Data from the Series 13 

NATIONAL HEALTH SURVEY Number 51 

Character&ticsof NursingHomeResidents, 

HealthStatus,andCareReceived: 

Nationalksiig HomeSurvey 

U@edstates, May-December 1977 

Data are presented on utilization and health status characteristics of 

nursing home residents by major demographic characteristics, such 

as age, sex, and race or ethnicity. Utilization characteristics include 

length of stay since admission, primary reason for care, prior living 

arrangements, and primary source of payment. Health status characteristics include primary diagnosis at last examination, chronic conditions and impairments, functional status, sensory impairments, 

and behavioral problems. Data on the care received by residents are 

also examined; the variables include level of nursing care, medications, physician care, therapy, and other health services. Variables 

are examined from two perspectives: the health status of the 

resident and service characteristics of the facility. 

DHHS Publication No. (PHS) 81-1712 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Public Health Service 

Office of Health Research, Statistics, and Technology 

National Center for Health Statistics 

Hyattsville, Md. April 1981 
Library of Congress Cataloging in Publication Data 

Hing, Esther. 

Characteristics of nursing home residents, health status, and care received. 

(Vital and health statistics: Series 13, Data from the National Health Survey; no. 51) 

(DHHS publication; no. (PHS) 81-1712) 

Includes bibliographical references. 

‘Supt. of Dots. no.: HE 20.6209:13/51 

,; $1. ~ursinghb’hre patients-United States-Statistics. 2. Nursing homes-United StatesUtili~aation-Statistics. 3. United States-Statistics, Medical. I. Title. II. Series: United States. 

Nation.+ I Center for Health Statistics. Vital and health statistics: Series 13, Data from the 

National Health Survey, Data on health resources utilization; no. 51. III. Series: 

United States. Dept. of Health and Human Services. DHHS publication; no. (PHS) 81-1712. 

[DNLM: 1. Nursing homes-United States. 2. Geriatric nursing. 3. Nursing care. 4. PatientsStatistics. W2 A N148m no. 511 

RA407.3.A349 no. 51 [RA997] 362.1’1’0973 80-607877 

ISBN 0-8406-0212-X [362.1’6’0973] 

For sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 30402 
NATIONAL CENTER FOR HEALTH STATISTICS 

DOROTHY P. RICE, Director 

ROBERT A. ISRAEL, Deputy Director 

JACOB J. FELDMAN, Ph.D., Acting Associate Director for Anhlysis and Epidemiology 

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

GARRIE J. LOSEE, Acting Associate Director for Data Processing and Services 

ALVAN 0. ZARATE, Ph.D., Assistant Director for International Statistics 

E. EARL BRYANT, Acting Associate Director for Interview and Examination Statistics 

ROBERT C. HUBER, Acting Associate Director for Management 

MONROE G. SIRKEN, Ph.D., Acting Associate Director for Research and Methodology 

PETER L. HURLEY, Acting Associate Director for Vital and Health Care Statistics 

ALICE HAYWOOD, Information Officer 

DIVISION OF HEALTH CARE STATISTICS 

W. EDWARD BACON, Ph.D., Director 

EVELYN MATHIS, Acting Chief; Long-Term Care Statistics Branch 

MARY A. MOIEN, Acting Chief, Hospital Care Statistics Branch 

JOSEPH BARBANO, Chiefi Health Professions Statistics Branch 

JAMES E. DeLOZIER, ChieA Ambulatory Care Statistics Branch 

MANOOCHEHR K. NOZARY, ChieJ Technica Services Branch 

STEWART C. RICE, Chiefi Family Planning Statistics Branch 

Vital and Health Statistics-Series 13-No. 51 

DHHS Publication No. (PHS) ?l-1712 

Library of Congress Catalog (3rd Number 80-607877 
CONTENTS 

r 

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

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

Sources and~~QualXications of’Da& ...................................................................................................- Bachground ....................................................................................................................................... 

Demographic Characteristics .................................................................................................................. 

Age .................................................................................................................................................... 

Sex .................................................................................................................................................... 

Race .................................................... ..~........................“....~ ............................................................ 

Marital Status ..................................................................................................................................... 

Visitors Received ............................................................................................................................... 

Utilization ............................................................................................................................................... 

Prior Living Arrangements ................................................................................................................ 

Primary Reason for Care ................................................................................................................... 

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

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

Health Status .......................................................................................................................................... 

Chronic Conditions or Impairments .................................................................................................. 

Primary Diagnosis at Last Examination ............................................................................................. 

Functional Status .” ........................................................................................................................... 

Sensory Impairments ........................................................................................................................ 

Behavioral Problems .......................................................................................................................... 

Health Services Received ........................................................................................................................ 

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

Physician Services .................................................................................... ..” ...................................... 

Medications Received ........................................................................................................................ 

Therapy Services ............................................................................................................................... 

Service Characteristics of Facility ..................................................................................................... 

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

Appendixes 

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

Il. Definition of Certain Terms Used in This Reoort ... . .. ... .. . ..... . . ... . . ..... . .. .. . .... . ... . .... .. .... . . ..... .. ... .. .. 

ILL Selected Questionnaires Used in the 1977 N&onal Nursing Home Survey ................................ 

IV. Criteria for Classifymg Nursing Homes According to Level of Nursing Care. ............................ 

7 

7 

8 

9 

10 

12 

12 

12 

15 

17 

18 

19 

19 

z 

24 

25 

30 

33 

102 

113 

118 

137 

‘ 

LIST OF TEXT FIGURES 

1. Percent distribution of nursing home residents, by length of stay since admission: United States, 

1977 .. ... .. .. .... . ... .. .. .. ... .. .. .... . .. ... .. .. .... . . .... . ... .. . ... .. ... . .... .. .... ..“.-......................................................... 11 

2. Prevalence rates per 1,000 nursing home residents for selected chronic conditions and impairments, by age and sex: United States, 1977 ... .. ...*.......................................................................... 1g 

3. Percent of nursing home residents using eyeglasses, by age and sex: United States, 1977 . ... .. .. ... . .. . 18 

iii 
4. Percent of nursing home residents using a hearing aid, by age and sex: United States, 1977.......... 18 

5. Percent of nursing home ,residents receiving intensive nursing care, by mobility status: 

United States, 1977 ... ... .. .. ... .. . ..... .. .. ..... . .. ... .. .. .. ..... ..... ... .. ..... . .... . . .... .. .. ... ... . .... .. ... ... .. .. .... . .. .... .. .. ..... 20 

LIST OF TEXT TABLES 

A. Percent distribution of nursing home residents by sex and race, according to age: United States, 

1977 .. .... . ..... . ... ..... .. . .... . .... .... .. .. ... .. ... ... .. . .... .. .. ... ... .. ..... . .. .. .. .. .. .... . ... .. .... . ..... .. .. ... ... ... ........................ 3 

B. Number of nursing home residents per 1,000 population, by age, sex, and race: United States, 

1963, 1969, 197374, and 1977 .. ..... ... . .... .. .. ... . ... .... .. . ..... . .... . .. .. . ..... .... ... ... .. .... .. .. .. ... .. .... .. . .... .. .. ..... 4 

C. Mean age of nursing home residents at admission and standard error of the mean, by sex, race or 

ethnicity, and marital status: United States, 1977 .... ... ... . .... .. ... .. . .. .. .... .. .. ... .. ... .. ... . .... .. ... ... ... . ...... .. . 5 

D. Number of nursing home residents and the noninstimtionaliied population age 65 years and over 

and percent distribution, by age, sex, race, and marital status: United States, 1977.; .. .. .. ..... . .. ..... .. . 6 

E. Number of residents in nursing homes and homes for the aged per 1,000 population, by marital 

status and age: United States, 1970 . .... ..... ... .. .. .... .. ... . . ... .. ... .. .... ... .... .. .. ... ... . .... . .... .... .. ..... . ... .... ... . ... 6 

F. Percent distribution of nursing home residents by visitors received, according to age, race or 

ethnicity, and marital status: United States, 1977 .. ... . .... .. ... ... ... . .... ... .. ... .. .. .... .. ... .. ... .. ..... . .. ... .... . .... 7 

G. Percent distribution of nursing home residents by primary diagnosis at last examination, according to age: United States, 1977 . ...... .. .... .. ... ... .. .. .... . ... ..... . .. .... .. ... ... .. . ..... ... .. .... . .. .... .. .. ..... . .. .... .. ... .... 14 

H. Mean length of stay since admission and standard error of the mean, by primary diagnosis at last 

examination and age: United States, 1977 ..,................................................................................... 16 

J. Percent distribution of nursing home residents, by physician services received: United States, 

1977 .... . .. .... . ... .... .. . ..... . .. .. .. .. .. ...... .... .. ... .. .... . .. .... ... . ..... . .... .. .... . .... . .. .... .... ...... .. .... .. ... ......................... 20 

K. Mean time since last physician visit, by length of stay since admission: United States, 1977.......... .21 

L. Number and percent of nursing home residents, by type of medication received: United States, 

197374 . . ... .... .. .. .... ... .. .... .. .. ... ... .. ..... ... ... ... .. .... . .. .. .. .... . .... . .. .. .. .... ..... .. . .. .. .. .. . ... .. ... ... ... .. .................... 23 

M. Percent distribution of nursing home residents by level of care received, according to number of 

categories of medication received: United States, 1973-74 ... .. . .... ... .. .... . ... ... .. . .. .... . ... .... .. . ..... . ... ..... . 24 

N. Number and percent distribution of nursing home residents, by therapy services received: 

United States, 1977 .... .. .. ..... . . ..... .. .. ... ... .. .... . ... .. ... .. .... .. ... .. .... . .... . .... .. .... . ..... . ... ..... . . ..... . .. .... ... . .... .. ... 25 

0. Number of nursing homes by facility certification and percent distribution by selected facility 

characteristics, according to facility certification: United States, 1977 .. ..... . .... .. .. ... ... ...a................. 26 

P. Number of nursing home residents and percent distribution, by level of care received: 

United States, 1964, 1973-74, and 1977 .... .... .. . ..... . .. . .... .. . ..... .. .. .... .. .. .... .. ... ... .. . ..... ... . .... .. .. .. ... .. .. .... 27 

Q. Number of nursing home residents and percent distribution, by time since last physician visit: 

United States, 1964, 1973-74, and 1977 ..... ... .. ..... . .. .... ... . .... . .. ..... ... . .... .. . .. ... .. .. .... .. ... .. .... . ..... .. . .. .. .. . 27 

R. Number of nursing home residents by facility certification and percent distribution by primary 

reason for care and independence in the six activities of daily living, according to facility certification: United States, 1977 ... ..... . ... ... .. ... .... . . .. .. .... .. .... . .. .... .... . .... . . ..... ... .. .... .. .. ... ... .. .... . ... ... ... . ..... .. . .. 28. 

iv 
SYMBOLS 

Data not available __-

_ Category not applicable . . . 

Quantity zero 

Quantity more than 0 but less than 0.05- 0.0 

Figure does not meet standards of * reliability or precision 

I 

V 

I 
CHARACTERISTICS OF NURSING HOME RESIDENTS, 

HEALTH STATUS, AND CARE RECEIVED 

Esther Hing, Division 

INTRODUCTION 

Scope of Report 

This report presents data on demographic, 

utilization, and health status characteristics of 

nursing home residents during the period MayDecember 1977. The utilization characteristics 

that were examined are resident related rather 

than facility related and include length of stay 

since admission, primary reason for care, prior 

living arrangements, and primary source of payment. Examined health status characteristics include primary diagnosis at last examination, 

chronic conditions and impairments, functional 

status, sensory impairments, and behavioral problems. The examination of utilization and health 

status characteristics emphasizes major demographic characteristics, such as age, sex, and race 

or ethnicity. 

This report also presents an examination of 

the care received by residents. The variables include level of nursing care, medications, physician care, therapy, and other health services. The 

variables are examined from two perspectives: 

the resident’s health status and the facility’s 

service characteristics. 

Sources and Qualifications of Data 

The data presented in this report are based 

on the 1977 National Nursing Home Survey, 

conducted by the Division of Health Care Statistics of the National Center for Health Statistics. The survey was conducted from May to 

December 1977 in a sample of nursing homes in 

the conterminous United States. The survey 

of Health Care Statistics 

covered all types of nursing homes, including 

nursing care homes, personal care homes with 

nursing, personal care homes, and domiciliary 

care homes. Places that only provide room and 

board were excluded. 

Subsamples of residents in each sampled 

facility, residents discharged during calendar 

year 1976, and employees gave detailed information about the population served and the persons who provided direct care. Data in this 

report are primarily based on the Resident Questionnaire, which was completed by interviewing 

knowledgeable nursing home staff members, 

who referred to residents’ medical records when 

necessary. 

A detailed description of the sampling frame, 

sample design, and survey procedures is presented in appendix I. Appendix I also includes 

imputation procedures and estimation techniques. Since the data in this report are national 

estimates based on a sample and subject to sampling errors, standard error charts 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 interpret the data in 

this report. Facsimiles of selected questionnaires 

and forms used in the survey are shown in appendix III. Criteria for classifying nursing homes 

within the scope of the survey are presented in 

appendix IV. 

Background 

The 1977 National Nursing Home Survey 

(NNHS) is the second in an ongoing survey system. Two reports that present final estimates 

1 
from the 1977 NNHS have already been published. The first presents summary national data 

on nursing homes; the second presents utilization data on nursing homes in California, Illinois, Massachusetts, New York, and Texas.‘p2 

In addition, two reports that present provisional 

estimates from the 197 7 NNHS have been published.3p4 The first NNHS was conducted between August 1973 and April 1974 and covered 

all nursing care homes and personal care homes 

with nursing. The 1973-74 NNHS universe differed from that of the 1977 survey. The 1977 

NNHS included not only nursing care homes and 

personal care homes with nursing but also personal care homes without nursing and domiciliary care homes. Since the impact of including 

these facilities in the 197 7 NNHS is expected to 

be small, no special adjustments are made in this 

report when data from the 1977 NNHS are cornpared with the 1973-74 NNHS data. (According 

to the Master Facility Inventory (MFI), a census 

of all inpatient health facilities conducted by the 

National Center for Health Statistics, about 

2 percent of all nursing homes in 1973 were personal care or domiciliary care homes and housed 

only about 1 percent of the beds and residents.5) 

Reports based on data collected in the 1973-74 

survey that focus on operating and financial 

characteristics of the f acilities,6 social and 

demographic characteristics of the residents,7 

utilization of nursing homes,8 health status of 

residents,g general characteristics of the nursing 

homes,lO charges and sources of payment for 

residents,ll nursing home costs,‘2 and employees13 have been published. 

Before creating this continuing data collection system, the National Center for Health 

Statistics (NCHS) conducted a series of three ad 

hoc sample surveys of nursing and personal care 

homes called the Resident Places Surveys (RPS1, -2, -3). These surveys provided much of the 

background information and experience used to 

develop the first NNHS. The three surveys were 

conducted during April-June 1963, May-June 

1964, and June-August 1969, respectively. 

During the first survey, RPS-1 (1963), data were 

collected on nursing homes, chronic disease and 

geriatric hospitals, nursing home units, and 

chronic disease wards of general and mental hospitals.14-17 RPS2 (1964), the second ad hoc 

survey, was concentrated mainly on nursing 

homes and geriatric hospitals, and more detailed 

information about each institution, its residents, 

and its employees was collected.ls-26 During the 

third survey, RPS-3 (1969), nursing and personal 

care homes in the conterminous United States 

were sampled.27-33 

Since the methodology and much of the 

data collected in past surveys are comparable 

with that of the 1977 NNHS, selected trend data 

on residents are examined in this report. 

DEMOGRAPHIC CHARACTERISTICS 

On any given day during the survey period 

May-December 1977 about 1,303,100 residents ’ 

resided in the 18,900 nursing homes nationwide, 

representing a 21-percent increase over the 

1,075,800 residents reported in the 1973-74 

NNHS. The demographic characteristics of nursing home residents in 1977, however, were 

the same as those reported in previous

stu&es,7,15,25,28 in which the typical nursing , 

home resident was found to be very aged, white, 

female, and widowed. 

Age 

In 1977 the resident population in nursing 

homes was predominantly elderly. Eighty-six . 

percent of the residents were 65 years and over, 

and a majority (70 percent) were 75 years and 

‘over. At the other extreme, only 14 percent 

were under 6.5 years (table 1). The average age 

of the residents was 78 years (table A). The 

utilization of nursing homes at any given time 

increases with age. In 1977 less than 1 out of 

every 1,000 persons under age 65 years in the 

United States resided in nursing homes, compared with 48 per 1,000 persons age 65 years 

and over (table B). The rate of nursing home 

residence increased sharply, after 65 years of age 

from 15 per 1,000 persons for those age 65-74 

years to 216 per 1,000 for those age 85 years 

and over. The average age at which residents 

were admitted to nursing homes was 75 years 

(table C). 

Sex 

Not only were nursing home residents predominantly elderly, they were also predominantly 
Table A. Percent distribution of nursing home residents by sex and race, according to age: United States,.1977 

Average 

Sex and race age in 

years 

Percent distribution Age in 

years 

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 100.0 77.9 

Sex 

Male.. ........................................................................................................... 28.8 45.9 37.9 26.3 20.4 73.9 

Female.. ....................................................................................................... 71.2 54.1 62.1 73.7 79.6 79.6 

Race 

7 

White1 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . 93.3 87.8 88.7 95.4 95.4 78.3 

Black and other .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.7 12.2 11.3 4.6 4.6 72.6 

Black .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.2 11.6 10.4 4.2 4.2 72.5 

lIncludes parsons of Hispanic origin. 

female. About 71 percent of the residents were 

women, and regardless of age group, the proportion of females exceeded that of males (table 1). 

The female-to-male ratio increased with age. 

At 65-74 years, there were nearly two females 

to every male, while at 85 years and over, there 

were four females to every male. The average 

age was 80 years for females and 74 years for 

males (table A). The preponderance of females 

in nursing homes is due in part to their longer 

life expectancy and also to their greater utilization of nursing homes compared with males. As 

table B shows, the residency rate in nursing 

homes per 1,000 population age 65 years and 

over was nearly twice as high for females as 

for males. Moreover, the differences increased 

sharply with advancing age. As shown in table C, 

the average age at admission for females (77 

years) was significantly greater than that for 

males (72 years). 

Race 

Table A shows the percent distribution of 

nursing home residents by race. In 1977 residents in nursing homes were predominantly 

white. Including Hispanic Americans, white residents comprised 93 percent of the residents 

(persons of Hispanic origin comprised 1 percent 

of the residents). Only 7 percent of the residents 

in nursing homes, compared with 13 percent in 

the total population, were classified as black or 

of other races (Asians or Pacific Islanders, 

American Indians or Alaskan Natives). Six percent of the residents were classified as black, 

compared with 12 percent in the total U.S. 

population. Black and other residents in nursing 

homes were younger than white residents. The 

average age was 78 years for white persons (including those of Hispanic origin) and 73 years 

for black persons and those of other races. The 

proportions of black persons and others decreased with increasing age. Whereas 12 percent 

of the residents under 65.years were classified as 

black or other, only 5 percent of the residents 

85 years and over were classified as black or 

other (table A). This difference in race among 

the older age groups is due in part to the longer 

life expectancy of white persons (74 years) compared with persons of other races (69 years)34 

and also to differential rates of residence by 

elderly black and other residents in nursing 

homes. As shown in table B, the 1977 residency 

rate in nursing homes for white persons 65 years 

and over was 50 per 1,000 population, compared with 30 per 1,000 population for black 

and other persons. After age 75 years the residency rates for white persons were significantly 

higher than those for black and other persons 
. 

Table B. Number of nursing home residents per 1,000 population, by age, sex, and race: United States, 1963, 1969, 1973-74, and 1977

- ­ lr Sex T Race 

Age and year Total Black and other Male Female White1 

Total Black 

1963 . 

Under 65 years ................................................................................................... 0.6 0.7 0.6 0.6 0.6 

65 years and over. ............................................................................................... 25.4 18.1 31 .I 26.6 10.3 

65-74 years.. .................................................................................................. 7.9 6.8 8.8 8.1 5.9 

7544 years.. .................................................................................................. 39.6 29.1 47.5 41.7 13.8 

85 years and over.. ......................................................................................... 148.4 05.6 175.1 157.7 41.8 

1969 

Under 65 years ................................................................................................... 0.9 0.9 0.9 0.9 0.8 0.4 

65 years and over.. .............................................................................................. 37.1 25.0 46.1 38.8 17.6 17.8 

65-74 years .................................................................................................... 11.6 9.9 12.9 11.7 9.6 10.0 

7584 years.. .................................................................................................. 51.7 36.0 62.3 54.1 22.9 22.3 

85 years and over.. ......................................................................................... 203.2 30.8 247.6 221.9 52.4 51.8 

1973-742 

Under 65 years ................................................................................................... 0.6 0.6 0.7 0.6 0.5 0.5 

65 years and over.. .............................................................................................. 45.1 30.2 55.5 47.3 21.9 22.4 

65-74 years.. .................................................................................................. 12.3 11.3 13.1 12.5 10.6 11 .o 

75-84 years.. .................................................................................................. 59.4 40.8 71 .l 61.9 30.1 39.9 

85 years and over.. ......................................................................................... 253.7 80.4 290.6 269.0 91.4 96.4 

1977 

Under 65 years . . . . . . . . . . . .._..................................................................................... 0.9 0.9 1.0 0.9 0.8 0.9 

65 years and over .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47.9 30.7 59.7 49.7 30.4 31.4 

65-74 years . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.5 12.7. 15.9 14.2 16.8 17.1 

75-84 years .._............._................................................................................... 68.0 47.4 80.6 70.6 38.6 42.0 

85 years and over . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . 216.4 40.0 251.5 229.0 102.0 106.7 

IIncludes persons of Hispanic origin. 

*Excludes residents in personal care homes. 

SOURCES: Data for 1963 are from the National Center for Health Statistics: Characteristics of residents in institutions for the aged 

and chronically ill, United States, April-June 1963, by G. Wunderlich. Vital and Health Statistics. PHS Pub. No. lOOO-Series 12-No. 2. 

