Data from the

NATIONAL HEALTH SURVEY

Chargesfor Care

and Sources of Payment

for Residentsin NursingHomes

United States: National Nursing Home Survey

August 1973-April 1974

Data are presented on charges for care and sources of payment for

nursing home residents in relation to certification, service, ownership, size, geographic region of the nursing home and age, sex,

primary reason for admission, length of stay since current

admission, primary source of payment, and heakh ‘status of the

resident. Health status was measured by primary diagnosis at last

examination, reported chronic conditions and impairments, number

of chronic conditions, and level of patient care received. Data on

charges and sources of payment for 1973-74 are compared with

those for 1964 and 1969 to examine changes during the 10-year

period.

DHEW Publication No. (PHS) 78-1783

Series 13

Number 32

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

Public Health Service

National Center for Health Statistics

Hyattsville, Md. November 1977
Lkmary of Congress Ca~aloging in Publication Data

Hkg, Esther.

United States. National Center for Health Statistics.

Charges for care and sources of payment for residents in nursing homes, United States.

(Data from the National Health Survey: Series 13; no. 32) (DHEW publicuticm; no.

(PHS) 78-1783)

Bibliography: pp. 26-27

Supt. of Dots. no.: HE 20.6209:13/32

1. Nursing homes-United States–Rates—Statistics. I. Title. II. Series: United Stxtes.

National Center for Health Statistics. Vital and health statistics: Series 13, Data from tl~c

National Health Survey, Data on health resources utilization; no. 32. III, Series: l-l!~jtc(l

States. Dept. of Health, Education, and Welfare. DHEW publication; no. (PHS) 78-1783.

RA407.3.A349 no. 32 [M997] [338.4’3] 36~.~’~’0973&

ISBN 0-8406 -0112-3 77-14578

For sale by the Superintendent of Documents, U.S. Government J3intfnS Offke

Washington, D. C. 3M)2

Stock No. 017-0WOR03-1
NATIONAL CENTER FOR HEALTH STATISTICS

DOROTHY P. RICE, Director

ROBERT A. ISRAEL, Deputy Director

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

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

ELIJAH L. WHITE, Associate Director for Data Systems

JAMES T. BAIRD, JR., Ph.D., Associate Directtv for International Statktics

ROBERT C. HUBER, Associate Director for Management

MONROE G. SIRKEN, Ph.D., Associate Director for Mathematical Statistics

PETER L. HURLEY, Associate Director for Operations

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

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

ALICE HAYWOOD, Information Officer

DIVISION OF HEALTH RESOURCES UTILIZATION STATISTICS

SIEGFRIED A. HOERMANN, Director

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

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

STEWART C. RICE, Acting Chief Family Planning Statistics Branch

JAMES E. DeLOZIER, Chiej Ambulatory Care Statistics Branch

MANOOCHEHR K. NOZARY, Chief Technical Services Branch

Vital and Health Statistics-Series 13-No, 32

DHEW Publication No. (PHS) 78-1783

Library of Congress Catalog Card Number 77-14578
CONTENTS

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

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

Background Information ....................................................................................................................

Sources and Qualifications of Data ....................................................................................................

Charges for C&e ......................................................................................................................................

Ovemiew ............................................................................................................................................

Facility Characteristics ......................................................................................................................

Certification .................................................................................................................................

Type of Service Provided ..............................................................................................................

Ske ...............................................................................................................................................

Geographic Region .......................................................................................................................

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

Resident Ch.ctenstics .....................................................................................................................

Age and Sex..................................................................................................................................

Primary Reason for Admission .....................................................................................................

Length of Stay Since Current Admission ......................................................................................

Primary Diagnosis at Last Examination and Reported Chronic Conditions ...................................

Level of Care Received .................................................................................................................

Sources of Payment .................................................................................................................................

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

Facility Characteristics ..................................................................... .................... ........................

Resident Chmcteristics ................................................................................................................

Total Sources of Payment ...................................................................... ...................... ......................

Charges in 1964, 1969, and 1973-74 .......................................................................................................

Charges for Cme.................................................................................................................................

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

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

fist of Detailed Tables ............................................................................................................................

Appendixes

I. Technical Notes on Methods ......................................................................................................

II. Definition of Certain Terms Used in This Repon .......................................................................

III. Resident Questionnaire Used in the 1973-74 Natiomd Nursing Home Survey ............................

1

1

:

2

:

3

4

4

5

6

6

8

8

:

10

11

11

11

12

14

17

18

18

22

25

26

28

48

58

61

LIST OF FIGURES

1. Average total monthly charge for care, by certification and ownership: United States, August

1973-April 1974 ........................................................................................................................... 6

2. Average total monthly charge for care, by certification and size: United States, August 1973-April

1974 ............................................................................................................................................. 7

...

Ill
%

4.

5.

6.

A.

B.

c.

D.

E.

F.

G.

H.

J.

K

L.

M.

N.

o.

Average totaf montfdy charge for care, by certification and geographic region: United States,

August 1973-April 1974 ...............................................................................................................

Cumulative percent distribution of nursing home residents, by total monthly charge for care:

United States, 1964, 1969, and 1973-74 ......................................................................................

Average total monthly charge for care and average totaJ monthly charge in constant (1964)

dollars: United States, 1964, 1969, and 1973-74 ..........................................................................

Percent distribution of residents by primary source of payment: United States, 1964, 1969, and

1973.74 ........................................................................................................................................

LIST OF TEXT TABLES

Average total monthly charge for cae and percent d@ibution of residents, by certification, type

of service provided, ownership, size, and geographic region of the home: United States, August

1973-April 1974 ...........................................................................................................................

Average total monthly charge for care and percent distribution of residents by certification,

according to ownership, size, and geographic region of the home: United States, August

1973-April 1974 ...........................................................................................................................

Average totaf monthly charge for care and percent distribution of residents by age, according to

sex: United States, August 1973-April 1974 .................................................................................

Average totaf monthly charge for care and percent distribution of residents by level of care

received, according to age: United States, August 1973 -Aprif 1974 ..............................................

Average totaf monthly charge for care and percent distribution of residents, by primary reason for

admission and length of stay since current admission: United States, August 1973-April 1974 ........

Average total monthly charge for care and percent distribution of residents, by primary diagnosis

at last examination: United States, August 1973-April 1974 ..........................................................

Average totaf monthly charge for care and percent distribution of residents, by primary source of

payment: United States, August 1973-April 1974 ........................................................................

Average total monthly charge for care and percent distribution of residents by primary source of

payment, according to certification, type of service provided, ownership, size, and geographic

region of the home: United States, August 1973-Apnl 1974 ........................................................

Average total monthly charge for care and percent distribution of residents by age, sex, primary

reason for admission, and length of stay since current admission, accordkg to primary source of

payment: United States, August 1973 -ApIif 1974 ........................................................................

Average total monthly charge for care and percent distribution of residents by level of care

received, accordhg to primary source of paymenti United States, August 1973-April 1974 ........

Percent distribution of residents with two payment sources, by primary and secondary sources of

payment: United States, August 1973 -April 1974 ........................................................................

Average total monthly charge for care and percent distribution of residents, by selected facifity

and resident characteristics: United States, 1964, 1969, and 1973-74 ..........................................

Average total monthly charge for care, number of residents, medical care price index, and average

totaf monthly charge in constant (1964) dollars: United States, 1964, 1969, and 1973 -74 ..............

Average totaf monthly charge for care in constant (1964) dolkrs and percent change, by selected

facilitv and resident characteristics: United States, 1964, 1969, and 1973-74 ..............................

7

20

22

22

4

5

8

9

9

10

12

13

15

16

17

19

20

21
P. Average total monthly charge for care and number and percent distribution of residents, by primary

source of payment: United States, 1964, 1969, and 1973-74 ....................................................... 23

Q. Average total monthly charge for care in constant (1964) dollaxs and percent change, by primary

source of payment: United States, 1964, 1969, and 1973.74 ....................................................... 24

R. Percent of residents receiving intensive or other nursing care, by primary source of payment:

United States, 1964,1969, and 1973-74 ..................................................................................... 24
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

reliability or precision--— ---------------- *

.,,4
CHARGES FOR CARE AND SOURCES OF PAYMENT

FOR RESIDENTS IN NURSING HOMES

Esther Hing, Division of Health Resources Utilization Statistics

INTRODUCTION

SCOPE OF REPORT

This report presents an analysis of average

total monthly charges and sources of payment

for residents in nursing homes in the United

States from August 1973 to April 1974. Included in the average total monthly charge were

all charges for lodging, meals, nursing care,

spec”ial services, drugs, and special medical supplies. Charges “ were analyzed in relation to

certain characteristics of the nursing home (certification, service, ownership, size, and geographic region) and certain characteristics of the

resident (age, sex, length of stay since current

admission, primary reason for admission, primary source of payment, and health status).

Health status was measured by primary diagnosis

at last examination, prevalence of selected

chronic conditions, number of chronic conditions, and level of care received.

Special emphasis was placed on the analysis

of average total monthly charge by primary

source of payment to assess the impact that the

Medicare and Medicaid programs had on charges

for residents and patterns of utilization of

nursing homes in 1973-74. In addition, 1973-74

data were compared with similar data from 1964

and 1969 surveys to examine trends that have

occurred during the 10-year period.

BACKGROUND INFORMATION

Data presented in this report are based on

the 1973-74 National Nursing Home Survey

conducted by the Division of Health Resources

Utilization Statistics. The survey was conducted

from August 1973 to April 1974 in the conterminous United States in a sample of homes that

provided some level of nursing care (i.e., nursing

care homes and personal care homes with

nursing). Homes that provided personaI or custodial care at the time the sample was drawn are

not included, even if they subsequently began to

provide nursing care to residents. Within each

sampled home, subsamples of both residents and

employees were selected to obtain detailed

information about the population served and

persons involved in direct care.

Reports based on data collected in the

1973-74 National Nursing Home Survey have

been published about the operating and financial

characteristics of the home,l social and demographic characteristics of the residents,z utilization of nursing homes,s the health status of

residents,~ and general characteristics of the

homes

Data on charges for care were collected for

each sampled resident by asking the question,

“Last month, what was the total charge for this

resident’s care, including all charges for special

services, drugs, and special medical supplies?”

(See question 25c of the Resident Questionnaire

in appendix III. ) Although most of the Resident

Questionnaire was completed by interviewing

the nurse who usually provided care for the

resident, the charges for care usually were

supplied by a bookkeeper or similar staff member who referred to billing records for the exact

amount. Since the question asked for charges for

1
last month, charge data were not collected for ~

63,900 residents living in the home for less than

a full month. In this report, charges are reported

by the total figure for the resident’s care last

month (question 25C of the Resident Questionnaire) rather than by the basic charge last month

(question 25b of the Resident Questionnaire)

because, on the average, the basic charge for

lodging, meals, and nursing care ($468) did not

differ in a statistically significant amount from

the total charge for care ($479). (Total charge

included the basic charge plus any special

charges for medical or nursing services, medical

supplies or equipment, miscellaneous services or

personal items.)

In calculating the average total monthly

charge, the 9,600 residents with no-charge

arrangements (e.g., residents of homes supported

by religious or fraternal organizations who were

not charged for care) and the 6,200 residents

who had made an initial payment for lifetime

care were included so that the figure for the

total average monthly charge represented

charges for aI1 nursing home residents. Even

though these residents usually did not pay a

basic monthly fee for care, in some cases they

were charged small amounts for miscellaneous or

personal services such as laundry, television

rental, beautician or barber visits, and personal

items.

To examine trends over a 10-year period,

average monthly charges for residents in the

1973-74 survey were compared with average

monthly charges for residents in similar surveys

conducted earlier by the National Center for

Health Statistics in 19646 and 19697. To permit

a valid comparison of 1964, 1969, and 1973-74

data, average monthly charges were adjusted to

exclude charges for the 35,300 residents in the

1964 survey and for the 35,600 residents in the

1969 survey who resided for at least 1 month

in personal care homes. This adjustment was

necessary because the 1973-74 survey excluded

this type of facility. Average monthly charges

for both 1964 and 1969 also included total

charges for residents with life-care plans and

residents with no-charge plans, just as in the

1973-74 survey data.

SOURCES AND QUALIFICATIONS

OF DATA

A detailed description of the sampling

frame, the sampling design, and the survey

procedures used is presented in appendix L

Appendix I also includes imputation procedures

and estimation techniques. Since the data in this

report are nationzd estimates based on a sample

and are subject to sampling errors, tables and

;harts of standard errors and illustrations of

their use are provided in appendix I.

Appendix II presents definitions of terms

used in this report. Reference to the definitions

in appendix II is essential to the interpretation

of data in this report, particularly for definitions

of certification, type of services provided, and

level of care received by the resident. Appendix

III presents the Resident Questionnaire used in

the survey.

CHARGES FOR CARE

OVERVIEW

In 1973-74, there were 15,700 nursing

homes in the United States providing some level

of nursing care to 1,075,800 residents. Of the

1,012,000 residents who had been in a nursing

home at least 1 month, 71 percent were female

and 89 percent were 65 years of age or older.

The median age was 81 years. Senility was the

most frequently reported chronic condition (58

percent of these residents), and arthritis or

rheumatism was reported as a chronic condition

for 35 percent of the residents. The average

number of chronic conditions per resident was

2.2. For 42 percent of these residents, the

primary diagnosis at last examination involved

diseases of the circulatory system.

The total monthly charge for residents in a

facility at least 1 month ranged from $0 to over

$800. These extreme charges were the exception, however, since only 1 percent of the

residents paid nothing and 7 percent paid $800

2
or more. The average total monthly charge for

residents was $479 per month, with about

two-thirds of the residents Davinz less than $500

(table 1). In 1973-74, 6~ perc;nt of the “’residents used public funds in some form for

I

primary payment–48 percent of the residents

used Medicaid as the primary source of pay1 ment.

FACILITY CHARACTERISTICS

Certification

In 1966, the Medicare and Medicaid programs began to provide coverage for the elderly

in nursing care institutions. In 1973-74, nearly 8

of every 10 (77 percent) facilities providing

some level of nursing care in the United States

were participating in either the Medic’me or

Medicaid program or in both. I Participating

Medicare facilities, designated as extended care

facilities (ECF’S), provided inpatient skilIed

nursing care and related services to Medicare

cnrollees eligible for posthospital benefits. To be

certified by the Medicare program, a facility had

to meet specific regulatory standards as required

by the Medicare legislation (Title XVIII of the

Social Security Act) in effect at the time of the

survey. The Medicaid program offered coverage

for both skilled and intermediate nursing care

services to the medically indigent. Nursing

homes participating in the Medicaid program

were certified as either skilled nursing homes

(SNH’S) or as intermediate care facilities (ICF’S)

or as both according to the requirements of the

Medicaid legislation (Title XIX of the Social

Security Act). In July 1973, the extended care

facility designation under Medicare and the

skilled nursing home designation under Medicaid

were replaced by the term “skilled nursing

facility. ” Both types of facilities were required

to meet the same standards. In this report, the

extended care facility and skilled nursing home

designations are used since most of the survey

was conducted prior to the legislation that

created the skilled nursing facility.

Nearly 87 percent of all residents were in

facilities certified by Medicare, Medicaid, or

both (77 percent of all facilities). Proportionately more residents were in certified facilities because Medicare extended care facilities

and Medicaid skilled nursing homes tended to be

larger, on the average, than facilities with lower

levels of certification. 1 Thirty-seven percent of

the residents were in facilities certified to

participate in both the Medicare and Medicaid

programs and 50 percent were in facilities

certified by Medicaid only (either as SNH’S,

ICF’S, or as both).

In the remainder of this report, some small

certification subgroups were combined with

larger ones when both provided similar levels of

care in order to provide detailed data by

certification status. Thus, in table 1, the 372,300

residents of homes classified as certified by both

Medicare and Medicaid include 20,900 residents

who were in homes certified by Medicare only.

Similarly, the 278,100 residents in homes classified as Medicaid skilled nursing homes included

122,900 residents who were in homes also

certified as intermediate care facilities.

The average total monthly charges according

to the four certification levels are presented in

table A. Examination of these charges showed

that as the level of certification increased (from

not certified facilities, to ICF’S, to SNF’S, to

facilities certified by both Medicare and Medicaid), the average total monthly charge increased. Residents in facilities not certified by

either Medicare or Medicaid paid significantly

lower charges per month ($329) than did those

in ICF’S ($376) and those in SNH’S ($484).

Residents in facilities certified by both Medicare

and Medicaid paid the highest charge ($592) on

the average. The increase in average charge by

these certification levels was directly related to

the care received or available in the home as

required for Medicare and/or Medicaid certification. Based on data from the same survey, a

previously published report on the utilization of

nursing homes showed that as the certification

level of the homes increased more staff was

available to provide services.3 Facilities certified

by both Medicare and Medicaid and those

certified by Medicaid as SNH’S had more

full-time equivalent staff per 100 residents than

those certified as ICF’S or those not certified

had. In addition, a smaller proportion of not

certified homes (64 percent) had the services of

some member of the staff available round the

3
Table A. Average total monthly charge for care and percent

distribution of residents, by certification, type of service

orovided. ownershitJ. size, and aerrara~hic region of the

home: United States; August 197~-A~ril 1974 -

Certification, type of sarvice provided,

ownership, size, and geographic region

All homes.., ................................

Certification

Both Medicare and Medicaid3 ......................

SNH only4 ...................................................

ICF only ......................................................

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

Type of service provided

Nursing care .................................................

Personal care with nursing ............................

Ownership

Proprieta~ ...................................................

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

—Size

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

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

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

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

Geographic region

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

North Central ...............................................

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

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

~verage

total

nonthly

:hargel

$479

592

484

376

329

495

448

489

456

397

448

502

576

651

433

410

454

Percent

listri-

,ution

f resi-

~ents

100.0

~

36.8

27.5

22.4

13.3

64.8

35.2

69.8

30.2

15.2

34.1

35.6

15.1

22.0

34.6

26.0

17.4

lIncludes life-care residents and no-charge residents.

21ncludes only those residents who have lived in the nursing

homes for at least a month.

31ncludes 20,900 residents in facilities certified by kfedicare only.

41ncludes 122,9r)rJ residents in facilities certified by Medicaid as both SNH’S and ICF’S.

clock than homes certified by both Medicare

and Medicaid (96 percent), SNH’S (93 percent),

or ICF’s (88 percent) had. Furthermore, facilities with higher certification levels had a clientele that required more intensive nursing services

(as opposed to personal services); a larger proportion of the residents in facilities certified by

both Medicare and Medicaid were transferred to

the home from a general or short-stay hospital

(50 percent) than were residents in SNH’S (33

percent), ICF’S (22 percent), and homes not

certified (17 percent).s

It should be noted that the lower average

charge in not certified facilities was also related

to the disproportionate number of residents in

these facilities with either initial-payment/Iifecare plans or with no-charge arrangements. Of

these residents who paid little or nothing, 63

percent resided in facilities that were not certified (table 1).

Type of Service Provided

Institutions included in the 1973-74 National Nursing Home Survey were those classified as either nursing care homes or personal

care homes with nursing. The criteria used for

these classifications constitute another indicator

of the level of service provided. Basically, a

nursing care home was defined as a home in

which 50 percent or more of the residents

received nursing care during the week prior to

the survey and in which at least one full-time

registered nurse or licensed practical nurse was

employed. A personal care home with nursing,

on the other hand, was a facility in which less

than 50 percent of the residents received nursing

care (see appendix II for detailed definitions of

nursing care and types of service provided).

Thus, residents in nursing care homes were more

likely to require intensive nursing care services

than residents of personal care homes with

nursing were. The intensity of services provided

to residents of nursing care homes was reflected

in the higher average total monthly charge that

they paid ($495), compared with the amount

that residents in homes providing personal care

with nursing paid ($448) (table A). This finding

is consistent with those of previous surveys

conducted in 1964 and 1969.6 ~TTable 2 gives

additional information on the distribution of

charges by type of service provided.

Ownership

In 1973-74, most residents of nursing homes

resided in proprietary facilities rather than in

nonprofit or government facilities. About 70

percent of the residents lived in proprietary

facilities, in contrast with 30 percent who lived

in nonprofit or government facilities (table A).

4
Table B. Average total monthly charge for care and percent distribution of residents by certification, according to ownership, size, and

geogkph ic r

Ownership, size, and geographic region

Ownership

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

Nonprofit end government ............................

—Size

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

50.99 beds ... ..................................................

100-188 beds .................................................

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

Geographic region

Northaast ,., ,,. ,,, .,,,,.,,., ...................................

North Central ................................................

South .,...,,,,,,....,,,., ........................................

on of the home: United States, August 1973-April 1974 -

II Certification

All

types Both

Medi- Of

care SNH ICF Not

certifiand only2 only certi -

cation

Medic- fied

aidl

Avarage total monthly charge3

$489 $588

456 605

397 537

448 559

502 592

576 656

651 764

433 557

410 504

454 502

$483

4B6

482

461

473

547

617

465

422

405

$382

358

378

369

377

404

481

366

359

369

$353

299

316

322

310

430

375

334

300

265

II Certification

All

types Both

of Medicare SN H ICF Not

certifi -

and only2 only certi -

cation

Medic- fied

aidl

Percent distribution of residents4

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

40.4

28.4

11.0

32.6

47.4

47.2

45.3

25.6

27.7

61.9

25.9

31.1

18.7

26.4

29.2

34.8

33.1

24.6

28.7

24.3

23.1

20.9

41.7

26.9

15.8

8.6

10.6

29.7

32.2

8.3

10.6

19.5

28.5

14.1

7.6

9.5

11.1

20.0

11.4

5.5

lIncludes 20,900 residents in facilities certified by Medicare only.

21ncludes 122,900 ~esidentg ifl facflitie~ by Medicaid as both SNH$~ and IfJF>s -

31nc]ude~[ife.care residents and “~char~~ residents.

The average charge for residents of proprietary

facilities ($489) was higher than that for residents of nonprofit or government facilities

($456 ).’ The higher charge for residents of

proprietary facilities was influenced by level of

certification and by intensity of services available in these facilities. Table B shows that the

proportion of residents in facilities certified bv

%cludes only those residents who have-lived in the nursing home for at least a month.

Another factor that may have influenced

charges was the disproportionate representation

of residents paying low or no charges in nonprofit and government facilities. Fully 89 percent of

the residents with either life-care or no-charge

arrangements resided in nonprofit or government facilities (table 1).

‘‘ bb~k’ Medicare and Medicaid was greater fo’r

proprietary facilities (4’0 percent o~ the residents) than for nonprofit ,andgovernment facilities (28 percent). In addition, the proportion of

residents receiving intensive nursing care tended

to be greater in propri~tary facilities (43 percent) than in nonprofit and government facilities

(35 percent),

(‘ ‘~This conclusion differs from that in a previous

report on operating and financial characteristics of

nursing homes 1 because the final standard errors used in

the test of significance were more precise than the

provisional standard errors used in that report.

Size

When examined in relation to the size of the

facility, there was a direct relationship between

the average total monthly charge and the size of

the facility: the average charge increased from

$397 for residents in facilities with less than 50

beds to $448 for those in facilities with 50-99

beds and to $502 for those in facilities with

100-199 beds. Residents in facilities with 200

beds or more paid the highest average charge

($576). The direct relationship between charges

and size was probably related to the fact that

larger facilities (100 beds or more) were more

5
likely to be certified by both Medicare and

Medicaid. I Of the large facilities, those certified

for Medicare or Medicaid provided care for

nearly half (47 percent) of all nursing home

residents (table B). Thus, the higher charges in

larger homes were due, in part, to the expense of

meeting the standards for staffing, construction,

equipment, and provision of services required

for Medicare and Medicaid certification.

Geographic Region

In 1973-74, the North Central Region had

the largest proportion of nursing home residents

(35 percent), followed by the South (26 percent), Northeast (22 percent ), and West Regions

(17 percent). When charges were compared by

geographic region, residents in the Northeast

paid a higher average total monthly charge than

residents in the North Central, South, or West

Regions did. The average charge in the Northeast

was $651, compared with $454 in the West,

$433 in the North Central, and $410 in the

South (table A).

The substantially higher cost of providing

care in the Northeast was a major factor in the

higher charge for the residents in that region.

According to a previous report on the operating

and financial characteristics of nursing homes,l

the average cost per resident day incurred by the

facility in 1972 was $19.60 in the Northeast,

compared with $15.62 in the West, $15.05 in

the North Central, and $13.50 in the South. The

primary reason for this difference was the higher

cost for labor in the Northeast, which was 35

percent greater than in the next highest region.

The higher charge in the Northeast also coincides with a high proportion (45 percent) of

residents in homes certified by both Medicare

and Medicaid. Further information on the distribution of charges by region are presented in

table 3.

Summary

The preceding discussion noted that charges

were highest in the Northeast Region and in

proprietary facilities. Charges increased with the

size of the facility and with increasing levels of

certification (i.e., ”

ICF’S, to SNH’S,

from not certified facilities to

to facilities certified by both

Medicare and Medicaid). Figures 1-3 show that

the major influence on the average total

monthly charge for residents in 1973-74 was the

certification level of the facility. Average charges

increased with higher certification levels regardless of ownership (figure 1), size (figure 2), or

region classification (figure 3). Within each

certification level, in contrast, the differences in

average charge by size, ownership, and for three

of the four regions were not significant and

generally could have resulted from sampling

error. For example, in proprietary facilities, the

average charge increased from $353 in not

certified facilities to $588 in facilities certified

by both Medicare and Medicaid. Similarly, in

nonprofit or government facilities, the average

charge increased from $299 in not certified

facilities to $605 in facilities certified by both

Medicare and Medicaid (figure 1). Among residents of facilities certified by both Medicare and

Medicaid, however, the average charge paid by

those in proprietary facilities ($588) did not

differ from that paid in nonprofit or government

facilities ($605). Among residents in each of the

remaining certification groups, there also were

no significant differences in charges by ownership. This pattern was also present when charges

were examined by size. For each size class,

charges increased with higher certification levels

~ SNH only?

