NCHS reports can be downloaded from: https://www.cdc.gov/nchs/products/index.htm.
NATIONAL CENTER FOR HEALTH STATISTICS
Vital and Health Statistics
Series 3, Number 43
February 2019
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
Long-term Care Providers and
Services Users in the United States,
2015–2016
Analytical and Epidemiological Studies
98.1 (0.93)
99.5 (0.26)
98.7 (0.75)
99.3 (0.73)
98.4 (1.49)
98.4 (1.58)
94.7 (1.95)
98.6 (1.30)
92.4 (2.88)
92.5 (2.46)
96.7 (2.48)
91.8 (3.61)
17.0 (0.46)
16.7 (0.55)
16.8 (1.01)
11.8 (2.48)
20.0 (1.88)
12.9 (1.13)
8.7 (1.26)
7.3 (2.20)
17.1 (4.43)
14.5 (3.05)
7.7 (2.11)
3.8 (0.64)
4.7 (1.03)
*2.4 (1.00)
84.5 (7.72)
*8.3 (3.48)
13.6 (2.00)
*3.9 (1.52)
17.5 (2.81)
*19.2 (7.52)
*18.5 (6.70)
*17.1 (4.85)
96.9 (0.21)
97.0 (0.24)
97.2 (0.44)
96.8 (1.27)
95.2 (0.88)
96.7 (0.78)
99.3 (0.29)
94.8 (1.66)
95.6 (1.39)
97.5 (1.40)
93.1 (2.60)
98.1 (0.93)
99.5 (0.26)
98.7 (0.75)
99.3 (0.73)
98.4 (1.49)
98.4 (1.58)
94.7 (1.95)
98.6 (1.30)
92.4 (2.88)
92.5 (2.46)
96.7 (2.48)
91.8 (3.61)
97.0 (0.24)
97.2 (0.44)
96.8 (1.27)
95.2 (0.88)
96.7 (0.78)
99.3 (0.29)
94.8 (1.66)
95.6 (1.39)
97.5 (1.40)
93.1 (2.60)
98.1 (0.93)
99.5 (0.26)
98.7 (0.75)
99.3 (0.73)
98.4 (1.49)
98.4 (1.58)
94.7 (1.95)
98.6 (1.30)
92.4 (2.88)
92.5 (2.46)
96.7 (2.48)
91.8 (3.61)
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
Long-term Care Providers and
Services Users in the United States,
2015–2016
Analytical and Epidemiological Studies
NATIONAL CENTER FOR HEALTH STATISTICS
Vital and Health Statistics
Series 3, Number 43
February 2019
NCHS reports can be downloaded from: https://www.cdc.gov/nchs/products/index.htm.
Copyright informaon
All material appearing in this report is in the public domain and may be reproduced or
copied without permission; citation as to source, however, is appreciated.
Suggested citaon
Harris-Kojetin L, Sengupta M, Lendon JP, Rome V, Valverde R, Caffrey C. Long-term care
providers and services users in the United States, 2015–2016. National Center for Health
Statistics. Vital Health Stat 3(43). 2019.
Library of Congress Cataloging-in-Publicaon Data
Names: National Center for Health Statistics (U.S.), issuing body.
Title: : Long-term care providers and services users in the United States,
2015-2016.
Other titles: DHHS publication ; no. 2019-1427. | Vital & health statistics.
Series 3, Analytical and epidemiological studies ; no. 43.
Description: Washington, DC : U.S. Department of Health and Human Services,
Centers for Disease Control and Prevention, National Center for Health
Statistics, January 2019. | Series: DHHS publication ; no. 2019-1427 |
Series: Vital and health statistics, Series 3 ; number 43 | Includes
bibliographical references and index.
Identifiers: LCCN 2018056225 | ISBN 084060694X (pbk.)
Subjects: | MESH: Long-Term Care | Insurance, Long-Term Care | United States
| Statistics
Classification: LCC RA412.2 | NLM W2 A N148vc no. 43 2018 | DDC
368.38/200973--dc23
LC record available at https://lccn.loc.gov/2018056225
For sale by the U.S. Government Publishing Office
Superintendent of Documents
Mail Stop: SSOP
Washington, DC 20401–0001
Printed on acid-free paper.
Long-term Care Providers and
Services Users in the United States,
2015–2016
Data from the National Study of Long-Term Care
Providers
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
Hyattsville, Maryland
February 2019
DHHS Publication No. 2019–1427
NATIONAL CENTER FOR HEALTH STATISTICS
Vital and Health Statistics
Series 3, Number 43 February 2019
Long-term Care Providers and
Services Users in the United States,
2015–2016
Data from the National Study of Long-Term Care
Providers
NATIONAL CENTER FOR HEALTH STATISTICS
Vital and Health Statistics
Series 3, Number 43 February 2019
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
Hyattsville, Maryland
February 2019
DHHS Publication No. 2019–1427
Naonal Center for Health Stascs
Charles J. Rothwell, M.S., M.B.A., Director
Jennifer H. Madans, Ph.D., Associate Director for Science
Division of Health Care Stascs
Denys T. Lau, Ph.D., Director
Alexander Strashny, Ph.D., Associate Director for Science
Series 3, Number 43 v NATIONAL CENTER FOR HEALTH STATISTICS
Contents
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii
Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Key Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Long-term Care Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
The National Study of Long-Term Care Providers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Structure of Report and Other NSLTCP Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
National Profile of Long-term Care Services Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Supply of Long-term Care Services Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Organizational Characteristics of Long-term Care Services Providers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Staffing: Nursing, Social Work, and Activities Employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Services Provided . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
National Profile of Long-term Care Services Users. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Use of Long-term Care Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Demographic Characteristics of Long-term Care Services Users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Health and Functional Characteristics of Long-term Care Services Users . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
Appendix I. Technical Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Appendix II. Crosswalk of Definitions by Sector . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Appendix III. Detailed Tables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73
Text Figures
1. Percent distribuon of long-term care services providers, by sector and region: United States, 2016 . . . . . . . . . . .6
2. Percent distribuon of long-term care services providers, by sector and metropolitan stascal area
status: United States, 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
3. Long-term care services provider capacity per 1,000 people aged 65 and over, by sector and region:
United States, 2015—2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
4. Percent distribuon of long-term care services providers, by sector and ownership: United States, 2016 . . . . . . . . . 8
5. Percentage of long-term care services providers that are chain-aliated, by sector: United States, 2016 . . . . . . . . . 9
6. Percentage of long-term care services providers that are Medicare- and Medicaid-cered, by sector:
United States, 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
7. Percent distribuon of long-term care services providers, by sector and number of people served daily:
United States, 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
8. Percent distribuon of long-term care services providers, by sector and number of people served
annually: United States, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
9. Total number and percent distribuon of nursing and social work full-me equivalent employees, by
sector and sta type: United States, 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
10. Percentage of long-term care services providers with any full-me equivalent employees, by sector and
sta type: United States, 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
NATIONAL CENTER FOR HEALTH STATISTICS vi Series 3, Number 43
11. Average sta hours per resident or parcipant per day, by sector and sta type: United States, 2016 . . . . . . . . . . 13
12. Percentage of long-term care services providers that provide social work services, by sector:
United States, 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
13. Percentage of long-term care services providers that provide mental health or counseling services,
by sector: United States, 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
14. Percentage of long-term care services providers that provide any therapeuc services,
by sector: United States, 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
15. Percentage of long-term care services providers that provide skilled nursing or nursing services, by
sector: United States, 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
16. Percentage of long-term care services providers that provide pharmacy or pharmacist services,
by sector: United States, 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
17. Percentage of long-term care services providers that provide hospice services, by sector:
United States, 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
18. Percentage of long-term care services providers that provide dietary and nutrional services, by sector:
United States, 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
19. Percent distribuon of long-term care services providers, by sector and demena care unit:
United States, 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
20. Percent distribuon of long-term care services users, by sector and age group: United States,
2015 and 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
21. Percent distribuon of long-term care services users, by sector and sex: United States, 2015
and 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
22. Percent distribuon of long-term care services users, by sector and race and Hispanic origin:
United States, 2015 and 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
23. Percentage of long-term care services users with Medicaid as payer source, by sector:
United States, 2015 and 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
24. Percentage of long-term care services users with selected diagnoses, by sector:
United States, 2015 and 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
25. Percentage of long-term care services users needing any assistance with acvies of daily living, by
sector and acvity: United States, 2015 and 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
26. Percentage of long-term care services users with overnight hospital stays, emergency department visits,
and falls, by sector: United States, 2015 and 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Appendix Tables
I. Response rates for adult day services centers, by state, 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
II. Response rates for residenal care communies, by state, 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
III. Eligibility rate among residenal care communies, by bed size and survey year. . . . . . . . . . . . . . . . . . . . . . 33
IV. Weighted number and percent distribuon of residenal care communies, by bed size and survey year . . . . . . . 34
V. Long-term care services providers, by geographical and organizaonal characteriscs and sector:
United States, 2015–2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Contents—Con.
Series 3, Number 43 vii NATIONAL CENTER FOR HEALTH STATISTICS
Contents—Con.
VI. Stang characteriscs of long-term care services providers, by sta type and sector:
United States, 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
VII. Provision of services by long-term care services providers, by type of service and sector:
United States, 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
VIII. Long-term care services users, by selected characteriscs and sector: United States,
2015–2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
IX. Nursing home residents, by selected characteriscs and length of stay: United States, 2016 . . . . . . . . . . . . . . . 78
NATIONAL CENTER FOR HEALTH STATISTICS viii Series 3, Number 43
Acknowledgments
The authors are grateful to the many people who provided
technical expertise and assistance in implementing the
2015–2016 National Study of Long-Term Care Providers
(NSLTCP) and in developing this report.
This report was edited and produced by the National Center
for Health Statistics (NCHS) Office of Information Services,
Information Design and Publishing Staff: Danielle Taylor
edited the report, and graphics and layout were produced
by Odell D. Eldridge (contractor), Mike Jones (contractor),
and Shamir Ballard.
The authors are indebted to the directors and administrators
of the assisted living and similar residential care communities
and adult day services centers, and their designated staff,
who took time to complete the questionnaires. This report
would lack information on these sectors without their
participation.
The authors recognize the following organizations for their
vital contributions in successfully completing the 2016
NSLTCP adult day services center and residential care
community surveys: Adult Day Health Care Association
of Texas (ADCAT), American Seniors Housing Association
(ASHA), Argentum, California Association for Adult Day
Services (CAADS), Center for Excellence in Assisted Living
(CEAL), LeadingAge, National Adult Day Services Association
(NADSA), The National Association of States United for Aging
and Disabilities (NASUAD), and National Center for Assisted
Living (NCAL). For promoting participation in the 2016
surveys, the authors thank Tynetta Alston (Pennsylvania
Adult Day Services Association), Maribeth Bersani
(Argentum), Jeanne McGlynn Delgado (ASHA), Donna
Hale (NADSA), Blanca Laborde (ADCAT), Stephen Maag
(LeadingAge), Lydia Missaelides (CAADS), Peter Notarstefano
(LeadingAge), Lisa Peters-Beumer (NADSA), Martha Roherty
(NASUAD), Lindsay Schwartz (NCAL and CEAL), and Randy
Slikkers (CEAL).
The authors thank the members of the 2011 NSLTCP Work
Group, whose expertise helped guide the NSLTCP survey
content. Members, with affiliations at the time of the 2011
meeting, include: Jean Accius, AARP; Gretchen Alkema, The
SCAN Foundation; Nicholas Castle, University of Pittsburgh;
Thomas Clark, the American Society of Consultant
Pharmacists; Joel Cohen, Agency for Healthcare Research
and Quality; Rosaly Correa-de-Araujo, U.S. Department of
Health and Human Services; Holly Dabelko-Schoeny, The
Ohio State University; Frederic Decker, the Health Resources
and Services Administration; Elena Fazio, Administration for
Community Living; Michael Furukawa, Office of the National
Coordinator for Health Information Technology; Mary
George, Centers for Disease Control and Prevention (CDC);
Stacie Greby, CDC; Stuart Hagen, Congressional Budget
Office; Christa Hojlo, Department of Veterans Affairs (VA);
Teresa Johnson, NADSA; Judith Kasper, Johns Hopkins
University; Enid Kassner, AARP; Ruth Katz, Office of the
Assistant Secretary for Planning and Evaluation (ASPE); Gavin
Kennedy, ASPE; Mary Jane Koren, the Commonwealth Fund;
Dave 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, Senate Special Committee
on Aging; Vincent Mor, Brown University; Richard Nahin,
CDC; Carol O’Shaughnessy, the 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 at Greensboro; Robert Rosati,
Visiting Nurse Service of New York; Emily Rosenoff, ASPE;
James Scanlon, ASPE; Daniel Schoeps, VA; Margo Schwab,
Office 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 & Hospice; Nicola Thompson,
CDC; Daniel Timmel, CMS; Julie Weeks, NCHS; Janet Wells,
National Consumer Voice for Quality Long-Term Care; and
Cheryl Wiseman, CMS.
Under a contract with NCHS, RTI International implemented
the 2016 NSLTCP surveys. The authors gratefully acknowledge
the talented and dedicated staff at RTI International for their
contributions to the design and successful implementation
of the 2016 NSLTCP surveys, especially, Angela Greene,
Melissa Hobbs, Katherine Mason, Mai Nguyen, Linda Lux,
and Celia Eicheldinger.
The authors are grateful for the technical support and
assistance from staff at CMS and the Research Data
Assistance Center who helped identify and obtain needed
administrative data sources throughout this project,
specifically, Faith Asper, Stephanie Bartee, Dovid Chaifetz,
Christine Cox, Karen Edrington, Angela Jannotta, Waruiru
Mburu, and Matt McFalls.
Series 3, Number 43 1 NATIONAL CENTER FOR HEALTH STATISTICS
Long-term Care Providers and Services
Users in the United States, 2015–2016
by Lauren Harris-Kojen, Ph.D., Manisha Sengupta, Ph.D., Jessica Penn Lendon, Ph.D., Vincent Rome, M.P.H.,
Roberto Valverde, M.P.H., and Chrisne Carey, Ph.D.
Key Findings
In 2016, about 65,600 paid, regulated long-
term care services providers in ve major
sectors served over 8.3 million people in
the United States.
●
Long-term care services were provided by 4,600 adult
day services centers, 12,200 home health agencies,
4,300 hospices, 15,600 nursing homes, and 28,900
assisted living and similar residential care communities
(Appendix III, Table V).
●
In 2016, there were an estimated 286,300 current
participants enrolled in adult day services centers,
1,347,600 current residents in nursing homes, and
811,500 current residents living in residential care
communities. In 2015, about 4,455,700 patients were
discharged from home health agencies, and 1,426,000
patients received services from hospices (Appendix III,
Table VIII).
Abstract
Objective
This report presents the most current national results
from the National Study of Long-Term Care Providers
(NSLTCP) conducted by the National Center for Health
Statistics (NCHS) to describe providers and services
users in five major sectors of paid, regulated long-term
care services in the United States.
Methods
Data sources include NCHS surveys of adult day services
centers and residential care communities (covers 2016
data year) and administrative records from the Centers
for Medicare & Medicaid Services on home health
agencies, hospices, and nursing homes (covers 2015 and
2016 data years).
Results
This report provides information on the supply,
organizational characteristics, staffing, and services
offered by providers; and the demographic, health,
and functional composition, and adverse events
among users of these services. Services users include
residents of nursing homes and residential care
communities, patients of home health agencies
and hospices, and participants of adult day services
centers. This third edition updates “Long-Term Care
Providers and Services Users in the United States: Data
From the National Study of Long-Term Care Providers,
2013–2014” (available from: https://www.cdcgov/nchs/
data/series/sr_03/sr03_038.pdf). New content in this
edition includes an additional service (dietary and
nutritional services offered by providers); additional
diagnoses (Alzheimer disease, arthritis, asthma, chronic
kidney disease, chronic obstructive pulmonary disease,
depression, diabetes, heart disease, hypertension, and
osteoporosis); overnight hospitalizations among nursing
home residents; and estimates by length of stay for
selected characteristics (age, sex, race and ethnicity,
diagnoses, overnight hospital stays, and falls) for nursing
home residents.
Conclusion
In 2016, about 65,600 paid, regulated, long-term care
services providers in five major sectors served more
than 8.3 million people in the United States. Sectors
differed in ownership and chain status, and supply
varied by region. Long-term care services users varied by
sector in their demographic and health characteristics
and functional status.
Companion products will include: “Long-term Care
Providers and Services Users in the United States—
State Estimates Supplement: National Study of Long-
Term Care Providers, 2015–2016” and “Long-term
Care Services Use Rates in the United States—U.S.
Maps Supplement: National Study of Long-Term Care
Providers, 2015–2016.” NCHS plans to conduct NSLTCP
every 2 years. NSLTCP results and publications are
available from: https://www.cdc.gov/nchs/nsltcp/nsltcp_
products.htm.
Keywords: aging • disability • home- and community-
based services • chronic condions • long-term
services and supports • postacute care
NATIONAL CENTER FOR HEALTH STATISTICS 2 Series 3, Number 43
Sectors differed in ownership and chain
status, and supply varied by region.
●
The majority of home health agencies, hospices, nursing
homes, and residential care communities were for profit,
while a minority of adult day services centers were for
profit (Figure 4). The majority of nursing homes and
residential care communities and a minority of adult day
services centers were chain-affiliated (Figure 5).
●
The supply of residential care beds per 1,000 persons
aged 65 and over 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 other regions (Figure 3).
Almost 1.5 million nursing employee
full-time equivalents (FTEs)—including
registered nurses (RNs), licensed practical
or vocational nurses (LPNs or LVNs),
and aides—and about 35,000 social work
employee FTEs worked in the ve sectors.
●
The relative distribution of nursing and social work
employee FTEs varied across sectors; the most common
employee FTEs were aides in adult day services centers,
nursing homes, and residential care communities, while
RNs were the most common employee FTEs in home
health agencies and hospices (Figure 9).
Sectors differed in their average staffing
levels for nursing, social work, and
activities employees.
●
Among the three sectors where nursing staff levels (RNs,
LPNs or LVNs, and aides) could be examined, the average
total nursing staff hours per resident or participant day
was higher in nursing homes than in residential care
communities and adult day services centers (Figure 11).
●
In contrast, the average social work staffing level was
higher in adult day services centers than in nursing
homes or residential care communities, and the average
activities staffing level in adult day services centers was
more than twice that of nursing homes and residential
care communities.
Daily-use rates 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, and the lowest daily-
use rate was for adult day services center participants.
Long-term care services users varied by
sector in their demographic and health
characteristics and functional status.
●
Adult day services center participants tended to be
younger than services users in other sectors (Figure 20).
Adult day services center participants were the most
racially and ethnically diverse among the five sectors
(Figure 22).
●
At least one-quarter of services users in each of the
five sectors had Alzheimer disease or other dementias,
arthritis, heart disease, or hypertension (Figure 24).
However, the prevalence of these and six other reported
diagnosed chronic conditions varied widely between
sectors.
●
Fewer adult day services center participants needed
assistance with four of six activities of daily living
(ADLs; bathing, dressing, toileting, and walking or
locomotion) than services users in other sectors (Figure 25).
Adverse events among long-term care
services users varied by sector.
●
Compared with adult day participants and residential
care residents, more home health patients had overnight
hospital stays and emergency department visits (Figure 26).
●
More residential care residents had falls compared with
adult day participants and nursing home residents.
Short- and long-stay current nursing
home residents varied on a variety of
characteristics.
●
Short-stay (less than 100 days) residents differed from
long-stay (100 days or more) residents by age and sex,
and in the prevalence of numerous diagnosed conditions,
overnight hospital stays, and falls (Appendix III, Table IX).
Introduction
Long-term Care Services
Long-term care services 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 (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 defines the term to include certain institutionally
based and noninstitutionally based long-term services and
Series 3, Number 43 3 NATIONAL CENTER FOR HEALTH STATISTICS
supports [Section 10202(f)(1)]. This report uses “long-term
care services” to reflect both the changing vocabulary and
the fact that these services can include both health care-
related and nonhealth care-related services.
Long-term care services include assistance with activities
of daily living (ADLs; dressing, bathing, and toileting),
instrumental activities of daily living (IADLs; medication
management and housework), and health maintenance
tasks. Long-term care services assist people to improve or
maintain an optimal level of physical functioning and quality
of life, and can include help from other people and special
equipment or assistive devices. The need for long-term care
services is generally defined 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.
Individuals may receive long-term care services in a variety
of settings (2–5):
●
In the community, such as at an adult day services center
●
In the home, for example, from a home health agency,
hospice, or family and friends
●
In institutions, such as in a nursing home or skilled nursing
facility
●
In other residential settings, for instance, in an assisted
living or similar residential care community
Long-term care services provided by paid regulated providers
are an important component of personal health care
spending in the United States (6). Estimates of expenditures
for paid long-term care services vary, depending on what
types of providers, populations, and services are included.
According to a recent estimate, in 2013 total national
spending for paid long-term care services was almost $339
billion, with public spending accounting for about 72% of
this amount (7). The cost of long-term care services varies
by the type of paid care provided and the type of provider
or sector (e.g., adult day services centers, assisted living and
similar residential care communities, home health agencies,
or hospices) (2,8).
Finding a way to pay for long-term care services is a growing
concern for older adults, other persons with disabilities, and
their families, and it is a major challenge facing state and
federal governments (9–12). People who use paid long-term
care services, through home- and community-based services
or institutional care, are among the most costly participants
in Medicare and Medicaid programs (13). Medicaid finances
the largest portion of paid long-term care services, followed
by Medicare, out-of-pocket payments by individuals and
families, other private sources, private insurance, and other
public programs (4,6,14).
Medicaid finances a variety of long-term care services
through multiple mechanisms (e.g., Medicaid State Plan,
home- and community-based services waiver program, and
other options for community-based long-term care services),
including an array of home- and community-based services
and institutional services (15–17). Medicaid spending
on long-term care services totaled $158 billion in 2015,
accounting for 30% of total Medicaid expenditures (18). This
report does not address all long-term care services financed
by Medicaid. For example, intermediate care facilities for
people with intellectual or developmental disabilities are
excluded.
Experts disagree on whether Medicare expenditures for
skilled nursing facilities and home health agencies, since
they are postacute services, should be considered long-term
care services (14). This report includes Medicare-certified
skilled nursing facilities and home health agencies, which are
often referred to as postacute care services.
The distribution of the different financing sources described
previously varies by long-term care services sector and
population. For example, most residents pay out of pocket
for assisted living and similar residential care communities
(19), with a small percentage using Medicaid to help pay for
services (20). In contrast, the largest single payer for long-
term nursing home care is Medicaid, whereas Medicare
finances hospice costs and a major portion of the costs
for short-stay postacute care in skilled nursing facilities for
Medicare beneficiaries (21,22).
Although people of all ages may need long-term care
services, the risk of needing these services increases with
age. The number of Americans over age 65 is projected to
shift from 47.8 million in 2015 to over 87.9 million in 2050,
representing an increase of 84% and comprising 22% of
the population (23). The population aged 85 and over is
projected to triple, from 6.3 million in 2015 to over 18.9
million in 2050, and will account for almost 5% of the U.S.
population (23). This “oldest old” population tends to have
the highest disability rate and highest need for long-term
care services, and is also more likely to be widowed and
without someone to provide assistance with daily activities
(24,25). The number of older people in the United States
with significant physical or cognitive disabilities is projected
to increase from 6.3 million in 2015 to 15.7 million in 2065
(26).
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 (27). Among persons who need long-term
care services, adults aged 65 and over are more likely than
younger adults to receive paid help (28). Results from
the National Health and Aging Trends study show that
of the 10.9 million older adults who reported receiving
help with daily activities in a given month in 2011, about
3 in 10 received paid help (29). Recent projections using
microsimulation modeling estimate that about one-half of
Americans reaching age 65 will need long-term care services
and will incur, on average, $138,000 in long-term care costs
(26). The average projected length of needing long-term
NATIONAL CENTER FOR HEALTH STATISTICS 4 Series 3, Number 43
care services is 2 years, including an average length of 1 year
of paid long-term care services. However, about one-third of
people turning age 65 are projected to need long-term care
services for more than 2 years and to incur higher long-term
care services costs (26).
In sum, projections estimate that the number of older adults
using paid long-term care services will grow considerably
in the coming years (30–34). As a substantial share of paid
long-term care services is publicly funded through programs
such as Medicaid, accurate and timely statistical information
can help guide those programs and inform relevant policy
decisions. The National Study of Long-Term Care Providers
(NSLTCP) is designed to help supply this information.