Public Health Service. Washington. U.S. Government Printing Office, Sept. 1965. Data for 1969 are from the National Center for Health 

Statistics: Measures, of chronic illness among residents of nursing homes, United States, June-August 1969, by D. Ingram. Vital and 

Health Statistics. Series 12-No. 24. DHEW Pub. No. (HRA) 74-1709. Health Resources Administration. Washington. U.S. Government 

Printing Office, Mar. 1974. Population data for 1973-74 and 1977 used to compute the rates are from the U.S. Bureau of the Census: 

Estimates of the population of the United States by age, sex and race, 1970-1977. Cuwent Population Reports. Series P-25, No. 721. 

Washington. U.S. Government Printing Office, 1978. 

(and for black persons in particular) regardless first ad hoc survey of nursing homes was conof age group. However, for persons age 65-74 ducted. In that year the utilization rate for 

years, the rate of nursing home use was similar white persons (27 per 1,000 population age 65 

for white persons (14 per 1,000 population) and years and over) was nearly 3 times the rate for 

black and other persons (17 per 1,000 popu- black persons and others (10 per 1,000 populalation). tion age 65 years and over) (table B). Despite 

Previous nursing home surveys conducted by general underutilization of nursing homes by 

the National Center for Health Statistics have black and other persons, their rate of nursing 

shown that the underrepresentation ,of persons home use has been increasing since 1963;due to 

classified as black and others in nursing homes the increasing proportion of persons classified as 

has been a consistent trend since 1963, when the black and others in the general population. 

4 
Table C. Mean age of nursing home residents at admission and 

standard error of the mean, by sex, race or ethnicity, and 

marital status: United States, 1977 

/ Ey::’ 

Sex, race or ethnicity, and marital status 

Standard I

Mean I error 

All residents . . . . . . . . . . . . . . .._.................. 

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

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

Race or ethnicity 

White (not HispanicI .............................. 75.9 0.23 

Black (not Hispanic). ................................ 69.9 0.80 

Hispanic and other.. .................................. 70.2 1.88 

Marital status 

Married ...................................................... 74.8 0.46 

Widowed1 ................................................. 80.0 0.15 

Divorced or separated ............................... 64.3 0.62 

Never married ........................................... I 65.0 I 0.59 

lIncludes a small number of unknowns. 

The lower nursing home utilization rate for 

elderly black and other persons may be related 

to their greater availability of informal home 

care. According to a 1968 study of home care 

use, proportionately more black and other persons received home care than did white persons. 

For the U.S. noninstitutionalized population age 

75 years and over, 17 percent of black and other 

persons received home care, compared with 13 

percent of white persons.35 Other factors affecting black and other persons’ utilization of nursing homes are discussed in subsequent sections 

of this report. 

In the previous discussion of nursing home 

use by race, persons ‘of Hispanic origin were included in the racial category “white” for analytical purposes. This was done because the total 

population estimates used to derive residency 

rates in nursing homes include Hispanic persons 

in that category. Since 1977 NNHS data concern 

residents’ race and ethnicity (see question 3 of 

the Resident Questionnaire in appendix III), the 

following ethnic categories are used in the remainder of this report: white (not Hispanic), 

black (not Hispanic), and Hispanic and other. 

Marital Status 

Due to their greater longevity, females are 

more likely than males to become widowed. 

This is reflected to an extreme degree in the 

nursing home population, where 72 percent of 

female residents were widowed, compared with 

38 percent of males. As table 1 shows, a larger 

proportion of females than males were widowed 

regardless of age group. Conversely a larger proportion of males (23 percent) were married than 

were females (7 percent). As 86 percent of the 

residents were elderly (65 years and over), information on residents’ marital status essentially 

reflects the marital status of elderly residents. In 

contrast to elderly nursing home residents, residents under 65 years were more often never 

married (51 percent) or divorced or separated 

(21 percent). Only 17 percent of the younger 

residents were *widowed. 

The marital status distribution of the nursing 

home population reflects the frequently cited 

finding that chronically ill elderly persons who 

live alone, without a spouse or other social supports, are at greatest risk of institutionalization. 

For example, in the First Longitudinal Study of 

Aging, conducted by the Duke Center for the 

Study of Aging and Human Development, 

Palmore found that those living alone have a 

higher chance of institutionalization (33 percent) than those not living alone (24 percent) 

“because they were less able to arrange for 

someone to care for them outside an institution 

when they became physically or mentally incapacitated.” Other factors associated with greater 

risk of institutionalization are being never married, separated from spouse, and having none or 

few children.36 Thus in comparison with the 

U.S. population age 65 years and over, persons 

who are widowed or never married are overrepresented in nursing homes: 69 percent of the 

nursing home population age 65 years and over 

are widowed, while only 36 percent of the noninstitutionalized U.S. population age 65 years 

and over are widowed. Similarly, 14 percent of 

the elderly nursing home population, in contrast 

to 6 percent of their noninstitutionalized counterparts, were never married (table D). 

Data from the 1970 census also confirm the 

greater likelihood of an unmarried elderly person being institutionalized in a nursing home or 

5 
Table D. Number of nursing home residents and the noninstitutionalized population age 65 years and over and percent distribution, by age, sex, race, and marital status: 

United States, 1977 

Age, sex, race, and marital status 

Number 

All residents . . . . . . . . .. . . . . . . . . . . . . . ,I 26,000 1 22,100,OOO 

Percent distribution 

Total ................................... 100.0 100.0 

Age 

66-74 years .................................... 18.8 64.0 

75 years and over.. ......................... 81.2 36.0 

Sex 

Male ...................... . ........................ 26.1 41.3 

Female.. ......................................... 73.9 58.7 

Race 

White*. .......................................... 93.3 90.6 

Black and other ............................. 6.7 9.4 

Marital status 

Married .......................................... 12.1 53.2 

Widowed ........................................ 69.3 I 36.4 

Divorced or separated.. .................. 

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

IData are from the U.S. Bureau of the Census: Marital status 

and living arrangements: March 1977. Current Population 

Reports. Series P-20, No. 323. Washington. U.S. Government 

Printing Office, Apr. 1978. 

*Includes persons of Hispanic origin. 

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

home for the aged and dependent. As table E 

shows, in 1970 the residency rate per 1,000 

population 65 years and over for married persons was 9, in contrast to 72 per 1,000 population for widowed persons, 40 per 1,000 population for divorced or separated persons, and 83 

per 1,000 population for never-married persons. 

Table E also shows that the residency rate 

among never-married persons was higher at ages 

65-74 years (45 per 1,000 population) than the 

other marital statuses (4-27 per 1,000 population), indicating that the chances of institutionalization for never-married elderly persons are 

higher at younger ages than for the other 

marital statuses. 

. 

Table E. Number of residents in nursing homes and homes for 

the aged per 1,000 population, by marital status and age: 

United States, 1970 

Marital status 

1 

SOURCES: 1970 Census of the Population, General Population Characteristics, U.S. Summary, PC (1) - D 1; 19 70 Census of 

Population, Persons in Institutions and Other Group Quarters, 

PC (1) - 91. 

Visitors Received 

Although data on the existence of family 

members were not collected, information on the 

relationships of persons visiting residents provides proxy information on kinship supports. 

About 13 percent of the residents had no visitors, while over 87 percent had visitors. About 

66 percent were visited by a member of the 

residents’ immediate family (defined as spouse, 

children, siblings, or parents). Usually (over 50 

percent) the visitor was a child of the nursing 

home resident, while 7 percent of the residents 

were visited by a spouse. Over 62 p.ercent of the 

residents had daily or weekly visits, and over 25 

percent had less frequent visits (table F). 

When the frequency of visitors was examined 

by the resident’s age, the proportion of residents 

receiving no visitors declined with age. Nearly 22 

percent of those under 65 years received no 

visitors, in contrast to 10 and 8 percent of residents 75-84 years and 85 years and over, respectively. A smaller proportion of residents under 

75 years (21 percent of those under 65 years 

and 39 percent of those 65-74 years) were 

visited by their children than were those over 75 

years of age (56-61 percent). Residents age 65-

74 years were more likely to have been visited 

by a spouse (14 percent) than were residents in 

the other age groups (3-8 percent). 

When marital status was considered, a larger 

proportion of residents who were never married 

(23 percent) or divorced or separated (24 percent) received no visitors than did residents who 

6 
Table F. Percent distribution of nursing home residents by visitors received, according to age, race or ethnicity, and marital status: 

United States, 1977 

Visitors received 

NOW.. ........................................... 

Daily or weekly ............................ 

Other1 .......................................... 

TvP~* -

Immediate family3 ....................... 

spouse ..................................... 

Children.. ................................. 

Other relatives or unknown4.. ...... 

Age Race or ethnicity Marital status r 

All -

residents Under 66-74 75-84 85years White Black Hispanic 

Married Widowed1 

Divorced Never h0t hl0t and or 65 years years years and over Hispanic)1 Hispanic) other separated married 

Percent distribution 

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 

21.5 17.4 10.8 8.3 11.7 22.0 19.8 5.2 9.3 23.7 23.1 

44.4 55.4 65.6 68.9 63.2 48.2 56.8 80.5 67.1 44.0 41 .l 

25.4 34.1 27.3 23.7 22.8 25.1 29.8 23.4 14.3 23.5 32.3 35.7 

66.4 62.2 62.8 67.9 68.3 67.4 52.2 65.3 87.0 71.4 58.4 40.3 7.0 7.8 13.8 7.5 2.9 7.0 7.5 5.1 58.1 ‘0.2 ‘2.8 l 

21 .l 39.0 56.1 61 .l 51.6 30.8 47.8 60.0 64.3 41.9 1.6 

48.1 54.9 64.0 68.1 62.5 53.2 53.4 56.2 65.2 52.0 57.4

1Includes asmall number of unknowns. 

‘Figures do not add to totals because multiple responses were permitted. 

31ncludes parents. spouse, children, and siblings. 

4Includes grandchildren, other relatives, unrelated persons, and unknown. 

were widowed (9 percent) or married (5 percent). 

Further, never-married and divorced or separated residents were least likely to have daily or 

weekly visits. When race or ethnicity was considered, a larger proportion of black (not His­

\ panic) residents (22 percent) than white (not 

Hispanic) residents (12 percent) received novisitors. 

UTILIZATION 

As stated in the previous section, nursing 

home utilization varies by the major demographic 

variables of age, sex, race or ethnicity, and marital status. In the following section, such utilization characteristics as prior living arrangements, 

primary reason for care, primary source of payment, and length of stay since admission are examined by these major demographic variables in 

order to shed further light on factors that affect 

nursing home use. 

Prior Living Arrangements 

Examination of residents’ prior living arrangements sheds some light on their social supports prior to admission as well as on prior 

institutionalization. In 1977, 37 percent of the 

residents in nursing homes were admitted from 

their private residence, where they had usually 

lived with their immediate family (20 percent) 

or alone (13 percent). The next largest category 

of prior living arrangements was “general or 

short-stay hospital” (32 percent) followed by 

nursing homes (13 percent) and mental hospitals 

(6 percent). Three percent were admitted from 

semiprivate residences (boarding homes or homes 

for the aged) (table 2). 

The type of prior living arrangement varied 

by sex. A higher proportion of females than 

males had either lived alone or with their children. Fourteen percent of female residents had 

lived alone prior to entering the nursing home, 

while only 10 percent of the male residents had 

lived alone. In addition, 12 percent of the 

females, in contrast to 6 percent of the males, 

had lived with their children prior to admission. 

Male residents, however, were more likely than 

female residents to have lived with their spouses 

prior to admission. Nine percent of the male 

residents, compared with 4 percent of the female 

residents, had lived with their spouses prior to 

admission. To some extent these findings are 

related to the greater likelihood of female resi-’ 

dents being widowed (72 percent) than male 

residents were (38 percent), and the greater likelihood that male residents had a living spouse 

(23 percent) than female residents had (7 

percent). 
The residents’ prior living arrangements also 

varied with age. A smaller proportion of younger 

residents (under 65 years) were admitted to the 

nursi;lg home from a general or short-stay hospital (25 percent) than were elderly residents 

over 65 years of age (32-35 percent). Transfers 

from another nursing home did not vary by age; 

however, admissions from mental hospitals declined with age. Twenty-one percent of residents 

under 65 years of age were admitted from a 

mental hospital, compared with 2 percent of 

those 85 years and over. A smaller proportion of 

residents under 65 years (3 percent) and residents 

65-74 years (6 percent) had previously lived 

with their children than had residents in the two 

oldest age groups (12 and 14 percent, respectively); this finding reflects, in part, the need’for 

informal social support of very elderly persons 

and the smaller probability of younger residents 

(under 65 years) having lived with their children, 

since 51 percent of these residents had never 

married. 

When race or ethnicity was considered, a 

larger proportion of black (not Hispanic) residents were previously institutionalized (60 percent) than were white (not Hispanic) residents 

(54 percent). This difference is primarily accounted for by the larger proportion of black 

(not Hispanic) residents (12 percent) than white 

(not Hispanic) residents (6 percent) who were 

transferred from a mental hospital. As a group 

minority residents, that is, black (not Hispanic) 

and Hispanic and other residents, were less likely 

to have been admitted from their private residence than were white (not Hispanic) residents. 

Thirty-one percent of minority residents were 

admitted from their own homes, compared with 

38 percent of white residents. Minority residents, 

however, were less likely to have lived alone in 

their homes (6 percent) than were white residents (13 percent) (table 3). 

Residents without spouses were more likely 

to have lived alone prior to admission. A smaller 

proportion of married residents (4 percent) had 

r 

lived alone prior to admission to the, facility 

than was the case with any other marital status 

(9-15 percent). Similarly married residents were 

most likely to have lived with others prior to 

admission: 38 percent of married residents had 

lived with others, compared with 13-21 percent 

of nonmarried residents. There were other differences in prior institutionalization by marital 

status. A smaller proportion of never-married 

residents were transferred to the facility from 

general or short-stay hospitals (24 percent), and 

a larger proportion of divorced or separated 

residents (13 percent) and never-married residents (16 percent) were admitted from mental 

hospitals. 

Primary Reason for Care ..-

Overall, nearly 4 of every 5 residents were 

admitted because of poor physical health (78 

percent), 7 percent were in the facility because 

of mental illness, and 4 percent were, admitted 

because of mental retardation. About 2 percent 

were admitted because of behavioral problems., 

5 percent be,cause of social reasons, and 4 percent because of economic or other reasons. 

Prior living arrangements were related to the 

primary reason for care. A larger proportion of -.’ 

those in the facility because of mental illness or 

mental retardation had previously been institutionalized in another health facility (72 arid 63 

percent, respectively) than were those admitted 

because of poor physical health, or behavioral, 

social, economic, or other reasons (38-54 percent). Residents admitted to the facility because 

of mental illness came primarily from mental 

hospitals (40 percent) or general or short-stay 

hospitals (17 percent). Residents admitted because of mental retardation were. also chiefly 

admitted ‘from mental hospitals (24 percent), 

with about 17 and 16 percent transferred from 

another nursing home or other type of health 

facility, respectively (table 4). 

Residents admitted because of poor physical 

health, or behavioral, social, economic, or other 

reasons were more often admitted from their 

own homes (38-51 percent) than were residents 

who received care because of mental illness (18 

percent) or mental retardation (29 percent). 

Larger proportions of residents in nursing homes 

because of social and economic or other reasons 

had lived alone prior to admission (23 and 20 

percent, respectively) than had residents admitted 

because of poor health (13 percent) (table 4). 

8 
*. I ._ 

1 

. I \ 

Primary Source of Payment 

Data on sources of funds used to maintain 

residents in nursing homes provide a rough measure of residents: income sources ‘since public 

~:~%ui%lsfor nursing home care are generally available only to those who, alone, cannot afford to 

pay for such care. The Medicaid program, for 

example (title XIX of the Social Security Act), 

was designed to ease the financial burden of 

medical care for the poor of all ages. The Medicare program (title XVIII of the Social Security 

Act) covers all persons age 65 years and over 

and two additional high-risk groups: disabled 

persons under 65 who had been entitled to 

receive social security cash benefits for at least 

2 years, and persons with end-stage renal disease. 

Medicare is available to those persons regardless 

of income level. 

Medicare finances up to 100 days of extended care services for persons 65 years and 

over in certified nursing home facilities during 

single spells of illness. Medicare specifically 

covers posthospital extended care to continue 

necessary medical treatment (following discharge 

after a minimum stay of 3 days in a hospital) in 

an institution (or distinct part thereof) that pro- ’ 

vides a level of care distinguished from the 

level of intensive care ordinarily furnished by a 

hospital. 

Medicaid finances both skilled nursing and 

intermediate care services in nursing homes. In 

1972 amendments to the Social Security Act, 

which became effective July 1, 1973, established 

a new name to reflect the common set of 

standards for institutions formerly identified as 

extended care facilities under Medicare and as 

skilled nursing homes under Medicaid. The name 

of these institutions is now “skilled nursing facilities” (SNF’s). 

Intermediate care services are those provided 

in an intermediate care facility (ICF). Intermediate care facilities provide health-related care 

and services to those who do not need care in 

skilled nursing facilities but require institutional 

care beyond room and board. Under new regulations, institutions for the mentally retarded or 

for victims of cerebral palsy, epilepsy, or other 

neurological conditions defined in the Developmental Disabilities Act may qualify as ICF’s if 

they provide health and rehabilitative services. 

Recognition of ICF’s became necessary because 

many elderly persons need long-term institutional care, although they do not need the level 

and degree of care available in skilled nursing 

facilities under titles XVIII and XIX. 

The data show nine primary sources of payment for nursing home care: residents’ own income or family support, Medicare (title XVIII 

of the Social Security Act), Medicaid (title 

XIX of the Social Security Act), other government assistance or welfare, religious organizations, Veterans’ Administration (VA) contracts, 

initial payment-life care funds, no charge, and 

other sources (see question 46 of the Resident 

Questionnaire in appendix III). The data reflect 

the principal source used in the month preceding 

the survey, or, if the resident had been in the 

facility for less than a month, the time period 

between the date of admission and the date of 

the survey. 

In 1977 nearly half of all residents (48 percent) relied on Medicaid as their primary source 

of payment for care., Thus Medicaid was the 

major funding source for nursing home care. 

Twenty and 28 percent of all nursing home 

residents received skilled nursing services and 

intermediate care services financed primarily by 

Medicaid, respectively. The next most frequent 

primary source of ‘payment was residents’ own 

income or family support (38 percent). This 

payment source also included private health 

insurance, retirement funds, and social security. 

Six percent of the residents relied primarily on 

other government assistance or welfare, and 5 

percent relied on all other sources (religious 

organizations, foundations, volunteer agencies, 

VA contracts, initial payment arrangements, 

life-care arrangements, miscellaneous sources, 

and no-charge arrangements). A minority of the 

residents (2 percent) relied primarily on Medicare for payment of care (table 5). 

Use of these payment sources varied by age. 

The proportion of residents who received intermediate care financed primarily by Medicaid was , 

greatest in the two younger age groups under 75 

years. Thirty-four percent of residents under 65 

years and 32 percent of residents 65-74 years 
received intermediate care, compared with 25-2 7 

percent for the two older age groups. Use of 

either Medicare or Medicai&ski&d care did not 

vary by age; however, the proportion of residents primarily using other government assistance or welfare and all other sources generally 

declined with age. When sex was considered, a 

larger proportion of female than male residents 

relied primarily on Medicaid for skilled nursing 

care. 

When race or ethnicity was examined, a significantly larger proportion of black (not Hispanic) residents relied on Medicaid for their stay 

in nursing homes (73 percent) than did white 

(not Hispanic) residents (46 percent) or Hispanic 

and other residents (51 percent). Use of Medicaid to pay for intermediate care services was 

greatest for black (not Hispanic) residents than 

for others. Forty-seven percent of black (not 

Hispanic) residents received intermediate care, 

compared with 27 percent of white (not Hispanic) residents and 21 percent of Hispanic and 

other residents. A larger proportion of black 

(not Hispanic) residents (26 percent) than white 

(not Hispanic) residents (19 percent) received 

skilled nursing care paid primarily by Medicaid. 

In contrast to their relatively greater use of Medicaid for primary payment, black (not Hispanic) 

residents were less likely to use their own income or family support for primary payment for 

care. (This was also the case for Hispanic and 

other residents.) Thirteen and 18 percent, respectively, of black (not Hispanic) and Hispanic 

and other residents, compared with 41 percent 

of white (not Hispanic) residents, relied on their 

own income or family support for primary payment for care. 

Examination by marital status revealed other 

differences concerning primary source of payment. Use of Medicaid for primary payment 

(skilled or intermediate) was lower for married 

residents than for any other marital status. 

Thirty-four percent of married residents, compared with 48-53 percent of nonmarried residents, used Medicaid as the primary source of 

payment for care. Similarly, a smaller proportion of married residents (19 percent) than nonmarried residents (27-35 percent) received intermediate care financed primarily by Medicaid. A 

larger proportion of married residents (50 percent), followed by widowed residents (40 percent), divorced or separated residents (28 

percent), and never-married residents (30 percent), used their own income or family support 

for primary payment. These findings are probably related to the greater financial resources of 

persons who are married or who have children 

than of those without spouses or children. 

Length of Stay Since Admission 

At the time of the survey most nursing home 

residents were characterized by long stays in the 

facility; 64 percent had resided in the facility 

1 year or more. About 24 percent of the residents had been in the facility less than 6 months, 

and 15 percent had been in the facility less than 

3 months (table 6). 

As figure 1 shows, the length-of-stay distribution of the nursing home population is a generally decreasing function,, which reflects the 

decreasing probabilities of residents’ surviving 

to long stays after admission. The mean length 

of stay, which is influenced by the range of 

cases, was significantly longer (2.6’ years) than 

the median length of stay after admission (1.6 

years) (table 7). The median length of stay is the 

point in the distribution where half the residents 

have shorter stays and half have longer stays. 

