I Data from the

NATIONAL HEALTH SURVEY

Selected Operating and

Financial Characteristics of

Nursing Homes

United States:

1973=74 National Nursing Home Survey

Statistics are presented on the major operating and financial

characteristics of nursing homes based on data collected in the

1973-74 National Nursing Home Survey. Data are reported by

type of ownership, certification status, size of home, and

geographic region.

DHEW Publication No. (HRA) 76-1773

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Public Health Service

Series 13

Number 22

Health ResourcesAdministration

National Center for Health Statistics

Rockville, Md. December 1975
Library of Congress Cataloging in Publication Data

United States. National Center for Health Statistics.

Selected operating and financial characteristics of nursing homes, United States:

1973-74 National nursing home survey.

(Vital and health statistics: Series 13, Data from the National Health Survey; no. 22)

(DHEW publication; no. (HRA) 76-1773)

Includes bibliographical references.

Supt. of Dots. no: HE 20.6209: 13/22

1. Nursing homes–United States–Statistics. 2. Nursing homes–United States–

Finance–Statistics. I. Title. II. Series: United States. National Center for Health Statistics.

Vital and health statistics: Series 13, Data from the National Health Survey, Data from the

hospital discharge survey; no. 22. III. Series: United States. Dept. of Health, Education, and

Welfare. DHEW publication; no. (HRA) 76-1773. [DNLM: 1. Costs and cost analysis. 2.

Economics, Hospitals–U.S.–Statistics. 3. Nursing h’omes-U.S.-Statistics. 4. Nursing

homes–Utilization–U.S. W2 AN148vm no. 22 etc.]

RA407.3.A349 no. 22 [RA997] 362.1’1’0973 75-619405

ISBN 0-8406-O064-X [362.1’6’0973]

—

For sale by the Superintendent of Documents, U.S. Government Printing Office, Wasldugton, D.C. 20402-Price $1.S0
NATIONAL CENTER FOR HEALTH STATISTICS

DOROTHY P. RICE, Director

ROBERT A. ISRAEL, Deputy Director

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

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

ELIJAH L. WHITE, Associate Director for Data Systems

GEORGE P. FAILLA, Associate Director for Management

PETER L. HURLEY, Associate Director for Operations

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

ALICE HAYWO OD, Information Officer
CONTENTS

Introduction ..............................................................................................

Scope of Report .....................................................................................

Background and Qualifications of Data .................................................

Highlights of Characteristics for all Nursing Homes ....................................

Characteristicsby Ownership ....................................................................

Characteristics by Certification Status ........................................................

Characteristics by Size ...............................................................................

Characteristics by Region ..........................................................................

Summary ..................................................................................................

References .................................................................................................

.

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

Appendix L Technical Notes on Methods ..................................................

Survey Design ........................................................................................

General ..............................................................................................

Sampling Frame ................................................................................

Sampling Design .................... ...........................................................

Data Collection Procedures for~1973-74 National Nursing Home

Survey .............................................................................................

General Qualifications ...........................................................................

Nonresponse and Imputation of Missing Data ....................................

Rounding of Numbers .......................................................................

Data Processing ..................................................................................

Estimation Procedures .......................................................................

Reliability of Estimates ................................................. . . . . . . . . . . . . . . . . . . . . . . . .

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

Terms Relating to Facilities or Residents ..............................................

Terms Relating to Employees ................................................................

Geographic Terms ..................................................................................

Coverage of Financial Data ....................................................................

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CONTENTS–Con.

Questionnaires Used in the 1973-74 National Nursing Home

Survey .....................................................................................................

Appendix IV. Criteria for Classifying Nursing Homes According to Level

of Nursing Care ........................................................................................

Types of Facilities Included in the Survey .............................................

SYMBOLS

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

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

Quantity zero ---------------------------------------------- -

Quantity more than Obut less than 0.05----- 0.0

Figure does not meet standards of

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SELECTED OPERATING AND

FINANCIAL CHARACTERISTICS

OF NURSING HOMES, UNITED STATES:

1973-74NATIONAL NURSING HOME SURVEY

Mark R. Meiners, Division of Health Resources Utilization Statistics

INTRODUCTION

Scope of Report

During the period August 1973 to April 1974,

the Division of Health Resources Utilization Statistics of the National Center for Health Statistics

conducted a nationwide sample survey of nursing

homes, their residents, and staff. a This report

presents estimates from that survey of the major

operating and financial characteristics of the

Nation’s nursing homes. The data are reported

by type of ownership, certification status, size

of home, and geographic region breakdowns of

all facilities, and will cover the following topics:

. Facility operating characteristics—number

I ●

of homes, beds, residents, resident days of

care, average bed size, average full-time

equivalent employees per 100 beds, and

average occupancy rate.

Facility financial characteristics—average

total monthly charge per resident, percent

aprovisional estimates were made available in a“previous supplement from the National Center for Health Statistics. Nursing

Homes: An Overview of National characteristics for 1973-74.

hfonthly Vital Statistics Report, Volume 23, Number 6, supplement. DHEW publication Number (HRA) 75-1120. Health

Resources Adminktration, Washington, U.S. Government Printing Office, September .s, 1974.

distribution of homes by monthly charge

intervals, average costs per resident day,

and percent distribution of homes by cost

intervals for total, labor, fixed, operating,

and miscellaneous expenses.

Before presenting these estimates, a brief

description of the survey as it relates to the data

in this report is included to assist the reader in

interpreting the resulting estimates. A detailed

description of the survey is given in the section

ItSurvey Design” in appendix 10

Background and

Qualifications of Data

The survey was designed to satisfy the diverse data needs of those who establish standards

for, plan, and provide long-term care. Facilities

within the scope of this survey were (1) those

nursing homes classified in a 1971 census as

providing some level of nursing care, plus (2)

all such nursing homes newly opened in 1972.

A definition of nursing care and detailed criteria

for identifying homes providing nursing care are

presented in appendix IV.

Data on the nursing homes’ operating and

financial characteristics were collected using

a combination of mail and personal interview

techniques. The reference period for which these

data were collected varied on the basis of the

availability of information at the time of the

1’
survey. All data on costs incurred by the facility

for providing care as well as some operating

characteristics were collected for calendar year

“1972, or, if the home’s accounting records were

on a fiscal year basis, for the most recently

completed fiscal year prior to the survey. The

data on charges made by the facility and the

remaining facility operating characteristics were

collected for the period in 1973-74 during which

the survey was conducted. In addition to these

time period differences, several further definitions and qualifications of these data should be

noted.

Facility cost comparisons in this report

are based on the average cost per resident day.

This variable was calculated by dividing the

individual home’s costs for 1972 by rhe aggregate

days of resident care it provided during that

time and then averaging this ratio for those homes

in a particular classification. Resident charge

comparisons, however, are based on the average

total monthly charge per resident. Residents are

generally billed on a monthly basis by the facil- ,

ities so the data were collected and are reported

on that basis. In addition, the data on facility

costs and resident charges are not adequate in

themselves to provide a direct comparison be-

. tween costs and revenues of nursing home

operations because of differences in coverage.

A detailed description of the definitional coverage

of these financial data is given in appendix II.

Data on the availability of staff to provide

cake in the homes is presented in terms of the

number of full-time equivalent (FTE) employees

per 100 beds. Thirty-five hours of part-time employees’ work are conventionally taken as equivalent to one full-time employee. Part-time employees were converted to FTE employees by

dividing the number of hours worked per week by

35. By using the number of FTE employees rather

than total employees, the variation between homes

in the proportion of part-time staff is held

constant. The ave-vqw FTE employees pev 100

beds was calculated by averaging the FTE employees per 100 beds ratio of each home.

Each hornets occupancy rate was determined

by dividing the aggregate number of days of care “

it provided to residents in 1972 by its number of

beds in 1973-74 adjusted for the home’s net change

in beds from 1972 times 366 and then multiplying

this ratio by 100.” This rate for each home was

then averaged to get the avwage occupancy rate.

Since all the estzmates are based on a sample

of nursing homes rather than on a complete enumeration, they are subject to sampling variability.

Provisional estimates of the sampling errors are

used in this report because final estimates are

not yet available. Detailed information on the

meaning and use of the provisional sampling

variability of the estimates is given in the section

“Reliability of Estimates’f in appendix I. Tests of

significance were conducted using these standard

errors so that the differences between selected

characteristics could be statistically verified.

All statistical comparisons mentioned throughout

this report were tested using a 95 percent confidence interval, i.e., the probability is no more

than 1 chance in 20 that the differences noted

here as being statistically significant would not

be confirmed by a complete enumeration of all

homes.

HIGHLIGHTS OF CHARACTERISTICS

FOR ALL NURSING HOMES

To place the data to be reported by the various classification breakdowns in perspective,

table 1 presents the operating and financial characteristics of all nursing homes in the United

States.

For the period August 1973 to April 1974, the

national estimates projected from the sample

indicated some 15,700 nursing homes in the United

States had a total of 1,174,800 beds and served

1,075,800 residents. The aw?rage” facility had

available 63.9 FTE employees per 100 beds, of

whom about 61 percent were employed as part

of the nursing staff. Seventy-four percent of those

on the nursing staff were classified as nurse’s

aides. During the 1973-74 period, the average

monthly charge per resident for all aspects of

care was $479. Almost 46 percent of the homes

had average monthly charges of less than $400

and fully 71 percent had charges under $500.

In 1972 these nursing homes provided around

369 million resident days of care and experienced

bAggregate number of days of care provided to residents in

1972 X1OO

Estimated number of beds in 1972 X 366

2

.
~

an average occupancy rate of88.2percent. During

I

this time the average total cost per resident day

in the Nation’s nursing homes was $15.63, about

59 percent of which went for labor expenses

I

($9.1?). As a result of the high dependence of the

industry on nursing personnel as the primary

I provider of care, the wages paid the nursing

= LULL lllUUC Up UC) ~tU CCLIL U1 LULiil Wtl&S tlIKS

slightly more than a third of total expenses.

Operating costs (at $3.41) were the second largest major cost component, accounting for about

22 percent of total costs. Fixed costs ($2.37)

accounted for about 15 percent of the total, and

miscellaneous costs ($0.68) for about 4 percent,

Although the Nation’s nursing homes averaged

a total cost per resident day of $15.63, 59 percent

of the homes had average total costs per resident

day below $15.00. The mean cost per resident

day was also greater than the median cost per

resident day for each of the major cost categories.

Over 50 percent of the homes had labor, fixed,

operating, and miscellaneous costs per resident

day which were less than the national average

for these categories.

CHARACTERISTICS BY

OWNERSHIP

Of the nursing homes represented in the

1973-74 survey, an estimated 75 percent were

operated under proprietary auspices while 25

percent were operated under nonprofit (nonproprietary and government) auspices (table 2). Proprietary homes had the greater proportion of all

beds (71 percent) and residents (70 percent), although the average size of these homes (70 beds)

was smaller than that for the nonprofit homes

(88 beds).

In addition to being larger, the nonprofit

‘ homes had a substantially larger number of FTE

. employees per 100 beds (83.5) than did the proprietary homes (57.4). This difference in staffing

is primarily attributable to the fact that nonprofit homes averaged more than twice as many

AU oth~ c FTE employees per 100 beds than

cThe “~ other” J?TEcateuorv ‘2. includes the clericsl. food

service,housekeeping,andmaintenancepersonnelaswellasany

other staff not performingnursing,administrative,medical,or

therapeuticfmctions.

proprietary homes. Acting as a possible offset

to the lower number of total personnel per bed

in proprietary homes was the fact that these

homes averaged more administrative, medical,

and therapeutic FTE employees per 100 beds

(4.9) than did the nonprofit homes (3.8), with the

difference statistically significant.

During the survey period in 1973-74, the

estimated average monthly charge per resident

was found to be $33 more in proprietary than in

nonprofit homes, although when the variation of

these estimates is considered this difference is

not statistically significant. The distribution of

homes does, however, show that more nonprofit

homes are distributed in the lower average charge

categories than is the case with the proprietary

home. Fifty-three percent of the nonprofit homes

had their average monthly charge per resident

under $400 while only about 44 percent of the

proprietary homes fell in this range. These findings are indicative of the proprietary facility’s

greater dependence on user charges to cover

‘costs whil= nonprofit facilities are more apt to

cover part of their costs through donations,

grants, and subsidies.

In 1972 proprietary homes provided about

71 percent of the estimated 369 million resident

days of care with the remainder provided by the

nonprofit homes. The average occupancy rates

for the proprietary homes (88.8) and the nonprofit homes (86.5), however, were not significantly different.

In 1972 the average total cost per resident

day was notably higher in nonprofit homes ($17.71)

than in proprietary homes ($14.86). The apparent

cause of this substantial difference in costs is

the greater use of labor by the nonprofit homes,

which is reflected by the cost data as well as

the FTE employees data. The nonprofit homes

not only averaged higher labor costs per resident day ($10.90) than the proprietary homes

($8.53) but also devoted a greater proportion of

their total costs per resident day to the labor

component (61.5 percent) than did the proprietary

homes (57.4 percent). The estimated total of

operating, fixed, and miscellaneous costs per

resident day also averaged higher in nonprofit

homes ($6.81) than in proprietary homes ($6.33),

but this difference was not found to be statistically significant.

3
The distribution of homes by cost per resident day intervals gives additional comparative

cost information. As noted previously, proprietary homes generally report lower total costs

per resident day than do nonprofit homes. Around

62 percent of the proprietary homes had total

costs per resident day below $15.00 while only

52 percent of the nonprofit homes fell below this

level. Conversely, only about 14 percent of the

proprietary homes had total costs per resident

day of $20 or more, while about 30 percent of

the nonprofit homes were in this range.

This general pattern (i.e., proprietary homes

being more heavily distributed in the two lowest

cost intervals while nonprofit homes are more

heavily distributed in the highest) is similar for

the distributions of homes by labor, operating,

and miscellaneous costs per resident day; although the difference in percentages is not statistically significant in the case of miscellaneous

costs. The distribution of homes by average fixed

costs per resident day, however, completely reverses the pattern. Only about 47 percent of the

proprietary homes had fixed costs per resident

day of $2 or less while around 69 percent of the

nonprofit homes fell in this range. Approximately

29 percent of the proprietary homes were in the

highest fixed cost per resident day interval ($3

or more) compared to only about 15 percent of

the nonprofit homes. The fact that nonprofit homes

generally report lower fixed costs per resident

day is probably due to the more favorable tax

treatment received by nonprofit institutions as

well as the Hill= Burton program which provided

subsidy funds (loans, grants, and loan guarantees)

for nonprofit health facility construction. Without

these benefits it appears that the indicated difference in total costs between nonprofit and proprietary homes would have been even larger.

CHARACTERISTICS BY

CERTIFICATION STATUS

The nursing homes included in the 1973-74

survey comprised:

. Those homes certified

facilities by Medicare

Social Security Act) d

4

as extended care

(Title XVIII of the

. Those certified as skilled nursing homes by

Medicaid (Title XIX of the Social Security

Act) d

. Those certified as intermediate care facilities by Medicaid

. Those not certified by either program but

providing some level of nursing care.

Of the homes which were certified, some

were certified under both the Medicare and the

Medicaid programs. Other homes certified only

by the Medicaid program were certified to participate as both a skilled nursing home and an

intermediate care facility. In order to provide

detailed data by certification status, some small

certification subgroups were combined with larger

ones when both provided similar levels @ care.

Thus, those 4,200 homes classified in table 3 as

having been certified by both Medicare and Medicaid (BM&M) include 8 percent which were certified by Medicare only. Similarly, the 3,500 homes

classified in table 3 as having been certified by

Medicaid as skilled nursing homes (SNH’S) included 35 percent which were also certified as

intermediate care facilities (ICFfs).

Seventy-seven percent of all nursing homes

were certified by Medicare, by Medicaid, or by

both programs with about 50 percent of them

certified for Medicaid only. Although the homes

certified by both Medicare and Medicaid or by

Medicare only (the BM&M group in this report)

comprised about 27 percent of all homes, they

housed about 38 percent of the total beds and

residents. Similarly, those certified as skilled

nursing homes by Medicaid with no Medicare

certification (the SNH group in this report) com-

‘prised only about 22 percent of the Nationfs

nursing homes, but had 27 percent of the total

beds and residents. In contrast, homes certified

only by Medicaid and only as intermediate care

facilities (the ICF group in this report) comprised 28 percent of all homes but had only about

22 percent of the total beds and residents, while

homes not certified for Medicare or Medicaid

‘The Extended Care Facility and Skilled Nursing Home designations are used in this report because most of the survey was

conducted prior to the legislation which created the Skilled

Nursing Facflity.
comprised 23 percent of all homes and housed

about 13 percent of the beds and residents.

The homes classified in the BM&M certification group averaged 105 beds while those homes

in the SNH and ICF certification groups averaged

92 and 57 beds, respectively. Those homes not

certified for either Medicare or Medicaid were

the smallest averaging 45 beds. Each of the differences in average size was found to be statistically

significant except for that between the BM&M

homes and the SNHIS.

The availability of FTE employees per 100

beds also varied by certification status.’ The SNH

group had the greatest number of total FTE employees per 100 beds (76.3) while the ICF group

had the lowest number (55.8), although the ICFS’

average was not significantly different from that

for the noncertified homes (56.7). The difference

in total personnel between the SNH group and the

other certification groups was primarily due to

the substantially greater number of Ali othev

FTE employees per 100 beds used by SNH’S. A

partial explanation for this is related to the previous finding that nonprofit homes employed substantially more All othev FTE employees per 100

beds. Table 4 shows that among the certification

groups the SNH group had the largest percentage

(28) of nonprofit homes. The BM&M homes averaged more nursing FTEs per 100 beds (44.4) than

any of the other certification groups, although the

SNHS’ average (42.8) was not significantly different. The number of administrative, medical, and

therapeutic FTE employees per 100 beds, however, averaged nearly twice as high in the noncertified homes as in any”of the certified home

classifications. One explanation for this is that

by any standards a minimum administrative,

medical, and therapeutic staff may be needed to

adequately operate a nursing home and this results in a greater per-bed coverage by the professional staff in the smaller average size noncertified homes.

The average total monthly charge data indicate that the per-resident charges in 1973-74

were highest for homes in the BM&M group and

decreased with the lesser certification status of

the home. The estimated decrease was $108 between each of the subsequent levels of certified

homes (i.e., BM&M to SNH and SNH to ICF), possibly reflecting the differences in the type of service offered. The estimated average monthly charge

for residents in the noncertified homes ($329)

was the lowest of the four certification status

groups although only $47 less than the average

for the ICF group ($376).

Nursing homes certified only for Medicaid

provided approximately half of the total number

of resident days of care in 1972 with the SNH

group accounting for about 27 percent and the ICF

group accounting for about 22 percent. Homes

in the BM&M group provided 37 percent and those

not certified provided 14 percent of the 1972 resident days of care. During this period the BM&M

homes had an estimated average occupancy rate

of 85.6 which was somewhat lower than the occupancy rates estimated for the other certification groups. While a difference might be expected because of the generally shorter stay of

Medicare residents (at the maximum, Medicare

will finance 100 days of care) and the resulting

turnover vacancy periods, the tests of significance do not confirm this expectation.

The 1972 average cost per resident day of

$21.17 for BM&M homes was much higher than

that for any of the other types of homes (table 3).

This higher cost was apparently due to the expense of meeting the standards for staffing, construction, equipment, and provision of services

required for Medicare certification, since all the

major cost components show these homes to be

distributed more heavily in the higher cost intervals. When homes certified by Medicaid only were

compared, those in the SNH group had higher

average total costs ($15.58) than those certified

as ICF’S only ($11.99). As in the previous instance,

this is probably due to the greater expense of

meeting the higher standards for SNH’s. The estimated average cost per resident day for the noncertified homes was $14.03.

CHARACTERISTICS BY SIZE

The number of beds in a facility was chosen

as the most appropriate indicator of size available

to report the selected financial and operating

characteristics. Four bed size breakdowns are

used (see table 5) and for purposes of discussion

the classes will be lettered beginning with A for

the smallest size “Less than 50 beds.” Group A

included 41 percent of the nursing homes and 15

5
percent of the total beds for an average facility

size of 28 beds. Group B (50-99 beds) included

35 percent of the homes and 33 percent of the

beds for an average facility size of 71 beds.

Group C (100-199 beds) had 20 percent of all the

homes and 35 percent of all the beds for an

average facility size of 130 beds. The largest

group, D (200 beds or more), had only 4 percent

of the homes but 16 percent of the beds for an

average facility size of 314 beds. The distribution

of the total residents closely followed that of the

total beds with both A and D each having about

15 percent, B having 34 percent, and C having

36 percent.

When compared by size class, the availability of FTE employees per 100 beds is in most

cases not statistically different either for total

employees or for individual occupation groups.

One particularly noteworthy difference, however,

was in the availability of professional staff in

group A homes. These homes average substantially more administrative, medical, and therapeutic FTEs per 100 beds (6.6) than any of the

other size groups. This greater per bed coverage

by the professional staff in the smallest homes

gives credence to the possibility, suggested

earlier, that a minimum administrative, medical,

and therapeutic staff is needed to adequately

operate a nursing home.

The general indication of the 1973-74 data

on average monthly charge per resident is that

charges were greater the larger the facility

size. The percentage of homes which averaged

monthly charges of $500 or more per resident

increased with the increase in facility size group.

Conversely, the percentage of homes with charges

below $400 decreased with the increase in facility

size group. This direct relationship ‘between

charges and size was probably due in part to the

greater number of services which larger facilities

tend to offer. Some services are economically

feasible only in facilities which are large enough

to spread the costs so that the resident will be

able to afford them. Table 4 gives evidence consistent with this explanation. Homes in the larger

size groups were more likely to be classified as

BM&M homes or SNH?S which are required to

offer more services and thus tend to charge more.

Group D had 80 percent of their homes in these

classes (48 percent as BM&M and 32 percent as

SNH) while group C had 76 percent. In contrast,

group B had 56 percent classified as either BM&M

or SNH, while group A had only 25 percent.

The approximately 369 million resident days

of care provided in 1972 were distributed among

the bed size groups in a manner similar to the

1973-74 distribution of residents (table 5). Group

A provided 16 percent of the resident days of

care, group B provided 34 percent, group C provided 35 percent, and group Dprovided 15percent.

