Series 13

No. 120

Hospice and

Home Health Agency

Characteristics:

United States, 1991

April 1995

Vital and

Health Statistics

From the CENTERS FOR DISEASE CONTROL AND PREVENTION / National Center for Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics
Copyright information

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reproduced or copied without permission; citation as to source, however, is

appreciated.

Suggested citation

Delfosse R. Hospice and home health agency characteristics: United States,

1991. National Center for Health Statistics. Vital Health Stat 13(120). 1995.

Library of Congress-in-Publication Data

Delfosse, Renee.

Hospice and home health agency characteristics : United States, 1991.

p. cm. — (Vital and health statistics. Series 13, Data from the National Health

Survey ; no. 120)

‘‘April 1995.’’

Includes bibliographical references.

ISBN 0-8406-0505-6

1. Home care services—United States—Statistics. 2. Hospices (Terminal

care)—United States— Statistics. I. National Center for Health Statistics (U.S.)

II. Title. III. Series.

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Services—United States—statistics. W2 A N148vm no. 120 1995]

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Hospice and

Home Health Agency

Characteristics:

United States, 1991

Series 13:

Data From the National Health Survey

No. 120

This report presents State and National statistics on home health

agencies and hospices from the 1991 National Health Provider

Inventory. Included are facility characteristics such as number of

clients, type of ownership, and type of certification. Also included are

services provided and volunteers.

Hyattsville, Maryland

April 1995

DHHS Publication No. (PHS) 95-1781

Vital and

Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics
National Center for Health Statistics

Jack R. Anderson, Acting Director

Jennifer H. Madans, Ph.D., Acting Deputy Director

Jacob J. Feldman, Ph.D., Associate Director for Analysis,

Epidemiology, and Health Promotion

Gail F. Fisher, Ph.D., Associate Director for Planning and

Extramural Programs

Peter L. Hurley, Associate Director for Vital and Health

Statistics Systems

Robert A. Israel, Associate Director for International

Statistics

Stephen E. Nieberding, Associate Director for

Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

Monroe G. Sirken, Ph.D., Associate Director for Research

and Methodology

Division of Health Care Statistics

W. Edward Bacon, Ph.D., Director

Thomas McLemore, Deputy Director

Evelyn S. Mathis, Chief, Long-Term Care Statistics Branch
Contents

Introduction............................................................................................ 1

Discussion ............................................................................................. 2

References............................................................................................. 6

List of detailed tables.................................................................................... 7

Appendixes

I. Technical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

II. Questionnaire used in the inventory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

III. Classifications and definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Text tables

A. Number and percent distribution of home health agencies by number of clients, according to geographic region:

United States, 1991................................................................................. 2

B. Number and percent distribution of hospices by number of clients, according to geographic region:

United States, 1991................................................................................. 3

C. Number and percent distribution of clients by type of care received, according to type of agency:

United States, 1991 ................................................................................ 3

D. Number and percent distribution of home health agencies and hospices by ownership of agency:

United States, 1991................................................................................. 4

E. Number and percent distribution of clients by type of care received and ownership of agency:

United States, 1991................................................................................. 4

F. Number and percent of home health agencies by ownership of agency, according to geographic region:

United States, 1991................................................................................. 4

iii
Hospice and Home Health

Agency Characteristics:

United States, 1991

By Renee Delfosse, M.A., Division of Health Care

Statistics

Introduction

The National Center for Health Statistics (NCHS) collected data on hospices and home health agencies (HHA’s) for

the first time in the 1991 National Health Provider Inventory

(NHPI). This report focuses on their numbers, distributing

them by State, type of ownership, and type of certification. It

also presents data on services provided and volunteers.

The NHPI’s predecessor was the National Master Facility

Inventory (NMFI). The NMFI has been conducted 10 times

since 1963. The first six Inventories included hospitals, nursing and related care homes, and other types of inpatient health

facilities that included homes for the blind, deaf, mentally

retarded, and emotionally disturbed (1). The 1978, 1980, and

1982 Inventories were limited to nursing and related care

homes (1). The 1986 Inventory (known as the Inventory of

Long-Term Care Places) included mental retardation facilities

in addition to nursing and related care homes (2). The

Inventory was expanded in 1991 to include HHA’s and

hospices. Both provide services in the patient’s place of

residence, some having inpatient beds. Including these two

providers follows the current effort to view long-term care as a

system that gives the chronically ill more options and that uses

health care resources more efficiently.

The NHPI provides an up-to-date sampling frame for

surveys about health care providers. For example, NCHS uses

data collected about nursing and related care homes, hospices,

and home health agencies to select samples for the Long-Term

Care Component of the National Health Care Survey (3).

Another purpose of the Inventory is to provide basic national

statistics on nursing homes, residential-care facilities, home

health agencies, and hospices.

The appendixes describe how the numbers in the report

were obtained. Appendix I describes the process of determining the number of agencies and the method of classifying

these agencies either as a home health agency or as a hospice.

Appendix I also gives additional background information

about the NHPI. The questionnaire used in the 1991 NHPI is

shown in appendix II. Definitions of terms are provided in

appendix III.

1
Discussion

Modern home health care in this country began with the

founding of a prototype hospital-based home health care

program at Montefiore Hospital in New York City in 1947 (4).

The modern hospice industry started as a local grass-roots

volunteer phenomenon and has grown, over the last 17 years,

into an approach reimbursed by insurers (5). Of the 7,804

agencies surveyed in 1991, 6,853 were identified as home

health agencies (HHA’s) and 951 as hospices.

The number of HHA’s and of hospices are shown in

tables A and B by geographic region, and tables 1 and 2 by

State. HHA’s provide services primarily to promote, maintain,

or restore their patient’s health and hospices provide specialized services to the terminally ill. Table A shows that in 1991

the South accounted for 2,691 HHA’s—almost 40 percent of

all HHA’s in the Nation. The South also had the largest

number of hospices—311, or 33 percent of the Nation’s total

(table B). The Midwest followed closely with 293 hospices, or

about 30 percent. The State distribution in table 1 shows that

11 States accounted for half of the 6,853 home health agencies

in the Nation, and that only four of these States are located in

the South. Texas was ranked first with 8 percent of the HHA’s

in the Nation. Florida and New York followed, each accounting for 6 percent of all HHA’s. Similarly, 11 States, only two

of which are located in the South, accounted for half of the

951 hospices in the Nation (table 2). California, Michigan, and

Illinois lead the ranking, together accounting for 20 percent of

all hospices in the Nation. Sixteen States each had fewer than

10 hospices.

These tables also show the number of HHA’s and hospices by number of clients. The most common size for an

HHA in all four regions was 100–299 clients, whereas the

most common size for a hospice was 8–19 clients in all

regions, except in the Midwest, where hospices had even

fewer clients. The average size of an HHA was 180 clients;

HHA sizes ranged from no clients to more than 70,000 clients

at the time of the Inventory. The average size of a hospice was

34 clients, which was above the 8–19 modal size; hospice

sizes ranged from no clients to 2,100 clients at the time of the

Inventory. Nationally, only 14 percent of HHA’s had 300 or

more clients. The Northeast had a higher percent of large

HHA’s than any other region; 23 percent of its HHA’s had 300

or more clients. Table 1 shows that first-ranked Texas had

many more small HHA’s than second-ranked Florida and

third-ranked New York. This is not surprising when Texas’

large geographic size and its population spread are considered.

Some atypical client sizes, not isolated in the tables, were: 12

HHA’s reported 4,000–6,000 clients at the time of the Inventory; one HHA reported approximately 7,000 clients; and

another reported over 70,000 clients. Six hospices reported

450–600 clients at the time of the Inventory, and one reported

approximately 700 clients. The numbers of HHA’s and hospices reporting no clients at the time of the Inventory were 391

and 77, respectively.

Table C presents the numbers of clients the HHA’s and

hospices served by the type of care received. Although an

agency may have cared for more than one type of client, this

situation was infrequent. For example, in addition to caring for

clients receiving only home health care, an HHA may have

cared for clients receiving only hospice care, as well as clients

receiving both home health and hospice care. Approximately

Table A. Number and percent distribution of home health agencies by number of clients, according to geographic region:

United States, 1991

Number of clients

All geographic regions Northeast Midwest South West

Number

Percent

distribution Number

Percent

distribution Number

Percent

distribution Number

Percent

distribution Number

Percent

distribution

All clients ................. 6,853 100.0 1,271 100.0 1,964 100.0 2,691 100.0 927 100.0

0–9 clients . . . . . . . . . . . . . . . . 754 11.0 126 9.9 192 9.7 311 11.5 125 13.4

10–29 clients . . . . . . . . . . . . . . . 865 12.6 114 8.9 294 14.9 308 11.4 149 16.0

30–59 clients ............... 1,137 16.5 169 13.2 379 19.2 432 16.0 157 16.9

60–99 clients ............... 1,084 15.8 185 14.5 324 16.4 409 15.1 166 17.9

100–299 clients ............. 2,055 29.9 380 29.8 576 29.3 872 32.4 227 24.4

300–499 clients . . . . . . . . . . . . . 515 7.5 136 10.7 116 5.9 217 8.0 46 4.9

500–999 clients . . . . . . . . . . . . . 303 4.4 103 8.1 58 2.9 108 4.0 34 3.6

1,000 clients or more . . . . . . . . . . 140 2.0 58 4.5 25 1.2 34 1.2 23 2.4

2
15 percent of the 6,853 HHA’s served clients receiving

hospice care and about 14 percent of the 951 hospices served

clients other than those receiving only hospice care.

Table 3 presents the numbers of clients the agencies

served by State and type of care the clients received. New

York, California, Florida, and Texas served the largest number

of clients receiving only home health care and the largest

numbers receiving only hospice care. Collectively, they served

31 percent of the approximately 1.2 million clients receiving

home health care, and 34 percent of the approximately 43,000

clients receiving hospice care. Of the total number of clients

receiving home health care, New York served 181,454 clients,

more than two-and-one-half times the number of clients than

was served by second-ranked California. This pattern is reversed

for clients receiving hospice care; California cared for almost

twice as many hospice clients as New York.

The NHPI inventoried the provision of 14 types of

services. These are shown in tables 4 and 5. The large majority

of HHA’s offered referral services (80 percent) and high tech

care (75 percent). Harrington suggests that the high percent of

HHA’s offering high tech care may be because their typical

client is acutely ill, discharged from hospitals sooner and

sicker than before the implementation of diagnosis-related

groups (DRG’s) (6). Of the remaining 12 services, more than

half of all HHA’s offered speech therapy (65 percent), occupational therapy/vocational therapy (57 percent), homemaker/

companion services (56 percent), dietary and nutritional services

(54 percent), and counseling (52 percent). These percents were

consistent across the four regions.

Most hospices offered most of the inventoried services.