Before analyzing the differences in length of 

stay among nursing home residents, certain 

caveats should be noted. First, the length of stay 

measured for residents is incomplete; that is, it 

reflects only the time the resident had been in 

the facility, not the time he or she will ultimately 

spend in the facility. Second, the length-of-stay 

distribution of residents, although typical of 

those found in previous cross-sectional sample 

surveys of nursing home residents,7,2l is heavily 

weighted with long-term residents as a result of 

the methodology that samples all persons on the 

facility roster 3the night before the survey. In 

contrast, a previous report from the 1977 

National Nursing Home Survey, based on data, 

from a sample of all discharges from nursing 

homes during 1976, shows that nursing homes 

provide a substantial volume of short-term care 

,in addition to the prolonged care for the elderly 

usually associated with nursing homes.3 Charac10 
-- 

LENGTH OF STAY SINCE ADMISSION 

Figure 1. Percent distribution of nursing home residents, by length of stay since admission: United States, 1977 

teristics of short-term nursing home residents, as 

well as an examination of outcome, is presented 

in a forthcoming report that covers persons discharged from nursing homes (both live and 

dead) during calendar year 1976.37 The following analysis looks at characteristics of long-term 

nursing home residents by examining the average 

length of stay since admission in the resident 

nursing home population. 

In 1977 ‘long-term nursing home residents 

could be characterized as those persons with 

prior institutionalization in mental hospitals, 

and those elderly persons who lacked the social 

resources to prevent early institutionalization in 

nursing homes. Residents transferred from mental hospitals had longer average stays (4.5 years) 

than had residents transferred from general or 

short-stay hospitals (1.8 years) or nursing homes 

(2.2 years) (table 7). Similarly, when primary 

reason for care was examined, residents admitted 

because of mental illness (3.5 years), mental 

retardation (4.3 years), and social reasons (3.2 

years) had longer average stays than had residents admitted because of poor physical health 

(2.4 years) or behavioral reasons (1.7 years). 

Among residents admitted from private residences, the average stay was longer for those 

who had lived alone (3.1 years) than for those 

who had lived with either their spouse (2.4 

years) or children (2.5 years). When frequency 

of visitors was examined, residents who received 

no visitors (3.4 years) had longer average stays 

than residents receiving daily or weekly visits 

(2.2 years). When marital status was examined, 

never-married residents had longer average stays 

(3.7 years) than any other marital status, while 

married residents had the shortest average stays 

(1.6 years). 

Although most residents were in the facility 

for long stays, certain residents were characterized by shorter lengths of stay. The stays for 

Medicare recipients, for example, were considerably shorter than those for residents who used 

any of the remaining sources because Medicare 

provides for only the first 100 days of inpatient 

care in a skilled nursing facility. In 1977, 89 percent of the residents who used Medicare as their 

primary source of payment were in the facility 

for less than 6 months, and the average time 

spent in the facility by residents who used Medicare was 0.7 year. In contrast, the average stays 

for residents who used the remaining primary 

sources of payment ranged from 2.2 to 3.1 years 

(table 7). (Because the primary source of payment for residents was the one that paid the 

greatest amount of the resident’s charge in the . month prior to the survey, it is possible that the 

primary payment source changed for Medicare 

recipients during the course of the stay.) 

Length of stay by selected health characteristics is discussed in the next section on health 

status. 

11 

I 
HEALTH STATUS 

As mentioned, the primary reason cited for 

residents’ institutionalization was poor physical 

health requiring nursing services, personal care, 

‘or rehabilitation. Since 86 percent of the residents in nursing homes were elderly (age 6.5 

years and over), many nursing home residents’ 

health problems were associated with old age. 

However, the health problems of some residents 

were associated with developmental disabilities 

or were the result of accidents. The following 

section presents a health status profile of the 

nursing home resident population with regard to 

prevalence of chronic conditions or impairments, primary diagnosis at last examination, 

functional status, sensory impairments (vision, 

hearing, speech, communication, and use of dentures), and behavioral problems. 

Chronic Conditions or Impairments 

Due to the elderly composition of the nursing home population, most residents in nursing 

homes suffer from chronic multiple conditions 

associated with old age. Almost all residents had 

one or more chronic conditions or impairments 

(99 percent), with an average of 3.9 chronic conditions per resident. The most prevalent chronic 

condition suffered by residents was arteriosclerosis (48 percent), followed by heart trouble 

(34 percent), senility (32 percent), chronic brain 

syndrome (25 percent), and arthritis and rheumatism (25 percent), Prevalence of each of these 

conditions or impairments increased with age. 

Other chronic conditions or impairments that increased with age were the following: cataracts, 

hip fractures, constipation, anemia, and edema. 

. In contrast, the prevalence of several conditions 

markedly decreased with age: mental illness, 

mental retardation, and paralysis unrelated to 

stroke. In general, these were the conditions 

with the highest prevalence rates among residents under 65 years of age. Mental illness and 

mental retardation were the most prevalent conditions reported for younger residents. The 

prevalence of mental retardation showed the 

steepest decline with age (table 8). 

Prevalence rates for chronic conditions 

varied by sex; however, these differences were 

relatively small compared with age differences. 

The prevalence rate of mental retardation among 

males (96 per 1,000 residents) was more than 

twice that for females (47 per 1,000 residents). 

Other conditions for which the prevalence rate 

among men exceeded that for women included 

mental illness, paralysis or palsy related to 

stroke, cancer, chronic respiratory disease, alcoholism, and missing arms, legs, or extremities, 

including feet, toes, hands, or fingers. 

Female residents had higher prevalence rates 

for arteriosclerosis (502 per 1,000 residents for 

females compared with 411 for males), hypertension (227 per 1,000 residents for females 

compared with 165 for males) and senility (348 

per 1,000 residents for females compared with 

250 for males) (figure 2). Females also had 

higher rates than males for arthritis and rheumatism, diabetes, edema, constipation, hip fractures, and other bone fractures. The rate of hip 

fractures was about 2% times as high for females 

as for males: 101 per 1,000 female residents had 

hip fractures, compared with 41 per 1,000 male 

residents (table 8). 

When race or ethnicity was considered, 

white (not Hispanic) residents had a higher 

prevalence rate of arteriosclerosis (484 per 1,000 

residents) than black (not Hispanic) and Hispanic 

and other residents (412 and 268 per 1,000 

residents, respectively) (table 9). The rate for 

black (not Hispanic) residents, however, was 

higher than that for white residents for the following conditions or impairments: hypertension, 

stroke, paralysis or palsy related to stroke, 

chronic brain syndrome, and alcoholism. Hispanic and other residents had a higher prevalence rate of diabetes than white (not Hispanic) 

residents had. 

Primary Diagnosis at Last Examination 

To complement data on reported chronic 

conditions and impairments, the primary diagnosis as recorded by the physician at last examination was obtained from the medical record for 

each sample resident. 

The primary diagnosis recorded was the one 

condition that currently affected the resident 

most seriously. Table G shows the most recent 

primary diagnosis for residents: ,about 40 per=’ 

12 
600 HYPERTENSION ARTHRITISAND CHRONIC 

RHEUMATISM RESPIRATORY 

DISEASE 

E 

65 years years and-over 65 years and-over 

DIABETES r ARTERIOSCLERO SENILITY 

All ages Under 65.74 7584 85 years All ages Under 65.74 75.84 a5 years All ages Under 65.74 75.84 85 years 65 yearr YW,S years and over 65 YearE years years and over 65 years years years and wet 

Figure 2. Prevalence rates per 1,000 nursing home residents for selected chronic conditions and impairments, by age and sex: 

United States, 1977 

500 

600 

428.6 

0 
Table G. Percent distribution of nursing home residents by primary diagnosis at last examination, according to age: United States, 1977 

Age 

Primary diagnosis at last examination] 

w 

Percent distribution 

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 

Diseases of the circulatory system 

Total , . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . ............. 39.7 13.5 43.8 

* Congestive heart failure .......................................................................................................................... 4.1 4.6 

Arteriosclerosis.. ..................................................................................................................................... 20.3 2.3 23.1 

Hypertension.. ........................................................................................................................................ 3.7 2.2 3.9 

Stroke.. ................................................................................................................................................... 7.9 6.1 8.2 

* Heart attack, ischemic heart disease.. ...................................................................................................... 1.7 1.9 

Other.. .................................................................................................................................................... 2.0 1.7 2.0 

Mental disorders and senility without psychosis 

Total ....................................................................................................................................... 20.4 45.9 16.4 

* Senile psychosis.. .................................................................................................................................... 1.6 1.6 

Other psychosis ...................................................................................................................................... 4.4 15.1 2.7 

Chronic brain syndrome ......................................................................................................................... 7.4 6.5 7.6 * Senility without psychosis ...................................................................................................................... 2.0 2.3 

Mental retardation.. ................................................................................................................................ 3.3 17.9 ‘0.9 

Alcoholism and other mental disorders.. ................................................................................................. 1.7 5.4 1.1 

Other diagnoses* 

33.0 32.3 33:l 

Diseases of the musculoskeletal system and connective tissues: 

Arthritis and rheumatism . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.3 2.1 4.7 

Diseases of the nervous system and sense organs: 

Parkinson’s disease . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... 1.8 *0.9 1.9 

Accidents, poisonings, and violence: 

Hip fracture .. . . . . . . . . . . .._........................................................................................................................ 2.2 *0.8 2.5 

* Other bone fracture .. . . . . . . . . . .._............................................................................................................. 0.8 0.9 

Endocrine, nutritional, and metabolic diseases: 

Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..................... 5.5 4.8 5.6 

Neoplasms: 

Cancer . . . . . . . . . . .. . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...................... 2.2 +1.4 2.3 

Diseases of the respiratory system . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.4 1.6 2.5 

Diaanosis unknown3 

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . . . . . ............ :.. 6.9 8.3 6.7 

IDisease group categories base’d on Eighth Revision International Classification of Diseases, Adapted for Use in the United States 

(ICDA). 

*Only diagnoses of sufficient magnitude are noted. 

3Includes those who received no physician visit while in facility. 

cent had diseases of the circulatory system, over the diagnosis was unknown. (This category also 

20 percent had a mental disorder or senility includes residents with no information on diagwithout psychosis, and 33 percent had some nosis in their records because they had not seen 

other diagnosis. For 7 percent of the residents a physician since entering the facility.) Arterio14 
sclerosis, or hardening of the arteries, was the 

most frequent individual diagnosis for residents 

(20 percent). 

Table G also shows significant differences in 

the primary diagnosis between the two major 

age groups: those 65 years and over, and those 

under 65 years. The primary diagnosis for nearly 

half of those under 65 years (46 percent) was 

mental disorders or senility without psychosis, 

while the primary diagnosis for nearly half of 

residents 65 years and over (44 percent) was 

diseases of the circulatory system. The proportion of residents 65 years and over with the following diagnoses exceeded that for residents 

under 65 years: arteriosclerosis, hypertension, 

stroke, arthritis and rheumatism, and chronic 

brain syndrome. In contrast, the proportion of 

residents under 65 years with psychosis, mental 

retardation, and alcoholism and other mental 

disorders exceeded that of residents 65 years 

and over. 

Length of stay varied by diagnosis. A larger 

proportion of residents with a diagnosis of 

cancer (50 percent), hip fractures (49 percent), 

or other fractures (49 percent) had stays less 

than 6 months than residents with any other 

diagnosis (table 21 of reference 1). Similarly, the 

average stay for persons with these diagnoses 

was shorter than those for other diagnoses. The 

average length of stay since admission for residents diagnosed as having cancer, hip fractures, 

and other bone fractures was 1.3 years, 1.2 

years, and 1.3 years, respectively, compared 

with 2.1 to 4.6 years for persons with other 

diagnoses. Residents with a primary diagnosis of 

mental retardation had the longest average stay 

(4.6 years) (table H). 

Functional Status 

One indicator of residents’ need for nursing 

care is their functional status in performing daily 

living activities, such as bathing, dressing, using a 

toilet room, mobility, continence, and eating. As 

shown in table 10, r-nursinghome residents were 

highly dependent in many of these activities. 

Eighty-six percent of the residents required assistance in bathing, 69 percent required assistance in dressing or remained partially or completely undressed, 66 percent required assistance 

in walking or were chairfast or bedfast, 53 percent required assistance or did not use the toilet 

room, and 45 percent were incontinent in 

bowels or bladder. Residents were most likely to 

require assistance with bathing (86 percent). The 

proportion of residents requiring assistance in 

these activities increased tith age. 

The index of activities of daily living (ADL), 

developed by Katz et al.,385g summarizes overall performance in six functions of daily living 

(bathing, dressing, using a toilet room, mobility, 

continence, and eating) by scaling the degree of 

assistance required in the activities. According to 

the index, performance is summarized as grade 

A, B, C, D, E, F, or G, where A is the most independent grade and G the most dependent grade. 

The general form of the index is as follows: 

A Independent in bathing, dressing, 

using toilet room, mobility, continence, and eating. 

B Dependent in only one activity. 

C Dependent in bathing and one other 

activity. 

D Dependent in bathing, dressing, and 

one other activity. 

E Dependent in bathing, dressing, using 

toilet room, and one other activity. 

F Dependent in bathing, dressing, using 

I 

toilet room, mobility, and one other 

activity. 

G Dependent in all six activities. 

Other Dependent in at least two activities 

but not classifiable as C, D, E, or F. 

The index was originally developed as a 

measure of function, one which could be used to 

objectively evaluate the chronically ill and 

elderly population. The index has been used to 

predict chronic conditions, to assess need for 

care, and to determine the effectiveness of treatment. For example, one study found that the 

ADL status determined at initial assessment was 

highly predictive of the patients’ type of discharge within the following 6-week period.40 In 

15 
Table H. Mean length of stay since admission and standard error of the mean, by primary diagnosis at last examination and age: 

United States, 1977 

- Length of stay since admission in days 

Primary diagnosis at last examination1 T T Standard error 

All Under 65 years All Under 65 years 

ages 65 years and over ages 65 years and over 

Total . . . . . . . . . .._......._............................................. 957.9 1.122.9 931.9 f 16.8 47.0 17.0 

Diseases of the circulatorv system 

Total ................................................................................. 944.7 995.9 942.3 21.5 94.6 22.1' 

Congestive heart failure.. ................................................................... 751.9 “732.1 752.9 55.0 247.8 56.0 

Arteriosclerosis.. ................................................. . .............................. 1.044.1 1 ,013.6 1,044.6 33.0 232.2 33.3 

Hypertension.. ................................................................................... 1 rO34.6 1.277.5 1 ,013.3 66.5 300.4 67.8 

Stroke ............................................................................................... 774.7 849.8 766.0 39.8 120.3 42.4 

Heart attack, ischemic heart disease .................................................. 883.9 ‘1.049.1 876.8 93.9 423.8 96.1 

Other ................................................................................................. 890.4 1,222.5 845.0 86.2 303.4 88.7 

Mental disorders and senility without psychosis 

Total . .._............................................................................. 1.148.1 1.315.8 1.074.2 38.6 73.9 42.8 

* * Senile psychosis ................................................................................. 840.5 834.6 78.5 76.9 

Other psychosis.. ............................................................................... 1.266.5 1.177.6 1344.0 84.0 111.2 109.3 

Chronic brain syndrome.. .................................................................. 987.3 1.069.0 976.1 45.5 133.0 48.0 

Senility without psychosis.. ............................................................... 1,019.5 395.0. 1,031.g 90.9 1Ol:S 92.5 

Mental retardation ............................................................................. 1.669.6 1.648.5 1,732.7 115.0 125.9 267.0 

Alcoholism and other mental disorders.. ........................................... 990.6 992.3 989.3 149.2 197.9 214.6 

Other diagnoses* 

Total ................................................................................. 884.4 914.9 879.7 24.4 66.2 25.9 

Diseases of the musculoskeletal system and connective tissues: 

Arthritis and rheumatism ............................................................. 927.9 682.4 945.7 52.3 149.7 53.8 

Diseases of the nervous system and sense organs: 

Parkinson’s disease ....................................................................... 1,042.3 1,043.6 1,042.2 94.6 208.8 101.0 

Accidents, poisonings, and violence: 

Hip fracture.. ......................................................... .:. .................... 430.7 158.2 445.2 52.6 46.3 54.8 

Other bone fracture.. .................................................................... 461 .I 431.7 463.6 83.9 60.1 91.0 

Endocrine, nutritional, and metabolic diseases: 

Diabetes ....................................................................................... 1,001.4 1,134.S 983.5 54.5 244.0 52.5 

Neoplasms: 

Cancer.. ........................................................................................ 475.6 180.6 503.0 53.4 51.6 57.7 

Diseases of the respiratory system: 

Emphysema.. ................................................................................ 797.4 896.4 787.8 74.6 265.5 76.0 

Diagnosis unknown3 

Total ................................................................................. 822.5 1.072.1 774.3 64.9 168.6 67.7 

IDisease group categories based on Eighth Revision International Classification of Diseases, Adapted for Use in the United States 

(ICDA).

*Only diagnoses of sufficient magnitude are noted. 

31ncludes those who received no physician visit while in facility. 

that study, a higher percent of patients in A-E The functional status data items collected in 

categories than in F and G groups were dis- the 197 7 National Nursing Home Survey gencharged to their homes. erally conform to the definitions used by Katz 

16 
et al. (See questions 27-34 of the Resident Questionnaire in appendix III for actual data items 

used.) These data items were used to construct 

the index of dependency in activities of daily living. (See appendix II for criteria used to classify 

a resident as dependent.) The data show that, 

in 1977, lo/percent of the residents in nursing 

homes were functionally independent in all activities (category A) while 16 and 23 percent, 

respectively, were in the two most functionally 

dependent categories;F and G. As expected, the 

residents’ scores were related to age: 23 percent 

of residents under age 65 years were functionally independent (category A), compared with 

4 percent of residents 85 years and over. Similarly, the proportion of residents in the most 

dependent category (G) increased with age from 

16 percent of those under 65 years to 28 percent of those 85 years and over. When sex was 

considered, a larger proportion of females had 

dependency level F or G (41 percent) than males 

had (33 percent) (table 11). 

When race or ethnicity was examined, no 

significant differences were found among the 

proportions of residents by functional status 

among white (not Hispanic) and black (not Hispanic) residents. There were major differences, 

however, in the level of dependency by marital 

status. A larger proportion of married residents 

(31 percent) and widowed residents (25 percent) 

were in the most dependent category (G) than 

were residents in any other marital status (15-17 

percent). Further, a larger proportion of divorced 

or separated residents (21 percent) and nevermarried residents (17 percent) were in the most 

independent category (A). The higher level of 

functional status of divorced or separated and 

never-married residents is further indication that 

their institutionalization may have simply been a 

means of satisfying housing and social needs. It 

also reflects the generally younger ages of divorced or separated and never-married residents. 

When primary source of payment was examined, a larger proportion of Medicare (42 percent) and Medicaid-skilled care residents (33 

percent) were in the most dependent category 

care may be certified only for eligible individuals 

who require skilled nursing or skilled rehabilitative services on a daily basis. 

Sensory Impairments 

As shown in table 10, the majority of residents (67 percent) were considered to have imimpaired vision; that is, they could read ordinary 

newsprint regardless of whether they wore eyeglasses. About 19 percent of the residents had 

partially impaired vision (with or without eyeglasses), while 7 percent had severely impaired 

vision (they could recognize the features of 

familiar persons only if they were within 2-3 

feet). An estimated 38,400 persons, or 3 percent, were blind. Visual impairments are typically associated with aging, and the proportion 

of residents with partially or severely impaired 

vision increased with age. The proportion of 

residents with partially impaired vision increased 

from 11 percent of those under age 65 years to 

24 percent of those 85 years and over. Similarly, 

the proportion of residents with severely impaired vision increased from 2 percent of the 

residents under 65 years to 10 percent of residents 85 years and over. Sixty-one percent wore 

eyeglasses to correct their vision. Use of eyeglasses, like the prevalence of visual impairments, increased with age (figure 3). Female 

residents used eyeglasses more often (64 percent) than male residents did (52 percent). 

Like visual impairments, hearing loss or impairments increased with age. Table 10 shows 

that the proportion of residents with partially 

impaired hearing increased from 7 percent for 

residents under age 65 years to 33 percent for 

residents 85 years and over. The prevalence of 

hearing impairments did not vary by sex. Although 26 percent of the residents had partially 

or severely impaired hearing, only 6 percent 

used hearing aids. As shown in figure 4, there 

was a pattern of increased utilization of hearing 

aids with age. 

Speech impairments, unlike visual or hearing 

impairments, were most prevalent in the younger 

residents, particularly among those under age 65 

(G) than were residents who used any other pri- , years. The proportion of younger residents with 

mary payment source (19-22 percent), indicat- severe speech impairments (12 percent) was 

ing the effect of regulations. Under Medicare nearly 3 times that for residents 85 years and 

and Medicaid skilled nursing facility regulations, over (5 percent). Similarly, the proportion of 

17 
70 68.2 

60 

50 

i- 40 

5 

P 

E 30 

20 

10 

” 

All Under 65. 75. 85 Mk? Female 

ages 65 74 84 WE. 

AGE SEX 

Figure 3. Percent of nursing home residents using eyeglasses, 

by age and sex: United States, 1977 

'0 r 

8 

All Under 65. 75. 85 Male Female 

ages 65 74 84 years 

yearr wars years a”* 

wer 

AGE SEX 

Figure 4. Percent of nursing home residents using a hearing aid, 

by age and sex: United States, 1977 

residents with partially impaired speech or who 

were mute was also highest for residents under 

65 years. A larger proportion of ma les than 

females had some level, of speech impairment. 

Overall, more than 75 percent of the residents had unimpaired speech, while 12 percent 

had partially impaired speech. The residents’ 

ability to make known their physical, mental, or 

social needs to nursing home, staffs Is related to 

the ability to speak. Most residents in the survey 

(86 percent) communicated verbally, while 10 

percent communicated nonverbally. Four percent of the residents communicated nonverbally 

because of mental or emotional problems, and 

6 percent could not talk, were too ill, or di¬ 

speak English. A sizeable number of residents 

(58,000, or 4 percent), however, did notcommunicate at all. 

The use of dentures increased dramatically 

with age. Whereas 58 percent of the residents 

had dentures, the ma jority were age 65 years 

and over (94 percent). The proportion of residents with no dentures was highest among residents under 65 years (70 percent), and the proportion decreased with age from 49 percent of 

residents 65-74 years to 27 percent of residents 

85 years and over. Sixty and 63 percent of residents 75-84 years and 85 years and over, respectively, had dentures and used them, in contrast 

to 22 percent of residents under 65 years and 41 

percent of residents age 65-74 years (table 10). 

