Do Services and Staffing in Residential Care Facilities Vary With Residential Needs?. 5.1.1. Residential Care Facility Residents: Health Conditions and Functional and Cognitive Status

07/22/2013

One of this study's goals is to provide a comprehensive picture of RCF residents--their age, health, and functional status--and examine how health, functional, and cognitive profiles of RCF residents under the age of 65 compare with those for residents ages 65 and over. Figure 1 presents the age distribution of RCF residents. Although more than half (53.9 percent) of all RCF residents are ages 85 and over, 10.5 percent are under age 65, and 8.5 percent are 65-74 years of age. This age distribution is comparable to that in nursing homes (CMS, 2010). Nationally, 77,218 younger residents ages 18-64 live in RCFs.

 

FIGURE 1. Age Distribution of Residential Care Facility Residents

FIGURE 1 shows age distribution of RCF residents. BAR CHART: 18-64 years (10.5); 65-74 years (8.5); 75-84 years (27.1); 85 and over (53.9).

SOURCE: RTI International analysis of the NSRCF.

 

Figure 2 presents selected common chronic health conditions by age. The prevalence of chronic conditions is high. Almost half (45.7 percent) of residents ages 65 and older are believed to have Alzheimer's disease or other dementia (compared with 11.5 percent of those under the age of 65). Almost a third of all residents ages 65 or older have arthritis. Rates of diabetes are higher in the under-65 group than among residents who are 65 or older (24.5 percent and 16.4 percent, respectively), and the under-65 group has almost double the rate of nervous system disorders. The rates of chronic obstructive pulmonary disease and stroke are about the same for the two age groups.

FIGURE 2. Residents' Selected Chronic Conditions, by Age

FIGURE 2 shows residents' selected chronic conditions, by age. BAR CHART: Under Age 65--Alzheimer's and other dementia (11.5); Congestive Heart Failure (4.5); COPD (11.9); Diabetes (24.5); Arthritis (11.9); Stroke (9.4); Nervous system disorders (12.6). Age 65 and Over--Alzheimer's and other dementia (45.7); Congestive Heart Failure (14.3); COPD (10.7); Diabetes (16.4); Arthritis (29.1); Stroke (11.2); Nervous system disorders (7.2).

SOURCE: RTI International analysis of the NSRCF.
NOTE: COPD: chronic obstructive pulmonary disease.

Figure 3 presents selected mental health conditions by age. Substantial portions of RCF residents have severe mental illness, depression, or intellectual and developmental disabilities. Under age 65 RCF residents have substantially higher rates of serious mental illness, depression, and intellectual and development disabilities than older RCF residents. Severe mental illness includes such conditions as schizophrenia or psychosis. Intellectual and developmental disabilities include mental retardation, Down syndrome, and severe autism.

FIGURE 3. Residents' Selected Mental Health Conditions, by Age

FIGURE 3 shows residents' selected mental health conditions, by age. BAR CHART: Under Age 65--Serious mental illness (39.1); Depression (39.0); Intellectual and developmental disabilities (20.3). Age 65 and Over--Serious mental illness (3.9); Depression (26.2); Intellectual and developmental disabilities (1.3).

SOURCE: RTI International analysis of the NSRCF.

Figure 4 presents residents' cognitive status by age. Sixty-seven percent of residents have some cognitive impairment, which includes having an Alzheimer's disease or other dementia diagnosis, behavioral symptoms, or short or long-term memory impairment. Large proportions of both older and younger RCF residents were reported to have exhibited problem behaviors, but the cause may differ by age. For older residents, behavior problems may result from dementia; for younger residents, they may result from a serious mental illness or an intellectual or other developmental disability.

FIGURE 4. Resident Cognitive Status, by Age

FIGURE 4 shows resident cognitive status by age. BAR CHART: Under Age 65--Any cognitive impairment (68.5); Any behavioral symptoms in the last 30 days (53.2); Any memory impairments (39.7). Age 65 and Over--Any cognitive impairment (67.0); Any behavioral symptoms in the last 30 days (35.7); Any memory impairments (57.4).

SOURCE: RTI International analysis of the NSRCF.

