Data from the

NATIONAL HEALTH SURVEY

NursingHome Utilizationin

California,Illinois,Mqsachusetts,

New York,and Texas:

1977 NationalNursing Home Sunrey

Estimates are for the coterminous United States and for California,

Illinois, Massachusetts, New York, and Texas. Data include type of

ownership, certification status, bed size, occupancy rate, cost per.

resident day, discharge status (alive or dead), and demographic characteristics and health status of residents. Estimates are based on

data collected in the 1977 NationaI Nursing Home Survey.

DHHS Publication No. (PHS) 81-1799

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Office of Health Research, Statistics, and Technology

National Center for Health Statisti~

Hyattsville, Md. October 1980

Series 13

Number 48

For snle by the Superintendent of Documents, U.S. Government Printi& 05ce, Washington, ‘D.C. 20402
.—

v

/

Library of Congress Cataloging in Publication Data

Foley, Daniel Joseph.

Nursing home utilization in California, Illinois, Massachusetts, New York, and Texas:

1977 national nursing home survey.

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

health resources utilization; no. 48) (DHHS publication; no. (PHS) 81-1 799)

Supt. of Dots. no.: HE 20.6209:13/48

1. Nursing homes –California-Statistics. 2. Nursing homes–Illinois-Statistics. 3. Nursing homes—Massachusetts—Statistics. 4. Nursing homes–New York (State) –Statistics.

5. Nursing homes–Texas–Statistics. 6. Nursing homes–United States–Statistics. I. Title.

II. Series: United States. National Center for Health Statistics. Vital and health statistics:

Series 13, Data from the National Health Survey, Data on health resources utilization; no.

48. 111. Series: United States. Dept. of Health and Human Services. DHHS publication; no.

(PHS) 81-1799. [DNLM: 1. Nursing homes-United States-Statistics. 2. Health facility

planning–United States. W2 A N148vm no. 48]

RA407.3.A349 no. 48 [RA997] 362.1’1’0973s 80-14677

[362.1’6’09794]
NATIONAL CENTER FOR HEALTH

DOROTHY P. RICE, Director

ROBERT A. ISRAEL, Depu@ Director

STATISTICS

JACOB J. FELDMAN, Ph.D., Associate Directorfor Analysis

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

ROBERT A. ISRAEL, Acting AssoczizteDirector for Data Systems

ALVAN O. ZARATE, Ph.D., Acting Assoctite Director for International Statistics

ROBERT C. HUBER, Associate Director for Management

MONROE G. SIRKEN, Ph.D., Associate Director for MathematicalStatistics

PETER L. HURLEY, Associate Director for Operations

JAMES M. ROBEY, Ph.D., Associate Director forprogmm Development

GEORGE A. SCHNACK,Acting Asscwhte Director for Research

ALICE HAYWOOD,Information djj?cer

DIVISION OF HEALTH RESOURCESUTILIZATION “STATISTICS

W. EDWARD BACON,Ph.D., Acting Director

JOAN l?.VAN NOSTRAND, ChiefiLong-Te?m CareStatistics Branch

JAMES E. DELOZIER, ChiefiAmbulatory CareStatistics Branch

W. EDWARD BACON,Ph.D., Acting chie~ Hospital ChreStatistics Branch

MANOOCHEHRK. NOZARY, Chiej Technica2ServicesBranch

STEWART C. RICE, chie~ Family PlanningStatistics Branch

Vital and Health Statistics-Series 13-No. 48

DHI-IS Publication No. (PHS) 81-1799

Libwy of CongressCatahg CardNumber 80-14677
CONTENTS

Introduction ........................................................................................................................................... I

Facility Cbaracteristies........................................................................................................................... 2

Utilization .............................................................................................................................................. 2

ResidentCharacteristicsand HealthStatus............................................................................................. 4

List of DetailedTables ........................................................................................................................... 5

Appendixes............................................................................................................................................. II

I. Tecludcal Notes ........................................................................................................................ 12

II. Definition of CertainTermsUsedin Thii Report ...................................................................... 20

SYMBOLS

Data not available— —.— .-.

Category notapplicable-—-———— . . .

Quantity zero—— ———

Quantity morethan Obutlessthan0.05—— 0.0

l?igwe does not meet standards of

reliability or precision— —-—-——- *
NURSING HOME UTILIZATION IN

CALIFORNIA, ILLINOIS,

MASSACHUSEllS, NEW YORK, AND TEXAS

Daniel J. Foley, Division of Health Resources Utilization Statistics

INTRODUCTION

This report presents selected characteristics

of nursing homes for the coterrninous United

States and for the five States on the National

Master Facility Inventory with the largest proportion of nursing home residents–Califomia,

Illinois, Massachusetts, New York, and Texas.

Data are from the 1977 National Nursing Home

Survey, conducted by the National Center for

Health Statistics from May through December

1977. This is the second in a continuing series

of surveys, but it is the first from which statistically reliable State estimates have been obtained.

The first survey in the series was conducted

from August 1973 through April 1974.

The 1977 National Nursing Home Survey

was a nationwide sample survey of nursing

homes in which descriptive data about the facilities, their costs, and the characteristics of their

residents, discharges, and staff were collected.

