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.

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 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.

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.

Advance Directives State Requirements, Center Practices, and Participant Prevalence in Adult Day Services Centers: Findings From the 2016 National Study of Long-Term Care Providers.

OBJECTIVES: Adult day services centers (ADSCs) may serve as an entrée to advance care planning. This study examined state requirements for ADSCs to provide advance directives (ADs) information to ADSC participants, ADSCs' awareness of requirements, ADSCs' practice of providing AD information, and their associations with the percentage of participants with ADs. METHODS: Using the 2016 National Study of Long-Term Care Providers, analyses included 3,305 ADSCs that documented ADs in participants' files. Bivariate and linear regression analyses were conducted. RESULTS: Nine states had a requirement to provide AD information. About 80.8% of ADSCs provided AD information and 41.3% of participants had documented ADs. There were significant associations between state requirements, awareness, and providing information with AD prevalence. State requirement was mediated by awareness. DISCUSSION: This study found many ADSCs provided AD information, and ADSCs that thought their state had a requirement and provided information was associated with AD prevalence, regardless of state requirements.

Trends in Electronic Health Record Use Among Residential Care Communities: United States, 2012, 2014, and 2016.

Introduction-This report presents a trend analysis of electronic health record (EHR) use and health information exchange capability among residential care communities. EHR systems and health information exchange have the potential to improve communication and facilitate care coordination, especially during care transitions. Methods-Data in this report are from the residential care community survey component of the 2012, 2014, and 2016 waves of the biennial National Study of Long-Term Care Providers (NSLTCP), which is conducted by the National Center for Health Statistics. For the EHR use measure, respondents were asked if, for other than accounting or billing purposes, they used EHRs. Among those who indicated they did use EHRs, health information exchange capability was also measured using items that asked residential care communities if their computerized system supported electronic health information exchange with physicians or pharmacies. A weighted least-squares regression was used to test the significance of trends across the 2012, 2014, and 2016 NSLTCP waves by several residential care community characteristics, including bed size, ownership status, chain affiliation, U.S. Census division, and metropolitan statistical area (MSA) status. Results-The percentage of residential care communities that used EHRs increased between 2012 and 2016 overall (20% to 26%), for all bed size categories, profit and nonprofit ownership, chain and nonchain affiliation, six out of nine census divisions, and MSA and non-MSA status. Among residential care communities reporting EHR use, computerized support for health information exchange with physicians or pharmacies also increased between 2012 and 2016 overall (47.2% to 55.0%) and among communities that had more than 100 beds, were for profit, chain affiliated, located in the East North and East South Central census divisions, and in both MSAs and non-MSAs.

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.

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 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:

Relationships Between Residential Care Community Characteristics and Overnight Hospital Stays and Readmissions: Results From the National Study of Long-Term Care Providers.

THE PROBLEM: Hospitalizations and subsequent readmissions can produce significant challenges when trying to reduce costs and improve quality of care. This study describes hospitalizations and readmissions using residential care community data from the 2012 National Study of Long-Term Care Providers. THE RESOLUTION: About 61.0% of residential care communities had hospitalizations, and among these communities, 39.3% had readmissions. Residential care communities in the Northeast were more likely to have had hospitalizations and readmissions. Residential care communities located in a continuing care retirement community (CCRC) had a lower likelihood of hospitalizations, and communities that provided therapeutic services had a lower likelihood of readmissions. TIPS FOR SUCCESS: An association with a CCRC and provision of therapeutic services were found to be protective against hospitalizations and readmissions, respectively.

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 residential care communities that use electronic health records.

OBJECTIVES: Residential care communities' (RCCs) use of electronic health records (EHRs) has the potential to improve communication and facilitate care coordination. This study describes the use of, and examines characteristics associated with, any type of EHR system among RCCs in the United States, nationally and by Census division. STUDY DESIGN: This study examined organizational and geographic characteristics, as well as resident case-mix in association with the use of EHRs among RCCs. METHODS: Data from the 2012 National Study of Long-Term Care Providers were used for the analyses. Of 4694 sampled RCCs that completed the questionnaire, 3987 cases with complete data were included in the study. RESULTS: About 20.2% of RCCs used any type of EHR system and 3.1% used EHRs that had 6 selected computerized capabilities to meet this study's definition for a basic EHR system. Compared with the national rate of 20.2%, a higher percentage of RCCs in the following Census divisions used some type of an EHR system: New England (23.2%), East North Central (26.3%), and West North Central (32.9%). Larger size, being chain affiliated, owned by other organizations or part of a continuing care retirement community, and geographic location were independently associated with the use of any EHRs among RCCs. CONCLUSIONS: As RCCs serve increasingly less healthy and more disabled residents, improved communication and effective care coordination among RCC staff and across different care settings are critical. The estimates presented in this study can be used to establish a baseline for monitoring trends in EHR use among RCCs.

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.

Use of electronic health records in residential care communities.

KEY FINDINGS: In 2010, only 17% of residential care communities in the United States used electronic health records. Residential care communities that used electronic health records were more likely to be larger, not-for-profit, chain-affiliated, colocated with another care setting, and in a nonmetropolitan statistical area. The types of information most commonly tracked electronically by residential care communities that used electronic health records were medical provider information, resident demographics, individual service plans, and lists of residents' medications and active medication allergies. Four in 10 residential care communities that used electronic health records also had support for electronic exchange of health information with service providers; nearly 25% could exchange with pharmacies, and 17% could exchange with physicians.

Residents living in residential care facilities: United States, 2010.

In 2010, residential care residents were mostly female, non-Hispanic white, and aged 85 and over, and had a median length of stay of about 22 months. For about 20% of residents­or 137,700 persons­Medicaid paid for at least some long-term care services provided by the RCF. This estimate is similar to that found in a recent study (3). Almost 40% of all residential care residents received assistance with three or more ADL limitations, and over 40% had Alzheimer's disease or other dementias. These findings suggest a vulnerable population with a high burden of functional and cognitive impairment. Residential care is an important component of the U.S. long-term care system. This report presents national estimates of people living in RCFs, using data from the first-ever national probability sample survey of RCFs with four or more beds. This brief profile of residential care residents may provide useful information to policymakers, providers, and consumer advocates as they plan for the future long-term care needs of older as well as younger adults. In addition, these findings serve as baseline national estimates as researchers continue to track the growth of and changes in the residential care industry.