~ ICF only

~ Not cenifwd

s5E13

Proprietary

OWNERSHIP

1Includes 20,9Q2 res$dmtsm hdmes cm Itied by MeJcnre .nly.

21ml.des 122.9CU3rcs!dcntsm facdmesmtlfied by Medicaid m Iwh SNHS and ICV%

Figure 1. Average total monthly charge for care, by certification

and ownership: United States, August 1973-April 1974

6
1

800

g

5

~ 600

g

u!

g

~

~:

z

r-

: 400

:

~

Ill

u

<

z

>

< Zrm

o

Less than 50 beds 50.99 beds 1S0.199 beds 200 beds or more

SIZE

llnJ.dcs 2WHW res(dcnu 10 Mlllics ccrukl by.!fcibcm only.

%c[ude% 12LW0 rmldmls m radhtlcs .ertilied by Mcd,cmd mb.!h Srwk and ICF’S

Figure 2. Average total monthly charge for care, by certification and size: United States, August 1973-April 1974

800 dt

s

= 600

~

0

~

u

g

<

5

G h+)

$

0

2

;

o

b

.:

,Fj zoo

>

<

0

Northeast North Central South West

GEOGRAPHIC REGION

! Induk! 31,w!l twlmls m IJCIIIIICSkcrtlficd by M<dMc only.

‘Ind.dc$ I QWfl kwlcnls In fJLdl(Icsccrhlied hy Mcd!c.d m br,di SNN,S .nd ICFS

Figure 3. Average total monthly charge for care, by certification and geographic region: Unitad States, August 1973-April 1974

7
(figure 2), while within each certification level

the differences in charges by size were not

significant.

RESIDENT CHARACTERISTICS

Age and Sex

Residents in nursing homes were an aged

population. Eighty-nine percent of those in the

facility for at least 1 month were 65 years and

over; the median age was 81 years. Seventy-one

percent of the residents were female, and 29

percent were male.

Not only were there more females than

males, but females also tended to be older than

males. Ninety-two percent of the females were

65 years and over, compared with 83 percent of

the males (tables C and 4). Furthermore, the

median age for females, 82 years, was significantly higher than the median age for males, 78

years.

In general, residents who were under 65

years of age paid less ($434) than residents who

were 65 years and older ($484). One reason for

this lower charge for younger residents is that a

smaller proportion (35 percent) of these residents received intensive nursing care than residents 65 years and older (41 percent) did (tables

D and 5). No statistically significant difference

existed between the average total monthly

charge paid by males ($466) and that paid by

females ($484) (table C). There also were no

differences in average charge by age for each sex.

Primary Reason for Admission

The question on the primary reason for the

resident’s admission to the home had four

possible responses: (1) physical reasons (e.g.,

illness or need for treatment); (2) social reasons

(e.g., no family or lack of family interest); (3)

behavioral reasons (e.g., disruptive behavior,

mental deterioration; (4) economic reasons (e.g.,

no money and/or resources). (See question 7 of

the Resident Questionnaire in appendix 111.)The

majority of the residents (81 percent) entered

the home primarily for physical reasons. About

12 percent entered the home for behavioral

reasons, 7 percent for social reasons, and 1

percent for economic reasons (tables E and 4).

Residents entering the home for physical

reasons paid higher monthly charges ($499 ), on

the ave~age,than residents entering the home for

any other reason. A major factor in this

difference was the intensity of the care received.

A greater proportion of those admitted for

physical reasons received intensive nursing services (44 percent) than did residents admitted for

behavioral reasons (30 percent), social reasons

(18 percent), or economic reasons (24 percent).

Length of Stay Since Current Admission

The length of stay as defined in this report is

the time interval between the resident’s cuwent

Table C. Average total monthly charge for care and percent distribution of residents by age, according to sex: United States, August

1973-April 1974 i

Both sexes Mele Fdmde’

Per- Per- PerAge Average cent Average cent Avarege cent

totel distri- total distri- total distri.

monthly bution monthly bution monthly bution

chargel of resi- chargel of resi- chargel of resi.

dents dents dents

All ages2,,,..,...,,,,.,.,., ..................................................................... $479 100,0 $466 100.0 $464 100,0

Under 65 years .............................................................................................. 434

65-74 years

10.6 426 16.8 441

.................................................................................................... 473 15.0 484 20.5 m’ ‘ $:

75-84years.................................................................................................... 488 35.5 475 32.1

85 years end over ..........................................................................................

493 37.0

485 38.8 478 307 487 42.2

lIncludes life-care residents and no-charge residents.

21ncludes only those residents who have lived in the nursing home for at least a month.

8
Table D. Average totel monthly charge for care and percent distribution of residents by level of care received, according to age: United

States, August 1973-April 1974

Age

All a~s2 ..............................................................................................

Under 65 years .......................................... .............................. ............................

65-74 yeers ........ ..................................................................................................

75-84 years ............................ ..............................................................................

85 years and over .................................................................................................

AH aWs2 ....................................................................... .......................

Under 65 years ....................................................................................................

65-74 yaars ... .................... .. .................................................................................

75-84 yearn ............................................................................... ...........................

65 years and over .................................................................................................

I

Level of cere received

11 in9 I care I ing

II,...-I I ~ou. No

Pernu rsing or

sonal percare sonal

II

care

I I

care

care

II -- I I

Averaga total monthly chargel jmPercent distribution of residents

100.0 40.6 9.8 32.3 16.4 0.9

100.0 34.8 9.2 30.2 24.9 ‘

100.0 36.2 11.2 34.0 17.5 ●

100.0 40.6 10.2 33.3 14.9 1.0

100.0 44.0 9.0 31.5 15.0 0.7

lInc]udes life-care residents and no-charge residents.

%rcludes only those residents who have lived in the nursing home for at least a month.

admission to the home and the day the survey

was conducted (see question 5 of the Resident

Questionnaire). Only 19 percent of the residents

were in the home from 1 to 6 months, 51

percent were in the home for 6 months to 3

years, and 30 percent were in the home for 3

years or more (tables E and 4). The median

length of stay for residents in the home at least

1 month was 1.6 years.

Table E shows that the longer a resident had

Acen=in the facility, the lower the average charge

(for last month) .- The average charge-for re;idents in the home from 1 to less than 3 months

was $541. In contrast, the average charge for

those in the home 5 years or more was $411.

Two factors influenced this pattern. One was

that facilities certified by both Medicare and

Medicaid had a significantly larger percentage of

short-term residents (less than 1 year) as a result

,?f Medicare’s provisions for coverage of only the

first [l00 d~ys of care following hospitalization.

Since these residents received skilled nursing or

rehabilitative services on a daily basis, their care

tended to be more expensive than for those

Table E. Average total monthly charge for care and percent

distribution of residents, by primary reason for admission

and length of stay since current admission: United States,

August 1973-April 1974

Primary reason for admission and length

of stay since current admission

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

primarv reason for admission

Physical ........................................................

Social ...........................................................

Behavioral ....................................................

Economic .....................................................

Length of stay since current admjss~og

1 to less than 6 months ................................

1 to less than 3 months ...........................

3 to less than 6 months ...........................

6 to less than 12 months ..............................

1 to less than 3 years ....................................

3 to less than 5 years ....................................

5 years or more ............................................

4

PerAverage cent

total distrimonthly bution

chargel of residents

$479 100.0

499 80.6

369 6.6

419 11.8

294 1.0

-L530 19.0

541 8.9

520 10.2

501 15.6

479 35.3

459 14.8

411 15.2

11n~ludes life.care resjden ts and no-charge residents.

21nc]ude5 OnIYthose residents who have lived in the ISUKiSSg

home for at least a month.

9
receiving personal or custodial care. In addition,

residents with either initial-payment/life-care or

no-charge arrangements tended to have longer

lengths of stay. Of these residents, 44 percent

were in the home 5 years or more compared

with 15 percent of residents with other payment

arrangements. Furthermore, the median length

of stay for residents with life-care or no-charge

arrangements (4.4 years) was significantly longer

than the median length of stay for residents with

other payment arrangements (1.6 years). The

zero or low charges for residents with life-care or

no-charge arrangements contributed to the association of lower charges with longer stays.

Primary Diagnosis at Last Examination

and Reported Chronic Conditions

The average total monthly charge varied

according to the primary diagnosis at last examination (see question 8 of the Resident Questionnaire-note that only one diagnosis was recorded

for each resident). Charges ranged from a low of

$406 for residents with mental disorders (11

percent) to a high of $545 for those in the home

because of accidents, poisonings, and violence (4

percent) (tables F and 6). The three most

frequent primary diagnoses, covering 67 percent

of the residents, were diseases of the circulatory

system (42 percent); senility, old age, other

symptoms and ill-defined conditions (14 percent); and mental disorders (11 percent). Residents with the two most frequent primary

diagnoses (diseases of the circulatory system and

senility) paid, on the average, the same monthly

charge of $495.

In contrast to the situation for primary

diagnosis, the percent distribution of residents

by reported chronic conditions (see question 9

of Resident Questionnaire) exceeded 100 percent, since most residents had more than one

chronic condition. The average number of

chronic conditions per resident was 2.2. Only 5

percent of the residents reported no chronic

conditions. Twenty-seven percent had one

chronic condition, 63 percent had from two

to four, and 5 percent had five or more chronic

Tabla F. Avereae total monthlv.- charae for care and Dercent distribution of residents, by Drimarv diewosis at laSt examination: United

States, August 1973-April 1974 -

Primary diagnosis at last examination

All diqnoses ....................................... .........................................................................................................

Accidents, poisonings, and violence ......................... ....................................................................................................

Diseases of the skin and subcutaneous tissue ................................................................................................................

Neoplasms ....................................................................................................................................................................

Diseases of the circulatory system ................................................................................................................................

Senility, old age, other symptoms and illdefined conditions .......................................................................................

Diseases of the genitourinary system ............................................................................................................................

Diseases of the respiratory system ................................................................................................................................

Diseases of the nervous system and sense organs ........................................................... ...............................................

Endocrine, nutritional, and metabolic diseases .............................................................................................................

Diseases of the digestive system ...................................................................................................................................

Diseases of the blood and bl~od-forming organs .................................................................. ........................................

Congenital anomalies ......................................................................................................................................... ,.,.,,.!..

Diseases of the musculoskeletal system and connective tissue ......................................................................................

Infective and oarasitic diseases ................................. ....................................................................................................

Mental disorders ...................................................................................................................................... ...................

Certain causes of perinatal morbidity and mortality ....................................................................................................

Unknown diagnoses4 ...................................................................................................................................................

Average

total

nonthly

:hargel

$479

545

504

498

495

495

493

484

483

474

467

464

●

443

●

408

●

400

~

Parcent

distrimtion

)f resiients2

100.0

4.2

0.6

2.2

42.0

13.9

1.4

2.0

6.1

4.6

1.9

R

6.9

●

11.0

●

2.2

lIncludes life-care residents and no-charge residents.

%cludes only those residents who have lived in the nursing home for at least a month.

sIn~ludes mental retardation and mental ihIeSS.

41ncludes complications of pregnancy and childbirth, and other diagnoses not listed above.

10
conditions. When standard errors were considered, there were no differences in average

charge by number of chronic conditions report;d. The most frequently reported chronic

conditions were senility (58 percent), arthritis

and rheumatism (35 percent ), and chronic heart

trouble (33 percent). Although charges for

selected chronic conditions are presented in

table 7, they should be interpreted with caution.

Since the total charge for each resident with

multiple conditions (68 percent) appears in the

average charge for each reported condition,

comparison of these charges is misleading (and

generally not significant) due to the high correlation.

Level of Care Received

Information on the level of care the resident

actually received was elicited by asking the nurse

if the resident had received any of a list of

services within the past 7 days (see appendix II

for a complete list of services). The responses

were classified into the five following levels of

patient care with each subsequent category

representing a lower level of care:

Intensive nursing care

Limited nursing care

Routine nursing care

Personal care

No nursing or personal care

Forty-one percent of the residents received

intensive nursing care, 10 percent received

limited nursing care, 32 percent received routine

nursing care, and 16 percent received personal

care services. Less than 1 percent of the residents received no nursing or personal care. This

is due perhaps to the scope of the survey, which

included only those homes providing some level

of nursing care (tables D and 5).

Residents receiving intensive nursing care

paid higher total monthly charges, on the

average, than residents receiving routine nursing

care, personal care, or no nursing or personal

care. The average total monthly charge for

residents receiving intensive nursing care was

$510, compared with $466 for residents receiving routine nursing care, $435 for residents

receiving personal care, and $315 for residents

receiving no nursing or personal care. The

difference in the average total monthIy charge

for residents receiving intensive nursing care

($510) and residents receiving limited nursing

care ($480 ) was not statistically significant.

SOURCES OF PAYMENT

Data on the residents’ means of paying for

care (i.e., sources of payment) and on the

variation in the average monthly charges according to source of payment are presented in this

section. The data were based on responses to

questions 26a and 26b of the Resident Questionnaire in appendix III. These questions dealt with

both the resident’s primary (question 26b) and

total (question 26a) sources of payment. The

nine possible payment sources were: own income or family support, Medicare (Title XVIII

of the Social Security Act), Medicaid (Title XIX

of the Social Security Act), other public assistance or welfare, church support, VA (Veterans

Administration) contract, initial payment/life

care, no charge for care, and miscellaneous

sources. Because residents using church support,

VA contract, initial-payment/life-care, no

charge, or miscellaneous sources comprised ordy

3 percent of the residents (table 8), data for

these categories have been grouped into one

category labeled “all other sources” in the remainder of the report.

PRIMARY SOURCE OF PAYMENT

In 1973-74, Medicaid was the most frequent

primary source of payment used. Forty-eight

percent of all nursing home residents received

care financed primarily by Medicaid. The next

most frequent primary source of payment was

the resident’s own income or family support (37

11
percent) followed by other public assistance or

welfare (11 percent). Only a minority of the

residents (1 percent) used Medicare for primary

payment. Less than 1 percent of all residents

used each of the remaining sources (church

support, VA contract, initial payment/life care,

no charge for care, and miscellaneous sources) as

the primary source of payment (tables G and 8).

Overall, 60 percent of the residents used public

funds (Medicare, Medicaid, other public assistance or welfare) for primary payment.

The average charge for residents receiving

care primarily financed by Medicare ($754) was

significantly higher than that financed by any

other source of payment and higher than the

national average of $479. In comparison, significantly lower average charges were paid by

residents using Medicaid ($503) and own income

or family support ($491). (No significant differences, however, existed in the average charge for

these two groups.) The average charge for

residents receiving care financed by other public

assistance or welfare was $381 while the average

charge for residents using all other sources

($225) was lowest, probably due to the minimal

charges for life-care and no-charge residents

included in this category.

Because Medicare and Medicaid provided

funding for nearly half (49 percent) of nursing

Table G. Average total monthly charge for care and percent

distribution of residents, by primary source of payment:

United States, August 1973-April 1974

Primary source of payment total distrimonthly bution

charga of residents

All sourcasl ................................. $479 100.0

Own income or family support .................... 491 36.7

Medicare ...................................................... 754 1.1

Medicaid ...................................................... 503 47.9

Other public assistanceor walfara ................ 381 11.4

Church support ............................................

●

VA contract ................................................. 44; 0.8

Initial payment/life cara............................... 0.6

No charge ●

..................................................... 0.9

Miscellaneous sources................................... 467 0.4

lIncludes only those residents who have lived in the nur.$ing

home for at least a month.

home residents, the following discussion on

primary source of payment by facility and

resident characteristics will emphasize the impact Medicare and Medicaid programs had on

resident charges and patterns of utilization of

nursing homes.

Facility Characteristics

The Medicaid program, initiated in 1966,

was designed to ease the burden of financing

medical care for the poor of all ages. The

1!373-74 data show that utilization of Medicaid

funds for provision of nursing home care was

extensive. As table H shows, Medicaid was the

dominant source of payment for most residents

in certified facilities: The proportion of Medicaid

residents was 54 percent in facilities certified by

both Medicare and Medicaid, 59 percent in

Medicaid certified skilled nursing homes, and 53

percent in intermediate care facilities. In 1964

and 1969, similar surveys of nursing homes

found that the resident’s own income was the

most frequent primary source of payment.e ~’

(See section on “Primary Source of Payment” in

1964,1969, and 1973-74 surveys.) In 1973-74,

in contrast, the proportion of private pay

residents (relying on their own income or family

support for primary payment) was 36 percent in

facilities certified by both Medicare and Medicaid, 32 percent in Medicaid-certified skilled

nursing homes, and 36 percent in intermediate

care facilities. Medicaid was also the most frequent primary payment source for residents in

both nursing care homes (51 percent) and

personal care homes with nursing (42 percent),

in proprietary facilities (52 percent), and in

three of the four geographic regions (53 percent

in the Northeast and 55 percent in the South

and West).

Utilization of Medicaid benefits was greater

in large facilities since these facilities were most

likely to be participating in the program. The

proportion of Medicaid residents increased from

37 percent in small facilities (less than 50 beds)

to 52 percent in large facilities (200 beds or

more) (table H). In contrast, use of own income

for payment correspondingly decreased as the

size of the facility increased-the proportion of

residents relying on their own income was

highest in small facilities (42 percent) and lowest

12
Table H. Average total monthly charge for cara and percant distribution of residents by primary source of payment, according to certification, type of

service provided, ownership, size, and geographic region of the home: United States, August 1973-April 1974

Primary source of payment

Own

Certification, type of service Other unprovided, ownership, size, and come public

Medi- MedicAll

geographic region assist- other

fa;ily care aid ante sOurcesl

sup- er welport fare

Avarage total monthly charge

All homas2................................ S491

Certification

Both Medicare and Medicaid . .................. 613

SNH only4 ................................................ 489

ICF only ................................................... 388

Not cartified ............................................. 377

Tvpe of sewice provided

Nursing mre .............................................. 516

Penonal care with nursing......................... 447

Ownership

PrOprieta~ ................................................ 525

Nonprofit and government ........................ 427

—Size

Lessthan 60 beds...................................... 429

613-88beds ................................................ 484

100-199 beds ............................................ 523

200 beds or moral ..................................... 606

Geographic ragion

Northeast .................................................. 637

North Central ............................................ 449

%uth ........................................................ 452

wMt .......................................................... 487

$754

~

754

. . .

. . .

. . .

803

*

754

●

.

●

787

●

●

*

●

●

$503

581

469

375

,..

501

507

486

556

431

448

508

656

718

454

408

442

-

$361 $225

480 334

469 308

333 ●

330 ●

398 296

361 156

373 406

397 136

286 .

356 166

414 256

496 307

538 131

360 252

II Prima~ source of payment

Own

Other inTotal come public

Medi- Medic- All

or

assistcare aid ante other

family sOurcesl

super walport

fare

Percent distribution of residents

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

36.7

36.0

31.8

35.8

50.6

35.9

38.2

34.5

41.9

41.5

37.8

36.3

30.7

30.6

44.4

31.0

37.9

1.1

2.9

. . .

. . .

. . .

1.2

0.8

1.2

0.9

.

0.9

1.3

●

1.4

0.8

1.1

.

47.8

54.0

58.6

53.1

. . .

51.1

41.9

52.0

38.4

37.1

47.8

50.8

51.6

53.2

35.6

55.2

54.6

11.4

4.9

7.8

9.7

39.3

9.5

14.7

11.0

12.2

17.5

10.9

8.8

12.3

10.5

16.1

10.3

4.6

3.0

2.2

1.6

1.4

10.2

2.3

4.3

1.4

6.6

3.4

2.5

2.8

4.1

4.5

3.0

2.4

1.9

l[ncludes church support, VA contract, initial payment/Iife care, no charge fOr care, and IZIkCdheOUS SOUrCeS.

21ncludes only those residenti who have lived in the nursing home for at least a month.

31ncludes 20,900 residents in facilities certified by Medicare OfliY.

41ncludes 122,9oo residents in facilities certified by Medicaid as both SNH’S and [C F’s.

in large facilities (31 percent). This pattern may benefits in nursing homes was infrequent. Nareflect a tendency on the part of private pay tionally, only 1 percent of the residents used -.

residents to utilize lower cost services (since

charges tended to be lower in small facilities—see

section titled “Size” earlier in this report) or it

may be related to the high utilization by private

pay residents of not certified facilities (51

percent) which tended to be smaller. I The

resident’s own income was also the most frequent primary source of payment in nonprofit

and government facilities (42 percent) and in the

North Central Region (44 percent). For further

details of resident utilization by primary source

of payment, see tables 9-11.

In contrast to Medicaid, use of Medicare

this source for pr~mary payment; about the same

proportion used this source regardless of type of

service, ownership, size, or region classification

(table H). Within facilities certified by both

Medicare and Medicaid, Medicare recipients

made up only 3 percent of the residents.

Although Medicare benefits are available to

persons aged 65 years and older, a report from

the Social Security Administration noted that

utilization in nursing homes was low because

“Medicare extended care benefits are not intended primarily for the purpose of providing

extended or long-term . . . care but rather =e
designed to be a less expensive ‘extension’ of

inpatient hospital care for persons still requiring

active institutional medical treatment after hospitalization.”8 According to Medicare regulations in effect at the time of the survey,

admission to an extended care facility was

possible only if the Medicare recipients had been

discharged from a hospital (after a stay of at

least 3 days) and if the recipient was certified as

needing daily skilled nursing or skilled rehabilitative services (usually for a condition treated in

the hospital). These strict levels of care requirements resulted in the limited use of extended

care services.8

With increasing certification levels, the average charge for residents using their own income

and for residents using Medicaid increased. The

average charge for Medicaid residents increased

from $375 in intermediate care facilities to $591

in facilities certified by both Medicare and

Medicaid, while that for private pay residents

increased from $377 in not certified facilities to

$613 in facilities certified by both programs

(table H). The average charges for these two

primary payment groups, however, did not

differ statistically within each certification level,

nor when examined for each region and for each

size class under 200 beds. In general, the

similarity in charges for Medicaid and private

pay residents was due to similar use of services

by these two groups, (This finding will be

discussed more fully in the next section, “Resident Characteristics.”) The exception to this

pattern was in nonprofit facilities and in facilities with 200 beds or more, where the average

charge for Medicaid residents was higher than

that for private pay residents.

The average charges for residents using other

public assistance or welfare or all other sources

were significantly lower than those for residents

using either their own income or Medicaid when

examined by the facility characteristics in table

H. The charges for these two payment groups

tended to be lower because only 33 percent of

the residents using other public assistance or

welfare and 30 percent using all other sources

received intensive nursing care in contrast to the

43 percent of the residents using Medicaid and

41 percent of the private pay residents. Another

reason for the lower charges was the inclusion of

residents’ with life-care/initial-payment or nocharge arrangements in the “all other sources”

category. For example, the lower average charge

in nonprofit and government facilities for residents using all other sources ($136 compared

with $397-$556 for residents using other public

assistance, their own income, or Medicaid) was

principally due to the fact that 89 percent of the

residents with either life-care or no-charge arrangements resided in nonprofit or government

facilities.

Resident Characteristics

When Medicare began in 1966, it covered

only “aged” persons, defined as those aged 65

years and over. Effective July 1, 1973, amendments to Title XVIII (Medicare) of the Social

Security Act extended the full range of Medicarq

benefits to two additional high-risk groupsl

disabled persons under age 65 who had been

entitled to receive social security cash benefits

for at least 2 years and persons with end-stage

renal disease.g During the 1973-74 survey

period, Medicare was used primarily by the aged

in nursing homes; 99 percent of the Medicare

recipients were aged 65 years or over. The

median age of Medicare recipients (81 years),

however, did not differ from that of residents

using their own income (83 years), Medicaid (82

years), other public assistance or welfare (80

years), or all other sources (80 years).

Although Medicaid provides funds for the

medically indigent of all ages, within nursing

homes it was also used primarily by the elderly,

similar to the utilization of Medicare. Nearly 9

out of 10 (88 percent) of the Medicaid recipients were aged 65 years and over (table J) while

the median age was 82 years. Women recipients

substantially outnumbered the men in both the

Medicare and Medicaid programs, making up 76

percent of the Medicare recipients and 72

percent of the Medicaid recipients (tables J and

12). Women represented a smaller proportion of

the residents using all other sources (57 percent), however, than they did in the remaining

primary payment groups (69-76 percent). When

charges were separately examined for each primary source of payment group, there were no

statistically significant differences in charges by

age or by sex.

14
Table J, AveraW total monthly charge for care and parcent distribution of residents by age, sex, primary reason for admission, and

length of stay since current admission, according to primarv source of Davment: United States. Auaust 1973 -Atsril 1974

Age, sex, primary reason for

admission, and length of stay

since current admission

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

—Age

Under 65 years .............................

65-74 years...................................

75-64 years ...................................

85 years and over .........................

~

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

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

Primary reason for qdmission

Physical ........................................

Sociel ...........................................

Behavioral ....................................

Economic .....................................

Length of stay sinca current

admission

1 to less than 6 months ...............

6 to lessthan 12 months ..............

1 to lessthan 3 years ....................

3 to lessthan 5 years ....................

5 years or more ............................

Primary source of payment

Own

in- Other

come

public

Medi- MedicAll

or

assistcare

other

family aid ante sourcesl

super welport fare

Average total monthly charge

$491

497

470

490

498

471

499

506

384

467

●

549

512

485

456

412

$754

●

●

725

●

●

735

764

●

●

4

795

●

●

●

●

$503

457

503

517

505

495

506

514

452

436

●

517

516

503

500

474

$381

351

367

385

402

360

390

408

305

331

●

412

400

392

367

348

$225

325

●

219

152

341

●

281

●

●

●

331

●

261

●

136

.-

Primary source of payment

Own

in- Other

come

public

Medi- MedicAll

or

assist- other

family care aid ante

sources 1

super welport fare

Percent distribution of residents

100.0

5.2

12.6

40.2

42.0

28.4

71.6

81.2

8.6

9.6

0.6

21.7

18.3

34.5

13.0

12.6

100.0

●

●

46.1

31.5

23.9

76.1

96.1

●

●

●

82.5

●

●

●

●

100.0

12.0

16.3

33.7

38.0

28.3

71.7

84.2

4.0

11.3

0.6

17.1

15.1

37.6

15.9

14.3

100.0

20.9

17.6

26.9

34.6

31.5

68.5

67.5

7.9

22.9

●

13.2

12.1

33.6

17.3

23.9

100.0

19.8

12.4

36.1

31.7

43.3

56.7

59.2

20.5

9.6

10.8

17.9

8.5

25.9

15.5

32.2

The length of stay for Medicare recipients

was considerably shorter than that for residents

using any of the remaining sources because of

Medicare’s provisions for coverage of only the

first 100 days of inpatient care in an extended

care facility. Eighty-three percent of the Medicare recipients resided in the facility less than 6

months, compared with less than 22 percent of

recipients in any of the remaining source of

payment groups (table J). Furthermore, the

median length of stay for Medicare residents

(0.2 years) was significantly shorter than that

for residents using their own income (1.4 years),

I[ncludes church support, VA contract, initial payment/life care, no charge for care, and miscellaneous sources.