In order to produce State estimates, the national

sample was supplemented with the additional

nursing homes needed to produce reliable State

estimates. State supplement samples were drawn

for Massachusetts, Illinois, New York, and

Texas. This was not done for California since the

sample for that State was already sufficient to

produce State estimates. Nursing homes included in the survey were those classified by the

1973 National Master Facility Inventory (NMFI)

as nursing care homes, personal care homes (with

or without nursing), and domiciliary care homes,

as well as all nursing homes that opened for

business from the time the 1973 NMFI was conducted through December 1976. The NMFI is a

census of zdl inpatient health facilities conducted

every 2 or 3 years by mail by the National Center for Health Statistics.l

This report focuses on comparisons of State

with national data and addresses only those

States with substantial differences from the

national norms rather than making comparisons

for each of the five States. Data in this report

center on facifity characteristics and selected

measures of utilization. Facility characteristics

include bed size, ownership, certification, and

staff. The measures of utilization selected for

discussion are financing of resident days of care,

primary source of payment, occupancy rate, discharge status (alive or dead), costs of providing

care, “and charges for care. Demographic data on

nursing home residents and a profile of their

health status and the services they received are

also presented. Estimates of the number of facilities, beds, residents, full-time equivalent employees (further information about this and

other terms can be found in appendix 11 of this

report), and the average monthly charge are

based on 1977 data; and estimates of the annual

] National Center for Health Statistics: Inpatient

health facilities as reported from the 1973 MFI Survey,

by A. Sirrocco. Vital and Health Statistics. Series 14-No.

16. DHEW Pub. No. (HRA) 76-1811. Health Resources

Administration. Washington. U.S. Government Printing

Office, May 1976.

1
occupancy rate, resident days, discharges, and

cost per resident day of care are based on 1976

data. Information on sampling variability is presented in appendix I of this report. For a summary of the national data collected in the 1977

National Nursing Home Sumey, see footnote 2.

FACILITY CHARACTERISTICS

From May through December 1977, there

were about 6,700 nursing homes in the five

States of California, Illinois, Massachusetts, New

York, and Texas, representing about 35 percent

of the 18,900 nursing homes nationwide. These

five States also accounted for about one-third of

the Nation’s 1.3 million nursing home residents

and about one-third of the Nation’s 1.4 million

nursing ho’me beds (table 1).

California aIone had 16 percent of the nursing homes nationally and 9 percent of the beds,

while New York, with only 5 percent of the

homes, had nearly as many beds (8 percent) as

California, reflecting a dramatic difference in

average bed size. In California nursing homes

averaged 42 beds each, and those in New York

averaged 123 beds. However, 20 percent of the

homes in New York (200) had a bed size of 200

beds or more and provided care for about half

the nursing home residents in the State.

The national distribution of nursing homes

by type of ownership indicates that about threefourths (77 percent) of the homes operated

under proprietary auspices. By State, however,

a significantly larger proportion of facilities in

CaIifomia (88 percent), Massachusetts (87 percent), and Texas (89 percent) were proprietary,

while a significantly smaller proportion of those

in New York (64 percent) were proprietary.

Certification refers to a facility’s certification by the Medicare or Medicaid program or by

both. A skilled nursing facility (SNF) provides

the most intensive nursing care available outside

‘National Center for Health Statistics: The National

Nursing Home Survey: 1977 supmaty for the United

States, by J. F. Van Nostrand et al. V{tal and Health

Statistics. Series 13-No. 43. DHEW Pub. No. (PHS) 79-

1794. Public Health Service. Washington. U.S. GovernmentPrinting Office, July 1979.

a hospital. Skilled nursing facilities certified by

Medicare provide posthospital care to eligible

Medicare enrollees. Facilities certified by Medicaid as skilled nursing facilities provide intensive

nursing care on a daily basis to individual eligible for Medicaid benefits. An intermediate care

facility (ICF) is certified by the Medicaid program only and provides health-related services

on a regular basis to persons eligible for Medicaid who do not require hospital or skilled nursing facility care but do require institutional care

above the level of room and board. A health related faciIity (HRF) in the State of New York is

equivalent to an ICF facility.

Table 1 shows that in 1977 there were significantly higher proportions of facilities certified as SNF only in New York (49 percent) and

California (37 percent) than in the United States

as a whole (19 percent). Texas had over twice

as many homes certified as ICF only than the

national average—nearly three-fourths (72 percent) for Texas compared with only 32 percent

nationwide. Massachusetts, with about half (50

percent) of its nursing homes certified as ICF

only, also had a significantly Iarger proportion

than the national average.

To provide direct health-related sewices to

residents, the Nation’s nursing homes employed

the equivzdent of 46 full-time staff members per

100 beds. Two-thirds of the health services staff

were nurse’s aides (table 2). In Illinois, Massachusetts, and Texas, where many nursing homes are

certified as ICF only and very few as SNF only,

the full-time equivalent staffing rat;os were significantly lower than nationality. However, in each

of the five States there was no significant difference between the proportions of staff employed

as nurse’s aides, licensed practical nurses, registered nurses, or administrative, therapeutic, and

professional staff and the national

UTILIZATION

proportions.

In this section, the utilization of nursing

homes in the five States is compared with national estimates. The nursing home utilization

measures discussed are resident days of care,

source of payment, occupancy rate, discharge

status, costs, and charges for care.

2
Table 3 indicates that in 1976 about 60 percent of the Nation’s resident days of care in

nursing homes were financed either totally or

partially by the Medicaid program. The proportions of Medicaid resident days of care in Illinois

and Massachusetts were roughly the same as the

national level, while New York (67 percent) and

Texas (72 percent) had significantly higher proportions. Although the proportion of Medicaid

resident days of care in California (51 percent)

was significantly lower than nationally, it still

constituted a maj,ority of the State’s total number of resident days of care. Thus Medicaid was

the principal purchaser of long-term care services

both at the national level and, as was evidenced

in these five States, at the State level.

Data on the primary source of payment reported for residents in 1977 further highlight

Medicaid’s role in providing nursing home care.

The primary source of payment refers to the

source that paid the greatest amount of the resident’s charge in the last completed calendar

month prior to the survey. The records of about

48 percent of the Nation’s nursing home residents reported Medicaid as their primary source

of payment (table 4). California had significantly

lower Medicaid participation than nationally,

with about 42 percent of its resident records indicating Medicaid as the primary source of payment. Massachusetts, New York, and Texas had

significantly higher proportions of Medicaid

residents (57 percent, 61 percent, and 54 percent, respectively).