None of the occupancy rates averaged by the size

groups was found to be statistically different

despite what appeared to be a relatively smaller

rate registered by group D.

The 1972 data on average cost per resident

day presented in table 5 indicate that total costs

were greater the larger the facility, No indication

is given of an optimum size nursing home from

the standpoint of cost minimization. The positive

cost- size relationship is,. however, consistent

with. the earlier suggestion-that larger facilities

tend to be able to offer more services because

of their greater cost spreading potential, This

could tend to overshadow operating efficiencies

which may occur from larger nursing homes

providing the same level of services more efficiently than could be” accomplished by smaller

nursing homes. In any case, caution must be

taken in attributing the positive cost-size relationship entirely to the effect of size on cost,

as no adjustment has been made to any of the

data presented in this report to account for the

interrelationships of the various other classification factors (i.e., ownership, certification, and

region). For example, table 4 shows that 52 percent of those homes in group D were nonprofit

homes while for homes in groups C, B, and A the

percentage of nonprofit homes was only 24, 25,

and 22, respectively. As noted above, nonprofit

homes had higher average costs per resident

day than proprietary homes. In addition, only 9

percent of group A homes were in the certification class with the highest cost per resident

day (BM&M), while group B had 31 percent, group

C had 47 percent, and group D had 48 percent in

this certification class. In contrast, 36 percent of

group A homes were in the certification class

with the lowest cost per resident day (ICF), while

groups B, C, and D had 28, 16, and 8 percent,

respectively, as ICFS. Further analysis is planned

!6
to clarify the relationship between facility costs

and size characteristics with the results to be

presented in future reports.

CHARACTERISTICS BY REGION

The selected operating and financial characteristics are presented in table 6 by the geographic regions— Northeast, North Central, South,

and West. A review of the 1973-74 data reveals

a consistent pattern in the regional distribution

of total homes, beds, and residents. The North

Central Region had the highest proportion of the

total homes (36 percent), beds (35 percent), and

residents (34 percent). The South had the second

highest proportion with 26 percent of each. The

Northeast Region was next with 20 percent of all

the homes, 21 percent of all the beds, and 22 percent of all the residents. The West with 18 percent of the total in each of these categories had

the smallest proportion.

Homes in the Northeast had an estimated 81

beds per home while those in the North Central

Region had 73 beds per home. The South and

West each average 74 beds per home. None of

these bed size averages were significantly different. The staffing estimates, however, reveal both

similarities and differences in the regional @ailability of FTE employees. Homes in the North

Central and Northeast Regions had more FTE

employees per 100 beds available (70.2 and 68.9,

respectively) than did homes in the West and

South (57.1 and 56.1, respectively). This pattern

is due to the All othe~ component which shows a

similar regional relationship. None of the regional differences in the nursing, administrative,

medical, and therapeutic components were statistically significant.

During the survey period in 1973-74, nursing

homes in the Northeast averaged- substantially.

larger total monthly charges per resident ($651)

than that averaged by homes in any of the other

geographic regions. Although the estimates varied

between the West ($454), the North Central Region

($433), and the South ($410), the differences were

not statist ically significant.

The 1972 regional distribution of resident

days of care was similar to the regional distribution of residents in the 1973-74 survey period.

Homes in the North Central Region provided

about 35 percent of the approximately 369 million

resident days of care while homes ?n the South,

Northeast, and West provided 26, 22, and 18 percent, respectively. During 1972 the estimated

regional occupancy rates ranged from an average

of 89.5 in the Northeast to 86.0 in the West, but

none of the differences were statistically significant.

Total costs per resident day averaged higher

in the Northeast ($19.60) than in any other region.

The primary cause of this regional disparity in

nursing home costs was the labor component.

Labor costs per resident day in the Northeast averaged $12.03 which was 35 percent larger than the

next highest average for this category ($8.90 in the

North Central Region). The total of operating,

fixed, and miscellaneous costs per resident day

also averaged higher in the Northeast ($7.57)

than in any of the other regions except possibly the West ($6.88) where the difference was

not statistically significant. Barring any major

changes in the regional cost relationship between

1972 and the 1973-74 survey period, the substantially higher costs in the Northeast, with

particular emphasis on the effect of the labor

component, offers the best explanation for the

substantially higher resident charges in that

region.

SUMMARY

Operating and financial characteristics of

nursing homes in the United States are influenced

by a complex set of factors and their interrelationships. Estimates of the major operating and financial characteristics collected in the 1973-74

nationwide sample survey of nursing homes were

presented with special emphasis on the individual

impact of ownership, certification, size, and

region on these characteristics. More detailed

analysis is planned to determine the effect ,of

the interrelationships of these and other factors

on nursing home characteristics with the tabulations and conclusions to be presented in future

reports.

000 —

7
1Van Nostrand, J.F.: Development of survey methodology

to measure cost and quality of care in nursing homes, paper

presented at 10lst Annual Meeting of American Public Health

Association, San Francisco, Nov. 8,1973.

‘Natiomd Center for Health Statistics: Development and

maintenance of a National Inventory of Hospitak and Institutions. Vital and Health Statistics, PHS pub. No. 1000-Series

l-No. 3. Public Health Service. Washington. U.S. Government

Printing Office, Feb. 1965.

3Nationd Center for Health Statistics: Design and methodology of the 1967 Master Facihy Inventory Survey. Vital and

Health Statistics, PHS pub, No, 1000-Series 1-No, 9. public

Health Service. Washington, U.S. Government Printing Office,

Jan. 1971.

4National Center for Health Statistics: The agency reporting system for maintaining the National Inventoq of Hospitals

and Institutions. Vital and Health Statistics. PHS Pub. No.

1000-Series l-No. 6. Public Health Service. Washingron. U.S.

Government Printing Office, Apr. 1968.

5Nation~ Center for Health Statistics: Institutions for the

aged and chronically ill. United States–Apr&June 1963. Vital

and Health Statistics. PHS pub. No. 1000-Series 12-No. 1.

Public Health Service. Wa~hington. U.S. Government Printing

Office, Jtdy 1965.

6National Center for Health Statistics: krarrgements for

physician services to residents in nursing and personal c~e

homes. United States–May-June 1964. Vital and Health Statistics, PHS pub. No. 1000-Series 12-No. 13. public Health Service.

Washington. U.S. Government Printing Office, Feb. 1970.

7National center for Health Statistics: Selected characteristics of nursing homes for the aged and chronically ill. United

States–June-August 1969. ~ital and Health Statistics. DHEW

pub. No. (HRA) 74-1708. Series 12-No. 13. Health Resources

Administration. Washington. U.S. Government Printing Office,

Jan. 1974.

8Nation~ Center for Health Statistics: Inpatient health

facilities as reported from the 1971 Master Facility Inventory

Swey. Vital and ,Healtk Statistics. Series 14-No. 12. DHEW

Pub. No. (HRA) 74-1807. Health Resources Administration.

Washington. U.S. Government Printing Office, Feb. 1970.

8
LIST OF DETAILED TABLES

Page

Table 1. Selected operating and financial characteristics of United States nursing homes .............................................. 10

2. Selected financial andoperating characteristics of United States nursing homes by ownership classification ... 11

3. Selectad operating andtinancial charatieristics of United States nursing homes bycetiifimtion satus ........... 12

4. Percent of nursing homes according to cross classifications of ownership, certification, size, and region:

United States, 1973-74 ................................................................................................................................ 13

5. Selected operating and financial characteristics of United States nursing homes by facility size .............. 14

6. Selected operating and financial characteristics of United States nursing homes by geographic region ...... 15

I
Table 1. Selectedoperatingand financialcharacteristicsof United States nursing homes

Operating and financialcharacteristics

OPERATING CHARACTERISTICS

Number of homes (l973-l974)--------------------------------------------------

Number of beds (l973-l974)---------------------------------------------------

Average bed size (l973-l974)-------------------------------------------------

Average total FT.Eemployeesper 100 beds-------------------------------------

Nursing FTE employeesper 100 beds-----------------------------------------

RN FTE employeesper 100 beds--------------------------------------------

LPN FTE employeesper 100 beds-------------------------------------------

Nurses’s aide FTE employeesper 100 beds---------------------------------

Administrative,medical, and therapeuticFTE employeesper 100 beds--------

All other FTE employeesper 100 beds---------------------------------------

Number of residents (l973-l974)----------------------------------------------

Number of resident days of care (1972)---------------------------------------

Average occupancyrate (l972)------------------------------------------------

FINANCIAL CHARACTERISTICS

1973-1974resident charges:

Average total monthly charge per resident----------------------------------

Percent of homes by average total monthly charge per resident:

L;;; th& $299-----------------------------------------------------------

H

------------------.........-------------------------------------

400: 499----------------------------------------------------------------

p;-:,,, --------------------- --------------------- -------------- --------

r mOre -------------------------------------------------------------

1972 facility costs:

Average total costs per resident day---------------------------------------

Labor costs per resident day---------------------------------------------

Fringe benefit cost per resident day-----------------------------------

Wage costs per resident day--------------------------------------------

Nursing staff costs per resident day---------------------------------

Other staff costs per resident day-----------------------------------

Fixed costs per resident day---------------------------------------------

Operating costs per resident day-----------------------------------------

Food and drug costs per resident day-----------------------------------

All other costs per resident day---------------------------------------

Miscellaneouscosts per resident day-------------------------------------

Percent of homes by average total costs per resident day:

Less than $lO.OO---------------------------------------------------------

ii

10.00- l4.99------------------------------------------------------------

15.00- l9.99------------------------------------------------------------

20.00 or more-----------------------------------------------------------

Percent of homes by average labor costs per resident day;

L~;ot&n$4. OO----------------------------------------------------------

i

------------------------------------------------------------

8:oo:$li.99-------------------------------------------------------------

$12.00 Ormore -----------------------------------------------------------

Percent of homes by average fixed costs per resident day:

----------------------------------------------------------

E%%?:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

$3.00 or more------------------------------------------------------------

Percent of homes by average operatingcosts per resident day:

L;s;oth~9j2.OO----------------------------------------------------------

18

------------------------------------------------------ --------

3:00: 3.99--------------------------------------------------------------

4.00 or more ------------------------------------------------------------

Percent of homes by average miscellaneouscosts per resident day:

L;s;oth;n9~0.5O----------------------------------------------------------

~$

--------,-----------------------------------------------------

1:00: l:99--------------------------------------------------------------

2.00 or more------------------------------------------------------------

All facilities

15,700

1,174,800

75

63.9

38.7

4.4

2:::

20:6

1,075,800

368,906,000

88.2

$479

17.8

28.1

25.3

14.9

13.9

$1;.;;

0;67

8.50

5.36

;.;$

3:41

1.60

1.81

0.68

23.0

36.3

22.9

17.8

4!::

32.0

17.7

19.6

32.4

22.4

25.6

20.0

39.7

18.8

21.5

55.5

26.8

12.7

5.0

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

10
Table 2. Selected financial and operatinz characteristics of United States nursing homes by o~ership

classification

Operating and financial characteristics

OPERATING — CHARACTERISTICS

Number of homes (1973-1974)-----------------------------------

Number of beds (1973-1974)------------------------------------

Average bed size (1973-1974)----------------------------------

Average total FTE employees per 100 beds----------------------

Nursing FTE employees per 100 beds--------------------------

Administrative, medical, and therapeutic FTE employees

per 100 beds-----------------------------------------------

All other FTR employees per 100 beds------------------------

Number of residents (1973-1974)-------------------------------

Number of resident days of care (1972)------------------------

Average occupancy rate (1972)---------------------------------

FINANCIAL CHARACTERISTICS

1973-1974 resident charges:

Average total monthly charge per resident-------------------

Percent of homes by average total monthly charge per

resident:

L;;; t~ $299--------------------------------------------

~!

----------------------------.--------------------

400: 499-------------------------------------------------

500- 599-------------------------------------------------

600 or,more----------------------------------------------

1972 facility costs:

Average total costs per resident day------------------------

Labor costs per resident day------------------------------

Nursing staff costs per resident day----------------------

Operating, fixed,and miscellaneous costs per resident

day------------------------------------------------------

Percent of homes by average total cost per resident day:

Less than $10.00------------------------------------------

it

10.00- l4.99---------------------------------------------

15.00- l9.99---------------------------------------------

20.00 or more--------------------------------------------

Percent of homes by average labor costs per resident day:

L~;oth;n9j4.00 -------------------------------------------

~i

-----------------------------------------------

8:00~ li.99----------------------------------------------

12.00 or more--------------------------------------------

Percent of homes by average fixed costs per resident day:

L;s;oth;n9~l.00-------------------------------------------

~ -t

----------------------------------------------

2:00- 2:99-----------------------------------------------

3.00 or more---------------------------------------------

Percent of homes by average operating,costs per resident

day:

L;s;oth;n9~2.00-------------------------------------------

~$

----------------------------------------------

3:00: 3:99-----------------------------------------------

4.00 or more---------------------------------------------

Percent of homes by average miscellaneous costs per

resident day:

L;s:oth~n9j0.50-------------------------------------------

ii

-----------------------------------------------

1:00: l:99-----------------------------------------------

2.00 or more---------------------------------------------

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

Proprietary

11,900

830,700

70

57.4

36.7

1;::

756,200

260,449,600

88.8

$489

16.2

27.4

26.1

16.5

13.8

$1$.;:

5:10

6.33

24.7

36.9

24.3

14.1

13.2

33.4

24.6

28.8

21.1

43.6

18.7

16.7

53.8

29.4

12.4

4.5

Nonprofit

3,900

344,300

88

83.5

44.1

3.8

35.5

319,700

108,456,400

86.5

$456

22.4

30.2

22.9

10.0

14.4

$;;.;:

6:06

6.81

17.6

;:.$

29:5

32:!

25.4

32.3

39.5

29.6

15.5

15.4

16.8

27.7

19.3

36.2

60.9

18.9

13.4

6.8

11
Table 3. Selected operating and financial characteristics of United States nursing homes by certification status

Operating and

financial characteristics

OPERATING CHARACTERISTICS

Number of homes (1973-1974)---------------

Number of beds (1973-1974)----------------

Average bed size (1973-1974)--------------

Average total FTE employees per 100 beds--

Nursing FTE employees per 100 beds------

Administrative, medical, and therapeutic

FTE employees per 100 beds-------------

All other FTE employees per 100 beds----

Number of residents (1973-1974)-----------

Number of resident days of care (1972)----

Average occupancy rate (1972)-------------

FINANCIAL CHARACTERISTICS

1973-1974 resident charges:

Average total monthly charge per

resident-------------------------------

Percent of homes by average total

monthly charge per resident :

Less than $299------------------------

$300-$399-----------------------------

!

400-$499-----------------------------

500-$599-----------------------------

600 or more--------------------------

1972 facility costs:

Average total costs per resident day----

Labor costs per resident day----------

Nursing staff costs per resident day--

Operating, fixed, and miscellaneous

costs per resident day---------------

Percent of homes by average total costs

per resident day:

~~~%4:;;::!::------------”----- --------------------

-$19.99-------------------------

$20.00 or more------------------------

Percent of homes by average labor costs

per resident day:

Less than $4.00-----------------------

$4.00-$7.99---------------------------

~!2.0G$or more---------------------

.00 11.99--------------------------

Percent of homes by average fixed costs

per resident day:

Less than $1.00-----------------------

I

1.00-$1,99-:-------------------------

2.00-$2.99---------------------------

3.00 or more-------------------------

Percent of homes by average operating

costs per resident day:

Less than $2.00-----------------------

~:::::$:.;9---------------------------

9---------------------------

$4.00 or”more-------------------------

Percent of homes by average miscellaneous costs per resident day:

Less than $0.50-----------------------

f!

0.50- 0.99---------------------------

1.00- 1.99---------------------------

2.00 or more-------------------------

Both Medicare

and Medicaidl

4,200

441,000

105

68.2

44.4

1;:;

406,900

136,292,900

85.6

$592

2:

29.8

28.6

33.0

$21.17

12.13

6.91

9.04

2::;

37.9

38.5

1:::

48.7

32.6

1?:$

24.4

51.3

Medicaid only

Total

7,900

572,800

73

64.9

38.5

529,191

180,756,500

89.2

$435

10.3

42.3

28.3

11.5

7.7

$13.53

8.24

4.89

5.29

25.1

47.9

16.2

10.8

52::

27.3

11.6

18.0

40.9

25.6

15.5

23.9

49.7

14.4

12.1

62.9

25.7

;:;

18 percent of these homes were certified for Medicare only.

235 percent of these homes were certified as b~ SNHS and ICFS.

Skilled

nursing

homes’*

3,500

320,500

92

76.3

42.8

292,500

98,908,100

89.2

$484

2::;

41.0

16.0

14.6

5.93

10.2

j:.:

17:1

4;:;

38.3

18.4

15.7

32.8

27.7

23.8

16.0

48.3

18.5

17.2

55.8

29.0

11.7

3.5

Intermediate

care

facilities

4,400

252,300

57

55.8

35.0

1::;

236,700

81,848,400

89.2

$376

16.1

55.6

18.1

;::

$11,99

7.18

4,30

4.81

36.4

49.1

8.5

6.1

19.7

47.0

24.1

9.2

29.8

50.7

11.3

8.2

68.3

23.2

;.:

.

Not

certified

3,600

161,000

45

56.7

32.5

139,800

51,856,600

89.0

$329

53.7

21.1

1;.;

5:6

6.15

41.5

27.5

20.9

10.1

25.6

36.5

23.6

14.4

38.5

30.0

;;.;

28.0

30.5

17.6

23.9

55.7

32.7

;::

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

12
Table 4. PcrcenC of nursing homes according to cross classifications of ownership, certification, size,

States, 1973-74

and region: United

Characteristicl

Ownership

Proprietary--------------

Nonprafit------------.-.-

Certific.atiOn

Size —

Less than 50 beds (A)----

50-99 beds (B)-----------

100-199 beds (C)---------

200 beds or more (D)-----

ReKion

Northeast----------------

Ncmth Central------------

south--------------------

W(?at---------------------

Ownership

PrO-

?rietary

100

77

72

79

73

78

75

::

:$

82

84

Non.

pr#-

10;

23

28

21

27

22

25

::

26

:;

16

Both

Medicare

Medicaid

27

24

10C

3?

:;

31

H

50

Certification

Skilled

nursing

homes3

21

26

106

16

25

:2

27

%

22

Intermediate

care

fflac:;

29

24

100

36

28

16

8

18

:;

13

Not

:ertified

;;

10;

39

15

1?

24

;:

15

.—

;ess

:han

50

>eds

IA)

—

;;

14

29

51

68

100

46

45

33

36

Size

50-

99

beds

(B)

35

36

42

39

%

106

27

2:

42

1oo199

beds

(c)

21

20

36

26

12

7

106

22

:;

18

.

!00

teds

or

lore

D)

Northeast

20

21

24

24

13

21

22

15

::

100

Region

North

:entral

::

22

32

45

44

::

33

37

10:

South

28

19

20

26

34

24

21

30

?:

10I5

iest

20

12

34

18

12

16

22

;:

10G

a.medat the beginning of the row

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

13
Table 5. Selected operating end financial characteristics of United States nursing homes by facility

size

Operating and financial characteristics

OPERATING CHARACTERISTICS

Number of homes (1973-1974)-----------------------

Number of beds (1973-1974)------------------------

Average bed size (1973-1974)----------------------

Average total FTE employees per 100 beds----------

Nursing FTE employees per 100 beds--------------

Administrative, medical, and therapeutic F1’E

employees per 100 beds-------------------------

All other FTE employees per 100 beds------------

Number of residents (1973-1974)-------------------

Number of resident days of care (1972)------------

Average occupancy rate (1972)---------------------

FINANCIAL CHARACTERISTICS

1973-1974 resident charges:

Average total monthly charge per resident-------

Percent of homes by average total monthly

charge per resident:

L;;; @ $299--------------------------------

i

-------------------------------------

400:$499-------------------------------------

500-$599-------------------------------------

$600 or more----------------------------------

1972 facility costs:

Average total costs per resident day------------

Labor costs per resident day------------------

Nursing staff costs per resident day----------

Operating, fixed and miscellaneous costs

per re~ident day-----------------------------

Percent of homes by average total costs

per resident day:

Less than $10.00------------------------------

1$

10.00- 14.99---------------------------------

15.00- 19.99---------------------------------

20.00 or more--------------------------------

Percent of homes by average labor costs

per resident day:

Less than $4.00-------------------------------

!

4.00-$7.99-----------------------------------

8.00-$11.99----------------------------------

12.00 or more--------------------------------

Percent of homes by average fixed costs

per resident day:

Less than $1.00-------------------------------

$

1.00-$1.99-----------------------------------

2.00-$2.99-----------------------------------

$3.00 or more---------------------------------

Percent of homes by average operating costs

per resident day:

Less than $2.00-------------------------------

!

2.00-$2.99-----------------------------------

3.00-$3.99-----------------------------------

$4.00 or more---------------------------------

Percent of homes by average miscellaneous

costs per resident day:

Less than $0.50-------------------------------

$0.50- 0.99-----------------------------------

$1.00-!1.99-----------------------------------

$2.00 or more---------------------------------

Less than

50 beds (A)

6,400

179,400

28

69.0

39.6

162,600

58,611,900

88.5

$397

32.2

27.8

20.2

lQ.5

-9.2

$14.29

8.59

5.21

5.69

34.0

32.1

22.5

11.3

15.7

40.8

29,4

14.1

;;.;

16:1

15.7

24.9

41.2

15.5

18.4

58.5

29.6

:::

50-99

beds (B)

5,500

392,800

71

60.0

37.8

367,700

126,359,600

89.1

$448

3:::

27.6

16.9

13.2

$15.77

9.00

5.22

6.77

18.4

42.3

20.5

18,8

4::;

30.6

16.8

12.0

32.3

27.7

28.0

18.5

41.5

19.2

20.8

100-199

beds (C)

3,200

414,500

130

60.2

38.6

1;:;

386,100

129,437,700

86.3

$502

2$:

30.0

18,9

21.9

$17.12

9.87

5.64

7.25

12.0

36.4

26.8

24.8

3;::

38.5

21.7

11.6

22.6

26.8

39.0

15.1

37.1

22.1

25.7

;;.;

20:1

6.3

200 beds

m more (D)

600

188,100

314

64.1

37.9

159,300

54,496,800

83.9

$576

12:

31.9

20.9

27.3

$20.31

12.90

6.70

7.42

2%2

27.9

41.1

1;::

38.3

41.0

25.9

19.5

17.5

37.1

2;::

32.7

37.2

59.5

24.8

1;.:

.

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

14
I

Table 6. Selected operating and financial characteristics of United States nursing homes by geographic

Operating and financial characteristics

OPERATING CHARACTERISTICS

Number of homes (1973-1974)------------------

Number of beds (1973-1974)-------------------

Average bed size (1973-1974)-----------------

Average total PTE employees per 100 beds-----

Nursing FTE employees per 100 beds---------

Administrative, medical, and therapeutic

HE employees per 100 beds----------------

All other l?TEemployees per 100 beds-------

Number of residents (1973-1974)--------------

Number of resident days of care (1972)-------

Average occupancy rate (1972)----------------

FINANCIAL CHARACTERISTICS

1973-1974 resident charges:

Average total monthly charge per resident--

Percent of homes by average total monthly

charge per resident:

Less than $299---------------------------

1

i

300- 399--------------------------------

400- 499--------------------------------

500-$599--------------------------------

600 or more-----------------------------

1972 facility costs:

Average total costs per resident day-------

Labor costs per resident day-------------

Nursing staff costs per resident day-----

Operating, fixed, and miscellaneous costs

per resident day------------------------

Percent of homes by average total costs

per resident day:

Less than $10.00-------------------------

410.00- 14.99----------------------------

j$15.00- 19.99----------------------------

20.00 or more---------------------------

Percent of homes by average labor costs

per resident day:

L~;oth~9~4.00--------------------------

1$

------------------------------

8:00= li.99-----------------------------

,12.00 or more---------------------------

Percent of homes by average fixed costs

per resident day:

$;s;oth~9J1.00--------------------------

~!

------------------------------

2:00~ 2:99------------------------------

3.00 or more----------------------------

Percent of homes by average operating

costs per resident day:

Less then ,$2.00--------------------------

1$

2,00- 2.99------------------------------

3.00- 3.99------------------------------

4.00 or more ----------------------------

Percent of homes by average miscellaneous

costs per resident day:

L;s;oth~9$0.50--------------------------

~$

------------------------------

1:00: 1:99------------------------------

2.00 or more----------------------------

region

Northeast

3,10C

250,80C

81

68.5

41.7

5.:

21.s

236,1OC

80,996,40C

89.:

$651

13.2

1;:;

17.5

42.5

$19.60

12.03

6.52

7.57

2:;:

29.0

37.0

1:::

41.0

37.4

20.9

24.7

20.2

34.2

3;:;

24.8

33.7

44.9

30.2

19.9

5.0

North Central

5,600

407,200

73

70.2

40.1

22:;

368,700

127,460,800

89.0

$433

19.5

33.6

24.8

1.5.8

13.5

$1:.::

5:32

6.16

29.6

34.7

21.6

14.2

4;:;

30.3

14.8

22.3

32.7

23.9

21.1

23.6

39.7

15.9

20.9

62.0

25.6

:::

South

4,100

302,900

74

56.1

36.0

278,200

94,577,100

87.7

$410

21.3

41.1

24.6

:::

$13.50

7.71

4.69

5.79

29.4

43.0

17.4

10.3

13.6

52.6

23.2

10.6

24.8

37.9

21.4

16.0

25.3

38.4

19.3

17.0

59.7

25.9

10.0

4.5

West

2,900

214,000

74

57.1

36.4

d:;

192,800

65,871,800

86.0

$454

14.2

18.7

36.2

23.9

7.1

$1:.;;

5:18

6.88

15.4

41.8

:;.;

.

4M

39.1

12.4

3:::

23.4

40.0

21.0

46.0

17.1

15.7

47.9

26.8

18.1

7.3

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

15.
APPENDIX I

TECHNICAL NOTES ON

SURVEY DESIGN

General

From August 1973 to April 1974, the Division of

Health Resources Utilization Statistics (DHRUS) conducted the National Nursing Home Survey (NNHS)-a

sample survey of nursing homes, their residents and

staff in the conterminous United States. The survey

was designed and developed by the DHRUS in conjunction with a group of experts in various fields encompassing the broad area of long-term care. 1 It was

specifically designed as the first of a series of surveys to satisfy the diverse data needs of those who

establish standards for, plan, provide, and assess

long-term care services.

Sampl’ing Frame

The 1973-74 NNHS focused on ‘nursing homes

which provided some level of nursing care. Only homes

providing nursing care were included because detailed questions on facility services and resident health

status were relevant only to these facilities. These

homes included both nursing care homes and personal care with nursing homes, while personal care homes

and domiciliary care homes were excluded. Homes

were either freestanding establishments, or nursing

care units of hospitals, retirement centers, and similar

institutions. A definition of nursing care and detailed

criteria for classifying homes providing such care are

presented in appendix IV.

The survey universe consisted of two groups of

homes: those providing some level of nursing care as

classified in the 1971 Master Facility Inventory (MFI)

and homes opening for business in 1972. The major

group (93 percent) was composed of all nursing homes

providing some level of nursing care as classified by

the 1971 MFI. The MFI is a census of all inpatient

health facilities conducted every 2 years by mail by

the National Center for Health Statistics. A detailed

NOTE: The tist of references fotlows the text.

METHODS

description of how the MFI was developed, its content,

and procedures for updating and assessing its coverage

has been published. 2S~14~

In order for data collection to begin in August,

the sampling frame was “frozen” in the spring of 1973

so that the sample could be selected in ample time to

permit the scheduling of nationwide data collection. To

obtain as current a sample frame as possible, all

nursing homes which opened for business during 1972

were also included in the universe. (Homes opening in

early 1973 could not be included since data about them

were not yet available.) The homes which opened in

1972 comprised the second, and smaller (7 percent),

group of facilities in the universe. Although the universe included only homes providing nursing care, all

homes opened in 1972 were included because the level

of nursing care they provided was unknown prior to the

survey. Once the NNHS was conducted, facilities not

meeting the criteria were classified as out of scope

(see table I for details).

Although the NNHS was conducted in 1973-74, it

should be noted that estimates will not correspond

precisely to figures from the ‘ 1973 MFI census for

several reasons. In comparison to the MFI, the NNHS

universe excluded the following: 1) personal care homes

and domiciliary care homes; 2) homes which opened

in 1973; and 3) which, between 1971 and 1973, upgraded the level of care they provided, thereby meeting

the “nursing care II criteria when surveyed in the 1973

MFI. Data from the NNHS are also subject to sampling

variability, while data from the MFI are not, since the

MFI is a census.

Sampling Design

The sampling was a stratified two-stage probability design: The first stage was a selection of establishments’ and the second stage was a selection of

residents and employees of the sample establishments.

In preparation for the first-stage sample selection,

establishments listed in the MFI were sorted into three

types of strata based on Medicare and Medicaid certification: 1) Both Medicare and Medicaid and Medicare

onlfi 2) Medicaid only; and 3) Not Certified. Homes in

16
Table I. DISTRIBUTIONOF HOMES IN THE 1973-74 N4TIONALNURSING HOMS SURVEY UNIVERSEAND DISPOSITION OF SAMPLE HOMES ACCORDING TO pRIWy SWLING STRATA (CERTIFImTION STATUS AND SIZE OF

HOME):,CONTERMINOUSUNITED STATES, 1973-74

Certificate:;::::us and size

Number of homes in sample

Universe

(sampling

frame)l

In scope end

out-of- in business

scope or

out of

business

Total

homes

Nonresponding Responding

All types--------------------- 147

Both Medicare end Medicaid and

Medicare only------------------

Unknown beds------------------------

Less than 25 beds-------------------

25-49 beds--------------------------

50-99 beds--------------------------

17.685 2,118 63

26

1,908

4.099 803 20 757

0

1

0

14; 3

538

1,713

1,385

224

68

20

0

4

0

0

0

7

8

+

11

3

2

1

2?:

315

93

I,–

100-199beds------------------------

200-299beds------------------------

300-499beds------------------------

500 beds or more--------------------

Medicaid only-------------------

Unknown beds------------------------

Less than 15 beds-------------------

15-24 beds--------------------------

25-49 beds--------------------------

50-99 beds--------------------------

100-199beds------------------------

200-299 beds------------------------

300-499 beds------------------------

500 beds or more--------------------

Not certified-------------------

Unknown beds------------------------

Less than 15 beds-------------------

15-24 beds--------------------------

25-49 beds--------------------------

50-99 beds--------------------------

100-199beds------------------------

200-299beds------------------------

300-499beds------------------------

500 beds or more--------------------

100

46

20

43

19

T

790

0

3;

123

293

241

52

24

16

7,473

25;

967

2,253

2,688

1,108

145

43

16

34 24 732

0

2—

Ii%

281

3 232

5

3

2

93 419

1,2;;

1,062

1,575

1,334

652

120

I 2:

o

0

0

1!

9 29

13

H

12

1;:

116

31

23

15

52

20

4

5

I

‘The universeconsistedof nursing homes providing some level of nursing care as classifiedin

the L971MFI and homes opened for business in 1972.

each of thesethreestratawere sortedintobedsize universefigure(17,685)becausesome homes wentout

grou~s,producing26primarystrataasshownintable1.

The nursinghomes in theuniversewere orderedby

typeofownership,geographicregion,State,andcounty.

The samplewas thenselectedsystematicallyaftera

random startwithineach primarystratum.TableI

showsthedistribution ofestablishmentsinthesampling

frame and thefinaldispositionofthesamplewithregard to responseand in-scopestatus.The numberof

homes estimatedby thesurvey(15,749)islessthanthe

of businessor outof scopebetweenthetimetheuniverse was “frozen”and the surveywas conducted.

Differencesrangingfrom 2,100-2,900betweensurvey

estimatesand univere.efiguresoccurredinthe1963,5

1964,6and 19697nursinghome surveysfor the same

reason.

The second-stageselectionof residentsndemployeeswas carriedoutby theinterviewersatthetime

of theirvisitstothees~ablishmentsinaccordsncewith

specificinstructionsgivenforeachsampleestablishNOTE:The tist of references fotlowsthe text. ment. The sample frame forresidentswas thetotal

17
number of residents on the register of the establishment on the evening prior to the day of the survey.

Residents whowere physically absent from the facility

due to overnight leave-or a hospital visit but had a bed

maintained for them at the establishment were included

in the sample frame. An average of 10 residents were

in the sample per home.

The sampling frame for employees was the Staff

Control Record (see appendix III) on which the interviewer listed the names of all staff (inclu@g those

employed by contract) and sampled profeasional, semiprofessional, and nursing staff. Those generally not

involved in direct patient care, such as office staff,

food service, houaekeeping, and maintenance personnel

were excluded from the sample. The interviewer used

predesignated sampling instructions that appeared at the

head of each column of this form. An.average of 14 staff

were in the sample per home.

Data Collection Procedures for 1973-74

National Nursing Home Survey

The 1973-74 NNHS utilized eight questionnaires

(see appendix 111for copies):

Administrator Letter and Worksheet

Facility Questionnaire

Expense Questionnaire

Resident Control Record

Resident Questionnaire

Staff Questionnaire—Parts I and II

Staff Control Record

Data was collected according to the following

procedure:

1.

2.

A letter was sent to the administrators of

sample homes informing them of the survey

and the fact that an interviewer would contact

them for an appointment. On the back of the

letter was a worksheet which the administrator

was requested to fill out prior to the interviewer’s visit. This worksheet asked for those

data that required access to records and some

time in compiling (such as total admission and

discharges, inpatient days of care, etc.). Included with this introductory letter were letters

of endorsement from the American Nursing

Home Association and the American Association of Homes for the Aging urging the administrators to participate in the survey (see

appendix HI for copies).

Several days to 1 week after the mailing of

the letters, the interviewer telephoned the

sample facility “and made an appointment with

the administrator.

3.

If the

At the time of the appointment, the followin~

procedures were followed The Facility Questionnaire was completed by the interviewer

who interviewed the administrator or owner

of the home. After completing this form, the

interviewer secured the administrator’s permission to send the Expense Questionnaire to

the facility’s accountant. (If financial records

were not kept by an outside firm, the Expense

Questionnaire was filled by the administrator,

with the interviewer present.) The interviewer

completed the Staff Control Record (a list of

all currently employed staff Imth full and part

time), selected the sample of staff from it, and

prepared Staff Questionnaires, Patys I and 11,

which were left for each sample staff person

to complete, seal in addressed and franked

envelopes (one for each part of the questionnaire), and return either to the interviewer or

by mail. The interviewer then completed the

Resident Control Record (a list of all residents

currently in the facility), selected the sample

of residents from it, and filled a Resident

Questionnaire for each sample person by interviewing the member of the nursing staff familiar

with care provided to the resident. The nurse

referred to the resident’s medical records. No

resident was interviewed directly.

Expense Questionnaire was not returned within

2 w’eeks, the interviewer telephoned” the accountant

requesting its prompt return. If the Staff Questionnaires were not returned in one week, the interviewer

contacted the staff member and requested the return

of the form.

The following table presents a summary of the data

collection procedures:

Questionnaire

. ..-

I?acilit y

Expense

Resident

Staff

Respondent

Adnrkds trator

Facility’s

accountant