Figure 5 presents residents' use of acute and post-acute care services in the prior 12 months by age. RCF residents use substantial amounts of these services, with about a third of residents having had an emergency room visit in the past year, and about two-fifths of these emergency room users having more than one visit (not presented in graph). Use of emergency room visits raises questions about whether additional health services or better coordination with health services is needed. A quarter of residents had a hospital stay in the 12 months before the survey. Only a small proportion of residents--4.1 percent of people under age 65 and 8.0 percent of people ages 65 and over--used any rehabilitation facility or nursing home stays in the prior 12 months.

FIGURE 5. Resident Health Service Utilization in the Last Year, by Age

FIGURE 5 shows resident health service use by age. BAR CHART: Under Age 65--Any nursing home or rehab facility stays (4.1); Any hospital overnight stays (22.5); Any hospital ER visits (31.3). Age 65 and Over--Any nursing home or rehab facility stays (8.0); Any hospital overnight stays (24.0); Any hospital ER visits (35.0).

SOURCE: RTI International analysis of the NSRCF.
NOTE: ER: emergency room.

Figure 6 and Figure 7 present need for assistance with ADLs by age, and Figure 8 and Figure 9 present limitations in IADLs by age. Fifty-four percent of RCF residents under age 65, and 77 percent ages 65 and over, receive assistance with at least one ADL. The ADL that residents most commonly need assistance with is bathing, followed by dressing and toileting. Younger RCF residents receive significantly less assistance overall and for each activity type. On average, residents receive help with 1.9 ADLs (1.2 for the younger group and 2.0 for the older group). Nationally, almost 20 percent of the younger population and 39.5 percent of the older residents received assistance with three or more ADLs. Almost all RCF residents require assistance with IADLs. There is little difference between the needs for overall IADL assistance between younger and older residents (97.4 percent and 94.9 percent, respectively).

FIGURE 6. Activities of Daily Living Assistance Receipt, by Age

FIGURE 6 shows ADL assistance receipt by age. BAR CHART: Under Age 65--Transfer (3.9); Dressing (32.1); Eating (16.5); Toilet Use (18.0); Bathing (49.9); Mean ADL Score (1.2). Age 65 and Over--Transfer (13.9); Dressing (54.3); Eating (22.4); Toilet Use (36.8); Bathing (74.7); Mean ADL Score (2.0).

SOURCE: RTI International analysis of the NSRCF.

Figure 7 presents the RCF resident levels of assistance on ADLs by age. Almost 46 percent of RCF residents under 65 do not receive assistance with ADLs, compared with only 23.4 percent of those ages 65 and over. At the other extreme, almost 20 percent of residents under the age of 65 require assistance with three or more ADLs, as did almost 40 percent among those age 65 or older.

FIGURE 7. Levels of Assistance With Activities of Daily Living, by Age

FIGURE 7 shows ADL levels of assistance by age. BAR CHART: Under Age 65--No ADLs (45.7); 1-2 ADLs (34.7); 3-4 ADLs (18.0); 5 ADLs (1.6). Age 65 and Over--No ADLs (23.4); 1-2 ADLs (37.2); 3-4 ADLs (33.2); 5 ADLs (6.3).

SOURCE: RTI International analysis of the NSRCF

 

 

FIGURE 8. Instrumental Activities of Daily Living, by Age

FIGURE 8 shows IADL by age. BAR CHART: Under Age 65--Shopping (56.4); Money management (72.5); Using a phone (27.9); Housekeeping (62.7); Taking medications (92.5); Mean IADL Score (3.1). Age 65 and Over--Shopping (77.3); Money management (80.5); Using a phone (34.8); Housekeeping (74.8); Taking medications (86.9); Mean IADL Score (3.5).

SOURCE: RTI International analysis of the NSRCF.

 

FIGURE 9. Instrumental Activities of Daily Living: Levels of Impairment, by Age

FIGURE 9 shows IADL levels of impairment by age. BAR CHART: Under Age 65--No IADLs (2.7); 1-2 IADLs (32.1); 3-4 IADLs (44.7); 5 IADLs (20.5). Age 65 and Over--No IADLs (5.1); 1-2 IADLs (16.9); 3-4 IADLs (46.2); 5 IADLs (31.8).

SOURCE: RTI International analysis of the NSRCF.

Virtually all RCF residents have IADL impairments: less than 5 percent of the total sample is reported not to have any IADL limitations. In fact, a great majority of RCF residents have multiple IADL limitations: 65.2 percent of those under 65 and 78 percent of those ages 65 and older are reported to have limitations on at least three IADLs, such as difficulties with taking medications, managing money, shopping, housekeeping, and using a telephone.

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