These State differences in Medicaid participation and utilization were influenced by the

marked differences between States in benefit

packages and outlay of Medicaid expenditures.

Although Medicaid is jointly funded by the Federal and State governments, it is operated and

administered by each State. Each State determines the benefits, rates of payment, and eligibility criteria for Medicaid services, subject to

Federal guidelines.

Another measure of the utilization of nursing homes is the occupancy rate of the beds in

the home. An occupancy rate based on days of

care provided for a calendar year gives a more

stable estimate of utilization than a rate based

on number of beds occupied the night before

the survey was administered. This rate was computed for this report by using the following

forrnulx

Aggregate number of days

~ of care provided to residents in 1976X 100

Occupancy rate =

z

Estimated number of beds

in 1976 X 366

The number of beds in 1976 was estimated by

adjusting the number of beds in 1977 for any

change in beds during the preceding yew of

1976.

Generally, 89 percent of the Nation’s nursing home beds were occupied in 1976. At the

State level, only Texas had a significantly lower

occupancy rate (80 percent) than nationally.

While the other States did vary from the national occupancy rate, no significant differences

were found.

In 1976 an estimated 1,117,500 persons

were discharged from the Nation’s 18,900 nursing homes, and most (74 percent) were discharged dive. Live discharges were more likely

to be discharged to another health facility than

to a private or semiprivate residence (see

table 5). Illinois, Massachusetts, and New York

had about the same percent of live discharges as

nationally, and California (82 percent) and

Texas (83 percent) had significantly higher proportions. As in the Nation, within each of the

five States more live discharges were transfemed

to other health facilities than to private or semiprivate residences.

Nationally, the average cost to a nursing

home to provide a single resident day of care in

1976 was $23.84, of which 60 percent was spent

on labor (table 3). The costs per resident day in

California ($21 .56), Illinois ($21.1 1), Massachusetts ($24.23), and Texas ($19 .33) were not

significantly different from the national figure,

but New York’s cost per resident day of care

($40.12) was about 68 percent higher than the

national average. In all five States, labor accounted for most of this cost.

i%other measure related to the fiiancial

condition of nursing homes is the monthly

charge. The monthly charge is the total amount

charged to a resident by the facility in the last

completed calendar month prior to the 1977

3
NNHS. It includes all basic charges and all

charges for private duty nursing, drugs, and special medical supplies. The average monthly

charge to residents in nursing homes nationally

was $689 (table 4). The average monthly charges

for California, I1linois, Massachusetts, and Texas

were not significantly different from the national average; however, the monthly charge in

New York ($1,1 24) was about 63 percent

higher.

RESIDENT CHARACTERISTICS

AND HEALTH STATUS

Table 6 shows that in 1977 the elderly population (defined as 65 years of age and over)

represented about 11 percent of the total U.S.

population and roughly 11 percent of the population in each of the five States. About 5 percent

of the Nation’s elderly cohort resided in nursing

homes, with about six nursing home beds available per 100 population 65 years of age and

over. Table 6 also presents State estimates that

indicate that as the availability of nursing home

beds increased, the proportion of elderly residing in nursing homes also increased. Thus New

York and California, with about 5 and 6 beds

available per 100 elderly, respectively, had about

5 percent of their elderly in nursing homes,

while Massachusetts, with about 9 beds per 100

elderly, had about 7 percent of its elderly people

residing in nursing homes.

The “typical” nursing home resident in each

of the five States as well as nationally was white,

female, widowed, and about 80 years old. The

median length of stay for a nursing home resident varied from 1.2 years for California to 1.7

years for Massachusetts; the national median

length of stay was 1.6 years (table 7).

As is shown in table 4, the largest proportion

of nursing home residents nationwide (40 percent) were admitted from private or semiprivate

residences, followed by those admitted from

general or short-stay hospitals (32 percent),

other nursing homes (13 percent ), mental hospitals (6 percent), and other types of arrangements

or unknown (9 percent). In California, Massachusetts, and New York, the largest proportions

of residents were admitted from general or

short-stay hospitals (42, 45, and 41 percent,

respectively) rather than from private or semiprivate residences.

I1linois and Massachusetts had significa.dy

higher proportions of residents admitted from

mental hospitals (9 and 12 percent, respectively)

than nationally (6 percent). This finding suggests

greater than average utilization of nursing home

services for the care of the mentally impaired in

these two States. Data on resident health status

further support this finding (table 7). In Illinois

and Massachusetts about one-fourth of the residents were diagnosed in the category of “mental

disorders ~d senility without psychosis.” This

proportion was significantly higher than those

for California (18 percent), New York (17 percent), Texas (13 percent), and the Nation (2 O

percent). Illinois and Massachusetts also had significantly higher proportions of residents suffering from mental illness or mental retardation as

a chronic condition (28 percent in Illinois and

25 percent in Massachusetts) than the proportions in California (15 percent), New York (13

percent), Texas (12 percent), and the Nation (18

percent).

The nursing home residents were a functionally dependent population (table 8). About 86

percent of the Nation’s nursing home residents

required assistance in bathing; 69 percent required assistance in dressing; 53 percent required

assistance in using the toilet room; 33 percent

required assistance in eating; 66 percent were

chairfast, bedfast, or walked only with assistance; and 45 percent had difficulty with bowel

and/or bladder control. About 23 percent of the

Nation’s nursing home residents were dependent

in all six of these activities. In California, Illi- “

nois, New York, and Texas these proportions

were roughly similar to those found nationally.

Massachusetts alone showed marked differences

from the national proportions; these differences

were in specific activities as well as in the proportion dependent in all six activities. Except

for incontinence, Massachusetts residents were

less dependent in bathing, dressing, using the

toilet room, eating, and mobility. Only 16 percent of Massachusetts residents were dependent

in all activities as compared with 23 percent nationally. No attempt to explain this difference

will be made until further analysis is conducted.
LIST OF DETAILED TABLES

1.