21ncludes only those ~esident~ who have lived in the ~~ming home for at least a month.

Medicaid, (1. 7 years), other public assistance or

welfare (2.2 years); or all ‘other sources (2.9

years) for primary payment.

Nationally, charges tended to be higher

among those residents with shorter lengths of

stay (table 12). A contributing factor toward

this pattern was the shorter and more expensive

stay of Medicare residents (tables J and 13). The

average total monthly charge for Medicare residents with a length of stay of under 6 months

was $795. In contrast, the average charge for

residents staying

but using any of

for the same am&nt OFtime

the remaining primary sources

15
Table K. Average total monthly charge for care and percent distribution of residents by level of care received, according to primary source

of payment: United States, August 1973-April 1974

Primary source of payment

Own

in- Other

Level of care received come

public

Medi- MedicAll

or

assist- other

family care aid ante soureesl

super welport fare

I

Average total monthly charge

All levels of care2 ......................................................................................... $491 $754 $503 $381 $225

Intensive nursing care ................................................................................................... 541 773 504 427 267

Limited nursing care ..................................................................................................... 492 * 506 392 *

Routine nursing care ..................................................................................................... 467 * 498 364 231

Personal care ................................................................................................................. 430 * 508 339 178

No nursing or personal care .... ................................ ...................................................... 327 - ● ●

●

,

i

percentdistribution of residents

All levels of care2 .................................................. ................. ............ ......... 100.0 100.0 100.0 100.0 100.0

Intensive nursing care ................................................................................................ ... 40.8 62.6 42.5 32.9 28.5

Limited nursing care ................ ..................................................... ................................ 9.2 ● 9.9 10.9 10.5

Routine nursing care ..................................................................... ........ ............ ............ 31.2 * 33.6 32.3 30.1

Personal care ....................................................................... .......... ........ .. ...................... 17.3 * 13.7 22.7 27.3

No nursing or personal care .............................................. .... ........ ................................ 1.5 - ● *

●

lIncludes church support, VA contract, initial payment/life care, no charge for care, and miscellaneous SOUrCeS.

21ncludes only those residents who have lived in the nursing home for at least a month.

ranged from $331 to $549. Although the average charges for residents using their own income

or all other sources also tended to decrease with

longer stays, those for residents using Medicaid

or other public assistance or welfare were not

significantly different regardless of the length of

stay.

Nationally, the average charge for residents

using Medicare was higher “than the average

charge for residents using any of the remaining

primary sources. The higher charge for these

residents was in large part due to the strict level

of care requirements necessary for Medicare

coverage (i.e., skilled nursing or skilled rehabilitative services are required on a daily basis). As a

result of these strict requirements, a larger

proportion of the Medicare recipients (96 percent) were admitted to the home for treatment

of physical illness than of the remaining source

of payment groups (59-84 percent—table J), and

73 percent of those receiving Medicare benefits

were admitted from general or short-stay hospitals.b Consequently, of all the primary payment

groups, Medicare residents were most likely to

receive intensive nursing care. Sixty-three percent of the Medicare residents received intensive

nursing care compared with less than 43 percent

for the remaining groups (table K). Among

residents admitted to the home for physical

reasons, the average charge for Medicare residents ($764) was significantly higher than that

for private pay residents ($506) and Medicaid

residents ($514) (table J).

When examLned by the resident characteristics in tables J and K, the average charge for

Medicaid residents and private pay residents

were similar regardless of age, sex, length of

bMthough Medicare coverage in a nursinghome

requiresa hospital stay prior to admission, there may be

a brief interim stay (up to 14 days) in a private residence

if, for example, no nursing home bed ia available or if it

ia medically appropriate.

16
stay, reasons for admission, or level of care

received. In general, the similarity in charges for

private pay residents and Medicaid residents was

due to similar use of services by these two groups.

As table K shows, the proportion of residents receiving each level of care was similar for both

Medicaid recipients and residents using their

own income. For example, the proportion of

private pay residents receiving intensive nursing

care (41 percent) did not differ significantly

from the proportion of Medicaid residents receiving such care (43 percent). Similarly, the proportion of residents receiving limited nursing care,

routine nursing care, or personal care differed at

most by less than 4 percentage points for the

two groups. The proportion of residents admit-

.

ted t; th> home “for physical reasons for

two groups was also similar (table J).

these

TOTAL SOURCES OF PAYMENT

“Table 14 shows the distribution of residents

according to their total sources of payment (see

question 26a of the Resident Questionnaire). In

1973-74, 662,000 residents (65 percent) used

public funds (Medicare, Medicaid, other public

assistance, or welfare) in partial or ftdl payment

for care; 787,700 residents (78 percent) used

their own income or family support for partial

or full payment (calculated from table 14). The

percent distribution of residents by total sources

of payments exceeds 100 percent since 461,600

residents (46 percent) had two payment sources

and a small proportion of the residents (2

percent) had three or more sources for payment

(calculated from table 14). About 533,400

residents (53 percent) had only one source of

payment.

Table 15 shows the most likely payment

arrangements used by residents in 1973-74 to

finance their care in the facility. Overall, residents using their own income were most likely

(89 percent) to rely on it as the only source for

payment. In contrast, less than 50 percent of the

residents used any of the remaining sources

solely for payment. Residents using public funds

(Medicare, Medicaid, or other public assistance

or welfare) for primary payment were most

likely to have two sources for payment; the

proportion of residents with two sources was 63

percent for Medicare, 71 percent for Medicaid,

and 53 percent for other public assistance or

welfare. In most cases, this second source was

the resident’s own income (table L). When the

461,600 residents using two sources were examined, the resident’s own income was used to

supplement payment for 84 percent of the

Medicare recipients, for 96 percent of the

Table L. Percent distribution of residents with two payment sources, by primary and secondary sources of payment: United States,

August 1973-April 1974

I 1

II Secondary source of payment

Own

Other inPrimary source of payment Two

come

public

Medi- MedicAllsources

or

assist- other

timily care aid antesources 1

super welport fare

I

Percent distribution of residents

All sources2 .................................................................................. 100.0 87.0 1.0 4.6 4.5 2.8

Own income or family support ..................................................................... 100.0 8.1 47.9 22.9 21.1

MAicare ....................................................................................................... 100.0 83:9 . . . +

● ●

Medicaid ....................................................................................................... 100.0 96.1 + . . . 3.0 ●

Other public assistance or welfare ................................. .................. ............. 100.0 96.9 ● ● . . .

●

All other sourcesl ........ ................................................................................ 100.0 65.6 - ● ● . . .

llncludes church support, VA contract, initial payment/life care, no charge for care, and miscellaneous sources.

Zlncludes On]y those 46 1,6s)0 residents having two payment sources who have lived in the MMshg home for at least a month.

17
Medicaid recipients, and for 97 percent of those

receiving other public assistance or welfare.

This pattern of payment arrangements for

recipients of public funds was a consequence of

the limitations of coverage of the various programs, especially in the area of coverage of

personal convenience items such as the services

of a beautician or barber, rental of a television,

or use of a telephone. Medicare, for example, is

a health insurance program for the aged. Of the

maximum of 100 days of extended care that

Medicare provides for, the first 20 days are paid

in full. For the remaining 80 days, however, the

patient was responsible for co-insurance payments each day equal to one-eighth of the

current inpatient hospital deductible. The Medicare daily co-insurance rate was $9.00 in 1973

and $10.50 in 1974.9 Medicare recipients were

also responsible for the costs of noncovered

services which included: personal convenience

items, private-duty nursing, private room

charges, eye or ear examinations, routine physical examinations, or immunizations (unless required because of an injury or immediate risk of

infection). 10

Services covered by Medicaid varied from

State to State since, in this State-Federal program, States determined which services would be

reimbursed. In general, Medicaid did not cover

personal convenience items.

CHARGES IN 1964, 1969, AND 1973-74

CHARGES FOR CARE

In the last 10 years, the increased utilization

of nursing homes has made them one of the

most rapidly expanding sectors of the Nation’s

health care delivery system. In 1973-74, 5

percent of the U.S. population aged 65 years

and over resided in nursing homes; in contrast,

the proportion in 1964 was only 3 percent.z ~11

In actual numbers, the population in nursing

homes nearly doubled between 1964 and 1973-

74,2,11

Comparisons of the average monthly charge

in 1973-74 with the average charges from similar

surveys of nursing homes conducted by the

National Center for Health Statistics in 19646

and 19697 show that between 1964 and 1973-

74, the average total monthly charge increased

159 percent–from $185 in 1964 to $479 in

1973-74 (table M). The largest percent increase

in average charge occurred between 1964 and

1969 when charges increased 81 percent ‘or

about 16 percent per year. In contrast, the

average charge increased by only 43 percent

from 1969 to 1973-74, or about 11 percent per

year. An examination of the cumulative ~ercent

distribution of monthly charges for 196[, 1969,

and 1973-74 further illustra~es

charges (figure 4). Whereas 87

this increase in

percent of the

residents were charged $300 or less in 1964, the

proportion of residents in this range was less

than 50 percent in 1969 and only 12 percent in

1973-74.

When charges were compared for the three

survey periods, increases occurred for each type

of service category, for each type of ownership,

for each age group, and for males as well as

females. The average charge was found to

increase in the Northeast, North Central, and

South Regions for all 3 survey years. The

difference was not statistically significant, however, for the West between 1969 and 1973-74.

When levels of care received’ were compared for

the 3 survey years, the average charge consistently increased for all levels of care with the

exception of residents receiving neither nursing

nor personal care. For such residents, charges

did not differ significantly between 1969 and

1973-74 due to the large sampling variability for

this small group. Although charge data by size of

facility were not available for 1964, a comparison of charges by size for 1969 and 1973-74

found that charges were higher in 1973-74 than

in 1969 for each size category.

cData in 1964 and 1969 for other nursingcare

correspondto combineddata for the limited and routine

nursing care categories of 1973-74,

18
Table M. Average total monthlv .- charge for care and crercent distribution of residents. bv selected facilitv and resident characteristics:

United States, 1984, 1969

Selected facility and resident characteristics

FACILITY CHARACTERISTIC

All f*ilities .................................................................................

Type of service provided

Nursing care ................................................................................................

Personal care with nursing ...........................................................................

Ownership

Proprietary .........................m........................................................................

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

—Size

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

50-99 &ds ....................................................................................................

100.199 kds ................................................................................................

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

Geographic region

Northeest .....................................................................................................

North Central ...............................................................................................

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

West ....m........................................................................................................

RESIDENT CHARACTERISTICS

A&?

Under 65 years .............................................................................................

65.74 years ...................................................................................................

75.84 years ...................................................................................................

85 years and over .........................................................................................

—Sex

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

Femala .........................................................................................................

Level of care received

Intensive nursing care.. o.. .. ... ... ... ... . ... .. ... ... ... .. .. .. . ... .. .. .... .. ... . .... .. .. ... .. ... .. ... .. ..

Other nursing care3 .. ... ... ... ... ... .. ... .. .. ... ... .. .... .. ... .. ... .. ... .. ... .. ... ... .. .. .. ... .. ... .. .. ..

Personal care ................................................................................................

No nursing or parsonal care...3 .....................................................................

Id 1973-74 “

19841

Average

total

monthl}

charge2

$185

211

118

208

150

. . .

. . .

---

. . .

208

172

162

198

185

162

186

188

190

175

191

221

197

162

97

Percent

distribution

Df resi

dents

1Oo.c

72.C

28.C

60.>

39.8

. .

.-.

.-.

.-.

28.4

36.5

18.7

16.5

100.0

11.4

18.9

41.8

28.0

34.6

65.4

33.0

30.3

25.6

11.1

19691

Average

total

monthly

charge2

$335

356

242

352

300

288

345

363

352

395

302

311

370

335

288

332

343

343

323

340

374

335

293

230

Percent

distribution

of resi

dents

1Oo.c

81.4

18.6

68.0

32.0

27.3

36.0

26.2

10.6

22.5

36.0

27.3

14.2

100.0

10.8

16.5

39.5

33.2

30.4

69.6

33.7

43.0

18.0

5.3

1973-74

Average

total

monthly

charge2

$479

495

448

489

456

397

448

502

576

651

433

410

464

479

434

473

488

485

466

484

510

469

435

315

Percant

distribution

)f residents

100.0

64.8

35.2

69.8

30.2

15.2

34.1

35.6

15.1

22.0

34.6

26.0

17.4

100.0

10.6

15.0

35.5

38.8

29.1

70.9

40.6

42.1

16.4

0.9

lData have been adjusted to exclude residents of personal care homes. For sources of data, see references 6 and 7, WSPdhWIY.

~

21nchrdes life-care residents and no-charge reeidents.

3Data in 1964 and 1969 for other nursing care correspond to combined data for the limited and routine nursing care categories of

1973-74.

19
-.-1964

---1969

—1973-74

109-

---

z 90 -

g ./

/“--

,,

~ 60 -

/“ /

g

/“/ ,, ~

~ 70 -

/“ /

g

n 60 -

/“ //

+

g 50 -

; do

2

~ 30 -

i

:20 -

E i “ 3 /. //’

~ 10 -

./” ,0~

/

300 400 503 602 7C0 Soo ~0,,01

TOTAL MONTH LY CHARGE (OOLLARS)

Figure 4. Cumulative percent distribution of nursing home

residents, by total monthly charge for care: United States,

1964, 1969, and 1973-74

The increase in the average total monthly

resident charges between 1964 and 1973-74 may

have been the result of several factors including:

the price of services and supplies, increased

utilization, supply of facilities and health manpower, and the quality and quantity of care

received. Of these factors, rising medical care

prices (or inflation) played a dominant role. The

Consumer Price Index (CPI) prepared by the

Bureau of Labor Statistics measures the change

in average prices of goods and services purchased

by urban wage earners and clerical workers and

their families. One measure of overall medical

care prices is the medical care component of the

CPI. Using 1964 as the base year, the medical

care component indicates that medical care

prices increased 62 percent between 1964 and

1973-74 (column 3 of table N).d That is, the

same medical services that cost $100 in 1964

would have cost $162 in 1973-74. Thus, charges

for nursing home residents increased because the

prices of medical services and supplies rose.

The increase in charges not attributable to

inflation may be roughly estimated by converting the average charges to constant dollars so

that they do not reflect the effect of rising

medical care prices. Column 4 of table N shows

the average total monthly charges for 1969 and

dThe medical care component of the CPI was used

as an overall measure of nursinghome prices because the

CPI does not have a nursinghome component.

Table N. Average total monthly charge for care, number of

residents, medical care price index, and average total

monthly charge in constant (1984) dollars: United States,

1964.1969. and 1973-74

I I I I

Average

total

IIAverage Number

Medical monthly

total care of charge

monthlv usidents

price in con-

----- _-

1

indexz stant

(1984) I

~haraei I ~

II I dollars3

18844 .. . . . . . . . . . . . . . $185 518,700 100.0 $185

19694 ............... 335 728,600 130.6 257

1973-74 ............ 479 1,012,CJO0 162.0 296

lIn~Iudes fife-care and no-charge residents.

2The medical care price index was adjusted to make 1964

equat to 100 by dividing the medicat care component of the CPI

for each year by that for 1964. Data used in this adjustment are

presented below. Source: Bureau of Labor Statistics.

Medical care component Date of the CPI (1967=100)

87.3 June 1964

114.0 July 1969

141.4 December 1973

3T0 convert average charges to constant (1964) dollars,

charges were divided by the medical care price index and

multi tied by 100.

$Data have been adjusted to exclude residents of personal

care homes. For sources of data, see references 6 and 7,

respectively.

1973-74 expressed in terms of 1964 dollars

(average total monthly charge divided by the

consumer price index for medical care services).

In constant dollars, the average monthly resident

charge increased 60 percent between 1964 and

1973-74: from .$185 to $296. The largest constant dollar increase (39 percent) was between

1964 and 1969; between 1969 and 1973-74

the constant dollar increase in average charges

was only 15 percent (table O). Figure 5 further

illustrates this increase in constant dollar charges.

Table O shows the constant dollar average

charge by selected facility and resident characteristics. Examination of this table shows that

constant dollar charges increased for each survey

year for each type of service provided by the

home, for each type of ownership, for the

Northeast, North Central, and South Regions,

for each age and sex group, and for each level of

care received.

At least part of the increase in the constant

dollar average charges for 1964, 1969, and

1973-74 was due to an excess demand for

20
Table O. Averaoe total monthlv chame for care in constant (1964) dollars and percent change, by selected facility and resident

‘characteristics: United States, 1864, 1

Selected facility and resident characteristics

FACILITY CHARACTERISTICS

All facilities ......................................................................................

Type of service provided

Nursing care .....................................................................................................

Parsonal care with nursing................................................................................

Ownership

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

Nonprofit and ~vernment ...............................................................................

~e

Lessthan 50 bads.............................................................................................

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

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

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

Geographic regioq

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

North Central ...................................................................................................

tiuth ...............................................................................................................

west ..........................................o............................!.........................................

RESIDENT CHARACTERISTICS

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

Age

Under 65 yearn.................................................................................................

65.74 years ......................................................................................................

75-84 yaars ......................................................................................................

85 years and owr .............................................................................................

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

Famale .............................................................................................................

Level of care received

Intensive nursing mre .......................................................................................

Other nursing care3..........................................................................................

Parsonal mre ....................................................................................................

No nursing or personal mre ..............................................................................

9, and 1!

19641

Average

total

monthly

charge

in constant

(1864)

dollars

$185

211

118

208

150

. . .

. . .

---

. . .

209

172

162

198

185

162

186

188

190

175

191

221

197

162

97

1-74 -

19691

Avarage

total

monthly

charge

in constant

(1964)

dollarsz

$257

273

185

270

230

221

264

278

270

302

231

238

263

257

221

254

263

263

247

260

286

257

224

176

Percent

1964%9

38.7

29.2

57.0

29.6

53.1

..-

---

.-.

. . .

44.7

34.4

47.0

43.1

38.7

36.1

36.7

39.7

38.2

41.3

36.3

29.6

30.2

38.5

81.6

1973-74

Average

total

monthly

charge

in constant

(1964)

dollarsz

$296

306

277

302

281

245

277

310

356

402

267

253

280

296

268

282

301

299

26s

289

315

290

269

194

Percent

change

1969-74

15.3

12.1

49.2

12,0

22.5

11.1

4.7

11.5

31.9

32.9

15.6

5.3

-1.1

15.3

21.5

14.9

14.7

14.0

16.3

14.8

9.9

12.9

19.7

10.4

1For sources of data, see table M and references 6 and 7. Includes life-care and no-charge residents.

2To convert average ~harge~ to constant ( 1964) dolla~, charges were divided by the medical care price index and multiplied by

100.

3Data in 1964 and 1969 for other nursing care ~orre~Pond tc. ~~mbined data for the ]imited and routine nursing care categories Of

1973-74.

21
PRIMARY SOURCE OF PAYMENT

$335

19691

~ Averagemonthly charge

~ Averagemrmthly charge

m constant(1964) dollars

YEAR

‘Data havebeen adjustedm exclude reddents of prmml cm Ib.ms.

Figure 5. Average total monthlv charae for care and averacre

total mont~ly charge in constant-(1964) dollars: Unit;d

States, 1964, 1969, and 1973-74

nursing home beds. A previous report on the

utilization of nursing homes found that in

1973-74, 72 percent of all nursing homes

maintained waiting lists.a The increased demand

for nursing home beds was probably due to the

increase in number of elderly persons and the

lack of available caregivers for many of them.

This demand was greatly stimulated in the late

1960’s when Medicare and Medicaid funds became available for nursing home care.

The overall quality of care received also

influenced the increase in charges, since more

residents received intensive or other nursing care

services (the highest two levels) in 1973-74 than

in either of the preceding survey periods. In

1973-74, 83 percent of the residents received

intensive or other nursing care compared with

77 percent in 1969 and 63 percent in 1964.

Furthermore, the percent of residents receiving

no nursing or personal care (the lowest level)

decreased both in 1969 and in 1973-74. Less

than 1 percent of the residents received no

nursing or personal care in 1973-74 compared

with 5 percent in 1969 and 11 percent in 1964

(table M).

The implementation of the Medicare and

Medicaid programs in 1966 had the major effect

of shifting a 1arge proportion of the aged’s

nursing home bill from the private to the public

sector. In 1964, 47 percent of the residents used

public funds (chiefly other public assistance or

welfare) for primary-payment, and 53 percent of

the residents used private sources (own income

and all other sources—figure 6). After the introduction of Medicare and Medicaid, however, the

proportion of residents using public funds increased to 53 percent in 1969 and was up to 60

percent in 1973-74. Thus there were more than

2% times as many residents using public funds

for primary payment in 1973-74 as there were in

1964 (table P);

YEAR

‘Data [WC &en adymd !. exclude rmkknu of pmmd care bmm

Figure 6. Percent distribution of residents by primary source of

payment: United States, 1964, 1969, and 1973-74

22
Table P. Average total monthly charge for care and number and percent distribution of residents, by primary source of payment: United

Primary source of payment

All sources................

Own income or family

support.. !...............................

Public assistance:

Medicare .............................

Madicaid .............................

Other public assistanceor

welfare .............................

All other sourcesz ....................

States, 1964, ‘

19641

Average

total

monthly

charge

$185

206

. . .

. . .

184

58

-1- PerNumber cent

distri- Of bution residents of residents

518,700 100.0

1

I

238,500 46.0

. . . . . .

. . . . . .

243,000 46.9

37,100 7.2

;9, and 1973-74

19691

Average

total

monthly

charge

$335

350

533

395

288

287

Number

of

residents

728,600

288,500

25,200

97,000

265,600

52,200

Percent

distribution

of residents

100.0

39.6

3.5

13.3

36.4

7.2

Average

total

monthly

charge

$479

491

754

503

381

225

1973-74

Number

of

rasidents

1,012,000

371,700

108,000

484,300

114$00

30,200

Percent

distribution

If residents

100.0

36.7

1.1

47.9

11.4

3.0

1

lData have been adjusted to exclude residents of personal care homes. For sources of data, see references 6 and 7, ressJectivelY.

21ncludes church suP~@ VA contract, initial payment/life cme, no charge for care, and misce]]aneous sources.

Medicaid funding, in particular, played an

increasingly important role after 1966. In 1969,

13 percent of the residents used Medicaid funds

for primary payment; by 1973-74,48 percent of

all residents were using this source. The actual

number of residents using Medicaid increased

almost fivefold, from 97,000 residents in 1969

to 484,300 residents in 1973-74 (table P). Use

of Medicare funds for extended-care services, in

contrast, was less prevalent. In 1969, 4 percent

of the residents used Medicare as the primary

source for payment but by 1973-74, only 1

pm-cent of the residents used this source. Medicare program statistics indicate that the number

and rate of extended-care admissions reached a

peak in 1969 and then declined,g due to strict

enforcement of the level of care requirements

for coverage.s Declines in the proportion of

residents using Medicare for primary payment,

as well as declines from 1964 to 1973-74 in the

proportions using their own income (from 46 to

37 percent), other public assistance or welfare

(from 47 to 11 percent), and all other sources

(from 7 percent to 3 percent) were chiefly due

to the increasing reliance on Medicaid funds as

the primary source of payment for nursing home

care.

For most primary payment sources, the

average total monthly charge increased in each

survey year. The increase in charge for most

payment sources was more pronounced between

1964 and 1969 than between 1969 and 1973-

74. The average charge for residents using their

own income, for example, increased 70 percent

between 1964 and 1969 (from $206 to $350),

while the increase between 1969 and 1973-74

was only 40 percent (table P). The average

charge for residents receiving other public assistance or welfare increased 57 percent between

1964 and 1969 but only 32 ‘percent between

1969 and 1973-74. An exception to this pattern

was the average charge for residents using all

other sources. Between 1964 and 1969, charges

for these residents increased 395 percent (from

$58 to $287); between 1969 and 1973-74,

however, the difference in charge was not

statistically significant.

Since Medicare and Medicaid did not come

into existence until after 1964, data on charges

for these sources are available for 1969 and

1973-74 only. Between 1969 and 1973-74,

however, the average charge for Medicaid residents increased significantly (from 8395 to

$503). Although the average charge for Medicare

residents in 1973-74 ($754) was higher than that

in 1969 (.$533), the difference was not statistically significant due to the large sampling

variability of these estimates.

23
The increase in charge for Medicaid residents

was related to rising medical care prices and to

the increased demand for nursing home services

under this program (the 97,000 residents served

in 1969 rose to 484,300 in 1973-74). Of these

two factors, rising medical care prices played the

dominant role. When the average charge for

these residents was converted to constant dollars

(to control for the effects of inflation), the

average charge in 1969 ($302) was similar to

that in 1973-74 ($310) (table Q). The low

percent increase (3 percent) in constant dollar

charges for Medicaid residents during that time

was probably the result of close monitoring of

nursing home reimbursement levels which were

set by the States. Because of the unanticipated

high cost of the Medicaid program, many States,

within a few years of its implementation, sought

to cut Medicaid costs by tightening eligibility

requirements, reducing the scope of benefits,

and cutting back reimbursement levels to providers of medical care services.1z

The care received by Medicaid residents,

however, was generally the same in 1973-74 as

in 1969. The proportion of Medicaid residents receiving intensive or other nursing care

was similar in 1973-74 (86 percent) to the 1969

proportion (85 percent) (table R). This pattern

was also true for Medicare residents. In 1973-74,

the proportion of Medicare residents receiving

intensive or other nursing care (92 percent) was

similar to that in 1969 (91 percent).

