Vital and Health Statistics
Series 3, Number 37 December 2013
Long-Term Care Services in
the United States: 2013
Overview
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Suggested citation
Harris-Kojetin L, Sengupta M, Park-Lee E, Valverde R. Long-term care services
in the United States: 2013 overview. National Center for Health Statistics. Vital
Health Stat 3(37). 2013.
Library of Congress Cataloging-in-Publication Data
Long-term care services in the United States : 2013 overview.
p. ; cm. -- (Vital and health statistics. Series 3, Analytical and epidemiological studies ; number 37) (DHHS pub ; no.
2014-1040)
Includes bibliographical references and index.
Reprint. Originally published: Hyattsville, Maryland : U.S. Department of Health and Human Services, Centers for
Disease Control and Prevention, National Center for Health Statistics, 2013.
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I. National Center for Health Statistics (U.S.), issuing body. II. Series: Vital & health statistics. Series 3, Analytical and
epidemiological studies ; no. 37 III. Series: DHHS publication ; 2014-1040. 0276-4733
[DNLM: 1. Long-Term Care--United States--Statistics. 2. Health Care Surveys--United States--Statistics. W2 A N148vc
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Series 3, Number 37
Long-Term Care Services in the
United States: 2013 Ov ervie w
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
Hyattsville, Maryland
December 2013
DHHS Publication No. 2014–1040
Contents
iii
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 Prole 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
Stafng: Nursing and Social Work Employees .....................................................................................14
Services Provided ..................................................................................................................................18
Chapter 3. National Prole 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
iv
Contents
Appendices
A. Crosswalk of Denitions by Provider Type ............................................................................................59
B. Detailed Tables ........................................................................................................................................87
1. Number and percent distribution of long-term care services providers, by geographical
and organizational characteristics and provider type: United States, 2012 ....................................88
2. Number and percent distribution of stafng characteristics, by staff and provider type:
United States, 2012 .........................................................................................................................89
3. Percentage of long-term care services providers that provide selected services, by type
of service provided and provider type: United States, 2012 ...........................................................90
4. Number and characteristics of users of long-term care services, by selected characteristics
and provider type: United States, 2012 ........................................................................................... 91
5. Use of long-term care services providers, by state and provider type: United States, 2012 ..........92
Figures
1. Percent distribution of long-term care services providers, by provider type and region:
United States, 2012 ...........................................................................................................................9
2. Percent distribution of long-term care services providers, by provider type and
metropolitan statistical area status: United States, 2012 .................................................................10
3. Capacity of long-term care services providers, by provider type and region:
United States, 2012 .........................................................................................................................11
4. Percent distribution of long-term care services providers, by provider type and
ownership: United States, 2012 ......................................................................................................12
5. Percent distribution of long-term care services providers, by provider type and
number of people served: United States, 2011 and 2012 ................................................................13
6. Total number and percent distribution of nursing employee full-time equivalents,
by provider type and staff type: United States, 2012 ......................................................................14
7. Percentage of long-term care services providers with any full-time equivalent
employees, by provider type and staff type: United States, 2012 ................................................... 15
8. Average hours per resident or participant per day, by provider type and staff type:
United States, 2012 .........................................................................................................................17
9. Percentage of long-term care services providers that provide social work services,
by provider type: United States, 2012 ...........................................................................................18
10. Percentage of long-term care services providers that provide mental health or
counseling services, by provider type: United States, 2012 ...........................................................19
11. Percentage of long-term care services providers that provide therapeutic services,
by provider type: United States, 2012 ............................................................................................20
12. Percentage of long-term care services providers that provide skilled nursing or
nursing services, by provider type: United States, 2012 .................................................................21
13. Percentage of long-term care services providers that provide pharmacy or pharmacist
services, by provider type: United States, 2012 ..............................................................................22
Contents
v
14. Percentage of long-term care services providers that provide hospice services, by
provider type: United States, 2012 .................................................................................................23
15. Adult day services center participants aged 65 and over: United States, 2012 ..............................27
16. Nursing home residents aged 65 and over: United States, 2012 ....................................................28
17. Residential care residents aged 65 and over: United States, 2012 ..................................................29
18. Home health patients aged 65 and over discharged in calendar year: United States, 2011 ............ 30
19. Hospice patients aged 65 and over in calendar year: United States, 2011......................................31
20. Percent distribution of long-term care services providers, by provider type and age
group: United States, 2011 and 2012 ..............................................................................................32
21. Percent distribution of users of long-term care services, by provider type and sex:
United States, 2011 and 2012 .........................................................................................................33
22. Percent distribution of users of long-term care services, by provider type and race
and Hispanic origin: United States, 2011 and 2012 ........................................................................ 34
23. Percent distribution of users of long-term care services with a diagnosis of Alzheimer’s
disease or other dementias, and with a diagnosis of depression, by provider type:
United States, 2011 and 2012 .........................................................................................................35
24. Percentage of users of long-term care services needing any assistance with activities
of daily living, by provider type and activity: United States, 2011 and 2012 ................................36
Acknowledgments
vi
Acknowledgments
The authors are grateful to the many people who provided technical expertise, guidance, and assistance in
implementing the rst-ever National Study of Long-Term Care Providers (NSLTCP) and developing this
report.
The authors acknowledge the following National Center for Health Statistics (NCHS) staff for their
contributions to the report: Lisa Dwyer served as the survey manager for the 2012 NSLTCP surveys, led
outreach for the adult day services center survey, and provided editing and content review assistance and
estimate verication for the report. Christine Caffrey led outreach for the residential care community
survey, and provided programming, content review, and analytic support for the report, including estimate
verication. Iris Shimizu provided expertise and support on sampling design and statistical analysis.
Anita Bercovitz provided input on developing the report’s concept, and identied needed administrative
data sources. Frederic Decker, Adrienne Jones, Abigail Moss, and Kimberly Ross also contributed to
the development and implementation of NSLTCP. Jennifer Madans provided leadership and input in
conceptualizing and designing NSLTCP. Clarice Brown provided ongoing leadership and guidance for
NSLTCP design and implementation. Denys Lau and Thomas McLemore reviewed earlier versions of the
report.
This report was edited and produced by NCHS/Ofce of Information Services, Information Design
and Publishing Staff: Danielle Woods edited the report, and graphics and layout were produced by
Odell D. Eldridge, Mike W. Jones, Ryan M. Dumas (contractors), and Kyung M. Park.
The authors greatly appreciate the guidance, time, and expertise of the members who served on the
panel tasked by the NCHS Board of Scientic Counselors (BSC) to conduct an external review of the
Long-Term Care Statistics Program at NCHS. NCHS pursued NSLTCP, in part, in response to the panel’s
recommendations. Panel members included: Panel Chair Penny Feldman, Visiting Nurse Service of New
York; Peter Kemper, formerly of the Ofce of the Assistant Secretary for Planning and Evaluation (ASPE);
Andrew Kramer, University of Colorado; Nancy Mathiowetz, University of Wisconsin-Milwaukee; Vincent
Mor, Brown University; William Scanlon, National Health Policy Forum; and BSC liaisons Graham Kalton,
Westat, and Michael O’Grady, O’Grady Health Policy.
The authors recognize the following organizations for their vital contributions to successfully completing
the rst wave of NSLTCP surveys: LeadingAge, formerly American Association of Homes and Services
for the Aging, American Seniors Housing Association (ASHA), Assisted Living Federation of America
(ALFA), National Adult Day Services Association (NADSA), and National Center for Assisted Living
(NCAL). For promoting participation in the surveys, the authors thank Teresa Johnson of NADSA, Holly
Dabelko-Schoeny of Ohio State University, Peter Notarstefano of LeadingAge, Karen Love of the Center for
Excellence in Assisted Living (CEAL), and CEAL board members Josh Allen (American Assisted Living
Nurses Association), Rachelle Bernstecker (ASHA), Maribeth Bersani (ALFA), David Kyllo (NCAL), and
Stephen Maag (LeadingAge).
The authors sincerely thank the members of the NSLTCP Work Group, whose expertise helped guide the
NSLTCP survey content. Members include: Jen Accius, AARP; Gretchen Alkema, The SCAN Foundation;
Nicholas Castle, University of Pittsburgh; Thomas Clark, Commission for Certication in Geriatric Pharmacy;
Joel Cohen, Agency for Healthcare Research and Quality; Rosaly Correa-de-Araujo, U.S. Department of
Health and Human Services; Holly Dabelko-Schoeny, Ohio State University; Frederic Decker, formerly of
the Health Resources and Services Administration; Elena Fazio, Administration for Community Living;
Michael Furukawa, Ofce of the National Coordinator for Health Information Technology; Mary George,
vii
Acknowledgments
Centers for Disease Control and Prevention (CDC); Stacie Greby, CDC; Stuart Hagen, Congressional
Budget Ofce; Christa Hojlo, Department of Veterans Affairs (VA); Teresa Johnson, NADSA; Judith
Kasper, Johns Hopkins University; Enid Kassner, AARP; Ruth Katz, ASPE; Gavin Kennedy, ASPE; Mary
Jane Koren, The Commonwealth Fund; David Kyllo, NCAL; Sheila Lambowitz, Centers for Medicare &
Medicaid Services (CMS); Karen Love, CEAL; William Marton, ASPE; Lisa Matthews-Martin, American
Health Care Association; Anne Montgomery, Altarum Institute and National Academy of Social Insurance;
Vincent Mor, Brown University; Richard Nahin, CDC; Carol O’Shaughnessy, National Health Policy
Forum; Doug Pace, Long-Term Quality Alliance; Georgeanne Patmios, National Institute on Aging; Carol
Regan, Paraprofessional Healthcare Institute; Robin Remsburg, University of North Carolina-Greensboro;
Robert Rosati, Visiting Nurse Service of New York; Emily Rosenoff, ASPE; James Scanlon, ASPE; Daniel
Schoeps, VA; Margo Schwab, Ofce of Management and Budget; Carol Spence, National Hospice and
Palliative Care Organization; Nimalie Stone, CDC; Robyn Stone, LeadingAge; Mary St. Pierre, National
Association for Home Care and Hospice; Nicola Thompson, CDC; Daniel Timmel, CMS; Julie Weeks,
NCHS; Janet Wells, National Consumer Voice for Quality Long-Term Care; and Cheryl Wiseman, CMS.
The authors gratefully acknowledge the talented and dedicated staff at RTI International for their
contributions to the design and successful implementation of the NSLTCP 2012 surveys: Angela Greene,
Elvessa Aragon-Logan, Melissa Hobbs, Katherine Mason, Linda Lux, Celia Eicheldinger, Ruby Johnson,
Sara Zuckerbraun, and Joshua Weiner.
The authors are indebted to the directors and administrators of assisted living and similar residential care
communities and adult day services centers who took the time to complete the questionnaires. This report
would lack information on these sectors without their participation.
The authors are grateful for technical support and assistance from staff at CMS and the Research Data
Assistance Center who helped identify and obtain needed administrative data sources, specically,
Christine Cox, Stephanie Bartee, Dovid Chaifetz, Karen Edrington, and Faith Asper. The authors would
also like to acknowledge the technical support and assistance received from U.S. Census Bureau staff in
using population estimates vintage 2011 and 2012 to calculate rates, specically, Victoria Velkoff, Alexa
Kennedy Jones-Puthoff, Christine Klucsarits, Karen Humes, and Joseph Brunn.
viii
Executive Summary
Executive Summary
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 signicant component of personal health care spending in the United States. This report presents
descriptive results from the rst 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 ve sources: NCHS surveys of adult day
services centers and residential care communities, and administrative records obtained from the Centers for
Medicare & Medicaid Services on home health agencies, hospices, and nursing homes. This report provides
information on the supply, organizational characteristics, stafng, 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.
Keywords: aging • disability • long-term services and supports (LTSS) • National Study of Long-Term
Care Providers
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 ve sectors were for prot, whereas the majority of adult day services centers
were nonprot. 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 stafng 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 reect 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.
Executive Summary
ix
Rates of use of long-term care services varied by sector and state. Reecting 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 ve 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 ve 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 ndings in this report provide a current national picture of providers and users of ve
major sectors of paid, regulated long-term care services in the United States. These ndings 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.
Chapter 1
Introduction
Chapter 1
2
Chapter 1. Introduction
Long-Term Care Services
Long-term care services
1
include a broad range of health, personal care, and supportive services that
meet the needs of frail older people and other adults whose capacity for self-care is limited because of a
chronic illness; injury; physical, cognitive, or mental disability; or other health-related conditions (HHS,
2013). Long-term care services include assistance with activities of daily living [(ADLs) e.g., dressing,
bathing, and toileting]; instrumental activities of daily living [(IADLs) e.g., medication management
and housework]; and health maintenance tasks.
2
Long-term care services assist people in maintaining or
improving an optimal level of physical functioning and quality of life, and can include help from other
people and special equipment and assistive devices.
Individuals may receive long-term care services in a variety of settings: in the home from a home health
agency or from family and friends, in the community from an adult day services center, in residential
settings from assisted living communities, or in institutions from nursing homes, for example. Long-term
care services provided by paid, regulated providers are a signicant component of personal health care
spending in the United States (O’Shaughnessy, 2013). Estimates of expenditures for long-term care services
vary, depending on what types of providers, populations, and services are included. Recent estimates for the
amount spent annually on paid, long-term care services are between $210.9 billion (O’Shaughnessy, 2013)
and $306 billion (Colello, Girvan, Mulvey, & Talaga, 2012; Genworth Financial, 2012; MetLife Mature
Market Institute, 2012).
3
Finding a way to pay for long-term care services is a growing concern for older adults, persons with
disabilities, and their families, and is a major challenge facing state and federal governments (Commission
on Long-Term Care, 2013; Reinhard, Kassner, Houser, & Mollica, 2011). Medicaid nances a major portion
of paid, long-term care services,
4
followed by Medicare and out-of-pocket payments by individuals and
1
Historically, the term “long-term care” has been used to refer to services and supports to help frail older adults
and younger persons with disabilities maintain their daily lives. Recently, alternative terms have gained wider use,
including “long-term services and supports.” The Patient Protection and Affordable Care Act (ACA, P.L. 111–148, as
amended) uses the term “long term services and supports,” and denes the term to include certain institutionally based
and noninstitutionally based long-term services and supports [Section 10202(f)(1)]. This report uses “long-term care
services” to reect both the changing vocabulary and the fact that these services can include both health care-
related and nonhealth care-related services.
2
The need for long-term care services is generally dened based on functional limitations (need for assistance with
or supervision in ADLs and IADLs) regardless of cause, age of the person, where the person is receiving assistance,
whether the assistance is human or mechanical, and whether the assistance is paid or unpaid.
3
This $306 billion estimate for 2010 is based on analysis by the Congressional Research Service of National
Health Expenditure Account data obtained from the Centers for Medicare & Medicaid Services, Ofce of the Actuary,
prepared November 15, 2011. Excluding Medicare spending on home health and skilled nursing facilities, total long-
term care services spending was $237.7 billion in 2010. The $210.9 billion estimate for 2011 is based on analysis by
the National Health Policy Forum using published (Hartman, Martin, Benson, Caitlin, & National Health Expenditure
Accounts Team, 2013) and unpublished data from the National Health Expenditure Account.
4
Medicaid nances a variety of long-term care services through multiple mechanisms (e.g., Medicaid State Plan,
home- and community-based services waiver programs, and other options for community-based long-term care
Chapter 1
3
families (Colello et al., 2012; O’Shaughnessy, 2013).
5
However, the distribution of nancing sources varies
by provider sector and by population. For example, most residents pay out-of-pocket for assisted living
(Mollica, 2009), with a small percentage using Medicaid to help pay for services (Caffrey et al., 2012). In
contrast, the largest single payer for long-term nursing home care is Medicaid, whereas Medicare nances
hospice costs and a major portion of the costs for short-stay, post-acute care in skilled nursing facilities
for Medicare beneciaries (Federal Interagency Forum on Aging-Related Statistics, 2012; The SCAN
Foundation, 2013).
The number of people using nursing facilities, alternative residential care places, or home care services
is projected to increase from 15 million in 2000 to 27 million in 2050. Most of this increase will be due
to growth in the older adult population who need such services (HHS, 2003). Although people of all ages
may need long-term care services, the risk of needing these services increases with age. Recent projections
estimate that over two-thirds of individuals who reach age 65 will need long-term care services during their
lifetime (Kemper, Komisar, & Alecxih, 2005–2006). Largely due to aging baby boomers, the population is
expected to become much older, with the number of Americans over age 65 projected to more than double,
from 40.2 million in 2010 to 88.5 million in 2050 (Vincent & Velkoff, 2010). The estimated increase in the
number of the “oldest old”—those aged 85 and over—is even more striking. The oldest old are projected to
almost triple, from 6.3 million in 2015 to 17.9 million in 2050, accounting for 4.5% of the total population
(U.S. Census Bureau, 2012).
This oldest old population tends to have the highest disability rate and need for long-term care services, and
they also are more likely to be widowed and without assistance with ADLs (Feder & Komisar, 2012; Houser,
Fox-Grage, & Ujvari, 2012). Decreasing family size and increasing employment rates among women may
reduce the traditional pool of family caregivers, further stimulating demand for paid long-term care services
(Congressional Budget Ofce, 2004). Among persons who need long-term care services, adults aged 65 and
over are more likely than younger adults to receive paid help (Kaye, Harrington, & LaPlante, 2010). Recent
studies project that the number of older adults using paid, long-term care services will grow substantially
(Johnson, Toohey, & Wiener, 2007; Kaye, 2013; Stone, 2006; The Lewin Group, 2010). A substantial share
of paid, long-term care services is publicly funded through programs such as Medicaid and Medicare;
accurate, timely statistical information can help guide those programs and inform relevant policy decisions.
The National Study of Long-Term Care Providers
The long-term care services delivery system in the United States has changed substantially over the last
30 years. For example, although nursing homes are still a major provider of long-term care services, there
is growing use of skilled nursing facilities for short-term, post-acute care and rehabilitation (Decker, 2005).
Further, consumers’ desire to stay in their own homes, and federal and state policy developments (e.g.,
the Supreme Court’s Olmstead ruling, introduction of the Medicare Prospective Payment System, and
balancing Medicaid-nanced services from institutional to noninstitutional settings) have led to growth in a
variety of home- and community-based alternatives (Doty, 2010; Wiener, 2013). The major sectors of paid,
long-term care services providers now also include adult day services centers, assisted living and similar
residential care communities, home health agencies, and hospices.
services), including an array of home and community-based services and institutional services (Scully et al., 2013;
Watts, Musumeci, & Reaves, 2013). This report does not address all long-term care services nanced by Medicaid. For
example, intermediate care facilities for people with intellectual or developmental disabilities are excluded.
5
Experts disagree on whether Medicare expenditures for skilled nursing facilities and home health agencies should
be considered long-term care services, because they are post-acute services. This report includes Medicare-certied
skilled nursing facilities and home health agencies. See Technical Notes for details on the types of providers included.
Chapter 1
4
In 2011, the National Center for Health Statistics (NCHS) launched the National Study of Long-Term Care
Providers (NSLTCP)—an integrated strategy for efciently obtaining and providing statistical information
about the supply and use of major sectors of paid, regulated long-term care services providers in the United
States. NSLTCP provides relevant, timely, and credible information to monitor trends and examine the
effects of policy changes on the supply, use, and characteristics of the major sectors of long-term care
services providers.
NSLTCP has these main goals:
Estimate the supply of paid, regulated long-term care services providers
Estimate key policy-relevant characteristics of these providers
Estimate the number of long-term care services users
Estimate key policy-relevant characteristics of these users
Compare provider sectors
Produce national and state estimates, where feasible
Monitor trends over time
NSLTCP replaces NCHS’ periodic National Nursing Home Survey and National Home and Hospice Care
Survey, and the one-time National Survey of Residential Care Facilities. The NSLTCP core is designed to
(1) broaden NCHS’ ongoing coverage of paid, regulated long-term care services providers beyond nursing
homes, home health agencies, and hospices to include assisted living or similar residential care communities
(referred to in this report as residential care communities) and adult day services centers; (2) broaden the
study over time to add other types of paid, regulated long-term care services providers (e.g., home care
agencies); (3) use national administrative data from the Centers for Medicare & Medicaid Services (CMS)
on nursing homes, home health agencies, and hospices; (4) collect primary data every other year from
cross-sectional, nationally representative, establishment-based surveys of adult day services centers and
residential care communities (administrative data do not exist); and (5) monitor trends more frequently than
in the past decade.
In addition to the core content, the NSLTCP data collection system provides the infrastructure on which
to build provider-specic surveys, cross-provider topical modules, more in-depth surveys to respond to
evolving or emerging policy issues, and sampling and collecting information on individual users (e.g.,
nursing home residents).
Structure of Report
This descriptive overview report provides a baseline, and is intended to serve as an information resource for
use by policy makers, providers, researchers, advocates, and others to inform planning for long-term care
services. The report includes two chapters that present ndings: Chapter 2 presents ndings on providers
of long-term care services (i.e., adult day services centers, home health agencies, hospices, nursing homes,
and residential care communities); and Chapter 3 presents ndings on users of long-term cares services.
Chapter 4 reviews major ndings, and Chapter 5 describes the data sources used to present provider and
user information, outlines the approach used for data analyses, and discusses study limitations. Appendix A
denes each provider type and variable used in the study, and Appendix B presents data tables.
This overview report presents results from the rst wave of NSLTCP, using data from surveys of residential
care communities and adult day services centers elded by NCHS between September 2012 and February
Chapter 1
5
2013, and using administrative records on nursing homes, home health agencies, and hospices obtained
from CMS between 2011 and 2012.
6
This report mainly provides national results.
7
Forthcoming products
will complement this national overview report, including additional state estimates on providers and users
of long-term care services, and reports on characteristics of adult day services centers and residential care
communities using survey data not included here. NCHS plans to eld the second wave of NSLTCP surveys
between June 2014 and December 2014, obtain the next wave of administrative data during a similar time
frame, and produce future reports to examine trends over time. Future NSLTCP products will be available
from the NSLTCP website: http://www.cdc.gov/nchs/nsltcp.htm.
6
See Technical Notes for denitions of the ve provider sectors and the corresponding data sources used in this report.
7
See Chapter 3 for state estimates on the use of long-term care services in the ve provider sectors.
Chapter 2
National Profile of Providers of
Long-Term Care Services
8
Chapter 2
Chapter 2. National Profile of Providers of Long-Term
Care Services
Introduction
As of 2012 in the United States, there were an estimated 4,800 adult day services centers, 12,200 home
health agencies, 3,700 hospices, 15,700 nursing homes, and 22,200
1
residential care communities. Of these
approximately 58,500
2
regulated,
3
long-term care services providers, about two-thirds provided care in
residential settings (26.8% were nursing homes and 37.9% were residential care communities), and about
one-third provided care in home- and community-based settings (8.2% were adult day services centers,
20.9% were home health agencies, and 6.3% were hospices).