2.

3.

4.

5.

6.

7.

8.

Percent distribution of nursing homes, beds, and residents by selected facility characteristics: United States, California, I ilinois, Massachusetts, New York, and Texas, 1977 .................... ...................................................................................................

Selected staffing characteristics for nursing homes: United States, California, I Ilinois, Massachusetts, Naw York, and Texas,

1977 ............................................................................................................... ........................... ............................ ...................

Selected nursing home utilization characteristics: United States, California, Illinois, Massachusetts, New York, and Texas,

1976 ...................................................................... .................... ...................................... ................................ .........................

Percent distribution of nursing home residents according to selected demographics, living arrangements prior to admission,

primary source of payment, and averaga monthly charges: United States, California, Illinois, Massachusetts, New York, and

Texas, 1977 .......................................................................................... ................ .................................. .......................... ........

Percent distribution of nursing home discharges by discharge status and percent distribution of live discharges by living

arrangement after discharge: Unitad States, California, Illinois, Massachusetts, New York, and Texas, 1976 .............................

Selected population characteristics: United States, California, Illinois, Massachusetts, New York, and Texas, 1977 ..................

Median length of stay and selected services received by nursing home residents: United States, California, I Ilinois, Massachusetts, New York, and Texas, 1977 .................................... ............................................................................................ ........

Percent of nursing home residents by salacted health status characteristics: United States, California, i Ilinois, Massachusetts,

New York, and Texas, 1977 ........ ...................................... .................................................................................................. .......

6

7

7

8

9

9

9

10

5
Table 1. Percent distribution of nursing homes, beds, and residents by selected facility characteristics: United States, California, Illinois,

Massachusetts, New York, and Texas, 1977

Facility characteristic

All nursing homes.......................................................................

Ownership

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

Voluntary nonprofit and government .........................................................

Certification

Skilled nursing facility only ........................................................................

Skilled nursing and intermediate care facility .............................................

Intermediate cere facility only ...................................................................

Not certif ied...............................................................................................

Bed size

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

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

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

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

All beds......................................................................................

Ownership

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

Voluntary nonprofit and government .........................................................

Certification

Skilled nursing facility only ........................................................................

Skilled nursing and intermediate care facility .............................................

Intermediate care facility only ...................................................................

Noncertif ied............... ..............................................................................

Bed size

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

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

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

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

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

Ownarship

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

Voluntary nonprofit and government .........................................................

Certification

Skilled nursing facility only ........................................................................

Skilled nursing and intermediate care facility .............................................

Intermediate care facility only ............... ...................................................

Not cartif ied...............................................................................................

Bed size

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

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

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

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

I I I I I

Unitad I

California Illinois I

Massachusetts New York Taxas States

I I I I I

Number of nursing homes

18,900 I 3,000 j 900 ] 900 I 900 / 1,000

Percent distribution

76.7

23.3

19.2

24.2

31.6

25.0

42.3

30.8

22.3

4.6

88.0

“1 2.0

36.9

16.9

●7.8

38.4

67.6

21.5

●9.5

●1.5

76.5

23.5

10.7

33.1

32.0

24.1

28.2

32.6

27.9

11.2

87.0

13.0

●7.9

23.4

49.5

19.1

54.8

21.5

22.1

●1.6

63.8 B9.2

36,2 10.8

49.1 ●8.2

23.1 12.8

●4.B 72.4

23.0 ●6.5

37.6 10.9

19.:3 40.8

23.3 44.0

19.$) ●4,3

Number of beds

1,402,400 I 127,300 j 92,400 j 61,200 I 110,600 j 100,300

Percent distribution

69.3

30.8

21.0

39.2

27.9

11.9

13.0

29.8

39.0

16.2

83.7

16.3

54.6

27.7

+1.3

16.4

20.7

40.1

29.6

9.7

77.3

22.7

14.1

43.7

30.9

11.2

8.9

25.5

35.4

30.2

86.9

13.1

6.6

36.3

48.2

9.0

21.3

22.0

50.6

6.1

53.5

46.5

41.1

40.4

7.8

10.7

6.9

12.0

26.9

54.2

64.4

15.6

8.4

18.7

68.4

4.6

4.6

29.2

55.2

10.9

Number of residents

1,303,100 j 115,400 I 83,100 I 58,000 I 102,800 I 88,700

Percent distribution

68.2

31.8

20.7

40.5

28.3

10.6

12.9

30.5

38.8

17.9

84.5

15.5

54.6

28.2

●1.3

15.8

20.2

40.0

30.1

9.7

74.5

25.5

10.4

46.5

36.2

6.9

6.3

26.8

34.8

32.1

86.1

13.9

6.6

36.2

49.8

7.3

21.9

24,6

50.0

3.5

51.6 62.5

48.4 17.5

42.4 7.1

42.1 24.7

7.7 63.8

7.8 4.5

6.7 4.8

12.7 28.3

27.2 55.6

53.3 11.3
Table 2, Selected staffing characteristics for nursing homes United States, California, I Ilinois, Massachusetts, New York. and Texas,

Type of employee

Full-time equivalent amployeesl

All health-related amployaes2 ................................

Administrativa, therapeutic, and professional ........................

Ragisterad nurse .................................................................. ...

Licensed practical nurse ............................................. ............

Nurse’s aide ............................................................................

Nursing homes with a registered nurse on duty

around the clock .................................................... ..............

