Utilization of Nursing HomesNursing homes–LJnited States–Utilization-Statistics. I. Sutton, Jearmine FOX. II. Title. III. Series United States. National Center for Health Statistics

I Data from theNATIONAL HEALTH SURVEY

Utilization of Nursing HomesUnited States:National Nursing Home SurveyAugust 1973-April 1974

Presents statistics on various measures of utilization according toselected facility, resident, staffing, and financiaI characteristics.These statistics include distribution of beds, occup~cy rate, demo-graphic characteristics of residents, length of stay since currentadmission, primary reason for admission, living arrangements priorto admission, admissions, discharges, rate of turnover, full-timeequivalent staff, skill of charge person, charges for care, and sourcesof payment. Based on data collected in the National Nursing HomeSurvey.

DHEW Publication No. (H RA) 77-1779

Series 13Number 28

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFAREPublic Health Service

Health Resources AdministrationNational Center for Health StatisticsHyattsvil Ie, Md. ‘July 1977

.

Library of Congress Cataloging in Publication Data

United States. National Center for Health Statistics.Utilization of nursing homes, United States.

(Vkd and health statistics: Series 13, Data from the National Health Survey; no. 28)

(DHEW publication; no. (HRA) 77-1779)Includes bibliographical references.1. Nursing homes–LJnited States–Utilization-Statistics. I. Sutton, Jearmine FOX.

II. Title. III. Series United States. National Center for Health Statistics. Vital and healthstatistics: Series 13, Data on health resources utilization; no. 28. IV. Series: United States.Dept. of Health, Education, and Welfare. DHEW publication; no. (HRA) 77-1779.RA407.3.A349 no. 28 [RA997] 362.1’1’0973 [362.6’15’09731

ISBN 0-8406-0090-9 77-608185

For SJle by the Superintendent of Documents, U.S. Government Printfng OfficeWash@ton, D.C. YX02

Stock No. 017-w2-00567-1

NATIONAL CENTER FOR HEALTH STATISTICS

DOROTHY P. RICE, Director

ROBERT A. ISRAEL, Deputy Director

JACOB J. FELDMAN, Ph.D., Associate Director for Analysis

GAIL F. FISHER, Associate Director for the Cooperative Health S tatistics System

ELIJAH L. WHITE, Associate Director for Data Systems

JAMES T. BAIRD, JR., Ph.D., Associate Director for International Statistics

ROBERT C. HUBER, Associate Director for Management

MONROE G. SIRKEN, Ph.D., Associate Director for Mathematical S tatistics

PETER L. HURLEY, Associate Director for Operations

JAMES M. ROBEY, Ph.D., Associate Director for Program Development

PAUL E. LEAVERTON, Ph. D., Associate Director for Research

ALICE HAYWOOD, Information Officer

DIVISION OF HEALTH RESOURCES UTILIZATION STATISTICS

SIEGFRIED A. HOERMANN, Director

JOAN F. VAN NOSTRAND, Chief Long-Term Care Statistics Branch

W. EDWARD BACON, Ph.D., Chiej Hospital Care Statistics Branch

STEWART C. RICE, Acting Chiej Family Pkmning Statistics Branch

JAMES E. D.LOZIER, Chie~ Ambulatory Care Statistics Branch

MANOOCHEHR K. NOZARY, Chief Technical Services Branch

Vital and Health Statistics-Series 13-No, 28

DHEW Publication No. (HRA) 77-1779Library of Congress Catalog Card Number 77-608185

CONTENTS

Introduction ..................... .................................................. .................. ............... ..................................... 1Scope of Report ................................................................................................................................... 1Background .......................................................................................................................................... 1

Facility Data ................ .............. .................................................................................. ............................ 2General Characteristics of Homes ............................................................................................. ............ 2Dktribution of Beds ............................. ...... .......................................................................................... 3Occupancy Rate .......................... ........................................................................................................ . 4

Resident Data ... .......................................... ........................................... ....................................................Demographic Characteristics ..... ................................................ ............................................. ...............Ixngth of Stay Since Current Admission .............................. .................................................... ..... .......Pnmaxy Reason for Admission ........ .....................................................................................................Living Arrangements Prior to Admksion ....................................................................................... .......Adrnissipns ........................... ........................................................................................ ........................Rate of Patient Turnover ..................................................................................................... .................Waiting fists ................................................o...o....................................................................................Dk.charges................... ................................................................................................ ..........................

556789

101112

Staffing and Financial Characteristics ....................................................................................... ................. 15

FuB-Time Equivalent Employees ....... ................................................................................................... 15Level of Skill of Person in ~age .....................................................$....................................... ............ 16

Average Total Monthly Charge for Care........................................................................................ ........ 17

Primary Source of Payment ....... ........ ................................................................................................... 19

References ........ ....... ....................... ...... ............. ............... ........................................... .............................. 21

List of Detailed Tables ........... ............ ........................................................................................................ 23

AppendixesI. Technical Notes on Methods ................................................................................................... ... 39

II. Definitions of Certain Terms Used in This Report ..................................................................... 51

111. Selected Questionnaires Used in the 1973-74 NationaI Nursing Home Survey ........................... 53IV. Criteria for Classifying Nursing Homes According to Level of Nursing Care............................... 77

LIST OF FIGURES

1. Percent change in the number of nursing homes and the average annuzd change for 1963,1969, andAugust 1973-April 1974: United States ............................................................................................ 3

2. Percent change in the number of nursing home beds and the average annual change for 1963,1969,and August 1973-April 1974: United States ...................................................................................... 4

3, Percent distribution of residents by sex and age: United States, August 1973-April 1974 ................... 5

4. Percent distribution of residents by length of stay since current admission: United States, August1973-ApIil 1974 ........................... ................ ................................................................... ................. 6

5. Percent distribution of residents by the primary reason for admission to the nursing home: UnitedStates, August 1973 -ApriJ 1974 .......................... ..................................................... ................ ......... 8

ili

6. Percent distribution of full-time equivalent employees in nursing homes by occupation category:United States, August 1973-April ~ 974 - “...... ......................................................................................

7. Percent distribution of nursing homes by number of shifts per day: United States, August 1973-April1974 .................. ........................... ....................................................................................................

LIST OF TEXT TABLES

A. Number and percent distribution of nursing homes by certification status, according to size, owner-ship, and geographic region: United States, August 1973-April 1974 ................................................

B. Number and percent distribution of nursing home beds by ownership and geographic region of thehome, according to certification status of the bed: United States, August 1973-April 1974 .............

C. Occupancy rate of beds in nursing homes, by certification status, ownership, size, and geographicregion: United States, 1972 .................................................................................................. ............

D. Number and percent distribution of residents by length of stay since current admission, according toage and sex: United States, August 1973-April 1974 .. ......................................................................

E. Number and pert.nt distribution of residents by length of stay since current admission, according tocertification status, ownership, size, and geographic region: United States, August 1973-April1974 ....... ......................................... ....................................................................................... ..........

F. Median length of stay of residents since current admission, by certification status, ownership, size,and geographic region: United States, August 1973-April 1974 ........................................................

G. Percent distribution of residents by primary reason for admission, according to sex, age, and lengthof stay since current admission: United States, August 1973-April 1974 .............. ............................

H. Percent distribution of residents by primary reason for admission, according to certification status,ownership, size, and geographic region: United States, August 1973-April 1974 ..............................

J. Number and percent distribution of residents by living arrangements prior to admission, according tocertification status, ownership, size, and geographic region: United States, August 1973-April1974 .... .......... .......................................................................................................................... .........

K. Number and percent distribution of admissions to nursing homes, by certification status, ownership,size, and geographic region: United States, 1972 ..............................................................................

L. Number of admissions to nursing homes and admissions per bed: United States, 1962, 1968, and1972 ............................................................................................................................................. ....

M. Rate of resident turnover (admissions per bed), by certification status, ownership, size, and geo-graphic region: United States, 1972 ..................................................................................................

N. Number and percent dk.ribution of nursing homes by whether or not a wziting list was maintained,accordhg to certification status, ownership, size, and geographic region: United States, August1973-April 1974 .......... ...................... .... ...........................................................................................

O. Number and percent distribution of discharges by discharge status, according to certification status,ownership, size, and geographic region: United States, 1972 ............................................................

P. Number and percent distribution of discharges by discharge status: United States, 1962, 1968, and1972 ........................ ................................................ ................................................. ........................

Q. Percent distribution of full-time equivalent employees by occupation category, according to certifi-cation status of the home: United States, August 1973-April 1974 ..................................................

R. Number of full-time equivalent employees per 100 residents, by occupation category and certifica-tion status of the home: United States, August 1973-April 1974 ......................................................

S, Number of full-time equivalent employees per 100 nursing home residents for 1964, 1968, andAugust 1973-April 1974: United States ........................................................................................ ....

15

17

2

4

5

6

7

8

9

10

11

12

12

12

13

14

14

15

16

16

iv

T. Percent distribution of numing homes with person in charge on duty for three shifts by level of skiflof the person in charge, according to certification status, ownership, and size of home: UnitedStates, August 1973 -Aptif 1974 ............................................................................................... ......... 18

U. Number and percent of nursing homes with three shifts and percent with RN’s in charge for theeshifts: United States, 1968 and August 1973-Aprif 1974 .............................................................. .... 18

W. Average totaf monthly charge and number of residents, by age, sex, length of stay since current ad-mission, and primary reason for admission: United States, August 1973-Apxil 1974 .. ...................... 19

Y. Average total monthly charge: United States, 1964, 1969, and August 1973-ApIif 1974 .................... 19

Z. Percent distribution of residents by primary source of payment, according to age, sex, length of staysince current admission, and primary resson for admission: United States, August 1973-April1974 .............................................................................................................. ...................... ............. 20

v

SYMBOLS

Data not available---------------------------—----- ---

Category not applicable------------------------– . . .

Quantity zero--–-—-–-----–-—-----—- -

Quantity more than Obut less than 0.05-— 0.0

Figure does not meet standards ofreliability or precision--—------—--—--- *

vi

UTILIZATION OF NURSING HOMES

Jeannine Fox Sutton, Division of Health Resources Utilization Statistics

IINTRODUCTION

Scope of Report

In the last 10 years, the increased utilizationof nursing homes has made them one of themost rapidly expanding sectors of the Nation’shealth care delivery system. This report will pre-sent a three-dimensional view of the Nation’sutilization of nursing homes by reviewing (1)facility data, (2) resident data, and (3) staffingand charge data collected in the NationalNursing Home Survey from August 1973 toApril 1974. Examination of these three areas~$,illinclude a review of such measures as admis-

sions to and discharges from nursing homes,primary reason for admission, prior livingarrangement, occupancy rates of nursing homebeds, the average length of stay since currentadmission, the level of skill of the person inIcharge of work shifts in the home, and the aver-age monthly charge for resident care.

Reports pertaining to data collected in the1973-74 National Nursing Home Survey havebeen published. One report presents data onoperating and financial characteristics of thefacilit y,l and a second report presents data ondemographic and social characteristics of theresidents.2 Future publications will present dataon the health profile of the residents, theirchm.ges for care, and medical services received as~trcll-’us data on” facility and staff characteristics

and cm the cost of providing care.

Background

The 1973-74 National Nursing Home Surveywas designed and developed by the Division ofHwdth Resources Utilization Statistics in con-

junction with a group of experts in various fieldsencompassing the broad area of long-term care.It was specifically designed as the first in a con-tinuing series of surveys to satisfy the diversedata needs of those who establish standards for,plan, and provide long-term care. Facilitieswithin the scope of this survey were those nurs-ing homes that provided some level of nursingcare. Criteria for classifying nursing homes anddefinitions of the two classes discussed here arepresented in appendix IV.

From August 1973 to April 1974, data froma national sample of nursing homes concerningtheir services, costs, residents, and staff werecollected via a combination of mail and personalinterview survey techniques. Data on characteris-tics of the facilities and on all staff memberswere collected by interviewing the administra-tor. Data for a sample of residents werecollected by personal interview with the nursewho usually provided care for the resident.When answering the questions, the nurse gen-erally referred to the resident’s medical record.A detailed description of the data collectionprocedures is presented in appendix I; defini-tions of terms are given in appendix II; the datacollection instruments are presented in appendixIII. Because the estimates from the survey arebased on a sample of nursing homes rather thanon a complete enumeration, they are subject tosampling variability. Detailed information on thesampling variability of these estimates is given inappendix I.

Data from five previous surveys of nursinghomes conducted by the National Center forHealth Statistics may be used to study changesin nursing home care. Published data are availa-ble from the three sample surveys of “resident

1

Table A. Numbar and percent distribution of nursing homes by certification sUnited States, August 1973-A

Size, ownership, and geographic region

All homes ... .. .. ... . .. .. .. .. .. .. .. .. ... .. . .. . .. ... . ... .. .. .. .. .. .. .. .. .. .. .. .. .. ... . .. ... . ... ...

Size—

Less than 50 beds . . .. .. ... .. .. .. .... .. ... . .... . .. .. .. ... .. . ... . ... .. .. .. .. .. .. .. .. .. . ... .. .. ... . .. .. .. .. .. ..

50-99 beds ... .. ... . ... .. .. .. .. .. ... .. .. .. .. .. . .... . .. .. ... .. .. .. .. . ... .. .. .. .. .. .. .. ... . . ... ... . .. .. ... .. . ... .. .100-199 beds . .. .. .. .. .. .. .. . ... .. .. .. .. .. .. .. .. .. .. .. .. .. .. ... .. . .. .. . . ... . .. ... .. . .. .. ... . ... . .. .. .. .. . ... .. .200 beds or more ... . ... .. .. .. . .... .. . .. .. . .... . .. .. .. ... . .. ... . ... .. .. .. . .. ... .. . ... .. .. .. .. .. .. ... . .. .. .. ..

Ownershio

Proprietary ... . .. .. .. ... .. . .. ... .. .. .. .. .. ... . .. .. .. ... . .. ... . .... . . ... .. .. ... .... . ... .. ... .. .. ... . ... .. . ... .. ..Nonprofit and government . .. ... . ... . ... .. .. .. .. . .. . . .... .. . .. .. ... .. . ... . ... .. .. .. .. .. .. .. ... . .. ... .. .

Geographic region

Northeast . .. .. .. ... .. .. ... .. .. . .. ... .. .. .. .. .. .. ... . ... .. . .... . .. .. .. ... .. .. .. .. .. .. .. .. .. .. .. . ... . ... .. .. .. .. .. .North Central . ... . .. .. .... . . .... . ... .. . ... .. .... .. .. .. .. .. .. .. .. . ... .. .. ... . ... . .. ... . ... .. . ... . .. ... .. .. .. ...South . .. ... .. .. .. .... ... ... .. .. .. .. .. . ... .. .. .. .. .. .. .. .. .. .. .. .. ... . .. .. .. .. .. . . .. .. .. . ... . ... .. .. . ... . ... .. .. . ...

West ... .... .. .. .. .. .. .. .. ... . .... . . .. .. . . .. .. .. .. .... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ... . .. ... . .. .. .. . ... .. .

10f these homes, s percent were certified by Medicare only.2of these homes, 35 percent were certified as both SNH’S and ICF’S-

NOTE: Figures may not add to totals due to rounding.

places” conducted in 1963,3’6 1964,7-14 and1969,1 5‘2 1 as well as from a national census ofnursing homes conducted in 1968. The 1963,1964, and 1969 surveys included those facilitiesthat provided either nursing or personal care,and the 1973-74 survey included only thoseproviding some level of nursing care. (The 1963survey also covered homes providing hospitalcare.) To allow for valid comparisons of dataover time, homes providing personal care orhospital care were excluded from the 1963,1964, and 1969 estimates.

FACILITY DATA

General Characteristics of Homes

Approximately 15,700 homes provided nurs-ing care in the United States during the period

]tus, accordi ng to size, ownership, and geographic region:ril 1974

Numberof

homes

15,700

6,400

5,5003,200

600

11,9003,900

3,1005,6004,100

2,900

II Certification status

Both Medicaid only

TotalMedi-care

Notcerti-

;::i. SNH’S2 ICF’S fied

caidl

Percent distribution

100.0

100.0100.0100.0100.0

100.0100.0

100.0100.0100.0100.0

26.5

9.531.846.74B.2

27.224.4

31.316.3

20.1

50.3

22.4

15.924.829.132.9

21.225.9

27.119.9

22.422.0

28.1

35,9

28.516.0

*

29.324.4

17.735.6

36.512.B

23.1

38.B

14.9B.2

●

22.325.3

24.028.2

21.015.0

under study., Of these homes, about 75 percentwere operated under a proprietary t~pe ofownership (table A) and about 25 percent undernonprofit or government auspices. These homesprovided care for about 1,075,800 residents, orapproximately 5 percent of the U.S. population65 years of age and over. The following nursingcare homes were included in the 1973-74 sur-vey:

Those certified as extended care facilities(ECF’S) by Medicare (Title XVIII of theSocial Security Act).’

aThe extended care facility and skilled nursinghome designations are used in this report because mostof the survey was conducted prior to the legislation thatcreated the skilled nursing facility.

2

by

Those certified as skilled nursing homes(SNH’S) by Medicaid (Title XIX of theSocial Security Act).’

Those certified as intermediate care facili-ties (ICF’S) by Medicaid.

Those not certified by either program butproviding some level of nursing care.

Of the homes certified, some were certifiedboth the Medicare and the Medicaid pro-

grams, and others were certified only by theMedicaid program to participate as both a skillednursing home and as an intermediate care facil-ity. In order to provide detailed data on thehomes by certification status, some small certifi-cation subgroups were combined with largerones when both provided similar levels of care.Thus, the 4,200 homes classified as having beencertified by both Medicare and Medicaid include8 percent that were certified by Medicare only.Similarly, the 3,500 homes classified as havingbeen certified by Medicaid as skilled nursinghomes (SNH’S) include 35 percent that werealso certified as intermediate care facilities(ICF’S).

When the number of homes in these fourcertification groups are examined (table A),percents range from 22 percent for SNH’S to 28percent for ICF’S. Even though the distributionof homes appears nearly equal over the fourcertification groups, there were, in fact, signifi-cantly more homes in the ICF group than in theSNH group.

Examination of the geographic location ofthe homes shows that, of the four geographic

regions, the North Central Region had the high-est proportion of the total homes (over one-third) and the South had the second highest(over one-fourth) (table A). Additional informa-tion on the distribution of nursing homes ispresented in table 7.

When the number of homes from the 1963and 1969 surveys were adjusted to reflect thesame population as that used for the 1973-74survey, the percent increase in the number ofhomes providing nursing care since 1969 wassmall, about 3 percent for the entire period oran average yearly increase of less than 1 percent.For the 10- or n-year span from 1963 to 1973-74, however, the increase was 23 percent (or an

P2,61969 to

1973.740,7

I 2281963 m1973.74

2.3

—

I I I I I Io 5 10 15 20 25

PERCENT

KOTE F,gurt, from 1963 and 1969 were ad,u,tcd m cxcludc Per,ond art homes and hmPNal <are fw!l,.

,,,$. For ,0.,.,, “f datz, SC, refmnce, 6 and 20.

Figure 1. Percent change in the number of nursing homes and

the average annual change for 1963, 1969, and August

1973-April 1974: United States

average yearly increase of over 2 percent) (figure1). “

Distribution of Beds

Nursing care homes in the 1973-74 surveyhave been categorized for this report into fourbed-size groups-less than 50 beds, 50-99 beds,100-199 beds, and 200 beds or more. Homeswith more than 200 beds accounted for only 4percent of the total number of homes and rep-resented a significantly smaller percent of homesthan those in the other three groups. At theother end of the spectrum, homes with less than100 beds represented about 75 percent of allhomes.

During the survey period, nursing home bedstotaled about 1,177,300. Of these, 24 percentwere certified as ECF beds by Medicare; 49percent were certified as SNH beds by Medicaid;and 32 percent were certified as ICF beds byMedicaid (table B). It should be noted that thesepercents do not add to 100 percent becausesome beds have dual certification. For example,a bed certified by Medicare may also be certifiedby Medicaid. Since one bed may be countedtwice, the sum of all certified beds exceeds theactual number of beds by more than 5 percent.Homes under a proprietary ownership accountedfor over 70 percent of the total number of beds.Since over three-fourths of all homes are in this

3

Table B. Numbar and percent distribution of nursing home beds by ownership and geographic region of the home, according tocertification status of the bed: United States, August 1973-April 1974

I Certification of bed

Ownership and geographic region

All bedslMedicare

bedsSNH beds ICF beds

I Number

All beds

~

. .. . .. .. .. .. .. .. .. .. ... . ... .. .. .. ... .... .. .. .. .. .. .. .. .. .. .. ... .. .. ... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. . , ,

Total .. ... .. .. .. .. ... . .. .. .. .. .. .. ... .. .. .. .. .. .. .. .. .. ... .. .. . .. .. .. .. ... .. ... . ... .. .. .. .. .. .. .. .. .. .. .. .. .. .

Ownership

Proprietary .. .. .. .. .. .. .. . ... .. .. .. .. .. .. .... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ... . .. .. .. .. .. .... ... .. ... .. .. .. .. .. . ... .. .. .. ..Nonprofit and government .. .. .. .. .. ... .. . .. .. .. .. ... . .. ... .. . .. .. .. .. ... . .... .. .. . . .. . ... . ... .. .. .. .. .. .. .. .. .. ..

Geographic region

Northeast .... . .. ... .. .. .. . ... .. .. .. . ... ... . ... . .. . .. ... . ... ... . . ... . ... .. ... . .. .. .. ... .. . ... . ... .. .. . ... .. .. .. .. .. .. ... .. . .North Central . ... .. .. .. . .. ... . ... . .. .. .... . .. . .... . ... .. .. . .. ... . .. . .... .. .. . ... .. .. .. .. .. .. .. .. . ... .. .. .. .. .. .. . . .. .. .. .

South . . ... ... .. . .. ... .. .. .. . ... .. .. .. .. .. .. .. .. .. .. ... . .. .. .. .. .. ... . .. .. .. .. .. .. ... .. .. ... . ... .. .. .. .. .. . ... .. .. ... . .. .. .. ..West .. . ... . ... .. .. .. .. .. .. .. .. .. .. .. .. .. ... . .. . . .. .. .. .. ... . .. .. . .. ... . . ... ... .. .. . .. ... .. .. . ... .. .. .. .. .. .. .. .. .. .. .. ... .. .. .

100.0

I100.0

70.7 78.2

29.3 21.8

21.3 28.3

34.7 17.3

25.8 17.918.2 36.5

100.01 100.0

76.0 73.124.0 26.9

24.2 14.225.9 39.421.7 34.628.1 11.8

l’r’h~ sum of certified beds ~xceed~ the total ~umb~r of bed5 beca”~e some beds may have dua] ce~tifi~ation.

NOTE: Estimates for beds differ by an average of 0.3 percent from those presented in reference 2 due to inclusion of a bed-ratioadjustment factor in the weighting as described in appendix I.

ownership category, this significantly higher per-cent of beds is not unexpected.

The numbers of beds were distributed simi-larly to the number of homes when examined byregion. As with homes, the percent of beds inthe North Central Region was significantlygreater than the percents in the other three re-

gions. The South also accounted for a signifi-cantly larger percent of beds than the Northeast

or the West did.Figure 2 shows the percent change in the

number of beds in homes providing nursing care.When the numbers of beds from the 1963 and1969 surveys are adjusted to reflect a similarpopulation to that of the 1973-74 survey, thepercent increase in beds between 1963 and1973-74 is 131 percent or an average yearlyincrease of about 13 percent. Growth since 1969was much slower; the increase was 38 percentfor the 4-year span, or over 9 percent per year.

Occupancy Rate

Another measure of the utilization of nurs-ing homes is the occupancy rate of the beds inthe home. This rate was computed for this

I

I I I I I I I I I I I I I I I

o 10 20 30 40 50 60 70 80 90 100 110 120 130 140

PERCENT

NOTE, F,w,, from 1963 and1969 w,,, adjusted to .xcludc Pmm.1 CU. homes and hmpttd ,am 1.,111t,,,, For mu,,,, of data, seer, ferenms 6 md 20,

Figure 2. Percent change in the number of nursinghomebedsand the average annual change for 1963, 1969, and August1973-April 1974: United States

report by using the formula

zAggregate number of days of care provided

to residents in 1972 X 100

L ‘ Estimated number of beds in 1972 X 366

4

The number of beds in 1972 was estimated byadjusting the number of beds in 1973-74 for anychange in beds during the preceding year of1972. An occupancy rate based on days of careprovided gives a more stable estimate of utiliza-tion for a calendar year than a rate based onnumber of beds occupied last night does.

Generally, 87 percent of all beds were occu-pied in homes during 1972 (table C). While theoccupancy rate by type of certification variedfrom 85 percent for both Medicare and Medi-caid homes to 89 for ICF ‘s, no significant differ-ences were found. No significant differenceswere found in the occupancy rates by owner-ship, size, or geographic region of the home.

Table C. Occupancy rate of beds in nursing homes, by certifica-tion status, ownership, size, and geographic region: UnitedStates. 1972

Certification, ownership, siza, andgeographic region

All homes ............................... ............

Certification status

Both Medicare and Medicaid2 ............................Medits~~s~nly:

..........................................................ICF’S ....................... ...................... ................

Not cartified .......................................................

Ownership

Proprietary .........................................................Nonprofit and government .................................

6ize—

Lessthan 50 beds ...............................................50-99 beds ..........................................................100-199 beds ......................................................200 beds ormore ................................... ............

Geographic ragion

Northeast ..................................................... ......North Central .....................................................South ,,, .,, ,.,,.,.... .................................................West ...................................................................

Occwe?yy

86.5

84.9

85.789.288.4

86.486.7

89.288.686.380.1

89.086.286.584.2

‘z Aggregate number of days of care providedto residents in 1972 X 100

~Estimatednumberof bedsin 1972 X 366See a pendix II for additional information concerning ratios.

!&f these homes, s percent were certified by Medicare

only.30 f these homes, 3S percent were certified as both SNH’S

and ICF’S.

For Medicare, SNH, and ICF beds, table 6 -presents the percent of beds filled “last night.”When sampling variability is considered, the per-cent of beds filled “last night” is significantlysmaller for Medicare beds than for those certi-fied as SNH or ICF beds. Almost 60 percent ofthe SNH and ICF beds were filled comparedwith about 12 percent of Medicare beds. Furtherexamination shows that, regardless of the owner-ship, size, or geographic region of the homes, asmaller percent of Medicare beds was filled onthe night prior to the survey.

RESIDENT DATA

Demographic Characteristics

An overall picture of the types of personsusing nursing homes during the 1973-74 surveycan be obtained by examining the age and sex ofthe residents, their length of stay since currentadmission, primary reason for admission, andliving arrangements prior to admission. Since,as of July 1973, almost 60 percent of the civil-ian population over 65 years of age werewomen, it is not surprising that 7 out of 10 nurs-ing home residents that year were women.Generally, there were 238 females per 100males. Of the female nursing home residents,almost 80 percent (figure 3) were 75 years andover—a reflection of the longer lifespan of

‘GE URiE~ H65”74Y’”SlE!E~::e

All residents

Male 16.5

Female 8.2

1 I I I I I I I I I 1

0 10 20 30 40 50 60 70 80 90 lWPERCENT OF RESIDENTS

Figure 3. Percent distribution of residents by sax and age:United States, August 1973-April 1974

5

women. In comparison, about 63 percent of themale nursing home residents were 75 years andover. (The Division of Vital Statistics of theNational Center for Health Statistics estimatesthe lifespan in 1973 to have been 75 years forfemales and 68 years formales.22 )

Length of Stay Since Current Admission

The length of stay as defined in this report isthe time interval between the patient’s currentadmission to the home and the day the surveywas conducted. (See question 5 of the ResidentQuestionnaire in appendix III). Nearly 72 per-cent of all residents in nursing homes during the1973-74 survey had been there for less than 3years and nearly 15 percent had been in nursinghomes for less than 3 months (figure 4).

The length of stay of residents according totheir age and sex is shown in table D and table 1.Between 70 and 75 percent of the residents hada length of stay of less than 3 years regardless ofthe sex or age category examined.

Table E and table 2 examine length of stayaccording to various faciIit y characteristics.Homes certified by both Medicare and Medicaidhad a significantly larger percentage of the short-term residents (less than 3 years) than homes in

E“ Less than 3.5,9 6.11.9 1.2,9 3 years3 months months months years or mora

LENGTH OF STAY SINCE CURRENT AOMISSION

Figure 4. Percent distribution of residents by length of stay

since current admission: United States, August 1973-April1974

the other certification groups had. Thk wasprobably due to the generally shorter stay ofresidents receiving Medicare benefits (Medicarewill finance a maximum of 100 days of cake).Homes that were not certified had a significantlyhigher percent of longer term residents (3 yearsor more) in comparison with homes certified asSNH’S, or for both Medicare and Medicaid.

When ownership of the home is considered,government and nonprofit homes had a signifi-cantly higher percent of long-term residents(38 percent). Proprietary homes had 24 per-

Table D. Number and percent distribution of residents by length of stay since current admission, according to age and sex: UnitedStates, August 1973-April 1974

Age and sex

All residents .. .. .. .. ... .. . ... . ... . .. .... . .. .. ... .. . .. .. .. ...

Less than 65 years . .. . ... .. .. .. .. . ... .. .. .. .. .. .. ... . .. ... . .. . .. .. ... . ...65-74 years .. . ... .. .. .. .. .. .. ... .. .. .. .. .. .. .. . ... .. .. .. .. ... . ... . ... .. . ... .75 years or more .. ... . ... .. . ... . ... .. . .... . .. .. . .... . .. ... . ... . ... .. . ... .

Males .. . ... .. ... .. .. .. .. .. . ... .. .. .. .. .. .. .. .. ... . ... . ... .. . ... .. ... .

