Abstract Every two years since 2012, the National Study of Long-Term Care Providers includes provider surveys with residential care communities (RCCs) and adult day services centers (ADSCs), via a multi-mode approach using Web, hard-copy questionnaires, and computer-assisted telephone interviewing. In each wave, we struggled to achieve target response rates. First, diversity among providers surveyed—e.g. RCC size, type of ADSC—presents unique challenges. For RCCs, small communities have lower response compared to larger ones. For ADSCs, how they define themselves (medically vs socially oriented) influenced their decision to participate. Second, respondents’ perceived burden, particularly the time required to complete the survey, is a recurring concern especially for directors of multiple RCCs and ADSCs. Finally, reaching target respondents—directors, administrators or operators—is problematic. These challenges affect data quality. In this presentation, we share results of our efforts to enhance contacting and interviewing protocols intended to address low participation associated with these challenges.

Abstract Voluntary surveys of aging services providers are important data sources for research, quality improvement, and program evaluation efforts to inform evidence-based decision making. Ideally, provider surveys—a type of establishment survey—offer valuable information on providers and services users. However, decreasing survey response rates in recent years raise data quality concerns. This symposium highlights challenges leading to lower response rates (e.g., time constraints, skepticism, confidentiality concerns, getting to the correct respondent); specific data collection techniques tested, what did and did not work, and lessons learned. Although the surveys focus on long-term services and supports (LTSS) providers (e.g., assisted living) and services users (e.g., residents), the session is generalizable to other establishment surveys. Presenters bring extensive survey experience and diverse organizational perspectives—academic research center, national provider association, federal statistical agency, and research contractor. Over the years, the presenters have used their research network to share challenges and lessons learned with each other, which addresses the GSA conference theme, “Strength in Age: Harnessing the Power of Networks.” The first presentation describes test results of a state survey protocol to obtain sampled resident information from assisted living providers. The second presentation examines approaches to increase provider participation in a quality improvement initiative. The third presentation discusses efforts to address response challenges in an on-going national survey of providers in two LTSS sectors. The session allows time for and facilitates interaction with audience members to share their insights and lessons learned.

Research on licensed nurses in assisted living and residential care communities (RCCs) is sparse compared to that on licensed nurses in nursing homes. RCCs are state-regulated; thus, staffing requirements vary considerably. The current study analyzed variation in characteristics of licensed nurses by state-specific requirements for licensed nurses in RCCs. A significantly higher percentage of RCCs with one or more RNs (68.87%) and licensed practical nurses (LPNs) or licensed vocational nurses (LVNs) (56.85%) were found among states with licensed nurse requirements compared to states with no such requirements (37.35% and 29.08%, respectively; p < 0.05). LPN/LVN hours were higher among RCCs in states with licensed nurse requirements compared to RCCs in states with no such requirements (17 minutes and 8 minutes, respectively; p < 0.05). The findings provide the first evidence of variation in characteristics of licensed nurses by state-specific requirements for licensed nurses. [Res Gerontol Nurs. 2019; 12(1):27-33.].

Assisted living and similar residential care is an important source of care for elders, including those with dementia. Meaningful activities may help residents maintain function, improve self-esteem, and enhance quality of life. Using data from the 2010 Nation& Survey of Residential Care Facilities, this study identifies the extent of resident engagement in different types of activities; examines the extent to which cognitive status, other resident characteristics, and residential care community characteristics relate to activity engagement; and, among cognitively impaired residents, assesses whether being in dementia-specific settings is associated with activity engagement. Compared with persons without cognitive impairment, those with severe cognitive impairment are less likely to go on outings (79% versus 36%) and talk with family and friends (85% versus 72%). Residents with mild to severe cognitive impairment have higher participation in leisure activities than other residents if they live in dementia-specific settings (73% higher) than those who do not.

