The Eldercare Facility Ordinance of Los Angeles: A Synthetic Control Analysis of Residential Care Development and Growth

Abstract

French

Chinese

The 2006 eldercare facility ordinance of Los Angeles was designed to streamline permitting of senior housing development in the jurisdiction. Using California State Department of Social Services residential care and census place data, this study compares the pre and post effect of the ordinance on the number of large residential care facilities developed in Los Angeles with a comparison group using synthetic control analysis. In posttreatment, Los Angeles shows up to 33 percent more facilities per ten thousand older adults per year more than the synthetic control, underscoring the importance of such ordinances in increasing senior housing development in Los Angeles.

Keywords

land use eldercare residential care senior housing Los Angeles synthetic control

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References

AARP Public Policy Institute. 2012. Assisted Living and Residential Care in the States in 2010. Washington, DC: AARP Public Policy Institute. https://www.aarp.org/content/dam/aarp/research/public_policy_institute/ltc/2012/residential-care-insight-on-the-issues-july-2012-AARP-ppi-ltc.pdf.

Abadie

Alberto

. 2021. “Using Synthetic Controls: Feasibility, Data Requirements, and Methodological Aspects.” Journal of Economic Literature 59 (2): 391–425. doi:10.1257/jel.20191450.

Abadie

Alberto

Diamond

Alexis

Hainmueller

Jens

. 2010. “Synthetic Control Methods for Comparative Case Studies: Estimating the Effect of California’s Tobacco Control Program.” Journal of the American Statistical Association 105 (490): 493–505. doi:10.1198/jasa.2009.ap08746.

Abadie

Alberto

Diamond

Alexis

Hainmueller

Jens

. 2015. “Comparative Politics and the Synthetic Control Method.” American Journal of Political Science 59:495–510. doi:10.1111/ajps.12116.

Ball

Mary M.

Perkins

Molly M.

Hollingsworth

Carole

Whittington

Frank J.

King

Sharon V.

2009. “Pathways to Assisted Living: The Influence of Race and Class.” Journal of Applied Gerontology 28 (1): 81–108. doi:10.1177/0733464808323451.

Beck

Laurel

Johnson

Hans

. 2015. Planning for California’s Growing Senior Population. Sacramento: Public Policy Institute of California. https://www.ppic.org/publication/planning-for-californias-growing-senior-population/.

Bliss

Laura

. 2019. “The NIMBY Principle.” Bloomberg CityLab, July 26. https://www.bloomberg.com/news/articles/2019-07-26/how-to-bridge-the-nimby-vs-yimby-housing-battle.

Bowblis

John R.

2012. “Market Structure, Competition from Assisted Living Facilities, and Quality in the Nursing Home Industry.” Applied Economic Perspectives and Policy 34 (2): 238–57. doi:10.1093/aepp/pps006.

Bowers

Lois A.

2016. “Elopement in Assisted Living: Not Common, but Costly.” McKnight’s Senior Living, November 3. https://www.mcknightsseniorliving.com/home/news/elopement-in-assisted-living-not-common-but-costly/.

10.

California Advocates for Nursing Home Reform. 2019. Overview of Assisted Living/Residential Care Facilities for the Elderly (RCFEs). San Francisco: California Advocates for Nursing Home Reform. http://canhr.org/factsheets/rcfe_fs/html/rcfe_fs.overview.htm.

11.

California Association of Health Facilities. 2020. Guide to Long Term Care. Sacramento: California Association of Health Facilities. https://www.cahf.org/About/Consumer-Help/Guide-to-Long-Term-Care.

12.

California Department of Finance. 2007. E-8 Historical Population and Housing Estimates for Cities, Counties, and the State—1990-2000. Sacramento: State of California Department of Finance. https://www.dof.ca.gov/Forecasting/Demographics/Estimates/.

13.

California Department of Finance. 2012. E-8 Historical Population and Housing Estimates for Cities, Counties, and the State—2000-2010. Sacramento: State of California Department of Finance. https://www.dof.ca.gov/Forecasting/Demographics/Estimates/.