Less than 65 years . ... .. .. . ... .. .. . ... .. .. . ... .. .. ... . ... . .. .. .. ... .. .. ..65-74 years .. . ... .. ... .. .. .. .. .. ... . ... . .. ... . ... . .. ... .. . .. . .. ... . .. .. .. ...75 years or more .. ... . .. . . .. ... . ... .. . ... .. .. .. ... .. .. .. .. .. .. .. .. .. .. ...

Females ... . ... .. ... . ... .. . .... . .. .. . ... .. .. .. .. .. ... . ... .. . .. .. ... .

Less than 65 years .. .. .. .. .. ... . .. ... . ... .. .. .. . .... . .. .. .. .. ... . .. .. ... .

65-74 years . .. .. .. .. ... . ... .. .. .. .. .. .. .. ... . .. .. .. ... .. . .. . . ... .. ... .. . ... .75 years or more . ... .. .. . ... .. .. . ... .. .. .. .. ... . ... .. . .... ... .. . ... .. ... .

Numberof

residents

1,075,800

114,300163,100798,400

318,100

52,40065,100

200,600

757,700

61,900

98,000597,800

II Length of stay since current admission

TotalLess than

3 to less 6 to less 1 to less I3 yeers

3 monthsthan 6 than 12 than 3 or

months months years more

100.0

100.0100.0100.0

100.0

100.0100.0100.0

100.0

100.0100.0100.0

14.4

14.416.514.0

17.1

15.517.317.5

13.3

13.5

16.012.9


9.7

9.311.0

9.4

10.5

9.611.010.5

9.3

9.1

10.99.1

14.5

14.115.814.3

14.7

14.115.214.7

14,4

14.0

16.114.1

33.2

31.731,333.9

32.2

31.930.832.7

33.7

31.6

31.734.2

28,2

30.425.328.4

25.6

28.926.624.7

29.3

31.8

25.3

29.7

NOTE: Figures may not add to totals due to rounding,

6

Table E. Number and percent distribution of residents by length of stay since current admission, according to certification status,ownership, size, and geographic regi&r: United’ States, August 1973-April 1974 -

Age and sex

All residents .. ... .. .. ... . ... .. ... . .. .. .. ... .. .. ... . ... .. .. ..


Both Madicaid and Medicarel .. .. .. .. ... . ... .. .. ... .. .. .. .. .. .. ...Medicaid only:

SNH’S2 . .. ... .. .. ... . ..... . .. .. .. ... .. ... .. ... . .. ... .. ... . .. ... .. ... . .. ..ICF’S .. . .. ... ... . .. ... . .... .. ... . ... .. ... .. .. ... . .... . .. ... .. . ... .. ... . .. ..

Not certifiad . .... . . .. .. .. ... . ... .. ... .. .. ... . .... . .. ... .. ... . .. .. ... .. . .. ..

Ownership

Proprietary . .. ... ... ...o. .... . .. .... .. .. .. ... .. . ... .. .. ... .. .. .. ... . ... .. . .. .No~profit and government . ... .. . ... .. ... .. .. .. .. .. ... . ... .. ... . ... .

Size—

Les than 50 beds . .. ... ... . ... .. .. ... . ... . .... . .. ... . ... .. .. ... . ... . .. ...i50- 9 beds .. .. ... .. .. .. .. .... . .. ... .. .. .. .. .. .. ... . .... .. ... . .. ... . .... . .. ..

100-199 bads . .. .. ... . ... ... . .. .. ... ... . .. ... .. ... . ... . ... .. .. ... . .... . ... .200 beds or mora .. ... .. .... ... . .... . .. .. ... .. .. .. .. .. .... . . ... .... . .. .. .

Geographic region

Northeast . . ... .. ... .. .. .. ... .. ... .. . .... . .. ... . ... .. ... . ... .. .. ... .. ... . .. .. .North Central ... . ... .. .. .. ... .. .. ... .. .. .. .. . ... .. ... .. ... .. .. .. .. .. .. .. ...

South . ... .. .. .. .. .... . ... .. .. ... .. .. . .... .. .. .. .. ... .. . ... . .... .. . ... . .... .. .. .West .. .. ... . .. .. .... .. .. .. .. ... ... . ... .. .. .. .. ... . .. .. . ... .. . ... .. .. .. .. ... . ... .

Numberof

residents

1,075,800

406,900

292,500236,700139,800

756,200319,700

162,600367,700386,100159,300

236,100368,700

278,200192,800

Total

100.0

100.0

100.0100.0100.0

100.0100.0

100.0100.0100.0100.0

100.0100.0100.0100.0

II Length of stay since current admission1 I 1 i

Less than3 months

3 to lessthan 6

months

6 to Iess 1 to lessthan 12 than 3

months years


14.4

20.1

12.110.310.1

16.010.7

12.114.916.411.0

14.611.714.619.3

9.7

11.3

8.59.37.8

10.47.9

10.39.2

10.38.5

9.69.49.2

11.0

14.5

16.3

14.013.112.5

15.113.0

11.714.615.514.4

14.114.1

14.815.3

33.2

33.1

35.332.930.0

34.530.2

32.134.333.232.1

31.7

33.135.232.4

3 yearsor

more

28.2

19.2

30.234.439.5

24.038.1

33.827.024.534.0

30.1

31.7

26.222.0

@f these residents, 23,500 were in facilities certified by Medicare only.20 f these residents, 129,600 were in facilities certified as both .CJNH$sand 1CF>5.


cent of their residents in this “3-years-or-more” shorter stays and half have longer stays. As such,group.

Homes in the smallest and largest size groups(those with less than 50 beds and those with 200or more) had significantly higher. percents oflong-term residents than homes in the middle-size categories had. Specifically, homes in eachof these two bed-size groups accounted forabout 34 percent of long-term residents.

Homes in the Northeast and North CentralRegions had significantly larger percents (30-31percent) of long-term residents than homes inthe West Region (22 percent) had. Southernhomes had 26 percent of residents with thislonger length of stay.

The median length of stay is the point in thedistribution where half of the residents have

it is a good measure of central tendency since itis not affected by the extremes in the distribu-tion. The median length of stay for all residentsin the survey was 547 days, or 1.5 years. TableF shows how this median vanes according tocertification, ownership, size, and geographicregion of the home. Residents with a medianlength of stay greater than 2 years were those innoncertified facilities and those in homesoperated under nonprofit and governmentauspices.

Primaty Reason for Admission

The nurse respondent was asked to selectthe primary reason the resident was admitted

7

Table F. Median length of stay of residents sinca current admis-sion by certification status, ownership, size, and geographic

region: United States, August 1973-April 1974

Certification, ownership, size andgeographic region

All residants ... .. .. . ... . .. .. . ... .. .. .. .. .. .. .. ..


Both Medicare and Madicaidl . .. .. . .. .. .. .. .. . ... .. .. .Medicaid only:

SNH’+’ . .. .. .. .. .. ... . .... . ... .. .. .. . ... .. . .... . .. ... . .. .. ... .ICF’S .. . ... .. .. ... . ... . ... . .. ... .. ... . .. .. .. .. ... . .. ... ... . .. . .

Not certified . . ... .. .. .. .. .. .. .. ... . ... . .. ... . .. .. . ... .. . . ... . ...

Ownership

Proprietary . . .. ... .. ..m.. . ... . ... .. .. .. ... ... .. ... . ... .. .. .. .. .. .Nonprofit and government . ... .. .. ... . .. . ... ... . ... .. ...

Size

Less than 50 beds . ... .. .. .. . .. .. .. ... ... . . .. ... . ... .. .. .. .. ..50-99 beds . .. . .. .. ... ... . .. ... . ... .. .. .. . .... . .. ... . ... . .. ... . ...100-99 beds . .. .. .. . ... .. . ... .. ... . .. ... .. . ... .. .. . .. ... .. ... . .. .200 beds or more .. .. .. ... . ... . ... .. .. .. .. .. .. . .... .. . ... .. ..

Geographic region

Northeast .. . ... .. ... . .. .. .. .. ... .. . .. ... .. ... . ... .. . ... . ... ... . ..North Central .. .. .. .. .. .. ... . ... . ... .. .. ... . .. ... . ... .. .. .. .. ..

South . ... .. . .. .. ... ... . .. . .... .. . ... .. .. .. .. .. .. .. .. .. .. .. .. ... . ...

west ................................................................

Median lengthof stay

since currentadmission

Indays

547

~

397

608691762

485

751

635538472667

581

614532

430

Inyaara

1.5

1.1

1.71.92.1

1.32.1

1.71.51.31.8

1.6

1.71.5

1.2

lof these residents, 23,500 were in facilities cefiified by

Medicare only.20f these residents, 129,600 were in facilitiesce~ified ~

both SNH’Sand ICF’S.

to the home from four general categories. Thesecategories were listed as “physical reasons,”“social reasons,” “behavioral reasons,” and“economic reasons.” (See question 7 of theResident Questionnaire , appendix III.) Over 80percent of persons residing in nursing homesduring the survey entered the home because of

physical reasons (figure 5). In fact, regardlessof sex, age, or length of stay of the resident(table G) or of any of the facility characteristics(table H), a significantly larger portion of resi-dents were admitted to homes because of physi-cal pr~blems. Although nearly one-eighth of allresidents were admitted because of behavioral

ao

70

60

20

10

0REASON FOR ADMISSION

Uu!mlIlEconomic

Ils131 s”’”’

mBahavlord

u “’s’’”

Figure 5. Percent distribution of residents by tha primary rea-son for admission to the nursing home: United States,August 1973-April 1974

problems, about one-third of the younger resi-dents (under 65 years of age) were admitted be-cause of behavioral problems (table G). Incontrast, a significantly smaller percent of resi-dents in the older age groups was admitted forbehavioral problems. Nearly 7 percent of resi-dents were admitted primarily for social reasonsand only 1 percent for economic reasons. Tables3 and 4 present additional information onreason for admission.

Living Arrangements Prior to Admission

Of the 1,075,800 persons in nursing homesduring August 1973-April 1974,38 percent wereadmitted from a private residence and 59 per-cent from another facility (table J). (See ques-tion 6a of the Resident Questionnaire, appendixIII.) For 35 percent of all residents, the place ofresidence prior to admission was a general orshort-stay hospital. This percent is significantlylarger than any for the other types of facilities.As many as half of the residents admitted to

Table G. Parcent distribution of residents by primary reason for admission, according to sex, age, and length of stay since currant

admission: United States. Auaust 1973 -A~ril 1974.-

Sax, age, and Iangth of stay since current admission

Both sexes . .. .. ... .. ... .. . .. .. .... .. .. .. .. ... .. ... . . ... .. ... .. .. .. .. .. .. . ... .. ... .. .. .. .. .

Less than 65 years .. .. .. .. .... . ... . ... .. .. .. .. ... .. .. .. .. ... .. .. ... . .. ... .. ... . .. ... . .. .. ... .. .. .. .. ..65-74 years .. . ... ... . .... . ... .. .... . .. .. ... .. . ... .. .. ... .. ... . ... .. . ... .. ... . .. ... .. .. .. . ... .. .. ... . ... .. .75 years or more ......................................................................................

Male ...............................................................................................

Less than 65 years ....................................................................................65-74 years ....... ........................................................................................75 years or more ............................... ................ .......................................

Female . .. ... ... .. .. .. .... .. .. .. .. ... . ... .. ... .. .. .. .. .... . . ... .. ... . .. ... .. ... . .. ... . .... . .. ... ..

Less than 65 years ....................................................................................65.74 years ......................... ........................................... ...........................75 years or more ... .. . .... . .... . ... .. .. ... .. .. .. .... . ... .. .. .. .. .. .. .... .. . ... .. .. .. .. ... .. ... . ... ... .

Lenath of stav since current admission

Lessthan 3 months . .. ... . ... .. ... . .... . .. ... . .. .. .. . ... .. ... .. . .. .. ... .. . .. . . .. ... .. .. ... .. .. . ... .. .3 to lessthan 6 months . ...........................................................................6 to lessthan 12 months ............... ...........................................................1 to lessthan 3 years .................................................................. .. ...... ......3 to lassthan 5 years ................................................................................5 to lessthan 10 years . ...................................... .......................................10 years or mora ......................... .............................................................


homes certified by both Medicare and Medicaidwere admitted from general or short-stay hospi-tals. Since Medicare residents are generally ad-mitted to ECF’s following discharge from ahospital, many of them were probably admittedto recuperate from an operation or acute illness.Also, homes certified by both Medicare andMedicaid generally provide a higher level of nurs-ing care, which is appropriate for personsrecuperating from a hospital stay. Table 5 showsin more detail the distribution of residentsaccording to their living arrangements prior toadmission.

Admissions

About 1,110,800 persons were admitted tonursing homes during 1972. (See question 13 ofthe Facility Questionnaire, appendix 111.) Over

Al I reasons

100.0

100.0100.0100.0

100.0

100.0

100.0100.0

100.0

100.0100.0

100.0

100.0100.0

100.0

100.0

100.0100.0100.0

Primary reason for admission

PhysicalI

Social I BehavioralI

Economic


80.9

59.476.684.9

79.0

57.777.385.1

81.8

60.876.284.8

87.284.7

84.2

81.3

79.074.156.3

6.5

5.55.46.8

6.5

5.7

5.76.9

6.4

5.45.3

6.8

5.04.5

4.5

5.66.9

10.520.2

11.6

33.916.9

7.4

13.4

35.315.8

6.9

10.9

32.717.6

7.5

7.510.1

10.5

12.212.914.119.4

1.0

**

1.0

1.2

***

0.9

**

0.9

*●

*

1.0***

half of these admissions (table K) were to theone-quarter of homes that were” certified byboth Medicare and Medicaid. The fact that thesehomes, on the whole, were larger accounts forthis significantly large portion of the admissions.

An examination of admissions according toownership of the home shows a significantlylarger percent of admissions to proprietaryhomes in 1972. Since about three-fourths of allhomes were operated under proprietaryauspices, this could be expected.

Examination of admissions according to geo-graphic location of the home revealed no signifi-cant difference among the percents for the fourregions—they ranged from 22 percent of theadmissions for homes in the Northeast Regionto 28 percent of those for homes in the NorthCentral. Table 6 presents additional data onadmissions.

9

Tabla H. Percent distribution of residents by primary reeson for admission, according to certification status, ownership, size, andgeographic region: United States, August 1973-April 1974

Certification, ownership, size, and geographic region

All residents ..................................................................... ........


Both Medicare and Medicaidl ...................................... ............................Medicaid only:

SNH’S2 .................... ............................................................................ICF’S ...................................................................................................

Not certified .............................................................................................

Ownership

Proprietary ........................................ ........................... ............................Nonprofit and Government .......................................................... ............

Size—

Lessthan 50 beds .....................................................................................50-99 beds .... .. . .. . .... . ... .. .. .. .. .. . .. ... .. ... . .. ... . .. .. ... . .. . ... .. .. .. .. . ... .. ... . .. .. .. ... . .. ... . ..100-199 beds ............................................................................................200 beds or more ................................... ...... ...... ......................................

Geographic region

Northeast .................................................................................................North Central .......................................,,, .,,,,,....,.,.,.. ................................South ..................................................................... ..................................West .........................................................................................................

Primary reason for admission

Al I reasonsPhysical I Social I Behavioral I Economic


100.0

100.0

100.0100.0100.0

100.0100.0

100.0100.0100.0100.0

100.0100.0100.0100.0

ICIf these re$idents, 23,500 were in facilities certified by Medicare only.Zofthese residents, 129,600 were in facilities cefiified as both SNH>sand ICF)s.

NOTE: Figures maynotadd tototals dueto rounding.

Table L shows a comparison of the admis-sions to nursing homes in 1962, 1968, and 1972.(Data have been adjusted to reflect similar popu-lations.) For the 10-year period since 1962,admissions to nursing homes increased by 210percent, but the number of beds increased byonly 131 percent. This might indicate increasedutilization of previously unoccupied beds and areduction in the length of stay.

Rate of Patient Turnover

A relative measure of turnover, which allowsa comparison to be made among the varioustypes of institutions, is the number of admis-sions per bed. This ratio varied somewhat in1972 according to the certification, ownership,

80.9

87.1

83.078.363.3

82.377.7

75.581.883.079.4

82.477.382.284.3

6.5

4.0

5.26.6

16.1

4.311,5

8.25.26.47.7

7.97.75.24.0

11.6

8.2

11.214.517.4

12.88.7

14.712.19.9

17.5

8.114,111.711.1

1.0

0.7

*●

3.2

0.52.2

1.60.90.71.5

1.70.90.9

●

size, and geographic region of the home. Anexamination of ;able M- reveals a significantlyhigher rate of turnover of residents in homescertified by both Medicare and Medicaid, homeswith a proprietary type of ownership, andhomes in the West Region of the United States.Admissions per bed per year ranged from 0,7for homes in the largest size group (200 beds ormore) to 1.1 for homes in the 100-199 bed-sizegroup. In fact, homes with 200 beds or morehad a significantly smaller rate of turnover thanhomes in the bed-size groups 50-99 and 100-199.

The rate of turnover has varied over theyears as shown in table L. Admissions per bedvaried from 0.7 for 1962 to 1.1 for 1968 to 0.9for 1972. The lower ratio for 1972 as compared

10

Table J. Number and percent distribution of residents by living arrangements prior to admission, according to certification status,ownership, size, and geographic region: United States, August 1973-April 1974

Certification, ownership, size, andgeographic region

All residents ........................


Both Medicare and Medicaidl ............!Me&Na~d~~nly:

...........................................ICF’S ..............................................

Not certified .......................................4

Ownership

Proprietary ..........................................Nonprofit and government ..................

Size—

Lassthan 50 beds ................................50.99 beds ........... ............ ........ .. ..........100-199 beds .......................................200 bedsor mora ................................

Geoma~hic reaion

Northeast ............................................North Central ., ...,,..,,,.,,, ..................... .South ., ................o...............................Wast ....................................................

Number

1,075,BO0

406,900

292,500236,700139,800

756,200319,700

162,600367,700386,100159,300

236,100366,700278,200192,800

Total

100.0

100.0

100.0100.0100.0

100.0100.0

100.0100.0100.0100.0

100.0100.0100.0100.0

Other health facility

IGen-

AI I eral or

facil- short-

ities stayhospi-

tal

58.8

69.7

57.550.044.4

64.245.9

54.959.461.654.6

60.B56.552.070.4

34.8

50.0

32.921.716.5

38.625.8

24.135.539.632.2

41.030.529.642.8

Mentalhospi-tal orotherlong-termcarespe-

cialtyhospi-

tal

Anothernursinghomeor re-lated

facility


7.9

5.5

7.710.610.4

9.24.8

11.08.06.57.9

4.810.2

7.77.5

13.9

12.2

14.716.213.2

14.612.4

16.914.013.212.4

12.113.913.516.6

Boardinghome

or otherplace

2.2

2.0

2.11.54.3

1.93.0

2.81.92.32.1

2.81.91.23.5

Privateresi-

dence

37.5

27.3

38.946.049.4

32.746.6

42,136.734.940.6

37.139.043.725.9

Un-known

3.8

3.0

3.64.06.2

3.15.4

3.03.93.54.8

2.14.54.33.7

@f these residents, 23,500 were in facilities certified by Medicare Only.

20f these residents, 129,600 were in facilities certified as both SNH’S andICF’S.


with that for 1968 is probably due to the greater This can be indicated by the number of homesincrease in the number of beds (37 percent) maintaining a waiting list and the number ofwhen compared with the increase in the number persons on these lists. During the survey, 72 per-of admissions (17 percent). cent of all homes (or 11,300) maintained

waiting lists (table N). These lists contained the

Waiting Lists names of 152,300 persons who, if admitted,would have utilized 13 Percent of all beds.

Another measure of utilization of nursing Because one pekon may have had his name onhomes is the demand for nursing home beds. several lists, the number 152,300 overestimates

11

Table K. Number and percent distribution of admissions tonursing homes, by certification status, ownership, size, andaeoaraohic reaion: United States, 1972----


All admissions .. .. .... . . ... .. ... .. .


Both Medicare and Medicaidl . .. .... . ... . ..Medicaid only:

SNH’S2 ... .. .. ... . .. ... . .. . .. .. .. ... .. . ... .. .. .. ..ICF”S .. .. .. .. .. .. .. .. ... . .. .. .... . ... . ... .. .. . ... . .

Not certified ....................................... .

Ownership

Proprietary ..........................................Nonprofit and government ..................

Size—

Less than 50 beds ................................50-99 beds . . .. ... ... . ... . .. ... . ... .. . ... .. .. .. .. .. .. .100-199 beds . . ... . ... .. . ... .. .. .. .. .. .. .. ... . ... . ..200 beds or more . . ... .. .. .. .. ... . .. . .. .. .. .. ... ..

Geographic region

Northeast . .... .. . ... .. .. .. .. .. .. .. .. .. .. ... . .. .. .... ..

North Central . .. .. .. ... . ... . .. .. .. . ... .. . ... .. ... . .South .. . .. ... .. .. .. .. .. ... .. .. . ... .. .. .. ... . .. ... . .... . .West . .. . ... ... .. .. .. .. .. ... .. . .... . .. ... . ... .. . ... . .... . .

Number

1,110,800

624,100

223,600164,900

98,200

852,800258,000

148,900397,000441,200123,700

238,700

306,900

289,100276,100

Percentdistri-bution

100.0

56.2

20.114.8

8.8

76.823.2

13.435.739.711.1

21.5

27.6

26.024.9

lof these homes, 8 percent were certified by Medicareonly.

20f these homes, 3S percent were certified as both SNH’Sand ICF’S.


Table L. Number of admissions to nursing homes and admissionsper bed: United States, 1962, 1968, and 1972

Admissions and

admissions per bed I 19621I 19681 I 1972

Number of admissions ...... 358,500 946,000 1,110,800

Admissions per bed . . ... .. .. . 0.7 1.1 0.9

lThese figures were adjusted to include only homes provid-ing some level of nursing care. For sources of data see references6 and 20, respectively.

the demand. Nevertheless, the fact that 72 per-cent of all homes maintained waiting lists indi-cated that the demand for beds exceeded thesupply in a majority of homes.

Of the homes not certified by Medicare orMedicaid, 61 percent maintained waiting lists

Table M. Rate of resident turnover (admissions per bed), by

certification status, ownership, size, and geographic region:United States, 1972


All homes .... .. ... .. .. .. .. ... . .. ... ... .. .. .. .. .. ... . .. ... . .


Both Medicare and MedicaidI .. . . .. . ... .. .. .. .. .. .. .. .. .. .. .. ... .

Medicaid only:SNH’S2 .. .. . ... .. . .... . .. .. . .... .. .. .. .. ... .. .. .. .. .. .. .. .. .. ... . .. .. .. .ICF’S .. .. .. ... . ... .. .. .. .. ... . ... .. ... . ... .. . ... .. ... . ... .. . .. ... . ... . .. .

Not certified . . ... . .. .... . .. ... .. .. .. ... .. . ... .. .. .. ... . .. . ... . .... . ... ....

Ownership

Proprietary . . .. .. .. .. .. .. .. ... . .... .... .. .. .. .. .. .. .. .. .. .. .. .. .. . . .... . ..

Nonprofit and government . ... .. . ... .. .. ... . ... . ... .. . .... . .. ... ..

Size—

Less than 50 beds ......................................................5099 beds . ... .. .. .. ... . .. .. ... .. .. . .... . .. .. .. ... ... .... .. .. .. ... .. ... .. ..100-199 beds .............................................................200 beds or more . ... .. . ... .. ... .. . .. . .. ... .. .. .. .. ... . ... ... ... . . .... ..

Geographic region

Northeast . .. .. .. ... .. ... . ... .. ... .. .. ... .. .. .. .. .. .. .. ... .. ... . .. ... . ... .. ..

North Central . ... .. .. .. ... .. ... .. .. ... . ... .. .. ... .. .. .. . .. .. ... .. .. ... .. .South .. . ... .. .. .. .. ... . ... .. ... .. ... .. . .... . ... .. . .. .. .. .. .. .... .. .. .. .. ... ...West ... . .. ... . .... . .. ... .. ... .. ... . ... .. .. ... .. ... .. ... . .. ... . .. ... . ... . ... . .. .

Admis-sionsperbed

.9

1.4

.7

.7

.6

1.0.7

,81.0

+ 1.1.7

1.0.8

1,01.3

@f these homes, 8 percent were certified by Medicareonly.

20f these homes, 3S percent were certified as both SNH’Sand ICF’S.

NOTE: See appendix II for additional information concern-ing ratios.

(table N). This percent was significantly smallerthan the percents for homes in the other threecertification categories. The 77 percent of non-profit and government homes with waiting listswas not significantly greater than the 70 percentof proprietary homes. Significantly fewer hoties(67 percent) with less than 50 beds than thosewith 50-99 beds (76 percent) maintained waitinglists. About 75 percent of all homes in the twolarger bed-size groups maintained these lists.

Discharges

About 1,077,500 persons were dischargedfrom nursing homes in 1972–approximately

12

Tabla N. Number and percent distribution of nursing homes by whether or not a waiting list was maintained, according to certificationstatus. ownershim size, and ~eographic region: United States, Augu~ 1973-April 1974

Certification, ownarship, size, and geographic region

All homes...... .......... .......................................................................


Both Medicare and Madcaidl ........................ ................................................Me~~~s~ly:

.....................................................................................................lCF's ............................................................................. ........................O...

Not certified ................+.................................................................................

Ownershi~

Proprietary ...........m........o...........................m....................................................Nonprofit and government . ................. ...........................................................

Size—

Lessthan 50 beds...........................................................................................50-99 beds .....................................................................................................100-199 beds .................................................................................................200 beds or more ............................................... ...... ...................... ................

Geographic region

Northeast ............................................................................ ...........................North Cantml ................................................................................................ .South ............................................................................ .......................O.O......-West ......................................................... .......................................... ............

10f these homes, 8 percent were certified by Medicare only.20f these homes, 35 percent were certified as both SNH’S and ICF’S.

NOTE: Figures may not add to totala due to rounding.

33,000 less than the number of persons admit-ted. As might be expected, discharges in 1972followed the same pattern as that of admissions:

Over half of the discharges were from homescertified by both Medicare and Medicaid.

‘ ‘About three-fourths of all discharges werefrom proprietary homes.

A significantly smaller portion of the dis-charges were from homes in the smallest andlargest bed-size groups.

Discharges were rather evenly distributedamong homes in the four geographic regions.

Total

15,700

4,200

3,5004,4003,600

11,9003,900

6,4005,5003,200

600

3,1005,6004,1002,900

Withwaiting

Iist

11,300

3,200

2,8003,1002,200

8,3003,000

4,3004,2002,400

500

2,4004,0003,0002,000

Withoutwaiting

Iist

4,400

1,000

7001,3001,400

3,500900

2,1001,300

800●

8001,6001,100

900

IIIWithWith-out

Total wait- wait-ingIist

inglist


100.0

100.0

100.0100.0100.0

100.0100.0

100.0100.0100.0100.0

100.0100.0100.0100.0

72.0

77.1

79.270.261.2

70.377.0

66.976.174.075.8

75.470.772.470.1

28.1

22.9

20.829.838.8

29.723.0

33.123.926.0

●

24.629.327.729.9

Almost 70 percent of all persons dischargedin 1972 were ‘dive and 30 percent were dead(table O). Although only 30 percent of the dis-charges were due to death, for 1972 the deathrate for nursing homes residents of 304 per1,000 was 5.1 times the rate for the U.S. popula-tion aged 65 and over.

The percent of discharges due to death wassignificantly larger for homes not certified (47percent) than for homes certified as SNH’S orICF’S (34 percent) or by both Medicare andMedicaid (25 percent).

Homes in the smallest size group (less than50 beds) had a significantly larger percent ofdischarges due to death (41 percent) than homes

13

Table O. Number and gercent distribution of dischames by discharge status, according to cer’tificaticm status, Ownership, size, andgeogra~hic region: Un;ted States, 1972

Certification, ownership, size, and geographic region

All dscharges .......................................................................................................


Both Medicare and Medicaidl ..............................................................................................Me~zttsjnl y:

...........................................................................................................................ICF’S ........................................................................................................................ .......

Not certified ....................................... ........................! ........................... .............................

Ownership

Proprietary ...........................................................................................................................Nonprofit and government ............................................................ .......................................

Size—

Lessthan 50 beds ... .. .. .. .. .. .. . ... .. .. ... . ... . .. .. .. .. ... .. ... . ... . .. ... . .. ... . ... .. .. .. .. . ... . ... .. .. ... . .... ... .. ... .. .. .. .. ..50-99 beds .................... .......................................................................................................100-199 beds .......................................................................................................................200 beds or more .................................................................................................................

Geographic region

No~heafi ............................................................................................. ................................North Central ................................................................................................................ .......South ...................................................................................................................................West .....................................................................................................................................

10f these homes, 8 percent were certified by Medicare only.20f these homes, 35 percent were certified as both SNH’S and ICF’S.


with 50-99 beds or 100-199 beds had. Table 6presents additional data on discharges.

Table P shows the number of dischargesboth alive and dead for 1962, 1968, and 1972.Data for 1962 and 1968 have been adjusted toreflect a population similar to the one includedin the 1973-74 survey. Although percent changein discharges since 1962 follows a pattern similarto that for admissions, the amount of change isslightly larger. Since 1968, discharges increasedby 24 percent over the 4-year span, or 6 percent

per year. For the 10-year period since 1962, thenumber of discharges increased by 218 percent,or about 22 percent per year. There was a signif-icant decline in the percent of discharges due to

Numberof

discharges

1,077,500

599,300

209,400153,600115,300

833,800243,700

164,500378,900415,500118,600

223,300307,800273,300273,100

~

TotalDis- 1Dis-

charged chargadalive dead


100.0

100.0

100.0100.0100.0

100.0100.0

100.0100.0100.0100.0

100.0100.0100.0100.0

69.6

74.9

66.366.352.7

70.566,4

59.271.772.168.7

70.962.4‘70.076.4

30.4

25.1

33.733.747.3

29.533.6

40.8, 28.3

27.931.3

29.137.630.023.6

Table P. Number and percent distribution of discharges bvdischarge status: United States, 1862,1968, and 19~2

Discharges 1 19621 I 19681 I 1972

Number of dis-charges .........

