Alzheimer Disease or Other Dementias in Adult Day Services Centers, 2020.

Objectives-Alzheimer disease or other dementias are among the most common chronic conditions of adult day services center (ADSC) participants. This report compares prevalence of these conditions (referred to collectively as dementia) among participants in ADSCs that provide specialized care for dementia with other ADSCs, by census region, metropolitan statistical area status, chain affiliation, and ownership type. Methods-This report uses data from the ADSC component of the 2020 National Post-acute and Long-term Care Study. The survey collects data on ADSCs every 2 years from all 50 states and the District of Columbia. Data were collected from January 2020 through mid-July 2021. The results are based on survey responses from about 1,800 eligible ADSCs from a census of 5,500 ADSCs and are weighted to be nationally representative. The percentage of participants diagnosed with dementia is calculated from responses to a question about the number of current participants diagnosed with dementia. Geographical and ADSC characteristics include census region, metropolitan statistical area, ownership status, and chain affiliation. Results-In ADSCs that provide specialized dementia care, 42.2% of participants had dementia, while 22.7% of participants also had dementia in ADSCs that do not specialize in dementia care. The overall prevalence of dementia was similar across regions, with a slightly lower percentage in the West. Dementia was more prevalent in ADSCs in metropolitan statistical areas, nonchain centers, and nonprofit centers. In general, for each of the selected characteristics, the prevalence of dementia was higher in specialized centers than in nonspecialized centers.

Infection Control Policies and Practices in Residential Care Communities by Selected Organizational and Geographic Characteristics: United States, 2020.

Objectives-Emergency operations plans that are specific to or include response to pandemics, approaches to implement the plans, and related infection control policies and practices vary among residential care communities (RCCs). This report presents nationally representative percentages of RCCs with infection control programs by selected characteristics. Methods-Data are from the RCC component of the 2020 National Post-acute and Long-term Care Study, conducted biennially by the National Center for Health Statistics. The study asked four binary questions, including whether the RCC had a written Emergency Operations Plan that was specific to or included pandemic response, had a designated staff member or consultant responsible for coordinating the infection control program, offered annual influenza vaccination to residents, and offered annual influenza vaccination to all employees or contract staff. RCC characteristics presented in this report are bed size, chain affiliation, ownership status, and provision of dementia-specific care (RCCs that only served residents with dementia or had a dementia wing). Metropolitan statistical area (MSA) was used to characterize geographic location. Results-Most RCCs reported having a written Emergency Operations Plan that was specific to or included pandemic response. A higher percentage of RCCs with more than 26 beds and those with a designated space for dementia care reported having a written Emergency Operations Plan and a designated staff to coordinate an infection control program. The largest differences were observed in the provision of annual influenza vaccination to residents and to all employees or contract staff by MSA status, bed size, and presence of a designated space for dementia care. A higher percentage of RCCs in non-MSAs (83.4%), RCCs with a designated space for dementia care (95.0%), those with more than 50 beds (93.9%), those with 26-50 beds (93.3%), and those with nonprofit ownership (85.8%) offered annual influenza vaccination to all employees or contract staff.

Metro-Nonmetro Differences in Adverse Events in Residential Care Communities: Results From the National Post-Acute and Long-Term Care Study.

More than 1 in 5 older Americans live in rural areas (10.6 million of the 46.2 million aged 65 and older). Long-term care for aging rural populations is a growing challenge in the United States. Research on long-term care services in nonmetro areas has focused almost exclusively on nursing home care, despite growth of residential care alternatives. This paper uses unique facility-level data from the 2020 National Post-acute and Long-term Care Study (NPALS) to examine the relationship of residential care community (RCC) features in metro and nonmetro settings with adverse outcomes (emergency department visits, overnight hospital stays, and falls). Nationally, in 2020, about 13.5% of RCC residents made visits to the emergency department, 8.6% had overnight hospital stays, and 21.3% had falls. Controlling for facility characteristics, RCCs in metro areas had higher risks of overnight hospital stays (p < .001) but lower risks of falls (p = .06).

Eligibility Rate Differences Among Residential Care Communities: 2010 National Survey of Residential Care Facilities and 2012-2018 National Study of Long-Term Care Providers.

Objectives Over the last decade, the National Survey of Residential Care Facilities (NSRCF) and multiple waves of the National Study of Long-Term Care Providers (NSLTCP) (renamed National Post-acute and Long-term Care Study in 2020) have collected data about residential care communities (RCCs). This report provides a review of RCC eligibility rates over survey years and describes design differences and methodological changes-including minor wording changes to screener questions and placement of question-specific instructions-that may be related toobserved differences in eligibility rates.

