What is NCI-AD?

Establish in 2015, National Core Indicators—Aging and Disabilities™ (NCI-AD™) is a voluntary effort by state aging and physical disability agencies to measure and track their performance using a standardized set of nationally validated measures. The effort is coordinated by Advancing States and Human Services Research Institute (HSRI). Learn more about our history here.

In 2021-22 a total of 19 states participated in NCI-AD. Not all participating states do all surveys every year.

What is the NCI-AD
Adult Consumer Survey?

The NCI-AD Adult Consumer Survey (ACS), is standardized survey conducted with a person receiving long term services and supports (LTSS) through state aging and physical disability systems. Surveys are conducted by trained surveyors through in-person, secure video meeting, or over-the-phone conversations with service participants. The main part of the survey contains subjective questions about how well services are supporting the person; these can only be answered by the person themselves. A subset of more objective questions may be answered by a proxy respondent if needed. In addition to the questions for service participants, the survey also collects background information on the person –demographic and service-related data – mainly from service agency records. In 2021-22, the survey included two state-optional modules:

Person-Centered Planning Module. This is a series of questions that ask about the person-centered planning process, including the person’s experience developing the service plan and the service planning meeting. The following states conducted the Person-Centered Planning Module: CO, DE, GA, IN, KS, MI, MN, MO, NJ, OK, TX, WA, WI.

COVID-19 Supplement. This included a series of questions of the person’s experience with services during COVID-19 and the overall impact of the pandemic on the person’s life. The following states conducted the COVID-19 Supplement: CO, DE, GA, IN, KS, MI, MN, MO, NJ, OK, TX, WA, WI.

Sampling

There is considerable variation in how states’ long-term services and supports (LTSS) programs serving older adults and adults with physical disabilities are organized, funded, and administered. The NCI-AD program allows states to include programs funded through Medicaid, the Older Americans Act, Program of All-Inclusive Care for the Elderly (PACE), state-only funds, and/or other state- and federal-blended funds. The NCI-AD project team works closely with each participating NCI-AD state to advise and track which LTSS program populations and sub-populations are included in the state’s sampling strategy, how that sample is designed and how many surveys are targeted for completion. See detailed information on state sample frames here.

Missouri Specific Sample

Total Sample Frame: 71868

Total surveys completed: 2028

Overall Margin of Error 2.15%

Program Category

Table 1. Classification of 2021-22 State programs

STATE Program Funding Source Description of Program Total Population Eligible for NCI-AD Total Usable Surveys Collected MoE (95%Confidence, 0.5 Distribution) MoE (95%Confidence, 0.7 Distribution)
MO Consumer Directed Services Medicaid (Title XIX of the Social Security Act) through MO HealthNet Division (MHD); and General Revenue (GR) through the DHSS/DSDS State Plan Personal Care, which includes but is not limited to: personal Care, toileting, health, housekeeping, meals, and transportation 38507 383 5.01% 4.59%
MO Independent Living Waiver Medicaid 1915 (c) Waiver Independent Living Waiver (ILW) – this program offers additional services beyond the limitations of the Consumer Directed State Plan Personal Care program to a limited number of eligible consumers. ILW services include case management, personal care, environmental accessibility adaptations and specialized medical equipment and supplies. 674 238 6.35% 5.82%
MO Personal Care – Agency Model State general revenue and/or Medicaid 1915 (c) Waiver Personal Care - (Agency Model) (PC) services are generally medically oriented tasks provided as an alternative to nursing facility care, and designed to meet the maintenance needs of individuals with chronic health conditions. PC services must be reasonable according to the condition and functional capacity of the participant. 11118 375 5.06% 4.64%
MO Aged and Disabled Waiver Medicaid 1915 (c) Waiver Older adults above age 65, and individuals with physical disabilities ages 63-64. 15883 367 5.12% 4.69%
MO Adult Day Care Waiver Medicaid 1915 (c) Waiver Individuals with physical and other disabilities ages 18-63 years. 1602 311 5.56% 5.09%
MO Residential Care Facility / Assisted Living Facility State general revenue and/or Medicaid 1915 (c) Waiver Personal Care (PC) services are maintenance services provided to residents of Residential Care Facilities (RCF) or Assisted Living Facilities (ALF) to assist with activities of daily living (ADL). Services are authorized to eligible residents when the needs of the resident exceed the minimum obligations of the facility as established in the licensure requirements. 4909 354 5.21% 4.77%

What is included in this report?