Total ................

Discharged alive ...............Discharged dead ...............


100.0 100.0 100.0

58.9 69.641.1 ::: 30.4

lThese figures were adjusted to include ordy homes provid-ing some level of nursing care. For sources of data see references6 and 20, respectively.

death over the 10-year span. Between 1962 and1972, the percent of discharges due to deathdropped from 41 percent to 30 percent.

STAFFING AND FINANCIALCHARACTERISTICS

Full-Time Equivalent Employees

Employees of nursing homes may be exam-ined best in terms of full-time equivalent (FTE)employees rather than actual employees.Because a full-time equivalent employee isdefined as one who works a minimum of 35hours per week, part-time employees were con-verted to FTE’s by dividing the number of hoursworked per week by 35. By using this equiva-lent, the variation between homes in the propor-tion of part-time staff was held constant.

During the 1973-74 survey, there were about713,100 full-time equivalent employees in nurs-ing homes; of these, over half were members ofthe nursing staff (figure 6) and about 46 percentwere nurse’s aides. As the level of education andtraining of the nursing staff increased from

~.. .AdmmKtratwe, medical,and therapeutic

is’”’

llBIHLp”s

~ Nurre%aides

HAll other ssaff

I I I I [ 1 I I I I I

o 10 20 30 40 50 60 70 80 90 Im

PERCENT OF FULL.TIME EQUIVALENT EMPLOYEES

Fiaure 6. Percent distribution of full-time equivalent employeesin nursing homes by occupation category: United Statas,August 1973-April 1974

nurse’s aide to licensed practical nurse (LPN) toregistered nurse (RN), the percent of FTE’s de-creased from 46 percent for nurse’s aides to 9percent for LPN’s to 7 percent for RN’s (tableQ and table 8). In fact, the percent of nurse’s

Table Q. Percent distribution of full-time equivalent employees by occupation category, according to certification status of the home:United States, August 1973-April 1974

Occupation cetegory

—All occupations .. . ... .. .. ... . .... . ... .. .. ... . ... .. .. ... . ... .. .. ... . ... . ... .. .. .. .. .. ... .. ... . ... . .. .. .. .... . ..

Administrative and medica13 .. ... .. .. ... .. ... .. . .... . .. ... .. ... . ... .. .... . .... . .. ... .. .. .. .. ... . ... . ... ... . .. . .... .. ..Therapeutic .... .. .. .. .. .... . .... . .. ... .. .. .. ... .. .. .. ... .. ... .. .. .. .. .. ... . ... ... . ... . ... .. .. .. .. .. .. .. ... . .... . .. ... . ... .. ..Nursing staff:

Registered nurse . ... ... . ... . ... .. .. ... . .... .. . ... . .... . .. ... . .... . .. .. ... .. .. .. ... .. .. .. .. .. . .... . ... . ... .. .. .. .. .. ... ..Licensed practical nurse .. ... .. .. ... .. .. .. .. ... ... .... .. .. .. .. .. .. .. ... .. ... . ... .. .. .. .. .. ... . .. .. ... ... . ... . .. .. .. .Nurse’s aide .. .. ... .. ... .. .. ... .. ... . ... .. ... .. . ... .. ... .. .. ... .... .. .. .. .. ... . .... . .. ... . .. ... . ... .. .. .. .. ... . .... . .. .. .. .

All other staff . ... .. .. ... ... .. .. .. .. .. .. .. .. .. .... . .. . .. . ... .. .. .. .. .. .. .... . . .. .. .. .. .. .. .. .. .. .. .. .. ... .. .. . .... . ... .. .. ... . .

Allhomes

II Certification

IIand I I Icertl-

Medi-SNH’+’ ICF’S fied

II caidl I II11 1 1 I


I100.0 100.0

3.8 3.01.8 2.4

7.4 9.18.8 8.9

46.3 45.9

31.9 30.7

100.0

3.41.6

7.59.4

45.5

32.5

100.0

4.71.1

4.28.5

49.5

32.0

100.0

6.31.4

6.47.2

44.0

34.8

10f these homes, 8 percent were certified by Medicare only.20f these homes, 3S percent were certified as both SNH’S and ICF’S.31nclude5 administrators, phy~i~ians, dentists, pharmacists, dietitians, medical records administrators, and other professional staff.41n~ludes occupational therapists, physical therapists, speech pathologists, audiologists, activities directors, social workers, and their

assistants.


15

Table R. Number of full-time aquivelent employees per 100 residents, by occupation category and certification status of the home:United States, August 1973-April 1974

Certification

Both Medicaid only

Occupation categoryAll Medi-

homes careNot

andcerti-

Medi-SNH’S2 ICF’S fied

caidl

Number of employees per 100 residents

All occupations . . .. .. .. .. .. .. .. .. .... .. .. .. . .. ... .. .. .. .. .. .. .. .. .. .... . ... . . .. .. .. .. . .. ... .. .. .. .. .. .. .. ... .. 66.3 72.3 68.7 57.5 58.5

Administrative and medica13 ... . ... . ... .. . .... . .. ... . ... .. . ... .. .. .. .. .. .. .. .. . . ... . .. ... .. ... . .. .. .. ... . .. ... .. .. ... . 2.5 2.2 2.4 2.7 3.7

Therapeutic . .. .. .. .. ... . .. .. ... .. . .... . . .... .. .. .. .. .. .. .. . ... .. .. . .. . ... .. . .. ... .. .. .. ... . .. ... . .. ... .. .. .. .. .. . ... ... . ... .. 1.2 1.7 1.1 0.7 0.8

Nursing staff .. .. .. .. .. .. . ... .. .... . . .... . . .. . . .. . .. . .. .. . ... . ... .. .. .. .. . ... .. ... . ... .. . .. ... . .. . .. . ... .. ... .. .. .. . .... . .. ... .. 41.4 46.1 42.9 35.8 33.6

Registered nurse .. .. .. ... .. .. .. .. .. ... . ... .. .. ... .. .. ... ... . ... ... ... .. . ... .. .. .. .. .. .. ... .. . .. ... ... . . ... .. ... .. . ... . .. 4.9 6.5 5.2 2.4 3.7

Licensed practical nurse .. ... . ... .. .. .. .. ... . .. .. .. ... .. . ... .. .. ... .. .. . ... .. . ... . ... ... . ... . .. .. . .. .. .. .. .. ... . ... . 5.8 6.4 6.5 4.9 4.2

Nurse’s aide . ... ... . ... . ... .. .. .. ... .. . .. ... .. . ... .. . .... . .. .. .. ... . .. ... . ... . ... .. .. .. .. .. ... .. .. . ... .. .. ... . .. .. ... . .. .. . 30.7 33.2 31.2 28.5 25.7

All other staff . . ... ... .. .. .. . ... .. ... .. . .. ... . .... . . ... .. ... .. . ... . ... . ... ... . .. .. .. .. ... .. .. .. .. .. . .... . ... .. . ... .. ... . . .... . . 21.2 22.2 22.3 18.4 20.4

lof these homes, 8 percent were certified by Medicare only.20f these homes, 35 percent were certified as both SNH’S and ICF’S.31nclude~ administrators, ~hYsicians, dentists, pharmacists, dietitians, medical records administrators, and other professional staff.41ncludes occupational therapkt~, physical therapists,speechpathologists,riurliologkts,activitiesdirectors, social workers, and their

assistants.

NOTE: See appendix II for additional information concerning ratios.

aides was significantly greater than the percentof RN’s or LPN’s were. Administrative, medical,and therapeutic FTE’s comprised less than 6 per-cent of the total nursing home staff.

The percents of FTE nursing staff (RN’s,LPN’s, and aides) ranged from 58 percent forhomes not certified to 64 percent for homescertified by both Medicare and Medicaid. Whenthe percents and their sampling variabilities werecompared, the percent of FTE nursing staff wassignificantly smaller for homes with no certifica-tion.

The ratio of FTE’s per 100 residents pro-vides a crude measure of the workload as well asthe availability of staff to provide care for resi-dents. Overall, there were 66 full-time equivalentemployees per 100 residents, or about 1 FTEemployee for every 1.5 residents (table R).Forty-one percent of FTE’s were part of thenursing staff. Homes certified by both Medicareand Medicaid or as SNH’S had significantly moreFTE’s per 100 residents than those certified asICF’S and those that were not certified.

Over a 10-year span, the number of FTE’sper 100 residents increased by 22, from 44 per

100 in 1964 to 66 in 1973-74 (table S). Thisincrease indicates that residents in the 1973-74survey received more staff time and care thanresidents in prior survey years did.

Table S. Number of full-time equivalent employees per 100nursing home residents for 1964, 1968, and August 1973-

April 1974: Unitad States

FTE’sper

Year 100rasi -

dents

1973.74 . ... . ... .. .... .. .. .. .. ... . .... .. .. .. ... .. . .... .... .. .. .. .. .. .. ... . . ... . 66.319681 61.5l964l:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: 44.1

lThese figures were adjusted to include only homes provid-ing some level of nursing care. For sources of data see references7 and 23, respectively.

NOTE: See appendix H for additional information con-cerning ratios.

Level of Skill of Person in Charge

Another measure of the availability of carein nursing homes is the number of shifts in the

16

home and the level of skill of the nurse in chargewho is on duty (that is, awake, dressed, and serv-ing the residents) for each of the shifts. (Seequestions 22 and 23 of the Facility Question-naire, appendix III.) Most nursing homes in thesurvey (86 percent) had three shifts and had anon-duty charge nurse available around the clock(figure 7).

As the level of certification of the home de-creased, the percent of homes with three shiftsdecreased (table 9). A significantly smaller per-cent of homes not certified (64 percent) than ofthose with some type of certification (86 per-cent or more) had three shifts.

Since the proportion of homes with threeshifts represents such a large percent (86 per-cent) of all the homes, the examination of thelevel of skill (education) of the nurse in chargewas based on those in these homes. In 78 per-cent of these homes, RN’s and/or LPN’s werethe on-duty persons in charge. Slightly over

90 -

80 -

70 -

60 -

z~S

!!? 60

EE

2 40 -

:

2

30 -

20 -

10 -

0 -

m 2 Shifrs

NUMBER OF SHIFTS PER DAY

\t!rl 11,,h, than 1 pmcnt .1 hmnc, “,,1, a ,har$e nurse on ,.11 r,,imr ,1>,” o“ d.,, .,, ,nclud,d m the

1 .h,ft , 4,,*<.,,

Figure 7. Percent distribution of nursing homes by number ofshifts per day: United States, August 1973-April 1974

one-fourth of the homes had an RN on duty forall three shifts (table T and table 9).

Examination of table T shows that as thecertification status of the home decreased sodid the level of skill of the charge nurse onduty. Homes certified by both Medicare andMedicaid had an RN, LPN, or some combinationof the two on duty for three shifts in a signifi-cantly larger percent of homes—over 94 percent.This pattern is directly related to certificationrequirements in effect at the time of the sur-vey—that homes certified by Medicare wererequired to provide 24-hour nursing serviceswith an RN on duty for 40 hours per week.(This requirement could be waived in certainspecial situations, such as in rural nursing homesthat were unable to assure the presence of afull-time RN.) On the other hand, 61 percent ofICF’S and only 49 percent of homes not certi-fied had a combination of RN’s and LPN’s onduty.

When level of skill of person in charge isconsidered in relation to size of the home, allhomes having 200 beds or more had an RN orsome combination of RN’s or LPN’s in chargefor all three shifts. This is probably true becausemost of these larger homes were certified byboth Medicare and Medicaid or were providinga high level of nursing care.

Data relating to RN’s on duty for all threeshifts are available from the 1968 Nursing HomeSurveyzs as well as from this 1973-74 survey. In1968, 95 percent of the 15,200 homes operatedthree shifts of employees each day (table U). Ofthese homes, 2,900 (or 19 percent) had an RNon duty for all three shifts. In contrast, fewerhomes (86 percent) operated these shifts in1973-74 but more homes (approximately 3,700or 23 percent) had an RN on duty for all of thethree shifts. When sampling vanabilit y wasexamined, however, there was no significantdifference in the percent of homes with an RNon duty for three shifts between 1968 and 1973-74.

Average Total Monthly Charge for Care

Data on average total monthly charge forcare were based on the answer to the question,“Last month, what was the total charge for the

17

Table T. Percent distribution of nursing homes with person in charge on duty for thrae shifts by level of skill of the person in charge,according to certification status, ownership, and size of home: United States, August 1973-April 1974

.Certification, ownership, and siza

All homes with three shifis . ... .. . ... . .... . .. ... .. .. .. . ... .. ... .. .. .. .. ... . . ..


Both Medicare and Me~caid2 .. .. .. .. .... . . ... .. ... .. .. .. .. ... . . ... .. .. ... .. .. . .... .. ... .. ..Medicaid only:

SNH’S3 ... .. . ... .. .... . ... . .. .. .. .. ... .. ... . .. .. .. ... .. . ... .. ... . .. .. .. .... . ... . .. ... .. . ... . .... . ..

ICF’S . .. .... .. ... .. ... .. .. .. .. ... .. . .. .. .... . . .. . ... .. .. . ... . ... .. .. .. .. .. .. .. .. . .. ... .. .. .. . ... .. ..

Not certified . . . .... . ... .. .. .. .. .. .. .. .. .. .. ... . ... . ... .. .. .. .. ... .. .. .. .. .. .. .. ... . .. ... . ... . .... . ...

Ownership

Proprietary . ... . .... . .... . .. .. .. .. .. .. .. . . ... . .. .. .. ... .. . .... ... .. .. ... .. ... . .. ... . ... . .. ... .. .. . .. ..Nonprofit and government ... .. . . ... . ... .. .. ... . . ... . . .. ... . .... . ... . ... . .. ... .. . .... .. ... .. .

Size—

Less than 50 beds .. .. .. .. .. .. .. .. .. .. .... .. .. .. . ... .. .. .. .. .. .. .. .. .. .. .. . . .. .. .... .. . ... .. .. .. .. .

50-99 beds . ... .. .. ... .. .. .. .. .. .. .. . . ... .. . .. . . .... . . .. .. . ... . . .. .. .. .. .. .. ... .. ... . .. ... .. .. .. .. .. .. .100-199 beds .. ... . .. .. . .. ... . . .. .. .. .. .. .. ... . ... . .... ... .. .. .. ... . ... . .... . .. .. .. .... . . ... . .. ... .. .

200 beds or more . .. .. .. .. .. .. ... . ... .. . .. . ... . .. ... .. . ... . ... .. .. ... . .. ... . ... .. ... .. . ... . .... . .. .

II Skill of charge person on duty in homes withthree shifts

Total

100.0~

100.0

100.0

100.0100.0

100.0100.0

100.0

100.0100.0100.0

!,%l%!ii&r’’lNRN’s all

I I shiftslI I I

27.4

53.2

32.0

6.5

11.9

25.034.3

12.1

21.152.6

79.3


45.1

40.9

60.644.1

32.4

47.5

38.1

37.7

58.439.8

*

5.8

*

●

10.1*

5.66.5

7.7

6.1**

lIncludes homes with RN ‘Son duty for two of three shifts and homes with LPN’s for twO Of three shifts.20f these homes, 8 percent were certified by Medicare only.30f these homes, 3S percent were certified as both SNH’S and ICF’S.

NOTE: Figures may not add to totalsdue to rounding.

Table U. Number and percent of nursing homas with three shiftsand percent with RN’s in charge for three shifts: UnitedStates, 1968 and August 1973-April 1974

Per-cent

Per- withNum- cent RN’s

Year ber of with inhomes three charge

shifts forthree

shifts

1973 -74 .... .. .. . . ... . ... .. . .... . . ... . .... .. .. .. 15,700 85.5 23.4

19681 . ... ... .. .. .. .. .. .. ... . .. .. . ... .. . .... . ... . 15,200 94.8 19.3

lThese figures were adjusted to include only homes pro-viding some level of nursing care. For source of data see refer-ence 23.

*.

4.9

*

5.0

19.5

5.5*

12.0*●

16.7

*

*

34.3

31.6

16.3

18.1

30.6

12.9*●

resident’s care, including all charges for specialservices, drugs; and spe;ial medi&l supp”fies?”(See question 25c of the Resident Question-naire, appendix III.) Since the question askedfor total charges for last month, data were notcollected for those residents living in nursinghomes for less than one full month. The averagemonthly charge data included about 15,700residents who were covered by “life-care” plansor “no-charge” plans.

For the survey period, the average totalmonthly charge for the 1,012,000 residents whohad been in the home for at least a monthranged from no charge to over $1,000. About 3percent of these residents paid over $1,000while only about 1 percent paid no charge at(all.

18

In fact, the average total charge for all residentswas $479 per month with about two-thirds ofall the residents being charged less than $500.

Table W presents the average total monthlycharge by selected resident characteristics. Whenexamined according to length of stay since cur-rent admission, the average total charge rangedfrom under $390 per month for those residentswith a length of stay of 10 years or more to$542 for residents with stays of less than 3months. In fact, residents with 10 years or morepaid significantly less than those staying less

Table W. Average total monthly charge and number of rasidents,by age, sex, length of stay since current admission, andprimary reason for admission: United States, August 1973-April 1974

Age, sex, length of stay since currentadmission, and primary raason for

admission

All residents in home 1month or more ...............

Arts

Lessthan 65 years..............................66-74 yeers ........................................75 years or more ................................

Sex—

Mele .. .................................................Femele ........................................... ....

Length of stay since currentadmission

Less than 3 months ............................3 to lessthan 6 months ......................6 to lessthan 12 months ....................1 to lessthan 3 years..........................3 to lessthan 5 years..........................6 to lessthan 10 years........................10 years or more ................................

Primarv reason for admission

Physical .................... ..........................Social ....... ..........................................Behavioral ..........................................Economic ...........................................

Averagetotal

monthly

charge 1

.$479

434473466

466464

542

521499479

459420383

499369419294

Numberof resi-dents

1,012,000

107,500152,000752,500

294,800717,200

91,500103,800155,700357,700149,700116,20037,300

815,20066,400

119,80010,500

,lIncludes basic charge plus any specird charges for medicdor nursing services, medical supplies, equipment, and so forth.

NOTE:Figures may not add to totals due to rounding.

than a year did. Since over 21 percent of theresidents participating in life care (resident madean initial payment for lifetime care) or no-chargeplans had a length of stay of 10 years or more,the significantly lower charge for these longerterm residents was related to these arrange-ments.

The primary reason for admission was re-lated to the average total monthly charge forcare. Residents admitted because of physicalproblems paid significantly higher charges permonth than persons admitted for social, behav-ioral, or economic reasons did. Since thoseadmitted for physical problems generally re-quire greater care and increased services, it is notsurprising that the charges for those residentswere greater. Additional data on average totalmonthly charge are presented in table 10.

Data on the average total monthly charge forcare were collected in the sample surveys con-ducted in 1964 and 1969. Table Y shows howthese monthly charges increased over the 10years from 1964 to 1974. Since 1964, theincrease in charges was 159 percent (or about 16percent per year), but since 1969 it increased byonly 43 percent (or about 11 percent per year).

Table Y. Average total monthly charge: United States, 1964,1969, and August 1973-April 1974

Average

Yea r totalmonthly

chargel

1973.74 . .. ... .. . ... ... .. .. .. .. .. .. ... .. .. .. .. .. . .... .. .. ... . .. .. .. ... . .... $47919692 335l9642:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: 185

lIncludes basic charge plus any special charges fOr medicalor nursing services, medical supplies, equipment, and so forth.Based on data for residents in the home for 1 month or more.

2These figures were adjusted to include only homespro-vidlng some level of nursing care. Residents with life care andno-charge arrangements were included in these figures. Forsources of data see references 11 and 18, respectively.

Primary Source of Payment

Data on the resident’s primary means ofpaying for care are based on responses given tothe question, “What was the primary source ofpayment for care last month?” (See question26b of the Resident Questionnaire, appendix

19

Table Z. Percant distribution of residents by primary source of payment according to age, sex, length of stay since current admission,and primary reason for admission: United States, August 1973-April 1974

Age, sex, length of stay since current admission,and primary reason for admission

All residents in home 1 month or more ..................................................

Aqe

Lessthan 65 years..................................................................................................65-74 years ............................................................................................................75 years or more ................................................ ....................o...............................

Sex—

Male ............................................................................................. ..........................Female ...................................................................................................................

Length of stay since current admission

Lessthan 3 months ................................................................................................3 to lessthan 6 months ..........................................................................................6 to lessthan 12 months ................................................................................... .....1 to lessthan 3 years..............................................................................................3 to lessthan 5 years..................................... .........................................................5 years or more ......................................................................................................

Prima~ reason for admission

Physical .. .. .. ... . ... .. .. ... . ... . ... .. .. .. .. ... .. . .... ... ... ... .. ... .. .. .. .. .. ... . .. .. .. .. .. .. .. .. ... .. ... ... ... . ... .. . ...Social . . .. .. ... ... . ... .. .. .. .. ... . ... .. . .. . .. .. ... . ... . .. ... . .... . ... .. . ... . . ... . . .. ... . .... . ... . .. ... .. .. .. .. .. .. .. ... . ...

Behavioral .......................................................................... ...... ..............................Economic ........................................................... ....................................................

NOTE: F@sres may not add to totals due to rounding.

III.) As shown in table Z, Medicaid was theprimary source of payment for almost half (48percent) of the residents in nursing homesduring the survey, and about 37 percent of theresidents used their own income. Medicare wasthe primary payment source for about 1 percentof the residents. Table Z and table 11 show theprimary sources of payment according to se-lected resident characteristics. Regardless of ageor sex of the resident, Medicaid was the mostfrequent primary source of payment. It was alsothe most frequent source for residents staying 1year or more. In contrast, residents staying less

o 0

II Primary source of payment


100.0

100.0100.0100.0

100.0100.0

100.0100.0100.0100.0100.0100.0

100.0100.0100.0100.0

36.7

18.130.840.6

35.937.1

40.543.542.635.932.230.4

37.048.029.822.7

1.1

**

1.1

0.91.1

7.8****●

1.3●

●

●

47.9

53.951.946.2

46.548.4

40.544.846.451.051.345.2

50.028.945.527.7

11.4

22.313.39.4

12.311.0

8.37.38.9

10.813.317.9

9.513.721.918.2

3.0

5,62.52.7

4.42.4

2.92.61.72.23.16.3

2.29.32.4

30.8

than 1 year used their own income as freauentlv. .as they- used Medicaid.

When the primary source of payment isexamined according to the reason for the resi-dent’s admission to the home, Medicaid was themost frequent primary source for residents ad-mitted because of physical or behavioral reasons.Residents admitted for social reasons most fre-quently used their own income as the primarysource of payment.

Detailed tabulations and an in-depth analysisof resident charges and primary source of pay-ment will be presented in a future report.

o ,L

20

REFERENCES

1National Center for Health Statistics: Selectedoperating and financial characteristics of nursing homes,United States: 1973-74 National Nursing Home Survey.Vital and Health Statistics. Series 13-No. 22. DHEWPub. No, (HRA) 76-1773. Health Resources Administra-tion, Washington. U.S. Government Printing Office, Dec.1975.

2National Center for Health Statistics: Characteristics,social contacts, and activities of nursing home residents,United Stqtes, 1973-74 National Nursing Home Survey.Vital and Health Statistics. Series 13-No. 27. DHEW Pub.No. (HRA) 77-1778. Health Resources Administration.Washington. U.S. Government Printing Office,JuIy 1977.

3National Center for Health Statistics: Institutionsfor the aged and chronically ill, United States, April-June 1963. Vital and Health Statistics. PHS Pub. No.1000-Series 12-No. 1. Public Health Service. Washington.U.S. Government Printing Office, July 1965.

4National Center for Health Statistics: Characteri-stics of residents in institutions for the aged and chroni-cally ill, United States, April-June 1963. Vital andHealth Statistics. PHS Pub. No. 1000-Series 12-No. 2.Public Health Service. Washington. U.S. GovernmentPrinting Office, Sept. 1965.

5National Center for Health Statistics: Characteris-tics of patients in mental hospitals, United States, April-June 1963. Vital and Health Statistics. PHS Pub. No.1000-Series 12-No. 3. Public Health Service. Washington.U.S. Government Printing Office, Dec. 1965.

6National Center for Health Statistics: Utilizationof institutions for aged and chronically ill, United States,April-June 1963. Vital and Health Statistics. PHS Pub.No, 1000-Series 12-No. 4. Public Health Service. Wash-ington. U.S. Government Printing Office, Feb. 1966.

7National Center for Health Statistics: Employeesin nursing and personal care homes, United States, May-June 1964. Vital and Health Statistics. PHS Pub. No.1000-Series 12-No. 5. Public Health Service. Washington.U.S. Government Printing Office, Sept. 1966.

8National Center for Heslth Statistics: Employeesin nursing and personal care homes: Number, work ex-perience, special training, and wages, United States, May-June 1964. Vital and Health Statistics. PHS Pub. No.1000-Series 12-No. 6. Public Health Service. Washington.U.S. Government Printing Office, Jsm. 1967.

‘National Center for Health Statistics: Chronic ill-ness among residents of nursing and personal carehomes, United States, May-June 1964. Vital and HealthStatistics. PHS Pub. No. 1000-Series 12-No. 7. PublicHealth Service. Washington. U.S. Government PrintingOffice, Mar. 1967.

1‘National Center for Health Statistics: Prevalenceof chronic conditions and impairments among residentsof nursing and personal care homes, United States, May-June 1964. Vital and Health Statistics. PHS Pub. No.1000-Series 12-No. 8. Public Health Service. Washington.U.S. Government Printing Office, July 1967.

11National Center for Health Statistics: Charges forcare in institutions for the aged and chronically ill,United States, May-June 1964. Vital and Health Statis-tics. PHS Pub. No. 1000-Series 12-No. 9. Public HealthService. Washington. U.S. Government Printing Office,Aug. 1967.

12National Center for Health Statistics: Nursing andpersonal care services received by residents of nursingand personal care homes, United States, May-June 1964.Vital and Health Statistics. PHS Pub. No. 1000-Series12-No. 10. Public Health Service. Washington. U.S. Gov-ernment Printing Office, Sept. 1968.

13National Center for Health Statistics: Use of spe-cial aids in homes for the aged and chronically ill, UnitedStates, May-June 1964. Vital and Health Statistics. PHSPub. No. 1000-Series 12-No. 11. Public Health Service.Washington. U.S. Government Printing Office, Dec.1968.

14Nation~ Center for Health Statistics: Marital

status and living arrangements, before admission tonursing and personal care homes, United States, May-June 1964. Vital and Health Statistics. PHS Pub. No.1000-Series 12-No. 12. Public Health Service. Washing-ton. U.S. Government Printing Office, May 1969.

15National Center for Health Statistics: Adminis-trators of nursing and personal care homes, Educationand training, United States, June-August 1969. Vitaland Health Statistics. Series 12-No. 18. DHEW Pub. No.(HSM)73-01703. Health Services and Mental HealthAdministration. Washington. U.S. Government PrintingOffice, Feb. 1973.

16National Center for Health Statistics: Characteris-tics ofUnited

residents in nursing and personal care homes,States, June-August 1969. Vital and Health

21

statistics. Series 12-No. 19. DHEW Pub. No. (HSM)73-01704. Health Services and Mental Health Administra-tion. Washington. U.S. Government Printing Office, Feb.1973.

17National Center for Health Statistics: Administra-tors of nursing and personal care homes, Work exper-ience, United States, June-August 1969. Vital and HealthStatistics. Series 12-No. 20. DHEW Pub. No. (HSM) 73-01705. Health Services and Mental Health Administra-tion. Washington. U.S. Government Printing Office, Msx.1973.

18National Center for Health Statistics: Charges forcare and sources of payment for residents in nursinghomes, United States, June-August 1969. Vital andHealth Statistics. Series 12-No. 21. DHEW Pub. No.(HRA)74-1706. Health Resources Administration. Wash-ington. U.S. Government Printing Office, July 1973.

1‘National Center for Health Statistics: Chronicconditions and impairments of numing home residents,United States, 1969. Vital and Health Statistics. Series12-No. 22. DREW Pub. No. (HRA)74-1 707. HealthResources Administration. Washington. U.S. Gover-nmentPrinting Office, Dec. 1973.

20 National Center for Health Statistics: Selectedcharacteristics of nursing homes for the aged and chron-ically ill, United States, June-August 1969. Vital andHealth Statistics. Series 12-No. 23. DHEW Pub. No.(HRA)74-1708. Health Resources Administration.Washington. U.S. Government Printing Office, Jan.1974.

21 National Center for Health Statistics: Measures ofchronic illness among residents of nursing and personalcare homes: United States, June-August 1969. Vital andHealth Statistics. Series 12-No. 24. DHEW Pub. No.(HRA)74-1709. Health Resources Administration. Wash-ington. U.S. Government Printing Office, Mar. 1974.

22National Center for Health Statistics: Vital Statis-tics of the United States, 1973, Vol. II, Sec. 5, LifeTables. DHEW Pub. No. (HRA)76-1104. HealthResources Administration. Rockville, Md. pp. 5-15.

23 National Center for Health Statistics: Employeesin nursing homes: United States, April-September 1968.Vital and Health Statistics. Series 12-No. 15. DHEW

Pub. No. (HSM)73-1700. Health Services and MentalHealth Administration. Washington. U.S. GovernmentPrinting Office, Oct. 1972.

24vm Nos@md, J. F.: Development of sweY

methodology to measure cost smd quality of care innursing homes. Paper presented at 10lst Annual Meetingof American Public Health Association, Ssm Francisco,NOV. 8, 1973.

25 National Center for Health Statistics: Develop-ment and maintenance of a National Inventory of Hos-pitals and Institutions. Vital and Health Statistics. PHSPub. No. 1000-Series l-No. 3. Public Health Service.Washington. U.S. Government Printing Office, Feb.1965.