Over 90 percent offered bereavement care and pastoral care,

services particular to the care of the terminally ill and their

families. Over 90 percent of the hospices also offered counseling and referral services. Of the remaining services, more than

half of all hospices offered all of the inventoried services

except two. These two exceptions were enterostomal therapy,

provided by 44 percent of all hospices, and meals on wheels,

provided by only 13 percent of all hospices. As with the

HHA’s the pattern of services offered was consistent across

the four regions, although a slightly larger percent of hospices

in the South offered medically oriented services (dietary and

nutritional services, occupational therapy/vocational therapy,

speech therapy, medications, and high tech care) than did

hospices in any other region.

In addition to the 14 services listed in the questionnaire,

agencies were asked to specify any others offered: 39 percent

of HHA’s and 26 percent of hospices offered services other

than the 14 listed. Among the most frequently listed were:

nursing care, home health aide care, physical therapy, medical

equipment, and in-patient services. An interesting finding was

that several hospices listed nontraditional services such as

counseling services to the community at large, and day care

for both hospice and nonhospice ill. A national survey studying hospice programs discovered a trend of hospices offering

these ‘‘higher visibility services’’ (7). The explanation offered

for this trend is that hospices are trying to survive in the

competitive health care service industry (7).

Agency ownership is the subject for the next set of tables.

Table D shows the number of agencies by type of agency and

table E presents the number of clients by type of care received;

tables 6–10 present these data by State. Tables 11 and 12 give

the percent of agencies providing services according to ownership. The percent distribution of agencies having volunteers,

according to ownership, is given in table 13.

Table B. Number and percent distribution of hospices by number of clients, according to geographic region: United States, 1991

Number of clients

All geographic regions Northeast Midwest South West

Number

Percent

distribution Number

Percent

distribution Number

Percent

distribution Number

Percent

distribution Number

Percent

distribution

All clients . . . . . . . . . . . . . . . . . 951 100.0 157 100.0 293 100.0 311 100.0 190 100.0

0–7 clients . . . . . . . . . . . . . . . . 235 24.7 26 16.5 104 35.4 53 17.0 52 27.3

8–19 clients . . . . . . . . . . . . . . . 282 29.6 46 29.2 90 30.7 96 30.8 50 26.3

20–34 clients . . . . . . . . . . . . . . . 204 21.4 40 25.4 44 15.0 72 23.1 48 25.2

35–49 clients . . . . . . . . . . . . . . . 80 8.4 18 11.4 21 7.1 26 8.3 15 7.8

50–74 clients . . . . . . . . . . . . . . . 56 5.8 11 7.0 14 4.7 19 6.1 12 6.3

75–99 clients . . . . . . . . . . . . . . . 31 3.2 7 4.4 4 1.3 13 4.1 7 3.6

100–149 clients . . . . . . . . . . . . . 29 3.0 5 3.1 9 3.0 13 4.1 2 1.0

150 or more clients . . . . . . . . . . . 34 3.5 4 2.5 7 2.3 19 6.1 4 2.1

Table C. Number and percent distribution of clients by type of care received, according to type of agency: United States, 1991

Type of agency

Type of care received

All clients Home health Hospice

Both home health

and hospice care

Number

Percent

distribution Number

Percent

distribution Number

Percent

distribution Number

Percent

distribution

Home health .......... 1,231,512 100.0 1,188,509 96.5 14,709 1.2 28,294 2.3

Hospice ............. 32,192 100.0 955 3.0 28,778 89.4 2,459 7.6

3
The hospice industry was primarily nonprofit (88 percent), whereas the home health agency industry was more

diverse (table D). Thirty-seven percent of all HHA’s were

nonprofit, with the remaining HHA’s being 41 percent proprietary and 22 percent government-owned. Comparing the data

from both tables D and E, nonprofit agencies, which were

43 percent of all agencies, cared for 56 percent of the clients.

Nonprofit agencies cared for 78 percent of clients receiving

only hospice care, 55 percent of clients receiving only home

health care, and 56 percent of clients receiving both types of

care. Nonprofit HHA’s had approximately twice the number of

clients receiving home health care as did proprietary HHA’s.

Also, nonprofit hospices had more clients receiving home

health care than did proprietary hospices, but this difference

was small.

Despite its low national figure, government-owned HHA’s

predominated in 10 States (table 6). These 10 States were of a

rural character: Alabama, Arkansas, Iowa, Kansas, Minnesota,

North Carolina, North Dakota, South Carolina, South Dakota,

and Wyoming. The majority of these States also had more

nonprofit HHA’s than proprietary ones. Government-owned

agencies also enrolled the majority of clients receiving home

health care in five of these States (Minnesota, North Carolina,

North Dakota, South Carolina, and South Dakota), and in one

not listed (Montana) (table 8).

Grouping HHA’s by region, those considered more rural

(the Midwest and the South) had 31 percent and 23 percent of

their agencies under government-ownership, respectively, compared with 17 percent in the West and 9 percent in the

Northeast (table F). The South had the greatest percent of

HHA’s under proprietary ownership (49 percent) compared

with the Northeast (40 percent), the West (39 percent), or the

Midwest (29 percent).

Tables 11 and 12 show the percent of HHA’s and of

hospices that provide selected services by ownership status of

the agency. Of the 14 services surveyed, the majority were

offered by a larger percent of proprietary HHA’s than by either

nonprofit or government-owned HHA’s. Note, in particular,

Table D. Number and percent distribution of home health agencies and hospices by ownership of agency: United States, 1991

Ownership

Type of agency

All agencies Home health agency Hospice

Number

Percent

distribution Number

Percent

distribution Number

Percent

distribution

All agencies ............... 7,804 100.0 6,853 100.0 951 100.0

Proprietary ................ 2,827 36.2 2,779 40.6 48 5.0

Nonprofit ................. 3,353 43.0 2,515 36.7 838 88.1

Government ............... 1,559 20.0 1,508 22.5 51 5.4

Other . . . . . . . . . . . . . . . . . . . . 65 0.8 51 0.7 14 1.5

Table E. Number and percent distribution of clients by type of care received and ownership of agency: United States, 1991

Ownership

Type of care received

All clients Home health care Hospice care

Both home health

and hospice care

Number

Percent

distribution Number

Percent

distribution Number

Percent

distribution Number

Percent

distribution

All agencies .......... 1,263,704 100.0 1,189,464 100.0 43,487 100.0 30,753 100.0

Proprietary ........... 349,863 27.7 333,480 28.0 7,003 16.1 9,380 30.5

Nonprofit ............ 708,871 56.1 657,881 55.3 33,739 77.6 17,251 56.1

Government .......... 195,886 15.5 189,279 15.9 2,581 5.9 4,026 13.1

Other ............... 9,084 0.7 8,824 0.7 164 0.4 96 0.3

Table F. Number and percent of home health agencies by ownership of agency, according to geographic region: United States, 1991

Geographic region

All agencies Ownership

Number

Percent

distribution Proprietary Nonprofit Government Other

All regions ................ 6,853 100.0 40.6 36.7 22.0 .7

Northeast ................. 1,271 100.0 40.2 50.0 9.4 .4

Midwest .................. 1,964 100.0 29.4 38.5 31.3 .8

South ................... 2,691 100.0 49.3 27.0 22.9 .8

West . . . . . . . . . . . . . . . . . . . . 927 100.0 39.2 42.8 17.0 1.0

4
the percent differences between proprietary and nonprofit

HHA’s offering occupational therapy and counseling. Such

differences may be because it’s more profitable to offer a wide

selection of services. In contrast, table 12 shows that 11

services were offered by a lower percent of proprietary

hospices than by either nonprofit or government-owned hospices. Keep in mind the low numbers of proprietary and

government-owned hospices when viewing the hospice distribution in this table.

Table 13 gives the percent of agencies that had volunteers

by geographic region according to ownership. Because a

Medicare-certified hospice is required to staff volunteers (8),

and the majority of hospices in 1991 were certified, the

percent of hospices having volunteers was high—93 percent

of all hospices had volunteers compared with 21 percent of all

HHA’s. Most noteworthy about this table, however, is the

percent of proprietary agencies versus nonprofit agencies

having volunteers. Fifty percent of proprietary hospices and

5 percent of proprietary HHA’s had volunteers compared with

96 percent of nonprofit hospices and 39 percent of nonprofit

HHA’s.

Tables 14–20 present certification data. The agency distribution by State is given in tables 14 and 15 and the client

distribution by State is given in tables 16–18. Medicare and

Medicaid began covering certain home health care services

from the time they were enacted in 1965 (9). Since 1965, the

number of Medicare-certified agencies increased most rapidly

between 1982 and 1986, after the 1980 legislation permitted

States not having licensing laws to certify proprietary agencies

(5). Hospice became a Federal program reimbursable under

Medicare in 1982 and under Medicaid in 1985.

The agency counts show that the majority of HHA’s and

hospices were Medicare- and/or Medicaid-certified, but that

larger percents of HHA’s were certified than hospices—

81 percent versus 63 percent by Medicare, and 81 percent

versus 53 percent by Medicaid. The agency counts also show

that Medicare- and Medicaid-certification seem to coincide.

Some of the more notable exceptions to this were New York

and North Dakota, where much higher percents of HHA’s

were certified by Medicaid than by Medicare, and Arizona

where the opposite occurred. Note that in 28 States the number

of Medicare-certified HHA’s differed from the number of

Medicaid-certified HHA’s by two or fewer agencies, and that

in 31 States the number of Medicare-certified hospices differed from the number of Medicaid-certified hospices by one

or no agencies.

The client counts show that Medicare- and Medicaidcertified agencies cared for the large majority of clients

receiving each type of care—home health care only, hospice

care only, and both home health care and hospice care. For

example, 89 percent of clients receiving only home health care

and 86 percent of clients receiving only hospice care were

enrolled in Medicare-certified agencies.

Table 19 shows the number of agencies by certification

and ownership, and table 20 gives this information for clients.

According to table 19, nonprofit and government-owned HHA’s

were more likely to be certified than proprietary ones were.

For example, 89 percent of all nonprofit agencies compared

with 71 percent of all proprietary agencies were certified by

Medicare. Unlike HHA’s, approximately the same percent of

nonprofit, proprietary, and government-owned hospices were

certified. According to table 20, clients receiving home health

care, hospice care, or both were most likely to receive their

care from a certified nonprofit agency.

5
References

1. Roper DA. Nursing and related care homes as reported from the

1982 National Master Facility Inventory Survey. National Center for Health Statistics. Vital Health Stat 14(32). 1986

2. Sirrocco A. Nursing home characteristics: 1986 Inventory of

Long-Term Care Places. National Center for Health Statistics.

Vital Health Stat 14(33). 1989.

3. Institute of Medicine. Toward a national health care survey, a

data system for the 21st century. Washington: National Academy Press. 1992.

4. Spiegel AD. Domanowski GF. Beginnings of home health care:

A brief history. Journal of Long Term Home Health Care

2(3):28–33. 1983.

5. Rhymes JA. Home Hospice Care. Clinics in Geriatric Medicine

7(4):803–16. 1991.