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 has been growing
use of skilled nursing facilities for short-term postacute care
and rehabilitation (35). Additionally, consumers’ desire to
stay in their own homes, as well as federal and state policy
developments, have led to growth in a variety of home- and
community-based alternatives (36–38). Examples of these
federal and state policy developments include the Supreme
Court’s Olmstead decision; introduction of the Medicare
Prospective Payment System; and a variety of initiatives to
encourage balancing of Medicaid-financed services from
institutional to noninstitutional settings, such as Money
Follows the Person, Community First Choice Option, and the
Balancing Incentives Payment Program (39).
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.
In 2011, the National Center for Health Statistics (NCHS)
launched the biennial NSLTCP—an integrated strategy for
efficiently obtaining and providing statistical information
about the major sectors of paid, regulated long-term
care services in the United States. NSLTCP is designed to
provide reliable, accurate, relevant, and timely statistical
information to support and inform long-term care services
policy, research, and practice.
The main goals of NSLTCP are to:
1. Esmate the supply, provision, and use of paid, regulated
long-term care services
2. Esmate key policy-relevant characteriscs and pracces
3. Produce naonal and state esmates, where feasible
4. Compare esmates among sectors
5. Monitor trends over me
NSLTCP replaces NCHS’ periodic National Nursing Home
Survey and National Home and Hospice Care Survey,
as well as the one-time National Survey of Residential
Care Facilities. Unlike the previous strategy of surveying
major sectors of long-term care services separately and at
different times—often several years apart—NSLTCP intends
to provide information on five major sectors of providers
and services users at a similar point in time, and to provide
updated information on all five sectors every 2 years. The
NSLTCP core is designed to:
●
Broaden NCHS’ ongoing coverage of paid, regulated
long-term care services providers beyond home health
agencies, hospices, and nursing homes to also include
adult day services centers and assisted living and similar
residential care communities (called “residential care
communities” in this report)
●
Have the potential over time to add other types of paid,
regulated long-term care services providers (e.g., home
care agencies)
●
Capitalize on existing national administrative data from
the Centers for Medicare & Medicaid Services (CMS) on
home health agencies, hospices, and nursing homes
●
Collect primary data every other year from cross-
sectional, nationally representative, establishment-based
surveys of adult day services centers and residential care
communities, because administrative data do not exist
●
Produce state estimates, where feasible
●
Compare and monitor trends across the five sectors
In addition to the core content, the NSLTCP data collection
system provides the infrastructure on which to build
provider-specific 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 and Other NSLTCP
Products
This is the third edition of a descriptive overview report
intended to inform policy makers, providers, researchers,
consumer advocates, the media, foundations, and others
to inform planning for long-term care services. The report
includes two sections that present findings. “National Profile
of Long-term Care Services Providers” presents findings on
providers of long-term care services (i.e., adult day services
centers, home health agencies, hospices, nursing homes,
and residential care communities). This section includes
estimates on provider supply, organizational characteristics,
staffing, and services offered. New to this edition, this
section presents estimates on dietary and nutritional
services offered.
Staffing is especially important to examine because paid
long-term care services are provided by a wide array of
trained professionals and paraprofessionals, with the largest
Series 3, Number 43 5 NATIONAL CENTER FOR HEALTH STATISTICS
share—an estimated 70% to 80%—being direct care workers
that include certified nursing assistants and personal care
aides and home health aides, generally referred to as aides
(40,41). Previous studies have provided evidence that higher
nurse staffing levels are associated with higher quality of
care outcomes for nursing home residents (42–44); nursing
homes are required to meet minimum nurse staffing ratios
for participation in Medicare and Medicaid. Less research
has been conducted on staffing levels and outcomes in adult
day, home health, hospice, and residential care settings (for
an exception see reference 45).
In its 2008 report, “Retooling for an Aging America: Building
the Health Care Workforce,” 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 (46). According to one study, while
about 36,100 to 44,200 professional social workers were
employed in long-term care settings in 2002, approximately
110,000 social workers would be needed in these settings
by 2050 (47). Projections estimate that social workers and
home health and personal care aides are among the long-
term care services occupations that will grow the most by
2030 (48). This report contributes to the literature on the
long-term care services workforce by using NSLTCP data to
provide information by sector on the numbers of nursing,
licensed social work, and activities employees, and average
hours per service user day.
“National Profile of Long-term Care Services Users” presents
findings on users of long-term care services, including
participants of adult day services centers, patients of home
health agencies and of hospices, and residents of nursing
homes and of residential care communities. This section’s
topics include demographic characteristics; functional
status; selected health conditions, including Alzheimer
disease and other dementias; and adverse events among
services users, including hospitalizations and falls. Alzheimer
disease is a common precipitating factor for transition to
receiving long-term care services (49). According to the
Alzheimer’s Association, in 2018 there were about 5.7 million
Americans living with Alzheimer dementia; 5.5 million of
them were aged 65 and over (50). The number of people
with Alzheimer disease or other dementias will continue
to increase along with the growth of the older population
(49). New to this report, this section presents estimates
on 10 diagnoses; estimates on overnight hospitalizations
among nursing home residents; and estimates by length of
stay for selected characteristics (age, sex, race and ethnicity,
diagnoses, overnight hospital stays, and falls) for nursing
home residents.
The Technical Notes (Appendix I) describe the data sources
used to produce the information on providers and services
users in each of the five sectors, outlines the approach used
for data analyses, and discusses study limitations. Appendix
II defines each variable used for each sector in the study, and
Appendix III presents the data tables for the figures in the
report.
This report presents national results from the third wave of
NSLTCP, using data from surveys about adult day services
centers and participants, and residential care communities
and residents that were fielded by NCHS between August
2016 and February 2017. The report also uses data from
administrative records obtained from CMS on home health
agencies and patients, hospices and patients, and nursing
homes and residents, which reflect these providers and
services users between 2015 and 2016. See the Appendix I
Technical Notes for definitions of the five sectors and the
corresponding data sources used in this report.
This report also updates previous editions of this report:
“Long-Term Care Services in the United States: 2013
Overview”(https://www.cdc.gov/nchs/data/nsltcp/long_
term_care_services_2013.pdf), which reported findings from
the first NSLTCP wave conducted in 2012 (data years 2011
and 2012); and “Long-Term Care Providers and Services
Users in the United States: Data From the National Study of
Long-Term Care Providers, 2013–2014 (https://www.cdc.
gov/nchs/data/series/sr_03/sr03_038.pdf), which reported
findings from the second NSLTCP wave conducted in 2014
(data years 2013 and 2014).
A companion product, “Long-term Care Providers and Services
Users in the United States—State Estimates Supplement:
National Study of Long-Term Care Providers, 2015–2016,”
contains tables showing comparable state estimates for the
national findings in this report. These state tables update
previous editions of this product: “Long-Term Care Services
in the United States: 2013 State Web Tables and Maps”
(https://www.cdc.gov/nchs/data/nsltcp/State_estimates_
for_NCHS_Series_3_37.pdf); and “Long-Term Care Providers
and Services Users in the United States—State Estimates
Supplement: National Study of Long-Term Care Providers,
2013–2014 (https://www.cdc.gov/nchs/data/nsltcp/2014_
nsltcp_state_tables.pdf).
An additional companion product, “Long-term Care Services
Use Rates in the United States—U.S. Maps Supplement:
National Study of Long-Term Care Providers, 2015–2016,”
shows rates of use for each sector by state population of
adults aged 65 and over and aged 85 and over. These and
other NSLTCP results and publications, when published, will
be available from: https://www.cdc.gov/nchs/nsltcp/nsltcp_
products.htm. NCHS is fielding the fourth wave of NSLTCP
surveys between July 2018 and February 2019 and obtaining
the fourth wave of administrative data within a similar time
frame. NCHS intends to produce future reports to examine
trends over time and produce public-use survey data files
for the 2018 adult day services center and residential care
community surveys. The 2018 surveys are redesigned for
the first time to collect data on a scientifically drawn random
sample of individual adult day services center participants
and residential care residents.
The findings in this report provide the most current national
picture of providers and users of five major sectors of paid,
regulated long-term care services in the United States.
NATIONAL CENTER FOR HEALTH STATISTICS 6 Series 3, Number 43
Findings on differences and similarities in supply, provision,
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.
National Prole of Long-term Care
Services Providers
Supply of Long-term Care Services
Providers
As of 2016 in the United States, there were an estimated
4,600 adult day services centers, 12,200 home health
agencies, 4,300 hospices, 15,600 nursing homes, and 28,900
residential care communities. This 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-certified, and
hospices were Medicare-certified. Of these approximately
65,600 paid, regulated long-term care services providers,
7.0% were adult day services centers, 18.6% were home
health agencies, 6.6% were hospices, 23.8% were nursing
homes, and 44.1% were residential care communities.
This section provides an overview of the supply,
organizational characteristics, staffing, and services offered
by paid, regulated providers of long-term care services in
each of these five sectors. Supply information is provided
nationally, by census geographic region, and by metropolitan
statistical area (MSA) status. Organizational characteristics
include ownership type, chain affiliation, Medicare and
Medicaid certification, and number of people served.
Staffing measures include number and distribution of
nursing and social work employees; percentage of providers
employing any nursing, social work, or activities employees;
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, hospice, dietary and
nutritional services, and dementia care units.
Geographic distribuon
The supply of providers in the five long-term care services
sectors varied in their geographic distribution. The largest
share of adult day services centers (32.2%), home health
agencies (45.6%), hospices (39.4%), and nursing homes
(34.8%) was in the South, while the largest share of residential
care communities (40.8%) was in the West (Figure 1).
Figure 1. Percent distribution of long-term care services providers, by sector and
region: United States, 2016
NOTES: Percentages are based on unrounded estimates. Percent distributions may not add to 100 because of rounding.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table V in Appendix III.
0
20
40
60
80
100
West
South
Midwest
Northeast
40.8
28.0
22.6
8.6
Residential care
community (28,900)
15.4
34.8
33.0
16.8
Nursing home
(15,600)
28.6
39.4
21.8
10.4
Hospice
(4,300)
18.4
45.6
27.4
8.6
Home health
agency (12,200)
30.8
32.2
16.9
20.1
Adult day services
center (4,600)
Percent
Series 3, Number 43 7 NATIONAL CENTER FOR HEALTH STATISTICS
Metropolitan and micropolitan statistical areas are
geographic entities defined by the Office of Management
and Budget for use by federal statistical agencies in collecting,
tabulating, and publishing federal statistics.
A metropolitan statistical area contains a core urban area
of 50,000 or more population, and a micropolitan statistical
area contains an urban core of at least 10,000 (but less than
50,000) population. Each metropolitan or micropolitan
statistical 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 (51). Most providers in all five long-
term care services sectors were in MSAs (Figure 2). This
distribution reflects the higher population density in these
areas. Compared with hospices (79.0%) and nursing homes
(71.5%), a greater percentage of adult day services centers
(84.8%), home health agencies (84.8%), and residential care
communities (82.5%) were located in metropolitan areas.
Capacity
Based on the maximum number of participants allowed, the
4,600 adult day services centers in the country could serve
a daily maximum of up to 298,400 participants nationally
(Appendix III, Table V). The allowable daily capacity of adult
day services centers ranged from 2 to 530, with an average
of 66 participants. The 15,600 nursing homes in the country
provided a total of 1,660,400 certified beds. Nursing homes
ranged in capacity from 2 to 1,389 certified beds, with an
average of 106 certified beds. The 28,900 residential care
communities in the United States provided 996,100 licensed
beds. Residential care communities ranged in capacity from
4 to 518 licensed beds, with an average of 35 licensed beds.
Capacity for home health agencies and hospices was not
examined because licensed maximum capacity or a similar
metric was not available.
The supply of adult day services center capacity and nursing
home and residential care beds varied by region (Figure 3).
Compared with other regions, the Midwest had the largest
supply of nursing home beds (45) and the smallest supply
of adult day services center capacity (3) per 1,000 persons
aged 65 and over. The West (25) and Midwest (24) had a
Figure 2. Percent distribution of long-term care services providers, by sector and
metropolitan statistical area status: United States, 2016
0
20
40
60
80
100
Metropolitan
Micropolitan
Neither
NOTES: Metropolitan statistical areas and micropolitan statistical areas are geographic entities delineated by the Office of Management and Budget for use by federal statistical
agencies in collecting, tabulating, and publishing federal statistics. A metropolitan statistical area contains a core urban area of 50,000 or more population, and a micropolitan
statistical area contains an urban core of at least 10,000 (but less than 50,000) population. Each metropolitan or micropolitan statistical 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 (see reference 51 in report). Percentages are based on unrounded estimates. Percent distributions may not add to 100 because of rounding.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table V in Appendix III.
Adult day
services center
5.0
10.2
84.8
Home health
agency
7.2
8.1
84.8
Hospice
8.2
12.8
79.0
Nursing home
14.6
13.9
71.5
Residential care
community
6.9
10.6
82.5
Percent
NATIONAL CENTER FOR HEALTH STATISTICS 8 Series 3, Number 43
Figure 3. Long-term care services provider capacity per 1,000 people aged 65 and over,
by sector and region: United States, 2015–2016
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. See Appendix II for definitions of capacity used for each sector. Capacity for home health agencies and hospices was not examined because licensed
maximum capacity or a similar metric was not available. Rates are based on unrounded estimates.
SOURCES: NCHS, National Study of Long-Term Care Providers.
0
10
20
30
40
50
WestSouthMidwestNortheastTotal
Percent
Licensed residential care
community beds
Certified nursing
home beds
Adult day services center
maximum participants
allowed
6
34
20
7
39
17
3
45
24
6
33
18
10
21
25
Figure 4. Percent distribution of long-term care services providers, by sector and
ownership: United States, 2016
0
20
40
60
80
100
NOTES: See Appendix II for definitions of ownership used for each sector. Percentages are based on unrounded estimates. Percent distributions may not add to 100 because of
rounding.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table V in Appendix III.
Adult day services
center
4.6
50.8
44.7
Home health
agency
4.6
14.8
80.6
Hospice
14.1
22.8
63.0
Nursing home Residential care
community
Percent
7.2
23.5
69.3
Government
and other
Nonprofit
For profit
1.3
17.7
81.0
Series 3, Number 43 9 NATIONAL CENTER FOR HEALTH STATISTICS
aged 65 and over. The West (25) and
Midwest (24) had a larger supply of
residential care beds per 1,000 persons
aged 65 and over compared with the
Northeast (17) and the South (18).
In the West, the supply of residential
care beds (25) was greater than
the supply of nursing home beds
(21) per 1,000 persons aged 65 and
over, whereas nursing home beds
outnumbered residential care beds in
all other regions.
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 profit
(Figure 4). Home health agencies (80.6%)
and residential care communities (81.0%)
had the highest percentages of for-profit
ownership, while adult day services
centers (44.7%) had the lowest
percentage. About one-half of adult day
services centers were nonprofit (50.8%).
Chain status
The majority of nursing homes (57.6%)
and residential care communities
(57.2%) were chain-affiliated, while
fewer adult day services centers
(42.6%) were part of a chain (Figure 5).
Chain affiliation for home health
agencies and hospices was not
examined because this information
was not available.
Medicare and Medicaid
cercaon
All data on home health agencies and
nursing homes used in this report
are only for Medicare- or Medicaid-
certified providers, and all data on
hospices are only for Medicare-
certified hospices. Almost all nursing
homes (95.2%), about three-quarters
of adult day services centers (76.9%)
and home health agencies (78.4%),
and almost one-half of residential
care communities (48.3%) were
Figure 5. Percentage of long-term care services providers
that are chain-affiliated, by sector: United States, 2016
NOTES: See Appendix II for definitions of chain affiliation used for each sector. Chain affiliation for home health
agencies and hospices was not examined because this information was not available. Percentages are based on
unrounded estimates.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table V in Appendix III.
0
10
20
30
40
50
60
Residential care
community
Nursing homeAdult day services
center
42.6
57.6
57.2
Percent
Figure 6. Percentage of long-term care services providers
that are Medicare- and Medicaid-certified, by sector:
United States, 2016
. . . Category not applicable.
NOTES: See Appendix II for definitions of Medicare and Medicaid certifications used for each sector. Percentages
are based on unrounded estimates.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table V in Appendix III.
Residential care
community
Nursing homeHome health
agency
Adult day services
center
0
20
40
60
80
100
Percent
76.9
98.7
78.4
97.5
95.2
48.3
. . .. . .
Medicaid-certifiedMedicare-certified
NATIONAL CENTER FOR HEALTH STATISTICS 10 Series 3, Number 43
authorized or certified to participate
in Medicaid (Figure 6). Information
was not available on whether any of
the Medicare-certified hospices were
also certified by Medicaid. Virtually all
home health agencies (98.7%), hospices
(100.0%; data not shown in figure), and
nursing homes (97.5%) were Medicare-
certified. In 2016, Medicare did 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 certification.
Number of people served
See Appendix II for how number of
people served was defined for each
sector.
In terms of persons served daily per
provider, nursing homes served, on
average, more than twice the number
of people as adult day services centers,
and three times the number of people
as residential care communities.
Nursing homes housed an average
of 86 current residents daily, while
adult day services centers had a
mean weekday daily attendance of
42 participants, and residential care
communities served an average of 28
residents daily (Appendix III, Table V).
The majority of nursing homes
served between 26 and 100 residents
daily (63.7%), while the majority of
residential care communities served
25 residents or fewer daily (65.0%)
(Figure 7). Nearly one-half of adult
day services centers served 26 to
100 participants daily (48.6%); 45.0%
served 25 participants or fewer.
Figure 7 does not include data for
home health agencies or hospices
because the data on services users in
these sectors that were used for this
report are for patients served annually,
not daily. Daily use among home
health agencies and hospices could
not be derived from these data.
The percentage of nursing homes
serving more than 100 persons daily
(30.6%) was almost five times as large
as the percentage of adult day services
centers (6.4%) doing so and almost
Figure 7. Percent distribution of long-term care services
providers, by sector and number of people served daily:
United States, 2016
NOTES: Number of people served categorizes the number of current residents (nursing homes and residential care
communities) or the average daily attendance of participants in a typical week (adult day services centers) into three
categories: 1–25, 26–100, and 101 or more. See Appendix II for definitions of number of people served for each
sector. Figure does not include home health agencies or hospices because the data on services users in these
sectors that were used for this report are about patients served annually, not daily. Daily use among home health
agencies and hospices could not be derived from these data. Percentages are based on unrounded estimates.
Percent distributions may not add to 100 because of rounding.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table V in Appendix III.
0
20
40
60
80
100
Percent
Adult day services
center
6.4
48.6
45.0
Nursing home
30.6
63.7
5.7
101 or
more
26–100
1–25
Residential care
community
4.3
30.7
65.0
Figure 8. Percent distribution of long-term care services
providers, by sector and number of people served
annually: United States, 2015
NOTES: Number of people served is derived from the number of home health patients whose episode of care
ended at any time in 2015 and the number of hospice patients receiving care at any time in 2015, respectively, and
has three categories: 1–100, 101–300, and 301 or more. See Appendix II for definitions of number of people served
for each sector. This figure does not include adult day services centers, nursing homes, or residential care
communities because the data on services users in these sectors that were used for this report are about services
users served daily, not annually. Annual use among adult day services centers, nursing homes, or residential care
communities could not be derived from these data. Percentages are based on unrounded estimates. Percent
distributions may not add to 100 because of rounding.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table V in Appendix III.
0
20
40
60
80
100
Home health agency
29.4
25.8
44.8
301 or
more
101–300
1–100
Hospice
31.8
34.0
34.2
Percent
Series 3, Number 43 11 NATIONAL CENTER FOR HEALTH STATISTICS
eight times as large as the percentage of residential care
communities (4.3%) doing so (Figure 7).
In terms of persons served annually, a home health agency
served an average of 401 patients who were then discharged
from the agency in 2015, while a hospice served an average
of 353 patients during the year (Appendix III, Table V).
About 44.8% of home health agencies discharged 100
patients or fewer annually, while 25.8% discharged 101 to
300, and 29.4% discharged more than 300 (Figure 8). The
number of patients served annually per hospice agency was
about evenly distributed, with about one-third of agencies
each serving 1 to 100 patients (34.2%), 101 to 300 patients
(34.0%), and more than 300 patients (31.8%). Figure 8 does
not include data for adult day services centers, nursing
homes, or residential care communities because the data on
services users in these sectors that were used for this report
are for services users served daily, not annually. Annual
use among adult day services centers, nursing homes, and
residential care communities could not be derived from
these data.
Staffing: Nursing, Social Work, and
Activities 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,
social workers, and activities staff. See Appendix II for the
definition of full-time equivalent (FTE) and each staff type
used for each sector. Contract staff that work for these
providers were excluded because comparable information
on contract staff was not available for all five sectors.
Nursing and social work employee full-me
equivalents
In 2016, about 1,460,400 nursing employee FTEs—including
RNs, LPNs or LVNs, and aides—and about 35,000 social work
employee FTEs were working in the five sectors (data not
shown). Of these nursing and social work employees in the
five sectors, 63.3% (945,700 FTEs) worked in nursing homes,
20.0% (298,800 FTEs) were residential care community
employees, 9.7% (145,000 FTEs) were employed by home
health agencies, 5.7% (85,600 FTEs) were employed by
hospices, and 1.3% (19,900 FTEs) were adult day services
center employees.
The relative distribution of social work and nursing
employee FTEs varied across sectors. In adult day services
centers (56.8%), nursing homes (63.9%), and residential care
communities (83.3%), the majority of these employee FTEs
Figure 9. Total number and percent distribution of nursing and social work full-time
equivalent employees, by sector and staff type: United States, 2016
NOTES: FTEs is full-time equivalent. 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 the Appendix I Technical Notes for information on how outliers were identified and
coded. Percentages are based on unrounded estimates. Percent distributions may not add to 100 because of rounding.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table VI in Appendix III.
0
20
40
60
80
100
Percent
Adult day
services center
(19,900 FTEs)
20.6
11.3
56.8
11.3
Hospice
(85,600 FTEs)
48.0
8.8
31.8
11.4
Home health
agency
(145,000 FTEs)
53.0
19.5
25.1
2.5
11.9
22.4
63.9
Nursing home
(945,700 FTEs)
1.8
Registered nurse
Licensed practical or
vocational nurse
Aide
Social worker
Residential care
community
(298,800 FTEs)
6.1
9.9
83.3
0.8
NATIONAL CENTER FOR HEALTH STATISTICS 12 Series 3, Number 43
were aides (Figure 9). However, in home health agencies
(53.0%) and hospices (48.0%), RNs were the most common
of these employee FTEs. Social work FTE employees were
more common in adult day services centers (11.3%) and
hospices (11.4%) than in the other sectors.
The administrative data used in this report for the home
health, hospice, and nursing home sectors used 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 II for how aide was defined for each sector.
Providers employing any nursing, social work, or
acvies sta
Among the four staff types examined across all five sectors,
employing any aides showed the least variation by sector
(Figure 10). In all five sectors, the majority of providers
employed aides; nursing homes were most likely (98.8%)
and adult day services centers were least likely (67.3%) to
have any aides on staff.
The majority of providers in all sectors except residential
care communities employed licensed nursing staff (either
RNs, or LPNs or LVNs). Virtually all home health agencies,
hospices, and nursing homes employed at least one RN
(99.7%, 100.0%, and 99.1%, respectively). In contrast, 62.1%
of adult day services centers and 39.4% of residential care
communities directly employed any RNs. The majority of
nursing homes (98.3%), home health agencies (70.7%),
and hospices (62.5%) employed at least one LPN or LVN,
whereas a minority of adult day services centers (45.8%) and
residential care communities (35.7%) directly employed any
LPNs or LVNs.
Employing any social workers showed the most variation
across five sectors. Virtually all hospices employed social
workers (99.3%), as did 76.8% of nursing homes. About
46.7% of home health agencies and 39.9% of adult day
services centers employed social workers; however, only
10.2% of residential care communities directly employed
social workers.
The majority of nursing homes (96.7%), adult day services
centers (84.8%), and residential care communities (58.3%)
directly employed an activities director or activities staff.
Figure 10. Percentage of long-term care services providers with any full-time equivalent
employees, by sector and staff type: United States, 2016
Any activities
director or staff
Any social workerAny aideAny licensed practical
or vocational nurse
Any registered nurse
- - - Data not available.
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 the Appendix I Technical Notes for information on how outliers were identified and coded.
Percentages are based on unrounded estimates.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table VI in Appendix III.
0
20
40
60
80
100
Percent
99.1
98.3
98.8
76.8
96.7
39.4
35.7
81.7
10.2
58.3
62.1
45.8
67.3
84.8
39.9
99.7
70.7
89.9
46.7
- - -
100.0
62.5
97.8
99.3
- - -
Hospice Nursing home Residential
care community
Home health agencyAdult day
services center
Series 3, Number 43 13 NATIONAL CENTER FOR HEALTH STATISTICS
Use of any activities staff was not examined for home health
agencies and hospices because this information was not
available.