26 National Center for Health Statistics: Designand methodology of the 1967 Master Facility Inven-tory Survey. Vital and Health Statistics. PHS Pub. No.1000-Series l-No. 9. Public Health Service. Washington.U.S. Government Printing Office, Jan. 1971.

27 National Center for Health Statistics: The agencyreporting system for maintaining the National Inventoryof Hospitals and Institutions. Vital and Health Statistics.PHS Pub. No. 1000-Series l-No. 6. Public Health Serv-ice. Washington. U.S. Government Printing Office, Apr.1968.

28 National Center for Health Statistics: Arrange-ments for physician services to residents in nursing andpersonal care homes. United States–May-June 1964.Vital and Health Statistics. PHS Pub. No. 1000 -Series12-No. 13. Public Health Service. Washington. U.S.Government Printing Office. Feb. 1970.

29 Nation~ Center for Health Statistics: Desifw

and methodology for a national survey of nursinghomes. Vital and Health Statistics. PHS. Pub. Series 1-No. 7. Public Health Service. Washington. U.S. Gover-nmentPrinting Office, Sept. 1968.

30 National Center for Health Statistics: Inpatienthealth facilities as reported from the 1971 MasterFacility Inventory Survey. Vital and Health Statistics.Series 14-No. 12. DHEW Pub. No. (HRA) 74-1807.Health Resources Administration. Washington, U.S.Government Printing Office, Feb. 1970.

22

.

LIST OF DETAILED TABLES

1,

2.

3,

4.

5,

6,

7.

8.

9.

10,

11.

Number and percent distribution of residents in nursing homes by length of stay since current admission, eccording to age andsex: United States, August 1973-April 1974 ..... .... ................ ........................................ ..................................... ...... ....................

Number end percent distribution of residents in nursing homes by length of stay since current admission, according to certifi-cation status, ownership, size, and geographic region: United States, August 1973-April 1974 .................... ............ ...................

Number and percent distribution of residents in nursing homes by primary reason for admission, according to sex, age, andlength of stay since current admission: United States, August 1973-April 1974 ....... .......................................... .......... ............ ....

Number and percent distribution of residents in nursing homes by primary reason for admission, according to certificationstetus, ownership, size, and geographic region: United States, August 1973-April 1974 .................. .............. ........ ........ ..............

Number and percent distribution of nursing home residents by living arrangements prior to admission, according to certifica-tion stetus, ownership, siza, and geographic region: United States, August 1973-April 1974 ...................... .................................

Measures of utilization for 1972 and number of residents and certified beds for August 1973-April 1974, by certificationstatus, ownership, size, and geographic region: United States ........ .................................................................... ..........................

Number and percent distribution of nursing homes by certification status, according to ownership, size, and geographic region:United States, August 1973-April 1974 ......... ............................................................................ .. .................. .. ............................

Total number and number per 100 residents of full-time equivalent staff in nursing homes, by occu~ation and certificationstatus: United States, August 1973 -Apri\ 1974 .. .................................... .................. ............ ............................................ .. ..........

Number of nursing homes by skill of parson in charge on duty for each shift, certification status, ownership, and size: UnitedStates, August 1973-April 1974 ... .. .................... ................ .................................. .................................... ................. .................

Number of nursing home residents by average monthly charge for care, aga, sex, length of stay sinca current admission, andprimary raason for admission: United States, August 1973-April 1974 .......................................................................................

Numbar of residants by primary source of payment, age, sax, primary reason for admission, length of stay since current admis-sion, and median Iangth of stay from current admission: United States, August 1973-April 1974 ...............................................

24

26

28

29

30

31

32

33

34

36

37

23

Table 1. Number and percent distribution of residents in nursing homes by length of stay since current admission, according to age andsex: United States, August 1973-April 1974


All Less 3 to less 6 to less 1 to lessresidents

3 to lessthan 3 than 6 than 12 than 3 than 5 5 years

months months months years years or more

Age and sex

Both sexes

All ages ..................................................

Number

103,800 155,7001,075,800 155,400 357,700 149,700 153,500

Under 45 years ......................................................45-54 years .............................. ..............................55-64 years .. ..........................................................65-69 years ............................................................70-74 years ............. ...............................................75-79 years ............................................................80-84 years ......... .......... .........................................85-89 years ............................................................90-94 years ............................................................95 years and over ...................................................

Male

All ages ..................................................

Under 45 years ......................................................45-54 years ............................................................55-64 years ............................................................65-69 years ............................................................70-74years ............................................................75-79 years ............................................................80-84 years ............................................................85-89 years ......... ...................................................90-94 years ............................................................95 years and over ............... .......................... ..........

Female

AH ages ..................................................

23,50028,30062,50064,70098,400

162,700222,100233,300137,00043,300

318,100

3,5003,4009,600

10,30016,70027,00035,50030,70014,7004,000

54,400

2,7002,7005,3007,900

10,00017,20022,70022,20010,8002,400

33,300

3,3003,8009,0009,200

16,50025,70032,90033,50016,8005,000

46,800

7,2008,800

20,20020,00031,10055,20076,10079,80046,80012,400

102,300

3,7004,5008,5008,700

12,30019,80030,00032,50021,900

7,900

40,300

3,2005,1009,9008,600

11,80017,80025,00034,60026,00011,500

41,000

12,60012,60027,20028,70036,50047,20055,10056,60032,800

8,900

757,700

10,90015,70035,30036,10061,900

115,500167,000176,700104,20034,400

**

4,6004,5006,8009,300

10,00010,7003,800

*

101,000

**

5,0005,8009,900

17,70025,50020,00010,9002,800

*●

2,4003,4003,8005,2005,8006,3003,100

●

70,600

*●

3,8004,3005,6006,7008,9008,1004,500

*

108,900

3,7004,3008,7008,60011,50015,10018,40018,40011,400

*

255,300

●

●

3,7003,7003,8005,7005,8007,3004,700

*

109,400

●

4,1;4,1005,1005,1006,2005,9005,300

●

112,500

Under 45 years ......................................................45-54 years .............. ..............................................55-64 years ............................................................65-69 years .............. ..............................................70-74 years ............................................................75-79 years ............................................................80-84 years ........................................ ....................85-89 years ............................................................90-94 years ............................................................95 years and over ...................................................

*●

3,0004,5006,300

12,00016,90015,900

7,700*

*●

5,2004,900

10,90019,00024,00025,40012,300

3,800

3,5004,500

11,50011,40019,60040,10057,70061,40035,40010,200

*2,6004,7005,0008,500

14,00024,20025,30017,200

6,100

●

3,2005,9004,5006,700

12,70018,80028,70020,700

9,800


24

Table 1. Number and percent distribution of residents in nursing homes by length of stay since current admission, according to age andsex: United States, August 1973-April 1974–Con.


AllLess 3 to less 6 to less 1 to less 3 to less

residents than 3 than 6 than 12 than 3 than 5 5 years


Age and sex

Both sexes

All agas ..................................................

Under 45 years ......................................................45-54 years ............................................................55-64 yaars ........ ....................................................65-69 years ..........................................................m.70-74 years ............................................................75-79 years ........................................................ ....80-64 years ......................... .................................. .85-89 years ............................................................90.94 years ......m..........m...................................... ....95 years and ovar ...................................................

Mela


100.0 14.4 9.7 14.5 33.2 13.9 14.3

100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0

100.0

14.812.215.315.916.916.616.013.110,7

9.3

17.1

11.49.48.5

12.210.210.610.29.57.95.6

10.5

14.013.414.414.316.815.814.814.412.311.5

14.7

30.831.232.330.931.633.934.334.234.128.8

32.2

15.615.913.513.412.512.213.513.916.018.3

12.7

13.518.015.913.312.011.011.214.819.026.5

12.9All ages ..................................................

Undar 45 years ......................................................45-54 years ...................................... ......................55-64 years ............................................................65-69 years ........ ....................................................70-74 years ............................................................75-79 years ..h. ........................................................80-84 years ............................................................85-89 years ............................................................90.94 years ............................................................95 years and over ...................................................

Female

100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0

100.0

*●

8.712.010.310.910.511.19.4

*

9.3

*●

14.015.115.314.316.214.313.8

*

14.4

29.534.032.030.031.532.133.432.534.7

●

33.7

●

☛

14.914.413.810.911.310.416.1

*

14.8

*●

16.715,618.619.718.118.911.7

●

13.3

●

☛

13.712.910.412.210.512.814.3

*

14.4All ages ..................................................

Under 45 years ......................................................45-54 years ........................ ....................................55-64 years .............. ..............................................65-69 years ............................................................70-74 years ............................................................75-79 years ............................................................80-84 years ............................................................85-89 years ............................................................90-94 yaars .,, ,,. ......................................................95 years and ovar ...................................................

100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0

**

14.216.216.015.315.311.310.48.2

●

●

8.412.310.110.410.19.07.4

*

●

☛

14.713.617.616.414.414.411.811.1

32.328.932.631.631.734.734.534.834.029.5

*16.813.413.813.712.214.514.316.517.8

*20.316.712.510.911.011.216.219.928.4


25

Tabla 2. Number and parcant distribution of residents in nursing homes by length of stay since current admission, according tocertification status, ownershirx size, and craomaghic reaion: United States. Auaust 1973-Arxil 1974

Certification, ownership, size,and gaographic region

All homes ........... ...................................


Both Medicare and Medicaidl ................................Medicaid only:

SNH’S2 .......... ...................................................ICF’S .. ..............................................................

Not certified ....... ...................................................

Ownership

Proprietary ............................................................Nonprofit and government ....................................

Size—

Lessthan 50 beds ..................................................50-99 beds ...................... .......................................100-199 beds .. .. .. .. ... . .. . . ... .. . .... . . .. . .. .. .. ... . .. ... .. . .. .. ... .200 beds or more ......................................... ..........

Geographic region

Northeast ................ ...............................................North Central ............................... .........................South .....................................................................West .............. .........................................................

--- -


AllLess 3 to less 6 to less 1 to less

residents3 to less

than 3 than 6 than 12 than 3 than 5 5 years


II i I I 1 1

1,075,800

406,900

292,500236,700139,800

756,200319,700

162,600367,700386,1001!59,300

236,100368,700278,200192,800

155,400

81,700

35,30024,30014,100

121,10034,300

19,70054,70063,40017,500

34,40043,30040,50037,200

103,800

46,000

24,80022,10011,000

78,40025,400

16,70033,70039,90013,500

22,60034,50025,60021,200

10f these residents 23,500 were in facilities certified by Medicare only.20f the5e re5idents 129,600 were in facilities certified as both SNHY~ and ICF>s.

Number

155,700

66,400

40,90030,90017,500

114,00041,700

19,00053,70060,00022,900

33,20051,80041,10029,600

357,700

134,600

103,10078,00042,000

261,10096,600

52,300126,100128,20051,100

74,900122,20098,10062,500

149,700

45,100

44,30039,30021,000

100,50049,200

25,70051,20050,60022,300

33,40053,40039,80023,100

153,500

33,100

44,10042,00634,200

81,00072,500

29,30048,20044,00031,900

37,50063,50033,20019,300


26

Table 2. Number and percent distribution of residents in nursing homes by length of stay since current admission,certification status, ownership, size, and geographic region: United States, August 1973-April 1974–Con.

according to

Certification, ownership, size,and geographic region

All homes ..............................................


Both Medicare and Medicaidl ................................Medicaid only:

SNH’S2 .............................................................ICF’S ..............................0.................................

Not certified ....... ...................................................

Ownership

Proprietary ............................................................Nonprofit and government ....................................

Size—

Less than 50 bads ..................................................50.99 beds .............................................................100-199 beds .........................................................200 beds or more ...................................................

Geographic region

Northaast ........................... ....................................North Central ........................................................South .....................................................................West ..................................o....................................


All Less 3 to less 6 to less 1 to lessresidents

3 to lessthan 3 than 6 than 12 than 3 than 5 5 years



100.0

100.0

100.0100.0100.0

100.0100.0

100.0100.0100.0100.0

100.0100.0100.0100.0

14.4

20.1

12.110.310.1

16.010.7

12.114.916.411.0

14.611.714.619.3

9.7

11.3

8.59.37.8

10.47.9

10.39.2

10.38.5

9.69.49.2

11.0

@f these residents 23,500 were in facilities certified by Medicare Only.@f these ~e~idents 129,600 were in facilities certified as both SNH>~ and I(JF>s,

14.5

16.3

14.013.112.5

15.113.0

11.714.615.514.4

14.114.114.815.3

33.2

33.1

35.332.930.0

34.530.2

32.134.333.232.1

31.733.135.232.4

13.9

11.1

15.116.615.0

13.315.4

15.813.913.114.0

14.214.514.312.0

14.3

8.1

15.117.824.5

10.722.7

18.013.111.420.0

15.917.211.910.0


27

Table 3. Number and percent distribution of residents in nursing homes by primary reason for admission, according to sex, age, andIenath of stav since current admission: United States. Auaust 1973-Arwil 1974

Sex, age and length of staysince current admission

Both sexes ..................

Under 65 years ....... ....................65-74 years .................................75-84 years .................................85 years and over ............... .........

Males . . ... .. .. ... . .. .. .. .... ... ... ...

Under 65 years ...........................65-74 years ......... ........................75-84 years .................................85 years and over ........................

Females .............. ..............

Under 65 years ...........................65-74 years .................................75-64 years ... ..................... .........85 years and over ........................

Length of stay since currentadmission

Lessthan 3 months .....................3 to lessthan 6 months ...............6 to lessthan 12 months ......... ....1 to lessthan 3 years ..................3 to lessthan 5 years ..................5 years or more ...........................

II Primary reason for admission

All

residentsPhysical Social

Behav- Eco-ioral nomic

Number

1,075,800

114,300163,100384,900413,600

318,100

52,40065,100

102,30098,300

757,700

61,90098,000

282,600315,300

155,400103~oo155,700357,700149,700153,500

870,700

67,900124,900321,000356,900

251,200

30,20050,30086,20084,500

619,500

37,60074,600

234,800272,400

135,50088,000

131,100290,700118,300107,100

69,400

6,3008,900

24,30028,900

20,600

3,0003,7006,3007,600

48,900

3,3005,200

18,00022,300

7,7004,7007,100

19,90010,30019,800

125,000

38,70027,6003530022,800

42,700

18,50010,3008,7005,200

82,300

20,20017,30027,20017,700

11,70010,50016,30043,50019,40023,600

10,700

**

3,7003,900

3,700

●

***

7,000

*●

2,6002,800

●

●

●

3,600*

3,000



100.0

100.0100.0100.0100.0

100.0

100.0100.0100.0100.0

100.0

100.0100.0100.0100.0

100.0100.0100.0100.0100.0100.0

BO.9

59.476.683.486.3

79.0

57.777.384.385.9

81.8

60.876.283.186.4

87.264.784.281.379.069.8

6.5

5.55,46.37.2

6.5

5.75.76.17.7

6.4

5.45.36.47.1

5.04.54.55.66.9

12.9

11.6

33.916.99.35.5

13.4

35.315.8

8,55.3

10.9

32.717.6

9.65.6

7.510.110.512.212.915.4

1.0

●

●

1.00.9

1.2

●

**●

0.9

●

●

0.90.9

●

*●

1.0●

1.9


28

Table 4. Number and percent distribution of residents in nursing homes by primary reason for admission, according to certificationstatus, ownership, size, and geographic region: United States, August 1973-April 1974

Certification, ownership, size,and geographic region

All homes ...................


Both Medicare and Madicaidl .....Mer&a~~~;nl y:

..................................ICF’S .....................................

Not certified ...............................

Ownership

Proprietary .................................Nonprofit and government .........

Size—

Lass than 50 beds .......................50-99 beds ..................................100-199 beds ..............................200 beds or more ........................

Geographic region

Northeast ....................................North Central .............................South ..........................................West ............................................


Allresidents Physical

Bahav- Eco.Social ioral nomic

1,075,800

406,900

292,500236,700139,800

756,200319,700

162,600367,700366,100159,300

236,100368,700278,200192,800

870,700

354,300

242,700185,300

88,500

622,400248,300

122,900301,000320,500126,400

194,400285,100228,800162,400

Number

69,400

16,200

15,10015,70022,400

32,80036,600

13,40019,10024,80012,200

18,70028,60014,500

7,700

125,000

33,500

32,70034,40024,400

97,20027,800

23,90044,60038,30018,300

19,00052,00032,50021,500

10,700

2,800

**

4,500

3,8006,900

2,5003,1002,7002,400

3,9003,1002,500

●

lof these residents 23,500 were in facilities certified by Medicare only.20f these residents 129,600 were in facilities certified as both SNH)s and I(JF>s.


~;’tmmiil=100.0

100.0

100.0100.0100.0

100.0100.0

100.0100.0100.0100.0

100.0100.0100.0100.0


80.9

87.1

83.078.363.3

82.377.7

75.581.883.079.4

82.477.382.284.3

6.5~

4.0

5.26.6

16.1

4.311.5

8.25.26.47.7

7.97.75.24.0

11.6

8.2

11.214.517.4

12.88.7

14.712.19.9

11.5

8.114.111.711.1

1.0

0.7

**

3.2

0.52.2

1.60.90.71.5

::;0.9

*

I NOTE: Figures may not add to totals due to rounding.

29

Table 5. Number and percent distribution of nursing home residents by living arrangements prior to admission, according to certification status, ownership, size, and geographic ragion:United States, August 1973-April 1974

Living arrangements prior to admission

Another facility Private residmce

MentalAll Board-

With otherslAnother hospital Un-

arrange- nursing m other General ing Un- known

ments home or 10ng- or short- homeAlone Other Non- knovm

related term stay or

facilityTotal Spouse Children rela- if with

hospital otherreIa-

sp3cialty tivzs tives othws

hospital place

Certification, ownership, size, a“dgeographic region

All homes. ............ .......... 1,075,80C~

406,BO0

292,500236,70C139,800

758,21X319,700

162,6oO367,700386,100I 59,300

236,100368,700278,200192,800

149.600 84,600 374,200 23,800 127,900 231,900 B3,8W

19,900

18,20016,8008,800

41,10022,70+3

10,10023,30020,6009,800

12,70022,00019,8009,300

101,403

30,200

30,20027,90013,000

66,9W32,500

16,10034,80036,48014,000

19,S+3034,30033,10014,100

59,800

15,900

16,60017,10010,200

38,40021,400

11,20019,20019,8009,6CKI

13,00021 ,Zoil20,6012

5,000

5.6

12,20Q

3,600

2,7003,1002,800

7,5004,600

3,5004,4002,800

.

2,8004,0004,400

.

1.1

43,100

13,500

13,6009,7006,300

24,9oO18,200

4,60010,40016,10012,000

11,90012,70013,8004,700

4.0

40,7W~

12,100

10,4009,5008,70Q

23,30017,400

4,90014,40013,600

7,70Q

5,00016,50012,100

7,100

3.8

Certification stmus

Both Medicare and Mediczid2 ........Medicaid only:

SNH’S3 ....... ................. .............ICF’S ... .. ..... .................... .. .... .....

Not certified . ........................ .........

48,8oo

43,10038,30018,400

I 10,00039,6oo

27,50051,50051,00019,700

28,70051,30037,60032.000

22,50=3

22,60025,20014,500

68,40015,300

17,80028,20024,8CQ12,500

11,30037,50021,40014,400

7.9

5.5

7.710.610.4

9.24.s

11,08.o6.67.9

4.810.2

7.77.5

203,400

88,30051,40023,100

281,60082,500

39,200130,600153,000

51,400

96,900112,500

82,30082,600

34.8

50.0

32.921.716.5

38.625.8

24.135.538.632.2

41.030.528.642.8

8<000

6,3003,4006,100

14,30+39,500

4,6007,0008,9003,300

8,7007,1003,3006,700

2.2

2.0

2.11.54.3

1.93.0

2.81.92.32.1

2.61.81.23.5

28,BO0

33,70035,90028,400

70,90057,0CM

24,10044,80040,70018,200

28,70052,20030,7W16,300

67,700

66,60063,30034,300

151,70080,200

39,70079,80077,90034,500

46,90078,90077,10029,000

Ownership

Proprietary . .......... ............... ...........Nonprofit and government .............

size—

Less than 50 beds..... ........... ...... .....50-99 beds .................... ... ...... .. .... ..lCQ-188 beds .......... ........... ............200 beds or more .......... .. .. .... ......

Geographic region

Northeast .. ...... ..... ......................... .North Central..., ............................ .South ... ........... ...............................West ...............................................

Perc3nt distribution

21.6 5.9 9.4

16.6 4.8

22.8 6.226.724.5 :;

20.1 5.425.1 7.1

24.4 6.221.7 6.320.221.7 E

18.9 5.421.4 6.027.7 7.115.0 4.8 7.3

All homes... .. .. ..... .. ......... 13.9 11.8

7.3

11.515.220.4

9.417.6

14.812.210.611.4

12.114.211.0

8.5

Certificzticm status

Both Medicare and Medicaid2 ........Medicaid only:

SNH’S3 ... .. ...... ..........................ICF’S ..... .... .... .. ..................... .....

Not certified ... .................. .... ... ..... .

Ownership

Pr0pr4et2ry ................ .... .... .. ... .. ......Nonprofit and government .. ...... .....

100.0 12,2

14.716,213.2

14.612.4

16.814.013.212.4

12.113.913.5

7.4

10.311.8

9.3

9.110.2

8.99.58.48.B

B.49.3

11.9

3.9

5.77.27.3

5.16.7

6.95.25.16.0

5.55.77.42.6

0.9

0.9

;:

1.01.4

2.21.20.7

●

1.21.11.6

●

3.3

4.74.14.6

3.35.7

2.82.84,27.6

5.13.44.92.4

2.9

3.64.06.2

3.16.4

3.03.9

%

2.14.54.33.7

100.0100.0100.0

100.0100.0

Size.

Lessthan 50 beds., .. ....... ..... ...........50-99 beds ...... .... ..... ............ ..........100-189 beds .......... .. ...... .............. .ZOObeds or more.,., .......................

100.0100.0100.0100.0

Geographic region

Northeast . ....... .... ..... .......... .. ..........North Central ..... ...... ..... ................South ......... .... ................................west ........... .. .. .. .... ..........................

100.0100.0100.0100.0 16.6

—

1Because residents may have lived with more than one c.ztegory of person, the sum of the subparts exceeds the total.20f these residents, 23,500 were in facilities certified by Medicare only.30f these residents, 129,600 were in facilities certified as both SNH’Sand ICF’S.

NOTE: Figures may not add to mtal due to rounding,

30

Table 6. Measure; of utilization for 1972 and number of residents and certified beds far IUS 1973 -Apri[ 1974, bv certificatmm status, ownersh!p. size, and geographic region:United S s

—

Residents1973-74

1,075,800

Admis-sions

I,11 0,80+3

Measures of utilization, 1972—

occu-pancy

ratez

86.51

Beds,l 1973-74

Discharges Medicare SNH ICF

Live

750,100

Certi-fiedbeds

287,400

—Per.centfilledlast

night—

12.3

—Per.centfilledlast

Certlflcation, ownership, size,and geographic region

Per-centfilledlast

night

59.6

Totalbeds

I,177,300

Cert4-f,edbeds

579,5fXl

Certt.fiedbeds

373,200

Total

1,077,600

night

All types of certifica-tion and ownership ....

Proprietary ..... ...... ............... ...... ....Nonprofit and government ............

8oth Medicare and Medi.cald3 . .................... ...... ....

PrOpriOtafy,, ... ...... ..................... ....Nonprofit and government..,., .......

Medicaid only: SNH4 ... ... ...

Proprietaw ........................... ... .. ....Nonprofit and government..,,,, ......

Medicaid only: ICF ...... ......

Proprietary,.,, ................................Nonprofit and Wvernment . ...........

Not certified ............ ... .......

Proprietary ..... .......................... ....Nonprofit and government .......... .

*

Lessthan 60 beds........ ... ............W.99 badt .!.... ...................! ..........100.199 badt ............ ....................200 beds or more .......... .. .. .. .. ........

Geographic region

Northeast ................................... .. .North Central ....... .... ....................South ..... .. .... .... ........ .... ..... ... ... .....west .........................+...................

327,400

—

58.7

852,80025S,000

624,100

497,700126,400

223,800

169,90063,700

164,9oO

121,30043,600

9S,200

63,90034,300

14 B.900397,00+3441,200123,700

238,700306,900289,100276,100

833,800243,700

599,30J3

4S0,1CKI119,20CI

209,400

158,60060,800

153,600

113,00040,600

116,300

62,21Xl33,100

164,50037s,900415,500118,600

223,30+3307,600273,30Q273,1 W

568,200161,900

44s,s00

360,5008B,300

t 38,800

108,40029,400

101,s00

74,30027,500

60,700

44,10016,700

97,400271,500299,70081,500

158,300191,900191,20020B,700

245,60+381 ,Wf3

150,500

119,60030,90+3

70,600

49,20021,400

51,800

38,70013,103

54,500

36,10016,400

67,000I07,4C0115,BO037,100

65,000l15,90ilS2,1 0+364,400

86.4286.72

S4.87

S5.0984.14

85.72

64.0689.26

S9.17

69.56B8.07

B8.36

90.60B5.56

89.16B8.60B6.2780.10

B8.9766.21B6.4984.22

756,200319,700

406,900

313,90093,000

292,500

193,70098,800

236,700

170,10066,600

139,600

76.50061,300

162,600367,7003S6,100159,300

236,10036s,70027S,200192,800

832,300345,000

442,300

339,500102,s00

321,200

218,900102,300

253,200

1s4,10069,100

160,600

S9,BO070,800

17S,600392,500417,900188,000

250,S00406,800303,700214,100

224.90Q62,500

287,400

224,90062,500

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

18,60+3106,600119,50042,700

81,40049,80051,400

104,900

11.315.7

12.3

11.315.7

. .

. . .

. . .

. . .

. . .

.

18.811.112.013.0

12.420.015.8

6.7

440.3oi2139,200

337,500

269,40068,200

242,000

170,90071,100

. . .

. . .

. . .

. . .

. . .

43,3W193,700244,900

97.700

140,400150,400126,000162,80fJ

68.958.1

54.9

55.054.5

63.9

64.961.5

. . .

. . .

. . .

. . .

. . .

. . .

58.356.357.965.5

66.649.760.758.6

272,700100,500

70,100

52,S0017,300

66,3o2

42,00024,300

236,700

177,80058,900

. . .

. . .

. . .

75,900134,8&l117,200

45,300

53,000147,200129,20043,900

61.653.3

62.6

50.559.1

60.4

64.453.5

61.2

64.551.5

. . .

. . .

. . .

61.857.660.458.6

74.451.269.439.9

lThe sum of certified beds exceeds the total number Of beds because some beds may have dud certification.2X Aggregate number of days of care provided to residents in 1972 X 100

Number of beds X 366For those homes which had changes i“ size in ] 972, the ““mber of be& hm bee” adjusted accorcfingly.

30f these homes, 8 percent were certified by Medicare oniy.40f these homes, 35 percent w,ere certified m both SNH’S and ICt%

NOTES: Estimates for beds differ by an average of O 3 percent fmm those presented i“ reference 2 due to inclusion of a bed-ratio adjustment factor in the weighting as describedIn appendix 1.

See appendix 11for rtdditiomd information co”ceming mticm

Figures may not add to totals due to rounding.

31

Table 7. Number and percent distribution of nursing homes by certification status, according to ownership, size, and geographic region:

Ownership, size, and geographic region

All homes.....................................

Ownershio

ProprietaW ...................................................Nonprofit and government ...........................

Size—

Lessthan 50 beds.........................................50-99 beds ...................................................100-199 beds ...................................... .........200 beds or more ..................... ....................

Geoararshic reqion

Northeast . ....................................................North Central ...............................................South ..........................................................West .............................................................

United States, August 1973-April 1974

mII 1 I I

Number

15,700

11,9003,900

6,4005,5003,200

600

3,1005,6004,1002,900

4,200~

3,200900

6001,8001,500

300

1,000900800

1,400

10f these h~mes. 8 ~ercent were certified for Medicare onlv.

3,500

2,5001,000

1,0001,400

900200

8001,100

900600

4,400

3,500900

2,3001,600

500*

6002,0001,500

400

3,600

2,7001,000

2,500800300

*

8001,600

900400

All II Both I Medicaid onlv I


100.0

100.0100.0

100.0100.0100.0100.0

100.0100.0100.0100.0

26.5

27.124.4

3?:46,748.2

31.316.320.150.3

22.4

21.225.9

15.924.829.132.9

27.119.922.422.0

28.1

29.324.4

35.928.516.0

*

17.735.636.512.8

23.1

22.325.3

38.814.98.2

*

24.028.221.015.0

20 f these homes; 34 percent were certified as both SNH’S ~nd ICF’S.


32

“----

Table 8, Total number and number per 100 residents of full-time equivalent staff in nursing homes, by occupation and certificationstatus: United States, August 1973-April 1974

Certification

All typas ..........................................................

Both Madicare and Madicaid3 ............................. .............Mec&rIIs~l y:

, ........................................................................ICF’S ...........................................................................

Not certified .,, ,., ., ., !.,,..... ..................................................

All typas ....... ..... ........................ ......................

Both Medicare and Medicaid3 ..........................................Medicaid only:

SNH’S4 ........................................................................ICF’S ......................................................... .................

Not certified ....................................................................

Admin- ~.

