A majority of America's Baby Boomers believe that their own parents will be moving from their homes into a senior housing facility within 10 years.

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. As family finances continue to dwindle, the selection of nursing home or assisted living care will be driven by available dollars. 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 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 is a relatively new housing phenomenon. Although extremely rare even ten or fifteen years ago, these communities have 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 of these 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 community provides private or semi-private rooms, meals and housekeeping services. Many of these facilities also provide some social activities.

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 these housing types: "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 (these) 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 regulation. Unfortunately, many were found to have shortcomings in rules enforcement and routine inspections. The most glaring deficiency that was identified, however, was the lack of on-site training, which the study found was the situation 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 these communities. Nursing home inspections often uncover neglect in treatment of patients, including untreated bedsores and hypothermia.

Annual inspections of assisted living facilities are rare, and will probably become more uncommon because of budget cuts. In California, for example, a 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 federal Nursing Home Reform Act of 1987 was a legislative attempt to ensure minimum services for nursing home residents. 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 recommended extending federal regulation to assisted living facilities.

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 report found that deficiency rates, while varied, skyrocketed to 100 percent of facilities in the District of Columbia, Alaska, Wyoming and Idaho.