6. Harrington C. Quality, access and costs: public policy and home

health care. Nursing Outlook 36(4):164–6. 1988.

7. Peterson S. Beyond hospice care: A survey of community

outreach programs. Amer J Hospice Palliative Care 9(1):15–22.

1992.

8. 48 FR 56026

9. Benjamin AE. An historical perspective on home care policy.

The Milbank Quarterly 17(1):129–167. 1993.

10. National Center for Health Statistics. The Agency Reporting

System for maintaining the national inventory of hospitals and

institutions. National Center for Health Statistics. Vital Health

Stat 1(6). 1968.

11. Eisenhower D., Maffeo C., DiGaetano R. Feasibility Study for

Surveying Hospices and Home Health Agencies. Contract No.

200–88–7016. Rockville, Maryland: Westat. 1990.

12. Strahan G. Overview of home health and hospice care patients:

preliminary data from the 1992 National Home and Hospice

Care Survey. Advance data from vital and health statistics; no.

235. Hyattsville, Maryland: National Center for Health Statistics. 1993.

6
List of detailed tables

1. Number of home health agencies by number of clients and

State: United States, 1991 ....................... 8

2. Number of hospices by number of clients and State:

United States, 1991 ........................... 9

3. Number of clients by type of care received and State:

United States, 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

4. Number and percent of home health agencies by type of

service provided, according to geographic region: United

States, 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

5. Number and percent of hospices by type of service

provided, according to geographic region: United States,

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

6. Number of home health agencies by type of ownership

and State: United States, 1991 . . . . . . . . . . . . . . . . . . . 12

7. Number of hospices by type of ownership and State:

United States, 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

8. Number of current clients receiving home health care by

type of ownership and State: United States, 1991 . . . . . . 14

9. Number of current clients receiving hospice care by type

of ownership and State: United States, 1991 . . . . . . . . . 15

10. Number of current clients receiving both home health care

and hospice care by type of ownership and State: United

States, 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

11. Number and percent of home health agencies by type of

services and ownership: United States, 1991 . . . . . . . . . 17

12. Number and percent of hospices by type of services and

ownership: United States, 1991 . . . . . . . . . . . . . . . . . . . 17

13. Number and percent of home health agencies and hospices

having volunteers by type of ownership and geographic

region: United States, 1991 . . . . . . . . . . . . . . . . . . . . . . 18

14. Number of home health agencies by type of certification

and State: United States, 1991 . . . . . . . . . . . . . . . . . . . 19

15. Number of hospices by type of certification and State:

United States, 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

16. Number of current clients receiving home health care by

type of certification and State: United States, 1991 . . . . 21

17. Number of current clients receiving hospice care by type

of certification and State: United States, 1991 . . . . . . . . 22

18. Number of current clients receiving both home health

and hospice care by type of certification and State:

United States, 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

19. Number and percent distribution of home health agencies

and hospices by type of certification, according to type of

ownership: United States, 1991 . . . . . . . . . . . . . . . . . . . 24

20. Number and percent distribution of current clients

receiving home health care, hospice care, and both by

type of certification, according to type of ownership:

United States, 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

7

Symbols

- - - Data not available

. . . Category not applicable

− Quantity zero

0.0 Quantity more than zero but

less than 0.05

Z Quantity more than zero but

less than 500 where numbers

are rounded to thousands

* Figure does not meet standard

of reliability or precision
Table 1. Number of home health agencies by number of clients and State: United States, 1991

State

All

clients

Number of clients

0–9

clients

10–29

clients

30–59

clients

60–99

clients

100–299

clients

300–499

clients

500–999

clients

1,000 or

more clients

United States .................... 6,853 754 865 1,137 1,084 2,055 515 303 140

Alabama . . . . . . . . . . . . . . . . . . . . . . . 127 5 7 12 18 60 16 6 3

Alaska . . . . . . . . . . . . . . . . . . . . . . . . 10 2 3 2 1 1 1 – –

Arizona . . . . . . . . . . . . . . . . . . . . . . . 71 5 14 11 16 16 5 3 1

Arkansas . . . . . . . . . . . . . . . . . . . . . . 133 13 25 36 28 25 4 2 –

California (ranked 4th) . . . . . . . . . . . . . . 333 36 38 43 52 102 27 19 16

Colorado . . . . . . . . . . . . . . . . . . . . . . 101 20 17 14 24 22 1 1 2

Connecticut . . . . . . . . . . . . . . . . . . . . . 110 9 5 9 26 33 15 7 6

Delaware . . . . . . . . . . . . . . . . . . . . . . 19 4 2 1 6 5 – – 1

District of Columbia . . . . . . . . . . . . . . . . 18 4 3 2 1 4 1 2 1

Florida (ranked 2nd) . . . . . . . . . . . . . . . 413 83 59 58 53 100 38 17 5

Georgia . . . . . . . . . . . . . . . . . . . . . . . 70 4 – 2 3 22 18 18 3

Hawaii . . . . . . . . . . . . . . . . . . . . . . . . 18 6 1 7 1 3 – – –

Idaho . . . . . . . . . . . . . . . . . . . . . . . . . 26 4 2 6 6 8 – – –

Illinois (ranked 6th) . . . . . . . . . . . . . . . . 309 21 35 54 50 104 24 15 6

Indiana . . . . . . . . . . . . . . . . . . . . . . . 150 7 13 44 27 46 8 2 3

Iowa . . . . . . . . . . . . . . . . . . . . . . . . . 155 11 14 24 39 52 11 3 1

Kansas . . . . . . . . . . . . . . . . . . . . . . . 153 41 44 28 18 19 2 1 –

Kentucky . . . . . . . . . . . . . . . . . . . . . . 112 7 5 10 12 58 11 6 3

Louisiana . . . . . . . . . . . . . . . . . . . . . . 180 11 14 27 38 77 6 5 2

Maine . . . . . . . . . . . . . . . . . . . . . . . . 35 5 – 7 3 12 2 2 4

Maryland . . . . . . . . . . . . . . . . . . . . . . 96 12 6 23 18 30 4 2 1

Massachusetts . . . . . . . . . . . . . . . . . . . 166 17 10 18 17 48 24 23 9

Michigan (ranked 9th) . . . . . . . . . . . . . . 196 15 24 33 28 71 10 11 4

Minnesota (ranked 10th) . . . . . . . . . . . . . 196 15 27 29 31 71 12 9 2

Mississippi . . . . . . . . . . . . . . . . . . . . . 116 3 1 15 22 54 16 3 2

Missouri . . . . . . . . . . . . . . . . . . . . . . . 173 8 22 36 37 54 10 4 2

Montana . . . . . . . . . . . . . . . . . . . . . . . 49 14 15 6 4 8 1 – 1

Nebraska . . . . . . . . . . . . . . . . . . . . . . 75 5 29 17 6 12 3 2 1

Nevada . . . . . . . . . . . . . . . . . . . . . . . 28 2 7 6 8 5 – – –

New Hampshire . . . . . . . . . . . . . . . . . . 60 13 9 8 6 18 3 1 2

New Jersey . . . . . . . . . . . . . . . . . . . . . 111 15 9 15 17 25 13 9 8

New Mexico . . . . . . . . . . . . . . . . . . . . 45 7 8 10 11 8 1 – –

New York (ranked 3rd) . . . . . . . . . . . . . . 410 38 38 52 51 125 53 35 18

North Carolina . . . . . . . . . . . . . . . . . . . 155 6 4 13 13 77 28 13 1

North Dakota . . . . . . . . . . . . . . . . . . . . 70 14 19 22 7 7 – – 1

Ohio (ranked 8th) . . . . . . . . . . . . . . . . . 252 21 26 44 45 76 27 8 5

Oklahoma . . . . . . . . . . . . . . . . . . . . . . 75 7 8 15 16 25 3 1 –

Oregon . . . . . . . . . . . . . . . . . . . . . . . 71 5 14 14 15 16 2 4 1

Pennsylvania (ranked 5th) . . . . . . . . . . . . 317 26 36 52 54 104 20 17 8

Rhode Island . . . . . . . . . . . . . . . . . . . . 43 2 4 7 9 10 5 3 3

South Carolina . . . . . . . . . . . . . . . . . . . 101 7 7 17 14 36 11 7 2

South Dakota . . . . . . . . . . . . . . . . . . . 80 24 26 16 4 9 1 – –

Tennessee (ranked 7th) . . . . . . . . . . . . . 262 31 22 30 43 94 28 12 2

Texas (ranked 1st) . . . . . . . . . . . . . . . . 557 85 118 118 82 113 24 11 6

Utah . . . . . . . . . . . . . . . . . . . . . . . . . 53 5 11 10 10 14 2 1 –

Vermont . . . . . . . . . . . . . . . . . . . . . . . 19 1 3 1 2 5 1 6 –

Virginia (ranked 11th) . . . . . . . . . . . . . . . 193 24 23 39 33 64 6 2 2

Washington . . . . . . . . . . . . . . . . . . . . . 81 5 9 20 10 23 6 6 2

West Virginia . . . . . . . . . . . . . . . . . . . . 64 5 4 14 9 28 3 1 –

Wisconsin . . . . . . . . . . . . . . . . . . . . . . 155 10 15 32 32 55 8 3 –

Wyoming . . . . . . . . . . . . . . . . . . . . . . 41 14 10 8 8 1 – – –

8
Table 2. Number of hospices by number of clients and State: United States, 1991

State

All

clients

Number of clients

0–7

clients

8–19

clients

20–34

clients

35–49

clients

50–74

clients

75–99

clients

100–149

clients

150 or more

clients

United States . . . . . . . . . . . . . . . . . . . . 951 235 282 204 80 56 31 29 34

