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Measuring the Size and Characteristics of the Older Residential Care Population: Evidence from Three National Surveys

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Measuring the Size and Characteristics of the Older Residential Care Population: Evidence from Three National Surveys. Brenda C. Spillman The Urban Institute Supported by funding from the Office of Disability, Aging, and Long-Term Care Policy, ASPE/DHHS. Background.

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Measuring the Size and Characteristics of the Older Residential Care Population:Evidence from Three National Surveys

Brenda C. Spillman

The Urban Institute

Supported by funding from the Office of Disability, Aging, and Long-Term Care Policy, ASPE/DHHS

background
Background
  • Growth in residential care alternatives to nursing homes
  • Census definitions do not reflect residential care settings of today
    • Unclear demarcation between private homes and residential care, institutional and noninstitutional settings
  • Existing provider frames inadequate
  • No consensus on names, characteristics of residential care
project purpose
Project Purpose
  • Review existing estimates, data, and methods(http://aspe.hhs.gov/daltcp/reports/ltcpopsz.pdf)
    • Review estimates of nursing home and alternative residential care residents from all types of data
    • Identify issues contributing to differences in estimates
    • Identify surveys for empirical investigation
  • Empirical analysis (http://aspe.hhs.gov/daltcp/reports/3natlsur.pdf)
    • Produce estimates narrowing methodological differences
    • Improve understanding of the size and characteristics of the LTC population across settings
key methodological issues
Key Methodological Issues
  • Age of the population examined
  • Methods of assigning individuals to "facility" or "institutional" population
  • Methods of identifying nursing homes
  • Methods of identifying alternative residential care settings
  • Sample representation and weighting.
surveys selected for analysis
Surveys Selected for Analysis
  • Medicare Current Beneficiary Survey Cost and Use 2002
    • Ever enrolled age 65+ in Medicare during year
    • "Facility" and "community" settings identified
  • National Long Term Care Survey 1999
    • Medicare enrollees weighted to represent all 65+
    • "Institutional" and "community" settings identified
  • Health and Retirement Study 2002
    • "Noninstitutional" population age 65+
identifying nursing homes
Identifying Nursing Homes
  • MCBS
    • Facility type is nursing home on survey, or
    • All beds in facility identified as certified beds
  • NLTCS
    • Facility type is nursing home on survey
    • Facility type is unclear (i.e. not MRDD, mental health or other place) but identified on screener as resident’s unit in nursing, convalescent or rest home or home for the aged
defining residential care facilities
Defining Residential Care Facilities
  • Hawes definition:
    • Facility self identifies as "assisted living," or
    • Offers 24 hour supervision, housekeeping, meals and help with 2 of medication supervision, bathing or dressing
  • Operationally:
    • Named residential care type, or
    • Closest feasible identification by service package
identifying residential care
Identifying Residential Care
  • HRS: Offers ADL help (bathing, dressing, or eating) or nursing or "oversight," meals, and housekeeping
  • MCBS
    • Community: "Assisted living," or place provides all of meals, laundry or housekeeping, and medication supervision
    • Facility: Certified/licensed as a nursing home/other LTC or provide at least one personal care service or 24/7 supervision and self-identified by name associated with alternative residential care
  • NLTCS
    • Community: No medical/health supervision and
      • Interviewer identified as assisted living, resident unit in LTC facility or other institution
      • Respondent identified as foster/family care home; group home/community residential facility/assisted living
    • Facility: Nursing/health supervision by definition and not a nursing home, MR/DD, mental health or other place
summary
Summary
  • About 6.5 percent of the population age 65+ currently in residential care
    • 1.45 million (4.2 percent) in nursing homes
    • 750,000 (2.2-2.3 percent) in alternative residential care
  • But, we may have missed an unknown proportion of "community" residential care because of data limitations
  • HRS estimate for "community" residential care approaches total in community and facility settings on MCBS and NLTCS
implications for data collection
Implications for data collection
  • Best practice:
    • Screen broadly for services, "special" setting
    • collect bothfacility- or respondent-reported place type and services offered and used
  • Services should include ADL, IADL, other hallmark services, including medical/other oversight (Hawes criteria)
  • Data collected should be as consistent as feasible across settings
  • Larger samples are needed to better understand settings and their residents
broader implications
Broader Implications
  • Better measurement would improve identification, but wouldn\'t solve the small sample size problem.
  • Larger sample sizes require sound methods to allow oversampling in national surveys
    • better Census guidance
    • a reliable frame cutting across community/facility definitions
    • identifying characteristics that can be replicated by national surveys
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