Post-acute and Long-term Care Providers and Services Users in the United States, 2017-2018.

This report presents the most current national results from the National Study of Long-Term Care Providers (NSLTCP), conducted by the National Center for Health Statistics (NCHS) to describe providers and services users in seven major sectors of paid, regulated postacute and long-term care services in the United States.

Variation in Adult Day Services Center Participant Characteristics by Center Ownership: United States, 2020.

An estimated 237,400 participants were enrolled in adult day services centers (ADSCs) in the United States in 2020 (1). Compared with users of other long-term care services, ADSC participants are younger and more racially and ethnically diverse (2). ADSC participants have a diverse set of needs, with many participants requiring assistance with activities of daily living (ADLs) and having chronic health conditions (3). This report presents the most current national estimates of selected characteristics of participants in ADSCs and compares these characteristics by center ownership type.

Variation in Residential Care Community Resident Characteristics, by Size of Community: United States, 2020.

Residents of residential care communities are people who cannot live independently but generally do not require the skilled care provided by nursing homes. On any given day in 2020, an estimated 818,800 residents lived in residential care communities (1,2). With the aging of the population, the number of people living in residential care communities will likely increase, creating a sizeable group within the long-term care population. This report presents national estimates of selected characteristics of residential care community residents in 2020 and compares these characteristics by community size.

COVID-19 Pandemic Impact on the National Health Care Surveys.

While underscoring the need for timely, nationally representative data in ambulatory, hospital, and long-term-care settings, the COVID-19 pandemic posed many challenges to traditional methods and mechanisms of data collection. To continue generating data from health care and long-term-care providers and establishments in the midst of the COVID-19 pandemic, the National Center for Health Statistics had to modify survey operations for several of its provider-based National Health Care Surveys, including quickly adding survey questions that captured the experiences of providing care during the pandemic. With the aim of providing information that may be useful to other health care data collection systems, this article presents some key challenges that affected data collection activities for these national provider surveys, as well as the measures taken to minimize the disruption in data collection and to optimize the likelihood of disseminating quality data in a timely manner. (Am J Public Health. 2021;111(12):2141-2148. https://doi.org/10.2105/AJPH.2021.306514).

Residential Care Community Resident Characteristics: United States, 2018.

Residential care communities provide housing for persons who cannot live independently but generally do not require the skilled care provided by nursing homes. On any given day in 2018, an estimated 918,700 residents lived in residential care communities (1,2). With the aging of the U.S. population, the numbers of residential care community residents will likely increase, becoming a substantial segment of the long-term care population. This report presents national estimates of selected characteristics of residential care community residents in 2018.

Variations Between Adult Day Services Centers in the United States by the Racial and Ethnic Case-Mix of Center Participants.

This is the first nationally representative study to identify differences between adult day services centers, a unique home- and community-based service, by racial/ethnic case-mix: Centers were classified as having a majority of participants who were Hispanic, non-Hispanic Black, or non-Hispanic other race/ethnicities and non-Hispanic White. The associations between racial/ethnic case-mix and geographic and operational characteristics of centers and health and functioning needs of participants were assessed using multivariate regression analyses, using the 2014 National Study of Long-term Care Providers' survey of 2,432 centers. Half of all adult day centers predominantly served racial/ethnic minorities, which were more likely to be for-profit, had lower percentages of self-pay revenue, more commonly provided transportation services, and had higher percentages of participants with diabetes, compared with predominantly non-Hispanic White centers. Findings show differences by racial/ethnic case-mix, which are important when considering the long-term care needs of a diverse population of older adults.

Characteristics of Residential Care Communities by Percentage of Resident Population Diagnosed With Dementia: United States, 2016.

Introduction-Increasingly, residential care communities (RCCs) are becoming a source of care for older adults with Alzheimer's disease and other dementias. Nationally in 2016, 41.9% of RCC residents were diagnosed with dementia. This report examines selected characteristics of RCCs and characteristics of their residents by the prevalence of Alzheimer's disease and other dementias. Methods-Data in this report are from the RCC survey component of the 2016 wave of the biennial National Study of Long-Term Care Providers (NSLTCP), conducted by the National Center for Health Statistics. RCCs were grouped into three categories indicating prevalence of Alzheimer's disease and other dementias in their communities: RCCs with less than 25% of their residents diagnosed with dementia, RCCs with 25%-75% of their residents diagnosed with dementia, and RCCs with more than 75% of their residents diagnosed with dementia. RCC characteristics included bed size, metropolitan statistical area location, provision of mental health services, and staff hours per resident day. Resident characteristics included selected conditions and need for assistance with activities of daily living. Results-Approximately one-quarter of RCCs (25.3%) had more than 75% of their residents diagnosed with Alzheimer's disease and other dementias. More RCCs with over 75% of their residents diagnosed with dementia were in metropolitan statistical areas (90.5%) compared with RCCs with 25%-75% (81.4%) and less than 25% of their residents diagnosed with dementia (76.4%). Aide and activities staff hours per resident day were higher in RCCs with more than 75% of their residents diagnosed with dementia compared with the other dementia prevalence categories. The prevalence of depression and the need for assistance with activities of daily living were higher in RCCs with more than 75% of the residents diagnosed with dementia compared with the other dementia prevalence categories.

