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Chronic Conditions in Residential Care Communities: United States, 2025
Data from the National Post-acute and Long-term Care Study
- In 2025, almost one-half of residential care communities reported having residents diagnosed with all four selected chronic conditions (48.0%)—Alzheimer disease or other dementias, diabetes, depression, and heart disease.
- Residential care communities with 11 or more beds and those located in nonmetropolitan areas, the Northeast, and the Midwest were more likely to report having all four chronic conditions represented among their current residents.
- A higher percentage of nonprofit (54.3%) and chain-affiliated (54.3%) residential care communities, as well as communities using electronic health records (56.7%), reported having all four chronic conditions represented.
- Residential care communities that reported adverse events among their current residents (emergency department visits, hospitalizations, and falls) showed a higher prevalence of having all four conditions represented.
Introduction
In 2025, on a given day, an estimated 1 million residents lived in about 31,400 residential care communities (1). Many of these communities served residents with multiple chronic conditions, indicating potential complex needs among their resident populations. This report uses 2025 National Post-acute and Long-term Care Study (NPALS) data to examine the characteristics of residential care communities that reported four chronic conditions among their current residents: Alzheimer disease and other dementias, heart disease, diabetes, and depression. Data on the communities are presented overall and by selected organizational characteristics and adverse events.
Number of chronic conditions
- Almost one-half of residential care communities, representing about 15,100 communities, reported having all four selected chronic conditions (48.0%)—Alzheimer disease or other dementias, diabetes, depression, and heart disease—among one or more of their current residents (Figure 1, Table 1).
- Across all residential care communities, 14.8% reported none of the four conditions, 6.0% reported one condition, 12.2% reported two conditions, and 19.1% reported three conditions represented among their current residents.
Size and geographic characteristics
- Residential care communities with 11–25 beds (56.9%), 26–50 beds (65.2%), and more than 50 beds (59.0%) were more likely to have all four selected chronic conditions represented among their current residents compared with communities with 4–10 beds (31.5%) (Figure 2, Table 2).
- A larger percentage of residential care communities in nonmetropolitan areas (62.4%) than in metropolitan areas (45.4%) had all four chronic conditions represented. The Northeast (64.4%) and Midwest (57.9%) had higher percentages than the South (44.5%) and West (41.4%).
Organizational characteristics
- A larger percentage of nonprofit communities (54.3%) than for-profit communities (46.8%) had all four selected chronic conditions represented among current residents. Similarly, a higher percentage of chain-affiliated communities (54.3%) than nonchain-affiliated communities (39.8%) had all four chronic conditions represented (Figure 3, Table 3).
- Residential care communities that used electronic health records (EHRs) had all four chronic conditions represented more often (56.7%) compared with non‑EHR users (40.0%).
Adverse events
- Residential care communities that reported at least one resident with an emergency department visit in the last 90 days had a higher percentage of all four selected chronic conditions represented among current residents (62.0%) than communities that had no emergency department visits (33.9%). Similarly, communities reporting at least one resident with an overnight hospital stay had a higher percentage of all four chronic conditions represented (63.4%) than those that had no overnight hospital stays (40.7%) (Figure 4, Table 4).
- A larger percentage of communities reporting a resident fall in the past 90 days had all four chronic conditions represented (66.3%) compared with communities without reported falls (31.0%).
Summary
In 2025, almost one-half of residential care communities in the United States were serving residents with complex needs, with 48.0% having four common chronic conditions represented among their current residents. A higher percentage of larger (11 or more beds), nonmetropolitan, Northeast, and Midwest residential care communities had all four selected chronic conditions represented. Nonprofit and chain-affiliated residential care communities, and those using EHRs, had higher percentages of all four chronic conditions represented. Residential care communities reporting resident emergency department visits, overnight hospitalizations, and falls more often had all four chronic conditions represented.
This report presents the most recent national estimates of residential care communities with four selected chronic conditions represented among current residents, by organizational characteristics and adverse events. This brief profile provides information to policymakers, providers, researchers, and consumer advocates as they plan how to best meet the needs of post-acute and long-term care providers delivering care to an aging population with complex care needs.