This report presents Missouri 2021-22 ACS demographics and outcomes results. Data are shown for the overall statewide average, broken out by program sampled, and include the weighted NCI-AD Average.

Please note: Extreme caution should be used when interpreting results where the number of valid responses is small. Each program’s valid number of responses (valid Ns) is shown in every chart and table in this report.

To protect people’s privacy we do not show the data when 20 or fewer people from a state or within a program responded to a question, however their data are included in the overall state average.

Presentation of Data

Data may be viewed as bar charts or in tables by clicking the appropriate tab for each outcome. Data presented in charts are “collapsed” meaning that data grouped by response options to what is considered to reflect a positive outcome and all other responses. Tables represent the un-collapsed data outcomes.

All NCI-AD data are collapsed “yes” responses only, unless otherwise noted.

All state and NCI-AD averages throughout this report are “weighted” to account for any non-proportional sampling of programs and to “rebalance” the states’ sample sizes according to their populations of survey-eligible service recipients. See more details on weighting in Part II of this report.

Results

Demographics

Table 2. Average age (reported for those under 90 years old)

Program Age N
Consumer Directed Services 60.0 376
Independent Living Waiver 48.3 236
Personal Care – Agency Model 62.5 361
Aged and Disabled Waiver 73.0 343
Adult Day Care Waiver 45.3 310
Residential Care Facility / Assisted Living Facility 57.3 333
Overall State Average 62.6 1959
NCI-AD Weighted Average 66.8 12847

Table 3. Age Category (including those 90 and older)

Program 18-44 45-64 65-89 90+ N
Consumer Directed Services 11% 54% 35% 1% 379
Independent Living Waiver 39% 54% 6% 0% 237
Personal Care – Agency Model 12% 35% 49% 3% 372
Aged and Disabled Waiver 1% 7% 86% 5% 362
Adult Day Care Waiver 46% 52% 1% 0% 310
Residential Care Facility / Assisted Living Facility 20% 44% 33% 2% 340
Overall State Average 10% 40% 47% 2% 2000
NCI-AD Weighted Average 8% 27% 58% 6% 13593

Table 4. Gender

Program Male Female Other Don’t know or unclear N
Consumer Directed Services 32% 68% 0% 0% 383
Independent Living Waiver 49% 51% 0% 0% 237
Personal Care – Agency Model 33% 67% 0% 0% 373
Aged and Disabled Waiver 29% 71% 0% 0% 364
Adult Day Care Waiver 47% 53% 0% 0% 307
Residential Care Facility / Assisted Living Facility 52% 48% 0% 0% 346
Overall State Average 33% 67% 0% 0% 2010
NCI-AD Weighted Average 32% 68% 0% 0% 13595

Table 5. Race and ethnicity

Program American Indian or Alaska Native Asian Black or African American Pacific Islander White Hispanic or Latino Other Don’t know Unclear/Refused/No Response N
Consumer Directed Services 1% 2% 48% 0% 42% 1% 1% 1% 6% 352
Independent Living Waiver 0% 1% 37% 0% 52% 1% 1% 0% 8% 221
Personal Care – Agency Model 3% 1% 30% 0% 60% 2% 2% 0% 4% 336
Aged and Disabled Waiver 1% 0% 35% 1% 57% 0% 2% 1% 6% 331
Adult Day Care Waiver 0% 0% 63% 0% 28% 0% 2% 1% 6% 265
Residential Care Facility / Assisted Living Facility 2% 1% 16% 0% 81% 3% 0% 1% 0% 270
Overall State Average 1% 1% 41% 0% 50% 1% 1% 1% 5% 1775
NCI-AD Weighted Average 2% 5% 23% 0% 60% 9% 2% 3% 2% 13134

