Advance Directive Documentation Among Adult Day Services Centers and Use Among Participants, by Region and Center Characteristics -The National Study of Long-Term Care Providers, 2016

September 12, 2018

Jessica Lendon, Health Statistician

Questions for Jessica Lendon, Health Statistician and Lead Author of “Advance Directive Documentation Among Adult Day Services Centers and Use Among Participants, by Region and Center Characteristics -The National Study of Long-Term Care Providers, 2016

Q: Can you describe what an advance directive is?

JL: An advance directive is any written statement that expresses a person’s health care preferences in the event that she or he are unable to make decisions. The types of advance directives include documents that designate a health care decision maker, proxy, or surrogate, do-not-resuscitate orders, physician or medical orders for life-sustaining treatments, and living wills.  Advance directives can be completed by adults at any age and any health status.


Q: Why did you decide to focus on advance directives in the United States?

JL: Advance directives are an important component of care planning for individuals with serious illnesses who require long-term care services and supports or need end-of-life care, which may improve quality and satisfaction with end-of-life care. Advance directives has been examined in many healthcare settings in the United States, but has not yet been studied in adult day services centers (ADSCs).

ADSCs are not federally mandated to provide information about advance directives to users or to maintain documentation, like other long-term care settings. ADSCs are licensed by a variety of requirements at the state level.


Q: How many adult day service centers maintain documentation of advance directives?

JL: An estimated 3,300 (78%) adult day services centers reported that they maintain documentation of advance directives in their participants’ files.


Q: How did the findings vary by region?

JL: A larger percentage of adult day services centers in the Northeast reported that they maintained documentation and had participants with an advance directive, compared to the other regions. The West had the lowest percentage of centers that maintained documentation and prevalence among participants.


Q: Is this the most recent data that you have on this topic and will you be continuing to examine in future data?

JL: Yes. This is the most recent data on advance directives in adult day services centers. My co-authors and I are preparing another report, which will be a more in-depth examination of the relationship between policy, practices, and prevalence of advance directives in adult day services centers in 2016. The 2018 National Study of Long-Term Care Provider’s survey of adult day services centers also includes questions about advance directives, which will be analyzed in the future.


Q: What is the take home message in this report?

JL: The majority of adult day services centers document advance directives, which may be an important part of ensuring individuals’ end-of-life wishes are fulfilled, and only 38% of participants have a documented advance directive.

This report shows policy-relevant differences regarding advance directives, for example, adult day services centers that are Medicaid licensed are more likely to maintain documentation and have a larger percentage of participants with advance directives.

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QuickStats: Percentage Distribution of Long-Term Care Staffing Hours by Staff Member Type and Sector — United States, 2016

May 4, 2018

In 2016, aides provided more hours of care in the major sectors of long-term care than the other staffing types shown. Aides accounted for 59% of all staffing hours in nursing homes, compared with licensed practical or vocational nurses (21%), registered nurses (13%), activities staff members (5%), and social workers (2%).

Aides accounted for 76% of all staffing hours in residential care communities, in contrast to activities staff members (10%), registered nurses (7%), licensed practical or vocational nurses (6%), and social workers (1%).

In adult day services centers, aides provided 39% of all staffing hours, followed by activities staff members (30%), registered nurses (15%), licensed practical or vocational nurses (9%), and social workers (6%).

Source: National Study of Long-Term Care Providers, 2016. https://www.cdc.gov/nchs/nsltcp/index.htm.

https://www.cdc.gov/mmwr/volumes/67/wr/mm6717a6.htm


QuickStats: Percentage of Residential Care Communities That Use Electronic Health Records, by Community Bed Size — United States, 2016

February 6, 2018

In 2016, one fourth (26%) of residential care communities used electronic health records (EHRs).

The percentage of communities that used EHRs increased with community bed size.

The percentage was 12% in communities with 4–10 beds, 28% with 11–25 beds, 35% with 26–50 beds, 43% with 51–100 beds, and 50% with more than 100 beds using EHRs.

Source: National Study of Long-Term Care Providers, 2016

https://www.cdc.gov/mmwr/volumes/67/wr/mm6704a8.htm


Vaccination Coverage Among Adults Aged 65 and Over: United States, 2015

June 28, 2017

Questions for Tina Norris, Ph.D., Health Statistician and Lead Author of “Vaccination Coverage Among Adults Aged 65 and Over: United States, 2015

Q:  Why did you conduct this study?

TN:  We produced this report because vaccination is an important preventive health measure. Older adults have greater susceptibility to—and complications from—disease, and so they stand to benefit greatly from vaccinations as a preventive health measure. This study explores how the percentage of adults aged 65 and over, who received these recommended vaccinations, varied by sex, age group, race/ethnicity, and poverty status.