THE PROBLEM:Hospitalizations and subsequent readmissions can produce significant challenges when trying to reduce costs and improve quality of care. This study describes hospitalizations and readmissions using residential care community data from the 2012 National Study of Long-Term Care Providers. THE RESOLUTION:About 61.0% of residential care communities had hospitalizations, and among these communities, 39.3% had readmissions. Residential care communities in the Northeast were more likely to have had hospitalizations and readmissions. Residential care communities located in a continuing care retirement community (CCRC) had a lower likelihood of hospitalizations, and communities that provided therapeutic services had a lower likelihood of readmissions. TIPS FOR SUCCESS:An association with a CCRC and provision of therapeutic services were found to be protective against hospitalizations and readmissions, respectively.

All residential care communities Northeast Midwest South West Percentage

OBJECTIVES:This report presents national and state estimates of staffing levels in residential care communities for registered nurses, licensed practical or vocational nurses, and aides in the United States for 2014.METHODS:Data were drawn from the residential care community component of the 2014 wave of the biennial National Study of Long-Term Care Providers, conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics. For each staff type, the "staffing level" measure is presented as average hours per resident per day, defined as the total number of hours worked divided by the total number of residents, which does not necessarily reflect the amount of care given to a specific resident. Analyses examined the extent to which residential care community nurse and aide staffing levels varied by selected organizational characteristics and selected resident composition characteristics of the communities. Differences among subgroups were evaluated using two-sided t tests at the 0.05 level.RESULTS:In 2014, the total registered nurse, licensed practical or vocational nurse, and aide staffing level among all residential care communities was about 2 hours and 50 minutes. Registered nurse staffing levels differed for two of the three organizational characteristics (size and metropolitan statistical area [MSA]) and for only one of the four resident composition characteristics (primarily serving residents needing any assistance with activities of daily living). Licensed practical or vocational nurse staffing levels differed for all three organizational characteristics (size, MSA, and ownership) and for only one of the four resident composition characteristics (primarily serving residents diagnosed with Alzheimer’s disease or other dementias). In contrast, differences in aide staffing levels were common when examining both community organizational and resident composition characteristics. Registered nursing, licensed practical and vocational nursing, and aide staffing levels varied geographically by state.

Long-term care services provided by paid, regulated providers are an important component of personal health care spending in the United States. This report presents the most current national descriptive results from the National Study of Long-Term Care Providers (NSLTCP), which is conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS). Data presented are drawn from multiple sources, primarily NCHS surveys of adult day services centers and residential care communities (covers 2014 data year); and administrative records obtained from the Centers for Medicare and Medicare Services (CMS) on home health agencies, hospices, and nursing homes (covers 2013 and 2014 data years). This report provides information on the supply, organizational characteristics, staffing, and services offered by paid, regulated providers of long-term care services; and the demographic, health, and functional composition of 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 report updates "Long-Term Care Services in the United States: 2013 Overview" (available from: http://www.cdc.gov/nchs/data/nsltcp/long_term_care_services_2013.pdf), which covered data years 2011 and 2012. In contrast, the title of this report and future reports will reflect the years of the data used rather than the publication year, in this case 2013 through 2014. A forthcoming companion product to this report, "Long-Term Care Providers and Services Users in the United States—State Estimates Supplement: National Study of Long-Term Care Providers, 2013–2014," contains tables and maps showing comparable state estimates for the national findings in this report, and will be available from: http://www.cdc.gov/nchs/ nsltcp/nsltcp_products.htm.

KEY FINDINGS:Assisted living and similar residential care communities provide services to individuals who cannot live independently but generally do not require the skilled level of care provided by nursing homes. In 2014, there were 30,200 residential care communities nationwide (1). This report presents the most current national estimates of residential care community operating characteristics and compares these characteristics by community bed size. State-level estimates for the characteristics presented in this report are available from http://www.cdc.gov/nchs/nsltcp/nsltcp_products.htm.

More than one-quarter million participants were enrolled in adult day services centers in the United States on the day of data collection in 2014. The number of for-profit adult day services centers has grown in recent years. In 2012, 40% of adult day services centers were for-profit, serving more than one-half of all participants. This report presents the most current national estimates of selected characteristics of participants in adult day services centers and compares these characteristics by center ownership type. State-level estimates for the characteristics presented in this report are available online at http://www.cdc.gov/nchs/nsltcp/nsltcp_products.htm.