Member of nursing staff f amiliar with care

provided to the

resident/resident’s medical

records (10 sampled residents

per facility)

Sampled ataf f

member (14 per

facility)

Interview

situat ion

Personal

interview

Self-enumerated

queationnaire

Personal

interview

Self -enumerated

questionnaire
GENERAL QUALIFICATIONS

Nonresponse and Imputation

of Missing Data

Reaponae rateadiffered foreach type of questionnaire as indicated below

Questionnaire Response Rate

Facility 97 percent

Expense 88 percent

Resident 98 percent

Staff 82 percent

Generally, response rates were higher for questionnaires administered in a personal interview situation

(facility and resident) as compared to those which were

aelf-enumerated (expense and staff). Statistics pre.

sented in this report were adjusted for failure of a home

to respond. Data were also adjuated for nonresponse

which resulted from failure to complete one of the

questionnaires (expense, resident, staff) or from fsilure to complete an item on a questionnaire. Those

items left unanswered on a partially compieted questionnaire (facility, expense, resident, staff) were generally imputed by aasigning a value from a responding

unit with major characteristic identical to those of

the nonresponding unit.

Estimation Procedures

Statistics reported in this publication are derived

by a ratio estimating procedure. The purpose of ratio

estimation is to take into account all relevant information in the estimation process, thereby reducing

the variability of the estimate. The estimation of number of establishments and establishment data not related to size are inflated by the reciprocal of the probability of selecting the sample establishment and adjusted for the nonresponding establishments within

primary certification-size strata. Two ratio adjustments, one at each stage of selection, were also used

in the estimation process. The first-stage ratio adjustment (along with the above inflation factors) was

included in the estimation of establishment data related to size, resident data, and staff data for all primary certification-size strata from which a sample of

homes was drawn. The numerator was the total beds

according to the Master Facility Inventory data for

all homes in the stratum. ‘The denominator was the

estimate of the total beds obtained through a simple

inflation of the Master Facility Inventory data for the

sample homes in the stratum. The effect of the firststage ratio adjustment was to bring the sample in

closer agreement with the known universe of beda.

The second-stage ratio adjustment was included in the

estimation of resident and staff data within establishments. The second-stage ratio adjustment is the product of two fractiona: the first is the inverse of the

sampling fraction for residents (or staff) upon which

the selection is based, the second is the ratio of the

number of sample residents (or staff) in the establishment to the number of residents (or staff) for whom

questionnaires were completed within the home.

Rounding of Numbers

RELIABILITY OF ESTIMATES

Estimates of homes, residents, resident days, and

beds have been rounded to the nearest hundred. For

this reason detailed figures within tables do not always

add to totals. Percents were calculated on the basis

of original, unrounded figures and will not necessarily

agree precisely with percents which might be calculated

from rounded data.

Data Processing

A series of checks were performed during the

course of the survey. This included field followups

for missing and inconsistent data, some manual editing

of the questionnaires, extensive editing as conducted

by computer to assure that all.responses were accurate,

consistent, logical, and complete. Once the data base

was edited, the computer was used. to calculate and

assign weights, ratio adjustments, recodes, and other

related procedures necessary to produce national estimatea from the sample data.

As in any survey, the results are subject to reporting and processing errors and errors due to nonresponse. To the extent possible, these types of errors

were kept to a minimum by methods built into survey

procedures.

Since statistics presented in this report are based

on a sample, they will differ somewhat from figurea

that would have been obtained if a complete census had

been taken using the same schedules, instructions, and

procedures.

The standard error is primarily a measure of the

variability that occurs by chance because only a sample,

rather than the entire universe, is surveyed. The atsndard error also reflects part of the measurement error,

but it does not measure any systematic biases in the

data. It is inversely proportional to the square root of

the number of observations in the sample. Thus, as

the sample size increases, the standard error generally

decreases. Provisional estimates of the standard errors
. . .

Figure 1. Provisional Rakstive standard Errors for Estimated Numtxm of Residents, Beds, FTE Employaes, and Facilities

SIZE OF ESTIMATE

Illustration of use of figure I: AS shown irrtable 2 proprietary homes had an estimated 830,700 beds in 1973-74. The relativestandarderror

of this estimateas read from curve A is approximately 1.22 percent: the standarderror k 10,135 (1.22 percent of 830,700).

are presented in this report because final estimates are

not yet available.

The relative standard error of an estimate is the

standard error of the estimate divided by the estimate

itself and is expressed as a percentage of the estimate.

According to NCHS standards, reliable estimates are

those which have a relative standard error of 25 percent or less. For example, curve A of figure I shows

the provisional relative standard errors for the estimated number of residents. For a relative standard

error of 25 percent or less, the minimum number of

residents ia 1,400. Thus, resident estimates must be

1,400 or larger in order to meet the standards of reliabili~. Similarly, in figure I the estimates of number

of homes must be 150 or larger in order to have a

relative standard error of 25 percent or less.

Because of the relationship between the relative

standard error and the estimate, the standard error

of an estimate can be found by multiplying the estimate

by its relative standard error. Both values can be

determined from the curves in figures I and II. For

example, curve A of figure I shows the provisional

relative standard error curve for beds. Table 5 shows

that the total number of beds in all homes with less

than 50 beds was 179,400. The relative standard error

corresponding to this estimate on curve A is approximately 2.35 percent. The standard error is 179,400 x

(.0235) = 4216.

The chances are about 68 out of 100 that an estimate from the sample differs from the value which

would be obtained from a complete census by less

than the standard error. The chances are about 95 out

of 100 that the difference is less than twice the standard

error and about 99 out of 100 that it is less than 2!4

times as large. For example, the average facility lalxm

cost per resident day for nonprofit homes waa $10.90

20
Figure Il. ProvisionalRalativeStandard Errorsfor EstimatedNumber of ResidantDays

SIZE OF ESTIMATE (IN Ml LLIONS)

Ih.rtrdiotr of use of figure II: As shown in table 6, an estimated 80,996,400 days of care during 1972 were provided to residentsin nursing

homes located in the Northeast. The relativestandarderrorof this estimateasreadfmrn figure2 is approximately1.z4 percent:the Stand=derror

is 1,004,355 (1.24 percent of 80, 996,400).

(see illustration of use of table IV). The chances are

95 out of 100 that the true value is contained in the interval $10.90 ~ 2.0($0.23) (i.e., between $10.44 and $11.36),

and 99 out of 100 for the interval $10.90 f. 2.5 ($0.23)

(i.e., between $10.32 and $11.48).

Statistical tests to determine whether the differences between selected characteristics in the classification breakdowns are statistically significant can be

implemented by comparing the confidence intervals for

the estimates in question. If there is no overlapping of

the confidence intervals, the estimates are considered

statistically different. For example, the average facility labor cost per resident day for proprietary homes

was $8.53, and the approximate standard error of this

is $0.15. The chances are 95 out of 100 (the 95 percent confidence interval) that the true value being estimated is contained in the interval between $8.23 and

$8.83. Since this interval does not overlap with the

9S percent confidence interval of the nonprofit homes

($10.32-$11.48 as ob~ained above) the difference between the average labor cost per resident day in these

two ownership classifications is considered statistically significant in this report.

The particular figure or table to which one refers

to obtain a standard error is contingent on the type of

estimate (e.g. residents) and whether the estimate is

a level or a percent. Table II shows the provisional

standard errors of estimated percentages for facilities.

Table III shows the provisional standard errors for

estimated percentages of residents and beds. Table IV

shows the provisional standard errors for average cost

per resident day estimate. Table V shows the prov -

sional standard errors for average monthly charge

estimates. Figure I shows the provisional relative

standard error curves for estimated residents, beds,

FTE employees, and facilities. Figure II shows the
Table II.. PROVISION/iLSTANDARDERRORS OF PERCENTAGESFOR FACILITIES

Base of estimatedpercent

(numberof facilities)

200---------------------------

300---------------------------

500---------------------------

750--------------------------- .-.

1,000-------------------------

2.000------------------------- _=––-

3,000-------------------------

4,000-------------------------

5,000-------------------------

7,500-------------------------

10,000------------------------

16,000------------------------

Estimatedpercent

2 cm 98 5 or 95 10 or 90 20 or 80 30 or 70 40 or 60 50

t

Standarderror in percentagepoints

2.8

2.5

2.2

1.4

1.3

1.1

1.0

0.9

%:

0.4

0.3

6.1

5.0

3.8

3.2

2.8

H

::;

::;

0.7

8.3

6,.7

:::

3.7

2.6

2.1

1.8

1.6

1.3

1.1

0.9 I_

9.6 10.1

8.3

;:; 6.4

4.9

4.2 $:

.

;::

2.1 ;:;

1.9

1.5 H

1.5

H 1.2

1:.:

6:5

i:;

3.2

2.6

2.3

2.0

M

1.2

Illustrationof use-of table II: In the text it was noted that 36 percent (5,600)of the estimated 15,700 nursing homes_ in the United states were located in the North Central Region. Linear

interpolation between values shown fin tab~e II will yield an approximate standard error of 1.17

percent for an.estimete of 36 percent with a base of 15,700.

provisional st~dard error curve for estimated resi~ less than 50 beds is 69.0 which is equal to a total of

dent days. 123,786 FTE employees divided by 179,400 beds times

Approximate standard errors of such ratios as 100. The relative standard error of123,786 total FTE

occupancy rate and full time equivalent employees per employees is (from figure 1, curve B) approximately

100 beds can be calculated as in the following example: 3.05 percent, and the relative standard error of

Suppose the provisional standard error ( UR, ) for 179,400 beds (from figure I, curve A) is approximately

the ratio of total FTE employees per 100 beds is desired 2.35 percent. The square rootof thesumof the squares

for nursing homes with less than 50 beds. 1ntable5 of these two relative standard errors provides anapthe total FTE employees per 100 beds forhomestith proximation for the relative standard error of the

Table III. PROVISIONALSTANDABDERRORSOF PERCEIWAGESFOR RESIDENI’SAND BEDS

Base of estimated percent

(numberof residents or beds)

1,000-------------------------

2,500-------------------------

5,000-------------------------

10,000------------------------

20,000------------------------

30,000------------------------

40,000------------------------

.;;,;;:------------------------

------------------------

106,000-----------------------

200,000-----------------------

joo,ooo-----------------------

1,000,000---------------------

1,200,000---------------------

Estimated percent

2 or 98 5 or 95 10 or 90 20 or 80 30 or 70 40 or 60 50

Standard error in percentage points

11.9

7.5

H

2.7

2.2

1.9

1.7

M

0.9

:::

0.4

13.3

8.6

M

3.1

2.5

::!

1:4

:::

0.4

0.4

14.5

9.3

:::

3.3

2.7

:::

1.7

1.4

1.1

0.7

0.5

0.5

Illustrate.on of use of table III: In the textitwas noted that the homes certifiedby Medicare

housed about 38 percent of the 1,075,800residentsin the United States. Linear interpolation

between values shown in table III will yield an approximatestandarderror of 0.48 percent for an

estimateof 38 percept with a base of 1,075,800.

22
Table IV. PROVISIONALSTANDARDERRORS OF AVEZUGE COST PER RESIDENT DAY

Base of ratio

(Numberof residentdays)

20,000,000----------------------

30,000,000----------------------

40,000,000----------------------

50,000,000----------------------

60,000,000----------------------

70,000,000----------------------

80,000,000----------------------

90,000,000----------------------

100,000,000---------------------

200,000,000---------------------

300,000,000---------------------

$5.00

---

---

---

0.21

0.20

0.18

0.17

0.16

0.15

0.11

0.09

Average establishmentcost

for providingcare per resident day

$9.00

---

0.36”

0.32

0.28

0.26

0.24

0.23

0.22

0.21

0.15

0.13

$13.00 $17.00 $21.00

--- 0.61 -0.69

0.44 0.50 0.57

0.38 0.44 0.49

0.34 0.40 0.45

0.31 0.37 0.42

0.30 0.36 0.39

0.28 0.33 0.37

0.27 0.31 0.35

0.26 0.30 0.35

0.20 0.23 0.27

0.17 0.21 ---

$25.00

0.76

0.63

0.55

0.50

0.46

0.43

0.41

0.40

0.38

0.30

---

$29.00

0.83

0.69

0.60

0.55

0.51

0.48

0.46

0.44

0.42

0.34

-..

.$33.00

0.90

0.74

0.65

0.60

0.56

0.53

0.50

0.48

0.47

---

---

Illustrationof useoftable IV: Table 2 shows that the average labor cost per resident day for

nonprofithomes was $10.90with 108,456,400residentdays.,Linearinterpolation betweenvalues

shown in table IV will yield an approximatestandarderrorof$O.23 for en estimateof $10.90with

a base of 108,456,400.

desiredratio.Inotherwords,lettingVX.betherelative The approximatestandarderrorof theratioof

standarderror of number of totalFTE employees, totalFTE employeesper 100bedsmay nowbeobtsfned

~ be therelativestandarderrorofnumber ofbeds. by multiplyingtherelativestandarderrorbytheratio

and VR,be the relativestandarderrorof theratio asdonebelow:

R’-XjjY”:

u~J==V~JxR’

VR: D Vx:+vy?

=.0374x 69.0

=(.0305f+ (.0235)2

= 2.58

- .0009+.0005

= .0014

vRt.~4 = .0374

Table V. PROV1S1ONAL sTAfJTMSDERRORS OF AVRSAG3 MONTHLY SESIDENT CSASGE

Estfmated

Average monthly resident charge

number of

residents $150 $175 $2009225$250+275$300%325$350 $375 $400 $450 $500 $550 $600 $650 $700 $750 $800 $85 $900 $950 $1>000

Standard error in dollars

-N2,500--------- ;; 65 77 82 89

g 49

;: 100 106 112 124 135 147

5 ooo---------

158 170 1s1 192 204 215 226 237 249

;: 63 6E 82 87 ;; 104 114 123 132

pm:-------- ;i

141 151 160 169 178 188 197

39 :: :; 59 U 67 87 ’33 102

?: i: 50 54 57 ;; 68 76

110 119 127 134 143 151 158 166

29 33 40

30;000== 23 27

90 97 103 110 118 125 132 139 147

30 34 37 :; 44 48 51 54 65 78 85 ‘3; 99 106 113 120 127 134 141

40,000-------- 22 26 2’3 32 36 42 46 49 52 56 63 ;; 76 96 103 110 116 123 129 136

50,000-------- 22 25 2E ;: 35 41 45 4s ;; 55 62 6S 75 % 88 95 101 108 114

:! 40

120 126 133

80 000-------- ;: 24 34 43 47

lob,ooo-------

53 :: 66 72 7E 85 92 98

:; ;; 33 36 ~:

105 111 118 124 131

23 43 46 49 ;. 65 71 78 84 91 ‘3: 104 110 117 123 130

200,000------- ~; 23 32 35 42 45

7oo,boo------- 22 it 28 32 35 38 41 --- -:! --- -:: -ff -~: -:: -:: -:: ---

103 109 115 122 128

... --- --- --- ---

Illustration of uae of table V: Table 5sbows that 159,300 residents in size group Dmrslng homes (200 beds m mm.) paid a“ average t.tal monthly charge

of $576. Linear interpolation between values shown in table IV yields an apprmdmate standard error of S74.t%r an estimate of S576 with a base of 159,300.

— 000 —

23
APPENDIX II

DEFINITIONS OF CERTAIN TERMS USED IN THIS REPORT

Terms Relating to Facilities

or Residents

Nursing home.— This term refers to all institutions that were within the scoue of the 1973-74 Nursirm

Home Survey (see appendix Ii).

Type of ownership.— Facilities

type of ownership as follows:

Propn”etury home. —A facility

private commercial ownership.

are classified by

operated u~der

Non@ofit Lwme.-For the purposes of the report

this could be a nonproprietary or a government

home. A nonproprietary home is operated under

vohtntary or nonprofit auspices, including both

church-related and other nonprofit homes. A government home is operated under Federal, State,

or local government auspices.

Resident.—A person who has been formally admitted but not discharged from an establishment. All

such persons were included in the survey whether or

not they were physically present at the time of the

survey.

Charge. —The charge made by the establishment

itself. It doea not include charges which are not part

of the bill rendered by the institution such as those

for services of physicians.

Bed.— One set up and regularly maintained for

patients or residents. Beds maintained for staff and

beds used exclusively for emergency services are

excluded.

PaYt-time.—Employees who worked less than 35

hours in the week prior to the survey are designated’

“part-time.”

Full-time equizxaknt. —For the purposes of the

report, 35 hours of “part-time” employees’ work per

week are counted as equivalent to one “full-time!!

employee.

Geographic Terms

Classification of homes by geographic area is

provided by grouping tlie States into regions. These

regions correspond to those used by the U.S. Bureau

of the Census and are as follows:

.Re@”on

Northeast -------

North Central ---

South -----------

Terms Relating to Employees

West ----------

Employee. —This term refers to any person who

was on f~e staff of the facility or was employed under

contract. It includes any paid worker, proprietor, or

member of a religious order who contributes his

services.

Full-time. —Employeep who worked 35 hours or

more in the week prior to the survey are designated

“full-t ime.”

w

States Included

Maine, New Hampshire, Vertiont,

Massachusetts, Rhode Island,

Connecticut, New York, New Jersey,

Pennsylvania

Michigan, Ohio, Illinois, Indiana,

Wisconsin, Minnesota, Iowa,

Missouri, North Dakota, South

Dakota, Nebraska, Kansas

Delaware, Maryland, District of

Columbia, Virginia, West Virginia,

North Carolina, South Carolina,

Georgia, Florida, Kentucky,

Tennessee, Alabama, Mississippi,

Arkansaa, Louisana, Oklahoma,

Texas

Montana, Idaho, Wyoming, Colorado,

New Mexico, Arizona, Utah, Nevada,

Washington, Oregon, California,

Hawaii, Alaska

Coverage of Financial Data

The financial data colIected were not designed nor

are they adequate to provide a direct comparison be-
tween costs and revenues of nursing home operations.

The resident charge andestablishment cost data were

collected for different time periods. Resident charge

data were collected for the period August 1973-April

1974 by recording for the sampled residents the amount

charged for their care for the month prior to the survey. The cost data are generally kept by the facilities

on a calendar year basis and were collected for 1972,

the most recently completed year at the time of the

survey. Facilities which used only a fiscal year basis

of accounting were asked to report their cost data for

the most recently completed fiscal year.

The total charge data were collected only for those

sample residents who had been in the facility for at

least one full month and included all charges for lodging,

meals, nursing care, medical supplies, and special

services, The charge data are not equal to the facility

revenue for several reasons. In the instances where

charges were made but not collected, the facility’s

actual revenues from patient services rendered do not

equal charges for those services. A facility’s total

charges as collected also differ from its revenuea in

that the charge data do not account for the amount of

contributions, grants, or subsidies received for general operating purposes from voluntary agencies,

foundations, governmental agencies, and similar groups.

Other sources of revenue which are not reflected in

the charge data are income from investments (interest

and dividends), services not directly related to patient

care, and capital gains on the sale of equipment or

other tangible assets.

The cost data were collected according to the

following major components:

Labor costs —wages and fringe benefits for staff

members and contract employees.

Fixed costs—equipment, building and land rentals,

insurance, taxes, licenses, interest, financing and

depreciation charges, and amortization of leasehold improvements.

Operating costs—expenses for food, drugs, supplies, equipment, laundry, linen, utilities, buildings

and grounds maintenance, and contractual arrangements for laboratory, professional, and household

services.

Miscellaneous costs —dues, subscriptions, travel,

advertising, and other expenses.

Excluded from costs are any losses sustained in

the sale or disposition of fixed assets and other extraordinary losses or costs not related to the current

cost of providing health care. To the extent that homes

do not charge patients the full value of donated goods

and services which are used for patient care, revenues

from patient care will be smaller than they could be.

Hence, they are not comparable to the collected cost

data which include an estimate of the market value of

donated goods and services.

— 000

29

8
APPENDIX Ill

QUESTIONNAIRES USED IN THE

1973-74 NATIONAL NURSING NURSING HOME SURVEY

@

.,Ii r we,,

~’,

>,

[ Q3‘; DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

‘%V~, ‘,+”> PUBLIC HEALTH SERVICE

“s.

HEALTH RESOURCES ADMINISTRATION

ROCKVI LLE, MARYLAND 20S52

NATIONAL CENTER FOR