Table R. Percent of residents recaiving intensive or other nursing

care, by primary source of payment: United States, 1864,

1%9, and 1973-74

Primary source of payment I

lg641 18691 1973-74

Percent of residents

Own income or family support .... 64.5 74.4 81.2

Medicare ...................................... . . . 90.8 91.6

Medicaid ...................................... . . . 85.1 86.0

Other public assistance or welfare 66.6 77.7 76.0

All other sources? ....................... 33.3 61.5 70.0

lData in 1964 and 1969 for other nursing care correspond

to combined data for the limited and routine nursing care

categories of 1973-74. Data have also been adjusted to exclude

residents of personal care homes. For aourcea of data, see

references 6 and 7, respectively.

zIncludea church support, VA contract, initial payment/life

care, no charge for care, and miscellaneous aourcea.

In contrast to Medicare and Medicaid, the

level of care received by the residents using the

remaining payment sources increased each survey year. In 1964, almost 65 percent of the

residents using their own income received intensive or other nursing care compared with 74

percent in 1969 and 81 percent in 1973-74. The

dramatic increase in charges for residents using

all other sources (from $58 to $287) between

1964 and 1969 was largely a reflection of the

increased proportion of residents receiving intensive or other nursing care during that time (from

33 to 62 percent).

Table Q. Average total monthly charge for care in constant (1964) dollars and percent change, by primary source of paymant: United

States, 1964, 1969, and 1973-74

Primary sourca of payment

Own income or family support ........................................................................

Medicare ..........................................................................................................

Medicaid ..........................................................................................................

Other public assistanceor welfare ....................................................................

All other sources3............................................................................................

I 19641 I 19691 I 1973-74

Average

total

monthly

charge

in constant

(1964)

dollars

$206

. . .

. . .

184

58

Average

total

monthly

charge

in constant

(1964)

dollars2

$268

408

302

221

220

IzF

Percent monthly

change charge

1964-69 in constant

(1964)

dollarsz

-130.1 $303

. . . 465

. . . 310

19.8 235

278.9 139

lFor sources of data, see table P and references 6 and 7.

2T0 convert average charges to constant (1964) dollars, charges were divided by the medical care price index and mu-.

100.

Percent

change

1869-74

13.1

14.0

2.7

6.7

-36.8

iplied by

%cludes church support, VA contract, initial payment/life care, no charge for care, and miSCellaneoUssources.

24
CONCLUSIONS

Since 1964, the average total monthly

charge for residents in nursing homes has increased 159 percent—from $185 in 1964 to

$479 in 1973-74. Much of the increase was due

to inflation or rising medical care prices, but at

least part of the increase was due to the

increased demand for nursing home services. The

higher level of services received by residents also

contributed to the increase.

In 1973-74, the average charge was highest

in the Northeast Region and k proprietary

facilities. Charges increased —.7—with the size of the

facility and with increasing —— le;& of certification. Charges did not dlf~er ~& ‘–males and

females but tended to be lower for those

residents under 65 years of age. Residents

admitted to the home for physical reasons

tended to pay more than those admitted for

behavioral, social, or economic reasons; and

residents receiving intensive nursing care paid

more than residents receiving routine nursing

care, personal care, or neither nursing nor personal care. A lower average charge was associated with residents who had longer lengths of

stay.

In 1973-74, nearly half of all nursing home

residents used Medicare or Medicaid for primary

payment. The average charge for Medicare residents tended to be more expensive than for

other payment sources due to the higher intensity of services received by these residents. The

average charge for Medicaid residents was similar

to that for residents using their own income.

Between 1969 and 1973-74, the strict requirements for skilled nursing care under the

Medicare program resulted in a decline in use of

this program, and the increased demand for

nursing home services was accommodated by the

Medicaid program.8 Between 1969 and 1973-74,

the average charge for Medicaid residents increased from $395 to $503. When the average

charge for these residents was expressed in terms

of constant (1964) dollars, however, the charge

in 1973-74 was only 3 percent higher than in

1969. Thus, most of the increase in charge for

these residents could be traced to inflation or

rising medical care prices.

o 00

25
REFERENCES

1Nation~ center for He~th stati~tic~: Selected

operating and financial characteristics of nursing homes,

United States, 1973-74 National Nursing Home Survey.

Vital and Health Statistics. Series 13-No. 22. DHEW

Pub. No. (HRA) 76-1773. Health Resources Administration. Washington. U.S. Government Printing Office, Dec.

1975.

2National Center for HeaIth Statistics: Chuacteris.

tics, social contacts, and activities of nursing home

residents, United States, 1973-74, National Nursing

Home Survey. Vital and Health Statistics. Series 13-No.

27. DHEW Pub. No. (HRA) 77-1778. Health Resources

Administration. Washington. U.S. Government Printing

Office, May 1977.

3Nation~ Center for He~th Statistics: Utilization of

Nursing Homes, United States, National Nursing Home

Survey, August 1973-April 1974, Vital and Health

Statistics. Series 13-No. 28. DHEW Pub. No. (HRA)

77-1779, Health Resources Administration. Washington.

U.S. Government Printing Office, June 1977.

4National Center for Health Statistics: Profile of

chronic illness in nursing homes, United States: 1973-74

National Nursing Home Survey. Vital and Health Statistics. Series 13-No. 29. DHEW Pub. No. (HRA) 78-1790.

Health Resources Administration. Washington. U.S. Government Printing Office. In preparation.

5National Center for Health Statistics: Nursing

homes in profile, United States, 1973-74. Vital and

Health Statistics. Series 14-No. 17. DHEW Pub. No.

(HRA) 78-1812. Health Resources Administration.

Washington. U.S. Government Printing Office. In press.

6National Center for Health Statistics: Charges for

care in institutions for the aged and chronically ill,

United States, May-June 1964. Vital and Health Statistics. PHS Pub. No. 1000-Series 12-No. 9. Public Health

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

Aug. 1967.

7National Center for Health Statistics: Charges for

care and sources of payment for residents in nursing

homes, United States, June-August 1969. Vital and

Health Statistics. Series 12-No. 21. DHEW Pub. No.

(HRA) 74-1706. Health Resources Administration.

Washington. U.S. Government Printing Office, July

1973.

8Office of Research ad Statistics: Medicare, use of

skilled nursing facility services, 1969-73. Health Insurance Statktics. HI-75. DHEW Pub. No. (SSA) 77-11702.

Social Security Administration. Washington, D.C. Feb.

2, 1977.

9Gomick, M.: Ten years of Medicare: Impact on the

covered population. Sot. Secur. Bull., 39(7):3-21, July

1976.

10Social Security Administration: Your Medicare

Handbook. DHEW Pub. No. (SSA) 76-10050. Washington, D.C. Jan. 1976.

1I National Center for Health Statistics: Marital status

and living arrangements before admission to nursing and

personal care homes, United States, May-June 1964.

Vital and Health Statistics. PHS Pub. No. 1000-Series

12-No. 12. Public Health Service. Washington. U.S.

Government Printing Office, May 1969.

12Davis, K.: Achievements and problems of Medicaid.

Public Health Rep. 91(4) :309-3 16, July-Aug. 1976.

13Van 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.

14National Center for Health Statistics: Development

and maintenance of a National Inventory of Hospitals

and Institutions. Vital and Health Statistics. PHS Pub.

No. 1000-Senes l-No. 3. Public Health Service. Washington. U.S. Government Printing Office, Feb. 1965.

15 National Center for Health Statistics: Design and

methodology of the 1967 Master Facility Inventory

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

1000-Series l-No. 9. Public Health Service. Washington.

U.S. Government Printing Office, Jan. 1971.

16National Center for Health Statistics: The agency

reporting system for maintaining the National Inventory

of Hospitals and Institutions. Vital and Health Statistics.

PHS Pub. No. 1000-Series l-No. 6. Public Health

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

Apr. 1968.

17 Nation~ center for He~fi statistics: Institutions

for the aged and chronically ill, United States, AprilJune 1963. Vital and Health Statistics. PHS Pub. No.

1000-Series 12-No. 1. Public Health Service. Washington.

U.S. Government Printing Office, July 1965.

18 National Center for Health Statistics: Arrangements

for physician services to residents in nursing and

personal care 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.

19Nation~ Center for Health Statistics: selected

characteristics of nursing homes for the aged and

chronically ill, United States, June-August 1969. Vital

26
and Health $tatistics. Series 12-No. 23. DHEW Pub. No. Vital and Health Statistics. Series 14-No. 12. DHEW

(HRA) 74-1708. Health Resources Administration. Pub. No. (HRA) 74-1807. Health Resources AdministraWashington. U.S. Government Printing Office, Jan. tion. Washington. U.S. Government Printing Office, Feb.

1974. 1970.

20 Cochran, W. G.: Sampling Techniques, 2nd ed. New 22National Center for Health Statistics: Eighth Revi1

York. John Wiley & Sons, 1963. a-on International Classification of Diseases, Adapted for

Use in the United States. PHS Pub. No. 1693. Public

I 21National Center for He~th Statistics: Inpatient Health Service. Washington. U.S. Government Printing

health facilities as reported from the 1971 MFI Survey. Office, 1967.

27
LIST OF DETAILED TABLES

1. Average total monthly charge for care and number and percent distribution of residents by monthly charge intervals,

according to certification, ownership, and size: United States, August 1973-April 1974 ...........................................................

2. Average total monthly charge for care and number and parcant distribution of residents by monthly charge intervals,

according to ownership and type of service provided: United States, August 1973-April 1974 ..................................................

3. Average total monthly charga for care and numbar and percent distribution of residents by monthly charge intervals,

according to certification, ownership, and geographic region of home: United States, August 1973-April 1974 ........................

4. Average total monthly charge for care and number and percant distribution of residents by monthly charge intervals,

according to sex, age, primary reason for admission, and length of stay since current admission: United Stata$, August

1973-April 1974 ................................................................................................................................ ................ ........................

5. Average total monthly charge for care and numbar and percent distribution of residents by monthly charge intervals,

according to Ieval of care received and aga: United States, August 1973-April 1974 ..................................................................

6. Average total monthly charge for care and number and percent distribution of residents by monthly charge intervals,

according to primary diagnosis at last examination: United Statas, August 1973-April 1974 .....................................................

7. Averaga total monthly charge for care and number and parcent distribution of residents by monthly charge intervals,

according to raportad chronic conditions and impairments and number of chronic conditions: United States, August

‘1973-April 1974 ................................................................................................................................ ................................ ........

8. Average total monthly charge for care and number and percant distribution of residents by monthly charge intervals,

according to primary source of payment: United States, August 1973-April 1974 ....................................................................

9. Average total monthly charga for care and number of residents, by primary source of peyment, certification, ownarship, and

size: United States, August 1973-April 1974 .............................................................................................................................

10. Average total monthly charge for care and number of residents, by primary source of payment, certification, ownarship, end

geographic region of home: United States, August 1973-April 1974 ..........................................................................................

11. Average total monthly charge for care and number of residants, by primary source of payment, ownership, and type of

service providad: United States, August 1973-Apri I 1974 ..........................................................................................................

12. Averaga total monthly charge for care and number of residents, by primary source of payment, sex, age, primary raason for

admission, and length of stay since current admission: United States, August 1973-April 1974 ................................................

13. Average total monthly charge for care and number and percent distribution of residents by length of stay since current

admission, according to Iaval of care received and primary source of payment: United States, August 1973-April 1974 ............

14. Number of residents by sources of payment, sex, and age: United States, August 1973-April 1974 ..........................................

15. Numbar and percent distribution of residents by number of sources of payment, according to primary sourca of payment:

United Statesr August 1973-April 1974 ......................................................................................................................,,.,.,..,...,,,

29

30

32

34

35

36

37

37

38

40

42

43

44

45

46
Table 7, Average totat monthly charge for care and number and percent distribution of residents

.. ..? .. ,.. . .

montnly cnarge mtervm, accomng 10 =nmcaucm, ownersnp. amsne: unmo

t 1973-AI <Q7A

Number

of

esidents2

1,012,000

tates, AI

-

Average

total

monthly

chargel

$479

II Monthly charge for care

Certification, ownership, and size otal $150- $300- $400- $500- $600- $::

$299 $399 $499 $599 $799

more

* I 1 I I t

Percent distributmn

100.0

.

100.0

100.0

100.0

100.0

0.9

.

.

0.8

0.8

.

0.4

—

.

.

.

2.2

.

.

.

.

.

.

.

.

.

.

10.3

=

23.9

9.0

6.8

7.7

8.2

26.1

.

29.4

31.9

24.3

14.2

26.4

27.1

.

23.o

29.o

27.5

25.8

30.3

13.2

.

9.6

12.6

13.9

16.7

13.9

13.4

.

7.0

11.4

17.5

14.9

13.9

7.4

.

3.6

4.0

7.8

17.9

6.8

1.6

.

2.2

1.4

1.3

1.7

.

397

44e

502

576

489

153,50C

345,50C

360,50c

152,40c

706,500 100.0

41C

463

521

60~

456

364

406

447

553

592

119,00C

259,20C

266,60c

61 ,70c

305,40C

34,50C

86,300

93,90C

90,700

372,300

100.0

100.0

100.0

100.0

.

.

.

.

4.7

9.3

5.6

4.1

2.8

1.0

-

●

.

.

.

.

23.3

7.3

3.4

.

15.2

26.2

14.1

16.5

10.5

2.5

-

●

●

2.1

4.5

1.3

28.4

32.1

22.8

14.1

25.6

32.8

31.2

28.7

14.3

9.8

.

.

9.4

10.4

9.9

9.5

25.9

30.9

31.9

28.8

19.7

10.3

13.4

14.9

19.0

11.5

::

11.0

15.1

17.7

33.7

18.0

16.6

15.9

18.3

7.7

12.6

18.0

13.5

12.4

3.2

3.4

8.4

20.9

100.0 8.8

100.0

100.0

100.0

100.0

13.0

23.3

15.1

23.7

31.5

—

21.6

36.1

31.0

24.6

34.9

.

7.8

16.2

15.8

21.9

-

24.1

22.4

23.9

15.9

21.8

27.8

23.2

22.9

12.8

22.2

●

6.6

6.2

15.8

15.6

=

●

9.7

14.9

27.8

13.9

—

.

7.9

14.3

30.0

20.8

100.0

537

559

592

658

688

17,000

112,600

170,600

72,000

285,600

100.0

100.0

100.0

100.0

100.0

24.7

40.8

33.7

27.7

20.5

559

558

688

673

605

10,800

92,900

143,600

38,300

86.800

100.0

100.0

100.0

100.0

.

.

●

✎

6.4

.

8.5

10.0

10.8

11.0

37.5

18.1

17.5

16.6

15.4

.

.

3.8

●

●

✎ 100.0

500

565

611

641

484

6,100

19,700

27,200

33,700

278.100

100.0

100.0

100.0

100.0

.

.

.

.

.

-

.

.

●

✎

.

.

.

7.7

5.0

.

13.6

12.6

8.8

25.0

.

25.4

J7.2

21.1

33.7

●

17.6

12.2

14.7

16.6

●

18.7

29.0

19.6

14.8

.

18.4

18.5

25.2

4.8

-

9.6

.

2.4

11.1

3.5

.

. 100.0

482

461

473

547

483

490

470

478

544

466

26,700

91200

105,300

53,000

183.100

100.0

100.0

100.0

100.0

.

●

✎

✎

✎

9.9

3.8

5.1

4.5

2.7

20.9

27.5

27.6

17.4

25.3

20.2

26.1

27.3

12.8

24.6

36.7

37.8

31.9

28.7

36.5

13.6

16.1

14.1

18.8

17.1

6.6

11.8

17.8

17.4

100.0 14.8

22,30Q

65,600

77,000

18,100

95,100

6,300

25,600

28,300

34,900

100.0

100.0

100.0

100.0

.

.

.

.

.

.

.

9.6

38.1

37.6

35.9

33.4

28.2

●

37.9

21.0

26.3

14.5

18.6

14.6

24.7

12.8

.

9.8

12.4

15.8

11.3

12.6

16.9

18.7

14.7

—

9.1

20.4

16.7

.

.

.

.

7.4

—

.

.

.

12.8

.

. —

.

.

.

100.0

100.0

100.0

100.0

100.0

454

437

460

546

.

9.6

11.7

.

.

25.6

29.3

19.8

.

.

.

29
Table 1. Averaoe. total . monthlv.-charae for care and number and riercent distribution of residents bv monthlv chame intewals, according to Citification, owner~hlp, and size: United

States, August 1973-April 1974 -COri. -

II Monthly charge for care

Werage

total

nonthly

chargel

$376

378

369

377

404

382

Number

of

esidents2

226,900

64,100

92,800

58,900

13,100

163,000

Certification, ownership, and size

Percent distribution

All types of ownership ............................................................. 100.0

-

100.0

100.0

100.0

10+2.0

100.0

.

=

.

.

.

●

●

.

=

.

.

.

.

.

15.4 55!1 19.3

—

24.1

17.2

15.2

28.4

22.2

6.6 2.5

=

.

.

.

.

2,4

●

✝

✎

✎

●

.

19.6

12.3

14.8

19.5

12.5

—

46.9

62.7

58.4

26.1

55.9

=

3.6

6.0

7.7

20.5

Proprietary .................................................................................... 5.7 —

388

373

390

.

358

52,600

70,200

36,000

4,200

63,900

100.0

100.0

100.0

100.0

100.0

●

✎

✎

●✍

.

.

.

.

18.4

10.7

8.0

●

22.8

42.3

63.6

61.5

.

52.9

29.0

16.1

20.0

.

11.9

●

14.6

●

30.1

14.4

4.4

5.7

.

.

8.7

●

✎

●

✎

●

●

✎

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

334

356

355

404

329

11,400

22,600

21,000

6,900

134,500

100.0

100.0

100.0

100.0

100.0

●

✎

✎

●

4.5

25.1

17.5

26.6

.

34.0

67.8

59.4

52.9

.

24.9

●

✎

✎

✎

5.s

●

●

2.0

.

7.6

.

.

.

6.8

Not certified

All types of ownership .............................................................

316

322

310

430

353

343

364

360

●

299

43,600

48,800

27,500

14,400

74,900

33,200

30,500

10,100

●

59,600

100.0

100.0

100.0

100.0

100.0

6.2

6.9

11.4

,*

.

●

4.8

.

.

.

.

.

●

8.4

47.0

39.6

25.9

25.1

38.5

60.0

30.3

●

●

28.5

18.4

33.2

26,6

.

29.3

19.2

39.6

31.7

●

19.3

13.0

14.5

14.1

18.4

16.0

—

13.2

16.3

●

●

13.6

6.5

5.5

8.8

●

7.2

5.3

4.8

●

●

6.2

●

●

●

●

●

✎

✎

✎

●

Proprietaw .................................................................................... —

100.0

100.0

100.0

100.0

100.0

.

.

●

15.9

8.1

●

●

6.6

.

●

●

Nonprofit and government ............................................................ 5.3

Less than 50 btis .....................................................................................

50.99 Ms ................................................................................................

102-199 &ds ............................................................................................

200 bsds or more .....................................................................................

llncludes live.care residents and no-charge residents.

21nc1udes only those residents who have lived in the nursing home for at least a month.

31ncludes 20,900 residents in facilities certified by Medicare rely.

41ncludes 122,900 residents in facilities certified by Medicaid as both SNH’Sand ICF’S.

231

251

282

444

10,600

18,300

17.400

13.200

100.0

1Oo.c

mo.a

100.0

—

25.1

17.6

14.4

.

—

37.8

28.4

28.2

21.5

—

●

✎

●

●

.

22.6

23.6

.

.

.

●

19.5

●

●

●

✎

.

.

●

✎

.

●

✎

✎ — ✎

30
.. ..—–.. . . .. .

Table 2, Avarage total monthlv charge for care and number and percent distribution of residents

United States, August 1973

Average Number

Ownership and type of service provided total of

monthly residents

chargel

All types of ownership .............................................................

L

$479

Nurcing care ............................................................................................. 495

Personal care with nursing ........................................................................ 448

PrOprletaW ...............................................................................

t

489

Nursing care ............................................................................................. 498

Personal care with nursing ........................................................................ 465

Nonprofit and government ....................................................... 456

Nursing care ............................................................................................. 485

Personal care with nursing ........................................................................ 421

1.01 2.0+30

655,600

356,400

706,500

487,900

218,700

305,400

167,700

137,700

I llncludes life-care residents and no.charge residents.

21ncludes only those residents who have lived in the nursing home for at least a month.

monmiy charge intervals, accorcung to ownersmp ano wpe or sewlce provmeo:

>ril 1974

Monthly charge for care

Initial

payTotal mentl

life

$1- $150- $300- $400. $500- $600- $::

$149 $299

care,

6399 $499 $599 $799

more

no

charge

Percent distribution

E

100.0 1.6 0.9 10.3

100.0 0.9 0.7 6.2

100.0 2.8 1.4 17.8

100.0 ‘ 0.4 8.2

10Q.O “ “ 5.0

100.0 “ “ 15.4

100.0 4.7 2.2 15.2,

100.0 2.6 1.6 9.9

100.0 7.0 2.9 21.5

26.1 I27.1 13.2 i13.4

I

7.4

26.8 29.4 14.2 II14.37.6

25.0 22.9 11.3 11.9 7.0

R#26.4 30.3 13.9 13.9 6.8

26.6 31.6 14.7 14.3 7.1

25.5 27.3 12.2 12.6 6.1

25.6 19.7 11.5 12.4 8.8

26.7 23.0 12.9 14.1 9.1

24.3 15.8 9.8 10.5 8.3

31
Table 3. Average total monthly charge for care and numbsr and percent distribution of residents by monthly charge intewals, according to certification, ownership, and g.mgraphic

region of hofn~ United States, August 1973-April 1974

II Monthly charge for care

II Initial I I I I I I ‘-”T Average

total

monthly

chargel

$479

Number

of

esidents2

payTotal mentl

life

$1- $150- $300- S4CQ. $500. $600 $::

$149 $299 $399 $499 $599 $799

care, more

no

char%

Percenr distribution

1,012,000 100.0 1.6 0.9 10.3 26.1 27.1 13.2 13.4 7.4

.

3.4

1.4

0.9

●

.

●

.

●

.

4.7

— .

651

433

410

454

489

223,000

350,100

262,700

176,200

7C%,500

100.0

100.0

10+3.0

100.0

100.0

.

0.8

1.2

.

0.4

—

.

.

.

.

2.2

4.9

15.7

6.9

6.6

6.2

—

2.5

12.9

9.1

5.5

15.2

.

8.9

19.9

7.7

23.3

2.5

5.7

26.1

44.4

20.8

26.4

.

3.6

25.5

45.2

22.3

25.6

17.0

24.6

26.8

45.2

30.3

11.7

15.9

10.1

14.4

13.9

30.9

10.8

6.0

7.6

13.9

25.6

2.7

1.8

2.1

6.6

683

453

411

465

456

139,800

211,400

210,100

145,3CQ

305,400

100.0

100.0

100.0

100.0

100.0

18.5

26.5

27.4

48.2

19.7

11.~

19.0

1O.c

14.2

11.5

.

11.5

11.0

10.1

15.6

17.7

36.6

11.3

5.7

7.6

12.4

26.2

2.5

G

8.6

599

402

407

401

592

83,200

136,700

52,600

30,900

372.300

100.0

100.0

100.0

100.0

100.0

8.7

3.3

.

●

1.0

●

●

●

●

.

.

1.7

.

.

●

9.0

32.2

41.3

13.6

9.6

14.4

18.7

24.3

30.8

31.5

21.2

10.2

7.4

.

21.9

.

34.9

27.0

13.0

11.6

21.6

24.5

3.0

●

.

15.5

-

42.6

8.0

5.6

3.1

13.9

ioo.o

1W.o

100.0

100.0

100.0

784

557

504

502

m

790

556

502

505

605

768

561

512

482

4s4

100,900

89,700

72,800

109,000

285,600

2.8

3.4

.

2.3

1.3

2.3

8.6

20.0

11.0

9.5

7.3

25.9

38.7

53.8

34.9

8.4

25.3

21.0

17.7

18.3

●

●

✎

✎

✎

73,400

60,600

56,600

94,900

86,800

100.0

100.0

1Oao

100.0

100.0

.

.

.

.

3.8

.

.

.

.

.

.

.

●

6.4

.

6.9

19.0

11.5

11.0

6.7

30.1

39.9

56.7

20.5

8.5

30.0

21,6

16.6

15.4

40,2

24.1

13.7

11,0

22.2

41.4

6.3

4.4

3.2

20.6

27,50+3

29,11x3

16,200

14,000

276,100

100.0

100.0

100.0

100.0

100.0

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

5.0

.

12.1

23.4

●

25.0

6.9

17.0

34.5

34.4

33.7

●

15.8

18.9

25.3

15.6

=

11,6

26.8

9.6

10.7

17.1

—

15.6

31.6

6.7

11.6

12.8

20.9

33.0

.

.

14.8

—

39.0

10!9

3.2

.

14.6

45.8

11.6

.

.

4.6

-

16.4

.

●

3.5

.

●

_

617

465

422

405

483

73,700

86,200

75,300

42,900

183,100

38,700

51,400

60,100

32,900

95,100

100.0

100.0

100.0

100.0

100.0

.

100.0

100.0

100.0

100.0

100.0

●

●

●

✎

✎

✎

✎

✎

3.5

7.7

●

8.3

2.7

4.8

●

●

9.8

6.5

19.9

39.6

36.1

25.3

.

15.2

40.0

42.1

24.5

19.1

32.4

45.7

40.4

36.5

19.7

34.7

47.1

39.6

28.2

637

488

420

416

488

48.3

12.6

.

●

14.7

14.6

.

