Inaugural Report Released on US Long-Term Care Services

A new report offers a comprehensive overview of long-term care providers, including their supply, organizational characteristics, staffing, and services. It also provides up-to-date statistics on the demographic, health, and functional characteristics of long-term care residents and users. Long-Term Care Services in the United States: 2013 Overview is the first in a series of reports from the new National Study of Long-Term Care Providers (NSLTCP), and was published by the Center for Disease Control’s National Center for Health Statistics (NCHS).

The report covers paid, regulated providers of long-term care services in five major sectors including skilled nursing facilities, residential care communities, adult day services centers, hospices, and home health agencies. It reveals that in 2012, providers served about 8 million people in the United States. Each day in 2012, there were 273,200 participants enrolled in adult day services centers, 1,383,700 residents in nursing homes, and 713,300 residents in residential care communities. And in 2011, about 4,742,500 patients received services from home health agencies, and 1,244,500 patients received services from hospices.

Additional highlights from the report include:

–       Provider sectors differed in ownership, and average size and supply varied by region. In all sectors except adult day services centers, the majority of long-term care services providers were for-profit. The largest share of adult day services centers, home health agencies, hospices, and nursing homes was found in the South, while the largest share of residential care communities was in the West.

–       Provider sectors differed in their nursing staffing levels. The majority of nursing employee full-time equivalents (FTEs) in residential care communities, adult day services centers, and nursing homes were aides, while the majority of nursing FTEs in hospices and home health agencies were registered nurses (RN). For every nursing staff type examined (RNs, LPNs/LVNs, aides), the average daily staff hours per resident or participant day was higher in nursing homes than in residential care communities and adult day services centers. This difference may reflect the higher functional needs of nursing home residents.

–       Provider sectors differed in their use of social workers, and the types of services offered. Most hospices employed at least one social worker, while just over one-tenth of residential care communities did so. In terms of services offered, more hospices and nursing homes offered mental health and counseling services compared with adult day services centers and residential care communities.

–       Rates of use of long-term care services varied by sector and state. The report examined daily-use rate among individuals age 65 and better per 1,000 persons in that age group, and found that the rate varied by sector. The highest daily-use rate was for nursing home residents, followed by residential care residents; the lowest rate was for adult day services centers. However, in about a dozen states, the nursing home daily-use rate was similar to or lower than the residential care daily-use rate. Within each of the five sectors, the use rate varied by state. For example, average adult day services daily-use rates ranged from a low of less than 1 participant per 1,000 persons in West Virginia, to a high of 12 participants in New Jersey. Average residential care community daily-use rates ranged from as few as 2 residents per 1,000 persons in Iowa, to 40 residents in North Dakota.

–       Users of long-term care services varied by sector in their demographic characteristics. Hospices, nursing homes, and residential care communities served more persons aged 85 and better, and adult day services centers served more persons under age 65. Adult day services centers were the most racially and ethnically diverse among the five sectors: 20.1% were Hispanic and 16.7% were non-Hispanic black.

–       Users of long-term care services varied by sector in their health status and functional status. Alzheimer’s Disease and other dementias ranged in prevalence from 30.1% among home health patients, to 48.5% among nursing home residents. Depression ranged in prevalence from 22.2% among hospice patients, to 48.5% of nursing home residents. Although the need for assistance with activities of daily living was common in all sectors, functional ability varied by sector. A higher percentage of nursing home residents needed assistance in bathing, dressing, toileting, and eating compared to users in other sectors.

The NSLTCP findings in this report provide a current national picture of providers and users of long-term care services in the United States. The NSLTCP is a new initiative to monitor the diverse spectrum of paid, regulated providers of long-term care services and inform long-term care planning and policymaking to meet the needs of an aging population. The NSLTCP uses survey data from adult day services centers, assisted living and similar residential care communities, and administrative data on home health agencies, hospices, and nursing homes to produce representative national and state estimates. NCHS plans to release state-level estimates on the topics in this report in spring 2014. To monitor trends, NCHS plans to conduct NSLTCP every two years.

To learn more about NSLTCP, please visit

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