HEALTH STATISTICS

Dear Administrator:

The National Center for Health Statistics (NCHS) of the U. S. Public

Health Service is conducting a sample survey of resident facilities

providing nursing and personal care to obtain basic data on their

policies, services, and staff. This survey is being conducted as a

part of the Department of Health, Education, and Welfare’s nursing

home improvement program. The information from this survey will be

used to compile statistics on the number and kinds of such facilities

in the United States. Enclosed are two summary reports from previous

surveys, which are illustrative of the kinds of data to be obtained

from this survey. These statistics will be used to meet the needs of

Congress, State legislatures, Federal, regional, and local health

planners, national health associations , and many others who plan and

provide health services to the aged.

As you can see from these reports, it is not possible to identify any

particular facility. We wish to as sure you that any information which

permits the identification of the services provided by your facility,

or the residents and staff will be held strictly confidential. This

information will be used only by persons engaged in and for the purposes

of the survey, and will not be disclosed or released to others for any

purpose. Because the NCHS is committed to provide a factual basis for

planning national programs designed to advance the health of the American

people, limited basic information aboUt your facility (such as name,

address, size, type, and owner ship) will be made available upon request

to the NCHS.

Within about one week an interviewer will contact you for an appointment;

this person will be with Applied Management Sciences, the firm under

Federal contract to conduct this survey. In preparation for this call,

please review the worksheet printed on the back of this letter. These

questions request necessary information which may take time to assemble

from your records. I have enclosed them so that you may do this at

your convenience prior to the interviewer’s visit.

This survey includes a small, car efully selected nationwide sample of

nursing homes and similar facilities. Because this ntirsing home represents several facilities of similar type, your participation is vital in

obtaining accurate and complete data. We would appreciate your cooperation

in this effort.

Sincerely yours,

26 Edward B. Perrin, Ph. D.

Acting Director
THE FOLLOWING QUESTIONS ON ADMISSIONS AND DISCHARGES CONCERN CALENDAR YEAR 1972,

WHICH IS THE PERIOD OF JANUARY 1, 1972 THROUGH DECEMBER 31, 1972.

From —— through

Month Year G Year

● HOW MANY PERSONSWERE ADMITTED TO THIS FACILITY DURING 1972?

Admissions

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

Dlwharw$

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

Deaths

● IN 1972, WHAT WERE THE TOTAL INPATIENT DAYS OF CARE PROVIDED? (THE SUM OF THE DAILY PATlENT CENSUS

C~UNT FROM 1/1/72 THROUGH 12/31 /72,)

Days

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

a. 1 badonly ❑ None

b. 2 beds ❑ None

c. 3 beds ❑ None

d, 4 or morebeds ❑ None

RETAIN THIS FORM AND DATA FOR THE INTERVIEWER TO COLLECT.

27
12CXI15th Street,N.W./Washington, D.C. 20005 Phone: (202) 833-2058

Dear Administrator:

I am writing to urge your participation in the 1973 Nursing Home

Survey. The National Center for Health Statistics has invested

over a year in developing this study which will collect national

data on services, basic costs, staff, and residents in nursing

homes.

The support of our association and of all nursing home administrators is indispensable to the successful inauguration of this

research which will provide invaluable data for planning and

organizing health care of the aged, drafting health legislation~

and setting national policies and priorities to obtain quality

care for all nursing home residents.

I believe you will find the survey design maximizes the utility

of the data collected while it attempts to minimize the amount

of staff involvement. In addition, strict confidentiality

provisions are to be maintained. Only summary data will be

published and made available to health planners, researchers,

health professionals, and the public.

I am confident that the information derived will be well worth

the initial investment of your time and effort as it will ultimately result in increased quality of care for all nursing home

residents.

Again may I urge your cooperation with the Survey. Its success

will provide us in the nursing home field with much needed and,

hitherto, unavailable data in this rapidly expanding segment of

the health care industry.

Sincerely,

DON T. BARRY “

Association President

DTB :lb

28
AMERICAN ASSOCIATION OF HOMES FOR THE AGING

374 National Press Building. 14th & F Streets, N.W., Washington, D.i; 20004

The national organ!zahon of NONPROFIT HOMES Telephone (202) 347-2000

*

Dear Administrator:

The NationalCenter for Health Statisticshas requestedthe

cooperationof AAHA homes in connectionwith its 197’3Nursing Home

Survey. Because I believe this surveywill provideHEW with information which will enable the Departmentto improvenationalpolicywith.

respect to long term care, I am writing to urge your participation.

The studywill collectnationaldata on services,costs, staff,

and residentsin nursinghomes. The data will then be used for planning and organizinghealth care of the aged, draftinghealth legislation, and settingnationalpoliciesand prioritiesto obtain quality

care for all nursinghome residents.

Strict confidentialityprovisionsare to be maintainedby the

Center. Only summarydata will be publishedand made availableto

health planners,researchers,health professionals,and the public.

Although I recognizethe amount of time which will be required

to completethe survey’questionnaireis substantial,I believe the

informationderivedwill be worth the investmentof your the, as it

will ultimatelybe used in an effort to improve long term care. Also,

I believe it is importantto have the nonprofitpoint of view represented in public policy. Failure to participateon the part of nonprofithomes could result in the making of public policywithout our

input.

X thereforeagain urge your cooperationwith this Survey.

Sincerely,

%-

7T

Eugene Hackler,President

AmericanAssociationof Homes for the Aging
FACILITY QUESTIONNAIRE I OMB # 06S3-72172 I

1973 Nursing Home Survey I

Expir& 7-31-74 I

National Center for Health Statistics

Haslth Resources Administration

Rockville, Maryland

TELEPHONE NUMBER

Area Code Number

Name and address label

ccl-1 CC2 cdl-l CC12

CC24 CC27

SECTION A - FACILITY INFORMATION

la.

2a.

Is THE CORRECT

(name of facility on label)

Correct Name of Facility if Different from Above

NAME FOR YOUR FACILITY?

34-1 ❑ w

/ “

A .’

Numbar Streat P.O. i30x, R-auto,

-2 •1

mc.

no- b. WHAT IS THE CORRECT NAME?

Is THE CORRECT City or Town County

(addrasa on label)

MAILING ADDRESS FOR YOUR FACILITY?

Stcte

35-1 ❑ yes

Zip Code

-2 •1 IKI~ b. WHAT IS THE ENTIRE CORRECT .-/ L~

MAILING ADDRESS?

●3. WHICH CATEGORY BEST DESCRIBES THE TYPE OF SERVICE THIS FACILITY OFFERS THE MAJORITY OF ITS

RESIDENTS OR PATIENTS? (Mark (X) only one lmx.)

3S-1 ❑ a, Nursing home (includes Medicare mfiified Extend* care Facilities and Mwfimid certified Skilled Nursing Homes)

-2 ❑ b. Intermediate care facility (includes Medicaid certifiad Intermediate Care Facilities)

“3 •1 c. COnvsdascent or rest homa

-4Dd. Home for the agad

{

~De. Extended care unit of a hospital

[

-6Df. Nursing care unit of a retirement center

“7 ❑ 9, Other resident fecilky (Describe) 37-

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

‘4a WHAT IS THE TYPE OF OWNERSHIP WHICH OPERATES THIS FACI LITY7 (Mark (X) only one box.)

38,39-23 ❑ e.

-24 ❑ b.

-26 ❑ c.

-20 ❑ d.

-21 ❑ e.

-22 •1 f.

-11 ❑ g.

-12 ❑ h.

-13 ❑ i.

-14 ❑ j.

-16 ❑ k.

-16 ❑ 1.

-47 ❑ m.

-18 ❑ n.

-19 ❑ 0.

Form 73NHS-1

.30

Indlviduel

7

Partnership

Corporation

Church raleted

Nonprofit corporation

/

4.b. IS THIS HOME A MEMBER OF A GROUP OF HOMES OPERATING

UNDER ONE GENERAL AUTHORITY OR GENERAL OWNERSHIP?

40-1 ❑ yes

-2 •l nO

J

Other nonprofit ownership

State

County

City

City-County

Hospltel District

U.S. Public Health Service

Armad Forces

Vaterans Adminktration

Othar Fadaral Agency -- Specify 41-
5, DOES YOUR FACILITY ACCEPT: (Mark (X) only one box.)

44-1 D Males only?

-2 D Females only?

‘3 D Both males and femalm?

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

45-1 ❑ Yes (Skip to Question 7)

-2

L

No

b. WHAT IS THE MINIMUM AGE ACCEPTED? ❑ No rni”im.mageor _ yrs.

CC46, 47

c. WHAT IS THE MAXIMUM AGE ACCEPTED? Q No maxim.m age or _ yrs.

CC4S, 49

7. WHAT IS THE TOTAL NUMBER OF BEDS REGULARLY MAINTAINED FOR RESIDENTS? (INCLUDE ALL BEDS SETUP

AND STAFFED FOR USE WHETHER OR NOT THEY ARE IN USE BY RESIDENTS AT THE PRESENT TIME. DO ~

INCLUDE BEDS USED BY STAFF OR OWNERS OR BEDS USED EXCLUSIVELY FOR EMERGENCY PURPOSES, SOLELY

DAY CARE, OR SOLELY NIGHT CARE.)

Total beds

CC50

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

54-2 ❑ No (Skip to Question 9)

.1

%

Yas

b. Increase of beds

CC55

c. Decrease of beds

CC58

9,a, WHAT WAS THE TOTAL NUMBER OF RESIDENTS ON THE REGISTER OF THIS FACILITY LAST NIGHT? (INCLUDE ALL

RESIDENTS, EVEN THOUGH THEY MAY HAVE BEEN TEMPORARILY AWAY OR ON OVERNIGHT LEAVE, DO NOT

INCLUDE STAFF OR OWNERS.)

Total residents

CC81

b. HOW MANY OF THESE WERE:

[1) Males? ❑ No”eor

CC65

(2) Females? ❑ None or

CC69

CARD 2

ccl 1-2

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

12-1 H Yes ~

‘2 ❑ NO (Skip to Question II)

b. WHAT IS THE PROVIDER NUMBER?

CC13

❑ No provider% give”

c. HOW MANY BEDS ARE CERTIFIED FOR MEDICARE?

beds

CC19

d. HOW MANY OF THESE CERTIFIED BEDS WERE OCCUPIED BY MEDICARE

PATIENTS LAST NIGHT?

❑ None or beds

CC23

Form 73N HS-I

31

I
1I.a. IS THIS FACILITY PARTICIPATING IN THE MEDICAID (TITLE XIX) PROGRAM?

/Ji! ‘e’ ~ ‘0‘Skip’” a”eti’on”)

b~l) DOES IT HAVE ANY SKILLED NURSING BEDS?

n No ❑ Yes~

[

b.(2) WHAT IS THE PROVIDER NUMBER?

20-2 -1

/

C&l

•1

No provider # given

I

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

❑ Noneor - beds

/

[

b.(4) HOW MANY OF THESE CERTIFIED BEDS WERE

OCCUPIED BY MEDICAID PATIENTS LAST NIGHT?

❑ None or beds

CC43

c.(1) DOES IT HAVE ANY INTERMEDIATE CARE BEDS?

❑ No ❑ Yes~

52-2 -1

[

c.(2) WHAT IS THE PROVIDER NUMBER?

CC53

/

•1

No provider # given

/1 c.(3) HOW MANY BEDS ARE CERTIFIED AS INTERMEDIATE CARE BEDS?

❑ None or beds

CC66

c.(4) HOW MANY OF THESE CERTIFIED BEDS WERE

OCCUPIED BY MEDICAID PATIENTS LAST NIGHT?

❑ None or ~c70 beds

SECTION B - CLASSIFICATION INFORMATION (CONFIDENTIAL)

ASSURANCE OF CONFIDENTIALITY - All information which would permit identification of the individual facility will be held in

strict mnfidence, will be used only by parsons engeged in and for the purposes of the survey, and will not be disclosed or

released to others for any purposes.

12.a. WAS THIS BUILDING ORIGINALLY CONSTRUCTED FOR USE AS A NURSING HOME, REST HOME, CONVALESCENT

HOME, HOME FOR THE AGED?

CARD 3

ccl 1-3 ❑ Yes

1=

❑ No

12.1 -2

(Skip to next page)

b. WHAT WAS THE ORIGINAL PURPOSE AND USE OF THIS Blfl LDING? (Merk (X) only one box,)

13-1 ❑

-2 •l

-3 •1

40

*U

*IZ

Private home (i.e., single family dwelling)

Duplex (2 to 4 units)

Apartment house (5 or more units)

Hotel or motel

Hospital

Other (Specify) 14-

Form 73 N HS-1

32
Int*rvl*w*r:

Sca back of

lmtor to

administrator

for quast!ons

13 throuoh 17.

THE FOLLOWING QUESTIONS ON ADMISSIONS AND DISCHARGES CONCERN CALENDAR YEAR 1972,

WHICH IS THE PERIOD OF JANUARY 1, 1972 THROUGH DECEMBER 31, 1972. IF YOUR ANSWERS TO

THESE QUESTIONS COVER A PERIOD OTHER THAN CALENDAR YEAR 1972, WHAT IS THIS OTHER TIME PERIOD?

From _ through —.

Month Year Month Year

ccl 5,16 CC17,16 CC19,20 CC21 ,22

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

Admissions

CC23

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

Discharges

CC27

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

Deaths

CC31

16. IN 1972, WHAT WERE THE TOTAL INPATIENT DAYS OF CARE PROVIDED? (THE SUM OF THE DAILY PATlENT CENSUS

COUNT FROM 1/1/72 THROUGH 12/31 /72.)

Days ❑ (mark (X) ifaetimated)

CC35 41-1

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

a. ❑ None or 1 bad only

CC44

b. ❑ None or 2 beds

CC48

c. ❑ None or 3 beds

CC62

d. ❑ None or 4 or more bads

IX66

“16. ARE ANY OF THE FOLLOWING SERVICES ROUTINELY PROVIDED TO RESIDENTS IN ADDITION TO ROOM AND BOARD?

a.

b,

c.

d.

e.

f,

9.

h.

i.

Supervision over medications which may be self-administered

Medications and treatments administered in accordance with

physicians’ orders

Rub and massage

Help with tub bath or shower

Help with dressing

Halp with eorrespondenca or shopping

Help with walking or getting about

Help with sating

OR

60-1 Q Yes -2 ❑ No

61-1 ❑ Yes -2 ❑ No

62-1 ❑ Yes -2 ❑ No

63-1 ❑ Yes -2 ❑ No

64-1 ❑ Yes -2 ❑ No

65-1 •l Yes -2 ❑ No

66-1 ❑ Yes -2 ❑ No

67-1 ❑ Yas -2 ❑ No

None of the above services routinely provided, room and 68-1 ❑ Yes

board provided only

Form 73NHS-1

33
●19. DURING THE PAST SEVEN DAYS, HOW MANY RESIDENTS RECEIVED EACH OF THE FOLLOWING SERVICES?

CARD 4

ccl 14

a. Nasal feeding b. Blcod pressure reading c. Enema

cC12 CC16 CC20

d. Catheterization

9.

L

e. Full bad-bath f. Bowel or bladder

CC24 CC28 retraining CC32

Oxygen therapy h. Application of dres- i. Temparature-pulsaca36 sing or bandage CC40 respiration

Hypodermic injeation k. I rrlgation 1. I ntravenous InjectIon

C(A8 CC62

CC44

●20. DOES THIS FACILITY PROVIDE ANY OF THE FOLLOWING PROFESSIONAL REHABILITATION SERVICES ON THE

PREMISES? (THE THERAPISTS MUST BE LICENSED OR REGISTERED IN THEIR SPECIFIC PROFESSIONS.)

a.

b.

c.

d.

e.

f.

Physical therapy

Occupational therapy

Recreational therapy

Speech and heering therapy

Counseling by social worker, psychologist, or mental health

worker

Other rehabilitation awvices (Specify)

rMCC56

60-1 ❑ Yes

61-1 n Yes

62-1 ❑ Yes

63-1 ❑ Yea

64-1 a Yes

65-1 ❑ Ye,

-2 ❑ No

-2 ❑ No

-2 ❑ No

-2 ❑ No

-2 ❑ No

-2 ❑ No

21. DOES THIS FACILITY CONDUCT TRAINING PROGRAMS FOR PEOPLE NOT ON YOUR STAFF IN COOPERATION

WITH AN EDUCATIONAL INSTITUTION?

❑ Yes ; NCI

87-1

22. WHAT ARE THE ACTUAL HOURS FOR EACH SHIFT? (circle am or pm)

CARO 5

a. Oay Shift from am em

ccl 1.5 to

ccl 2 pm CC16 pm

b. Evening Shift

C. Night Shift

from am *O am ❑ No mch shift

CC20 pm CC24 pm

from am to am D No such shift

ac28 pm CC32 pm

Form 73NHs-1

34
I

23,a. 1. FOR THE DA Y SHIFT YESTERDAY, WAS THE PERSON IN CHARGE OF NURSING CARE (FOR THE ENTIRE

FACILITY): (Mark (x) Only One Box)

~“”c’” “2T5g;’?:,KILLoFT,,,pERsoN, WHAT IS THE LEVEL OF a.3. WORKyESTERDAy,cIrcia WHAT HOURS DID ~PERSON

(Mark (X) Only One Box) am or pm.)

w-l

-2

-3

4

❑ Ragiatarcd N.rsa

am am

from to

Cc41 pm CC45 Pm

❑ Licamad Practical N.raa

❑ N.rse’.sAida

Q Othw 40-

Specify Occupation

23,b. 1. FOR THE FVENING SHIFT YESTERDAY, WAS THE PERSON IN CHARGE OF NURSING CARE (FOR THE ENTIRE

FACILITY): (Mark (X) Only One Box)

46-1 ON CALL -2

L

ON DUTY - that is awake, -3

Q

NO sUCH SHIFT

dresaad, and serving tha

residents

(Skip to Part 23.c.)

b.2. WHAT IS THE LEVEL OF

SKILL OF THIS PERSON?

(Mark (X) Only Ona Box)

60-1 ❑

-2 •1

-’cl

-40

Ragiaterad Nuraa

Licensed Practical Nuraa

Nuraa’s Aide

b.3.

from .

spacityuocupwon

WHAT HOURS DID THI PERSON

WORK YESTERDA * ? (circle

amor pm.)

am am

to

IX52 pm 0456 Pm

23.c. 1. FOR THE NIGHT SHIFT YESTERDAY, WAS THE PERSON IN CHARGE OF NURSING CARE (FOR THE ENTIRE

FACI LITYE (Mark (X) Only One Box)

W-1 a ON CALL -2 ❑ ON DUTY - that is awake, -3 ❑ NO SUCH SHIFT

/

kc.,. dreaaad, and eewing the

61-1

-2

-3

-f

&(Skip to Question 24)

WHAT IS THE LEVEL OF c.3. WHAT HOURS DID THIS PERSON

SKILL OF THIS PERSON? WORK YESTERDA~rc!e

(Mark (X) Only One Box) am or tam.)

❑ Ragisterad Nurse

am am

from to

CC63 pm c&37 pm

❑ L&mad PraoticalNursa

❑ Nursa’sAide

❑ Other 62-

Specify Occupation

24, HOW MANY DIFFERENT PHYSICIANS CURRENTLY AlTEND THEI R OWN PRIVATE PATIENTS IN THIS FACILITY?

(DO NOT COUNT PHYSICIANS WHO ARE ONLY ON THE STAFF OF THE FACILITY OR ARE ONLY EMPLOYED

UNDER CONTRACT.)

Physicians

CC71

Form 73 NHs-1

35
25a. WHAT TYPE OF STAFF MEMBER EXERCISES DAI LY, ON-DUTY SUPERVISION OVER ALL CLINICAL SERVICES

IN THIS FACILITY? (Mark (X) Only One Box.)

Administrator. . . . . . . . . 75-1 ~b. IS THE ADMINISTRATOR ALSO A:

physician 76-1 ❑ Yes -2 ❑ No

ragisterad nurse 77-1 H Yes +? ❑ No

Iicencsd practical 7B-I ❑ Ye., -2 n No

nurse

Physician . . . . . . . . . . . . 75-2 ❑

Registered Nursa . . . . . . .

“3 •1

Other . . . . . . . . . . . . . . -4

7

Specify 79-

●26. DOES THIS FACILITY PROVIDE ANY OF THE FOLLOWING SERVICES TO PERSONS WHO ARE NOT RESIDENTS OF

THIS FACILITY?

a.

CARD 6

cell-6

b.

c.

d.

e.

f.

9.

h.

i.

L

Day care (services provided during the day to persons who

do not sleep in the home overnight. Day care sewicas can

include nursing care, physical or occupational therapy,

recreation I activities, at least one f ull meal a day) . . . . . . 12-1 ❑ Yes .2 ❑ No

Meals either home deliverad or in a group actting . . . . . . 13-1 ❑ Yes -2 ❑ No

Transportation and/or escort services. . . . , . , . . . . . . . 14-1 ❑ Yes -2 ❑ No

Homemaker orchorea?rvices . . . . . . . . . . . . . . . . 15-1 ❑ Yes -2 ❑ No

Information and/or referral for health needs , . . . . . . . 16-1 ❑ Yes .2 ❑ No

Friemllyv;siting . . . . . . . . . . . . . . . . . . . . . . . . . . 17-1 ❑ Yes ‘2 ❑ No

Daily telephone checking service . . . . . . . . . . . . . . . . 1S-1 ❑ Yes -2 ❑ No

Arrangement or provision of recreational activities . . . . . . 19-1 ❑ Yes -2 ❑ No

Laundry earvice . . . . . . . . . . . . . . . .,.........20-1 ❑ Yes “2 c! No

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...21-1

P

Yes 20N0

Specify 22-

27a. DOES THIS FACILITY KEEP A WAITING LIST OF PERSONS TO BE ADMITTED WHEN A BED BECOMES AVAILABLE?

0-1 ‘es ❑ No (Skip to Question 2S)

-2

b. HOW MANY PEOPLE ARE ON THIS WAITING LIST?

❑ None or — peOple

CC24-26

c. DO YOU PROVIDE ANY SERVICES TO THE PERSONS ON THIS WAITING LIST?

P

<es ❑ No (Skip to Question 28)

27-1 -2

* c.(1) WHICH OF THE FOLLOWING SERVICES DO YOU PROVIDE?

a.

b.

c.

d.

e.

f.

9.

h.

i.

i.

Day care (services provided durir’ig the dey to pereons who

do not sleep in the home overnight. Day care services can

include nursing care, physical or occupational therapy,

recreational activities, at least one full meal a day), . . . . . . 2S-1 ❑ Yes

Meals either home delivered or in a group setting . . . . . . 28-1 ❑ Yes

Transportation and/or escort services . . . . . . . . . . . ...30-1 ❑ Yes

Homemaker or chore services . . . . . . . . . . . . . . . . 31-1 ❑ Yes

Information andlor referral for health needs . . . . . . . .32-1 D Yes

Friendly visiting . . . . . . . . . . . . . . . . . . . . . . .. 33-I H Yes

Daily telephone checking service . . . . . . . . . . . . . ...34-1 ❑ Yes

Arrangement or provision of recreational activities . . . ...35-1 ❑ Yes

Laundry service . . . . . . . . . . . . . . . . . . . . . . . ...38-1 ❑ Yes

Other . . . . . . . . . . . . . . . . . . , . . . . . . . . . . ...37-1

P

Yes

Specify

-2 ❑ No

-2 ❑ No

-2 ❑ No

-2 ❑ No

-2 ❑ No

-2 ❑ No

-2 ❑ No

-2 ❑ No

-2 ❑ No

-2 ❑ No

36-

Form 73NHS-1

36
*28. DOES THIS FACILITY INCLUDE AS PART OF ITS 8ASIC CHARGE TO EACH RESIDENT THE CHARGES FOR:

a,

b.

c.

d,

e,

f!

9.

h.

Yes No

Physlci.en services . . . . . . . . . . . . . . . . . . . . . . . . 29-1 ❑ -2 ❑

Private dutynursirsq . . . . . . . . . . . . . . . . . . . . . . 40-1 ❑ “2 ❑

Other nursing services . . . . . . . . . . . . . . . . . . . ...41-1 •1 -2 •1

Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . ...42-I •1 -2 •1

Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4s-1 ❑ -2 •1

Mediceleupplies . . . . . . . . . . . . . . . . . . . . . . . . 44-1 ❑ “2 •1

Specialdiet . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45-1 ❑ -2 •1

P

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..~-l -2 •1

Specify 47-

29. HASTHISNURSING HOME8EEN IN BUSINESSATTHISADDRESS FOR LESSTHANTWOYEARS? (COUNT FROMTHE

TIMEITFIRSTOPENED ATTHISADDRESS ASANURSINGHOME EVENTHOUGHTHE OWNERSHIP ORTHE SERVICES

OFFEREDMAY HAVE CHANGED.)

fYes

50-1

Do Not Administer Expense Questionnaire

Form 73N HS-1

37
EXPENSE QUESTIONNAIRE

1973 Nursing Home Survey

National Center for Health Statistics

Health Resources Administration

Rockville, Maryland

Dear Accountant:

The National Center for Health Statistics (NCHS) of the U. S. Public Health Service is conducting a

survey of all resident facilities providing nursing and personal care to obtain basic data on their operating

expenses, services, and staff. This survey is being conducted as a part of the Department of Health,

Education, and Welfare’s nursing home improvement program. The information from this survey will

be used to compile statistics on the number and kinds of such facilities in the United States. These

statistics will be used to meet the needs of Congress, State legislatures, Federal, regional, and local

health planners, national health associations, and many others who plan and provide health services

to the aged.

This booklet contains the Expense Questionnaire, together with the account descriptions of the cost

categories included in the questionnaire. In addition, there is a full-time Certified Public Accountant

whose services are free of charge available via toll free telephone (800-6384856) to answer your questions

about completing this questionnaire. However, we ask that you frost attempt to complete the attached

questionnaire (which immediately follows in this booklet), using this instruction booklet. If you still have

questions, please use the free telephone contact (listed above) to acquire answers prior to completing

the questionnaire.

Please note at the bottom of this page that authorization is given for you to release the requested

information. We wish to assure you that any information which permits the identification of the

