How to Develop a Successful Observation Unit

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Multidrug TB Prophylaxis Not Needed in Advanced HIV (CME/CE)

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How Size Affects Residential Care Communities and Their Residents by: Geralyn Magan

The size of a residential care community can affect the organization’s structure and the characteristics of its residents, according to a new analysis by the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention (CDC).

The NCHS analysis was released in 2 separate reports in December. One report compares the operating characteristics of different size residential care communities. The second report compares the characteristics of residents living in communities of different sizes.

Data for the analysis came from the 2014 National Study of Long-Term Care Providers. LeadingAge assisted in the development of the residential care community component of the survey, which was used in the NCHS analysis.

“I am often asked about data for assisted living communities and this has by far the most comprehensive data available,” says Steve Maag, LeadingAge’s director of residential communities. “LeadingAge was pleased to join other provider associations in assisting the National Center for Health Statistics in developing this survey.”

An Overview of How Size Matters

NCHS researchers found that large residential care communities — those with 50 or more beds — are more likely than other communities to:

Be affiliated with a chain.
Offer dementia care programs.
Use electronic health records (EHR).
Have larger proportions of older, female residents who are at risk for cardiovascular disease and falls.
On the other hand, smaller communities — those with 4 to 25 beds — are more likely than other communities to:

Be for-profit and less than 10 years old.
Offer programs to help residents manage their diabetes, cardiovascular disease, and depression.
Have larger proportions of residents who receive Medicaid benefits, live with Alzheimer’s disease and/or depression, and need assistance with activities of daily living.

The Details: Operating Characteristics of Residential Care Communities

According to Variation in Operating Characteristics of Residential Care Communities, by Size of Community: United States, 2014, larger residential care communities with 50 or more beds were more likely to:

Be chain affiliated. 74% of larger communities were chain-affiliated, compared to 47% of smaller communities.
Offer programs for residents living with Alzheimer’s disease and other dementias. More than two-thirds (67%) of larger communities offered these programs, compared with 56% of smaller communities.
Use EHRs. Almost one-third (32%) of larger communities used EHRs, compared with only 12% of smaller communities. In addition, larger communities were more likely (29%) to have computerized support for electronic health information exchange with physicians, pharmacies, or hospitals than small communities (16%).
Smaller residential care communities were more likely to:

Be for-profit. Most (87%) of smaller communities were for-profit, compared with three-quarters of larger communities (76%).
Be less than 10 years old. Only half (50%) of smaller communities had been operating for more than 10 years, compared to 79% of larger communities.
Offer disease-specific programming. Almost two-thirds (61%) of smaller communities offered diabetes programming, compared with 56% of larger communities. Smaller communities also outpaced larger communities in offering cardiovascular disease-specific programming (56% vs. 46%) and depression-specific programming (52% vs. 42%).

The Details: Resident Characteristics

According to Variation in Residential Care Community Resident Characteristics, by Size of Community: United States, 2014, the majority of residents in all residential care communities were aged 85 and older (53%), female (70%) and needed assistance with bathing (62%) in 2014.

Residents in larger communities were more likely to:

Be older. Only 5% of residents in larger communities were under age 65, compared with 15% of residents in smaller communities.
Experience falls. Almost a quarter (24%) of residents in larger communities reported falling, compared with 11% of residents in smaller communities.
Residents in smaller communities were more likely to:

Receive Medicaid. 23% of residents in smaller communities had at least some services paid for by Medicaid, compared with 13% in communities with more than 50 beds.
Live with dementia. 47% of residents in small communities had Alzheimer’s disease and other dementias, compared with 37% of residents in larger communities.
Have depression. 27% of residents in smaller communities had a depression diagnosis, compared with 22% of residents in larger communities.
Need assistance with bathing. More than three-quarters (77%) of residents in small communities needed this assistance, compared with 58% of residents in large communities.

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