1977

United

Statas

California Illinois Massachusetts New York Texas

Number per 100 beds

46.2

5.0

4.8

6.1

30.3

46.9 I 40.4 I 43.5 48.8 I 35.0

I I I

6.1 II 4.9 4.8

4.8 4.6 6.2

.5.6 4.8 4.9

30.5 26.2 27.6

6.6 3.3

6.6 1.6

7.4 6.9

28.2 23.2

Percent of total

22.2 I 13.5 I 23.3 I 16.7 I 49.5 I *5.1

135 hours of pti.time employees’ work is considered equivalent to 1 full-time employee. part-time employees were converted to

full-time equivalent employees by divMing the number of hours worked per week by 3S.

2~cludes only employees providiig duect health-related services to residents.

Table 3. Selected nursing home utilization characteristics Unitad States, California, Illinois. Massechusette, Naw York, and Texas, 1976

Type of certification

Program certif icetion

All days of care ...........................................

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

Medicaid-skilled ..........................................................

Mdimid.intermdia~ .................................................

Ail other .....................................................................

Facility certification

All nursing horn+ss.......................................

Willed nursing fecilitias only ......................................

Skilled nursing and intermediate care fecilitias ............

intermediate care facilities ..........................................

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

Ail nursing homes .......................................

Skilled nursing facilities only ......................................

Skilled nursing and intermediate care facilities ............

Intermediate care fecilitias ..........................................

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

Percent of cost per rasident day spent on labor ...........

United

States I

California I

Illinois

I

Massachusetts INew York ITexas

Number of resident days of care

452,878,700 I 42,017,300 I 28,131,500 I 20,479,900 I 36,738,000 I 29,345,700

2.9 5.3

25.5 44.2

34.4 6.9

37.2 43.6

89.0

92,0

88.6

87.3

68.1

ParCant

●2.6 +0.9 5.2

19.0 16.5 46.0

39.2 46.3 21.2

39.2 36.2 27.7

Occupancy rate per 100 beds

80.1I84.7 I 91.9 I 90.3

,

87.9

88.0

●85.9

89.8

66.8 ●95.9 98.0

86.4 92.2 82.2

85.8 92.5 ●88.8

72.6 84.9 92.9

●1.6

7.3

64.9

26.2

80.1

● 74.6

88.5

78.4

●81 .6

Total cost in dollars per resident day

23.64 I 21.56 ] 21.11 I 24.23 I 40.12 \ 19.33

29.71

26.53

‘18.37

24.88 22.08 %34.03 46.95

23.97 23.58 27.88 41.97

●1O.13 17.62 21.04 ●25.14

22.36

23.11

16.95

16.88 [ 8.94 I 19.34 I 18.90 I 16.63 I “32.02

Percent of total cost

59.7 I 56.2 i 57.7 I 564 [ 62.0 I 57.9

7
Tabla 4. Percent distribution of nursing home residents according to selected demographics, living errangemen~ prior to admission,

primary sourca of payment, and average monthly charges: United Statas, California, 1Ilinois, Massachusetts, New York, and Texas. 1977

Resident characteristic

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

DEMOGRAPHIC CHARACTERISTIC

—Sex

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

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

Race or athnicitv

White (not Hispanic) 1 .......................................................

All others2 ........................................................................

Marital status

Married ................................................. ............................

Widowadl ....................................... ..................................

Divorced or $aparawd .......................................................

Never married ...................................................................

Living arrangement Drier to admission

private or semiprivate residence ............ 00.......<......... O.O......

Another health facility ......................................................

Another nursing home .................................................

Generel or short-stay hospital ........ ..............................

Mental hospital ............................................................

Other health facility or unknown .................................

Unknown or other arrangement ........................................

PrimaW source of payment

Own incoma or family support .........................................

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

Medicaid-skilled ................................................................

Maticaid.intermediate .......................................................

All other murWs3 ................~............................................

Aae

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

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

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

85 yaars and over ..............................................................

Median aga in years ...........................................................

PrimaW source of payment

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

~::l:eome or family support .........................................

............................................................ ...............

Medicaid-skilled .................................. ....... .......................

Medicaid.intarmediate .......................................................

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

I I I I I

United

States

California Illinois Massachusetts New York

1-

Texas

Number of residents

1,303,100 I 115,400 I 83,100 I 58,000 j 102,800 I 88,700

Percent distribution

28.8

71.2

92.2

7.8

11.9

62.2

6.7

19.1

40.3

54.2

12.5

32.3

5.9

3.5

5.5

38.4

2.0

20.0

27.8

11.7

13.6

16.2

35.7

34.5

81 1

689 I

30.2

69.8

89.5

10.5

12.8

66.4

8.8

12.1

33.1

62.1

14.7

41.6

3.2

*2.6

4.8

43.7

3.5

38.4

3.6

10.9

14.1

15.2

34.7

36.0

81 I

30.3

69.7

88.5

11.5

10.7

56.2

6.9

26.2

32.0

64.1

17.2

32.5

9.4

5.0

3.9

41.8

●1.6

10.8

32.8

13.0

17.2

17.5

31.7

33.6

Age in years

80 I

23.1

76.9

98.9

*1.1

8.0

55.7

4.8

31 .!5

26.6

71.8

11.1

45.0

12.3

3.4

*1.6

35.3

●0.7

12.6

44.0

7.5

16.2

18.8

29.6

35.4

79

24.2

75.8

93.4

6.6

9.3

63.6

5.1

21.9

29.6

63.8

12.5

40.7

6.2

4.4

6.6

27.9

‘3.0

43.2

18.0

7.9

9.7

12.7

42.1

35.5

81

Average monthly charge in dollars

683 576 662 1,124

690 685 655 661 1,060

1,167

577

856 717 1,208

873

1,369 1,356

733 633 824 1,391

610

633

518 468 648

477

833 553

497 485 430 463 505

32.7

67.3

83.8

16.2

11.5

69.2

9.4

9.9

48.5

41.1

10.8

25.3

*2.5

*2.5

10.5

32.8

*1.O

3.5

50.9

118

10.3

19,5

39.8

30.4

80

566

1Includes a small number of unknowns.