Behavioral Problems 

Behavioral problems ekhibited by nursing 

home residents may be the result of developmental disabilities, chronic illness, or the effects 

of aging. In 1977 nearly 66 percent of all residents exhibited some type of behavioral problem. The most frequent problem reported for 

residents was depressed or withdrawn behavior 

(35 percent), followed by agitated, nervous, or 

hyperactive behavior (34 percent), abusive, aggressive, or disruptive behavior (17 percent), 

wandering (11 percent), and other behavioral 

problems (9 percent) (table 10). Younger residents (under 65 years) exhibited behavioral 

problems more often than did residents in the 

older age groups in all categories of behavioral 

problems, except depressed or withdrawn be18 
havior and wandering. Residents in the two age 

groups under 75 years exhibited depressed or 

withdrawn behavior (47 percent of residents 

under 65 years and 41 percent of residents 65 

74 years) more often than did residents in the 

two older age groups (29-34 percent). The proportion of residents who wandered did not vary 

by age. A previous report1 shows that extra 

nursing time was required to monitor these 

problem behaviors. The proportion of residents 

who required extra nursing time was 80 percent 

of residents who were abusive, aggressive, or 

disruptive; 76 percent of residents who wandered; 77 percent of residents who exhibited 

other behavioral problems; 71 percent of residents who were agitated, nervous, or hyperactive; and 60 percent of residents who were 

depressed. 

HEALTH SERVICES RECEIVED 

The following section examines direct and 

indirect health services received by residents. 

Direct services include services received individually by residents, such as level of care received, 

time since last physician visit and nature of visit, 

type of medications received, and type of therapy services received. Indirect services include 

services generally available to all residents as a 

result of the nursing home environment, such as 

the availability of a medical director and skill 

level of the nursing staff. 

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 following four levels of nursing care: 

Intensive nursing care. 

Other nursing care. 

Personal care. . 

Neither nursing nor personal care. 

In 1977,85 percent of all nursing home residents 

received nursing care services: 44 percent received intensive nursing care, and 41 percent 

received other nursing care. Only 14 percent of 

all residents received personal care services, and 

1 percent received neither nursing nor personal 

care (table 12). 

Since health status generally declines with 

age, it is not surprising that the proportion of 

residents who received intensive nursing care increased with age. A larger proportion of residents age 85 years and over received intensive 

nursing care (48 percent) than did residents 

under 65 years (34 percent). More directly, however, the need for nursing services is related to 

the resident’s level of functional dependency. Increasing levels of functional dependency were 

associated with increasing proportions of residents receiving intensive nursing care. As table 

12 shows, the proportion of residents receiving 

intensive nursing care increased from 5 percent 

of the residents in the most independent category (A) to 76 percent of residents in the most 

dependent category (G). 

Level of nursing care received was also associated with certain primary diagnoses and 

chronic conditions. A larger proportion of residents with primary diagnoses of stroke (61 percent), Parkinson’s disease.--(57 percent), cancer 

(57 percent), bone fractures other than hip (57 

percent), and hip fractures (53 percent) received 

intensive nursing care than did residents with 

any other’ diagnosis (table 13). Certain chronic 

conditions or impairments were also associated 

with greater levels of nursing care. The proportion of residents who received intensive care was 

greatest for those with bedsores (72 percent), 

paralysis or palsy related to stroke (68 percent), 

paralysis or palsy unrelated to stroke (62 percent), - .- kidney trouble (59 percent), permanent 

stiffness or deformity of back, arms, legs, or extremities, including feet, toes, hands, or fingers 

(59 percent), and stroke (58 percent). Since 

many of these conditions and impairments involve joint movement limitations, it is, perhaps, 

not surprising that a relationship exists between 

mobility status and the need for intensive nursing services. As figure 5 shows, the proportion of 

residents who received intensive nursing care increased with each category of mobility impairment from 20 percent of those who waIked 

unassisted to 86 percent of those who were 

bedfast. 

19 
Table J. Percent distribution of nursing home residents, by 

physician servicesreceived: United States, 1977 

100 r 

Walks Walkswith Chairfast Bedfast 

unassisted assistance 

MOBILITY STATUS 

Figure 5. Percent of nursing home residents receiving intensive 

nursing care, by mobility status: United States, 1977 

When primary source of payment was examined, residents who received skilled nursing care 

paid primarily by the Medicaid or Medicare programs received greater levels of care. The proportions of residents primarily using the Medicare 

and Medicaid-skilled programs for payment who 

received intensive nursing care was 67 and 55 

percent, respectively, in contrast to 37-42 percent of residents in any of the remaining primary source of payment groups (table 14). 

Physician Services 

In 19 77 about 4 out of 5 residents in nursing 

homes (81 percent) had regularly scheduled 

physician visits, while 13 percent received physician visits only when called, and 2 percent had 

some other arrangement. Usually the attending 

physician for the resident was the resident’s own 

private physician (64 percent); only 30 percent 

of the residents were attended by a physician 

who was assigned by or worked for the facility 

(table J). 

The average time since the last physician 

visit for residents was 39 days, and the median 

Percent 

Physician services distribution 

Total ............................................................. 100.0 

Time since last physician visit: 

Less than 1 week ................................................ 

1 to less than 2 weeks.. ....................................... 

2 weeks to less than 1 month.. ............................ 

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

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

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

1 year or more.. .................................................. 

No physician visits since entering facility.. .......... 

Median time since last physician 

visit in days.. .................................................... 

Time between last two physician visits: 

Less than 1 week ................................................ 

1 to less than 2 weeks.. ....................................... 

2 weeks to less than 1 month.. ............................ 

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

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

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

1 year or more.. .................................................. 

Not received two physician visits since 

entering facility3 ............................................. 

Services given at last physician visit2p3: 

Examination ....................................................... 

Treatment.. ......................................................... 

Prescription ........................................................ 

Orders for lab tests ......................... . ................... 

Other ..................................... . ............................ 

Location of last physician visit3: 

Outside facility.. ................................................. 

Inside facilityl.. .................................................. 

Arrangement for physician services3: 

Physician on call ........................................... . ..... 

Regularly scheduled physician visits.. ................. 

Other arrangements1 .......................................... 

Employment status of physician3: 

Private physician.. ............................................... 

Physician assigned by or works for 

facility ............................................................. 

Other statuses.. ................................................... 

l~ncludes a small number of unknowns. 

20.6 

16.8 

28.4 

22.3 

4.5 

1.7 

1.3 

4.4 

18.0 

6.4 

6.8 

28.2 

36.1 

4.7 

1.8 

1.8 

9.9 

84.5 

14.5 

60.8 

18.7 

5.6 ” 

13.0 ” 

82.7 

13.0 

81.1, 

1.5 

63.5 

29.7 

2.5 

*Figures do not add to totals because multiple responses 

were permitted. 

3Excludes those who received no physician visit while in 

facility. 

time between visits was 18 days. Overall, 21 per-. 

cent of the residents had been visited by a physician less than a week prior to the survey date, 

20 
and 66 percent had been visited by a physician 

less than a month prior to the survey date. Only 

4 percent had not seen a physician since entering 

the facility, and 8 percent had their last physician visit at least 3 months ago (table J). 

The frequency distribution of physicianvisits 

for residents with at least two physician visits 

since entering the facility varied from the frequency distribution of last physician visits. For 

example, the proportion of residents whose 

last physician visit was in the most frequent time 

interval of less than 1 week (21 percent) was 

greater than the similar proportion for residents 

with two physician visits (6 percent) (table J). 

This finding is influenced by newly admitted 

residents who are more Iikely to have had recent 

physician contact than residents with more stabilized conditions have had. Thus the average 

time since last physician visit increased with 

length of stay since admission from 20 days for 

residents in the facility less than 3 months to 

48 days for residents in the facility 5 years or 

more (table K). In addition, newly admitted 

residents were less likely to have had two physician visits since entering the facility, due to their 

shorter stays. 

The need for physician services is directly 

related to health status. As table 15 shows, the 

proportion of residents who last saw a physician 

1 month prior to the survey date increased with 

higher levels of functional dependency; the proportion of residents whose last visit was less than 

Table K. Mean time since last physician visit, by length of stay 

since admission: United States, 1977 

Mean time 

since last 

Length of stay since admission physician 

visit in 

days1 

Total . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38.7 

Less than 3 months.. ............................................ 20.4 

3 to less than 6 months ........................................ 33.5 

6 months to less than 1 year.. ............................... 34.5 

1 to less than 3 years ............................................ 40.4 

3 to less than 5 years.. .......................................... 47.5 

5 years or more .................................................... 48.2 

IExcludes those who received no physician visit since 

entering the facility. 

1 month prior to the survey date rose from 52 

percent of residents in the most independent 

category (A) to 72 percent of those in the most 

dependent category (G). There is a similar difference in frequency of last physician visit by primary diagnosis at last examination, with greater 

frequency among those with certain serious or 

acute conditions. For example, 78 percent of 

those with neoplasms (cancer) and 78 percent 

of those with hip fractures had a physician visit 

within the month prior to the survey; in contrast, only 61 percent of those whose primary 

diagnosis was mental retardation and 58 percent 

of those with arthritis or rheumatism were in 

that category. ’ 

Information was also obtained on the services provided by the physician at the time of the 

last visit. Overall, 85 percent of the residents received an examination at the time of the last 

visit, 15 percent received some type of treatment, and 61 percent received a prescription 

(including refills). Nineteen percent received 

orders for laboratory tests and 6 percent received other services. Required physician services varied by primary diagnosis at last examination. For example, the proportion of residents 

who received a prescription at last examination 

was lowest among those with a diagnosis of 

senility without psychosis (47 percent), mental 

retardation (51 percent), hip fracture (52 percent), and bone fracture other than hip (44 

percent). 

Physician services received by residents were 

also influenced by regulatory requirements for 

certification. When primary source of payment 

‘was examined, residents primarily using the 

Medicare or Medicaid (skilled or intermediate) 

programs for payment had regularly scheduled 

physician visits more often than residents using 

the other payment sources. Eighty-five to 94 

percent of the Medicare and Medicaid residents 

had regularly scheduled physician visits, compared with 69-75 percent for the remaining payment sources (table 14). Medicaid intermediate 

care facility regulations require that the resident 

be seen by a physician at least once every 60 

days (unless the physician decides that this frequency is unnecessary), while Medicare and 

Medicaid skilled nursing facility regulations 

require that the resident be seen by an attending 

21 
physician at least once every 30 days for the 

first 90 days following admission.4 1 

A significantly larger proportion of residents 

who primarily relied on the Medicare and Medicaid programs for skilled care had their last physician visit less than 1 week prior to the survey 

(39 and 25 percent, respectively) than had residents who primarily used their own income or 

family support, the Medicaid intermediate care 

progam, other government assistance or welfare, or all other sources (19 percent of each). 

This finding is related to the Medicare and Medicaid skilled nursing care requirement that the 

resident be medically evaluated, based on a 

physical examination performed within 48 hours 

after admission (unless such an examination was 

performed within 5 days prior to admission),41 

as well as to the greater frequency of physician 

visits required by the skilled nursing facility 

programs. 

Medications Received 

Data were also obtained about medications 

received by residents during the last 7 days. Information was collected on whether any medications, prescription or nonprescription, were 

received within 7 days prior to the survey date 

for any of the reported conditions or impairments listed in question 13 of the Resident 

Questionnaire, as well as whether the resident 

had in the last 7 days received tranquilizers, vitamins or minerals, or any other medication not 

previously mentioned (see question 14 of the 

Resident Questionnaire in appendix III). The 

data show that, due to the multiplicity of conditions exhibited by residents in nursing homes, 

93 percent of all residents received some type of 

medication in the week prior to the survey. The 

proportion of residents who received any medication for a condition or impairment ranged 

from 17 percent of those with missing arms, 

legs, or extremities, including feet, toes, hands, 

or fingers,l to 94 percent of those with chronic 

constipation. The proportions of residents who 

received medication for selected conditions are 

presented in a previous report.1 In addition to 

medications received for conditions and impairments reported, 36 percent of all residents had 

received tranquilizers, and 41 percent had received vitamins or minerals during the last 7 

days.’ Including the receipt of tranquilizers and 

vitamins or minerals, most nursing home residents received multiple drugs-on the average 

3.2 medications per resident. The average number of conditions per resident was 3.9. 

Although data were collected on whether 

the resident received medication for each of 39 

chronic conditions or impairments, data on the 

type of medication were limited to whether the 

resident received tranquilizers, vitamins or minerals, or any other medication. Because tranquilizers may have been prescribed for a condition listed in’ question 13 of the Resident 

Questionnaire, it is possible that the count of 

residents receiving tranquilizers may be underestimated. The count of residents receiving vitamins or minerals may also be underestimated. 

For this reason, and because data on the type of 

medication received were limited in the 1977 

survey, the remaining discussion presents previously unpublished data from 1973-74 National 

Nursing Home Survey.a 

In the 1973-74 National Nursing Home 

Survey, data were collected on 14 broad categories of medications, covering both prescription 

and nonprescription categories. The categories, 

with common labels noted when appropriate, 

are tranquilizers, hypnotic-sedatives (including 

sleeping pills), stool softeners (laxatives), antidepressants, antihypertensives, diuretics, analgesics (including aspirin), diabetic agents, antiinflammatory agents, anti-infectives, anti-anginal 

drugs, cardiac glycosides, anticoagulants, and 

vitamins or iron. There was an additional residual category for any medication received 

that was not classifiable into any of the other 

categories. 

In 1973-74, of the 1,075,800 nursing home 

residents, 96 percent received at least one type of 

medication in the week prior to data collection. 

Nearly half (48 percent) of those taking medications received tranquilizers, while 38 percent 

aThe discussion of medications from the 1973-74 

National Nursing Home Sprvey is substantially based on 

an unpublished report, written by Aurora Zappolo of 

the National Center for Health Statistics, on medical 

services received by nursing home residents. 

22 
received vitamin or iron supplements, 37 percent 

received analgesics, and 35 percent received 

stool softeners. In addition, more than a fourth 

of the residents received either diuretics (29 percent) or cardiac glycosides (26percent) (table L). 

Table 16 presents type of medication received by age and sex. Use of certain types of 

medications was directly related to age. Use of 

diuretics and cardiac glycosides increased as age 

increased. Fifteen percent of those under age 65 

years who received one or more medications 

received diuretics, and 7 percent received cardiac 

glycosides; the proportions increased with each 

subsequent age group, with 33 percent of those 

85 years and over receiving diuretics, and 32 percent receiving cardiac glycosides. According to a 

study of physician drug prescription patterns in 

skilled nursing facilities,*2 these drugs are prescribed to a greater extent to residents with 

heart disease; therefore, this pattern of use is not 

unexpected since the prevalence of heart disease 

also increases with age. Use of stool softeners, 

analgesics, and vitamins or iron supplements also 

increased with age. The use of tranquilizers and 

antidepressants was inversely related to age. 

Among residents who received one or more 

medications, the proportion receiving tranquilizers decreased from 63 percent of those under 

65 years to 41 percent of those ‘85 years and 

over. Similarly the proportion of residents receiving antidepressants decreased from 11 percent of those under 65 years to 7’percent of 

those age 85 years and over. The greater proportion of mentally retarded persons among the 

younger age group accounted for this pattern. 

An examination of the use of different types 

of medications according to chronic conditions 

or impairments further highlights these findings. 

A larger proportion of residents who were mentally ill (69 percent) or mentally retarded (64 

percent) received tranquilizers than did residents 

with any other condition (table 17). Other patterns evident are that a greater proportion of 

persons with heart trouble (53 percent) than 

others received cardiac glycosides, and a greater 

proportion of persons with arthritis or rheumatism (48 percent) or chronic back trouble (55 

percent) received analgesics than did others. 

The proportion of residents who received 

various types of medications was related to sex; 

Table L. Number and percent of nursing home residents, by 

type of medication received: United States, 1973-74 

Residents Residents 

receiving receiving Type of medication received each med- each medication ication 

Number Percent 

Residents receiving one or 

more medication& ............. 890,000 95.9 

Tranquilizers.. .................................. 492,600 47.7 

Hypnotic-sedatives.. .......................... 355,200 34.4 

Stool softeners.. ............................... 359,500 34.8 

Antidepressants.. .............................. 

Antihypertensives............................ 

91,300 

119,900 

8.9 

11.6 

Diuretics .......................................... 296,700 28.8 

Analgesics ........................................ 377,500 36.6 

Diabetic agents.. ............................... 102,000 9.9 

Anti-inflammatory agents ................ 80,300 7.8 

Anti-infectives.. ................................ 91,500 8.9 

Anti-angina1 drugs.. .......................... 47,500 4.6 

Cardiac glycosides.. .......................... 270,900 26.3 

Anticoagulants ................................. 12,100 1.2 

Vitamins or iron.. ............................. 388,400 37.6 

Other ............................................... 477,300 46.3 

None.. .............................................. 43,800 . . . 

IFigures do not add to totals because residents may have 

received more than one type of medication. 

gene&y, a greater proportion of females than 

males received medications. For example, females of all ages received more antidepressants, 

analgesics, and diuretics than did males in the 

comparable age groups (table 16). Females age 

65 and over received more vitamins and iron 

supplements than did males in each age group, 

and females age 75 and over received more tranquilizers and more antihypertensives than did 

males in the two older age groups. Females 

under 65 years received more diabetic agents 

than did males in that age group. There were 

exceptions to this general pattern, however. For - example, the proportion of males age 75 and 

over who received anti-infectives was greater 

than that for females of the same age. 

Table 18 shows the number of categorjes of 

medication by chronic conditions or impairments, primary diagnosis at last examination, 

and primary reason for admission. The median 

number of categories of medication received by 

nursing home residents in 1973-74 was 3.7. As 

23 
Table M. Percent distribution of nursing home residents by level of care received, according to number of categories of medication 

received: United States, 1973-74 

Level of care received 

Number of categories of medication 

None .......................................................................................................... 

One ............................................................................................................ 

Two ............................................................................................................ 

Three.. ........................................................................................................ 

Four.. .......................................................................................................... 

Five ............................................................................................................ 

Six .............................................................................................................. 

Seven or more ............................................................................................ 

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

expected, those who ,were admitted for social 

reasons received fewer medications than others: 

31 percent of those admitted for social reasons 

received one medication or none at all, compared with 13 percent of those admitted, for 

physical reasons and 23 percent of those admitted for behavioral reasons. Though they 

received more tranquilizers, mentally retarded 

residents received fewer medications overall than 

those with any other chronic condition or impairment: 24 percent received one medication or 

none at all, compared with 17 percent of the 

mentally ill and even fewer of any other group 

(table 18). 

The number of medications received was 

also strongly related to the level of nursing care 

received. As table M shows, the proportion of 

those who received intensive nursing care increased with the number of medications received 

from 28 percent of those receiving no medications to 51 percent of those receiving seven 

medications or more. 

Therapy Services 

Therapy is an integral part of the multidisciplinary services provided by many nursing 

homes to aid residents’ rehabilitation. In the 

1977 survey, information was obtained on seven 

specific categories of therapy that were provided 

Percent distribution 

31.6 18.8 

38.4 27.3 

41.2 21.2 

42.7 16.3 

42.7 13.1 

46.3 9.2 

44.8 7.8 

43.7 5.2 L 

21.2 

by licensed, registered, or professionally trained 

therapists (whether inside or outside the facility) 

in the month before the survey. The categories 

were physical therapy, recreational therapy, 

occupational therapy, speech or hearing therapy, 

counseling by a social worker, counseling by a 

mental health worker, and reality orientation. 

Only 35 percent of nursing home residents 

received any of these therapy types. The largest 

category was recreational therapy. Twenty percent of all residents received this form of 

therapy, which included organized recreational 

programs and activities arranged by trained professionals. Fourteen percent of the residents 

received physical therapy, 7 percent received 

counseling by a social worker, 7 percent received 

reality orientation, and 6 percent received occupational therapy (table N). Less than 1 percent 

of the residents received speech or hearing therapy, despite evidence that the need for these 

services was great: 19 percent of the residents 

had partially or severely impaired speech, and 

26 percent had partially or severely impaired i 

hearing (table 10). According to a 1974 study43 

this pattern was also evident in skilled nursing 

facilities. Among the total resident population 

in skilled nursing facilities in 1974, 13 percent 

needed speech or hearing therapy but only i percent received it. Similarly, while 47 percent of 

the resident population needed physical therapy, 

24 
Table N. Number and percent distribution of nursing home 

residents, by therapy services received: United States, 1977 

Number Percent 

Therapy services of distriresidents bution 

All residents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,303,100 100.0 

No therapy service during last 

month I....._ ....................................... 847,100 65.0 

Therapy service during last 

month*. ............................................ 456000 35.0 

Physical therapy ............................. 178,900 13.7 

Recreational therapy ...................... 261,300 20.0 

Occupational therapy ..................... 76,700 5.9 

Speech br hearing therapy .............. 12,200 0.9 

Counseling by social worker.. ......... 91,400 7.0 

Counseling by mental health 

worker.. ....................................... 17,800 1.4 

Reality orientation ......................... 86,500 6.6 

Other theraov services .................... 22,200 1.7 

lhcludes a small number of unknowns. 

*Figures do not add to totals because multiple responses 

were permitted. 

only 14 percent received it; while 35 percent 

required occupational therapy, only 4 percent 

received it. 

Among residents who received therapy, certain diagnoses were associated with specific 

services. For example, residents diagnosed with 

stroke (28 percent), hip fracture (47 percent), or 

bone fracture other than hip (37 percent) were 

more likely than others were to receive physical 

therapy. A similar pattern was found when 

chronic conditions or impairments was examined (table 19). 

When primary source of payment was examined, a greater proportion of Medicare and Medicaid skilled care residents received one or more 

types of therapy (58 and 4‘2 percent, respectively) than did residents using other primary 

payment sources. When type of therapy was 

examined, nearly half of Medicare residents (49 

percent) received physical therapy, in contrast 

‘to lo-19 percent of the other primary payment 

sources (table 14). 

Service Characteristics of Facility 

In addition to the resident’s health status, 

the care received by the resident was related to 

the type of facility in which he or she resided. 

Indirect services, for example, staffing patterns 

and the availabihty of a medical director, are 

related to facility characteristics. Certification 

status of the facility, in particuIar, is directly 

related to the level of services provided since, by 

the following definition: 

Skilled nursing facility (SNF) services are 

those required for individuals who need, on 

a daily basis, skilled nursing care (provided 

directly by or requiring the supervision of 

skilled nursing personnel) or other skilled 

rehabilitative services that, as a practical 

matter, can only be provided in a skilled 

nursing facility on an inpatient basis. 

