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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


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Background Residential Care Population:

  • 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


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Relationship of Census definitions Residential Care Population:to residential care settings


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Project Purpose Residential Care Population:

  • 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


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Key Methodological Issues Residential Care Population:

  • 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.


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Surveys Selected for Analysis Residential Care Population:

  • 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+


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Identifying Nursing Homes Residential Care Population:

  • 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


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Defining Residential Care Facilities Residential Care Population:

  • 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


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Identifying Residential Care Residential Care Population:

  • 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



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ADL disability with help by setting Residential Care Population:


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Percent with income < $10,000 by setting Residential Care Population:


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Summary Residential Care Population:

  • 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


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Implications for data collection Residential Care Population:

  • 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


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Broader Implications Residential Care Population:

  • 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