the demographics of senior living according to the national study of long-term care providers

Overview, Current Products, and Select Findings

Manisha Sengupta, PhD

Argentum Senior Living Executive Conference May 9-12, 2016

National Study of Long-Term Care Providers (NSLTCP)

Contributors to this presentation

• Christine Caffrey

• Lauren Harris-Kojetin

• Jessica Lendon

• Vincent Rome

• Roberto Valverde

2

Acknowledgements

• Directors and staff of participating residential care communities

• Argentum for supporting the study

• Argentum state partners for encouraging participation

3

Overview

4

• Sponsored by CDC’s National Center for Health Statistics

• Integrated initiative to monitor trends in paid, regulated long-term 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

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

5

Provider Association Supporters

6

Sectors and Data Sources

7

HospiceNursing Home

Home

Health

Residential Care

Adult Day Services

S E C T O R S

Administrative records Survey questionnaire

D A T A S O U R C E S

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 CollectionAdult Day Residential Care

Years fielded 2012 and 2014

Target respondent Director or Administrator

Modes Mail, Web, Telephone

Cases fielded

2012

2014

Census

5,254

5,443

Census and Sample

11,690

11,618

Completions 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%

9

Topics about Providers

Bolded topics available for most sectors as applicableNew 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

10

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, re-hospitalizations, 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

12

Results and Publications

13*

Overview Report and PowerPoint Slides

14

Data Briefs and State Estimates

15

Staffing NHSR

16

Quickstats

17

Selected NSLTCP Findings

18

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

20

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.

Selected National Results

Provider Characteristics

21

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

22

19.88.1 11.3

16.98.2

17.0

28.0 22.8

32.9

21.8

33.0

46.641.2

34.7

28.1

30.3

17.324.8

15.5

42.0

Adult day services center(4,800)

Home health agency(12,400)

Hospice(4,000)

Nursing home(15,600)

Residential care community(30,200)

Northeast Midwest South West

NOTE: Percentages are based on the unrounded numbers.

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

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

23

6 7 3 6 10

3641

48

342322 18

2518

27

Total Northeast Midwest South West

Adult day services center Nursing home Residential care community

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

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

24

12.12.5

11.91.8 0.8

59.2

25.6

31.563.9

82.0

10.9

18.8

8.5

22.3

10.717.8

53.1 48.1

12.0 6.5

Adult dayservices center(23,100 FTEs)

Home healthagency

(140,300 FTEs)

Hospice(73,200 FTEs)

Nursing home(971,100 FTEs)

Residential carecommunity

(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.

Registered nurse

Licensed practical or vocational nurse

Aide

Social worker

Percent distribution of long-term care services providers, by sector and dementia care unit: United States, 2014

25

84.8 77.8

14.812.1

0.410.1

Nursing home Residential care community

Only serving adults with dementia

With a unit, wing, or floor designated as a dementia care unit

Without dementia care units

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.

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 < 0.05.2Differences 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.

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 < 0.05.2Differences 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


2014.

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 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. 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


2014.

http://www.cdc.gov/nchs/data/databriefs/db222.htm#source

Selected National Results

Service User Characteristics

29

Percent distribution of long-term care services users, by sector and age group: United States, 2013 and 2014

30

36.417.5 5.6 15.1 7.2

20.0

25.5

17.116.1

10.4

27.531.1

30.027.2

29.9

16.2 26.047.3 41.6 52.6

Adult day servicescenter

Home health agency Hospice Nursing home Residential carecommunity

Under 65 65 - 74 75 - 84 85 and over

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.

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).2Significant 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.

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

32

29.9 31.4

44.750.4

39.6

25.5

37.9

22.9

48.7

23.229.7

45.2

27.632.4

16.9

Adult day servicescenter

Home health agency Hospice Nursing home Residential carecommunity

Alzheimer's disease or other dementias Depression Diabetes

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

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).2Significant 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.

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

34

5.7

16.7

8.36.6

14.912.4

7.8

16.5

21.1

Adult day services center Home health agency Nursing home Residential care community

Overnight hospital stays Emergency department visits Falls

NOTES: For home health agencies, data were unavailable for falls; for nursing home data were unavailable for overnight hospital staysand 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 innursing 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.

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

35

41.0

96.4 96.4

62.4

37.1

88.4 91.8

47.435.6

73.2

87.9

39.333.7

94.0 90.7

29.129.8

87.8 85.2

29.724.3

56.7 58.0

19.8

Adult day services center Home health agency Nursing home Residential care community

Bathing Dressing Toileting Walking/locomotion Transfering in and out of bed Eating

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.

36

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.

http://www.cdc.gov/nchs/data/databriefs/db223.htm#source

Selected State Results (Maps)—Service Users

37

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


Note: The national estimate is 62.

Source: NCHS, National Study of

Long-Term Care Providers.

Percentage of residential care community residents diagnosed

with Alzheimer’s disease or other dementias: United States,

2014


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





Percentage of residential care residents that had any falls in last

90 days: United States, 2014





Percentage of residential care residents that had

hospitalizations: United States, 2014





Percentage of residential care community residents that need

assistance with bathing: United States, 2014





Percentage of residential care community residents that need

assistance with eating: United States, 2014





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?

Please visit us at Booth #55

For further information contact:

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301-458-4747

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the demographics of senior living according to the national study of long-term care providers

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