●

7.4

—

18.3

●

594

434

430

371

35,000

34,900

15,200

10,000

100.0

100.0

100.0

100.0

.

.

.

.

.

●

7.4

12.0

.

.

18.4

28.9

40.0

42.2

7.2

19.7

.

.

28.7

8.3

●

.

32
—

Table 3. Average total monthly charge for care and number and percent distribution of residents by monthly charge intervals, according to certification, ownership, and geographic

region of home: United States. Auqust 1973-A!xil 1974—Con.

_

Monthly charge for care

III $150- $300- $400- $500-

$299 $399 $499 $599

—

$800

or

more

$1-

$149

Inttial

paymeml

life

care,

no

charge

Average

total

nonthly

chargel

Number

of

estdents2

Certification, ownership, and mgio” Tm.al $600-

$799

Percent dtsrribution

$376 226,900 55.1 6.6 2.5

_

.

.

.

.

2.4

,

.

.

.

.

.

_

.

.

.

.

.

.

.

.

100.0 .

.

.

.

.

.

.

.

.

7.6

21.3

3.5

.

.

.

.

.

.

.

.

.

.

.

.

4.5

.

.

3.6

.

.

.

15.4 19.3

_ — _

481

366

359

369

382

475

383

361

368

358

502

340

349

.

329

23,600

104,000

84,600

14,700

163,000

17,600

62,700

69,700

13,000

639,000

6,100

41,300

14,900

.

134,500

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

.

21.9

9.6

22.9

12.6

.

18.3

8.7

18.8

22.8

.

27.4

.

.

34.0

10.0

47.9

77.4

49.0

55.9

.

44.6

77.8

51.1

52.9

.

53.0

76.9

.

24.9

49.5

23.1

6.1

20.1

22.2

57.2

29.8

6.5

22.7

11.9

.

12.8

.

14.4

.

19.3

15.9

8.9

.

15.0

27.9

4.7

3.1

.

5.7

17.9

4.7

3.5

.

8.7

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

I

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

56.7

.

.

6.9

_

10.4

6.6

.

.

7.2

.

.

.

5.8

.

12.0

3.9

.

.

6.2

●

✎

2.0

_

.

.

.

.

●

_ .

375

334

300

265

353

24,700

70,100

30,000

9,6oO

74,800

100.0

100.0

100.0

100.0

100.0

19.2

32.0

43.0

59.4

38.5

.

33.9

22.8

.

29.3

432

360

322

.

299

10,100

36,700

23,600

4,600

59,800

100.0

100.0

100.0

100.0

100.0

.

.

.

,

15.9

.

.

●

8.4

●

32.4

49.3

68.8

28.5

.

37.7

25.2

.

19.3

32.4

15.0

●

.

13.6

.

16.8

.

.

●

7.8

.

●

6.5

.

.

●

5.3

.

.

●

.

.

.

●

✎

✎

✎

●

335

307

220

249

14,600

33,500

6,400

5,200

100.0

100.0

100.0

100.0

35.0

7.0

●

.

17.5

31.5

.

51.2

●

✎

✎

✎

.

.

.

.

.

29.6

●

.

~

llncludes life. care residents and rm.c-barge residents.

21ncludes only those residents who have lived in the nursing home for at least a momh.

%cludes 20,900 residents in facilities certified by hfedic,ve only.

41ncludes t 22,900 residents in facilities certified by Medic~id m both SNH’S and lCF’S.

33
Table 4. Average total monthly charge fc.r care and number and percent dtstributi.m of residents by monthly charge intewals, according to sex, age, primary reason fOr admission,

and length of stay since current admission: United States. Awmst 1973-Amil 1974

Initial

pay.

mentl

life

care,

no

charge

Monthlv charue for care

1111 $300- $400- $500- $600- $:’J

$399 $499 $599 $799 T more

$1- $160-.

$149 $299

Average

total

monthly

charge 1

$479

Number

of

,esidentsz

1,012.000

Sex, age, prima~ reason for admission, and length of

stay since current admiss!on

Total

Sex and age Percent distribution

Both sexes, all ages................................................................... 100.0 0.9

.

●

●

0.8

0.9

1.1

10.3

.

16.9

12.8

9.2

8.5

12.3

18.8

14.6

10.1

9.5

9.5

26.1

.

29.9

25.4

25.6

25.9

27.9

28.B

25.4

27.2

29.7

25.4

1.6 27.1 13,2

.

.

●

1.6

1.7

1.2

13.4

.

7.4

12,5

14.1

14.8

12.0

—

6.8

11,0

12.8

14.6

14.0

8,0

13.5

14.6

14.9

14.6

8.6

9.1

.

16.7

16.8

16.6

14,9

13,4

11,9

9.3

—

7.4

.

434

473

488

485

466

107,500

152,000

359,500

393,000

294,800

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

26.2

27.8

26.6

26.9

26.1

9.5

12.1

13.9

14.0

12.8

5.4

E

7.3

6.6 — —

426

464

475

478

484

49,400

60,400

94,500

90,500

717,200

●

✎

●

✎

1.7

.

.

●

●

0.9

26.7

27.1

26.4

24.7

27.5

29.4

28.2

26.7

27.6

28.0

18.1

26,5

.

26.3

27,3

25.5

26.6

29.1

26,3

22.7

10.4

12.8

14.0

12.9

13.3

5.2

6.7

7.1

6.7

Female, all ages.............................................................................. 7.7 —

441

479

493

467

499

369

419

294

530

541

520

501

479

459

411

58,100

91,500

265,000

302,500

615,200

66,400

118,800

10,500

192,700

89,800

102,900

156,300

357,700

149,700

153,500

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

●

●

1.7

t.9

E

.

29.2

.

.

.

●

1.0

1.7

4.6

●

●

✎

0.9

0.5

4.4

●

●

●

.

.

●

.

.

2.9

15,2

11.5

8.9

8.2

7.7

24.2

19.3

.

6.4

5.7

7.1

7.9

9.B

12.0

17.1

30.8

25.4

25.1

24.7

25.7

26.7

30.2

.

22.7

21.2

24.0

24,1

26.3

29.8

28.4

8.8

11.7

13.8

14.3

14.1

8.3

9.9

.

15.7

15.5

16,6

14.9

13.0

11.4

10.6

5.6

7.6

8,5

7.5

8.4

.

3.0

.

11,0

12.4

9.9

6.4

6.6

5.9

4.5

llncludes life-care residents md no-charge residents.

%cludes only those residents who have lived in the “ur.sing home for at least a month.

34
Table 5, Average total monthly charge for care and number and percent distributmn of residents by monthly charge intervals, accord,ng m level of care recewed and age. United

States. Al t 1973 -Aorll 1974

Monthly charge for care

Initml

Paymentl

life $1- $150- $300-

care,

$149 $299 $399

no

charge

Average

total

monthly

chargel

Number

of

.esidents2 -i-l- $500- S60W ‘~

$599 $799

more

Level of care received and age Total $400-

$499

Percem dmr,butmn

10.3

=

16.9

12.8

9.2

8.5

5.0

26.1

—

29.9

25.4

25.6

25.9

24.3

27.1

28.2

27.8

26.6

26.9

29.2

13.2

_

9.5

12.1

13.9

14.0

15.1

13.4

.

7.4

12.5

14.1

14.6

16.4

7.4

-

5.4

7.2

8.1

7.3

8.4

1,012,000 100.0

=

100.0

100.0

100.0

100.0

100.0

1.6

-

.

.

1.6

1.7

1.0

0.9

=

●

.

0.8

0.9

.

107,500

152,000

359,500

393,000

411,100

37,400

55,100

145,800

172,800

98,700

9,900

16,900

36,700

35,200

327,200

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

.

●

✎

✎

✎

✎

✎

✎

✎

1.3

.

.

.

.

.

—.

.

.

.

1.0

.

6.6

4.7

4.7

9.2

—

.

.

7.8

8.0

10.8

26.8

21.9

23.9

24,8

27.1

31.4

22.9

28.1

27.0

29.8

35.8

31.5

28.3

27.9

27.2

27.1

31.4

25.8

26.7

27.3

10.2

13.6

15.7

16.1

13.8

.

●

15.2

13.5

12.1

10.6

16.4

17.2

17.0

13.3

.

●

14.0

14.4

10.8

8.4

8.2

8.8

8.0

7.0

.

.

7.1

7.5

6.9

32,400

51,700

119,600

123,600

165,900

100.0

100.0

100.0

100.0

100.0

.

.

.

.

2.9

.

.

.

.

1.7

15.9

12.6

9.9

9.6

21.2

37.4

30.6

28.7

28.5

23.3

24.5

27.2

27.6

27.8

22.0

8.6

11.6

12.4

12.6

10.8

.

9.4

11.5

12.1

11.7

.

6.3

7.8

7.0

6.4

26,800

26,600

53,700

58.800

9,000

100.0

100.0

100.0

100.0

100.0

.

.

.

.

.

.

.

.

.

.

32.7

24.4

18.9

16.8

41.6

25.3

24.2

22.2

22.8

.

23.4

19.7

21.3

23.0

.

●

10.2

11.8

11.5

.

●

10.5

12.2

14.8

.

●

✎

8.1

6.2

.

.

.

3,700

2,600

100.0

100.0

100.0

100.0

.

.

.

.

.

.

.

—

.

.

.

.

.

.

.

.

●

✎

✎

✎

.

.

.

.

.

.

.

.

llncludes Iife.care residents and no-charge residents.

21ncludes only those residents who have lived in the nursing home for at least a month.

35
Table 6, Averaw total monthly charge for care and number and percent dktributian of residents by monthly char.w intewals. accortihm to cwimaw dta.annsisat last examination:

United States, August 1973

Primary diagnosis at last examination

All primary diagnoses ...............................................................

Accidents, poisonings, and violence ..........................................................

Diseases of the skin and subcutaneous tissue ............................................

Neoplasms ................................................................................................

Diseases of the circulator system ............................................................

Stroke .................................................................................................

Harden,ng of the arteries .....................................................................

Heart attack ........................................................................................

Diseases of the circulatory system other than hardening of the

arteries, stroke, and heart att=k .......................................................

Senility, old age, other symptoms and illdefined conditions ....................

Diseases of the genitourinary system ........................................................

Diseasesof the respiratory system ............................................................

Dtseasesof the newous system and sense orgam ......................................

Endocrine, nutritional, and metabolic diseases.........................................

Diseases of the digestive ~stem ................................................................

Diseases of the blood and blood-forming organ ......................................

Congenital anomalies ................................................................................

Diseases of the mu$culoskeletal system emd connective tissue ..................

Infective and parasitic dmeases.................................................................

Mental disorders3 .....................................................................................

Certain causes of perinatal morbidity and mortality .................................

Unknown diagnoses4 ................................................................................

Average

total

monthly

chargel

$479

_

545

504

498

495

508

502

466

457

495

493

484

483

474

467

464

●

443

.

406

●

400

—

Number

of

.esidents2

I ,012,000

—

42,500

5,600

21,800

424,8oo

105,200

230,t 00

52,300

37,200

140,300

13,700

18,900

61,500

46,100

18,900

7,100

3,100

70,000

.

111,600

●

22,600

. . .

pril 1974 -

Total

100.0

-

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

II Monthly charge for care

Initial

paymentt

life

care,

no

1.6

.

.

.

1.2

.

1.0

●

●

.

●

.

.

.

.

.

●

●

●

●

IT$1- $160- $300-

$149 $299 $388

0.9

.

.

●

.

0.7

.

.

.

.

.

.

.

.

●

●

.

●

.

.

.

—

$400- $!No-

$499 $599

Percent distribution

10.3

.

5.9

.

.

7.4

5.1

7.7

8.6

10.6

12.1

.

13.2

8.6

8.8

.

●

.

12.0

.

20.0

.

19.5

26.1

—

20.7

.

18.3

25.9

24.9

25.0

30.2

28.1

26.0

23.1

22.7

24.2

25.6

21.6

●

●

31.3

.

31.1

.

27.9

—

27.1

.

26.6

41.4

26.9

28.3

28.7

28.6

26.7

25.8

23.9

24.8

27.9

28.5

28.5

27.8

●

.

26.1

.

25,6

●

20.2

13.2

-

14.2

.

17.1

13.9

14.2

13.8

14,6

13.5

12.4

19,5

12.4

13.2

15.9

74.2

.

.

10.7

.

10.1

.

yJ&g $::0

moro

13.4

.

17.0

.

17.8

14.8

16.5

14.3

13.6

14.1

12.5

17.9

14.0

14.1

13.0

14.9

.

●

11.2

.

8.1

.

13,0

7.4

13.9

.

●

7.8

6.0

9.0

4.8

.

10,9

.

.

8.o

5.4

.

.

●

5.2

2.2

.

.

lIncludes life-care residents and no-charge residents,

21ncludes only those residents who have lived in the mming home for at least a month.

31”cludes mental retardaticm and mental illness.

41ncludes complications of pregnancy a“d childbirth, a“d other diagmmes mM listed ab.we.

36
Table 7. Average total monthly charge for care and number and percent distribution of residents by monthly charge intervals, according to reported chronic conditions and

impairments and number of chronic conditions: United State August 1973 -ApriI 1974

Monthly charge for care

Number

of

residents

I,012,000

—.

590,800

191,400

70,900

352,900

177,100

106,300

134,400

102,100

143,800

337,800

51,200

I,012,000

Total

100.0

=

1.00.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Initial

Paymentl

life

care,

no

charge

$300-

$399

COmrage

Reported chronic conditions and impairments and number of

chronic conditmm

total

nonth IV

charge 1

$479

_

483

444

404

466

508

490

502

467

476

499

473

478

$400-

$499

$1-

$149

$150-

$299

Percent distribution

All reported chronic conditions and impairments . .................. 1.6

0.9

.

.

1.7

.

.

.

.

1.6

1.2

5.4

1.6

0,9

—

0.7

.

.

1.0

.

.

.

.

.

0.8

●

0.9

10.3

.

7.6

13.7

20.5

9.2

6.4

8.5

7.6

8.4

6.1

7.9

14.3

10.3

26.1

_

27.9

31.0

33.0

29.8

24.6

27.0

23.7

29.0

27.8

24.9

18.8

26.1

27.1

-

28.9

26.8

23.8

27.3

28.6

26.7

29.1

28.4

30.9

28.3

21.1

27.1

13.2

=

14.0

12.4

9.3

12.4

13.6

12.4

15.6

11.3

13.7

13.7

13.0

13.2

13.4

=

13.5

10.1

7.4

12.9

15.7

13.7

14.6

13.9

13.1

14.9

15.8

13.4

7.4

-

6.5

4.3

.

5.8

8.7

8.9

8.2

5.4

5.7

H

7.4

Senllltv .....................................................................................................

Mental illness............................................................................................

Mental retardation ....................................................................................

Arthrltls or rheumatism ............................................................................

Paralysis or palsv other than arthritis .......................................................

Glaucoma or cateracti ..............................................................................

Diabetes ...................................................................................................

Chronic trouble with back or spine ..........................................................

Amputation of extremities or limbs or permanent stiffness or any

deformity of foot, leg, fingers, arm, or back ..........................................

Heart trouble ............................................................................................

None of the above ....................................................................................

Number of chronic conditions ..................................................

473

474

483

486

471

470

51,200

277,000

330,600

212,100

91,300

49,700

100.0

100.0

100.0

100.0

100.0

100.0

5.4

1.8

1.4

1.2

.

.

●

1.1

0.8

.

.

.

14.3

13.4

10.4

7.7

7.9

.

18.8

26.0

25.2

27.6

26.7

35.1

21.1

25.2

27.4

28.1

30.3

31.6

13.0

12.5

13.4

14.1

13.6

11.1

15.8

12.8

13.7

13.7

12.8

13.1

9.9

8.2

7.7

6.8

5.2

.

condition,

Table 8. Average total monthly charge for care and number and percent distribution of residents bv monthly charge intewals, according m primary source of payment: United

st 1S73-April 1974

I

States, Au

~

Average

PrimaV source of payment total

monthly

charge 4

Number

of Total

resldentsl

~ All sources................................................................................ $479

Parcent distribuw.m

1,012,000 100.0 1.6 0.9 10.3 26.1 ] 27.1 13.2 13.4 7.4

Own Income or family suppOrt .................................................................

r

491

Mcdlcare ................................................................................................... 754

Mcdlcaid ................................................................................................... 503

Other public assistance or welfare ............................................................ 381

Church support ........................................................................................ ‘

VAcontrwt ............................................................................................. 446

initial pnyment/life care ...........................................................................

Nocharw .................................................................................................

.

Miscellaneous sources ............................................................................... 467

371,700

10,800

484,300

114,900

.

100.0

100.0

100.0

100.0

100.0

1.5

●

2.3

●

.

12.7

.

4.3

29.3

.

.

.

21.8 21.7

. .

29.4 34.3

32.3 20.3

. .

. .

. .

16.9

.

12.2

6.5

.

.

17.9

28.2

11.5

6.8

.

.

3::

S.2

2.5

.

.

100.0

t 00.0

S,Zoo

6,200

9,600

4,400

100.0

100.0

100.0

100.0 .

37
Table 9. Average total monthly ch ? for care and number of residents, by primary source of payment, certification, ownership, and siz= United States, August 1973-April 1974

Own income or

family support

Other public assistance or welfare All sources Medicare Medicaid All other sourcesl

Certification, ownership, and size

Average

total

Average

total

monthly

charge

$754

●

●

787

.

754

Werage

total

nonthly

charge

$503

Werage

total

nonthly

charge

$381

---L Average Number total of nonthly residents charge

Number

of

residents

Number

of

residents

371.700

Number

of

.esidents

10,800

_

.

3,100

4,700

.

8,100

Number Number

of totai

nonthly

charge

of

residents

484,300

monthlv

charge”

$491

_

429

484

523

508

525

114,90(

All types of certification

All types of ownership ......

Lessthan 50 beds ..........................

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

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

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

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

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

50.99 beds .....................................

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

200 beds Or more ...........................

Nonprof,t and government .......

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

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

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

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

8oth Medicare and Medicaid3

All types of ownershbp ........

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

50-89 beds .....................................

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

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

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

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

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

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

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

Nonprofit and government .......

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

50-99 b-sds.....................................

100-199 k-eds.................................

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

Medicaid only: SN H4

All types of ownership ........

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

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

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

200 bds m me . ..........................

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

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

50.99 beds .....................................

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

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

Nonprofit and government .......

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

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

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

200 twds or mime...........................

See fmtmxes at e“d of table.

-1- $225 30,200

.

5,200

186 8,700

256 10,000

307 6,300

$479 1,012,000

—

153,500

345,500

360,500

152,400

706,500

_ _

397

448

502

576

489

63,700

130,500

130,800

46,700

243,800

431

449

508

6s6

486

56,900

165,500

183,300

78,600

367,000

47,000

133,300

147,600

39,000

117,300

296

356

414

496

373

294

360

445

477

397

.

341

353

504

480

26,80[

37,60(

31,80(

18,70(

77,70C

Zz,loi

29,00(

20,90C

6,60C

37,30(

4,70C

8,60C

10,900

13,1OC

18,300

410 *

463

521

609

4S6

119,000

259,200

266,6oO

61,700

305,400

449

514

569

564

427

47,600

91,700

89,100

15,500

127,800

●

✎

783

●

.

.

2,500

4,200

●

2,600

426

444

499

647

556

.

2,700

409 4,900

. .

T

136 20,300

●

3,300

,

6,0LM

●

5,100

298 5,600

354

406

447

563

592

34,500

85,300

93,900

90,700

372,300

367

413

425

477

613

16,100

38,900

41,700

31,300

134,100

●

✎

✎

✎

754

_

●

.

787

●

754

.

●

●

✎

10,800

.

3,100

4,700

.

8.100

451

469

545

884

591

532

521

579

716

556

9,900

32,200

35,700

39,600

200,900

-

6,900

59,100

90,500

44,500

157,700

4,600

50,100

76,900

26,100

43,200

T

334 8,300

. .

. ●

●

3,200

●

2,700

537

559

592

658

588

559

558

588

673

605

500

565

611

641

484

17,000

112,600

170,800

72,000

285,600

577

619

621

587

625

7,800

43,300

63,800

19,200

103,800

.

437

505

●

481

.

.

496

.

479

●

5,500

8,600

3,600

13,0W

.

3,900

7,500

.

5,400

--t-

●

2,900

. .

. .

10,800

92,900

143,600

38,300

86,800

6,100

19,700

27,200

33,700

276,100

28,700

91,200

105,300

53,000

183,100

22,3oo

65,600

77,000

18,100

95,100

S96

626

627

628

571

.

585

569

548

488

478

489

489

500

520

5,600

35,600

53,200

9,400

30,200

.

7,600

10,600

9,8oo

68,400

12,000

30,900

31,600

13,900

52,300

.

.

783

.

●

.

.

.

.

. . .

. . .

. . .

. . .

. . .

. . .

.

2,500

4,200

.

2,600

516

506

562

698

662

+

. ●

● ●

●

5,300

. ●

● ●

. ●

.

2,500

.

●

✎

✎

✎ ✎ ✎

✎ ✎ ✎

✎ ✎ ✎

✎ ✎ ✎

✎ ✎ ✎

✎ ✎ ✎

●

597

676

741

489

●

9,000

13,60Q

18,3(2U

162,900

.

.

.

.

469

.

.

,

.

21,7W

+

308 5,1(XJ

● ●

● ●

● ●

. .

.

2,400

. .

. .

● ●

. .

.

2,700

482

461

473

547

483

490

470

478

544

$486

512

453

465

595

466

13,000

53,900

65,600

30,300

114,900

11,100

41,500

51,100

11,300

48,000

.

12,400

14,600

19,000

●

448

506

486

498

.

.

590

.

$422

.

.

.

478

3,2CKI

4,900

5,900

7,700

13,400

2,9oO

3,21XI

4,100

3,2oO

8.400

529

508

525

.

$445

7,900

20,300

20,500

3,6oo

36,100

491

451

451

559

$544

.

460

511

616

...

.,.

...

...

...

..

..

..

..

..

..

..

.. T

● .

. .

. .

454

437

460

548

6,300

25,6oo

28,300

34.900

.

451

423

487

4,100

10,500

11,100

10,300 4,60(

...

...

...

...

38
Table 9, Average total monthly charge for care and number of residents, by primary source of payment, certification, ownership, and size: United States, August 1973-April

1974–COn.

Prtmary source of payment

Other publtc assistance or welfare

Own income or

family support All sources Medicare Med!ca,d All other sourcesl

Certification, ownership, and size Average

total

monthly

charge

Average

total

monthly

charge

Average

total

monthly

charge

ivarage

total

Average

total

monthly

charge

Average

total

nonthly

charge

Number

of

res;dents

Number

of

residents

Number

of

residents

Number

of

res)d@nts

Number

of

Number

of

restdents

Ionthlv

.esidents charge”

~ Medlcaldonly: ICF

All types of ownership ........ 376 226,900 386 S1,200

—

20,500

32,400

20,900

7,400

49,700

15,400

21,900

10,600

.

31,500

375

_

383

363

378

.

376

120,600

_

37,000

52,500

27,200

3,9CQ

94.400

333 22,000 .

-

●

✎

✎

✎

✎

— ... 3,200

...

...

...

...

...

...

...

...

...

...

...

...

...

...

... —

...

...

...

...

...

...

_

..

...

. .

. .

...

...

..

.

...

...

...

...

...

.

_

.

...

.

...

...

_ _

I

Las: than 50 bcd$ ..........................

50-99 bad. ....................................

1W-199 beds .................................

378

369

377

404

5,800

6,800

7,900

.

16,500

5,100

5,900

4,900

.

5,500

.

.

3,000

.

52,600

64,100

92,800

55,900

13,100

163,000

52,600

70,200

36,000

4,200

63,900

11,400

22,600

21,000

8,900

134,500

393

384

382

402

410

415

403

422

.

352

325

346

341

405

377

301

330

360

.

334

299

333

367

.

332

.

.

.

.

330

.

.

.

.

2,400

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

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

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

60-99 Ids . ....................................

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

200 buds or more ...........................

Nonprofit and government .......

382

388

373

390

.

390

360

380

.

372

344

372

371

.

. . .

_

. .

.

. . .

.

. . .

. . .

. .

. . .

. . .

. .

31,30+3

41,800

19,700

.

26,200

●

✎

✎

✎

✎

✎

✎

✎

✎

✿

✎

●

✎

✎

✎

✎

✎

✎

●

✎

.

.

●

✎

✎ 358

334

366

355

404

Lass than 60 bcd$ ..........................

60.99 beds .....................................

6,100

10,600

10,300

5,600

68,000

—

23.400

24,000

14,400

6,200

37,900

5,700

10,800

7,500

.

. . .

_

. .

. . .

. .

. . .

.

. . .

. . .

.

.

.

13,700

100-189 bcd$ .................................

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

Not certified

All types of ownership .......

Lets than 60 beds ..........................

W.99 beds .....................................

100.199 beds .................................

200 beds or morn ...........................

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

Lass than 60 beds ..........................

50.99 baas .....................................

100-199 ~ds .................o.o.............

200 Lwdsor more...,, ......................

Nonprofit and government ......

Less than W beds ..........................

60.99 has .....................................

100.199 bads ............................w

20C Inds or more ...........................

329

. _

316

322

310

430

43,s00

48,800

27,500

14,400

74,900

386

370

369

392

407

273

321

316

548

303

273

327

.

.

381

17,2(Y3

20,400

9,400

5,800

34,800

141 ,00Q

16,000

4,400

●

18,000

3,100

4,500

3,700

2,400

●

.

.

.

●

11,500

353

343

364

360

.

33,200

30,500

10,100

●

59,600

400

413

439

●

339

18,600

13,800

4,700

●

30,200

...

...

...

...

...

..

.

.

299 .

231

251

282

444

10,600

16,300

17,400

13,200

330

312

334

406

4,800

10,200

9,700

5,500

.

.

320

566

3,100

4,50J3

5,000

5,500

.

.

.

.

2,700

3,700

2,800

.

...

...

...

...