individual facility will be held in strict confidence, will be used only by persons engaged in and

for the purposes of the survey, and will not be disclosed or released to others for any purposes.

Please complete this questionnaire and return it in the enclosed postage-paid envelope within 5 working

days. Your cooperation in this survey will be greatly appreciated.

Sincerely yours,

Edward B. Perrin, Ph. D.

Acting Director

I hereby authorize of

(Accountant’s Name) (Accountant’s Address and Telephone)

I

❑ fiscal year

to list the ❑ 1972 Calendar year 1

expenses in operating the

(Facility Name)

of

(Facility Address)

Date

(Signature) (Title)

Form 73NHS-2

38
INSTRUCTIONS FOR COMPLETING THE EXPENSE QUESTIONNAIRE

PLEASE READ THESE INSTRUCTIONS CAREFULLY BEFORE YOU BEGIN TO ANSWER

THE EXPENSE QUESTIONNAIRE WHICH IS ATTACHED TO THIS BOOKLET

The definitions in this manual highlight the substance of each cost grouping as well as

related groupings of expenses to be excluded from specific cost definitions.

Donated services, supplies, space, etc., are to be priced at their reasonable value and added to

the cost category to which applicable.

Where a home is an affiliate of another facility, such as a hospital, and the records of the home

are a part of the total accounting system, allocation techniques may be required to identify certain of the

costs such as payroll, rent, supplies, and insurance. This is acceptable providing a sound basis is established

for the allocation.

While it is preferred that the report be on the calendar year ending December 31, 1972, you

may cover a different twelve-month period if you are on a fiscal year basis. The cost data, of course,

must be for the same time frame as the related statistical data included in other phases of this survey.

This is for the purpose of including all of the costs of delivering health care, disregarding whether the

services were paid for or (as in homes staffed by members of a religious order) donated.

Expenses may be reported on either a cash or accrua I basis; however, there must be a

consistency in the system applied throughout the entire period under report.

The cost categories in this questionnaire are aimed at the total cost of care for patients, and

are matched to statistical data being collected for parallel purposes. Typical functional cost information

(e.g., administrative, clerical, medical cost categories) will not provide.an appropriate framework for the

study and should consequently not be used.

—

The expense categories used in this questionnaire are also not intended to be a recommended

cost structure for homes; they are tailored to a single specific use in the survey. It is recognized that

certain of the costs, such as supplies, foods, drugs, and equipment specif ical Iy purchased for sale to

patients, may not, within the present expense structure of a home, be recorded as expense. Again, this

survey is for the purpose of capturing a II costs incident to providing health care In a home and therefore

must include services and supplies dire=ly charged to patients.

In general, it is essential that all recorded expenses incurred by the Home be included in the

expense categories, as well as the value =donated items not recorded in the account structure. Excluded

from costs, however, are any losses sustained in the sale or disposition of fixed assets and other extraordinary losses not related to the current cost of providing hea Ith care.

Form 73NHS-2

39
EXPENSE QUESTIONNAIRE

1973 Nursing Home Survey

=

National Center for Heelth Statistics

Heelth Reeources Administration

Rockville, Maryleml

ccl-2

I I

ASSURANCE OF CONFIDENTIALITY - All information which would permit identification

ESTABLISHMENT NO.

of the individual facility will be held in strict confidence, will be usad only by persons engaged in

and for the purposes of the survey, and will not be disclosed or released to others for any purposes.

CC2

A. PLEASE LIST BELOW THE 1972 CALENDAR YEAR EXPENSES FOR OPERATING THE FACILITY, IF EXPENSES

ARE NOT FOR THE 1972 CALENDAR YEAR, SPECIFY PERIOD COVERED:

CARD 1 from to

Cal 1-1 month yaw month year

ccl 2 ccl 4 ccl 6 ccl 8

B. REFER TO THE ENCLOSED DEFINITIONS WHEN COMPLETING THIS FORM. FOR FURTHER CLARIFICATION

PLEASE CALL FREE OF CHARGE THE FOLLOWING PHONE NUMBER: 800-638-0856.

EXPENSE CATEGORY AMOUNT

1.

CARD 2

ccl 1-2

2.

3.

4.

5.

6.

7.

(See Note 1on next page) (If NONE, please enter “O”)

Payroll Expense (Do not include contracted wvicas):

a. Wages and Salaries [gross emount including

employees’ FICA, vacation and sick pay,

taxes, etc.):

(1) Nursing staff payroll expense . . . . . . . . . . ..$

(includeRNs,LPNs, Practical nurses, CC21

aides, orderlies, student nurses, and

other nursing staff)

(2) Physicians,other professionalsand semiprofessionals payroll expenaa . . . . . . . . . . . .$

CC31

(3) All other staff payroll expense . . . . . . . . ..$

(All employees not listed in (1) and (2) CC41

including m Iary or withdrawals for

self-employed proprietor-owner*)

SUBTOTAL (add lines a.(l), a.(2), and

a.(3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$

C&l

b. Fringe Benefits (state unemployment, . . . . . . . . . . . . . . . . . . . . ..$

group health end Iifa insurance and all othar C&l

F9yr011 ati non-payroll benefits for all

employees on the etaff)

TOTAL PAYROLL EXPENSE (add

subtotal lineand line lab.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$

CC71

Equipment Rent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$

CC21

Insuranca (include profassional-public Iiabllityand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$

other insurance) CC31

Taxes andlicensas (includafranchisa trix). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$

CC41

lntarastand Financing Charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$

C&l

Depreciation Charges (Buildings and Equipment) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...*

Rant on Building and Land . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.

CC61

$

CC71

● If self-employed proprietor-ownar isnon-salariwJ, please estimate salary.

Form 73NHS-2

40
CARD 3

ccl 1.3

8,

9.

10,

11.

12,

13,

CARD 4

ccl 14

14.

16.

16.

Amortization of Leasehold improvements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$

CC21

FoodandOtherDietaryltems.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$

(include non-contracted services only) CC31

DrugExpenses(coatofdrugseitherpurchasad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$

or obtainad by contract, or purchased for patients CC41

and sold directly to them)

Suppllesand Equipment(costofsuppliesand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$

aquipment either purchased or obtained by CC51

contract, or purchased for patients and sold

dlractlyto them)

PurchasedMaintenanceofBuildings, Grounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$

and Equipment CCG1

Laundryand LinanExpense(include non- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

contracted services only) CC71

Purchased Department Functions:

a. Madical,therapy,educationallaboratory . . . . . . . . . . . . . . . . . . . .$

and other professional servicas obtainad CC21

by mntract.

b. Another contracted services(include house- . . . . . . . . . . . . . . . . . . .$

keeping, linen, food, or other servicas rwt CC31

obtained in.house)

TOTALPURCHASEDDEPARThfENTFUNCTIONS (add lines . . . . . . . . . . . . . . . . . . . .$

14.a and 14.b) CC41

Utilities(telephone,gas,water,and electricity] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$

CC51

OtherandMiscellaneousExpanse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$

(Include dues, sub.scriptlo&, travel, auto- CC61

mobile, advertising, other servicas not

Incl,,clad elsewhera, medical and non-medical

fees, unclassified). See Note 2 below.

TOTAL EXPENSES (addexpensecategorylineitems..... . . . . . . . . . . . . . . . . . . . . . . . . . ..$

1 through 16) CC71

Please check the addition of subcategories and total expenses. /

Note 1, If your accounting system does not generate coat items as catworizad above, please use your best estimate

of allocation 8mong the line items.

Note 2. If O ther and Miscellaneous Expense comprises 10 percant or more of the total expenses, please give details below

of major amounts which constitute 20 percent or more of Line 16.

Description Amount

If your questions are not answared by the instructions, you may contact a certifiad public accountant free of charge at the

following toll-free number for answers:

(800) 638-0856

Thank you.

Form 73N HS-2

41
DEFINITIONS

1. PAYROLL EXPENSE

a. Wages and Salaries

Wages and salaries are generally defined as gross earnings paid an employee including payment for annual and sick

leave, overtime, bonuses and other remuneration of a payment nature received by the employee. The wages and salaries represent

theamount earned andreported tothelnternal Revenue Sewiceon hisorher W-2statement. Self-employed proprietors, while

not salaried as employees, are to be included in this definition either in the amount reported on the tax return as self-employed

salary, or as a reasonable amount, related to the technical or non-technical services provided.

Employee salaries and wages, by the above definition, exclude payments for professional or non-professional services

obtained under contract, or fees paid doctors on a fee-for-service basis. Also excluded from Wages and Salaries are Fringe Benefits

as definedin 1 b(Payroll Expense -Fringe Benefits) below.

Non-funded employee benefits such as meals and living quarters, if provided an employee, and considered a part of the

gross salary received, areto reincluded ingress wages and salaries.

Wages and salaries are to be reported on the gross basis, without deductions for FICA, Federal and State taxes, and other

deductions from an employee’s gross pay.

(1) Nursing and Staff Payroll Expense

Nursing staff payroll expense is defined as the total wage and salary compensation given those employees who

administer nursing care to patients.

This category includes registered nurses, licensed practical nurses, practical nurses, nurses’ aides, orderlies, and student

nurses.

(2) physicians and Other Professionals Payroll Expense

Physicians and other professionals payroll expense is defined as wage and salary compensation given those professional

employees who provide direct health care to patients.

This category includes physicians, psychiatrists, dentists, optometrists, therapists, psychologists, podiatrists, audiologists, etc.

(3) All Other Staff Payroll Expense

All other staff payroll expense is defined as wage and salary compensation given all employees not specifically

categorized in (1) or (2) above.

This category includes medical and dental technicians, social service workers, X-ray assistants, lab assistants, and

administrative personnel including a self-employed proprietor-owner.

Nursing staff, physicians and other professionals are excluded from this category.

Any employee who spends 75 percent or more of his time in any one of the three areas mentioned above should have

—all of thewage andsalary compensations charged to that expense category. Further allocation is acceptable if it isafeatureo}

Your accountirw svstem.

b. Fringe Benefits

Fringe benefits areexpenses incurred bythe home forthecurrent and future benefitof home employ ees. These

expenses, not added to the wages and salaries of the employees, include such items as group health, hospitalization, employer’s

portion of FICA, Federal and State Unemployment Insurance, and life insurance premiums (exclusive of premiums paid where

(a) the Home is the beneficiary or (b) on the life of the proprietor-owner).

Excluded from this cost category are payments for vacation, maternity and sick pay, terminal payments, employee’s

share of FICA, and Iiving facilities provided employ eeswhere such facilities are established forthebenefit of the home.

2. EQUIPMENT RENT

Equipment rent is defined as all costs incurred for the rental or leasing of equipment. Charges to this category

would include the rental or leasing of furniture, typewriters, computers, X-ray machines orother forms of equipment. Exclude

from this category all lease-purchase agreements and deferred payment plans on tha purchase of equipment. These lattertype

purchases will be treated through the Depreciation Cost Category (expense category 6).

Form 73NHS-2
3. INSURANCE

Insurance is defined as the cost of premiums for policies necessary to the normal operation of nursing homes.

These charges include fidelity bonds, fire and extended coverage, malpractice, property and bodily injury liability, and

automobile insurance where transportation isincluded asaservice of the facility.

Exclude insurance paid for the benefit of em ployees, such as employee life or group hospitalization, as well as key man

life insurance. Seedefinition ofexpensecategoryl (b) fordistribution ofemployee benefit insurance paid. lftha home's

accounting system is on the accrual basis, exclude any prapaid costs and includa only the premiums on the current year’s portion.

4. TAXES AND LICENSES

Taxes and licenses are defined as costs paid or due to Federal, state, county, and local governments for taxes levied or licenses

required.

This category includes licenses obtained for the right to do business and taxes on real astate, personal property, excise and

business franchise taxes.

Amounts remitted to Federal, stata, county, and local governments for income taxes withheld from wages and salaries must

be excluded.

5. INTEREST AN~ FINANCING CHARGES

Intereat and financing charges are defined as costs incurred as interest or f inance cha rges on loans, notes, or other forms of

indebtedness.

These charges include amounts ofinterest onnotes payable, mortg~es payable orlong-term purchase agreements. The

initiel cost of financing or refinancing a loan, however, is to be excluded as an extraordinary cost not related to the normal cost

of providing health service. Alwtobe excluded from this expense category areplacement fees onloans andcoHs related to

penalty clauses on early retirement of mortgages or other loans.

Penalties paid to Federal, state, county, or local governments for improper filing of tax or information returns should be

excluded.

6. DEPRtCIATION CHARGES

Depreciation is defined as the distribution of the cost of tangible capital assets, lesssalvage (if any), over the estimated

life of the asset.

Charges to this category should exclude amortization as defined in expense category 8.

Depreciation charges are to be limited to the straight-line method rather than an amount that may be acceptable under the

Federal tax law (doubledeclinhsg, sum-of-the years digits, one and one-half straight-line, etc.).

Tangible capital assets, currently being purchased under a lease-purchase agreement, are to be depreciated rather than treated

es a rental payment. Exclude from this category any equipment of a nominal amount expensed in Equipment (Cost category 11. ).

7. RENT ON BUILDING AND LAND

Rent on building and land is defined as all costs incurred for space occupied pursuant to leases or rental agreements.

Included in this category is the cost of all buildings or real estate rented or leased by the home.

Charges to this category should exclude lease-purchase agreements and payments made on a mortgage covering the building

or land.

!.3 AMORTIZATION OF LEASEHOLD IMPROVEMENTS

Amortization of leasehold improvements is defined as the writeoff of improvements to leased premises over the remaining

life of the lease or the useful life of the improver,.ent, whichever is shorter.

Improvements to leased premises which have a remaining lease or useful life of one year or lessshould be expensed directly

when incurred.

Included in this category are improvements to leased premises such as wall partitions, permanent counters and cabinets,

tile floors and wall coverings, and plumbing fixtures.

43

Exclude from this category any improvements of a nominal amount charged to repairs and maintenance and included in

another cost category in this questionnaire.

Form 73NHS-2
9. FOOD AND DIETARY ITEMS

Dietary and food items purchased for preparation on the homers prem ieasare to be charged to this account.

Income received on the sale of meals to non-patiants and staff (when charged) will ba deducted from the recordad gross

cost of the food and dietary items.

Where food inventories are maintained, the coat of food consumed will be the basis for the recording of cost (inventory at

beginning of year plus purchases, less ending inventory.) Freight and sales taxes, whether included in the purchase, or as a separate

item (freight only), aretobe charged tothecost of food anddietary items, rather than to bacharged to 'Taxes and Licenses”

(sales tax) or “other and Miscellaneous Expense” (freight).

This cost category excludes related food costs, such as food preparation (wages), cost of kitchen operation, menu preparation,

and paper supplies related to the serving of meals.

The cost of meals purchased from hospitals or other outside services is excluded from this cost category (see 14 (b), Contracted

Services - Food) whether or not under contract.

Food purchased (to beprepared bythe home) forsale tospecific patients isalsoto recharged tothis account.

10. DRUG EXPENSES

Drug expenses represent the cost (or value when donated) of drugs consumed out of inventory or purchased for patients

and resold to them. Drugs not under inventory control will be considered expensed when purchased.

For purposes of this definition, drugs include both prescription type medicines as well as non-Prescription items such as

aspirin, laxatives, and vitamins, Excluded from this definition are such non-medicine items as cotton, bandages, syringes, and other

items which do not meet the common definition of drugs, and are categorized under SUPPIies, item 11, below.

Recognizing that medical supplies may be co-mingled in the cost account with drug items, an allocation technique maybe

adopted for the purposes of determining the separate cost of drug expenses.

The cost of drugs includes freight costs as well as sales taxes added to the purchase price of drugs.

Drug cost is not to be reduced by revenues from patients whether sold out of the nursing home inventory or purchased

.

specifically for the=se.

11. SUPPLIES AND EQUIPMENT

a. Supplies

Includes the purchase or donated value of all supplies axclusive of drug supplies (sac 10.) and food and other dietary

items (see 9.)

Supplies include, but are not Iimitad to, supplies used in food preparation and serving (dishes, kitchen ware, paper

supplies, etc.), office supplies, medical supplies, laundry, linen and blanket supplies, uniforms, the purchase of minor equipment

(staplers, ash trays, etc.) classified as supplies, and repair and maintenance supplies and parts (cleaning supplies, light bulbs, small

tools, etc.).

Undar normal conditions, supplies of the nature of those classified for inclusion in this cost category are not maintained

under inventory control except as a minimum level which may be used as a re-order point. The accounting system of the haml: will

dictate whether these costs will be developed on a “delivery basis” or on “issued” basis. Either method will be acceptable.

In those instances where the nursing home is affiliated with another facility such as a hospital and there is no separation

o~ accounting records. an allocation cost distribution method, consistent with sound accounting practices and principles, will be

acceptable,

b. Equipment

Includes the purchase or donation of items classified as equipment, but because of the nominal cost or nature of the

items, they are —not capitalized.

Equipment in this grouping include, but are not limited to, appropriate items of medical equipment, furnitura and

fixtures of a nominal value not maintained under asset control, repair and maintenance equipment, kitchen equipment, and

administrative equipment.

Form 73NHS-2

44
Equipment purchased specifically for sale to a patient, regardless of the cost or nature of the purchase, is to be

included in this category. Reasoning behind this decision is that title belongs to the patient and, accordingly, the home has no

basis for depreciating the equipment. Accordingly, all_equipment purchased for patients will be recorded in this cost category. The

revenues derived from the sale of the equipment to the patients will not be credited as an offset to the cost recorded in Supplies

and Equipment.

Exclude from this category any equipment which is being depreciated in cost category 6.

12. PURCHASED Maintenance OF BUILDING, GROUNDS, AND Equipment

This cost grouping includes contract costs for elevator maintenance, equipment appliance maintenance, ground maintenance,

contracts to maintain plumbing, electrical systems, and similar type service requirements. Excluded from this grouping are contracts

for such services as trash removal, cleaning services, and other housekeeping services. The cost for these latter contracts is to be

recorded in 14( b), Purchased Department Functions -- All Other Contracted Services.

Maintenance costs, not under contract, to be recorded in this cost category include the expense of plumbers, electricians,

ground maintenance, carpenters, general repairmen (appliance repairs, etc.), and similar non-contractual maintenance services.

13. LAUNDRY AND LINEN EXPENSE

This account relates to the cost of outside service only, rather than the cost of purchasing linens, towels, blankets, uniforms,

etc. This cost may or may not be under a service contract and may include the rental cost of the supplies provided under a contract.

%

Laundry and linen expense, as classified in this cost category, excludes services for this function provided by nursing home

staff, Personnel costs forthis service will be charged to 1.a.(3), Wages and Salaries -- All Other Staff Payroll Expense.

