U.S. Department of Health and Human ServicesU.S. Department of Health and Human Services
This report was prepared under contract between the U.S. Department of Health and Human Services (HHS), Office of Family, Community and Long-Term Care Policy (now the Office of Disability, Aging and Long-Term Care Policy (DALTCP)) and the Bureau of the Census. For additional information about the study, you may visit the DALTCP home page at http://aspe.hhs.gov/_/office_specific/daltcp.cfm or contact the office at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201. The e-mail address is: webmaster.DALTCP@hhs.gov. The DALTCP Project Officer was Robert Clark.
The opinions and views expressed in this report are those of the authors. They do not necessarily reflect the views of the Department of Health and Human Services, the contractor or any other funding organization.
The purpose of this survey is to determine 1) whether the Census provides a suitable frame for selecting board and care places and 2) whether the questionnaire will elicit sufficient information to identify such places. Board and care places are housing units or group quarters which provide room, meals and one or more services to dependent persons. The services center on activities of daily living or instrumental activities of daily living. They can be as concrete as assisting the dependent person with eating or as abstract as providing protective oversight.
Drawn from the central Missouri census dress rehearsal file, the survey included three frames. Two were housing units and one was group quarters. The housing unit frames were designated by the number of nonrelatives and, in some cases, the presence of a disabled household member. The nonrelatives were classified as housemate, roommate, boarder, roomer, foster child or other nonrelative. All households with three or more nonrelatives were included in the survey. Since the number of households with one or two nonrelatives was very large and since there was a limited budget, additional criteria were used to select households with one or two nonrelatives. Households with one or two nonrelatives in the above specified categories were included if they were long form respondents and they had a disabled member in the household.
The Group Quarters were selected by category. we included every place in the categories designated by the sponsor. The categories were selected to be inclusive.
The survey was conducted in three stages: 1) a mail out/ mail back questionnaire with a second mailing to places which did not respond within three weeks, 2) a telephone followup, and 3) personal visits.
Eighty six percent of the places provided completed questionnaires; 13 percent were vacant or no longer in existence.
Identified board and care places were 1.3 to 7.2 times expert estimates. Two different estimates and the decision to include or exclude group quarters account for the wide range.
The screening questions were effective: 3.4 percent of housing units and 37 percent of group quarters were board and care.
Unit screening questions effectively distinguished board and care places from places such as boarding homes which housed independent nonrelatives. It did not separate board and care places from those with professional care services such as skilled nursing facilities.
Among housing units, the proportion of board and care places is higher for places which have the same owner/renter as 2 1/2 years ago (i.e. during the dress rehearsal) (7 percent) than it is for places with a different owner or renter. It is also higher among long form respondents who reported a disabled household member in the dress rehearsal (6.6 percent) than it is among long form respondents with 3 or more nonrelatives and no disabled household member or among short form respondents with 3 or more nonrelatives with disability status not known.
The 5 board and care places whose survey responses led to the incorrect conclusion that they were not board and care (i.e. false negatives) included 3 units which do not provide meals and-2 places which misreported the presence of nonrelatives.
The 169 places whose survey responses led to the incorrect conclusion that they were board and care (i.e. false positives) included 90 places with professional services, 50 places with independent nonrelatives some of whom are quasi-families, 23 foster families and 6 schools, prisons or converted units.
Board and care places usually provide both protective oversight and housekeeping services. Eighty four percent of housing units and 97 percent of group quarters provide at least these two services.
The presence of nonrelatives, a census and unit screener, appears to be frequently misreported. Among housing units with the same owner/renter as 1988, 48 percent claim to house only relatives during the period of the dress rehearsal through the survey.
Provision of services to nonrelatives is also misreported. Fifty eight percent of respondents in housing units with independent nonrelatives claimed to provide one or more of the ADL (activities of daily living) or IADL (instrumental activities of daily living) services to nonrelatives. Many confused a division of labor with the provision of services.
Eighty percent of Group Quarters were board and care, professional care facilities or vacant/delete. However, 10 of the Group Quarter categories contain no board and care places.
Most (78 percent) board and care housing units have clients who have physical disabilities and/or mental problems. Most (83 percent) board and care group quarters have clients with mental problems and/or mental retardation, or physical disabilities and/or senility, or mental problems and/or substance abuse.
Board and care housing units in this survey usually care for either adults 65 or older only or those under 65 only. Most board and care group quarters care for both persons 65 or older and persons under 65.
Most board and care housing units (62 percent) have one of four disability and age combinations. They have clients with physical disabilities who are either 65 and over or under 65, or clients with mental/emotional problems who are under 65 or under 18.
Half of the board and care housing units and 82 percent of board and care group quarters have one or more clients who receive social security or veterans' administration payments because of their disability.
The match rate between the survey and the independent Lewin/ICF list of licensed places was high. Overall, 80 percent (n=107) of the licensed places on the Lewin list are in the survey. A maximum of between 10 and 27 places on the Lewin list that could have been on the survey were not on the survey.
The survey identified more board and care units than did the list of licensed places. There were 157 board and care places in the survey; 47 of these board and care places were not on the Lewin/ICF list of licensed places.
The survey identified most of the board and care housing units. The matched places were primarily from group quarters, and secondarily from the frame of 3 or more nonrelatives. One place was in the frame of 2 nonrelatives.
The matched places include both board and care and professional care facilities.
The decennial census provides feasible frames for a national study of board and care places. It effectively targets housing units with a board and care population.
Two alternative frames of housing units for a national survey are presented. The first replicates the housing unit frames of the pretest; the second uses long form respondents only. In both alternatives, group quarters are treated separately. Either separate questionnaires are developed, or group quarters data are collected in conjunction with other surveys.
Recommendations which could reduce survey costs include 1) conducting research to examine characteristics of nonrelatives in survey housing units such as their age, educational status, and tenure in relation to the units' board and care status in order to eliminate places housing college students and other young adults sharing living quarters for financial or social reasons only, 2) more extensive and detailed use of reverse telephone directories, and 3) screening potential target housing units clustered in limited geographical areas.
Recommendations which improve data quality include 1) the development of separate questionnaires for housing units and group quarters, 2) adding questions to distinguish places providing more sophisticated professional and medical care from board and care places, 3) revising the service question or adding instructions so that the response reflects services to dependent persons, 4) obtaining data for each person rather than aggregated responses, and 5) reduction/ elimination of the "other" catch-all category.
| The Full Report is also available from the DALTCP website (http://aspe.hhs.gov/_/office_specific/daltcp.cfm) or directly at http://aspe.hhs.gov/daltcp/reports/haystk.htm. |