Totalistrative Thare- Regis- censed

N urse’sAll

and peutic tered practi - otherstaff medical staffp nurse cal aide slaff

staffl nurse

Number of full-time equivalent staff

7

713,100 27,200 13,000 52,700 62,500 330,000 227,BO0

294,200 8,800 7,000 26,600 26,100 135,200 90,400

201,000 6,900 3,300 15,100 19,000 91,400136,200 6,400

65,4001,600 5,700 11,600 67,400 43,500

81,800 5,100 1,100 5,200 5,900 36,000 28,500

Numbar of full-time equivalent staff per 100 residents

66.3 2.5 1.2 4.9 5.8 30.7 21.2

72.3 2.2 1.7 6.5 6.4 33.2 22.2

68.7 2.4 1.1 5.2 6.5 31.2 22.357.5 2.7 0.7 2.4 4.9 28.5 18.458.5 3.7 0.8 3.7 4.2 25.7 20.4

lIncludes administrators, physicians, dentists, pharmacists, dietitians, medical records administrators, and other professional Staff.21n~l~des occupational therapists, physical therapists, speech pathologists, audiologists, activities directors, social workers, and their

assistants.30f these homes, 8 percent were certified by Medicare only.40f these homes, 35 percent were certified as both SNH’S and ICF’S.

NOTES: See appendix II for additional information concerning ratios.

Figurea may not add to totala due to rounding.

33

..-.’

Table 9. Number of nursina homes by skill of person in charm on duty for each shift, certification status, ownership, and size: UnitadStates, Au&st 1973-April 1974

Certification, ownership, and size

Total ............. .....................................................................................


Both Medicare and Medicaidl ................................................................ ............Madicaid only:

SNH’S2 ..........................................................................................................ICF’S ............................................................. .................................................

Not cartified ..................................................... ..................................................

Ownership

Proprieta~ .................c........................................................................................Nonprofit and government ..................................................................................

Size—

Lessthan 50 beds ................................................................................................50-99 beds ..........................................................................................................100-199 beds ........... ...........................................................................................200 beds or more ..... . ... .. . .. ... .. .. .. .. . .. ... .. .. .. . ... .. .. .. .. ... . .. ... . ... .. . ... .. .. . .. .... . . ... .. .. .. .. .. ..

Totalhomes

15,700

4,200

3,5004,4003,600

11,9003,900

6,4005,5003,200

600

;hargewrse‘n call

●

✎ ✎ ✎

☛

☛

☛

☛

●

☛

☛

Homes with 1 shift

RN

500

=

. . .

***

200200

**●

*

LPN

300

=

. . .

**●

300*

200●

*●

Nurse’saide

300

. . .

●

300

300*

300*

Otherstaff

300

. . .

●

300

300●

300**

lof these homes, 8 percent were certified for Medicare ordY.20f these homes, 35 percent were certified as both SNH’S and ICF’S.


34

United Statesr Augus~ 1973-April 1974–Con.I Table 9. Number of nursing homes bv skill of person in charge on duty for each shift, certification status, ownership, and size:

BothRN’s

200

. . .

+!

*

*

**

***●

Homes with 2 shifts

BothLPN’s

*

. . .

**

**

●

☛

☛

Bothnurse’saides

*

. . .

**

**

**

Bothotherstaff

*

. . .

*

*

*

Allothercom-bina-tions

300

. . .

**

200

200●

300●

**

AllRN’s

3,700

2,100

1,000300300

2,5001,200

6001,1001,600

500

AllLPN’s

800

*

*

400●

600200

400300

**

Allnurse’saides

700

. . .

200500

600*

600●

*

Homes with 3 shifts

Allotherstaff

*

*

*

**

RN’sfor 2of 3

shifts

2,500

800

1,000400400

2,000600

7001,100

600●

LPN’sfor 2of 3

shifts

3,600

900

1,0001,300

400

2,800700

1,2001,800

500●

Nurse’saidesfor 2of 3

shifts

1,400

*

*

800500

1,000400

1,000300

*●

Allothercom-bina-tions

800

*

*

500200

600*

400300

●

35

Table 10. Number of nursing home res(de.ts by avera9emonthly charge for care, we, sex, length of stay sm.e current zdmisnon, and zmmaw reason for admtswan: Umted States, August 1973.Awl 1974—

L,fecare

Total momhly chargdAverage

bastenonth!ycharge

kveragstO1al

nonthlychargel

Age, sex, length of stay sincecurrent admissionand pri-mary reasonfor admmmn

Totalres,dents I $150.I $300.

ch%e $?49 I $400. I $502.I $6@3. I $700. S800.$299 $399 $499 $5s9 S699 $796 $699

2S4,500

32,10fl38,60092,1 W

101,600

82,200182,3W

19,50024,90d37,70U94,10044,70043,70d

209,3w17,70036,2oo

.

Numbs

All res,dentsm home1 month or more $466

422462476474

455473

621504486470460404

467362412288

$479

434473468485

456484

542521488479459411

499369419294

1,012,000 6,200

.

2,50+33,400

.

5,700

.

.

.

.

.

3,000

.

.

.

.

9,6oo

.

.

3,4003,200

3,2006,40+3

.

.

.

.

.

4,000

6,200...

9,400=

.

.

2,8003,400

3,3006,100

.

.

.

.

.

4,400

4,4002,900

.

.—

104,200

18.10019,40033,10033,502

36,20067,900

6,1007,30012,50035,00918,oOO26,200

62,9fN16,1OC23,100

.

274,100

30.30042,20095,61J3

I 06,800

76,900I97,1OO

24,80026,70044,300

104,00039,30034,8oo

228,40012,00031.700

.

I33,400

10,20018,40049,90055,00+3

37,70+395,700

14,10016,30023,20046,61X17,10016,1W

115,1C45,5Ck7

11.900.

96.200 39,8IXI=

.

5,20016,30417,100

9,56030,200

6,6005,3007,3fM

12,3005,00f34,000

35,200.

3,1W.

22,200

.

3,2@36,2009,200

5,71016,600

2,8003,3004,4007,700

.

.

20,700..

20.200 32.300

107,500152,000359,500393,000

5,700I 3,9m35,40041,200

25,8oo70,4W

9,6IX11,90C15,80235,80C12,90C10,3W

83.51X4,50(7,80i

.

.3,1007,9007,602

5,6U014,6J20

3,40C2,30C3,2006,2oc2,5W2,60C

18,100...

2,7004,8Q3

13.2@3

294,800717,200

8.10024,104

5.1024,7005,100

10,6CQ4,2002.600

29,900...

Length of stay sincecurrentadm8ss,0n

Lessrhan 3 months ..................3 to lessthan 6 months ............6.to lessthan 12 months ..........1 to lessthan 3 years................3 to lessthan 5 years................5 yearsor more ......... ....... ......

Primary reasonfor admissmn

Physical....................................Social . ........ ........................ ....Behavioral ............. ........ ...... ..Economic.................................

81,500103,803155,700357,700149,7f13153,5042

815,20066,4W

119,8001o.5fKl

llncludes bdsic charge plus any special ch.rge. for medicd or n.rhittg wrvices, medtct.1 mpplie$ tmd equipment, md so forth.

NOTE: I:iguresmay not udd lo totits due III rmmdmg.

36

.

Table 11, Number of residents by primary source of payment, age, sex, primary reason for admission. length of stay since currentadmission, and madian length of stay from current admission: United States, August 1973-April 1974

Age, sex, primary reason for admission, and length of staysince current admission

All rasidents in home 1 month or more .. . .. . ... ... . . ... ... .. ..

Aae

Lessthan 65 years .........................................................................65-74 years .................................................... ................ ........... ....75-84 yaars ...................................................................................85 years or more ...........................................................................

Sex—

Male ..............................................................................................Female ..........................................................................................

Prima~ reason for admission

Physical.........................................................................................Social ............................................................................................Behavioral .....................................................................................Economic ......................................................................................


Lessthan 3 months ............................................. ......... ...... ...........3 to lessthan 6 months .................................................................6 to lessthan 12 months ............ ...................................................1 to lessthan 3 years.....................................................................3 to lessthan 5 years .....................................................................5 yeare or more ......o......................................................................

Median length of stay from current admission ..............................

Primary source of payment

OtherAl I Own Medi- Medi- public

sourcesOther

income care caid assist-ance

Number

1,012,000

107,500152,000359,500393,000

294,800717,200

815,20066,400

119,80010,500

91,500103,800155,700357,700149,700153,500

371,700

19,50046,800

149,500155,900

105,700266,000

301,70031,90035,700

2,400

37,00045,20066,400

128,20048,20046,700

10,800

**

5,0003,400

2,6008,200

10,400***

7,100●

●

●

●

*

484,300

57,90078,900

163,300184,300

137,200347,200

407,70019,20054,600

2,900

37,10046,60072,200

182,30076,80069,400

114,900

24,00020,20030,90039,800

36,20078,700

77,6009,100

26,300*

7,6007,600

13,90038,60019,90027,400

30,200

6,0003,700

10,9009,600

13,10017,100

17,9006,2002,9003,200

2,6002,7002,6007,8004,7009,700

Days

547 II 507 I 68 I 630 I 816 I 1,058


37

APPENDIXES

I.

II.

m.

Iv.

I.

11,

III.

Iv.

v.

VI.

VII.

CONTENTS

Technical Notes on Methods .............................................................................................................Survey Design ...................................................... ........................................................................

General ...................................................................................................................... .............Sampling Frame .....................................................................................................................Sampling Design ......................... ........................ ............... .....................................................Data Collection Procedures for the 1973-74 National Nursing Home Suwey ......................... .

General Qwfifications ............... ..................................................................................................Nonresponse and Imputation of Missing Data ........................................................................Rounding of Numbers ............................................................................................................Data Processing .............................................................................................................. ........Estimation Procedures . ....................................................................................................... ....

Refiabifity of Estimates ...............................................................................................................

Definitions of Certain Terms Used in This Report ............................................................................Terms Relating to Residents .......... ............................................................... ...............................Terms Relating to Facilities ................................................. ........................................................Terms Relating to Employees ................. ................................................................................."..Geographic Terms ........................................................................................................................Ratio ...........................................................................................................................................

Selected Questionnaires Used in the 1973-74 Nationaf Nursing Home Survey ..................................

Criteria for Classifying Nursing Homes According to Level of Nursing Care ......................................Types of Facilities Included in the Survey ...................................................................................

LIST OF APPENDIX TABLES

Distribution of homes in the 1973-74 National Nursing Home Survey. universe and disposition ofsample homes according to primary sampling strata: Conterminous United States .........................

Summary of data collection procedures ............................................................ ............................ ....

Standard errors of percentages for establishments ................................ .............................................

Standard errors of percentages for beds ............................................................................................

Standard errors of percentages of residents .......................................................................................

Standard emors of percentages for adtilons and discharges ...........................................................

Standard errors of average monthly resident charge ..........................................................................

VIII. Standard errors of occupancy rate ............................... .....................................................................

LIST OF APPENDIX FIGURES

I. Relative standard errors for estimated numbers of admissions and discharges, beds, residents, andestabhshments ...................................................................................................... .. ........................

IL Relative standard emor for estimated number of resident days .........................................................

III. Provisional relative standard errors for estimated numbers of full-time equivalent employees ...........

3939393940

?24242424343

515151525252

5!?

7777

40

42

47

47

48

48

49

50

44

45

46

38

APPENDIX I

TECHNICAL NOTES ON METHODS

SURVEY DESIGN

General

From August 1973 to April 1974, theDhision of Health Resources Utilization Statis-tics (DHRUS) conducted the National NursingHome Survey (NNHS)–a sample survey ofnursing homes, their residents, and staff in theconterminous United States. The survey wasdesigned and developud by the DHRUS inconjunction with a group of experts in variousfields encompassing the broad area of long-termcare.z 4 It was specifically designed as the first ofa series of surveys to satisfy the diverse dataneeds of those who establish standards for, plan,provide, and assesslong-term care services.

Sampling Frame

The 1973-74 NNHS focused on nursinghomes which provided some level of nursingcare. Only homes providing nursing care wereincluded because detailed questions on facilityservices and resident health status were relevantonly to these facilities. These homes includedboth nursing care homes and personal-care-with-nursing homes, while personal care homes anddomiciliary care homes were excluded. Homeswere either freestanding establishments ornursing care units of hospitals, retirement cen-ters, and similar institutions. A definition ofnursing care and detailed ctiteria for classifyinghomes providing such care are presented inappendix IV.

The survey universe consisted of two groupsof homes: those providing some level of nursingcare as classified in the 1971 Master Facility

NOTE:Thelistof referencesfollowsthetext.

Inventory (MFI) and homes opening for businessin 1972. The major group (93 percent) wascomposed of all nursing homes providing someIevel of nursing care as classified by the 1971MFI. The MFI is a census of all inpatient healthfacilities conducted by mail every 2 years by theNational Center for Health Statistics. A detaileddescription of how the MFI was deveIoped, itscontent, and procedures for updating and as-sessing its coverage have been published.z 5‘z T

In order for data collection to begin inAugust, the sampfing frame was “frozen” in thespring of 1973 so that the sample could beselected in ample time to permit the schedulingof nationwide data collection. To obtain ascurrent a sampIe frame as possibIe, aIl nursinghomes which opened for business during 1972were also included in the universe. (Homesopening in early 1973 could not be includedsince data about them were not yet available.)The homes which opened in 1972 comprised thesecond, and smaller (7 percent), group of facil-ities in the universe. Although the universeincluded only homes providing nursing care, allhomes opened in 1972 were included becausethe level of nursing care they provided wasunknown prior to the survey. Once the NNHSwas conducted, facilities not meeting the criteriawere classified as out of scope (see table I fordetails).

Although the NNHS was conducted in1973-74, it should be noted that estimates willnot correspond precisely to figures from the1973 MFI census for several reasons. In com-parison to the MFI, the NNHS universe excludedthe following: (1) personal care homes anddomiciliary care homes; (2) homes that openedin 1973; and (3) homes that, between 1971 and1973, upgraded the level of care they provided,

39

-“

Table 1. Distribution of homes in the 1973-74 National Nursing Home Survey universe and disposition of sample homes according toprimary sampling strata: Conterminous United States

Number of homes in sample

In scope and

in businessUni-verse

(sam-pling

frame) 1

out ofscopeor outof busi-

ness

Certification status and size of homeNon-

re-spend-

ing

Totalhomes Re-

spend-ing

All types . .. . ... .. .. .. ... .. . .. ... .. .. .. .. .. .. .. .. .. ... .. .. .. .. ... .. . ... .. .. .. ... . .... .. ... .. .. .. ... .. .. .. .. .

Both Medicare and Medicaid and Medicare only ... .. .. ... . .. ... .. ... . ... .. .. .. .. .. .. .. ... .

Unknown beds . .. . .. ... . .. .. .. .. .. ... .. . .. ... . ... .. .. .. .. .. .. ... .. . ... . .. .. .. . .. .. .. ... . ... .. ... .. . ... . .. ... .. .. .. .. ... .Less than 25 beds ... .. .. .. .. .. .. .. .. .. ... .. . ... .. .. .. .. ... . .... . .. .. .. .. ... . ... . .... . .. .. .. ... .. .. .. ... . ... .... . ... .. .

25-49 beds . .. .. .. ... . .. .. . . .... . ... . . .. .. .. .. .. . ... .. .. .. .. ... . ... .. . ... .. . ... .. ... . ... .. .. .. .. .. .. .. .. .. .. ... ... .. . .. ... .50-99 beds . .. .. .. ... .. .. . ... .. .. .. .. .. .. .. .. .. .. .. .. ... .. . .... . .. ... . ... .. .... .. .. .. . .... . .. .. .. ... .. . ... . ... .. ... . ... .. . .100-199 beds . .. .. .. ... .. .. .. . ... .. .. .. .. ... . .. .. ... .. .. . ... .. ... . .. .. .. .. ... .. .. .. .. .. .. .. .. .. ... .. .. .. .. ... . .. ... . ... ..200-299 beds .. ... .. ... . ... .. .. .. .. .. ... . ... .. . ... . .... . . .... . .. ... . ... .. .. .. .. ... . . ... . . ... .. ... .. . ... . .. .. ... ... . ... . ..300499 beds .... .. . ... ... . ... . ... . ... .. . ... .. .. ... ... ... . ... . .. ... . ... .. .. .. .. .. .. .. ... . .. .. .. .... . . .. . . .... .. .. .. .. .. ..

500 beds or more . .. ... . ... . .. .. .. .... . .. .. .. ... . .. ... . .. ... .. .. . .... . .. ... . .. ... . ... .. .. ... . ... .. .. .. .. .. .. .. .. .. ... ..

Medicaid only . ... .. .. .. . .... . .. ... . .... . .. .. . ... .. .. ... .... .. .. .. .. .. .. . .... . ... .. . .... . .. .. .. .. ... .. .. . ... ..

Unknown beds .. .. .. .. .. .. .. ... . .. ... .. . ... . ... .. .. ... . .. .. .. .. ... . ... .. . .. .. .. .. .. .. .. .. .. .. .. ... . .. .. .. ... . .. ... . .... .

Less than 15 beds . .. .. . ... .. .. .. . .... . ... .. . ... .. .. .. . .... . .. .. . . .. ... .. .. .. .. .. .. ... . .. ... .. .. .. .. .. .. ... . .. ... . ... ..

15-24 beds .. . .. .. ... . ... .. .. .. .. .. .. .. ... . .. .. .. .... . .. .. . ... .. ... .. . ... .. .. .. .. ... . .. ... .. .. .. .. .. .. .. .. ... .. .. ... . .. ... .25-49 beds ... .. ... .. . ... . ... .. .. .. .. .. ... . ... .. .. . ... .. .. ... .. . ... .. . ... .. .. .. ... .. .. .. .. .. .. .. . .... . .. .. ... .. ... .. .. .. .. .

50-99 beds .. ... . ... ... .. .. . ... .. .. .. .. .. .. .. ... . ... . ... . .. .... . ... . . ... .. ... .. .. .. .. ... .. . ... .. . .. . . .... . ... .. . .... . . .... .100-199 beds . .. .. .. ... .. .. .. . ... .. .. .. .. ... .. .. .. .. .. .. .. .. .. .. ... . ... .. .. .. .. ... . ... .. . ... . .. ... .. ... . .. .. .. .. ... .. ... .

200-299 beds . .. ... . ... .. .. .. .. ... . .. .. .. .. .. . . ... . .. ... . .... .. .. .. .. .. .. .. .. .. .. .. .. ... . .... . .. . .. ... .. . .... . ... .. .. ... .300-499 beds . .. ... . .. .. ... .. . .... .. .. .. .. .. .. .. .. .. .. .. .. .. . . .. ... . ... .. . ... .. ... . .. ... . ... .. .. ... . ... .. . .. .. .... . .. ... .500 beds or more . .... . .. .. . .... .. . ... .. . ... . .... . ... . . .... . ... .. .. ... . .. .. ... .. .. .. .. .. .. .. .. .. .. ... .. .. . ... ... . .. ... .

Not certified .. ... .. .. .. .. .. .. . .... . .. ... . ... .. .. .. . ... .. .. ... . ... .. .. .. .. .. .. .. ... . .. .. .. ... . ... .. .. ... . .. ... .

Unknown beds . ... . ... .. . ... .. .. .. ... .. . .... . ... .. . ... .. ... . . ... .. ... .. . ... .. .. .. . ... .. .. ... . ... .. .. .. .. ... .. . ... .. ... . .Less than 15 beds . ... ... . . .. ... .. ... .. .... . .. ... . ... .. .. .. .. ... .. ... . . ... .. ... .. . .. .. ... .. . ... .. .. .. .. .. .. ... . .. .. ... .15-24 beds .... ... . .. .. ... .. . .. . ... .. .. . ... .. .. .. .. .. .. ... . .. ... . ... .. ... . .. ... . ... .. . .. ... .. .. .. .. .. .. ... . ... .. .. .. .. ... . .2549 beds .. .. ... .. . .. ... .. .. .. .. ... . ... . .. ... . .. .. . .. ... . ... . .. ... . .... . . .... . ... .. . ... .. .. .. .. .... ... .. .. .. .. ... .. .. ... .50-99 beds . . ... .. .. . .. .. ... .. .. . ... .. ... . . .... . .. ... . ... .. .. ... . ... .. .. .. .. ... . ... .. .. .. .. .. .. .. .. .. .. ... .. .. .. ... . .. .... .100-199 bads .. ... .. . ... .. ... . .. ... .. . .. .. ... . ... .. .. ... . ... . .. .. ... .. .. .. .. .. ... .. .. .. .. .. ... ... .. ... .. .. .. ... .. .. .. ... .200-299 beds .. ... .. .. .. .. .. .. .. ... . ... .. . ... . . ... . . .. . ... .. .. . ... . ... .. .. ... . ... .. . ... . ... ... . ... .. ... . . ... .. .. ... . ... ..300-499 beds . . ... .. . ... . ... . ... ... . .. .. . .... .. .. .. . ... .. ... .. . ... .. .. .. . ... .. ... .. .. .. . .. .. . . ... .. ... .. .. .. .. .. ... .. ... .

500 beds or more . . ... .. ... . .. .. .. .. .. .. .... . .. .. .. ... . .. ... . .. ... ... . .. ... . .. ... .. .. .. . ... . .. .. .. . .. . .. .. ... .. .. .. .. ..

17,685 2,118 147 63 1,908

4,099 803 20 26 757

2149

5381,7131,385

22468

20

7,473

04

35228370100

4620

790

000784

1

0

34

0117

1132

1

24

03

34

214351

9343

19

732

3

250

967

2,2532,6881,108

1454316

6,113

05

36

123293241

522416

525

015

1143

532

93

02

1

386310

13

02

30

109281232

442014

419

0132971

121

116

31

23

15

191,2791,0621,575

1,334

652120

52

20

0233887

145

14143

28

20

010

91319

2112

4

5

0003540

1

0

lT’he universe consisted of nursing homes providing some level of nursing care as classified in the 1971 MFI and homes ouened forbusiness in 1972.

thereby meeting the “nursing care” Critefiawhen surveyed in the 1973 MFI. Data from theNNHS are also subject to sampling variability,while data from the MFI are not, since the MFIis a census.

tion of establishments and the second stage wasa selection of residents and employees of thesample establishments. In preparation for thefirst-stage sample selection, establishments listedin the MFI were sorted into three types of stratabased on Medicare and Medicaid certification:(1) Both Medicare and Medicaid and Medicareonly; (2) Medicaid only; and (3) Not certified.Homes in each of these three strata were sortedinto bed-size groups, producing 26 primary

Sampling Design

The sampling was a stratified two-stageprobabilityy design: The first stage was a selec-

40

strata as shown in table I. The nursing homes inthe universe were ordered by type of ownership,geographic region, State, and county. The sam-ple was then selected systematically after arandom start within each primary stratum. TableI shows the distribution of establishments in thesampling frame and the final disposition of thesample with regard to response and in-scopestatus. The number of homes estimated by thesurvey (15,7 49) is less than the universe figure(17,685) because some homes went out ofbusiness or out of scope between the time theuniverse was “frozen” and the survey wasconducted. Differences ranging from2,100-2,900 between survey estimates and uni-verse figures occurred in the 1963,3 1964,28and 196920 nursing home surveys for the samereason.

The second-stage selection of residents andemployees was carried out by the interviewers atthe time of their visits to the establishments inaccordance with specific instructions given foreach sample establishment. The sample framefor residents was the total number of residentson the register of the establishment on theevening prior to the day of the survey. Residentswho were physically absent from the facility dueto overnight leave or a hospital visit but had abed maintained for them at the establishmentwere included in the sample frame. An averageof 10 residents were in the sample per home.

The sampling frame for employees was theStaff Control Record on which the interviewerlisted the names of all staff (including thoseemployed by contract) and sampled profes-sional, semiprofessional, and nursing staff. Thosegenerally not involved in direct patient care,such as office staff, food service, housekeeping,and maintenance personnel were excluded fromthe sample. The interviewer used predesignatedsampling instructions that appeared at the headof each column of this form. An average of 14staff were in the sample per home.

Data Collection Procedures for the 1973-74National Nursing Home Survey

I The 1973-74 NNHS utilized eight question-naires (see appendix III for copies of question-naires relevant to this report. For all other datacollection instruments see reference 1.)

Administrator Letter and

Facility Questionnaire

Expense Questionnaire

Resident Control Record

Resident Questionnaire

Worksheet

Staff Questionnaire-Parts I and H

Staff Control Record

Data were collected according to the fol-lowing procedure.

A letter was sent to the administrators ofsample homes informing them of the surveyand the fact that an interviewer wouldcontact them for an appointment. On theback of the letter was a worksheet which theadministrateor was requested to fill out priorto the interviewer’s visit. This worksheetasked for those data that required access torecords and some time in compiling (such astotal admission and discharges, inpatientdays of care, etc.). Included with this in-troductory letter were letters of endorse-ment from the American Nursing HomeAssociation and the American Association ofHomes for the Aging urging the administra-tors to participate in the survey.

Several days to 1 week after the mailing ofthe letters, the interviewer telephoned thesample facility and made an appointmentwith the administrator.

At the time of the appointment, the fol-lowing procedures were used: The FacilityQuestionnaire was completed by the in-terviewer who interviewed the administratoror owner of the home. After completing thisform, the interviewer secured the adminis-trator’s permission to send the ExpenseQuestionnaire to the facility’s accountant.(If financial records were not kept by anoutside firm, the Expense Questionnaire wasfilled out by the administrator, with theinterviewer present. ) The interviewer com-pleted the Staff Control Record (a list of allcurrently employed staff both full and parttime), selected the sample of staff from it,

41

and prepared Staff Questionnaires, Parts Iand II, which were left for each sample staffperson to complete, seal in addressed andfranked envelopes (one for each part of thequestionnaire), and return either to the in-terviewer or by mail. The interviewer thencompleted the Resident Control Record (alist of all residents currently in the facility),selected the sample of residents from it, andfilled out a Resident Questionnaire for eachsample person by interviewing the memberof the nursing staff familiar with care pro-vided to the resident. “The nurse referred tothe resident’s medical records. No residentwas interviewed directly.

If the Expense Questionnaire was not re-turned within 2 weeks, the interviewer tele-phoned the accountant requesting its promptreturn. If the Staff Questionnaires were notreturned in one week, the interviewer contactedthe staff member and requested the return ofthe form.

Table II presents a summary of the datacollection procedures.

Table Il. Summary of data collection procedures

Questionnaire

Facility ... .. . ...

Expense . .. .. .. .

Resident .. .. .. ..

Staff . .. .. .. ... .. ..

Respondent

Administrator

Facility’s accountant

Member of nursing stafffamiliar with care pro-

vided to the resident/resident’s medical records

(10 sampled residents perfacility)

Sampled staff membar (14

per facility)

Interviewsituation

Personalinterview

Self-an umeratedquestionnaire

Personal

interview

Self-enumerated

questionnaire

GENERAL QUALIFICATIONS

Non responseand Imputationof Missing Data

Response rates differed for each type ofquestionnaire as indicated:

42

Questionnaire Response rate

Facility 97 percent

Expense 88 percent

Resident 98 percent

Staff 82 percent

Generally, response rates were higherquestionnaires administered in a personal

forin-

~erview situation (facility and resident) than forthose which were self-enumerated (expense andstaff). Statistics presented in this report wereadjusted for failure of a home to respond. Datawere also adjusted for nonresponse which re-sulted from failure to complete one of thequestionnaires (expense, resident, staff) or fromfailure to complete an item on a questionnaire.Those items left unanswered on a partiallycompleted questionnaire (facility, expense, resi-dent, staff) were generally imputed by as-signing a value from a responding unit withmajor characteristics identical to those of thenonresponding unit.

Rounding of Numbers

Estimates of homes, residents, resident days,beds, etc., have been rounded to the nearesthundred. For this reason detailed figures withintables do not always add to totals. Percents werecalculated on the basis of original, unroundedfigures and will not necessarily agree preciselywith percents that might be calculated fromrounded data.

Data Processing

A series of checks was performed during thecourse of the survey. This included field fol-lowups for missing and inconsistent data, somemanual editing of the questionnaires, and ex-tensive editin~ as cond;cted by computer toassure that all responses were accurate, con-sistent, logical, and complete. Once the database was edited, the computer was used tocalculate and assign weights, ratio adjustments,recodes, and other related procedures necessaryto produce national estimates from the sampledata.

--%_

Estimation Procedures

Statistics reported in this publication arederived by a ratio estimating procedure. Thepurpose of ratio estimation is to take intoaccount all relevant information in the esti-mation process, thereby reducing the variabilityof the estimate. The estimation of number ofestablishments and establishment data not re-lated to size are inflated by the reciprocal of theprobability of selecting the sample establishmentand adjusted for the nonresponding establish-ments within primary certification-size strata.Two ratio adjustments, one at each stage ofselection, were also used in the estimationprocess. The first-stage ratio adjustment (alongwith the above inflation factors) was included inthe estimation of establishment data related tosize, resident data, and staff data for all primarycertification-size strata from which a sample ofhomes was drawn. The numerator was the totalbeds according to the Master Facility Inventorydata for all homes in the stratum. The denom-inator was the estimate of the total bedsobtained through a simple inflation of theMaster Facility Inventory data for the samplehomes in the stratum. The effect of the first-stage ratio adjustment was to bring the sample incloser agreement with the known universe ofbeds. The second-stage ratio adjustment wasincluded in the estimation of resident and staffdata within establishments. The second-stageratio adjustment is the product of two frac-tions: The first is the inverse of the samplingfraction for residents (or staff) upon which theselection is based; the second is the ratio of thenumber of sample residents (or staff) in theestablishment to the number of residents (orstaff) for whom questionnaires were completedwithin the home.

RELIABILITY OF ESTIMATES

As in any survey, the results are subject toreporting and processing errors and errors due tononresponse. To the extent possible, these typesof errorsbuilt into

Sincebased on

were kept to a m~nimum by meth;dssurvey procedures.statistics presented in this report area sample, they will differ somewhat

from figures that would have been obtained if acomplete census had been taken using the sameschedules, instructions, and procedures.

The standard error is primarily a measure ofthe variability that occurs by chance becauseonly a sample, rather than the entire universe, issurveyed. The standard error also reflects part ofthe measurement error, but it does not measureany systematic biases in the data. It is inverselyproportional to the square root of the numberof observations in the sample. Thus, as thesample size increases, the standard error gener-ally decreases.

