Mainers in residential care facilities are on average older and more likely to have dementia than those in nursing home facilities, according to a report from the Catherine Cutler Institute at the University of Southern Maine.

Brenda Gallant, the state advocate for long-term care residents and their families, said that while residential care and assisted living facilities are intended to provide a lower level of care, the report “verifies” that the population in these facilities has changed.

“People have a greater need than in prior years,” she said. “What began as a social model has evolved into serving older and disabled adults with greater needs.”

About 41 percent of residents in large residential care facilities in 2023 were 85 or older – compared to 37 percent in nursing homes, according to the report. The average age was 81 in these residential facilities and 79 in nursing homes.

The disappearance of nursing home beds has sent thousands to residential care facilities, which are considered by the state to be “nonmedical” residences that aren’t intended to handle more intensive health needs.

A 2023 investigation by The Maine Monitor and ProPublica found that these facilities are routinely called on to care for residents with much higher needs, even though they are not designed or prepared to do so.

The report also found that 54 percent of Mainers in residential care had been diagnosed with dementia, compared to 51 percent of residents in nursing homes.

Residential care facilities also had a higher percentage of residents with diagnoses of anemia, arthritis and osteoporosis than those in nursing homes.

The percentage of residents who need help with daily activities remained highest in nursing homes. However the percentage of people in residential care facilities who need more assistance has “consistently increased” from 2021 to 2023, while it has “remained relatively constant” in nursing homes.

According to the report, the average length of stay in nursing homes decreased from 814 days in 2021 to 735 days in 2023. Average stay in residential care facilities, on the other hand, increased from 866 days to 941 days.

Across all settings, there were more female residents than male residents: 63 percent in nursing homes and 70 percent in residential care. Residents were 99 percent white in both residential care facilities and nursing homes.

Gallant said there are likely many Mainers in residential care facilities who are eligible for nursing homes but opt to stay where they are because they prefer to “age in place” or because it is difficult to find a nursing home due to closures and conversions to lower levels of care.

To meet the increasing needs in residential care facilities, Gallant said it is important to ensure that there is enough staff and that they are adequately trained.

“The current staffing is not sufficient to meet the needs of residents,” she said.

The state is in the middle of updating regulations for residential care and assisted living facilities that would significantly increase staffing requirements, among other changes.

The proposed regulations follow an 18-month investigation by The Maine Monitor and ProPublica, which found that the disappearance of nursing home beds across the state is pushing more Mainers with higher needs into residential care facilities and that there were roughly 200 violations involving “medications and treatments” at these facilities from 2020 to 2022.

The assisted living and residential care industry has pushed back on the state’s proposal, saying they were blindsided by the significant staffing changes and that the associated costs could lead to “catastrophic outcomes” at a time when facilities are already struggling to find staff.

The state is evaluating public comments and is expected to submit a final proposal to lawmakers in January.

This story was originally published by The Maine Monitor, a nonprofit civic news organization. To get regular coverage from the Monitor, sign up for a free Monitor newsletter here.