# Post #328: How many assisted-living beds does Vienna need?

Posted on July 28, 2019

Answer:  About 40.  Maybe a few more, because we’re wealthy, and assisted living is something that you have to be fairly wealthy to afford.   Maybe a few less, because our resident population is a little younger than the US average.  But, best guess, if we use assisted living at the US average rate, then 40 assisted living beds would serve the needs of the entire Town of Vienna.

I calculated that back in March, when Sunrise assisted living (proposed for Maple and Center) was a hot topic, but never got around to making that public.  Here, I work through the arithmetic, then just line out the variety of options available for elderly who have various levels of need for assistance.

If you want information on assisted living, in general, in Northern Virginia, see Post #205.

### Two calculations.

One way to get a rough estimate of the assisted living beds required to serve Vienna residents is to assume that our assisted living use, per person, will be near the national average.   So that calculation is easy enough:

Expected assisted living beds needed to serve Vienna = (US assisted living beds/US population)*Vienna population

This assumes that Vienna’s age mix matches the nation, and that our propensity to use assisted living matches the nation.  There’s not much I can do about that second assumption, but I can do an interesting age-adjusted calculation to account for the age mix of the Vienna population.

First, by age, what fraction of the US population is currently in assisted living?  I can infer that from the total assisted living population and age breakout provided by an assisted living industry association, and the corresponding US population breakout by the same categories from the US Census.

As you can see from the table above, the majority of assisted living residents are age 85 or older.  But even with that heavy focus on the oldest-old, only 6.4 percent of those age 85 and older reside in assisted living facilities.

If I now apply those percentage in the right hand column above, to the Vienna population by age, I can come up with a more refined estimate of our need for assisted living beds.  In this case, I estimate just 36 beds would serve the needs of the Town of Vienna population.

All of that assumed that we would tend to use assisted living at roughly the national average rate.  I suspect that our use will be higher due to our generally higher income and wealth here in Vienna.  But I could not find any empirical estimates to allow me to adjust for that.

So, somewhere around 40 beds, that’s my best estimate for the number of assisted living beds needed to serve Town of Vienna residents.

### Some background and definitions.

Assisted living is only one of many care options available for individuals who are transitioning from being fully independent and living in the community toward increasing levels of assistance.  A good, broad typology can be found at this web page.

Briefly:

If you focus solely on dedicated housing or facilities for the elderly, then care choices fall into a fairly easily understood spectrum, from least assistance to most assistance provided.  And the break points between them are whether you need help with activities of daily living (ADLs), and then, separately whether you need skilled nursing care.

Think of the ADLs as everything you must do to get up and out the door in the morning:  Get out of bed, shower, toilet, dress, eat breakfast, and walk or otherwise get around. Then, separately, skilled nursing services are things that require a registered nurse or specially licensed health care practitioner.  Examples of skilled nursing care from Medicare’s website include: occupational therapy, wound care, intravenous (IV) therapies, and physical therapy.

The spectrum is then:

• Independent Living Facility:  no assistance needed for routine self-care (ADLs)
• Assisted Living Facility:  assistance needed for self-care (ADLS), but no need for skilled nursing services .
• Nursing facility/skilled nursing facility/nursing home:  Some need for skilled nursing services.

Independent living facilities are more-or-less seniors-only retirement communities.  The typical resident needs little or no help with self-care.  These facilities tend to offer only social services, such as transportation and meals, if needed.

Assisted living facilities offer care to individuals who need help with one or more of the ADLs.  Most will have some skilled-nursing staff on hand (Registered Nurse or RN) to handle prescriptions and assess residents, but care is given by lower-skilled staff who provided “practical nursing” services.  In Virginia, these are licensed by the Department of Social Services.  Many or most such facilities are not licensed to care for bed-bound patients or patients who are unable to get out of bed unaided, and in my limited experience, that can be the cut point beyond which an individual must move to a nursing home.

A memory care unit or Alzheimer’s unit is a subset of assisted living facilities specializing in those with dementia.  These are individuals who need help with ADLs and are severely impaired by dementia.

Nursing facilities, nursing homes, skilled nursing facilities (the terms get used interchangeably) provide some types of skilled nursing care in addition to help with ADLs.   These are used both by individuals recovering from some acute event (e.g., after hip replacement) and by long-term residents.  In Virginia, these are licensed by the Department of Health.

Finally, a Continuing Care Community (or similar) is an entity that provides all three levels of care on one campus.  These are for people who want to move to a location while they are still able to get around on their own, and remain there regardless of their eventual level of disability.

If you also consider options that are not dedicated senior housing, then there are at least three other.

Technology-based home monitoring covers an array of services designed to keep track of seniors who otherwise need no help with ADLs, and to let someone know if something appears wrong.  Classically, this could be a system under which seniors must call in daily.  It can be home-based alarms that an elderly person may trigger.  Or, in the modern world, it can include more sophisticated devices.  In general, these systems do not provide any routine help.

Visiting nurse services/home health services bring nurses aides and (sometimes) registered nurses to an individual’s home.  A visiting nurse service corresponds to an assisted-living level of care, while home health typically corresponds to Medicare-paid post-acute care dealing with issues that require a registered nurse (e.g., wound care).

In my limited experience, visiting nurse services have two significant limitations.   First, in most areas, licensed practical nurses and nurses aides cannot dispense prescription medications.  Thus, they cannot actually give an elderly person their prescriptions, and it remains up to the elderly person to remember to take their prescriptions.  This is a significant limitation for those with memory or cognitive issues or visual impairments.  Second, they frequently will not take on elderly clients who live alone, because they cannot guarantee that they will always be able to get to the elderly client.  Thus, in at least some areas, these services cannot be used to allow (e.g.) an elderly widow to remain, alone, in her family home.

Adult day care services provide an assisted-living level of service, but only during working hours, and typically only Monday-Friday.  These services allow caregiving relatives to get to work during the day, but take care of their elderly relatives at night.

### New assisted living facilities proposed in the immediate area.

We now have (or had) three sites near Vienna under consideration for construction of new assisted-living facilities.  All told, that’s three new assisted living facilities proposed within a roughly one mile radius.

Unlike my previous count of (e.g.) local 7-11s, it’s not straightforward to get a map of all assisted living facilities and related facilities in this area.  This is due, at least in part, to the wide range of living arrangements and associated descriptions.

Many developments that provide assisted living as part of a continuum of care only appear when the search term is “continuing care communities” or similar.   For example, in our area, the Virginian (near the intersection of Nutley and Route 50) does not show up in a simple search of “assisted living”, nor does the large Greenspring retirement community in Springfield.

The term “elderly housing” brings up yet a different set of facilities in the area.  And “memory care” (e.g., care of individuals with Alzheimer’s) reveals yet a different set of elderly-care facilities.  Adult day-care centers constitute yet another category, as do traditional skilled-nursing facilities.

That said, assisted living facilities have to be licensed by the Commonwealth, and you can search for every licensed entity in the area here.  In the end, the only way to map all assisted living facilities in the area was to rely on licensure data.  This “live” map from Post Post #205, which has a more detailed description of the data source.  The number next to each pin is the number of licensed beds.