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_______________________________

Institute for Workplace Studies----------------- Professor Samuel B. Bacharach

School of Industrial & Labor Relations-------- Director, Institute for Workplace Studies

Cornell University

16 East 34th Street, 4th floor---------------------- Stuart Basefsky

New York, NY 10016 -------------------------------Director, IWS News Bureau

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National Center for Health Statistics (NCHS)

 

LONG-TERM CARE SERVICES IN THE UNITED STATES: 2013 OVERVIEW [12 December 2013]

http://www.cdc.gov/nchs/data/nsltcp/long_term_care_services_2013.pdf

[full-text, 105 pages]

 

[excerpts]

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)

...

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.

 

Key Findings

In 2012, about 58,500 paid, regulated long-term care services providers served about 8 million people in

the United States. Long-term care services were provided by 4,800 adult day services centers, 12,200 home

health agencies, 3,700 hospices, 15,700 nursing homes, and 22,200 assisted living and similar residential

care communities. Each day in 2012, there were 273,200 participants enrolled in adult day services centers,

1,383,700 residents in nursing homes, and 713,300 residents in residential care communities; in 2011, about

4,742,500 patients received services from home health agencies, and 1,244,500 patients received services

from hospices.

 

Provider sectors differed in ownership, and average size and supply varied by region. The majority

of providers in four of the five sectors were for profit, whereas the majority of adult day services centers

were nonprofit. The average size of a provider, based on the number of people served, varied by sector. On

average, a nursing home served more than twice as many people daily as an adult day services center or

residential care community. On an annual basis, a home health agency served more patients on average than

a hospice. In the West, the supply of residential care beds and nursing home beds per 1,000 persons aged

65 and over was comparable, whereas nursing home beds far outnumbered residential care beds in all other

regions. The supply of nursing home and residential care beds and the capacity of adult day services centers

varied by region, suggesting geographic differences in access for consumers of long-term care services. For

example, the supply of residential care beds was higher in the Midwest and West than in the Northeast and

the South, and the capacity of adult day services centers was higher in the West than in the South.

 

Provider sectors differed in their nursing staffing levels, use of social workers, and variety of services

offered. For every measure of nursing staff type examined, the average daily staff hours per resident or

participant day was higher in nursing homes than in residential care communities and adult day services

centers. This difference may reflect the higher functional needs of nursing home residents relative to service

users in other sectors. Sectors varied in their use of social workers, ranging from most hospices employing

at least one social worker, to just over one-tenth of residential care communities doing so. In terms of

services offered, more hospices and nursing homes offered mental health and counseling services compared

with adult day services centers and residential care communities.

 

Rates of use of long-term care services varied by sector and state. Reflecting similar differences found

when comparing supply, the daily-use rate among individuals aged 65 and over per 1,000 persons aged 65

and over varied by sector. The highest daily-use rate was for nursing home residents, followed by residential

care residents; the lowest rate was for adult day services centers. However, in about a dozen states, the

nursing home daily-use rate was similar to or lower than the residential care daily-use rate. Within each of

the five sectors, the use rate varied by state. For example, average adult day daily-use rates ranged from a

low of less than 1 participant per 1,000 persons in West Virginia, to a high of 12 participants in New Jersey.

Average residential care community daily-use rates ranged from as few as 2 residents per 1,000 persons in

Iowa, to 40 residents in North Dakota.

 

Users of long-term care services varied by sector in their demographic and health characteristics and

functional status. Adult day services center participants and home health patients tended to be younger than

users in other sectors. Adult day services center participants were the most racially and ethnically diverse

among the five sectors: 20.1% were Hispanic and 16.7% were non-Hispanic black. Alzheimer’s disease and

other dementias ranged in prevalence from 30.1% among home health patients, to 48.5% among nursing

home residents. Depression ranged in prevalence from 22.2% among hospice patients, to 48.5% of nursing

home residents. Although the need for assistance with activities of daily living was common in all sectors,

functional ability varied by sector. A higher percentage of nursing home residents needed assistance in

bathing, dressing, toileting, and eating compared to users in other sectors.

 

The NSLTCP findings in this report provide a current national picture of providers and users of five

major sectors of paid, regulated long-term care services in the United States. These findings can inform

policy and planning to meet the needs of an aging population. NCHS plans to conduct NSLTCP every

2 years to monitor trends. Future NSLTCP products will be available from the NSLTCP website:

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

 

 

Contents

Acknowledgments .........................................................................................................................................vi

Executive Summary ................................................................................................................................... viii

Key Findings ....................................................................................................................................... viii

Chapter 1. Introduction ..................................................................................................................................1

Long-Term Care Services ........................................................................................................................2

The National Study of Long-Term Care Providers .................................................................................3

Structure of Report ..................................................................................................................................4

Chapter 2. National Profile of Providers of Long-Term Care Services .........................................................7

Introduction .............................................................................................................................................8

Supply of Long-Term Care Services Providers .......................................................................................9

Organizational Characteristics of Long-Term Care Services Providers ................................................12

Staffing: Nursing and Social Work Employees .....................................................................................14

Services Provided ..................................................................................................................................18

Chapter 3. National Profile of Users of Long-Term Care Services .............................................................25

Introduction ...........................................................................................................................................26

Users of Long-Term Care Services .......................................................................................................26

Demographic Characteristics of Users of Long-Term Care Services ...................................................32

Health and Functional Characteristics of Users of Long-Term Care Services ......................................35

Chapter 4. Summary ....................................................................................................................................37

Supply and Use of Long-Term Care Services .......................................................................................38

Characteristics of Long-Term Care Services Providers and Users .......................................................38

Chapter 5. Technical Notes ..........................................................................................................................41

Data Sources ..........................................................................................................................................42

Data Analysis .........................................................................................................................................51

Limitations .............................................................................................................................................53

References ....................................................................................................................................................55

 

 

 

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