The chances are about 67 out of 100 that anestimate from the sample differs from the valuethat would be obtained from a complete censusby less than the standard error. The chances areabout 95 out of 100 that the difference is lessthan twice the standard error and about 99 outof 100 that it is less than 2?42 times as Iarge. Therelative standard error of an estimate is obtainedby dividing the standard error of the estimate bythe estimate itself. According to the NCHSstandards, reliable estimates are those that havea relative standard error of 25 percent or less.

Relative standard errors of estimated num-ber of admissions and discharges, beds, residents,establishments, and resident days of care areshown in figures I and IL Provisional relativestandard errors of estimated number of full-timeequivalent employees are presented in figure III.

Because of the relationship between therelative standard error and the estimate, thestandard error of an estimate can be obtained bymultiplying the estimate by its relative standarderror. Thus, for example, in figure I, an estimateof 2,300 residents has a relative standard errorof 25 percent. Its standard error is .25 X 2,300 =575.

The particular figure or table to which onerefers to obtain a standard error is contingent onthe type of estimate (e.g., residents) and wheth-er the estimate is a level or a percent. TablesIII-VI show the standard errors for percentestimates used in this report for establishments(table III), beds (table IV), residents (table V),and admissions and discharges (table VI). TableVII shows the standard errors for averagemonthly charge, and table VIII shows thestandard errors of the occupancy rate.

43

-H-H-+?H+fd#&- :— f-l!,

~ CURVE A Admissions, dmchwges W.,, ,.! --,

1009080706050

40

- 30

kLu 200ELu

~ 10m:0726

UJ’

n’$53

SIZE OF ESTIMATE

Figure 1. Relative standard errors for estimatad numbers of admissions and discharges, beds, residents, and establishments

Example of statistical tests used for thisreport to determine whether the differencesbetween selected characteristics in the classifica-tions breakdown are statistically significant arepresented here for average monthly charge,full-time equivalent employees, and discharges.These tests are based on comparisons of confi-dence intervals for the estimates in question. Ifthere is no overlapping of the confidence inter-vals, the estimates are considered statisticallydifferent.

Example I.–The average monthly nursinghome charge for females between August 1973and April 1974 was $473, and the approximatestandard error of this charge (from table VII)was $8.76. The chances are 95 out of 100 (the95-percent confidence interval) that the truevalue being estimated is contained in the intervalbetween $455 and $491 ($473 * 2($8.76)).Since this interval overlaps with the 95-percentconfidence interval for males ($428-$482 as

obtained above), the difference between theaverage monthly charge in these two sex classifi-cations is not considered statistically significantin this method.

Example 2.–An example of a ratio such asfull-time equivalent (FTE) employees per 100residents can be calculated as follows: Supposethe provisional standard error (crR,) for the ratioof FTE employees per 100 residents is desiredfor nursing homes certified as skilled nursinghomes under Medicaid. In table 8 the totalnumber of FTE employees per 100 residents forSNH homes is 68.7, which is equal to a total of201,000 full-time equivalent employees dividedby 292,500 residents times 100. The relativestandard error of 201,000 FTE employees(figure III, curve A) is approximately 2.1 per-cent, and the relative standard error of 292,500residents (figure I, curve C) is approximately 2.4percent. The square root of the sum of squaresof these two relative standard errors provides an

44

10090 , ,!,!1,,,, , , I I + I1 1 180 I 111IItIll I [ I 1 8

1 I I 1 1

70 I

60I

I r

>“ . , 1 ! 1 I 1 1 111 I I I 1

40 111111111 I I I I

~n

I , , , r 1

I 11111

.n I I I I I I t 1 I 1 1 1 111111 I 1 1 1 1 1 1 I , I I I , , ,

‘1’’’’1098

7

6

1K ,

tllllllll 1111

, , , , , , I II I I I, , I , , 1 1

L

I, , 1

111111111 II I I

5—1I I I I I I I 1111111111 I I I I I I Iullllllllll

1

4’

3.

I I I I

I I I I

I ,8 , r 1

11111111 ,2

.0

.9,8.7

.6

.5

.4

.3

.2

.1

f 2 34 56789A 2 3 4 56789A 210 100

SIZE OF ESTIMATE (IN MILLIONS)

Figure 11.Reletive standard error for estimated number of resident days

approximation for the relative standard error of = (.024)2the desired ratio. In other words, letting VXt be = .006 +the relative standard error of number of totalFTE employees, VV1 be the relative standard

= .0010

error of ‘number of residents, and VRI be the

3

?!

456789A1,Too

+ (.021)*

.004

—

relative standard error of the ratio R‘ =-k ‘/y’ = .032

V;j = v:, + v?The approximate standard error of the ratio of

Y total FTE emrslovees ~er 100 residents mav now.- ...- —-1-–

,. –,-.. ,

45

Lu

10090807060

50

40

30

2,0

109876

5

4

3

2

1.9.8.7.6

.5

.4

.3

.2

“’ A 23 456789A 23 4 56789A 2 3 4 56789A 2

100 1,000

3 456789A

10,000 100,000 1,000,000

SIZE OF ESTIMATE

Figure I I 1. Provisional reletive standard errors for estimated numbers of full-tima equivalent employees

be obtained by multiplying the relative standarderror by the ratio as follows:

rJRl=v~/xR’= .032 X 68.7

= 2.20

The confidence interval now may be obtained atthe 95-percent confidence level as 64.3 to 73.1FTE’s per 100 residents.

Example 3. –To test whether or not homeswith less than 50 beds had more discharges dueto death (40.8 percent) than homes with 50-99beds (28.3 percent) had, standard errors wereobtained from table VI. Using the percentage

base of 164,500 from table 6 (total discharges inthe “less-than-5 O beds” group) and interpolatingfrom table VI, a standard error of 3.6 wasobtained. The confidence interval then at the95-percent level for the percent of dischargesdue to death in homes with less than 50 beds is33.6 percent to 48.0 percent (40.8 percent *2(3.6)). Similar calculations give a confidenceinterval of 24.1 percent to 32.5 percent forthese discharges from homes with 50-99 beds,Since these two intervals do not overlap, thepercent of discharges due to death from homeswith 50 beds may be considered significantlylarger than the percent of these discharges fromhomes with 50-99 beds.

-.. ... .Iarxel ii. Wanctarcserrors of percentages for establishments

Base of estimated percent(number of establishments)

100 ..........................................................................................200 ..........................................................................................300 ..........................................................................................4w ..........................................................................................600 ........................................... ...............................................600 ......... .................................................................................700 ..........................................................................................800 ..........................................................................................

1,000.......................................................................................2.000 .......................................................................................3.mo ...........................m....o......................................................4.000 ......................................m................................................5,000 ............................................ ...........................................6,000 .......................................................................................7,000 .......................................................................................8.000 ... ............................................................................... .....9,000 .......................................................................................10,000 ,,, ,,.,, ................................. ............................................20,000 ................................................ .....................................

Estimated percent

1

I2 I 5

I10

I20

or 99 or 98 or 95 or 90 or 8030 I 40 I 50

or 70 or 60

3.332.361.931.671.491.361.261.181.111.050.750.610.530.470.430.400.370.350.330.24

4.693.322.712.352.101.921.771.661.561.481.050.860.740.660.610.560.520.490.470.33

Standard error in percentage points

7.305.164.223.653.272.982.762.582.432.311.631.331.151.030.940.870.820.770.73

J0.52

10.057.115.805.034.504.103.803.553.353.182.251.841.591.421.301.201.121.061.010.71

Table IV. Standard errors of percentages for beds

Baseof estimated percent(numbar of beds)

7.000 .......................................................................................8.000 .......................................................................................9,000 ..,, ...................................................................................lo.ow .....................................................................................20.000 .....................................................................................30.000 .........................................m...........................................40.000..$ .....................................................m............................50,000 ,,,. ,,, .,, .,,,,..., ..................................................................60.000 .......................... ...........................................................70.000 ............ .......................................................... ...............80.000 .....................................................................................90.000 .....................................................................................loo.oooa ..................................................................................2oo.ooo ...................................................................................3oo.ooo ...................................................................................400,000 .......... .........................................................................5oo.ooo ...................................................................................600.000 ...................................................................................700,000 ... ................................................................................8W.000 ...................................................................................9oo.wo ...............m.............................mm.m..m...............................l.ooo.ooo ..................... ...........................................................2.mo.wo ....m...........................................................................

13.419.487.746.706.005.475.074.744.474.243.002.452.121.901.731.601.501.411.340.95

15.3610.868.877.686.876.275.806.435.124.863.432.802.432.171.981.841.721.621.541.08

16.4211.619.488.217.346.706.215.806.475.193.673.002.602.322.121.961.841.731.641.16

16.7611.859.678.387.496.846.335.925.595.303.753.062.652.372.162.001.871.771.681.18

Estimated percent

1 2I

5 10 20 30 40or 99 or 98 or 95 or 90 or 80

50or 70 or 60

2.462.302.172.061.461.191.030.920.840.780.730.690.650.460.380.330.290.270.250.230.220.210.15

3.473.243.062.902.051.671.451.301.181.101.020.970.920.650.530.460.410.370.350.320.310.290.20


5.395.054.764.513.192.612.262.021.841.711.601.501.431.010.820.710.640.580.540.500.480.450.32

7.436.956.556.214.393.593.112.792.542.352.202.071.961.391.130.980.880.800.740.690.650.620.44

9.909.268.738.285.864.784.143.703.383.132.932.762.621.851.511.311.171.070.990.930.870.830.59

11.3410.6110.009.496.715.484.744.243.873.593.363.163.002.121.731.501.341.231.131.061.000.950.67

12.1311.3410.6910.15

7.175.865.074,544.143.833.593.383.212.271.851.601.431.311.211.131.071.010.72

12.3811.5810.9110,357.325.985.184.634.233.913.663.453.272.321.891.641.461.341.241.161.081.040.73

47

Table V. Standard errors of percentages of residents

Base of estimated percent

(number of residents)

2.000 .. . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6.000 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8.000 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .lo.ooo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30.000 .. . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90.000 . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .loo.ooo .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2oo.ooo .. . . . . . . . . . . . . . . . . . ..! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..m.. . . . . . . . . . . . . . . . . . . . . . . . .3oo.ooo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .400,000 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5m.ooo . .. . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . .600.000 . . . . . . . . . . . . . . . . . . ..o. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7oo.ooo .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..o. . . . . . . . . . . . . . . . . . . . . . . . . . . . .800.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9m.ooo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .l.ooo.ooo .. . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .l.loo.ooo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..m. . . . . . . . . . . .. . . . . . .

Table Vi. Standard errors o

Base of &timated percent

(number of admissions and discharges)

lo.ooo .....................................................................................20.000 . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30.000 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40.000 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50;ooo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . .90;ooo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .loo.ooo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . .3oo.ooo .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4oo.ooo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5oo.ooo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .600.000 . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .7oo.ooo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .800.000 .. . . . . . . . . . . . . . . . . . . . . . . . . . ..o. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9oo.ooo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .l.ooo.ooo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2.000.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1or 99

2.691.901.561.351.210.850.700.600.540.490.460.430.400.380.270.220.190.170.160.140.130.130.120.10

2or 98

Estimated percent

5 10 20or 95 or 90 or 80 or 70 or 60

3.792.682.191.901.701.200.980.850.760.690.640.600.570.540.380.310.270.240.220.200.190.180.170.17


5.904.173.412.952.641.871.521.321.181.081.000.930.880.630.590.480.420.370.340.320.300.280.260.24

8.125.754.694.063.632.572.101.821.621.481.371.281.211.150.810.660.570.510.470.430.410.380.360.35

10.837.666.255.424.843.432.802.422.171.981.831.711.611.531.080.880.770.690.630.580.540.510.480.46

12.418.787.176.215.553.923.202.782.482.272.101.961.851.761.241.010.880.780.720.660.620.590.660.53

13.279.387.666.635.934.203.432.972.652.422.242.101.981.881.331.080.940.640.770.710.660.630.590.57

13.549.587.826.776.064.283.503.032.712,472.292.142.021.921.351.110.960.860.780.720,680.640,610.57

ercentages for admissions and discharges

Estimated percent

1 2 5 10 20 30 40or 99 or 98 or 95 or 90 or 80

50or 70 or 60


2.872.031.661.441.281.171.091.020.960.910.640.520.4!50.410.370.340.320.300.290.20

4.042.862.332.021.811.651.531.431.351.280.900.740.640.570.520.480.450.430.400.29

6.294.453.633.152.812.572.382.222.101.991.411.150.990.890.810.750.700.660.630.44

8.666.135.004.333.873.543.273.062.892.741.941.581.371.231.121.040.970.910.870.61

11.558.176.675.775.174.724.374.083.853.652.582.111.831.631.491.381.291.221.150.82

13.239.367.646.625.925.405.004.684.414.182.962.422.091.871.711.581.481.391.320.94

14.1510.00

8.177.076.335.77!3.355.004.724.473,162.582.242.001.831.691.581.491.411.00

14.4410.21

8.347.226.465.895.465.104.814.573.232.642.282.041.861.731.611.521.441.02

48

Estimated number ofresidents

3,500 ............. ...............4,000 ............................5,000 ............................6;000 .....................,,,...,7,000 .........................8,000 ............................9,000 ............................10,000 ......... .................20,000 ..........................30,000 ..........................40,000 ..,,.,,,,.,,.,..,,, ,, .,,.,50,000 ..........................60,000 ..........................70,000 ..................... .....80,000 ..........................90,000 ..........................100,000 ....................200,000 ........................300,000,.., ....... .............400,000,..,., ..................600,000 ........................600,000 ........................700,000 ..... ...................800,000 ................ ........900,000 ........................1,000,000 .................1,100,000 .....................

Table Wt. Standard errors of average monthly resident charge

Average monthly resident charge

$150 $200 $250 $300 $325 $350 $375 $400 $425 $450 $475 $500 $525

Stendard error in dollers

●

☛

☛

●

☛

363432231916151312111110

7655444333

●

☛

☛

●

474442392823201816151413129766554444

●

●

☛

605552494633272321191716151510876655544

**

746863595553373026242120191817121087766555

●

●

797267625956393228252321201918121098776655

**

647671666259423430262422212019131198776665

●

●

88807470

z443631282523222120141110

9877666

●

9;847873

z4638332927252322211512109887766

●

9;89827772

6948403431282624232215121110987776

**

101938660767251413632292725242316131110988777

●

118106978984797553433733312826252417141210998877

●

123110101

93878278554539353229282625171412111098887

●

128115105

97918581574741363331282726181513111099887

49

Table V1l. Standard errors of average month Iy resident charge–Con.

Average monthly resident charge

$550 $575 $600 $625 $650 $675 $700 $750 $6I3o $850 $800 $950

Estimated number ofresidents

Standard error in dol lam

169158141129119111105100

705850454138353331221816141312111010

9

174163145133123115108103

735951464239363432231916141312111010

9

164172154141130122115109

77635449444138363424201715141312111010

195182163149138129121115

81665751474341

::26211816141312121110

.3,500 .........................4,000 .........................5,000 .........................6,000 .........................7,000 ........ .................8,000 .........................9,000 .........................10,000 .......................20,000 .......................30,000 ...................... .40,000 .......................50,000 ....... ................60,000 .......................70,00 .........................80,000 .......................90,000 .......................100,000 .....................200,000 .....................300,000 .....................400,000 .....................500,000 .....................600,000 .....................700,000 ................... ..800,000 ... .... ..............900,000 .....................1,000,000 ..................1,1 00,000 ..................

*133119109101

948984604942383432302827191513121110

9988

*143128117108101

959064524540373432302820161413111110

:8

*148132121112105

9994665447423835333129211715131211101099

215201180164152142134127

90736457524845424028232018161514131212

22621118917216014914113394776760545047444230242118171514131312

236221197160167166147140

88817062575349464431252219181615141313

● ✎

138124113104

989287625044393633312928191614121110

9988

●

1531371251151081029/685648433936343230211715131211101099

20519217115714513612812186706154494643403827221917151413121211

Table Vlll. Standard errors of occupancy rate

Estimated number of bedsOccupancy rate

10 20 30 40 50 60 70I

80 I 90I100


14.1011.489.918.838.047.426.916.506.144.203.302.742.352.041.791.581.391.221.06

15.7012,7711.02

9.838.948.247.687.226.824.643.633.012.562.211.921.671.451.241.04

17.2714.0512.1210.809.829.068.447.927.495,083.963.263.762.362.031.751.491.240.99

20,000 ................................................................30.000 ................................................................40.000 .................. ..............................................50.000 ................................................................60.000 ............. ...................................................70.000 ................................................................80.000 ................................................................90.000 ...................................... ..........................loo.ooo ..............................................................2m#ooo ..............................................................3m.ooo ..................................... .........................4oo.ooo ................................................... ...... .....5oo.ooo ..............................................................6M.000 ................................................... ...........7oo.ooo ..............................o...............................800.000 ......................................... .....................9oo.ooo ..............................................................l.ooo.ooo .........................................o........o........l.loo.ooo ...................... .....................................

******

2.382.242.121.491.211.040.920.830.760.710.660.620.59

**

4.974.444.053.743.493.293.122.171.751.491.311.181.070.980.910.850.79

*

7.326.335.655.154.764.444.183.962.742.191.851.621.441.301.181.081.000.92

*

8.777.586.766.165.695.314.994.723.252.582.171.891.671.491.341.211.101.00

12.4610.158.767.827.116.576.125.765.453.732.952.472.131.861.651.471.311.171.05

18.8215.3113.2011.7610.699.869.188.628.145.504.283.502.952.512.141.811.511.220.91

20.3616.5514.2712.7111.5510.65

9.919.318.795.924.593,743.132.642.231.861.521.17

●

50

APPENDIX II

DEFINITIONS OF CERTAIN TERMS USED IN THIS REPORT\

Terms Relating to Residents

Resident.–A person who has been formallyadmitted but not discharged from an establish-ment. AU such persons were included in thesurvey whether or not they were physicallypresent at the time of the survey.

Age.–Age of resident at date survey wasconducted.

Length Oj- stay since current admission.–Length of stay refers to the current stay of aresident in the facility. It means the period ofstay starting from the date of most recentadmission to the institution to the date of thesurvey.

Living arrangements pn”or to admission.-Aresident’s prior living arrangement refers to theplace of residence immediately preceding ad-mission to the facility, regardless of length oftime in the previous arrangement.

Total monthly charge. -This is the totalamount charged to the resident each month bythe establishment, and it includes basic chargeplus any special charges for medical or nursingservices, medical supplies or equipment, and soforth. It does not include charges that are notpart of the bill rendered by the institution, suchas those for physicians’ services.

l%mary source of payment. –Primary sourceof payment refers to private income or medicalassistance used in payment for resident’s stay inthe nursing home,

Own income is any private source or incomefrom investments, Social Security, or pen-sion plans.

Medicare refers to payments from Medicareprogram described below.

Medicaid refers to payment from Medicaidprogram described below.

Other public assistance refers to any publicassistance other than Medicare and Medicaid.

Other refers to all other methods of pay-ment or support including church support,VA contract, intitial payment for life care,cases for which no charge was made, andmiscellaneous sources.

Terms Relating to Facilities

Nursing home. –This term refers to all insti-tutions that were within the scope of the1973-74 National Nursing Home Survey (seeappendix IV).

Nursing care. –Nursing care is defined as aservice that provides one or more of the fol-lowing treatments: hypodermic injection; intra-muscular injection; taking of temperature, pulse,respiration, or blood pressure; application ofdressings or bandages; bowel and bladder re-training; nasal feeding; catheterization; irri-gation; oxygen therapy; full-bed bath; andenema.

Type of ownership. –Type of ownershiprefers to the type of organization that controlsand operates the nursing home.

Proprietary facility is a facility operatedunder private commercial ownership.

Nonprofit facility is a facility operatedunder voluntary or nonprofit auspices, in-cluding both church-related facilities andthose not church-related.

Government facility is a facility operatedunder Federal, State, or local governmentauspices.

Bed.–One set up and regularly maintainedfor patients or residents. Beds maintained forstaff and beds used exclusively for emergencyservices are excluded.

Certification status.—Certification statusrefers to the facility certification by the Med-icare and/or Medicaid progyams.

Medicare refers to the medical assistanceprovided in Title XVIII of the Social Secu-rity Act. Medicare is a health insuranceprogram administered by the Social SecurityAdministration for persons aged 65 yearsand over who are eligible for benefits.

Extended care facility refers to certificationas an extended care facility under Medicare.

Medicaid refers to the medical assistanceprovided in Title XIX of the Social SecurityAct. Medicaid is a State-administered pro-gram for the medically indigent.

Skilled nursing home refers to certificationas a skdled nursing home under Medicaid.

Intermediate care facility refers to certifica-tion as an intermediate care facility underMedicaid.

Not certified refers to facilities which arenot certified as providers of care either byMedicare or Medicaid.

T *rms Relating to Employees

Employee. –This term refers to any personwho was on the staff of the facility or wasemployed under contract. It includes any paidworker, proprietor, or member of a religiousorder who contributes his services.

Full-time. –Employees who worked 35hours or more in the week prior to the surveyare designated “full-time.”

Part-time.–Employees who worked less than3!5 hours in the week prior to the survey aredesignated “part-time.”

Full-time equivalent. –For the purposes ofthe report, 35 hours of part time employees’work per week are counted as equivalent to onefull-time employee.

Geographic Terms

Classification of homes by geographic area isprovided by grouping the States (excluding

Alaska and Hawaii) into regions. These regionscorrespond to those used by the U.S. Bureau ofthe Census and are as follows:

Re~”on

Northeast . . .

NorthCentral . . .

States included

Maine, New Hampshire,Vermont, Massachusetts,Rhode Island, Connecticut,New York, New Jersey,Pennsylvania

Michigan, Ohio, Illinois,Indiana, Wisconsin, Minne-sota, Iowa, Missouri, NorthDakota, South Dakota,Nebraska, Kansas

South . . . . . . . . Delaware, Maryland, Dis-trict of Columbia, Virginia,West Virginia, North Car-olina, South Carolina,Georgia, Florida, Kentucky,Tennessee, Alabama, Missis-sippi, Arkansas, Louisiana,Oklahoma, Texas

West . . . . . . . . Montana, Idaho, Wyoming,Colorado, New Mexico,Arizona, Utah, Nevada,Washington, Oregon, Cal-ifornia

Ratio

Ratios presented in this report were calcu-lated by the following generaI formula:

where:

X = numerator of the ratioY = denominator of the ratiow = weight

Detailed information concerning this formulahas been published.z 9 Results from the formulawill differ somewhat from those obtained whenthe ratio is calculated for each individual facilityand then weighted.

52

APPENDIX Ill

SELECTED QUESTIONNAIRES’ USED IN THE 1973-74

NATIONAL NURSING HOME SURVEY

@

>,,. r,,,<

(’([~ ‘“jDEPARTMENT OF HEALTH, EDUCATION, AND

‘%O ,*”18,.PUBLIC HEALTH SERVICE

HEALTH RESOURCES ADMINISTRATIONROCKVILLE, MARYLAND 20S52

WELFARE

NATIONAL CENTER FORHSALTH STATISTICS

Dear Administrator:

The National Center for Health Statistics (NCHS) of the U. S. PublicHealth Service is conducting a sample survey of resident facilitiesproviding nursing and personal care to obtain basic data on theirpolicies, services, and staff. This survey is being conducted as apart of the Department of Health, Education, and Welfare’s nursinghome improvement program. The information from this survey will beused to compile statistics on the number and kinds of such facilitiesin the United States. Enclosed are two summary reports from previous

surveys, which are illustrative of the kinds of data to be obtainedfrom this survey. These statistics will be used to meet the needs ofCongress, State legislatures, Federal, regional, and local healthplanners, national health associations, and man y others who plan andprovide health services to the aged.

As you can see from these reports, it is not possible to identify anyparticular facility. We wish to as sure you that any information whichpermits the identification of the services provided by your facility,or the residents and staff will be held strictly confidential. Thisinformation will be used only by persons engaged i.~ and for the purposesof the survey, and will not be disclosed or released to others for anypurpose. Because the NCHS is committed to provide a factual basis forplanning national programs designed to advance the health of the Americanpeople, limited basic information abOut your facility (such as name,address, size, type, and ownership) will be made available upon request

to the NCHS.

Within about one week an interviewer will contact you for an appointment;,’,I this person will be with Applied Management Sciences, the firm under

~ 1See reference 1 for copies of all questiomaires used in the survey.

53

Federal contract to conduct this survey. In preparation for this call,please review the worksheet printed on the back of this letter. Thesequestions request necessary information which may take time to assemblefrom your records. I have enclosed them so that you may do this atyour convenience prior to the interviewer’s visit.

This survey includes a small, carefully selected nationwide sample ofnursing homes and similar facilities. Because this ntirsing home repre -s ents several facilities of similar type, your participation is vital inobtaining accurate and complete data. We would appreciate your cooperationin this effort.

Sincerely yours,

Edward B. Perrin, Ph.D.Acting Director

54

THE FOLLOWING QUESTIONS ON ADMISSIONS AND DISCHARGES CONCERN CALENDAR YEAR 1972,WHICH IS THE PERIOD OF JANUARY 1, 1972 THROUGH DECEMBER 31, 1972.

From through——Month Year = Year

● HOW MANY PERSONS WERE ADMITTED TO THIS FACILITY DURING 1972?

Admksions

● HOW MANY PERSONS WERE DISCHARGED FROM THIS FACILITY DURING 1972, EXCLUDING DEATHS?

Dlschar@c

● HOW MANY PERSONS DIED DURING 1972 WHILE RESIDENTS OR PATIENTS OF THIS FACILITY?

Deeths

● IN 1972, WHAT WERE THE TOTAL INPATIENT DAYS OF CARE PROVIDED? (THE SUM OF THE DAILY PATlENT CENSUSCOUNT FROM 1/1/72 THROUGH 12/31 /72,)

Days

● HOW MANY ROOMS FOR RESIDENTS DOES THIS FACILITY HAVE THAT CONTAIN:

a. 1 bedonly O None

b, 2 beds O None

c, 3 beds ❑ Nona

d, 4 or morebeds O None

RETAIN THIS FORM AND DATA FOR THE INTERVIEWER TO COLLECT.

55

FACILITY QUESTIONNAIRE I OMB# 06W-72172 I I

1973 Nursing Home Survey Expires 7-31-74

National Center for Health Statiwics1

Health Resources AdministrationRockville, Maryland

Name and address label

TELEPHONE NUMBER

Area Code Number

ccl-1 CC2 cdl-f CC12

CC24 CC27

SECTION A -FACILITY INFORMATION

1.a,

2a.

Is THE CORRECT(nameof facility on label)

NAME FOR YOUR FACILITY?

34-1 ❑ yes

-2 ❑ ~+ b. WHAT IS THE CORRECT NAME? <

Is THE CORRECT(addresa on label)

MAILING ADDRESS FOR YOUR FACILITY?

35-1 ❑ yes

.2 ❑ m~b. WHAT IS THE ENTIRE CORRECT~MAiLING hDDREss?

A

Correct Name of Facility if Different from Above

Number Street P.O. BOX, Route,Ctc.

City or Town County

1

State Zip Code

●3. WHICH CATEGORY BEST DESCRIBES THE TYPE OF SERVICE THIS FACILITY OFFERS THE MAJORITY OF ITSRESIDENTS OR PATIENTS? (Mark (X) only one box.)

36-1 1“-J a. Nursing home (includes Medicare certified Extended care Facilities and Mcdiccid certified Skilled Nursing Homes)

-2 ❑ b. I ntermadiete care fecilit y (includes Medicaid certif iad I ntermediete Cere Facilities)

-3 •1 c. Convalescent or rest home

-4Dd, Homa for the aged

{

-5 •l e. Extend& care unit of a hospitel

r

~of. Nursing owe unit of a retirement center

-7 ❑ g. Other resident facility (Describe) 37-

INTERVIEWER: IF BOX e OR f IS CHECKED, RECORD DATA ONLY FOR THE UNIT AND NOT FOR THE ENTIRE FACILITY.

●4a WHAT IS THE TYPE OF OWNERSHIP WH ICH OPERATES THIS FACILITY? (Mark (X) only one kx.)

3B,39 -23 ❑ a.

-24 ❑ b.

-25 ❑ c.

-20 ❑ d,

-21 ❑ e.

-22 ❑ f.

-11 ❑ g.

-12 ❑ h.

-13 ❑ i.

-14 ❑ j.

-15 ❑ k.

-16 ❑ 1.

-17 ❑ m.

-18 ❑ n.

-19 ❑ o.

Form 73N HS-1

56

Individual

Partnership

1

/

4.b. IS THIS HOME A MEMBER OF A GROUP OF HOMES OPERATINGUNDER ONE GENERAL AUTHORITY OR GENERAL OWNERSHIP?

Corporation

40-1 ❑Church raletad

yas

-20 ~Nonp+ofit corporation

JOther non~ofit ownership

State

Count y

City

City-Count y

Hospital District

U.S. Public Heelth Service

Armed Forces

Veterans Administration

Other Federal Agency -- Specify 41-

5. DOES VOUR FACILITY ACCEPT: (Mark (X) only one box.)

44-1 ❑ Males only?

-2 ❑ Females only?

“3 ❑ BOth males end femede~?

6a. DOES YOUR FACILITY ACCEPT PERSONS OF ALL AGES, INCLUDING INFANTS AND CHILDREN?

45-1 ❑ Yes(Skipto Question7)

-2

L

No

b. WHAT IS THE MINIMUM AGE ACCEPTED? ❑ No minimum .geor _ yrs.cc’%,47

.

c. WHAT IS THE MAXIMUM AGE ACCEPTED? ❑ No maximum age or yrs.CC48. 49

7, WHAT IS THE TOTAL NUMBER OF BEDS_REGULARLY MAINTAINED FOR RESIDENTS? (INCLUDE ALL BEDS SETUPAND STAFFED FOR USE WHETHER OR NOT THEY ARE IN USE BY RESIDENTS AT THE PRESENT TIME. DO ~INCLUDE BEDS USED BY STAFF OR OWNERS OR BEDS USED EXCLUSIVELY FOR EMERGENCY PURPOSES, SOLELYDAY CARE, OR SOLELY NIGHT CARE.)