More than one-quarter of a million participants were enrolled in 4,800 adult day services centers in the United States in 2014. Unlike other long-term care providers, such as nursing homes, home health agencies, hospices, and residential care communities, the majority of adult day services centers are nonprofit. However, for-profit ownership of adult day services centers has increased, from 27% in 2010 to 40% in 2012, and more recently to 44% in 2014. This report presents the most current national estimates of selected adult day services center operating characteristics, and compares these characteristics by center ownership. State estimates for the characteristics presented in this data brief are available online at: http://www.cdc.gov/nchs/ nsltcp/nsltcp_products.htm.

Seniors Housing & Care Journal 3 Using data from the 2010 National Survey of Residential Care Facilities, this study estimated the percentage of U.S. residential care communities (RCCs) offering selected medication management services (MMS) and examined differences in prevalence by community characteristics. The most common services were central storage for medications and cueing residents, while the least common were administering injections and intravenous medications. Medication reminders, helping residents take medications, and administering drops/topical ointments and injections varied by RCC characteristics. Characteristics most commonly associated with these differences are size, purposefully built status, nursing hours, and availability of a physician or pharmacist to review medication appropriateness. Understanding these MMS variations may benefit clinicians’ efforts to achieve medication adherence among RCC patients, and inform policy makers, RCC providers, and consumers. Medication Management Services Offered in U.S. Residential Care Communities Lisa L. Dwyer, MPH; Paula C. Carder, PhD; Lauren D. Harris-Kojetin, PhD Prudential Real Estate Investors Outstanding Research Paper

In 2012, there was a higher percentage of older, female residents in communities with more than 25 beds compared with communities with 4–25 beds. Residents in communities with 4–25 beds were more racially diverse than residents in larger communities. The percentage of Medicaid beneficiaries was higher in communities with 4–25 beds than it was in communities with 26–50 and more than 50 beds. A higher percentage of residents living in communities with 4–25 beds had a diagnosis of Alzheimer’s disease or other dementias compared with residents in larger communities. Need for assistance with each of the activities of daily living (ADLs) examined (except walking or locomotion) was substantially higher among residents in communities with 4–25 beds, compared with residents in larger communities. Emergency department visits and discharges from an overnight hospital stay in a 90-day period did not vary across residents by community bed size. This report presents national estimates of residents living in residential care, using data from the first wave of NSLTCP. This brief profile of residential care residents provides useful information to policymakers, providers, researchers, and consumer advocates as they plan to meet the needs of an aging population. The findings also highlight the diversity of residents across the different sizes of residential care communities. Corresponding state estimates and their standard errors for the national figures in this data brief can be found on the NSLTCP website, available from: http://www.cdc.gov/nchs/nsltcp/nsltcp_products.htm. These national and state estimates establish a baseline for monitoring trends among residents living in residential care.

KEY FINDINGS:Data from the National Study of Long-Term Care Providers. In 2012, 40% of the 4,800 adult day services centers were for-profit entities, serving nearly one-half of the 272,300 center participants. About 60% of adult day services centers used a standardized tool to screen for cognitive impairment, and about 20% used a standardized tool for depression screening. A greater percentage of for-profit than nonprofit centers used these tools. More than one-half of adult day services centers provided skilled nursing, therapeutic, and social work services, while less than one-half of centers provided mental health, pharmacy, and dental services. With the exception of social work services, a greater percentage of for-profit than nonprofit centers provided these services. Almost all adult day services centers provided daily transportation to and from the center. The most recent data estimate that 4,800 adult day services centers nationwide serve nearly a quarter million participants daily (1). Unlike other long-term care providers, such as nursing homes, home health agencies, hospices, and residential care communities, the majority of adult day services centers are nonprofit (1). However, for-profit ownership of adult day services centers appears to be increasing, from 27% in 2010 to 40% in 2012 (2). Using data from the National Study of Long-Term Care Providers, this report presents national estimates for characteristics of adult day services centers in 2012 and compares them by type of center ownership.