Trends in Assisted Living and Memory Care Supply From 2019 to 2023

Objectives: Describe geographic variation from 2019 to 2023 in assisted living (AL) and memory care supply, and its correlation with county-level characteristics. Design: Descriptive study of the supply of AL and memory care. Setting and Participants: Licensed AL communities in the United States operating in 2019 and 2023. Methods: Data come from a national list of licensed ALs and the US Census Bureau's American Community Survey. The primary outcomes of interest were AL supply and memory care supply (beds per 1000 adults aged 65+ at the county level). We descriptively evaluated county characteristics by AL supply in 2019 and the change in AL supply from 2019 to 2023. Results: In 2023, counties with the highest AL and memory care supply were more likely to have greater wealth, higher educational attainment, and were urban. Between 2019 and 2023, 43% of counties had a decrease in AL supply, 35% of counties had no change in AL supply, and 22% of counties had an increase in AL supply. Counties with a decrease or no change in AL supply compared with increase in AL supply had a larger proportion of the population aged 65+ years, lower median household income, and were more rural. Between 2019 and 2023, 29% of counties had a decrease in memory care supply, 37% had no change in memory care supply, and 34% had an increase in memory care supply. Counties with unchanged or a decrease in memory care supply had lower educational attainment, more poverty, lower home values, and were more rural. Conclusions and Implications: We found low overall availability of AL and memory care supply and decreases in their supply in rural and socioeconomically disadvantaged counties. It is important to incentivize ALs, including memory care, to operate in underserved areas to ensure equitable access to these important long-term care settings.