Stang hours for nursing, social work, and
acvies sta
Rather than hours per day, which have been used in nursing
home and residential care settings, alternative staffing
metrics have been reported in the literature for adult day
services centers, home health agencies, and hospices, such
as average number of visits per 8-hour day (52) and worker-
to-participant ratio (53). However, to provide a measure by
which to compare staffing levels across sectors, hours per
user (resident or participant) per day are provided in this
report. See Technical Notes (Appendix I) and Appendix II for
details on how hours per resident or participant per day were
computed for adult day services centers, nursing homes,
and residential care communities. Hours per patient per 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, which is needed to produce this estimate.
For both licensed nursing staff types examined (i.e., RN, or LPN
or LVN), the average staff hours per resident or participant
per day was higher in nursing homes than in residential care
communities and adult day services centers (Figure 11). In
contrast, the average social work staff hours per resident or
participant per day was higher in adult day services centers
(0.13 hours or 8 minutes) than in nursing homes (0.08 hours
or 5 minutes) or residential care communities (0.03 hours
or 2 minutes), and the average activities staff hours per
resident or participant per day in adult day services centers
(0.67 hours or 40 minutes) was more than twice the size of
the ratio for residential care communities (0.31 hours or 19
minutes) or nursing homes (0.19 hours or 11 minutes).
The average total nursing hours (combining RNs, LPNs or
LVNs, and aides) per resident or participant per day was 3.80
(3 hours and 48 minutes) for nursing home residents, 2.64
(2 hours and 38 minutes) for residential care residents, and
1.41 (1 hour and 25 minutes) for adult day participants. The
average total nursing hours per resident per day in nursing
homes was more than twice the size of the ratio for adult
day services centers.
Figure 11. Average staff hours per resident or participant per day, by sector and staff
type: United States, 2016
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 was computed by multiplying the
number of full-time equivalent (FTE) employees for the staff type by 35 hours, and divided by average daily attendance of participants and by 5 days. For nursing homes and
residential care communities, average hours per resident per day was 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 the Appendix I Technical Notes for information on how outliers were identified and coded. Hours per patient per 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, which is needed to produce this estimate. Rates are based on unrounded estimates.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table VI in Appendix III.
0 1 2 3 4 5
Hour
Adult day services center 0.34 0.21 0.86 0.67
0.13
Nursing home 0.54 0.85 2.41 0.19
0.08
Residential care community 2.27 0.31
0.03
0.17
0.20
Activities director or staffSocial workerAideLicensed practical or
vocational nurse
Registered nurse
NATIONAL CENTER FOR HEALTH STATISTICS 14 Series 3, Number 43
The average total licensed nursing hours (combining RNs
with LPNs and LVNs) per resident or participant per day was
1.39 (1 hour and 23 minutes) for nursing home residents,
0.55 (33 minutes) for adult day participants, and 0.37
(22 minutes) for residential care residents. The average
licensed nursing hours per resident or participant per day
in nursing homes was more than twice the size of the
corresponding ratios for residential care communities and
adult day services centers.
Services Provided
This section provides information on what percentage
of providers in each sector (where data were applicable
and available) offered each of seven services: social
work; mental health or counseling; therapies (physical,
occupational, and speech); skilled nursing or nursing;
pharmacy or pharmacist; hospice; and dietary and nutrition.
Services could be provided directly by the provider or by
others through arrangement by the provider. These seven
services were chosen because they are commonly provided
by Medicare- and Medicaid-certified long-term care services
providers, and administrative data were available for most
sectors. However, the available administrative data did not
have information on whether or not the following sectors
provided mental health or counseling services (home health
agencies) and pharmacy or pharmacist services (hospices).
In addition to the seven services listed, the provision of
dementia special care units is also included. See Appendix II
for definitions of services included for each sector.
As was done for the 2014 adult day and residential care
community questionnaires—but in contrast with the 2012
adult day and residential care community questionnaires—
for each service in the 2016 questionnaires, if an adult day
services center or residential care community reported
offering only referrals to participants or residents,
respectively, the provider was considered as not providing
the service. See Technical Notes (Appendix I) for more
information on differences in how services were measured
in 2012 compared with the 2014 and 2016 adult day and
residential care community questionnaires.
Social work services
The majority of providers in all sectors offered social work
services (Figure 12). All hospices provided social work
services (100.0%), as did most nursing homes (88.5%) and
home health agencies (82.5%), likely because providing
these services is required for Medicare certification.
Figure 12. Percentage of long-term care services providers that provide social work
services, by sector: United States, 2016
NOTES: Social work services refer 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. See Appendix II for definitions of the provision of social work services for each sector. See
the Appendix I Technical Notes for an explanation of differences in how services were measured in 2012, 2014, and 2016. Percentages are based on unrounded estimates.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table VII in Appendix III.
Percent
0
20
40
60
80
100
Residential care
community
Nursing homeHospiceHome health
agency
Adult day services
center
52.1
82.5
100.0
88.5
51.1
Series 3, Number 43 15 NATIONAL CENTER FOR HEALTH STATISTICS
Fewer adult day services centers (52.1%) and residential
care communities (51.1%) reported providing social work
services.
Mental health or counseling services
Mental health or counseling services were offered by most
hospices (97.0%), nursing homes (87.6%), and the majority
of residential care communities (55.0%), while about one-
third of adult day services centers (33.8%) reported offering
these services (Figure 13).
Therapeuc services
Virtually all nursing homes (99.5%), hospices (98.2%),
and home health agencies (96.3%) offered therapeutic
services, as did more than seven-tenths of residential care
communities (71.4%) and almost one-half of adult day
services centers (46.7%) (Figure 14).
Skilled nursing or nursing services
All home health agencies, hospices, and nursing homes
(100.0%) offered skilled nursing or nursing services, as
did the majority of adult day services centers (64.5%) and
residential care communities (66.1%) (Figure 15).
Pharmacy or pharmacist services
Nearly all nursing homes (97.2%) and more than four-fifths
of residential care communities (83.6%) offered pharmacy or
pharmacist services, while fewer adult day services centers
(30.0%) and home health agencies (4.9%) provided these
services (Figure 16).
Hospice services
About 80.7% of nursing homes offered hospice services,
compared with 67.7% of residential care communities,
20.8% of adult day services centers, and 5.7% of home
health agencies (Figure 17).
Dietary and nutrional services
All nursing homes (100.0%) and 82.8% of residential care
communities offered dietary and nutritional services, while
67.8% of adult day services centers provided these services
(Figure 18).
Demena care units
About 14.9% of nursing homes and 14.3% of residential
care communities offered a dementia care unit within
Figure 13. Percentage of long-term care services providers that provide mental health or
counseling services, by sector: United States, 2016
NOTES: Mental health services refer to services that target residents' mental, emotional, psychological, or psychiatric well being, and include diagnosing, describing, evaluating, and
treating mental conditions. See Appendix II for definitions of the provision of mental health services for each sector. See the Appendix I Technical Notes for an explanation of
differences in how services were measured in 2012, 2014, and 2016. The available administrative data did not have information on whether or not home health agencies provided
mental health or counseling services. Percentages are based on unrounded estimates.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table VII in Appendix III.
Percent
0
20
40
60
80
100
Adult day services
center
33.8
Hospice
97.0
Nursing home
87.6
Residential care
community
55.0
NATIONAL CENTER FOR HEALTH STATISTICS 16 Series 3, Number 43
Figure 14. Percentage of long-term care services providers that provide any therapeutic
services, by sector: United States, 2016
NOTES: Any therapeutic services refer to physical, occupational, or speech therapy services. See Appendix II for definitions of the provision of any therapeutic services for each
sector. See the Appendix I Technical Notes for an explanation of differences in how services were measured in 2012, 2014, and 2016. Percentages are based on unrounded estimates.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table VII in Appendix III.
Percent
0
20
40
60
80
100
Adult day services
center
46.7
Home health
agency
96.3
Hospice
98.2
Nursing home
99.5
Residential care
community
71.4
Figure 15. Percentage of long-term care services providers that provide skilled nursing
or nursing services, by sector: United States, 2016
NOTES: Skilled nursing services refer to services that must be performed by a registered nurse or licensed vocational or practical nurse and are medical in nature. See Appendix II
for definitions of the provision of skilled nursing services for each sector. See the Appendix I Technical Notes for an explanation of differences in how services were measured in 2012,
2014, and 2016. Percentages are based on unrounded estimates.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table VII in Appendix III.
Percent
Residential care
community
Nursing homeHospiceHome health
agency
Adult day services
center
64.5
100.0 100.0 100.0
66.1
0
20
40
60
80
100
Series 3, Number 43 17 NATIONAL CENTER FOR HEALTH STATISTICS
a larger facility or community
(Figure 19). While another 8.7% of
residential care communities served
only residents with dementia, few
nursing homes (0.4%) did so. Dementia
care units or dementia-only providers
were not examined for adult day
services centers, home health agencies,
or hospices because these topics are
more relevant for residential sectors,
such as nursing homes and residential
care communities.
National Prole of
Long-term Care
Services Users
In this report, “current” participants
or residents in 2016 refers to those
participants enrolled in the adult day
services center, or residents living
in the nursing home or residential
care community, on the day of data
collection in 2016, rather than the total
number of participants ever enrolled
in the center or residents ever living
in the nursing home or residential care
Figure 16. Percentage of long-term care services providers that provide pharmacy or
pharmacist services, by sector: United States, 2016
NOTES: Pharmacy services refer to the filling and delivery of prescriptions. See Appendix II for definitions of the provision of pharmacy services for each sector. See the Appendix I
Technical Notes for an explanation of differences in how services were measured in 2012, 2014, and 2016. The available administrative data did not have information on whether or
not hospices provided pharmacy or pharmacist services. Percentages are based on unrounded estimates.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table VII in Appendix III.
Percent
0
20
40
60
80
100
Adult day services
center
30.0
Home health
agency
4.9
Nursing home
97.2
Residential care
community
83.6
Figure 17. Percentage of long-term care services
providers that provide hospice services, by sector:
United States, 2016
NOTES: See Appendix II for definitions of the provision of hospice services for each sector. See the Appendix I
Technical Notes for an explanation of differences in how services were measured in 2012, 2014, and 2016. All
hospices were expected to provide hospice services. Percentages are based on unrounded estimates.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table VII in Appendix III.
Percent
0
20
40
60
80
100
Adult day
services center
20.8
Home health
agency
5.7
Nursing home
80.7
Residential care
community
67.7
NATIONAL CENTER FOR HEALTH STATISTICS 18 Series 3, Number 43
community at any time throughout
the 2016 calendar year.
In 2016, there were an estimated
286,300 current participants enrolled
in adult day services centers (of
which 193,400 attended on a typical
day) and 811,500 current residents
living in residential care communities
(Appendix III, Table VIII). Of the
1,347,600 current residents in nursing
homes in 2016, about 606,800—
approximately 43%—had a stay of
less than 100 days (short stay), and
794,000—approximately 57%—had a
stay of 100 days or longer (long stay)
(Appendix III, Table IX). The number
of nursing home residents by length
of stay (short and long stay) is based
on the number of residents in the
Minimum Data Set Active Resident
Episode Table (MARET) (see the
Appendix I Technical Notes), but the
total number of nursing home residents
is based on Certification and Survey
Provider Enhanced Reports (CASPER).
After merging MARET and CASPER,
some residents from MARET could
not be matched with the CASPER file
and therefore were not included in
the merged data file, resulting in a
difference between the estimated
total number of residents in nursing
homes and the estimated total derived
from the sum of short- and long-stay
residents. In 2015, about 4,455,700
patients received services and were
discharged from home health agencies,
and 1,426,000 patients received services
from hospices. See the Appendix I
Technical Notes for more information
on the definitions of services users and
data sources used for each sector.
Together these five long-term care
services sectors served over 8.3
million (8,327,100) people annually.
This estimate is the sum of the
estimates of the people served in
each of the five sectors, and is a rough
approximation. The data used for
each sector captured services users
in different ways, and the data year
used for each sector varied across
sectors. The estimated number of
adult day services center participants
represents current participants in
2016. The estimated number of home
Figure 18. Percentage of long-term care services
providers that provide dietary and nutritional services, by
sector: United States, 2016
NOTES: See Appendix II for definitions of the provision of dietary and nutritional services for each sector. See the
Appendix I Technical Notes for an explanation of differences in how services were measured in 2012, 2014, and
2016. The available administrative data did not have information on whether or not home health agencies or
hospices provided dietary and nutritional services. Percentages are based on unrounded estimates.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table VII in Appendix III.
Percent
Residential care
community
Nursing home
Adult day services
center
0
20
40
60
80
100
67.8
100.0
82.8
Figure 19. Percent distribution of long-term care services
providers, by sector and dementia care unit:
United States, 2016
NOTES: See Appendix II for definitions of dementia care units for each sector. Dementia care units or dementia-only
providers were not examined for adult day services centers, home health agencies, or hospices because these topics
are more relevant for residential sectors such as nursing homes and residential care communities. Percentages are
based on unrounded estimates. Percent distributions may not add to 100 because of rounding.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table VII in Appendix III.
0
20
40
60
80
100
Only serving adults
with dementia
With a unit, wing, or
floor designated as
a dementia care unit
Without dementia
care units
Percent
Nursing home
0.4
14.9
84.7
Residential care community
8.7
14.3
77.0
Series 3, Number 43 19 NATIONAL CENTER FOR HEALTH STATISTICS
health patients represents patients who ended care in
2015 (i.e., discharges). The estimated number of hospice
patients represents patients who received care at any time
in 2015. The estimated number of nursing home residents
and residential care community residents each represent
current residents on any given day in 2016. The same person
may be included more than once in the sum of services
users in the five sectors, 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).
Given that the estimate for the number of current adult day,
nursing home, and residential care services users in a given
year is likely to be less than the number of all services users
in these sectors throughout that year, it is expected that the
estimate of all services users in all five sectors as of 2016
is at least nine million, in spite of the possibility of double
counting the same person across sectors.
This section provides an overview of the demographic,
health, and functional composition of users of long-term care
services, and their experience of adverse events, by sector.
Demographic measures include age, race and ethnicity, and
sex. Medicaid as a payer source is used to measure payment
characteristics. Measures of health status include diagnosis
of Alzheimer disease and other dementias, arthritis, asthma,
chronic kidney disease, chronic obstructive pulmonary
disease (COPD), depression, diabetes, heart disease, high
blood pressure or hypertension, and osteoporosis. Measures
of functional status include needing assistance with selected
activities of daily living (ADLs; bathing, dressing, eating,
toileting, transferring in and out of a chair or bed, and
walking or locomotion). Measures of adverse events include
overnight hospital stays, emergency department visits, and
falls.
Use of Long-term Care Services
As noted previously, participants in adult day services
centers and residents in nursing homes and residential
care communities are current users in 2016. Home health
patients refer to patients who ended home health care
anytime in 2015. Hospice patients refer to patients who
received care anytime in 2015. 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. Use of long-
term care services by individuals aged 65 and over per 1,000
persons aged 65 and over varied by sector. The daily-use
rate was higher for nursing homes (24 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 (75 per 1,000) compared
with hospices (27 per 1,000).
Demographic Characteristics of Long-
term Care Services Users
Long-term care services users by age
The majority of long-term care services users were aged 65
and over: 94.6% of hospice patients, 93.4% of residential
care residents, 83.5% of nursing home residents, 81.9% of
home health patients, and 62.5% of participants in adult
day services centers (Figure 20). Among nursing home
residents, 81.4% of short-stay residents and 85.1% of long-
stay residents were aged 65 and over (Appendix III, Table IX).
The age composition of services users varied by sector, with
residential care communities (52.1%), hospices (47.8%), and
nursing homes (38.6%) serving more persons aged 85 and
over, and adult day services centers (37.4%) serving more
persons under age 65 than other sectors. Among nursing
home residents, 32.2% of short-stay residents and 43.5%
of long-stay residents were aged 85 and over (Appendix III,
Table IX).
Long-term care services users by sex
In all five sectors, the users of long-term care services were
overwhelmingly women, with residential care communities
having the highest proportion (70.6%) (Figure 21). Among
nursing home residents, 60.3% of short-stay residents and
67.9% of long-stay residents were women (Appendix III,
Table IX).
Long-term care services users 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 percentage of
non-Hispanic white persons was highest in hospice (83.6%)
and residential care communities (81.4%), followed by home
health agencies (76.1%) and nursing homes (75.1%). Less
than one-half of the participants in adult day services centers
were non-Hispanic white (42.0%). Adult day services centers
were the most racially and ethnically diverse among the five
sectors: 15.4% of center participants were non-Hispanic
black and 22.7% were Hispanic. About one-tenth of home
health patients (12.9%), nursing home residents (14.3%),
and hospice patients (8.2%) were non-Hispanic black, while
4.1% of residential care residents were non-Hispanic black.
In nursing homes, 74.6% of short-stay residents and 75.6%
of long-stay residents were non-Hispanic white, followed
by non-Hispanic black (14.0% and 14.6% among short- and
long-stay residents, respectively) (Appendix III, Table IX).
NATIONAL CENTER FOR HEALTH STATISTICS 20 Series 3, Number 43
Figure 20. Percent distribution of long-term care services users, by sector and age
group: United States, 2015 and 2016
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 2016, respectively. Denominators
used to calculate percentages for home health agencies and hospices were the number of patients whose episode of care ended at any time in 2015 and the number of patients for
whom Medicare-certified hospices submitted a Medicare claim at any time in 2015, respectively. See the Appendix I Technical Notes for more information on the data sources used
for each sector. Percentages are based on unrounded estimates. Percent distributions may not add to 100 because of rounding.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table VIII in Appendix III.
Nursing home
38.6
26.7
18.2
16.5
Hospice
47.8
29.3
17.5
5.5
Home health
agency
25.2
29.9
26.8
18.1
Adult day
services center
16.3
25.9
20.3
37.4
Percent
0
20
40
60
80
100
Residential care
community
52.1
30.3
11.0
6.6
85 and over
75–84
65–74
Under 65
Figure 21. Percent distribution of long-term care services users, by sector and sex:
United States, 2015 and 2016
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 2016, respectively. Denominators
used to calculate percentages for home health agencies and hospices were the number of patients whose episode of care ended at any time in 2015 and the number of patients for
whom Medicare-certified hospices submitted a Medicare claim at any time in 2015, respectively. See the Appendix I Technical Notes for more information on the data sources used
for each sector. Percentages are based on unrounded estimates. Percent distributions may not add to 100 because of rounding.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table VIII in Appendix III.
Percent
0
20
40
60
80
100
Women
Men
Adult day
services center
58.2
41.8
Home health
agency
60.9
39.1
Hospice
58.7
41.3
Nursing home
64.6
35.4
Residential care
community
70.6
29.4
Series 3, Number 43 21 NATIONAL CENTER FOR HEALTH STATISTICS
Figure 22. Percent distribution of long-term care services users, by sector and race and
Hispanic origin: United States, 2015 and 2016
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 2016, respectively.
Denominators used to calculate percentages for home health agencies and hospices were the number of patients for whom Medicare-certified home health agencies submitted a
Medicare claim at any time in 2015 and the number of patients for whom Medicare-certified hospices submitted a Medicare claim at any time in 2015, respectively. For adult day
services centers and residential care communities, includes non-Hispanic American Indian or Alaska Native, non-Hispanic Asian, non-Hispanic Native Hawaiian or Other Pacific
Islander, non-Hispanic of two or more races, and unknown race and ethnicity. See the Appendix I Technical Notes for more information on the data sources used for each sector.
Percentages are based on unrounded estimates. Percent distributions may not add to 100 because of rounding.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table VIII in Appendix III; and U.S. Census Bureau, Population Division, Population Estimates, July 1, 2016.
Percent
0
20
40
60
80
100
Non-Hispanic other
Non-Hispanic black
Non-Hispanic white
Hispanic
Residential
care
community
11.5
4.1
81.4
3.1
Nursing
home
5.1
14.3
75.1
5.4
Hospice
2.7
8.2
83.6
5.5
Home health
agency
3.7
12.9
76.1
7.4
Adult day
services
center
19.8
15.4
42.0
22.7
Population
aged 65
and over
5.3
8.7
78.3
7.7
Figure 23. Percentage of long-term care services users with Medicaid as payer source,
by sector: United States, 2015 and 2016
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 2016, respectively. The
denominator used to calculate the percentage for home health agencies was the number of patients whose episode of care ended at any time in 2015. Data on Medicaid as payer
source were not available for hospice patients. See Appendix II for definitions of Medicaid as payer source for each sector. Percentages are based on unrounded estimates.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table VIII in Appendix III.
Percent
0
20
40
60
80
100
Adult day services
center
65.8
Home health
agency
9.5
Nursing home
61.8
Residential care
community
16.5
NATIONAL CENTER FOR HEALTH STATISTICS 22 Series 3, Number 43
Figure 24. Percentage of long-term care services users with selected diagnoses, by
sector: United States, 2015 and 2016
Residential care community
Nursing home
Hospice
Home health agency
Adult day services center
- - - Data not available.
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 2016, respectively. Denominators
used to calculate percentages for home health agencies and hospices were the number of patients for whom Medicare-certified home health agencies submitted a Medicare claim at
any time in 2015 and the number of patients for whom Medicare-certified hospices submitted a Medicare claim at any time in 2015, respectively. See the Appendix I Technical Notes
for more information on the data sources used for each sector. See Appendix II for definitions of conditions used for each sector. Percentages are based on unrounded estimates.
Available data for nursing homes could not produce estimates for asthma, chronic kidney disease, and chronic obstructive pulmonary disease (COPD), because asthma and COPD
were grouped together (21.2%), and only end-stage renal disease (12.9%) was available, which accounts for only a portion of residents with chronic kidney disease.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table VIII in Appendix III.
Percent
0 20 40 60 80 100
Osteoporosis
Hypertension
Heart disease
Diabetes
Depression
COPD
Chronic
kidney
disease
Asthma
Arthritis
Alzheimer
disease
or other
dementias
- - -
- - -
- - -
30.9
32.3
44.5
47.8
41.9
37.9
59.6
28.7
26.2
42.4
8.3
23.7
8.4
6.8
7.2
46.9
35.9
8.3
10.0
31.9
20.7
14.0
28.2
39.4
23.4
46.3
30.9
31.4
45.1
27.0
32.0
18.1
27.1
55.0
38.7
38.1
34.3
50.3
88.9
51.0
71.5
51.2
21.2
15.3
7.2
12.3
23.7
Series 3, Number 43 23 NATIONAL CENTER FOR HEALTH STATISTICS
Long-term care services users by use of Medicaid
as a payer source
The percentage of long-term care services users using
Medicaid as a payer source was highest in adult day services
centers (65.8%), followed by nursing homes (61.8%)
(Figure 23). Among residential care residents, 16.5% used
Medicaid as a payer source, followed by 9.5% of home
health patients. Data on Medicaid as payer source were not
available for hospice patients.
Health and Functional Characteristics of
Long-term Care Services Users
Diagnosed chronic condions among long-term
care services users
Alzheimer disease or other dementias were most prevalent
among nursing home residents (47.8%) and were least
prevalent among adult day services center participants
(30.9%) (Figure 24). The percentage of nursing home
residents with a diagnosis of Alzheimer disease was higher
among long-stay residents (58.9%) than among short-stay
residents (36.7%) (Appendix III, Table IX). Arthritis was most
prevalent among home health patients (59.6%) and was least
prevalent among nursing home residents (26.2% overall;
25.1% among short-stay residents and 29.7% among long-
stay residents). The percentage of long-term care services
users with a diagnosis of asthma was highest among home
health patients (23.7%) and lowest among residential care
community residents (6.8%). A diagnosis of chronic kidney
disease was most common among home health patients
(46.9%), followed by hospice patients (35.9%), and was least
common among adult day services center participants (7.2%)
and residential care community residents (8.3%). Similarly,
COPD was most common among home health patients
(31.9%), followed by hospice patients (20.7%), residential
care community residents (14.0%), and adult day services
center participants (10.0%).
The percentage of long-term care services users with a
diagnosis of depression was highest in nursing homes (46.3%)
and lowest in hospices (23.4%) (Figure 24). Among nursing
home residents, the prevalence of depression was higher
among long-stay residents (53.0%) than short-stay residents
(42.6%) (Appendix III, Table IX). Diabetes was most prevalent
among home health patients (45.1%), followed by nursing
home residents (32.0% overall; 37.0% of short-stay residents
and 32.2% of long-stay residents) and adult day services
center participants (31.4%), but it was least prevalent among
residential care community residents (18.1%). A diagnosis
of heart disease was most common among home health
patients (55.0%). Over one-half of long-term care services
users in all five long-term care sectors had a diagnosis of
hypertension, with the highest proportion among home
health patients (88.9%). The percentage of long-term care
services users with a diagnosis of osteoporosis was highest
in residential care communities (23.7%), followed by adult
day services centers (21.2%), home health agencies (15.3%),
nursing homes (12.3% overall; 9.8% of short-stay residents
and 15.1% of long-stay residents), and hospices (7.2%).