Intermediate care facility (ICF) services are 

health-related care and services provided on 

a regular basis to individuals who do not 

require the degree of care and treatment that 

a hospital or skilled nursing facility is designed to provide, but who, because of their 

mental or physical condition, require care 

and services (beyond room and board) that 

can be provided only through institutional 

facilities.44 

Facility certification status thus serves as a 

proxy or indicator of the standards imposed on 

participating facilities to assure that the appropriate level of care and services are provided to 

qualified. program beneficiaries. Indirectly, these 

standards benefit all residents in participating 

facilities. 

For example, since December 2, 1974, Medicare and Medicaid skilled nursing facilities have 

been required to retain a licensed physician as 

medical director responsible for the overall coordination of medical care services provided to 

patients of the facility. “Coordination” of medical care includes liaison with attending physicians to ensure that they write orders promptly 

upon admission of a patient. It also includes 

periodic evaluation of the adequacy and appropriateness of health professional and supportive 

staff and services.45 In addition to coordinating 

patient care services, the medical director is 

responsibIe for surveillance of the facility employees’ health status. Although waiver of the 

25 
medical director requirement was allowed in special cases, such as rural nursing homes where the 

supply of physicians was not sufficient to permit 

compliance, the majority (86 percent) of certified skilled nursing facilities had a medical director. Ninety-seven percent of facilities certified as 

both skilled nursing and intermediate care had a 

,medical director, in contrast to 46 percent of 

certified intermediate care facilities and 34 percent of those facilities classified as noncertified 

(table 0). 

Medical direction could be designated 

through arrangements with an individual physician, a group of physicians, a local medical 

society, or a hospital staff. About half (51. percent) of all medical directibn was provided by an 

individual physician. In 76 percent of certified 

skilled nursing facilities an individual physician 

provided medical direction, and in certified 

skilled nursing-intermediate care facilities, the 

proportion was 84 percent. In contrast, a significantly smaller proportion of intermediate care 

facilities (34 percent) and of noncertified facilities (23 percent) had individual physicians who 

were responsible for medical direction of patient 

care services (table 0). 

Another participation requirement for 

skilled nursing facilities is the availability of a 

24-hour nursing service with sufficient nursing 

personnel to meet patients’ needs. Although this 

requirement could also be waived in special situations, such as rural nursing homes that were 

unable to assure the presence of adequate staff, 

the majority of certified skilled nursing facilities 

Table 0. Number of nursing homes by facility certification and percent distribution by selected facility characteristics, according to 

facility certification: 

Item 

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

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

Medical director arrangement 

No medical director ...................................................................... 

Individual physician ....................................................................... 

Physician partnership or group practice.. ....................................... 

Several individual physicians.. ........................................................ 

Health Maintenance Organization medical 

school or medical society ............................................................ 

Hospital staff ................................................................................. 

Other arrangement.. ....................................................................... 

Skill level of onduty charge person for 

three-shift facility 

All registered nurses.. ..................................................................... 

All licensed practical nurses.. ......................................................... 

All nurse’s aides.. ........................................................................... 

Registered nurses for two shifts.. ................................................... 

Licensed practical nurses for two shifts.. ....................................... 

Nurse’s aides for two shifts.. .......................................................... 

All other combinations .................................................................. 

United States, 1977 

Certification 

Skilled I 

Total nursing- intermediate Noncertified intermediate I care facility I 

care facility 1 

Number 

18,900 11 3,600 1 4,600 1 6,000 1 4,700 

Percent distribution 

100.0 100.0 * 100.0 100.0 100.0 

36.9 13.8 

51.3 75.7 

2.9 +2.3 * 3.4 

* * 

2.4 5.5 * 2.9 

22.1 40.6 * 5.4 

3.0 6.9 

12.4 17.1 

22.1 23.1 * 6.1 * 4.5 

“3.3 53.6 66.0 

83.5 34.4 22.9 

4.9 *2.4 7.8 

4.9 3.7 *2.2 

+ I( 

*2.2 + "1.9 

* 4.8 *3.8 

43.0 6.2 7.8 * *2.5 13.9 

* 6.5 

19.7 10.6 *4.1 

24.7 28.5 10.8 

* 8.5 11.7 

* 9.5 5.3 

26 
, 

had three shifts with an onduty charge nurse 

available around the clock; the proportion of 

facilities with this arrangement was 90 percent 

among skilled nursing facilities and 92 percent 

among skilled nursing-intermediate care facilities, in contrast to 78 percent of intermediate 

care facilities and 47 percent of noncertified 

facilities (table 0). The level of skill of the onduty charge nurse was also greater in facilities 

with higher levels of certification. Homes certified as skilled nursing only or as skilled nursingintermediate care had a registered nurse, licensed 

practical nurse, or some combination of the two 

onduty for three shifts in a significantly larger 

percent of homes: 90 percent of skilled nursingintermediate care facilities and over 82 percent 

of certified skilled nursing facilities. In contrast, 

only 59 percent of certified intermediate care 

facilities and 23 percent of noncertified facilities 

had a combination of registered and licensed 

practical nurses onduty for three shifts (table 0). 

Since 1965, when the Medicare and Medicaid programs were first enacted, they have had 

an enormous effect on the growth of the nursing 

home industry. The upgrading of standards and 

regulatory requirements for participation probably have increased the intensity of care received. 

As table P shows, since 1964 the proportion of 

residents receiving intensive or other nursing 

care has increased from 60 percent of all nursing 

home residents in 1964 to 85 percent in 1977. 

Table P. Number of nursing home residents and percent distribution, by level of care received: Unitsd States, 1964, 

1973-74, and 1977 

Item 1964 1973-74 1977 

Number 

All residents .. .. ... .. . 554,000 1 1.075.800 1 1,303,100 

Level of care received Percent distribution 

Total . ... ... . .. ... .. .. ... . I 300.0 100.0 100.0 

Nursing care: 

Intensive ... .. .. ... . ... .. .. ... 31.0 40.6 43.8 

Other .. .. .. .. . .... .. . .... . .. ... 28.7 42.1 40.7 

Personal care . . .. .... . .. ... . . .... 26.9 16.4 14.4 

Neither nursing nor 

personal care .. ... . . .... . .. ... 13.5 0.9 1.1 

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

SOURCES: Data for 1964 are from the National Center for 

Health Statistics: Nursing and personal care services received by

residents of nursing and personal care homes, United States, 

May-June 1964, by R. Morgan. Vital and HeaZth Statistics. PHS 

Pub. No. 1000~Series 12-No. 10. Public Health Service. Washmgton. U.S. Government Printing Office, Sept. 1968. Data for 

1973-74 are unpublished data from the 1973-74 National 

Nursing Home Survey and exclude residents of personal care 

homes. 

Similarly, the proportion of residents who saw a 

physician within the last month increased from 

39 percent in 1964 to 66 percent in 1977 (table 

Q). Between 1973-74 and 1977, the proportion 

of residents receiving one or more types of therapy increased from 28 percent to 35 percent. 

Table 0. Number of nursing home residents and percent distribution, by time since last physician visit: United States, 1964, 1973-74, 

and 1977 

Item 1964 1973-74 1977 

Number 

All residents . ... .... . ... ... .. . ..... . . ..... .1.. .... . . .... . . .. ... . .. .... .. . .... . .. ... . .... .. .. .. .. ... . ...-........................ 554,.000 1 1,075,800 1 1,303,100 

Time since last physician visit Percent distribution 

I 

Total ... ... .. .. ... .. .. ... ... .. .... .. .... . ... .. .. . .. . .. .. . .... . .. ... ... .. . .... . .... . . .... .... . ... .. .. .. .. .. .. . . .... . ... .. .. .. ........ 100.0 

Less than 1 month.. ......................................................................................................................... 

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

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

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

1 year or more.. ............................................................................................................................... 

No physician visits since entering facility ... ... . .... . . .... .1.. .. .. .. ... .. ... .. .. . .. ... .. ... ... . ... . .. .... .. .... . .. .. .. .. .. .. .. .. . 

65.8 

22.3 

4.5 

1.7 

3.3 

4.4 

SOURCES: Data for 1964 are from the National Center for Health Statistics: Arrangements for physician services to residents in 

nursing and personal care homes, United States, May-June 1964, by J. Solon and A. Nelson. Vital Md HeaZth Statistics. PHS Pub. No. 

1000~Series 12-No. 13. Public Health Service. Washington. U.S. Government Printing Office, Feb. 1970. Data for 1973-74 are 

unpublished data from the 1973-74 National Nursing Home Survey and exclude residents of personal care homes. 

27 
The direct recipients of Medicare and Medicaid financed care are, of course, the program 

beneficiaries. In certified skilled nursing facilities, the proportion of residents who use Medicare or Medicaid as their primary source of 

payment for care was 46 percent; the similar 

proportions in skilled nursing-intermediate care 

facilities and intermediate care only facilities 

was 60 and 55 percent, respective1y.l The availability of skilled or intermediate care services in 

participating facilities, however, may have influenced the type of resident admitted to the facilities. For example, those with higher levels of 

certification tended to serve a more disabled 

resident population than was found in intermediate care and noncertified facilities. Table R 

shows that the proportion of residents who were 

functionally independent in all six activities of 

daily living decreased as certification level rose. 

Twenty-seven percent of all residents in noncertified facilities, in contrast to 6 percent of all 

residents in certified skilled nursing facilities, 

were functionally independent. Similarly, the 

proportion of residents whose primary reason 

for care was nonmedical (mental retardation, 

mental illness, or behavioral problems; and 

social, economic, or other reasons) decreased 

with higher certification levels. Conversely, the 

proportion of residents receiving care for poor 

physical health increased with certification level 

from 60 percent of all residents in noncertified 

facilities to 84 percent of all residents in certified skilled nursing facilities. 

The following discussion examines the 

health services received by residents according 

to facility certification status. This analysis 

reflects in part the impact of the care received 

by Medicare or Medicaid beneficiaries, as well 

as the “case-mix” of residents in these facilities. 

For example, because nursing homes that participated in Medicare or Medicaid skilled nursing 

facility programs tended to serve a more dependent population, residents in these facilities 

tended to receive more services. The proportion 

of residents who received intensive nursing services increased with the level of certification from 

27 percent of residents in noncertified facilities 

to 55 ,percent of residents in certified skilled 

nursing facilities. Similarly, the proportion of 

residents who were administered a special diet in 

the week prior to the survey increased with certification level from 27 percent of residents in 

Table R. Number of nursing home residents by facility certification and percent distribution by primary reason for care and 

independence in the six activities of daily living, according to facility certification: United States, 1977 

Certification 

Skilled item Skilled nursing- Intermediate Tot: PI nursing Noncertified intermediate care facility facility care facility 

Number 

All residents .. .... ... . .... .. ... ... .. . .... .. . .... ... . .... .. .. .... . .. .... .. . ... 1.303.100 11269,600 1 527,600 1 366,200 1 137,500 

Primary reason for care Percent distribution 

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

Poor physical health’. ................................................................ 

Mental retardation, mental illness, or behavioral problem .......... 

Social, economic, or other.. ........................................................ 

Independence in the six activities of daily living2.. ..................... 

$cludes a small number of unknowns. 

LBathing, dressing, using toilet room, mobility, continence, and eating. Unknowns were considered independent for the purpose of 

this index. 

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

28 
noncertified facilities to 48 percent of residents 

in certified skilled nursing facilities (table 20). 

Be&i& resident? $jZZan contact was 

more frequent as certification level rose. A larger 

proportion of residents in skilled nursing and 

skilled nursing-intermediate care facilities (88 

percent and 89 percent, respectively) had regularly scheduled physician visits, in contrast to 

74 percent of residents in intermediate care 

facilities and 57 percent of residents in noncertified facilities. The location of the last physician 

visit was inside the facility for a greater proportion of residents in skilled nursing and skilled 

nursing-intermediate care facilities (88 and 90 

percent, respectively) than in intermediate care 

facilities (7 7 percent), and noncertified facilities 

(58 percent). In 1977 the proportion of residents who saw a physician during the week prior 

to the survey increased with certification level 

from 15 percent of residents in intermediate 

care facilities to 26 percent of residents in 

skilled nursing facilities. The proportion of residents who received no physician visit since 

000 

entering the facility was greatest in noncertified 

facilities. Ten percent of the residents’in noncertified facilities, compared with 4 percent in each 

of the certified categories, had had no physician 

visit since entering the facility. A significantly 

larger proportion of residents in intermediate 

care facilities (13 percent) and noncertified 

facilities (18 percent) had not received two physician visits since entering the facilitv. 

Therapy services were more likely to be received by residents in skilled nursing and skilled 

nursing-intermediate care facilities than by those 

in intermediate care and noncertified facilities. 

Forty-one percent of skilled nursing facility residents and 40 percent of skilled nursingintermediate care facility residents received one 

or more types of therapy, in contrast to 27 and 

26 percent, respectively, in intermediate care 

and noncertified facilities. This pattern was also 

true among residents who received physical, 

recreational, and occupational therapy in skilled 

nursing and skilled nursing-intermediate care 

facilities. 

29 
REFERENCES 

lNational Center for Health Statistics: The National 

Nursing Home Survey: 19 77 summary for the United 

States, by J. F. Van Nostrand et al. Vital and Health Statistics. Series 13-No. 43. DHEW Pub. No. (PHS) 79-

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

zNationai Center for Health Statistics: Nursing home 

utilization in California, Illinois, Massachusetts, New 

York, and Texas: 197 7 National Nursing Home Survey, 

by D. Foley. ‘Vital and Health Statistics. Series 13-No. 

48. DHHS Pub. No. (PHS) 81-1799. Public Health Service. Washington. U.S. Government Printing Office, Aug. 

1980. 

‘National Center for Health Statistics: A comparison 

of nursing home residents and discharges from the 1977 

National Nursing Home Survey: United States, by E. 

Hing and A. Zappolo. Advance Data From Vital and 

Health Statistics, No. 29. DHEW Pub. No. (PHS) 78-

1250. Public Health Service. Hyattsville, Md., May 17, 

1978. 

4NationaI Center for Health Statistics: An overview 

of nursing home characteristics, provisional data from 

the 19 77 National Nursing Home Survey, by M. Meiners. 

Advance Data From Vitai and Health Statistics, No. 35. 

DHEW Pub. No. (PHS) 78-1250. Public Health Service. 

Hyattsville, Md., Sept. 6, 1978. 

5National 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. 

6National Center for Health Statistics: Selected operating and financial characteristics of nursing homes, 

United States: 1973-74 National Nursing Home Survey, 

by M. Meiners. Vital atid Health Statistics. Series 13-No. 

22. DHEW Pub. NO. (HRA) 76-1773. Health Resources 

Administration. Washington. U.S. Government Printing 

Office, Dec. 1975. 

7National Center for Health Statistics: Characteristics, social contacts, and activities of nursing home residents, United States, 1973-74 National Nursing Home 

Survey, by A. Zappolo. 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. 

8National Center for Health Statistics: Utilization of 

nursing homes, United States, National Nursing Home 

Survey, August .1973-April 1974, by J..F. Sutton. Vital 

and Health Statistics. Series 13-No. 28. DHEW Pub. No. 

(HRA) 77-1779. ‘Health Resources Administration. 

Washington. U.S. Government Printing Office, July 197 7. 

gNational Center for Health Statistics: Profile of 

chronic illness in nursing homes, United States: National 

Nursing Home Survey, August 1973-Aprill974, by D. K. 

Ingram. Vital and Health Statistics. Series 13-No. 29. 

DHEW Pub. No. (PHS) 78-1790. Public Health Service. 

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

1977. 

lONational Center for Health Statistics: Nursing homes 

in the United States: 1973-74 National Nursing Home 

Survey, by A. Sirrocco and H. Koch. Vital and Health 

Statistics. Series 14-No. 17. DHEW Pub. No., (HRA) 78- ,, 

1812. Health Resources Administration. Washington. 

U.S. Government Printing Office, Oct. 1977. 

l1 National Center for Health Statistics: Charges. for 

care and sources of payment for residents in nursing 

homes, United States: National Nursing Home Survey, 

August 1973-April 1974, by E. Hing. Vital and Health 

Statistics. Series 13-No. 32. DHEW Pub. No. (PHS) 78-

1783. Public Health Service. Washington. U.S. Government Printing Office, Nov. 1977. 

12NationaI Center for Health Statistics: Nursing home 

costs-1972, United States: National Nursing Home Survey, August 1973-April 1974, by M. Meiners. Vital and 

Health Statistics. Series 13-No. 38. DHEW Pub. No. 

(PHS) 79-1789. Public Health Service. Washington. U.S. 

Government Printing Office, Nov. 1978. 

13National Center for Health Statistics: Employees in 

nursing homes in the United States: 1973-74 National 

Nursing Home Survey, by A. Sirrocco. Vital and Health 

Statistics. Series 14-No. 20. DHEW Pub. No. (PHS) 79-

1815. Public Health Service. Washington. U.S. Govemment Printing Office, Feb. 1979. 

14NationaI denter for Health Statistics: Institutions 

for the aged and chronically ill, United States, AprilJune 1963, by E. Bryant. Vital and Health Statistics. 

PHS Pub. No. lOOO-Series 12-No. 1. Public Health Service. Washington. U.S. Government Printing Office, July 

1965. 

15NationaI Center for Health Statistics: Characteristics 

of residents in institutions for the aged and chronically 

iii, United States, April-June 1963, by G. Wunderlich. 

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

12-No. 2. Public Health Service. Washington. U.S. Government Printing Office, Sept. 1965. 

30 
16National Center for Health Statistics: Characteristics 

of patients in mental hospitals, United States, April-June 

1963, by C. Taube. Vital and Health Statistics. PHS Pub. 

No. 1000~Series 12-No. 3. Public Health Service. Wash­

&ton. U.S. Government Printing G&e, Dec. 1965. 

17National Qnter for Health Statistics:. Utilization of .. institutions for the aged and chronically ill, United 

States, April-June 1963, by E. Bryant and C. Taube. 

Vital and Health Statistics. PHS Pub. No. lOOO-Series 12-

No. 4. Public Health Service. Washington. U.S. Govemment Printing Office, Feb. 1966. 

18National Center for Health Statistics: Employees in 

nursing and personal care homes, United States, MayJune 1964, by C. Taube. VitaZ and HeaZth Statistics. PHS 

Pub. No. lOOO-Series 12-No. 5. Public Health Service. 

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

1966. 

lgNational Center for Health Statistics: Employees in 

nursing and personal care homes: number, work experience, special training, and wages, United States, MayJune 1964, by C. Taube and E. Bryant. Vital and Health 

Statistics. .PHS Pub. No. lOOO-Series 12-No. 6. Public 

Health Service. Washington. U.S. Government Printing 

Office, Jan. 1967. 

*‘National Center for Health Statistics: Chronic ilhress 

among residents of nursing and personal care homes, 

United States, May-June 1964, by A. Nelson. Vital and 

Health Statistics. PHS Pub. No. 1000Series 12-No. 7. 

Public Health Service. Washington. U.S. Government 

Printing Office, Mar. 1967. 

*lNational Center for Health Statistics: Prevalence of 

chronic conditions and impairments among residents of 

nursing and personal care homes, United States, MayJune 1964, by A. Nelson. Vital and Health Statistics. 

PHS Pub. No. lOOO-Series 12-No. 8. Public Health Service. Washington. U.S. Government Printing Office, July 

1967. 

**National Center for Health Statistics: Charges for 

care in institutions for the aged and chronically ill, 

United States, May-June 1964, by M: Kovar. Vital and 

Health Statistics. PHS Pub. No. lOOO-Series 12-No. 9. 

Public Health Service. Washington. U.S. Government 

Printing Office, Aug. 1967. 

23Nation$Cepter for Health Statistics: Nursing and 

person+ care serv@es received by residents of nursing 

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

by R. Morgan. Vital and Health Statistics. PHS Pub. No. 

1000Series 12-No. 10. Public Health Service. Washington. U.S. Government Printing Office, Sept. 1968. 

24National Center for Health Statistics: Use of special 

+ds in homes for the aged and chronically ill, United 

States, May-June 1964, by D. EWund and A. Sirrocco. 

Vital and Health Statistics. PHS Pub. No. 1000~Series 12-

No. 11. Public Health Service. Washington. U.S. Govemment Printing Office, Dec. 1968. 

25National Center for Health Statistics: Marital status 

and living arrangements before admission to nursing and 

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

R. Morgan. VitaE and Health Statistics. PHS Pub. No. ...-

1000Series 12-No. 12. Public Health Service. Washington. U.S. Government Printing Office, May 1969, 

26National Center for Health Statistics: Arrangements 

for physician services to residents in nursing and personal care homes, United States, May-June 1964, by J. 

Solon and A. Nelson. Eta1 and Health Statistics. PHS 

Pub. No. lOOO-Series 12-No. 13. Public Health Service. 

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

1970. 

27National Center for Health Statistics: Administrators of nursing and personal care homes: Education and 

training, United States, June-August 1969, by B. Brown. 

Vital and Health Statistics. Series 12-No. 18. DHEW Pub. 

No. (HSM) 73-1703. Health Services and Mental Health 

Administration. Washington. U.S. Government Printing 

Office, Feb. 1973. 

28National Center for Health Statistics: Characteristics 

of residents in nursing and personal care homes, United 

States, June-August 1969, by E. Mathis. Vital hnd Health 

Statistics. Series 12-No. 19. DHEW Pub. No. (HSM) 73-

1704. Health Services and Mental Health Administration. Washington. U.S. Government Printing Office, Feb. 

1973. 

2gNational Center for Health Statistics: Admiuistrators of nursing and personal care homes: Work experience, United States; June-August 1969, by B. Brown. 

VitaZ and HeaZth Statistics. Series 12-No. 20. DHEW Pub. 

No. (HSM) 73-1705. Health Services and Mental Health 

Administration. Washington. U.S. Government Printing 

Office, Mar. 1973. 

30National Center for Health Statistics: Charges for 

care and sources of. payment for residents in nursing 

homes, United States, June-August 1969, by J. F. 

Van Nostrand and J. F. Sutton. 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. 

