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.

Advancing Adult Day Services Research: The 2016 and 2018 National Study of Long-Term Care Providers

This presentation demonstrates how researchers can leverage data from the 2018 redesign and new content from the forthcoming NSLTCP survey of adult day services centers (ADSC) conducted by National Center for Health Statistics. For the first time, NSLTCP data will allow analyses at the services-user level. New policy-relevant topics about centers and ADSC participants include reasons for hospitalization, medication use, patient-centered and end-of-life care, staffing turnover, and unmet needs. Additionally, the presentation highlights latest findings from the 2016 survey. About 53% of centers were primarily medical model. Almost 79% of participants in medical model centers used Medicaid, compared to 51% in social model centers. About 4% of participants had at least one 90-day hospitalization. 40% of participants had difficulty bathing. The most prevalent chronic conditions were hypertension (50%), arthritis (38%), and diabetes (31%). Nearly 40% of participants had an advance directive. Findings are contextualized within the broader understanding of ADSCs.

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.

FACTORS ASSOCIATED WITH RESIDENTIAL CARE COMMUNITIES THAT HAVE RESIDENTS VISITING EMERGENCY DEPARTMENTS

Emergency department (ED) visits are an important part of healthcare utilization. However, ED visits can be costly, lead to hospitalizations, and are sometimes unnecessary. Studies characterizing ED visits among long-term care settings have been largely focused on nursing homes where the unit of analysis is typically the resident. Facility- or community-level analyses describing residential care communities (RCCs) with ED visits are limited. Using RCCs as the unit of analysis, this study examines community-level factors associated with RCCs that have residents with ED visits. Community-level factors include ownership and chain affiliation, Medicaid participation, electronic health records use, service provision, nurse staffing, U.S. census region and metropolitan status. The study uses data from the 2016 National Study of Long-Term Care Providers conducted by the National Center for Health Statistics. In 2016, about 81% of RCCs had at least one resident visiting the ED in the past 90 days and around 19% of RCCs had no residents with ED visits in the past 90 days. Bivariate analyses indicated that ED visits varied by chain affiliation, ownership status, electronic health records use, and Medicaid participation. Logistic regression modeling to examine factors associated with whether or not RCCs had any residents with ED visits in the past 90 days will also be presented. Results may benefit efforts focused on implementing practices to reduce ED visits in RCCs.

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.

Variation in Residential Care Community Nurse and Aide Staffing Levels: United States, 2014

OBJECTIVES

This report presents national and state estimates of staffing levels in residential care communities for registered nurses, licensed practical or vocational nurses, and aides in the United States for 2014.

METHODS

Data were drawn from the residential care community component of the 2014 wave of the biennial National Study of Long-Term Care Providers, conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics. For each staff type, the "staffing level" measure is presented as average hours per resident per day, defined as the total number of hours worked divided by the total number of residents, which does not necessarily reflect the amount of care given to a specific resident. Analyses examined the extent to which residential care community nurse and aide staffing levels varied by selected organizational characteristics and selected resident composition characteristics of the communities. Differences among subgroups were evaluated using two-sided t tests at the 0.05 level.

RESULTS

In 2014, the total registered nurse, licensed practical or vocational nurse, and aide staffing level among all residential care communities was about 2 hours and 50 minutes. Registered nurse staffing levels differed for two of the three organizational characteristics (size and metropolitan statistical area [MSA]) and for only one of the four resident composition characteristics (primarily serving residents needing any assistance with activities of daily living). Licensed practical or vocational nurse staffing levels differed for all three organizational characteristics (size, MSA, and ownership) and for only one of the four resident composition characteristics (primarily serving residents diagnosed with Alzheimer’s disease or other dementias). In contrast, differences in aide staffing levels were common when examining both community organizational and resident composition characteristics. Registered nursing, licensed practical and vocational nursing, and aide staffing levels varied geographically by state.

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 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.

Variation in Operating Characteristics of Adult Day Services Centers, by Center Ownership: United States, 2014

More than one-quarter of a million participants were enrolled in 4,800 adult day services centers in the United States in 2014. Unlike other long-term care providers, such as nursing homes, home health agencies, hospices, and residential care communities, the majority of adult day services centers are nonprofit. However, for-profit ownership of adult day services centers has increased, from 27% in 2010 to 40% in 2012, and more recently to 44% in 2014. This report presents the most current national estimates of selected adult day services center operating characteristics, and compares these characteristics by center ownership. State estimates for the characteristics presented in this data brief 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.

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.

Comparison of the kinetics of pancreatic secretion and gut regulatory peptides in the plasma of preruminant calves fed milk or soybean protein

Exocrine secretion from the pancreas and concentrations of cholecystokinin, gastrin, secretin, and somatostatin in plasma were measured in relation to feeding in 70- to 120-d-old preruminant calves fed either a milk diet or a soybean diet. Pancreatic fluid was continuously collected, measured, and reintroduced in catheterized calves. Blood samples were withdrawn for measurements of gut regulatory peptide concentrations in plasma. A slight increase in outflow of pancreatic fluid was observed 30 min before the milk diet was introduced but not before the soybean diet was fed. In contrast, concentrations and outflows of protein and trypsin immediately after feeding were higher when calves were fed the soybean diet. Overall, during the first 5 h postfeeding, the outflow of pancreatic fluid was 40% higher when the milk diet was fed than when the soybean diet was fed. No difference in outflow of protein was observed, but that of trypsin was 82% higher when the soybean diet was fed. This enhanced enzyme secretion could have been related to the increased plasma concentrations of gastrin and cholecystokinin after the soybean diet was fed. Secretin release was less in calves fed the milk diet that in calves fed the soybean diet during the first 2 h postfeeding, suggesting that this gut peptide along with gastrin and cholecystokinin, contributed to the stimulation of enzyme secretion. Plasma gut regulatory peptides could be influenced by the soybean diet, which does not coagulate in the stomach, inducing faster gastric emptying of protein and fat, and by the chemical form of protein from the soybean diet and the lower susceptibility of these proteins to protease compared with casein. However, the resulting enhancement of pancreatic trypsin secretion and activity seemed to be insufficient to increase the digestibility of soybean protein up to a level similar to that of milk.