Abstract
A new study from the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention, profiles Hispanic health in America. NCHS releases a comprehensive report on long-term care services.
Hispanic Health
“Health of Hispanic Adults: United States, 2010-2014” 1 profiles the health of the approximately 54 million Hispanic people living in the United States. The report is based on findings from NCHS’s National Health Interview Survey (NHIS), a large-scale household interview survey of the nation’s civilian, noninstitutionalized population. It presents data on selected estimates of health measures for all Hispanic adults aged ≥18 years and for adults in the following four Hispanic subgroups: Central or South American, Cuban, Mexican, and Puerto Rican. Subgroup comparisons and comparisons with the non-Hispanic US adult population are age-adjusted because of the varying age composition of the Hispanic groups and the non-Hispanic population.
Topics covered in the report include self-reported health status, prevalence of chronic conditions and serious psychological distress, inability to work, and restrictions on participation in social activities. Key findings show that Puerto Rican (19.2%) and Mexican (17.4%) adults were more likely than Central or South American (12.3%) or Cuban (14.7%) adults to be in fair or poor health. The age-adjusted percentage of adults with fair or poor health was higher for Hispanic (16.8%) than for non-Hispanic (11.9%) US adults. Cuban, Mexican, and Puerto Rican adults were more likely than non-Hispanic US adults to be in fair or poor health. The prevalence of fair or poor health for Central or South American adults and non-Hispanic US adults was similar.
The study found differences among Hispanic subgroups in the prevalence of chronic conditions. Puerto Rican (27.3%) and Mexican (20.8%) adults were more likely than Central or South American (16.6%) or Cuban (18.6%) adults to have two or more chronic conditions, including hypertension, coronary heart disease, stroke, diabetes, cancer, arthritis, hepatitis, emphysema, weak or failing kidneys, or asthma. The age-adjusted percentage of Hispanic adults with multiple chronic conditions (20.8%) was lower than the age-adjusted percentage of non-Hispanic US adults with multiple chronic conditions (24.6%). Compared with non-Hispanic US adults, Central or South American, Cuban, and Mexican adults were less likely and Puerto Rican adults were more likely to have multiple chronic conditions. Puerto Rican adults (6.2%) were also more likely than Central or South American (3.3%), Cuban (3.7%), or Mexican (3.9%) adults to report serious psychological distress during the previous 30 days. Overall, Hispanic adults (4.1%) were more likely than non-Hispanic US adults (3.2%) to report serious psychological distress during the previous 30 days.
Hispanic adults (5.2%) were less likely than non-Hispanic US adults (6.8%) to be unable to work because of health problems. Differences among Hispanic subgroups showed that Puerto Rican adults (11.4%) were more likely than Central or South American (2.9%), Cuban (3.9%), or Mexican (4.8%) adults to be unable to work because of health problems.
The NHIS also assesses restriction of social participation, which is defined as difficulty participating in activities such as going shopping, to the movies, or sporting events, and participating in social activities such as visiting friends, attending clubs and meetings, or going to parties without accompaniment or without using any special equipment. After age adjustment, Puerto Rican adults (6.3%) were more likely than Central or South American (3.1%), Cuban (3.1%), Mexican (4.7%), and non-Hispanic US (3.9%) adults to have a restriction in social participation.
Overall, compared with non-Hispanic US adults, Central and South American adults had similar or better health and Puerto Rican adults had worse health. Puerto Rican adults had poorer health than other Hispanic subgroups, and Central or South American adults had better health than other Hispanic subgroups.
Long-Term Care Services
“Long-Term Care Providers and Services Users in the United States: Data from the National Study of Long-Term Care Providers, 2013-2014” 2 presents the most current national results, by type of provider, from NCHS’s National Study of Long-Term Care Providers. Data were drawn from multiple sources, primarily NCHS surveys of adult day services centers and residential care communities. Administrative records on home health agencies, hospices, and nursing homes were obtained from the Centers for Medicare & Medicaid Services. The report presents information on the supply, organizational characteristics, staffing, and services offered by paid, regulated providers of long-term care services, as well as the demographic, health, and functional composition of users of these services. Services users include residents of nursing homes and residential care communities, patients of home health agencies and hospices, and participants of adult day services centers.
Key findings from the report show that in 2014, about 67,000 paid, regulated long-term care services providers served about nine million people in the United States. Long-term care services were provided by 4,800 adult day services centers, 12,400 home health agencies, 4,000 hospices, 15,600 nursing homes, and 30,200 assisted-living and similar residential care communities. In 2014, an estimated 282,200 participants were enrolled in adult day services centers, 1,369,700 residents were in nursing homes, and 835,200 residents were living in residential care communities. In 2013, an estimated 4,934,600 patients were discharged from home health agencies, and an estimated 1,340,700 patients received services from hospices.
The report also examines characteristics (e.g., ownership and organization) of the services providers. At least 60% of home health agencies, hospices, nursing homes, and residential care communities were for profit, and about 40% of adult day services centers were for profit. Most nursing homes and residential care communities were chain-affiliated, and most adult day services centers were not. Providers in the five long-term care services sectors varied in their geographic distribution. The largest percentage of adult day services centers (33.0%), home health agencies (46.6%), hospices (41.2%), and nursing homes (34.7%) was in the South, whereas the largest percentage of residential care communities (42.0%) was in the West.
Services provided varied by long-term care sector. Most providers in all sectors except residential care offered social work services. Nearly all hospices (99.9%) provided social work services, as did most nursing homes (89.2%) and home health agencies (82.4%), likely because these services are required for Medicare certification. Fewer adult day services centers (51.7%) and residential care communities (48.0%) reported providing social work services. Mental health or counseling services were provided in 97.2% of hospices, 87.1% of nursing homes, 52.1% of residential care communities, and 33.5% of adult day services centers. Nearly all nursing homes (99.4%), hospices (98.1%), and home health agencies (96.6%) offered therapeutic services (e.g., physical therapy, occupational therapy, speech therapy), whereas 69.0% of residential care communities and 48.8% of adult day services centers provided such services.
Staffing patterns varied by long-term care sector. In 2014, more than 1.5 million nursing employee full-time equivalents (FTEs)—including registered nurses (RNs), licensed practical nurses or licensed vocational nurses, and aides—and about 35,200 social work employee FTEs worked in the five sectors. Of the FTEs who were nurses or social workers, 62.9% worked in nursing homes, 21.5% worked in residential care communities, 9.3% worked at home health agencies, 4.7% worked in hospices, and 1.5% worked at adult day services centers. The relative distribution of nursing and social work FTEs varied across sectors; most FTEs in adult day services centers, nursing homes, and residential care communities were aides, whereas most FTEs in home health agencies and hospices were RNs.
Long-term care services users varied by demographic and health characteristics, functional status, and experience of adverse events. Participants of adult day services centers tended to be younger than services users in other sectors, but most long-term care service users were aged ≥65 years. Participants in adult day services centers were the most racially/ethnically diverse of the five sectors: 20.4% were Hispanic, 17.3% were non-Hispanic black, 18.6% were other races/ethnicities, and 43.9% were non-Hispanic white. The prevalence of Alzheimer’s disease or other dementias in long-term care services users differed by sector: 50.4% in nursing homes, 44.7% in hospices, 39.6% in residential care communities, 31.4% in home health agencies, and 29.9% in adult day services centers. Diabetes was more prevalent among home health patients (45.2%) than residents of residential care communities (17.0%).