This chapter provides an overview of the supply, organizational characteristics, stafng, and services of
regulated providers of long-term care services for these ve provider sectors. Supply information is provided
nationally, by metropolitan statistical area (MSA) status and by census geographic region. Organizational
characteristics include capacity, type of ownership, number of people served, and Medicare and Medicaid
certication. Stafng measures focus on nursing and social work employees, and include number and
distribution of employees, percentage of providers employing such staff, and average hours per resident
or participant per day, by staff type. Services include social work, mental health or counseling, therapeutic
services, skilled nursing or nursing, pharmacy or pharmacist services, and hospice services.
1
See Technical Notes for a discussion about the differences between the 2010 and 2012 estimates of the number of
residential care communities.
2
Estimates are rounded as whole numbers to the nearest hundred; estimates may not add to totals because of rounding.
3
The report includes only providers that are in some way regulated by federal or state government. Adult day services
centers and residential care communities were state-regulated, home health agencies and nursing homes were Medicare-
or Medicaid-certied, and hospices were Medicare-certied. Based on the 2007 National Home and Hospice Care
Survey, 93% of hospice agencies were Medicare-certied. See Technical Notes for details on the Institutional Provider
and Beneciary Summary hospice data that were used to provide the most coverage of and information on hospice
patients.
Chapter 2
9
Supply of Long-Term Care Services Providers
Geographic distribution
The supply of providers in the ve long-term care services sectors varied in their geographic distribution.
The largest share of adult day services centers (32.4%), home health agencies (48.3%), hospices (42.4%),
and nursing homes (34.5%) was in the South, while the largest share of residential care communities
(36.4%) was in the West (Figure 1).
West
South
Midwest
Northeast
Residential care
community
(22,200)
Nursing
home
(15,700)
Hospice
(3,700)
Home health
agency
(12,200)
Adult day
services center
(4,800)
NOTE: Percentages are based on the unrounded numbers.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 1 in Appendix B.
Figure 1. Percent distribution of long-term care services providers, by provider
type and region: United States, 2012
28.6
32.4
18.3
20.7
16.4
48.3
27.3
8.0
21.3
42.4
23.7
12.6
15.6
34.5
32.9
17.0
36.4
30.6
22.9
10.1
10
Chapter 2
The vast majority of providers in all ve long-term care services sectors were in MSAs (Figure 2). This
distribution reects the higher population density in these areas. Compared with hospices (73.9%) and
nursing homes (70.8%), a greater percentage of adult day services centers (83.9%), home health agencies
(83.9%), and residential care communities (81.0%) were located in metropolitan areas.
NOTES: Percentages may not add to 100 because of rounding. Percentages are based on the unrounded numbers.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 1 in Appendix B.
Figure 2. Percent distribution of long-term care services providers, by provider
type and metropolitan statistical area status: United States, 2012
Neither
Micropolitan
Metropolitan
Residential
care community
Nursing homeHospiceHome health
agency
Adult day
services center
83.9
9.8
6.4
7.8
10.7
15.2
7.2
11.8
81.0
14.0
70.8
15.4
73.9
8.2
83.9
Chapter 2
11
Capacity
Based on the maximum number of participants allowed, the 4,800 adult day services centers in the country
together could serve 276,500 participants daily (Appendix B, Table 1). The allowable daily capacity of
adult day services centers ranged from 1 to 780, with an average of 58 participants. The 15,700 nursing
homes in the country provided a total of 1,669,100 certied beds. Nursing homes ranged in capacity from
2 to 1,389 certied beds, with an average of 106 certied beds. The 22,200 residential care communities in
the United States provided 851,400 licensed beds. Residential care communities ranged in capacity from 4
to 582 licensed beds, with an average of 38 licensed beds.
4
The supply of nursing home and residential care beds and adult day services center capacity varied by
region (Figure 3). Compared with other regions, the Midwest had the largest supply of nursing home beds
(51) and the smallest supply of adult day services center capacity (3) per 1,000 persons aged 65 and over.
In the West, the supply of residential care beds (24) and nursing home beds (25) per 1,000 persons aged 65
and over was comparable, whereas nursing home beds far outnumbered residential care beds in all other
regions.
NOTES: Capacity refers to the number of certified nursing home beds, the number of licensed residential care community
beds, and the maximum number of adult day services center participants allowed. Capacity of providers is per 1,000 persons
aged 65 and over. See Appendix A for definitions of capacity for each provider type.
SOURCE: CDC/NCHS, National Study of Long-Term Care Providers.
Figure 3. Capacity of long-term care services providers, by provider type and
region: United States, 2012
Adult day services center
Nursing home
Residential care community
Total Northeast Midwest South West
6
39
20
7
44
17
51
22
6
37
17
10
25
24
3
4
Capacity for home health agencies and hospices was not examined because licensed maximum capacity or
a similar metric was not available.
12
Chapter 2
Organizational Characteristics of Long-Term Care Services
Providers
Ownership type
In all sectors except adult day services centers, the majority of long-term care services providers were for
prot (Figure 4). Home health agencies (78.7%) and residential care communities (78.4%) had the highest
proportion of for-prot ownership, while adult day services centers (40.0%) had the lowest proportion. The
majority of adult day services centers were nonprot (54.9%).
Medicare and Medicaid certification
All data on nursing homes and home health agencies used in this report were only for Medicare- or Medicaid-
certied providers, and all data on hospices were only for Medicare-certied hospices. Almost all nursing
homes (95.0%), about three-quarters of adult day services centers (77.1%) and home health agencies
(77.5%), and one-half of residential care communities (51.8%) were authorized or certied to participate
in Medicaid. Information was not available on whether any of the Medicare-certied hospices were also
certied by Medicaid. Virtually all home health agencies (98.6%), hospices (100.0%), and nursing homes
(96.5%) were Medicare certied (data not shown). Medicare does not certify or reimburse for services
provided by adult day care services centers or residential care communities; therefore, these providers were
not asked about Medicare certication.
NOTES: Percentages may not add to 100 because of rounding. Percentages are based on the unrounded numbers. See
Appendix A for definitions of ownership for each provider type.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 1 in Appendix B.
Figure 4. Percent distribution of long-term care services providers, by provider type
and ownership: United States, 2012
Adult day
services center
5.1
54.9
40.0
Hospice
13.7
29.7
56.6
Nursing
home
6.8
25.1
68.2
Home health
agency
5.7
15.6
78.7
1.2 Government
and other
Nonprofit
For profit
Residential care
community
20.4
78.4
Chapter 2
13
Number of people served
In terms of persons actually served,
5
a nursing home served on average, more than twice the number of
people daily as an adult day services center or a residential care community. A nursing home housed an
average of 88 current residents, while an adult day services center had a mean weekday daily attendance
of 39 participants, and a residential care community served an average of 32 residents daily (Appendix B,
Table 1).
The majority of nursing homes (61.7%) served between 26 and 100 residents daily, while the majority of
residential care communities (59.9%) served 25 or fewer residents daily (Figure 5). Adult day services
centers were about evenly split between those serving 25 or fewer participants daily (47.4%) and those
serving 26 to 100 participants daily (47.3%).
The proportion of nursing homes (32.8%) serving more than 100 persons daily was about six times as large
as the proportion of adult day services centers (5.2%) and residential care communities (5.5%) doing so.
NOTES: Number of people served categorizes the number of residents on a given day (nursing homes and residential care
communities) or the average daily attendance of participants on a typical week (adult day services centers). For home
health agencies and hospices, number of people served categorizes the number of patients whose episode of care in a
home health agency ended at any time in 2011, and the number of patients who received care from Medicare-certified
hopices at any time in 2011. See Appendix A for more information on how number of people served was defined for each
provider type. Percentages may not add to 100 because of rounding. Percentages are based on the unrounded numbers.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 1 in Appendix B.
Figure 5. Percent distribution of long-term care services providers, by provider
type and number of people served: United States, 2011 and 2012
HospiceHome health
agency
Residential care
community
Nursing
home
Adult day
services center
1–25
26–100
101 or more
301 or more
101–300
1–100
5.2
47.3
47.4
32.8
61.7
5.6
5.5
34.6
59.9
40.0
27.6
32.4
32.6
35.0
32.5
5
See Appendix A for how number of people served was dened for each provider type.
14
Chapter 2
Staffing: Nursing and Social Work Employees
This section focuses on workers employed directly by adult day services centers, home health agencies,
hospices, nursing homes, and residential care communities. Information is provided about registered nurses
(RNs), licensed practical nurses (LPNs) or licensed vocational nurses (LVNs), aides, and social workers.
Contract staff that work for these providers were excluded because comparable information on contract
staff was not available for all ve sectors.
6
Nursing employee full-time equivalents
In 2012, nearly 1.5 million nursing employee full-time equivalents (FTEs) were working in the ve sectors,
including RNs, LPNs and LVNs, and aides (Figure 6). Of these nursing employees, almost two-thirds
(65.5% or 952,100 FTEs) worked in nursing homes, almost one-fth (19.2% or 278,600 FTEs) were
employees of residential care communities, about one-tenth (9.9% or 143,600 FTEs) were employed by
home health agencies, and less than one-twentieth were employed by hospices (4.0% or 57,800 FTEs) and
adult day services centers (1.4% or 20,700 FTEs).
The relative distribution of staff types of nursing employee FTEs varied across sectors. The majority of
nursing employee FTEs in residential care communities (82.1%), adult day services centers (69.4%), and
6
See Appendix A for denition of full-time equivalent (FTE) and each staff type used for each provider type.
NOTES: Only employees are included for all staff types; contract staff are not included. For adult day services centers and
residential care communities, aides refer to certified nursing assistants, home health aides, home care aides, personal care
aides, personal care assistants, and medication technicians or medication aides. For home health agencies and hospices,
aides refer to home health aides. For nursing homes, aides refer to certified nurse aides, medication aides, and medication
technicians. See Technical Notes for information on how outliers were identified and coded. Percentages may not add to 100
because of rounding. Percentages are based on the unrounded numbers. FTE is full-time equivalent.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 2 in Appendix B.
Figure 6. Total number and percent distribution of nursing employee full-time
equivalents, by provider type and staff type: United States, 2012
Aide
Licensed practical
or vocational nurse
Registered nurse
Adult day
services center
(20,700 FTEs)
69.4
11.3
19.2
Home health
agency
(143,600 FTEs)
26.6
19.0
54.4
Hospice
(57,800 FTEs)
35.7
9.6
Nursing
home
(952,100 FTEs)
65.4
22.9
11.7
Residential care
community
(278,600 FTEs)
82.1
10.2
7.6
54.7
Chapter 2
15
nursing homes (65.4%) were aides. However, in hospices (54.7%) and home health agencies (54.4%), the
majority of nursing employee FTEs were RNs.
7
Providers employing any nursing or social work staff
Among the four staff types examined, employing any aides showed the least variation by sector (Figure 7).
In all ve sectors, the vast majority of providers employed aides; nursing homes (98.3%) were most likely
and adult day services centers (74.4%) were least likely to have any aides on staff.
With the exception of residential care communities, the majority of providers employed licensed nursing
staff (RNs or LPNs and LVNs). Because virtually all home health agencies, hospices, and nursing homes
in this report are Medicare-certied, it is to be expected that nearly all of them employed at least one RN.
In contrast, 59.2% of adult day services centers and 46.3% of residential care communities employed
any RNs. The majority of nursing homes (98.2%), home health agencies (68.7%), and hospices (56.4%)
NOTES: Only employees are included for all staff types; contract staff are not included. For adult day services centers and
residential care communities, aides refer to certified nursing assistants, home health aides, home care aides, personal care
aides, personal care assistants, and medication technicians or medication aides. For home health agencies and hospices,
aides refer to home health aides. For nursing homes, aides refer to certified nurse aides, medication aides, and medication
technicians. Social workers include licensed social workers or persons with a bachelor’s or master’s degree in social work in
adult day services centers and residential care communities, medical social workers in home health agencies and hospices,
and qualified social workers in nursing homes. See Technical Notes for information on how outliers were identified and coded.
Percentages are based on the unrounded numbers.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 2 in Appendix B.
Figure 7. Percentage of long-term care services providers with any full-time
equivalent employees, by provider type and staff type: United States, 2012
Any registered nurse Any licensed
practical or
vocational nurse
Any aide Any social worker
Residential care
community
Nursing
home
HospiceHome health
agency
Adult day
services center
56.4
96.5
98.9
98.7
98.2
98.3
75.9
46.3
41.6
86.5
14.0
59.2
44.7
74.4
42.8
99.8 99.8
68.7
90.2
44.9
7
The administrative data used in this report for the home health, hospice, and nursing home sectors used a less-inclusive
wording to capture aides than was used in the questionnaire data for adult day services centers and residential care
communities. Consequently, estimates using the administrative data may undercount the number of aides employed
by providers in those sectors. See Appendix A for how an aide was dened for each provider type.
16
Chapter 2
employed at least one LPN or LVN, whereas a minority of adult day services centers (44.7%) and residential
care communities (41.6%) employed LPNs or LVNs.
Employing any social workers showed the most variation across sectors. Almost all hospices (98.9%)
employed social workers, as did more than three-fourths of nursing homes (75.9%), and more than four-
tenths of adult day services centers (42.8%) and home health agencies (44.9%); only 14.0% of residential
care communities employed social workers.
Staffing hours
For every measure of nursing staff type examined (i.e., all nursing staff, all licensed nursing staff, RN only,
LPN and LVN only, and aides only), the average staff hours per resident or participant day were higher in
nursing homes than in residential care communities and adult day services centers (Figure 8).
8
The average total nursing hours (RNs, LPNs and LVNs, and aides) per resident or participant day were
3.83 for nursing home residents, 2.62 for residential care residents, and 1.58 for adult day participants.
The average total nursing hours per resident day in nursing homes were about 46.0% higher than the
corresponding ratio for residential care communities, and more than twice the size of the ratio for adult
day services centers. The average total nursing hours per resident or participant day in residential care
communities were about 66% higher than the ratio for adult day services centers.
The average total licensed nursing hours (RNs, and LPNs and LVNs) per resident or participant day were
1.37 for nursing home residents, 0.50 for adult day participants, and 0.46 for residential care residents. The
average licensed nursing hours per resident or participant day in nursing homes were over twice the size
of the corresponding ratios for residential care communities and adult day services centers. The average
licensed nursing hours per resident or participant day were similar in residential care communities and adult
day services centers.
The average aide hours per resident or participant day in nursing homes were 13.9% higher than the ratio for
residential care communities, and more than twice the ratio for adult day services centers (147.6 minutes,
compared with 129.6 minutes and 64.8 minutes, respectively). The average aide hours per resident or
participant day in residential care communities were twice the size of the ratio for adult day services centers.
The average licensed social worker hours per resident or participant day for adult day services centers (9.0
minutes) were about two to three times the size of the corresponding ratio for nursing homes (4.8 minutes)
and residential care communities (3.0 minutes).
8
Rather than hours per day, which have been used in nursing home and residential care settings, alternative stafng
metrics have been reported in the literature for adult day services, home health agencies, and hospices, such as
average number of visits per 8-hour day (National Association for Home Care and Hospice & Hospital and Healthcare
Compensation Service, 2009), and worker-to-participant ratio (MetLife Mature Market Institute, 2010). However, in
order to provide a measure by which to compare stafng levels across sectors, hours per user (resident or participant)
day are provided in this report. See Technical Notes and Appendix A for details on how hours per resident or participant
day were computed for adult day services centers, nursing homes, and residential care communities. Hours per patient
day could not be provided for home health agencies or hospices, because the administrative data available provided
total number of all patients served in a year, not the number served on a given day.
Chapter 2
17
Figure 8. Average hours per resident or participant per day, by provider type
and staff type: United States, 2012
NOTES: Only employees are included for all staff types; contract staff are not included. For adult day services centers and
residential care communities, aides refer to certified nursing assistants, home health aides, home care aides, personal care
aides, personal care assistants, and medication technicians or medication aides. For home health agencies and hospices,
aides refer to home health aides. For nursing homes, aides refer to certified nurse aides, medication aides, and medication
technicians. Social workers include licensed social workers or persons with a bachelor’s or master’s degree in social work in
adult day services centers and residential care communities, medical social workers in home health agencies and hospices,
and qualified social workers in nursing homes. For adult day services centers, average hours per participant per day were
computed by multiplying the number of full-time equivalent (FTE) employees for the staff type by 35 hours, divided by
average daily attendance of participants and by 5 days. For nursing homes and residential care communities, average hours
per resident per day were computed by multiplying the number of FTE employees for the staff type by 35 hours, and divided
by the number of current residents and by 7 days. See Technical Notes for information on how outliers were identified and
coded.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 2 in Appendix B.
0.0 0.5 1.0 1.5 2.0 2.5
Hour
3.0 3.5 4.0 4.5
Adult day
services center
Nursing home
Residential care
community
Registered nurse Licensed practical or
vocational nurse
Aide Social worker
0.27
0.52
0.28
0.22
1.08 0.15
0.85 2.46 0.08
0.19
2.16 0.05
18
Chapter 2
NOTES: See Appendix A for definitions of social work services for each provider type. Percentages are based on the
unrounded numbers.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 3 in Appendix B.
Figure 9. Percentage of long-term care services providers that provide social work
services, by provider type: United States, 2012
Residential care
community
Nursing homeHospiceHome health
agency
Adult day
services center
63.5
82.3
100.0
88.9
75.6
Services Provided
This section provides information on what proportion of providers in each sector offered each of six
services—social work; mental health or counseling; therapies (physical, occupational, or speech); skilled
nursing or nursing; pharmacy or pharmacist; and hospice. Services could be provided directly by the
provider or by others, through arrangement.
9
Social work services
The majority of providers in all ve sectors offered social work services (Figure 9). All hospices (100.0%)
provided social work services, as did most nursing homes (88.9%) and home health agencies (82.3%), likely
because providing these services is required for Medicare certication. Fewer residential care communities
(75.6%) and adult day services centers (63.5%) provided social work services.
9
These services were chosen because they are commonly provided by Medicare- and Medicaid-certied long-term
care services providers, and administrative data were available for most sectors. However, the available administrative
data did not have information on whether home health agencies provided mental health or counseling services or
whether hospices provided pharmacy or pharmacist services. See Appendix A for denitions of services used for each
provider type.
Chapter 2
19
Mental health or counseling services
Mental health or counseling services were offered by most hospices (97.2%), nursing homes (86.6%), and
residential care communities (77.8%), while less than one-half of adult day services centers (47.3%) offered
these services (Figure 10).
NOTES: See Appendix A for definitions of mental health or counseling services for each provider type. Percentages are based
on the unrounded numbers.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 3 in Appendix B.
Figure 10. Percentage of long-term care services providers that provide mental
health or counseling services, by provider type: United States, 2012
Residential care
community
Nursing homeHospiceAdult day
services center
47.3
97.2
86.6
77.8
20
Chapter 2
Therapeutic services
Virtually all nursing homes (99.3%), hospices (98.4%), and home health agencies (96.6%) offered
therapeutic services, and most residential care communities (88.7%) did so (Figure 11). The majority of
adult day services centers (63.8%) offered therapeutic services.
NOTES: See Appendix A for definitions of therapeutic services for each provider type. Percentages are based on the
unrounded numbers.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 3 in Appendix B.
Figure 11. Percentage of long-term care services providers that provide
therapeutic services, by provider type: United States, 2012
Residential care
community
Nursing homeHospiceHome health
agency
Adult day
services center
63.8
98.4
96.6
99.3
88.7
Chapter 2
21
Skilled nursing or nursing services
All home health agencies, hospices, and nursing homes (100.0%) provided skilled nursing or nursing
services, as did most residential care communities (76.1%) and adult day services centers (70.1%)
(Figure 12).
NOTES: See Appendix A for definitions of skilled nursing or nursing services for each provider type. Percentages are based on
the unrounded numbers.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 3 in Appendix B.
Figure 12. Percentage of long-term care services providers that provide skilled
nursing or nursing services, by provider type: United States, 2012
Residential care
community
Nursing homeHospiceHome health
agency
Adult day
services center
70.1
100.0100.0 100.0
76.1
22
Chapter 2
Pharmacy or pharmacist services
Nearly all nursing homes (97.4%) and residential care communities (92.6%) offered pharmacy or pharmacist
services, while fewer adult day services centers (34.9%) and home health agencies (5.5%) provided these
services (Figure 13).
NOTES: See Appendix A for definitions of pharmacy or pharmacist services for each provider type. Percentages are based on
the unrounded numbers.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 3 in Appendix B.
Figure 13. Percentage of long-term care services providers that provide pharmacy
or pharmacist services, by provider type: United States, 2012
Residential care
community
Nursing homeHome health
agency
Adult day
services center
34.9
5.5
97.4
92.6
Chapter 2
23
Hospice services
A greater percentage of residential care communities (89.4%) offered hospice services than did nursing
homes (78.6%). Fewer adult day services centers (24.4%) offered hospice services, and only a small
percentage of home health agencies (5.6%) offered hospice services (Figure 14).
NOTES: See Appendix A for definitions of hospice services for each provider type. Percentages are based on the unrounded
numbers.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 3 in Appendix B.
Figure 14. Percentage of long-term care services providers that provide hospice
services, by provider type: United States, 2012
24.4
5.6
78.6
89.4
Residential care
community
Nursing homeHome health
agency
Adult day
services center
Chapter 3
National Profile of Users of
Long-Term Care Services
26 Chapter 3
Chapter 3. National Profile of Users of Long-Term
Care Services
Introduction
On any given day in 2012, there were 273,200 participants enrolled in adult day services centers,
1
1,383,700
residents in nursing homes, and 713,300 residents living 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. Overall, these ve long-term care services provider sectors served about 8,357,100 people
annually.
2
This chapter provides an overview of the use rate and demographic, health, and functional composition of
users of long-term care services, by provider type. Demographic measures include age, race and ethnicity,
and sex. Measures of health status include diagnosis of Alzheimer’s disease and other dementias and
depression. Measures of functional status include needing assistance with selected activities of daily living
[(ADLs) i.e., bathing, dressing, toileting, and eating].
Users of Long-Term Care Services
Participants in adult day services centers and residents in nursing homes and residential care communities
are current users on any given day in 2012. Home health patients refer to patients who received and ended
care any time in 2011. Hospice patients refer to patients who received care any time in 2011. Use of long-
term care services by individuals aged 65 and over per 1,000 persons aged 65 and over varied by provider
type and state (Figures 15–19).
3
The daily-use rate was higher for nursing homes (26 per 1,000), compared
with residential care communities (15 per 1,000) and adult day services centers (4 per 1,000). The annual-
use rate was higher for home health agencies (94 per 1,000) compared with hospices (28 per 1,000).
