A New Resource to Support Research, Policy, and Practice

Lauren Harris-Kojetin, PhDLHarrisKojetin@cdc.gov

Eunice Park-Lee, PhDEParkLee@cdc.gov

Long-Term Care Statistics Branch

The Long Term Care Discussion GroupJanuary 27, 2015

National Study of Long-Term Care Providers (NSLTCP)

• Christine Caffrey• Lisa Dwyer• Lauren Harris-Kojetin• Eunice Park-Lee• Vincent Rome• Manisha Sengupta• Roberto Valverde

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Contributors to this Presentation

National Center for Health Statistics—Long-Term Care Statistics Program

• National Health Care Surveys’ Mission To collect, analyze, and disseminate data on…

• use, access, quality, and cost of health care provided in the United States and

• health care organizations and professionals who deliver that care

• Long-Term Care Services Providers Surveyed National Nursing Home Survey (NNHS)

• National Nursing Assistant Survey (NNAS) supplement National Home and Hospice Care Survey (NHHCS)

• National Home Health Aide Survey (NHHAS) supplement National Survey of Residential Care Facilities (NSRCF) National Study of Long-Term Care Providers (NSLTCP)

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Overview

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• 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 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

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Topics about Providers

Bolded topics are available for all five sectors

• Basic operating characteristics—Ownership, chain status, capacity, number served, Medicaid participation, part of a CCRC, years in operation, dementia special care unit

• Services offered and how—Dental, hospice, social work, case management, medication management, mental health, therapeutic, pharmacy, podiatry, skilled nursing, transportation

• Staffing—Nursing, social workers, activities staff• Practices—Depression screening, disease management

programming, EHR, person-centered practices

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Topics about Users (Aggregate distributions)Bolded topics are available for all five sectors• Demographics—Age, Race, Ethnicity, Sex, Medicaid use• Selected medical conditions—Alzheimer’s disease or

other dementias, developmental disability, severe mental illness, depression

• Physical and Cognitive Functioning—Need any ADL assistance (transferring, eating, dressing, bathing, toileting, locomotion), wheelchair/scooter use

• Health care use—Overnight hospitalizations, re-hospitalizations, ED use

• Other characteristics—Move-ins, move-outs and where went, left because of cost

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Provider Sectors and Data Sources

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Hospices Nursing Homes

Home Health Care

Agencies

Residential Care

Communities

Adult Day Services Centers

P R O V I D E R S E C T O R S

Administrative records Survey questionnaire

D A T A S O U R C E S

Published in 2013

• Survey restricted data files for adult day and residential care available through NCHS Research Data Center—10/2013

• First overview report on all 5 sectors—12/2013

Published in 2014

• Adult day data briefs with link to state web tables—10/2014

• Residential care data briefs with link to state web tables—11/2014

• Quickstats—varied topics and dates

To be published in 2015

• State web tables to complement first overview report—2/2015

• Weighted national estimates document—by 4/2015

Products Using 2012 Data

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http://www.cdc.gov/nchs/nsltcp.htm

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http://www.cdc.gov/nchs/nsltcp/nsltcp_products.htm

Selected National Results Across Sectors

As of 2012 in the United States…

• about 58,500 paid, regulated long-term care services providers served about 8 M people. 4,800 adult day services centers had 273,200 participants

enrolled on a typical day 12,200 home health agencies served over 4.7 M patients

annually 3,700 hospices served over 1.2 M patients annually 15,700 nursing homes served almost 1.4 M residents on a

typical day 22,200 residential care communities housed 713,300

residents on a typical day

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Percent Distribution of Long-Term Care Providers, by Type of Provider and Region: United States, 2012

NOTE: Percentages are based on the unrounded numbers.SOURCE: CDC/NCHS, National Study of Long-Term Care Providers

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(4,800) (12,200) (3,700) (15,700) (22,200)

Percentage of Long-Term Care Services Providers with Any Full-Time Equivalent Employees, by Type of Provider and Staff Type: United States, 2012

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NOTE: Percentages are based on the unrounded numbers.SOURCE: CDC/NCHS, National Study of Long-Term Care Providers

Percent Distribution of Users of Long-Term Care Services, by Type of Provider and Age Group: United States, 2011 and 2012

Adult day services centers

Home health agencies

Hospices Nursing homes Residential care communities

36.5

17.65.5

14.96.7

19.4

24.6

16.4

14.9

10.4

27.2

32.2

31.327.9

32.4

16.925.5

46.8 42.350.5

<65 65-74 75-84 85+

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NOTE: Percentages may not add to 100 because of rounding. Percentages are based on the unrounded numbers.SOURCE: CDC/NCHS, National Study of Long-Term Care Providers

Percent Distribution of Users of Long-Term Care Services, by Type of Provider and Race and Hispanic Origin: United States, 2011 and 2012

6.920.2

8.4 4.6 5.1 2.4

80.0 47.3 74.5 85.3 78.7 87.3

8.4

16.8

14.18.1 14.0 4.0

4.715.7

3.0 2.1 2.3 6.3

Hispanic Non-Hispanic White Non-Hispanic Black Non-Hispanic Other

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NOTE: Percentages may not add to 100 because of rounding. Percentages are based on the unrounded numbers.SOURCE: CDC/NCHS, National Study of Long-Term Care Providers

Percentage of Users of Long-Term Care Services Needing Any Assistance with Activities of Daily Living, by Type of Provider and Activity: United States, 2011 and 2012

Adult day services centers Home health agencies Nursing homes Residential care communities

39.6

95.1 96.1

61.4

37.8

83.8

90.9

44.9

36.2

64.6

86.6

36.8

25.3

51.256

17.7

Bathing Dressing Toileting Eating

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NOTE: Percentages are based on the unrounded numbers.SOURCE: CDC/NCHS, National Study of Long-Term Care Providers

Percentage of Users of Long-Term Care Services with a Diagnosis of Alzheimer’s Disease or Other Dementias and with a Diagnosis of Depression, by Type of Provider: United States, 2011 and 2012

Adult day services cen-

ters

Home health agencies

Hospices Nursing homes Residential care communities

31.930.1

44.3

48.5

39.6

23.5

34.7

22.2

48.5

24.8

Alzheimer's disease or other dementias Depression

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NOTE: Percentages are based on the unrounded numbers.SOURCE: CDC/NCHS, National Study of Long-Term Care Providers

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NOTE: Percentages are based on the unrounded numbers.SOURCE: CDC/NCHS, National Study of Long-Term Care Providers

Percentage of Long-Term Care Services Providers that Used Electronic Health Records and with Computerized Support for Electronic Health Information Exchange with Physicians and Pharmacies, by Provider Type: United States, 2012

Adult day services centers Residential care communities

20.0 20.0

5.9

20.3

7.5

13.3

Used electronic health recordsWith computerized support for electronic health information exchange with pharmaciesWith computerized support for electronic health information exchange with physicians

Selected State Results for Adult Day or Residential Care

Eunice add depression screening for adult day centers

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Next Steps• 2012 wave provides a baseline to examine trends in future

waves• Infrastructure in place to collect data for adult day services

centers and assisted living and similar residential care communities

• Potential to add sectors, collect primary data on other sectors, or add content to current surveys

• Exploring feasibility of person-level sampling and data collection

• Just completed 2nd wave of survey data collection• Aim to start publishing results using 2014 data by end of 2015• Working to produce public-use survey files

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Thank you!

Questions?

Supplemental Information

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Residential Care Community Definition•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.