Jan. 8--Virginia seniors are voting with their feet and choosing assisted living and other housing that offers independence with the security of knowing a higher level of care is available if needed.

A study out this week in the journal Health Affairs ranked Virginia second in the nation in the number of assisted-living units per older resident. The growth has been driven by demand for supportive senior housing.

Twenty percent of the 214 units at Covenant Woods in Mechanicsville are assisted living, marketing director Beth Richardson said. The 75-acre continuing-care retirement community is expanding for the second time in four years by adding 106 new independent-living units in a $78 million project.

"People who come into an independent-living environment can take care of themselves. They are just planning for the future," Richardson said.

"They know where they will go. They don't have to wait until they need assisted living and then go shop around everywhere or have their children do it."

According to the Health Affairs article, Virginia has 46 assisted-living units per 1,000 people age 65 and over. The highest assisted-living penetration was in Minnesota, with 104 units per 1,000 people over 65, and third was Oregon, with 43 units per older resident.

"There are almost as many assisted-living beds in Virginia as there are nursing-home beds," said Mary Lynne Bailey, vice president for legal and government affairs at the Virginia Health Care Association, which represents nursing homes and assisted-living facilities.

"Larger assisted-living facilities are focused around affluent areas. You see many in the Richmond area -- Midlothian and the West End -- and in Northern Virginia and popular retirement communities, including Virginia Beach and the Williamsburg area. But we also have quite a few in the southwestern part of the state. I think they tend to be smaller," Bailey said.

The study does not say why Virginia specifically has high penetration but says states with a larger segment of people ages 45 to 65 with long-term-care insurance and states with a greater portion of Medicaid dollars used for homeand community-based care have higher penetration.

Assisted-living facilities are less-regulated than nursing homes, which gives builders flexibility, said Beverley Soble, vice president for regulatory affairs for the Virginia Health Care Association.

"I think that is why developers came into the market," she said. "There are areas of affluence in Virginia, and because at least earlier there were very few requirements of what they had to put into their buildings."

Assisted-living facilities range from small mom-and-pop operations with space for four residents, to corporate-owned complexes with a capacity for 500 residents that can resemble small cities.

Facilities offer 24-hour supervision, meals, social activities and help with activities of daily living.

Assisted-living facilities can be solely that or part of a continuum of care offered in places like Covenant Woods, which in addition to independent and assisted living offers nursing-home care and dementia care.

In the Health Affairs study, researchers David G. Stevenson and David C. Grabowski, health policy professors at Harvard Medical School, looked at facilities with 25 or more units.

Results showed assisted-living facilities are located disproportionately in areas with higher income, educational attainment and housing wealth.

That's to be expected considering most residents pay for assisted living with private dollars, the researchers wrote. Developers have located where the market is.

Low-income people, minorities and people living in rural areas have less access to assisted living. In Virginia, some public money -- what's called auxiliary grants -- pay for the care of a small number of assisted-living residents.

"The smaller [facilities] tend to focus on the auxiliary-grant residents, which in a lot of cases, they are psychiatric patients," said Soble, with the Virginia Health Care Association.

Growth of new assisted-living facilities has slowed, said Richard Brewer, president of Commonwealth Assisted Living, based in Charlottesville, and legislative chairman for the Virginia Assisted Living Association. According to state records, Virginia had 314 licensed assisted-living facilities in 1979 and 629 in 2004. It has 562 currently.

The housing-market falloff may be a factor going forward as people who need to sell their homes first can't sell or can't sell for enough to cover moving.

Assisted-living operators also are facing new rules. Virginia approved comprehensive assisted-living regulations about six years ago, Soble said. Facility administrators have to be licensed, and medication aides also have to be registered.

"The other thing we did in that legislation was require a disclosure statement when people go shopping, so they can compare facilities," Soble said. "So there would not be hidden agency charges. . . . Virginia is way ahead of other states."

Contact Tammie Smith at (804) 649-6572 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

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