A recent study conducted by the Coalition to Protect Choice in Senior Living found that an astounding 84 percent of Americans over 50 expect that, within the next 10 years, at least one member of their immediate family will move into a senior living community, and that nearly one-quarter of those over 65 anticipate that they will do so as well.

There's more. More than one-half of younger Americans--Baby Boomers, 76 million in number, the largest generation in our history--believe that their own parents will be relocating from their single-family homes into a senior housing project within the decade.

As might be expected, the study found that cost and quality of care will be the most important factors as these Boomers and seniors evaluate the various long-term housing options.

Prospects will be very budget-conscious as they consider assisted living or nursing home care. They intend to keeps costs at a minimum. Fully 78 percent of the study's respondents agreed with the statement, "It is difficult to find the quality you desire at the price you can afford.”

Here's how prospective assisted living residents and their family members ranked the most important attributes for a facility:

76%: Personal care quality;

76%: Residents' personal safety;

74%: Cleanliness; and

68%: Staff and management (57%) quality

Assisted living facilities are a relatively new housing phenomenon. Although they were extremely rare even ten or fifteen years ago, they've become the fastest-growing and most popular elderly residential product type. Although actual numbers are sketchy, an estimated one million seniors currently reside in approximately 40,000 assisted living facilities, as compared with only 600,000 who did so only ten years ago, when there were about one-quarter of these projects nationwide. And looking ahead, experts estimate that by the year 2020, 14 million of us will require this kind of housing, double the number who do so today.

Perhaps not surprisingly, as their popularity has grown, assisted living facilities have been subject to criticism because of the health and healthcare issues that some residents have experienced. The typical assisted living project provides private or semi-private rooms, meals and housekeeping services. Many of these facilities also provide some social activities.

What may be surprising to some, however, is the fact that, unlike nursing homes, only approximately one-half of assisted living facilities are staffed by registered nurses. A recent study in the Elder Law Journal, published by the Illinois College of Law, summarized the differences between assisted living and nursing home facilities:

"In contrast to assisted living facilities, nursing homes are subject to federal guidelines because they rely on Medicaid and Medicare funds. A second major difference between assisted living facilities and nursing homes is their respective costs. Assisted living facilities typically cost less than nursing homes. However, this cost (differential) is misleading because assisted living residents use private funds to pay for their expenses while eligible persons can use Medicaid to cover nursing home costs."

The study surveyed the type and extent of state-level assisted living regulation. Unfortunately, many of these facilities had shortcomings in rules enforcement and routine inspections. The most glaring deficiency, however, was the lack of on-site training, which the study found was the case in many states.

Indeed, Maryland, one of the states critiqued in the study requires a mere three hours of training as a prerequisite to working in one of its assisted living projects. Perhaps as a consequence, patients in these facilities were found to have significant signs of neglect, including untreated bedsores and hypothermia.

As states increasingly wrestle to balance their budgets, it is likely that annual inspection of assisted living facilities will be a target for cost-cutting. In California, for example, as state that previously required annual inspections, now requires inspections only every five years. Alabama lawmakers recently slashed the budget for these inspections, reducing funding from $5.5 million to inspect 244 facilities in 2002 to $500,000 for 330 of these projects last year.

The purpose of the federal Nursing Home Reform Act in 1987 was to require some minimal level of service. In addition, it established a bill of rights for nursing home residents.

The Illinois study found that the law has favorably impacted the quality of nursing home life, including reduction in the use of physical and chemical restraints, as well as reducing hospitalization rates. The study concluded that extending federal regulation to assisted living facilities, and particularly, requiring improved personnel training, would be desirable.

On the other hand, Daniel R. Levinson, inspector general of the Department of Health and Human Services reports that, just last year, and despite the Nursing Home Reform Act cited above, more than 90 percent of nursing homes were cited for federal health and safety violations.

Indeed, nearly 20 percent of these facilities had deficiencies that, in the words of the inspector general, caused “actual harm or immediate jeopardy” to patients. These problems included infected bedsores, medication mix-ups, poor nutrition, and abuse and neglect of patients.

In fact, about 20 percent of the 37,150 complaints that were inspected, 39 percent were found to be valid and approximately 20 percent of them involved patient abuse or neglect.

There are approximately 15,000 nursing homes in the U. S., housing more than 1.5 million seniors. They're typically inspected annually, and, to qualify for Medicaid and Medicare participation, they must meet federal standards. These federal programs, which cost more than $75 billion a year, cover the expenses for more than two-thirds of nursing home residents.

The inspector general's report found deficiency rates varied widely, ranging from a high of 76 percent in Rhode Island to 100 percent in the District of Columbia, Alaska, Wyoming and Idaho.