31National Center for Health Statistics: Chronic conditions and impairments of nursing home residents, 

United States, 1969, by A. Sirrocco. Vital and Health 

Statistics. Series 12-No. 22. DHEW Pub. No. (HRA) 74 

170 7. Health Resources Administration. Washington. 

U.S. Government Printing Office, Dec. 1973. 

32National Center for Health Statistics: Selected characteristics of nursing homes for the aged and chronically 

ill, United States, June-August 1969, by R. Gag-non. 

Vital and Health Statistics. Series 12-No. 23. DHEW Pub. 

No. (HRA) 74-1708. Health Resources Administration. 

Washington. U.S. Government Printing Office, Jan. 1974. 

33National Center for Health Statistics: Measures of 

chronic illness among residents of nursing homes, United 

States, June-August 1969, by D. Ingram. Vital and Health 

Statistics. Series 12-No. 24. DHEW Pub. No. (HRA) 74 

1709. Health Resources Administration. Washington. 

U.S. Government Printing Office, Mar. 1974. 

34National Center for Health Statistics: Vital Statis& 

of the United States, 1977, Vol. II, Sec. 5. DHEW Pub. 

No. (PHS) 80-1104. Public Health Service. Washington. 

U.S. Government Printing Office, 1980. 

35National Center for Health Statistics: Home care for 

persons 55 years and over, United States, July 1966-

June 1968, by M. Wilder. Vital and Health Statistics. 

Series lo-No. 73. DHEW Pub. No. (HSM) 72-1062. 

31 
Health Services and Mental Health Administration. 

Washington. U.S. Government Printing Office, July 1972. 

36Palmore, E.: Total chance of institutionalization 

among the aged. Gerontologist. 16(6): 504-507, 1976. 

37National Center for Health Statistics: Discharges 

from nursing homes: 1977 National Nursing Home Survey, by A. Zappolo. Vital and Health Statiktics. Series 

13-No. 54. DHHS Pub. No. (PHS) 81-1715. Public Health 

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

In preparation. 

38Katz, S. et al.: Progress in development of the index 

of ADL. Gerontologist. 10: 20-30, Spring 1970. 

3gKatz, S. et al.: Studies of illness in the aged. JAMA. 

185(12): 914-919, Sept. 1963. 

40Densen, P. et al.: An approach to the assessment of 

long-term care: Final report. U.S. Department of Health, 

Education, and Welfare. Public Health Service, National 

Center for Health Services Research, Dec. 13, 1976. 

41U.S. Department of Health, Education, and Welfare: 

Skilled nursing facilities, standards of participation in 

Medicare and Medicaid programs. Federal Register. Vol. 

39, No. 12, Part III, Jan. 17, 1974. 

42Office of Long-Term Care: Physician’s Drug Prescribing Patterns ‘m Skilled Nursing Facilities, Long-Term 

Care Facility Improvement Campaign Monograph No. 2. 

DHEW Pub. No. (05) 76-50050. Public Health Service. 

Washington. U.S. Government Printing Office, June 

1976. 

43U.S. Department of Health, Education, and Welfare: 

Long-term care facility improvement study: Introductory report. Public Health Service. Office of Nursing 

Home Affairs, July 1975. 

000 

44Health Care Financing Administration: Title XIX, 

Grants to States for Medicaid Assistance Programs. 

Medicaid Bureau, Department of Health, Education and 

Welfare. Washington, D.C. pp. 534,535. Revised Jan. 

1979. 

45U.S. Department of Health, Education, and Welfare: 

Skilled nursing facilities. Federal Register. Vol. 39, No. 

193, Part II, Oct. 3,1974. 

46National Center for Health Statistics: Development 

and maintenance of a National Inventory of Hospitals 

and Institutions. Vital and Health Statistics. PHS Pub. 

No. lOOO-Series l-No. 3. Public Health Service. Washington. U.S. Govermnent Printing Office, Feb. 1965. 

47Nationai Center for Health Statistics: Design and 

methodology of the 1967 Master Facility Inventory Survey, by G. Hollis. Vital atid Health Statistics. PHS Pub. 

No. lOOO-Series l-No. 9. Public Health Service. Washington. U.S. Government Printing Office, Jan. 1971. 

48National Center for Health Statistics: The agency 

reporting system for maintaining the National Inventory 

of Hospitals and Institutions, by D. Eklund. Vital and 

Health Statistics., PHS Pub. No. lOOO-Series l-No. 6. 

Public Health Service. Washington. U.S. Government 

Printing Office, Apr. 1968. 

4gNa.tional center for Health Statistics: Eighth Revision International Classification of Diseases, Adapted for 

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

Health Service. Washington. U.S. Government Printing 

Office, 1967. 

32 
LIST OF-DETAILED TABLES 

1. Number and percent distribution of nursing home residents by marital status and race or ethnicity, according to sex and age: 

United States, 1977 ... . .. ... .. .. ... ... . .... . .. ... . ... ... . .. ... ... . .... . . .... . . .... . .. ... ... . .. ... . ... .. . .... . . .... . .. ... . .. .. .... .... . .. .............................................. 

2. Number and percent distribution of nursing home residents by sex and living arrangement prior to admission, according to 

age: United States, 1977 . ... ... .. ... .. ... . .... . . .... .. .. ... .. .. .. .. .. .... . ..... . ... .. .. .. .. . ... .... . .... . . ..-................................................................. . ... 

3. Number and percent distribution of nursing home residents by living arrangement prior to admission, according to marital 

status and race or ethnicity: United States, 1977 .. .. .. .. .... ... .. . .... . . .... .. ... . .. .. .. .. .. .... .. .... . . .... . . .... . ... .. .. .. ... .. . .. .. . . .... .. .... . ... .. ... . .. ... . . ... 

4. Number and percent distribution of nursing home residents by living arrangement prior to admission, according to primary 

reason for care: United States, 1977 . ... . . ..... . .. ... ... .... .. . .... . . .... . .... .. . .. ... .. . ... .. . ..... . . .. .. .. ... . .. ... .. .. ... .. .... .. .. ... . .. ... ... . .. ... . ... .................. 

5. Number and percent distribution of nursing home residents by primary source of payment, according to sex. age, marital 

status, and race or ethnicity: United States, 1977 . .... .. ..... . .. ... .. ... . ... . ..... . . .... .. .... .... .. . .. ... .... .. .. .. .... . .... . .... . .. .. .. .. . . ..... . .... . .. ... . ..... . .. . 

6. Number and percent distribution of nursing home residents by length of stay since admission, according to sex and age: 

United States, 1977 ... .. ... .. . .... . .. ... .. .. .... . . .... . . .... .. .. .. .. .. .. .... .. .. . .. .... .. .... ... ... .. . ..... . . ... .. .. ... . .. ... ... ... .. . ... . ............................................ 

. 7. Mean length of stay, standard error (S.E.) of the mean, median length of stay, and standard error (SE.1 of the median for 

nursing home residents, by selected resident characteristics: United States, 1977 . .... . . .... . .. ... ... . ... .. . .... . . .... . .. .... .. .. ... .. ... .. . .... .. . ... 

8. Number and rate per 1,000 nursing home residents, by sex, selected health statuses, and age: United States, 1977 . .. .... . .. ... . .. .. 

9. Number and rate per 1,000 nursing home residents, by selected health statuses, race or ethnicity, and ljrimary source of 

payment: United States, 1977 ..... . .. .. .. .. . .... . . .... . ... .. ... .. .. .. .. .... . . .... .. .... . ... .. ... . .... .. ... .. . ... .. .. ... .. . ... .. . ... .. .. .... . .... . . ... ........................... 

10. Number and percent distribution of nursing home residents by selected functional statuses, according to sex and age: 

United States, 1977 .... .... .. . .... . .. ... ... . ... .. . .... . . .... .. . ... .. .. ... .. .. .. .. .. .... . .. ... .. . .. ... .. ... .. ..... . . ... .. .. ... .. .. . ... .. .. ............................................. 

11. Number and percent distribution of nursing home residents by index of dependency in activities of daily living, according to 

selected resident characteristics: United States, 1977 . ... . . .... .. .. .. .. .. .... .. . ... .. .. .. .. . ... .. . .... .. . ... .. .. ... .. . ... .. . .... . .. ... ... .. .. .. .. ... . .. ... . .. ... .. .. . 

12. Number and percent distribution of nursing home residents by level of care received during 7 days prior to survey date, 

according to age, length of stay since admission, mobility status, and index of dependency in activities of daily living: 

United States, 1977 . ... . .... . .. ... ... . .. .. .. ..... . ..... . .. ... . ... ... .. . .... . . .... . . ..... ... ... .. .. .. .. . ... .. . .... . .. ... .. . ... .. . .... .. . .... .. ......................................... 

13. Number and percent distribution of nursing home residents by level of care received during 7 days prior to survey date, 

according to selected health statuses: United States, 1977 ... . .... .. .... .. .. .. .. .. .. .. .. .... .. .... . .. ... .. .. ... .. . ... .. . .... . . ..... . .. ... . .. . .. ... . .... . . ..... . ... 

14. Number and percent distribution of nursing home residents by selected health services received, according to primary source 

of payment: United States, 1977 .... . .... . . .... . .. ... . ... .. . .... ... .. . ... .. ..... . . .... . .. ... .. . ... .. . ... .. . ... . .. .... ... .. .. . .... .. . ..... .. .... . . .... . .. ....................... 

15. Number and percent distribution of nursing home residents by selected physician services received at last visit, according to 

selected health statuses: United States, 1977 ... ... .. .. .. .. .. .. . . .... .. .... .. .... .. . ... .. . .. ... . ... .. . ... .. ..... . .... .. .. .. .. .. .. ... . .. ... .... .. . ... .. . .... . ... .. .. .. ..... 

16. Number of nursing home residents receiving medication and percent distribution by type of medication received, according 

to sex and age: United States, 1973-74 ..... . .. .. .. . ... .. .. .. .. .. .. .... .. .... . ..... .. .... .. .. .. ... ... .. . .. ... .... . .. ... .. .. .. . .. ... .. .. . .. ... ... .. ..... . .... .. . ............. 

17. Number and percent distribution of nursing home residents by type of medication received, according to chronic conditions 

or impairments, primary diagnosis at lest examination, and primary reason for admission: United States, 1973~74.................. 

35 

37 

39 

40 

41 

42 

43 

45 

57 

62 

65 

67 

69 

72 

75 

85 

86 

33 
18. Number and percent distribution of nursing home residents by number,-of categories of medication received, according to 

chronic conditions or impairments, \primary diagnosis at last examination, and primary reason for admission: United States, 

1973-74 . ... ... ... . ..... . ... ... .... . .... . ... ...~...............................................................................~............................................... .... . .... ... .. 90 

19. Number and percent distribution of nursing home residents by therapy services received, according to selected health 

statuses: United States, 1977 . ...... ... .. ... .. . .... . .. .... .. .. .... . .. .... .. ... .... . . .... .. ... .. ... .. .... . ... .. .... ..... . .. ... .. ... .. .... . ..... ..... .................... . . ,.... .. .. 92 ( 

20. Number and percent distribution of nursing home residents by selected health services received, according to facility certification, bed size, and ownership: United States, 1977 .. .... . ... .. .... . .... . .. ..... ... . .... .. ..... . .. .... ... . .... .. .. .... ... . ... .. .... .. ... .. ..... .... ... ... . ..... . ... 97 

. 

. 

. 

34 
Table 1. Number and percent distribution of nursing home residents by marital status and race or ethnicity, according to sex and age: United States, 1977 

Sex and age 

Both sexes 

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

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

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

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

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

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

. Male 

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

t 

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

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

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

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

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

Female 

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

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

65 years end over.. ..................................................... 

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

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

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

See footnotes at end of table. 

Marital status I Race or ethnicity 3

Total Divorced N&er White Black Hispanic 

Married Widowed1 or married All races (not (not and 

separated Hispanic)’ Hispanic) other 

Number 

1,303,100 155,400 810,700 87,500 249,500 

177,100 19,600 30,300 37,100 90,100 

1 ,126,OOO 135,800 780,400 50,400 159,500 

211,400 39,100 95,300 26,300 50,600 

464,700 63,800 320,300 16,400 64,100 

449,900 32,900 364,700 7,600 44,700 

375,300 87,100 142,800 41,700 103,700 

81,300 9,600 8,900 17,100 45,800 

294,000 77,500 134,000 24,600 57,900 

80,200 20,100 23,100 11,700 25,200 

122,100 36,400 53,700 8,100 23,900 

91,700 20,900 57,200 4,800 8,800 

927,800 68,300 667,900 45,800 145,800 

95,800 10,000 21,500 20,000 44,300 

832,000 58,300 646,400 25,800 101,500 

131,200 18,900 72,300 . 14,600 25,400 

342,600 27,400 266,700 8,400 40,200 

358,200 11,900 307,500 “2,900 35,900 

1.200.900 81,400 20,800 

151,500 20,600 5,000 

1.049.400 60,800 15,800 

184,600 22,000 4,800 

439,000 19,700 6,000 

425,800 19,100 5,000 

335,700 29,400 10,200 

68,000 10,600 ‘2,800 

,267,800 18,800 7,400 

66,800 

114,700 

9,200 

5,400 

4,200 

l 2,000 

86,300 4,200 

865,200 52,000 10,600 

83,600 10,000 x2.200 

781,600 

117,800 

42,000 

12,800 

8,400* 

324,200 14,400 4,000 

339,600 14,900 3,800 

l 
Table 1. Number and percent distribution of nursing home residents by marital status and race or ethnicity, according to sex and age: United States, 1977-Con. 

Marital status Race or ethnicity 

Sex and age Total 

Married Widowed1 

Divorced Never or married

separated 

All races 

White 

(not 

HispanicI 

Black 

(not 

Hispanic) 

Hispanic 

and 

other 

Both sexes Percent distribution 

All ages.. .................................... 100.0 11.9 62.2 6.7 19.1 100.0 92.2 6.2 1.6 

Under 65 years .......................................................... 100.0 11.1 17.1 20.9 50.9 100.0 85.6 11.6 2.8 

65 years and over.. ..................................................... 100.0 12.1 69.3 4.5 14.2 100.0 93.2 5.4 1.4 

65-74 years.. ......................................................... 100.0 18.5 45.1 12.5 24.0 100.0 87.3 10.4 2.3 

7584 years.. ......................................................... 100.0 13.7 68.9 3.5 13.8 100.0 94.5 4.2 1.3 

85 years and over.. ................................................ 100.0 7.3 81.1 1.7 9.9 100.0 94.6 4.2 1.1 

All ages.. .................................................... 100.0 23.2 38.1 11.1 27.6 100.0 89.5 7.8 2.7 

Under 65 years .......................................................... 100.0 11.8 10.9 21 .o 56.3 100.0 83.6 13.0 l 3,4 

65 years and over.. ..................................................... 100.0 26.4 45.6 8.4 19.7 100.0 91.1 6.4 2.5 

65-74 years.. ......................................................... 100.0 25.1 28.8 14.6 31.4 100.0 83.3 11.5 5.2 

75-84 years.. ......................................................... 100.0 29.8 43.9 6.6 19.6 100.0 94.0 4.4 “1.6 

85 years and over .................................................. 100.0 22.8 62.4 5.2 9.6 100.0 94.0 4.6 l 

Female 

All ages.. ..................................................... 100.0 7.4 72.0 4.9 15.7 100.0 93.2 5.6 1,1 

Under 65 years .......................................................... 100.0 10.5 22.4 20.9 46.2 100.0 87.2 10.5 ‘2.3 

65 years and over.. ..................................................... 100.0 7.0 77.7 3.1 12.2 ‘100.0 93.9 5.0 1 .o 

65-74 years.. ......................................................... 100.0 14.4 55.1 11.1 ‘19.4 100.0 89.8 9.7 l 

75-84 years.. ......................................................... 100.0 8.0 77.8 2.4 11.7 100.0 94.6 4.2 1.2 

85 years and over.. ................................................ 100.0 3.3 85.8 l 0.8 10.0 100.0 94.8 4.1 1.1 

11ncludes a small number of u&owns. 

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

Table 2. Number and percent distribution of nursing home residents by sex and living arrangement prior to admission, according to age: 

United States, 1977 

All ages 65 years and over years 

Both sexes Number 

All arrangements. .............................................................. 1.303.100 I ,126,OOO 211,400 

Private residence ............................................................................................... 49,000 435,600 65,300 

Alone.. ......................................................................................................... 6,200 159,600 24,200 

Unknown if with others.. .............................................................. .:. ............ *1,900 30,800 4,700 

With others1 ................................................................................................ 40,900 245,200 36,300 

Immediate family2 ................................................................................. 36,600 216,900 32,700 

spouse ............................................................................................... 9,300 63,200 14,200 

Children ............................................................................................. 5,400 130,700 12,500 

Other relatives ........................................................................................ 26,700 57,100 10,300 

Unrelated persons ................................................................................... ‘1,700 13,100 *1,600 

Another health facility3 ................................................................................... 591,700 129,900 

Another nursing home.. ............................................................................... 20,200 142,800 27,200 

General or short-stay hospital ...................................................................... 43,600 377,000 73,000 

Mental hospital ............................................................................................ 36,400 40,500 19,500 

Other health facility or unknown ................................................................ 14,800 31,400 10,300 

Semiprivate residence ....................................................................................... 3,800 36,500 5,700 

Unknown or other arrangement ........................................................................ 71,400 9;200 62,200 10,400 

Sex and living arrangement prior to admission Under 65 years 65-74 

177,100 

484,700 

165,800 

32,800 

286,100 

253,500 

72,500 

136,100 

83,800 

14,800 

706,700 115,100 

163,000 

420,600 

76,900 

46,200 

40.300 

Male - II 

All arrangements ......................................................................... 375,300 81,300 294,000 80,200 

Private residence ............................................................................................... 121,600 20,500 101,100 21,300 

Alone.. ......................................................................................................... 38,000 ‘2,500 35,500 8,900* Unknown if with others.. ............................................................................. 6,900 l 1,300 5,500 

.With others1 ................................................................................................ 76,700 16,700 60,100 11,300 

Immediate family2 ................................................................................. 69,200 15,300 53,900 10,000 

spouse ............................................................................................... 32,600 l 3,1 00 29,500 6,300 

Children ............................................................................................. ii- 23.400 ‘1.600 21,900 *2,800 

Other relatives ........................................................................................ 23;300 121700 10,500 *2,700 

Unrelated persons ................................................................................... 3,700 I) l 3,000 l 

Another health facility3 ................................................................................... 217,700 I/ 53,200 164,500 52,000 

47,800 38,700 

75-84 85 years 

years and over 

164,700 449,900 

,81,800 188,600 

64,300 71,100 

13,100 13,000 

104,400 104,500 

94,100 90,100 

30,500 18,500 

53,700 64,400 

23,100 23,700 

6,000 5,500 

z43.100 218,700 

57,800 57,800 

158,500 145,400 

14,400 6,700 

12,300 8,800 

12,600 18,200 

27,200 24,600 

122,100 91,700 

43,400 36,400 

15,500 11,100 

‘2,200 ‘2,200 

25,700 23,100 

23,100 20,800 

14,100 9,100 

7,600 11,500 

3,900 4,000 

'1,800 l 

66,200 46,300 

16,500 11,100 

39,600 31,400 

5,000 l 

5,200 +2,700 

3,600 4,500 

9,000 4,500 

342,600 358,200 

138,400 152,100 

48,800 59,900 

10,900 10,800 

78,700 81,400 

71,100 69,300 

16,400 9,400 

46,100 53,000 

19,200 19,700 

4,200 5,000 

176,900 172,300 

41,400 46,700 

118,900 114,000 

9,400 5,500 

7,200 6,100 

9,100 13,700 

18,200 20,100 

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

General or short-stay hospital ...................................................................... 120,400 

Mental hospital ............................................................................................ 27,900 

Other health facility or unknown ................................................................ 21,600 

Semiprivate residence ....................................................................................... 12,400 

Unknown or other arrangement ........................................................................ 23,500 

Female 

All arrangements ......................................................................... 927,800 

Private residence ............................................................................................... 363,000 

Alone.. ......................................................................................................... 127,800 

Unknown if with others.. ............................................................................. 25,900 

With others1 ................................................................................................ 209,300 

Immediate family’ ................................................................................. 184,300 

spouse ........................................................................................... .: .. 39,800 

Children.. ........................................................................................... 112,600 

Other relatives.. ...................................................................................... 60,600 

Unrelated persons.. ................................................................................. 11,100 

Another health facility3 ................................................................................... 489,000 

Another nursing home.. ............................................................................... 115,200 

General or short-stay hospital ...................................................................... 300,200 

Mental hospital ............................................................................................ 49,000 

Other health facility or unknown ................................................................ 24,600 

Semiprivate residence ....................................................................................... 27,900 

Unknown or other arrangement.. ...................................................................... 47,900 

9,100 11,100 

21 ,100 99,300 28,300 

14,800 13,100 *7,000 

8,200

l 2,100 

13,400 

10,300 

5,600

l 2,200 

5,400 18,100 4,700 

95,800 832,000 131,200 

28,500 334,500 44,000 

25,300 3,600 

24,200 185,100 25,000 

21,300 163,000 22,700 

6,100 33,700 7,900 

3,800 108,800 9,700 

14,000 46,600 7,600I 

3,700I 124,100 15,300 

l 10,100 

61,800 427,200 78,000 

11,100 104,100 16,100 

22,500 277.600 44,700 

21,600 27,400 12,500 

6,600 18,000 4,700 

l 1 ,600 26,200 3,500 

3,800 44,100 5,700 

See footnotes at end of table. 

37 
Table 2. Number and percent distribution of nursing home residents by sex and living arrangement prior to admission, according to age: 

United States, 

-

1977-Con. 

