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Assisted Living and Special Populations: What Do We Know About Differences in Use and Potential Access Barriers?

Correspondence: Address correspondence to Mauro Hernandez, PhD, Department of Social and Behavioral Sciences, University of California, San Francisco, 3333 California Street, Suite 455, San Francisco, CA 94118. E-mail: mauro.hernandez{at}ucsf.edu

Purpose: The purpose of this article was to review existing knowledge about assisted living (AL) use by traditionally underserved populations, including people of color, low-income people, and those living in rural communities. Design and Methods: We reviewed methodologies and findings of research on AL and residential care up to June 2004.  Results: Some studies suggested that low-income people and people of color either are less likely to utilize AL or receive AL in settings with less space and amenities and/or lower scores in selected quality measures. Generalizations from national or multistate studies to the population have methodological limitations. Numerous topics remain unstudied, including the pricing of AL, the experience of choosing an AL facility, the presence of discriminatory admission and retention practices, and the role of resident preferences. Data on access to AL in rural areas are inconclusive. Implications: We offer recommendations for national surveys to better classify supportive housing settings. Furthermore, we suggest quantitative and qualitative studies to illuminate the experience of low-income, racial/ethnic minority, and rural populations in AL settings.

Key Words: Aged • Ethnic groups • Income • Home- and community-based services • Residential care • Rural health