Table 6. Marital Status

Program Single, never married Married or in domestic partnership Separated or divorced Widowed Don’t know or unclear N
Consumer Directed Services 42% 13% 27% 18% 0% 358
Independent Living Waiver 67% 6% 18% 9% 0% 224
Personal Care – Agency Model 37% 13% 28% 23% 0% 345
Aged and Disabled Waiver 25% 13% 32% 30% 0% 334
Adult Day Care Waiver 87% 3% 7% 3% 0% 293
Residential Care Facility / Assisted Living Facility 60% 2% 16% 10% 12% 336
Overall State Average 40% 12% 27% 20% 1% 1890
NCI-AD Weighted Average 28% 15% 27% 25% 4% 13114

Table 7. Preferred Language

Program English Spanish Other Don’t know or unclear N
Consumer Directed Services 96% 1% 4% 0% 367
Independent Living Waiver 99% 1% 0% 0% 229
Personal Care – Agency Model 97% 1% 3% 0% 349
Aged and Disabled Waiver 98% 0% 2% 0% 349
Adult Day Care Waiver 99% 0% 0% 0% 292
Residential Care Facility / Assisted Living Facility 100% 0% 0% 0% 338
Overall State Average 97% 0% 3% 0% 1924
NCI-AD Weighted Average 89% 4% 7% 0% 13409

Table 8. Residential Designation

Categories created using zip codes and corresponding RUCA codes

Program Metropolitan Micropolitan Rural Small Town N
Consumer Directed Services 70% 12% 9% 8% 328
Independent Living Waiver 74% 9% 6% 12% 199
Personal Care – Agency Model 55% 20% 9% 15% 318
Aged and Disabled Waiver 66% 14% 9% 11% 311
Adult Day Care Waiver 94% 2% 0% 2% 244
Residential Care Facility / Assisted Living Facility * 53% 26% 4% 9% 234
Overall State Average 67% 14% 9% 10% 1634
NCI-AD Weighted Average 72% 14% 6% 9% 13085

Table 9. Median Income (based on zip code)

Newly reported in 2021-2022

Program $0- $9,999 $10,000- $19,999 $20,000- $29,999 $30,000- $39,999 $40,000- $49,999 $50,000- $59,999 $60,000- $69,999 $70,000- $79,999 $80,000- $89,999 $90,000- $99,999 $100,000 and over N
Consumer Directed Services 0% 4% 17% 46% 18% 9% 4% 1% 1% 0% 1% 327
Independent Living Waiver 0% 4% 10% 46% 19% 10% 7% 5% 0% 0% 1% 198
Personal Care – Agency Model 0% 0% 13% 48% 19% 12% 4% 2% 1% 0% 1% 316
Aged and Disabled Waiver 0% 2% 14% 47% 16% 12% 3% 2% 4% 0% 0% 309
Adult Day Care Waiver 0% 3% 13% 47% 16% 15% 2% 2% 2% 1% 0% 243
Residential Care Facility / Assisted Living Facility * 0% 1% 2% 53% 33% 5% 4% 2% 0% 0% 0% 215
Overall State Average 0% 3% 15% 47% 18% 10% 4% 1% 1% 0% 0% 1608
NCI-AD Weighted Average 0% 1% 9% 27% 27% 16% 9% 5% 3% 1% 1% 12977

Table 10. Type of Residence

Program Own or family house or apartment Senior living apartment or complex Group home, adult family home, foster home, host home Assisted living facility, residential care facility Nursing facility, nursing home Homeless or temporary shelter Other Don’t know or unclear N
Consumer Directed Services 91% 7% 0% 1% 1% 0% 1% 0% 371
Independent Living Waiver 96% 4% 0% 0% 0% 0% 0% 0% 228
Personal Care – Agency Model 80% 16% 0% 1% 1% 0% 1% 0% 356
Aged and Disabled Waiver 78% 18% 1% 1% 1% 0% 1% 0% 348
Adult Day Care Waiver 91% 6% 1% 1% 0% 0% 1% 0% 297
Residential Care Facility / Assisted Living Facility 0% 3% 3% 93% 1% 0% 0% 0% 349
Overall State Average 81% 11% 0% 6% 1% 0% 1% 0% 1949
NCI-AD Weighted Average 76% 7% 2% 7% 6% 0% 2% 1% 13448

