Biennial Overview of Post-acute and Long-term Care in the United States

Data from the 2020 National Post-acute and Long-term Care Study

The NCHS National Post-acute and Long-term Care Study (NPALS) collects data on post-acute and long-term care providers every two years. The goal is to monitor post-acute and long-term care settings with reliable, accurate, relevant, and timely statistical information to support and inform policy, research, and practice. These data tables provide an overview of the geographic, organizational, staffing, service provision, and user characteristics of paid, regulated long-term and post-acute care providers in the United States.   The settings include adult day services centers, home health agencies, hospices, inpatient rehabilitation facilities, long-term care hospitals, nursing homes, and residential care communities.

The tables were updated to include estimates for the 50 U.S. states and the District of Columbia for the adult day services center and residential care community settings. Users can select a state from the Geography drop-down menu to see the state’s estimates. Please see footnotes for each table for information about estimates that may be unreliable or cannot be displayed according to NCHS confidentiality standards.

These tables with national estimates and a forthcoming National Health Statistics Report (NHSR) replace the previous report, which was published for 2012, 2014, 2016, and 2018 National Study of Long-Term Care Providers (NSLTCP), now renamed NPALS. The state estimates in these tables update the previously published 2016 state tables. The associated online survey methodology documentation, questionnaires and ReadMe documents provide more background about the providers, characteristics, and methodology in NPALS. These data are available as restricted data files in the NCHS Restricted Data Center. For details about the measures used in these tables, see the NPALS Variable Crosswalk.

The tables are interactive and data users can choose to display estimates for all the characteristics by provider type or can choose to display estimates for selected characteristics and selected provider types. Users can also choose to display national estimates, or estimates for a selected state.

Table 1: Post-acute and Long-term Care Providers by Geographic and Organizational Characteristics: United States, 2020

This table shows the number and percent of providers with the following geographic and organizational characteristics. Definitions of each of these characteristics by provider-type is available from the NPALS Variable Crosswalk.

Table 2: Staffing Characteristics of Post-acute and Long-term Care Services Providers, by staff type: United States, 2020

This table shows estimates about the following staffing characteristics for registered nurses, licensed practical or licensed vocational nurses, aides, social workers, and activities staff, where applicable. Definitions of each of these characteristics by provider-type is available from NPALS Variable Crosswalk.

Table 3: Types of Services Offered by Post-acute and Long-term Care Services Providers: United States, 2020

This table shows percent of providers that offer the following types of services and dementia care, where applicable. Definitions of each of these characteristics by provider-type is available from the NPALS Variable Crosswalk.

Table 4: Post-acute and Long-term Care User Demographic and Health-related Characteristics: United States, 2020

This table shows the number of users, the percent distribution of demographic characteristics (age, sex, race and ethnicity, Medicaid beneficiary) among providers, and the percent of users with selected diagnoses, needing assistance in physical functioning, and having adverse events. Definitions of each of these characteristics by provider-type is available from NPALS Variable Crosswalk.

Technical Notes

• In 2020, NCHS collected survey data from adult day services centers and residential care communities and obtained administrative and assessment data from Centers for Medicare and Medicaid Services (CMS) on nursing homes, home health agencies, hospices, inpatient rehabilitation facilities, and long-term care hospitals.
• The data shown in these tables are based on final survey data collected via mail, web, and CATI survey modes from November 12, 2020 through July 15, 2021 and CMS data on current providers by end of CY 2020.
• The adult day services center (ADSC) estimates were based on survey responses from 1,780 eligible ADSCs, representing over 4,100 ADSCs. To be eligible to participate in NPALS, an ADSC must be licensed or certified by the state specifically to provide adult day services, or accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF), or authorized or otherwise set up to participate in Medicaid (Medicaid state plan, Medicaid waiver, or Medicaid managed care), or part of a Program of All-Inclusive Care for the Elderly (PACE); have an average daily attendance of one or more participants based on a typical week; and have one or more participants enrolled at the ADSC at the designated location at the time of the survey.
• The residential care community (RCC) estimates are based on survey responses from 4,312 eligible RCCs, representing over 30,600 RCCs. To be eligible to participate in NPALS, a RCC had to be licensed, registered, listed, certified, or otherwise regulated by the state; have four or more licensed, registered, or certified beds; provide room and board with at least two meals a day, around-the-clock on-site supervision, help with personal care, such as bathing and dressing or health related services such as medication management, and serve a predominantly adult population. RCCs licensed to exclusively serve the mentally ill or the intellectually disabled/developmentally disabled populations or both are excluded from NPALS.
• All estimates shown meet the NCHS data presentation standards for confidentiality and for reliability of proportions ( https://www.cdc.gov/nchs/data/series/sr_02/sr02_175.pdf).
• Additional information about survey data and administrative data is available from: https://www.cdc.gov/nchs/npals/questionnaires/#cdc_listing_res4-2020.