...

...

...

...

...

.

...

..

...

.

lIncludes church support, VA .m”trmt, initial pe.yment/life care, no charge for care, and miscellaneous sources.

21ncludes only those residents whohave fivedin thenursing home foratlemt a month.

31ncludes 20,900 residents in facilities certified by Medicdi-e only.

41ncludes 122,900 residents in facilities certified by Medicaid as both 8NH’s and ICF’S.

39
Table 10. Averme total monthly charge forcareand number of residents, byprimaty source of payment, cenificatiOn, ownership, andgeWraphic region ofhom@: United States,

August 1973-April 1974

Other public assiwance or welfare

Own income or

family support All sources Medicare Medicaid All other sourcesl

Certification, ownership, and

region Average

total

nonthly

charge

Werage

total

~verage

total

nonthly

charge

Average

total

nonthly

charge

\verege

total

ncmthly

charge

4verage

total

nonthly

charge

Number

of

Numb

of

Wmber

of

esidents

Number

of

residents

Number

of

Uumbar

of

esldonts

nonthlv

charge”

All types of certification

$479 1,012,000 $491 371,700 $754

.

.

●

●

754

●

●

●

●

.

.

●

.

●

754

_

●

●

.

.

754

All types of ownership ........ 10,s00 $503 484,3oo $381 114,900 $225 30,200

_

651

433

410

454

489

223,000

350,100

262,700

176,200

706,500

139,800

211,400

210,100

145,300

305,400

83,2oO

138,700

52,600

30,900

372,300

837

449

452

487

526

665

490

460

519

427

543

39s

427

381

613

68,100

155,500

81,400

66,700

243,800

45,000

86,600

60,700

51,500

127,900

23,100

68,900

20,700

15,200

134,100

3,0Q0

2,600

2,9oO

.

8,100

2,700

.

.

●

2,6oO

.

●

●

●

10,800

_

3,0W

2,8W

2,900

.

8,100

718

454

408

442

488

705

449

405

439

556

742

466

424

454

591

116,500

124,700

146,000

96,1 W

367.000

538

360

306

323

373

23,400

55,500

27,000

8,000

77,700

14,300

34,300

23,500

5,600

37,300

131

252

278

●

4C6

.

.

.

.

136

9,9W

10,600

6,400

3,300

9,900

.

3,200

3.600

●

20,3fM

8,400

7,4W

2,800

●

8,300

—

2,600

3,200

●

.

2,900

●

.

●

●

5,300

PrOprietaV ...............................

883

453

411

465

456

78,40+3

85,600

120,4CKJ

84,700

117,300

629

362

308

313

Nonprofit and government ....... 397

599

402

407

401

592

42,100

39,100

24,600

11,500

200,900

552

357

.

.

480

9,100

22,2W

3,500

2,400

18,300

●

175

●

●

334

_

●

.

.

.

.

Both Medicare and Medicaid3

All types of ownership ........

_

784

557

504

502

588

100,900

89,700

72,800

109,000

2B5,600

741

569

556

584

825

32,900

36,600

26,500

38,200

103,800

644

545

471

468

586

57,100

39,800

39,000

65,000

157,700

585

488

.

.

4B1

576

478

●

●

479

5,300

7,300

3,400

.

13,000

4,0W

4,700

2,9(KJ

●

5,400

790

556

502

505

605

824

513

462

463

682

73,400

60,600

56,600

94,900

86,800

761

604

572

571

571

24,900

25,900

19,500

33,400

30,200

.

.

.

.

●

2,700

●

●

.

2,600

41,100

27,500

31,600

57,500

43,20JJ

●

●

●

✎

✎ Nonprofit and government .......

768

581

512

482

484

_

617

465

422

405

483

27,500

29,100

16,2oO

14,000

278,100

—

73,700

86,200

75,300

42,900

183,100

38,700

51,400

60,100

32,900

95,100

679

553

508

519

489

_

583

483

459

417

620

668

521

458

453

445

7,900

10,600

6,900

4,800

88,400

_

20,000

34,200

18,800

15,400

62,300

10,300

17,900

13,700

10,400

36,100

.

.

.

●

✎ ✎ ✎

✿

✎ ✎ ✎

✎ ✎ ✎

✎ ✎ ✎

✎ ✎ ✎

✎ ✎ ✎

✎ ✎ ✎

✎ ✎ ✎

✎ ✎ ✎

✎ ✎ ✎

✎ ✎ ✎

.

.

●

✎

✎ ✎ ✎

✿

✎ ✎ ✎

✎ ✎ ✎

✎ ✎ ✎

✎ ✎ ✎

✎ ✎ ✎

✎ ✎ ✎

✎ ✎ ✎

✎ ✎ ✎

✎ ✎ ✎

✎ ✎ ✎

884

617

510

934

489

_

646

471

411

399

466

622

475

410

400

544

15,000

12,300

7,300

7,500

162,900

—

45,200

39,600

53,200

24,900

114,900

23.20+3

26,600

43,700

21,400

48.000

●

●

✎

●

469

_

583

423

.

●

498

647

437

.

.

422

●

2,600

.

●

21,700

_

7,500

10,600

.

●

13,400

4,900

6,200

.

.

8.40Q

●

✎

✎

●

30B

●

.

.

●

.

.

2,500

●

●

5,100

—

●

.

●

.

2.400

Medicaid only: SNH4

All types of ownership ........

Proprietaw ...............................

637

486

420

416

486

●

●

✎

✎

✎

●

●

✎

✎

2.700

594

434

430

371

36,oOO

34,900

15,200

10,000

494

442

461

341

9,700

16,300

5,100

4,900

672

462

416

.

22,000

13,000

9,400

3,500

.

405

●

●

2,700

4,400

.

●

.

●

●

✎

.

*

●

●

...

...

...

...

...

...

...

...

See footnotes at end of table.

40
Table 10, Average totel monthlv charge forcareand number of residents, bv mimaw source ofpavment, cemrfication, ownemhip, andgeographic rwionof home: Unitti States,

August 1973-April 1974-Con.

Primary source of payrne”t

Other pubhc assistance or welfare

i=

All sources

Own income or

family support

Number

Average

total of

residents

monthly

charge

Medicare Medicaid All other murcesl

Certification. ownership, and

region

Aver@e

total

monthly

charge

Number

of

residents

Average

total

monthly

charge

Wmber

of

esidents

Average

total

monthly

charge

Number

of

.esidents

Average

total

monthly

charge

$376

-

481

366

359

369

382

475

383

361

368

358

502

340

349

.

329

\verage

total

nonthly

charge

Number

of

residents

Wmber

of

esldents

Medicaid only: ICF

All types of ownership, ....... 226,9oO II $388 81,200

_

4,800

47,400

22,300

6,700

49.700

$375

_

475

360

359

352

376

120,600

—

16,200

45,200

52,900

6,330

94,400

12,000

31,500

45,100

5,800

26,200

4,200

13,700

7,800

.

. . .

—

. . .

. . .

. . .

. . .

. . .

$333 22,000 .

.

.

.

.

.

3,200

●

.

.

.

2.400

...

_

...

.

.

.

.

...

_

...

...

.

..

23,600 515

104,000 378

84,6oo 376

14,700 402

.

331

316

.

334

●

10,000

8.700

.

Proprietary ............................... 16.500

t

163,000 410

17,600 542

62,7oo 410

69,700 385

13,000 398

3,800

23,200

16,900

5,800

31,500

.

24,200

5,400

.

68,000

457

371

360

353

372

526

335

354

.

.

_

.

. . .

.

. . .

. .

.

.

.

.

.

.

.

.

.

.

.

.

.

.

13,700

—

5,800

4,200

3,000

.

.

.

342

313

.

332

.

.

.

.

330

.

6,900

7,200

.

5,500

.

3,200

.

.

52,600

...

...

...

...

...

.

...

...

...

...

_

...

...

...

.

...

..

...

...

...

...

. .

.

.

..

...

..

.

.

_

. .

...

.

t

63,9oo 352

6,100 .

41,300 348

14,900 346

. .

.

.

,

.

.

_

.

.

.

.

Not certified

All types of ownership ........ 134,500 II 377

24,7oo 467

70,100 371

30,000 367

9,6oo 284

375

334

300

265

353

432

360

322

.

299

335

307

220

.

10,500

37,400

13,800

6,300

37,900

6,000

19,600

10,600

.

30,200

4,6oO

17,800

3,200

4,600

487

314

275

.

303

8,400

28,500

13,100

2,800

34,800 <r 74,900 407

10,100 490

36,7oO 407

23,6oO 376

4,500 .

.

308

283

.

381

3,800

16,400

11,900

2,6oO

18,000

.

.

.

.

.

.

.

.

11,500

...

..

.

.. .

...

...

...

...

...

z

59,6oo 339

14,600 438

33.500 333

6,4oo .

5,200 .

591

321

.

.

4,500

12,100

.

.

.

.

.

5,500

3,500

.

.

...

..

... .

,..

...

..

JIncludes church support, VA contract, initial ptiymc”t/ life care, no charge for care, and miseell. meom sources.

21ncludcsunly those residents h<ho livedin the nursmghome for tit bastarno”th.

31ncIudes 20,900 residentsin facilities certified byhfedicure rely.

41ncludcs 122,900 residen tsi” facilities certified by Medicaid as botlt SNH,s and IC1. .S.

41
Table 11. Average total monthly charge for care and number of residents, by primary source of payment, ownership, and type of service provided: United States, August 1973-April

1974

Ownership and type of service

prowded

All types of ownership2 ......

Nursing care ...................................

Personal care with nursing .............

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

Nursing care ...................................

Personal care with nursing .............

Nonprofit and government ,.....,

Nursing care ...................................

Personal care with nursing .............

Primary source of payment

All sources II Own income or

family support I

Medicare

Average Number Average Number Average

total total

of

total

monthly monthly of

residents residents

monthly

charge charge charge

-1-i $479 1,012,000$491 371,700 $754

495 655,600 516 236,600 803

448 356,400 447 136,200 .

489 I 708,500 II 525 I 243,800 I 754

499 I

487,900

I

542 I

167,400 I806

485 218,700 487 76,400 .

Number

of

residents

10,800

7,800

2,900

8,100

6,000

.

2,600

.

.

Medicaid I Cltherp.blic assistI ante or welfare

Average

total

monthly

charge

$503

501

507

488

466

485

556

557

556

t

Number I

Average

total

of monthly

residents charge

334,900 I

398

149,500 361

367,0CXI I 373

263,300 I

388

103,700 353

-t

117,300 397

71,600 422

45,700 374

Number

of

residents

114,900

62,5oo

52,400

77,700

44,400

33,300

37,300

18,200

19,100

All other sourcesl

Average

total Number

monthly of

char~ residents

$226 I 30,203

296 14,800

156 15,400

-1- 406 9,900

427 6,900

●

3,100

136 20,300

184 8,000

.

12,300

lIncludes church suppcmt, VA contract, initial payme@ife care, no charge fcmcare, and miscell,ww.aus sources.

21ncludes mdy those residents who have lived in the nursing h.ame for at least a month.

42
Table 12. Average total monthly charge for care and number of resid.mts, by primary source of payment, sex, age, primaw reason for admission, and length of stay since current

Sex, age, primaw reason

for admission, and length of

stay slnm current admission

Sex and w

edmission: United States, August 1973-April 1974

Primary source of payment

All sources II Own income or

family support

Other public assistance or welfare I

Medicare Medicaid All other sourcesl

Average

total

monthly

chars? +-l- Average Number Average

total total

monthly of monthly

charge residents charge

Wera9e

Number

of

residents

464,300

57,900

78,900

163,300

184,300

137,200

totai

nonthly

charge

$503

.—

457

503

517

605

495

of

residents

10,600

.

●

W

2,600

of

esidents

30,200

6,000

3,700

10,900

9,600

13,100

I

Both eexes, all ages,,...,,,,.., $754

.

.

725

.

. v

$381 114,900 $225

351 24,000 325

367 20,200 .

3s5 30,900 219

402 39,600 152

Undw 65 years ..............................

65.14 years...,.., .............................

~

76-64 years ....................................

85 years and over.,...,,.,,,,,,,,,,.,,..,..,

Male, all sges............................ 360 I 36,200 I 341

Under 65 years ..............................

66-74 years ....................................

76-64 years .,,,,,,..,,...,, <..,,..,.,..., ......

86 years and over..,., ......................

426 49,400 470 9,100

464 60,400 449 16,500

475 94,500 472 41,700

478 90,500 479 38,400

464 717,200 499 266,000

459

505

504

500

506

24,600

32,500

39,800

40,200

347,200

337 11,500 .

346 8,300 .

382 7,500 .

361 8,900 .

390 76,700 136

.

.

.

.

735

.

.

.

.

8,200

4,100

2,400

4,400

.

17,100

.

.

6,500

7,400

30,209

Female, all ages ........................

Under 65 years ..............................

65.74 years ....................................

76.64 years ....................................

85 years and over ...........................

441 58,100 520 10,400

479 91,500 482 30,400

493 265,000 497 107,800

467 302,500 504 117.500

.

.

726

●

754

.

●

4,000

2,600

10,800

455

501

521

506

503

33,40+3

46,400

123,40+3

144,000

484,300

364 12,400 .

361 11.900 .

366 23,400 .

4C$ 30,900 .

Prlmaw reason for admission

Total ................................... 381 114,900

[

225

281

.

●

.

225

331

.

●

.

261

●

136

it

479 1,012,000 491

498 815,200 506

368 66,400 364

419 119,800 468

284 10,500 .

371,700

_ _

Pfwlcd .........................................

*cial .............................................

Eahnvioml ......................................

Economic ......................................

301,700

31,900

35,700

2,400

784

.

●

●

754

-

785

781

.

●

●

●

.

10,400

.

.

.

10,s00

—

8,900

7,200

.

●

.

●

.

514

452

436

.

503

_

517

518

516

516

503

500

474

407,700

19,200

54,600

2,900

464,300

_

62,600

36,600

46,100

73,200

182.300

76,S00

69,400

408

305

331

.

77,600

9,100

26,300

.

17,900

6,200

2,900

3,200

30,200

Length of stay since currant

admission

Total ................................... 371,700 381

_

412

42S

397

400

382

367

346

114,900

15,200

7,500

7,700

13,800

38,600

19,900

27,400

1 to lassthan 6 months ..................

1 to Ieecthan 3 months ............

3 to less than 6 months ............

6to less than 12 months ................

1 to less than 3 yeafe .....................

3 to less than 6 years .....................

5 years or more ..............................

630 192,700 549 80,60Q

541 69,600 555 35,s0+3

520 102,900 544 44,800

501 158,3fXJ 512 68,0cm

479 357,700 485 128,200

459 149,700 456 48,200

411 153,500 412 46,700

5,400

2,600

2,700

2,600

7,8W

4,700

9,700

lkludes church support, VA contract, initial payment/fife care, no charge for care, and miscellaneom sources.

Zlncludes only those residents who have lived in the nursing home for at least a month.

43
Table 13. Average total monthly charge for care and number and oercent distribution of residents bv Ienrrth of stav since current

admission, according to level of care received an ximary source of pavment: United States, August ~973-April ‘1974

Average

total

monthly

charge mLength of stay since current admission

Level of care received and primary source

of payment

of

residents

1,012,000

Percent distribution of residents

All levels of carel ......................... $479

491

754

503

581

225

510

100.0 19.3

22.1

82.5

17.3

13.2

17.9

21.5

15.4

17.9

●

14.9

12.1

8.5

15.0

35.4 14.8 15.2

12.6

●

14.3

23.9

32.2

14,3

Own income or family support .....................

Medicare .......................................................

Medicaid .......................................................

Other public assistance or welfare .................

All other sources . ........................ ...............

371,700

10,800

464,300

114,900

30,200

411,100

100.0

100.0

100.0

100.0

100.0

100.0

‘ 34.5

●

37.6

33.6

25.9

34.3

13.0

●

15.9

17.3

15.5

Intensive nursing care,., ...................... 14.9

Own income or family support .....................

Medicare .......................................................

Medicaid .......................................................

Other public assistance or welfare .................

All other sources2 .........................................

541

773

504

427

267

480

151,700

6,800

205,900

37,800

8,900

98,700

100.0

100.0

100.0

100.0

100.0

100.0

23.0

85.1

18.8

18.1

26.7

20.0

26.0

●

16.7

●

●

18.4

17.7

●

14.1

11.3

●

15.3

34.5

●

35.9

32.9

●

34.5

12.8

●

16.7

16.6

●

15,7

12.1

●

14,5

21.2

27.5

Limited nursing care .......................... 14.4

Own income or family support .....................

Medicare .......................................................

Medicaid .......................................................

Other public assistanceor welfare .................

All other sources2,........................................

492

●

506

392

●

466

34,100

*

47,800

12,500

3,200

327,200

100.0

100.0

100.0

100.0

100.0

100.0

15.9

●

15.4

●

●

16.7

32.1

●

38.7

32.1

●

37.3

15.7

15.3

20.8

●

14.0

10.3

13,8

20.2

●

Routine nursing care ... ....................... 13.7

Own income or family support .....................

Medicare .......................................................

Medicaid .......................................................

Other public assistanceor welfare .................

All other sourcesz.........................................

467

●

498

364

231

435

116,100

●

162,900

37,100

9,100

165,900

100.0

100,0

100.0

100.0

100.0

100.0

22.6

●

16.5

10.5

●

15.6

19,1

●

16.2

13.9

●

14,0

35.6

*

39.8

35.1

29.3

34.8

12.1

14.8

16.6

●

15.6

10,7

●

12.7

23.9

28.1

Personal care ...................................... 19.9

Own income or family support .....................

Medicare .......................................................

Medicaid .......................................................

Other public assistanceor welfare .................

All other sources2 .........................................

430

●

508

339

178

315

64,300

●

66,300

26,100

8,200

9,000

100.0

100.0

100.0

100.0

100.0

100.0

18.1

●

14.8

10,9

●

●

16.8

●

14.0

9.9

●

●

34.3

●

37.2

33.7

●

29.8

13.6

●

16.4

17.8

●

●

17.2

17.7

27.7

36,9

No 31.4 nursing or parsonal care ................

Own income or family support .....................

Medicare .......................................................

Medicaid .......................................................

Other public assistance or welfare .................

All other sources2 .........................................

327

●

●

●

5,500

●

●

●

100.0

100.0

100.0

100.0

●

●

●

●

●

●

●

●

●

●

☛

●

●

●

●

●

●

☛

●

llncIudes only those residents in the home for at least a month.

%scludes church support, VA contract, initial payment/life care, no charge for care. and miscellaneous sources.

44
Table 14. Number of residents by sources of payment, sex, and age: United States, August 1973-April 1974

Sex and age

‘es::nts2 m“fpa’men”

Both sexes

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

Under 65 years ,,,...,,,,,,,,,., .....

66.74 years ............................

76-84 years ............................

85 years and over,,,..., ............

—Male

1,012,000

107,500

162,000

359,500

393.000

All ages.,.,,,,,, .........

r

294,800

Under 65 years ...................... 48,400

66-74 years.,,,,..,,, .................. 60,400

76.84 ynars,,,..,..,,,,,,.,,..,,.,...,. 94,500

8S years and over................... 90,500

Female I

m

221,200 I 4,5oo I 146,800

26,400 .

25,9oo

41,500 . 34,400

77,600 .44,300

75,8oQ ●

42,2oo

*

566,5W 13,700 35S,500

30,400 .34,400

66,200 .46,4oo

220,1 w 6,300 128,8oo

249,800 5,000 146,800

I

Number of sources of

payment

“.... ”.. .-

support contract meml ‘“”

life

charge

care

I

-1- 136,500 4,200

27,900 .

24,900 “

39,000 ‘

46,800 .

13,300

10,500 .

9,600 .

10,200 ●

:-

llncludea only those residents who have lived in the nursing home for at least a month.

?Numbcr of residents exceeds total since residents may have more than one ?,cmrce

Tof payment.

94,800 3,700

14,600 .

14,300 .

29,400 .

36,500 ‘

=Q=

●1 :

3,500

-L# 3,300 3,900

●

5,600

7,600 “

2,900

.

2,400 .

. .

2,403 9,200

I

. . . . . 3,500

●

5,000

8,900

=

.

.

3,000

3,200

2,800

.

.

.

.

6,100

.

.

.

2,400

7,500

~

.

.

.

.

4,100

.

.

.

.

3,4(WJ

.

.

.

.

533,400

—

62,300

79,700

167,200

204,300

Two Three

sources ‘our=s

or more

461,600

—

43,600

69,300

165,800

182,900

T

157,300 131,800

27,900 20,60Q

30,200 28,BO0

51 ,0J30 4 1,61XJ

48,200 40,900

34,400

49,500

136,200

156,100

23,000

40,500

124,200

142.00+1

17,000

—

.

2,900

6,600

5,800

5,700

.

.

.

.

11,300

.

.

4,700

4.400

45
Table 15. Number and gercent distribution of residents by number of sources of PaYment, according to Primarv source of payment:

United States, August 1973-April 1974

Primary source of payment

All sources ...................

Own income or family support ....

Medicare ......................................

Medicaid ..,..,, ...............................

Other public assistance or

welfare ......................................

All other sources . .......................

All sources ...................

Own income or family support,,..

Medicare ......................................

Medicaid ......................................

Other public assistance or

welfare ......................................

All other sourcas2 ........................

All

residents

1,012,000

371,700

10,800

484,300

114,900

30,200

I

One Two

source sources

533,400

330,200

3,000

132,600

53,000

14,700

461,600

39,700

6,800

343,300

60,300

11,500

Number of sources of payment

Secondary source I

Own Other Three

income public

Medi- Medic- All sources

or

assistcare

other or more

family aid antesourcesz

-“ipport or welfare

>L

Number of residents

401,700

5,700

330,100

58,400

7,500

4,800

3,200

*

●

21,000

19,000

*

●

*

100.0 46.2 52,5

100.0 48.6 38.0

Percent distribution of residents

39.7

53.0

68.1

50.9

24,9

20,900

9,100

●

10,300

●

13,100

8,400

●

*

●

●

m

L_I--lL

17,000

*

●

8,500

●

4,100

1.7

●

●

1.8

*

13,5

lIncl~des only those residents who have lived in the nursing home for at least a month.

Zlncludes church support, VA contract, initial payment/life care, no charge for care, and miscellaneous sources.

46
APPENDIXES

CONTENTS

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

Survey Desi~ ...............................................................................................................................

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

Sampling Desi~ ......................................................................................................................

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

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

Nonrcsponse and Imputation of Missing Data .........................................................................

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

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

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

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

Hypothesis Testing .......................................................................................................................

48

48

48

49

50

51

51

51

51

52

52

56

IL Definition of Certain Terns Used in Tfis Repoti .............................................................................. 58

Terns Relating to Factities .......................................................................................................... 58

Terns Relating to Residents ......................................................................................................... 59

Orographic Terms ........................................................................................................................ 60

111. Resident Questionnaire Used in the 1973.74Nationd Nursing Home Sumey ................................... 61

LIST OF APPENDIX FIGURES

I. Relative standard errors of estimated number of residents ................................................................. 54

IL Relative standard errors of estimated percentages of residents ........................................................... 55

LIST OF APPENDIX TABLES

I. Dk.tribution of faciMies in the 1973-74 Natiomd Nursing Home Survey universe and disposition of

. . .

sample faclhtres according to primary strata: contermmous Umted States ......................................... 49

IL Summary of data collection procedures ............................................................................................. 51

III. Standard errors of average total monthly resident charge................................................................... 53

IV. Worksheet for weighted least squares regression of average total monthly charges, by length of stay

since current admission: United States, 1973.74 ............................................................................. 57

47
APPENDIX 1

TECHNICAL NOTES ON METHODS

SURVEY DESIGN

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 DHRLJSin conjunction

with a group of experts in various fields encompassing the broad area of long-term care.13 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 assesslong-term care services.

Sampling Frame

The 1973-74 NNHS focused on nursing

homes which provided some level of nursing

care. Only facilities providing nursing care were

included because detailed questions on facility

services and resident health status were relevant

only to these facilities. They included both nursing care homes and personaI care with nursing

homes, while personal care homes and domiciliary care homes were excluded. Facilities 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 facilities providing such care are presented in appendix II.

The survey universe consisted of two groups

of facilities: those providing some level of nursing care as classified in the 1971 Master Facility

Inventory (MFI) and those opening for business

NOTE: The list of referencesfollows the text.

in 1972. The major group (93 percent) was composed of all nursing homes providing some Ievel

“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

description of how the MFI was developed, its

conten~, and procedures for updating and assessing its coverage has been published. 14-16

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. (Facilities opening

in early 1973 could not be included since data

about them were not yet available.) The facilities which opened in 1972 comprised the second, and smaller (7 percent), group of facilities

in the universe. Although the universe included

only facilities providing nursing care, all facilities

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) facilities which opened in

1973; and (3) facilities which, between 1971

and 1973, upgraded the level of care they pro48
vided, thereby meeting the “nursing care” cri- establishments. In preparation for the first-stage

teria when surveyed in the 1973 MFI. Data from sample selection, establishments listed in the

the NNHS are also subject to sampling variabil- MFI were sorted into three types of stratabased

ity, while data from the MFI are not, since the on Medicare and Medicaid certification: (1) both

MFI is a census. Medicare and Medicaid and Medicare only; (2)

Sampling Design

Medicaid only; and (3) not certified. Facilities in

each of these three strata were sorted into bedThe sampling was a stratified two-stage prob- size groups, producing 26 primary st~ata as

ability design: The first stage was a selection of shown in table I. The nursing homes in the uniestablishments and the second stage was a selec- verse were ordered by type of ownership, geotion of residents and employees of the sample graphic region, State, and county. The sample

Table 1. Distribution of facilities in the 1973-74 National Nursing Home Survey universe and disposition of sample facilities according to

rwimarv ..-samd ina strata: conterminous United States

Certification status and size of facility

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

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

Unknown number of beds .....................................................................................

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

26-49 bads ............................................................................................................

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

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

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

300499 beds ........................................................................................................

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

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

Unknown number of beds ................................... ..................................................