14.

California Department of Finance. 2020. E-5 Population and Housing Estimates for Cities, Counties, and the State—January 1, 2011-2020. Sacramento: State of California Department of Finance. https://www.dof.ca.gov/Forecasting/Demographics/Estimates/.

15.

California Department of Housing and Community Development. 2019a. Housing for a Healthy California. Sacramento: California Department of Housing and Community Development. http://www.hcd.ca.gov/grants-funding/active-funding/hhc.shtml#funding.

16.

California Department of Housing and Community Development. 2019b. Multifamily Housing Program (MHP). Sacramento: California Department of Housing and Community Development. http://www.hcd.ca.gov/grants-funding/active-funding/mhp.shtml#guidelines.

17.

California Department of Housing and Community Development. 2019c. SB 2 Planning Grants. Sacramento: California Department of Housing and Community Development. http://www.hcd.ca.gov/grants-funding/active-funding/planning-grants.shtml#funding.

18.

California Department of Social Services. 2017. Residential Care Facilities for the Elderly. Sacramento: California Department of Social Services. https://www.ccld.dss.ca.gov/carefacilitysearch/DownloadData.

19.

California Health Care Foundation. 2002. Residential Care for the Elderly: Supply, Demand, and Quality Assurance. Oakland: California Health Care Foundation. https://www.chcf.org/wp-content/uploads/2017/12/PDF-rcfefullreport.pdf.

20.

Centers for Disease Control and Prevention. 2021. Interim Infection Prevention and Control Recommendations to Prevent SARS-COV-2 Spread in Nursing Homes. Washington, DC: Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html.

21.

Chen

Shuo

. 2020. “Caring For Mom: Establishing Statutory Rights for Elder Care Facilities.” American Journal of Law and Medicine 46:111–32. doi:10.1177/0098858820919555.

22.

Commission on Long Term Care. 2013. Report to Congress. Washington, DC: Center for Medicare Advocacy. http://www.medicareadvocacy.org/wp-content/uploads/2014/01/Commission-on-Long-Term-Care-Final-Report-9-18-13-00042470.pdf.

23.

Davidoff

Thomas

. 2016. “Supply Constraints Are Not Valid Instrumental Variables for Home Prices Because They Are Correlated with Many Demand Factors.” Critical Finance Review 5 (2): 177–206. doi:10.1561/104.00000037.

24.

Eaton

Joe

. 2020. Who’s to Blame for the 100,000 COVID Dead in Long-Term Care: Finger-Pointing in Wake of Health Disaster is Widespread, but Causes Were Laid Decades Ago. Washington, DC: American Association of Retired Persons. https://www.aarp.org/caregiving/health/info-2020/covid-19-nursing-homes-who-is-to-blame.html.

25.

Florida

Richard

. 2017. “Anatomy of a NIMBY.” Bloomberg CityLab, February 23. https://www.bloomberg.com/news/articles/2017-02-23/how-better-urbanism-can-combat-nimbyism.

26.

Galiani

Sebastian

Quistorff

Brian

. 2017. “The Synth_Runner Package: Utilities to Automate Synthetic Control Estimation Using Synth.” The Stata Journal 17 (4): 834–49. doi:10.1177/1536867X1801700404.

27.

Grogan

William H.

1999. “The Tension between Local Zoning and the Development of Elderly Housing: Analyzing the Use of the Fair Housing Act and the Americans with Disabilities Act to Override Zoning Decisions.” Suffolk University Law Review 33 (2): 317–60. https://heinonline.org/HOL/LandingPage?handle=hein.journals/sufflr33&div=22&id=&page=.

28.

Harper

Jeremy

. 2017. “Facing the Challenges of Affordable Senior Housing.” Urban Land Magazine, September 20. https://urbanland.uli.org/economy-markets-trends/facing-challenges-creating-affordable-senior-housing/.

29.

Hoffman

A. Kimberly

Landon

James A.