Alabama ....................... 19 – 7 81 2 – – 1

Alaska ........................ 5 3 2 –– – – – –

Arizona ....................... 9 1 3 2– 1 – 1 1

Arkansas ...................... 11 6 3 –1 1 – – –

California (ranked 1st) . . . . . . . . . . . . . . 83 15 21 23 9 7 4 1 3

Colorado ...................... 19 8 3 52 – 1 – –

Connecticut ..................... 9 – 3 5– 1 – – –

Delaware ...................... 3 1 – 1– – 1 – –

District of Columbia ................ 3 1 – 11 – – – –

Florida (ranked 8th) ................ 34 3 3 2 4 2 4 5 11

Georgia ....................... 18 4 8 32 1 – – –

Hawaii ........................ 8 2 4 1– 1 – – –

Idaho ......................... 14 7 3 3– – 1 – –

Illinois (ranked 3rd) . . . . . . . . . . . . . . . . 49 11 14 12 6 2 – 1 3

Indiana ....................... 13 4 2 3– 2 1 1 –

Iowa . . . . . . . . . . . . . . . . . . . . . . . . . 25 11 7 1 2 3 – – 1

Kansas . . . . . . . . . . . . . . . . . . . . . . . 23 13 6 – 2 – – 2 –

Kentucky ...................... 19 1 4 62 3 1 – 2

Louisiana ...................... 11 3 3 21 1 – 1 –

Maine ........................ 15 2 8 3– 1 – 1 –

Maryland ...................... 25 5 7 6– 2 2 2 1

Massachusetts . . . . . . . . . . . . . . . . . . . 26 2 10 6 4 3 – – 1

Michigan (ranked 2nd) . . . . . . . . . . . . . . 57 22 20 8 3 2 – 1 1

Minnesota (ranked 9th) . . . . . . . . . . . . . 33 17 10 4 – 1 1 – –

Mississippi ..................... 1 – 1 –– – – – –

Missouri ....................... 15 2 4 31 – 1 2 2

Montana ....................... 12 8 1 21 – – – –

Nebraska ...................... 6 2 1 1– 2 – – –

Nevada ....................... 2 – 1 –– – 1 – –

New Hampshire .................. 13 5 3 41 – – – –

New Jersey ..................... 19 2 5 51 1 2 2 1

New Mexico .................... 3 1 1 –– 1 – – –

New York (ranked 7th) . . . . . . . . . . . . . . 35 4 10 7 7 2 4 – 1

North Carolina (ranked 4th) . . . . . . . . . . . 48 6 20 15 2 2 2 1 –

North Dakota .................... 2 1 1 –– – – – –

Ohio (ranked 6th) . . . . . . . . . . . . . . . . . 39 7 15 8 5 2 – 2 –

Oklahoma ...................... 13 3 7 3– – – – –

Oregon ....................... 14 2 5 42 1 – – –

Pennsylvania (ranked 10th) ........... 28 6 6 83 3 1 1 –

Rhode Island .................... 5 1 – 11 – – 1 1

South Carolina ................... 13 1 7 22 – 1 – –

South Dakota ................... 7 5 2 –– – – – –

Tennessee ..................... 11 3 3 3– – – 2 –

Texas (ranked 5th) . . . . . . . . . . . . . . . . 42 7 9 12 4 4 2 1 3

Utah ......................... 4 1 2 1– – – – –

Vermont ....................... 7 4 1 11 – – – –

Virginia (ranked 11th) ............... 28 6 9 82 1 – 1 1

Washington ..................... 11 – 3 61 1 – – –

West Virginia .................... 12 3 5 –4 – – – –

Wisconsin ...................... 24 9 8 42 – 1 – –

Wyoming ...................... 6 4 1 1– – – – –

9
Table 3. Number of clients by type of care received and State: United States, 1991

State

All

clients

Type of care received

Home

health care

Hospice

care

Both home

health and

hospice care

United States .............................. 1,263,704 1,189,464 43,487 30,753

Alabama ................................. 26,578 25,328 844 406

Alaska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 764 727 34 3

Arizona ................................. 10,392 9,790 532 70

Arkansas ................................ 11,052 10,336 308 408

California (ranked 2nd) ........................ 76,175 68,902 4,641 2,632

Colorado ................................ 9,277 8,881 378 18

Connecticut ............................... 29,716 28,123 393 1,200

Delaware ................................ 5,730 5,590 139 1

District of Columbia .......................... 4,631 4,563 68 –

Florida (ranked 3rd) .......................... 67,277 60,908 5,376 993

Georgia ................................. 27,500 26,571 529 400

Hawaii .................................. 1,051 908 127 16

Idaho ................................... 2,338 2,111 210 17

Illinois (ranked 7th) .......................... 52,303 48,927 1,500 1,876

Indiana ................................. 21,839 20,656 597 586

Iowa ................................... 20,685 19,847 676 162

Kansas ................................. 8,518 7,528 562 428

Kentucky ................................ 26,486 24,747 1,238 501

Louisiana ................................ 26,037 24,383 750 904

Maine .................................. 11,662 11,141 513 8

Maryland ................................ 15,963 14,110 1,328 525

Massachusetts (ranked 6th) ..................... 52,622 47,850 1,808 2,964

Michigan (ranked 10th) ........................ 41,696 40,325 1,348 23

Minnesota ................................ 29,365 28,442 733 190

Mississippi ............................... 24,532 24,444 88 –

Missouri ................................. 22,858 20,720 930 1,208

Montana ................................. 6,382 6,121 157 104

Nebraska ................................ 7,398 7,056 232 110

Nevada ................................. 2,167 1,978 184 5

New Hampshire ............................ 9,294 8,894 366 34

New Jersey ............................... 34,574 29,093 1,360 4,121

New Mexico .............................. 2,981 2,759 217 5

New York (ranked 1st) ........................ 181,454 177,547 2,346 1,561

North Carolina ............................. 36,038 34,443 1,325 270

North Dakota .............................. 7,521 7,360 59 102

Ohio (ranked 9th) ........................... 42,673 40,481 1,307 885

Oklahoma ................................ 7,883 7,681 154 48

Oregon ................................. 9,512 8,644 714 154

Pennsylvania (ranked 5th) ...................... 62,190 58,766 2,220 1,204

Rhode Island .............................. 14,971 14,075 564 332

South Carolina ............................. 19,570 18,739 491 340

South Dakota ............................. 3,097 3,026 69 2

Tennessee (ranked 8th) ....................... 43,961 42,612 483 866

Texas (ranked 4th) .......................... 65,131 59,258 2,354 3,519

Utah ................................... 4,852 4,701 136 15

Vermont ................................. 5,594 5,418 176 –

Virginia ................................. 27,058 24,429 1,286 1,343

Washington ............................... 14,638 13,842 712 84

West Virginia .............................. 8,237 7,859 374 4

Wisconsin ................................ 18,167 17,572 501 94

Wyoming ................................ 1,314 1,252 50 12

10
Table 4. Number and percent of home health agencies by type of service provided, according to geographic region: United States, 1991

Type of service All regions Northeast Midwest South West

Number ..................................... 6,853 1,271 1,964 2,691 927

Referral services ............................... 80.1 79.5 82.3 76.9 85.4

High tech care ................................. 75.1 67.8 74.5 77.6 79.3

Speech therapy ................................ 65.0 68.3 60.2 65.5 69.5

Occupational therapy/vocational therapy ................. 56.7 67.7 53.3 50.2 68.1

Homemaker/companion ........................... 55.6 67.3 57.7 48.8 55.2

Dietary and nutritional ............................ 53.9 55.0 52.7 53.0 57.6

Counseling ................................... 51.9 61.1 45.1 48.9 62.8

Enterostomal therapy ............................. 45.8 45.1 41.5 45.4 57.1

Medications ................................... 42.4 43.3 45.3 38.3 47.2

Respite care .................................. 40.1 53.3 41.3 30.2 48.1

Bereavement care ............................... 26.9 35.4 26.0 21.1 33.7

Transportation ................................. 19.4 20.9 20.9 17.1 20.8

Pastoral care .................................. 14.1 18.9 14.4 10.1 18.2

Meals on wheels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.5 14.2 8.1 5.9 8.8

Other services ................................. 38.7 38.5 35.9 40.4 40.0

Table 5. Number and percent of hospices by type of service provided, according to geographic region: United States, 1991

Type of service All regions Northeast Midwest South West

Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 951 157 293 311 190

Bereavement care ............................... 95.0 91.1 97.6 94.2 95.3

Referral services ............................... 91.8 91.7 91.5 92.9 90.5

Counseling ................................... 90.3 86.6 89.8 92.3 91.1

Pastoral care .................................. 90.1 80.9 93.2 92.3 89.5

Respite care .................................. 86.1 84.7 87.0 84.9 87.9

Dietary and nutritional ............................ 76.1 70.7 75.1 83.6 70.0

Homemaker/companion ........................... 70.6 72.0 70.6 70.4 69.5

Medications ................................... 66.5 65.0 63.5 74.9 58.4

Speech therapy ................................ 65.8 67.5 64.2 73.0 55.3

Occupational therapy/vocational therapy ................. 65.0 65.0 64.2 70.4 57.4

Transportation ................................. 58.3 59.2 62.1 54.7 57.4

High tech care ................................. 57.5 55.4 54.9 67.2 47.4

Enterostomal therapy ............................. 44.3 45.9 45.7 45.7 38.4

Meals on wheels ............................... 13.0 11.5 19.1 9.3 11.1

Other services ................................. 26.2 31.2 22.5 28.3 24.2

11
Table 6. Number of home health agencies by type of ownership and State: United States, 1991

State

All

agencies

Ownership

Proprietary Nonprofit Government Other

United States .................................. 6,853 2,779 2,515 1,508 51

Alabama . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 34 23 70 –

Alaska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 – 6 4 –

Arizona . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 33 29 9 –

Arkansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 16 41 76 –

California . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333 164 140 24 5

Colorado . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 34 42 24 1

Connecticut . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 35 61 12 2

Delaware . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 6 11 2 –

District of Columbia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 7 9 2 –

Florida . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413 293 86 33 1

Georgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 36 28 5 1

Hawaii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 7 7 4 –

Idaho . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 10 10 6 –

Illinois . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309 126 135 47 1

Indiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 60 61 27 2

Iowa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 16 49 88 2

Kansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 40 51 62 –

Kentucky . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 38 44 26 4

Louisiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 99 56 25 –

Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 15 19 1 –

Maryland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 35 32 29 –

Massachusetts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 37 110 18 1

Michigan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 73 78 41 4

Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 42 71 81 2

Mississippi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 48 29 39 –

Missouri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 51 77 45 –

Montana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 5 29 15 –

Nebraska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 20 35 19 1

Nevada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 15 9 4 –

New Hampshire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 21 36 3 –

New Jersey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 53 48 10 –

New Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 22 17 6 –

New York . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 188 156 65 1

North Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 45 39 70 1

North Dakota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 7 21 42 –

Ohio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252 97 100 53 2

Oklahoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 35 26 13 1

Oregon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 18 38 14 1

Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317 138 168 10 1

Rhode Island . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 23 20 – –

South Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 31 19 51 –

South Dakota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 4 20 56 –

Tennessee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262 151 61 48 2

Texas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 557 364 132 54 7

Utah . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 24 19 10 –

Vermont . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 1 17 1 –

Virginia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 75 63 52 3

Washington . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 27 37 16 1

West Virginia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 14 28 21 1

Wisconsin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 42 58 53 2

Wyoming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 4 14 22 1

12
Table 7. Number of hospices by type of ownership and State: United States, 1991

State

All

agencies

Ownership

Proprietary Nonprofit Government Other

United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 951 48 838 51 14

Alabama . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 1 16 2 –

Alaska ...................................... 5 – 5 – –

Arizona ..................................... 9 1 8 – –

Arkansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 – 10 – 1

California . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 5 70 6 2

Colorado . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 – 16 2 1

Connecticut ................................... 9 – 9 – –

Delaware .................................... 3 1 2 – –

District of Columbia .............................. 3 – 3 – –

Florida . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 8 26 – –

Georgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 1 11 5 1

Hawaii ...................................... 8 – 7 1 –

Idaho . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2 10 2 –

Illinois . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 2 45 2 –

Indiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 1 11 1 –

Iowa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 – 23 2 –

Kansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 1 20 1 1

Kentucky . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 – 19 – –

Louisiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 1 10 – –

Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 1 14 – –

Maryland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 3 21 – 1

Massachusetts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 – 22 3 1

Michigan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 – 55 1 1

Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 – 29 4 –

Mississippi ................................... 1 – 1 – –

Missouri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 1 13 1 –

Montana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 – 11 – 1

Nebraska .................................... 6 1 4 1 –

Nevada ..................................... 2 – 2 – –

New Hampshire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 – 13 – –

New Jersey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 – 18 1 –

New Mexico .................................. 3 – 3 – –

New York . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 2 30 3 –

North Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 – 43 5 –

North Dakota .................................. 2 – 2 – –

Ohio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 – 37 2 –

Oklahoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 – 13 – –

Oregon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 – 14 – –

Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 3 22 2 1

Rhode Island .................................. 5 1 4 – –

South Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 – 11 1 1

South Dakota ................................. 7 – 7 – –

Tennessee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 1 9 1 –

Texas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 8 34 – –

Utah ....................................... 4 – 3 – 1

Vermont ..................................... 7 – 7 – –

Virginia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 2 26 – –

Washington . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 – 11 – –

West Virginia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 – 11 1 –

Wisconsin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 1 21 1 1

Wyoming .................................... 6 – 6 – –

13
Table 8. Number of current clients receiving home health care by type of ownership and State: United States, 1991

State

All

clients

Ownership

Proprietary Nonprofit Government Other

United States .................................. 1,189,464 333,480 657,881 189,279 8,824

