The Demographics of Senior Living According to the National Study of Long-Term Care Providers

National Study of Long-Term Care Providers (NSLTCP)

Overview, Current Products, and Select Findings Manisha Sengupta, PhD Argentum Senior Living Executive Conference May 9-12, 2016

Contributors to this presentation • • • • •

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Christine Caffrey Lauren Harris-Kojetin Jessica Lendon Vincent Rome Roberto Valverde

Acknowledgements • Directors and staff of participating residential care communities

• Argentum for supporting the study • Argentum state partners for encouraging participation

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Overview • Sponsored by CDC’s National Center for Health Statistics • Integrated initiative to monitor trends in paid, regulated longterm care • Five sectors  adult day services centers and participants  home health agencies and patients  hospices and patients  nursing homes and residents  residential care communities and residents

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Primary Goals 1. Estimate supply and use of paid, regulated long-term care services

2. Estimate key policy-relevant characteristics of providers and service users, and practices of providers 3. Produce national and state-level estimates, where possible 4. Compare within and between sectors 5. Examine trends over time

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Provider Association Supporters

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Sectors and Data Sources

SECTORS Hospice

Nursing Home

Home Health

Residential Care

Adult Day Services

DATA SOURCES

Administrative records

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Survey questionnaire

Residential Care Community Eligibility Criteria • • • •

4 or more beds; primarily an adult population; at least 1 resident at time of interview; licensed, registered, listed, certified, or otherwise regulated by the state to…

• provide room and board with at least 2 meals a day; • provide around-the-clock on-site supervision; and • offer help with personal care OR health care-related services.

•Exclusions: Nursing homes and providers exclusively serving adults with severe mental illness or ID/DD. 8

Survey Data Collection Adult Day

Years fielded

Residential Care

2012 and 2014

Target respondent Modes

Director or Administrator Mail, Web, Telephone

Cases fielded

2012 2014

Census 5,254 5,443

Census and Sample 11,690 11,618

2012 2014

3,212 2,763

4,694 5,035

National response rates 2012 2014

67% 58%

55% 50%

State response rates (Range) 2012 2014

42% - 93% 39% - 80%

44% - 84% 41% - 79%

Completions

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Topics about Providers Bolded topics available for most sectors as applicable New in 2016 • Location—metropolitan statistical area status, Census region, state • Operating characteristics—ownership, chain status, capacity, number of people served, Medicare and Medicaid certification, model type (adult day), part of a CCRC, years in operation, dementia special care unit, revenue sources (adult day) • Services offered and how—case management, dementia care unit, dental, hospice, medication management, mental health, pharmacy, podiatry, skilled nursing, social work, therapeutic, transportation • Staffing—nursing, social work, activities • Practices—advance directives (inform and document), depression screening, disease management programs, EHRs, fall risk assessment and reduction interventions, person-centered practices

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Topics about Service Users (Aggregate distributions) Bolded topics available for most sectors as applicable **New in 2016 • Socio-demographics—age, race, ethnicity, sex, Medicaid use • Selected conditions—Alzheimer’s disease or other dementias, cardiovascular disease, depression, developmental disability, diabetes, severe mental illness; more conditions in 2016 • Physical and Cognitive Functioning—need any ADL assistance (bathing, dressing, eating, toileting, transferring, walking/locomotion), wheelchair/scooter use • Health care use and adverse events—advance directives, emergency department visits, falls, fall-related injuries, hospitalizations, rehospitalizations, receiving hospice • Other characteristics—move-ins, move-outs and where went, left because of cost, living arrangements (adult day) 11

http://www.cdc.gov/nchs/nsltcp.htm

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Results and Publications

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Overview Report and PowerPoint Slides

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Data Briefs and State Estimates

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Staffing NHSR

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Quickstats

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Selected NSLTCP Findings

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As of 2014 in the United States…

• about 67,000 paid, regulated long-term care services providers served almost 9 M people.  4,800 adult day services centers had 282,200 participants enrolled on a typical day  12,400 home health agencies served over 4.9 M patients annually  4,000 hospices served over 1.3 M patients annually  15,600 nursing homes served almost 1.4 M residents on a typical day  30,200 residential care communities housed 835,200 residents on a typical day 19

Number and percentage of residential care communities and residents, by community bed size: United States, 2014

NOTES: Percentages are based on unrounded numbers. Estimates may not add up to totals because of rounding.