1
In 2012, the average number of participants served daily in adult day services centers was 185,300, which is smaller
than the total enrollment because some participants did not attend each weekday.
2
This sum is an approximation and likely an undercount. The estimates for adult day services center participants,
nursing home residents, and residential care community residents are for current service users on any given day, rather
than all users in a year. The estimate for home health patients includes only those who ended care in 2011 (discharges).
The same person may be included in this sum more than once, if a person received care in more than one sector in a
similar time period (e.g., a residential care resident receiving care from a home health agency).
3
Given the data available, daily-use rates were compared for nursing home residents, residential care residents, and
adult day services center participants, while annual-use rates were compared for home health patients and hospice
patients.
Chapter 3
27
National rate is 4
Significantly lower than national rate
Significantly higher than national rate
No significant difference
NOTES: Rates based on adult day services center participants per 1,000 persons aged 65 and over on any given day.
Significance tested at p < 0.05.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 5 in Appendix B.
CA
AK
HI
ID
WA
OR
NV
AZ
ND
SD
NE
KS
MO
IA
MN
IL
IN
MS
FL
OH
MI
PA
MD
NJ
CT
RI
MA
ME
NH
MT
WY
UT
CO
NM
WI
DC
NY
NC
GA
VA
AL
WV
TN
LA
OK
AR
DE
SC
VT
TX
KY
Figure 15. Adult day services center participants aged 65 and over:
United States, 2012
Daily enrollment in adult day services centers
In 2012, national daily enrollment in adult day services centers was 4 participants aged 65 and over
(Figure 15). This rate varied by state in 2012, from a high of 12 participants per 1,000 persons in
New Jersey, to a low of less than 1 participant in West Virginia (Appendix B, Table 5). Daily enrollment fell
below the national rate in over 30 states, indicating that the nationwide rate was being driven by a few large
states, including California, New York, Texas, and New Jersey.
28 Chapter 3
Daily use of nursing homes
Nationally in 2012, daily nursing home use was 26 residents aged 65 and over (Figure 16), and ranged from
7 residents in Alaska to 49 residents in North Dakota. About 40% of states had a rate that was higher than
the national rate; these states were largely concentrated in the South and the Midwest, with a few in the
Northeast. States on the west and east coasts had use rates that were below the national rate.
Figure 16. Nursing home residents aged 65 and over: United States, 2012
National rate is 26
NOTES: Rates based on nursing home residents per 1,000 persons aged 65 and over on any given day. Significance tested at
p < 0.05.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 5 in Appendix B.
CA
AK
HI
ID
WA
OR
NV
AZ
ND
SD
NE
KS
MO
IA
MN
IL
IN
MS
OH
MI
PA
ME
VT
MT
WY
UT
CO
NM
WI
NY
NC
VA
AL
KY
WV
TN
LA
OK
AR
DE
TX
MD
SC
GA
FL
NJ
CT
RI
MA
NH
DC
Significantly lower than national rate
Significantly higher than national rate
No significant difference
Chapter 3
29
Daily use of residential care communities
In 2012, national daily use of residential care communities was 15 residents aged 65 and over (Figure 17),
and ranged from 2 residents in Iowa to 40 residents in North Dakota. About 17 states had rates that were
higher than the national rate. The rates in most of the upper west and midwest states were higher than the
national rate, as were rates for several states in the Northeast.
National rate is 15
NOTES: Rates based on residential care residents per 1,000 persons aged 65 and over on any given day. Significance tested
at p < 0.05.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 5 in Appendix B.
CA
AK
HI
ID
WA
OR
NV
ND
SD
NE
KS
MO
IA
MN
IL
IN
MS
OH
MI
PA
MD
ME
MT
WY
UT
CO
WI
NY
NC
VA
KY
WV
TN
LA
OK
AR
DE
VT
NJ
CT
RI
MA
NH
DC
Significantly higher than national rate
Significantly lower than national rate
No significant difference
AL
AZ
GA
FL
SC
Figure 17. Residential care residents aged 65 and over: United States, 2012
NM
TX
30 Chapter 3
Annual use of home health agencies
In 2011, national annual use of home health care was 94 patients aged 65 and over (Figure 18), and ranged
from 28 in Hawaii to 138 in Massachusetts.
4
All of the states in the Northeast and most of the states in the
South had rates that were not statistically different from the national rate. Most of the states where use of
home health care was lower than the national rate were located in the West, with some in the Midwest. Only
Texas and Florida in the South, and Illinois and Michigan in the Midwest had rates higher than the national
rate.
Figure 18. Home health patients aged 65 and over discharged in calendar year:
United States, 2011
National rate is 94
NOTES: Rates based on home health patients per 1,000 persons aged 65 and over. Significance tested at p < 0.05.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 5 in Appendix B.
CA
AK
HI
ID
WA
OR
AZ
ND
SD
NE
KS
MO
IA
MN
IL
IN
MS
FL
OH
MI
PA
ME
MT
WY
UT
CO
NM
WI
NY
VA
AL
WV
TN
LA
AR
TX
SC
NC
GA
MD
NJ
CT
RI
MA
NH
DC
DE
VT
Significantly lower than national rate
Significantly higher than national rate
No significant difference
OK
KY
NV
4
Some states may not be signicantly different from the national mean, even if they have a higher use rate, due to
large standard errors. For instance, the home health use rate for Massachusetts is the highest in the nation, but it is not
statistically different from the national mean.
Chapter 3
31
Annual use of hospices
In 2011, the national annual use of hospice care was 28 patients aged 65 and over (Figure 19). The annual
rate ranged from 7 in Alaska to 39 in Delaware and Utah. All but 4 states (Alaska, California, New York,
and Wyoming) had annual rates that were not statistically different from the national rate.
Figure 19. Hospice patients aged 65 and over in calendar year: United States, 2011
National rate is 28
NOTES: Rates based on hospice patients per 1,000 persons aged 65 and over. Significance tested at p < 0.05.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 5 in Appendix B.
CA
AK
HI
ID
WA
OR
NV
AZ
ND
SD
NE
KS
IA
IL
IN
VT
MS
FL
OH
MI
PA
ME
MT
WY
CO
WI
NY
AL
KY
WV
LA
SC
GA
TN
NC
AR
MD
NJ
CT
RI
MA
NH
DC
DE
Significantly lower than national rate
Significantly higher than national rate
No significant difference
OK
MN
MO
UT
NM
TX
VA
32 Chapter 3
Demographic Characteristics of Users of Long-Term Care Services
Use of long-term care services by age
The majority of long-term care service users were aged 65 and over: 94.5% of hospice patients, 93.3% of
residential care residents, 85.1% of nursing home residents, 82.4% of home health patients, and 63.5% of
participants in adult day services centers (Figure 20).
The age composition of services users varied by sector, with residential care communities (50.5%), hospices
(46.8%), and nursing homes (42.3%) serving more persons aged 85 and over, and adult day services centers
(36.5%) serving more persons under age 65 than other sectors.
NOTES: Denominators used to calculate percentages for adult day services centers, nursing homes, and residential care
communities were the number of participants enrolled in adult day services centers, the number of residents in nursing homes,
and the number of residents in residential care communities on a given day in 2012. Denominators used to calculate
percentages for home health agencies and hospices were the number of patients whose episode of care in a home health
agency ended at any time in 2011, and the number of patients who received care from Medicare-certified hospices at any
time in 2011. See Appendix A and Technical Notes for more information on the data sources used for each provider type.
Percentages may not add to 100 because of rounding. Percentages are based on the unrounded numbers.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 4 in Appendix B.
Figure 20. Percent distribution of long-term care services providers, by provider
type and age group: United States, 2011 and 2012
85 and
over
75–84
65–74
Under 65
Adult day
services center
16.9
27.2
19.4
36.5
Home health
agency
25.5
32.2
24.6
17.6
Hospice
46.8
31.3
16.4
5.5
Nursing
home
42.3
27.9
14.9
14.9
Residential care
community
50.5
32.4
10.4
6.7
Chapter 3
33
Use of long-term care services by sex
In all ve sectors, the users of long-term care services were overwhelmingly women (Figure 21), with the
highest proportion in residential care communities (72.0%).
NOTES: Denominators used to calculate percentages for adult day services centers, nursing homes, and residential care
communities were the number of participants enrolled in adult day services centers, the number of residents in nursing
homes, and the number of residents in residential care communities on a given day in 2012. Denominators used to calculate
percentages for home health agencies and hospices were the number of patients whose episode of care in a home health
agency ended at any time in 2011, and the number of patients who received care from Medicare-certified hospices at any time
in 2011. See Appendix A and Technical Notes for more information on the data sources used for each provider type. Percentages
may not add to 100 because of rounding. Percentages are based on the unrounded numbers.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 4 in Appendix B.
Figure 21. Percent distribution of users of long-term care services, by provider
type and sex: United States, 2011 and 2012
Women
Men
Adult day
services center
59.6
40.4
Home health
agency
62.7
37.3
Hospice
59.7
40.3
Nursing
home
67.7
32.3
Residential care
community
72.0
28.0
34 Chapter 3
Use of long-term care services by race and ethnicity
Non-Hispanic white persons accounted for at least three-quarters of users in all long-term care services
sectors, except adult day services centers (Figure 22).
The proportion of non-Hispanic white persons was highest in residential care communities (87.3%),
followed by hospices (85.3%), nursing homes (78.7%), and home health agencies (74.5%). Less than one-
half of the participants in adult day services centers were non-Hispanic white (47.3%). The proportion of
non-Hispanic black persons was highest in adult day services centers (16.8%). Over one-tenth of home
health patients and nursing home residents were non-Hispanic black. About 8.1% of hospice patients and
4.0% of residential care residents were non-Hispanic black. Adult day services centers were the most
racially and ethnically diverse among the ve sectors: 16.8% of users were non-Hispanic black, and 20.2%
of users were Hispanic.
Residential
care
community
Nursing
home
HospiceHome
health
agency
Adult day
services
center
NOTES: Denominators used to calculate percentages for adult day services centers, nursing homes, and residential care
communities were the number of participants enrolled in adult day services centers, the number of residents in nursing homes,
and the number of residents in residential care communities on a given day in 2012. Denominators used to calculate
percentages for home health agencies and hospices were the number of patients whose episode of care in a home health
agency ended at any time in 2011, and the number of patients who received care from Medicare-certified hospices at any
time in 2011. See Appendix A and Technical Notes for more information on the data sources used for each provider type.
Percentages may not add to 100 because of rounding. Percentages are based on the unrounded numbers.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 4 in Appendix B.
Figure 22. Percent distribution of users of long-term care services, by provider
type and race and Hispanic origin: United States, 2011and 2012
Non-Hispanic other
Non-Hispanic black
Non-Hispanic white
Hispanic
Population
aged 65
and over
6.9
80.0
8.4
4.7
20.2
47.3
16.8
15.7
8.4
74.5
3.0
14.1
4.6
85.3
8.1
2.1
5.1
78.7
14.0
2.3
2.4
87.3
4.0
6.3
Chapter 3
35
Health and Functional Characteristics of Users of Long-Term Care
Services
Alzheimer’s disease or other dementias and depression
Alzheimer’s disease or other dementias were most prevalent among nursing home residents (48.5%), and
were least prevalent among home health patients (30.1%) (Figure 23). The percentage of users of long-term
care services with a diagnosis of depression was highest in nursing homes (48.5%), and lowest in residential
care communities (24.8%), adult day services centers (23.5%), and hospices (22.2%).
NOTES: Denominators used to calculate percentages for adult day services centers, nursing homes, and residential care
communities were the number of participants enrolled in adult day services centers, the number of residents in nursing
homes, and the number of residents in residential care communities on a given day in 2012. Denominators used to calculate
percentages for home health agencies and hospices were the number of patients whose episode of care in a home health
agency ended at any time in 2011, and the number of patients who received care from Medicare-certified hospices at any
time in 2011. See Appendix A and Technical Notes for more information on the data sources used for each provider type.
Percentages are based on the unrounded numbers.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 4 in Appendix B.
Figure 23. Percent distribution of users of long-term care services with a diagnosis
of Alzheimer's disease or other dementias, and with a diagnosis of depression,
by provider type: United States, 2011 and 2012
Depression
Alzheimer’s disease
or other dementias
Residential care
community
Nursing
home
HospiceHome health
agency
Adult day
services center
31.9
23.5
30.1
34.7
44.3
22.2
48.5 48.5
39.6
24.8
36 Chapter 3
Assistance with activities of daily living
The need for ADL assistance can be used to measure physical and cognitive functioning among users of
long-term care services (Katz, Down, Cash, & Grotz, 1970). Bathing, dressing, toileting, and eating are
the ADLs used in this report to monitor functioning among residents in nursing homes and residential care
communities, patients in home health care, and participants in adult day services centers.
5
Within each sector, the need for assistance with bathing was most common, whereas the need for assistance
with eating was least common (Figure 24). Overall, functional ability varied by sector. More nursing home
residents needed assistance in each of the four ADLs, followed by home health patients. Equal proportions
of adult day services center participants (36.2%) and residential care community residents (36.8%)
needed assistance with toileting. More adult day services center participants (25.3%) than residential care
community residents (17.7%) needed help with eating.
Although the prevalence of ADL needs differed by sector, at least 40.0% of long-term care services users in
all sectors needed assistance with at least one ADL.
Figure 24. Percentage of users of long-term care services needing any assistance
with activities of daily living, by provider type and activity: United States, 2011
and 2012
NOTES: Denominators used to calculate percentages for adult day services centers, nursing homes, and residential care
communities were the number of participants enrolled in adult day services centers, the number of residents in nursing homes,
and the number of residents in residential care communities on a given day in 2012. Denominator used to calculate percent-
ages for home health agencies was the number of patients whose episode of care in a home health agency ended at any
time in 2011. Participants, patients, or residents were considered needing any assistance with a given activity if they needed
help or supervision from another person, or they used special equipment to perform the activity. See Appendix A for definitions
of needing any assistance with a given activity for each provider type. Percentages are based on the unrounded numbers.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers and Table 4 in Appendix B.
36.2
39.6
96.1
EatingToiletingDressingBathing
Residential care
community
Nursing homeHome health
agency
Adult day
services center
37.8
25.3
95.1
83.8
64.6
51.2
90.9
86.6
56.0
61.4
44.9
36.8
17.7
5
Data on the need for ADL assistance were not available for hospice patients.
Chapter 4
Summary
38
Chapter 4
Chapter 4. Summary
In 2012, there were approximately 58,500 paid, regulated long-term care services providers in the United
States, including 4,800 adult day services centers, 12,200 home health agencies, 3,700 hospices, 15,700
nursing homes, and 22,200 residential care communities. In total, long-term care services providers in these
ve sectors served about 8,357,100 people annually. Specically, on any given day in 2012, there were
273,200 participants enrolled in adult day services centers, 1,383,700 residents living in nursing homes,
and 713,300 residents living 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.
Supply and Use of Long-Term Care Services
The supply of different long-term care services options was measured by examining the number of beds
or allowable daily capacity per 1,000 persons aged 65 and over. In the United States, the supply of nursing
home beds was almost twice the supply of residential care community beds, and about six times the
allowable daily capacity of adult day services centers. The supply of nursing home and residential care beds
and the capacity of adult day services centers varied by region, suggesting possible geographic differences
in access. There is also geographic variation in the relative mix of long-term care services options available
to consumers. In the West, the supply of residential care beds and nursing home beds per 1,000 persons was
comparable, whereas nursing home beds far outnumbered residential care beds in all other regions.
Use of long-term care services varied by provider type, reecting similar differences found when comparing
supply. When comparing rates of daily use nationally among individuals aged 65 and over, use was highest
in the nursing home sector and lowest in the adult day services center sector. Use of services also varied
geographically. For example, in Texas the daily-use rate of adult day services centers and nursing homes
was higher than the national rate, while the state’s residential care daily-use rate was lower than the national
rate. In contrast, in Virginia the daily-use rate of adult day services centers and nursing homes was lower
than the national rate, while the state’s residential care daily-use rate was higher than the national rate.
Although previous research found that the use of home- and community-based services is increasing at
a greater rate than the use of nursing homes (Houser et al., 2012), ndings from the National Study of
Long-Term Care Providers (NSLTCP) suggest that in most areas of the country the supply and use of
nursing homes are still greater than those of other long-term care services options. A recent analysis by the
AARP Public Policy Institute found that states vary tremendously on a variety of characteristics of their
long-term care services systems (Reinhard et al., 2011). The NSLTCP state-level ndings in this report add
to this picture of diversity among states.
1
Characteristics of Long-Term Care Services Providers and Users
Paid long-term care services are provided by a wide array of trained professionals and paraprofessionals,
with the largest share being direct-care workers that include certied nursing assistants, personal care aides,
and home health aides, generally referred to as aides (The SCAN Foundation, 2012). In all sectors, aide
hours were the most frequently used nursing hours: these ndings corroborate other studies showing that
direct-care workers provide an estimated 70% to 80% of the paid, hands-on, long-term care services in
the United States (Paraprofessional Healthcare Institute, 2012). Previous studies have provided evidence
that higher nurse-stafng levels are associated with higher quality of care outcomes for nursing home
1
Future NSLTCP products from the National Center for Health Statistics will provide additional state-level estimates
on providers and services users in these ve sectors.
Chapter 4 39
residents (e.g., Bostick, Rantz, Flesner, & Riggs, 2006; Castle & Engberg, 2007; Collier & Harrington,
2008), and nursing homes are required to meet minimum nurse stafng ratios for participation in Medicare
and Medicaid. Less research has been conducted on stafng levels and outcomes in adult day, residential
care (for an exception see Stearns et al., 2007), home health, and hospice settings. For every measure of
nursing staff type examined, the average staff hours per resident or participant day was higher in nursing
homes than in residential care communities and adult day services centers.
These differences in nurse-stafng levels among sectors reect the higher functional needs of nursing home
residents, relative to service users in other sectors. When comparing activities of daily living (ADLs) across
sectors, more nursing home residents and home health patients needed assistance with each of four ADLs
than did adult day participants and residential care residents. Fewer residential care community residents
needed help eating than did users in other sectors. Although ADL needs varied by sector, at least 40% of
long-term care services users in all four sectors needed assistance with at least one ADL.
Based on estimates from the Aging, Demographics, and Memory Study, a nationally representative sample
of older adults, 13.9% of people aged 71 and over in the United States have Alzheimer’s disease or other
types of dementia (Plassman et al., 2007). NSLTCP ndings show that a sizeable portion of service users
in all ve sectors had a diagnosis of Alzheimer’s disease or other dementias—almost one-third of adult
day services center participants and home health patients, about four-tenths of residential care residents,
and almost one-half of nursing home residents. These results suggest that this condition is a common
precipitating factor for using formal long-term care services (Alzheimer’
s Association, 2013).
In a 2008 report, the Institute of Medicine documented the growing need for gerontological social workers
and the lack of interest among social workers in working with older adults (Institute of Medicine, 2008).
According to a recent study, about 36,100 to 44,200 professional social workers were employed in long-term
care settings, and approximately 110,000 social workers would be needed in these settings by 2050 (HHS,
2006). The NSLTCP ndings show that the ve long-term care services sectors varied in the prevalence
of employing licensed social workers. The majority of hospices and nursing homes employed licensed
social workers, whereas a minority of adult day services centers, home health agencies, and residential
care communities had licensed social worker employees. In the sectors for which stafng levels could
be calculated (adult day services centers, nursing homes, and residential care communities), the average
licensed social worker hours per resident or participant day were small (3 minutes to 9 minutes).
Although the majority of providers in all sectors offered social work services, therapeutic services, and
skilled nursing services, there was some variation across sectors. For example, less than two-thirds of adult
day services centers offered social work services, whereas all hospices did so. These differences may be
related to different population needs among sectors or to Medicare requirements for hospices to provide
medical social services, among other reasons.
Compared with the 12.0% of U.S. adults aged 65 and over in 2008 who had clinically depressive symptoms
(Federal Interagency Forum on Aging-Related Statistics, 2012), depression was common among long-term
care services users in all ve sectors—ranging from 22.2% of hospice patients to 48.5% of nursing home
residents. A higher proportion of hospices and nursing homes offered mental health and counseling services
than did residential care communities and adult day services centers.
The adult day services sector was different from other sectors in notable ways. Adult day services centers
were more likely to be nonprot. There were also fewer adult day services centers than providers in other
sectors (except hospices), and they were less likely than providers in other sectors to offer social work
services, mental health or counseling services, therapeutic services, or pharmacy services. Reasons for
40
Chapter 4
offering fewer of these services may include nancing mechanisms (e.g., Medicare plays little, if any, role
in this sector), or differences in the needs of users in different sectors.
Adult day services center participants were more diverse than service users in other sectors with respect to
race and ethnicity and age. Compared with the approximately 7.0% of U.S. adults aged 65 and over who
were Hispanic and the approximately 9.0% who were non-Hispanic black in 2010 (Federal Interagency
Forum on Aging-Related Statistics, 2012), 20.2% of adult day services center participants were Hispanic,
and 16.8% were non-Hispanic black. While people of all ages may need long-term care services, NSLTCP
ndings corroborate previous research showing that the majority of users of paid, long-term care services
are older adults (Kaye et al., 2010; O’Shaugnessy, 2013). However, among adult day services center
participants, there was a lower proportion of persons aged 85 and over compared with users in other sectors.
In fact, over one-third of adult day services center participants were younger than age 65.
The NSLTCP ndings in this report provide a current national picture of providers and users of ve
major sectors of paid, regulated, long-term care services in the United States. Findings on differences and
similarities in supply and use, and the characteristics of providers and users of long-term care services offer
useful information to policymakers, providers, and researchers as they plan to meet the needs of an aging
population. These ndings also establish a baseline for monitoring trends and examining the effects of
policy changes within and across the major sectors of long-term care services.
Chapter 5
Technical Notes
42 Chapter 5
Chapter 5. Technical Notes
Data Sources
This report uses data from multiple sources, but it uses two main sources: administrative data from the
Centers for Medicare & Medicaid Services (CMS) on nursing homes, home health agencies, and hospices;
and cross-sectional, nationally representative, establishment-based survey data from the Centers for
Disease Control and Prevention’s National Center for Health Statistics (NCHS) for assisted living and
similar residential care communities and adult day services centers. Data for all ve provider types were
obtained for comparable time periods, where feasible.
Administrative data: home health agencies, hospices, and nursing homes
Provider-level data
Provider-specic data les from the Certication and Survey Provider Enhanced Reporting [(CASPER),
formerly known as Online Survey Certication and Reporting] system were used. These les were drawn
from the third quarter of 2012. CASPER data were collected to support the survey and certication regulatory
function of CMS; every nursing home, home health agency, or hospice in the United States that was certied
to provide services under Medicare, Medicaid, or both was included in the data. Different types of providers
had to report different information during the survey and certication process. The number of variables in
each le and the frequency of certication survey data collection varied by provider type.