Alabama ..................................... 25,328 9,800 5,764 9,764 –

Alaska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 727 – 514 213 –

Arizona ..................................... 9,790 3,854 4,598 1,338 –

Arkansas .................................... 10,336 1,405 5,354 3,577 –

California .................................... 68,902 19,411 40,675 6,813 2,003

Colorado .................................... 8,881 1,906 6,387 525 63

Connecticut ................................... 28,123 5,162 21,850 1,083 28

Delaware .................................... 5,590 282 5,207 101 –

District of Columbia .............................. 4,563 582 3,816 165 –

Florida ...................................... 60,908 38,434 20,447 2,012 15

Georgia ..................................... 26,571 13,756 10,530 2,041 244

Hawaii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 908 291 610 7 –

Idaho . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,111 865 777 469 –

Illinois ...................................... 48,927 15,560 29,287 4,020 60

Indiana ..................................... 20,656 4,462 13,675 1,773 746

Iowa ....................................... 19,847 1,346 9,470 8,534 497

Kansas ..................................... 7,528 2,458 2,958 2,112 –

Kentucky .................................... 24,747 7,579 10,494 5,115 1,559

Louisiana .................................... 24,383 13,947 7,939 2,497 –

Maine ...................................... 11,141 1,800 9,295 46 –

Maryland .................................... 14,110 2,480 9,125 2,505 –

Massachusetts ................................. 47,850 8,283 38,498 905 164

Michigan .................................... 40,325 7,476 28,097 4,577 175

Minnesota .................................... 28,442 7,676 9,263 11,297 206

Mississippi ................................... 24,444 11,366 5,791 7,287 –

Missouri ..................................... 20,720 5,219 12,747 2,754 –

Montana ..................................... 6,121 178 1,418 4,525 –

Nebraska .................................... 7,056 1,294 4,237 1,470 55

Nevada ..................................... 1,978 1,295 286 397 –

New Hampshire ................................ 8,894 639 8,224 31 –

New Jersey ................................... 29,093 3,395 24,267 1,431 –

New Mexico .................................. 2,759 1,020 1,286 453 –

New York . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177,547 18,937 125,380 33,213 17

North Carolina ................................. 34,443 10,769 8,973 13,962 739

North Dakota .................................. 7,360 839 743 5,778 –

Ohio ....................................... 40,481 10,087 22,246 7,692 456

Oklahoma .................................... 7,681 3,678 3,081 840 82

Oregon ..................................... 8,644 1,009 7,000 610 25

Pennsylvania .................................. 58,766 13,680 43,890 756 440

Rhode Island .................................. 14,075 2,137 11,938 – –

South Carolina ................................. 18,739 4,229 3,677 10,833 –

South Dakota ................................. 3,026 159 920 1,947 –

Tennessee ................................... 42,612 25,680 12,476 4,376 80

Texas ...................................... 59,258 33,089 23,801 2,056 312

Utah ....................................... 4,701 1,737 2,356 608 –

Vermont ..................................... 5,418 26 5,364 28 –

Virginia ..................................... 24,429 6,438 8,872 8,730 389

Washington ................................... 13,842 2,299 10,275 1,208 60

West Virginia .................................. 7,859 1,596 4,195 1,948 120

Wisconsin .................................... 17,572 3,563 9,270 4,510 229

Wyoming .................................... 1,252 307 538 347 60

14
Table 9. Number of current clients receiving hospice care by type of ownership and State: United States, 1991

State

All

clients

Ownership

Proprietary Nonprofit Government Other

United States .................................. 43,487 7,003 33,739 2,581 164

Alabama . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 844 162 457 225 –

Alaska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 – 34 – –

Arizona . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 532 169 363 – –

Arkansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308 1 273 30 4

California .................................... 4,641 633 3,761 243 4

Colorado . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378 13 339 24 2

Connecticut . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393 13 377 1 2

Delaware . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 4 135 – –

District of Columbia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 – 68 – –

Florida ...................................... 5,376 2,139 3,228 6 3

Georgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 529 106 300 118 5

Hawaii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 – 118 9 –

Idaho . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 25 176 9 –

Illinois ...................................... 1,500 233 1,185 82 –

Indiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 597 142 378 55 22

Iowa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 676 1 440 235 –

Kansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 562 15 502 45 –

Kentucky .................................... 1,238 4 1,216 6 12

Louisiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 750 501 235 14 –

Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513 7 505 1 –

Maryland .................................... 1,328 260 1,016 35 17

Massachusetts ................................. 1,808 12 1,320 476 –

Michigan .................................... 1,348 11 1,319 17 1

Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 733 2 572 159 –

Mississippi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 1 85 2 –

Missouri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 930 111 793 26 –

Montana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 – 157 – –

Nebraska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232 3 206 23 –

Nevada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 24 132 28 –

New Hampshire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366 56 310 – –

New Jersey ................................... 1,360 141 1,213 6 –

New Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217 17 194 6 –

New York . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,346 567 1,692 87 –

North Carolina ................................. 1,325 26 1,162 137 –

North Dakota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 – 44 15 –

Ohio ....................................... 1,307 42 1,022 243 –

Oklahoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 – 154 – –

Oregon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 714 12 701 1 –

Pennsylvania .................................. 2,220 216 1,912 28 64

Rhode Island . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 564 138 426 – –

South Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 491 1 417 59 14

South Dakota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 – 69 – –

Tennessee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 483 43 360 80 –

Texas ...................................... 2,354 1,023 1,315 16 –

Utah . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 2 133 – 1

Vermont . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176 – 176 – –

Virginia ..................................... 1,286 92 1,190 4 –

Washington . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 712 30 673 9 –

West Virginia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374 1 363 10 –

Wisconsin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501 4 477 7 13

Wyoming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 – 46 4 –

15
Table 10. Number of current clients receiving both home health care and hospice care by type of ownership and State:

United States, 1991

State

All

clients

Ownership

Proprietary Nonprofit Government Other

United States .................................. 30,753 9,380 17,251 4,026 96

Alabama . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406 297 58 51 –

Alaska ...................................... 3 – – 3 –

Arizona . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 – 70 – –

Arkansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408 – 15 393 –

California .................................... 2,632 444 1,356 800 32

Colorado . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 6 12 – –

Connecticut ................................... 1,200 556 641 1 2

Delaware .................................... 1 – 1 – –

District of Columbia .............................. – – – – –

Florida . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 993 567 394 32 –

Georgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 400 – – –

Hawaii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 – 16 – –

Idaho . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 17 – – –

Illinois ...................................... 1,876 289 1,187 340 60

Indiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 586 1 233 352 –

Iowa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 1 7 154 –

Kansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 428 4 244 180 –

Kentucky . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501 137 361 3 –

Louisiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 904 895 9 – –

Maine ...................................... 8 – 8 – –

Maryland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 525 3 267 255 –

Massachusetts ................................. 2,964 8 2,878 78 –

Michigan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 11 7 5 –

Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190 13 69 108 –

Mississippi ................................... – – – – –

Missouri ..................................... 1,208 401 737 70 –

Montana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 – 103 1 –

Nebraska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 3 28 79 –

Nevada ..................................... 5 – – 5 –

New Hampshire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 13 21 – –

New Jersey ................................... 4,121 3,028 1,093 – –

New Mexico .................................. 5 – 4 1 –

New York . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,561 968 221 372 –

North Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270 – 16 254 –

North Dakota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 – 102 – –

Ohio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 885 44 787 54 –

Oklahoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 45 3 – –

Oregon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 – 149 5 –

Pennsylvania .................................. 1,204 105 1,093 6 –

Rhode Island . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332 185 147 – –

South Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340 50 120 170 –

South Dakota ................................. 2 – 2 – –

Tennessee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 866 573 206 87 –

Texas ...................................... 3,519 143 3,317 59 –

Utah . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 1 13 1 –

Vermont ..................................... – – – – –

Virginia ..................................... 1,343 171 1,077 95 –

Washington . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 – 84 – –

West Virginia .................................. 4 1 3 – –

Wisconsin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 – 92 – 2

Wyoming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 – – 12 –

16
Table 11. Number and percent of home health care agencies by type of services and ownership: United States, 1991

Type of service

Ownership

All types Proprietary Nonprofit Government Other

Number ..................................... 6,853 2,779 2,515 1,508 51

Percent

Referral services ............................... 80.1 79.5 82.3 76.9 85.4

High tech care ................................. 75.1 67.8 74.5 77.6 79.3

Speech therapy ................................ 65.0 68.3 60.2 65.5 69.5

Occupational therapy/vocational therapy ................. 56.7 67.7 53.3 50.2 68.1

Homemaker/companion ........................... 55.6 67.3 57.7 48.8 55.2

Dietary and nutritional ............................ 53.9 55.0 52.7 53.0 57.6

Counseling ................................... 51.9 61.1 45.1 48.9 62.8

Enterostomal therapy ............................. 45.8 45.1 41.5 45.4 57.1

Medications ................................... 42.4 43.3 45.3 38.3 47.2

Respite care .................................. 40.1 53.3 41.3 30.2 48.1

Bereavement care ............................... 26.9 35.4 26.0 21.1 33.7

Transportation ................................. 19.4 20.9 20.9 17.1 20.8

Pastoral care .................................. 14.1 18.9 14.4 10.1 18.2

Meals on wheels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.5 14.2 8.1 5.9 8.8

Other services ................................. 38.7 38.5 35.9 40.4 40.0

Table 12. Number and percent of hospices by type of services and ownership: United States, 1991