SOURCE: NCHS, Variation in Operating Characteristics of Residential Care Communities, by Size of Community: United States, 2014, NCHS Data Brief No. 222, Figure 1. Data from the National Study of Long-Term Care Providers (NSLTCP), 2014.

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Selected National Results Provider Characteristics

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Percent distribution of long-term care providers, by provider type and region: United States, 2014

Northeast 17.3 30.3

Midwest

24.8

South

West 15.5 42.0 34.7

46.6 33.0

41.2 28.1 32.9

17.0 28.0

22.8

8.1

11.3

Home health agency (12,400)

Hospice (4,000)

19.8 Adult day services center (4,800)

NOTE: Percentages are based on the unrounded numbers.

SOURCES: NCHS, National Study of Long-Term Care Providers.

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21.8 16.9 Nursing home (15,600)

8.2 Residential care community (30,200)

Capacity of long-term care services providers per 1,000 people ages 65 and older, by sector and region: United States, 2014

Adult day services center

Nursing home 48 41

36 22 6

Total

Northeast

34

25

18 7

Residential care community

3

Midwest

18 6

South

23 27 10

West

NOTES: Capacity refers to the number of certified nursing home beds, the number of licensed residential care community beds, and the maximum number of adult day services center participants allowed.

SOURCES: NCHS, National Study of Long-Term Care Providers

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Total number and percent distribution of nursing and social work employee full-time equivalents (FTEs), by sector and staff type: United States, 2014 Registered nurse

17.8

Licensed practical or vocational nurse

10.9

Aide

59.2

12.0 53.1

48.1

31.5 Social worker

22.3

8.5

18.8

6.5 10.7

82.0 63.9

25.6 12.1

2.5 Adult day Home health services center agency (23,100 FTEs) (140,300 FTEs)

11.9

Hospice (73,200 FTEs)

1.8 0.8 Nursing home Residential care (971,100 FTEs) community (332,400 FTEs)

NOTES: Only employees are included for all staff types; contract staff are not included. For adult day services centers and residential care communities, aides refer to certified nursing assistants, home health aides, home care aides, personal care aides, personal care assistants, and medication technicians or medication aides. For home health agencies and hospices, aides refer to home health aides.

For nursing homes, aides refer to certified nurse aides, medication aides, and medication technicians. See Technical Notes for information on how outliers were identified and coded. Percentages may not add to 100 because of rounding. Percentages are based on the unrounded numbers.

SOURCES: NCHS, National Study of Long-Term Care Providers.

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Percent distribution of long-term care services providers, by sector and dementia care unit: United States, 2014 Only serving adults with dementia With a unit, wing, or floor designated as a dementia care unit

Without dementia care units 0.4 14.8

10.1 12.1

84.8

77.8

Nursing home

Residential care community

NOTES: Percentages may not add to 100 because of rounding. Percentages are based on the unrounded numbers.

SOURCES: NCHS, National Study of Long-Term Care Providers.

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Selected residential care community operating characteristics, by community bed size: United States, 2014

1Differences

among communities with 4–25 beds, 26–50 beds, and more than 50 beds are significant at p < 0.05. between communities with 4–25 beds and the other community bed sizes are significant at p < 0.05.

3Differences among communities with 4–25 beds, 26–50 beds, and more than 50 beds are significant at p < 0.05, and increase by bed size is statistically significant (p < 0.05) based on a weighted least-squares regression test.

SOURCE: NCHS, Variation in Operating Characteristics of Residential Care Communities, by Size of Community: United States, 2014, NCHS Data Brief No. 222, Figure 2. Data from the National Study of Long-Term Care Providers (NSLTCP), 2014.

2Differences

Disease-specific programs offered for selected conditions among residential care communities, by community bed size: United States, 2014

1Differences

between communities with more than 50 beds and the other community bed sizes are significant at p < 0.05. among communities with 4–25 beds, 26–50 beds, and more than 50 beds are significant at p < 0.05.

3Differences between communities with 4–25 beds and the other community bed sizes are significant at p < 0.05.

SOURCE: CDC/NCHS, Variation in Operating Characteristics of Residential Care Communities, by Size of Community: United States, 2014, NCHS Data Brief No. 222, Figure 3. Data from the National Study of Long-Term Care Providers (NSLTCP), 2014.

2Differences

Use of electronic health records and support for electronic health information exchange among residential care communities, by community bed size: United States, 2014

1Community's

computerized system supports electronic health information exchange with physicians, pharmacies, or

hospitals.