Need for assistance with ADLs among long-term
care services users
This report uses the need for assistance with six ADLs—
bathing, dressing, toileting, walking or locomotion,
transferring in and out of a chair or bed, and eating—to
measure physical and cognitive functioning among residents
in nursing homes and residential care communities, home
health patients, and adult day services center participants.
Data on need for assistance with ADLs were not available for
hospice patients.
Overall, functional ability varied by sector. Within each
sector except adult day services centers, the need for
assistance with bathing was most common. The need for
assistance with eating was least common within each of the
five sectors (Figure 25). Adult day services centers had fewer
participants that needed assistance with four of the six ADLs
(bathing, dressing, toileting, and walking or locomotion)
than services users in other sectors.
Fewer adult day services center participants needed
assistance with ADLs compared with services users in
the other four sectors. Among adult day services center
participants, the need for assistance with walking or
locomotion was most common (45.8%). Therefore, while the
prevalence of ADL needs differed by sector, at a minimum,
45.8% of services users across all sectors needed assistance
with at least one of the six ADLs.
Adverse events among long-term care services
users
This report estimates the prevalence of overnight
hospitalizations, emergency department visits, and falls
as indicators of adverse, potentially avoidable events. For
adult day services centers and residential care communities,
adverse events refer to a period of 90 days prior to the
survey. For home health agencies, adverse events refer to a
period since the last Outcome and Assessment Information
Set (OASIS) assessment. For nursing homes, falls refer to
the period since admission or since the prior assessment,
whichever is more recent. Varying reference periods by
sector do not allow for direct comparisons between sectors.
About equal percentages of home health patients had
overnight hospital stays (15.7%) and emergency department
visits (15.3%) (Figure 26). About 14.4% of nursing home
residents had overnight hospital stays; more short-stay
residents had overnight hospital stays (23.8%) than long-
stay residents (8.7%) (Appendix III, Table IX). About 8.3%
of residential care community residents and 4.4% of adult
day services center participants had overnight hospital
stays. About 7.2% of adult day services center participants
NATIONAL CENTER FOR HEALTH STATISTICS 24 Series 3, Number 43
Figure 25. Percentage of long-term care services users needing any assistance with
activities of daily living, by sector and activity: United States, 2015 and 2016
Toileting Walking or locomotion Transfering in and
out of bed
Percent
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 2016, respectively. The
denominator used to calculate the percentage for home health agencies was the number of patients whose episode of care ended at any time in 2015. Participants, patients, or
residents were considered needing any assistance with a given activity if they needed help or supervision from another person or used assistive devices to perform the activity. See
Appendix II for definitions of needing any assistance with activities of daily living used for each sector. Data on needing any assistance with activities of daily living were not available
for hospice patients. Percentages are based on unrounded estimates.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table VIII in Appendix III.
0
20
40
60
80
100
EatingDressingBathing
Residential care communityNursing homeHome health agencyAdult day services center
28.5
45.8
23.2
38.6
36.0
33.5
96.7
92.7
89.3
92.0
86.8
59.9
48.2
40.0
56.5
29.2
19.2
63.6
97.2
92.0
81.1
95.4
91.3
61.2
Figure 26. Percentage of long-term care services users with overnight hospital stays,
emergency department visits, and falls, by sector: United States, 2015 and 2016
Emergency department visits Overnight hospital stays
Percent
- - - Data not available.
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 2016, respectively. The
denominator used to calculate the percentage for home health agencies was the number of patients whose episode of care ended at any time in 2015. For adult day services centers
and residential care communities, adverse events refer to the 90 days prior to the survey. For home health agencies, adverse events refer to a period since the last Outcome and
Assessment Information Set. For nursing homes, falls refer to the period since admission or since the prior assessment, whichever is more recent. For hospices, data were not
available for overnight hospital stays, emergency department visits, or falls. See the Appendix I Technical Notes for more information on the data sources used for each sector. See
Appendix II for definitions of each adverse event used for each sector. Percentages are based on unrounded estimates.
SOURCES: NCHS, National Study of Long-Term Care Providers and Table VIII in Appendix III.
0
10
20
30
Falls
Adult day services center
4.4
7.2
7.8
Residential care community
8.3
14.2
21.5
Home health agency
15.7
15.3
- - -
Nursing home
14.4
16.1
- - -
Series 3, Number 43 25 NATIONAL CENTER FOR HEALTH STATISTICS
and 14.2% of residential care residents had emergency
department visits. About 21.5% of residential care
community residents, 16.1% of nursing home residents,
and 7.8% of adult day services center participants had falls.
Among nursing home residents, more long-stay residents
(19.1%) than short-stay residents (13.5%) had falls.
For home health patients, data for falls were not available.
For nursing home residents, data for emergency department
visits were not available, and data for hospitalizations were
not reported because the timing of Medicare claims data did
not match the other nursing home data sets used for this
report. For hospice patients, data for emergency department
visits, overnight hospital stays, and falls were not available.
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Series 3, Number 43 29 NATIONAL CENTER FOR HEALTH STATISTICS
Appendix I. Technical Notes
Data Sources
This report uses data from multiple sources, including 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 National Center for Health Statistics (NCHS) for
assisted living and similar residential care communities and
for adult day services centers. Data for all five sectors were
obtained for comparable time periods, where feasible, for
each of the 50 states and the District of Columbia.
Administrative data: Home health
agencies, hospices, and nursing homes
Provider-level data
Provider-level data files were from the Certification and
Survey Provider Enhanced Reports (CASPER) system. CASPER
data are collected to support the survey and certification
regulatory functions of CMS; every nursing home, home
health agency, and hospice in the United States that is
certified to provide services under Medicare, Medicaid, or
both is included. The CASPER data used in this report were
from the third quarter of 2016. The number of variables
in each file and frequency of certification survey data
collection varies by sector because different providers are
required to report different information during the survey
and certification process. This report excluded providers
located in American Samoa, Guam, Puerto Rico, and the U.S.
Virgin Islands.
Home health agency file—Included 12,208 home health
agencies coded as active providers located in the United
States. About 77.1% were Medicare- and Medicaid-certified,
21.6% were Medicare-certified only, and 1.3% were
Medicaid-certified only. About 82.7% of these home health
agencies completed a certification survey during the last 3
years (including 55.8% during the last 2 years).
Hospice file—Included 4,348 hospices coded as active
providers located in the United States; information on type
of certification (Medicare-only, Medicaid-only, or both) was
not available. CMS requires certification surveys of Medicare
hospices every 6 to 8 years, on average (54). The majority of
Medicare hospices (95.5%) completed a certification survey
during the last 8 years (including 75.6% during the last 3
years).
Nursing home file—Included 15,638 nursing homes coded
as active providers located in the United States. About
92.7% were Medicare- and Medicaid-certified, 4.8% were
Medicare-certified only, and 2.5% were Medicaid-certified
only. Nearly all of these nursing homes (99.5%) completed
a certification survey during the last 18 months (including
80.7% during the last 12 months).
User-level data
User-level assessment and claims data were from different
sector-specific CMS data sources. These 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 the unique provider identification (ID) number.
These user-level data were then merged to the respective
provider-specific CASPER data file using the provider ID
number.
Home health paents
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 (OASIS). 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
2015 (i.e., discharges), regardless of payment source.
These data included home health patients who received
services from Medicare-certified and Medicaid-certified
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 file
by provider ID number, 1,101 of the 12,208 agencies in the
CASPER file (9.0%) had no patient information in the OBQI
data; 440 of the 11,547 agencies in the OBQI file (3.8%) had
no provider information in the CASPER data.
The total number of patients in this merged file (4,455,651)
was used as the denominator when calculating percentages
of home health patients in different age and sex categories;
to calculate percentages of those receiving Medicaid,
needing any assistance with activities of daily living (ADLs),
having hospitalizations, and having emergency department
visits; and to calculate the annual number of users and the
annual-use rates of home health care.
Institutional Provider and Beneficiary Summary (IPBS)
home health data were used because the OBQI data did not
use racial and ethnic categories and information on patients’
diagnoses that was comparable to those used in other data
sources. The IPBS data file contained information on home
health patients for whom Medicare-certified home health
agencies submitted a Medicare claim at any time in calendar
year 2015. When merged with the CASPER home health
agency file, 1,088 of the 12,208 agencies in the CASPER
file (8.9%) had no patient information in the IPBS home
NATIONAL CENTER FOR HEALTH STATISTICS 30 Series 3, Number 43
health data. The total number of patients in this merged file
(4,078,769) was used as the denominator when calculating
percentages of home health patients in different racial and
ethnic categories, and to calculate percentages of those
diagnosed with the selected conditions.
Hospice paents
The IPBS hospice data file contained information on hospice
patients for whom Medicare-certified hospice agencies
submitted a Medicare claim at any time in calendar year
2015. Given that 93.0% of hospice agencies were Medicare-
certified in 2007 (based on findings 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. When merged with the CASPER
hospice agency file, 309 of the 4,348 hospices in CASPER
(7.1%) had no patient information in the IPBS hospice
data. The total number of hospice patients in this merged
file (1,426,014) was used for 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. Data included demographic characteristics (i.e., age,
sex, and racial and ethnic background) and selected diagnosed
conditions.
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-certified nursing home on the
last day of the third quarter of 2016, regardless of payment
source. Residents whose last assessment during the third
quarter of 2016 was a discharge assessment were excluded.
Minimum Data Set (MDS) assessment records are provided
by nursing homes and maintained by CMS to create a profile
of the most recent standard information for each active
resident. Within MARET, CMS defines 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.”
The resident-level MARET data were aggregated using the
provider ID number and merged to the CASPER nursing
home file. There were 131 of 15,638 nursing homes in the
CASPER file (0.8%) that had no resident information from
the MARET data. The number of nursing home residents
obtained from MARET and merged to CASPER (1,396,591)
was used as the denominator when calculating the
percentages of demographic characteristics (i.e., age, sex,
race and ethnicity), selected diagnosed conditions, and to
calculate the daily-use rates of nursing homes.
The measurement of short-stay (43.3% of residents admitted
for fewer than 100 days) and long-stay (56.7% of residents
admitted for 100 days or more) nursing home residents was
derived from the nursing home admission and assessment
dates in MARET. To estimate resident characteristics shown
in Appendix III, Table IX by length of stay, MARET was not
aggregated to the provider level, but was analyzed at
the resident level. Thus, estimates presented in Table IX
represent 1,400,810 residents by length of stay.
Medicare Provider Analysis and Review (MedPAR)
inpatient claims data from calendar year 2014 were merged
with 2014 MARET data using a unique beneficiary ID number
to measure overnight hospitalizations among nursing home
residents. This method was used because the MARET data
exclude residents whose last assessment was a discharge,
which contains information on hospitalizations. The time
frame, calendar year 2014, is 2 years older than the 2016
MARET data used for the other estimates in this report
because of the time lag in processing and releasing MedPAR.
The MedPAR file contained 8,445,659 beneficiaries with at
least 1, and up to 19 inpatient hospital claims. After merging
MedPAR and MARET using the beneficiary ID (included in
MedPAR) to the resident ID (included in MARET) crosswalk,
there were 1,286,490 individuals in both the nursing
home and MedPAR files. Qualifying hospitalizations were
measured by having any hospital discharge that occurred
after the nursing home admission date.
The CASPER nursing home file for the third quarter of 2016
included information on selected measures for 1,347,622
current residents of 15,638 nursing homes; this information
was collected using Form CMS-672 (Resident Census and
Conditions of Residents). The resident census information
was designed to represent the facility at the time of the
certification survey. CMS defined current residents as
“residents in certified beds regardless of payer source.”
Because the data were provided at the provider level, file
merging was unnecessary, and no nursing home had missing
data on resident census items. Resident census information
from the CASPER nursing home file was used for the number
of current residents and the percentages of residents with
ADL limitations.
Survey data: Adult day services centers and
residenal care communies
NCHS designed and conducted surveys for the adult
day services center and residential care community
components of the third wave of the National Study of Long-
Term Care Providers (NSLTCP) in 2016. The 2016 NSLTCP
questionnaires for adult day services centers and residential
care communities are available from: https://www.cdc.
gov/nchs/nsltcp/nsltcp_questionnaires.htm. The NSLTCP
questionnaires consist of topics common or comparable
across all five sectors (“core topics”) and topics that are
specific to a particular sector (“sector-specific topics”). To
facilitate comparisons across sectors, the core topics for the
primary data collection for adult day services centers and
residential care communities were designed to be as similar
Series 3, Number 43 31 NATIONAL CENTER FOR HEALTH STATISTICS
was estimated to be eligible. Eligibility rate was calculated
by the number of known eligible adult day services centers
divided by the total number of adult day services centers
with known eligibility status. Centers that were invalid or out
of business and centers that screened out as ineligible were
classified as “known ineligibles.” This estimated number
and the total number of eligible centers resulting from the
screening process were used to estimate the total number
of eligible adult day services centers in the United States.
Of the 4,586 eligible and presumed eligible centers, 2,836
completed the questionnaire, for a response rate of
61.8%. Response rates are calculated using standards set
by the American Association of Public Opinion Research
(AAPOR). AAPOR Response Rate #4 calculations include
assumptions of eligibility among potential respondents
that are not interviewed. AAPOR Response Rate #4 formula
was used to calculate response rates for adult day services
centers (completed questionnaires / [completed eligible
questionnaires] + [eligibility rate x cases of unknown
eligibility]). Response rates by state ranged from 45.5% to
93.8% and are presented in Table I.
Residenal care communies
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 2016 NSLTCP used the same definition
of residential care community and the same approach to
create the sampling frame (55) that was used for the 2010
National Survey of Residential Care Facilities (NSRCF) (56).
To be eligible for the study, a residential care community
must be licensed, registered, listed, certified, or otherwise
regulated by the state to:
●
Provide room and board with at least two meals a day and
around-the-clock, onsite supervision
●
Help with personal care, such as bathing and dressing or
health-related services, such as medication management
●
Have four or more licensed, certified, 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.
The residential care community component used a
combination of probability sampling and census taking.
Probability samples were selected in the states that had
sufficient numbers of residential care communities to
enable state-level sample-based estimation. A census was
taken of residential care communities in the states that did
not have sufficient numbers of residential care communities
to enable state-level sample-based estimation. From 42,149
communities in the sampling frame, 11,688 residential
care communities were sampled and stratified by state and
as possible to the core topics 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.
The 2016 NSLTCP surveys of adult day services centers and
residential care communities were conducted between
August 2016 and February 2017. The survey included
mail-, web-, and telephone-administered questionnaires. The
survey instruments were designed to assess study eligibility
and to collect data on services offered, the staffing profile,
center participant or community resident characteristics, and
record keeping at adult day services centers or residential
care communities. Two sets of questionnaires were used
to collect data designed at the state and national level:
(1) survey items that were included on both questionnaires
and asked of all respondents (designed to provide national-
and state-level estimates), and (2) a few selected items
included on one version of the questionnaires and designed
to provide only national-level estimates. This report only uses
items that were included on both questionnaires and can be
estimated at the state level, except for the percentages of
participants or residents who had a fall.
Adult day services centers
The survey for the adult day services center component of
the 2016 NSLTCP was based on a census of U.S. centers.
The sampling frame obtained from the National Adult Day
Services Association contained adult day services centers
that self-identified as adult day care, adult day services, or
adult day health services centers that were in operation as of
November 2015. After removing duplicates, the final frame
consisted of 5,348 adult day services centers that were
included in the data collection efforts. The set of eligibility
criteria for study participation was determined by self-report
in the screener section of the questionnaire. Additionally,
adult day services centers had to:
●
Be licensed or certified by the state specifically to provide
adult day services, or accredited by the Commission on
Accreditation of Rehabilitation Facilities; or authorized
or otherwise set up to participate in Medicaid (Medicaid
state plan, Medicaid waiver, or Medicaid managed care)
or part of a Program of All-Inclusive Center for the Elderly.
●
Have an average daily attendance of at least one
participant based on a typical week.
●
Have at least one participant enrolled at the designated
center at the time of the survey.
As a result of using these eligibility criteria, all responding
eligible centers participated in Medicaid or were in some
way regulated by the state. A total of 182 (3.4%) centers
were either invalid or out of business. However, 2,041centers
(38.2%) could not be contacted; therefore, the final eligibility
status of these centers was unknown. Using the eligibility
rate, a proportion of these centers of unknown eligibility
NATIONAL CENTER FOR HEALTH STATISTICS 32 Series 3, Number 43
community bed size. A set of screener
items in the questionnaire was used
to determine eligibility: 135 (1.2%
weighted) communities were invalid
or out of business and an additional
1,490 (24.0% weighted) communities
in the sample were determined to
be ineligible during data collection
because they did not meet the set
eligibility criteria. However, 5,485
communities (49.3% weighted) could
not be contacted by the end of data
collection and, therefore, the final
eligibility status of these communities
was unknown.
Using the eligibility rate, a proportion
of the 5,485 communities of
unknown eligibility was estimated
to be eligible. The eligibility rate was
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 classified as
“known ineligibles.” 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. Of the 8,626 eligible
and presumed eligible residential
care communities, 4,643 returned the
survey questionnaire, however, 65
communities (0.6%) only completed
the eligibility screener questions and
were coded as nonrespondents.
The number of residential care
communities that fully completed
the questionnaire was 4,578, with a
weighted response rate (for differential
probabilities of selection) of 50.7%.
Response rates are calculated using
standards set by AAPOR. AAPOR
Response Rate #4 calculations include
assumptions of eligibility among
potential respondents that are not
interviewed. AAPOR Response Rate #4
formula was used to calculate response
rates for residential care communities
(completed questionnaires / [completed
eligible questionnaires] + [eligibility rate
x cases of unknown eligibility]).
Table II. Response rates for residential care communities, by state, 2016
Area Rate Area Rate
United States 50.7 Missouri 55.8
Alabama 48.2 Montana 58.0
Alaska 50.0 Nebraska 65.8
Arizona 47.8 Nevada 51.1
Arkansas 71.8 New Hampshire 56.8
California 43.3 New Jersey 51.7
Colorado 55.0 New Mexico 48.4
Connecticut 63.2 New York 55.1
Delaware 58.3 North Carolina 52.2
District of Columbia 33.3 North Dakota 68.8
Florida 44.3 Ohio 62.3
Georgia 46.4 Oklahoma 55.1
Hawaii 54.1 Oregon 60.1
Idaho 52.9 Pennsylvania 56.1
Illinois 49.3 Rhode Island 50.0
Indiana 52.7 South Carolina 57.0
Iowa 70.9 South Dakota 69.7
Kansas 58.5 Tennessee 59.6
Kentucky 61.0 Texas 46.9
Louisiana 59.3 Utah 60.5
Maine 58.0 Vermont 56.3
Maryland 42.7 Virginia 53.9
Massachusetts 40.4 Washington 51.1
Michigan 49.5 West Virginia 49.1
Minnesota 54.7 Wisconsin 60.3
Mississippi 45.6 Wyoming 86.7
SOURCE: NCHS, National Study of Long-Term Care Providers, 2016.
Table I. Response rates for adult day services centers, by state, 2016
Area Rate Area Rate
United States 61.8 Missouri 55.3
Alabama 71.4 Montana 72.7
Alaska 71.4 Nebraska 69.6
Arizona 75.0 Nevada 73.7
Arkansas 57.6 New Hampshire 68.8
California 53.0 New Jersey 53.9
Colorado 64.2 New Mexico 45.5
Connecticut 72.5 New York 59.5
Delaware 76.9 North Carolina 85.6
District of Columbia 60.0 North Dakota 61.8
Florida 61.0 Ohio 61.2
Georgia 62.9 Oklahoma 78.4
Hawaii 70.0 Oregon 64.7
Idaho 58.3 Pennsylvania 65.4
Illinois 69.1 Rhode Island 64.0
Indiana 74.5 South Carolina 65.6
Iowa 67.7 South Dakota 82.4
Kansas 60.0 Tennessee 69.5
Kentucky 61.0 Texas 58.9
Louisiana 58.0 Utah 50.0
Maine 51.6 Vermont 93.8
Maryland 71.9 Virginia 72.0
Massachusetts 61.5 Washington 65.5
Michigan 65.6 West Virginia 61.5
Minnesota 74.3 Wisconsin 66.0
Mississippi 63.6 Wyoming 83.3
SOURCE: NCHS, National Study of Long-Term Care Providers, 2016.
Series 3, Number 43 33 NATIONAL CENTER FOR HEALTH STATISTICS
this question and may have screened themselves out
of the study erroneously. For more information, see
“Long-Term Care Services in the United States: 2013
Overview” (available from: https://www.cdc.gov/nchs/data/
nsltcp/long_term_care_services_2013.pdf) and the 2012
residential care community data file (available from:
https://www.cdc.gov/nchs/data/nsltcp/NSLTCP_RCC_Readme
_RDC_Release.pdf). Cognitive testing was conducted to
assess these eligibility questions, and preliminary findings
supported this hypothesis. To address these differences,
NCHS revised the NSLTCP eligibility question asking
whether the residential care community provided
24-hour supervision. The eligibility question asking
whether the residential care community provided 24-
hour supervision is question 4 on the 2012 questionnaire
(https://www.cdc.gov/nchs/data/nsltcp/2012_NSLTCP_
Residential_Care_Communities_Questionnaire.pdf)
and question 6 on the 2014 questionnaire (https://www.
cdc.gov/nchs/data/nsltcp/2014_NSLTCP_Residential_Care_
Communities_Questionnaire.pdf).
Results from the 2014 wave indicated that the overall
eligibility rate increased to 80.7%, similar to the 2010 NSRCF
rate. However, the 2014 eligibility rates for all bed size
categories except small providers (4–10 beds) were slightly
lower compared with the 2010 NSRCF (Table III) and may be
attributed to mode differences between 2010 and 2014. In
2016, the overall eligibility rate decreased to 73.8%. Decline
in eligibility was observed in all bed size categories, but
mostly among small and medium categories. The estimated
national number of residential care communities ranged
from 31,100 in 2010, 22,200 in 2012, and 30,200 in 2014,
to 28,900 in 2016. The number of beds were estimated at
971,900 in 2010, 851,400 in 2012, 1,006,300 in 2014, and
996,100 in 2016 (Table IV). NCHS is currently assessing what
caused the decline in eligibility between 2014 and 2016.
Populaon bases for compung rates
Populations used for computing rates of national supply
and rates of use by state population were obtained from
the U.S. Census Bureau’s Population Estimates Program.
The program produces estimates of the population for the
United States, its states, counties, cities, and towns, and for
the Commonwealth of Puerto Rico and its municipalities.
Response rates (weighted) by state ranged from 33.3% to 86.7%
and are presented in Table II.
Dierences in the number of residenal care
communies esmated in 2010, 2012, 2014,
and 2016
Estimates of the number of residential care community
providers varied between the 2010 NSRCF and the 2012
NSLTCP. NCHS assessed these differences and concluded that
they were largely related to the eligibility differences between
the 2010 NSRCF and the 2012 NSLTCP. While both surveys
used the same eligibility criteria, overall screener-based
eligibility dropped from 81.0% in the 2010 NSRCF to 67.1%
in the 2012 NSLTCP (Table III). The screener-based eligibility
rate was computed based on residential care communities
that completed the screening questions (completed eligible /
[completed eligible + completed ineligible]).
This decrease in the screener-based eligibility rate was most
pronounced for providers with small bed sizes (4 to 10 beds):
a decrease from 63.6% in 2010 to 45.8% estimated in 2012.
Given that the 2012 NSLTCP (n = 11,690) had a much larger
sample than NSRCF (n = 3,605), and that small bed size
providers make up the largest proportion of all residential
care communities, the lower eligibility rate in 2012 compared
with 2010 among small-sized residential care communities
had a large effect on the differences in the eligibility rate for
the two surveys.