Type of service

Ownership

All types Proprietary Nonprofit Government Other

Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 951 48 838 51 14

Percent

Bereavement care ............................... 95.0 58.3 97.5 90.2 85.7

Referral services ............................... 91.8 72.9 93.3 92.2 64.3

Counseling ................................... 90.3 58.3 92.5 96.1 50.0

Pastoral care .................................. 90.1 52.1 92.5 88.2 85.7

Respite care .................................. 86.1 60.4 87.7 86.3 78.6

Dietary and nutritional ............................ 76.1 62.5 76.3 92.2 57.1

Homemaker/companion ........................... 70.6 64.6 71.2 64.7 71.4

Medications ................................... 66.5 66.7 66.0 80.4 42.9

Speech therapy ................................ 65.8 56.3 65.8 80.4 50.0

Occupational therapy/vocational therapy ................. 65.0 54.2 64.9 80.4 50.0

Transportation ................................. 58.3 41.7 59.2 56.9 64.3

High tech care ................................. 57.5 54.2 57.8 68.6 14.3

Enterostomal therapy ............................. 44.3 47.9 44.0 51.0 21.4

Meals on wheels ............................... 13.0 12.5 11.9 27.5 28.6

Other services ................................. 26.2 27.1 27.1 15.7 7.1

17
Table 13. Number and percent of home health agencies and hospices having volunteers by type of ownership and geographic region:

United States, 1991

Geographic region

Ownership

All types Proprietary Nonprofit Government Other

Number

All HHA’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,853 2,779 2,515 1,508 51

Percent

All regions ................................... 20.9 4.8 39.3 19.4 35.3

Northeast .................................... 34.9 7.6 57.8 29.2 60.0

Midwest ..................................... 22.5 4.7 37.0 21.0 37.5

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.9 3.5 23.8 15.4 23.8

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24.6 6.1 42.5 21.5 44.4

Number

All hospices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 951 48 838 51 14

Percent

All regions ................................... 93.0 50.0 95.8 86.3 92.9

Northeast .................................... 91.1 28.6 95.7 77.8 50.0

Midwest ..................................... 95.2 71.4 96.6 81.3 100.0

South ...................................... 90.4 42.3 94.7 93.3 100.0

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95.3 75.0 96.4 90.9 100.0

1HHA is home health care agency.

18
Table 14. Number of home health agencies by type of certification and State: United States, 1991

State

All

agencies

Medicare Medicaid

Certified

Certification

pending

Not

certified Certified

Certification

pending

Not

certified

United States .................................. 6,853 5,561 48 1,244 5,579 76 1,198

Alabama . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 118 – 9 117 1 9

Alaska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 8 – 2 8 – 2

Arizona . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 54 1 16 21 2 48

Arkansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 129 1 3 129 2 2

California . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333 287 7 39 264 7 62

Colorado . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 88 2 11 87 2 12

Connecticut . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 106 1 3 107 – 3

Delaware . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 17 – 2 17 – 2

District of Columbia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 10 – 8 10 – 8

Florida . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413 229 5 179 222 16 175

Georgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 70 – – 70 – –

Hawaii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 17 – 1 17 – 1

Idaho . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 24 – 2 25 – 1

Illinois . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309 264 2 43 250 6 53

Indiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 129 – 21 133 1 16

Iowa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 139 – 16 140 – 15

Kansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 124 – 29 120 2 31

Kentucky . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 109 – 3 107 – 5

Louisiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 168 – 12 169 – 11

Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 27 – 8 29 – 6

Maryland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 73 – 23 68 – 28

Massachusetts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 134 – 32 136 – 30

Michigan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 147 2 47 147 3 46

Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 184 – 12 181 1 14

Mississippi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 112 1 3 112 1 3

Missouri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 170 – 3 169 1 3

Montana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 46 – 3 47 – 2

Nebraska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 62 – 13 59 – 16

Nevada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 25 1 2 25 1 2

New Hampshire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 35 1 24 37 1 22

New Jersey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 64 1 46 79 3 29

New Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 37 – 8 36 – 9

New York . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 188 5 217 270 6 134

North Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 139 – 16 147 – 8

North Dakota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 34 – 36 54 – 16

Ohio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252 213 4 35 220 4 28

Oklahoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 65 1 9 49 1 25

Oregon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 63 – 8 62 – 9

Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317 266 – 51 256 3 58

Rhode Island . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 16 2 25 19 1 23

South Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 82 – 19 92 – 9

South Dakota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 73 1 6 76 2 2

Tennessee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262 248 2 12 247 – 15

Texas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 557 458 3 96 422 6 129

Utah . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 44 1 8 44 1 8

Vermont . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 16 – 3 16 – 3

Virginia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 169 2 22 178 – 15

Washington . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 57 – 24 59 – 22

West Virginia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 56 – 8 60 – 4

Wisconsin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 141 – 14 144 – 11

Wyoming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 27 2 12 26 2 13

19
Table 15. Number of hospices by type of certification and State: United States, 1991

State

All

hospices

Medicare Medicaid

Certified

Certification

pending

Not

certified Certified

Certification

pending

Not

certified

United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 951 600 33 318 504 34 413

Alabama . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 16 1 2 14 1 4

Alaska ...................................... 5 – – 5 – – 5

Arizona ..................................... 9 7 1 1 2 – 7

Arkansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 7 – 4 4 – 7

California . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 39 2 42 26 2 55

Colorado . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 14 – 5 10 4 5

Connecticut ................................... 9 5 – 4 5 – 4

Delaware .................................... 3 2 – 1 2 – 1

District of Columbia .............................. 3 2 – 1 1 – 2

Florida . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 30 – 4 29 – 5

Georgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 16 – 2 13 1 4

Hawaii ...................................... 8 4 2 2 4 2 2

Idaho . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 11 – 3 11 – 3

Illinois . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 25 – 24 22 1 26

Indiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 7 1 5 5 – 8

Iowa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 13 1 11 13 1 11

Kansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 5 – 18 4 1 18

Kentucky . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 18 – 1 17 – 2

Louisiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 9 – 2 3 – 8

Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 3 3 9 1 1 13

Maryland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 13 1 11 13 – 12

Massachusetts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 18 2 6 18 1 7

Michigan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 29 3 25 29 3 25

Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 12 2 19 12 – 21

Mississippi ................................... 1 1 – – – – 1

Missouri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 11 – 4 11 – 4

Montana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 5 1 6 4 1 7

Nebraska .................................... 6 4 – 2 4 – 2

Nevada ..................................... 2 1 – 1 – – 2

New Hampshire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2 – 11 1 – 12

New Jersey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 17 1 1 10 – 9

New Mexico .................................. 3 2 – 1 2 – 1

New York . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 31 1 3 32 1 2

North Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 41 2 5 41 1 6

North Dakota .................................. 2 2 – – 2 – –

Ohio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 37 – 2 35 1 3

Oklahoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 8 1 4 2 – 11

Oregon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 9 2 3 2 1 11

Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 17 1 10 16 1 11

Rhode Island .................................. 5 4 – 1 4 – 1

South Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 9 – 4 5 – 8

South Dakota ................................. 7 4 1 2 2 1 4

Tennessee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 9 – 2 6 3 2

Texas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 36 – 6 35 1 6

Utah ....................................... 4 – 1 3 – 1 3

Vermont ..................................... 7 3 2 2 3 – 4

Virginia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 7 – 21 5 2 21

Washington . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 9 – 2 7 – 4

West Virginia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 10 – 2 3 – 9

Wisconsin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 15 1 8 14 2 8

Wyoming .................................... 6 1 – 5 – – 6

20
Table 16. Number of current clients receiving home health care by type of certification and State: United States, 1991

State

All

clients

Medicare Medicaid

Certified

Certification

pending

Not

certified Certified

Certification

pending

Not

certified

United States .................................. 1,189,464 1,059,612 2,846 127,006 1,057,478 5,747 126,239

Alabama ..................................... 25,328 24,502 – 826 21,998 409 2,921

Alaska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 727 522 – 205 522 – 205

Arizona ..................................... 9,790 8,528 40 1,222 3,127 144 6,519

Arkansas .................................... 10,336 9,687 – 649 10,042 134 160

California .................................... 68,902 64,239 122 4,541 62,023 210 6,669

Colorado .................................... 8,881 7,573 25 1,283 8,479 25 377

Connecticut ................................... 28,123 26,803 1,211 109 27,978 – 145

Delaware .................................... 5,590 5,446 – 144 5,446 – 144

District of Columbia .............................. 4,563 3,626 – 937 3,619 – 944

Florida ...................................... 60,908 46,867 259 13,782 40,615 1,544 18,749

Georgia ..................................... 26,571 26,566 – 5 26,566 – 5

Hawaii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 908 878 – 30 878 – 30

Idaho . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,111 2,072 – 39 2,108 – 3

Illinois ...................................... 48,927 43,297 37 5,593 41,731 947 6,249

Indiana ..................................... 20,656 18,545 – 2,111 19,765 54 837

Iowa ....................................... 19,847 17,353 – 2,494 17,369 – 2,478

Kansas ..................................... 7,528 5,737 – 1,791 5,558 658 1,312

Kentucky .................................... 24,747 23,907 – 840 23,889 – 858

Louisiana .................................... 24,383 23,960 – 423 23,990 – 393

Maine ...................................... 11,141 10,634 – 507 10,964 – 177

Maryland .................................... 14,110 12,257 – 1,853 11,359 – 2,751

Massachusetts ................................. 47,850 42,067 – 5,783 42,639 – 5,211

Michigan .................................... 40,325 30,283 155 9,887 30,506 225 9,594

Minnesota .................................... 28,442 27,779 12 651 27,315 125 1,002

Mississippi ................................... 24,444 23,849 190 405 23,848 190 406

Missouri ..................................... 20,720 20,633 – 87 20,514 148 58

Montana ..................................... 6,121 6,108 – 13 6,113 – 8

Nebraska .................................... 7,056 5,646 – 1,410 5,329 – 1,727

Nevada ..................................... 1,978 1,908 20 50 1,908 20 50

New Hampshire ................................ 8,894 7,645 6 1,243 7,945 6 943

New Jersey ................................... 29,093 25,068 50 3,975 26,519 99 2,475

New Mexico .................................. 2,759 2,466 – 293 2,466 – 293

New York . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177,547 143,474 256 33,817 154,431 236 22,880

North Carolina ................................. 34,443 32,691 – 1,752 33,982 – 461

North Dakota .................................. 7,360 1,803 – 5,557 2,393 – 4,967

Ohio ....................................... 40,481 38,140 27 2,314 39,428 27 1,026

Oklahoma .................................... 7,681 7,193 6 482 4,829 6 2,846

Oregon ..................................... 8,644 8,050 – 594 7,594 – 1,050

Pennsylvania .................................. 58,766 54,996 – 3,770 53,743 128 4,895

Rhode Island .................................. 14,075 11,244 317 2,514 11,429 232 2,414