21ncludes bhck, Hispanic, American Indian or Alaskan Native, &Jan or Pacific Islander.

31nclude~ other government a~titance or welfare, religious organizations, foundations, voluntaer agencies, Veterans Administration

contract, initial payment-life care funds, and other sourcas or no charge.
Table 5. Percent distribution of nursing home diwharges by discharge status and percent distribution of live discharges by living

arrangement after discharge: United States, California, I Ilinois, Massachusetts, New York, and Texas, 1976

Discharge status

All diachargesl ..................................................

Discharged alive ................................................................

Discharged dead ................................... .............................

Livina arrarroement after discharge

Ail live diwharges ..............................................

Private or semiprivate residence ........................................

Another health faciliW .................... ..................................

Anothar nursing home .................................................

General or short-stay hospital ......................................

Mental hoWital ............................................................

Other health facility or unknown .................................

Unknown or other arrangemnt ........................................

1Includes unknowns.

United

States

California Illinois Massachusetts New York Texas

Number of alI discharges

1,117,500 I 175,600 I 69,300 I 37,100 I 81,700 I 80,300

Percent distribution

73.9 I Ml %1 I El w

77.5

25.9 22.4

Number of live discharges

825,500 I 143,500 I 52,800 I 28,800 I 61,300 I 66,400

Percent distribution

37.2

58.7

13.2

41.1

1.5

2.9

4.2

44.4

46.1

10.9

28.7

●1.1

*5.4

9.5

31.4

67.9

12.2

50.1

●1.O

●4.6

●0.7

23.7

75.6

●7.9

65.9

+1.4

“0.5

“0.6 L

19.1 30.2

79.0 66.4

18.0 9.7

52.4 55.5

●4.6 “0.4

+4.0 “0.8

●1.9 ●3.4

Table 6. Selected population characteriati~ United States, California, Illinois, Massachusetts, New York, and Texas, 1977

Population characteristic United California Illinois Massachusetts New York Texas

States

Total population 1 ....................................... 216,332,000 21,896,000 11,245,000 5,782,000 17,924,000 12,830,000

Total population 65 years and over . .......... 23.484,000 2,185,000 1,194,000 667,000 2,082,000 1,228,000

Percent of total population 65 years

and over in nursing homes ........................ 4.8 4.5 5.8 7.1 4.5 6.5

lu.S. Bureau of the Census: Estimates of the population of States, by age, July 1, 1971 to 1977. -mrrt pOPUkStiOrr~ePo~ series

P-2s, No. 734. Washington. U.S. Government Printing Office, 1978.

Table 7. Median length of stay and selected services received by nursing home residents: United States. California, Illinois,

Massachusetts, New York; and Te~as, 1977

Median length of stay since admission in days ........................

Median time since last physician visit in days ................. ........

Percent of residents receiving intensive nursing care during

the last 7 days ......................................................................

Percent of residents receiving therapy during the last

I

United

States I

California

597

18

43.8

35.0

462

14

42.0

40.4

Illinois I

Massachusetts

1

566 623

20 20

39.6 37.7

44.8 50.7

1

New York I Texas

552 I

505

14 21

46.0 I 43.9

9
Table 8. Percent of nursing home residents by selected health status characteristics: United States, California, I Ilinois, Massachusetts,

New York, and Texas, 1977

Resident characteristic

All residenw ......................................................

Primary diagnosis at last examination

Mental disorders and senility without psychosis ................

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

Other diagnosis .................................................................

Diagnosis unknown 1 ........................ ............................... ..

Chronic conditions or impairments

Marital disorders and senility without psychosis:

Senility ........................................................................

Mental Retardation .... ...ti .................................. ...........

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

Chronic brain syndrome ...............................................

insomnia ...... ................................................................

Diseases of the circulatory system:

Arteriosclerosis ............................................................

Hypertension ....... ................................................ .......

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

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

Other chronic conditions or impairments:

Arthritis and rheumatism .......................................... ...

Constipation ................................................................

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

Edema .............. ............................................................

Cancer ..........................................................................

Chronic reviratory disease ..........................................

Anemia ................................................................ ........

Camracts ............................................................. .........

Hip or other bone fracture ...........................................

Blindness or deafness ...................................................

Kidney trouble ...................................................... .......

Dependency in activities of dailing living:

Requires assistance in bathing ......................................

Requires assistance in dressing .....................................

Requires assistance in using toilet room ........... ............

Requires assistance in eating ........................................

Walks only with assistance or is chairfast or bedfast .....

Difficulty with bowel and/or bladder control ..............

Dependent ina116 activities ........................................

United

States

Cal if orn ia IIIllinois Massachusetts New York I

Texas

Number of resid?nts

1,303,100 I 115,400 I 83,100 I 58,000 j 102,800 I 88,700

Percent distribution

20.4

39.7

33.0

6.9

32.0

6.1

11.4

24.9

9.6

47.6

20.9

16.4

34.5

24.6

24.0

14.5

17.9

4.9

6.6

5.4

6.1

11.3

11.1

10.1

86.3

69.4

52.5

32.6

66.1

45.3

23.3

1~cl~des residents who received no physician viaits while in factiity.