The discrepancy in eligibility between the 2010 NSRCF
and the 2012 NSLTCP was likely due to differences in data
collection modes used in 2010 (interviewer-administered
computer-assisted telephone interviewing [CATI] screener
followed by an in-person interview for eligible communities)
and 2012 (primarily respondent self-administered screener
and questionnaire completed by mail or web), and the
resulting differences in how the respondents who self-
administered the questionnaire interpreted the eligibility
questions. In the 2012 NSLTCP, the most common eligibility
criterion that providers, particularly small-bed size
residential care communities, did not meet, was provision
of onsite, 24-hour supervision. Some respondents using
the self-administered modes (i.e., hard copy questionnaire
or web questionnaire) likely did not fully comprehend
Table III. Eligibility rate among residential care communities, by bed size and survey year
Eligible community
National Study of Long-Term Care Providers 2010 National
Survey of Residential
Care Facilities2016 2014 2012
Overall (percent) 73.8 80.7 67.1 81.0
Bed size
Small (4–10 beds) 55.5 65.3 45.8 63.6
Medium (11–25 beds) 74.5 81.0 68.5 82.8
Large (26–100 beds) 86.9 91.7 82.4 94.5
Extra large (more than 100 beds) 91.2 93.8 85.5 95.9
SOURCES: NCHS, National Study of Long-Term Care Providers, 2016, 2014, 2012; and National Survey of Residential Care Facilities, 2010.
NATIONAL CENTER FOR HEALTH STATISTICS 34 Series 3, Number 43
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 country, states, and
counties. Population estimates for each state and territory
were not subject to sampling variation because the sources
used in the demographic analysis were complete counts. For
a more detailed description of the estimates methodology,
see: https://www.census.gov/popest/.
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, 2016, were used (57). For
calculating rates for use by state for home health agencies
and hospices, estimates of the population aged 65 and over
for July 1, 2015, were used to match the time frame of the
administrative data for these sectors (57).
Comparing NSLTCP esmates with esmates
from other data sources
Administrave data
Home health agencies—Selected estimates from the 2016
merged home health file (which was created by linking the
CASPER home health file, IPBS home health file, and OBQI
Case Mix Roll-up file by provider ID number) were compared
with estimates from different reports and data sources. These
benchmark data sources included the Medicare Payment
Advisory Commission’s “Report to the Congress: Medicare
Payment Policy” chapter on home health services (58);
Home Health Chartbook 2017 (59); and 2015 CMS Program
Statistics (60). Estimates also were compared with analyses
on Medicare- or Medicaid-certified home health agencies
that participated in NCHS’ 2007 National Home and Hospice
Care Survey (NHHCS) and with data used in the 2012 and
2014 NSLTCP. Select provider and user characteristics were
comparable with other data sources except certification
status, age distribution of patients, and patients diagnosed
with select conditions. About 1% of home health agencies in
the 2014 and 2016 merged home health file were Medicaid-
only certified compared with 14% from NHHCS. About 18%
of patients in the 2014 and 2016 merged home health file
were under age 65 compared with 31% in NHHCS. These
differences in the number and age distribution of patients
could be related to the 2016 home health merged file’s
inclusion of fewer Medicaid-only certified home health
agencies, and the fact that the 2016 merged file contained
discharged home health patients rather than current home
health patients (on whom the 2007 NHHCS collected data).
Hospices—Selected estimates from the 2016 merged
hospice file (which was created by linking the CASPER hospice
file and IPBS hospice file by provider ID number) were
compared with estimates on hospice care services provided
in the MedPAC (58) report. Estimates also were compared
with analyses on Medicare- or Medicaid-certified hospice
agencies that participated in the 2007 NHHCS and with data
used in the 2012 and 2014 NSLTCP. Select provider and user
characteristics were comparable with other data sources
except age distribution of patients; about 6% of hospice
patients in the merged file were under age 65 compared
with 17% in NHHCS. Estimates for age distribution of patients
varied due to differences in the patient population each data
source covered. NHHCS collected information on patients
(not just Medicare beneficiaries) discharged from hospices
in 2007 that were Medicare- or Medicaid-certified, pending
certification, or state licensed; the 2016 merged hospice
file included Medicare beneficiaries who received hospice
services from Medicare-certified hospices in 2015.
Table IV. Weighted number and percent distribution of residential care communities, by bed size and survey
year
Characteristic
National Study of Long-Term Care Providers
2010 National
Survey of Residential
Care Facilities2016 2014 2012
Number Percent Number Percent Number Percent Number Percent
Number of residential care
communities 28,900 100.0 30,200 100.0 22,200 100.0 31,100 100.0
Small (4–10 beds) 13,200 45.6 14,500 47.9 9,300 41.7 15,400 50.0
Medium (11–25 beds) 4,400 15.3 4,500 14.9 3,700 16.8 4,900 16.0
Large (26–100 beds) 9,100 31.5 9,100 30.1 7,300 32.7 8,700 28.0
Extra large (more than 100
beds) 2,200 7.7 2,100 7.0 1,900 8.7 2,100 7.0
Number of beds 996,100 100.0 1,006,300 100.0 851,400 100.0 971,900 100.0
Small (4–10 beds) 81,800 8.2 89,600 8.9 64,700 7.6 96,700 9.9
Medium (11–25 beds) 76,500 7.7 76,900 7.6 86,900 10.2 86,800 8.9
Large (26–100 beds) 518,300 52.0 522,600 51.9 434,800 51.1 493,800 50.8
Extra large (more than 100
beds) 319,500 32.1 317,200 31.5 265,000 31.1 294,600 30.3
SOURCES: NCHS, National Study of Long-Term Care Providers, 2016, 2014, 2012; and National Survey of Residential Care Facilities, 2010.
Series 3, Number 43 35 NATIONAL CENTER FOR HEALTH STATISTICS
questionnaires (Questions 16 in 2012, 15 in 2014, and 28
in version A and 29 in version B in 2016) were revised after
each wave. In 2012, each service item had four response
categories indicating that the service was “not provided,”
“provided only by residential care community/adult day
services center employees,” “provided only by others
through arrangement,” or “provided by both residential
care community/adult day services center employees and
others through arrangement.” In 2014, respondents were
asked to mark one or more of five categories indicating
that the service was provided by “paid residential care
community/adult day services center employees,”
“arranging for and paying outside vendors,” “arranging for
outside vendors paid by others,” “referral,” or “none of
these apply/not provided.” In 2016, the response options
were revised to four categories indicating that a residential
care community or adult day services center “provides
the service by paid residential care community/adult day
services center employees,” “arranges for the service
to be provided by outside services,” “refers residents/
participants or family to outside service providers,” or
“does not provide, arrange, or refer for this service.”
●
Formatting and wording for staffing questions in the adult
day services center (Questions 23 in 2012, 14 in 2014, and
31–33 in version A and 28–30 in version B in 2016) and
residential care community (Questions 26 in 2012, 17 in
2014, and 29–31 in version A and 30–32 in version B in
2016) questionnaires changed between the three waves.
In 2012, respondents had the option of providing either
the separate numbers of full-time and part-time staff or
the number of full-time equivalent (FTE) staff. In 2014,
the response categories only included number of full-time
staff and number of part-time staff (not FTEs). In both
2012 and 2014, the staffing questions were formatted as
a block to include both employees and contract staff. In
2016, respondents continued to provide the number of
full-time and part-time staff (not FTEs), but the questions
were formatted into two separate blocks for employees
and contract staff. Also in 2016, respondents could skip
the contract staff block if they answered “no” to a stem
question about having any contract or agency staff.
The differences in formatting in 2016 led to some
methodological changes to the staffing data edits in 2016
compared with previous waves. Details about differences
in how the staffing data were edited in 2014 and 2016 are
provided in the “Data Description and Usage (Readme)”
documents for the adult day services center survey (https://
www.cdc.gov/nchs/data/nsltcp/NSLTCP_2016_ADSC_
Readme_RDC.pdf) and the residential care community survey
(https://www.cdc.gov/nchs/data/nsltcp/NSLTCP_2016_
RCC_Readme_RDC.pdf).
●
The ADL question about walking or locomotion in the
adult day services center (Questions 32g in 2012, 19f in
2014, and 16f in 2016) and residential care community
(Questions 34g in 2012, 22f in 2014, and 17f in 2016)
questionnaires changed. The 2012 and 2016 waves
Nursing homes—Estimates from the merged 2016 CASPER
nursing home and MARET files were compared with
estimates on skilled nursing facilities from the MedPAC
report (58), the Nursing Home Data Compendium (61), and
the LTCFocus 2015 data (62). Provider-related estimates
using the 2016 merged nursing home file were comparable
with these other data sources.
Survey data
Estimates from the 2016 adult day services center and
residential care community components of NSLTCP were
compared with the 2010 MetLife National Study of Adult Day
Services (53) and findings from the 2010 National Survey of
Residential Care Facilities, respectively. Differences between
2010, 2012, 2014, and 2016 estimates for the number of
residential care communities, beds, and residents were
discussed previously in this appendix. The 2016 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.
Dierences between survey waves
The adult day and residential care components of NSLTCP
have evolved over the three waves of the study, in terms of
new questions, changes in question wording and response
categories, as well as data editing. A comparison of the
questions used in the three waves lists all the new items
added to NSLTCP (https://www.cdc.gov/nchs/data/nsltcp/
NSLTCP_2012-2016_crosswalk.pdf). In addition to new
questions, the question wording and response categories for
several questions were revised in the 2016 wave, as listed
below. Some of these differences may have led to differences
in data editing methods, as well as differences in estimates
between the waves.
●
Response categories for the revenue source question in
the adult day services center questionnaires (Question
11 in 2012, Question 9 in 2014, and Question 10 in
2016) were revised after each wave. The 2012 and 2014
questions included six response categories: Medicaid,
Medicare, other government, out-of-pocket payment
by the participant family, private insurance, and other.
In 2014, a brief definition was added to the Medicaid
response category to specify that this category include
Medicaid managed care programs. In 2016, the number
of response categories increased to eight, with the
“other government” category broken into three separate
categories: Older Americans Act, Veterans Administration,
and other federal, state, or local government. Also, the
Medicaid category definition was revised to include
revenue from a Medicaid state plan, Medicaid waiver,
Medicaid managed care, or California regional center.
●
Response categories for questions on services provided in
the adult day services center questionnaires (Questions
19 in 2012, 12 in 2014, and 30 in version A and 27 in
version B in 2016) and the residential care community
NATIONAL CENTER FOR HEALTH STATISTICS 36 Series 3, Number 43
included a brief description stating that assistance with
locomotion or walking included using a cane, walker,
wheelchair, or help from another person; this description
was not included in the 2014 wave.
●
The question on falls in the adult day services center
(Questions 22 in 2014 and 25 in version A in 2016) and
residential care community (Questions 25 in 2014 and
23 in version A in 2016) questionnaires changed. The
2014 wave asked about the number of falls (any) in the
last 90 days and directed respondents to include onsite
and offsite falls. The 2016 wave added instructions for
respondents to include falls that occurred in the residential
care community or adult day services center or offsite,
whether or not the resident or participant was injured,
and whether or not anyone saw the resident/participant
fall or caught them. Respondents also were asked to only
count one fall per resident or participant who fell, even if
the resident or participant fell more than one time, and
to include a resident or participant who had a fall in the
last 90 days even if they were currently in a hospital or
rehabilitation facility.
Data Analysis
Results describing providers and services 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 files. 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, statistical analysis weights were computed
as the product of two components: the sampling weight
(only for residential care communities in states where they
were sampled) and adjustment for unknown eligibility
due to nonresponse. 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. To adjust the adult day services center
and residential care community weights for unknown
eligibility, the SUDAAN procedure WTADJUST (63) was used;
the procedure uses a constrained logistic model to predict
known eligibility and to compute the unknown eligibility
adjustment factors for the weights. Standard errors for
survey data were computed using Taylor series linearization.
Variance esmates
Administrave data: Home health agencies,
hospices, and nursing homes
The home health, hospice, and nursing home data files
were created using CMS administrative data. The files
represented 100% of the CMS population at the specific
time that the data set was constructed, and they were not
subject to sampling variability. Thus, the standard errors
could be seen as being zero. 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 data entry and other reporting errors.
To account for these types of variability, the administrative
data estimates were treated as a simple random sample,
providing conservative standard errors for the random
variation that might be associated with the files.
Survey data: Adult day services centers and
residenal care communies
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 comprise
the adult day services center file were not sampled, the
variability associated with the nonresponse was treated
as if it were from a stratified (by state) sample without
replacement.
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
stratified (by state and size) sample without replacement.
Stascal signicance tests
All statements in this report describing differences in
estimates indicate that statistical testing was performed,
and the differences between two point estimates were
determined to be statistically significant at the 0.05 level.
Differences among sectors were evaluated using t tests. All
statistical significance tests were two sided using p < 0.05
as the significance level. Lack of comment regarding the
difference between any two statistics does not necessarily
mean that the difference was tested and found not to be
statistically significant. Data analyses were performed using
SAS version 9.3, the SAS-callable SUDAAN version statistical
package (63), and STATA/SE 14.0 (64). Individual estimates
may not sum to totals because estimates were rounded.
Data eding
Data files were examined for missing values and
inconsistencies. 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, to inform respondents that an answer
Series 3, Number 43 37 NATIONAL CENTER FOR HEALTH STATISTICS
was required, and to include data validations such as asking
respondents to check an answer if it was not the expected
number. For instance, if responses to items that needed to
total the number of residential care community residents
or adult day services center participants did not match the
total, respondents were reminded to check their responses.
For the adult day services center and residential care
community survey data, selected aggregate resident- or
participant-level variables were imputed (i.e., age, race,
and sex). Although administrative data were also reviewed
for missing values and inconsistencies, the files did not go
through the same data cleaning and editing as the survey
data.
For both survey and administrative data, staffing information
was edited in the same manner. Outliers were defined as
values two standard deviations above or below the size-
specific mean for a given staff type, where size was defined
as number of people served. When calculating the size-
specific mean for a given staff type, cases were coded as
missing if the number of FTE registered nurse 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, if the number of FTE social work employees was
greater than 99, or if the number of FTE activities director
or staff employees was greater than 99. Additional edits
were made to the staffing variables, some of which were
different from earlier waves of NSLTCP. For the definitions
and categories of number of people served for each sector,
see Appendix II.
Cases with missing data were excluded from analyses on
a variable-by-variable basis. For administrative data used
to estimate characteristics of nursing home residents and
home health patients, individual user-level information was
rolled up to provider-level data. If a nursing home or home
health agency had missing data on a given variable for 20%
or more of its residents or patients, it was considered to not
have enough data to provide an estimate representative of
that nursing home or home health agency, and was coded
as having missing data on the variable. Variables used in
this report had a percentage (weighted if survey data,
unweighted if administrative data) of cases with missing
data ranging between 0.2% and 15.8%. The range of cases
with missing data for each sector is as follows:
●
Adult day services center: 0.2% (Medicaid participation
status) to 15.8% (number of participants diagnosed with
osteoporosis).
●
Home health agency: 8.9% to 9.1% were missing data on
all patient measures (e.g., number of patients aged 65
and over) due to agencies with no patient information
available in the IPBS data and the OBQI home health data,
respectively. In addition, 10.4% of home health agencies
had no information on the number of patients who had
utilized a hospital emergency department, including 9.1%
of agencies with no patient information available in the
OBQI data and 1.3% of agencies with missing data on the
variable for 20% or more of its patients.
●
Hospice: 7.1% were missing data 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: 0.8% were missing data for all resident
demographic information due to nursing homes with
no resident information available in the MARET data. In
addition, 10.2% of nursing homes had no information
on the number of residents who had osteoporosis and
arthritis, including 0.8% of nursing homes with no resident
information available in the MARET data and 9.4% of
nursing homes with missing data on the variable for 20%
or more of its residents.
●
Residential care community: 1.9% (e.g., Medicaid status)
to 15.6% (e.g., number of residents diagnosed with
asthma).
Limitations
Dierences in queson 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
and reference periods used for adverse events). When
possible (i.e., when available and appropriate), findings
were presented on a given topic for all five sectors. However,
due to two types of data-related differences, for some topics
in the report, information was provided for some but not all
five sectors.
The first type of data-related difference was due to the
settings served by the five sectors. 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 they 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., electronic
health records and health information exchange). NCHS
produced Data Briefs and weighted estimates tables that
presented additional results on adult day services centers and
NATIONAL CENTER FOR HEALTH STATISTICS 38 Series 3, Number 43
residential care communities, using survey data not included
in this overview report. These latest reports are available
from: http://www.cdc.gov/nchs/nsltcp/nsltcp_products.htm.
Dierences in me frames among data sources
Different data sources had different time frames or 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 2015. 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 services users in 2016. In this report, “current”
participants or residents in 2016 refers to those participants
enrolled in the adult day services center, or residents living
in the nursing home or residential care community, on the
day of data collection in 2016, rather than the total number
of participants ever enrolled in the center or residents ever
living in the nursing home or residential care community
at any time throughout the 2016 calendar year. In other
words, the estimated number of adult day services center
participants represents current participants in 2016. The
estimated number of home health patients represents
patients who ended care in 2015 (i.e., discharges). The
estimated number of hospice patients represents patients
who received care at any time in 2015. The estimated
number of nursing home residents represents current
residents in 2016. The estimated number of residential care
community residents represents current residents in 2016.
Given these differences in denominator, comparisons across
all five sectors were not feasible for some variables.
Age of administrave data
The administrative data for home health agencies, hospices,
and nursing homes were collected to support the survey and
certification function of CMS in these different sectors; both
the content and the frequency with which the certification
surveys were conducted differ across these three provider
sectors. Consistent with the required frequency for the
recertification survey, CASPER data on virtually all nursing
homes were under 18 months old: 82.7% of CASPER home
health agency data were no more than 3 years old, and
95.5% 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 of calendar year
2015, 9.0% of home health agencies and 7.1% of hospices in
the CASPER files did not match with provider ID numbers in
OBQI and IPBS hospice data, respectively. It is possible that
home health agencies and hospices with missing patient-
level information might no longer be operational or might
have begun operating in 2016, so their patient information
was not captured in the user-level data from 2015. Of 888
home health agencies that did not match with provider
numbers in OBQI data, about 62% had completed the
agency’s initial certification survey in 2014.
Series 3, Number 43 39 NATIONAL CENTER FOR HEALTH STATISTICS
Appendix II. Crosswalk of
Definitions by Sector
NATIONAL CENTER FOR HEALTH STATISTICS 40 Series 3, Number 43
Supply of long-term care services providers, by sector
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Number of
providers¹
Number of paid, regulated
long-term care services
providers
Number of adult day
services centers based on
2016 National Survey of
Long-Term Care Providers
(NSLTCP) survey of adult day
services centers
Number of assisted living
and similar residential care
communities based on 2016
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 2016
Number of hospices certified
to provide services under
Medicare, Medicaid, or both
in the third quarter of 2016
Number of nursing homes
certified to provide services
under Medicare, Medicaid,
or both in the third quarter
of 2016
Region Grouping of conterminous
states into geographic areas
corresponding to groups
used by the United States
Census Bureau. A map
showing the states included
in each of the four
U.S. Census regions is
available from: https://
www2.census.gov/geo/pdfs/
maps-data/maps/reference/
us_regdiv.pdf.
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 area²
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 metropolitan area contains
a core urban area of 50,000
or more population, and a
micropolitan area contains an
urban core of at least 10,000
(but less than 50,000)
population.
Each 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
See footnotes at end of section.
Series 3, Number 43 41 NATIONAL CENTER FOR HEALTH STATISTICS
Supply of long-term care services providers, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Capacity³ Used to quantify the supply
of long-term care services
provided in the community
(i.e., adult day services
center or residential
care community) or in
an institutional setting
(i.e., nursing home).
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.
Q2. At this residential
care community, what is
the number of licensed,
registered, or certified
residential care beds?
Include both occupied
and unoccupied beds.
… … Derived from: [CRTFD_
BED_CNT]
Number of beds in
Medicare- or
Medicaid-certified
areas within a facility.
… Category not applicable.
1
Study-specic eligibility criteria were used to dene residential care communities. See the Appendix I Technical Notes for information on eligibility criteria.
2
All provider types used the 2013 OMB standards for delineating metropolitan and micropolitan statistical areas.
3
For NH, the number of certied beds was used because current residents in the Certication and Survey Provider Enhanced Reports (CASPER) (CNSUS_RSDNT_CNT) are dened as those in certied beds regardless
of payer source.
NOTES: For survey data, (ADSC and RCC), question numbers refer to the order in National Study of Long-Term Care Providers (NSLTCP) questionnaires. Questionnaires and detailed documentation on survey variables
are available from: https://www.cdc.gov/nchs/nsltcp/nsltcp_questionnaires.htm. For administrative data (HHA, HOS, and NH), when the data source is not specied, the source is the Centers for Medicare & Medicaid’s
(CMS') CASPER.
NATIONAL CENTER FOR HEALTH STATISTICS 42 Series 3, Number 43
Organizational characteristics of long-term care services providers, by sector
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
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]
Q9. What is the type of
ownership of this adult
day services center?
1= Private, nonprofit
2= Private, for profit
3= Publicly traded company
or limited liability company
(LLC)
4= Government—federal,
state, county, local
If OWNERSHP= 3, code
OWN as 2.
Else if OWNERSHP= 1,
code OWN= 1; Else
OWN= 3.
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
or limited liability company
(LLC)
4= Government—federal,
state, county, local
If OWNERSHP= 3, code
OWN as 2.
Else if OWNERSHP= 1,
code OWN= 1; Else
OWN= 3.
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;
See footnotes at end of section.
Series 3, Number 43 43 NATIONAL CENTER FOR HEALTH STATISTICS
Organizational characteristics of long-term care services providers, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
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
2015 (hospices), or the
number of patients who
ended an episode of
care at any time in
calendar year 2015
(home health agencies).
1= 1–25
2= 26–100
3= 101 or more
Derived from:
[AVGPART]
Q2. Based on a typical
week, what is the
approximate average
daily attendance at this
adult day services center
at this location?
1= 1–25
2= 26–100
3= 101 or more
Derived from:
[TOTRES]
Q5. What is the total
number of residents
currently living at
this residential care
community?
Please include residents
for whom a bed is being
held while in the hospital.
If you have respite care
residents, please include
them.
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 2015
(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 data]
Number of hospice care
patients for whom
Medicare-certified hospice
care agencies submitted a
Medicare claim at any time
in calendar year 2015.
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
... ... 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
See footnotes at end of section.
NATIONAL CENTER FOR HEALTH STATISTICS 44 Series 3, Number 43
Organizational characteristics of long-term care services providers, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Medicaid
certification
Refers to Medicaid
certification or participation
status
1= Certified
2= Not certified
Derived from: [MEDICAID]
Q1_b. Is this adult day
services center
authorized or otherwise
set up to participate in
Medicaid (Medicaid state
plan, Medicaid waiver, or
Medicaid managed care)
or part of a Program of
All-Inclusive Care for the
Elderly (PACE)?
1= Certified
2= Not certified
Derived from: [MEDICAID]
Q9. Is this residential
care community
authorized or otherwise
set up to participate
in 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
- - - 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
Chain affiliation Refers to chain affiliation
status of adult day services
centers, residential care
communities, and nursing
homes
Q5. Is this center owned
by a person, group, or
organization that owns
or manages two or more
adult day services
centers? This may include
a corporate chain.
Q13. Is this residential
care community owned
by a person, group, or
organization that owns
or manages two or
more residential care
communities? This may
include a corporate chain.
- - - - - - Derived from: [MLT_
OWND_FAC_ORG_SW]
Owned or leased by
multifacility organization
Check “yes” if the facility
is owned or leased by a
multifacility organization,
otherwise check “no.” A
Multifacility organization is
an organization that owns
two or more long-term
care facilities. The owner
may be an individual or
a corporation. Leasing of
facilities by corporate chains
is included in this definition.
... Category not applicable.
- - - Data not available.
NOTES: For survey data, (ADSC and RCC), question numbers refer to the order in NSL TCP questionnaires. Questionnaires and detailed documentation on survey variables are available from: https://www.cdc.gov/
nchs/nsltcp/nsltcp_questionnaires.htm. For administrative data (HHA, HOS, and NH), when the data source is not specified, the source is CMS' CASPER.
Series 3, Number 43 45 NATIONAL CENTER FOR HEALTH STATISTICS
Staffing: Nursing, social work, and activities employees, by sector
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Registered nurse
1
Number of full-time
equivalent (FTE) registered
nurse (RN) employees
(based on a 35-hour work
week)
Derived RNFTE1 from:
[RNFT1, RNPT1]
Q31a/Q28a. RNs: Number
of full-time employees;
Number of part-time
employees.
Derived RNFTE1 from:
[RNFT1, RNPT1]
Q29a/Q30a. RNs: Number
of full-time employees;
Number of part-time
employees.
Derived RNFTE1 from:
[RN_CNT]
Number of FTE registered
professional nurses
employed by a provider.
Derived RNFTE1 from:
[RN_CNT]
Number of FTE registered
professional nurses
employed by a provider.
Derived RNFTE1 from:
[RN_FLTM_CNT, RN_PRTM_
CNT]
Number of FTE registered
nurses employed by a facility
on a full-time basis;
Number of FTE registered
nurses employed by a facility
on a part-time basis.