South Carolina ................................. 18,739 16,060 – 2,679 17,587 – 1,152

South Dakota ................................. 3,026 2,200 – 826 2,858 36 132

Tennessee ................................... 42,612 42,057 – 555 41,088 – 1,524

Texas ...................................... 59,258 57,282 26 1,950 55,414 77 3,767

Utah ....................................... 4,701 3,689 7 1,005 3,689 7 1,005

Vermont ..................................... 5,418 5,339 – 79 5,339 – 79

Virginia ..................................... 24,429 22,739 20 1,670 23,542 – 887

Washington ................................... 13,842 11,266 – 2,576 11,328 – 2,514

West Virginia .................................. 7,859 7,389 – 470 7,710 – 149

Wisconsin .................................... 17,572 16,794 – 778 17,219 – 353

Wyoming .................................... 1,252 755 60 437 747 60 445

21
Table 17. Number of current clients receiving hospice care by type of certification and State: United States, 1991

State

All

clients

Medicare Medicaid

Certified

Certification

pending

Not

certified Certified

Certification

pending

Not

certified

United States .................................. 43,487 37,184 524 5,779 35,097 641 7,749

Alabama . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 844 793 14 37 732 14 98

Alaska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 5 – 29 5 – 29

Arizona . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 532 474 16 42 323 – 209

Arkansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308 289 – 19 229 – 79

California .................................... 4,641 3,871 72 698 3,236 47 1,358

Colorado . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378 347 – 31 290 68 20

Connecticut . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393 334 – 59 334 – 59

Delaware . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 134 – 5 134 – 5

District of Columbia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 62 – 6 42 – 26

Florida ...................................... 5,376 5,126 3 247 5,269 3 104

Georgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 529 508 – 21 452 42 35

Hawaii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 88 23 16 88 23 16

Idaho . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 196 – 14 196 – 14

Illinois ...................................... 1,500 1,146 – 354 1,101 5 394

Indiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 597 452 15 130 405 – 192

Iowa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 676 598 6 72 598 6 72

Kansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 562 470 – 92 446 14 102

Kentucky .................................... 1,238 1,228 – 10 1,207 – 31

Louisiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 750 741 – 9 619 – 131

Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513 312 80 121 162 50 301

Maryland .................................... 1,328 1,087 10 231 1,087 – 241

Massachusetts ................................. 1,808 1,633 31 144 1,630 25 153

Michigan .................................... 1,348 1,093 14 241 1,087 14 247

Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 733 547 23 163 520 – 213

Mississippi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 88 – – 76 – 12

Missouri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 930 634 – 296 619 15 296

Montana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 138 3 16 108 3 46

Nebraska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232 138 – 94 136 – 96

Nevada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 170 – 14 87 – 97

New Hampshire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366 178 – 188 182 – 184

New Jersey ................................... 1,360 1,190 55 115 1,046 51 263

New Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217 211 – 6 211 – 6

New York . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,346 1,733 5 608 2,016 5 325

North Carolina ................................. 1,325 1,249 36 40 1,249 20 56

North Dakota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 44 – 15 59 – 0

Ohio ....................................... 1,307 1,229 – 78 1,182 35 90

Oklahoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 106 7 41 44 – 110

Oregon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 714 628 15 71 415 8 291

Pennsylvania .................................. 2,220 2,024 50 146 1,998 51 171

Rhode Island . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 564 546 – 18 546 – 18

South Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 491 319 – 172 366 – 125

South Dakota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 59 5 5 33 5 31

Tennessee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 483 466 – 17 401 65 17

Texas ...................................... 2,354 2,318 – 36 2,086 14 254

Utah . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 62 27 47 62 27 47

Vermont . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176 153 10 13 153 – 23

Virginia ..................................... 1,286 590 – 696 572 8 706

Washington . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 712 584 – 128 574 – 138

West Virginia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374 348 – 26 260 – 114

Wisconsin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501 441 4 56 422 23 56

Wyoming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 4 – 46 2 – 48

22
Table 18. Number of current clients receiving both home health and hospice care by type of certification and State: United States, 1991

State

All

agencies

Medicare Medicaid

Certified

Certification

pending

Not

certified Certified

Certification

pending

Not

certified

United States .................................. 30,753 26,331 68 4,354 26,492 67 4,194

Alabama . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406 368 7 31 368 7 31

Alaska ...................................... 3 – – 3 – – 3

Arizona . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 70 – – 67 – 3

Arkansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408 408 – – 408 – –

California .................................... 2,632 2,444 37 151 2,532 25 75

Colorado . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 17 – 1 17 – 1

Connecticut ................................... 1,200 1,168 – 32 1,168 – 32

Delaware .................................... 1 – – 1 – – 1

District of Columbia .............................. – – – – – – –

Florida . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 993 943 – 50 943 – 50

Georgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 400 – – 400 – –

Hawaii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 – 16 – – 16 –

Idaho . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 17 – – 17 – –

Illinois ...................................... 1,876 1,806 – 70 1,804 – 72

Indiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 586 575 – 11 575 – 11

Iowa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 159 – 3 159 – 3

Kansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 428 428 – – 303 – 125

Kentucky . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501 501 – – 501 – –

Louisiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 904 895 – 9 895 – 9

Maine ...................................... 8 5 3 – 5 – 3

Maryland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 525 510 – 15 510 – 15

Massachusetts ................................. 2,964 779 2 2,183 779 – 2,185

Michigan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 17 – 6 12 – 11

Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190 188 – 2 188 – 2

Mississippi ................................... – – – – – – –

Missouri ..................................... 1,208 1,065 – 143 1,065 – 143

Montana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 98 – 6 98 – 6

Nebraska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 110 – – 50 – 60

Nevada ..................................... 5 5 – – 5 – –

New Hampshire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 6 – 28 16 – 18

New Jersey ................................... 4,121 4,093 – 28 4,054 – 67

New Mexico .................................. 5 5 – – 5 –

New York . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,561 427 – 1,134 716 – 845

North Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270 262 2 6 262 – 8

North Dakota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 102 – – 102 – –

Ohio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 885 856 – 29 856 – 29

Oklahoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 48 – – 1 – 47

Oregon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 128 – 26 128 – 26

Pennsylvania .................................. 1,204 1,113 – 91 1,090 – 114

Rhode Island . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332 267 – 65 267 – 65

South Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340 220 – 120 340 – –

South Dakota ................................. 2 2 – – 2 – –

Tennessee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 866 854 – 12 854 – 12

Texas ...................................... 3,519 3,484 – 35 3,477 3 39

Utah . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 13 1 1 13 1 1

Vermont ..................................... – – – – – – –

Virginia ..................................... 1,343 1,289 – 54 1,274 15 54

Washington . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 84 – – 64 – 20

West Virginia .................................. 4 1 – 3 1 – 3

Wisconsin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 89 – 5 89 – 5

Wyoming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 12 – – 12 – –

23
Table 19. Number and percent distribution of home health agencies and hospices by type of certification, according to type of

ownership: United States, 1991

Ownership

Medicare Medicaid

All Certified Certification pending Not certified Certified Certification pending Not certified

Number

Percent

distribution Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

All home health care

agencies ............ 6,853 100.0 5,561 81.1 48 0.7 1,244 18.2 5,579 81.4 76 1.1 1,198 17.5

Proprietary ........... 2,779 100.0 1,975 71.1 29 1.0 775 27.9 1,968 70.8 51 1.8 760 27.3

Nonprofit ............ 2,515 100.0 2,243 89.2 10 0.4 262 10.4 2,223 88.4 14 0.6 278 11.1

Government .......... 1,508 100.0 1,302 86.3 6 0.4 200 13.3 1,346 89.3 8 0.5 154 10.2

Other . . . . . . . . . . . . . . . 51 100.0 41 80.4 3 5.9 7 13.7 42 82.4 3 5.9 6 11.8

All hospices . . . . . . . . . . 951 100.0 600 63.1 33 3.5 318 33.4 504 53.0 34 3.6 413 43.4

Proprietary . . . . . . . . . . . 48 100.0 32 66.7 1 2.1 15 31.3 26 54.2 3 6.3 19 39.6

Nonprofit . . . . . . . . . . . . 838 100.0 529 63.1 31 3.7 278 33.2 441 52.6 29 3.5 368 43.9

Government . . . . . . . . . . 51 100.0 36 70.6 1 2.0 14 27.5 34 66.7 2 3.9 15 29.4

Other . . . . . . . . . . . . . . . 14 100.0 3 21.4 – 0.0 11 78.6 3 21.4 – 0.0 11 78.6

Table 20. Number and percent distribution of current clients receiving home health care, hospice care, and both by type of certification,

according to type of ownership: United States, 1991

Ownership

Medicare Medicaid

All Certified Certification pending Not certified Certified Certification pending Not certified

Number

Percent

distribution Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent

Home health care

All . . . . . . . . . . . . . . 1,189,464 100.0 1,059,612 89.1 2,846 0.2 127,006 10.7 1,057,478 88.9 5,747 0.5 126,239 10.6

Proprietary ......... 333,480 100.0 287,208 86.1 801 0.2 45,471 13.6 278,936 83.6 3,522 1.1 51,022 15.3

Nonprofit .......... 657,881 100.0 597,192 90.8 1,632 0.2 59,057 9.0 600,378 91.3 1,049 0.2 56,454 8.6

Government ........ 189,279 100.0 166,732 88.1 358 0.2 22,189 11.7 169,634 89.6 1,121 0.6 18,524 9.8

Other ............. 8,824 100.0 8,480 96.1 55 0.6 289 3.3 8,530 96.7 55 0.6 239 2.7

Hospice

All . . . . . . . . . . . . . . 43,487 100.0 37,184 85.5 524 1.2 5,779 13.3 35,097 80.7 641 1.5 7,749 17.8

Proprietary ......... 7,003 100.0 5,770 82.4 117 1.7 1,116 15.9 5,655 80.8 154 2.2 1,194 17.0

Nonprofit .......... 33,739 100.0 29,015 86.0 403 1.2 4,321 12.8 27,058 80.2 453 1.3 6,228 18.5

Government ........ 2,581 100.0 2,294 88.9 1 0.0 286 11.1 2,279 88.3 31 1.2 271 10.5

Other . . . . . . . . . . . . . 164 100.0 105 64.0 3 1.8 56 34.1 105 64.0 3 1.8 56 34.1

Both

All . . . . . . . . . . . . . . 30,753 100.0 26,331 85.6 68 0.2 4,354 14.2 26,492 86.1 67 0.2 4,194 13.6

Proprietary ......... 9,380 100.0 7,919 84.4 45 0.5 1,416 15.1 8,090 86.2 36 0.4 1,254 13.4

Nonprofit .......... 17,251 100.0 14,377 83.3 23 0.1 2,851 16.5 14,427 83.6 31 0.2 2,793 16.2

Government ........ 4,026 100.0 3,941 97.9 – – 85 2.1 3,881 96.4 – – 145 3.6

Other . . . . . . . . . . . . . 96 100.0 94 97.9 – – 2 2.1 94 97.9 – – 2 2.1

24
Appendixes

Contents

I. Technical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Creation of a mailing list . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Mail survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Results of mail survey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Classification of agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Editing procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

II. Questionnaire used in the inventory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

III. Classifications and definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Types of agencies and institutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Characteristics of agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Appendix figure

I. Classification of agencies: United States, 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Appendix table

I. Number of agencies by NCHS and ‘‘Question 7’’ classification: United States, 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

25
Appendix I

Technical notes

Creation of a mailing list

The NHPI was a mail survey conducted by NCHS. The

mailing list of home health agencies and hospices for the 1991

NHPI contained 14,089 records. These were records of all

agencies that NCHS was able to identify as potentially being

either a home health agency or a hospice. The list was

constructed using NCHS’s Agency Reporting System, which

is an ongoing system designed to periodically update the

NHPI listings (10). The sources for the mailing list included

the names and addresses of providers obtained from the most

recently published directories and listings from different national

and State organizations, both private and public. The data set

and collection procedures for hospices and home health agencies were developed and tested in the study, ‘‘Feasibility of

Studying Hospices and Home Health Agencies’’(11).

