety.
• Those without access to personal care services.

Visiting home health aides, transportation programs and home- or community-based services such as Meals on Wheels are examples of services that help older adults age in their homes. The Older Americans Act (OAA), passed in 1965, provides federal funding to states for these services. States with greater investment in home-delivered meal programs have a lower proportion of low-care nursing home residents. In the 2021 National Survey of OAA participants, 89% said that the program helps them continue to live independently.

Research suggests that state investment in personal care services can lead to Medicaid savings by reducing the cost of long-term care services for those able to remain in their homes. Increasing home-delivered meals by 1% among older adults in every state could save state Medicaid programs more than $109 million by decreasing the number of low-care nursing home residents.

The Centers for Medicare & Medicaid Services offers information and resources for nursing home alternatives.

Binette, Joanne. 2021. “Home and Community Preferences 2021: Age Breaks Annotated Questionnaire.” Washington, D.C.: AARP Research. https://doi.org/10.26419/res.00479.002.

Buttar, Amna, Caroline Blaum, and Brant Fries. 2001. “Clinical Characteristics and Six-Month Outcomes of Nursing Home Residents with Low Activities of Daily Living Dependency.” The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 56 (5): M292-297. https://doi.org/10.1093/gerona/56.5.m292.

Castle, Nicholas G. 2002. “Low-Care Residents in Nursing Homes: The Impact of Market Characteristics.” Journal of Health & Social Policy 14 (3): 41–58. https://doi.org/10.1300/J045v14n03_03.

Hahn, Elizabeth A., Kali S. Thomas, Kathryn Hyer, Ross Andel, and Hongdao Meng. 2011. “Predictors of Low-Care Prevalence in Florida Nursing Homes: The Role of Medicaid Waiver Programs.” The Gerontologist 51 (4): 495–503. https://doi.org/10.1093/geront/gnr020.

Marek, Karen Dorman, Lori Popejoy, Greg Petroski, David Mehr, Marilyn Rantz, and Wen-Chieh Lin. 2005. “Clinical Outcomes of Aging in Place.” Nursing Research 54 (3): 202–11. https://doi.org/10.1097/00006199-200505000-00008.

Thomas, Kali S. 2013. “The Relationship between Older Americans Act In-Home Services and Low-Care Residents in Nursing Homes.” Journal of Aging and Health, December. https://doi.org/10.1177/0898264313513611.

Thomas, Kali S., and Vincent Mor. 2013. “Providing More Home-Delivered Meals Is One Way to Keep Older Adults with Low Care Needs out of Nursing Homes.” Health Affairs 32 (10): 1796–1802. https://doi.org/10.1377/hlthaff.2013.0390.