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

15.24 beds ....... .......... .................................. .........................................................

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

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

100.199 beds .,......................................................................................................

200.299 beds ........................................................................................................

300499 beds ........................................................................................................

500 bads or more ..................................................................................................

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

Unknown number of beds.....................................................................................

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

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

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

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

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

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

300499 beds ...................................................................................................... ..

600 beds or more ....................................................................... ...........................

Universe

(sampling

frame) 1

17,685

4,099

2

149

538

1,713

1,385

224

68

20

7,473

3

250

967

2,253

2,688

1,108

145

43

16

6,113

19

1,279

1,062

1,575

1,334

652

120

52

20

Number of facilities in sample

Total

facilities

2,118

803

0

3:

228

370

100

46

20

790

0

5

36

123

293

241

52

24

16

525

0

23

38

87

145

141

43

28

20

out of

scope

or out

>f business

147

20

0

0

0

7

8

4

1

0

34

0

1

5

11

4

3

5

3

2

93

0

10

9

13

19

21

12

4

5

In scope and in

businass

Nonresponding

63

26

0

1

1

7

11

3

2

1

24

0

2

1

3

8

6

3

1

0

13

0

0

0

3

5

4

0

1

0

desponding

1,908

757

0

3

34

214

351

93

43

19

732

0

2

30

109

281

232

44

20

14

419

0

13

29

71

121

116

31

23

15

lThe universe consisted of nursing homes ~ro~iding some level of numing care as classified in the 1971 MFI and those opened fOr

business in 1972.

49
was then selected systematically after a random

start within each primary stratum. Table I shows

the distribution of establishments in the sampling frame and the final disposition of the sample with regard to response and in-scope status.

The number of facilities estimated by the survey

(15,749) is less than the universe figure (17,685)

because some facilities went out of business or

out of scope between the time the universe was

“frozen” and the survey was conducted. Differences ranging from 2,100-2,900 between survey

estimates and universe figures occurred in the

1963,17 1964,18 and 196919 nursing home surveys for the same reason.

The second-stage selection of residents and

employees was carried out by the interviewers at

the time of their visits to the establishments in

accordance with specific instructions given for

each sample establishment. The sample frame

for residents was the total number of residents

on the register of the establishment on the evening prior to the day of the survey. Residents

who were 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 was in the sample per facility.

The sampling frame for empIoyees was the

Staff Control Record on which the interviewer

listed the names of all staff (including those employed by contract) and sampled professional,

semiprofessional, and nursing staff. Those generally not involved in direct patient care, such as

office staff, food service, housekeeping, 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

was in the sample per facility.

Data Collection Procedures for 1973-74

National Nursing Home Survey

The 1973-74 NNHS utilized eight questionnaires. (See appendix III for questionnaire relevant to this report, For all other data collection

instruments, see reference 1.)

Administrator Letter and Worksheet

Facility Questionnaire

Expense Questionnaire

Resident Control Record

Resident Questionnaire

Staff Questionnaire–Parts I and II

Staff Control Record

Data were collected according to the following procedure:

1. A letter was sent to the administrators of

sample facilities 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 admissions 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.

2. 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. At the time of the appointment, the following procedures were followed: The

Facility Questionnaire was completed by

the interviewer who interviewed the administrator or owner of the facility.

After completing this form, the interviewer secured the administrator’s permission to send the Expense Questionnaire to the facilit y’s accountant. (If financial records were not kept by an outside firm, the Expense Questionnaire

was filled out by the administrator, with

the interviewer present.) The interviewer

completed the Staff Control Record (a

list of all currently employed staff both

full and part time), selected the sample

of staff from it, and prepared Staff Questionnaires, Parts I and II, which were left

50
If

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 Iist 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.

the Expense Questionnaire was not returned within- 2 we;ks, 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.

Table II presents a summary of the data

collection procedures.

Table Il. Sur

Questionnaire

Facility ....................

~ Expense ...................

Rasident ...................

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

naryof data collection procedures

Respondent

Administration

Facility’s

accountant

Member of nursing

staff familiar with

care provided to the

resident or rasident’:

medical records (1O

sampled rasidents

par facility)

Sampled staff

member (14 per

facility )

Interview

situation

Personal

interview

Self-enumerated

question naire

Personal

interview

Self-enumerated

questionnaire

GENERAL QUALIFICATIONS

Nonresponseand Imputation

of Missing Data

Response rates differed

questionnaire as indicated by

for each type of

the following:

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 self-enumerated

(Expense and Staff). Statistics presented in this

report were adjusted for failure of a faciIity to

respond. Data were also adjusted for nonresponse which resulted from failure to complete

one of the questionnaires (Expense, Resident,

Staff) or from failure to complete an item on a

questionnaire. Those items left unanswered on a

partially completed questionnaire (Facility, Expense, Resident, Staff) were generally imputed

by assigning a value from a responding unit with

major characteristics identical to those of the

nonresponding unit.

Rounding of Numbers

Estimates of residents 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 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

estimates from the sample data.

51
Estimation Procedures

Statistics repoited 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 reciproczd 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 (zdong with the

above inflation factors) was included in the estimation of establishrilent data related to size, resident data, and staff data for all primary

certification-size strata from which a sample of

facilities was drawn. The numerator was the

total beds according to the Master Facility Inventory data for all facilities 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 first-stage ratio

adjustment was to bring the sample in closer

agreement with the known universe of beds. The

second-stage ratio adjustment was included in

the estimation of resident and staff data within

estabolishments. The second-stage ratio adjustment is the product of two fractions: 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 facility.

RELIABILiTY OF ESTIMATES

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 wilI differ somewhat

from figures 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 standard 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.

The estimated standard errors of the average

monthly charge used in this report are presented

in table 111.The chances are about 68 out of 100

that an estimate from the sample would differ

from a complete census by less than the standard error. The chances are about 95 out of 100

that the difference would be less than twice the

standard error and about 99 out of 100 that it

would be less than 2?42 times as large. Thus, for

example, the standard error of an average

monthly charge of $400 for a base of 100,000

residents is approximately $21 (table 111). The

chances are 95 out of 100 that the true value of

the average monthly charge is contained in the

interval $400 * $42 (i.e., between $358 and

.$442).

The relative standard error of an estimate is

obtained by dividing the standard error of the

estimate by the estimate itself and is expressed

as a percentage of the estimate. The relative

standard errors for the estimated number of

residents and for percentages in percent distribution of residents are presented in figures I and II,

respectively. 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. Illustrations of use of these relative standard error charts have been provided.

According to NCHS standards, reliable estimates are those which have a relative standard

error of 25 percent or less. Thus in figure I, an

estimate of 2,300 residents has a relative standard error of 25 percent. In this report, asterisks

are shown for any cell with a resident estimate

of less than 2,300 or a percentage which represents a number of less

more than a 25-percent

than 2,300, i.e., with

relative standard error.

52
I Table I I1. Standard errors of average total month [y resident charge

Average total monthly resident charge

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

Estimated number of residents

Standard error in dollars

●

●

79

72

67

62

59

56

39

32

28

25

23

21

20

19

18

12

10

9

8

7

7

6

6

5

5

●

●

88

80

74

70

66

62

44

36

31

28

25

23

22

21

20

14

11

10

9

8

7

:

6

6

●

●

93

84

78

73

69

65

46

38

33

29

27

25

23

22

21

15

12

10

9

8

8

7

7

6

6

●

●

97

89

62

77

;

48

40

34

31

28

26

24

23

22

15

12

11

10

9

8

7

7

7

6

3,500 ......................................................

4,000 .,, ,,,, ,., ,..,, .,,.., .................................

5,000 ......................................................

6,000 .....................................!................

7,000 ......................................................

8,000 ......................................................

9,000 ......................................................

lo.ooo ....................................................

20,000 ....................................................

30,000 ....................................................

40,000 ....................................................

50,000 ....................................................

60,000 ....................................................

70,000 ....................................................

80,000 ....................................................

90,000 ....................................................

100,000 ..................................................

200,000 ..................................................

300,000 ,..,., .........i.. i...............................

400,000 ..................................................

600,000 ..................................................

600,000 ..................................................

700,000 ..................................................

800,000 ..................................................

900,000 ..................................................

1,000,000 ...............................................

1,100,000 ...............................................

●

●

●

●

●

36

34

32

23

19

16

15

13

12

11

11

10

:

5

5

4

4

4

3

3

3

●

☞

●

60

55

52

49

46

33

27

23

21

19

17

16

15

15

10

8

7

6

6

5

5

5

4

4

●

●

101

93

66

80

76

72

51

41

36

32

29

27

25

24

23

16

13

11

10

9

8

8

7

7

7

●

118

106

97

89

84

79

75

53

43

37

33

31

28

26

25

24

17

14

12

10

9

9

8

8

7

7

●

●

●

‘*

47

44

42

39

28

23

20

18

16

15

14

13

12

9

7

6

6

5

5

4

4

4

4

●

●

74

68

63

59

55

53

37

30

26

24

21

20

19

18

17

12

10

8

7

7

6

6

5

5

5

●

☛

84

76

:;

62

69

42

34

30

26

24

22

21

20

19

13

11

9

8

7

7

6

6

6

5

*

123

110

101

93

87

82

78

55

45

39

35

32

29

28

26

25

17

’14

12

11

10

8

8

8

8

7

●

128

115

105

97

91

85

81

57

47

41

36

33

31

29

27

26

18

15

13

11

10

9

9

8

8

7

$550 $575 $600 $625 $650 $675 $700 $750 $800 $850 $900 $950 H ,000

Standard error in dollars

3,500 ......................................................

4,000 ......................................................

%% :::::::::::::::::::::::::::::::::::::::::::::::;:;;:;

7,000 ...............l......................................

8,000 ......................................................

9,000 ......................................................

lo.ooo ....................................................

20,000 ....................................................

30,000 ....................................................

40,000 ....................................................

50,000 ....................................................

60,000 ...............i....................................

70,000 ....................................................

80,000 ................................!0..................

90,000 ....................................................

100,000 ..................................................

200,000 ..................................................

300,000 ..................................................

400,000 ..................................................

600,000 ..................................................

600,000 ..................................................

700,000 ..................................................

800,000 ........o.........................................

900,000 ..................................................

1,000,000 ,..............................................

1,100,000 ...............................................

●

133

119

109

101

94

89

84

60

49

42

38

34

32

30

28

27

19

15

13

12

11

10

9

9

8

8

●

138

124

113

104

98

92

87

62

50

44

39

36

33

31

29

28

19

16

14

12

11

10

9

9

8

8

.

143

128

117

108

101

95

90

64

52

45

40

37

34

32

30

28

20

16

14

13

11

11

10

9

9

8

*

148

132

121

112

105

99

94

66

54

47

42

38

35

33

31

29

21

17

15

13

12

11

10

10

9

9

●

153

137

125

115

108

102

97

68

56

48

43

39

36

34

32

30

21

17

15

13

12

11

10

10

9

9

169

156

141

129

119

111

105

100

70

58

50

45

41

38

35

33

31

22

18

16

14

13

12

11

10

10

9

174

153

145

133

123

115

108

103

73

59

51

46

42

29

36

34

32

23

19

16

14

13

12

11

10

10

9

184

172

154

141

130

122

115

109

77

63

54

49

44

41

38

36

34

24

20

17

15

14

13

12

11

10

10

195

182

163

149

138

129

121

115

81

66

57

51

47

43

41

38

36

26

21

18

16

14

13

12

12

11

10

205

192

171

157

145

136

128

121

86

70

61

54

49

46

43

40

38

27

22

19

17

15

14

13

12

12

11

215

201

180

164

152

142

134

127

90

73

84

57

52

48

45

42

40

28

23

20

18

16

15

14

13

12

12

226

211

236

221

197

180

167

156

147

140

99

81

70

62

57

53

49

46

44

31

25

22

19

18

16

15

14

13

13

189

172

160

149

141

133

94

77

67

60

54

50

47

44

42

30

24

21

18

17

15

14

13

13

12

For reporting means (average total monthly percent.z” In figure I, this corresponds with a

charge), two basic criteria were used. The first base of at least 3,500. Thus, for example, in

table 13 the average charge for residents receiving limited nursing care and using all other

criteri~ was that the relative standard error of

the base (number of residents) was less than 20

53
Figure I. Relative standard errors of estimated number of residents 

100 

ii: 

70 

60 

50 

40 

30 

18 

a 

; 

5 

4 

3 

1 

:89 

.7 

.6 

.5 

.4 

-3 

.2 

.l 

..- 

I I ‘; I I 

I I I 

-- r . _ -- 

I 

I I ii III‘II I III1 IIII 

I 

I I I” I I I 

II I 

___L-- - -- . . ..---.----L-j_ 

2 3 4 56789 A 2 3 4 56789 A 2 3 4 56789 A 2 345 

loo 1,000 10,000 100,000 

6789 

1 ,ooo,ooo 

80 

70 

60 

50 

1 

.9 

.8 

.7 

-6 

.5 

SIZE OF ESTIMATE 

Illustration of use of figure I: An estimate of 2,300 residents (on scale at bottom of chart) has a relative standard error of 25 

percent (read from curve on scale at left side of chart) or a standard error of 575 (25 percent of 2,300). 
Figure II. Relative standard errors of estimated percentages of residents,

[Base of percentage shown on curves]

100

9080

70

60

50

40

30

1:

100

90

80

70

60

50

40

W’H-P4000W—I—W4 30

20

W.1111 S30,000 I ‘L I I

z 8

7

6

5

4

3

2

1

.9

.8

.7

.6

8

7

6

5

K

o

a

K

w

c1

2

n

z

$

w

>

4

3

2

I

!4( \ I

1,000,000

1

.9

.8

.7

.6

.5

.4

I

I I I I 1111111111

{

I

I

I 1111

{

I 1 I I I I I I I I I I 1 11111

1

I I I I I I I 111111

I

.5

.4

.3

.2

.1

I

I I I I I I I [ I I I [1 [1111

1 I I I I I I I 1111111111

I

I I , ,

I I I I I I I I I I 1111111

L—H-H+w’’’’’’””

.3

.2

.1

, I

l---f- 1 I I I I I Miiii I II 11111

4 56789A 2 34 56789

10

2 3

1

ESTIMATED PERCENTAGE

of the 484,300 Medicaid

error for

Illustration of use of fipre II.- TabIe 13 shows that 17.3 percent

reci~ients had a length of stav of less than 6 months. From fi,mre 2, the relative standard

17.5 percent (on scd”e at botto’m of chart) is between 4.8 percen; for a base of 300,000 (read from the

scale at left side of chart) and 3.7 percent for a base of 500,000. Using interpolation, the relative

standard error is 3.8 percent for a base of 484,300. The standard error in percentage points is equal to

17.3 percent X 3.8 percent or 0.66 percentage points.

55
sources for primary payment was unreliable

(since the base was 3,200) and was replaced with

an asterisk. If, on the other hand, the first criterion was satisfied, then the second criterion of

a relative standard error of 25 percent or less

must have been demonstrated as well. In table

III, average charges with estimates of standard

errors have a relative standard error of 25 percent or less, and asterisks denote failure to meet

this criterion.

HYPOTHESIS TESTING

Two methods of hypothesis testing were

used in this report:

Z test.–To test the difference between two

statistics (mean, percent, etc.) the standard normal test was performed to determine whether or

not to reject the null hypothesis (for the two

means Xl, X2, the null hypothesis is Ho: Xl =

X. with the alternative H. : X. # X.). The

st=adard error of the difference ;f the ;;o estu

A

mates is approximately the square root of the

sum of the squares of the standard errors of each

of the estimates. Thus if SE(X1 ) is the standard

error of X, and SE (X.) is the standard error of \

X2, the ‘standard e%or of the difference

(Xl - X2) is SE(X1 - X2) =<SEZ (Xl)+ SEZ(X2)

(This formula will represent the actual standard

error for the difference between separate and

uncorrelated characteristics although it is only a

rough approximation in most other cases.)

The null hypothesis is rejected (i.e., the two

means Xl and X2 are different) if the probability of a type I error is less than 5 percent, i.e., if

xl - X2

z. >1.96.

~SE2(X1 ) + SE2(X,)

For example, from table 1, the average charge

for the 706,500 residents in proprietary facilities

was $489 while the average charge for the

305,400 residents in nonprofit and government

facilities was $456. From table III, linear interpolation yields an approximate standard error of

$8.90 for proprietary facilities and $13.10 for

nonprofit and government facilities. Since

z=di%%=2“08> 1“96’

the average charge for residents in proprietary

facilities was higher than the average charge for

residents in nonprofit or government facilities.

Weighted least squares as a test for trend.–If

there exists a strong relationship between an independent variable (e.g., length of stay) and

average total monthly charge, then a useful test

for this relationship would be to fit a regression

line to the data to determine the slope and then

to determine whether or not this slope is significantly greater than zero. That is, a regression

line of the form Y = a + fljXi+Xi is to be fit to

the data, where in this case Y‘ = average total

monthly charge, X = length of stay, a = “Yintercept,” i.e., value of average total monthly

charge if length of stay equaled zero, B = slope

of Y on X, i.e., the rate of change in average

total monthly charge per unit change in length

of stay, and finally, e = unexplained error.

The data available from the National Nursing

Home Survey present certain very basic problems which discourage the use of classicaJ regression procedures. Among these problems are

violation of the assumptions of independence of

the original observations, violation of homoscedasticity, i.e., equal variances of the dependent

variable within each category of the independent

variable, perhaps violation of the normality assumption, etc. Dr. Paul Levy, formerly of NCHS,

has worked out a “modified regression model

which makes no assumptions about the original

observations and which makes no stronger assumptions about the sample estimates than are

made in testing whether two means are equal

when the estimated means and their standard

errors are obtained from complex surveys.“e

The proposed model is as follows:

1. Let ~. be the estimated mean and s.. be

its estimated standard error for th~ ith

group.

2. Let Xi be the midpoint of the independent variable for the group.

‘From an unpublished memorandum by Dr. Levy.

56
3.

4.

Assume Syi is based on a large enough

number of observations that it can be assumed it is, in fact, equal to cryiand thus

has no sampling error.

Further assume that

I

E (Y’)= a + (3Xi

V (Fi) = S~o fori=l,2, . . ..K.

where K is the number of groups.

5. Finally, it is assumed that the ~i’s are

normally distributed and they are statistically independent of each other.

The weighting procedure proposed weights all

observations by- the recipr~cai of the v;riance,

That is, wi = l/S$i and the mean ~ = ZwiX~/Zwi

and the mean ~= Zwi~i/Zwi.

‘ The slope is computed in a manner similar to

the’ classical least squares regression, by the following formula:

Zwi(xi-x) q

b =

MiJi(xi - X)2

Computationally, this is easily computed by

The variance of the slope is

a.f)i(xi- X)2 0;

~2 =

b [Zwi(xi - F)]2

Now since Wi = l/cT~i, this

plified to

MUi(xi - X)2

rs: =

[Zwi(xi - X)2]2 =

and computationally

formula can be sim1

Zw;(xi - X)2

Sb=v’ 1

Ewix:- (Zwi)z

An approximate normal deviate test can now be

performed by z = b/Sb. This would test the

hypothesis that @= O or, alternatively, compute

confidence intervals for /3.

As an example, the average total monthly

charge by current length of stay is recorded

as shown in table IV. Applying this described

method to the data shown, we have:

ZwiXi~i = 221.8860 ~ = 28.8583

2Wi = 0.01711 7= 474.4717

ZwiXi = 0.4938 b =-1.7779.

Zwiyi = 8.1182 sb = 0.3788

ZwiXi2 = 21.2192 z = b/Sb =-4.6935

Thus, since the z value is quite large, a negative

association is demonstrated between the average

total monthly charge and the resident’s current

length of stay in the facility.

Tabla IV. Worksheet for weighted least squares regression of average total monthly charges, by length of stay since current admission:

United States. 1973-74

Midpoint

Standard

Average

of lengtherror of

Langth of stay since current admission

total average

of-stay .#

Wi=+

monthly total Yi

group charge monthly

‘Fi

(months] charge

1 month to less than 3 months ........................................................................

3 months to less than 6 months ......................................................................

6 months to less than 12 months ............................................... ........ .............

1 year to less than 3 years ...............................................................................

3 years to less than 5 years ..............................................................................

5 years end more .............................................................................................

2.0

4.5

9.0

24.0

48.0

60.0

$541

521

499

479

459

411

28.3

25.2

20.4

12.8

19.6

17.7

800.89

635.04

416.16

163.84

384.16

313.29

.00125

.00157

.00240

.00610

.00260

.00319

57
APPENDIX II

DEFINITION OF CERTAIN TERMS

Terms Relating to Facilities

Facilities included in the survey. –lnstitutions included in the 1973-74 Nursing Home

Survey were those classified as either nursing

care homes or personal care homes with nursing

according to data colIected in the 1971 Master

Facility Inventory (MFI) Survey21 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 residents 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-puke-respiration

or blood pressure; full bed bath; application

of dressings or bandages; catheterization;

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.

Personal care 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.

NOTE: The list of references follows the text.

USED IN THIS REPORT

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 selfadministered medicines, or ?rovided assistance with three or more activities for daily

living (such as help with tub bath or shower;

help with dressing, correspondence, or shopping; help with walking or getting about;

and help with eating).

Certification status. —Certification status

refers to the facility certification by the Medicare and/or Medicaid programs.

Medicare refers to the medical assistance

provided in Title XVIII of the Social Security Act. Medicare is a health insurance

program administered by the Social Security

Administration for persons aged 65 years

and over who are eligible for benefits.

Extended care facility refers to certification

as an extended care facility under Medicare.

Medicaid refers to the medical assistance

provided in Title XIX of the Social Security

Act. Medicaid is a State-administered program for the medically indigent.

Skilled nursing home refers to certification

as a skilled nursing home under Medicaid.

Intermediate care facility refers to certification as an intermediate care facility under

Medicaid.

58
~ Not certified refers to facilities which are

not certified as providers of care either by

Medicare or Medicaid.

Type of ownership. –Type of ownership

refers to the type of organization that controls

and operates the nursing home.

~

Proprietary facility is a facility operated

under private commercial ownership.

Nonprofit facility is a facility operated

under voluntary or nonprofit auspices, including both church-related facilities and I

those not church-related.

Government facility is a facility operated

under Federal, State, or local government

auspices.

Bed. –One set up and regularly maintained

for patients or residents. Beds maintained for

staff and beds used exclusively for emergency

services are excluded.

Terms Relating to Residents

Charge. –The total amount charged to the

resident each month by the establishment. Included in the average total monthly charge were

all charges for lodging, meals, nursing care, special services, drugs, and special medical supplies.

Charges that were not part of the bill rendered

by the institution, such as those for services of

physicians, were not included.

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

in the facility at the time of the survey.

Age. –Age of resident at date survey was

conducted.

Reported chronic conditions and a’mpairments. —A reported condition was considered to

be the affirmative response by the respondent

to any and all categories of item 9 of the Resident Questionnaire. The respondent, who was

the nurse most familiar with the care provided

to the resident, reported the existence of these

chronic conditions and impairments based upon

knowledge of the resident’s health and by

checking the resident’s medical record.

Pn”mary diagnosis at last examination. –The

primary diagnosis was the condition reported by

the respondent in response to item 8 of the Resident Questionnaire. The list of conditions corresponds to ICDA Eight Revision.** With the

assistance of the interviewer, the respondent was

instructed to extract from the resident’s medical

record the primary diagnosis recorded at the

last examination.

Level of care received. –These levels are defined in terms of the nursing services actually

received by the resident.

Based on the services listed in item 12 of the

Resident Questionnaire, the following classifications were made, each succeeding level being

exclusive of the previous levels:

Intensive nursing care

Catheterization

Oxygen therapy

Intravenous injections

Tube feeding

Bowel/bladder retraining

Full bed bath

Limited nursing care

Application of sterile dressings

Irrigation

Hypodermic injections

Routine nursing care

Enema

Blood pressure reading

Temperature-puke-respiration checked

Personal care

Rub or massage

Special diet

Administration of treatment or medication

Assistance in personal hygiene or eating

No nursing or personal care. –None of the

preceding services were received.

Length of stay since current admission. –

Length of stay refers to the current stay of a

resident in the facility. It means the period of

stay starting from the date of most recent admission to the institution to the date of the

survey.

59
Pra”mary source of payment. –Primary source

of payment refers to private income or medical

assistance used in payment for resident’s stay in

the nursing home.

Own income is any private source or income

from investments, Social Security, or pension plans.

Medicare refers to payments from Medicare

program described above.

Medicaid refers to payment from Medicaid

program described above.

Other public assistance refers to any public

assistance other than Medicare and Medicaid.

Other refers to all other methods of payment or support including church support,

VA contract, initial payment for life care,

cases for which no charge was made, and

miscellaneous sources.

Geographic Terms

Classification of homes by geographic area is

provided by grouping the States (excluding

Alaska and Hawaii) into regions. These regions

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

the Census and are as follows:

Regz”on States included

Northeast .............. Maine, New Hampshire,

Vermont, Massachusetts,

Rhode Island, Connecticut,

New York, New Jersey,

Pennsylvania

North Central ....... Michigan, Ohio, Illinois,

Indhma, Wisconsin, Minnesota, Iowa, Missouri, North

Dakota, South Dakota, Nebraska, Kansas

south .................. Delaware, Maryland, District

of Columbia, Virginia, West

Virginia, North Carolina,

South Carolina, Georgia,

Florida, Kentucky, Tennessee, Alabama, Mississippi,

Arkansas, Louisiana, Oklahoma. Texas

West ..................... Montana, Idaho, Wyoming,

Colorado, New Mexico, Arizona, Utah, Nevada, Washington, Oregon, California

000

60
APPENDIX III

RESIDENT QUESTIONNAIRE USED IN THE

1973-74 NATIONAL NURSING HOME SURVEY

I

NOTE: See reference 1 for copies of W instruments used in the survey.
RESIDENT QUESTIONNAIRE

1973 Nursing HOmC Sutvey

National Canter for Health Statistics

Health Resources Administration

Rockville, Maryland

1.7

OMB #6684-72172

Exoires 7-31-74

,,=,” , ,“”. ESTABLISHM’”Y “n I

1

ASSURANCE OF CONFIDENTIALITY – All information which wouki permit identification

of the individual will be held in strict mnfidence, will be used only by persons errgagcd in and for

the purpoeas of the survey, and will not lx disclosad or released to others for any purposes. I I I I I I I

ccl 4-t

LINE NO.