Licensed practical
nurse (LPN) or
licensed vocational
nurse (LVN)
1
Number of FTE licensed
practical nurse or licensed
vocational nurse (LPN/LVN)
employees (based on a
35-hour work week)
Derived LPNFTE1 from:
[LPNFT1, LPNPT1]
Q31b/Q28b. LPNs/LVNs:
Number of full-time
employees; Number of
part-time employees.
Derived LPNFTE1 from:
[LPNFT1, LPNPT1]
Q29b/Q30b. LPNs/LVNs:
Number of full-time
employees; Number of
part-time employees.
Derived LPNFTE1 from:
[LPN_LVN_CNT]
Number of FTE licensed
practical or vocational
nurses employed by a
provider.
Derived LPNFTE1 from:
[LPN_LVN_CNT]
Number of FTE licensed
practical or vocational
nurses employed by a
provider.
Derived LPNFTE1 from:
[LPN_LVN_FLTM_CNT, LPN_
LVN_PRTM_CNT]
Number of FTE licensed
practical or vocational
nurses employed by a
facility on a full-time basis;
Number of FTE licensed
practical or vocational
nurses employed by a
facility on a part-time basis.
See footnotes at end of section.
NATIONAL CENTER FOR HEALTH STATISTICS 46 Series 3, Number 43
Staffing: Nursing, social work, and activities employees, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Aide
1
Number of FTE 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 technicians who
are facility employees.
Derived AIDEFTE1 from:
[AIDEFT1, AIDEPT1]
Q31c/Q28c 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
employees; Number of
part-time employees.
Derived AIDEFTE1 from:
[AIDEFT1, AIDEPT1]
Q29c/Q30c 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 employees;
Number of part-time
employees.
Derived AIDEFTE1 from:
[HH_AIDE_CNT]
Number of FTE home
health aides employed
by a provider.
Derived AIDEFTE1 from:
[HH_AIDE_EMPLEE_CNT]
Number of FTE home
health aides employed
by a provider.
Derived AIDFTE1 from:
[NRS_AIDE_FLTM_CNT,
NRS_AIDE_PRTM_CNT,
MDCTN_AIDE_FLTM_CNT,
MDCTN_AIDE_PRTM_CNT]
Number of FTE certified
nurse aides employed by a
facility on a full-time basis;
Number of FTE certified
nurse aides employed by a
facility on a part-time basis;
Number of FTE medication
aides or technicians
employed by a facility on a
full-time basis;
Number of FTE medication
aides or technicians
employed by a facility on a
part-time basis.
See footnotes at end of section.
Series 3, Number 43 47 NATIONAL CENTER FOR HEALTH STATISTICS
See footnotes at end of section.
Staffing: Nursing, social work, and activities employees, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Social worker
1
Number of FTE social
worker employees (based
on a 35-hour work week)
Derived SOCWFTE1 from:
[SOCWFT1, SOCWPT1]
Q31d/Q28d Social
workers—licensed social
workers or persons with a
bachelor’s or master’s
degree in social work:
Number of full-time
employees; Number of
part-time employees.
Derived SOCWFTE1 from:
[SOCWFT1, SOCWPT1]
Q29d/Q30d. Social
workers—licensed social
workers or persons with a
bachelor’s or master’s
degree in social work:
Number of full-time
employees; Number of
part-time employees.
Derived SOCWFTE1 from:
[SCL_WORKR_CNT]
Number of FTE social
workers employed by a
provider.
Derived SOCWFTE1 from:
[MDCL_SCL_WORKR_ CNT]
Number of FTE medical
social workers employed by
a provider.
Derived SOCWFTE1 from:
[SCL_WORKR_FLTM_CNT,
SCL_WORKR_PRTM_CNT]
Number of FTE social
workers employed by a
facility on a full-time basis;
Number of FTE social
workers employed by a
facility on a part-time basis.
Activities directors
or activities staff
1
Number of FTE activities
directors or activities staff
employees (based on a 35-
hour work week)
Derived ACTFTE1 from:
[ACTFT1, ACTPT1]
Q31e/Q28e. Activities
directors or activities staff:
Number of full-time
employees;
Number of part-time
employees.
Derived ACTFTE1 from:
[ACTFT1, ACTPT1]
Q29e/Q30e. Activities
directors or activities staff:
Number of full-time
employees;
Number of part-time
employees.
- - - - - - Derived ACTFTE1 from:
[ACTVTY_PROFNL_FLTM_
CNT, ACTVTY_PROFNL_
PRTM_CNT, ACTVTY_
STF_OTHR_FLTM_CNT,
ACTVTY_STF_OTHR_PRTM_
CNT)
Number of FTE activity
professionals employed full
time by a facility;
Number of FTE activity
professionals employed part
time by a facility;
Number of FTE other
activities staff providing
therapeutic services
employed full time by a
facility;
Number of FTE other
activities staff providing
therapeutic services
employed part time by a
facility.
NATIONAL CENTER FOR HEALTH STATISTICS 48 Series 3, Number 43
Staffing: Nursing, social work, and activities employees, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Hours per resident
or participant per
day (HPPD)
2
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, HPPD 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 calculate
the HPPD.
Derived from: [RNFTE1,
LPNFTE1, AIDEFTE1,
SOCWFTE1, ACTFTE1/
AVGPART]
RNHPPD1= (RNFTE1*35)/
AVGPART/5 days;
LPNHPPD1= (LPNFTE1*35)/
AVGPART/5 days;
AIDEHPPD1= (AIDEFTE1
*35)/AVGPART/5 days;
SOCWHPPD1=
(SOCWFTE1*35)/
AVGPART/5 days;
ACTHPPD1= (ACTFTE1*35)/
AVGPART/5 days
Derived from: [RNFTE1,
LPNFTE1, AIDEFTE1,
SOCWFTE1, ACTFTE1/
TOTRES]
RNHPPD1= (RNFTE1*35)/
TOTRES/7 days;
LPNHPPD1= (LPNFTE1*35)/
TOTRES/7 days;
AIDEHPPD1=
(AIDEFTE1*35)/
TOTRES/7 days;
SOCWHPPD1= (SOCWFTE1*35)/
TOTRES/7 days;
ACTHPPD1= (ACTFTE1*35)/
TOTRES/7 days
- - - - - - Derived from: [RNFTE,
LPNFTE, AIDEFTE,
SOCWFTE/ CNSUS_ RSDNT_
CNT]
RNHPPD1= (RNFTE1*35)/
CNSUS_
RSDNT_CNT/7 days;
LPNHPPD1= (LPNFTE1*35)/
CNSUS_
RSDNT_CNT/7 days;
AIDEHPPD1= AIDEFTE1*35)/
CNSUS_
RSDNT_CNT/7 days;
SOCWHPPD1= (SOCWFTE1
*35)/ CNSUS_
RSDNT_CNT/7 days;
ACTHPPD1= (ACTFTE1*35)/
CNSUS_
RSDNT_CNT/7 days
- - - Data not available.
1
For ADSC and RCC, the 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. For HHA and HOS, the number
of FTE employees by staff type is provided in data. For NH, data 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). For all provider types, outliers are dened as cases with FTEs that are two standard deviations above or below the mean for a given size category, and recoded as the size-specic mean of FTE for
the given staff type. See the Appendix I Technical Notes for more information on editing of the staffing data.
2
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 reected 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.
NOTES: For survey data, (ADSC and RCC), question numbers refer to the order in NSLTCP questionnaires. Questionnaires and detailed documentation on survey variables are available from: https://www.cdc.gov/nchs/
nsltcp/nsltcp_questionnaires.htm. For administrative data (HHA, HOS, and NH), when the data source is not specied, the source is CMS' CASPER.
Series 3, Number 43 49 NATIONAL CENTER FOR HEALTH STATISTICS
Services provided by long-term care services providers, by sector
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Social work
services
1
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 may 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.
1= Provided
2= Not provided (includes
referral only)
Derived from: [SERVSOCW1,
SERVSOCW2, SERVSOCW3,
SERVSOCW4]
Q30_b/Q27_b.
Social work services—
provided by licensed social
workers or persons with a
bachelor’s or master’s
degree in social work,
and may include an
array of services such as
psychosocial assessment,
individual or group
counseling, and referral
services
1= Provides the service
by paid center employees
2= Arranges for the service
to be provided by outside
service providers
3= Refers participants or
family to outside service
providers
4= Does not provide,
arrange, or refer for this
service
1= Provided
2= Not provided (includes
referral only)
Derived from: [SERVSOCW1,
SERVSOCW2, SERVSOCW3,
SERVSOCW4]
Q28_b/Q29_b.
Social work services—
provided by licensed social
workers or persons with a
bachelor’s or master’s degree
in social work, and may
include an array of services
such as psychosocial
assessment, individual
or group counseling, and
referral services
1= Provides the service
by paid center employees
2= Arranges for the service
to be provided by outside
service providers
3= Refers participants or
family to outside service
providers
4= Does not provide,
arrange, or refer for this
service
1= Provided
2= Not provided
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;
1= Provided
2= Not provided
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;
1= Provided
2= Not provided
Derived from: [SCL_WORK_
SRVC_ONST_RSDNT_SW,
SCL_WORK_SRVC_ONST_
NRSDNT_SW, SCL_WORK_
SRVC_OFSITE_RSDNT_SW]
Qualified social workers
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; Else
SERVSOCW= 1;
See footnotes at end of section.
NATIONAL CENTER FOR HEALTH STATISTICS 50 Series 3, Number 43
Services provided by long-term care services providers, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Mental health
or counseling
services
1
Mental health services in
survey data refer
to services that target a
person’s mental, emotional,
psychological, or psychiatric
well-being, and may include
diagnosing, describing,
evaluating, and treating
mental conditions. For
hospices, 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”
(https://www.cms.gov/
Regulations-and-Guidance/
Guidance/Manuals/
downloads/som107ap_m_
hospice.pdf).
1= Provided
2= Not provided (includes
referral only)
Derived from: [SERVMH1,
SERVMH2, SERVMH3,
SERVMH4]
Q30_c/Q27_c.
Mental health services—
target participants’ mental,
emotional, psychological, or
psychiatric well-being and
may include diagnosing,
describing, evaluating, and
treating mental conditions
1= Provides the service by
paid center employees
2= Arranges for the service
to be provided by outside
service providers
3= Refers participants or
family to outside service
providers
4= Does not provide, arrange,
or refer for this service
1= Provided
2= Not provided (includes
referral only)
Derived from: [SERVMH1,
SERVMH2, SERVMH3,
SERVMH4]
Q28_c/Q29_c. Mental
health services—target
residents’ mental, emotional,
psychological, or psychiatric
well-being and may include
diagnosing, describing,
evaluating, and treating
mental conditions
1= Provides the service by
paid center employees
2= Arranges for the service
to be provided by outside
service providers
3= Refers participants or
family to outside service
providers
4= Does not provide, arrange,
or refer for this service
- - - 1= Provided
2= Not provided
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;
1= Provided
2= Not provided
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; Else
SERVMH= 1;
See footnotes at end of section.
Series 3, Number 43 51 NATIONAL CENTER FOR HEALTH STATISTICS
Services provided by long-term care services providers, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Therapeutic
services
1
Refers to providing any
of the three therapeutic
services: physical therapy,
occupational therapy, or
speech therapy or pathology.
1= Provided
2= Not provided (includes
referral only)
Derived from: [SERVTX1,
SERVTX2, SERVTX3,
SERVTX4]
Q30_d/Q27_d.
Any therapeutic services—
physical, occupational, or
speech
1= Provides the service by
paid center employees
2= Arranges for the service
to be provided by outside
service providers
3= Refers participants or
family to outside service
providers
4= Does not provide,
arrange, or refer for this
service
1= Provided
2= Not provided (includes
referral only)
Derived from: [SERVTX1,
SERVTX2, SERVTX3,
SERVTX4]
Q28_d/Q29_d.
Any therapeutic services—
physical, occupational, or
speech
1= Provides the service by
paid center employees
2= Arranges for the service
to be provided by outside
service providers
3= Refers participants or
family to outside service
providers
4= Does not provide,
arrange, or refer for
this service
1= Provided
2= Not provided
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;
1= Provided
2= Not provided
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;
1= Provided
2= Not provided
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 all 9 variables,
SERVTX= 2; Else SERVTX= 1;
See footnotes at end of section.
NATIONAL CENTER FOR HEALTH STATISTICS 52 Series 3, Number 43
Services provided by long-term care services providers, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Pharmacy
services
1
Includes filling of or delivery
of prescriptions.
1= Provided
2= Not provided (includes
referral only)
Derived from: [SERVRX1,
SERVRX2, SERVRX3,
SERVRX4]
Q30_e/Q27_e. Pharmacy
services—including filling
of or delivery of
prescriptions
1= Provides the service by
paid center employees
2= Arranges for the service
to be provided by outside
service providers
3= Refers participants or
family to outside service
providers
4= Does not provide,
arrange, or refer for this
service
1= Provided
2= Not provided (includes
referral only)
Derived from: [SERVRX1,
SERVRX2, SERVRX3,
SERVRX4]
Q28_e/Q29_e. Pharmacy
services—including filling of
or delivery of prescriptions
1= Provides the service by
paid center employees
2= Arranges for the service
to be provided by outside
service providers
3= Refers participants or
family to outside service
providers
4= Does not provide, arrange,
or refer for this service
1= Provided
2= Not provided
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;
- - - 1= Provided
2= Not provided
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; Else
SERVRX= 1;
See footnotes at end of section.
Series 3, Number 43 53 NATIONAL CENTER FOR HEALTH STATISTICS
Services provided by long-term care services providers, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Skilled nursing
services
1
In survey data, refers to
services that must be
performed by an RN or LPN
and are medical in nature.
For home health agencies,
the definition for nursing
services is not provided
in CMS’ “State Operations
Manual.” For hospices,
nursing services are
“routinely available on a 24-
hour basis, 7 days a week,”
and hospices must “provide
nursing care and services by
or under the supervision of a
registered nurse” (available
from: https://www.cms.
gov/Regulations-and-
Guidance/Guidance/
Manuals/downloads/
som107ap_m_hospice.pdf).
Nursing services in nursing
homes 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).
1= Provided
2= Not provided (includes
referral only)
Derived from: [SERVNURS1,
SERVNURS2, SERVNURS3,
SERVNURS4]
Q30_g/Q27_g.
Skilled nursing services—
must be performed by an
RN or LPN and are medical
in nature
1= Provides the service by
paid center employees
2= Arranges for the service
to be provided by outside
service providers
3= Refers participants or
family to outside service
providers
4= Does not provide,
arrange, or refer for this
service
1= Provided
2= Not provided (includes
referral only)
Derived from: [SERVNURS1,
SERVNURS2, SERVNURS3,
SERVNURS4]
Q28_g/Q29_g.
Skilled nursing services—
must be performed by an
RN or LPN and are medical
in nature
1= Provides the service by
paid center employees
2= Arranges for the service
to be provided by outside
service providers
3= Refers participants or
family to outside service
providers
4= Does not provide,
arrange, or refer for
this service
1= Provided
2= Not provided
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;
1= Provided
2= Not provided
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;
1= Provided
2= Not provided
Derived from: [NRSNG_
SRVC_ ONST_RSDNT_SW,
NRSNG_ SRVC_ONST_
NRSDNT_SW, 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;
Else SERVNURS= 1;
See footnotes at end of section.
NATIONAL CENTER FOR HEALTH STATISTICS 54 Series 3, Number 43
Services provided by long-term care services providers, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
HHA)
Hospice
(HOS)
Nursing home
(NH)
Hospice services
1
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
identified and dedicated for
residents needing hospice
services or have one or more
residents receiving hospice
care benefits, they were
coded as providing hospice
services.
1= Provided
2= Not provided (includes
referral only)
Derived from: [SERVHOS1,
SERVHOS2, SERVHOS3,
SERVHOS4]
Q30_a/Q27_a.
Hospice services
1= Provides the service by
paid center employees
2= Arranges for the service
to be provided by outside
service providers
3= Refers participants or
family to outside service
providers
4= Does not provide, arrange,
or refer for this service
1= Provided
2= Not provided (includes
referral only)
Derived from: [SERVHOS1,
SERVHOS2, SERVHOS3,
SERVHOS4]
Q28_a/Q29_a.
Hospice services
1= Provides the service by
paid center employees
2= Arranges for the service
to be provided by outside
service providers
3= Refers participants or
family to outside service
providers
4= Does not provide, arrange,
or refer for this service
1= Provided
2= Not provided
Derived from: [MDCR_
HOSPC_SW]
Indicates if the agency also
participates in the Medicare
program as a hospice
provider.
If MDCR_HOSPC_SW= ’Y’,
SERVHOS= 1; Else if
MDCR_HOSPC_SW= ‘N’,
SERVHOS= 2;
… 1= Provided
2= Not provided
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;
Dietary and
nutritional
services
1
Refers to dietary and
nutritional services
1= Provided
2= Not provided (includes
referral only)
Derived from: [SERVDIET1,
SERVDIET2, SERVDIET3,
SERVDIET4]
Q30_f /Q27_f. Dietary and
nutritional services
1= Provides the service by
paid center employees
2= Arranges for the service
to be provided by outside
service providers
3= Refers participants or
family to outside service
providers
4= Does not provide, arrange,
or refer for this service
1= Provided
2= Not provided (includes
referral only)
Derived from: [SERVDIET1,
SERVDIET2, SERVDIET3,
SERVDIET4]
Q28_f/Q29_f. Dietary and
nutritional services
1= Provides the service by
paid center employees
2= Arranges for the service
to be provided by outside
service providers
3= Refers participants or
family to outside service
providers
4= Does not provide, arrange,
or refer for this service
- - - - - - 1= Provided
2= Not provided
Derived from: [DTRY_
ONST_RSDNT_SW,
DTRY_ONST_NRSDNT_SW,
DTRY_OFSITE_RSDNT_SW]
Dietary 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), SERVDIET= 2; Else
SERVDIET= 1.
See footnotes at end of section.
Series 3, Number 43 55 NATIONAL CENTER FOR HEALTH STATISTICS
Services provided by long-term care services providers, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Dementia care
units
Refers to the provision of
dementia care units
… 1= Serves only residents
with dementia
2= Provides dementia
care units within larger
community
Derived from: [ONLYDEM,
DEMWING]
[Questions only
in Version B]
Q27. Does this residential
care community only serve
adults with dementia or
Alzheimer’s disease?
Q28. [If no to Q27]
Does this residential care
community have a distinct
unit, wing, or floor that is
designated as a dementia
or Alzheimer’s care unit?
… … 1= Serves only residents
with dementia
2= Provides dementia care
units within larger facility
Derived from: [CRTFD_BED_
CNT, ALZHMR_BED_CNT]
Number of certified beds;
Number of beds in a unit
identified and dedicated by
the facility for residents
with Alzheimer’s disease
if CRTFD_BED_
CNT= ALZHMR_
BED_CNT then DSU= 1;
else if ALZHMR_BED_
CNT>0 then DSU= 2; else
DSU= 0;
- - - Data not available.
… Category not applicable.
1
For ADSC and RCC, the 2016 questionnaires used “mark all that apply” questions to ask about different services provided. Respondents indicated as many as three different ways that the ADSC or RCC provided a given
service. For each service, four binary variables were created: three separate variables corresponding to three different ways that ADSCs or RCCs provide the service (i.e., by paid employees, by arranging for service to
be provided by outside providers, or by referral); one variable indicating whether the ADSC or RCC provides the service in any of these ways or does not provide the service. For this report, a derived variable with two
mutually exclusive categories was used: 1) Provided by paid employees, or arranging for service to be provided by outside providers, in addition to referral; 2) Not provided or provide only by referral.
NOTES: For survey data, (ADSC and RCC), question numbers refer to the order in NSLTCP questionnaires. Questionnaires and detailed documentation on survey variables are available from: https://www.cdc.gov/nchs/
nsltcp/nsltcp_questionnaires.htm. For administrative data (HHA, HOS, and NH), when the data source is not specied, the source is CMS' CASPER.
NATIONAL CENTER FOR HEALTH STATISTICS 56 Series 3, Number 43
Use of long-term care services, by sector
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Number of
services
users
Number of users of services
provided by paid, regulated
long-term care services
providers
Q3. What is the total number
of participants currently
enrolled at this adult day
services center at this
location?
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.
Q5. What is the total number
of residents currently living
at this residential care
community? Please include
residents for whom a bed
is being held while in the
hospital. If you have respite
care residents, please include
them.
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 the
United States; 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 (calendar year) 2015
(i.e., discharges), regardless
of payment source; 1,101
agencies (9.1%) 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 the
United States; TOTPAT was
used as the denominator
when computing percentages
for selected aggregate,
patient-level measures
(i.e., age, sex, and patients
needing any assistance with
activities of daily living).
Derived from: [BENE_CNT
from IPBS hospice data]
Number of hospice patients
for whom Medicare-certified
hospice submitted a
Medicare claim at any time
in CY 2015; 309 agencies
(7.1%)with missing IPBS
hospice data;
This data item (BENE_CNT)
was used to create SIZE
variable (number of people
served) and to obtain the
number of hospice patients in
the United States; BENE_CNT
was used as the denominator
when computing percentages
for all aggregate patient-level
measures.
Number of current residents
in certified beds in CASPER
nursing home data.
This data item (CNSUS_
RSDNT_CNT) was used to
create SIZE variable and to
obtain the number of current
nursing home residents in
the United States; CNSUS_
RSDNT_CNT was used when
computing percentages for
selected aggregate, resident-
level measures (i.e., residents
needing any assistance with
activities of daily living).
See footnotes at end of section.
Series 3, Number 43 57 NATIONAL CENTER FOR HEALTH STATISTICS
Use of long-term care services, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Number of
services
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 current
nursing home residents (who
were residing in a Medicare-
or Medicaid-certified nursing
home on the last day of
the third quarter of 2016,
regardless of payment
source. Residents whose last
Minimum Data Set [MDS]
assessment was a discharge
assessment were excluded).
… … Derived [from: [BENE_CNT
from IPBS home health data]
Number of home health
patients for whom Medicare-
certified home health care
agencies submitted a
Medicare claim at any time
in CY 2015; 1,088 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 and ethnicity,
diagnosed with chronic
conditions).
… Derived from:
[resident ID from Minimum
Data Set Active Resident
Episode Table (MARET) data]
Number of active nursing
home residents; 131 nursing
homes (0.8%) in CASPER
was 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, race and
ethnicity, diagnosed with
chronic conditions).
… Category not applicable.
NOTES: For survey data, (ADSC and RCC), question numbers refer to the order in NSL TCP questionnaires. Questionnaires and detailed documentation on survey variables are available from: https://www.cdc.gov/
nchs/nsltcp/nsltcp_questionnaires.htm. For administrative data (HHA, HOS, and NH), when the data source is not specified, the source is CMS' CASPER.
NATIONAL CENTER FOR HEALTH STATISTICS 58 Series 3, Number 43
Demographic characteristics of long-term care services users, by sector
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Age
1
Number of long-term
care services users
under age 65
Derived from: [AG17LESSRC,
AG18TO44RC,
AG45TO54RC, AG55TO64RC]
Q15. Of the participants
currently enrolled at this
center, what is the age
breakdown?
a. 17 years or younger?
b. 18–44 years?
c. 45–54 years?
d. 55–64 years?
Derived from: [AG17LESSRC,
AG18TO44RC, AG45TO54RC,
AG55TO64RC]
Q16. Of the residents
currently living in this
residential care
community, what is
the age breakdown?
a. 17 years or younger?
b. 18–44 years?
c. 45–54 years?
d. 55–64 years?
Derived from: [MSR_201_
VAL/ TOTPAT from OBQI
Case Mix Roll-up data]
Calculated age at the time of
episode of care.
Derived from: [AGE_
LESS_65/ BENE_CNT
from IPBS hospice data]
Number of beneficiaries
under age 65 utilizing
the provider.
Derived from: [C_RSDNT_
AGE_NUM from MARET
data]
Calculated age at the
time of nursing home
assessment.
Number of long-term
care services users
between ages 65
and 74
Q15. Of the participants
currently enrolled at this
center, what is the age
breakdown?:
e. 65–74 years?
Q16. Of the residents
currently living in this
residential care
community, what is
the age breakdown?
e. 65–74 years?
Derived from: [MSR_201_
VAL/ TOTPAT from OBQI
Case Mix Roll-up data]
Calculated age at the time
of episode of care.
Derived from: [AGE_65_69,
AGE_70_74/ BENE_CNT
from IPBS hospice data]
Number of beneficiaries
between ages 65 and 69
utilizing the provider;
Number of beneficiaries
between ages 70 and 74
utilizing the provider.
Derived from: [C_RSDNT_
AGE_NUM from MARET
data]
Calculated age at the
time of nursing home
assessment.
