OBJECTIVES To assess the effect of changes in assisted living (AL) capacity within a market on prevalence of residents with low care needs in nursing homes. DESIGN Retrospective, longitudinal analysis of nursing home markets. SETTING AND PARTICIPANTS Twelve thousand two hundred fifity-one nursing homes in operation during 2007 and 2014. MEASUREMENTS We analyzed the percentage of residents in a nursing home who qualified as low-care. For each nursing home, we constructed a market consisting of AL communities, Medicare beneficiaries, and competing nursing homes within a 15-mile radius. We estimated the effect of change in AL beds on prevalence of low-care residents using multivariate linear models with year and nursing home fixed effects. RESULTS The supply of AL beds increased by an average 258 beds per nursing home market (standard deviation = 591) during the study period. The prevalence of low-care residents decreased from an average of 13.0% (median 10.5%) to 12.2% (median 9.5%). In adjusted models, a 100-bed increase in AL supply was associated with a decrease in low-care residents of 0.041 percentage points (P = .026), controlling for changes in market and nursing home characteristics, county demographics, and year and nursing home fixed effects. In markets with a high percentage of its Medicare beneficiaries (≥14%) dual eligible for Medicaid, the effect of AL is stronger, with a 0.066-percentage point decrease per 100 AL beds (P = .026) vs a 0.016-percentage point decrease in low-duals markets (P = .48). CONCLUSIONS AND IMPLICATIONS Our analysis suggests that some of the growth in AL capacity serves as a substitute for nursing homes for patients with low care needs. Furthermore, the effects are concentrated in markets with an above-average proportion of beneficiaries with dual Medicaid eligibility.

中文翻译：

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长期护理市场的变化：辅助生活供应和疗养院中低护理居民的流行

目标 评估市场内辅助生活 (AL) 能力的变化对疗养院中护理需求低的居民患病率的影响。设计 养老院市场的回顾性纵向分析。设置和参与者 2007 年和 2014 年期间运营的 12,251 家养老院。 测量 我们分析了养老院中符合低护理标准的居民百分比。对于每个疗养院，我们构建了一个由 AL 社区、Medicare 受益人和 15 英里半径内的竞争疗养院组成的市场。我们使用具有年份和疗养院固定效应的多元线性模型估计了 AL 床位变化对低照护居民患病率的影响。结果 在研究期间，每个疗养院市场的 AL 床位供应平均增加了 258 张床位（标准差 = 591）。低照度居民的患病率从平均 13.0%（中位数 10.5%）下降到 12.2%（中位数 9.5%）。在调整后的模型中，AL 供应增加 100 个床位与低护理居民减少 0.041 个百分点 (P = .026) 相关，控制市场和疗养院特征、县人口统计数据以及年份和护理的变化家庭固定效应。在医疗保险受益人比例较高 (≥14%) 双重符合医疗补助条件的市场中，AL 的效果更强，每 100 张 AL 病床减少 0.066 个百分点 (P = .026) 与 0.016 个百分点低双市场的减少（P = .48）。结论和意义 我们的分析表明，AL 容量的一些增长可以替代护理需求低的患者的疗养院。此外，影响集中在具有双重医疗补助资格的受益人比例高于平均水平的市场。