Separate charges for laundry or linen lost or damaged by the nursing home under a service-rental agreement will be reflected

in this grouping.

14. PURCHASED DEPARTMENT FUNCTIONS

Purchased department functions are defined as those services which are obtained by the home through a contract with an

outside entity.

a. Medical, therapy, educational laboratory and other professional services obtained by contract

This category includes services contracted with physicians, therapists, laboratories, pharmacies, nurses, and other

professional service providers.

This category excludes all maintenance contract services and other non-professional contract services.

b. All Other Contracted Services

All Other Contracted Services include contracts for housekeeping, linen service, food and dietary service, ambulance

service and any other non-professional contract service not specifically mentioned above.

This category excludes maintenance service contracts and professional contract services.

15. UTILITIES

Utilities are defined as charges for telephone and telegraph, gas, fuel, oil, water, and electricity.

Charges to this category should exclude any utility charges, such as telephone, that are reimbursed by patients or employees

or charges that are paid by the lessor under the lease agreement.

16. OTHER AND MISCELLANEOUS EXPENSES

This expense category is a catchall to record all costs not classified in 1. through 15, above. Costs included in this grouping

are dues and subscriptions, printing costs, advertisements, travel costs, automobile expenses, non-classified medical and non-medical

fees (example - audit and legal fees), postage and casual labor not charged to other expense categories.

Form 73NHS-2

45
RESIDENT CONTROL RECORD Sheet of Sheets

1973 Nursing Home Survey

National Center for Health Statistics

Heelth Resources Administration

Rockville, Marylend m

ESTABLISHMENT NO.

TOTAL RESIDENTS IN HOME d.cuInIrn

ccl2-15 . ac2 ccl 1-1

IN SAMPLE

ccla-19

RESIDENTS IN NURSING HOME

SAMPLE

DESIGNATION

NAME OF RESIDENT SAMPLE

DESIGNATION

NAME OF RESIDENT

LINE

NO.

c

LINE

NO.

c

26

Sw Sw

TE

a

TE

b a b

27

03 28

04

05

29

06

07

08

32

33

09 34

10 35

11 36

12

13

14

37

38

39

40

41

.

15,

17 42

18 43

19 44

45

T

20

21

22 47

z

4a

60

Fornr 73NHS-S ~MweLriresAreNeedcd CON27NUE ON THEBACK

46
RESIDENT CONTROL RECORD

I RESIDENTS IN NURSING HOME

SAMPLE

DESIGNATION

Sw

TE

a

NAME OF RESIDENT

LINE

NO.

b c

SAMPLE NAhlE OF RESIDENT

DESIGNATION

LINE

NO.

Sw

TE

a b c

I I I I 51 76

I I I 52 I I

/ 77

53

I I

I I I 78

54

1 1

79

80

81

82

63

64

I I I 55

56

I I

57

I I

58

I

I I I I

I 85

I I I I

/ 86

I I I

I 87

63

64

65

66

88

88

80

91

I I I I

I I I 68 I I

I I I I

I I

I I I I

I I I 72 I I

I 97

I I I 73 I I I 98

I I I 74 I 99

I I 100

Form 73 NHS-S If More Lines Ara Needed Use A New RESIDENT CONTROL RECORD

And Renumber The Lines Beginning With #101

47
RESIDENT QUESTIONNAIRE

1973 Nursing Home SuNey

National Center for Haalth Statistics

Haalth Re.sourcasAdministration

Rockville, Maryland

1-7

OMB #06B-S-72172

Expires 7-3L74

I

ASSURANCE OF CONFIDENTIALITY – All information which would permit identification

ESTABLISHMENT NO.

of the individual will be held in strict confklence, will be used only by persons engaged in and for

the purposes of the survey, and will not be disclosed or released to others for any purposes.

CC14-1

LINE NO.

I I

ccl 1

1. WHAT IS – DATE OF BIRTH?

13nn”rn

Month Oay Year ,Aw

ccl 5,16 17,18 18-21 CC22-24

2. WHAT IS – SEX? ❑ Mele ~ Female

25-1

3. WHAT IS – ETHNIC BACK- 26-1 ❑ Cauc85i0n -2 ❑ Negro -3 ❑ Oriental

GROUND? (Mark (X) Only

one box) -4 ❑ Spanish American -5 ❑ American Indian -8 ❑ Other

4, WHAT IS – CURRENT MARITAL 27-1 ❑ Married -2 a Widowad -3 ❑ Divorced

STATUS? (Mark (X) only

one box) -4 ❑ Saperatad -5 ❑ Nwer Married

5. WHAT WAS THE DATE OF – CURRENT ADMISSION TO THIS PLACE?

000

Month Day Year

IX28, 29 30.31 32-34

6a. WHERE DID – LIVE AT THE TIME OF ADMISSION? (Mark (X) only one box)

(1)

(2)

(3)

(4)

(5)

(6)

[7)

In e boarding home 35-1

In another nursing home or ralated facility -2

In a mental hospital or other long-term specialty hocpital -3

In a Wneral or short-stay hospital 4

In a private apartment or house -5

Other place, (Specify) -s

.38-

Don’t know -7

❑

•1

❑

•1

)- ❑ 6b.

•1

•1

(1)

(2)

(3)

(4)

(5)

(6)

AT THE TIME OF ADMISSION

DID – LIVE WITH: (Mark (X)

all that apply)

Yas No

spouse? 37-1 ❑ -2 ❑

Childran? 38-1 •1 -2 •1

Other relatives? 38-1 ❑ -2 ❑

Unrelated persons? 40.1 ❑ -2 ❑

Lived alone? 41-1 ❑ -2 ❑

Don’t know? 42-1 ❑

7. WHAT IS THE PRIMARY REASON FOR – ADMISSION TO THE HOME? (Enter ‘“1”in box for primary reason; if sacondary

reason given, entar “2”.)

43-

44-

45-

46-

Form 73N Hs-7

48

•1

❑

•1

❑

Physical reasons (a.g., illness or need for traatmen~)

Social reasons (e.g., no family, or lack of family interest)

Behavioral reasons (e.g., disruptive behavior, mental deterioration)

Economic reasons (e.g., no money andlor resources)
8, WHAT WAS THIS RESI DENT’S PRIMARY DIAGNOSIS: (Mark (X) only one box in each column)

a. AT ADMISSION? b. AT THE TIME OF–LAST EXAMINATION?

49,50 •l aOl

•1 aoz

•1 aoz

•l a04

•1 ,05

•1 ma

•l a07

•1 ma

•1 ml

•l a10

•1 .11

•l a12

•l a13

•l a14

•1 ,15

❑ a16

❑ al?

❑ a18

•l a19

❑ a20

•l a21

51,52 ❑ bOl

❑ b02

❑ b03

❑ b04

❑ b05

❑ b06

❑ b07

❑ b08

❑ b08

❑ b10

❑ bll

❑ b12

❑ b13

❑ b14

❑ b15

❑ b16

❑ b17

❑ b18

n b19

❑ b20

❑ b21

❑ b22

Senility, old aga, and other symptoms and illdefined conditions (e.g., coma, uremia)

Heart attack (e.g., ischemic heart disaasa)

Stroke (e.g., cerebrovascular diseasas)

Hardening of arteries (e.g., arteriosclerosis, diseases of the arterias, arerioles, capillaries)

.

Other diseases of tha circulatory ayatem (e.g., NOT heart attack, $troka, or hardening of the arterias)

Accidents, poisonings, and violenca (e.g., fracture of hip, other broken bonas, burns, concussion)

Mental disorders (e.g., mental retardation, psychoses, neurosas, mental illness, emotional problems)

Diseases of the musculoskelatal system and connective tissue (a.g., arthritis, rheumatism, &k psi”)

Endocrine, nutritional, and metabolic diseases (e.g., goiter, diabetes, gout)

Diseasas of the respiratory system (e.g., pneumonia, amphyscma)

Neoplasms (e.g., cancer, tumors)

Disaasas of the nervous system and S+nsa organs (e.g., Parkinson’s disease, glaucoma, cataracts,

blindnaas, multiple sclerosis, spaatic paralysis, apilepay)

Diseases of the digestive system (e.g., cirrhosis of liver, ulcer, intestinal obstruction)

Infective and parasitic dieeasss (e.g., T.B., polio, syphilis)

Diseaws Of tha genitourinary system (e.g., nephrosis, chronic pelvic infection, hyparpf.aia Of profla~e)

Diseasas of the skin a“d submtmeous tissue (e.g., callulitis, ~b~e~, chrO”ic “Icer]

Diseases of the blood and blood-forming organi (e.g., anemia)

Congenital anomalities (e.g., hydrocaphalus)

Complications of pregnancy, childbirth and the puerperium (e.g., infections, hemorrhage, toxemias)

Certain causas of perinatal morbidity and mortality (e.g., birth injury or immaturity of infant)

Don’t know

Othw (Specify) 54-

.

\

Specify: 53-

9. DOES – HAVE ANY OF THE FOLLOWING CONDITIONS OR IMPAIRMENTS? (Mark (X) all that apply)

cc55-85 -1 ❑ a.

-2 •1 b.

-3 •1 c.

-4 ❑ d.

Senility (includes decline in intellect, memory, and judgemant, loss of orientation, difficulw in spaaking; feableneea.)

Mental illness (Psychiatric or emotional problems)

Mental retardation

Arthritis or rheumatism

Paralysis or palsy other than arthritis

- e. (1) IS THIS THE RESULT OF ASTROKE7 ❑ Yes

6S-1

❑ No

-2

*c If. Glaucoma or cataracts

-7 •1 g. Diabetas

-8 ❑ h. Any CHRONIC trouble with back or spine

-9 ❑ i. Amputation of extremities or limbs; or permanent stiffness or any deformity of the foot, lag, fingers, arm, or back

“o •1 j. Heart troubla

OR

‘auk Resident has none of the above conditions or impairments

Form 73NHs-7

“49
10. DOES THIS RESIDENT REGULARLY USE ANY OF THE FOLLOWING Al DS?

CARD 2

No

14-2 a. Walker 15-2 ❑

b. Crutches 16-2 ❑

c. Braces 17-2 ❑

d. Wheelchair 1s-2 H

e, Artificial Limb 19-2 ❑

f. Self-feeder 20-2 ❑

9. Any other aids (do not cwnt g!aaaea or hearing aids) 21-2 ❑

Yes

“1 •1

-1 •1

-’l •1

-’ •1

-1 •1

“1 •1

-’ c1

\

Specify 22-

11. DURING THE LAST MONTH, HOW MANY TIMES DID–RECEIVE ANY OF THE FOLLOWING THERAPY SERVICES? (INCLUDE

ONLY SERVICES PROVIDED BY A LICENSED OR REGISTERED PROFESSIONAL WHETHER INSIDE OR OUTSIDE THE hOME.)

a.

b.

c.

d.

e.

f.

Physical therapy

Recreational therapy

Occupational therapy

Profeaaional cwnacling by social

worker, psychologist or other

mantel health worker

NUMBER OF

TIMES

❑ Nona or [ I

CC23

❑ Nrmaor 1 I

CC25

❑ Ncmeor I 1 CC27

❑ Nona or

I

CC29

❑ Nonaor I I

CC31

Q Ncmaor I

.X33

12. DURING THE PAST 7 DAYS, WHICH OF THESE SERVICES DI D–RECEIVE? (Mark (X) all that apply)

CC35-62 -01 ❑ a.

-02 ❑ b.

-03 ❑ c.

-CM ❑ d.

-05 ❑ e.

-w ❑ f.

-07 ❑ g.

-Ci9 ❑ h.

-09 ❑ i.

-lo ❑ j.

-11 ❑ k.

-12 D 1.

-13 l_J m,

OR

-14 ❑ n.

Rub or maesage

Administration of traatmant by staff

Special diet

Application of atarila drassirrgs or bandages

Temparatura-pulse-respiration

Full bad-bath

Enema

Catheterization

Blood pressure reading

Irrigation

Oxygan therapy

Intravanous injaction

Hypwlermic injection

None of the above services received

Form 73NHS-7

50
13. DURING THE PAST 7 DAYS, DID – RECEIVE ANY MEDICATIONS?

CARD 3

T

Q ‘o(sk~ ‘es

WHICH TYPES OF MEDICATIONS DID – RECEIVE? (Mark (X) All That APpW)

CC16-45 -01 ❑ a.

-02 ❑ b.

-03 ❑ c.

-04 ❑ d.

-05 ❑ e.

-C6 ❑ f.

-07 ❑ g.

-08 ❑ h.

-09 ❑ i.

-lo ❑ j.

-11 ❑ k.

-12 ❑ 1.

-13 ❑ m.

-14 ❑ n.

-15 ❑ 0.

Tranquilizers (e.g., Thorazina, Mall.aril)

Hypnotics - Sadatives (e.g., Nembutal, Seconal, Phenobarbital, Butisol, Placidyl, Chloral Hydrate)

Stool softeners (e.g., Peri-COlace)

Anti-Depressant (e.g., Elsvil)

Anti-Hypartensives (e.g,, Ismelin)

Diuretics (e.g., Diuril, Esidrex)

Analgesics (e.g., Aspirin, Darvon, Demerol, Percndan, Empirin with Codaine)

Diabetic agents (e.g., Orinase, Insulin)

Anti-inflammatory agents (e.g., Cortisone, Sodium Salicylate, Butazolidin, I ndocin)

Anti-infactives (i.e., antibiotics)

Anti-Anginal drugs (e.g., Nitroglycerin, Peritrate)

Cardiac Glycosides (e.g., Digitalis, Lanoxin)

Anti-Coagulants (e.g., D icumarol, Warfarin)

Vitamins or iron

Other types of medications not listed above

14. THE FOLLOWING ACTIVITIES FOR DAILY LIVING LIST VARIOUS LEVELS OF CARE THAT MAY BE NEEDED BY A

RESIDENT, PLEASE INDICATE THE ONE THAT BEST DESCRIBES THE LEVEL OF CARE NEEDED BY HRESIDENT.

FOR EACH ACTIVITY, THE LEVELS ARE GIVEN IN ASCENDING ORDER: IN OTHER WORDS, THE LEVEL DESCRIBING

THE MINIMUM CARE IS FIRST AND THE LEVEL DESCRIBING THE MOST CARE IS LAST. IF YOU ARE UNDECIDED

WHICH OF TWO LEVELS TO INDICATE, CHOOSE THE ONE DESCRIBING THE LESSER AMOUNT OF CARE!

a, CONSIDERING THE FOLLOWING FOUR HYGIENE ACTIVITIES (WASHING FACE AND HANDS, BRUSHING TEETH OR

DENTURES, COMBING HAIR, AND SHAVING OR APPLYING MAKE-UP) DOES THIS RESIDENT:

(Mark (X) Only One BOX)

48-1❑

“2 •1

-3 •1

-4 •1

“5 •1

Perform all four with no assistance?

Perform all four with no essietance, but naads help in getting andlor putting away equipment?

Perfotm three or four with no assistance, but requiras help with a complete bath?

Require assistance with one or two of these hygiene activities?

Raquire assistance with all four of these hygiene activities?

b. CONCERNING DRESSING, DOES THIS RESIDENT:

(Merk (X) Only Ona Box)

47-1 ❑ Get clothes from closets and drswers and completely draas without assistance?

‘2 ❑ Get cfOthes frOm clo?e~ and drawem and completely dress with some assistance (tying shoes, faetening braces, closing buttons .X

zippers in back of garmants)?

‘3 ❑ Receiva a~istance in 9attin9 clothes, or in dressing (do not count tying shoas, faatening braces, closing buttons or zippers in back

of garments as assistance)?

4 ❑ Stay partly or completely undressed?

c. CONCERNING FEEDING, DOES THIS RESIDENT:

(Merk (X) Only One BOX)

48-1 ❑

-2 ❑

“3 •1

-’$0

“5 •1

Faad self without assistance?

Feed self with minor .amiatanca (cutting meat or buttering bread)?

Receiva major assistance in feeding (do not count cutting meat or buttering bread)?

Require intravenous feeding?

Rsquire tube fwding?

Form 73NHS-7

51
d. CONCERNING AMBULATION TO REACH THE TOILET ROOM, IS THIS RESIDENT:

(Mark (X) Only One BOX)

51-1 ❑ Able to go to the toilet room without nurm’ assistance (may use cane, walker, wheelchair, or other object of support), may

manage bedpan or commoda at night? ——

-2 •1 Receiving nurses’ assistance in going to the toilet room (do not count use of cane, walker, or other object of support),

using bedpan or commode at night, or cleaning self or arranging clothes after elimination?

-3 ❑ Unable to 90 to the toilet room for the elimination procass?

e. CONCERNING MOVING IN AND OUT OF A BED OR CHAIR, IS THIS RESIDENT:

Receiving no assistance?

Walking with assistance of ona person?

Walking with assistance of mm persons?

Up in a chair with assistance once in 8 hours?

Up in a chair with assistance twice in 8 hours?

Bwlfast with aaaistance in turning evary two hours?

Bedfast with assistance in turning every hour?

(Mark (X) Only One Box)

52-1 ❑

-2 •1

-3 ❑

)

4D

-5 •1

k

e.(1) DOES – HAVE

-6 ❑ BED SORES?

-7 •1-J

f. CONCERNING CONTINENCE, IS THIS RESIDENT:

(Mark (X) Only One BOX)

In control of both bowels and bladdar?

An ostomy patient?

In control of bladder only?

In control of bowels only?

NotinCOIItrOlof bowels or bladder?

53-1

? ‘es ?

No

(co;tinue with pe’rt f.)

54-1 ❑

-2 •1

-3 ❑-l

-4•1)-f.(1) IS – RECEIVING BOWEL AND/OR

BLADDER RETRAINING?

-5 •1

55-1 ❑ Yes (Skip to Question 15a,)

&fJ2) WOULD RETRAINING GIVE THIS

RESIDENT CONTROL OVER

BOWELS AND/OR BLADDER?

❑ Yes ~ No ~ Do.btf”l

56-1

15a. DOES THIS RESIDENT EXHIBIT ANY OF THE b. DOES THIS RESIDENT EXHIBIT THIS BEHAVIOR

FOLLOWING BEHAVIOR? MORE OFTEN THAN ONCE A WEEK OR ONCE A WEEK

OR LESS?

No

(1) Depressed 57-2 ❑ -1

(2) Agitated, nervous 59-2 ❑ -1

(3) Abusiva, aggressive 61-2 ❑ -1

(4) Confusad, senile 63-2 ❑ -1

(5) Disturbed sleep 65-2 ❑ -1

(6) Other problem behavior 67-2 ❑ -1

Yes

~ (Specify) 68-

More often than

once e weak

58-1 ❑

60-1 ❑

62-1 ❑

64-1 H

66-1 ❑

_ 69.1 D

Onca a waak

or [ass

“2 •1

-2 ❑

-2 El

“2 •1

-7- ❑

“2 •1

Form 73NHS-7

52
18a. DURING THIS RESIDENT’S STAY HERE, WHEN DID - LAST SEE A PHYSICIAN FOR TREATMENT, MEDICATION, OR FOR

AN EXAMINATION?

CARD 4 Month Day Yew

r

001

OR c1 Hes Never Seen A Doctor While Here (Skip to

21-1 Question 17a.]

CC15,16 17,18 19,20

i

b. AT THAT TIME, DID - RECEIVE:

(1)

(2)

(3)

(4)

Yes

An examination? 22-1 u -2 b

Treetmemt? 23-1 Q -2 •1

Prescription? 24-1 ❑ -2 ❑

Other? 2s-1

%

-2 •1

Specify 26-

C. DID THE PHYSICIAN ATTEND THE RESIDENT: (Mark (X) Only One Box)

27-1 ❑ as a private physician7

.2 ❑ for the home itself which furnishes the m~cal care?

‘3 ❑ tem~raril~ a$ a replacement for the resident’s private physician who was unable to attend the r~ident?

-4 ❑ under some other arrangement? (Specify) 2Bci. DOES A PHYSICIAN EXAMINE THIS RESIDENT: (Mark (X) Only One Box)

29-1 H only when called?

‘2 ❑ irre9ular!Y, but without being called?

-3

\

on a scheduled basis?

d. (1) HOW OFTEN DOES THE PHYSICIAN EXAMINE THE RESIDENT?

(Mark (X) Only One Box.)

30-1 ❑ once a weak

-2 ❑ every 2 weeks

-3 ❑ once a month

4 ❑ avery three months

-S ❑ Once a year

-6 ❑ other (Specify) 31-

17a. DOES - WEAR EYE GLASSES?

Yes No

‘v

32-1

7

-2

b. IS – SIGHT WITH GLASSES: (Mark (X) ‘Only Ona Box) c. IS – SIGHT: (Mark (X) Only One Box)

33-1 ❑ not impaired? (e.g., cm raad ordinary newspaper 33-1’ ❑ not impaired? (e.g., can read ordinary newspaper

print) print without glasses)

-2 ❑ partiallY impaired? (e.9., can wetch tel~isfon 8 to ‘2 ❑ Pamiallvimpaired?(e.g., can watch television B tO

12feet across the room) 12feetacrosstheroom)

‘3 ❑ s~arelYimpair~? (e.9., can recognize tha features -3 ❑ SWarelY impaired? (e.g., can recogniza tha featuraa

of familiar persons if they are within 2 to 3 faat) of familiar persons if they are within 2 to 3 feet)

4 ❑ completely lost? (e.g., blind) -4 ❑ cOmPleteiy 10st? (e.g., b~nd)

18a. DOES – USE A HEARING AID?

Yas

%’ 34-1

“b. IS -HEARING WITH A HEARING AID: c.

(Mark (X) Only Ona Box)

35.1 Q

.2 ❑.

.3 ❑

-4 •1

not impaired? (a,g., urn hear a telephone eenversation

on an ordinary telaphone)

partially impaired? (e.g., csn hear most of the things

e person seys)

severaly impaired? (e.g., can hear only a ffw wOrda e

person seys or loud noises)

completely lost? (e.g., deaf]

No

%’ -2

IS –HEARING: (Mark (X) only One BOX)

35-1 H

-2 •1

-3 •1

--40

not impairad? (e.g., em hear a telephone conversation

on an ordinary telephone)

partially impaired? (e.g., can haar most of the things

a person says)

severely impaired? (e.g., can hear only a faw words a

person aaya or loud noisas)

completely lost? (e.g., deaf)

Form 73N HS-7

53

._

.-
19. IS – ABILITY TO SPEAK: (Mark (X) Only One Box)

38-1 ❑ not impaired? (e.g., is able to be understoml; can carry on a normal conversation)

-2 ❑ Partially impaired? (e.9., is able to be understood but has difficulty pronouncing some words)

-3 ❑ $averely iMPSirad? (e.9., CannOt carry on a normal conversation; is understo.xr only with difficulty)

‘4 ❑ completely lost? (e.g., is mute)

20a. DOES THIS RESIDENT HAVE DENTURES?

•1 Yes7’ ~ NO(Skip to Q“estio” 21a.)

39-1

b. DOES – USE THE DENTURES?

❑ Yes ~ NO

40-1

21a. DURING THE LAST MONTH, DID - LEAVE THE HOME FOR ANY RECREATIONAL OR LEISURE ACTIVITIES?

HI ‘e’ A“”

b. FOR WHICH OF THE FOLLOWING ACTIVITIES c. WHY DIDN’T – LEAVE THE HOME TO PARTICIPATE IN

DID – LEAVE THE HOME? (Mark (X) .411That APPIY) ANY ACTIVITIES DURING THE LAST MONTH? (Mark (x)

CC42-52 -1 ❑

-2 ❑

“3 ❑

-’J •1

-5 ❑

-6 •1

-7 •1

-8 ❑

-9 ❑

“o •1

-&U

Get books, etc., from the library

Anend plays, movies, concerts, etc.

Attend arts and crafts classes outside the home

Visit museums, parks, fairs, etc.

Goon shopping trips organized by the home

Goon independent shopping trips organized

by the resident or visitors

Visit a beauty shopor barbershop

Visit community clubs (such as community centers, senior citizen clubs, service clubs, bridge

clubs, unions, etc.)

All That APPtY)

CC42-52 -1 ❑

-2 •1

-3 •1

-’$0

-5 ❑

-60

-7 ❑

-8 ❑

Attend religious services or other religious activities

Go for a walk

Other, (Specify) 53-

Resident was too Ill or was not able to move

well enough to participate

Resident was not interested

Staff was unable to determine resident’s interests

at this point

Staff feels thet the resident’s behavior

will not be tolerated outside the home

No one was available to accompany the resident

Residentcannotafford these activities

Lack of transportation

Other, (Specify) 53-

22a. DURING THE PAST YEAR, HAS THIS RESIDENT BEEN ON ANY KIND OF LEAVE OVERNIGHT OR LONGER,

EXCLUDING LEAVE FOR MEDICAL REASONS?

❑ Yes ❑ No (Skip to Q“esticm 23a.)

? -7-

p Don’t k“ ow (Skip to Question 23a.)

54-t

b. WHERE DID – USUALLY GO WHEN ON LEAVE? (Mark (X) only One Box)

55-1 ❑ To own home or apartment

‘2 ❑ TO homeof family or relatives

‘3 ❑ TO home of unrelated friends

-4 ❑ To foster home

‘5 ❑ TO boardinghouse or room

-6 ❑ TO another place, (Specify) 56-

-7 ❑ Don’t know

c. ABOUT HOW OFTEN DID THIS RESIDENT GO ON LEAVE? (Mark (X) only one Box)

67-1 •1

-2 •1

-3 •1

-4 •1

-5 ❑

-6 ❑

-7 •1

Form 73NHS-7

Nearly avery week

About once a month

About once every two months

Several times a yaar

About once a year or less

Othar (Specify) 5BDon’t know

54
23a. DOES – HAVE ANY VISITORS?

b. HO-W FREQUENTLY DO VISITORS SEE THE RESIDENT? (Mark (X) Only One Box)

16-1 ❑ Nearly every week ‘5 ❑ About once a year or Ie=

‘2 ❑ About once amonth -S ❑ Other (Specify) f7-

‘3 ❑ About once every two month$

-7 ❑ Don’t know

-4 ❑ Saveral times a year

24. HOW MANY BEDS ARE IN - ROOM? (Mark(X) OnlyOneBOXI

18-1 ❑ One bad (i.e., the rasident’s own bad) -4 ❑ Four beds

-2 n TWO beds -5 ❑ Five or more bads

-3 ❑ Thraa bads

25a. HAS THIS RESIDENT LIVED IN THIS FACILITY FOR ONE FULL MONTH OR LONGER?

❑ Yes ~ No~

19-1

Stop; goon to next

questionnaire.

b, LAST MONTH, WHAT WAS THE BASIC CHARGE FOR THIS RESIDENT’S LODGING, MEALS, AND NURSING CARE

NOT INCLUDING PRIVATE DUT_SING OR OTHER SPECIAL CHARGES?

❑ NO charm is maieforcsre (Skip to Qusstion 26a.) $

●

CC20-25

c. LAST MONTH, WHAT WAS THE TOTAL CHARGE FOR THIS RESIDENT’S CARE, INCLUDING ALL CHARGES FOR

SPECIAL SERVICES, DRUGS, AN=CIAL MEDICAL SUPPLIES?

❑ Noclmrga ismadeforcere (SkiptoQuestio” 26s.)

~ $ cc%-” ●—

(1) DID THIS AMOUNT INCLUDE SPECIAL CHARGES FOR

No Yes

(a) physician setvices? 32-2 ❑ -’ •1

(b} private duty nursing? 33-2 ❑ “’ •1

(c) therapy? 34-2 ❑ -1 •1

(d) drugs? 3S-2 ❑ -1 •1

(a) special madical supplies? 36-2 ❑ “’ •1

(f) special diet? 37-2 ❑ -’ •1

(g) othar?

P

3s-2 ❑ -1

Specify -39

26a. WHAT WERE ~THE SOURCES OF PAYMENT FOR THIS RESIDENT’S CARE LAST MONTH?

(Mark (X) All That APPM

CC4046 ❑ (1) Own incma or family ❑ (4) Otharpublicassistanm ❑ (7) j~:flmantsupport (private plens, or welfare

retirement funds, seciel

eacurity, ate.) ❑ (5) Chwchstsprmn ❑ (S)$N0::9a ismfxie

❑ [2) MadicareO’itla XVIII) ❑ (6) VAcontract

❑ (3) Medimid (Titla XIX)

❑ (9) Other (Specify) ~ 49.

b. WHAT WAS THE PRIMARY SOURCE OF PAYMENTS FOR – CARE LAST MONTH?

(Mark (X) Only One Box.)

60-1 ❑ Own income or femily 4 ❑ Othar Public assistance -7 ❑ Md#~ymentsapport (private plans, or welfars

retirement funds, social

sacurit y, etc.) -6 •l Church ~pport -B ❑ ~o: ch::m is made

-2 ❑ Madicara (Titla XVI 11) -6 ❑ VA contract

-9 ❑ Other (Specify) ~

-3 ❑ Medicaid (Title XIX) 51-

Form 73NHS-7

55
STAFF QUESTIONNAIRE – PART 1

1973 Nursing Home Suwey

National Center for Health Statistics -

Health Resources Administration

Rockville, Maryland

76 ..3-A 36

ASSURANCE OF CON FIDENTIALITY– AII information

which would permit identification of the individual will be held