Home health agency le—Included 12,206 home health agencies coded as active providers and
located in the United States. About 76.1% of these agencies were Medicare- and Medicaid-certied,
22.5% were Medicare-certied only, and 1.4% were Medicaid-certied only. About 89.5% of these
home health agencies completed a certication survey during the last 3 years.
Hospice le—Included 3,678 hospices coded as active providers and located in the United States;
information on type of certication (Medicare only, Medicaid only, or both) was not available.
CMS requires certication surveys of Medicare hospices every 6 to 8 years, on average (Ofce
of Inspector General, 2007). About 93.0% of Medicare hospices completed a certication survey
during the last 8 years (including 53.8% within the last 3 years).
Nursing home le—Included 15,675 nursing homes coded as active providers and located in the
United States. About 91.5% were Medicare- and Medicaid-certied, 5.0% were Medicare-certied
only, and 3.5% were Medicaid-certied only. Nearly all of these nursing homes (99.3%) completed
a certication survey during the last 18 months.
User-level data
User-level data were aggregated to the provider level (e.g., the distribution of an agency’s patients
or a facility’s residents by age, race, and sex), using a unique provider identication (ID) number.
These user-level data were merged to respective provider-level data les.
Home health patients
Outcome-Based Quality Improvement (OBQI) Case Mix Roll Up data (also known as Agency
Patient-Related Characteristics Report data) are from the Outcome and Assessment Information
Set. OBQI data were used as the primary source of information on home health patients whose
episode of care ended at any time in calendar year 2011 (i.e., discharges), regardless of payment
Chapter 5
43
source. These data included home health patients who received services from Medicare-certied
home health agencies and Medicaid-certied home health providers in states where those agencies
were required to meet the Medicare Conditions of Participation. When merged with the CASPER
home health agency le by provider ID number, 939 (7.7%) of the 12,206 agencies in the CASPER
le had no patient information in the OBQI data. The total number of patients in this merged le
(4,742,471) was used as the denominator when calculating percentages of home health patients in
different age categories, sex categories, and those needing any assistance with activities of daily
living (ADLs), and to compute the annual number of users and the annual-use rates of home health
care.
Institutional Provider and Beneciary Summary (IPBS) home health data were used to compute
percentages of home health patients of different racial and ethnic backgrounds, and to compute
percentages of those diagnosed with Alzheimer’s disease and other dementias and depression. IPBS
data were used for these measures because OBQI data did not use racial and ethnic categories that
were comparable to those used in other data sources and did not contain information on patient’s
diagnosis of dementia and depression. The IPBS data le contained information on home health
patients for whom Medicare-certied home health agencies submitted a Medicare claim at any
time in calendar year 2011. When merged with the CASPER home health agency le, 1,089 (8.9%)
of the 12,206 agencies in the CASPER le had no patient information in the IPBS home health
data. The total number of patients in this merged le (4,073,101) was used as the denominator
when calculating percentages of home health patients in different racial and ethnic categories,
and to compute percentages of those diagnosed with Alzheimer’s disease and other dementias and
depression.
Hospice patients
IPBS hospice data contained information on hospice patients for whom Medicare-certied hospice
agencies submitted a Medicare claim at any time in calendar year 2011. Given that 93.0% of
hospice agencies were Medicare-certied in 2007 (based on ndings from the 2007 National Home
and Hospice Care Survey) and that no other data source was available on hospice patients, IPBS
hospice data were assumed to provide current coverage and information on most hospice patients.
Data on demographic characteristics (i.e., age, sex, and racial and ethnic background) and selected
diagnosed chronic conditions (including Alzheimer’s disease and other dementias and depression)
were available; information on patients needing ADL assistance was not available. When merged
with the CASPER hospice agency le, 187 (5.1%) of the 3,678 hospices in CASPER had no patient
information in the IPBS hospice data. The total number of hospice patients in this merged le
(1,244,505) was used to compute the annual number of users, the annual-use rates, and it was used
as the denominator when calculating percentages for all aggregate, patient-level measures.
Nursing home residents
Minimum Data Set Active Resident Episode Table (MARET) data contained information on all
residents who were residing in a Medicare- or Medicaid-certied nursing home on the last day of the
third quarter of 2012, regardless of payment source. Excluded were residents whose last assessment
during the third quarter of 2012 was a discharge assessment. MARET assessment records were
used to create a prole of the most recent standard information for each active resident (available
from: https://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/
Minimum-Data-Set-3-0-Public-Reports/Minimum-Data-Set-3-0-Frequency-Report.html).
44 Chapter 5
Within MARET, CMS dened an active resident as “a resident whose most recent assessment
transaction is not a discharge and whose most recent transaction has a target date (assessment
reference date for an assessment record or entry date for an entry record) less than 150 days old.
If a resident has not had a transaction for 150 days, then that resident is assumed to have been
discharged.”
After aggregating individual resident-level MARET data to the provider ID level, the aggregated
MARET data were linked to the CASPER nursing home le. There were 385 (2.5%) of 15,675
nursing homes in the CASPER le that had no resident information in the MARET data. The total
number of nursing home residents in this merged le (1,320,355) was used as the denominator
when calculating percentages of nursing home residents with different demographic characteristics
(i.e., age, sex, and racial and ethnic background), and to compute the daily-use rates of nursing
homes.
The CASPER nursing home le for the third quarter of 2012 included information on selected
measures for 1,383,695 current residents living in 15,675 nursing homes; this information was
collected using CMS form 672 (Resident Census and Conditions of Residents). The resident census
information was designed to represent the facility at the time of the certication survey. Current
residents were dened as “residents in certied beds regardless of payer source.” Because the data
were provided at the individual provider-level, le merging was unnecessary, and no nursing home
had missing data on resident census items. Resident census information from the CASPER nursing
home le was used to compute the number of current residents and to obtain the number of residents
diagnosed with Alzheimer’s disease and other dementias, the number of residents diagnosed with
depression, and the number of residents with ADL limitations.
Survey data: adult day services centers and residential care communities
NCHS designed and conducted surveys for the adult day services center and residential care community
components for the rst wave of the National Study of Long-Term Care Providers (NSLTCP) in 2012.
1
The NSLTCP questionnaires consist of topics common or comparable across all ve provider types (“core
topics”) and topics that are specic to a particular type of provider (“provider-specic topics”). To facilitate
comparisons across provider types, the core content for the primary data collection for adult day services
centers and residential care communities was designed to be as similar as possible to the core content and
wording available through the CMS administrative data for home health agencies, hospices, and nursing
homes. The adult day services center and residential care community questionnaires included questions that
collected information at both the provider and aggregate user level.
Adult day services centers
The sampling frame obtained from the National Adult Day Services Association contained 5,212 adult
day services centers that self-identied as adult day care, adult day services, or adult day health services
centers that were operating as of May 31, 2012. Among responding centers, 97.0% were either licensed or
certied by a state agency to operate an adult day services center or participated in the Medicaid program.
1
The 2012 NSLTCP questionnaires for adult day services centers and residential care communities are available from:
http://www.cdc.gov/nchs/data/nsltcp/2012_NSLTCP_Adult_Day_Services_Center_Questionnaire.pdf and http://
www.cdc.gov/nchs/data/nsltcp/2012_NSLTCP_Residential_Care_Communities_Questionnaire.pdf.
Chapter 5
45
The remaining responding centers were neither regulated by the state to operate an adult day services center
nor participated in Medicaid. During data collection, 42 adult day services centers that were not on the
initial frame, but were in operation on or before May 31, 2012, were identied and included in the frame.
The nal frame included 5,254 adult day services centers. All the centers in the frame were included in
the data collection efforts. During data collection it was determined that 476 (9.1%) centers were either
invalid or out of business. All remaining adult day services centers (4,778) were assumed eligible. Data
were collected through three modes: self-administered, hard copy mail questionnaires; self-administered
web questionnaires; and Computer-Assisted Telephone Interview (CATI) interviews. The questionnaire
was completed for 3,212 centers, for a response rate of 67.2%.
2
Response rates by state are presented in
Table 5.1.
Table 5.1. Response rates for adult day services centers for the National Study of
Long-Term Care Providers, by state
Area Rate Area Rate
United States 67.2 Missouri 64.2
Alabama 69.6 Montana 42.9
Alaska 92.9 Nebraska 65.9
Arizona 78.3 Nevada 83.3
Arkansas 69.2 New Hampshire 70.8
California 56.5 New Jersey 73.0
Colorado 73.3 New Mexico 41.7
Connecticut 79.2 New York 76.0
Delaware 76.9 North Carolina 83.3
District of Columbia 66.7 North Dakota 42.9
Florida 65.0 Ohio 71.7
Georgia 57.0 Oklahoma 82.9
Hawaii 59.1 Oregon 56.3
Idaho 75.0 Pennsylvania 73.8
Illinois 75.0 Rhode Island 81.8
Indiana 75.6 South Carolina 78.6
Iowa 87.9 South Dakota 89.5
Kansas 81.3 Tennessee 73.3
Kentucky 77.5 Texas 60.5
Louisiana 66.0 Utah 83.3
Maine 60.6 Vermont 70.6
Maryland 68.6 Virginia 79.2
Massachusetts 69.8 Washington 69.0
Michigan 85.5 West Virginia 46.2
Minnesota 75.0 Wisconsin 74.8
Mississippi 70.7 Wyoming 57.1
SOURCE: CDC/NCHS, National Study of Long-Term Care Providers, 2012.
2
AAPOR (American Association for Public Opinion Research) response rate 2 formula was used to calculate the
response rate for adult day services centers (completed questionnaires / completed questionnaires + language barrier
+ refusals + other noncompleted questionnaires).
46 Chapter 5
Residential care communities
The sampling frame was constructed from lists of licensed residential care communities obtained from the
state licensing agencies in each of the 50 states and the District of Columbia. The 2012 NSLTCP used the
same denition of residential care community and the same approach to create the sampling frame (Wiener,
Lux, Johnson, & Greene, 2010) as was used for the 2010 National Survey of Residential Care Facilities
(NSRCF) (Moss et al., 2011). To be eligible for the study, a residential care community must:
Be licensed, registered, listed, certied, or otherwise regulated by the state to provide:
z Room and board with at least two meals a day and around-the-clock, on-site supervision
z Help with personal care such as bathing and dressing or health-related services, such as
medication management
Have four or more licensed, certied, or registered beds
Have at least one resident currently living in the community
Serve a predominantly adult population
Residential care communities licensed to exclusively serve individuals with severe mental illness, intellectual
disability, or developmental disability, and nursing homes were excluded.
NSLTCP used a combination of probability sampling and census-taking. Probability samples were selected
in the states that had sufcient numbers of residential care communities to enable state-level, sample-based
estimation. A census of residential care communities was taken in the states that did not have sufcient
numbers of residential care communities to enable state-level, sample-based estimation. From 39,779
communities in the sampling frame, 11,690 residential care communities were sampled and stratied by
state and facility bed size. A set of screener items in the questionnaire was used to determine eligibility. Of the
11,690 sampled residential care communities, 4,578 communities (44.0% weighted) could not be contacted
by the end of data collection and, therefore, the eligibility status of these communities was unknown. Using
the eligibility rate,
3
a proportion of these communities of unknown eligibility was estimated to be eligible.
This estimated number and the total number of eligible communities resulting from the screening process
were used to estimate the total number of eligible residential care communities in the United States.
Data were collected through three modes: self-administered, hard copy mail questionnaires; self-administered
web questionnaires; and CATI interviews. The questionnaire was completed for 4,694 communities, for a
weighted response rate (for differential probabilities of selection) of 55.4%.
4
Response rates by state are
presented in Table 5.2. Sample weights were adjusted to total the estimated number of eligible residential
care communities (22,185).
3
Eligibility rate is calculated by the number of known eligible residential care communities divided by the total number
of residential care communities with known eligibility status. Communities that were invalid or out of business, and
communities that screened out as ineligible were classied as “known ineligibles.”
4
AAPOR response rate 4 formula was used to calculate the response rate for residential care communities [completed
questionnaires / (completed eligible questionnaires) + (eligibility rate x cases of unknown eligibility)].
Chapter 5
47
Table 5.2. Response rates for residential care communities for the National Study of
Long-Term Care Providers, by state
Area Rate (weighted) Area Rate (weighted)
United States 55.4 Missouri 68.0
Alabama 50.7 Montana 62.1
Alaska 60.8 Nebraska 74.2
Arizona 51.9 Nevada 57.1
Arkansas 81.8 New Hampshire 67.9
California 51.6 New Jersey 56.7
Colorado 68.5 New Mexico 57.5
Connecticut 71.1 New York 67.1
Delaware 57.1 North Carolina 52.3
District of Columbia 50.0 North Dakota 75.2
Florida 43.9 Ohio 67.7
Georgia 55.2 Oklahoma 64.7
Hawaii 62.7 Oregon 54.0
Idaho 58.1 Pennsylvania 57.0
Illinois 60.2 Rhode Island 63.6
Indiana 64.1 South Carolina 60.3
Iowa 78.4 South Dakota 78.9
Kansas 69.6 Tennessee 66.8
Kentucky 59.2 Texas 55.8
Louisiana 61.6 Utah 64.7
Maine 68.1 Vermont 67.9
Maryland 46.2 Virginia 62.4
Massachusetts 51.0 Washington 57.1
Michigan 49.1 West Virginia 59.3
Minnesota 63.2 Wisconsin 60.3
Mississippi 54.5 Wyoming 84.0
SOURCE: CDC/NCHS, National Study of Long-Term Care Providers, 2012.
48 Chapter 5
Differences in the number of residential care communities in 2010 and 2012
The estimate of the number of residential care community providers varied between the 2010 NSRCF and
the 2012 NSLTCP (Table 5.3). NCHS continues to examine these differences. Preliminary assessments
indicate that the differences in estimates largely stem from the differences in eligibility rates between the
surveys. While both surveys used the same eligibility criteria, overall screener-based eligibility dropped
from 81.0% in NSRCF to 67.1%
5
in NSLTCP (Table 5.4). The drop in the screener-based eligibility rate was
most marked for small providers with 4 to 10 beds: a decrease from 63.6% in 2010 to 45.8% in 2012. Given
that NSLTCP (n = 11,690) had a much larger sample than NSRCF (n = 3,605), and that small providers
make up the largest proportion of all residential care communities, the low eligibility rate among small
residential care communities had a large effect on the differences in the eligibility rates for the two surveys
and the resulting differences in national estimates of the number of residential care communities.
Table 5.3. Number and percent distribution of residential care communities and beds, by
bed size and survey year
2012 National Study of Long-Term
Care Providers
2010 National Survey of
Residential Care Facilities
Weighted
number
Weighted
percent
Weighted
number
Weighted
percent
Residential care communities 22,200 100.0 31,100 100.0
Small (4–10 beds)
9,300 41.7 15,400 50.0
Medium (11–25 beds) 3,700 16.8 4,900 16.0
Large (26–100 beds) 7,300 32.7 8,700 28.0
Extra large (over 100 beds) 1,900 8.7 2,100 7.0
Beds
851,400 100.0 971,900 100.0
Small (4–10 beds) 64,700 7.6 96,700 9.9
Medium (11–25 beds) 86,900 10.2 86,800 8.9
Large (26–100 beds) 434,800 51.1 493,800 50.8
Extra large (over 100 beds) 265,000 31.1 294,600 30.3
NOTE: Percentages may not add to 100 because of rounding; percentages are based on the unrounded numbers.
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers, 2012 and National Survey of Residential Care Facilities, 2010.
Several reasons could account for these differences between the two surveys. Residential care community
regulations vary by state and facility bed size, and a larger NSLTCP sample may have captured more
accurately whether residential care communities met the eligibility requirements of the study. This may
be the case in census states where all providers in the state were sampled, because the vast majority of
residential care communities are small. A more plausible reason for eligibility differences may be found
in the different data collection modes used in 2010 (i.e., screeners administered by telephone interviewers,
followed by in-person interviews for eligible communities) and 2012 (i.e., primarily respondent self-
administered screener and questionnaire completed by mail or Web), and the resulting differences in how
self-administered respondents interpreted the eligibility questions.
5
The screener-based eligibility rate was computed based on residential care communities that completed the screening
questions [completed eligible / (completed eligible + completed ineligible)].
Chapter 5
49
Table 5.4. Percentage of eligible residential care communities, by bed size and survey
year
Eligible communities
2012 National Study of
Long-Term Care Providers
2010 National Survey
of Residential
Care Facilities
Overall 67.1 81.0
Bed size
Small (4–10 beds) 45.8 63.6
Medium (11–25 beds) 68.5 82.8
Large (26–100 beds) 82.4 94.5
Extra large (over 100 beds) 85.5 95.9
SOURCES: CDC/NCHS, National Study of Long-Term Care Providers, 2012 and National Survey of Residential Care Facilities, 2010.
In the 2012 NSLTCP, the most common eligibility criteria that providers, particularly small residential
care communities, did not meet was provision of on-site, 24-hour supervision. Some respondents using the
self-administered modes (i.e., hard copy questionnaire or web questionnaire) likely did not fully comprehend
this question, and may have screened themselves out of the study erroneously. Cognitive testing was
conducted to assess these eligibility questions, and preliminary ndings supported this hypothesis.
The other common cause of ineligibility was related to serving severely mentally ill, or intellectually
disabled or developmentally disabled populations exclusively. During the sample frame development
process, information about residential care communities that exclusively serve these special populations
was collected from state licensing agencies, but many state licensing agencies were still unable or unwilling
to provide listings of these providers. These listings were often maintained at different agencies, and states
did not have the manpower to cross-reference the listings. In addition, many state licensing agencies did not
provide information on the types of residents served by each provider; therefore, many of these providers
could not be eliminated from the states’ listings when developing the sample frame. This issue may have
partially accounted for the high percentage of residential care communities that were screened as ineligible
on these questions.
Because the differences in eligibility were largest in the case of small providers, the 2012 estimate of the
number of small providers was much lower than the 2010 estimate. The lower eligibility rate among small
providers in 2012 also may have explained why the differences in the national estimate of the total number
of residents between 2010 and 2012 (733,300 compared with 713,300) were less notable relative to the
difference in the number of providers (31,100 compared with 22,200). Smaller providers account for the
majority of communities, but they house the minority of residents.
Population bases for computing rates
Populations used for computing rates of national supply and rates of use by state populations were obtained
from the Census Bureau’s Population Estimates Program. The program produces estimates of the population
for the United States, its states, counties, cities, and towns, and produces estimates for the Commonwealth
of Puerto Rico and its municipals. Demographic components of population change (births, deaths, and
migration) were produced at the national, state, and county levels of geography. Additionally, housing unit
estimates were produced for the nation, states, and counties. Population estimates for each state and territory
were not subject to sampling variation because the sources used in demographic analysis were complete
counts. For a more detailed description of the estimates methodology, see http://www.census.gov/popest/.
50 Chapter 5
For calculating rates of national supply and rates of use by state for adult day services centers, nursing
homes, and residential care communities, estimates of the population aged 65 and over for July 1, 2012,
were used. For calculating rates of use by state for home health agencies and hospices, estimates of the
population aged 65 and over for July 1, 2011, were used, to match the time frame of the administrative data
for these sectors.
Comparing NSLTCP estimates with estimates from other data sources
Administrative data
Home health agencies—Selected estimates from the 2012 merged home health le
6
were
compared with estimates on home health care services provided in the Medicare Payment Advisory
Commission’s (MedPAC) report, using the 2011 home health standard analytical le (MedPAC,
2013), and compared with estimates from analyses on Medicare- or Medicaid-certied home health
agencies that participated in NCHS’ 2007 National Home and Hospice Care Survey (NHHCS).
Select provider and user characteristics were comparable with other data sources except certication
status and age distribution of patients. About 1% of home health agencies in the 2012 merged home
health le were Medicaid-only certied compared with 14% from NHHCS. About 18% of patients
in the 2012 merged home health le were under age 65 compared with 31% in NHHCS. These
differences in the number and age distribution of patients could be related to the 2012 merged home
health le’s inclusion of fewer Medicaid-only certied home health agencies, and the fact that
the 2012 merged le contains discharged home health patients as opposed to current home health
patients (on whom NHHCS collected data).
Hospices—Selected estimates from the 2012 merged hospice le
7
were compared with estimates
on hospice care services provided in MedPAC’s report, using Medicare cost reports, the Provider
of Services le, and the standard analytic le of hospice claims between 2000 and 2011 (MedPAC,
2013). Estimates also were compared with analyses on Medicare- or Medicaid-certied hospice
agencies that participated in the 2007 NHHCS. Select provider and user characteristics were
comparable with other data sources except age distribution of patients; about 6% of hospice patients
in the merged le were under age 65 compared with 17% in NHHCS. Estimates for age distribution
of patients differed due to differences in the patient population each data source covered. NHHCS
collected information on patients (not just Medicare beneciaries) discharged from hospices in
2007 that were Medicare- or Medicaid-certied, pending certication, or state licensed; the 2012
merged hospice le included Medicare beneciaries who received hospice services from Medicare-
certied hospices in 2011.
Nursing homes—Estimates from the merged 2012 CASPER nursing home and MARET les
were compared with estimates from the American Health Care Association’s “Nursing Facility
Operational Characteristics Report, September 2012;” custom tables created using Brown
University’s LTCFocus Website (Brown University, 2013);
8
a MedPAC report on skilled nursing
facility services (MedPAC, 2013); and analyses on Medicare- or Medicaid-certied nursing homes
that participated in the 2004 National Nursing Home Survey. Provider-related estimates using the
6
Created by linking CASPER home health le, IPBS home health le, and OBQI Case Mix Roll Up le by provider
ID number.
7
Created by linking CASPER hospice le and IPBS hospice le by provider ID number.
8
Available from: http://ltcfocus.org/map/1/average-acuity-index#2010/US/col=0&dir=asc&pg=&lat=38.9594087924
5423&lng=99.4921875&zoom=4.
Chapter 5
51
2012 merged nursing home le were comparable with these other data sources, while differences
in the racial and ethnic mix of residents were observed. Compared with the 10% of non-Hispanic
black nursing home residents presented in the MedPAC report, using the 2010 Medicare Current
Beneciary Survey, about 14% of nursing home residents in 2012 were non-Hispanic black.
Differences in estimates could be due to differences in the population and the time frame used to
obtain the estimates; the 2012 merged le included the latest assessment information on current
residents (regardless of payer source) as of the third quarter of 2012, while MedPAC estimates were
based on Medicare beneciaries utilizing skilled nursing facility services in 2010.
