Service Provision, Hospitalizations, and Chronic Conditions in Adult Day Services Centers: Findings From the 2016 National Study of Long-Term Care Providers

April 30, 2019

Questions for Lead Author Christine Caffrey, Health Statistician, of “Service Provision, Hospitalizations, and Chronic Conditions in Adult Day Services Centers: Findings From the 2016 National Study of Long-Term Care Providers.”

Q: Why did you decide to do a report on hospitalizations and chronic conditions by service provision in adult day services centers?

CF: A primary goal of adult day services centers is to help individuals remain living in the community and preventing or delaying institutionalization.  As part of this goal, adult day services centers offer a variety of services, including mental health, social work, therapeutic, dietary and nutritional, and skilled nursing services.

Hospitalizations among older adults are a strong predictor of future institutionalization or nursing home admission, and are associated with health and disability declines, lower quality of life, and greater health care costs. The increased risks associated with hospitalizations are of particular concern to adult day services centers, and reducing hospitalizations and readmissions is a main goal for them.  Often adult day services centers have participants with diverse health needs, including common chronic conditions, such as Alzheimer disease and other dementias, depression, diabetes, and heart disease.  These chronic conditions have been found to be associated with hospitalizations and readmissions in long-term care settings.

Having a participant case mix with hospitalizations and several different chronic conditions may increase the need to provide a wider variety of services. Despite adult day services centers main goals of reducing hospitalizations and readmissions and managing chronic conditions among participants through service provision, national estimates on the relationship between service provision and hospitalizations and chronic conditions are limited. This report fills this gap by presenting 2016 national estimates of the percentages of hospitalizations in the past 90 days and the number of chronic conditions among ADSCs, by service provision.


Q: How did the data vary by service provision?

CF: Overall, more than one-half of adult day services centers (52.6%) provided all five services, about 37.0% of centers provided one to four of the five services, and approximately one-tenth of centers (10.2%) provided none of the five services.  Nearly one-tenth (8.4%) of adult day services centers provided all of the five services with employees and 10.3% provided all of the five services by arrangement or referral.  The prevalence of hospitalizations varied by service provision.

Almost three-fourths of adult day services centers that provided all five services (74.3%) reported at least one hospitalization in the past 90 days compared to almost one-third (31.5%) of adult day services centers that provided none of the five services.  Among adult day services centers that provided all five services with employees, 81.7% had hospitalizations compared with 59.4% of centers that provided all five services by arrangement or referral.  The number of chronic conditions in an adult day services center also varied by service provision.  Across adult day services centers that provided all five services, 17.5% had zero to three of the four chronic conditions in their center and 82.5% had all four conditions.  In adult day services centers that provided none of the five services, 70.6% had zero to three of the four chronic conditions in their center and 29.4% had all four conditions.

Among adult day services centers that provided all five services with employees, 3.8% had zero to three of the four chronic conditions in their center and 96.2% had all four conditions.  In adult day services centers that provided all five services by arrangement or referral, 36.3% had zero to three of the four chronic conditions in their center and 63.7% had all four conditions.


Q: Was there a specific finding in your report that surprised you?

CF: That adult day services center with greater levels of participant needs, as indicated by increased hospitalizations and the number of chronic conditions, are more likely to provide a greater number of services in general, and these services are more often provided by employees and not solely by arrangement or referral.


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

CF: This report demonstrates that adult day services centers with greater levels of participant needs, as indicated by increased hospitalizations and the number of chronic conditions, are more likely to provide a greater number of services in general and these services are more often provided by employees and not solely by arrangement or referral. The level of participant needs, as indicated by hospitalizations, and chronic conditions among participants, were lower in adult day services centers that provided select services by arrangement or referrals and in adult day services centers that did not provide select services.

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QuickStats: Percentage of Residential Care Communities by U.S. Census Region — National Study of Long-Term Care Providers, 2012–2016

November 2, 2018

During 2012–2016, the percentage of residential care communities located in the West increased from 36.4% to 40.8%.

Throughout the period, a higher percentage of residential care communities were located in the West compared with other regions.

The percentage of residential care communities declined from 30.6% in 2012 to 28% in 2016 in the South and from 10.1% to 8.6% in the Northeast. In the Midwest, the percentage was 22.9% in 2012 and 22.6% in 2016.

Source: National Study of Long-Term Care Providers, 2012–2016 data. https://www.cdc.gov/nchs/nsltcp/index.htm.

https://www.cdc.gov/mmwr/volumes/67/wr/mm6743a7.htm


QuickStats: Percentage of Residential Care Community Residents with a Fall, by Census Region — United States, 2016

September 24, 2018

In 2016, 22% of current residents living in residential care communities had a fall in the past 90 days, representing 175,000 residents in the United States.

By region, 27% of residents living in communities in the Northeast, 23% of residents in Midwest communities, and 20% of residents in communities in the South and West, respectively, had a fall.

A higher percentage of residents in the Northeast had a fall compared with residents in the South and West.

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

https://www.cdc.gov/mmwr/volumes/67/wr/mm6737a6.htm


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.


QuickStats: Percentage Distribution of Adult Day Services Centers, by Type of Service — National Study of Long-Term Care Providers, 2016

August 20, 2018

In 2016, four in 10 adult day services centers had services that were designed to meet both the social and medical needs of their enrolled participants equally.

Approximately 31% of adult day services centers had services to meet primarily social needs and some medical needs of participants, 16% had services to meet only social needs, 13% had services to meet primarily medical needs and some social needs, and 1% had services to meet only medical needs.

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/mm6732a8.htm


QuickStats: Percentage of Residential Care Community Residents with an Advance Directive by Census Division — National Study of Long-Term Care Providers, 2016

July 23, 2018

In 2016, 77.9% of residents in residential care communities had an advance directive documented in their files.

By Census division, the highest percentage (87.8%) of residents who had an advance directive were located in the Mountain division, followed by residents in East North Central (83.7%), New England (80.0%), West North Central (78.9%), Pacific (77.6%), South Atlantic (77.4%), East South Central (76.4%), Middle Atlantic (68.8%), and West South Central (64.9%).

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

https://www.cdc.gov/mmwr/volumes/67/wr/mm6728a7.htm


QuickStats: Percentage of Residential Care Communities That Use Electronic Health Records by Census Region — United States, 2016

July 2, 2018

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

The percentage that used EHRs was 36% of communities in the Northeast, 41% of communities in the Midwest, 24% of communities in the South, and 17% of communities in the West.

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

https://www.cdc.gov/mmwr/volumes/67/wr/mm6725a8.htm