Number of long-term
care services users
between ages 75
and 84
Q15. Of the participants
currently enrolled at this
center, what is the age
breakdown?
f. 75–84 years?
Q16. Of the residents
currently living in this
residential care
community, what is
the age breakdown?
f. 75–84 years?
Derived from: [MSR_201_
VAL/ TOTPAT from OBQI
Case Mix Roll-up data]
Calculated age at the
time of episode of care.
Derived from: [AGE_75_79,
AGE_80_84/ BENE_CNT
from IPBS hospice data]
Number of beneficiaries
between ages 75 and 79
utilizing the provider;
Number of beneficiaries
between ages 80 and 84
utilizing the provider.
Derived from: [C_RSDNT_
AGE_NUM from MARET
data]
Calculated age at the
time of nursing home
assessment.
Number of long-term care
services users aged 85 and
over
Q15. Of the participants
currently enrolled at this
center, what is the age
breakdown?
g. 85 years and older?
Q16. Of the residents
currently living in this
residential care community,
what is the age breakdown?
g. 85 years and older?
Derived from: [MSR_201_
VAL/ TOTPAT from OBQI
Case Mix Roll-up data]
Calculated age at the
time of episode of care.
Derived from: [AGE_
OVER_84/ BENE_CNT
from IPBS hospice data]
Number of beneficiaries
over age 84 utilizing the
provider.
Derived from: [C_RSDNT_
AGE_NUM from MARET
data]
Calculated age at the
time of nursing home
assessment.
See footnotes at end of section.
Series 3, Number 43 59 NATIONAL CENTER FOR HEALTH STATISTICS
Demographic characteristics of long-term care services users, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Race and
ethnicity
2
Number of long-term care
services users of Hispanic or
Latino origin
Q13. Of the participants
currently enrolled at this
center, what is the racial-
ethnic breakdown?
a. Hispanic or Latino, of
any race?
Q14. Of the residents
currently living in this
residential care community,
what is the racial-ethnic
breakdown?
a. Hispanic or Latino, of
any race?
Derived from: [RACE_
HISPN/ BENE_CNT from
IPBS home health data]
Number of Hispanic
beneficiaries utilizing
the provider.
Derived from: [RACE_
HISPN/ BENE_CNT
from IPBS hospice data]
Number of Hispanic
beneficiaries utilizing
the provider.
Derived from: [A1000D_
HSPNC_CD/ TOTRES
from MARET data]
Number of Hispanic
residents.
Coded so that indicator
includes all Hispanic,
regardless of race
indicator.
Number of long-term care
services users who are non-
Hispanic white
Q13. Of the participants
currently enrolled at this
center, what is the racial-
ethnic breakdown?
f. White, not Hispanic or
Latino?
Q14. Of the residents
currently living in this
residential care community,
what is the racial-ethnic
breakdown?
f. White, not Hispanic or
Latino?
Derived from: [RACE_
WHITE/ BENE_CNT from
IPBS home health data]
Number of non-Hispanic
white beneficiaries utilizing
the provider.
Derived from: [RACE_
WHITE/ BENE_CNT
from IPBS
hospice data]
Number of non-Hispanic
white beneficiaries
utilizing the provider.
Derived from: [A1000F_
WHT_CD/ TOTRES from
MARET data]
Number of white
residents.
Coded so that
indicator includes only
non-Hispanic white.
Number of long-term care
services users who are non-
Hispanic black
Q13. Of the participants
currently enrolled at this
center, what is the racial-
ethnic breakdown?
d. Black, not Hispanic or
Latino?
Q14. Of the residents
currently living in this
residential care community,
what is the racial-ethnic
breakdown?
d. Black, not Hispanic or
Latino?
Derived from: [RACE_
BLACK/ BENE_CNT from
IPBS home health data]
Number of non-Hispanic
black beneficiaries utilizing
the provider.
Derived from: [RACE_
BLACK/ BENE_CNT
from IPBS hospice data]
Number of non-Hispanic
black beneficiaries
utilizing the provider.
Derived from: [A1000C_
AFRCN_AMRCN_CD/
TOTRES from MARET data]
Number of African-American
residents.
Coded so that indicator
includes only non-Hispanic
African American.
See footnotes at end of section.
NATIONAL CENTER FOR HEALTH STATISTICS 60 Series 3, Number 43
Demographic characteristics of long-term care services users, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Race and
ethnicity
2
—Con.
Number of long-term
care services users who
are of a race other than
white or black
Derived from: [AIANRC,
ASIANRC, NHOPIRC,
MULTIRACERC, OTHERRC,
UNKNOWNRC]
Q13. Of the participants
currently enrolled at this
center, what is the racial-
ethnic breakdown?
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 center’s
system?
i. Not reported (race and
ethnicity unknown)?
Derived from: [AIANRC,
ASIANRC, NHOPIRC,
MULTIRACERC, OTHERRC,
UNKNOWNRC]
Q14. Of the residents
currently living in this
residential care community,
what is the racial-ethnic
breakdown?
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?
i. Not reported (race and
ethnicity unknown)?
Derived from: [RACE_
NATIND, RACE_ API, RACE_
OTHER/ BENE_CNT from
IPBS home health]
Number of American
Indian or Alaska Native,
Asian Pacific Islander,
and other beneficiaries
not elsewhere classified
utilizing the provider.
Derived from: [RACE_
NATIND, RACE_ API, RACE_
OTHER/ BENE_CNT from
IPBS hospice data]
Number of American
Indian or Alaska Native,
Asian Pacific Islander,
and other beneficiaries
not elsewhere classified
utilizing the provider.
Derived from: [A1000A_
AMRCN_INDN_AK_NTV_CD,
A1000B_ASN_CD, A1000E_
NTV_HI_PCFC_ISLNDR_CD/
TOTRES from MARET data]
Number of American
Indian or Alaska Native,
Asian, and Native Hawaiian
or Pacific Islander residents.
Coded so that indicator
includes only non-Hispanic
“other” races.
See footnotes at end of section.
Series 3, Number 43 61 NATIONAL CENTER FOR HEALTH STATISTICS
Demographic characteristics of long-term care services users, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Sex
1
Number of long-term
care services users
who are male
Q14. Of the participants
currently enrolled at this
center, what is the sex
breakdown?
a. Male?
Q15. Of the residents
currently living in this
residential care community,
what is the sex breakdown?
a. Male?
Derived from: [MSR_202_
VAL/TOTPAT
from OBQI Case Mix
Roll-up data]
“Patient History,
Demographics,
Gender: Male”.
Derived from: [MALE/BENE_
CNT from IPBS hospice
data]
Number of male
beneficiaries utilizing
the provider.
Derived from: [A0800_
GNDR_CD/ TOTRES
from MARET data]
Identifies the resident’s
sex:
1= Male
Number of long-term
care services users
who are female
Q14. Of the participants
currently enrolled at this
center, what is the sex
breakdown?
b. Female?
Q15. Of the residents
currently living in this
residential care
community, what is
the sex breakdown?
b. Female?
Derived from: [MSR_202_
VAL/TOTPAT from OBQI
Case Mix Roll-up data]
“Patient History,
Demographics,
Gender: Female”.
Derived from: [FEMALE/
BENE_CNT from IPBS
hospice data]
Number of female
beneficiaries utilizing
the provider.
Derived from: [A0800_
GNDR_CD/ TOTRES
from MARET data]
Identifies the resident’s
sex:
1= Female
Medicaid as
payer source
3
Number of long-term
care users with Medicaid
paying for some or all
long-term care services
received
Q18. During the last 30
days, for how many of
the participants currently
enrolled at this adult day
services center did
Medicaid pay for some
or all of their services
received at this center?
Please include any
participants that received
funding from a Medicaid
state plan, Medicaid waiver,
Medicaid managed care, or
California regional center.
Q10. During the last 30
days, for how many of the
residents currently living
in this residential care
community, did Medicaid
pay for some or all of their
services received at this
center? If none, enter “0.”
Derived from: [MSR_207_
VAL/TOTPAT from OBQI
Case Mix Roll-up data]
Number of patients coded
as having Medicaid as
payer source if they had
any Medicaid as traditional
fee-for-service or HMO
(health maintenance
organization) or managed
care as current payment
sources for home care at
start of care or resumption
of care.
- - - Derived from: [CNSUS_
MDCD_CNT/ TOTRES]
Number of residents
whose primary payer
source is Medicaid.
- - - Data not available.
1
For ADSC and RCC, cases with missing data were imputed. For HHA and 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 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–9.1%; NH–0.8%), no facilities or agencies had missing data. For HOS, the IPBS–Hospice le contains hospice patient information at the provider-level; other than cases with missing data due to
nonmatching (7.1%), no agencies had missing data.
2
For ADSC and RCC, cases with missing data were imputed. For NH, MARET data are individual resident-level data; when rolling up individual user-level data to provider ID number, facilities with 20.0% or more of their
resident information missing for a given data item were coded as missing. About 0.9% of facilities, including facilities with missing data due to nonmatching (NH–0.8%), had missing data. For HHA and HOS, IPBS home
health data were used; race and ethnicity data in OBQI Case Mix Roll-up do not match race and ethnicity categories used in other data sources. 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–7.1%), no agencies had missing data.
3
For HHA, OBQI Case Mix Roll-up data are individual patient-level data; when rolling up individual user-level data to provider ID, agencies with 20.0% or more of their patient information missing for a given data item were
coded as missing. Other than 9.1% of cases missing due to nonmatching, no agencies had missing data.
NOTES: For survey data, (ADSC and RCC), question numbers refer to the order in NSLTCP questionnaires. Questionnaires and detailed documentation on survey variables are available from: https://www.cdc.gov/nchs/
nsltcp/nsltcp_questionnaires.htm. For administrative data (HHA, HOS, and NH), when the data source is not specied, the source is CMS’ CASPER.
NATIONAL CENTER FOR HEALTH STATISTICS 62 Series 3, Number 43
Health and functional characteristics of long-term care services users, by sector
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Diagnosed with
Alzheimer disease
or dementia
1
Number of long-term care
services users diagnosed
with Alzheimer disease or
dementia
Q17. Of the participants
currently enrolled at this
center, about how many have
been diagnosed with each of
the following conditions?
a. Alzheimer’s disease or
other dementias
Q18. Of the residents
currently living in this
residential care community,
about how many have been
diagnosed with each of the
following conditions?
a. Alzheimer’s disease or
other dementias
Derived from: [ALZRDSD_
BENE_CNT/ BENE_CNT
from IPBS home health data]
Number of beneficiaries
meeting the chronic condition
algorithm for Alzheimer’s
broad classification, including
dementia and utilizing the
provider (Alzheimer’s disease
and related disorders or
senile dementia).
Derived from: [ALZRDSD_
BENE_CNT/ BENE_CNT
from IPBS hospice data]
Number of beneficiaries
meeting the chronic condition
algorithm for Alzheimer’s
broad classification, including
dementia and utilizing the
provider (Alzheimer’s disease
and related disorders or
senile dementia).
Derived from: [I4200_
ALZHMR_CD, I4800_
DMNT_CD/ TOTRES from
MARET data]
Indicates whether the
resident had an active
diagnosis of Alzheimer’s
disease in the last 7 days
or indicates whether the
resident had an active
diagnosis of non-Alzheimer’s
dementia such as vascular or
multi-infarct dementia; mixed
dementia; or frontotemporal
dementia such as Pick’s
disease and dementia related
to stroke, Parkinson’s
disease, or Creutzfeldt-Jakob
disease in the last 7 days.
Diagnosed with
depression
1
Number of long-term care
services users diagnosed
with depression
Q17. Of the participants
currently enrolled
at this center, about how
many have been diagnosed
with each of the following
conditions?
g. Depression
Q18. Of the residents
currently living in this
residential care
community, about
how many have been
diagnosed with each of
the following conditions?
g. Depression
Derived from: [DEPR_BENE_
CNT / BENE_CNT from IPBS
home health data]
Number of beneficiaries
meeting the chronic condition
algorithm for depression
utilizing the provider.
Derived from: [DEPR_BENE_
CNT/ BENE_CNT from IPBS
hospice data]
Number of beneficiaries
meeting the chronic condition
algorithm for depression
utilizing the provider.
Derived from: [I5800_
DPRSN_CD/ TOTRES from
MARET data]
Indicates if the resident
had an active diagnosis
of depression (other than
bipolar) in the last 7 days.
Diagnosed with
diabetes
1
Number of long-term care
services users diagnosed
with diabetes
Q17. Of the participants
currently enrolled at this
center, about how many
have been diagnosed
with each of the following
conditions?
h. Diabetes
Q18. Of the residents
currently living in this
residential care
community, about
how many have been
diagnosed with each
of the following
conditions?
h. Diabetes
Derived from: [DIAB_BENE_
CNT/ BENE_CNT from IPBS
home health data]
Number of beneficiaries
meeting the chronic
condition algorithm
for diabetes utilizing
the provider.
Derived from: [DIAB_BENE_
CNT/ BENE_CNT from IPBS
hospice data]
Number of beneficiaries
meeting the chronic
condition algorithm
for diabetes utilizing
the provider.
Derived from: [I2900_DM_
CD/ TOTRES from MARET
data]
Indicates whether the
resident had an active
diagnosis of diabetes
mellitus (diabetic
retinopathy or neuropathy)
in the last 7 days.
See footnotes at end of section.
Series 3, Number 43 63 NATIONAL CENTER FOR HEALTH STATISTICS
Health and functional characteristics of long-term care services users, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Diagnosed with
arthritis
1
Number of long-term care
services users diagnosed
with arthritis
Q17. Of the participants
currently enrolled at this
center, about how many
have been diagnosed
with each of the
following conditions?
b. arthritis
Q18. Of the residents
currently living in this
residential care
community, about
how many have been
diagnosed with each
of the following
conditions?
b. arthritis
Derived from: [RAOA_BENE_
CNT/ BENE_CNT from IPBS
home health data]
Number of beneficiaries
meeting the chronic
condition algorithm for
rheumatoid or osteoarthritis
and utilizing the provider.
Derived from: [RAOA_BENE_
CNT/ BENE_CNT from IPBS
hospice data]
Number of beneficiaries
meeting the chronic
condition algorithm for
rheumatoid or osteoarthritis
and utilizing the provider.
Derived from: [I3700_
ARTHTS_CD/ TOTRES from
MARET data]
Indicates whether the
resident had an active
diagnosis of arthritis in
the last 7 days.
Diagnosed with
asthma
1
Number of long-term care
services users diagnosed
with asthma
Q17. Of the participants
currently enrolled
at this center, about
how many have been
diagnosed with each
of the following
conditions?
c. asthma
Q18. Of the residents
currently living in this
residential care community,
about how many have been
diagnosed with each of
the following conditions?
c. asthma
Derived from: [ASTHMA_
BENE_CNT/ BENE_CNT from
IPBS home health data]
Number of beneficiaries
meeting the chronic
condition algorithm for
asthma and utilizing the
provider.
Derived from: [ASTHMA_
BENE_CNT/ BENE_CNT from
IPBS hospice data]
Number of beneficiaries
meeting the chronic
condition algorithm for
asthma and utilizing the
provider.
---
Diagnosed with
chronic kidney
disease
1
Number of long-term care
services users diagnosed
with chronic kidney disease
Q17. Of the participants
currently enrolled at this
center, about how many
have been diagnosed
with each of the following
conditions?
e. chronic kidney disease
Q18. Of the residents
currently living in this
residential care community,
about how many have
been diagnosed with
each of the following
conditions?
e. chronic kidney disease
Derived from: [CKD_BENE_
CNT/ BENE_CNT from IPBS
home health data]
Number of beneficiaries
meeting the chronic condition
algorithm for chronic kidney
disease and utilizing the
provider.
Derived from: [CKD_BENE_
CNT/ BENE_CNT from IPBS
hospice data]
Number of beneficiaries
meeting the chronic condition
algorithm for chronic kidney
disease and utilizing the
provider.
---
Diagnosed
with chronic
obstructive
pulmonary
disease
(COPD)
1
Number of long-term care
services users diagnosed
with COPD
Q17. Of the participants
currently enrolled
at this center, about
how many have been
diagnosed with each
of the following
conditions?
f. COPD (chronic bronchitis
or emphysema)
Q18. Of the residents
currently living in this
residential care community,
about how many have been
diagnosed with each of the
following conditions?
f. COPD (chronic bronchitis
or emphysema)
Derived from: [COPD_BENE_
CNT/ BENE_CNT from IPBS
home health data]
Number of beneficiaries
meeting the chronic
condition algorithm for COPD
and utilizing the provider.
Derived from: [COPD_BENE_
CNT/ BENE_CNT from IPBS
hospice data]
Number of beneficiaries
meeting the chronic
condition algorithm for COPD
and utilizing the provider.
---
See footnotes at end of section.
NATIONAL CENTER FOR HEALTH STATISTICS 64 Series 3, Number 43
Health and functional characteristics of long-term care services users, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Diagnosed with
heart disease
1
Number of long-term care
services users diagnosed
with heart disease
Q17. Of the participants
currently enrolled
at this center, about how
many have been diagnosed
with each of the following
conditions?
i. heart disease (for example,
congestive heart failure,
coronary or ischemic heart
disease, heart attack, stroke)
Q18. Of the residents
currently living in this
residential care community,
about how many have
been diagnosed with
each of the following
conditions?
i. heart disease (for example,
congestive heart failure,
coronary or ischemic
heart disease, heart
attack, stroke)
Derived from: [IHD_BENE_
CNT/ BENE_CNT from IPBS
home health data]
Number of beneficiaries
meeting the chronic
condition algorithm for
ischemic heart disease
and utilizing the provider.
Derived from: [IHD_BENE_
CNT/ BENE_CNT from IPBS
hospice data]
Number of beneficiaries
meeting the chronic
condition algorithm for
ischemic heart disease
and utilizing the provider.
Derived from: [I0400_CAD_
CD, I0600_HRT_FAILR_CD,
I4500_STRK_CD/ TOTRES
from MARET data]
Indicates whether the
resident had an active
diagnosis of coronary
artery disease, congestive
heart failure, or stroke
(CVA or TIA or Stroke)
in the last 7 days.
Diagnosed with
high blood
pressure or
hypertension
1
Number of long-term care
services users diagnosed
with high blood pressure or
hypertension
Q17. Of the participants
currently enrolled
at this center, about how
many have been diagnosed
with each of the following
conditions?
j. high blood pressure or
hypertension
Q18. Of the residents
currently living in this
residential care community,
about how many have been
diagnosed with each of the
following conditions?
j. high blood pressure or
hypertension
Derived from: [HYPERT_
BENE_CNT/ BENE_CNT from
IPBS home health data]
Number of beneficiaries
meeting the chronic condition
algorithm for hypertension
and utilizing the provider.
Derived from: [HYPERT_
BENE_CNT/ BENE_CNT from
IPBS hospice data]
Number of beneficiaries
meeting the chronic condition
algorithm for hypertension
and utilizing the provider.
Derived from: [I0700_
HYPRTNSN_CD/ TOTRES
from MARET data]
Indicates whether the
resident had an active
diagnosis of hypertension in
the last 7 days.
Diagnosed with
osteoporosis
1
Number of long-term care
services users diagnosed
with osteoporosis
Q17. Of the participants
currently enrolled
at this center, about how
many have been diagnosed
with each of the following
conditions?
o. osteoporosis
Q18. Of the residents
currently living in this
residential care community,
about how many have been
diagnosed with each of the
following conditions?
o. osteoporosis
Derived from: [OST_BENE_
CNT/ BENE_CNT from IPBS
home health data]
Number of beneficiaries
meeting the chronic condition
algorithm for osteoporosis
and utilizing the provider.
Derived from: [OST_BENE_
CNT/ BENE_CNT from IPBS
hospice data]
Number of beneficiaries
meeting the chronic condition
algorithm for osteoporosis
and utilizing the provider.
Derived from: [I3800_
OSTPRS_CD/ TOTRES from
MARET data]
Indicates whether the
resident had an active
diagnosis of osteoporosis in
the last 7 days.
See footnotes at end of section.
Series 3, Number 43 65 NATIONAL CENTER FOR HEALTH STATISTICS
Health and functional characteristics of long-term care services users, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Assistance
with eating
2
Number of long-term care
services users needing
any assistance with eating.
Assistance refers to needing
any help or supervision from
another person or use of
assistive devices.
Q16. Of the participants
currently enrolled at this
center, about how many
need any assistance at their
usual residence or this center
in each of the following
activities?
b. With eating, like cutting
up food
Q17. Of the residents
currently living in this
residential care community,
about how many need any
assistance in each of the
following activities?
b. With eating, like cutting
up food
Derived from: [MSR_342_
VAL/ TOTPAT 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; are
unable to feed self and must
be assisted or supervised
throughout the meal or
snack; are able to take in
nutrients orally and receive
supplemental nutrients
through a nasogastric tube
or gastrostomy; are unable
to take in nutrients orally and
are fed nutrients through
a nasogastric tube or
gastrostomy; or are unable to
take in nutrients orally or by
tube feeding.
- - - Derived from: [CNSUS_
EATG_ ASTD_CNT, CNSUS_
EATG_ DPNDNT_CNT/
CNSUS_RSDNT_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.
See footnotes at end of section.
NATIONAL CENTER FOR HEALTH STATISTICS 66 Series 3, Number 43
Health and functional characteristics of long-term care services users, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Assistance with
dressing
2
Number of long-term care
services users needing any
assistance with dressing.
Assistance refers to needing
any help or supervision from
another person or use of
assistive devices.
Q16. Of the participants
currently enrolled at this
center, about how many
need any assistance at their
usual residence or this center
in each of the following
activities?
c. With dressing
Q17. Of the residents
currently living in this
residential care community,
about how many need any
assistance in each of the
following activities?
c. With dressing
Derived from: [MSR_335_
VAL & MSR_336_VAL/
TOTPAT 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
to dress the upper and lower
body.
- - - Derived from: [CNSUS_DRS_
ASTD_CNT; CNSUS_DRS_
DPNDNT_CNT/ CNSUS_
RSDNT_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.
See footnotes at end of section.
Series 3, Number 43 67 NATIONAL CENTER FOR HEALTH STATISTICS
Health and functional characteristics of long-term care services users, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Assistance with
toileting
2
Number of long-term care
services users needing
any assistance with using
bathroom. Assistance refers
to needing any help or
supervision from another
person or use of assistive
devices.
Q16. Of the participants
currently enrolled at this
center, about how many
need any assistance at their
usual residence or this center
in each of the following
activities?
e. With using the bathroom
(toileting)
Q17. Of the residents
currently living in this
residential care community,
about how many need any
assistance in each of the
following activities?
e. With using the bathroom
(toileting)
Derived from: [MSR_339_
VAL/ TOTPAT 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, or 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.
- - - Derived from: [CNSUS_
TOILT_ ASTD_CNT, CNSUS_
TOILT_ DPNDNT_CNT/
CNSUS_RSDNT_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.
See footnotes at end of section.
NATIONAL CENTER FOR HEALTH STATISTICS 68 Series 3, Number 43
Health and functional characteristics of long-term care services users, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Assistance with
bathing
2
Number of long-term care
services users needing any
assistance with bathing
or showering. Assistance
refers to needing any help
or supervision from another
person or use of assistive
devices.
Q16. Of the participants
currently enrolled
at this center, about how
many need any assistance
at their usual residence or
this center in each of the
following activities?
d. With bathing or showering
Q17. Of the residents
currently living in this
residential care community,
about how many need any
assistance in each of the
following activities?
d. 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.
- - - Derived from: [CNSUS_
BATHG_ASTD_CNT, CNSUS_
BATHG_DPNDNT_CNT/
CNSUS_RSDNT_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.
See footnotes at end of section.
Series 3, Number 43 69 NATIONAL CENTER FOR HEALTH STATISTICS
Health and functional characteristics of long-term care services users, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Assistance with
walking or
locomotion
2
Number of long-term care
services users needing any
assistance with walking
or locomotion. Assistance
refers to needing any help
or supervision from another
person or use of assistive
devices.
Q16. Of the participants
currently enrolled at this
center, about how many now
need any assistance at their
usual residence or this center
in each of the following
activities?
f. With locomotion or
walking—this includes using
a cane, walker, or wheelchair,
or help from another person
Q17. Of the residents
currently living in this
residential care community,
about how many need any
assistance in each of the
following activities?
f. With locomotion or
walking—this includes using
a cane, walker, or wheelchair,
or help from another person
Derived from: [MSR_341_
VAL from OBQI Case Mix
Roll-up data]
Number of patients coded
as needing any assistance
with ambulation or
locomotion if they are: able
to independently walk on
even and uneven surfaces
and negotiate stairs with or
without railings without use
of an assistive device, with
the use of a one-handed
assistive device, or with the
use of a two-handed device;
able to walk only with the
assistance of another person
at all times; chairfast, unable
to ambulate but are able to
wheel self independently;
chairfast, unable to ambulate
and unable to wheel self; or
bedfast, unable to ambulate
or be up in a chair.