17.9

41.7

34.7

5.7

32.5

4.1

10.5

27.0

13.9

49.1

18.4

19.7

34.2

23.8

20.7

12.6

12.0

5.2

6.7

3.5

4.7

10.2

10.3

8.2

84.1

68.2

44.8

32.1

66.4

47.8

21.0

25.3

43.0

24.4

7.4

Percent

33.7

10.6

17.0

22.4

10.5

47.4

18.7

12.1

31.4

22.9

21.1

15.0

15.7

3.9

6.0

3.4

4.0

10.4

12.0

9.2

82.9

65.7

46.4

35.5

62.2

46.1

24.3

27.2

33.4

32.1

7.3

28.0

3.9

21.5

14.3

9.8

46.6

13.9

13.0

27.7

19.1

18.5

23.1

10.5

4,7

6.5

5.3

4.9

8.4

10.2

11.8

78.9

55.3

29.5

22.9

51.3

39.8

15.7

16.9

41.1

36.4

5.6

22.5

4.4

8.9

27.1

9.8

51.9

24.3

14.2

43.1

24.2

18.9

18.8

15.8

5.5

8.4

8.1

9.1

11.6

11.2

7.7

88.0

71.9

48.8

37.9

66.5

48.0

25.2

I

13.3

45.7

32.2

8.8

33.8

3.3

8.2

32.1

7.1

54.5

26.2

18.7

36.5

26.2

20.6

12.8

13.9

4.8

7.8

6.7

4.9

11.1

15.0

11.8

88.2

72.8

51.1

38.7

69.1

45.6

26.9

z~,gures may not add go total because resident may have had more than 1 reported condition or impairment.

10
APPENDIXES

CONTENTS

I. Technical Notes ............................................................................................. ..............................

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

LIST OF APPENDIX FIGURES

I. Relative standard errors for estimated number of faciMies ...........................................................

II. Relative standard errors for estimated number of residents ............................................... ...........

III. Relative standard errors for estimated number of tisd=ges ........................................................

IV. Relative standard errors for estimated number of beds ................................................................ .

V. Relative standard errors for estimated number of resident days ................. ...................................

W. Relative standsrd errors for estimated costs ............... ...................................................................

VII. Relative standard errors for estimated nmnber of staff .................................................................

12

20

13

14

15

16

17

18

19

11
APPENDIX 1

TECHNICAL NOTES

The sample design for the 1977 National

Nursing Home Survey, conducted by the National Center for Health Statistics, was a stratified two-stage probability sample. The first stage

was a selection of facilities; and the second stage

was a selection of residents, discharges, and staff

from the sample facilities. Data on facility characteristics were collected by interviewing the administrator, while cost data were obtained from

the facility’s accountant via a mailback questionnaire. Data for a sample of residents on the facility’s roster at the time of the survey were collected by interviewing the nurse most familiar

with the care provided to the resident. When

necessary, the nurse referred to the resident’s

medical record. Data for a sample of discharges

in 1976 were also collected by interviewing the

nurse most familiar with the medical record of

the discharged resident. Data on a sample of employees were collected by leaving a questionnaire for the sampled person to complete and

return by mail.

Since the statistics presented in this report

are based on a sample, they will 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. The chances

are about 95 out of 100 that an estimate from

the sample differs from the value that would be

obtained from a complete census by less than

twice the standard error.

Rather than presenting specific errors for a

particular statistic, the approximate relative

standard errors of estimates have been provided.

The relative standard error of an estimate is the

standard error of the estimate divided by the

estimate itself and is expressed as a percent of

the total estimate. In this report an asterisk is

shown next to an estimate with more than a 30-

percent relative standard error.

Estimates of relative standard errors for the

national estimates are presented in appendix I

of Series 13-No. 43 in the Vital and Health Statistics series.3 Estimates of relative standard

errors for the estimated number of facilities in

each of the five States are presented in figure 1.

Relative standard errors for each State’s estimated number of residents are presented in figure II, discharges in figure III, beds in figure IV,

resident days in figure V, total cost in figure VI,

and total staff in figure VII.

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.

For example, curve A of figure IV shows the

relative standard error for beds in California.

Table 1 shows that the total number of beds in

all California facilities with less than 50 beds is

20.7 percent of the total 127,300 California

facilities, or 26,350. The relative standard error

corresponding to this estimate on curve A of figure IV is approximately 17.0 percent. The standmxl-enmr is 26,350 (0.17) = 4,480.

The approximate standard error of a ratio

such as that for full-time equivalent (FTE) employees per 100 beds can be calculated as in the

following example: Suppose the standard error

(arl) for the ratio of total FTE employees per

100 beds is desired for New York nursing

homes. In table 2 the total FTE employees per

100 beds for nursing homes in New York is

shown as 48.8, which is equal to a total of

54,000 FTE employees divided by 110,600 beds

3See footnote 2.

12
Figure 1. Relative standard errors for estimatad number of facilities

-.. A 2 34 56789A 2

10 100

SIZE OF

times 100. The relative standard error of 54,000

total FTE employees is (from figure VII, curve

D) approximately 3.2 percent, and the relative

standard error of 110,600 beds (from figure IV,

curve D) is approximately 4.5 percent. The

square root of the sum of the squares of these

two relative standard errors minus their covariance provides an approximation of the relative

34 56789A 2 34 56789A

1,000

ESTIMATE

standard error of

V. # is the relative

the ratio. In other words, if

standard error of the number

of total FTE empIoyees, VYJ is the relative

standard error of the number of beds, r is the

sample correlation coefficient between total

FTE employees and beds (conservatively estimated to be O.5), and VqJ is the relative standard

error of the ratio R’ =X /Y}:

13
Figure 11. Relative standard errors for estimated number of residents

1-

Cj

Lu

a

““A 2 34 56789A 2 34 56789A 2 34

1,000

56789A

10,000 100,000

SIZE OF EST~MATE

~r,2 = ~x,2 + ~y,2 - zr~x,~y, total FTE employees per 100 beds may now be

obtained by multiplying the relative standard

= (.032)2 + (.045)2 -1.00 (.032 X .045) error by the ratio as is done below:

= .0010+ .0020 - .0014= .0016 UrI ‘R’ X V??=48.8 X .04 = 1.95

v,! = .0150 = .04 The sample correlation coefficient (r) for

calculating the standard error estimates of the

The approximate standard error of the ratio of ratios presented in this report is assumed, to be

14
iUj

IJ.1

a

100

90

80

70

60

w

40

30

20

10

9

8

7

6

5

4

3

2

1.!