Definitions
Chronic conditions: Refers to an aggregated item that asked how many current residents had been diagnosed with any of the following conditions: Alzheimer disease or other dementias, diabetes, depression, or heart disease. These four conditions were chosen because they are highly common in residential care communities and often co-occur. This provider measure ranged from zero if a residential care community did not report or reported no residents with any of the four conditions to four if a community reported having all four chronic conditions represented across one or more residents. This measure was collapsed into two categories for this report: zero to three conditions and all four conditions.
Heart disease: Includes conditions such as congestive heart failure, coronary or ischemic heart disease, heart attack, and stroke.
Residential care communities: Includes assisted living communities and other residential care communities (as in personal care homes, adult care homes, board care homes, or adult foster care) that meet the study eligibility criteria. More details are available from the study eligibility criteria and the survey methodology document (1).
Data source and methods
Data for this report are from the residential care community survey component of the 2025 wave of the biennial NPALS, conducted by the National Center for Health Statistics (NCHS). To be eligible for the study, a residential care community must:
- Be regulated by the state to provide room and board with at least two meals a day, around-the-clock on-site supervision, and help with personal care such as bathing and dressing or with health-related services such as medication management.
- Have four or more licensed, certified, or registered beds.
- Have at least one resident currently living in the community at the time of the survey.
- Serve a predominantly adult population.
The survey uses a stratified random sample obtained from a sampling frame constructed from lists of licensed residential care communities from state licensing agencies in the 50 states and District of Columbia. More details about NPALS, including eligibility criteria, design, and outcomes, are available on the NPALS website and in the survey methodology document (1).
The percentage of cases with missing data for variables in this report ranged from 19.4% for depression diagnosis to 0.8% for ownership type (for-profit and nonprofit). Missing cases were excluded from the analyses on a variable-by-variable basis for organizational characteristics and adverse events. Residential care communities missing data for the chronic conditions were included in the denominator, and those missing data on all four chronic conditions were included in the category for none (n = 434). Data analyses were performed using SAS version 9.4 (2), SAS-callable SUDAAN version 11.0.3 (3), and Stata/SE version 17 (4). Analyses accounted for the complex survey design of the study, included complex survey weights, and used appropriate subsetting techniques. All estimates presented meet NCHS standards for confidentiality and reliability unless otherwise indicated (5).
About the authors
Christine Caffrey, Manisha Sengupta, Jessica P. Lendon, Shannon Kindilien, and Amanuel Melekin are with the National Center for Health Statistics, Division of Health Care Statistics.
References
- National Center for Health Statistics. 2025 National Post-acute and Long-term Care Study: Adult day services center and residential care community survey design and methodology. 2026 Jun. Available from: https://www.cdc.gov/nchs/data/npals/2025/2025-NPALS-survey-methodology-documentation.pdf.
- SAS Institute. SAS statistical software (Release 9.4) [computer software]. 2016.
- RTI International. SUDAAN (Release 11.0.3) [computer software]. 2018.
- StataCorp. Stata statistical software (Release 17) [computer software]. 2021.
- Parker JD, Talih M, Malec DJ, Beresovsky V, Carroll M, Gonzalez JF Jr, et al. National Center for Health Statistics data presentation standards for proportions. Vital Health Stat 2. 2017 Aug;(175):1–22. Available from https://www.cdc.gov/nchs/data/series/sr_02/ sr02_175.pdf.
Suggested citation
Caffrey C, Sengupta M, Lendon JP, Kindilien S, Melekin A. Chronic conditions in residential care communities: United States, 2025. NCHS Data Brief. 2026 Oct;(574):1─10. DOI: https://dx.doi.org/10.15620/cdc/252476.
Copyright information
All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.
National Center for Health Statistics
Carolyn M. Greene, M.D., Acting Director
Amy M. Branum, Ph.D., Associate Director for Science
Division of Health Care Statistics
Carol J. DeFrances, Ph.D., Director
Alexander Strashny, Ph.D., Associate Director for Science