I

ccl 1

1. WHAT IS – DATE OF BIRTH?

mnu”rn

Month pay Year A@

CC15,16 17.18 19-21 CC22-24

2, WHAT 1S– SEX? ❑ Made ~ Female

25-1

3. WHAT IS – ETHNIC BACK- 26-1 ❑ Caucasion -2 ❑ Negro -3 ❑ Oriental

GROUND? (Mark (X) Only

one box) -4 ❑ Spanish American -5 ❑ American Indian 43 ❑ Other

4. WHAT IS – CURRENT MARITAL 27-1 ❑ Married -2 ~ Wdwad -3 ❑ Oivorced

STATUS? (Mark (X) only

one box) -4 ❑ Separated -5 ❑ Never Msrriad

5. WHAT WAS THE DATE OF – CURRENT ADMISSION TO THIS PLACE?

non

Month Day Year

CC28, 29 W31 32-34

6a. WHERE DID - LIVE AT THE TIME OF ADMISSION? (Mark (X) only one box]

(1)

(2)

(3)

(4)

(5)

(6)

(7)

In a bosrding home 35-1

In anothsr nureing home or relatad facility -2

In a mental hospital or other long-term spacialty hospital -3

In a general or short-stay hoepital 4

In a private apartment or house -5

Other pl=e, (Spacify) -6

36-

Oon’t know -7

•1

•1

•1

•1

nu

(1)

(2)

(3)

(4)

(5)

[6)

AT THE TIME OF ADMISSION

DID – LIVE WITH: (Mark IX)

all that epply)

Yas

Spouel?? 37-1 ❑

Children? 36-1 H

Other relatives? 38-1 H

Unrelated parsons? 4&l ❑

Livad alone? 41-1 ❑

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, enter “2”.)

43.

44

46-

46-

Form 73NHS-7

62

•1

•1

•1

•1

Physical recwns (e.g., illness or nead for treatn-pmts)

Social ressons (e.g., no family, or lack of family interest)

8ehwioral reasons (e.g., disruptive bahsvior, mental detariorstion)

Economic reesons (e.g., no money andlor resourcss)

No

“2•1

“2•1

-2•1

-2•1

-2 •1
8, WHAT WAS THIS RESIDENT’S PRIMARY DIAGNOSIS: (Mark (X) only one box in eschcolumn)

a, AT ADMISSION? b. AT THE TIME OF–LAST EXAMINATION?

49,50 ❑ aOl

❑ aoz

❑ laoz

•1 ,Of

•1 am

❑ affi

•1 W

•l a06

❑ ,09

•l alO

•l all

•l a12

•l ●13

•l ●14

•1 ,15

❑ a16

•l al?

❑ a18

•l a19

•1 azo

•1 021

IJ a22

51,52 ❑ bol

•1 boz

❑ boz

clbo4

clbo5

❑ bo5

❑ b07

❑ lbos

❑ bo9

❑ b10

❑ bll

❑ b12

❑ b13

❑ b14

❑ b15

❑ b16

❑ bl?

❑ b18

❑ b19

❑ b20

❑ b21

❑ b22

Senility, old age, and other symptoms and illdefmed conditions (e.g., coma, uramia)

Haart attack (e.g., ischemic haart disaa=)

Stroke (e.g., cerebrovascular disamed

Hardaning of arterias (e.g., arteriosclerosis, disaasas of the arteries, arerioles, mpillarias)

Other diseasm of the circulatory system (e.g., NOT heart attack, stroke, or hardening of the arteriaa]

Accidents, poisonings, and violence (e.g., fracture of h!p, other broken bonas, burns, concussion)

Mental disorders (e.g., mental retardation, psychrxas, neurosas, mental illness, emotional problems)

Diseases of the musculoskeletal system and connective tissue (e.g., arthritis, rheumatism, back pain)

Endocrina, nutritional, and metabolic diseases (e.g., goiter, diabatas, gout)

Diseases of the respiratory system (e.g., pneumonia, emphysema)

Neoplasm (e.g., cancer, tumors)

Diseases of the nervous system and senss organs (e.g., Parkinson’s d!sease, glaucoma, catar~ts,

blindness, multiple sclerosis, spastic paralysis, epilepsy)

Diseasas of the digestive systam (e.g., cirrhosis of livar, deer, imesti”al obstruction)

Infective and parasitic diseases (e.g., T.B., polio, syphilis)

Diseases of the genitourinary system (e.g., nephros.is, chronic pelvic infection, hyperplesia of prostata)

Diseases of tha skin and subcutaneous tissue (e.g., cellu Iitis, abecass, chronic ulcer)

Disaeses of the blc-ad and blood-forming organi (e.g., anemia)

Congsrsital anomalities (e.g., hydrocephalus)

Complications of pregnancy, childbirth and the puerpwium (e.g., infactions, hemorrhage, toxemies)

Cartain wusas of psrinatal morbidity and mortality (e.g., birth injury or immaturity of infant)

Don’t know

Other (Spacify) 54-

53.

9. DOES – HAVE ANY OF THE FOLLOWING CONDITIONS OR IMPAIRMENTS? (Mark (x) all that apply)

CC55-65 -1 ❑ a. Senility (includes decline in intellect, memory, and judgement, loss of orientation, cliff icu lty in spaaking; fe~lenets.)

“2 •1 b, Mental illness (Psychiatric or amotional problems)

-3 •1 c, Mental retardation

-4 ❑ d. Arthritis or rheumatism

‘5\

Paralysis or palsy othar than arthritis

e. (1) IS THIS THE RESULT OF A STROKE? ❑ Yes ❑ No

66-1 -2

*cIf. Glaucoma or catarwts

-~ ❑ g. Diabetes

-8 ❑ h. Any CHRONIC trouble with back or spine

-9 •l i. Amputation of extremities or limbs or permanent stiffness or any deformity of the foot, lag, fingars, arm, or back

-0 ❑ j, Heart trouble

OR

-auk Resident has none of tha above conditmns or impairments

Form 73NHS-7

63
10. DOES THIS RESIDENT REGULARLY USE ANY OF THE FOLLOWING AIDS?

No

CARD 2

14-2 a. Walker 15-2 ❑

b. Crutches 16-2 n

c, Braces 17-2 ❑

d. Wheelchair 1s-2 ❑

e. Artificial Limb 19-2 ❑

f. Salf-feadar 20-2 a

9. Any other ●ida (do not cwnt glaasa$ or hewing ●ids) 21-2 D

Yes

-1 c1

-1 D

-1 IJ

-1 •1

-1 c1

“’ c1

-’ c1

\

Sp3cify 22-

11. DURING THE LAST MONTH. HOW MANY TIMES DID-RECEIVE ANY OF THE FOLLOWING THERAPY SERVICES? (INCLUDE

ONLY SERVICES PROVIOED BY A LICENSED OR REGISTERED PROFESSIONAL WHETHER INSIOE OR OUTSIDE THE hOMEJ

.

a.

b.

c.

d.

e.

f,

Physical therapy

Recreational therapy

Occupational therapy

NUMBER OF

TIMES

❑ Ncmaor I I

CC23

❑ Nom?or I I

CC25

❑ None.or I

CC27

Spaach tharapy ❑ Ncmaor

1 I

CC29

Hearing therapy

Profa$aional countaling by smial

wwrkar, psychologist or other

mental health worker

❑ Nme.r 1 I

CC31

❑ None or I I

CC33

12. DURING THE PAST 7 DAYS, WHICH OF THESE SERVICES DID–RECEIVE? (Mark (X) all that apply)

CC35-62 -01 ❑ Il.

-02 ❑ b.

-03 a c.

-~ •1 d,

-05 ❑ &

-05 u f.

“07 •1 9.

-OS ❑ h.

-~ Cl i.

-10 a j,

-11 ❑ k.

-12 fJ 1.

-13 Q l-n,

OR

-14 ❑ .,

Rub or masaaea

Administration of treatment by staff

Special diat

Application of aterila dreasinga or bandages

Temperature-pulsa-respketion

Full bad-bath

Enema

Catheterization

Blood pressure ratiing

Irrigation

Oxygen therapy

Intravenous iniaction

Hypodermic injection

None of the above services received

Form 73NHs-7

64
13. DURING THE PAST 7 DAYS, DID – RECEIVE ANY MEDICATIONS?

CARD 3 ,9 No (Skip to Q.mtion 14)

T

~ ‘e’

WHICH TYPES OF MEDICATIONS DID – RECEIVE? (Mark (X) All That Apply)

ccl 6-45 -01 ❑ a.

-02 ❑ b.

-03 ❑ c,

-04 ❑ d.

-05 ❑ e.

-~ •1 f.

-07 l-J g.

-M ❑ h.

-09 ❑ i.

-10 ❑ j.

-11 ❑ k.

-12 ❑ 1.

-13 ❑ m.

-14 ❑ n,

-15 ❑ 0.

Tranquilizers (e.g., Thorazine, Mellaril)

Hypnotics – Sedatives (e.g., Nembutal, Seconal, Phenobarbwal, 8utisol, Placidyl, Chloral Hydrate)

StOOl softeners (e.g., Peri-COlace)

Anti-Depressant (e.g., E1.mil)

Anti-Hypertensives (e.g,. ismetin)

Diuretics (e.g., Dwril, Esidrex)

Analgesics (e.g., Aspirin, Darwin, Demerol, Percodan, Empirm w!th Codeine]

Diabetic agents (e.g.. Orinase, Insulin)

Anti-inflammatory agents (e.g., CortwJne, Sodium Salicylate, Butazolidin, I tiocin)

Anti-in fwtives (I.e., antibiotics)

Anti-Anginal drugs (e.g., Nitroglycerin, Peritrate)

Cardiac G Iycosides (e.g., Oigitalis, Lanoxin)

Anti-Coagulants (e.g., Dicumarol, Warfarin)

Vitamins or iron

Other types of medications not listed ebove

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~RESIDENT.

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)

46-1(-J

“2 •1

“3 •1

-4 •1

“5 •1

Perform all four with no assistance?

Perform all four with no assistance, but needs help In getting and/or putting away equipment?

Perform three or four with no aswstance, but requires help w,th a complete bath?

Require assistance with one or two of these hygiene act!wtles?

Require assistance with all four of these hygiene =tivitles~

b. CONCERNING DRESSING, DOES THIS RESIDENT:

(Mark (X) Only One Box)

47-1 ❑ Get clothes from closets and drawers and completely dress without assistance?

.2 ❑ Get clothes from closets and drawers and completely dress with some assistance (tying shoes, fastenl w braces, Ciosi”g butto”~ or

zippers in back of garments)?

.3 ❑ Receive a~istance in LEttift9 clothes, or in dressing (do not count tying shoes, fasten!ng braces, ciosl”g b“tto”s w *iPWrs i“ ~ck

of garments as assistance)?

.4 ❑ StaY Partly Or completely undressed?

c. CONCERNING FEEDING, DOES THIS RESIDENT:

(Mark (X) Only One Box)

4s-1❑

“2 •1

-3 •1

-4 •1

-5 ❑

Feed self without easistance?

Feed self with minor assistance (cutfmg meat or buttering bread)?

Receive major assistance in feeding (do not count cutting meat or buttering bread)~

Require intravenous feeding?

Require tuba fe-ading?

Form 73NHS-7

65
d. CONCERNING AMBULATION TO REACH THE TOILET ROOM, IS THIS RESIDENT:

IMark IX) Only One Box)

51-1 ❑ Able to go to the toilet room without nurses’ assistance (may use cane, walker, wheelchair, or other objact of support), may

maria@ bedpan or commcde at night?

.—

“2 c1 Receiving nursas’ 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 clothas after elimination?

‘3 ❑ Unable tO w tO the toilet room for the elimination prOC=S?

e. CONCERNING MOVING IN AND OUT OF A BED OR CHAIR, IS THIS RESIDENT:

(Mark (X) Only Ona Box)

Receiving no assistance? 52-1 ❑

Walking with assistance of one person? -2 •1

Walking with assistance of two persons? -3 •1

UP in a chair with assistance once in 8 hours? )

-40

lJP in a chair with assistance twice in 8 hours?

Badfast with assistance in turning every two hours?

8edfast with assistance in turning every hour? I

-5 •1

e.(1) DOES – HAVE

-6 ❑ BED SORES?

-7 ❑

f. CONCERNING CONTINENCE, IS THIS RESIDENT:

(Mark (X) Only One Box)

I n control of both bowels and bladder?

An ostomy patient?

In control of bladder only?

In control of bowels only?

Not in control of bowels or bladder?

53-1

Y ‘es 7

No

(continue with part f.)

54-1 Q

“2 •1

-3 ❑

“4 •1

}

f.(1) IS – RECEIVING BOWEL AND/OR

BLADDER RETRAINING?

-5 •1

55-1 ❑ Yes (Skip to Question 15a.)

kf(z) wolJLD RETRAINING GIVE THIS

RESIDENT CONTROL OVER

BOWELS AND/OR BLADDER?

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) 0epreas6d 57-2 ❑ -1

(2) Agitated, nervous 59-2 a -1

(3) Abusive, a~assive 61-2 ❑ -1

(4) COnfus.xJ, senile 63-2 ❑ -1

(5) Oisturbed sleep 65-2 ❑ -1

(6) Other problem behavior 67.2 ❑ -1

Yas

D -

D

@ (Specify) 68

More of tan than

once a waak

58-1 ❑

60-1 ❑

62-1 ❑

64-1 ❑

66-1 ❑

~ 69.1 ❑

Once a week

or less

‘2 •1

‘2 ❑

‘2 •1

“2 •1

“2 •1

“2 •1

Form 73NHs-7

66
18a. DURING THIS RESIDENT’SSTAY HERE, WHEN DID – LAST SEE A PHYSICIAN FOR TREATMENT, MEDICATION, OR FOR

AN EXAMINATION?

CARD 4 Month Day Year

“~

OR ~~1 Hm Never Seen A Doctor While Here (Sktp to

Questmn 17a.)

b. AT THAT TIME, DID – RECEIVE:

Yes No

(1) An examination? 22-1 H -2 c1

(2) Treatment? 23-1 ❑ -2 •1

(3) Prescription? 24-1 ❑ “2 •1

(4) Other? 25-1

%

“2 •1

Specify 2sC, DID THE PHYSICIAN ATTEND THE RESIDENT: (Mark (X) Oniy One Box)

27-1 ❑ es a private physician?

‘2 ❑ fOr the =itwlf which furnishes the medical care?

‘3 •l tem~rarily as a replacement for the resident’s private physician ~hO WaS “n*Ie to attend the r~ide”t~

-4 ❑ under some other arrangement? (Specify) 28.

d. DOES A PHYSICIAN EXAMINE THIS RESIDENT: (Mark (X) Only One Box)

29-1 ❑ only when called?

‘2 ❑ imegularly, 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 week

-2 ❑ every 2 weeks

-3 ❑ once a month

-4 ❑ every three months

-5 ❑ once a year

-6 ❑ other (Specify) 31-

1 ?a, DOES - WEAR EYE GLASSES?

Yes

32-1 9 b. IS - SIGH+ WITH GLASSES: (Mark (X) Only One Box) c. IS – SIGH+: (Mark (X) Only One Box)

33-1 ❑ not impaired? (e.g., can read ordinary newspaper 33-1 ❑ not impaired? (e.g., can read ordinary newspaper

print) print without glasses)

‘2 •l p~tiallv immir~? (e.g., can watch television 8 tO

12 feet ecross the room)

‘2 ❑ partially impair~? (e.g., can watch telavisio” 8 to

12 feet across the room)

‘3 ❑ 5eVerelY impaired? (e.g., can recognize the features ‘3 ❑ swerelY imiMired? (e.g., can recognize the features

of familiar persons if they are within 2 to 3 feet) of famillar persons if they are within 2 to 3 feet)

-4 ❑ completely lost? (e.g., blind) -4 ❑ completely lost? (e.g., blind)

18a. DOES - USE A HEARING AID?

Yes

%’

No

34-1 b.7

b. IS-HEARING WITH A HEARING AID: c. IS –HEAR[NG: (Mark (X) Only One Box)

(Mark (X) Onlv One Box)

35.1 ❑

.2 •1

-3 •1

-4 El

not impaired? (e.g., can hear a telephone conversation 35-1 ❑

on an ordinary telephone)

partially impaired? (e.g., can hear most of the things -2 ❑ a person says)

severely impaired? (e.g., can hear only a few words a

-3 El

person says or loud noises)

completely lost? (e.g., deaf) ~Cl

not impaired? (e.g., can hear a telephone conversation

on an ordinary telephone)

partially Impaired? (e.g., can hear most of the things

a person says)

severely impaired? (e.g., can hear only a few words a

person says or loud noises)

completely lost? (e.g., deaf)

Form 73NHS-7

67
19. IS - ABILITY TO SPEAK: (Mark (X) Only One Box)

3B-1 ❑ not impaired? (e.g., is able to be understood; can carry on a normal conversatmn)

‘2 ❑ PartiallY Impaired? (e.9., is able to be understood but has difficulty pronouncing some words)

‘3 •l s~erel~ imwir~? (e.9., =nnOt carw on a normal conversation; IS understood only with difficulty)

-4 II completely lost? (e.g., is mute)

20a. DOES THIS RESIDENT HAVE DENTURES?

•l Yes

7

~ No (Skip to Question21s.)

39-1

b. DOES - USE THE DENTURES?

❑ Yes ~ No

4CL1

21a. DURING THE LAST MONTH, DID – LEAVE THE HOME FOR ANY RECREATIONAL OR LEISURE ACTIVITIES?

A ‘es AN”

b. FOR WHICH OF THE FOLLOWING ACTIVITIES c. WHY DIDN’T – LEAVE THE HOME TO PARTICIPATE IN

DID - LEAVE THE HOME? (Mark (X) All That Apply) ANY ACTIVITIES DURING THE LAST MONTH? (Mark (XJ

CC42-52 -1 ❑

“2 •1

-3 •1

-4 •1

“5 ❑

-6 ❑

-~ •1

-6 ❑

-9 ❑

-0 •1

All That Apply)

Get books, etc., from the library CC42-52 -1 ❑

Attend plays, movies, concerts, etc.

Attend arts and crafts classes outside the home

Visit museums, parks, fairs, etc.

Goon shopping trips organized by the home

Go or) independent shopping trips organized

by the resident or visitors

Visit a beauty shop or barbar shop

Visit community clubs (such as community ten.

ters, senior citizen clubs, service clubs, bridge

clubs, unions, etc.)

Attend religious sewices or other religious activities

Go for a walk

-Z ❑

“3 •1

-41J

-5 •1

-80

-7 •1

-B ❑

Resident was too Ill or was not abla m MOW

well enough to participate

Resident was not interested

Staff waa unable to determine resident’s interests

at this point

Staff feels that the resident’s behavior

wil I not be tolerated outsida the home

No one was available to accompany the resident

Resident cannot afford these activities

Lxk of transportation

Other, (Specify) 53-

-& ❑ Other, (Spacify) 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.estio” 23a.)

?-2

~ Do”l k“ ow (Skip to Question 23a.)

54-1

b. WHERE DID – USUALLY GO WHEN ON LEAVE? (Mark (x) Cmlv One BOX)

55-1 •1

-2 •1

-3 •1

-4 •1

-5 •1

-6 ❑

-7 •1

To own home or apartment

To home of family or relatwes

To home of unrelated friends

To foster home

To boardinghouse or room

To another place, (Specify) 56-

Don’t know

c. ABOUT HOW OFTEN DID THIS RESIDENT GOON LEAVE? (Mark (X) Only One Box)

—

57-1 ❑

-2 •1

-3 •1

-4 •1

-5 •1

-6 ❑

-~ •1

Form 73NHS-7

Nearly avery weak

About once a month

About once every two months

Several timas a year

About once a year or less

Other (Specify) 58-

Don’t know

68
23a. DOES – HAVE ANY VISITORS?

w /R’es ~Que,&:n’’knOw

b. HOW FREQUENTLY DO VISITORS SEE THE RESIDENT? [Mark (X) Only One Box)

16.1 ❑ Nearly awry week ‘5 ❑ AbOut once a year or Ie~~

‘2 ❑ About once E Inc)mtl

.6 ❑ Other (Spec!fy) 17-

“3 ❑ About once every two mwstll~

-7 ❑ Oon’t know

.4 ❑ Several times a year

24. HOW MANY BEDS ARE IN - ROOM? (Mark (X) Only One Box)

18.1 ❑ One bed (i.e., the resident’s own bed) -4 ❑ Four beds

.2 ❑ TWO beds -5 •1

Fwe or more bads

-3 ❑ Three beds

25a. HAS THIS RESIDENT LIVED IN THIS FACILITY FOR ONE FULL MONTH OR LONGER?

❑ Yes ❑ No

19-1 -2 7

Stop, go on to next

questionnaire.

b. LAST MONTH, WHAT WAS THE BASIC CHARGE FOR THIS RESIDENT’S LODGING, MEALS, AND NURSING CARE

NOT INCLUDING PRIVATE DUTmSING OR OTHER SPECIAL CHARGES?

❑ NCJcha rga is mede for care (Sk!p m Questmn 26a.) $

●

CC20-25

c. LAST MONTH, WHAT WAS THE TOTAL CHARGE FOR THIS RESIDENT’S CARE, INCLUDING ALL CHARGES FOR

SPECIAL SERVICES, DRUGS, AN=IAL MEDICAL SUPPLIES?

❑ Nochar~ isnwdeforcare LSkptoQuestm” 26a.)

~ $ ‘“’-3’ “—

(1) DID THIS AMOUNT INCLUDE SPECIAL CHARGES FOR

la)

(b)

(c)

(d)

(e)

(f)

(g)

physician services? 32-2

prwate duty nursing? 33-2

therapy? 342

drugs? 3!3-2

special med!cal supplies? 36-2

special diet? 37-2

other? 36-2

Yes

: -’ ❑

•1 “’ ❑

•1 -1 ❑

•1 -1 •1

•1 “’ •1

•1 -’ •1

❑ “’

Specify

P

-39

26a. WHAT WERE ALL THE SOURCES OF PAYMENT FOR THIS RESIDENT’S CARE LAST MONTH?

(Mark (X) All Th%%ply)

CC40.4B ❑ (1) Own income or family ❑ (4) Other p”blicassmtame ❑ (7) Initial pi3yrnentsupport (private plans, or welfare life care

retirement funds, social

security, etc.) a (!3 Ctmrch support ❑ (8)~o;;Es isrrmde

❑ (2) Medicare (Title XVIII, n (6) VA contract

❑ (3) Medicaid(Title XIX)

❑ (9) Other (Specify)~ 49

b, WHAT WAS THE PRIMARY SOURCE OF PAYMENTS FOR - CARE LAST MONTH?

(Mark (X) Only One Box.)

5G1 ❑ Own income or family “4 ❑ Other Public assistance -7 ❑ Initial paymentsupport (private plans, or walfare life care

retirement funds, eocial

sacurity, etc.) -5 ❑ Church support -8 ❑ No char~ ISmade

‘2 ❑ Madi~re (Title XVIII)

for care

-6 ❑ VA contract

.9 ❑ Other (Srmcify) 7

.3 ❑ Medicaid (Title XIX) 51-

Form 73NHS.7

*U.S. GOVERNMENT PRINTING OFFICE: 1978–260-937:40 69
VITAL AND HEALTH STATISTICS PUBLICATIONS SERIES

Formerly Public Health Service Publication No. 1000

Series 1. Programs and Collection Procedures. –Reports which describe the general programs of the National

Center for Health Statistics and its offices and divisions, data collection methods used, definitions, and

other material necessaty for understanding the data.

Serz”cs 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.

SC)%S 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$vm the Health Interview Survey. –Statistics on illness; accidental 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 j?om 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 ipecific 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 tmiverse of persons.

&7it’s 12. Data from the Institutionalized Population Surveys. –Discontinued effective 1975. Future reports from

three surveys will be in Series 13.

tkyic.s 13. Data on Health Resources Utilization. –Statistics on, the utilization of health manpower and facilities

providing long-term care, ambulatory care, hospital care, and family planning services.

Seri,x I ~. Data on Health Resources: Manpower and Facilities. –Stat istics on the numbers, geographic distribution, and characteristics of health resources including physicians, dentists, nurses, other health occupations, hospitals, nursing homes, and outpatient facilities.

Scn”Lx20. Data on Mortality. —Various statistics on mortality other than as included in regular annual or monthly

reports. Special anafyses by cause of death, age, and other demographic variables; geographic and time

!wriw amdyses; and statistics on characteristics of deaths not avti]ab]e from the vital records, based on

sample suwcys of those records.

SLX”LX21. Dtita on Natality, Marriage, and Divorce. –Various statistics on natality, marriage, and divorce other

th,m as included in regular annual or monthly reports. Special analyses by demographic variables;

~eoLyaphic and time series analyses; studies of fertility; and statistics on characteristics of births not

xvtilable from the vital records, based on sample surveys of those records.

S(vi<.s ~z. Dnt,z fiom the National Mortality and Natality Survey s. —Discontinued effective 1975. ~utur’e reports

from these sample surveys based on vital records Ivill be included in Series 20 and 21, respectively.

Sdyiix 23. D~zi,Jj+om the /\ratiC~?loiSurt,<y ofFamil), Growt h.–Statistics on fertility, family formation and dissolution, f~mill, planning, and related maternal and infant health topics derived from a biennial survey of

n nationwide probability sample of ever-married women 1544 vears of age.

Por a list of titks of rt’ports published in these series, ~vritt”to: Scientific and Technic~ Information Branch

National Center for Health Statistics

Public Health %rvice

Iii .~ttsvillt, i[ci. 207S2
_ ,.- ..—