End-Of-Life Care Planning and Bereavement Practices Among Adult Day Services Centers, 2018.

Introduction: This study describes the end-of-life (EOL) care planning and bereavement practices among adult day services centers (ADSC) when an ADSC participant is dying or has died. Methods: Data are from the 2018 National Study of Long-term Care Providers' biennial survey of ADSCs. Respondents were asked about the following 4 practices: 1) honoring the deceased in some public way in this center; 2) offering bereavement services to staff and participants; 3) documenting in the care plan what is important to the individual at the end of life (EOL), such as the presence of family or religious or cultural practices; and 4) discussing spiritual needs at care planning conferences. ADSC characteristics included US Census region, metropolitan statistical area status, Medicaid authorization, electronic health records (EHR) use, for-profit status, employment of aides, services provision, and model type. Results: About 50% to 30% of ADSCs offered the EOL care planning or bereavement services. Honoring the deceased was the most common practice (53%), followed by bereavement services (37%), discussing spiritual needs (29%), and documenting what is important at EOL (28%). Fewer ADSCs in the West had EOL practices relative to the other regions. The EOL planning and bereavement practices were offered more often in ADSCs that used EHRs, accepted Medicaid, employed an aide, provided nursing, hospice, and palliative care services, and were categorized as medical models, compared with ADSCs without these characteristics. Conclusion: These results highlight the importance of understanding how ADSCs provide EOL and bereavement care to participants who are near EOL.

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.

Where are children ages 5-17 years receiving their COVID-19 vaccinations? Variations over time and by sociodemographic characteristics, United States.

BACKGROUND: Knowing the settings where children ages 5-17 years received COVID-19 vaccination in the United States, and how settings changed over time and varied by socio-demographics, is of interest for planning and implementing vaccination programs. METHODS: Data from the National Immunization Survey-Child COVID-19 Module (NIS-CCM) were analyzed to assess place of COVID-19 vaccination among vaccinated children ages 5-17 years. Interviews from July 2021 thru May 2022 were included in the analyses for a total of n = 39,286 vaccinated children. The percentage of children receiving their COVID-19 vaccine at each type of setting was calculated overall, by sociodemographic characteristics, and by month of receipt of COVID-19 vaccine. RESULTS: Among vaccinated children ages 5-11 years, 46.9 % were vaccinated at a medical place, 37.1 % at a pharmacy, 8.1 % at a school, 4.7 % at a mass vaccination site, and 3.2 % at some other non-medical place. Among vaccinated children ages 12-17 years, 35.1 % were vaccinated at a medical place, 47.9 % at a pharmacy, 8.3 % at a mass vaccination site, 4.8 % at a school, and 4.0 % at some other non-medical place. The place varied by time among children ages 12-17 years but minimally for children ages 5-11 years. There was variability in the place of COVID-19 vaccination by age, race/ethnicity, health insurance, urbanicity, and region. CONCLUSION: Children ages 5-17 years predominantly received their COVID-19 vaccinations at pharmacies and medical places. The large proportion of vaccinated children receiving vaccination at pharmacies is indicative of the success in the United States of expanding the available settings where children could be vaccinated. Medical places continue to play a large role in vaccinating children, especially younger children, and should continue to stock COVID-19 vaccine to keep it available for those who are not yet vaccinated, including the newly recommended group of children < 5 years.

Service Provision, Hospitalizations, and Chronic Conditions in Adult Day Services Centers: Findings From the 2016 National Study of Long-Term Care Providers.

Introduction-This report presents the most recent nationally representative percentages of adult day services centers (ADSCs) with hospitalizations and chronic conditions by service provision. Service provision may further one or two of the primary goals of adult day services: to reduce the risk of hospitalizations and readmissions, and manage chronic conditions among their participants. Methods-Estimates are from the 2016 Adult Day Services Center survey in the biennial National Study of Long-Term Care Providers conducted by the National Center for Health Statistics. Service provision was measured using scales that included five types of services: mental health, social work, therapeutic (physical, speech, or occupational), dietary and nutritional, and skilled nursing. Provision methods included by employees only or a mix of employees, arrangement, or referrals; by arrangement or referrals; and not provided. The percentage of ADSCs with hospitalizations was measured by having at least one participant discharged from an overnight hospital stay in the past 90 days. The number of chronic conditions included the four most prevalent types of chronic conditions reported by ADSCs (Alzheimer disease and other dementias, diabetes, depression, and heart disease). Analyses included univariate and bivariate statistics showing the percentages of ADSCs with hospitalizations and chronic conditions by service provision. Results-Although a little more than one-half of ADSCs (52.6%) provided all five services, approximately one-tenth of ADSCs provided none of the five services. About 64.0% of ADSCs had hospitalizations among participants. Almost 7 in 10 ADSCs (69.2%) reported the prevalence of all 4 conditions in their center. Approximately three-fourths (74.3%) of ADSCs that provided all five services had hospitalizations among participants compared with almost one-third of ADSCs (31.5%) that provided none of the services. Almost 83.0% of ADSCs that provided all five services had all four conditions in their center, compared with approximately one-third (31.5%) of ADSCs that provided none of the five services.

Advance Directive Documentation Among Adult Day Services Centers and Use Among Participants, by Region and Center Characteristics: National Study of Long-Term Care Providers, 2016.

This report describes the percentage of adult day services centers (ADSCs) that typically maintain documentation of participants' advance directives by region and center characteristics. Further, among ADSCs that maintain documentation, this report describes the percentage of participants with advance directives by region and center characteristics.

Variation in Adult Day Services Center Participant Characteristics, by Center Ownership: United States, 2014.

More than one-quarter million participants were enrolled in adult day services centers in the United States on the day of data collection in 2014. The number of for-profit adult day services centers has grown in recent years. In 2012, 40% of adult day services centers were for-profit, serving more than one-half of all participants. This report presents the most current national estimates of selected characteristics of participants in adult day services centers and compares these characteristics by center ownership type. State-level estimates for the characteristics presented in this report are available online at http://www.cdc.gov/nchs/nsltcp/nsltcp_products.htm.

Ambivalence in Older Parent-Adult Child Relationships: Mixed Feelings, Mixed Measures.

This research compared direct and indirect measures of ambivalence, 2 commonly used strategies for measuring intergenerational ambivalence between older parents and their adult children. Directly and indirectly measured ambivalence, corresponding to felt and potential manifestations of the construct, were contrasted with each other and across generations. Data were derived from 253 older parent-adult child dyads participating in the Longitudinal Study of Generations in 2005. Direct and indirect measures of ambivalence were moderately correlated with each other within each generation. Children expressed greater indirect ambivalence than their parents but were no different than their mothers or fathers in their levels of direct ambivalence. Multivariate regression analyses examining the relationship between each type of ambivalence with individual and relationship characteristics found differences in associations across equations. The results suggest that direct and indirect measures are related but represent 2 distinct conceptions of ambivalence. This research highlights the challenges in understanding the full complexity of intergenerational relations and suggests that both generational perspectives be considered in future research.