Table 11. Who the person lives with

Program No One – Lives Alone Spouse or Partner Other Family Friend(s) Live-in PCA Others Don’t know or unclear N
Consumer Directed Services 46% 12% 40% 3% 1% 1% 0% 373
Independent Living Waiver 33% 8% 53% 3% 3% 1% 0% 229
Personal Care – Agency Model 57% 11% 29% 2% 0% 1% 0% 358
Aged and Disabled Waiver 61% 9% 26% 1% 1% 1% 0% 350
Adult Day Care Waiver 34% 3% 60% 2% 1% 1% 0% 294
Residential Care Facility / Assisted Living Facility 27% 1% 1% 14% 9% 56% 0% 349
Overall State Average 49% 10% 33% 3% 2% 4% 0% 1953
NCI-AD Weighted Average 47% 13% 28% 2% 2% 9% 1% 13355

Table 12. Address Change

Program Yes No Don’t know or unclear N
Consumer Directed Services 7% 93% 0% 364
Independent Living Waiver 9% 91% 0% 225
Personal Care – Agency Model 6% 93% 0% 354
Aged and Disabled Waiver 6% 93% 1% 343
Adult Day Care Waiver 11% 89% 0% 296
Residential Care Facility / Assisted Living Facility 1% 98% 0% 343
Overall State Average 7% 93% 0% 1925
NCI-AD Weighted Average 6% 92% 2% 12980
Program No Yes N
Consumer Directed Services 93% 7% 363
Independent Living Waiver 91% 9% 225
Personal Care – Agency Model 93% 7% 353
Aged and Disabled Waiver 94% 6% 340
Adult Day Care Waiver 89% 11% 296
Residential Care Facility / Assisted Living Facility 99% 1% 342
Overall State Average 93% 7% 1919
NCI-AD Weighted Average 94% 6% 12752

Table 13. Where people moved from (if moved in the last 6 months)

Program Own or family house or apartment Senior living apartment or complex Group home, adult family home, foster home, host home Assisted living facility, residential care facility Nursing facility, nursing home Homeless or temporary shelter Other Don’t know or unclear N
Consumer Directed Services 67% 5% 5% 0% 0% 5% 19% 0% 21
Personal Care – Agency Model 62% 5% 0% 0% 14% 0% 14% 5% 21
Adult Day Care Waiver 81% 0% 0% 0% 0% 0% 19% 0% 26
Overall State Average 70% 4% 3% 2% 3% 3% 16% 1% 100
NCI-AD Weighted Average 63% 5% 4% 5% 5% 3% 14% 1% 689
* The following programs had an N of less than 20 and were not shown: Independent Living Waiver, Aged and Disabled Waiver, Residential Care Facility / Assisted Living Facility

Table 14. Diagnoses

All categories except ‘physical disability’, ‘intellectual or other developmental disability’, and ’Alzheimer’s disease or other dementia are new in 2021-22. Categories are not mutually exclusive; therefore, N is not shown.

Program Physical Disability Traumatic brain injury or other acquired brain injury Intellectual or other developmental disability Alzheimer’s disease or dementia Heart Disease Cancer Chronic Obstructive pulmonary disease (COPD) Stroke Diabetes Hypertension (or high blood pressure
Consumer Directed Services 80% 8% 9% 4% 36% 12% 30% 21% 41% 69%
Independent Living Waiver 97% 18% 16% 2% 17% 11% 18% 15% 28% 39%
Personal Care – Agency Model 76% 11% 18% 6% 38% 17% 30% 21% 38% 66%
Aged and Disabled Waiver 71% 10% 6% 12% 38% 17% 35% 22% 42% 71%
Adult Day Care Waiver 65% 17% 53% 5% 18% 5% 11% 17% 23% 50%
Residential Care Facility / Assisted Living Facility 43% 11% 17% 5% 13% 9% 17% 11% 28% 37%
Overall State Average 75% 9% 11% 6% 35% 13% 30% 21% 39% 66%
NCI-AD Weighted Average 70% 11% 8% 11% 33% 12% 23% 20% 37% 60%

Table 15. Person has chronic psychiatric or mental health diagnosis

Program Yes No Don’t know or unclear N
Consumer Directed Services 33% 65% 1% 356
Independent Living Waiver 30% 69% 1% 227
Personal Care – Agency Model 39% 59% 2% 341
Aged and Disabled Waiver 29% 68% 3% 328
Adult Day Care Waiver 39% 60% 1% 285
Residential Care Facility / Assisted Living Facility 61% 35% 3% 322
Overall State Average 35% 63% 2% 1859
NCI-AD Weighted Average 35% 61% 3% 12828

Table 16. Level of Mobility

Categories are not mutually exclusive (except ‘Don’t know or unclear or unclear’).

