The size of an assisted living community may be the critical element that decides who your loved one ends up calling their neighbor.

A recent analysis of over 2,300 assisted living facilities, led by George Mason University researchers, found significant differences in age, affliction and behavior of occupants, based on the number of people living in a given community. Each facility was assigned to a category—small (4-10 beds), medium (11-26 beds) or large (26 or more beds).

Regardless of the scope of the community, analysts found that the typical assisted living resident was white, widowed and at least 85 years old.

There were, however, a few ways in which the size of the community did seem to matter:

  • Small communities: People younger than 65 years old were far more likely to be found in a smaller assisted living community. Also, the more miniscule the facility, the greater the chances that it would house a higher number of individuals with dementia, a developmental disability or a serious mental illness. Consequently, these communities also tended to have higher rates of behavioral problems among their residents, such as physical aggression and verbal outbursts. Medications to manage these behaviors were also almost twice as likely to be prescribed to someone living in a smaller community.
  • Large communities: Eighty-five percent of residents in larger assisted living communities were 75 or older. Chronic health concerns such as osteoporosis, hypertension and congestive heart failure were more likely to plague these men and women as opposed to those living in tinier facilities. Residents of bigger facilities were also more prone to having had an emergency room visit or a fall in the past year—though these events may have occurred prior to the person moving into the community.
  • Medium communities:The characteristics of residents in medium-sized assisted living communities were typically a mixture of those seen in the larger and smaller facilities.

Study authors caution not to read too much into their findings. "It's important to recognize that we are not drawing conclusions on the quality of care between communities of different sizes," says Andrew Carle, director of George Mason's Program in Senior Housing and Administration.

Rather, the results of the investigation can be used by caregivers and other family members to help make more well-informed decisions about where an aging loved one should live. As Carle points out, taking care of a person with Alzheimer's is far different from taking care of a diabetic who also suffers from severe arthritis. "What we now know is these specialty populations are being more frequently served within the nation's smaller communities," he says.


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When searching for senior housing for a loved one there are a variety of factors to consider. Along with the size of the community, other key characteristics include cost, services offered, distance from the rest of the family, etc. The list is almost endless, and needs to be individualized based on the unique specifications of an elder and their family.