in strict confidence, wil I be used only by persons engaged in and

for the purposes of the suwey, and will not be disclosed or released

to others for any purposes.

The National Center for Health Statistics of the Health

Resources Adminmtratmn IS conducting a nationwide

survey in nursing homes. One of the purposes of the survey

A. ESTABLISHMENT NO. B. LINE NO.

Uruuul

CC2 mCell

Your answers will be given confidential treatment. The information will be

used for statistical purposes only, and will be presented in such a manner that

no individual person or establishment can be identified. After completing the

is to obtz!n ccrtaln lnformatmn about the staff employed in these form please return it in the envelope provided.

fac!l!t,es. We would appreciate your taktng the brief amount of

time necessary to complete this questionnaire.

You may ask questions of the interviewer or by calling 800.638.0856.

1. HOW LONG HAVE YOU WORKED AS A

a. IN THIS FACILITY?

On

Years Months

CC20 CC22

b. IN OTHER NURSING HOMES,

HOMES FOR THE AGED, OR

SIMILAR FACILITIES? moo’

Years Months

CC24 CC26

c. IN HOSPITALS?

OnoR

Years Months

CC28 CC30

Mark (X) this box

if you have never

worked in any other •1

nursing home.

Mark IX) thm box

if you have

never worked •1

in a hospital.

2. WHAT IS YOUR DATE OF BIRTH? //

Month Day Year

CC32,33 CC34,35 CC36,37

3. HOW MANY HOURS PER WEEK DO YOU USUALLY WORK IN THIS FACILITY? I I

~ hours

4. HOW MANY HOURS DID YOU WORK LAST WEEK IN THIS FACILITY?

Ohcmrs ‘R ❑ .o”e

CC40

5. BESIDES THE HOURS WORKED IN THIS FACILITY, HOW MANY ADDITIONAL HOURS DID YOU WORK IN YOUR

PROFESSION LAST WEEK?

m hours 0’ ❑ mme

CC42

6. WHAT IS YOUR SALARY BEFORE DEDUCTIONS FOR THE WORK YOU PERFORM fN THIS FACILITY ONLY?

(Mark (N only oneBOX)

$ . per

CC44

i

.

OR

❑ I dcmatemy sewices

CC51-1

52-1 ❑ week

-2 •1 hour

-3 •1 two weeks

-40 one month

‘5 ❑ other time period, specify 53.

Form 73NHs-4

66
7, IN ADDITION TO THIS SALARY, DO YOU RECEIVE:

(Mark the Yes or No Box for Each Line) Yes No

a. Paid vacation, paid holidays, and/or paid sick leave? . . . . . . . . . 54-1 ❑ -2 •1

b. Cash bonus? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55-1 ❑ “2 •1

c. Pension plan in addition to Social Security? . . . . . . . . . . . . . . . . 56-1 ❑ -2 •1

d. Health insurance? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57-1 Q

-2 •1

e, Life Insurance? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5B-I ❑ -2 •1

f, Release time for attending training institutes? . . . . . . . . . . . . . . 59-1 ❑ -2 •1

g. Civic or personal leave (such as leave for jury duty, military

resewes, voting, funerals)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60-1 ❑ -7- •1

h. Room? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61-1 ❑ -2 •1

i. Meals? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62-1 ❑ -2 •1

j, Other? Specify_

64-

63-1 ❑ -2 •1

8, LAST WEEK IN THIS FACILITY, DID YOU PERFORM ANY OF THE FOLLOWING SERVICES:

(Mark the Yes or No 60x for Each Line)

Yes No

a. Administration of the facility? . . . . . . . . . . . . . . . . . . . . . . . . . . 65-1 ❑ -2 •1

b. Nursing care? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66-1 ❑ -2 •1

c, Medical and dental care? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67-1 ❑ -2 •1

d. Physical therapy ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-1 ❑ -2 ❑

e. Occupational therapy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69-1 ❑ -2 •1

f. Recreational therapy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70-1 ❑ -2 ❑

g. Speech and hearing therapy? . . . . . . . . . . . . . . . ...!... . . . . . 71-1 ❑ -2 ❑

h, Social work? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72-1 ❑ -2 ❑

i.Clerical work? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73-1 ❑ -2 ❑

j. Kitchen/dietary work, grocery shopping? . . . . . . . . . . . . . . . . . . 74-1 ❑ -2 •1

k. Housekeeping services? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75-1 ❑ -2 •1

1. Other? Specify service ~ 76-1 ❑ “2 •1

77-

9, WHAT IS THE HIGHEST GRADE YOU Circle highest grade completed CAR02

COMPLETED IN SCHOOL? ccl 4-2

a. College . . . . . . . . . . . . . . . . 1 2 3 4 5 ormore CC15

b. Nursing school (diploma) . . 123 CC16

c. Junior college . . . . . . . . . . . 1 2 ccl 7

d. High school . . . . . . . . . . . . 1 2 3 4 CC18

e. Elementary school . . . . . . . 1 2 3 4 5 6 7 8 CC19

10a, WHICH OF THE FOLLOWING DEGREES

DO YOU HAVE? b. FOR EACH OEGREE THAT YOU c. IN WHAT YEAR OID YOU

(Mark all that apply, count HAVE PLEASE ENTER YOUR RECEIVE EACH OEGREE?

MAJOR FIELO OF STUOY

completed degrees only)

Associate degree or certificate 20-1 ~ f9

CC25,26 CC27,28

6achelor’s degree 21-1 19

CC29,30 CC31,32

Master’s degree 22-1 *

19

CC33,34 CC35,36

Doctorate (M. D., O. 0., Ph. D., 23.1

etc. )

19

CC37,38

If none of these, mark(X) box o endskiptoCluestio” 11)

CC39,40

Form 73NHS-4

57
11. HAVE YOU TAKEN ANY NON-DEGREE TRAINING COURSES lNTHEPASTYEAR? TRAINING COURSES INCLUDE

CLASS SESSIONS AND SEMINARS. DO~ INCLUDE COURSES FOR DEGREE CREDIT. I

42-1

?

Yes -2

L_

No

(Skip to Question 12)

r

b. FOR EACH OF THE SUBJECT AREAS c. NUMBER OF

LISTED BELOW, INDICATE HOW MANY COURSES*

NON-DEGREE TRAINING COURSES’ YOU TAKEN IN PAST

HAVE TAKEN WITHIN THE PAST YEAR. 12 MONTHS

a. Nursing care of the aged

or chron!cal[y ill I I

CC43,44

I

b. Medical or dental care of the

aged or chronically ill I I CC45,46

c. Mental or social problems of

the aged or chronically ill CC47,46

d. Physical therapy or

rehabilitation CC49,50

e. Occupational therapy CC51 ,52

f. Nutrition or food services CC53,54

9. Nursing home administration CC55,56

I ‘

Inservice Education

I I

CC57,58

i. Medical records CC59,60

j. Activity programs for the

aged or chronically ill CC61,62

k. Social services for the aged

or chronically ill CC63,64

1. Pharmacology and care of

drugs CC65,66

E 67-

Other course related to your work

CC68,69

“Training coursas include class sessions and seminars. Do not include

courses for degree credit. I

I

PLEASE TURN THE PAGE FOR THE NEXT QUESTION.

Form 73N HS-4

58
12. ARE YOU A PHYSICIAN (M.D. OR D.O.)?

E. O,y= ❑ No (Pleasestop,this isthelastquestion which appliesto you.

Thank You for your cooperation. Please return the questionnaire

/ ‘2

in the enclosed postage paid envelope either to the interviewer or to:

/

Applied Management .%iemxs

962 Wayne Avenue, Suite 701

Silver Spring, Maryland 2091 0)

b. DO YOU ATTEND YOUR OWN PRIVATE PATIENTS IN THIS HOME?

CAR03 15-1 ❑ Yes *b.1 HOW MANY OF YOUR OWN PRIVATE PATIENTS DO YOU ATTENO IN THIS FACILITY?_

ccl 4.3

9

CC16

-2 No

c. ARE YOU NOW ATTENOING PATIENTS TEMPORARILY IN THIS

FACILITY TO COVER FOR THE PATl ENT’S OWN PHYSICIAN? 19-1 ❑ Yes -2 ❑ No

d. DO YOU TAKE EMERGENCY CALLS FOR ANY PATIENT IN THIs HOME? 20-1 H Yes -2 ❑ No

e. DO YOU PROVIOE OTHER DIRECT PATIENT sERVICE IN 6EHALF OF

THE HOME’S RESPONSIBILITY FOR SECURING SUCH COVERAGES

(e.g., AOMISSION EXAMS, PRONOUNCING OEATHS, SECURING

MEDICATION ANO OIET ORDERS, ETC.)? 21-1 u Yes -2 D No

f. 00 YOU PROVIDE INSERVICE TRAINING TO THE HOME’S PERSONNEL? 22-1 D Yes -2 ❑ No

9. FOR HOW MANY RESIDENTS IN THIS HOME 00 YOU PROVIDE MEDICAL CARE?

residents

CC23

Thank you for your cooperation. Please return the questionnaire in the enclosed postage paid envelope

either to the interviewer or to:

Applied Management Sciences, Inc.

962 Wayne Avenue, Suite 701

Silver Spring, Maryland 20910

Form 73NHs.4

59
STAFF QUESTIONNAIRE -- PART II

1973 Nursing Home Suwey

National Center for Health Statistics

Haelth Resources Administration

Rockville, Maryland

=

ccl -5 Cell-l

A. ESTABLISHMENT NO. B. LINE NO. c. occuASSURANCE OF CONFIDENTIALITY - All information

PATION

which wou Id permit identification of the individual wil I be

CODE

held in strict confidence, will be used only by parsons engaged ==2

CC12 CC15

in and for the purposes of the survey, and will not be disclosed or released to others for any purposes.

The National Center for Health Statistics of the Health Your answers will be given confidential treatment.

Resources Administration is conducting a nationwide The information will be used for statistical purposes

survey in nursing homes. One of the purposes of the survey only, and will be presentad in sucha mannerthat

isto obtain certain information about the staff employed in these

facilities. We would appreciate your taking the brief amount of

no individual person or establishment can be identified.

time necessary to mmplete this questionnaire. After completing the form please return it in the

envelope provided.

Thank You for your cooperation.

THE FOLLOWING STATEMENTS ARE ABOUT NURSING HOMES AND/OR HOMES FOR THE AGED. FOR EACH OF THE

STATEMENTS PRESENTED, MAR K (X) THE RESPONSE CATEGORY WHICH MOST NEARLY REPRESENTS YOUR FEELING.

MARK A BOX FOR EACH STATEMENT.

1. DEATHS IN HOMES FOR THE AGED OR NURSING HOMES SHOULD BE MADE AS INCONSPICUOUS AS POSSIBLE

AND ANY CONVERSATION ABOUT THEM AMONG RESIDENTS SHOULD BE DISCOURAGED.

A B c D E

18-1 ❑ -2 ❑ -3 ❑ -4 ❑ -5 ❑

Strowly agree Agree Don’t know Disagree Strongly disagree

2. RESIDENTS OF HOMES FOR THE AGED SHOULD BE ENCOURAGED TO ENGAGE IN VOLUNTARY ACTIVITIES,

E.G., RECEPTIONIST FOR THE HOME, FEEDING AND READING TO OTHER RESIDENTS.

A 8 c

19-1 ❑ -2 ❑ -3

•1 (1 ‘h

Strongly e9ree Agrae Don’t know Disegree Strongly disagree

3. THE FORMATION OF CLIQUES OR SMALL SOCIAL GROUPS SHOULD BE DISCOURAGED IN ANY RESIDENTIAL

SITUATION.

A B c D E

20-1 ❑ -2

•1

-3 ❑ -4 ❑ -5 ❑

Strordy agree Agree Don’t know Disagree Strongly disagree

4. SYMPTOMS OF SENILITY ARE ESSENTIALLY PHYSIOLOGICAL AND IT IS LARGELY A WASTE OF VALUABLE STAFF

TIME TO ATTEMPT TO ALLEVIATE THEM WITH “SOCIAL THERAPY”.

45

Strongly agree

-Zh

Agree

-Sil

Don’t know

“h

Disagree Strongly

-’h

disagree

5, “VACATIONS’ FOR RESIDENTS SHOULD BE DISCOURAGED SINCE THEY CAUSE SUCH PROBLEMS IN ADJUSTMENT

WHEN THE RESIDENTS RETURN TO INSTITUTIONAL LIVING.

A B c D E

22-1 ❑ -2 ❑ -3 ❑ 4 ❑ .5

•1

Strongly egree Agree Don’t know Diragrea Strongly di~gree

6. RESIDENTS SHOULD AT ALL TIMES BE SUSCEPTIBLE TO OBSERVATION BY THE STAFF.

A

23-1 ❑ -6 -Sh ‘b ‘h

Strongly agree Agree Don’t know Disagree Strongly disagree

Form 73 NHS-6

60

-N,

.
7. RESIDENTS SHOULD BE DISCOURAGED FROM SHOWING AN INTEREST IN THE OPPOSITE SEX, FOR SUCH BEHAVIOR

IS INAPPROPRIATE AT TH IS AGE.

2’-1 h -’b -’0 “b -5 b

Strong Iy agree Agree Don’t know Disagree Strongly disagree

8. IT ISA RESPONSIBILITY OF STAFF TO ENCOURAGE RESIDENTS OF HOMES FOR THE AGED TO PARTICIPATE IN

COMMUNITY ACTIVITIES WHEREVER POSSIBLE, E.G., HOBBY FAIRS, VOTING, ETC.

A B

27-1 ❑ -2 ❑ -’0 “b “b

Strongly agree Agree Don’t know Disagree Strongly dismree

9. OLD PEOPLE LIKE AND NEED SIMPLE, EASILY DIGESTED FOODS AND ARE NOT MUCH INTERESTED IN “FRILLS’.

A

28-1 ❑ -Sb -’0 ‘b “h

Strongly agree Agree Don’t know Disagree Strongly disagree

10. SOMETIMES RESIDENTS OF NURSING HOMES OR HOMES FOR THE AGED SHOULD BE CHALLENGED TO DO JUST

A LITTLE MORE THAN THEY HAVE BEEN DOING, EVEN AT SOME SMALL RISK, E.G., WALKING OUT-OF-DOORS.

A B c D E

29-1 ❑ -2 ❑ -3 ❑ -4 ❑ -5 ❑

Strongly agree Agree Don’t know Disagree Strongly disagree

11. RULES FOR VISITING HOURS ARE NECESSARY SO THAT THE ROUTINE OF CARE WILL NOT BE INTERRUPTED.

A B c D E

30-1 ❑ -m- a-m-m

Strongly agree Agree Don’t know Disagree Strongly disagree

12. ONE OF THE MAJOR DIFFICULTIES THE STAFF RUNS INTO IN WORKING WITH AGROUPOFOLD PEOPLE LSTHEIR

INSISTENCE THAT PERSONNEL STOP AND LISTEN TO THEIR PROBLEMS OF EVERYDAY LIVING.

31-1 h -2 b -’0 “ill “5 h

Strong Iy agree Agree Don’t know Disagree Strongly disagree

13, WE CAN MAKE SOME IMPROVEMENT, BUT BY AND LARGE THE CONDITIONS OF NURSING HOMES ARE ABOUT AS

GOOD AS THEY CAN BE, CONSIDERING THE CONDITION OF THE RESIDENTS.

A

32-1 ❑ -’b -36 “b “h

Strongly agree Agree Don’t know Disagree Strongly disagree

14. IT IS NECESSARY TO DISCOVER THE REASON FOR, NOT JUST TO CONTROL, DISRUPTIVE BEHAVIOR.

33-1 ii -’ii -’il”ii”fl

Strongly agree Agree Don’t know Diasgree Strongly diasgree

15. AN EFFECTIVE WAY OF HANDLING PROBLEMS WHICH ARISE IN THE HOME IN THE COURSE OF DAILY LIVING

WOULD BE TO HAVE REGULAR MEETINGS WHERE THE RESIDENTS AIR THEIR GRIPES.

A B c D E

34-1 ❑ -2

•1

-3 ❑ -4

•1

-5 ❑

Strongly agree Agrae Don’t know Disagree Strongly disagree

Form 73N HS-5

61
16. RESIDENTS IN HOMES NEED TO BE ENCOURAGED TO MAKE THEIR OWN DECISIONS FOR DAILY LIVING, RATHER

THAN BEING CONTROLLED BY ROUTINE.

A B c D E

37-1 ❑ -2

•1

-3 ❑ -4 ❑ -5 ❑

Strongly agree Agree Don’t know Disagree Strongly disagree

17. THE QUIET RESIDENT IS DEMONSTRATING A GOOD ADJUSTMENT TO THE HOME AND DOES NOT NEED AS MUCH

ATTENTION AS THE DEMANDING ONE.

A B

36-1

•1

-2 ❑ -’h “b “Ll

Strongly agree Agree Don’t know Disagree Strongly dissgree

18. AS SOON ASA PERSON SHOWS SIGNS OF SENILITY HE SHOULD BE PLACED IN A HOME.

A B c D E

39-1 ❑ -2 ❑ -3 ❑ 4 ❑ -5 ❑

Strongly agree Agree Don’t know Diaegree Strongly disagree

19. WE SHOULD BE SYMPATHETIC WITH OLD PEOPLE, BUT WE CANNOT EXPECT TO UNDERSTAND THEIR ODD

BEHAVIOR.

‘-1 h -il “b dii “b

Strongly agree Agree Don’t know Disagree Strongly disagree

20. OLD PEOPLE ARE FREQUENTLY KEPT IN NURSING HOMES ALTHOUGH THEY COULD GET ALONG WELL ENOUGH

IN THE COMMUNITY.

A B c D E

41-1 ❑ -2 ❑ -3 ❑ 4 ❑ -5 ❑

Strongly agree Agree Don’t know Dissgrae Strongly disagraa

Thank you for your cooperation. Please return the form in the enclosed postage paid envelopetcx

Applied Management Sciences

962 Wayne Avenue, Suite 701

Silver Spring, Maryland 20910

Form 73N HSJ5

62
STAFF CLASSIFICATION CARD

1973 Nursing Home Survey

Natlonel Center for Health Statistics

I

Health Resources Administration

Rockville, Maryland

OMB # 068-s-72172

Expires 7-31-74

WHICH OF THE FOLLOWING JOB CATEGORIES BEST FITS THE JOB WHICH THIS EMPLOYEE DOES IN THIS FACILITY?

01, ADMINISTRATOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

\

02, PHYSICIAN (M.D, OR D.O.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

03. DENTIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

04. PHARMACIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

“ 05. REGISTERED OCCUPATIONALTHERAPIST . . . . . . . . . . . . . . . . . . . .

06, REGISTERED PHYSICALTHERAPIST . . . . . . . . . . . . . . . . . . . . ..s...

07. ACTIVITIES DIRECTOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

08. DIETITIAN OR NUTRITIONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GROUP A

09. REGISTERED MEDICAL RECORDADMINISTRATOR . . . . . . . . . . . . . .

Enter in Column i

of Staff Control Record

10. SOCIALWORKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11. SPEECHPATHOLOGISTAND/OR AUDIOLOGIST . . . . . . . . . . . . . . . . . .

12. OTHER PROFESSIONAL OCCUPATIONS (INCLUDES INTERN,

RESIDENT,THERAPEUTIC RECREATOR) . . . . . . . . . . . . . . . . . . . . . .

13. OCCUPATIONTHERAPISTASSISTANT . . . . . . . . . . . . . . . . . . . . . . . . .

14. PHYSICALTHERAPISTASSISTANT . . . . . . . . . . . . . . . . . . . . . . . . . .

15. SOCIALWORKERTECHNICIAN/ASSISTANT . . . . . . . . . . . . . . . . . . . .

16, OTHER MEDICAL RECORD ADMINISTRATORS ANDTECHNICIANS . . . .

}

17.

1

GROUP B

REGISTEREDNURSE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . EnterinColumnj

of Staff Control Record

18.

I

GROUP C

LICENSED PRACTICALNURSEOR LICENSED VOCATIONAL NURSE. . . Enterin Columnk

of Staff Control Record

1

GROUP D

19. NURSE’SAIDE ANDORDERLY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Enter in Column I

of Staff Control Record

20. CLERICAL, BOOKKEEPING, OROTHER OFFiCESTAFF . . . . . . . . . . . .

21, FOODSERVICEPERSONNEL (COOK, KITCHEN HELP,ETC.) . . . . . . . .

I

GROUP E

22. HOUSEKEEPING ANDMAINTENANCE PERSONNEL(MAID,

LAUNDRYMAN, MAINTENANCE MAN, ETC.) . . . . . . . . . . . . . . . . . . . .

Enter in Column m

of Staff Control Record

23. JOBOTHERTHAN THOSE LISTED ABOVE (PLEASE SPECIFY JOB

TITLEONTHE INDIVIDUALLINEOF STAFFCONTROL RECORD) . . . .

63
STAFF CONTROL RECORD sk.t_.af_

1973 Nu”lns HonmSw+eY M

National Comer<WHealth Stititici

Health Rma.rm Adrninkwation

Rmkvllle, Marflmd

A33URANCE OF CONFIDENTIALITY .ANtnformaticow+ JchwwkJmrmlt Idsntifkmicm

cd .3 cd

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,f’
APPENDIX IV

CRITERIA FOR CLASSIFYING NURSING HOMES ACCORDING

TO LEVEL OF NURSING CARE

Types of Facilities Included

in the Survey

Institutions included in the 1973-74 Nursing Home

Survey were those classified as eithe~ nursing care

homes or personal care homes with nursing according

to data collected in the 1971 Master Facility Inventory

Survey 8 conducted by the National Center for Health

Statistics.

Definitions for these two classes of nursing homes

were as follows:

Nursing Care Home

● Fifty percent or more of the residetns received

nursing care during the week prior to the survey.

(Nursing care is defined as the provision of one

or more of the following services: taking temperature-pulse-respiration or blood pressure, full

bed bath; application of dressings or bandages;

catheterizatio~, intravenous, intramuscular, or

hypodermic injection; nasal feeding irrigation;

bowel and bladder retraining oxygen therapy; and

enema.)

● At least one full-time (35 or more hours per week)

registered nurse (RN) or licensed practical nurse

(LPN) was employed.

Pe-rsonal Cave Home with Nursing

● Some, but less than 50 percent of the residents

received nursing care during the week prior to

the survey.

. At least one full-time RN or LPN was employed.

or

● Some of the residents received nursing care during

the week prior to the survey.

● No full-time RN or LPN was employed.

● The institution either:

Provided administration of medicines or supervision over self-administered medicines,

or

Provided assistance with three or more activities for daily living (such as help with tub bath

or showeq help with dressing, correspondence,

or shoppin~, help with walking or getting about;

and help with eating),

000

* U.S. GOVERNMENT PRINTING OFF!CE 1976— 210.981:42

All

“f
VITAL AND HEALTH STATISTICS PUBLICATIONS SERIES

Formerly fiblic Health Service fiblication No. 1000

Series 1. Programs and Collection I+ocedures. –Reports which describe the general programs of the National

Center for Health Statistics and its offices and divisions, data collection methods used, definitions, and

other material necessary for understanding the data.

Sm”es 2. Data Evaluation and Methods Research. –Studies of new statistical methodology including experimental

tests of new survey methods, studies of vital statistics collection methods, new analytical techniques,

objective evaluations of reliability of collected data, contributions to statistical theory.

SerLx 3. Analytical Studies. –Reports presenting analytical or interpretive studies based on vital and health

statistics, carrying the analysis further than the expository types of reports in the other series.

Series 4. Documents and Committee Reports. –Final reports of major committees concerned with vital and

health statistics, and documents such as recommended model vital registration laws and revised birth

and death certificates.

Series 10. Data j%om the Health Interview Survey. –Statistics on illness; accidentrd injuries; disability; use of

hospital, medical, dental, and other services; and other health-related topics, based on data collected in

a continuing national household interview survey.

Series 11. Data from the Health Examination Survey. –Data from direct examination, testing, and measurement

of national samples of the civilian, noninstitutionalized population provide the basis for two types of

reports: (1) estimates of the medically defined prevalence of specific diseases in the United States and

the distributions of the population with respect to physical, physiological, and psychological characteristics; and (2) analysis of relationships among the various measurements without reference to an

explicit finite universe of persons.

Series 12. Data from the Institutionalized Population Surveys. –Discontinued effective 1975. Future reports from

these surveys will be in Series 13.

Series 13. Data on Health Resources Utilization. –Statistics on the utilization of health manpower and facilities

providing long-term care, ambulatory care, hospitrd care, and family planning services.

Series Id. Data on Health Resources: Manpow-er and Facilities. –Statistics on the numbers, geographic distribution, and characteristics of health resources including physicians, dentists, nurses, other health occupations, hospitals, nursing homes, and outpatient facilities.

Series 20. Data on Mortality. –Various statistics on mortality other than as included in regular annual or monthly

reports. Special analyses by cause of death, age, and other demographic variables; geographic and time

series analyses; and statistics on characteristics of deaths not available from the vital records, based on

sample surveys of those records.

Series 21. Data on Natality, Marriage, and Divorce. –Various statistics on natality, marriage, and divorce other

than as included in regular annual or monthly reports. Special analyses by demographic variables;

geographic and time series analyses; studies of fertility; and statistics on characteristics of births not

available from the vital records, based on sample surveys of those records.

Series 22. Data from the National Mortality and Natality Surveys. –Discontinued effective 1975. Future reports

from these sample surveys based on vital records will be included in Series 20 and 21, respectively.

Sert’cs23. Data from the National Survey of Family Growth. –Statistics on fertility, family formation and dissolution, family planning, and related maternal and infant health topics derived from a biemial survey of

a nationwide probability sample of ever-married women 1544 years of age.

For a list of titles of reports published in these series, write to: Scientific and Technical Information Branch

National Center for Health Statistics

Public Health Service, HRA

Rockville, Md. 20852