NOTES: Differences among communities with 4â&#x20AC;&#x201C;25 beds, 26â&#x20AC;&#x201C;50 beds, and more than 50 beds are significant at p < 0.05, and increase by bed size is statistically significant (p < 0.05) based on a weighted least-squares regression test. Figure excludes cases with missing data; see "Data source and methods" for details.

SOURCE: NCHS, Variation in Operating Characteristics of Residential Care Communities, by Size of Community: United States, 2014, NCHS Data Brief No. 222, Figure 4. Data from the National Study of Long-Term Care Providers (NSLTCP), 2014.

Selected National Results Service User Characteristics

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Percent distribution of long-term care services users, by sector and age group: United States, 2013 and 2014 Under 65 16.2 27.5 20.0 36.4 Adult day services center

26.0

65 - 74

75 - 84

47.3

85 and over

41.6

52.6

31.1 25.5 17.5 Home health agency

30.0 17.1 5.6 Hospice

27.2 16.1 15.1 Nursing home

29.9 10.4 7.2 Residential care community

NOTES: Denominators used to calculate percentages for adult day services centers, nursing homes, and residential care communities were the number of participants enrolled in adult day services centers, the number of residents in nursing homes, and the number of residents in residential care communities on a given day in 2014, respectively. Denominators used to calculate percentages for home health agencies and hospices were the number of patients whose episode of care ended at any time in 2013 and the number of patients who received care from Medicare-certified hospices at any time in 2013, respectively. See Technical Notes for more information on the data sources used for each sector. Percentages may not add to 100 because of rounding. Percentages are based on the unrounded numbers.

SOURCES: NCHS, National Study of Long-Term Care Providers.

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Selected characteristics of residential care residents, by community size: United States, 2014

1Significant

difference between communities with 26–50 beds and other community sizes (p < 0.05). difference between communities with 4–25 beds and other community sizes (p < 0.05).

3Significant differences among communities with 4–25 beds, 26–50 beds, and more than 50 beds (p < 0.05); decrease by bed size is statistically significant (p < 0.05) based on a weighted least-squares regression test.

SOURCE: NCHS, Variation in Residential Care Community Resident Characteristics, by Size of Community: United States, 2014, NCHS Data Brief No. 223, Figure 2. Data from the National Study of Long-Term Care Providers (NSLTCP), 2014.

2Significant

Percentage of long-term care services users with selected diagnoses, by sector: United States, 2013 and 2014

Alzheimer's disease or other dementias

29.9

25.5

29.7

Adult day services center

31.4

37.9

45.2

Diabetes

50.4 48.7

44.7 22.9

Home health agency

Depression

27.6

Hospice

32.4

39.6 23.2

Nursing home

16.9

Residential care community

NOTES: Denominators used to calculate percentages for adult day services centers, nursing homes, and residential care communities were the number of participants enrolled in adult day services centers, the number of residents in nursing homes, and the number of residents in residential care communities on a given day in 2014, respectively. Denominators used to calculate percentages for home health agencies and hospices were the number of patients whose episode of care ended at any time in 2013 and the number of patients who received care from Medicare-certified hospices at any time in 2013, respectively. See Technical Notes for more information on the data sources used for each sector. Percentages are based on the unrounded numbers.

SOURCES: NCHS, National Study of Long-Term Care Providers

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Selected diagnosed medical conditions among residential care residents, by community size: United States, 2014

1Significant

difference between communities with 4–25 beds and other community sizes (p < 0.05). differences among communities with 4–25 beds, 26–50 beds, and more than 50 beds (p < 0.05); decrease by bed size is statistically significant (p < 0.05) based on a weighted least-squares regression test.

3Significant difference between communities with 4–25 beds and those with more than 50 beds (p< 0.05).

SOURCE: NCHS, Variation in Residential Care Community Resident Characteristics, by Size of Community: United States, 2014, NCHS Data Brief No. 223, Figure 3. Data from the National Study of Long-Term Care Providers (NSLTCP), 2014.

2Significant

Percentage of long-term care services users with overnight hospital stays, emergency department visits, and falls, by sector: United States, 2013 and 2014 Overnight hospital stays

Emergency department visits

Falls 21.1

16.7

5.7

6.6

14.9

16.5 12.4 8.3

7.8

Adult day services center

Home health agency

Nursing home

Residential care community

NOTES: For home health agencies, data were unavailable for falls; for nursing home data were unavailable for overnight hospital stays and emergency department visits. Denominators used to calculate percentages for adult day services centers, nursing homes, and residential care communities were the number of participants enrolled in adult day services centers, the number of residents in nursing homes, and the number of residents in residential care communities on a given day in 2014, respectively. Denominator used to calculate percentages for home health agencies was the number of patients whose episode of care ended at any time in 2013. For adult day services centers and residential care communities, adverse events refer to a period of 90 days prior to the survey. For home health agencies, adverse events refer to a period since the last OASIS assessment. For nursing homes, falls refer to the period since admission or since the prior assessment whichever is more recent.