Survey data
Estimates from the 2012 adult day services center and residential care community survey components
of NSLTCP were compared with the 2010 MetLife National Study of Adult Day Services (MetLife
Mature Market Institute, 2010) and ndings from the 2010 National Survey of Residential Care Facilities,
respectively. Differences between 2010 and 2012 estimates for the number of residential care communities,
beds, and residents were discussed earlier in this chapter. The 2012 estimates for select provider and user
characteristics for both adult day services centers and residential care communities were found to be
comparable with these other data sources.
Data Analysis
Results describing providers and service users were analyzed at the individual agency or facility level.
Findings from administrative data on nursing homes, home health agencies, and hospices were treated
as sample based, and population standard errors were calculated to account for some random variability
associated with the les. For the survey data for residential care communities and adult day services centers,
point estimates and standard errors were calculated using appropriate design and weight variables to account
for complex sampling, when applicable. For survey data,
9
statistical analysis weights were computed as the
product of four components—the sampling weight, adjustment for unknown eligibility status, adjustment
for nonresponse, and a smoothing factor. Standard errors for survey data were computed using Taylor series
linearization.
Variance estimates
Administrative data: home health agencies, hospices, and nursing homes
The home health, hospice, and nursing home data les were created using CMS administrative data. The
les represented 100% of the CMS population at the specic time the frame was constructed, and they were
not subject to sampling variability. However, there might be some random variability associated with the
numbers. For example, if the administrative data were drawn at a different time, the estimates might be
different. Also, the data are subject to potential entry and other reporting errors. To account for these types
of variability, the administrative data estimates were treated as a simple random sample with replacement,
providing conservative standard errors for the random variation that might be associated with the les.
9
Sampling weights were used only for residential care communities where a sample was drawn; sampling weights
were not used for adult day services centers or for residential care communities in states where a census was taken. No
eligibility adjustment was made for adult day services centers because all centers were assumed eligible, regardless
of response status, except for those which were determined to be out-of-scope (e.g., out of business) during the data
collection.
52 Chapter 5
Adult day services centers
Although a census of all adult day services centers was attempted, estimates were subject to variability due
to the amount of nonresponse. Although the records that comprised the adult day services center le were
not sampled, the variability associated with the nonresponse was treated as if it were from a stratied (by
state) sample without replacement.
Residential care communities
Data from residential care communities included a mix of sampled communities from states that had enough
residential care communities to produce reliable state estimates and a census of residential care communities
in states that did not have enough communities to produce reliable state estimates. Consequently, the
residential care community estimates were subject to sampling variability and nonresponse variability. The
variability for the residential care communities estimates was treated as if it were from a stratied (by state
and bed size) sample without replacement.
Significance tests
Differences among provider types were evaluated using t tests. All signicance tests were two-sided, using
p < 0.05 as the level of signicance. Terms such as “no signicant differences” were used to denote that
the differences between estimates being compared were not statistically signicant. Lack of comment
regarding the difference between any two statistics does not necessarily suggest that the difference was
tested and found not to be statistically signicant. For maps, t tests were performed to compare a rate for
each state with the corresponding national mean. Some states may not be signicantly different from the
national mean, even if they have a higher use rate, due to large standard errors. For instance, home health
use rates for Massachusetts are the highest in the nation, but they are not statistically different from the
national mean. Data analyses were performed using SAS, version 9.3 and the SAS-callable SUDAAN,
version 11.0.0 statistical package (RTI International, 2012). Individual estimates may not sum to totals
because estimates were rounded.
Data editing
Data les were examined for missing values and inconsistencies. In order to minimize cases with missing
values and inconsistencies, residential care community and adult day services center survey instruments
were programmed to show critical items with missing values in the CATI and Web applications and inform
respondents an answer was required, and to include data validations such as asking respondents to resolve
an inconsistent answer or to check an answer if it was outside the expected range. For instance, responses
to items that needed to add to the total number of residential care community residents or adult day services
center participants were accepted only if the sum of responses was within a certain range (i.e., ± 10% of the
total number of residents or participants).
For the survey data for adult day services centers and residential care communities, selected aggregate
resident- or participant-level variables were imputed (i.e., age, race, sex, dementia diagnosis, depression
diagnosis, assistance with eating, and assistance with bathing). Although administrative data also were
reviewed for missing values and inconsistencies, the les did not undergo the same data cleaning and
editing as the survey data.
For both survey and administrative data, stafng information was edited in the same manner. Outliers
were dened as values two standard deviations above or below the size-specic mean for a given staff
type, where size was dened as number of people served. When calculating the size-specic mean for a
given staff type, cases were coded as missing if the number of full-time equivalent (FTE) registered nurse
Chapter 5
53
employees was greater than 999, if the number of FTE licensed practical or vocational nurse employees
was greater than 999, if the number of FTE personal care aide employees was greater than 999, and if the
number of FTE social work employees was greater than 99. Aide hours per resident or participant per day
were top coded at 24. For the denition and categories of the number of people served for each provider
type, see Appendix A.
Cases with missing data were excluded from analyses on a variable-by-variable basis. Variables used in this
report had a percentage (weighted if survey data, unweighted if administrative data) of cases with missing
data ranging between 1.0% and 9.0%. The range of cases with missing data for each provider type is as
follows:
Adult day services center: 1.0% (Medicaid participation status) to 8.0% (number of participants
needing any assistance with dressing)
Home health agency: 7.7% to 8.9% for all patient measures (e.g., number of patients aged 65
and over) due to agencies with no patient information available in the OBQI data and the IPBS
home health data, respectively
Hospice: 5.1% for all patient measures (e.g., number of patients diagnosed with depression)
due to agencies with no patient information available in the IPBS hospice data
Nursing home: 2.5% for all resident demographic information (e.g., number of residents who
are of Hispanic or Latino origin) due to nursing homes with no resident information available
in the MARET data
Residential care community: 5.0% (e.g., number of registered nurse employee FTEs) to 9.0%
(e.g., number of residents needing any assistance with toileting)
Limitations
Differences in question wording among data sources
While every effort was made to match question wording in the NSLTCP surveys to the administrative
data available through CMS, some differences remained and may affect comparisons between these two
data sources (e.g., capacity). To the extent possible (i.e., when available and appropriate), ndings were
presented on a given topic for all ve provider types. However, due to two types of data-related differences,
for some topics in the report, information was provided only for some provider sectors.
The rst data-related difference was due to the settings served by the ve provider types. For example,
home health agencies were not residential and, therefore, it was not relevant to discuss the number of
beds in this sector, whereas it was relevant for nursing homes and residential care communities. As a
result, information on capacity as measured by the number of beds was presented for nursing homes and
residential care communities only.
The second difference was attributable to differences among the administrative data sources used for
nursing homes, home health agencies, and hospices. For example, the CASPER data did not include
information on whether home health agencies offered mental health or counseling services, but it did
include this information for nursing homes and hospices. The NSLTCP residential care community and
adult day services center surveys included additional content that was not presented in this report because
no comparable data existed in the CMS administrative data (e.g., chain afliation; contract nursing staff;
and selected services such as dental, podiatry, and transportation). NCHS plans to produce forthcoming
54 Chapter 5
reports that present additional results on adult day services centers and residential care communities, using
survey data not included in this overview report.
Differences in time frames among data sources
Different data sources used different reference periods. For instance, user-level data used for home health
agencies (i.e., OBQI and IPBS home health data) and hospices (i.e., IPBS hospice data) were from patients
who received home health or hospice care services at any time in calendar year 2011. In contrast, survey
data on residential care community residents and adult day services center participants, and CMS data on
nursing home residents were from current users on any given day or active residents on the last day of the
third quarter of 2012. Given these differences in denominator, comparisons across all ve provider types
were not feasible for some variables.
Age of administrative data
The administrative data for home health agencies, hospices, and nursing homes were collected to support
the survey and certication function of CMS in these different sectors; both the content and the frequency
with which the certication surveys were conducted differ across these three provider sectors. Consistent
with the required frequency for the recertication survey, CASPER data on virtually all nursing homes
were under 18 months old, 89.5% of CASPER home health agency data were no more than 3 years old, and
93.0% of CASPER hospice data were no more than 8 years old. When these relatively older home health
agency and hospice data were linked to user-level data from calendar year 2011, 7.7% of home health
agencies and 5.1% of hospices in the CASPER les did not match with provider ID numbers in the OBQI
and IBPS hospice data, respectively. It is possible that home health agencies and hospices with missing
patient-level information might no longer be operational or had begun operating in 2012,
10
so that their
patient information was not captured in the user-level data from 2011.
10
Of 939 home health agencies in the CASPER le that did not match with provider numbers in the OBQI data, about
43.0% had completed their initial certication survey in 2012.
References
55
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Appendix A
Crosswalk of Definitions by
Provider Type
60
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Supply of long-term care services providers, by provider type
Number of
providers
Number of paid,
regulated, long-term
care services providers
Study-specific eligibility
criteria were used
to define residential
care ommunities. See
Technical Notes for
information on eligibility
criteria.
Number of adult day
services centers based
on 2012 NSLTCP survey
of adult day services
centers
Number of assisted
living and similar
residential care
communities based
on 2012 NSLTCP survey
of residential care
communities
Number of home health
agencies certified to
provide services under
Medicare, Medicaid, or
both in the third quarter
of 2012
Number of hospices
certified to provide
services under
Medicare, Medicaid, or
both in the third quarter
of 2012
Number of nursing homes
certified to provide services
under Medicare, Medicaid,
or both the in third quarter
of 2012
Region
Grouping of
conterminous states
into geographic areas
corresponding to
groups used by the U.S.
Census Bureau. A listing
of states included in
each of the four U.S.
Census regions is
available from: http://
www.census.gov/
Four census regions
1= Northeast
2= Midwest
3= South
4= West
Four census regions
1= Northeast
2= Midwest
3= South
4= West
Derived from:
[STATE_CD]
1= Northeast
2= Midwest
3= South
4= West
Derived from:
[STATE_CD]
1= Northeast
2= Midwest
3= South
4= West
Derived from:
[STATE_CD]
1= Northeast
2= Midwest
3= South
4= West
Metropolitan
statistical area
(MSA) and
micropolitan
statistical area
Geographic entities
delineated by the
Office of Management
and Budget (OMB)
for use by federal
statistical agencies in
collecting, tabulating,
and publishing federal
statistics. A metro area
contains a core urban
area of 50,000 or more
population, and a
micro area contains an
urban core of at least
10,000 (but less than
50,000) population.
Each metro or micro
area consists of one
or more counties and
includes the counties
containing the core
urban area, as well as
any adjacent counties
that have a high
degree of social and
economic integration
(as measured by
commuting to work)
with the urban core.
Metropolitan statistical
area status
1= Metropolitan
2= Micropolitan
3= Neither
Metropolitan statistical
area status
1= Metropolitan
2= Micropolitan
3= Neither
Derived from: [ZIP_CD]
1= Metropolitan
2= Micropolitan
3= Neither
Derived from: [ZIP_CD]
1= Metropolitan
2= Micropolitan
3= Neither
Derived from: [ZIP_CD]
1= Metropolitan
2= Micropolitan
3= Neither
All provider types: used
2009 OMB st
andards for
delineating metropolitan
and micropolitan
statistical areas.
Supply of long-term care services providers, by provider type
61
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of long-term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Supply of Long-term care services providers, by provider type
Capacity
Used to quantify the
supply of long-term
care services provided
in the community (i.e.,
adult day services
center or residential
care communities)
or in an institutional
setting (i.e., nursing
homes). See Technical
Notes for description of
population bases used
for computing rates.
Q4. What is the
maximum number of
participants allowed at
this adult day services
center at this location?
This may be called
the allowable daily
capacity and is usually
determined by law or
by fire code, but may
also be a program
decision.
Q11. At this residential
care community, what is
the number of licensed,
registered, or certified
residential care beds?
Include both occupied
and unoccupied beds.
Category not
applicable
Category not
applicable
Derived from:
[CRTFD_BED_CNT]
Number of beds in Medicare
and/or Medicaid certified
areas within a facility
NH: the number of
certified beds was
used because current
residents in CASPER
(CNSUS_RSDNT_CNT)
are defined as those in
certified beds regardless
of payer source.
Ownership
Classified into three
categories: for
profit, nonprofit, and
government and
other. Publicly traded
company or limited
liability company (LLC)
was categorized as
for profit
1= For profit
2= Nonprofit
3= Government and
other
Derived from:
[OWNERSHP]
Q1. What is the type of
ownership of this adult
day services center?
1= Private, nonprofit
2= Private, for profit
3= Publicly traded
company/ LLC
4= Government
(federal, state, county,
local)
If OWNERSHP= 3, code
OWN as 1. Else OWN =
OWNERSHP.
1= For profit
2= Nonprofit
3= Government and
other
Derived from:
[OWNERSHP]
Q8. What is the type
of ownership of this
residential care
community?
1= Private, nonprofit
2= Private, for profit
3= Publicly traded
company/ LLC
4= Government (federal,
state, county, local)
If OWNERSHP= 3, code
OWN as 1. Else OWN=
OWNERSHP.
1= For profit
2= Nonprofit
3= Government and
other
Derived from:
[GNRL_CNTL_TYPE_CD]
01= Voluntary NP,
religious affiliation
02= Voluntary NP,
private
03= Voluntary NP, other
04= Proprietary
05= Government, state/
county
06= Government,
Combination
Government and
Voluntary
07= Government, Local
If GNRL_CNTL_TYPE_
CD=’01’, ‘02,’ ‘03’, code
HHA as OWN=2; Else
if GNRL_CNTL_TYPE_
CD=’04’, code HHA as
OWN=1; Else OWN=3;
1= For profit
2= Nonprofit
3= Government and
other
Derived from:
[GNRL_CNTL_TYPE_CD]
01= Nonprofit, Church
02= Nonprofit, Private
03= Nonprofit, Other
04= Proprietary,
Individual
05= Proprietary,
Partnership
06= Proprietary,
Corporation
07= Proprietary, Other
08= Government, State
09= Government,
County
10= Government, City
11= Government, City-
County
12= Combination
Government and NP
13= Other
If GNRL_CNTL_TYPE_
CD=’01’, ‘02,’ ‘03’, code
HOS as OWN=2; Else
if GNRL_CNTL_TYPE_
CD=’04’,’05’, ‘06’, ‘07’,
code HOS as OWN=1;
Else OWN=3;
1= For profit
2= Nonprofit
3= Government and other
Derived from:
[GNRL_CNTL_TYPE_CD]
01= For profit, individual
02= For profit, partnership
03= For profit, corporation
04= Nonprofit, church related
05= Nonprofit, corporation
06= Nonprofit, other
07= Government, state
08= Government, county
09= Government, city
10= Government, city/county
11= Government, hospital
district
12= Government, federal
13= Limited Liability
Company
If GNRL_CNTL_TYPE_CD=’01’,
‘02,’ ‘03’,’13’, OWN=1; Else if
GNRL_CNTL_TYPE_CD=’04’,
‘05,’ ‘06’, OWN=2; Else OWN=3;
Supply of long-term care services providers, by provider type—Con.
62
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Organizational characteristics of long-term care services providers, by provider type
Number of
people served
Categorizes providers
into three categories
based on the number
of current participants
or residents (adult
day services centers,
nursing homes, and
residential care
communities), the
number of patients
receiving care at any
time in calendar year
2011 (hospices), or
the number of patients
who ended an episode
of care at any time
in calendar year
2011 (home health
agencies).
1= 1–25
2= 26–100
3= 101 or more
Derived from:
[AVGPART]
Q6. Based on a typical
week, what is the
approximate average
daily attendance at this
center at this location?
Include respite care
participants.
1= 1–25
2= 26–100
3= 101 or more
Derived from: [TOTRES]
Q12. What is the total
number of residents
currently living at
this residential care
community? Include
respite care residents.
1= 1–100
2= 101–300
3= 301 or more
Derived from: [TOTPAT
from Outcome-Based
Quality Improvement
(OBQI) Case Mix Roll
Up data]
Number of home health
patients whose episode
of care ended at any
time in calendar year
2011 (i.e., discharges),
regardless of payment
source
1= 1–100
2= 101–300
3= 301 or more
Derived from: [BENE_
CNT in Institutional
Provider and
Beneficiary Summary
(IPBS)-Hospice]
Number of hospice
care patients for whom
Medicare-certified
hospice care agencies
submitted a Medicare
claim at any time in
calendar year 2011
1= 1–25
2= 26–100
3= 101 or more
Derived from: [CNSUS_RSDNT_
CNT]
Number of current residents
reported in CASPER, defined
as those in certified beds
regardless of payer source
Medicare
certification
Refers to Medicare
certification status of
home health agencies,
hospices, and nursing
homes.
Category not
applicable
Category not
applicable
1= Certified
2= Not certified
Derived from: [PGM_
PRTCPTN_CD]
Indicates if the
provider participates in
Medicare, Medicaid, or
both programs.
1= MEDICARE ONLY
2= MEDICAID ONLY
3= MEDICARE AND
MEDICAID
1= Certified
2= Not certified
All hospices included in
CASPER are assumed to
be Medicare-certified
1= Certified
2=Not certified
Derived from: [PGM_
PRTCPTN_CD]
Indicates if the provider
participates in Medicare,
Medicaid, or both programs.
1= MEDICARE ONLY
2= MEDICAID ONLY
3= MEDICARE AND MEDICAID
Organizational characteristics of long-term care services providers, by provider type
63
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Staffing: Nursing and social work employees, by provider type
Medicaid
certification
Refers to Medicaid
certification or
participation status. 1= Certified
2= Not certified
Derived from:
[MEDPAID]
Q9. During the last 30
days, how many of this
center’s participants
had some or all of their
long-term care services
paid by Medicaid?
1= Certified
2= Not certified
Derived from: [MEDPAID]
Q15. During the last
30 days, how many of
this residential care
community’s residents
had some or all of their
long-term care services
paid by Medicaid?
1= Certified
2= Not certified
Derived from: [PGM_
PRTCPTN_CD]
Indicates if the
provider participates in
Medicare, Medicaid, or
both programs.
1= MEDICARE ONLY
2= MEDICAID ONLY
3= MEDICARE AND
MEDICAID
Data not available 1= Certified
2= Not certified
Derived from: [PGM_
PRTCPTN_CD]
Indicates if the provider
participates in Medicare,
Medicaid, or both programs.
1= MEDICARE ONLY
2= MEDICAID ONLY
3= MEDICARE AND MEDICAID
Registered nurse
Number of full-time
equivalent registered
nurse (RN) employees
(based on a 35-hour
work week)
ADSC, RCC: Number of
full-time and the number
of part-time employees
for a given staff type
were converted into full-
time equivalents (FTEs)
with an assumption that
full-time is 1.0 FTE and
part-time is 0.5 FTE.
HHA, HOS: Number
of FTE employees by
staff type is provided in
administrative data.
NH: Administrative data
on nursing homes report
the number of hours for
a given staff type during
the 2 weeks prior to
their annual survey. CMS
converts the number of
hours into FTEs (based
on a 35-hour work
week).
All provider types:
Outliers are defined
as cases with FTEs
that are two standard
deviations above or
below the mean for a
given size category. See
Technical Notes for more
information on editing of
the staffing data.
Derived from:
[RNFT1_R_1_1,
RNPT1_R_1_2,
RNFTE1_R_1_4]
Q23_a. RNs: Number
of full-time center
employees AND
Number of part-time
center employees; OR
Number of full-time
equivalent center
employees
Derived from:
[RNFT1_R_1_1,
RNPT1_R_1_2,
RNFTE1_R_1_4]
Q26_a. RNs: Number of
full-time residential care
community employees
AND Number of part-
time residential care
community employees;
OR Number of full-time
equivalent residential
care community
employees
Derived from: [RN_CNT]
Number of full-time
equivalent registered
professional nurses
employed by a provider
Derived from: [RN_CNT]
Number of full-time
equivalent registered
professional nurses
employed by a provider
Derived from:[RN_FLTM_CNT,
RN_PRTM_CNT]
Number of full-time
equivalent registered nurses
employed by a facility on a
full-time basis;
Number of full-time
equivalent registered nurses
employed by a facility on a
part-time basis
Organizational characteristics of long-term care services providers, by provider type—Con.
64
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Staffing: Nursing and social work employees, by provider type
Licensed
practical nurse
(LPN) or licensed
vocational nurse
(LVN)
Number of full-time
equivalent licensed
practical nurse or
licensed vocational
nurse employees
(based on a 35-hour
work week)
Derived from:
[LPNFTE1_R_1_1,
LPNFTE1_R_1_2,
LPNFTE1_R_1_4]
Q23_b. LPNs/LVNs:
Number of full-time
center employees AND
Number of part-time
center employees; OR
Number of full-time
equivalent center
employees
Derived from:
[LPNFTE1_R_1_1,
LPNFTE1_R_1_2,
LPNFTE1_R_1_4]
Q26_b. LPNs/LVNs:
Number of full-time
residential care
community employees
AND Number of part-
time residential care
community employees;
OR Number of full-time
equivalent residential
care community
employees
Derived from: [LPN_LVN_
CNT]
Number of full-time
equivalent licensed
practical or vocational
nurses employed by a
facility
Derive from: [LPN_LVN_
CNT]
Number of full-time
equivalent licensed
practical or vocational
nurses employed by a
facility
Derived from: [LPN_LVN_FLTM_
CNT, LPN_LVN_PRTM_CNT]
Number of full-time
equivalent licensed practical
or vocational nurses
employed by a facility on
a full-time basis; Number of
full-time equivalent licensed
practical or vocational
nurses employed by a facility
on a part-time
basis
ADSC, RCC: Number
of full-time and part-
time employees for a
given staff type were
converted into FTEs
with an assumption
that full-time is 1.0 FTE
and part-time is 0.5 FTE.
HHA, HOS: Number of
FTE agency employees
by staff type is provided
in administrative data.
NH: Administrative data
on nursing homes report
the number of hours for
a given staff type during
the 2 weeks prior to their
annual survey. CMS
converts the number of
hours into FTEs (based
on a 35-hour work
week).
All provider types:
Outliers are defined
as cases with FTEs
that are two standard
deviations above or
below the mean for a
given size category. See
Technical Notes for more
information on editing of
the staffing data.
Staffing: Nursing and social work employees, by provider type
65
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Staffing: Nursing and social work employees, by provider type
Aide
Number of full-time
equivalent aide
employees (based on
a 35-hour work week)
Aides refer to paid
staff providing direct
care and assistance to
residents, participants,
or patients with a broad
range of activities.
Different terms are used
to describe aides in
different data sources.
For adult day services
centers and residential
care communities,
aides include
certified nursing
assistants, home
health aides, home
care aides, personal
care aides, personal
care assistants, and
medication technicians
or medication aides
who are employees
of a community or
center. For home health
agencies and hospices,
aides refer to home
health aides employed
by the agency. For
nursing homes, aides
refer to certified nurse
aides, and medication
aides or medication
technicians who are
facility employees.