Q: What finding in your new study most surprised you and why?

TN:  While not unexpected, it was quite striking to see the overall variation in rates by vaccination type. We observed quite a range in the rates of vaccine coverage for influenza, pneumococcal disease, tetanus, and shingles. For example, more than two-thirds of adults aged 65 and over had an influenza vaccine in the past 12 months, while one-third had ever had a shingles vaccine.


Q:  Your report indicates you’ve examined receipt of vaccinations among community-dwelling adults aged 65 and over. What do you mean by “community-dwelling adults?”

TN:  By community-dwelling, we mean those individuals who are not living in any type of institutional setting (ex. nursing homes, hospitals, etc.).


Q:  What differences did you see among race and ethnic groups, and between the sexes?

TN:  We did see a number of significant differences in vaccination coverage among race groups and between the sexes. In terms of race, Non-Hispanic white adults were more likely than Hispanic and non-Hispanic black adults to have had an influenza vaccine in the past 12 months. Non-Hispanic white adults were more likely than Hispanic, non-Hispanic black, and non-Hispanic Asian adults to have had a tetanus vaccine in the past 10 years or to ever have had a vaccination for pneumococcal disease or shingles.

Vaccination also varied by sex. Among adults aged 65 and over, men were more likely than women to have had a tetanus vaccine in the past 10 years. However, men were less likely than women to have had a shingles vaccine at some point in the past.


Q:  What would you say is the take-home message of this report?

TN:  I think the take-home message of this report is that many adults aged 65 and over are not receiving recommended vaccinations. For example, two-thirds of adults never had a shingles vaccine, and nearly one-half did not have a tetanus vaccine in the past 10 years. We also see gaps in coverage for all four vaccinations—influenza, pneumococcal, tetanus, and shingles—by sex, age group, race and ethnicity, and poverty status.


Q:  Did you look at any titer-level testing for adults prior to vaccination receipt as a factor in vaccination coverage?

TN:  While titer-level testing is an interesting component in the strength of a body’s immune response to disease, titer-level testing was out-of-scope for this project.


Q:  Did your survey look at the different Medicare types of insurance as a factor in vaccination coverage for the population you studied?

TN:  No, insurance coverage was not included due to the cross-sectional nature of the survey and the long recall period for some of the vaccinations.  However, direct costs—and when the cost is incurred for vaccinations—have been shown to vary according to insurance coverage, and have been linked to financial burden for older adults.


QuickStats: Percentage of Adults Aged 65 Years or Older Who Saw Selected Types of Health Professionals in the Past 12 Months, by Diagnosed Diabetes Status

May 22, 2017

In 2015, adults aged 65 years or older with diagnosed diabetes were more likely than adults without diagnosed diabetes to report seeing general doctors (92.3% compared with 86.7%); eye doctors (66.9% compared with 56.6%); physician specialists (51.5% compared with 45.5%); foot doctors (29.9% compared with 13.0%) and mental health professionals (6.3% compared with 4.5%) in the past 12 months.

Those with diabetes were less likely than those without diabetes to report seeing a dentist or dental hygienist in the past 12 months (54.5% compared with 65%).

Sourcehttps://www.cdc.gov/mmwr/volumes/66/wr/mm6619a10.htm


QuickStats: Age-Adjusted Percentage of Adults Aged 65 Years or Older by Number of 10 Selected Diagnosed Chronic Conditions and Poverty Status

February 27, 2017

For the period 2013–2015, 13% of adults aged 65 years or older reported having none of 10 selected diagnosed chronic conditions; 25% had one, 46% had two or three, and 16% had four or more of the conditions.

No differences by poverty status were observed among those who reported having two or three conditions, but those in the lowest income group (100% or less of the poverty threshold) were less likely to have none or only one of the chronic conditions compared with those in the highest income group (400% or more of the poverty threshold).

Those in the lowest income group also were more likely to have four or more conditions when compared with those in the highest income group (21% compared with 12%).

Source: https://www.cdc.gov/mmwr/volumes/66/wr/mm6607a6.htm


QuickStats: Percentage of Adults Who Cannot or Find It Very Difficult to Stand or Be on Their Feet for About 2 Hours Without Using Special Equipment

December 2, 2016

A reported 10.2% of adults aged 18 years or older cannot, or find it very difficult to, stand or be on their feet for about 2 hours without using special equipment.

The percentage of adults who reported this difficulty increased with age: 2.9% of those aged 18–44 years, 11.8% of those aged 45–64 years, 19.1% of those 65–74 years, and 33.2% of those aged 75 years or older.

Overall, women were more likely (11.9%) than men (8.3%) to report this difficulty, and higher percentages were noted for women within each age group.

https://www.cdc.gov/mmwr/volumes/65/wr/mm6547a6.htm