Design and Operation of the 2010 National Survey of Residential Care Facilities. Design Process


There has been a longstanding recognition of the need for data on the number of residential care places and their residents. In 2006, ASPE convened a Technical Advisory Panel (TAP) to discuss the government’s intent to implement NSRCF. The group of experts provided input on the definition of residential care used for the study; the sampling design, sample size, and statistical power for both facilities and resident surveys; the survey domains that should be included in the questionnaires; and the best source of information for the data elements (4). A subset of TAP also commented on the questionnaires and the appropriateness of the questions for this population and helped refine questions and question objectives. TAP members are listed in Appendix II.

TAP drew heavily from a number of other federal efforts conducted to address data needs about residential care facilities and residents. These efforts provided important building blocks for NSRCF and were used to inform and guide the design of this survey:

  • The first national survey of residential care sponsored by ASPE and conducted in 1998, the National Study of Assisted Living for the Frail Elderly, focused exclusively on one component of residential care—assisted living (5). A major finding of that study concluded that there was significant variability in the assisted living industry.
  • In 2003, NCHS, AHRQ, and ASPE funded the Inventory of Long-Term Care Residential Places (6). This project developed an inventory of residential places that provided personal assistance. This inventory was used to make some estimates of the number of residential care facilities and beds, do simulations for the required sample sizes, define the size strata, and help inform the overall sampling design for NSRCF.
  • In 2003, NCHS used state licensing criteria and state regulations obtained in the Inventory of Long-Term Care Residential Places project, a review of relevant literature, expert opinions, and work by Mollica and Jenkens (7) describing state residential care and assisted living policy to develop a provider-based typology of LTC places. The typology was further refined during the course of a 2-day meeting of experts convened by NCHS in January 2004.
  • In 2005, ASPE contracted with the Urban Institute to understand how different definitions and variations in methodology used in national surveys and the Decennial Census contributed to a range of estimates of the LTC population in residential care (8). The definitional and methodological issues discussed in the report, The Size of the Long-Term Care Population in Residential Care: A Review of Estimates and Methodology, 2005, provided valuable information in developing the survey design, sampling frame, and questionnaires for NSRCF (3).
  • In 2005, AHRQ funded three relevant projects related to assisted living/residential care. The first project reviewed LTC tools and instruments developed to determine the availability and types of services provided in assisted living, assess the quality of care and services delivered, and develop quality of life measures that could be used or adapted for assisted living. The second project used a series of focus groups of assisted living stakeholders to determine the needs and priorities for developing improved consumer information and tools. The third project reviewed how states monitored assisted living and disseminated information to consumers (9).

In addition to convening TAP, in 2007 ASPE provided funding to RTI to update a 2004 compendium on assisted living. The compendium, Residential Care and Assisted Living Compendium, 2007, described regulatory provisions and Medicaid policy for residential care settings in all 50 states and the District of Columbia (10). The methodology for creating the compendium was used as a starting point for constructing a list of LTC residential places as the sampling frame for NSRCF.

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