Volume 53 | Number 6 | December 2018

Abstract List

Benjamin C. Silver Ph.D., David C. Grabowski Ph.D., Pedro L. Gozalo Ph.D., David Dosa M.D., M.P.H., Kali S. Thomas Ph.D.


Given the tremendous growth in assisted living () over the past 20 years, it is important to understand how expansion has affected the demand for long‐term care () provided in nursing homes (s). We estimated the effect of a change in county‐level beds on the prevalence of private‐pay residents and private‐pay resident days at the ‐level.

Data Sources

National census of large providers (25+ beds), and Minimum Data Set combined with Medicare enrollment records and claims from 2007 and 2014.

Study Design

Retrospective longitudinal analysis of markets.

Principal Findings

Mean beds per county increased from 285 to 324, while s exhibited a decrease in private‐pay residents (20.1 to 17.7 percent) and resident days (21.3 to 17.5 percent). An increase of 1,000 beds at the county level is associated with a reduction of 0.44 percentage points in private‐pay resident days but is not significantly associated with percent of private‐pay residents.


These results suggest that increases in capacity have potentially allowed residents to delay or decrease their privately financed lengths of stay. As demand for continues to grow, it will be important to assess the effects on other sectors.