2012. “Zoning and the Aging Population: Are Residential Communities Zoning Elder Care Out?” The Urban Lawyer 44 (3): 629–45. https://www.jstor.org/stable/24392319?seq=1.

30.

Luojia

Kaestner

Robert

Mazumder

Bhaskar

Miller

Sarah

Wong

Ashley

. 2017. The Effect of the Patient Protection and Affordable Care Act Medicaid Expansions on Financial Wellbeing. Chicago: Federal Reserve Bank of Chicago. doi:10.1016/j.jpubeco.2018.04.009.

31.

Johnson

Clay Stephen

. 2013. “Compared to What? The Effectiveness of Synthetic Control Methods for Causal Inference in Educational Assessment.” PhD diss. https://pdfs.semanticscholar.org/52fd/3aaadd5a6a34f5813bbdeba42317c8df2e1c.pdf.

32.

Joint Center for Housing Studies. 2014. Housing America’s Older Adults: Meeting the Needs of an Aging Population. Boston: Harvard University. https://www.jchs.harvard.edu/sites/default/files/jchs-housing_americas_older_adults_2014_1.pdf.

33.

Kaiser Family Foundation. 2021. COVID-19: Long-Term Care Facilities. San Francisco: Kaiser Family Foundation. https://www.kff.org/coronavirus-covid-19/issue-brief/state-covid-19-data-and-policy-actions/.

34.

Kaul

Ashok

Klöner

Stefan

Pfeifer

Gregor

Schieler

Manuel

. 2015. “Synthetic Control Methods: Never Use All Pre-Intervention Outcomes Together with Covariates.” MPRA Paper 83790. http://www.oekonometrie.uni-saarland.de/papers/SCM_Predictors.pdf.

35.

Kautz

Barbara

. 2011. Select California Laws Relating to Residential Recovery Facilities and Group Homes. Oakland: Goldfarb and Lipman LLP. https://santa-ana.primegov.com/meeting/attachment/13663.pdf?.

36.

Kling

Michael

. 2002. “Zoned Out: Assisted-Living Facilities and Zoning.” The Elder Law Journal 10 (1): 187–215. https://www.jstor.org/stable/24392319?seq=1.

37.

Lee

Ronald

. 2011. “The Outlook for Population Growth.” Science 333 (6042): 569–73. doi:10.1126/science.1208859.

38.

Los Angeles. 2006. Municipal Ordinance No. 178063. http://clkrep.lacity.org/onlinedocs/2003/03-1056_ord_178063.pdf.

39.

Manson

Steven

Schroeder

Jonathan

Van Riper

David

Krugler

Tracy

Ruggles

Steven

. 2021. “IPUMS National Historical Geographic Information System: Version 15.0.” doi:10.18128/D050.V15.0.

40.

McClelland

Robert

Gault

Sarah

. 2017. The Synthetic Control Method as a Tool to Understand State Policy. Washington, DC: The Urban Institute. https://www.urban.org/sites/default/files/publication/89246/the_synthetic_control_method_as_a_tool_0.pdf.

41.

Menkin

Cori

. 2001. “Senior Citizen Overlay Districts and Assisted Living Facilities: Different but the Same.” Pace Law Review 21 (6): 481–509. https://digitalcommons.pace.edu/plr/vol21/iss2/6/.

42.

Mollica

Robert L.

1995. Assisted Living Policy and Regulation: State Survey. Washington, DC: U.S. Department of Health & Human Services. https://aspe.hhs.gov/reports/assisted-living-policy-regulation-state-survey-0.

43.

National Center for Health Statistics. 2016. Residential Care Communities. Washington, DC: Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/fastats/residential-care-communities.htm.

44.

Pattiz

Emma

. 2016. “Big News on the Zoning Front: City Council Passes ZQA.” AIA New York, March. https://www.aiany.org/news/big-news-on-the-zoning-front-city-council-passes-zqa/.

45.

Pierce

J. Rush

Jr. Morley

Sarah K.

West

Theresa A.