Total beds

CC50

8a. WAS THERE AN INCREASE OR DECREASE IN THE TOTAL NUMBER OF BEDS DURING THE LAST YEAR?

54.2 H No (Skip to Question 9)

.1

%

Yes

b. I ncreasa of

CC55

c, Decrease of

CC58

beds

bads

9,a, WHAT WAS THE TOTAL NUMBER OF RESIDENTS ON THE REGISTER OF THIS FACILITY LAST NIGHT? (INCLUDE ALLRESIDENTS, EVEN THOUGH THEY MAY HAVE BEEN TEMPORARILY AWAY OR ON OVERNIGHT LEAVE, DO NOTINCLUDE STAFF OR OWNERS,)

Total residentsCC61

b. HOW MANY OF THESE WERE:

(1) Males? ❑ No”,.,

CC65

(2) Females? ❑ NoneorCS69

CARD 2

ccl 1-2

10,a, IS THIS FACILITY PARTICIPATING IN THE MEDICARE (TITLE XVIII) PROGRAM?

(h WHAT IS THE PROVIDER NUMBER?

I CC13H No provider # give”

12.1 ❑ Yes ~ c. HOW MANY BEDS ARE CERTIFIED FOR MEDICARE?

\

bedsCC19

d. HOW MANY OF THESE CERTIFIED BEDS WERE OCCUPIED BY MEDICAREPATIENTS LAST NIGHT?

~ ciNOneOr~c23 beds

‘2 ❑ NO (Skip to Question 1 I)

Form 73 NHs-1

57

11.a. IS THIS FACILITY PARTICIPATING IN THE MEDICAID (TITLE XIX) PROGRAM?

/

❑ Yes ❑ No (Skip to Question 12)29-1 -2

b.(1) DOES IT HAVE ANY SKILLED NURSING BEDS?

b.(2) WHAT IS THE PROVIDER NUMBER?Cc31

•1No provider # given

b.(3) HOW MANY BEDS ARE CERTIFIED AS SKILLED NURSING BEDS?

❑ No.ecw badsCC44

b.(4) HOW MANY OF THESE CERTIFIED BEDS WEREOCCUPIED BY MEDICAID PATIENTS LAST NIGHT?

❑ None or bedsCC46

C!(1) DOES IT HAVE ANY INTERMEDIATE CARE BEDS?

❑ No ❑ Yes. —

52-2

[

c.(2) WHAT IS THE PROVIDER NUMBER?-1 CC53

/

❑No provider # given

/

c.(3) HOW MANY BEDS ARE CERTIFIED AS INTERMEDIATE CARE BEDS?

❑ None or bedsCC66

c.(4) HOW MANY OF THESE CERTIFIED BEDS WEREOCCUPIED BY MEDICAID PATIENTS LAST NIGHT?

1❑ None or beds

CC70

SECTION B - CLASSIFICATION INFORMATION (CONFIDENTIAL)

ASSURANCE OF CONFIDENTIALITY - All information which would permit identification of the individual facility will be held instrict confidence, will be used only by persons engaged in and for the purposes of the survey, and will not be disclowd orreleased to others for any purposes.

12.a. WAS THIS BUILDING ORIGINALLY CONSTRUCTED FOR USE AS A NURSING HOME, REST HOME, CONVALESCENTHOME, HOME FOR THE AGED?

CARD 3ccl 1-3 ❑ Yes

F

❑ No12-1 -2

(Skip to next page)

b. WHAT WAS THE ORIGINAL PURPOSE AND USE OF THIS BUILDING? (Mark (X) only one box.)

13-1 ❑

“2 •1

-3 •1

I~cl

-5 •1

~cl

Private home (i.e., singlefamily dwelling)

Duplex (2 to 4 units)

Apartmant house(5 or more units)

Hotel or motel

Hospital

Other (Spscify) 14-

Form 73 NHS-1

5B

Intawlawar:tin back of

War todmlnlctmtorfor qu09t10ns13 throuoh 17.

THE FOLLOWING QUESTIONS ON ADMISSIONS AND DISCHARGES CONCERN CALENDAR YEAR 1972,WHICH IS THE PERIOD OF JANUARY 1,1972 THROUGH DECEMBER 31, 1972. IF YOUR ANSWERS TOTHESE QUESTIONS COVER A PERIOD OTHER THAN CALENDAR YEAR 1972. WHAT IS THIS OTHER TIME PERIOD7

From _ _ through _ _

Month Year Month Year

ccf5,16 CC17,16 CC19,20 CC21,22

13. HOW MANY PERSONS WERE ADMITTED TO THIS FACILITY DURING 1972?

Admissions

CC23

14. HOW MANY PERSONS WERE DISCHARGED FROM THIS FACILITY DURING 1972, EXCLUDING DEATHS?

DlaahsrgasC027

15; HOW MANY PERSONS DIED DURING 1972 WHILE RESIDENTS OR PATIENTS OF THIS FACILITY?

DeathsCC31

16, IN 1972, WHAT WERE THE TOTAL INPATIENT DAYS OF CARE PROVIDED? (THE SUM OF THE DAILY PATlENT CENSUSCOUNT FROM 1/1/72 THROUGH 12/31 /72.)

Days ❑ (mark (X) if estirrwtad)

CC35 41-1

17. HOW MANY ROOMS FOR RESIDENTS DOES THIS FACILITY HAVE THAT CONTAIN:

a, ❑ None or 1bad onlyCC44

b. ❑ Nonaor 2 beds

CC4S

c. ❑ None or 3 bsdsCC52

d. ❑ None or 4 or more bedsCC56

●18, ARE ANY OF THE FOLLOWING SERVICES ROUTINELY PROVIDED TO RESIDENTS IN ADDITION TO ROOM AND BOARD?

a.

b.

c,

d,

a.

f.

9.

h,

1.

Supervision over medications which may be self -administarsd

Medications and treatments administered in accordance withphysicians’ ordars

Rub and masaaga

Halp with tub bath or shower

Halp with dressing

Help with correspondence or shopping

Help with walking or getting about

Help with sating

OR

None of the above sewices routinely provided, room andboard providad only

W-1 ❑ Yes -2 ❑ No

61-1 ❑ Yes -2 ❑ No

62-1 ❑ Yes -2 ❑ No

63-1 ❑ Yas -2 ❑ No

64-1 ❑ Yes -2 ❑ No

65-1 ❑ Yes -2 ❑ No

66-1 ❑ Yas -2 ❑ No

67-1 ❑ Yes -2 ❑ No

66-1 ❑ Yes

Form 73NHS-1

59

‘ 19. DURING THE PAST SEVEN DAYS, HOW MANY RESIDENTS RECEIVED EACH OF THE FOLLOWING SERVICES?

CARD 4ccl 1-4

a. Nasal fading b. B Iwd pressure raading c. Enema

ccl 2 IX16 CC26

d. Cetheterization e. Full bed-both f. Bowel or bledder

CC24 CC28 retraining CC32

g. OxWCn therapy h. Application of dres- i. Temparaturqxclee-

CC36sing or bandage CC40 respiration

j. Hy@ermic injection k. Irrigation L I ntravanous injection

CC4S rx52

cd4

C=256

’20, DOES THIS FACILITY PROVIDE ANY OF THE FOLLOWING PROFESSIONAL REHABILITATION SERVICES ON THEPREMISES? (THE THERAPISTS MUST BE LICENSED OR REGISTERED IN THEIR SPECIFIC PROFESSIONS.)

a.

b.

c.

d.

e.

f.

Physical therapy

Occu~tional therapy

Recreational therapy

Spaach and hawing therepy

Counseling by social worker, psychologist, or mental health

worker

Other rehabilitation services (Specify)

6s-

60-1 n Yes

61-1 ❑ Yes

62-1 ❑ Yes

63-1 ❑ Yes

S4-1 ❑ Yes

S6-1 ❑ Yes

-2 c1 No

-2 a No

-2 ❑ No

-2 ❑ No

-2 ❑ No

-2 D No

21. DOES THIS FACILITY CONDUCT TRAINING PROGRAMS FOR PEOPLE NOT ON YOUR STAFF IN COOPERATIONWITH AN EDUCATIONAL INSTITUTION?

o Yes ~ No67-1

22. WHAT ARE THE ACTUAL HOURS FOR EACH SHIFT? (Circle am or pm)

CARD 5a. Dey Shift from am

ccl 1-5 toccl 2 pm

am

.x16 Pm

b. Evanicg Shift from am to am

C&U Pm CC24 Dm

c. Night Shift from amto

CC26 pm

am

IX32 Pm

❑ No such $hift

O No such shift

Form 73 NHS.I

60

23a, 1, FOR THE DAY SHIFT YESTERDAY, WAS THE PERSON IN CHARGE OF NURSING CARE (FOR THE ENTIREFACI LITYJ: (Mark (X) Only One Box)

‘To”’’” ‘27’~G’z’’g;ke’

[

23,b, 1,

-3

-4

WHAT IS THE LEVEL OF a.3. WHAT HOURS DID~PERSONSKILL OF THIS PERSON? WORK YESTERDAY? (circle(Mark (X) Only One Box) am or pm.)

❑ RegisteredNurse

❑ Licemed Practical Nurse

❑ N.rse’s Aide

n Othr

am amfrom to —

cdl pm CC45 pm

_40-—Specify Occupation

FOR THE EV ENING SHIFT YESTERDAY, WAS THE PERSON IN CHARGE OF NURSING CARE (FOR THE ENTIREFACILITY): (Mark (X) Only One Box)

49-1 ON CALL -2

L

ON DUTY - that isawake, -3

?

NO SUCH SHIFTdreacad,and sewingtheredklents

(Skip to Part 23.c.]

b.2. WHAT IS THE LEVEL OF b.3. WHAT HOURS DID THIS PERSONSKILL OF THIS PERSON? WORK YESTERDA~rcle(Mark (X) Only One Box) am or pm.]

w-1 •1

“2 •1-’cl-$0

am amRagiaterad Nurse from to

CC52 pm CC66 pm

Licensed Practical Nurse

Nurse’s Aide

Other 51-Specify Occupstio”

23,c. 1. FOR THE NIGHT SHIFT YESTERDAY, WAS THE PERSON IN CHARGE OF NURSING CARE (FOR THE ENTIREFACILITY): (Mark (X) Only One Box)

~“”c’’’”’e:‘3uN0sucHs61-1

-2

-3

4

❑

•1•1•1

5p3cify OccupatiOn

~(Sk,p to Question 24)

WHAT IS THE LEVEL OF c.3. WHAT HOURS DID THIS PERSONSKILL OF THIS PERSON? WORK YESTERDA~rcle(Mark (X) Only One Box) am or pm.)

am amRagicceradNurse from to

CC63 pm a67 pm

Licensed Practicsl Nurse

Nurse’s Aide

Other 62-.

24. HOW MANY DIFFERENT PHYSICIANS CURRENTLY ATTEND THEIR OWN PRIVATE PATIENTS IN THIS FACILITY?(DO NOT COUNT PHYSICIANS WHO ARE ONLY ON THE STAFF OF THE FACILITY OR ARE ONLY EMPLOYEDUNDER CONTRACT.)

Physicians

CC71

Form 73N HS-1

61(:

--.

25a. WHAT TYPE OF STAFF MEMBER EXERCISES DAILY, ON-DUTY SUPERVISION OVER ALL CLINICAL SERVICESIN THIS FACILITY? (Mark (X) Only One Box.)

Administrator . . . . . . . . . 76-1 -b. IS THE ADMINISTRATOR ALSO A:

physician 76-1 ❑ Yes -2 a No

ragieterad nurse 77-1 ❑ Yes .2 a No

Iksnsed practical 78.1 f’-J Yes -2 a NCJnurse

Physician . . . . . . . . . . ..76-2n

Ragisterad Nuraa . . . . . . . *CI

Other . . . . . . . . . . . . . . -4

YSfmoifv 78-

●26. DOES THIS FACILITY PROVIOE ANY OF THE FOLLOWING SERVICES TO PERSONS WHO ARE NOT RESIDENTS OFTHIS FACILITY?

a, Day care (sarvices provided during the day to pareons who

CARO 6 do not sleep in the home overnight. Oay cara services can

CC1l-6 include nursing sare, physical or occupational therapy,racraat”mna I activities, at beet one full meal a day) . .. . . . . 12-1 a Yes -2 ❑ No

b. Meals eithar home delivered or in a group sating . . . .’. . 13-1 ❑ Yes -2 ❑ No

c. Transportation andlor escort sawices, . . . . . . . . . . . . . 14-1 ❑ Yes -2 ❑ No

d. Homemaker orchureeavices . . . . . . . . . . . . . . . . 15-1 l_J Yes -2 0 No

e, Information andlor raferral for health needs . . . . . . , . 16-1 ❑ Yes -2 n No

f. Friendly visiting . . . . . . . . . . . . . . . . . . . . . . . . . . 17-1 ❑ Yes -2 ~ No

9. Oailytelephone checking sawice . . . . . . . . . . . . . . . . 18-1 ❑ Yes -2 ❑ No

h, Arrangement orprovision ofrecreational activities . . . ...19-1 ❑ Yes -2 ❑ No

i. Laundry aarvke . . . . . . . . . . . . . . . . . . . . . . . ...20-1 ❑ Yes -2 ❑ No

i. Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

P

21-1 Yes -2 ❑ No

Specify 22-

27a. DOES THIS FACILITY KEEP A WAITING LIST OF PERSONS TO BE ADMITTED WHEN A BED BECOMES AVAILABLE?

Al ‘es❑ No (SkiP to Question 28)

-2

b. HOW MANY PEOPLE ARE ON THIS WAITING LIST?

❑ Noneor — r=wleCC24-26

c. DO YOU PROVIDE ANY SERVICES TO THE PERSONS ON THIS WAITING LIST?

PYes ❑ No (Skip to Q.essio. 28)

27-1 -2

* c.(1) WHICH OF THE FOLLOWING SERVICES DO YOU PROVIDE?a,

b.

c.

d.

0,

f.

91

h.

i,

i.

Day care (sarvices lxovided durirrg tha day to paraons whodo rwt daep in the home overnight. Day care sarvicaa caninclude nursing care, physical or occupational therapy,racraationel activities, at least one full meal a day). . . . . . . 28-1 ❑ Yes -2 •1 No

Meals either home delivered or in a group setting . . . . .. 28.1 ❑ Yes -2 ❑ No

Transportation and/or eecort earvicas. . . . . . . . . . . . . . 30.1 ❑ Yes -2 ❑ No

Homemaker orclwres.ewices . . . . . . . . . . . . . ...31.1 ❑ Yes -2 ❑ No

Information awJ/or refwral for health needs . . . . . . . . 32-1 ❑ Yes -2 ❑ No

Friendly visiting . . . . . . . . . . . . . . . . . . . . . . . . 33.1 ❑ Yas -2 ❑ No

Daily telephone checking service . , , . . . . . . . . . . ...34.1 ❑ Yes -2 ❑ No

Arrangement or provision of recreational activities . . . . . . 35-1 l-J Yes -2 ❑ No

Leumlry aervioe . . . . . . . . . . . . . . . . . . . . . . . ...38.1 a Yes -2 ❑ No

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...37-1

P

Yes -2 ❑ No

SPacif y 38-

Form 73NHS-1

62

●28. DOES THIS FACILITY INCLUDE AS PART OF ITS BASIC CHARGE TO EACH RESIDENT THE CHARGES FOR:Yes No

●. Physician servims . . . . . . . . . . . . . . . . . . . . . . . . 39-1 ❑ “2 ❑

b. Private dutynursing . . . . . . . . . . . . . . . . . . . . . . 40-1 ❑ -2 ❑

c. Other nursing services . . . . . . . . . . . . . . . . . . . ...41-1 ❑ -2 ❑

d. Therap y . . . . . . . . . . . . . . . . . . . . . . . . . . ...42-1 •1 “2 •1

●. Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . ...43-1 •1 “2 •1

f,. Medkalsupplies . . . . . . . . . . . . . . . . . . . . . . . . 44-1 ❑ “2 o

0. Specialdlet, . . . . . . . . . . . . . . . . . . . . . . . . ...45-1 c1 -2 0

h, Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...46-1

P-2 c1

Specify 47-

29. HASTHISNURSING HOME BEEN IN BUSINESSATTHISADDRESS FOR LESSTHAN TWOYEARS? (COUNT FROMTHETIMEITFIRSTOPENED ATTHISADDRESS ASANURSINGHOME EVENTHOUGHTHE OWNERSHIP ORTHE SERVICESOFFEREDMAYHAVE CHANGED.)

1- Yes ; No50-1

Do Not Administer Expenea Questionnaire

63

RESIDENT CONTROL RECORD

1973 Nursing Home Survey

National Center for Health StatmlcsHealth Remurces AdmmmrationRockville, Maryland

Sheet_ _Sheets

&ESTABLISHMENT NO.

TOTAL RESIDENTS IN HOME ccl .6 111111CC12-15 CC2 ccl 1.1

IN SAMPLECC16-19

1

RESIDENTS IN NURSING HOME

SAMPLE

DESIGNATION

Sw

TE

a

NAME OF RESIDENT

b

LINENo.

c

I

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

1S

19

20

21

22

23

24

25

SAMPLE NAME OF RESIDENT

DESIGNATION

Sw I

I

I

LINENO.

c

26

27

28

29

30

31

32

33

34

35

36

37

3S

39

40

41

42

43

44

45

46

47

4S

49

50

Form 73NHS.6 If More Lines Are Needed CONTINUE ON THE BACK

64

RESIDENT CONTROL RECORD

I RESIDEP rs IN IURSING HOME—

SAMPLE NAME OF RESIDENTDESIGNATION

SAMPLE NAME OF RESIDENTDESIGNATION

Sw

TE

a b

LINEUo.

LINENO.

Sw ITE I

a bc c—

76

77—

78

51

52

53

54

55

79

m

56 81

57 82

58

59

63

64

85

86

60

61

62 87

8863

64

65

66 91

67

68

92

93

69 94

70

71

72

95.

96—

97

I

73

74

75

98

99.

00—

Form 73NHS43 If More Lirm Are Needed Use A New RESIDENT CONTROL RECORDAnd Renumber The Lines Beginning With # 101

65

RESIDENT QUESTIONNAIRE

1973 Nursing Home Survey =

National Center for Heelth StatisticsHealth Resources Administration

Rockville, Maryland1-7

ASSURANCE OF CONFIDENTIALITY – All information which WOUM permit identificationESTABLISHMENT NO.

of ttw individual will be held in strict mnfklence, will bc used only by persons engcgad in and forthe purpwes of the survey, and will not be disclosed or released to others for any purpases.

CC2

LINE NO.

ccl 1ccl 4-1

1. WHAT IS – DATE OF BIRTH?

Onn”rnMonth Day Year A%

CC15,16 17, 18 19-21 CC22-24

2. WHAT IS – SEX? ❑ Male $1 Female25-1

3. WHAT IS – ETHNIC BACK- 26-1 ❑ Caucasion -2 ❑ Negro -3 ❑ OriwstalGROUND? (Mark (X) only

one box) -4 ❑ Spanish American -5 ❑ American I miian -6 ❑ Other

4. WHAT IS – CURRENT MARITAL 27-1 ❑ Marriad -2 ~ widowed

STATUS? (Mark (X) only-3 ❑ Divorced

one box) 4 ❑ Separated -5 ❑ Never Married

5. WHAT WAS THE DATE OF – CURRENT ADMISSION TO THIS PLACE?

000Month Day Year

CC28, 29 30-31 32-34

6a. WHERE DID – LIVE AT THE TIME OF ADMISSION? (Mark (X) orslyone box)

(1) In a boarding home 35-1 ❑(2) In anothaf nursing home or related facility

-2 •1

(3) In e mental hospital or other Iong-tarm specialty hospital“3 •1

(4) In a general or short-stey hospital“cl

(5) in a private apartment or house

}

“5 •1 ~b

(6) Other place,(Specify)~o”

2&(7) Don’t know

-7 ❑

(1)

(2)

(3)

(4)

(5)

(6)

AT THE TIME OF ADMISSION

DID – LIVE WITH: (Mark (X)ell that apply)

Yes

spouse? 37-1 ❑ .2

Children? 38-1 ❑ -2

Other relativea? 38-1 ❑ .2

Unrelated parsons? 40.1 ❑ -2 ❑

Lived alone? 41-1 ❑ -2 ❑Don’t knaw? 42-1 ❑

7. WHAT IS THE PRIMARY REASON FOR – ADMISSION TO THE HOME? (Enter”1” in box for primary reason; if secondary

reason given, enter W“.)

43- ❑ Physical reesons (e.g., illness or need for treatments)

44D .Scmial reesons (e.g., no family, or lack of family intarast)

‘%-n 8ehwiorel reaaans (e.g., disruptive bahcvior, mental detariomtio”)

46-U Economic reasans (e.g., no money .snd/or reaoarcas)

Form 73NHS-7

66

8. WHAT WAS THIS RESIDENT’S PRIMARY DIAGNOSIS: (Mark(X) onlyonebox in=h ~lumd

a. AT ADMISSION? b. AT THE TIME OF–LAST EXAMINATION?

49,50 •1 001 51,52 ❑ bill

•1 002 ❑ b02

❑ 803 ❑ bm

•1 KM clbcM

•l aCE ❑ b05

•1 rim ❑ lbos

•1 ,07 ❑ b07

•l aOS ❑ bOB

•1 .09 clbo9

•l alO ❑ b10

•1 ,11 ❑ bll

•l a12 ❑ b12

•1 .13 ❑ b13

❑ ●14 ❑ b14

•l a16 ❑ b15

❑ a16 ❑ b16

•l a17 ❑ b17

•1 ala ❑ b18

•1 ,19 ❑ b19

•l a20 ❑ b20

❑ *21 ❑ b21

•l a22 ❑ b22

Senility, old age, and other symptoms and illdefined conditions (e.g., coma, uramia)

Heart attack (a.g., ischemic heart disease)

Stroka (a.g., cerebrova.tcular diseasca)

Hardening of arteries (e.g., arteriosclerosis, disaasas of the arterias, areriolas, capillaries)

Other disaaa?s of the circulatory system (e.g., NOT heart attack, stroke, or h=dening of the arteries)

Accidanta, poisonings, and violence (e.g., fractura of hip, other bmkan bones, burns, concussion)

Mental disorders (a.g., mental retardation, psychoses, neurosas, mental illness, emotional problems)

Oisea.sasof the musculoskeletal system and connective tissue (e.g., arthritis, rheumatism, &k psi”)

Endocrine, nutritional, and metabolic diseases (e.g., goiter, diabetes, gwt)

Oisecsas of the respiratory system (e.g., pneumonia, amphyssma)

Neoplaams (e.g., cancer, tumors)

Oiseases of tha nervous system and senss organs (e.g., Parkinson’s dkecse, glaucoma, cataracta,

blindness, multiple sclerosis, spastic paralysis, epilepsy)

Disaasas of the digestive systam (e.g., cirrhosis of Iivw, ulcer, intestinal obstruction)

Infective and parasitic diseases (a.g., T. B., polio, syphilis)

Diseases of the genitourinary system (e.g., nephrosis, chronic pelvic infection, hyperplasia of prostate)

Oiseasas of tha skin and subcutaneous tissue (e.g., cellu Iitis, abscess, chrcmic ulcer)

Disecsas of the blwd and blood-forming organs (e.g., anemia)

Congenital anomalities (e.g., hydrocaphalus)

Complications of pregnancy, childbirth and the puerparium (a.g., in fections,hamorrhaga, toxamias)

Certain causes of parinatal morbidity and morWity (e.g., birth injury or immaturity of infant)

Oon’t know

Other (Specify) 54-

\ Specify:

9, DOES – HAVE ANY OF THE FOLLOWING CONDITIONS OR IMPAIRMENTS? (Mark (X) ail that apply}

CC55.65 -1

-2

.3

-4

-5

-6

-7

-8

-9

.0

.&

❑ a. Sanility (includes decline in intellect, memory, and judgement, loss of orientation, difficulty in speaking; feckdeness.)

❑ b. Mental illnass (Psychiatric or emotional problems)

l-J c, Mental retardation

❑ d. Arthritis or rheumatism

%

Paralysis or palay other than arthritis

a. (1) IS THIS THE RESULT OF A STROKE?

❑ f. Glaucoma or cataracts

•1 9. Oiabates

❑ h. Any CHRONIC trouble with back or spit-m

❑ Yas ❑ No

66-1 -2

❑ ❉✎ Amputation of axtremitias or limbs or permanent stiffness or any deformity of tha foot, lag, fingars, arm, or back

❑ L Heart trcmbla

OR

❑ k Resident has none of the above conditions or impairments

Form 73N KS-7

67

10. DOES THIS RESIDENT REGULARLY USE ANY OF THE FOLLOWING AIDS?

NoCARD 2

14-2 a, Walkar 15-2 Q

b. Crutches 16-2 ❑

c. Bracas 17-2 ❑

d. Wheelchair 1s-2 ❑

a. Artificial Limb 19-2 ❑

f. Salf-faedar 20-2 ❑

9. Any other aids (do not count glaasas or hearing aids) 21-2 ❑

Yes

-1 •1-1 •1-1 c1-’ c1-1 c1“’ •1-’ c1

\Specify 22-

11. DURING THE LAST MONTH, HOW MANY TIMES DID–RECEIVE AN’f OF THE FOLLOWING THERAPY SERVICES? (INCLUDE

ONLY SERVICES PROVIDED BY A LICENSED OR REGISTERED PROFESSIONAL WHETHER INSIOE OR OUTSIDE THE hOME.)

NUMBER OF

TIMES

a.

b.

c.

d.

e.

f.

Physical therapy ❑ None.r I ICC23

❑ Noneor 1 Iw25

Occupational tharapy ❑ None or I 1cc27

Speech therapy ❑ Nonaor ICC29

Hearing therapy ❑ Nc.”eor ICC31

Profeational counseling by seeial

worker, psychologist or other

marital health worker ❑ Ncmaor \ ICC33

12. DURING THE PAST 7 DAYS, WHICH OF THESE SERVICES DID–RECEIVE? (Mark (X) all that apply)

CC35-62 -01 ❑ a.

-02 ❑ b,

-03 0 c.

-04 ❑ d.

-05 ❑ e.

.06 ❑ f.

-07 •1 9.

-OB ❑ h.

-09 ❑ i.

-10 c1 i.

-11 ❑ k.

-12 ❑ 1.

-13 ❑ m.

OR

-14 ❑ n.

Rub or maesage

Admirsiatration of treatmant by staff

Spatial diet

Application of sterila drasinga or bandagas

Temperatu~pulsa-respiration

Full bad-bath

Enema

Catheterization

Blood praesure reeding

Irrigation

Oxygen therapy

I ntrevenous injection

Hypodermic injection

None of tha almva eervicas racaivad

Form 73NHS-7

68

13. DURING THE PAST 7 DAYS, DID – RECEIVE ANY MEDICATIONS?

CARD 3T

g ‘“(sk~ ‘esWHICH TYPES OF MEDICATIONS DID – RECEIVE?

cc16-45 .01 ❑ a.

-02 ❑ b.

-03 f-J c.

-04 ❑ d.

-05 ❑ e.

-06 ❑ f.

-07 ❑ g.

-IX ❑ h.

-09 ❑ i,

-10 H j.

-11 ❑ k.

-12 ❑ 1.

-13 ❑ m.

-14 ❑ n.

-15 ❑ 0.

(Mark (X) All That Apply)

Tranquilizers (e.g., Thorazine, Mellaril)

Hypnotics - Sadatives (e.g., Nembutal, Seconal, Phenobarbital, Butisol, Placidyl, Chloral Hydrate)

Stool softeners (e.g., Peri-COlace)

Anti-Depressant (e.g., E Iavil)

Anti-Hyper’tensives (e.g,. Ismelin)

Diuretics (e.g., Diuril, Esidrex)

Analgesics (e.g., Aspirin, Darvon, Demerol, Percodan, Empirin with Codeine)

Diabetic agents (e.g., Orinase, I MI Iin)

Anti-inflammatory agents (e.g., Cortisone, Sodium Salicylate, Butazolidin, I ndocin)

Anti-infwtives (i.e., antibiotics)

Anti.Anginal drugs (e.g., Nitroglycerin, Peritrate)

Cardiac Glycosidas (e.g., Digitalis, Lanoxin)

Anti-Coagulants (e.g., D icumarol, Warfarin)

Vitamins or iron

Other types of medications not Iismcl z?to.

14. THE FOLLOWING ACTIVITIES FOR DAILY LIVING LIST ~. I I . Js LEVELS OF CARE THAT MAY BE NEEDED BY ARESIDENT. PLEASE INDICATE THE ONE THAT 131%TDESiXIBES THE LEVEL OF CARE NEEDED BY ~RESIDENT.FOR EACH ACTIVITY, THE LEVELS ARE GIVEN IN ASCENDING ORDER: IN OTHER WORDS, THE LEVEL DESCRIBINGTHE MINIMUM CARE IS FIRST AND THE LEVEL DESCRIBING THE MOST CARE 1S LAST. IF YOU ARE UNDECIDEDWHICH OF TWO LEVELS TO INDICATE, CHOOSE THE ONE DESCRIBING THE LESSER AMOUNT OF CARE:

a. CONSIDERl;dG THE FOLLOWING FOUR HYGIENE ACTIVITIES (WASHING FACE AND HANDS, BRUSHING TEETH ORDEPJ-I IJI?E5, COMBING HAIR, AND SHAVING OR APPLYING MAKE-UP) DOES THIS RESIDENT:

(IWi (A] CIIIIVOne Box)

“’”1 ❑ perform all four with “o assi~ta”ce?

‘2 ❑ pefiOrm all four with no assistance, but needs help in getting and/cm p“tti”g away ~uiPme”t?

