A primary purpose of the study is to determine whether the availability and receipt of nursing and supportive services in RCFs vary with the health and functional characteristics of residents. We expect that people with high health, functional, and cognitive needs will be in facilities that provide more services, and we hypothesize that people with high health and functional needs will receive more services than people with lower levels of need.
Table 1 presents data on the percentage of residents who live in facilities that offer specific services by residents' ADL assistance levels and cognitive status. More facilities will offer a particular service than the percentage of residents who will receive the service, because not all residents will need a particular service. At least 90 percent or more of residents live in RCFs that offer basic health monitoring (blood pressure and weight checks), assistance with ADLs3 and incontinence care, laundry services, and social and recreational activities in the facility. Seventy-five percent to 89 percent of residents live in RCFs that offer special diets and transportation to and from medical appointments, stores, and social and recreational activities outside the facilities. About two-thirds of all residents have access to case management services, and 44 percent have access to social services counseling. Only 40 percent of residents live in facilities that provide skilled nursing care;4 slightly more than half live in facilities that provide occupational and physical therapy.
In general, when residents are stratified by ADL assistance received, there is little relationship between higher disability level and the likelihood that a resident will live in a facility that offers more services, but that is largely because a very high proportion of facilities report that they offer most services. Individuals with higher disability levels are slightly more likely to live in facilities offering skilled nursing and special diets, but less likely to live in facilities offering various types of transportation and social service counseling. When service availability is examined by cognitive status, a higher proportion of residents with cognitive impairment or behavioral symptoms than those without live in facilities that provide special diets, basic health monitoring, incontinence care, and medical and non-medical transportation.
Table 2 presents data on service use by resident functional and cognitive status. At least 75 percent of residents receive basic health monitoring and assistance with bathing; 69.2 percent receive assistance with ADLs, 59.0 percent use transportation to and from medical appointments; 37.6 percent receive incontinence care; and 30.7 percent receive special meals. Only a small proportion of residents receive skilled nursing care and social service counseling: 12.5 percent and 15.8 percent, respectively.
There is a strong relationship between resident disability level and use of services. With the exception of transportation to medical appointments and social service counseling, residents with higher ADL dependence were more likely to use a variety of services, including special diets, skilled nursing, basic health monitoring, assistance with ADLs, incontinence care, social service counseling, personal laundry services, and social or recreational services in the facility. For example, among residents who do not receive any ADL assistance, only 5.7 percent receive skilled nursing services in the facility, compared with 10.1 percent of those receiving assistance with one or two ADLs and 19.6 percent of those in the three or more ADLs assistance group. A significantly higher proportion of residents in the cognitively impaired group (i.e., diagnosed with Alzheimer's disease or dementia, exhibited behavioral symptoms, or had memory impairment) received skilled nursing, health monitoring, assistance with ADLs, incontinence care, and special diets compared with those not so impaired. Figure 12 compares service availability and use for residents receiving assistance with three or more ADLs. Among these residents, 42 percent live in facilities that offer skilled nursing care, but only 20 percent are using this service. Whereas 97 percent of this highly disabled population lives in facilities that offer basic health monitoring (e.g., regular blood pressure and weight checks), 82 percent receive the service.
FIGURE 12. Service Availability and Use by Most Impaired Residential Care Facility Residents
(three or more activities of daily living)
SOURCE: RTI International analysis of the NSRCF.
Other findings are noteworthy. Although virtually all residents--99 percent--live in facilities that provide incontinence care, only 78 percent of those with the need for assistance with three or more ADLs receive incontinence care, at least partly because not all residents in the highest frailty category suffer from incontinence. Transportation to medical appointments is an important service that allows people with ADL impairments to age in place; 82 percent of all residents live in facilities where this service is available, but only 57 percent of those receiving assistance with three or more ADLs use this service. It is not known if relatives or friends took the residents to their medical appointments rather than relying on facility transportation.