Pentecost

Percy

Upton

Lori A.

Banks

Laura

. 2016. “Improving Long-Term Care Facility Disaster Preparedness and Response: A Literature Review.” Disaster Medicine and Public Health Preparedness 11 (1): 140–49. doi:10.1017/dmp.2016.59.

46.

Rosenthal

Larry A.

2009. “The Role of Local Government: Land-Use Controls and Aging-Friendliness.” Generations 33 (2): 18–25.

47.

Saiz

Albert

. 2010. “The Geographic Determinants of Housing Supply.” The Quarterly Journal of Economics 125 (3): 1253–96. doi:10.1162/qjec.2010.125.3.1253.

48.

Smersh

Greg T.

Smith

Marc T.

Schwartz

Arthur L.

Jr.

2003. “Factors Affecting Residential Property Development Patterns.” Journal of Real Estate Research 25 (1): 61–75. doi:10.5555/rees.25.1.kq687k214t1j5161.

49.

Steadfast Companies. 2019. Steadfast Senior Living & Care Acquisition Criteria: Land Development Opportunities. Irvine: Steadfast Companies. https://www.steadfastcompanies.com/wp-content/uploads/sites/2/2016/02/Acq-Criteria-Sr-Living-and-Care-Land-Development-Opportunities-REV32.pdf.

50.

Tobler

Waldo R.

1970. “A Computer Model Simulating Urban Growth in the Detroit Region.” Economic Geography 46:234–40.

51.

Turkova

Donze

2017. “The Effect of Firms Reporting to the Carbon Disclosure Project on Their CO2 Emissions: Application on Industrial Sector.” In Environmental and Economic Impact on Sustainable Development, edited by Brebbia

C. A.

Miralles i Garcia

J. L.

19–26. Southampton: WIT Press.

52.

U.S. Census Bureau. 2018. DATA GEMS: What Is a CDP? Making Sense of Census Geography. Washington, DC: U.S. Census Bureau. https://www.census.gov/data/academy/data-gems/2018/cdp.html.

53.

U.S. Department of Health & Human Services. 2003. The Future of Long-Term Care Workers in Relation to the Aging Baby Boom Generation. Washington, DC: U.S. Department of Health & Human Services, Office of the Assistant Secretary for Planning and Evaluation. https://aspe.hhs.gov/pdf-report/future-supply-long-term-care-workers-relation-aging-baby-boom-generation.

54.

U.S. Department of Housing and Urban Development. 2019a. Housing Choice Vouchers Fact Sheet. Washington, DC: U.S. Department of Housing and Urban Development. https://www.hud.gov/topics/housing_choice_voucher_program_section_8.

55.

U.S. Department of Housing and Urban Development. 2019b. Low-Income Housing Tax Credits. Washington, DC: U.S. Department of Housing and Urban Development. https://www.huduser.gov/portal/datasets/lihtc.html.

56.

U.S. Department of Housing and Urban Development. 2019c. Section 202 Supportive Housing for the Elderly Program. Washington, DC: U.S. Department of Housing and Urban Development. https://www.hud.gov/program_offices/housing/mfh/progdesc/eld202.

57.

U.S. Geological Survey. 2014. Earth Explorer: Home. Washington, DC: U.S. Department of the Interior, U.S. Geological Survey. https://earthexplorer.usgs.gov.

58.

U.S. Geological Survey. 2016. The National Map: Staged Products Directory. Washington, DC: U.S. Department of the Interior, U.S. Geological Survey. http://prd-tnm.s3-website-us-west-2.amazonaws.com/?prefix=StagedProducts/Hydrography/NHD/State/HighResolution/Shape/.

59.

Wiener

Joshua M.

Lux

Linda

Johnson

Ruby

Greene

Angela M.

2010. National Survey of Residential Care Facilities: Sample Frame Construction and Benchmarking Report. Washington, DC: U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, Office of Disability, Aging, and Long-term Care Policy. https://aspe.hhs.gov/system/files/pdf/76086/sfconst.pdf.