National Long Term Care Survey

The National Long Term Care Survey (NLTCS) is a longitudinal study of the health and functioning of the U.S. elderly population and its use of acute and long-term care (LTC) health services. The NLTCS was conducted in 1982, 1984, 1989, 1994, 1999, and 2004. Its sample is drawn from Medicare enrollment lists. In 1982, a procedure using 101 reduction sets of 500 individuals was used to determine the prevalence of chronic disability and institutionalization in a Medicare list sample of enrollees age 65 years and older. In the 1982 NLTCS, 35,000 individuals were interviewed to identify 6,000 chronically disabled community residents (the number of detailed interviews that the budget permitted).

NLTCS interviewing is done in two stages. The first stage involves screening all persons for activity of daily living (ADL) impairment or instrumental activity of daily living (IADL) impairment lasting at least 90 days. After chronically disabled persons are identified, they are given a face-to-face interview lasting 60 minutes and covering medical conditions, ADL and IADL disabilities, the health and social services received to help the persons manage with disabilities, demographic and housing traits, and socioeconomic factors.

In 1984, it was determined that a sample of 6,000 disabled community residents could be generated by reinterviewing surviving disabled persons from the 1982 NLTCS and roughly half of the 25,000 persons found not to be disabled in 1982. In 1984, the deaths of 1982 respondents were included in the sample so that the next of kin could be interviewed about health trajectories prior to death (e.g., nursing home entry). An institutional interview was developed and was administered to institutional residents in 1984. Only the fact of institutional residence was recorded in 1982.

The 1982 and 1984 NLTCSs were conducted by Health Care Financing Administration (HCFA) with support from the Assistant Secretary for Planning and Evaluation (ASPE). The 1989 NLTCS was conducted under a National Institute on Aging (NIA) grant with funds and design input provided by the ASPE. In 1989, both community-dwelling disabled residents and institutionalized persons were interviewed. As in 1984, all persons identified as chronically impaired in a prior NLTCS were given a detailed interview so that improvements and declines in functional status could be monitored. In 1989, there was evidence of a decline in disability prevalence. As in 1982, an informal caregiver survey was administered. As for the 1982 and 1984 NLTCSs, all NLTCS sample persons in 1989 were linked to Medicare Part A records. The 1982 and 1984 NLTCSs bridged the period of introduction of Medicare hospital prospective payment. The 1989 NLTCS was administered after the Catastrophic Care Act of 1988 was passed—and repealed shortly there-after—although it had significant consequences for LTC in the United States.

In 1994, the same two-stage interviewing process was used. As in 1984 and 1989, a replenishment sample of roughly 5,000 persons was drawn from lists of Medicare enrollees 65 to 69 years of age (i.e., persons who were under 65 years of age in the prior survey but who passed the age of eligibility between the 1989 [Page 407]and 1994 NLTCSs). This replenishment sample ensures that all NLTCSs are nationally representative longitudinally (once a chronically disabled person is identified, he or she receives a detailed interview up to the time of his or her death) and cross-sectionally (because of the 65- to 69-year-old replenishment sample). In 1994, three innovations were made. First, an oversample (n = 540) of very elderly persons (age 95 years and older) was drawn and screened. Second, nutrition questions were added to the community interview. Third, a sample of persons who did not report disability in the screen were given a detailed interview to improve the precision of estimates of the prevalence of traits of nondisabled persons. In 1990, the Medicare administrative record system was changed to include all types of Medicare services, including Part B outpatient services.

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