National Center for Health Statistics Guidelines for Analysis of Trends.

Many reports present analyses of trends over time based on multiple years of data from National Center for Health Statistics (NCHS) surveys and the National Vital Statistics System (NVSS). Trend analyses of NCHS data involve analytic choices that can lead to different conclusions about the trends. This report discusses issues that should be considered when conducting a time trend analysis using NCHS data and presents guidelines for making trend analysis choices. Trend analysis issues discussed include: choosing the observed time points to include in the analysis, considerations for survey data and vital records data (record level and aggregated), a general approach for conducting trend analyses, assorted other analytic issues, and joinpoint regression. This report provides 12 guidelines for trend analyses, examples of analyses using NCHS survey and vital records data, statistical details for some analysis issues, and SAS and SUDAAN code for specification of joinpoint regression models. Several an lytic choices must be made during the course of a trend analysis, and the choices made can affect the results. This report highlights the strengths and limitations of different choices and presents guidelines for making some of these choices. While this report focuses on time trend analyses, the issues discussed and guidelines presented are applicable to trend analyses involving other ordinal and interval variables.

Variation in Residential Care Community Resident Characteristics, by Size of Community: United States, 2016.

Residents of residential care communities are persons who cannot live independently but generally do not require the skilled care provided by nursing homes. On any given day in 2016, an estimated 811,500 residents were in residential care communities (1,2). As the population ages, the numbers in residential care communities will likely increase, creating a sizeable group within the long-term care population. This report presents national estimates of selected characteristics of residential care community residents in 2016 and compares them by community size. State-level estimates are available from:

Long-Term Care Providers and services users in the United States: data from the National Study of Long-Term Care Providers, 2013-2014.

Long-term care services provided by paid, regulated providers are an important component of personal health care spending in the United States. This report presents the most current national descriptive results from the National Study of Long-Term Care Providers (NSLTCP), which is conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS). Data presented are drawn from multiple sources, primarily NCHS surveys of adult day services centers and residential care communities (covers 2014 data year); and administrative records obtained from the Centers for Medicare and Medicare Services (CMS) on home health agencies, hospices, and nursing homes (covers 2013 and 2014 data years). This report provides information on the supply, organizational characteristics, staffing, and services offered by paid, regulated providers of long-term care services; and the demographic, health, and functional composition of users of these services. Services users include residents of nursing homes and residential care communities, patients of home health agencies and hospices, and participants of adult day services centers. This report updates "Long-Term Care Services in the United States: 2013 Overview" (available from: http://www.cdc.gov/nchs/data/nsltcp/long_term_care_services_2013.pdf), which covered data years 2011 and 2012. In contrast, the title of this report and future reports will reflect the years of the data used rather than the publication year, in this case 2013 through 2014. A forthcoming companion product to this report, "Long-Term Care Providers and Services Users in the United States­State Estimates Supplement: National Study of Long-Term Care Providers, 2013­2014," contains tables and maps showing comparable state estimates for the national findings in this report, and will be available from: http://www.cdc.gov/nchs/ nsltcp/nsltcp_products.htm.

Variation in Operating Characteristics of Residential Care Communities, by Size of Community: United States, 2014.

KEY FINDINGS: Assisted living and similar residential care communities provide services to individuals who cannot live independently but generally do not require the skilled level of care provided by nursing homes. In 2014, there were 30,200 residential care communities nationwide (1). This report presents the most current national estimates of residential care community operating characteristics and compares these characteristics by community bed size. State-level estimates for the characteristics presented in this report are available from http://www.cdc.gov/nchs/nsltcp/nsltcp_products.htm.

Variation in Residential Care Community Resident Characteristics, by Size of Community: United States, 2014.