Mail survey

The U.S. Bureau of the Census, under an interagency

agreement with NCHS, served as the data collection and data

processing agent.

Three questionnaire mailouts, plus a field followup, were

used to complete the Inventory. On April 5, 1991, all facilities

in the mailing list universe were mailed a questionnaire. About

a week later, a reminder/thank you letter was mailed. Two

additional mailings at 6-week intervals were made to the

nonresponding agencies and to the Postmaster Returns (PMR’s).

At the end of the mail survey, refusals, PMR’s, and nonresponses were contacted by telephone. Interviewers contacted

these providers until either the information was collected or a

firm refusal was received. This final followup ended on

November 1, 1991.

Questionnaire items 2, 3, 4, 5, 7, and 8 were considered

critical to determine whether an agency was in scope for the

NHPI and for stratifying the long-term care sample. These

items ask for the agency’s address, telephone number, county,

current operating status, and primary service category; and

whether the agency was certified under Medicare, respectively.

Appendix II includes a copy of the questionnaire used. If any

of these items were not completed on a returned questionnaire,

the agency was contacted by telephone either to obtain the

information directly or to arrange for a personal interview. If a

nonrespondent was reluctant to provide information either

over the telephone or through personal interview, the interviewer made a final attempt, by telephone, to determine these

critical questionnaire items (2, 3, 4, 5, 7, and 8), plus items 6

(type of agency ownership), 10 (number of clients), and 13

(number of visits in the last calendar year).

Results of mail survey

Of the 14,089 agencies to which questionnaires were

mailed, 7,804 were either an HHA or hospice. Of the remaining 6,285 agencies, 116 were nonrespondents and 6,169 were

out-of-scope or not in operation (questionnaires were returned

by the U.S. Post Office and/or field interviewers were unable

to locate them by telephone).

The 6,169 agencies that were out-of-scope or not in

operation fit into two major categories. The first category

included: 4,501 agencies that were not yet open, no longer

provided home health or hospice care, or were out of business;

99 agencies that were home offices only; and, 1,352 agencies

that were duplicates in the mailing list. The second category

consisted of 217 agencies that were not classified as home

health agencies or hospices. This classification scheme is

described in a later section. The majority of agencies in the

first category were removed from the list of eligible agencies

by the U.S. Bureau of the Census during the mailings and field

followup; 566 of the duplicate agencies in the first category

were removed by NCHS. Agencies in the second category

were also removed by NCHS.

The overall response rate was 98.5 percent. The numerator is 7,804 (number of responding agencies). The denominator is 7,920 (number of responding agencies plus 116 refusing

agencies and nonresponding agencies).

Classification of agencies

There were 7,804 agencies classified as either a home

health agency or a hospice. NCHS examined two ways to

classify the agencies: one by using ‘‘type of client’’ (questionnaire items 10 and 11) and one by using ‘‘PRIMARY service

category’’ (questionnaire item 7). The client data were used

because they permitted classification of the largest numbers of

agencies into either the home health agency category or the

hospice category, with only 64 agencies remaining in the

category of agencies providing both home health and hospice

care. Classifying the agencies as either a home health agency

or hospice was important for sampling purposes for the

National Home and Hospice Care Survey (12).

26
When questionnaire item 7 is used, the number of agencies in each category is different than when the client classification system is used (table I). There are two primary reasons

for the discrepancy. First, there were inconsistencies between

the answer to question 7 (‘‘PRIMARY service category’’) and

questions 10 and 11 (the client data). For example, if an

agency indicated ‘‘Home Health Agency’’ as its primary

service category, but it served clients receiving hospice care

and no clients receiving home health care, NCHS classified

the agency as a hospice. The second reason for the discrepancy occurred when an agency answered ‘‘Neither’’ for question 7 because home health and/or hospice services were only

part of the range of services it provided. Of the 6,142 agencies

that indicated their ‘‘PRIMARY service category’’ as home

health care, 34 were classified by NCHS as a hospice. Of the

863 agencies that indicated their ‘‘PRIMARY service category’’ as hospice, 12 were classified by NCHS as HHA’s.

The most notable difference between the two classification

methods is that the client system classifies only 64 of the

agencies as being both a home health agency and a hospice

and no agencies as being neither. In contrast, the ‘‘PRIMARY

service category’’ classifies 348 agencies as both a home

health agency and 451 as being neither.

The classification process for the 7,804 agencies is shown

in figure 1. The first step resulted in 4,991 HHA’s, 722

hospices, and 2,089 agencies being classified in the ‘‘both’’

category. These 2,089 agencies had both HHA and hospice

clients that were either ‘‘active,’’ were served in 1990, or were

discharged in 1990. That is, these agencies indicated that they

had HHA clients in either question 10.b, 11.b, or 14.b, and

hospice clients in either questions 10a, 11a, or 14c. These

2,089 clients were reclassified in steps 2–4 and 62 agencies

remained. These 62 agencies indicated that: (1) they had no

active clients, no 1990 clients, and no discharges in 1990; and

(2) they did not indicate their ‘‘PRIMARY service category’’

(question 7). The 62 agencies, plus the two agencies classified

as ‘‘unknown,’’ were placed in the home health agency or

hospice categories case-by-case, using other information in the

record. Clients (active clients, 1990 clients, and client discharges) were the determining factors in the classification, and

question 7 was used only as a last resort in step 5.

Editing procedures

In addition to eliminating the out-of-scope agencies, other

edits were necessary to prepare the file of in-scope facilities.

Edits were made to correct inconsistencies between data

items; for missing items, data were imputed from existing

information when possible. For example, a total of 59 missing

data items were imputed for questions 6–9 by allocating the

missing items proportionally to the answered items.

Table I. Number of agencies by NCHS and ‘‘Question 7’’

classification: United States, 1991

Classification All

Home health

care agency Hospice

Both

unknown Neither

NCHS .......... 7,804 6,797 943 64 0

Question 7 ....... 7,804 6,142 863 348 451

27
Figure 1. Classification of agencies: United States, 1991

Step one Step two Step three Step four 

Frequency Description Frequency Description Frequency Description Frequency Description Frequency 

Homehealthagency

4,991 Q10a=0 & Q11a=0

& Q14a=0 andQ10c=0 & Q11c=0 and(Q10b>0 or Q11b>0or Q14b>0)

+ 794 Q10b>0 &

Q10a=0

+ 758 Q10a>0 &

Q10b>0 &Q10b>Q10a

+48 [Either (Q10a=0 & Q10b=0) or

(Q10a>0 & Q10b>0 & Q10a=Q10b)]

AND

(Q11b>0 or Q14b>0) and(Q11a=0 & Q14a=0)

+ 206 Q

Qa

Hospice 722 (Q10a>0 or Q11a>0

or Q14a>0)and Q10c=0 & Q11c=0and Q10b=0 & Q11b=0& Q14b=0

+ 126 Q10a>0 &

Q10b=0

+ 62 Q10a>0

& Q10b>0& Q10a>Q10b

+ 19 [Either (Q10a=0 & Q10b=0) or

(Q10a>0 & Q10b>0 & Q10a=Q10b)]

AND

(Q11a>0 or Q14a>0) and(Q11b=0 & Q14b=0)

+ 14 Q

Qa

Both 2,089 All cases initially

classified as ‘‘Both’’were reclassifiedinto HHA or Hospiceusing the criteria forsteps 2, 3, 4 and 5.

(920) (820) (67) (220) F

[Qa

Unknown 2 Q10a/ Q10b/ Q10c all=0 and

Q11a/ Q11b/ Q11c all=0 andQ14a/ Q14b both=0 andQ7=4 (neither) or not answered

Total 7,804 

NOTE: Q is the item number on the questionnaire. NE is not equal to.

28
Appendix II

Questionnaire used in

the Inventory

29
30
31
32
Appendix III

Classifications and

definitions

Types of agencies and institutions

Home Health Agency—An agency providing health services to individuals in their place of residence for the purpose

of (a) promoting, maintaining, or restoring health; or (b)

maximizing the level of independence while minimizing the

effects of disability and illness (including terminal illness).

Hospice—An agency providing specialized services for

terminally ill people and their families, including medical

services, social and emotional support for patients and families, volunteer support, and bereavement services for families

following the death of the patient.

Characteristics of agencies

Ownership—Ownership designates the type of organization that owns the agency. Proprietary indicates control by

individual, partnership, or corporation. Nonprofit ownership

includes ownership by a religious group or by a nonprofit

corporation. Government ownership refers to agencies operated under Federal, State, or local government auspices.

Certification—Facility certification by Medicare and/or

Medicaid.

Medicare—The medical assistance provided in title XVIII

of the Social Security Act. Medicare is a health insurance

program administered by the Social Security Administration

for persons aged 65 years and over and for disabled persons

who are eligible for benefits.

Medicaid—The medical assistance provided in title XIX

of the Social Security Act. Medicaid is a State-administered

program for the medically indigent.

Current clients—Clients who were reported to be currently on the rolls of the agency at the time of the survey.

Geographic regions—The U.S. Bureau of the Census

groups the 50 States plus the District of Columbia into the

following regions:

Region States included

Northeast Connecticut, Maine, Massachusetts, New

Hampshire, Rhode Island, Vermont, New

Jersey, New York, Pennsylvania

Midwest Illinois, Indiana, Michigan, Ohio, Wisconsin,

Iowa, Kansas, Minnesota, Missouri, Nebraska,

North Dakota, South Dakota

South Delaware, District of Columbia, Florida,

Georgia, Maryland, North Carolina, South

Carolina, Virginia, West Virginia, Alabama,

Kentucky, Mississippi, Tennessee, Arkansas,

Louisiana, Oklahoma, Texas

West Arizona, Colorado, Idaho, Montana, Nevada,

New Mexico, Utah, Wyoming, Alaska,

California, Hawaii, Oregon, Washington

33