SOURCES: NCHS, National Study of Long-Term Care Providers.

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Percentage of Long-Term Care Services Users Needing Any Assistance with Activities of Daily Living, by Sector and Activity: United States, 2013 and 2014 Bathing

Dressing

Toileting

96.4

Walking/locomotion

94.0

88.4

Transfering in and out of bed

96.4 91.8

87.8

Eating

87.9 90.7 85.2

73.2 58.0

56.7 41.0 37.1

35.6 33.7

29.8

47.4

24.3

Adult day services center

Home health agency

62.4

Nursing home

39.3

29.1 29.7

19.8

Residential care community

NOTES: Denominators used to calculate percentages for adult day services centers, nursing homes, and residential care communities were the number of participants enrolled in adult day services centers, the number of residents in nursing homes, and the number of residents in residential care communities on a given day in 2014, respectively. Denominator used to calculate percentages for home health agencies was the number of patients whose episode of care ended at any time in 2013.

Participants, patients or residents were considered needing any assistance with a given activity if they needed help or supervision from another person, or used special equipment to perform the activity. See Appendix A for more information on how needing any assistance with a given activity was defined. Percentages are based on the unrounded numbers.

SOURCES: NCHS, National Study of Long-Term Care Providers.

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Need for assistance with selected activities of daily living among residential care residents, by community size: United States, 2014

1Significant

differences among communities with 4–25 beds, 26–50 beds, and more than 50 beds (p < 0.05); decrease by bed size is statistically significant (p < 0.05) based on weighted least-squares regression test.

2Significant difference between communities with 4–25 beds and other community sizes (p < 0.05).

NOTE: Cases with missing data are excluded; see "Data source and methods" for details.

SOURCE: NCHS, Variation in Residential Care Community Resident Characteristics, by Size of Community: United States, 2014, NCHS Data Brief No. 223, Figure 4. Data from the National Study of Long-Term Care Providers (NSLTCP), 2014.

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Selected State Results (Maps)â&#x20AC;&#x201D;Service Users

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Nursing home residents per 1,000 persons aged 85 and over : United States, 2014

Significance tested at p<0.05.

Note: The national rate is 87.

Note: Rates based on residents in nursing homes on any given day in 2014 per 1,000 persons aged 85 and over.

Source: NCHS, National Study of Long-Term Care Providers, 2014

Residential care residents per 1,000 persons aged 85 and over: United States, 2014

Significance tested at p<0.05.

Note: The national estimate is 62.

Source: NCHS, National Study of Long-Term Care Providers.

Percentage of residential care community residents diagnosed with Alzheimerâ&#x20AC;&#x2122;s disease or other dementias: United States, 2014

Significance tested at p<0.05.

Note: The national percentage is 40%.

Source: NCHS, National Study of Long-Term Care Providers.

Percentage of residential care community residents diagnosed with depression: United States, 2014

Significance tested at p<0.05.

Note: The national percentage is 23%.

Source: NCHS, National Study of Long-Term Care Providers.

Percentage of residential care residents that had any falls in last 90 days: United States, 2014

Significance tested at p<0.05.

Note: The national percentage is 21%.

Source: NCHS, National Study of Long-Term Care Providers.

Percentage of residential care residents that had hospitalizations: United States, 2014

Significance tested at p<0.05.

Note: The national percentage is 8%.

Source: NCHS, National Study of Long-Term Care Providers.

Percentage of residential care community residents that need assistance with bathing: United States, 2014

Significance tested at p<0.05.

Note: The national percentage is 62%.

Source: NCHS, National Study of Long-Term Care Providers.

Percentage of residential care community residents that need assistance with eating: United States, 2014

Significance tested at p<0.05.

Note: The national percentage is 20%.

Source: NCHS, National Study of Long-Term Care Providers.

Future Enhancements • Questionnaire content – new content in 2016 • Expanding scope – residential care communities exclusively serving residents with ID/DD in 2018 • Alternating study representation – National sample in 2018 • Extending to user-level data – user-level data collection in 2018

Questions or Comments?

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For further information contact: ltcsbfeedback@cdc.gov 301-458-4747