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.

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.

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.

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.

Adult Day Services Center Participant Characteristics: United States, 2018.

An estimated 251,100 participants were enrolled in adult day services centers (ADSCs) in the United States in 2018 (1). Compared with users of other long-term care services, ADSC participants were 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 national estimates of selected characteristics of participants of ADSCs from the 2018 National Study of Long-Term Care Providers.

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.

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.

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.

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.

"Because I was sick": seriously ill veterans' perspectives on reason for 30-day readmissions.

OBJECTIVES: To determine the perspectives of seriously ill individuals on reasons for 30-day hospital readmission. DESIGN: A prospective qualitative study was conducted employing individual interviews conducted at bedside. SETTING: Department of Veterans Affairs Greater Los Angeles Healthcare System. PARTICIPANTS: Seriously ill individuals with heart failure or cancer receiving inpatient palliative care and readmitted to the hospital within 30 days of hospital discharge were recruited to participate. Nine were interviewed. MEASUREMENTS: A semistructured interview protocol was used to elicit participant perspectives on readmission causes. RESULTS: All participants were male and had a mean age of 70.1±9.5. Participants were ethnically diverse (three African Americans, three Caucasians, three Hispanic or mixed ethnic background). Six lived alone, and four did not have caregiver support. Qualitative analysis of transcripts revealed three themes relating to reasons for hospital readmission: lack of caregiver support and motivation to provide self-care, acceptance of condition and desire for aggressive care, and access to care and poor quality of care. CONCLUSION: Participants identified potentially avoidable reasons for hospital readmission as well as causes that require rethinking regarding how community support is targeted and delivered. Participant preference for aggressive care, inability to provide self-care, and lack of caregiver support suggest the need for new and innovative mechanisms to support seriously ill community-dwelling individuals.

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.

Measuring Experience With End-of-Life Care: A Systematic Literature Review.

CONTEXT: Increasing interest in end-of-life care has resulted in many tools to measure the quality of care. An important outcome measure of end-of-life care is the family members' or caregivers' experiences of care. OBJECTIVES: To evaluate the instruments currently in use to inform next steps for research and policy in this area. METHODS: We conducted a systematic review of PubMed, PsycINFO, and PsycTESTS(®) for all English-language articles published after 1990 using instruments to measure adult patient, family, or informal caregiver experiences with end-of-life care. Survey items were abstracted and categorized into content areas identified through an iterative method using three independent reviewers. We also abstracted information from the most frequently used surveys about the identification of proxy respondents for after-death surveys, the timing and method of survey administration, and the health care setting being assessed. RESULTS: We identified 88 articles containing 51 unique surveys with available content. We characterized 14 content areas variably present across the 51 surveys. Information and care planning, provider care, symptom management, and overall experience were the most frequent areas addressed. There was also considerable variation across the surveys in the identification of proxy respondents, the timing of survey administration, and in the health care settings and services being evaluated. CONCLUSION: This review identified several comprehensive surveys aimed at measuring the experiences of end-of-life care, covering a variety of content areas and practical issues for survey administration. Future work should focus on standardizing surveys and administration methods so that experiences of care can be reliably measured and compared across care settings.

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.