Age 

Sex and living arrangement prior to admission Under 65 years 65-74 7584 85 years All ages 65 years and over years years and over 

All arrangements.. ............................................................. I 100.0 100.0 100.0 100.0 100.0 100.0 

Private residence.. .... !!. ...................................................................................... 37.2 27.7 38.7 30.9 39.1 41.9 

Alone.. ......................................................................................................... 12.7 3.5 14.2 11.5 13.8 15.8 

Unknown if with others.. ............................................................................. 2.5 ‘1.1 2.7 2.2 2.8 2.9 

With others1 ................................................................................................ 22.0 23.1 21.8 17.2 22.5 23.2 

Immediate family2 ................................................................................. 19.5 20.7 19.3 15.5 20.3 20.0 

Spouse.. ............................................................................................. 5.6 6.2 5.6 6.7 6.6 4.1 

Children.. ........................................................................................... 10.4 3.1 11.6 5.9 11.5 14.3 

Other relatives ............................. .l........................................................ 6.4 15.1 5.1 4.9 5.0 5.3 

Unrelated persons.. ................................................................................. l 1 .o 1.2 ‘0.7 1.3 1.2 

Another health facility3 ................................................................................... 52 65.0 52.5 61.5 52.3 48.6 

Another nursing home.. ............................................................................... 12.5 11.4 12.7 12.8 12.4 12.8 

General or short-stay hospital.. .................................................................... 32.3 24.6 33.5 34.6 34.1 32.3 

Mental hospital ............................................................................................ 5.9 20.6 3.6 9.2 3.1 1.5 

Other health facility or unknown ................................................................ 3.5 8.4 2.8 4.9 2.7 2.0 

Semiprivate residence ....................................................................................... 3.1 2.1 3.2 2.7 2.7 \ 4.0 

Unknown or other arrangement.. ...................................................................... 6.5 5.2 6.5 4.9 5.9 5.5 

Both sexes T Percent distribution 

Male -

All arrangements.. ....................................................................... 100.0 100.0 100.0 1.00.0 100.0 100.0 

Private residence ............................................................................................... 32.4 25.2 34.4 26.6 35.5 39.7 

Alone.. ... . ..................................................................................................... 

Unknown if with others.. ............................................................................. 

10.1 

1.8 

I ‘3.1 

“1.6 

\ 12.1 

1.9 

11.1

I 

12.7 

‘1.8 

12.1 

‘2.4 

With others1 ................................................................................................ 20.4 20.5 20.4 14.1 21 .o 25.2 

Immediate family* ................................................................................. 18.4 18.9 18.3 , 12.5 18.9 22.7 

Spouse.. ............................................................................................. 8.7 ‘3.9 10.0. 7.8 11.6 9.9 

Children.. ............................................................................................ 6.2 11.9 l 3.5 6.2 12.5 

Other relatives ........................................................................................ 6.2 15.7 3.6” “3.4 3.2 4.3 

Another health facility3 ................................................................................... 58.0 65.5 56.0 64.8 64.2 50.5 

Another nursing home ................................................................................. 12.7 \ 11.2 13.2 13.8 13.5 12.1 

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

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

32.1 

7.4 

25.9 

18.2, 

33.8’ 

4.4 

35.4 

l 8.7 

32.4 

4.1 

34.2 c 

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

Semiprivate residence ....................................................................................... 

5.8 

3.3 

10.1 

“2.6 

4.6 

3.5 

7.0 

l 2.8 

4.2 

2.9 

4.9 

4.9 

Unknown or other arrangement.. ...................................................................... 6.3 6.7 6.2 5.8 7.3 4.9 

Unrelated persons.. ................................................................................. 1.0 l l 1:0 l +1.6 t 

Female 

All arrangements.. ....................................................................... 100.0 100.0 100.0 100.0 100.0 100.0 

Private residence ............................................................................................... 39.1 29.8 40.2 33.5 40.4 42.5 

Alone ...................................................... \:. .................................................. 13.8 3.8 14.9 11.7 14.2 16.7 

Unknown if with others.. ............................................................................. 2.8 l 3.0 2.8 3.2 3.0 

With others1 ................................................................................................ 22.6 25.3 22.3 19.1 23.0 22.7 

Immediate family* ................................................................................. 19.9 22.2 19.6 17.3 20.7 19.3 

Spouse.. ......................................... .I .................................................. 4.3 6.4 4A 6.0 4.8 2.6 

Children. ............................................................................................ 12.1 4.0 13.1 7.4 13.5 14.6 

Other relatives ........................................................................................ 

Unrelated persons.. ................................................................................. 

6.5 

1.2 

14.6 l 

5.6 

1.2 

5.8

I 5.6 

1.2 

5.5 

1.4 

Another health facility3 ................................................................................... 52.7 64.5 51.3 59.4 51.6 48.1 

Another nursing home ........................................................................... *. ... 12.4 11.6 12.5 12.3 12.1 13.0 

General or short-stay hospital.. .................................................................... 32.4 23.5 33.4 34.1 34.7 31.8 

Mental hospital ............................................ a.. ............................................ 5.3 22.5 3.3 9.5 2.7 1.5 

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

Semiprivate residence ....................................................................................... 

2.7 

3.0 

6.9 

l 1.7 

2.2 

3.2 

3.6 

2.7 

2.1 

2.6 

1.7 

3.8 

Unknown or other arrangement.. ...................................................................... 5.2 4.0 5.3 4.4 5.3 5.6 

IResidents may have lived with more than one categ 9 ry of person, so the sum of the subparts exceeds the total. 

*Includes parents, spouse, children. and siblings. 

3Forty-nine percent of the residents who were admitted from another health facility had gone to that facility from a private or semipiivate residence. 

38 
Table 3. Number and percent distribution of nursing home residents by living arrangement prior to admission, according to marital status and race or ethnicitv: 

United States, 1977 / 

Marital status Race or ethnicity 

Living arrangement prior to admission Total Divorced Never White Black Hispanic 

Married Widowed1 or married (not (not and 

separated HispanicI Hispanic) other 

. . 

All arrangements ............................................................................. I 1,303,100 155,400 810,700 87,500 249,500 1.200.900 81,400 20,800 

Private residence ............................................................................................. 484.700 67,400 319,100 21,200 77,000 453,300 24,400 I,boo

Alone ......................................................................................................... 165,800 6,200 123,900 7,500 28,300 159,100 5,600 l 

Unknown if with others ............................................................................. 32,800 l 2,500 23,200 l 2,800 4,400 29,600 l 2,900 l 

With others2 .............................................................................................. 286,100 58,700 172,100 11,000 44,300 264,500 15,900 5,600 

Spouse .... ..” ........................... . ......................................................... 72,500 52,900 17,400 *I ,900 67,500 3,500 l 1 ,400 

Children .................................................................................... :.:. ... 136,100 8,700 122,500 4,300 l 126,800 5,900 “3.400 

Other relatives.. ..................................................................................... 83,800 3,600 35,900 4,800 39,600 75,900 5,900 ‘2,000 

Unrelated persons ........................................................................... ..- .. 14,800 l 10,000 l ‘3,400 13,300 l 1 ,500 

Another health facility4.. ................................................................................ 706,700 80,000 420,900 58,600 147,300 645,800 49,200 11,800 

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

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

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

163,000 

420,600 

76,900 

16,700 

54,200 

4,800 

103,300 

275,500 

21,000 

12,100 

31,400 

11,000 

31,000 

59,500 

40,100 

152,400 

384,300 

67,000 

8,200 

28,000 

9,400 

l 2,400 

8,300* 

Immediate family3 ................................................................................ 253,500 57,300 152,600 9,300 34,200 * 236,000 12,100 5,400 

Semiprivate residence ............................................................................ . ......... 40,300 *2.800 26,500 l 2,800 8,300 38,800 l l 

Unknown or other arrangement.. .................................................................... 71,400 5,200 44,300 4,900 17,000 63,000 6,900 *1,500 

Percent distribution 

All arrangements ............................................................................. I 100.0 100.0 100.0 ‘. 100.0 100.0 100.0 

Private residence ............................................................................................. 

Alone ......................................................................................................... 

37.2 

12.7 

43.4 

4.0 

39.4 

15.3 

24.2 / 30.9 

8.5 11.3 

37.7 

13.3 

29.9 

6.9 

33.6

* 

Unknown if with others ............................................................................. 2.5 ‘1.6 2.9 l 3.2 1.8 2.5 l 3.5 * 

With others2 .............................................................................................. 22.0 37.8 21.2 12.5 17.8 22.0 19.5 27.1 

Immediate family3 ................................................................................ 19.5 36.9 18.8 10.7 13.7 19.7 14.9 25.8 

Spouse ............................................................................................. 5.6 34.0 2.1 l 2.2 l 5.6 4.4 l 6.9 

Children ........................................................................................... 10.4 5.6 15.1 5.0 l 10.6 7.3 *16.2 

Other relatives.. ..................................................................................... 

Unrelated persons ................................................................................. 

6.4 

1.1 

2.3 x 4.4 

1.2 

5.5 15.9 

* x1.4 

6.3 

1.1 

7.3 

l 1.8 

‘9.6 

Another health facility4.. ................................................................................ 54.2 51.5 51.9 67.0 59.0 53.8 60.4 56.5 

Another nursing home.. ............................................................................. 12.5 10.7 12.7 1’3.8 12.4 12.7 10.1 *11.5 

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

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

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

32.3 

5.9 

3.5 

34.9 

3.1 

2.7 

34.0 

2.6 

2.6 

35.9 23.8 

12.5 16.1 

4.8 6.7 

32.0 

5.6 

3.5 

34.4 

11.5 

4.4 

39.8 

* 

* 

Other health facility or unknown ............................................................... 46,200 4,200 21,000 4,200 16,700 42,000 3,600 l 

Semiprivate residence ...................................................................................... 3.1 *I.8 3.3 *3.2 3.3 3.2 l * 

Unknown or other arrangement.. .................................................................... 5.5 3.4 5.5 5.6 6.8 5.2 8.4 c7.4 

ltncludes a small number of unknowns. 

2Residents may have lived with more than one category of person, so the sum of the subparts exceeds the total. 

31ncludes parents, spouse, children, and siblings.

4Forty-nine percent of the residents who were admitted from anothei’health facility had gone to that facility from a private or semiprivate residence. 

iii 
Table 4. Number and percent distribution of nursing home residents by living arrangement prior to admission, according to primary 

reason for care: United States, 1977 

II Primary reason for care 

Living arrangement prior to admission Total Poor Mental Mental Behavioral Social Economic 

physical illness retarda- problem reason or other 

health1 tion reason 

Number 

All arrangements.. .............................. 87,100 48,400 26,200 70,000 49,000 

Private residence ................................................. 16,000 14,200 

* 12,000 31,700 25,100 

Unknown if with others.. ............................... * * *1,700 

With others2 .................................................. 11,700 13,600 8,400 13,600 14.30; 

Immediate family3 ................................... 10,400 12,000 7,600 11,200 11,700 

Spouse ................................................. 3.900 l “2,700 *I ,600 4,300 ’ 

Children ............................................... *3,200 * 3,900 6,600 6,100 

Other relatives .......................................... 4,700 * 

12,600 

* 

*2,600 5,100 4,600 * 

Alone.. ........................................................... l 3,300 

* 

*2,900 16,400 9,900 

Unrelated persons.. ................................... + *1,300 

Another health facility4.. ................................... 63,000 30,400 11,600 31,400 18,600 

Another nursing home .................................... 8,900 8,000 ‘3,200 9,200 4,700 

General or short-stay hospital ........................ 15,100 ‘3,200 6,300 14,200 7,600 

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

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

35,100 11,400 

3,800 7,700 

* 1,400 * 

5,400 

* 2,600 

13,360 

*3,000 

Semiprivate residence ......................................... 

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

*3,200 *1,700 

4,800 *2,100 

*1,>00 * 

*2,600 

4,300 

*I ,600 

3,700 

Percent distribution 

All arrangements’................................ 100.0 100.0 100.0 100.0 

Private residence ................................................. 37.7 18.4 29.3 45.8 45.3 51.3 * Alone.. ........................................................... 13.0 ‘3.8 *11.0 23.4 20.2 

* * * * Unknown if with others.. ............................... 2.7 ‘2.5 

With others2.. ................................................ 22.0 13.4 28.2 30.8 19.4 29.2 

Immediate family3 ................................... 19.6 11.9 24.8 28.9 16.0 23.8 * Spouse.. ............................................... 5.9 4.5 *10.4 “2.2 8.7 * Children.. ............................................. 11.4 *3.7 15.0 9.5 12.5 

Other relatives .......................................... 5.3 5.4 26.0 “9.8 7.3 9.3 

* f * * Unrelated persons.. ................................... 1.1 l *I.8 

Another health facility4.. ................................... 54.0 72.4 62.8 44.2 44.8 37.9 

Another nursing home ................................... 12.6 10.3 16.6 *12.2 13.2 9.5 

General or short-stay hospital.. ...................... 36.6 17.4 *6.7 23.9 20.2 15.6 

Mental hospital .............................................. 2.0 40.3 23.6 +5.3 7.7 *6.7 

Other * health facility or unknown .................. 2.8 4.4 15.9 x3.7 *6.1 

Semiprivate residence ......................................... 2.9 *3.7 “3.6 *6.4 *3.7 *3.3 * Unknown or other arrangement.. ........................ 5.4 5.5 “4.3 6.2 7.5 

lIncludes a small number of unknowns. e- LResidents may have lived with more than one category of person, so the sum of the subparts exceeds the total. 

31ncludes parents, spouse, children, and siblings. 

‘Forty-nine percent of the residents who were admitted from another health facility had gone to that facility from a private or 

semiprivate residence. 

40 
5.1 

Table 5. Number and percent distribution of nursing home residents by primary source of payment, according to sex, age, marital 

status, and race or ethnicity: United States, 1977 

Primary source of payment 

Sex, age, race or ethnicity, and marital status 

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

Sex 

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

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

Age . -

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

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

7564 years ... . . .... . . .. .. .. . .... . . .. .. .. . .. ... . . .. ... . . .. .. .. . . ... .. . . ... .. . . .. . 

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

Marital status 

Married 

Wido,a~:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::~ 

Divorced or separated . .. .. . . . .. .. .. . . .. . .. . ... .. . . .. .. . .. . .. ... . . ... .. . . .. .. 

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

Race or ethnicitv 

White (not Hispanic)*. ...................................................... 

Black (not Hispanic) ......................................................... 

Hispanic and other ............................................................ 

All residents . ... .. .. ..._.......................................... 

Sex

-

Male ... .. . . .... . . .. .. .. .. .. .. .. .. .. .. .. .. .. . . .... . . .. .. .. . . .. .. .. .. .. .. . . .. ... . . . .... ! Female . ... .. . . .. ... . . .. .. .. . .. ... . .. .. . .. . .. .. .. . ... . .. ... . .. . . .. . .. .. .. .. .. . . .. . . . 

Age -

Under 65 years ... .. .. . . .. .. . . .:..............................,................, 

6574 years . ... .. .. .. .. . . .. . . .. .. .. .. . . .. .. .. .. .. . .. . .. .. .. . . .... . . . .. . .. . . .. .. .. . 

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

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

Marital status 

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

Widowed2 .. . . .. .. . . . .... . .. ... . . .. . ... . . ... .. . ... . .. . .. .. .. . . .... . . .. .. .. . .. . ... . . 

Divorced or separated ... . .. ... . . . ... ... .. .. . .. .. ... . . . .. ... . . .. .. .. . .. ... . . . 

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

Race or ethnicity 

White (not Hispanic)* . .. .. . . ... .. . .. ... . . .. ... .. . ... . .. . ... .. . . . . ... .. . .. ... 

Black (not Hispanic) .. .. .. . . . .. . ... .... . . . . ... .. . .. .. .. . .. .. .. . .. . .. .. . .. ... . 

Hispanic and other ... .. . .. .. . . .... . .. .. .. . .. .. .. . . .. . ... . .. .. .. . .. .. .. . . .. ... . 

lInc1ude.s religious organizations, volunteer agencies, 

charge.

21ncludes a small number of unknowns. 

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

Medicaid Other All All Own income government other so”rcas or family Medicare 

Skilled Inter- assistance support sources1 mediate or welfare 

Number 

1.303.100 500.900 26,200 260,700 362,600 83,400 69,200 

375.300 145,800 7,900 63,400 98,100 30,000 30,100 

927,800 355,200 18,300 197,300 264,500 53,500 39,100 

177,100 46,500 l 1,300 32,800 59.700 22,400 14,300 

211,400 70,800 6,200 40,000 67,900 14,900 11,400 

464,700 201,900 11,900 88,200 115,800 23,000 23,900 

449,900 181,700 6,800 99,600 119,100 23,100 19,600 

155,400 77,200 4,400 23,100 30,100 10,000 10,500 

810,700 325,500 18,600 171,300 219,000 42,900 33,400 

87,500 24,200 I 19,200 27,500 8,700 7,100 

249,500 74,100 l 2,400 47,000 86,000 21,700 18,200 

1.200.900 486,600 24,200 233,500 320,000 73.200 63.300 

81,400 10.700 l 1,400 21,000 38,200 5,800 4.300 

20,800 3.600 I 6.200 4,400 4.406 l 1,600 

100.0 38.4 2.0 20.0 27.8 

100.0 38.8 2.1 16.9 26.1 

100.0 38.3 2.0 21.3 28.5 

100.0 26.2 ‘0.8 18.5 33.7 

100.0 33.5 3.0 18.9 32.1 

100.0 43.4 2.6 19.0 24.9 

100.0 40.4 1.5 22.1 26.5 

100.0 49.7 2.8 14.9 19.4 

100.0 40.1 2.3 21 .l 27.0 

100.0 27.6 l 22.0 31.4 

100.0 29.7 l 1.8 18.8 34.5 

6.4 1 5.3 

’ 8.0 8.0 

5.8 4.2 

12.7 8.1 

2: 5.4 

5.1 4.4 

6.5 6.8 

5.3 4.1 

10.0 8.1 

8.7 7.3 

. 

100.0 40.5 2.0 19.4 26.7 6.1 5.3 

100.0 13.1 “1.8 25.8 46.9 7.1 5.3 

100.0 17.5 l 29.7 21 .o 21.3 7.9 

Veterans’ Administration .contracts, initial payment-life care funds, other sources, and no 

41 
Table6. Number and percent distribution of nursing home residents by length of stay since admission, according to sex and age: 

United States, 1977 

Sex and age 

Both sexes Number 

All ages.. ....................................................... I ,303.l oa 189,300 122,100 163,100 427,800 192,900 207,900 i 

Under 65 years.. ........................................................................... i 77,100 24,200 16,500 20,400 50,500 25,700 39,700 

65 years and over.. ........................................................................ 1 ,I 26,000 165,100 105,600 142,600 377,300 167,200 168,200 

65-74 years.. ............................................................................ 21 I ,400 38,200 21,600 30,300 64,000 27,600 29,600 

75-84 years.. ............................................................................ 464.700 ;I~,000 46,400 60,600 156,900 65,800 58,900 

85 years and over.. ................................................................... 449,900 50,900 37,600 51,800 156,400 73,700 79,700 

Male -

All ages.. ....................................................................... 375,300 64.400 41,500 51,600 113.100 50,900 53,800 

Under 65 years ............................................................................. 81,300 11,900 7,500 10,600 22,900 13,000 15,400 

65 years end over.. ........................................................................ 294,000 52,500 34,000 41,000 90,100 38,000 38,300 

65-74 veers.. ............................................................................ 80,200 15,800 9,000 12,700 24,200 8,000 10,500 

75-84 years.. ............................................................................ I 22,i 00 23,100 14,000 17,100 37,400 14,900 15,600 

85 years and over.. ................................................................... 91,700 13,600 11,100 11,200 28,500 15,100 12,200 

Female 

All ages ......................................................................... 927,800 124,900 80,600 111,560 314,800 141,900 154,200 

Under 65 years.. ........................................................................... 95,800 12,300 9,000 9,800 27,600 12,700 24,300 

65 years and over.. ........................................................................ 832,000 112.600 71,600 101,600 287,i 00 129,200 129,900 

65-74 years.. ............................................................................ 131,200 22,400 12,600 17,6OQ 39,800 19,600 19,100 

75-84 years.. ............................................................................ 342,600 52,900 32,500 43,400 119,500 51,000 43,400 

85 years and over.. ................................................................... 358,200 37,300 26,500 40,600 127,900 58,600 67,400 

Both sexes Percent distribution 

All ages.. ....................................................... 100.0 14.5 9.4 12.5 32.8 14.8 I 16.0 

Under 65 years.. ........................................................................... 100.0 13.7 9.3 11.5 28.5 14.5 22.4 

65 years and over.. ........................................................................ 100.0 14.7 9.4 12.7 33.5 14.8 14.9 

65-74 years .............................................................................. 100.0 18.1 10.2 14.3 30.3 13.1 14.0 

75-84 years .............................................................................. 100.0 16.4 10.0 13.0 33.8 14.2 12.7 

85 years and over.. ................................................................... 100.0 11.3 8.3 11.5 34.8 16.4 17.7 

Male 

All ages.. ....................................................................... 100.0 17.2 11.1 13.8 30.1 

Under 65 years ............................................................................. 100.0 14.6 9.2 13.0 28.2 

66 years and over .......................................................................... 100.0 17.9 11.6 14.0 30.7 

65-74 years .............................................................................. 100.0 19.7 11.2 15.8 30.2 

75-84 years ... ........................................................................... 100.0 I a.9 11.5 14.0 30.6 

85 years and over ..................................................................... 100.0 14.8 12.1 12.2 31 .I 16.5 13.3 

Female 

All ages.. ....................................................................... 100.0 13.5 6.7 12.0 - 33.9 15.3 16.6 -

Under 65 years.. ........................................................................... 100.0 i 2.8 9.4 10.3 28.8 13.3 25.3 

65 years and over.. ........................................................................ 100.0 13.5 8.6 12.2 34.5 15.5 15.6 

65-74 years .............................................................................. 100.0 17.1 9.6 13.4 30.3 15.0 14.6 

75-84 years.. ............................................................................ 100.0 15.4 9.5 12.7 34.9 14.9 12.7 

85 years and over ..................................................................... 100.0 10.4 7.4 11.3 35.7 t 16.4 ; 18.8 

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

42 

l 
Table 7. Mean length of stay, standard error (S.E.1 of the mean, median length of stay, and standard error (S.E.) of the median for 

nursing home residents, by selected resident characteristics: United States, 1977 

-

T Length of stay since admission in days 

Selected resident characteristic Mean S.E. of Median S.E. of 

length mean length median 

length of stay -of stay of stay length 

of stay 

All residents . ... .. ... . ... . .. .... .. . ... . .. . .. .. .. .... .. . ... .. . ... . .. .... . . .... .. .. ... . . .... ... . ... .. ....-................ 957.9 16.8 597.0 17.6 

-

Sex

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

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

-

Age 

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

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

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

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

Race or ethnicity 

White (not Hispanic)‘. ............................................................................................................ 

