Wednesday, March 11, 2020

2020 Census Procedures Outlined for Long Term Care (LTC) Facilities

Katherine Almendinger

The 2020 Census is underway and AHCA/NCAL is working closely with the Census Bureau to make sure the process goes smoothly and ease any burden on our members.

The Census Bureau has developed special procedures to count individuals living in “group quarters;” including college residence halls, residential treatment centers, skilled nursing facilities, group homes, correctional facilities and workers’ dormitories. Nursing facilities and group homes clearly fall under group quarters. In addition, Intermediate Care Facility for Individuals with Intellectual Disabilities (ICFs/ID) may have been classified as a group home or school for people with disabilities (GQ Type Codes). The status of assisted living and residential care facilities; however, is less clear.

During initial contact, Census workers classified assisted living facilities, residential care facilities and ICFs/ID as either housing units or group quarters, depending on the response from a representative of the facility. Facility representatives self-identified each facility. If an assisted living facility, residential care facility or ICF/ID was identified and classified as “housing units,” then by April 1, 2020, each resident in those settings will receive an invitation to participate in the 2020 Census. You will have three options for responding: on-line, by phone or by mail. If no one in the resident completes the form via on-line, by phone or mail, Census workers will follow up by conducting in-person visits. This is the same procedure the Census Bureau uses for enumerating all residential households.

Assisted living facilities are generally not considered to be group quarters (GQ). However, depending on the level of care provided, certain units, such as memory care units may qualify as group quarters under the definition: "Facilities licensed to provide medical care with seven-day, twenty-four-hour coverage for people requiring long-term non-acute care. People in these facilities require nursing care, regardless of age." Any portion of a facility that does not qualify as a group quarters, such as portions that include independent living and assisted living units, will be included in the housing unit operation. Each individual unit/apartment within the independent living or assisted living facility will receive an invitation in the mail asking that they respond via mail, online, or phone.

For those in housing units, if the individual in the facility is capable, they can fill out the census form, the 2020 Census Questionnaire, themselves. You may help complete the 2020 Census for someone else if asked, or if you are a legal guardian or executor. If this is the case, and you are knowledgeable about the address, please complete the questionnaire for the household. Please keep in mind that you are not responding for yourself. Answer the questions the way the person at this address would.

For group quarters, there are two phases: 1) 2020 Group Quarters Advance Contact (GQAC) (February 3 - March 6), and 2) 2020 Group Quarters Enumeration (GQE) (beginning April 2nd).

During the Group Quarters Advance Contact phase, which applies only to group quarters (including all nursing facilities and group homes), providers will have an opportunity to discuss by phone or receive a personal visit from a Census Bureau worker to discuss, understand, and prepare for enumeration. Providers will also be able to select an enumeration method. LTC facilities will have the following options:

  • Electronic Response Data Transfer (eResponse) – The group quarters administrator fills in a template with group quarters data and respondent level data for each person who is staying at the facility on Census Day (April 1, 2020).  The group quarters administrator electronically sends the census response data to the Census Bureau. Please note: The eResponse option is not available for service-based administrators.
  • In-Person Interview – A census worker conducts a face-to-face in-person interview with each person who is served or staying at the facility on April 1, 2020.
  • Drop-Off/Pickup of Questionnaire – A census worker leaves census questionnaires to be completed by or for each person who is staying at the facility on April 1, 2020. The census worker then picks up the completed questionnaires at an agreed-upon time.
  • Paper Response Data Collection – A census worker meets with the administrator of the facility to obtain a paper listing of census response data for each person who is served or staying at the facility on April 1, 2020.
  • Facility Self-Enumeration – A census worker swears in and trains the group quarters facility administrator and then leaves behind census materials so that the administrator can conduct the enumeration for each person who is living or staying at the facility on April 1, 2020. A census worker then returns to pick up the completed questionnaires at an agreed-upon time. Only military installation group quarters, correctional facilities, and health care facilities can select this option.

During the Group Quarters Enumeration phase, a Census Bureau worker will accept “administrative enumeration,” or Paper Response Data Collection, when counting group quarters if the facility representative determines that this the best procedure to use for their residents. In this case, the facility generates a paper listing of all the individuals in the facility, and the Census worker will develop a system of patient identification numbers from that list. If the individual in the facility is capable, they can fill out the census form, the Individual Census Questionnaire (ICQ), themselves. If the individual is incapable, the enumerator completes the form using administrative records; not medical records. No facility classified as a group quarters should feel compelled to use its own staff to complete the enumeration process. If the facility chooses to self-enumerate, the Census Bureau will provide staff training. Note: Please do not photocopy the ICQ. Each ICQ has a barcode that is unique.

When a Census worker arrives at your facility be aware of the following information:
  • Ask to see the worker’s badge to ensure the worker is from the Census Bureau. 
  • Rest assured that Census information is confidential and protected by law.  
  • Census data is used only for statistical purposes and is public only after 72 years. 
  • None of the information requested by the Census Bureau is protected health care information under the Health Insurance Portability and Accountability Act (HIPAA) (Informational Group Quarters Health Care Facility Manager Letter). 
In light of the current COVID-19 (or Coronavirus) Outbreak across the United States and Abroad, the Census Bureau is committed to taking all precautions to protect the health of both your residents and our census takers. As indicated above, there are five methods of enumeration for group quarters facility managers to consider. While the facility manager may have selected an enumeration method that required face-to-face contact with your residents, there will be an opportunity for facility managers to change that enumeration method to one that will reduce the need for face-to-face contact. During the 2020 Census Group Quarters Enumeration starting April 2, 2020 through June 5, 2020, census takers will began contacting the facilities that were contacted during the Advance Contact operation to confirm their method of enumeration. At that time, your facility manager may choose one of the methods that reduces the need for face-to-face contact. These include: drop off/pick up of questionnaires, paper response data collection, and electronic response data transfer (eResponse).

Please visit the Census Bureau's website at for more information about the 2020 Census Group Quarters operation. Please visit their website at for more information about the 2020 Census for those facilities or units that identify as housing units.

If you have any questions or concerns, please contact Dora Durante from the Census Bureau or 301-763-9371; or Katherine Almendinger from the American Healthcare Association.

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