Derived from:
[AIDEFT1_R_1_1,
AIDEPT1_R_1_2,
AIDEFTE1_R_1_4]
Q23_c. Certified nursing
assistants, nursing
assistants, home
health aides, home
care aides, personal
care aides, personal
care assistants, and
medication technicians
or medication aides:
Number of full-time
center employees AND
Number of part-time
center employees; OR
Number of full-time
equivalent center
employees
Derived from:
[AIDEFT1_R_1_1,
AIDEPT1_R_1_2,
AIDEFTE1_R_1_4]
Q26_c. Certified nursing
assistants, nursing
assistants, home
health aides, home
care aides, personal
care aides, personal
care assistants, and
medication technicians
or medication aides:
Number of full-time
residential care
community employees
AND
Number of part-time
residential care
community employees;
OR
Number of full-time
equivalent residential
care community
employees
Derived from: [HH_
AIDE_CNT]
Number of full-time
equivalent home health
aides employed by a
home health agency
Derived from: [HH_
AIDE_EMPLEE_CNT]
Number of full-time
equivalent home health
aides employed by a
hospice
Derived from: [NRS_AIDE_
FLTM_CNT, NRS_AIDE_PRTM_
CNT, MDCTN_AIDE_FLTM_CNT,
MDCTN_AIDE_PRTM_CNT]
Number of full-time
equivalent certified
nurse aides employed
by a facility on a full-time
basis; Number of full-
time equivalent certified
nurse aides employed by
a facility on a part-time
basis; Number of full-time
equivalent medication aides
or technicians employed
by a facility on a full-time
basis; Number of full-time
equivalent medication aides
or technicians employed by
a facility on a part-time basis
ADSC, RCC: Number
of full-time and the
part-time employees
for a given staff type
were converted into
FTEs with an assumption
that full-time is 1.0 FTE
and part-time is 0.5 FTE.
HHA, HOS: Number of
FTE agency employees
by staff type is provided
in administrative data.
NH: Administrative data
on nursing homes report
the number of hours for
a given staff type during
the 2 weeks prior to their
annual survey. CMS
converts the number of
hours into FTEs (based
on a 35-hour work
week).
All provider types:
Outliers are defined
as cases with FTEs
that are two standard
deviations above or
below the mean for a
given size category. See
Technical Notes for more
information on editing of
the staffing data.
Staffing: Nursing and social work employees, by provider type—Con.
66
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Staffing: Nursing and social work employees, by provider type
Social worker
Number of full-time
equivalent social
worker employees
(based on a 35-hour
work week)
Derived from:
[SOCWFT1_R_1_1,
SOCWPT1_R_1_2,
SOCWFTE1_R_1_4]
Q23_d. Social workers—
licensed social workers
or persons with a
bachelor’s or master’s
degree in social work:
Number of full-time
center employees AND
Number of part-time
center employees; OR
Number of full-time
equivalent center
employees
Derived from:
[SOCWFT1_R_1_1,
SOCWPT1_R_1_2,
SOCWFTE1_R_1_4]
Q26_d. Social workers—
licensed social workers
or persons with a
bachelor’s or master’s
degree in social work:
Number of full-time
residential care
community employees
AND Number of part-
time residential care
community employees;
OR Number of full-time
equivalent residential
care community
employees.
Derived from: [SCL_
WORKR_CNT]
Number of full-time
equivalent social
workers employed by
the agency
Derived from: [MDCL_
SCL_WORKR_CNT]
Number of full-time
equivalent medical
social workers
employed by a hospice
Derived from: [SCL_WORKR_
FLTM_CNT, SCL_WORKR_PRTM_
CNT]
Number of full-time
equivalent social workers
employed by a facility on a
full-time basis; Number of
full-time equivalent social
workers employed by a
facility on a part-time basis
ADSC, RCC: Number
of full-time and part-
time employees for a
given staff type were
converted into FTEs
with an assumption
that full-time is 1.0 FTE
and part-time is 0.5 FTE.
HHA, HOS: Number of
FTE agency employees
by staff type is provided
in administrative data.
NH: Administrative data
on nursing homes report
the number of hours for
a given staff type during
the 2 weeks prior to their
annual survey. CMS
converts the number of
hours into FTEs (based
on a 35-hour work
week).
All provider types:
Outliers are defined
as cases with FTEs
that are two standard
deviations above or
below the mean for a
given size category. See
Technical Notes for more
information on editing of
the staffing data.
Staffing: Nursing and social work employees, by provider type—Con.
67
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Staffing: Nursing and social work employees, by provider type
Hours per
resident or
participant per
day (HPPD)
Refers to the number
of hours providing
care for one resident
or participant per
day for a given staff
type. For adult day
services centers, hours
per participant per
day for a given staff
type was computed
by multiplying the
number of FTEs for the
staff type by 35 hours,
and dividing the total
number of hours for the
staff type by average
daily attendance of
participants and by
5 days. For nursing
homes and residential
care communities,
the number of FTEs
for a given staff was
converted into hours
by multiplying by 35
hours for the staff type,
and dividing the total
number of hours for
the staff type by the
number of current
residents in the facility,
and by 7 days to arrive
at hours per resident
per day.
Derived from: [RNFTE,
LPNFTE, AIDEFTE,
SOCWFTE, AVGPART]
RNHPPD
= (RNFTE*35)/
AVGPART/5 days;
LPNHPPD
= (LPNFTE*35)/
AVGPART/5 days;
AIDEHPPD
=(AIDEFTE*35)/
AVGPART/5 days;
SOCWHPPD
=(SOCWFTE*35)/
AVGPART/5 days;
Derived from: [RNFTE,
LPNFTE, AIDEFTE,
SOCWFTE, TOTRES]
RNHPPD
= (RNFTE*35)/TOTRES/7
days;
LPNHPPD
= (LPNFTE*35)/TOTRES/7
days;
AIDEHPPD
=(AIDEFTE*35)/
TOTRES/7 days;
SOCWHPPD
=(SOCWFTE*35)/
TOTRES/7 days;
Data not available Data not available Derived from: [RNFTE, LPNFTE,
AIDEFTE, SOCWFTE, CNSUS_
RSDNT_CNT]
RNHPPD
= (RNFTE*35)/ CNSUS_RSDNT_
CNT/7 days;
LPNHPPD
= (LPNFTE*35)/ CNSUS_
RSDNT_CNT/7 days;
AIDEHPPD
=(AIDEFTE*35)/ CNSUS_
RSDNT_CNT/7 days;
SOCWHPPD
=(SOCWFTE*35)/ CNSUS_
RSDNT_CNT/7 days;
Residential settings
(i.e., nursing homes
and residential care
communities) and
adult day services
centers operate and
staff differently to serve
the needs of their
residents or participants;
these differences
between provider
types are reflected in
using average daily
attendance and 5 days
(as opposed to number
of current residents
and 7 days) when
computing HPPD for staff
working at adult day
services centers.
Staffing: Nursing and social work employees, by provider type—Con.
68
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Services provided by long-term care services providers, by provider type
Social work
services
In survey data, refers
to services provided
by licensed social
workers or persons with
a bachelor’s or master’s
degree in social
work, and include
an array of services
such as psychosocial
assessment, individual
or group counseling,
and referral services.
In administrative data,
refers to qualified
social workers services
in nursing homes,
and medical social
services in home health
agencies and hospices.
Derived from:
[SERVSOCW]
Q16_c. Social work
services—provided by
licensed social workers
or persons with a
bachelor’s or master’s
degree in social
work, and include
an array of services
such as psychosocial
assessment, individual
or group counseling,
and referral services
1= Not provided
2= Provided only by
ADSC employees
3= Provided only
by others through
arrangement
4= Provided by both
ADSC employees
and others through
arrangement
If SERVSOCW=1,
SERVSOCW_RC=2;
else if SERVSOCW >1,
SERVSOCW_RC=1;
Derived from:
[SERVSOCW]
Q19_c. Social work
services—provided
by licensed social
workers or persons
with a bachelor’s or
master’s degree in
social work, and include
an array of services
such as psychosocial
assessment, individual
or group counseling,
and referral services
1= Not provided
2= Provided only by
RCC employees
3= Provided only
by others through
arrangement
4= Provided by both
RCC employees
and others through
arrangement
If SERVSOCW=1,
SERVSOCW_RC=2;
else if SERVSOCW >1,
SERVSOCW_RC=1;
Derived from: [MDCL_
SCL_SRVC_CD]
Indicates how medical
social services are
provided.
0= NOT PROVIDED
1= PROVIDED BY STAFF
2= PROVIDED UNDER
ARRANGEMENT
3= COMBINATION
If MCDL_SCL_SRVC_
CD=0, SERVSOCW=2;
else if MDCL_
SCL_SRVC_CD >0,
SERVSOCW=1;
Derived from: [MDCL_
SCL_SRVC_CD]
Indicates how medical
social services are
provided.
0= NOT PROVIDED
1= PROVIDED BY STAFF
2= PROVIDED UNDER
ARRANGEMENT
3= COMBINATION
If MCDL_SCL_SRVC_
CD=0, SERVSOCW=2;
else if MDCL_
SCL_SRVC_CD >0,
SERVSOCW=1;
Derived from: [SCL_WORK_
SRVC_ONST_RSDNT_SW,
SCL_WORK_SRVC_ONST_
NRSDNT_SW, SCL_WORK_
SRVC_OFSITE_RSDNT_SW]
Qualified social worker
services
1) Services provided onsite
to residents, either by
employees or contractors;
2) Services provided onsite to
nonresidents;
3) Services provided to
residents offsite/or not
routinely provided onsite;
If “No” to 1), 2), and 3),
SERVSOCW=2 (Not provided);
Else SERVSOCW=1(Provided);
Staffing: Nursing and social work employees, by provider type—Con.
69
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Services provided by long-term care services providers, by provider type
Mental health
or counseling
services
Mental health
services in survey
data refer to services
that target person’s
mental, emotional,
psychological, or
psychiatric well-
being and include
diagnosing, describing,
evaluating, and treating
mental conditions.
Counseling services are
provided to the patient
and family to assist
them in “minimizing the
stress and problems
that arise from the
terminal illness, related
conditions, and
the dying process”
(http://www.cms.
gov/Regulations-and-
Guidance/Guidance/
Manuals/downloads/
som107ap_m_hospice.
pdf) .
Derived from [SERVMH]
Q16_e. Mental
health services—
target participants’
mental, emotional,
psychological, or
psychiatric well-
being and include
diagnosing, describing,
evaluating, and treating
mental conditions
1= Not provided
2= Provided only by
ADSC employees
3= Provided only
by others through
arrangement
4= Provided by both
ADSC employees
and others through
arrangement
If SERVMH=1, SERVMH_
RC=2; else if SERVMH >1,
SERVMH_RC=1;
Derived from [SERVMH]
Q19_e. Mental
health services—
target residents’
mental, emotional,
psychological, or
psychiatric well-being
and include diagnosing,
describing, evaluating,
and treating mental
conditions
1= Not provided
2= Provided only by
RCC employees
3= Provided only
by others through
arrangement
4= Provided by both
RCC employees
and others through
arrangement
If SERVMH=1, SERVMH_
RC=2; else if SERVMH >1,
SERVMH_RC=1;
Data not available Derived from:
[CNSLNG_SRVC_CD]
Counseling services
0= Not provided
1= Provided by agency
staff
2= Provided under
arrangement
3= Combination
If CNSLNG_SRVC_CD=0,
SERVMH=2; else if
CNSLNG_SRVC_CD >0,
SERVMH=1;
Derived from: [MENTL_HLTH_
ONST_RSDNT_SW, MENTL_
HLTH_ONST_NRSDNT_SW,
MENTL_HLTH_OFSITE_RSDNT_
SW]
Mental health services
1)Services provided onsite
to residents, either by
employees or contractors;
2) Services provided onsite to
nonresidents;
3)Services provided to
residents offsite/or not
routinely provided onsite;
If “No” to 1), 2), and 3),
SERVMH=2 (Not provided);
Else SERVMH=1 (Provided);
Services provided by long-term care services providers, by provider type
70
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Services provided by long-term care services providers, by provider type
Therapeutic
services
Refers to providing any
of the three therapeutic
services: physical
therapy, occupational
therapy, or speech
therapy or pathology.
Derived from: [SERVTX]
Q16_f. Any therapeutic
services—physical,
occupational, or
speech
1= Not provided
2= Provided only by
ADSC employees
3= Provided only
by others through
arrangement
4= Provided by both
ADSC employees
and others through
arrangement
If SERVTX=1, SERVTX_
RC=2; else if SERVTX >1,
SERVTX_RC=1;
Derived from: [SERVTX]
Q19_f. Any therapeutic
services—physical,
occupational, or
speech
1= Not provided
2= Provided only by
RCC employees
3= Provided only
by others through
arrangement
4= Provided by both
RCC employees
and others through
arrangement
If SERVTX=1, SERVTX_
RC=2; else if SERVTX >1,
SERVTX_RC=1;
Derived from: [PT_
SRVC_CD, OT_SRVC_CD,
SPCH_THRPY_SRVC_CD]
Physical therapy,
occupational therapy,
or speech therapy
0= Not provided
1= Provided by agency
staff
2= Provided under
arrangement
3= Combination
If PT_SRVC_CD=0 AND
OT_SRVC_CD=0 AND
SPCH_THRPY_SRVC_
CD=0, SERVTX=2; Else
SERVTX=1;
Derived from: [PT_
SRVC_CD, OT_SRVC_CD,
SPCH_PTHLGY_SRVC_
CD]
Physical therapy,
occupational therapy,
or speech pathology
0= Not provided
1= Provided by agency
staff
2= Provided under
arrangement
3= Combination
If PT_SRVC_CD=0 AND
OT_SRVC_CD=0 AND
SPCH_PTHLGY_SRVC_
CD=0, SERVTX=2; Else
SERVTX=1;
Derived from: [PT_ONST_
RSDNT_SW,
PT_ONST_NRSDNT_SW,
PT_OFSITE_RSDNT_SW,
OT_SRVC_ ONST_RSDNT_SW,
OT_SRVC_ONST_NRSDNT_SW,
OT_SRVC_OFSITE_RSDNT_SW,
SPCH_PTHLGY_ONST_RSDNT_
SW, SPCH_PTHLGY_ONST_
NRSDNT_SW, SPCH_PTHLGY_
OFSITE_RSDNT_SW]
Physical therapist services,
occupational therapist
services, or speech or
language pathologists
1) Services provided onsite
to residents, either by
employees or contractors;
2) Services provided onsite to
non-residents;
3) Services provided to
residents offsite/or not
routinely provided onsite;
If “No” to 1), 2), and 3),
SERVTX=2 (Not provided);
Else SERVTX=1 (Provided);
Pharmacy,
pharmacist, or
pharmaceutical
services
Pharmacy services
include filling of and
delivery of prescriptions.
Pharmacist services
are provided by “the
licensed pharmacist(s)
who a facility is
required to use for
various purposes,
including providing
consultation on
pharmacy services,
establishing a system
of records of controlled
drugs, overseeing
records and reconciling
controlled drugs,
and/or performing
a monthly drug
regimen review for
each resident” (CMS
form 671). Definition
for pharmaceutical
services is not provided
in CMS’ State of
Operations Manual.
Derived from: [SERVRX]
Q16_g. Pharmacy
services—including
filling of and delivery of
prescriptions
1= Not provided
2= Provided only by
ADSC employees
3= Provided only
by others through
arrangement
4= Provided by both
ADSC employees
and others through
arrangement
If SERVRX=1, SERVRX_
RC=2; else if SERVRX >1,
SERVRX_RC=1;
Derived from: [SERVRX]
Q19_g. Pharmacy
services—including
filling of and delivery of
prescriptions
1= Not provided
2= Provided only by
RCC employees
3= Provided only
by others through
arrangement
4= Provided by both
RCC employees
and others through
arrangement
If SERVRX=1, SERVRX_
RC=2; else if SERVRX >1,
SERVRX_RC=1;
Derived from:
[PHRMCY_SRVC_CD]
Pharmaceutical
services
0= Not provided
1= Provided by agency
staff
2= Provided under
arrangement
3= Combination
If PHRMCY_SRVC_CD=0,
SERVRX_RC=2; else if
PHRMCY_SRVC_CD >0,
SERVRX=1;
Data not available Derived from: [PHRMCY_
SRVC_ONST_RSDNT_SW,
PHRMCY_SRVC_ONST_
NRSDNT_SW, PHRMCY_SRVC_
OFSITE_RSDNT_SW]
Pharmacist services
1) Services provided onsite
to residents, either by
employees or contractors;
2) Services provided onsite to
non-residents;
3)Services provided to
residents offsite/or not
routinely provided onsite;
If “No” to 1), 2), and 3),
SERVRX=2 (Not provided);
Else SERVRX=1 (Provided);
Services provided by long-term care services providers, by provider type—Con.
71
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Services provided by long-term care services providers, by provider type
Skilled nursing or
nursing services
In survey data, refers
to services that must
be performed by a
registered nurse or
a licensed practical
nurse and are medical
in nature. For home
health agencies, the
definition for nursing
services is not provided
in CMS’ State of
Operations Manual.
For hospices, nursing
services are “routinely
available and on call
on a 24-hour basis,
7 days a week,” and
“provided by or under
the supervision of a
registered nurse (RN)
functioning within a
plan of care developed
by the hospice
(IDG) in consultation
with the patient’s
attending physician, if
the patient has one”
(http://www.cms.
gov/Regulations-and-
Guidance/Guidance/
Manuals/downloads/
som107ap_m_hospice.
pdf). For nursing homes,
nursing services refer
to “coordination,
implementation,
monitoring and
management of
resident care plans.
Includes provision of
personal care services,
monitoring resident
responsiveness to
environment, range-
of-motion exercises,
application of sterile
dressings, skin care,
naso-gastric tubes,
intravenous fluids,
catheterization,
administration of
medications, etc.” (CMS
form 671).
Derived from:
[SERVNURS]
Q16_i. Skilled nursing
services—must be
performed by a RN or
LPN and are medical
in nature
1= Not provided
2= Provided only by
ADSC employees
3= Provided only
by others through
arrangement
4= Provided by both
ADSC employees
and others through
arrangement
If SERVNURS=1,
SERVNURS_RC=2;
else if SERVNURS >1,
SERVNURS_RC=1;
Derived from:
[SERVNURS]
Q19_i. Skilled nursing
services—must be
performed by a RN or
LPN and are medical in
nature
1= Not provided
2= Provided only by
RCC employees
3= Provided only
by others through
arrangement
4= Provided by both
RCC employees
and others through
arrangement
If SERVNURS=1,
SERVNURS_RC=2;
else if SERVNURS >1,
SERVNURS_RC=1;
Derived from: [NRSNG_
SRVC_CD]
Nursing care
0= Not provided
1= Provided by agency
staff
2= Provided under
arrangement
3= Combination
If NURSNG_SRVC_CD=0,
SERVNURS=2; Else if
NURSNG_SRVC_CD >0,
SERVNURS=1;
Derived from: [NRSNG_
SRVC_CD]
Nursing services
0= Not provided
1= Provided by agency
staff
2= Provided under
arrangement
3= Combination
If NURSNG_SRVC_CD=0,
SERVNURS=2; Else if
NURSNG_SRVC_CD >0,
SERVNURS=1;
Derived from: [NRSNG_SRVC_
ONST_RSDNT_SW, NRSNG_
SRVC_ONST_NRSDNT_S]W,
NRSNG_SRVC_OFSITE_RSDNT_
SW]
Nursing services
1) Services provided onsite
to residents, either by
employees or contractors;
2) Services provided onsite to
non-residents;
3) Services provided to
residents offsite/or not
routinely provided onsite;
If “No” to 1), 2), and 3),
SERVNURS=2 (Not provided);
Else SERVNURS=1 (Provided);
Services provided by long-term care services providers, by provider type—Con.
72
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Services provided by long-term care services providers, by provider type
Hospice
services
Refers to palliative and
supportive services to
dying persons and their
family members. For
home health agencies,
the agency was coded
as providing hospice
services if the agency
also participates in
the Medicare program
as a hospice. If
nursing homes have
at least one bed in
a unit identified and
dedicated by a facility
for residents needing
hospice services or
having one or more
residents receiving
hospice care benefits,
they were coded as
providing hospice
services.
Derived from
[SERVHOS]
Q16_b Hospice services
1= Not provided
2= Provided only by
ADSC employees
3= Provided only
by others through
arrangement
4= Provided by both
ADSC employees
and others through
arrangement
If SERVHOS=1,
SERVHOS_RC=2; Else if
SERVHOS >1, SERVHOS_
RC=1;
Derived from:
[SERVHOS]
Q19_b Hospice services
1= Not provided
2= Provided only by
RCC employees
3= Provided only
by others through
arrangement
4= Provided by both
RCC employees
and others through
arrangement
If SERVHOS=1, SERVHOS_
RC=2; Else if SERVHOS
>1, SERVHOS_RC=1;
Derived from: [MDCR_
HOSPC_SW]
Indicate if the Home
Health Agency also
participates in the
Medicare program as a
hospice.
If MDCR_HOSPC_SW=’Y’,
SERVHOS=1; Else if
MDCR_HOSPC_SW= ‘N’,
SERVHOS=2;
Category not
applicable
Derived from: [HOSPC_BED_
CNT, CNSUS_HOSPC_CARE_
CNT]
1) Number of beds in a unit
identified and dedicated
by a facility for residents
needing hospice services;
2) Number of residents
receiving hospice care
benefit;
If HOSPC_BED_CNT >0 or
CNSUS_HOSPC_CARE_CNT
>0, SERVHOS=1; Else if
HOSPC_BED_CNT=0 AND
CNSUS_HOSPC_CARE_CNT=0,
SERVHOS=2;
Number of
users
Number of users of
services provided
by paid, regulated,
long-term care services
providers
Q5. What is the total
number of participants
currently enrolled at this
center at this location?
Include respite care
participants.
Average daily
attendance of
participants (AVGPART)
was used to create
SIZE variable (number
of people served),
while this data item
(TOTPART) was used to
estimate the number
of adult day services
center participants
in the United States;
TOTPART was used
as the denominator
when computing
percentages for all
aggregate, participant-
level measures.
Q12. What is the total
number of residents
currently living at
this residential care
community? Include
respite care residents.
This data item (TOTRES)
was used to create SIZE
variable (number of
people served), and to
estimate the number of
residents in residential
care communities in
U.S.; TOTRES was used as
the denominator when
computing percentages
for all aggregate,
resident-level measures.
Derived from: [patient
ID from OBQI Case Mix
Roll Up data]
Number of home health
patients whose episode
of care ended at any
time in CY 2011 (i.e.,
discharges), regardless
of payment source; 939
agencies (7.7%) with
missing OBQI Case Mix
Roll Up data;
This data item (TOTPAT)
was used to create SIZE
variable (number of
people served), and to
obtain the number of
home health patients in
U.S.; TOTPAT was used
as the denominator
when computing
percentages for
selected aggregate,
patient-level measures
(i.e., age, sex, and
patients needing any
assistance in activities
of daily living).