‘3 ❑ ‘erfwm threa Or fOur with no WSkt&W3, but requires help with a complete bath?

‘4 ❑ R~uire a$si$tance with one or two of these hygi~”e ~ctivitie~?

“5 ❑ Rwire a~istanca with all four of these hygiene~tivitie~?

b. CONCERNING DRESSING, DOES THIS RESIDENT:

(Mark (X) Only One Box)

47.1 ❑ Get clothes from closets and drawers and completely dress without assistance?

.2 ❑ Get clothes from clo~ets and drawers and cOmpletaW dra~ with sOme assistance (tying shOes, fastening braces, closing buttons orzippers in back of garments) ?

“3 ❑ Receave a=istance in *tting clOthes. or in dre=ing (dO nOt cOunt Wing shOes, faflening brwes, closing buttons or zippers in backof garments as assiatanca) ?

.4 ❑ StaY PartlY Or completely undressed?

c, CONCERNING FEEDING, DOES THIS RESIDENT:


4s-1 ❑

“2 •1“3 c1-40-5 •1

Feed self without assistance?

Faad self with minor assistance (cutting meat or buttering bread)?

Receive major asaietance in feading (do not count cutting meat or buttarmg bred)?

Raquire intravenous feeding?

Require tubs f-ding?Form 73N HS-7

69

d. CONCERNING AMBULATION TO REACH THE TOILET ROOM, IS THIS RESIDENT


51-1 ❑ Able to go to the toilet room without nurses’ assistance (may use cane, walker, wheelchair, or other tiject of support), maymenage badpan or commode at night?-—

-2 ❑ Receiving nurSaS’ easistwsca in going to the toilet room (do not count use of cane, walkw, or other object of SUppOII),using bedpan or commode ●t night, or c!eening self or arranging clothes after elimination?

‘3 n Unable to go to the toilet room for the elimination pro-?

e. CONCERNING MOVING IN AND OUT OF A BED OR CHAIR, IS THIS RESIDENT

Receiving no assistance?

Walking with asai$tanm of one person?

Walking with asai$tence of two persons?

UP in a chair with assistance once in 8 hours?

Up in e their with assistance twice in 8 hours?

Bedfast with assistance in turning every two hours?

Bedfast with aetistance in turning every hour?

f. CONCERNING CONTINENCE, IS THIS RESIDENT:

In control of both trowels and bladder?

An ostomy patient?

In control of bladder only?

In control of bowels only?

Not in control of bowels or bladder?

[Mark (X) Only One Box)

52-1 ❑

-2 •1

-3

7-4 •1

F-5 ❑ 53-1e.(1) DOES – HAVE

7 ‘es 9

No-6 •1 BED SORES?

-7 •1 (continue with part f,)


54-1 ❑

-2 El

k

-3 •1

-40 f.(1) IS – RECEIVING BOWEL AND/ORBLADDER RETRAINING?

“5 ❑55-1 ❑ Yes (Skip to Question 15a.)

+fJ2) WOULD RETRAINING GIVE THIS

RESIDENT CONTROL OVERBOWELS AND/OR BLADDER?

FOLLOWING BEHAVIOR?

No

(1) Depressed 57-2 ❑ -1

(2) Agitated, nervous 59-2 ❑ -1

(3) Abusive, a~essive 61-2 n -1

(4) Confusad, smile 63-2 a -1

(5) Disturbad sleep 65-2 ❑ -1

(6) other Problembehavior 67-2 ❑ -1

15a. DOES THIS RESIDENT EXHIBIT ANY OF THE b. DOES THIS RESIDENT EXHIBIT THIS BEHAVIOR

MORE OFTEN THAN ONCE A WEEK OR ONCE A WEEKOR LESS?

Yes More often thanonce a week

5S-1 ❑

•1 - 60-1 ❑- 62-1 ❑

•1 - 64-1 ❑

•1 s 66-1f-J@ (Spacify) 56- ~ 69-1 ❑

Once ● weekor less

-2 •1

.2 •1

-2 •1

-2 ❑-2 •1

.’2 •1

Form Z3NHS-7

70

1Be. DURING THIS RESIDENT’S STAY HERE, WHEN DID – LAST SEE A PHYSICIAN FOR TREATMENT, MEDICATION, OR FORAN EXAMINATION?

‘s===7 OR ,7, Ha$ NaverSaenA Doctor While Here (Skip toQuestion 17a.)

b,

c,

d.

AT THAT TIME, DID – RECEIVE :Yes

(1) An examination? 22-1 ❑ -2 L1

(2) Treatment? 23-1 ❑ “2 •1

(3) Prescription? . 24-1 ❑ “2 ❑(4) Other? 25-1

Y

-2 •1

specify 26.

DID THE PHYSICIAN ATTEND THE RESIDENT: (Mark (x) Only One Box)

27-1 ❑ as a private physician?

.2 H for the home it*lf which furnishes the medical care?

‘3 ❑ temWrarilY as a replacement fOr the resident’s private physician who was unable to attend the re$ide”t?

-4 ❑ under aema other arrangement? (Specify) 2s-

DOES A PHYSICIAN EXAMINE THIS RESIDENT: (Mark (X) Only One BOX)

29-1 ❑ only when called?

“2 ❑ im%darlY, but without being called?

-3

\

on ● achaduled basis?

d. (1) HOW OFTEN DOES THE PHYSICIAN EXAMINE THE RESIDENT?(Mark (X) Only One Box.)

301 ❑ once a week

-2 ❑ every 2 weeks

-3 ❑ once a month

-4 ❑ ewery three months

-5 ❑ once a year

-6 D other (Specify) 31-

17a, DOES - WEAR EYE GLASSES?Yas No

932-1

9-2

b, IS - SIGHT WITH GLASSES: (Mark (X) Only One Box) c. IS – SIGHT: (Mark (X) Oniy Onc Box)

33-1 ❑ not impaired? (e.g., can mad ordinary newspaper 33-1 ❑ not impaired? (e.g., can read ordinary newspaper

print) print without glaasaa)

.2 ❑ partially impaired? (e.g., can watch television 8 to ‘2 •l pa~ially impaired? (e.g., can watch television 8 to12 feet across the room) 12 feet acroes the room)

‘3 ❑ weraly iIWMiti? [e.g., can recognize the featuresof familiar persons if they are within 2 to 3 feet)

-3 ❑ Swerely impaired? (e.g., can racognize the faaturesof familiar pcraons if thay are within 2 to 3 feat)

.4 ❑ completely lost? (e,g., blind) -4 ❑ @mPl@teW 10*? (e.g., blind)

18a, DOES - USE A HEARING AID?Yes

wb, IS - H~ARING WITH A HEARING AID: c.


35-1 ❑

“2 ❑

“3 ❑

“4 •1

No

%-2

IS –HEARING: (Mark (X) Only One Box)

not impaired? (e.g., can hear a telephone conversationan an ordinary telephone)

partially impaired? (a.g., can hear most of tha things

a person WYS)

aevarely impaird? (a.g., can haar only a few words aWrson aeys or loud noims)

completely loet? (e.g., deaf)

35-1 ❑

-2 •1

-3 ❑

~cl

not impaired? (e.g., can hesr a telephoc-a conwraationon an ordinary telephone)

partially impaired? (e.g., can hear moat of the thingsa person cays)

severely impaired? (e.g., can hear only a fcw words aperson says or loud noises)

completely lost? (e.g., deaf)Form 73NHS-7

71

19. IS – ABILITY TO SPEAK: (Mark (X) Only One Box)

38-1 ❑ not impaired? (e.g., is able to be understood; can carry on a normal conversation)

‘2 ❑ PartiallY impaired? (e.9., is able to be understmd but has difficulty pronoumi”g some words)

‘3 ❑ s~erely im~irad? (.%9., cannot carry on a nOrIIIal conversation; is understood only with difficulty)

‘4 •l completely lost? (e.g., is mute)

20a. DOES THIS RESIDENT HAVE DENTURES?

•1 Yes

7

~ No (Skip to Questicm 21..)39-1

b, DOES – USE THE DENTURES?

❑ Ye, ~ No40-1

21a. DURING THE LAST MONTH, DID – LEAVE THE HOME FOR ANY RECREATIONAL OR LEISURE ACTIVITIES?

A ‘es AN’b. FOR-WHICH OF THE FOLLOWING ACTIVITIES c. WHY-DIDN’T – LEAVE THE HOME TO PARTICIPATE IN

OID – LEAVE THE HOME? (Mark {X) All That Apply) ANY ACTIVITIES DURING THE LAST MONTH? (Mark (Xl

CC42-52 -1 ❑

-2 •1

-3 •1

-4 •1

-5 •1

-5 ❑

-7 •1

-8 ❑

-9 •1

-0 •1

-&U

All That Apply)

Get books, etc., from the library CC42-52 -1 ❑

Attend plays, movies, concerts, etc.

-2 •1Attend arts and crafts classes outside the home

-3 •1Visit museums, parks, fairs, etc.

Goon shopping trips organized by the home 40

Goon independent shopping trips organizedby the resident or visitors “5 •1

Visit a beauty shop or barber shop ~u

Visit community clubs (such as community ten. -7 •1ters, senior citizen clubs, service clubs, bridgeclubs, unions, etc.) -8 ❑Attend religious sewices or other religious activities

Go for a walk

Other. (Spacify) 53-

Resident was too Ill or was not abla ~ movewell enough to participate

Resident wac not interested

Staff was unable to determine resident’s interestsat this point

Staff feek that the resident’s behaworwill not be toleratad outside the home

No one was available to accompany the resident

Resident cannot afford these activities

Leek of transportation

Other, (Specify) 53.

22a. DURING THE PAST YEAR, HAS THIS RESIDENT BEEN ON ANY KIND OF LEAVE OVERNIGHT OR LONGER,EXCLUDING LEAVE FOR MEDICAL REASONS?

❑ Yes D No Ekip to Question 233.)

? -2

❑ Oo”t kmwv (Skip m (l&sticm 23a,)

54-1 -3

b. WHERE DID – USUALLY GO WHEN ON LEAVE? (Mark (X) Only One BOXI

55-1 ❑

-2 •1

-3 •1

-4 El

“5 •1

-6 ❑

-7 •1

To own home or apartment

To home of family or relatwes

To home of unrelated friends

To foster home

To boardinghouse or mom

To another placa, (Specify) 56-

Don’t know

c. ABOUT HOW OFTEN DID THIS RESIDENT GO ON LEAVE? (Mark (X) Only One 80X)

57-1 •1

-7- •1

“3 •1

-4 •1

“5 •1

-6 ❑

-7 ❑Form 73N HS-7

Nearly every week

About once a month

About once every two months

Saveral timas a year

About onca a year or less

Other (Specify) 56-

Don’t know

72

23a, DOES - HAVE ANY VISITORS?

* p’” ,goue,.:’tkn”w

b. HOW FREQUENTLY DO VISITORS SEE THE RESIDENT? (Mark (X) Only One Box)

16-1 ❑ Nearly wery week ‘5 ❑ AbOut once a year w Ie~~

‘2 ❑ About once a momh-6 ❑ Other (Specify) 17.

‘3 ❑ AbOut once every two momtw-7 ❑ Don’t know

.4 ❑ Several times a year

24, HOW MANY BEDS ARE IN – ROOM? (Mark (X) Only One Box)

18-1 ❑ One bed (i.e., the resident’sown bed) -4 ❑ Four beds

-2 n Two beds -5 ❑ Five or more beds

-3 ❑ Three bsds

25a, HAS THIS RESIDENT LIVED IN THIS FACILITY FOR ONE FULL MONTH OR LONGER?

❑ Yes ~ N0719.1

Stop; goon to nextquestionnaire.

b. LAST MONTH, WHAT WAS THE BASIC CHARGE FOR THIS RESIDENT’S LODGING, MEALS, AND NURSING CARENOT INCLUDING PRIVATE DUTmSING OR OTHER SPECIAL CHARGES?

❑ Noctrarge isrnedeforcare (Skip to Question 28a.) $ ●

CC20-25

c. LAST MONTH, WHAT WAS THE TOTAL CHARGE FOR THIS RESIDENT’S CARE, INCLUDING ALL CHARGES FORSPECIAL SERVICES, DRUGS, AN=IAL MEDICAL SUPPLIES?

❑ Nochqa ismadeforcare LSkiptoflmstion 26a.)

~ ‘ cc=-” “—(1) DID THIS AMOUNT INCLUDE SPECIAL CHARGES FOR

No Yes

(a) physicianservices? 32-2 ❑-’ ❑

(b) private duty nursing? 33-2 ❑-’ •1

(c) therapy? 34-2 ❑ -1 •1

(d) drugs? 3%2 ❑ -1 ❑(e) special medical suppli=? 36-2 n

-’ •1

(f) special diet? 37-2 n “’ •1

(g) other?

P

38-2 ❑ -1

Specify -39

2Ba. WHAT WERE *THE SOURCES OF PAYMENT FOR THIS RESIDENT’S CARE LAST MONTH?(Mark (X) All That APPW)

CC40-48 ❑ (1) Own income or family ❑ (4) Other p.blicaasistancesupport (private plans,

❑ (7) Initial lmymem-or welfare I ife care

retirement funds. socialsecurity, etc.) ❑ (5) Church aupmrt ❑ (8) N0.hww is made

❑ (2) Medicare (Title XVIII) ❑ (6) VA comract

❑ (3) Medicaid (Title XIX)

for care

❑ (9) Othai (Specify) ~ ~o-

b, WHAT WAS THE PRIMARY SOURCE OF PAYMENTS FOR: CARE LAST MONTH?(Mark (X) Only One Box.)

60.1 ❑

-2 •1-3 •1

Own income or family4 ❑ Other Public assistance -7 •1

WWft (prtiate plans, or welfare

retirement funds, eocialsecurity, etc.) . -5 ❑ Church wpport

=0

Medicare (Title XVI II) -6 ❑ VA contract

-9 c1Medicaid (Title XIX)

Initial payment-Iife care

No char~ is madefor care

Other (Specify) ~

51-Form 73NHS-7

73

STAFF CLASSIFICATION CARD

1973 Nursing Home SurveyNational Center for Health StatisticsHealth Resources Administration

Rockville, Maryland

WHICH OF THE FOLLOWING JOB CATEGORIES BEST FITS THE JOB WHICH THIS EMPLOYEE DOES IN THIS FACILITY?

01.

02.

03.

04.

05.

06,

07.

08.

08.

10.

11.

12.

13.

14.

15.

16,

17.

18.

19,

20.

21.

22.

23.

ADMINISTRATOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PHYSICIAN (M. D. OR D.O.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DENTIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PHARMACIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

REGISTERED OCCUPATIONALTHERAPIST . . . . . . . . . . . . . . . . . . . .

REGISTERED PHYSICALTHERAPIST . . . . . . . . . . . . . . . . . . . . . . . . . .

ACTIVITIES DIRECTOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DIETITIAN OR NUTRITIONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

REGISTERED MEDICAL RECORD ADMINISTRATOR . . . . . . . . . . . . . .

SOCIALWORKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SPEECHPATHOLOGISTAND/OR AUDIOLOGIST . . . . . . . . . . . . . . . . . .

OTHER PROFESSIONAL OCCUPATIONS (INCLUDES INTERN,RESIDENT,THERAPEUTIC RECREATOR) . . . . . . . . . . . . . . . . . . . . . .

OCCUPATIONTHERAPISTASSISTANT . . . . . . . . . . . . . . . . . . . . . . . .

PHYSICALTHERAPISTASSISTANT . . . . . . . . . . . . . . . . . . . . . . . . . .

SOCiALWORKERTECHNICIAN/ASSISTANT . . . . . . . . . . . . . . . . . . . .

OTHER MEDICAL RECORD ADMINISTRATORS ANDTECHNICIANS . . . .

GROUP A

EnterinColumni

of Staff Control Record

REGISTEREDNURSE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

LICENSED PRACTICALNURSEOR LICENSED VOCATIONAL NURSE . . .

NURSE’SAIDEANDORDERLY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CLERICAL, BOOKKEEPING,OR OTHEROFFICESTAFF . . . . . . . . . . . .

FOOD SERVICE PERSONNEL(COOK, KITCHEN HELP,ETC.) . . . . . . . .

HOUSEKEEPING AND MAINTENANCE PERSONNEL (MAID,LAUNDRYMAN, MAINTENANCE MAN, ETC.) . . . . . . . . . . . . . . . . . . . .

JOBOTHERTHAN THOSE LISTED ABOVE (PLEASE SPECIFY JOBTITLEON THE INDIVIDUALLINEOF STAFFCONTROL RECORD) . . . .

GROUP BEnter in Column j


GROUP CEnter in Column k


GROUP DEnter in Column I


GROUP E

EnterinColumnmof Staff Control Record

74

STAFF CONTROL RECORD\hL., . ..t.f —

1973 Nurmg Home S.rwVNat!..&l center for HealthStatmcs EziElHealth R,,o.,ct, Adm,”,,,,,t,o”17mkv,!l,, M,r”hnd

A55uRANc606 c0NFILIEN71ALITv Allmnformatnonwh,chwo.ldmrmmt ,dmd,cdt).n<,, 3 cc?

“1 the mdwduar %+11he held m ,,,,,, Cmltdence,w,lt b, “,ti .“1” by W,SOO,enga@ ESTABLISHMENT NOmmd tdr ,hesurcaMsol ,he,. rwe”,,ndw,ll ”ot~d, slo~dorrelt.~ mother,10, ,“” LW,FO,C$

INEIR

STAFF SEX ETHNICBACKGROUND EMPLOYER HOURSwORKED OccUpATlON LINENR

L,$tbelow fh, nama, of,ll ,,..,r

“m,, ,,,,,,.”?whoarean,h, st,llof the ,.,,,,” W.*, .,

!. ,.., .= ,.,. ..,, !,.. 6.,,, cd, ,,.”i s,,,, C,.,,,,,.,,,.. c.,.

or areemmwd ““d,, ,0”,,,,,.“..,., ” . . . ...- . . . .

,, W,, ,“,.,.,,,, . . ,.. ,!, !, -,, #...e. . . . . .. . 0, ,6 ,, ,8 ,9 20 z,I“dud, m,.,bor, “1 rmgm., ., ,.,. ..,, !,.. . ..., .,.mgwl!,m.”, and order, ~h. ,.,,,,. ., ,,.,, ,.. ,. , Cr... A G,-. B Gm.Pc G,... o Ea..,,, ,he\r s,r”bm, Are, code .-,,.,- ,,,, .,..,. .-”,...

L),, ,,l”m,,tra,o, and ,,,,$1,., ( ).,.,. ~.,, ~, ..,. . Sw_ W_ W _ W _ Lm.

amlln!,,rm.r ,-!.. ! -. ,. , m‘f — ‘E — ‘f — :<~ m NOT

Ex,lu,ievdlumm,,!..,!,!,.,,. . . :::,, :.,:,, ..~~ WLE

,.-!. *%.

L,,, p,<,an, ,ncharwola,h, f,P“-., .“-, ,.m”, ,.w.,

0“ m, m m,,, ,,.0, ., .0 . . . . . .t-.’...” [m.- 6.-$..- f-v..”, [m.,,.s,,, , ~,, ~,, , ,, .,,

r

(1) lb) (cl id)l!,,

w m w . . !. . . ,. M,,,. .%.,..,,4 <,,5 .,:’,9 :~’. 7 5-.4. ~ s,..,. ,,m!.

. ..< 0,,.. !.! . . .

“; ‘“; ! ‘: ~ :- ‘“~”’; “::::; :;:: ‘“5 ““ c’” ‘“

J&, A ,2 . %,, A 2, .s=

kol 12 1 23456 12 12

,02x01

12 123456 ,2 ,2

m3x02

12 123456 ,2 ,Z

01

x03

12 1?34!,6 12 ,Z

0201

12 1 23456 12 12

0302

12 123458 ,2 12

0403

12 1 23456 12 12

0504

12 123456 12 {2

0605

12 1 23456 12 12

0706

12 123456 12 12

COm

12 123456 1* ,2

04m

12 123656 ,* 12 I!0

m12 ,2345E ,2 12

111:

12 123456 12 12

1211

12 1 23456 12 12

1312

17 123456 ,2 ,Z

1413

12 12 3456 12 12

1614

12 T 23456 12 12

16

15

12 1 23456 12 12

1716

12 1 23456 12 12

10

17

12 123456 12 ,2

1918

12 123456 12 12

20

1912 123456 12 ,2

2120

12 123456 ,* 1?

2221

12 1 23456 12 12

23

2212 1 23456 12 12

24

23

12 1 23466 12 12

2524

12 123456 12 ,*

26

25

!2 1 23456 12 12

2726

12 1 23456 12 12

2827

12 123456 ,2 ,2

29

2812 12 3456 12 12

2U

29

12 123456 12 1’2

3132

12 123456 12 ,2

3231

12 1 23466 12 12

33

32

12 1 23456 12 12

34

22

12 1 23456 12 12

35

24

12 123456 12 12

30

35

12 1 234,56 12 12

37

3612 123456 121 *

3837

12 1 23456 121 2

39

Za12 1 23456 121 2

4029

12 1 23456 121 2

41

40

12 1 23456 121 2

42

41

12 1 23456 121 2

43

4212 123456 12, 2

4443

12 1 23456 121 2

46

44

12 1 23456 121 2

46

45

12 1 23456 121 2

47

46

12 1 23456 121 2

48

4T

12 1 23456 121 2

4948

12 1 23456 121 2

60

49

12 1 23456 121 2 m

If mow hms are neededCONTINUE ON 6ACK Ccmt,nuesmplu,s pattern ON BACK. - ,W”>s

75

LINENR, STAFF SEX m4NIc SACKGROUND EMPLOYER HOURSWWIKEO CM2CUPATION

L,,, Mow the name, of all y Home tdmhon.,, ,.., m., ,.,, ,.. ,,.. E.,., ti F,w” S,,lf cwarrc.t..n C4rd

Who,r, .”the,taff ol,h, ,.,!,,” .U”,t., ., .“vr. ““ . . . ...” 0..,

.a, ,,eemllloy, du”d,, ,0”,,,., S,W,F W,,nrweei . . t“. .,.44 -,. !.!!.. . . . . .. . ~1 ,6 ,7 ,8 ,9 ~ ~,

lnd.de membsn of ,,hg,ou,., ,.,, ,,,, ,,M h.#, ,,.

.qawathansand ordamwho,.,,,, ... ,,”,,,,,”. .,,

aonate them$wwcesGwo A

A,,, cedeG,GWB GCCWc G,c.mD E

.“l,!.,.d ,, ,5 . ...” .“,..,”““d” m.” ~, ~,. ,“

L(S ad!mnt$tmtorand awtantwnmutrm.n

( 1U41#

CO”!i.,!, .,.., m,, U1’r,.,,, !. TE _ TE _ ‘w _ M _ &w

Excludev.l”n,,,rs,.,, . . .

Lmtpews., m chars+of a ,htfton the top three N.es

c... ,.?,. 6,,,, ,.,.y.: S.-m. 5.”0. %.

,.,,., ,.,,”, ,“m,

[s1 lb) k) (d) I*) (f) (9I [h).,1 ,3 ,.14 ..,5 .,16 ..17 CC1819

. ..C 0......! .“..?

I i?::f’”l-”- ““” co”””’ ::: ?:.,!. r.., . NW.

12 1 23456 12 12 ,.: n ,C: * ,,L”2, J! 22 .%,

51 12 1 23456 12 12

52 12 1 23456 12 12

53 12 1 23456 12 12

34 12 12 3456 12 ,*

55 12 123456 12 12

56 12 1 23456 12 12

r 12 1 23456 12 12

58 12 1 23456 12 12

59 12 1 23456 1.2 12

K! 12 123456 12 12

61 12 123456 12 12

62 12 12 3456 12 12

63 12 1 23456 12 12

64 12 1 23456 12 12

65 12 1 23456 12 12

36 12 123456 ,2 ,2

67 12 1 23456 12 12

m 12 123456 12 12

56 12 1 23456 12 12

70 12 1 23456 12 12

71 12 1 23456 12 12

72 12 123456 ,* ,2

73 12 1 23456 12 12

74 12 1 23456 12 12

75 ;2 1 23456 12 12

76 12 1 23458 12 12

77 12 1 23456 12 12

7s 12 12 3456 12 12

79 12 123456 12 12

m 12 )23456 12 12

81 12 1 23456 12 12

82 12 1 23456 12 12

63 12 12 3456 12 12

64 12 1 234S6 12 12

85 12 123456 I* ,Z

26 12 1 23456 12 12

87 12 1 23456 12 12

66 12 1 23456 12 12

6$ 12 1 23456 12 12

so 12 12 3456 12 12

91 12 1 23456 12 12

92 12 123456 ,* ,2

93 12 1 23456 12 12

94 12 1 23456 12 12

95 12 1 23456 12 12

% 12 123456 ,* ,*

97 12 1 23456 12 12

98 12 1 23456 12 12

59 12 1 23456 12 12

cm t, ,, . . . . ,. ,.I t

. . . . . . . . . ,. I 1 I I I I

If moreImm are neededUS!JA NEW SHEET WIdrcn.mbcr the hnm begmuns wth H 10! . . and COnunu.$mPl!nz Pattern

Fwm 73+4*S-3

76

APPENDIX IV

CRITERIA FOR CLASSIFYING

ACCORDING TO LEVEL OF

NURSING HOMES

NURSING CARE

Types of Facilities IncludedIn the Survey

Institutions included in the 1973-74 NursingHome Survey were those classified as eithernursing care homes or personal care homes withnursing according to data collected in the 1971Master Facility Inventory Surveys 0 conductedby the National Center for Health Statistics.Definitions for these two classes of nursinghomes were as follows:

Nursing care home is one in which

Fifty percent or more of the residentsreceived nursing care during the week priorto the survey. (Nursing care is defined as theprovision of one or more of the followingservices: taking temperature, pulse, respira-tion, or blood pressure; full bed bath;application of dressings or bandages; cath-eterization; intravenous, intramuscular, orhypodermic injection; nasal feeding; irri-gation; bowel and bladder retraining; oxygentherapy; and enema.)

At least one full-time (35 or more hours perweek) registered nurse (RN) or licensedpractical nurse (LPN) was employed.

Personal care home with nursing is one inwhich

Some, but less than 50 percent of theresidents received nursing care during theweek prior to the survey.

At least one full-time RN or LPN wasemployed.

or

Some of the residents received nursing careduring the week prior to the survey.

No full-time RN or LPN was employed.

The institution either:

Provided administration of medicines orsupervision over self-administered medicines.

or

Provided assistance with three or more ac-tivities for daily living (such as help with tubbath or shower; help with dressing, corre-spondence, or shopping; help with walkingor getting about; and help with eating).

I *US

000

.GOVERNMENT PRINTING OFFICE 1977- 241-10S22

I

NOTE: The list of references follows the text.

77

Series 1.

Series 2.

Series 3.

Series 4.

VITAL AND HEALTH STATISTICS PUBLICATIONS SERIES

Formeriy Public Health Service Publication No. 1000

Programs and Collection Procedures. -Reports which describe the general programs of the National

Center for Health Statistics and its offices and divisions, data collection methods used, definitions, andother material necessary for understanding the data.

Data Evaluation and Methods Research. –Studies of new statistical methodology including experimentaltests of new survey methods, studies of vital statistics collection methods, new analytical techniques,objective evaluations of reliability of collected data, contributions to statistical theory.

Analytical Studies. –Reports presenting analytical or interpretive studies based on vital and healthstatistics, carrying the analysis further than the expository types of reports in the other series.

Documents and Committee Reports. –Final reports of maior committees concerned with vital andhealth statistics, and documen~s such as recommended mo~el vital registration laws and revised birthand death certiilcates.

Series 10. Data jiom the Health Interview Survey. –Statistics on illness; accidental injuries; disability; use ofhospital, medical, dental, and other services; and other health-related topics, based on data collected in

a continuing national household interview survey.

Series 11. Data born the Health Examination Survey. –Data from direct examination, testing, and measurementof national samples of the civilian, noninstitutionalized population provide the basis for two types ofreports: (1) estimates of the medically defined prevalence of specific diseases in the United States andthe distributions of the population with respect to physical, physiological, and psychological charac-teristics; and (2) analysis of relationships among the various measurements without reference to anexplicit finite universe of persons.

Series 12. Data from the Institutionalized Population Survey s.–Discontinued effective 1975. Future reports fromthese surveys will be in Series 13.

Series 13. Data on Health Resources Utilization. –Statistics on the utilization of health manpower and facilitiesproviding long-term care, ambulatory care, hospital care, and family planning services.

Series 14. Data on Health Resources: Manpown and Facilities. -Statistics on the numbers, geographic distrib-ution, and characteristics of health resources including physicians, dentists, nurses, other health occu-pations, hospitals, nursing homes, and outpatient facilities.

Sties 20. Data on Mortality. –Various statistics on mortality other than as included in regular annual or monthlyreports. Special analyses by cause of death, age, and other demographic variables; geographic and time

series anal yses; and statistics on characteristics of deaths not available from the vital records, based onsample surveys of those records.

Sm”es 21. Data on Natality, Marriage, and Divorce. –Various statistics on nat alit y, marriage, and divorce otherthan as included in regular annual or monthly reports. Special analyses by demographic variables;geographic and time series analyses; studies of fertility; and statistics on characteristics .of bwths notavailable from the vital records, based on sample surveys of those records.

Sm”es 22. Data from the National Mortality and Natdity Surveys. –Discontinued effective 1975. Future reportsfrom these sample surveys based on vital records will be included in Series 20 and 21, respectively.

Series 23. Datu from the Nah”onal Survey of Family Growth. -Statistics on fertility, family formation and disso-lution, family planning, and related maternal and infant health topics derived from a biennial survey ofa nationwide probability sample of ever-ma.mied women 1544 years of age.

For ~ list of tities of reports pubiished in these series, write to: Scientific and Technical Information BranchNational Center for Health StatisticsPublic Health Service, HRAEfyattsville, Md. 20782

/

/