Employee termination costs represent accrued severance payable to terminated employees with employment and/or separation agreements with the Company. Restructuring and other costs consists of the accrual related to lease commitments and write-offs of leasehold improvements and unused office space and property and equipment resulting from the closure of three adult day services centers in Illinois. These costs are included in general and administrative expenses on the Consolidated Statements of Income.

In 2016, the Company initiated steps to streamline its operations. The Company incurred total expenses related to these initiatives of approximately $1.9 million, $1.7 million and $8.0 million for the years ended December 31, 2018, 2017 and 2016, respectively. The expenses recorded for the year ended December 31, 2018, primarily relates to terminated employees resulting mainly from changes made to the management team during the year and other professional fees. The expenses recorded for the year ended December 31, 2017 included costs related to terminate employees resulting mainly from changes made to the management team made during the year, fees related to the termination of professional services relationships, other contract termination costs and asset write-offs. The expenses recorded for the year ended December 31, 2016 included costs related to terminated employees as a result primarily of the closure of the contact center and other changes made to the executive leadership team made during the year and other direct costs associated with implementing these initiatives including contract termination costs, accelerated depreciation and asset write-offs.

The following provides the components of and changes in our severance and restructuring accruals:

	Employee Termination Costs			Restructuring and Other
	(Amounts in Thousands)
Balance at December 31, 2016	$	1,326		$	1,786
Provision		1,038			627
Utilization		(1,802	)		(1,336	)
Balance at December 31, 2017	$	562		$	1,077
Provision		647			564
Utilization		(1,129	)		(1,056	)
Balance at December 31, 2018	$	80		$	585

The aforementioned accruals are included in accrued expenses on the Consolidated Balance Sheets and the aforementioned expenses are included in general and administrative expenses on the Consolidated Statements of Income. The remaining employee termination costs accrual, as of December 31, 2018 is expected to be paid by the end of 2019.