Derived from:
[BENE_CNT from IPBS-
HOSPICE]
Number of hospice
patients for whom
Medicare-certified
hospice submitted a
Medicare claim at any
time in CY 2011; 187
agencies (5.1%)with
missing IPBS-hospice
data; Denominator
for measures on all
aggregate patient-
related measures;
This data item
(BENE_CNT) was
used to create SIZE
variable (number of
people served), and to
obtain the number of
hospice patients in U.S.;
BENE_CNT was used
as the denominator
when computing
percentages for all
aggregate patient-level
measures.
Derived from:
[CNSUS_RSDNT_CNT]
Number of current residents
in certified beds in
nursing homes in CASPER;
Denominator for measures
on residents with activities
of daily living limitations and
diagnosed with depression
and dementia;
This data item (CNSUS_
RSDNT_CNT) was used to
create SIZE variable, and to
obtain the number of current
nursing home residents in
U.S.; CNSUS_RSDNT_CNT
was used when computing
percentages for selected
aggregate, resident-level
measures (i.e., diagnosed
with dementia, diagnosed
with depression, and
residents needing any
assistance in activities of
daily living).
Services provided by long-term care services providers, by provider type—Con.
73
Appendix A. Crosswalk of Definitions by Provider Type
Services provided by long-term care services providers, by provider type—Con.
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Use of long-term care services, by provider type
Number of
users—
Con.
Additional data
on home health
patients and nursing
home residents were
available; these data
contain information on
a smaller number of
home health patients
(who are Medicare
beneficiaries receiving
services from Medicare-
certified home health
agencies) and nursing
home residents
[excluding residents
with latest Minimum
Data Set (MDS)
assessment data are
based on discharge
assessment].
Category not
applicable
Category not
applicable
Derived from:
[BENE_CNT from IPBS-
Home health]
Number of home health
patients for whom
Medicare-certified
home health care
agencies submitted
a Medicare claim at
any time in CY 2011;
1,089 agencies (8.9%)
with missing IPBS-Home
health data;
This data item
(BENE_CNT) was used
as the denominator
when computing
percentages for
selected aggregate,
patient-level measures
(i.e., race-ethnicity,
diagnosed with
dementia, and
diagnosed with
depression).
Category not
applicable
Derived from:[resident ID
from Minimum Data Set
Active Resident Episode Table
(MARET)]
Number of active residents
(Exclude residents whose last
assessment during Q3 2012
was discharge assessment);
385 nursing homes (2.5%) in
CASPER with missing MARET
data;
This data item (NUMRES) was
used as the denominator
when computing
percentages for selected
aggregate, resident-level
measures (i.e., age, sex, and
race and ethnicity).
74
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Demographic characteristics of users of long-term care services, by provider type
Age
Number of long-term
care services users
under age 65 Derived from: [AGLT17,
AG18TO44, AG45TO54,
AG55TO64]
Q28. Of the participants
currently enrolled at
this adult day services
center, how many are:
a. 17 years or younger?
b. 18–44 years?
c. 45–54 years?
d. 55–64 years?
Derived from: [AGLT17,
AG18TO44, AG45TO54,
AG55TO64]
Q31. Of the residents
currently living in
this residential care
community, how many
are:
a. 17 years or younger?
b. 18–44 years?
c. 45–54 years?
d. 55–64 years?
Derived from:
[MSR_201_VAL from
OBQI Case Mix Roll Up
data]
Calculated age at the
time of episode of care.
Derived from:
[AGE_LESS_65 from IPBS-
Hospice]
Number of beneficiaries
under the age of 65
utilizing the provider
type of service
Derived from: [A0900_BIRTH_
DT from MARET]
Resident's birth date
ADSC, RCC: Cases
with missing data were
imputed.
HHA, NH: MARET data
are individual resident-
level data, and OBQI
Case Mix Roll Up data
are also individual
patient-level data; when
rolling up individual user-
level data to individual
provider identification
(ID) number, facilities or
agencies with 20.0% or
more of their resident
or patient information
missing for a given
data item were coded
as missing. Other than
cases with missing data
due to nonmatching
(HHA-7.7%; NH-2.5%),
no facilities or agencies
had missing data.
HOS: IPBS-Hospice file
contains hospice patient
information at the
provider-level; other than
cases with missing data
due to nonmatching
(5.1%), no agencies had
missing data.
Number of long-term
care services users
between ages 65
and 74
Q28. Of the participants
currently enrolled at
this adult day services
center, how many are:
e. 65–74 years?
Q31. Of the residents
currently living in
this residential care
community, how many
are:
e. 65–74 years?
Derived from:
[MSR_201_VAL from
OBQI Case Mix Roll Up
data]
Calculated age at the
time of episode of care.
Derived from:
[AGE_65_69, AGE_70_74
from IPBS-Hospice]
Number of beneficiaries
between ages 65 and
69 utilizing the provider
type of service; Number
of beneficiaries
between ages 70 and
74 utilizing the provider
type of service
Derived from: [A0900_BIRTH_
DT from MARET]
Resident's birth date
ADSC, RCC: Cases
with missing data
were imputed. HHA,
NH: MARET data are
individual resident-level
data, and OBQI Case
Mix Roll Up data are also
individual patient-level
data; when rolling up
individual user-level data
to individual provider
ID number, facilities or
agencies with 20.0% or
more of their residents
or patient information
missing for a given
data item were coded
as missing; other than
cases with missing data
due to nonmatching
(HHA–7.7%; NH–2.5%),
no facilities or agencies
had missing data.
HOS: IPBS-Hospice file
contains hospice patient
information at the
provider-level; other than
cases with missing data
due to nonmatching
(5.1%), no agencies had
missing data.
Use of long-term care services, by provider type
75
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Demographic characteristics of users of long-term care services, by provider type
Age—
Con.
Number of long-term
care services users
between ages 75
and 84
Q28. Of the participants
currently enrolled at
this adult day services
center, how many are:
f. 75–84 years?
Q31. Of the residents
currently living in
this residential care
community, how many
are:
f. 75–84 years?
Derived from:
[MSR_201_VAL Num
from OBQI Case Mix
Roll Up data]
Calculated age at the
time of episode of care.
Derived from:
[AGE_75_79, AGE_80_84
from IPBS-Hospice]
Number of beneficiaries
between ages 75 and
79 utilizing the provider
type of service; Number
of beneficiaries
between ages 80 and
84 utilizing the provider
type of service
Derived from: [A0900_BIRTH_
DT from MARET]
Resident's birth date
ADSC, RCC: Cases
with missing data
were imputed. HHA,
NH: MARET data are
individual resident-level
data, and OBQI Case
Mix Roll Up data are also
individual patient-level
data; when rolling up
individual user-level data
to individual provider
ID number, facilities or
agencies with 20.0% or
more of their resident
or patient information
missing for a given
data item were coded
as missing. Other than
cases with missing data
due to nonmatching
(HHA–7.7%; NH–2.5%),
no facilities or agencies
had missing data.
HOS: IPBS-Hospice file
contains hospice patient
information at the
provider-level; other than
cases with missing data
due to nonmatching
(5.1%), no agencies had
missing data.
Demographic characteristics of users of long-term care services, by provider type
76
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Demographic characteristics of users of long-term care services, by provider type
Age—
Con.
Number of long-term
care services users
aged 85 and over Q28. Of the participants
currently enrolled at
this adult day services
center, how many are:
g. 85 years and older?
Q31. Of the residents
currently living in
this residential care
community, how many
are:
g. 85 years and older?
Derived from:
[MSR_201_VAL from
OBQI Case Mix Roll Up
data]
Calculated age at the
time of episode of care.
Derived from: [AGE_
OVER_84 from IPBS-
Hospice]
Number of beneficiaries
over age 84 utilizing the
provider type of service
Derived from: [A0900_BIRTH_
DT from MARET]
Resident's birth date
ADSC, RCC: Cases
with missing data
were imputed. HHA,
NH: MARET data are
individual resident-level
data, and OBQI Case
Mix Roll Up data are also
individual patient-level
data; when rolling up
individual user-level data
to individual provider
ID number, facilities or
agencies with 20.0% or
more of their resident
or patient information
missing for a given
data item were coded
as missing. Other than
cases with missing data
due to nonmatching
(HHA–7.7%; NH–2.5%),
no facilities or agencies
had missing data.
HOS: IPBS-Hospice file
contains hospice patient
information at the
provider-level; other than
cases with missing data
due to nonmatching
(5.1%), no agencies had
missing data.
Demographic characteristics of users of long-term care services, by provider type—Con.
77
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Demographic characteristics of users of long-term care services, by provider type
Race and
ethnicity
Number of long-term
care services users
of Hispanic or Latino
origin
Q26. Of the participants
currently enrolled at this
center, how many are:
a. Hispanic or Latino, of
any race?
Q29. Of the residents
currently living in
this residential care
community, how many
are:
a. Hispanic or Latino, of
any race?
Derived from:
[RACE_HISPN from IPBS-
Home health]
Number of Hispanic
beneficiaries utilizing
the provider type of
service
Derived from:
[RACE_HISPN from IPBS-
Hospice]
Number of Hispanic
beneficiaries utilizing
the provider type of
service
Derived from:
[A1000D_HSPNC_CD from
MARET]
Indicates if the resident is
Hispanic.
HH: IPBS-Home health
data used; race-
ethnicity data in OBQI
Case Mix Roll Up do not
match race-ethnicity
categories used in other
data sources.
ADSC, RCC: Cases
with missing data were
imputed. NH: MARET
data are individual
resident-level data;
when rolling up
individual user-level
data to individual
provider ID number,
facilities with 20.0% or
more of their residents
information missing
for a given data item
were coded as missing.
About 5.0% of facilities,
including facilities
with missing data
due to nonmatching
(NH–2.5%), had missing
data. HHA, HOS:
IPBS-Home health data
and IPBS-Hospice data
contain information on
home health patients
and hospice patients
at the provider-level,
respectively; other than
cases with missing data
due to nonmatching
(HHA–8.9%, HOS–5.1%),
no agencies had
missing data.
Demographic characteristics of users of long-term care services, by provider type—Con.
78
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Demographic characteristics of users of long-term care services, by provider type
Race and
ethnicity—
Con.
Number of long-term
care services users who
are non-Hispanic, white Q26. Of the participants
currently enrolled at this
center, how many are:
f. White, not Hispanic or
Latino?
Q29. Of the residents
currently living in
this residential care
community, how many
are:
f. White, not Hispanic or
Latino?
Derived from:
[RACE_WHITE from IPBS-
Home health]
Number of white
beneficiaries utilizing
the provider type of
service
Derived from:
[RACE_WHITE from IPBS-
Hospice]
Number of white
beneficiaries utilizing
the provider type of
service
Derived from:
[A1000F_WHT_CD from
MARET]
Indicates if the resident is
white.
HH: IPBS-Home health
data used; race-
ethnicity data in OBQI
Case Mix Roll Up do not
match race-ethnicity
categories used in other
data sources.
ADSC, RCC: Cases
with missing data were
imputed. NH: MARET
data are individual
resident-level data; when
rolling up individual user-
level data to individual
provider ID number,
facilities with 20.0% or
more of their resident
information missing
for a given data item
were coded as missing.
About 5.0% of facilities,
including facilities
with missing data
due to nonmatching
(NH–2.5%), had missing
data. HHA, HOS: IPBS-
Home health data
and IPBS-Hospice data
contain information on
home health patients
and hospice patients
at the provider-level,
respectively; other than
cases with missing data
due to nonmatching
(HHA–8.9%, HOS–5.1%),
no agencies had
missing data.
Demographic characteristics of users of long-term care services, by provider type—Con.
79
Appendix A. Crosswalk of Definitions by Provider Type
Demographic characteristics of users of long-term care services, by provider type—Con.
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Demographic characteristics of users of long-term care services, by provider type
Race and
ethnicity—
Con.
Number of long-term
care services users who
are non-Hispanic, black Q26. Of the participants
currently enrolled at this
center, how many are:
d. Black, not Hispanic or
Latino?
Q29. Of the residents
currently living in
this residential care
community, how many
are:
d. Black, not Hispanic or
Latino?
Derived from:
[RACE_BLACK from IPBS-
Home health]
Number of non-
Hispanic black
beneficiaries utilizing
the provider type of
service
Derived from:
[RACE_BLACK from IPBS-
Hospice]
Number of non-
Hispanic black
beneficiaries utilizing
the provider type of
service
Derived from:
[A1000C_AFRCN_AMRCN_CD
from MARET]
Indicates if the resident is
African American.
HH: IPBS-Home health
data used; race-
ethnicity data in OBQI
Case Mix Roll Up do not
match race-ethnicity
categories used in other
data sources.
ADSC, RCC: Cases
with missing data were
imputed. NH: MARET
data are individual
resident-level data;
when rolling up
individual user-level
data to individual
provider ID number,
facilities with 20.0% or
more of their resident
information missing
for a given data item
were coded as missing.
About 5.0% of facilities,
including facilities
with missing data
due to nonmatching
(NH–2.5%), had missing
data. HHA, HOS:
IPBS-Home health data
and IPBS-Hospice data
contain information on
home health patients
and hospice patients
at the provider-level,
respectively; other than
cases with missing data
due to nonmatching
(HHA–8.9%, HOS–5.1%),
no agencies had
missing data.
80
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Demographic characteristics of users of long-term care services, by provider type
Race and
ethnicity—
Con.
Number of long-term
care services users who
are other, non-Hispanic
racial or ethnic
background
Derived from:
[AIAN, ASIAN, NHOPI,
MULTIRACE, OTHRACE]
Q26. Of the participants
currently enrolled at this
center, how many are:
b. American Indian
or Alaska Native, not
Hispanic or Latino?
c. Asian, not Hispanic or
Latino?
e. Native Hawaiian or
Other Pacific Islander,
not Hispanic or Latino?
g. Two or more races,
not Hispanic or Latino?
h. Some other
category reported in
this residential care
community’s system?
Derived from:
[AIAN, ASIAN, NHOPI,
MULTIRACE, OTHRACE]
Q29. Of the residents
currently living in
this residential care
community, how many
are:
b. American Indian
or Alaska Native, not
Hispanic or Latino?
c. Asian, not Hispanic or
Latino?
e. Native Hawaiian or
Other Pacific Islander,
not Hispanic or Latino?
g. Two or more races,
not Hispanic or Latino?
h. Some other
category reported in
this residential care
community’s system?
Derived from:
[RACE_NATIND, RACE_
API, RACE_OTHER from
IPBS-Home health]
Number of Alaska
Native or American
Indian beneficiaries
utilizing the provider
type of service; Number
of Asian Pacific Islander
beneficiaries utilizing
the provider type of
service; Number of all
other beneficiaries not
elsewhere classified
utilizing the provider
type of service
Derived from:
[RACE_NATIND, RACE_
API, RACE_OTHER from
IPBS-Hospice]
Number of Alaska
Native or American
Indian beneficiaries
utilizing the provider
type of service; Number
of Asian Pacific Islander
beneficiaries utilizing
the provider type of
service; Number of all
other beneficiaries not
elsewhere classified
utilizing the provider
type of service
Derived from:
[A1000A_AMRCN_INDN_AK_
NTV_CD, A1000B_ASN_CD,
A1000E_NTV_HI_PCFC_
ISLNDR_CD from MARET]
Indicates if the resident is
American Indian or Alaska
Native; Indicates if the
resident is Asian; Indicates if
the resident is Native
Hawaiian or Pacific Islander.
HH: IPBS-Home health
data used; race-
ethnicity data in OBQI
Case Mix Roll Up do not
match race-ethnicity
categories used in other
data sources.
ADSC, RCC: Cases
with missing data were
imputed. NH: MARET
data are individual
resident-level data;
when rolling up
individual user-level
data to individual
provider ID number,
facilities with 20.0% or
more of their resident
information missing
for a given data item
were coded as missing.
About 5.0% of facilities,
including facilities
with missing data
due to nonmatching
(NH–2.5%), had missing
data. HHA, HOS:
IPBS-Home health data
and IPBS-Hospice data
contain information on
home health patients
and hospice patients
at the provider-level,
respectively; other than
cases with missing data
due to nonmatching
(HHA–8.9%, HOS–5.1%),
no agencies had
missing data.
Demographic characteristics of users of long-term care services, by provider type—Con.
81
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Demographic characteristics of users of long-term care services, by provider type
Sex
Number of long-term
care services users who
are male Q27. Of the
participants currently
enrolled at this center,
how many are:
a. Male?
Q30. Of the residents
currently living in
this residential care
community, how many
are:
a. Male?
Derived from:
[MSR_202_VAL, TOTPAT
from OBQI Case Mix
Roll Up data]
“Patient History,
Demographics, Gender:
Female.”
Derived from:
[MALE from IPBS-
Hospice]
Number of male
beneficiaries utilizing
the provider type of
service.
Derived from:
[A0800_GNDR_CD from
MARET]
Identifies the resident's
gender.
'-'=Not assessed/no
information/unable to
determine
1= Male
2= Female
ADSC, RCC: Cases
with missing data were
imputed.
HHA, NH: MARET data
are individual resident-
level data, and OBQI
Case Mix Roll Up data
are also individual
patient-level data; when
rolling up individual
user-level data to
individual provider ID
number, facilities or
agencies with 20.0% or
more of their resident
or patient information
missing for a given
data item were coded
as missing. Other than
cases with missing data
due to nonmatching
(HHA–7.7%; NH–2.5%),
no facilities or agencies
had missing data.
HOS: IPBS-Hospice file
contains hospice patient
information at the
provider-level; other than
cases with missing data
due to nonmatching
(5.1%), no agencies had
missing data.
Number of long-term
care services users who
are female Q27. Of the
participants currently
enrolled at this center,
how many are:
b. Female?
Q30. Of the residents
currently living in
this residential care
community, how many
are:
b. Female?
Derived from:
[MSR_202_VAL from
OBQI Case Mix Roll Up
data]
“Patient History,
Demographics, Gender:
Female.”
Derived from:
[FEMALE from IPBS-
Hospice]
Number of female
beneficiaries utilizing
the provider type of
service.
Derived from:
[A0800_GNDR_CD from
MARET]
Identifies the resident's
gender.
'-'=Not assessed/no
information/unable to
determine
1= Male
2= Female
Demographic characteristics of users of long-term care services, by provider type—Con.
82
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Health and functional characteristics of users of long-term care services, by provider type
Diagnosed with
dementia
Number of long-term
care services users
diagnosed with
dementia
Q30. Of the participants
currently enrolled
at this center, about
how many have been
diagnosed with:
a. Alzheimer’s disease
or other dementias?
Q32. Of the residents
currently living in
this residential care
community, about
how many have been
diagnosed with:
a. Alzheimer’s disease or
other dementias?
Derived from:
[ALZRDSD_BENE_CNT
from IPBS-Home health]
Number of beneficiaries
meeting the chronic
condition algorithm
for Alzheimer's broad
classification, including
dementia and utilizing
the provider type of
service. (Alzheimer's
Disease and Related
Disorders or Senile
Dementia)
Derived from:
[ALZRDSD_BENE_CNT
from IPBS-Hospice]
Number of beneficiaries
meeting the chronic
condition algorithm
for Alzheimer's broad
classification, including
dementia and utilizing
the provider type of
service. (Alzheimer's
Disease and Related
Disorders or Senile
Dementia)
Derived from:
[CNSUS_DMNT_CNT]
Number of residents with
dementia: multi-infarct, senile,
Alzheimer's type, or other
than Alzheimer's type.
ADSC, RCC: Cases
with missing data were
imputed.
HHA, HOS: IPBS-Home
health data and IPBS-
Hospice data contain
information on home
health patients and
hospice patients at
the provider-level,
respectively; other than
cases with missing data
due to nonmatching
(HHA–8.9%, HOS–5.1%),
no agencies had
missing data.
Diagnosed with
depression
Number of long-term
care services users
diagnosed with
depression
Q30. Of the participants
currently enrolled
at this center, about
how many have been
diagnosed with:
d. Depression?
Q32. Of the residents
currently living in
this residential care
community, about
how many have been
diagnosed with:
d. Depression?
Derived from:
[DEPR_BENE_CNT from
IPBS-Home health]
Number of beneficiaries
meeting the chronic
condition algorithm for
depression and utilizing
the provider type of
service.
Derived from:
[DEPR_BENE_CNT from
IPBS-Hospice]
Number of beneficiaries
meeting the chronic
condition algorithm for
depression and utilizing
the provider type of
service.
Derived from:
[CNSUS_DPRSN_CNT]
Number of residents with
documented signs and
symptoms of depression.
Demographic characteristics of users of long-term care services, by provider type—Con.
83
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Health and functional characteristics of users of long-term care services, by provider type
Assistance with
eating
Number of long-term
care services users
needing any assistance
in eating. Assistance
refers to needing any
help or supervision from
another person, or use
of special equipment.
Q33. Of the participants
currently enrolled
at this center, about
how many need any
assistance in each of
the following activities?
c. With eating, like
cutting up food
Q34. Of the residents
currently living in
this residential care
community, about
how many need any
assistance in each of
the following activities?
c. With eating, like
cutting up food
Derived from:
[MSR_342_VAL from
OBQI Case Mix Roll Up
data]
Number of patients
coded as needing any
assistance with eating
if they are: able to feed
self independently but
require meal setup or
intermittent assistance
or supervision from
another person, require
a liquid, pureed or
ground meat diet;
unable to feed self and
must be assisted or
supervised throughout
the meal or snack;
able to take in nutrients
orally and receive
supplemental nutrients
through a nasogastric
tube or gastrostomy;
unable to take in
nutrients orally and are
fed nutrients through
a nasogastric tube or
gastrostomy; or unable
to take in nutrients
orally or by tube
feeding.
Data not available Derived from: [CNSUS_EATG_
ASTD_CNT, CNSUS_EATG_
DPNDNT_CNT]
Number of residents coded
as needing any assistance
with eating if they require
supervision, limited or
extensive assistance from
staff, or full staff performance
every time during entire
7-day period. If the facility
routinely provides “setup”
activities (e.g., opening
containers, buttering bread,
and organizing the tray)
and if this is the extent of
assistance provided for the
resident, the resident was
coded as not needing any
assistance with eating.
ADSC, RCC: Cases
with missing data were
imputed.
HHA: OBQI Case
Mix Roll Up data are
individual, patient-level
data; when rolling up
individual user-level data
to individual provider
ID number, agencies
with 20.0% or more of
their patient information
missing for a given
data item were coded
as missing. Other than
cases with missing data
due to mismatching
(7.7%), no agencies had
missing data.