KEY FINDINGS: Residents of residential care communities are persons who cannot live independently but generally do not require the skilled care provided by nursing homes. There were 835,200 current residents in residential care communities in 2014 (1,2). "Current residents" refers to those who were living in the community on the day of data collection (as opposed to the total number of residents who lived in the community at some time during the calendar year). This report presents national estimates of selected characteristics of current residents in 2014 and compares these characteristics by community bed size. State-level estimates for these characteristics are available online at: http:// www.cdc.gov/nchs/nsltcp/nsltcp_products.htm.

Characteristics of residents living in residential care communities, by community bed size: United States, 2012.

In 2012, there was a higher percentage of older, female residents in communities with more than 25 beds compared with communities with 4­25 beds. Residents in communities with 4­25 beds were more racially diverse than residents in larger communities. The percentage of Medicaid beneficiaries was higher in communities with 4­25 beds than it was in communities with 26­50 and more than 50 beds. A higher percentage of residents living in communities with 4­25 beds had a diagnosis of Alzheimer's disease or other dementias compared with residents in larger communities. Need for assistance with each of the activities of daily living (ADLs) examined (except walking or locomotion) was substantially higher among residents in communities with 4­25 beds, compared with residents in larger communities. Emergency department visits and discharges from an overnight hospital stay in a 90-day period did not vary across residents by community bed size. This report presents national estimates of residents living in residential care, using data from the first wave of NSLTCP. This brief profile of residential care residents provides useful information to policymakers, providers, researchers, and consumer advocates as they plan to meet the needs of an aging population. The findings also highlight the diversity of residents across the different sizes of residential care communities. Corresponding state estimates and their standard errors for the national figures in this data brief can be found on the NSLTCP website, available from: http://www.cdc.gov/nchs/nsltcp/nsltcp_products.htm. These national and state estimates establish a baseline for monitoring trends among residents living in residential care.

Operating characteristics of residential care communities, by community bed size: United States, 2012.

In 2012, the majority of residential care communities had 4­25 beds, yet 71% of residents lived in communities with more than 50 beds. A lower percentage of communities with 4­25 beds were chain-affiliated, nonprofit, and in operation 10 years or more, compared with communities with 26­50 and more than 50 beds. Dementia-exclusive care or dementia care units were more common as community size increased. A higher percentage of communities with more than 50 beds screened for cognitive impairment and offered dementia-specific programming compared with communities with 4­25 and 26­50 beds. A higher percentage of communities with more than 50 beds screened for depression compared with communities with 4­25 beds. Compared with communities with 4­25 beds, a higher percentage of communities with 26­50 beds and more than 50 beds provided therapeutic, hospice, mental health, and dental services; but a lower percentage of communities with more than 50 beds provided skilled nursing services than did smaller communities. This report presents national estimates of residential care communities, using data from the first wave of NSLTCP. This brief profile of residential care communities provides useful information to policymakers, providers, researchers, and consumer advocates as they plan to meet the needs of an aging population. The findings also highlight the diversity of residential care communities across different sizes. Corresponding state estimates and their standard errors for the national figures in this data brief can be found on the NSLTCP website at http://www.cdc.gov/nchs/nsltcp/ nsltcp_products.htm. These national and state estimates establish a baseline for monitoring trends among residents living in residential care.

Trends in length of hospice care from 1996 to 2007 and the factors associated with length of hospice care in 2007: findings from the National Home and Hospice Care Surveys.

Using the National Home and Hospice Care Surveys, we examined trends in length of hospice care from 1996 to 2007 and the factors associated with length of care in 2007. Results suggest that the increasing average lengths of care over time reflect the increase in the longest duration of care. For-profit ownership is associated with hospice care received for over a year.

Dementia special care units in residential care communities: United States, 2010.

In 2010, 17% of residential care communities had dementia special care units. Beds in dementia special care units accounted for 13% of all residential care beds. Residential care communities with dementia special care units were more likely than those without to have more beds, be chain-affiliated, and be purposely built as a residential care community, and less likely to be certified or registered to participate in Medicaid. Residential care communities with dementia special care units were more likely than those without to be located in the Northeast and in a metropolitan statistical area, and less likely to be in the West. Assisted living and similar residential care communities provide an alternative to nursing homes for individuals with dementia who can no longer live independently. In 2010, about 42% of individuals living in residential care communities had Alzheimer's disease or other dementia. Individuals with dementia can live in residential care communities that have dementia special care units, or in a more traditional setting where these residents are integrated with residents without dementia. Many states require residential care communities with dementia special care units to have certain physical features (e.g., locked door) and specially trained staff to care for residents with dementia. This report compares residential care communities with and without dementia special care units.