Program Non-Ambulatory Moves self with wheelchair Moves self with other aids Moves self without aids Don’t know or unclear N
Consumer Directed Services 3% 15% 61% 37% 1% 368
Independent Living Waiver 16% 60% 31% 11% 0% 230
Personal Care – Agency Model 3% 25% 56% 35% 1% 358
Aged and Disabled Waiver 4% 20% 61% 34% 2% 346
Adult Day Care Waiver 2% 14% 32% 62% 0% 296
Residential Care Facility / Assisted Living Facility 1% 6% 26% 73% 1% 331
Overall State Average 3% 17% 58% 38% 1% 1929
NCI-AD Weighted Average 8% 21% 53% 27% 8% 13086

Table 17. Has history of frequent falls (more than two falls in a six-month period)

Program Yes No Don’t know or unclear N
Consumer Directed Services 35% 64% 1% 355
Independent Living Waiver 24% 76% 0% 228
Personal Care – Agency Model 34% 64% 3% 356
Aged and Disabled Waiver 40% 59% 1% 334
Adult Day Care Waiver 26% 74% 0% 292
Residential Care Facility / Assisted Living Facility 20% 78% 2% 324
Overall State Average 35% 64% 1% 1889
NCI-AD Weighted Average 28% 70% 1% 12866

Table 18. Receives Medicare

Program Yes No Don’t know or unclear N
Consumer Directed Services 70% 23% 7% 320
Independent Living Waiver 72% 26% 3% 196
Personal Care – Agency Model 74% 20% 5% 310
Aged and Disabled Waiver 83% 7% 9% 307
Adult Day Care Waiver * 62% 37% 2% 234
Residential Care Facility / Assisted Living Facility * 57% 19% 24% 262
Overall State Average * 73% 19% 8% 1629
NCI-AD Weighted Average 79% 18% 3% 12473

Table 19. Length of time receiving LTSS services in current program

Program 0 - 5 months 6 months – less than 1 year 1 year – less than 3 years 3 or more years Don’t know or unclear N
Consumer Directed Services * 5% 3% 20% 66% 5% 271
Independent Living Waiver * 2% 0% 14% 79% 5% 157
Personal Care – Agency Model * 6% 6% 23% 61% 5% 253
Aged and Disabled Waiver * 6% 5% 23% 59% 7% 254
Adult Day Care Waiver * 4% 4% 14% 74% 4% 180
Residential Care Facility / Assisted Living Facility * 1% 4% 12% 81% 2% 247
Overall State Average * 5% 4% 21% 65% 5% 1362
NCI-AD Weighted Average 7% 6% 28% 54% 5% 11942

Outcome Tables and
Comparisons across Programs

Community Participation

Table 21. Gets to do things outside of their home as much as they want to

Bar chart

Table

Program Yes No N
Consumer Directed Services 60% 40% 282
Independent Living Waiver 65% 35% 172
Personal Care – Agency Model 56% 44% 265
Aged and Disabled Waiver 67% 33% 241
Adult Day Care Waiver 62% 38% 128
Residential Care Facility / Assisted Living Facility 67% 33% 219
Overall State Average 61% 39% 1307
NCI-AD Weighted Average 62% 38% 9950

Table 22. Takes part in activities with others as much as they want to (in-person or virtually)

Question changed in 2021-22

Bar chart

Table

Program Yes Sometimes No N
Consumer Directed Services 61% 13% 26% 280
Independent Living Waiver 65% 11% 24% 169
Personal Care – Agency Model 54% 14% 33% 259
Aged and Disabled Waiver 56% 11% 32% 235
Adult Day Care Waiver 60% 17% 24% 131
Residential Care Facility / Assisted Living Facility 70% 12% 18% 216
Overall State Average 59% 13% 28% 1290
NCI-AD Weighted Average 58% 11% 31% 9904

Table 23. Reasons cannot always take part in activities with others as much as they want to (in-person or virtually)

Bar chart