Health and functional characteristics of users of long-term care services, by provider type
84
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Health and functional characteristics of users of long-term care services, by provider type
Assistance with
dressing
Number of long-term
care services users
needing any assistance
in dressing. Assistance
refers to needing any
help or supervision from
another person, or use
of special equipment.
Q33. Of the participants
currently enrolled
at this center, about
how many need any
assistance in each of
the following activities?
d. With dressing
Q34. Of the residents
currently living in
this residential care
community, about
how many need any
assistance in each of
the following activities?
d. With dressing
Derived from:
[MSR_336_VAL from
OBQI Case Mix Roll Up
data]
Number of patients
coded as needing
any assistance with
dressing if: they are
able to dress upper
and lower body without
assistance, if clothing
and shoes are laid
out or handed to the
patient; someone must
help the patient put on
upper body clothing
or undergarments,
slacks, socks or nylons,
and shoes; or patient
depends entirely upon
another person dress
the upper and lower
body.
Data not available Derived from: [CNSUS_DRS_
ASTD_CNT; CNSUS_DRS_
DPNDNT_CNT]
Number of residents coded
as needing any assistance
with dressing if they require
supervision, limited or
extensive assistance from
staff, or full staff performance
every time during entire
7-day period. If the facility
routinely set out clothes for
all residents, and this is the
only assistance the resident
receives, the resident was
coded as not needing any
assistance with dressing.
HHA: OBQI Case
Mix Roll Up data are
individual, patient-level
data; when rolling up
individual user-level data
to individual provider
ID number, agencies
with 20.0% or more of
their patient information
missing for a given
data item were coded
as missing. Other than
cases with missing data
due to mismatching
(7.7%), no agencies had
missing data.
Health and functional characteristics of users of long-term care services, by provider type—Con.
85
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Health and functional characteristics of users of long-term care services, by provider type
Assistance with
toileting
Number of long-term
care services users
needing any assistance
in using bathroom.
Assistance refers to
needing any help
or supervision from
another person, or use
of special equipment.
Q33. Of the participants
currently enrolled
at this center, about
how many need any
assistance in each of
the following activities?
f. In using the bathroom
(toileting)
Q34. Of the residents
currently living in
this residential care
community, about
how many need any
assistance in each of
the following activities?
f. In using the bathroom
(toileting)
Derived from:
[MSR_339_VAL from
OBQI Case Mix Roll Up
data]
Number of patients
coded as needing
any assistance with
toileting if: the patient
is able to manage
toileting hygiene and
clothing management
without assistance if
supplies or implements
are laid out for the
patient; someone
must help the patient
to maintain toileting
hygiene or adjust
clothing; or the patient
depends entirely
upon another person
to maintain toileting
hygiene. Toileting
hygiene refers to the
patient’s current ability
to maintain perineal
hygiene safely, adjust
clothes or incontinence
pads before and after
using toilet, commode,
bedpan, and urinal. If
managing ostomy, it
includes cleaning area
around stoma, but not
managing equipment.
Data not available Derived from: [CNSUS_TOILT_
ASTD_CNT, CNSUS_TOILT_
DPNDNT_CNT]
Number of residents coded
as needing any assistance
with toileting if they require
supervision, limited or
extensive assistance from
staff, or full staff performance
every time during entire
7-day period. If all that is
done for the resident is to
open a package (e.g., a
clean sanitary pad), the
resident was coded as not
needing any assistance with
toileting.
HHA: OBQI Case
Mix Roll Up data are
individual, patient-level
data; when rolling up
individual user-level data
to individual provider
ID number, agencies
with 20.0% or more of
their patient information
missing for a given
data item were coded
as missing. Other than
cases with missing data
due to mismatching
(7.7%), no agencies had
missing data.
Health and functional characteristics of users of long-term care services, by provider type—Con.
86
Appendix A. Crosswalk of Definitions by Provider Type
Definition
Survey data
Question numbers refer to order in
National Study of Long-Term Care Providers
(NSLTCP) questionnaires:
http://www.cdc.gov/nchs/nsltcp/nsltcp_
questionnaires.htm
Administrative data
When data source is not specified, the data source is the
Centers for Medicare & Medicaid Services’ (CMS) Certification and
Survey Provider Enhanced Reporting (CASPER).
Notes
Adult day services
center (ADSC)
Residential care
community (RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Health and functional characteristics of users of long-term care services, by provider type
Assistance with
bathing
Number of long-term
care services users
needing any assistance
in bathing or showering.
Assistance refers to
needing any help
or supervision from
another person, or use
of special equipment.
Q33. Of the participants
currently enrolled
at this center, about
how many need any
assistance in each of
the following activities?
e. With bathing or
showering
Q34. Of the residents
currently living in
this residential care
community, about
how many need any
assistance in each of
the following activities?
e. With bathing or
showering
Derived from:
[MSR_337_VAL from
OBQI Case Mix Roll Up
data]
Number of patients
coded as needing any
assistance with bathing
if the patient is: with the
use of devices, able to
bathe self in shower
or tub independently,
including getting in
and out of the tub
or shower; able to
bathe in shower or tub
with the intermittent
assistance of another
person; able to
participate in bathing
self in shower or tub,
but requires presence
of another person
throughout the bath
for assistance or
supervision; unable
to use the shower or
tub, but able to bathe
self independently
with or without the
use of devices at the
sink, in chair, or on
commode; unable to
use the shower or tub,
but able to participate
in bathing self in bed,
at the sink, in bedside
chair, or on commode,
with the assistance or
supervision of another
person throughout
the bath; or unable to
participate effectively in
bathing and is bathed
totally by another
person.
Data not available Derived from: [CNSUS_
BATHG_ASTD_CNT, CNSUS_
BATHG_DPNDNT_CNT]
Number of residents coded
as needing any assistance
with bathing if they require
supervision, physical help
limited to transfer only or in
part of bathing activity, or full
staff performance every time
during entire 7-day period.
If the facility provides setup
assistance to all residents,
such as drawing water for
a tub bath or laying out
bathing materials, and the
resident requires no other
assistance, the resident was
coded as not needing any
assistance with bathing.
ADSC,
RCC: Cases
with missing data were
imputed.
HHA: OBQI Case
Mix Roll Up data are
individual, patient-level
data; when rolling up
individual user-level data
to individual provider
ID number, agencies
with 20.0% or more of
their patient information
missing for a given
data item were coded
as missing. Other than
cases with missing data
due to mismatching
(7.7%), no agencies had
missing data.
Health and functional characteristics of users of long-term care services, by provider type—Con.
Appendix B
Detailed Tables
88
Appendix B. Detailed Tables
Table 1. Number and percent distribution of long-term care services providers, by geographical and organizational characteristics and provider type:
United States, 2012
Characteristic
Adult day
services
center
Standard
error
Home
health
agency
Standard
error Hospice
Standard
error Nursing home
Standard
error
Residential
care
community Standard error
Number of providers 4,800 4.08 12,200 ... 3,700 … 15,700 … 22,200 209.00
Number of beds or licensed maximum capacity 276,500 2,234.46 … … … … 1,669,100 … 851,400 11,606.91
Average capacity
1
58 0.47 - - - - - - - - - - - - 106 0.50 38 0.38
Average number of people served
2
39 0.40 421 10.10 356 10.91 88 0.45 32 0.40
Region
Northeast 20.7 0.03 8.0 0.25 12.6 0.55 17.0 0.30 10.1 0.01
Midwest 18.3 0.03 27.3 0.40 23.7 0.70 32.9 0.38 22.9 0.07
South 32.4 0.04 48.3 0.45 42.4 0.81 34.5 0.38 30.6 0.04
West 28.6 0.04 16.4 0.34 21.3 0.67 15.6 0.29 36.4 0.04
Metropolitan statistical area status
Metropolitan 83.9 0.33 83.9 0.33 73.9 0.72 70.8 0.36 81.0 0.60
Micropolitan 9.8 0.28 8.2 0.25 15.4 0.59
14.0 0.28 11.8 0.54
Neither 6.4 0.23 7.8 0.24 10.7 0.51
15.2 0.29 7.2 0.33
Ownership
For profit 40.0 0.49 78.7 0.37 56.6 0.82 68.2 0.37 78.4 0.70
Not for profit 54.9 0.49 15.6 0.33 29.7 0.75 25.1 0.35 20.4 0.69
Government and other 5.1 0.21 5.7 0.21 13.7 0.57 6.8 0.20 1.2 0.16
Number of people served
3
Category 1 47.4 0.45 40.0 0.46 32.6 0.79 5.6 0.18 59.9 0.33
Category 2 47.3 0.48 27.6 0.42 35.0 0.81 61.7 0.39 34.6 0.42
Category 3 5.2 0.24 32.4 0.44 32.5 0.79 32.8 0.37 5.5 0.29
… Category not applicable.
- - - Data not available
1
For adult day services centers, capacity is based on licensed maximum capacity. For nursing homes and residential care communities, capacity is based on number of licensed or certified beds.
2
Participants in adult day services centers and residents in nursing homes and residential care communities are current users on any given day in 2012. Home health patients are patients who received and ended
care anytime in 2011. Hospice patients are patients who received care anytime in 2011.
3
For adult day services centers, nursing homes, and residential care communities, number of people served is based on current users on any given day in 2012 and is grouped into one of three categories: 1–25,
26–100, and 101 or more. For home health agencies and hospices, number of people served is based on number of patients in 2011 and is grouped into one of three categories: 1–100, 101–300, and 301 or more.
Home health patients are patients who received and ended care anytime in 2011. Hospice patients are patients who received care anytime in 2011.
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, 2012.
89
Appendix B. Detailed Tables
Table 2. Number and percent distribution of staffing characteristics, by staff and provider type: United States, 2012
Characteristic
Adult day
services
center Standard error
Home health
agency Standard error Hospice
Standard
error
Nursing
home
Standard
error
Residential care
community
Standard
error
Total number of nursing employee FTEs 20,700 205.86 143,600 1,485.50 57,800 1,234.69 952,100 4,235.39 278,600 5,283.56
Percent of total nursing employee FTEs
Registered nurse 19.2 0.22 54.4 0.33 54.7 0.36 11.7 0.06 7.6 0.40
Licensed practical nurse or licensed
vocational nurse
11.3 0.14 19.0 0.23 9.6 0.22 22.9 0.07 10.2 0.23
Aide 69.4 0.28 26.6 0.32 35.7 0.32 65.4 0.07 82.1 0.44
Percent of providers with one or more
employee FTE
Registered nurse 59.2 0.49 99.8 0.04 99.8 0.08 98.7 0.09 46.3 0.92
Licensed practical nurse or licensed
vocational nurse
44.7 0.47 68.7 0.42 56.4 0.82 98.2 0.11 41.6 0.78
Aide 74.4 0.46 90.2 0.27 96.5 0.30 98.3 0.10 86.5 0.82
Social worker 42.8 0.48 44.9 0.45 98.9 0.17 75.9 0.34 14.0 0.61
Hours per resident or participant per day
Registered nurse 0.28 0.01 - - - - - - - - - - - - 0.52 0.01 0.27 0.02
Licensed practical nurse or licensed
vocational nurse
0.22 0.01 - - - - - - - - - - - - 0.85
0.01 0.19 0.01
Aide 1.08 0.02 - - - - - - - - - - - - 2.46 0.02
2.16 0.04
Social worker 0.15 0.01 - - - - - - - - - - - - 0.08 – 0.05 0.01
- - - Data not available.
– Quantity zero.
NOTES: FTEs is full-time equivalent. 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, 2012.
90
Appendix B. Detailed Tables
Table 3. Percentage of long-term care services providers that provide selected services, by type of service provided and provider type: United States,
2012
Service
Adult day
services
center
Standard
error
Home health
agency
Standard
error Hospice
Standard
error
Nursing
home
Standard
error
Residential care
community
Standard
error
Social work
Yes 63.5 0.49 82.3 0.35 100.0 0.03 88.9 0.25 75.6 0.92
No 36.5 0.49 17.7 0.35 – – 11.1 0.25 24.5 0.92
Mental health or counseling
Yes 47.3 0.52 - - - - - - 97.2 0.27 86.6 0.27 77.8 0.93
No 52.7 0.52 - - - - - - 2.9 0.27 13.4 0.27 22.2 0.93
Therapy (physical, occupational,
or speech)
Yes 63.8 0.50 96.6 0.16 98.4 0.21 99.3 0.07 88.7 0.75
No 36.2 0.50 3.4 0.16 1.6 0.21 0.7 0.07 11.3 0.75
Skilled nursing or nursing
Yes 70.1 0.46 100.0 0.00 100.0 0.00 100.0 0.01 76.1 0.90
No 29.9 0.46 – – – – – – 23.9 0.90
Pharmacy or pharmacist
Yes 34.9 0.49 5.5 0.21 - - - - - - 97.4 0.13 92.6 0.63
No 65.1 0.49 94.5 0.21
- - - - - - 2.6 0.13 7.4 0.63
Hospice
Yes 24.4 0.42 5.6
0.21 ... … 78.6 0.33 89.4 0.65
No 75.6 0.42 94.4 0.21 … … 21.4 0.33 10.6 0.65
– Quantity zero.
- - - Data not available.
… Category not applicable.
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 2012.
91
Appendix B. Detailed Tables
Table 4. Number and percentage of users of long-term care services, by selected characteristics and provider type: United States, 2012
Characteristic
Adult day
services
center
Standard
error
Home health
agency
Standard
error Hospice
Standard
error Nursing home
Standard
error
Residential
care
community
Standard
error
Number of users
1
273,200 2,738.01 4,742,500 114,451.33 1,244,500 38,376.96 1,383,700 7,051.24 713,300 11,073.47
Age
65 and over 63.5 2.47 82.4 0.15 94.5 0.06 85.1 0.15 93.3 0.30
Under 65 36.5 2.47 17.6 0.15 5.5 0.06 14.9 0.15 6.7 0.30
65–74 19.4 0.76 24.6 0.09 16.4 0.11 14.9 0.06 10.4 0.31
75–84 27.2 1.07 32.2 0.07 31.3 0.07 27.9 0.07 32.4 0.57
85 and over 16.9 0.69 25.5 0.14 46.8 0.21 42.3 0.16 50.5 0.68
Sex
Men 40.4 0.18 37.3 0.07 40.3 0.11 32.3 0.12 28.0 0.29
Women 59.6 0.18 62.7 0.07 59.7 0.11 67.7 0.12 72.0 0.29
Race and ethnicity
Hispanic 20.2 0.40 8.4 0.21 4.6 0.37 5.1 0.12 2.4 0.25
Non-Hispanic white 47.3 0.51 74.5 0.36 85.3 0.47 78.7 0.26
87.3 0.58
Non-Hispanic black 16.8 0.32 14.1 0.24 8.1 0.23 14.0
0.21 4.0 0.23
Non-Hispanic other 15.7 0.52 3.0 0.11 2.1 0.12 2.3 0.08 6.3 0.46
Conditions
Diagnosed with Alzheimer’s
or other dementias
31.9 0.39 30.1 0.15 44.3 0.33 48.5 0.15 39.6 0.70
Diagnosed with depression 23.5 0.38 34.7 0.14 22.2 0.18 48.5 0.19 24.8 0.56
Needs assistance in physical functioning
Bathing 39.6 0.53 95.1 0.10 - - - - - - 96.1 0.09 61.4 0.85
Dressing 37.8 0.48 83.8 0.26 - - - - - - 90.9 0.11 44.9 0.75
Toileting 36.2 0.43 64.6 0.39 - - - - - - 86.6 0.13 36.8 0.74
Eating 25.3 0.35 51.2 0.39 - - - - - - 56.0 0.23 17.7 0.47
- - - Data not available.
1
Participants in adult day services centers and residents in nursing homes and residential care communities are current users on any given day in 2012. Home health patients are patients who received and
ended care anytime in 2011. Hospice patients are patients who received care anytime in 2011.
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, 2012.
92
Appendix B. Detailed Tables
Table 5. Use of long-term care services providers, by state and provider type: United States, 2012
Area
Adult day services center Nursing home Residential care community Home health agency Hospice
Daily rate
1
Standard error
Daily rate
2
Standard error
Daily rate
3
Standard error
Annual rate
4
Standard error
Annual rate
5
Standard error
United States 4.05 0.06 26.05 0.14 15.42 0.25 94.35 2.26 28.40 0.88
Alabama 0.51 0.05 26.27 1.91 11.00 0.50 119.57 16.27 35.91 5.71
Alaska 6.05 0.40 7.01 2.22 21.85 2.99 33.81 11.92 7.34 5.00
Arizona 1.06 0.06 8.73 0.83 14.85 1.23 59.72 10.20 36.50 7.77
Arkansas 1.28 0.14 33.07 2.34 3.24 0.15 82.61 10.44 28.98 6.92
California 8.88 0.37 16.73 0.56 17.02 0.85 78.32 5.01 23.49 2.33
Colorado 2.71 0.23 21.15 1.68 15.27 1.22 79.34 13.85 29.32 6.63
Connecticut 4.73 0.21 37.50 2.83 2.92 0.36 110.20 19.49 22.99 6.58
Delaware 2.50 0.22 22.97 3.93 11.92 0.73 90.29 34.26 38.85 14.67
District of Columbia 1.78 0.03 27.31 7.49 14.93 1.50 61.17 26.68 18.62 10.96
Florida 2.15
0.08 17.34 0.72 14.75 0.96 116.42 6.31 31.21 7.96
Georgia 2.34 0.18 23.97 1.40 12.60 0.90 92.77 13.16 34.73 3.87
Hawaii 7.62 0.63 14.25 2.71 10.87 0.97 28.39 10.32 17.83 8.16
Idaho 0.30 0.05 15.00 1.92 23.31 0.77 66.50 13.56 31.92 6.91
Illinois 3.81 0.36 32.11 1.37 10.10 0.72 114.26 9.04 26.09 4.11
Indiana 0.93 0.05 36.89 1.83 12.00 0.32 78.45 8.78 28.77 4.21
Iowa 1.65 0.10 46.49 2.57 2.29 0.14 58.95 10.57 37.46 6.35
Kansas 1.14 0.19 38.41 2.46 25.64 0.89 69.95 12.94 29.60 7.24
Kentucky 2.78 0.14 31.33 2.07 11.24 0.67 110.45 17.93 23.30 7.70
Louisiana 1.73 0.21 33.96 2.23 5.67 0.22 117.88 11.88 34.32 4.18
Maine 1.83 0.17 23.85 2.65 22.73 0.57 91.92 26.26 26.08 7.80
Maryland 7.85 0.53 25.38 1.96 20.07 2.47 81.48 15.88 23.19 6.81
Massachusetts 8.97 0.43 37.34
2.02 11.97 0.42 137.87 23.49 26.82 4.86
Michigan 1.41 0.08 23.23 1.28 12.90 1.02 129.62 13.51 32.50 4.94
Minnesota 5.63 0.42 32.03 1.93 32.70 2.84 57.91 11.64 25.47 5.71
Mississippi 2.01 0.15 32.02 2.47 12.01 0.51 122.85 23.17 32.80 5.26
Missouri 1.42 0.16 33.84 1.72 13.48 0.91 86.72 14.05 33.06 4.97
Montana 0.75 0.17 23.74 3.13 24.29 2.57 44.74 11.00 23.73 6.32
Nebraska 1.79 0.29 40.29 3.20 29.20 0.94 66.68 16.29 29.12 6.92
Nevada 2.18 0.17 9.51 1.64 8.91 0.38 85.58 16.79 29.86 9.56
See footnotes at end of table.
93
Appendix B. Detailed Tables
Table 5. Use of long-term care services providers, by state and provider type: United States, 2012—Con.
Area
Adult day services center Nursing home Residential care community Home health agency Hospice
Daily rate
1
Standard error
Daily rate
2
Standard error
Daily rate
3
Standard error
Annual rate
4
Standard error
Annual rate
5
Standard error
New Hampshire 3.70 0.46 31.66 4.22 15.25 0.53 99.22 27.09 23.68 6.86
New Jersey 11.55 0.48 29.50 1.76 11.56 0.27 85.88 17.26 26.30 4.92
New Mexico 1.02 0.22 15.78 2.15 12.54 1.00 61.97 11.57 28.25 8.04
New York 5.77 0.36 31.61 1.54 8.69 0.32 94.22 23.24 15.10 3.27
North Carolina 2.04 0.08 22.79 1.21 14.62 0.89 95.03 11.10 28.86 4.70
North Dakota 3.68 0.93 49.22 6.60 40.48 2.06 46.73 16.50 21.62 12.05
Ohio 2.94 0.14 36.15 1.31 15.91 0.51 98.33 10.61 35.48 5.87
Oklahoma 1.79 0.13 28.52 1.83 7.67 0.32 107.96 11.37 36.15 4.31
Oregon 1.01 0.12 9.56 0.93 35.28 2.36 58.82 15.26 30.94 6.72
Pennsylvania 3.37 0.19 33.18 1.51 22.92 1.69 114.26 14.93 31.19 3.45
Rhode Island 6.23
0.54 45.66 5.58 18.25 0.96 120.82 34.92 34.82 19.19
South Carolina 2.67 0.16 20.69 1.72 13.34 0.55 84.66 15.30 35.86 5.59
South Dakota 2.95 0.32 44.26 4.83 25.72 0.74 36.15 8.62 21.53 7.34
Tennessee 1.23 0.13 27.78 1.72 12.73 0.34 109.19 13.12 27.51 5.47
Texas 6.59 0.26 28.15 0.90 11.11 0.72 112.71 4.69 32.19 2.82
Utah 0.60 0.05 14.61 1.74 17.53 0.68 93.34 16.29 39.49 7.02
Vermont 8.78 0.79 23.85 4.41 21.99 1.34 101.61 36.28 18.14 6.72
Virginia 2.06 0.11 21.92 1.47 21.40 1.59 89.85 11.07 24.37 4.71
Washington 2.86 0.49 14.99 1.13 35.32 2.96 57.81 10.70 23.44 5.73
West Virginia 0.28 0.06 24.89 2.52 7.97 0.89 81.05 14.45 27.55 8.76
Wisconsin 2.60 0.17 29.95 1.72 35.19 3.31 51.51 11.14 30.15 5.48
Wyoming 1.32 0.33 26.00 5.02 11.39 0.57 43.06 12.00 14.46 5.10
1
Participants enrolled in adult day services center on any given day in 2012 per 1,000 persons aged 65 and over.
2
Residents in nursing homes on any given day in 2012 per 1,000 persons aged 65 and over.
3
Residents in residential care communities on any given day in 2012 per 1,000 persons aged 65 and over.
4
Home health patients whose episode of care ended anytime in 2011 per 1,000 persons aged 65 and over.
5
Hospice patients receiving care anytime in 2011 per 1,000 persons aged 65 and over.
SOURCE: CDC/NCHS, National Study of Long-Term Care Providers, 2012.
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