EVALUATING ENHANCEMENTS TO ADDRESS SAMPLE DIVERSITY, RESPONDENT BURDEN, AND DIFFICULTY REACHING RESPONDENTS

Every two years since 2012, the National Study of Long-Term Care Providers includes provider surveys with residential care communities (RCCs) and adult day services centers (ADSCs), via a multi-mode approach using Web, hard-copy questionnaires, and computer-assisted telephone interviewing. In each wave, we struggled to achieve target response rates. First, diversity among providers surveyed—e.g. RCC size, type of ADSC—presents unique challenges. For RCCs, small communities have lower response compared to larger ones. For ADSCs, how they define themselves (medically vs socially oriented) influenced their decision to participate. Second, respondents’ perceived burden, particularly the time required to complete the survey, is a recurring concern especially for directors of multiple RCCs and ADSCs. Finally, reaching target respondents—directors, administrators or operators—is problematic. These challenges affect data quality. In this presentation, we share results of our efforts to enhance contacting and interviewing protocols intended to address low participation associated with these challenges.

GETTING TO YES . . . I WILL RESPOND: CHALLENGES AND SUCCESSES SURVEYING AGING SERVICES PROVIDERS TO PRODUCE QUALITY DATA

Voluntary surveys of aging services providers are important data sources for research, quality improvement, and program evaluation efforts to inform evidence-based decision making. Ideally, provider surveys—a type of establishment survey—offer valuable information on providers and services users. However, decreasing survey response rates in recent years raise data quality concerns. This symposium highlights challenges leading to lower response rates (e.g., time constraints, skepticism, confidentiality concerns, getting to the correct respondent); specific data collection techniques tested, what did and did not work, and lessons learned. Although the surveys focus on long-term services and supports (LTSS) providers (e.g., assisted living) and services users (e.g., residents), the session is generalizable to other establishment surveys. Presenters bring extensive survey experience and diverse organizational perspectives—academic research center, national provider association, federal statistical agency, and research contractor. Over the years, the presenters have used their research network to share challenges and lessons learned with each other, which addresses the GSA conference theme, “Strength in Age: Harnessing the Power of Networks.” The first presentation describes test results of a state survey protocol to obtain sampled resident information from assisted living providers. The second presentation examines approaches to increase provider participation in a quality improvement initiative. The third presentation discusses efforts to address response challenges in an on-going national survey of providers in two LTSS sectors. The session allows time for and facilitates interaction with audience members to share their insights and lessons learned.

Variation in Licensed Nurse Staffing Characteristics by State Requirements in Residential Care

Research on licensed nurses in assisted living and residential care communities (RCCs) is sparse compared to that on licensed nurses in nursing homes. RCCs are state-regulated; thus, staffing requirements vary considerably. The current study analyzed variation in characteristics of licensed nurses by state-specific requirements for licensed nurses in RCCs. A significantly higher percentage of RCCs with one or more RNs (68.87%) and licensed practical nurses (LPNs) or licensed vocational nurses (LVNs) (56.85%) were found among states with licensed nurse requirements compared to states with no such requirements (37.35% and 29.08%, respectively; p < 0.05). LPN/LVN hours were higher among RCCs in states with licensed nurse requirements compared to RCCs in states with no such requirements (17 minutes and 8 minutes, respectively; p < 0.05). The findings provide the first evidence of variation in characteristics of licensed nurses by state-specific requirements for licensed nurses. [Res Gerontol Nurs. 2019; 12(1):27-33.].

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.

Do Content and Format Affect Older Consumers’ Use of Comparative Information in a Medicare Health Plan Choice? Results from a Controlled Experiment

We assessed the efficacy of materials that integrated comparative information on cost, benefits, and quality for employer-based retiree health plans and Medicare Advantage plans in a randomized experiment to test the impact of content and format. Results indicate that older consumers who received the intervention materials found the materials easier to use, gained greater knowledge about Medicare from them, were more likely to value comparative quality information, were more likely to select higher quality plans, and were more likely to choose a plan that reflected the dimensions they found most important compared to older consumers receiving the control materials.

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 States—State Estimates Supplement: National Study of Long-Term Care Providers, 2013–2014," 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

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

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.

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

In 2012, the majority of residential care communities had 4–25 beds, yet 71% of residents lived in communities with more than 50 beds. A lower percentage of communities with 4–25 beds were chain-affiliated, nonprofit, and in operation 10 years or more, compared with communities with 26–50 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 4–25 and 26–50 beds. A higher percentage of communities with more than 50 beds screened for depression compared with communities with 4–25 beds. Compared with communities with 4–25 beds, a higher percentage of communities with 26–50 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.

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 4–25 beds. Residents in communities with 4–25 beds were more racially diverse than residents in larger communities. The percentage of Medicaid beneficiaries was higher in communities with 4–25 beds than it was in communities with 26–50 and more than 50 beds. A higher percentage of residents living in communities with 4–25 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 4–25 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.