- - - Derived from: [CNSUS_
INDPNDNT_MBLTY_CNT,
CNSUS_RSDNT_CNT]
Number of residents who
require no help or oversight;
or help or oversight was
provided only one or two
times during the past 7 days.
Do not include residents who
use a cane, walker, or crutch.
Subtracted from CNSUS_
RSDNT_CNT.
See footnotes at end of section.
NATIONAL CENTER FOR HEALTH STATISTICS 70 Series 3, Number 43
Health and functional characteristics of long-term care services users, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Assistance with
transferring
2
Number of long-term care
services users needing any
assistance with transferring.
Assistance refers to needing
any help or supervision from
another person or use of
assistive devices.
Q16. Of the participants
currently enrolled at this
center, about how many now
need any assistance at their
usual residence or this center
in each of the following
activities?
a. With transferring in and
out of a chair
Q17. Of the residents
currently living in this
residential care community,
about how many need any
assistance in each of the
following activities?
a. With transferring in and
out of a bed or chair
Derived from: [MSR_340_
VAL from OBQI Case Mix
Roll-up data]
Number of patients coded
as needing any assistance
with transferring if they are:
able to transfer with minimal
human assistance or with
use of an assistive device;
able to bear weight and pivot
during the transfer process
but unable to transfer self;
unable to transfer self and
are unable to bear weight
or pivot when transferred
by another person; bedfast,
unable to transfer but are
able to turn and position
self in bed; bedfast, unable
to transfer and are unable to
turn and position self.
- - - Derived from: [CNSUS_
TRNSFR_ASTD_CNT,
CNSUS_ TRNSFR_DPNDNT_
CNT/ CNSUS_RSDNT_CNT]
Number of residents who
require help moving between
surfaces, including, to or
from bed, chair, wheelchair,
or standing positions.
Excludes transfers to or
from the bath or toilet. If the
facility routinely provides
“setup” assistance to all
residents, such as handing
the equipment (e.g., sliding
board) to the resident, and
this is the only assistance
required, the resident was
coded as not needing
assistance with transferring.
- - - Data not available.
1
For NH, MARET data are individual resident-level data; when rolling up individual user-level data to provider ID number, facilities with 20.0% or more of their resident information missing for a given data item were coded
as missing. From 8.6% (for diabetes) to 10.2% (for osteoporosis and arthritis) of facilities (including 0.8% of missing data due to nonmatching) had missing data. For HHA and 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–7.1%), no agencies had
missing data.
2
For HHA, OBQI Case Mix Roll-up data are individual patient-level data; when rolling up individual user-level data to 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 nonmatching, (HHA–9.1%), no agencies had missing data.
NOTES: For survey data, (ADSC and RCC), question numbers refer to the order in NSLTCP questionnaires. Questionnaires and detailed documentation on survey variables are available from: https://www.cdc.gov/nchs/
nsltcp/nsltcp_questionnaires.htm. For administrative data (HHA, HOS, and NH), when the data source is not specied, the source is CMS’ CASPER.
Series 3, Number 43 71 NATIONAL CENTER FOR HEALTH STATISTICS
Adverse events among long-term care services users, by sector
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Overnight
hospital stay¹
Number of long-term care
users who were discharged
from an overnight hospital
stay
Q20. Of the participants
currently enrolled at this
center, about how many
were discharged from an
overnight hospital stay in the
last 90 days? Exclude trips
to the hospital emergency
department that did not result
in an overnight hospital stay.
Q20. Of the residents
currently living in this
residential care community,
about how many were
discharged from an overnight
hospital stay in the last
90 days? Exclude trips to
the hospital emergency
department that did not result
in an overnight hospital stay.
Derived from: [MSR_447_
VAL from OBQI Case Mix
Roll-up data]
To which inpatient facility has
the patient been admitted?
1= Hospital
- - - Derived from: [PRVDRNUM
hospital codes and
DSCHRGDT from 2014
Medicare Provider Analysis
and Review (MedPAR)
inpatient claims data merged
to MARET]
Overnight hospital stay
defined as residents with
at least one inpatient
hospitalization claim
discharged after the nursing
home admission date within
the 2014 calendar year.
Emergency
department visits²
Number of long-term care
users who had emergency
department visits
Q19. Of the participants
currently enrolled at this
center, about how many
were treated in a hospital
emergency department in the
last 90 days?
Q19. Of the residents
currently living in this
residential care community,
about how many were
treated in a hospital
emergency department
in the last 90 days?
Derived from: [MSR_426_
VAL from OBQI Case Mix
Roll-up data]
Since the last time Outcome
and Assessment
Information Set data were
collected, has the patient
utilized a hospital emergency
department (includes holding
or observation)?
- - - - - -
See footnotes at end of section.
NATIONAL CENTER FOR HEALTH STATISTICS 72 Series 3, Number 43
Adverse events among long-term care services users, by sector—Con.
Characteristic Definition
Survey data Administrative data
Adult day services center
(ADSC)
Residential care community
(RCC)
Home health agency
(HHA)
Hospice
(HOS)
Nursing home
(NH)
Falls
3
Number of long-term care
users who had falls
Q25. As best you know,
about how many of your
current participants had a fall
in the last 90 days? Please
include falls that occurred
in your center or off-site,
whether or not the participant
was injured, and whether
or not anyone saw the
participant fall or caught
them. Please just count
one fall per participant who
fell, even if the participant
fell more than one time. If
one of your participants fell
during the last 90 days, but is
currently in the hospital or
rehabilitation facility, please
include that person in your
count.
[Question only in
Version A]
Q23. As best you know,
about how many of your
current residents had a fall in
the last 90 days?
[Question only in
Version A]
- - - - - - Derived from: [J1800_FALL_
LAST_ASMT_CD/ TOTRES
from MARET
data]
Has the resident had any falls
since admission or the prior
assessment, whichever is
more recent?
Length of stay
4
Short-stay residents had
been admitted less than 100
days from assessment date
and long-stay residents had
been admitted for 100 days
or more
- - - - - - - - - - - - Derived from: [LAST_TRGT_
DT and A1600_ENTRY_DT
from MARET data]
if LOS<= 100 then
SHORTSTAY_100= 1;
else if LOS>100 then
SHORTSTAY_100= 0;
- - - Data not available.
1
For HHA, OBQI Case Mix Roll-up data are individual patient-level data; when rolling up individual user-level data to provider ID, facilities or agencies with 20.0% or more of their patient information missing for a given data
item were coded as missing. About 9.5% of agencies (including 9.1% of missing data due to nonmatching) had missing data.
2
For HHA, OBQI Case Mix Roll-up data are individual patient-level data; when rolling up individual user-level data to provider ID, facilities or agencies with 20.0% or more of their patient information missing for a given data
item were coded as missing. About 10.4% of agencies (including 9.1% of missing data due to nonmatching) had missing data.
3
For NH, MARET data are individual resident-level data; when rolling up individual user-level data to provider ID number, facilities with 20.0% or more of their resident information missing for a given data item were coded
as missing. About 8.6% of facilities (including 0.8% of missing data due to nonmatching) had missing data.
4
For NH, MARET data are individual resident-level data that were not rolled up to the user-level data. This variable was used to compare short- and long-stay nursing home residents on various user characteristics.
NOTES: For survey data, (ADSC and RCC), question numbers refer to the order in NSLTCP questionnaires. Questionnaires and detailed documentation on survey variables are available from: https://www.cdc.gov/nchs/
nsltcp/nsltcp_questionnaires.htm. For administrative data (HHA, HOS, and NH), when the data source is not specied, the source is CMS’ CASPER.
SOURCE: NCHS, National Study of Long-Term Care Providers, 2015–2016.
Series 3, Number 43 73 NATIONAL CENTER FOR HEALTH STATISTICS
Appendix III. Detailed Tables
Table V. Long-term care services providers, by geographical and organizational characteristics and sector:
United States, 2015–2016
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
Number of providers
1
4,600 3 12,200 . . . 4,300 . . . 15,600 . . . 28,900 68
Number of beds or
licensed maximum
capacity
1
298,400 2,883 . . . . . . . . . . . . 1,660,400 . . . 996,100 8,787
Average number of beds
or licensed maximum
capacity
2,3
66.0 0.6 - - - - - - - - - - - - 106.0 0.5 35.0 0.3
Average number of
people served
3,4
Daily 42.0 0.4 . . . . . . . . . . . . 86.0 0.4 28.0 0.3
Annually . . . . . . 401.0 9.8 353.0 10.7 . . . . . . . . . . . .
Region Percent distribution
Northeast 20.1 0.0 8.6 0.3 10.4 0.5 16.8 0.3 8.6 0.1
Midwest 16.9 0.0 27.4 0.4 21.8 0.6 33.0 0.4 22.6 0.1
South 32.2 0.0 45.6 0.5 39.4 0.7 34.8 0.4 28.0 0.1
West 30.8 0.0 18.4 0.4 28.6 0.7 15.4 0.3 40.8 0.1
Metropolitan statistical
area status
Metropolitan 84.8 0.4 84.8 0.3 79.0 0.6 71.5 0.4 82.5 0.6
Micropolitan 10.2 0.3 8.1 0.3 12.8 0.5 13.9 0.3 10.6 0.5
Neither 5.0 0.2 7.2 0.2 8.2 0.4 14.6 0.3 6.9 0.4
Ownership
For profit 44.7 0.6 80.6 0.4 63.0 0.7 69.3 0.4 81.0 0.7
Nonprofit 50.8 0.6 14.8 0.3 22.8 0.6 23.5 0.3 17.7 0.7
Government and other 4.6 0.2 4.6 0.2 14.1 0.5 7.2 0.2 1.3 0.2
People served
5
Number
Category 1 45.0 0.5 44.8 0.5 34.2 0.8 5.7 0.2 65.0 0.3
Category 2 48.6 0.6 25.8 0.4 34.0 0.8 63.7 0.4 30.7 0.4
Category 3 6.4 0.3 29.4 0.4 31.8 0.7 30.6 0.4 4.3 0.2
Certification Percent
Medicare-certified . . . . . . 98.7 0.1 - - - - - - 97.5 0.1 . . . . . .
Medicaid-certified 76.9 0.5 78.4 0.4 - - - - - - 95.2 0.2 48.3 0.8
Chain-affiliated 42.6 0.6 - - - - - - - - - - - - 57.6 0.4 57.2 1.0
. . . Category not applicable.
- - - Data not available.
0.0 Quantity more than zero but less than 0.05.
1
Estimates are rounded as whole numbers to the nearest hundred.
2
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 certied beds.
3
Averages are based on unrounded numbers.
4
The estimated number of adult day services center participants represents current participants in 2016.The estimated number of home health patients represents
patients who ended care in 2015 (i.e., discharges). The estimated number of hospice patients represents patients who received care at any time in 2015. The
estimated number of nursing home residents represents current residents in 2016. The estimated number of residential care community residents represents
current residents in 2016.
5
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 2016,
and the categories are 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
2015, and categories are 1–100, 101–300, and 301 or more. Home health patients are patients who received and ended care anytime in 2015. Hospice patients
are patients who received care anytime in 2015.
NOTES: Percent distributions may not add to 100 because of rounding. Percentages are based on unrounded estimates.
SOURCE: NCHS, National Study of Long-Term Care Providers, 2015–2016.
NATIONAL CENTER FOR HEALTH STATISTICS 74 Series 3, Number 43
Table VI. Staffing characteristics of long-term care services providers, by staff type and sector: United States,
2016
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
Total number of nursing
and social work
employee FTEs 19,900 228 145,000 1,572 85,600 1,521 945,700 4,158 298,800 3,969
Total nursing and social
work employee FTEs Percent distribution
Registered nurse 20.6 0.3 53.0 0.4 48.0 0.3 11.9 0.1 6.1 0.2
Licensed practical
nurse or licensed
vocational nurse 11.3 0.2 19.5 0.3 8.8 0.2 22.4 0.1 9.9 0.2
Aide 56.8 0.4 25.1 0.4 31.8 0.3 63.9 0.1 83.3 0.3
Social worker 11.3 0.2 2.5 0.0 11.4 0.1 1.8 0.0 0.8 0.0
Providers with one or
more employee FTEs Percent
Registered nurse 62.1 0.6 99.7 0.1 100.0 0.0 99.1 0.1 39.4 0.8
Licensed practical nurse
or licensed vocational nurse 45.8 0.6 70.7 0.4 62.5 0.7 98.3 0.1 35.7 0.7
Aide 67.3 0.6 89.9 0.3 97.8 0.2 98.8 0.1 81.7 0.9
Social worker 39.9 0.6 46.7 0.5 99.3 0.1 76.8 0.3 10.2 0.5
Activities director or staff 84.8 0.5 --- --- --- --- 96.7 0.1 58.3 0.9
Employee hours per resident
or participant per day Mean
Registered nurse 0.34 0.01 --- ---
--- --- 0.54 0.01 0.20 0.01
Licensed practical
nurse or licensed
vocational nurse 0.21 0.01 --- --- --- --- 0.85 0.01 0.17 0.01
Aide 0.86 0.02 --- --- --- --- 2.41 0.01 2.27 0.10
Social worker 0.13 0.00 --- --- --- --- 0.08 0.00 0.03 0.00
Activities director or staff 0.67 0.01 --- --- --- --- 0.19 0.00 0.31 0.02
0.0 or 0.00 Quantity more than zero but less than 0.05.
- - - Data not available.
NOTES: FTE is full-time equivalent. Percent distributions may not add to 100 because of rounding. Percentages are based on unrounded estimates.
SOURCE: NCHS, National Study of Long-Term Care Providers, 2015–2016.
Series 3, Number 43 75 NATIONAL CENTER FOR HEALTH STATISTICS
Table VII. Provision of services by long-term care services providers, by type of service and sector:
United States, 2016
Service provided
Adult day
services
center
Standard
error
Home
health
agency
Standard
error Hospice
Standard
error
Nursing
home
Standard
error
Residential
care
community
Standard
error
Percent
Social work 52.1 0.6 82.5 0.3 100.0 — 88.5 0.3 51.1 1.1
Mental health or counseling 33.8 0.6 - - - - - - 97.0 0.3 87.6 0.3 55.0 1.1
Therapeutic 46.7 0.6 96.3 0.2 98.2 0.2 99.5 0.1 71.4 1.0
Skilled nursing or nursing 64.5 0.6 100.0 — 100.0 — 100.0 — 66.1 1.0
Pharmacy or pharmacist 30.0 0.6 4.9 0.2 - - - - - - 97.2 0.1 83.6 0.8
Hospice 20.8 0.5 5.7 0.2 . . . . . . 80.7 0.3 67.7 1.0
Dietary and nutritional 67.8 0.6 - - - - - - - - - - - - 100.0 — 82.8 0.9
Dementia-specific units
Only serve residents with
dementia . . . . . . . . . . . . . . . . . . 0.4 0.1 8.7 0.8
Have a distinct unit, wing,
or floor designated for
dementia special care . . . . . . . . . . . . . . . . . . 14.9 0.3 14.3 0.8
— Quantity zero.
- - - Data not available.
. . . Category not applicable.
NOTES: Percent distributions may not add to 100 because of rounding. Percentages are based on unrounded estimates.
SOURCE: NCHS, National Study of Long-Term Care Providers, 2015–2016.
NATIONAL CENTER FOR HEALTH STATISTICS 76 Series 3, Number 43
Table VIII. Long-term care services users, by selected characteristics and sector: United States, 2015–2016
Characteristic
1
Adult day
services
center
Standard
error
Home
health
agency
Standard
error Hospice
Standard
error
Nursing
home
Standard
error
Residential
care
community
Standard
error
Number
Users
2
286,300 3,180 4,455,700 109,617 1,426,000 43,639 1,347,600 6,769 811,500 8,343
Age Percent
Under 65 37.4 0.6 18.1 0.2 5.5 0.1 16.5 0.1 6.6 0.3
65 and over 62.5 0.6 81.9 0.2 94.6 0.1 83.5 0.1 93.4 0.3
65–74 20.3 0.2 26.8 0.1 17.5 0.1 18.2 0.1 11.0 0.3
75–84 25.9 0.4 29.9 0.1 29.3 0.1 26.7 0.1 30.3 0.5
85 and over 16.3 0.3 25.2 0.2 47.8 0.2 38.6 0.2 52.1 0.7
Sex Percent distribution
Men 41.8 0.2 39.1 0.1 41.3 0.1 35.4 0.1 29.4 0.3
Women 58.2 0.2 60.9 0.1 58.7 0.1 64.6 0.1 70.6 0.3
Race and ethnicity
Hispanic 22.7 0.5 7.4 0.2 5.5 0.4 5.4 0.1 3.1 0.2
Non-Hispanic white 42.0 0.6 76.1 0.3 83.6 0.5 75.1 0.3 81.4 0.8
Non-Hispanic black 15.4 0.3 12.9 0.2 8.2 0.2 14.3 0.2 4.1 0.2
Other
3
18.1 0.6 3.7 0.1 2.7 0.1 5.1 0.1 3.7 0.3
Diagnosis
4
Percent
Alzheimer disease or other
dementias 30.9 0.5 32.3 0.2 44.5 0.3 47.8 0.1 41.9 0.7
Arthritis 37.9 0.7 59.6 0.2 28.7 0.2 26.2 0.1 42.4 0.8
Asthma 8.3 0.2 23.7 0.1 8.4 0.1 --- --- 6.8 0.2
Chronic kidney disease 7.2 0.2 46.9 0.1 35.9 0.2 --- --- 8.3 0.3
COPD 10.0 0.3 31.9 0.2 20.7 0.2 --- --- 14.0 0.4
Depression 28.2 0.5 39.4 0.1 23.4 0.2 46.3 0.1 30.9 0.6
Diabetes 31.4 0.4 45.1 0.2 27.0 0.2 32.0 0.1 18.1 0.3
Disease
5
27.1 0.5 55.0 0.2 38.7 0.3 38.1 0.1 34.3 0.6
High blood pressure or
hypertension 50.3 0.6 88.9 0.1 51.0 0.3 71.5 0.1 51.2 0.7
Osteoporosis 21.2 0.6 15.3 0.1 7.2 0.1 12.3 0.1 23.7 0.6
Need assistance in
physical functioning
Eating 23.2 0.5 61.2 0.4 --- --- 59.9 0.3 19.2 0.5
Bathing 38.6 0.7 97.2 0.1 --- --- 96.7 0.1 63.6 0.8
Dressing 36.0 0.6 92.0 0.2 --- --- 92.7 0.1 48.2 0.7
Toileting 33.5 0.6 81.1 0.4 --- --- 89.3 0.1 40.0 0.7
Walking or locomotion 45.8 0.6 95.4 0.1 --- --- 92.0 0.1 56.5 0.8
Transferring in and out of
a chair or bed 28.5 0.6 91.3 0.2 --- --- 86.8 0.1 29.2 0.7
See footnotes at end of table.
Series 3, Number 43 77 NATIONAL CENTER FOR HEALTH STATISTICS
Table VIII. Long-term care services users, by selected characteristics and sector: United States,
2015–2016—Con.
Characteristic
1
Adult day
services
center
Standard
error
Home
health
agency
Standard
error Hospice
Standard
error
Nursing
home
Standard
error
Residential
care
community
Standard
error
Percent
Medicaid as payer source 65.8 0.7 9.5 0.3 --- --- 61.8 0.2 16.5 0.6
Adverse event
Overnight hospital stay
6
4.4 0.1 15.7 0.1 --- --- 14.4 0.0 8.3 0.2
Emergency department visit 7.2 0.1 15.3 0.1 --- --- --- --- 14.2 0.3
Fall 7.8 0.4 --- --- --- --- 16.1 0.1 21.5 0.7
- - - Data not available.
0.0 Quantity more than zero but less than 0.05.
1
All cases with missing data were removed from the denominator when calculating percentages. For variables that had missing data for more than 10% of all
cases, the percentage missing is reported in a footnote.
2
Estimates are rounded as whole numbers to the nearest hundred. The estimated number of adult day services center participants represents current participants
in 2016. The estimated number of home health patients represents patients who ended care in 2015 (i.e., discharges). The estimated number of hospice patients
represents patients who received care at any time in 2015. The estimated number of nursing home residents represents current residents in 2016. The estimated
number of residential care community residents represents current residents in 2016.
3
For adult day services centers and residential care communities, includes non-Hispanic American Indian or Alaska Native, non-Hispanic Asian, non-Hispanic
Native Hawaiian or Other Pacic Islander, non-Hispanic of two or more races, and unknown race and ethnicity.
4
For adult day services centers, the percentage of missing data was 11.2% for Alzheimer disease, 14.3% for arthritis, 14.8% for asthma, 15.0% for chronic kidney
disease, 15.3% for chronic obstructive pulmonary disease (COPD), 13.1% for depression, 11.8% for diabetes, 14.1% for heart disease, 13.1% for hypertension,
and 15.8% for osteoporosis. For residential care communities, the percentage of missing was 14.1% for arthritis, 15.6% for asthma, 15.3% for chronic kidney
disease, 13.6% for COPD, 12.6% for depression, 12.5% for diabetes, 13.0% for heart disease, 11.5% for hypertension, and 15.0% for osteoporosis.
5
For adult day services center participants and residential care community residents, heart disease includes congestive heart failure, coronary or ischemic heart
disease, heart attack, and stroke. For home health and hospice patients, heart disease refers to ischemic heart disease. For nursing home residents, heart
disease refers to coronary artery disease, congestive heart failure, and stroke.
6
For nursing home residents, overnight hospital stay is dened as any resident in the 2014 Minimum Data Set Active Resident Episode Table 3rd quarter le
having any inpatient hospital stay as determined in the 2014 Medicare Provider Analysis and Review data le.
NOTES: Percent distributions may not add to 100 because of rounding. Percentages are based on unrounded estimates.
SOURCE: NCHS, National Study of Long-Term Care Providers, 2015–2016.
NATIONAL CENTER FOR HEALTH STATISTICS 78 Series 3, Number 43
Table IX. Nursing home residents, by selected characteristics and length of
stay: United States, 2016
Characteristic
Short stay
(less than 100 days)
1
Standard
error
Long stay
(100 days or more)
1
Standard
error
Number
Users
2
606,800 586 794,000 586
Age Percent
Under 65 18.6 0.1 14.9 0.0
65 and over 81.4 0.1 85.1 0.0
65–74 20.8 0.1 16.1 0.0
75–84 28.4 0.1 25.5 0.1
85 and over 32.2 0.1 43.5 0.1
Sex Percent distribution
Men 39.7 0.1 32.1 0.1
Women 60.3 0.1 67.9 0.1
Race and ethnicity
Hispanic 5.4 0.0 5.4 0.0
Non-Hispanic white 74.6 0.1 75.6 0.1
Non-Hispanic black 14.0 0.0 14.6 0.0
Other 6.0 0.0 4.5 0.0
Diagnosis Percent
Alzheimer disease or other
dementias 36.7 0.1 58.9 0.1
Arthritis 25.1 0.1 29.7 0.1
Depression 42.6 0.1 53.0 0.1
Diabetes 37.0 0.1 32.2 0.1
Heart disease
3
35.8 0.1 38.8 0.1
High blood pressure or
hypertension 76.8 0.1 75.8 0.1
Osteoporosis 9.8 0.0 15.1 0.0
Need assistance in
physical functioning
Eating --- --- --- ---
Bathing --- --- --- ---
Dressing --- --- --- ---
Toileting --- --- --- ---
Walking or locomotion --- --- --- ---
Transferring in and out of
a chair or bed --- --- --- ---
Medicaid as payer source --- --- --- ---
Adverse event
Overnight hospital stay
4
23.8 0.1 8.7 0.0
Emergency department visit --- --- --- ---
Fall 13.5 0.1 19.1 0.0
0.0 Quantity more than zero but less than 0.05.
- - - Data not available.
1
Average length of stay among all residents is 485 days; 43% of residents are short-stay and 57% are long-
stay.
2
Estimates are rounded as whole numbers to the nearest hundred. The estimated number of nursing home
residents represents current residents in 2016.
3
Heart disease refers to coronary artery disease, congestive heart failure, and stroke.
4
Overnight hospital stay is dened as any resident in the 2014 Minimum Data Set Active Resident Episode
Table 3rd quarter le having any inpatient hospital stay as determined in the 2014 Medicare Provider Analysis
and Review data le.
NOTES: Percent distributions may not add to 100 because of rounding. Percentages are based on unrounded
estimates.
SOURCE: NCHS, National Study of Long-Term Care Providers, 2015–2016.
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