,8

.7

,6

5

,4

3

2

0.1

Figure II L Relative standard errors for estimated number of discharges

1,660 10,000 100,000

SIZE OF ESTIMATE

zero exce~t in the case of full-time equivalent was used to test all commu-isons mentioned in . .

employees per 100 beds, occupancy rate, and this report. Since not ~ observed differences

cost per resident day ratio estimates, where the were tested, lack of comment in the text does

correlation coefficient used was O.5. not mean that the difference was not statistiThe z test with a 0.05 level of significance tally significant.

15
Figure IV. Relative standard errors for estimated number of beds

a

0

z

a

Lu

n

a

~

z

2

Cn

Lu

>

i=

a

-1

UJ

K

1,000 10,000 100,000

SIZE OF ESTIMATE

16
Figure V. Relative standard errors for estimated number of resident days

~

K

a

LI.1

100

90

so

70

w

so

40

30

20

1:

8

7

8

5

4

3

2

1.:

,8

.$

,6

5

4

3

,2

0.1

106 1,000 1,000,000 10,000,000 100,000,000

SIZE OF ESTIMATE

17
Figure V1. Relative standard errors for estimated costs

100

90

84

70

e3

el

40

30

20

10

9

B

7

6

5

3

2

1.0

,9

8

.7

0

,5

,4

,3

.2

0.1

1 10 100 1,00(

SIZE OF ESTIMATE (IN MILLIONS)

18
cl

a

a

c1

z

~

Lu

>

i=aj

I.lJ

K

100

90

so

70

60

m

40

30

1:

B

7

6

5

4

3

2

1.0

.9

.8

.-l

,6

,5

.4

3

2

0.1

Figure VI 1. Relative standard errors for estimated number of staff

A 2 34 56789A 2 34 56789A 2 34 56789A

700 1,000 10,000 100,000

SIZE OF ESTIMATE

000

19
APPENDIX II

DEFINITION OF CERTAIN TERMS USED IN THIS REPORT

Ownership. –Type of ownership refers to the

type of organization that controls and operates

the nursing home.

Proprietary facila’ty.-A proprietary facility is

operated under private commercial ownership .

Nonprofit facWy.-A nonprofit facifity is

operated under voluntary on nonprofit

auspices, including both church-related facilities and those not church-related.

Government facility. –A government facility

is operated under Federal, State, or local

government auspices.

Discharge. –A discharge is a person who was

forrnaIly discharged from a nursing home during

1976. Both live and dead discharges are included. Theoretically, the same person can be

counted more than once if he was ,discharged

more than once from a nursing home during

1976.

Discharge status. –The discharge status is

whether the person was discharged from the

nursing home alive or dead.

Full-time equivalent (FTE). –Thirty-five

hours of part-time employees’ work per week is

considered equivalent to that of one full-time

employee.

ooo —

20

w.5. GOVERNMENT PRINTING OFFICE: 1980 341-161/25 1-3
VITAL AND HEALTH STATISTICS Series

Scri”es1. Programs and Collection Procedures. –Reports which decicnbe the general programs of the National

Center for Health Statistic and its offices and diviziom and data collection methods used and include

definitions and other material neces.saty for understanding the data.

Series 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 amdytical

techniques, objective evaluations of reliability of collected data, .ond contributions to statistical theory.

Series 3. Analytical Studies. –Reports presenting analytical or interpretive studies based cm vit~l and health

statistics, carrying the snalysis further than the expository types of reports in the other series.

Series 4 Documents and Committer Reports. – Final reports of major committees concerned w,ith vital and

hwfth statistics and documents such as recommended model vital r~gistration laws and revised birth

and death certificates.

Series 10. Data From the Health Interview Surrnq. –Statistics on illness, accidental injuries, disability, use of

hospital, medical, dental, and other servicm, and other health-related topics, all b~sed on data collected

in a continuing national household interview survey.

.kic~ 11. Data From th~, Health Examination Survey and the Health and Nutrition 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 medicafly defined

prevalence of specific diseases in the United States and the distributions of the population with respect

to physicaf, physiological, and psychological characteristics and (2) analysis of relationships among the

various measurements without reference to an explicit finite universe of persons.

Seri.s 12. I)aia From tile Institutionalized Population Survey s.-Discontinued effective 1975. Future reports from

these surveys will be in Series 13.

SCries 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 pkmning services.

Series 14 Data on Health Resources: Manpower and Facilities. –Statistics on the numbers, geographic distribution, and characteristics of health resources including physicians, dentists, nurses, other health

occupations, hospitafs, nursing homes, and outpatient facilities.

Series 20. Data on Mortality. –Various statistics on mortality other than as incIuded in regular annuaf or monthly

reports. Speciaf analyses by cause of death, age, and other demographic variables; geographic and time

series analyses; and statistics on characteristics of deaths not available from the vital records based on

sample surveys of those records.

Series 21, Data on Natalzly, Marriage, and Divorce. —Various statistics on natality, marriage, and divorce other

than as included in regular annual or monthly reports. Special analyses by demographic variables;

geographic and time series analyses; studies of fertility; and statistics on characteristics of births not

available from the vitaf records based on sample surveys of those records.

Series 22, Data From the National Mortality and Aratality Surveys. –Discontinued effective 1975. Future reports

from these sample surveys based on vital records will be included in Series 20 and 21, respectively.

Sm.es 23. Data From the National Survey of Family Growth. –Statistics on fertility, family formation and dissolution, family planning, and related matemaf and infant health topics deri~,ed from a biennial survey

of a nationwide probability sample of ever-msxried women 1544 years of age.

For a list of titles of reports published in these series, write to: Scientific and Technical Information Branch

National Center for Health Statistics

Public Heafth Service

HyattsvilIe, hfd. 20782
.

u S DEPARTMENT OF H H S

HHS 396

FIRST CLASS MA, L