Long-Term Care Services in the United States: 2013 Overview

Long-term care services include a broad range of services that meet the needs of frail older people and other adults with functional limitations. Long-Term care services provided by paid, regulated providers are a significant component of personal health care spending in the United States. This report presents descriptive results from the first wave of the National Study of Long-Term Care Providers (NSLTCP), which was conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS). Data presented in this report are drawn from five sources: NCHS surveys of adult day services centers and residential care communities, and administrative records obtained from the Centers for Medicare and Medicaid Services on home health agencies, hospices, and nursing homes. This report provides information on the supply, organizational characteristics, staffing, and services offered by providers of long-term care services; and the demographic, health, and functional composition of users of these services. Service users include residents of nursing homes and residential care communities, patients of home health agencies and hospices, and participants of adult day services centers.

Characteristics and use of home health care by men and women aged 65 and over

OBJECTIVE

This report presents national estimates on differences in the use of home health care between men and women aged 65 years and over.

METHODS

Estimates are based on data from the 2007 National Home and Hospice Care Survey, conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics.

RESULTS

In the United States, men aged 65 years and over used home health care at a lower rate than women. Among home health care patients 65 years and over, women were more likely to be 85 years and over while men were more likely to be married and receive home health care as post-acute care. Women 65 years and over who received home health care were less likely than males to receive wound care and physical therapy, and more likely to receive homemaker services. Among home health care patients who were 65 years and over, cancer was more prevalent among men, and essential hypertension was more common among women.

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 residents—or 137,700 persons—Medicaid 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.

Racial differences in dementia care among nursing home residents

OBJECTIVES

This article aims to describe potential racial differences in dementia care among nursing home residents with dementia.

METHODS

Using data from the 2004 National Nursing Home Survey (NNHS) in regression models, the authors examine whether non-Whites are less likely than Whites to receive special dementia care--defined as receiving special dementia care services or being in a dementia special care unit (SCU)--and whether this difference derives from differences in resident or facility characteristics.

RESULTS

The authors find that non-Whites are 4.3 percentage points less likely than Whites to receive special dementia care.

DISCUSSION

The fact that non-Whites are more likely to rely on Medicaid and less likely to pay out of pocket for nursing home care explains part but not all of the difference. Most of the difference is due to the fact that non-Whites reside in facilities that are less likely to have special dementia care services or dementia care units, particularly for-profit facilities and those in the South.

Home health care and discharged hospice care patients: United States, 2000 and 2007

OBJECTIVES

This report presents national estimates on home health care patients and discharged hospice care patients. Information on characteristics, length of service, medical diagnoses, functional limitations, service use, advance care planning, and emergent and hospital care use are presented for home health care patients and hospice care discharges. A comparison of selected characteristics for 2000 and 2007 is also provided to highlight changes.

METHODS

Estimates are based on data collected on agencies from the 2000 and 2007 National Home and Hospice Care Survey, conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. Estimates are derived from data collected during interviews with administrators and staff designated by the administrators.

RESULTS

Each day in 2007, there were an estimated 1,459,900 home health care patients. They were predominantly aged 65 years or over, female, and white. Their mean length of service was 315 days, and their most common primary diagnosis at admission was diabetes mellitus. About one-fourth of them had advance care planning and one-fifth had at least one overnight hospital stay since admission to the home health care agency. In 2007, there were 1,045,100 discharged hospice care patients. The majority of discharged patients were aged 65 or over, female, and white, and most were discharged deceased. Their mean length of service was 65 days, and the most common primary diagnosis at admission was malignant neoplasm. Most of them had advance care planning, and about one-fourth had three or more types of advance care planning instruments.

Similarities and differences in choosing health plans

BACKGROUND

Increasingly, consumers have multiple health insurance options. New information is being developed to help consumers with these choices.

OBJECTIVES

To study similarities and differences in how the publicly and privately insured choose health plans. To explore the effect of traditional enrollment materials and reports developed by the Consumer Assessment of Health Plans Study (CAHPS) on consumers' perceptions and decision-making.

RESEARCH DESIGN

Using data from eight CAHPS demonstrations, we tested for significant differences across consumers with employer-sponsored insurance, Medicaid, and Medicare.

SUBJECTS

Approximately 10,000 consumers with employer-sponsored, Medicaid, and Medicare health plans.

MEASURES

Perceptions of the health plan selection process, use of information sources, and reactions to and use of traditional enrollment materials and CAHPS reports.

RESULTS

Most consumers with all types of insurance thought that choosing a health plan was important and obtained information from multiple sources. Choosing a plan was more difficult for Medicare and Medicaid recipients than for the privately insured. When choosing a plan, Medicaid recipients cared most about convenience and access, whereas the privately insured emphasized providers and costs. The percentage of consumers who looked at and remembered the CAHPS report varied widely from 24% to 77%. In all but one of the demonstration sites, most consumers spent less than 30 minutes looking at the CAHPS report.

CONCLUSIONS

Group sponsors and the developers of information interventions such as CAHPS may need to invest in developing and testing different reporting approaches for Medicare, Medicaid, and privately insured consumers.

Increasing the impact of health plan report cards by addressing consumers' concerns

Most plan report cards that compare the performance of health plans have framed the decision about plan choice as an opportunity to get better-quality care. This study uses a controlled experimental design to examine the effect of reframing the health plan choice decision to one that emphasizes protecting oneself from possible risk. The findings show that framing the health plan decision using a risk message has a consistent and significant positive impact on how consumers comprehend, value, and weight comparative performance information.