Black (not Hispanic) ............................................................................................................... 

Hispanic and other.. ................................................................................................................ 

Marital status 

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

Widowed1 ............................................................................................................................... 

Divorced or separated ............................................................................................................. 

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

Frequency of visitors received 

NoneI.. ................................................................................................................................... 

Daily or weekly ...................................................................................................................... 

Other.. .................................................................................................................................... 

Living arrangement prior to admission 

Private residence ..................................................................................................................... 

Alone.. ............................................................................................................................... 

Unknown if with others.. ................................................................................................... 

With others* ...................................................................................................................... 

Spouse.. ......................................................................................................................... 

Children ........................................................................................................................ 

Other relatives .............................................................................................................. 

Unrelated persons. ........................................................................................................ 

Another health faci!ity3 ......................................................................................................... 

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

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

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

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

Semiprivate residence .............................................................................................................. 

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

See footnotes at end of table. 

884.9 28.5 488.0 20.2 

987.4 18.3 643.0 18.4 

1 ,122.g 47.0 676.0 53.5 

883.3 34.7 500.0 50.6 

847.9 23.3 515.0 18.8 

7,041.5 25.0 707.0 32.5 

961 .O 17.5 595.0 17.2 

977.0 52.6 691 .O 87.8 

703.4 65.6 448.0 58.2 

580.6 25.0 335.0 27.5 

921.3 16.8 599.0 20.5 

888.8 45.2 552.0 80.2 

1.335.8 47.3 887.0 52.2 

1,251.4 58.8 802.0 33.6 

806.7 16.1 488.0 13.5 

1.184.4 32.4 820.0 37.6 

1.075.0 26.3 706.0 36.4 

1 ,I 48.9 42.9 762.0 40.7 

1,260.6 86.3 1.005.0 171.0 

1 ,010.g 33.1 623.0 40.8 

866.7 57.4 504.0 53.7 

896.7 35.8 597.0 53.2 

1.294.2 76.4 846.0 68.0 

783.4 105.4 434.0 36.7 

835.9 19.8 509.0 15.4 

815.3 30.1 572.0 40.8 

663.6 18.9 401 .o 22.4 

1.650.2 84.1 1.299.0 102.6 

1 ,I 23.2 77.5 836.0 165.3 

906.6 77.4 563.0 87.0 

1,398.8 76.7 964.0 78.3 

43 
Table 7. Mean length of stay, standard error (SE.1 of the mean, median length of stay, and standard error (S.E.1 of the median for 

nursing home residents, by selected resident characteristics: United States, 1977-Con.

-

r Length of stay since admission in days 

, 

Selected resident characteristic Mean S.E. of Median S.E. of 

length mean length median 

of stay length of stay length 

of stay of stay 

Primary reason for care 

Poor physical health1 ..................................................... . ....................................................... 888.0 15.9 555.0 16.6 

Mental illness .......................................................................................................................... 1,279.5 68.3 853.0 49.6 

Mental retardation.. ................................................................................................................ 1.574.8 100.7 1.272.0 183.3 

Behavioral problem ................................................................................................................. 626.6 77.9 353.0 93.4 

Social reason. .......................................................................................................................... 1,172.l 74.8 641 .O 46.4 

Economic or other reason.. ..................................................................................................... 1 ,I 05.4 122.1 663.0 32.6 

Primary source of payment 

Own income or family support ............................................................................................... 816.3 21.2 500.0 15.6 " 

Medicare.. ............................................................................................................................... 266.3 113.4 33.0 5.8 

Medicaid-skilled.. .................................................................................................................... 1 ,01%.2 35.4 690.0 40.5 

Medicaid-intermediate ............................................................................................................ 1 ,I 15.8 29.9 763.0 27.7 

Other government assistance or welfare.. ................................................................................ 1,071 .I 64.1 623.0 65.2 

All other sources4.. ................................................................................................................. 1,053.2 85.5 339.0 108.9 

lbtcludes a small number of unknowns. 

PResidents may have lived with more than one category of person, so the sum of the subparts exceeds the total. 

3Forty-nine percent of the residents who were admitted from another health facility had gone to that facility from a private orsemiprivate residence. 

41ncludes religious organizations, foundations, volunteer agencies, Veterans’ Administration contracts, initial payment-life care funds, 

other sources, and no charge. 

44 
Table 8. Number end rate per 1,000 nursing home residents, by sex, selected health statuses, and age: United St$es, 1977 

Sex and selected health status’ Under 65 years 65-74 75-84 86years - All ages 65 years and over years years and over 

Number 

Both sexes. . .... .. .. .... .. .... .. .... .. .. .... . . .. .. . . ... . 1.303.100 177,100 1 ,126,OOO 211 A00 164.700 449.900 

PRIMARY DIAGNOSIS AT LAST EXAMINATION 

Diseasesof the circulatory system 

Total ..... .. ... .. ... .. ... .. ... .. ... .. .. .. .. ... .. ... .. . .... . .. .. .. .. ... ... . . 516,800 24,000 492,800 70,400 198,600 =I== 223,700

Congestive heart failure.. ........................................................ - 52,800 l 1 ,300 51,500 4,400 19,700 27,400 

Arteriosclerosis ...................................................................... 264,400 4,000 260.300 22,500 105,900 132,000 

Hypertension ......................................................................... 47,700 3,800 43.900 7,500 17,500 18,900 

Stroke.. .................................................................................. 103,500 10,800 92.700 27,700 41,900 23,100 

Heart attack, ischemic heart disease.. ..................................... 

Other ..................................................................................... 

22,500 

25,800 

l 

l 3,1 00 

21,600 

22,700 

‘3,100 

5,200 

6,600 

7,100 

11,900 

10,500 

Mental disorders and senility without psychosis b c 

Total .... .. . .... . ... ... ... ..... . . .... .. .. .. .. .. ... .. . .... . ... .. .. .. .. .. .. .. 266,100 81,300 184,800 52,300 75,800 56,700 

Senile psychosis ..................................................................... 21,200 l 19,900 3,500 9,700 6,800 

Other psychosis.. .................................................................... 57,400 26,700 30,700 18,400 9,800 ‘2,400 

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

Senility without psychosis ........................................... ..- ...... 

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

96,400 

26,600 

42,400 

11,600+ 

31,800 

84,800 

26,100 

-10,600 

15,400 

l 2,1 00 

6,900 

37,200 

11,200 l 2,800 

32,200 

12,700 l 

Alcoholism and other mental disorders.. ................................ 22,100 9,500 12,600 5,900 5,100. l 1,700 

Other diagnoses’ 

Total .... . . .... .. .. .... .. . ... .. . ..... . .. .... ..I .... . . .... .. . .... .. . ... .. . .. 429,700 57,200 372,600 75,600 155,800 141,200 

Diseases of the musculoskeletal system and connective 

tissues: 

Arthritis and rheumatism . ..... .... .. .. .. .. ... . .... .. .. .. .. . .... . ... ... .. . . 56,200 3,800 52,400 6,400 ,21,800 24,200 k 

Diseases of the nervous system and sense organs: 

Parkinson’s disease .. .. .. .. .. .. .... . .. ... .. .. ... .. . .... .. ..... . .. .. . .. . .... . .. . 23,300 ‘I ,700 21,600 6,300 10,700 4,700 

Accidents, poisonings, and violence: 

Hip fracture ... .. .. .. .... .. . ... .. .. .. .. .... .. .. .. .. .. .. .. .. .. ... . ... ... .. .. .. .. .. . 29.300 l 1 ,500+ 27,800 13,000 10,900 13.900 

Other bone fracture ... .. .. .. .. ... . ... ... .. .. .... . . .. .. .. .... . ... .. .. .. .. .. .. . 10,600 9,800 *I ,700 5,400 *2,600 

Endocrine, nutritional, and metabolic diseases: 

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

b

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

Neoplasms: 

71,700 8,500 63,200 15,200 29,600 18,500 

Cancer . .. .. .... . ... .. .. .. .. .. .. .. .. ... . ... . .. .. .. .. .... .. .. .... . .... . ... ... .. .. .. .. . . 28,900 * 2,400 26,400 6,600 10,700 9,100 

Diseases of the respiratory system .. .... .. .. ..I: .. .. .. .. ... . .. .... .. .. .... . . 31,000 l 2,700 28,300 7,000 10,200 11,100 

Diagnosis unknown3 

Total ... ... .. .. .. .. ... .... . ... ... . .. .. ... .. . .. . . .. .. ... . ... . .. .... . ..... .. . 90,500 14,600 75,800 13,100 34,500 28,200

-I284,400 

Hypertension ... .. .. ..... .. .. .. .. .. .. .. .. .... .. .. .... .. .... .. .... .. . .... . .. ... . . .... .. 272,900 22,400 250,600 43,200 109,200 98,200 

Stroke ... . ...... .. ... . .. .... . ... .... .. .. .. .. . . ... ... .... .. .. .. .. .. .... .. .. .. .. .... .. . ... .. 214,000 19,700 194.300 48,200 87,100 59,000 

Paralysis or palsy, other than arthritis, related to stroke .. ..... . 80,800 11,100 69,800 22,900 31,800 15,100 

Heart trouble ..... . .. ... . ... ... .. ... .. .. .. ... . .. .... .. . ... .. .. .... . ... .. . .. ... . .. ... .. 449,000 21,800 427,200 58,600 I71,000 197,600 

See footnotes at end of table: 

CHRONIC CONDITIONS OR IMPAIRMENTS4 

Diseases of the circulatory system 

Arteriosclerosis .. . . ... . .. . .... ... . ... ... ... ... .... ... . ... . ... .. ... ... ... .. .. .. .. ... . . 620,200 17,500 602,700 69,600 248,800 

45 
Table 8. Number and rate per 1,000 nursing home residents, by sex, selected health statuses, and age: United States, 1977-Con. 

Sex and selected health status.1 

Under 65 years 65-74 75-84 85 years All ages 65 years and over years years and over 

CHRONIC CONDITIONS OR IMPAIRMENTS4-Con. 

Number 

Mental disorders and senility without psychosis 

Mental illness ......................................................................... 148,300 54,700 93,600 41,800 36,100 

Chronic brain syndrome.. ....................................................... 324,700 30,000 294,600 48,200 129,500 

Senility .................................................................................. 416,400 IO,1 00 406,309 46,300 170,200 

Mental retardation ................................................................. 79,800 53,400 26,400 15,100 8,800 

Alcoholism.. ........................................................................... 36,900 14,200 22,700 13,300 7,500 

Drug addiction.. ..................................................................... 3,700 * 1,400 * 2,300 * * 

Insomnia.. .............................................................................. 125,500 17,400 108,100 20,700 44,400 

Other chronic conditions or impairments 

Diseases of the musculoskeletal system and connective 

tissues: 

Arthritis and rheumatism.. ...... ................ .............. ......... 8 320,500 12,500 308,000 34,000 122,600 

Chronic back/spine problems, excluding stiffness and 

deformity ....................................................................... 

Permanent stiffness or deformity of back, arms, legs, or 

extremities, including feet, toes, hands, or fingers.. ........ 

Missing arms, legs, or extremities, ihcluding feet, toes, 

hands, or fingers.. ........................................................... 

Diseases of.the nervous sy.stem and sense organs: 

Blindness ........................................................................... 

Glaucoma.. ........................................................................ 

Cataracts.. ......................................................................... 

Deafness.. .......................................................................... 

Parkinson’s disease.. .......................................................... 

Paralysis or palsy, other than arthritis, unrelated to 

stroke.. ........................................................................... 

Accidents, poisonings, and violence: 

Hip fracture ...................................................................... 

Other bone fracture .......................................................... 

Endocrine, nutritional, and metabolic diseases: 

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

Neoplasms: 

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

Diseases of the respiratory system: 

Chronic respiratory disease ............................................... 

Diseases of the digestive system: 

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

Diseases of the blood and blood-forming organs: 

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

Diseases of the skin and subcutaneous tissue: 

Bedsores.. .......................................................................... 

Conditions other than above: 

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

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

None of these conditions 

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

60,500 9,700 50,800 6,300 23,100 

181,500 30,600 150,900 27,400 62,600 

32,400 5,200 27,200 7,700 10,500 

72,200 6,000 66,200 6,700 23,500 

34,000 “2,300 31,800 6,400 12,300 

80,000 l 3,200 76,800 7,500 29,400 

90,400 5,800 84,600 6,200 26,100 

58.000 3,500 54,500 16,200 24,600 

46,500 25,200 21,200 7,000 9,700 

108,800 5,100 103,700 9.900 41,400 

46,300 3,900 42,400 6,100 18,700 

189,600 20,700 168,800 38,200 75,600 

63,600 3,900 59,700 11,100 25,000 

86,500 9,900 76,600 15,800 30,400 

313,200 34,200 279,000 47,700 109,800 

70,600 5,000 65,600 9,100 28,500 

35,100 6,500 28,600 4,160 14,000 

233,500 18,700 214.700 29,900 89,500 

131,700 14,800 116,900 21,100 49,500 

15,700 

116,900 

189,800 

“2,500 

“2,000 + 

43,000 

151,400 

21,400 

60,900 

8,900 

36,000 

13,100 

39,900 

52,400 

13,700 

4,600 

52,400 

17,600 

55,000 

23,600 

r 

30,400 

121,500 

28,000 

10,500 

95,400 

46,300 

*2,400 L 13,000 4,100 8,900 *I ,600 4,900 

See footnotes at end of table. 
Table 8. Number and rate per 1,000 nursing home residents, by sex, selected health statuses, and age: United States, 1977-Con. 

-

Sex and selected health status1 Under 65 years 65-74 75-84 85 years All ages 65 years and over years years and over 

i Number 

Male ................................................................. 375,300 81,300 294,000 80,200 122,100 91,700 

PRIMARY DIAGNOSIS AT LAST EXAMINATION 

Diseases of the circulatory system 

. Total ...................................................................... 134,100 12,700 121,400 26,700 50,000 44,700 

* 

Arteriosclerosis ...................................................................... 61,600 l 1,800 59,800 8,000 26,000 25,800 

Hypertension ......................................................................... 7,800 l 7,000 ‘I ,900 *2,700 2,400 

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

Heart attack, ischemic heart disease.. ......... ............................ 

Other ..................................................................................... 

36,100 

5,900 

9,100 

6,700* 

l 2,000 

29,400 

5,600 

7,100 

11,700* 

l 2,700 

12,800 

“2,100 

l 1 ,900 

4,900 

*2,700 

“2,500 

*Mental disorders and senility without psychosis 

Total ...................................................................... 85,000 37,400 47,600 18,100 18,800 10,800 

Senile psychosis ..................................................................... 

Other psychosis.. .................................................................... 

4.400 

17,500 

* 

10,100 

4,000 

7,500 

* 

5,400 

12,000 

‘I ,900 

‘1,300 * 

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

Senility without psychosis ............................................. :. ...... 

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

25,400 

6,300 

20,300 

5,700* 

15,800 

19,700 

6,200 

4,500 

4,600 l 

*3,300 

9,000 

13.400

I 

6,100 

‘2,200 

Alcoholism and other mental disorders.. ................................ 11,100 5,200 5,900 3,600 ‘I ,700 * 

Other diagnoses2 

Congestive heart failure.. ........................................................ 13,500 12,500 *1,700 4,400 6,300 

. Total.. .................................................................... 126,300 24,200 102,100 29,500 42.500 30,100 

Diseases of the musculoskeletal system and connective 

tissues : * Arthritis and rheumatism .................................................. 7,500 l 6,700 3,600 “2,300 

Diseases of the nervous system and sense organs: 

Parkinson’s disease ............................................................ 6,800 l 6,400 *I ,700 ‘3,100 *I ,600 

Accidents, poisonings, and violence: 

Other bone fracture .......................................................... ,I,500 l l * 

Endocrine, nutritional, and metabolic diseases: 

Diabetes ............................................................................ 17,900 3,800 14,100 4.300 5,800 4,000 

Neoplasms: 

Cancer.. ...................................................................... :. ..... 11,200 * 1,400 9,800 “2,700 4,000 *3,000 

Diseases of the respiratory system.. ........................................ 15,500 l 1 ,400 14,100 4,600 5,800 3,800 

Diagnosis unknown’ 

Total ...................................................................... 30,000 7.100 22,900 5,900 10,800 6,200 

Hip fracture ...................................................................... 5,200 * 4,700* l 1 ,300* *1,800 *1,600 

CHRONIC CONDITIONS OR IMPAIRMENTS4 

Diseases of the circulatory system 

Arteriosclerosis ...................................................................... 154,300 8,300 146,000 28,400 62,100 55,500 

Hypertension ...... ..- ............................................................... 62,000 10,000 52,000 15,200 23,500 13.300 

Stroke .................................................................................... 68,200 9,600 58,600 19,000 27,200 12,400 

Paralysis or palsy, other than arthritis, related to stroke.. ...... 28,400 5,800 22,600 9,100 11,000 *2,500 

Heart trouble ......................................................................... 123,000 10,600 112,400 23,200 45,500 43,700 

See footnotes at end of table. 

47 

l 
Table 8. Number and rate per 1,000 nursing home residents, by sex, selected health statuses, and age: United States, 1977-Con. 

Sex and selected health status’ 

Under 65 years 65-74 75-84 85 years All ages 65 years and over years years and over 

CHRONIC CONDITIONS OR IMPAIRMENTS4-Con. 

Number 

Mental disorders and senility without psychosis 

Mental illness.. ....................................................................... 48,900 23,800 25,000 14,200 8,300 “2,600 

Chronic brain syndrome.. ....................................................... 88,300 15,600 72,700 17,700 35,000 20,000 

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

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

93,700 

36,000 

3,700 

25,400 

90,000 

10,500 

14,600 

6,700 

39,100 

“2,900 

36,300 I 

* Alcoholism.. ........................................................................... 27,300 * 10,700 * 16,600 * 10,600 4,900 * Drug addiction.. ..................................................................... x * 

Insomnia.. .............................................................................. 33,600 6,600 27,000 7,890 11,500 7,700 

Other chronic conditions or impairments 

Diseases of the musculoskeletal system and connective 

tissues: 

Arthritis and rheumatism.. ................................................ 59,800 4,100 55,700 10,600 23,900 21,200 

Chronic back/spine problems, excluding stiffness and 

deformity.. ..................................................................... 14,800 3,900 10,900 l 2,300 4,700 ‘3,900 

Permanent stiffness or deformity of back, arms, legs, or 

extremities, including feet, toes, hands, or fingers .......... 49,800 13,600 36,200 11,700 .I 5,500 9.w , 

Missing arms, legs, or extremities, including feet, toes, 

hands, or fingers.. ........................................................... 17.400 “2,900 14,500 5,800 5,700 “3,006’ 

Diseases of the nervous system and sense organs: 

Blindness. .......................................................................... 

Glaucoma.. ....... . ................................................................ 

20,000 

8,600 

3,100 

* 16,900 

7,900 

*2,900 

*2,300 

5,800 

*3,000 

8,100 

‘2,600 

Cataracts.. ......................................................................... 22,700 ‘1,700 21,000 *3,300 7,600 IO,1 00 

Deafness.. .......................................................................... 

Parkinson’s disease.. .......................................................... 

30,300 

17.400 

*2,100 * 28,200 

16,500 

* 3,400 

5,600 

11,900 

7,700 

., 12,900 

*3,200 

Paralysis or palsy, other than arthritis, unrelated to * stroke.. ........................................................................... 15,900 10,000 6,000 “2,800 l 2,500 

Accidents, poisonings, and violence: 

Hip fracture ...................................................................... 15,200 l 2,600 12,600 * 2,900 4,900 4,900, 

Other bone fracture .......................................................... 9,100 * 2,500 6,600 *I ,400 “3,100 *2,100 

Endocrine, nutritional, and metabolic diseases: 

Diabetes ............................................................................. 47,500 8,800 38,700 11,600 16,600 10,500 

Neoplasms: 

Cancer.. ............................................................................. 23,500 *I ,800 21,700 4.600 8,600 8,400 

Diseases of the respiratory system: 

Chronic respiratory disease ............................................... 44,600 6,100 38,500 10,300 16,000 12,300 

Diseases of the digestive system: 

Constipation.. ................................................................... 80,200 12,100 68,100 16,100 30,400 21,600 , 

Diseases of the blood and blood-forming organs: 

Anemia ............................................................................. 17,300 *1,500 15,800 *2,800 6,900 6,000 

Diseases of the skin and subcutaneous tissue: * Bedsores.. .......................................................................... 10,800 “3,000 7,800 4,600 “2,100 

Conditions other than above: 

Edema.. ............................................................................. 54,100 7,000 47,100 10,500 18,400 18,100 

Kidney trouble.. ................................................................ 42,400 5,900 36,500 8,900 14,800 12,800 

None of these conditions 

Total.. .................................................................... 5,200 l 2,800 * 2,400 * * 

See footnotes at end of table. 

48 

i 
Table 8. Number and rate per 1,000 nursing home residents, by sex, selected health statuses, and age: United States, 1977-Con. 

Sex and selected health status1 

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

PRIMARY DIAGNOSIS AT LAST EXAMINATION 

Diseases of the circulatory system 

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

Congestive heart failure.. ............................. :.......................- .. 

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

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

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

Heart attack, ischemic heart disease.. ..................................... 

Other ..................................................................................... 

Mental disorders and senility without psychosis 

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

Senile psychosis ..................................................................... 

Other psychosis.. .................................................................... 

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

Senility without psychosis ..................................................... 

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

Alcoholism and other mental disorders.. ........................... i.. .. 

Other diagnoses2 

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

Diseases of the musculoskeletal system and connective 

tissues: 

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

Diseases of the nervous system and sense organs: 

Parkinson’s disease ............................................................ 

Accidents, poisonings, and violence: 

Hip fracture ...................................................................... 

Other bone fracture .......................................................... 

Endocrine, nutritional, and metabolic diseases: 

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

Neoplasms: 

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

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

Diagnosis unknown3 

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

CHRONIC CONDITIONS OR IMPAIRMENTS4 

Diseases of the circulatory system 

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

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

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

Paralysis or palsy, other than arthritis, related to stroke.. ...... 

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

See footnotes at end of table. 

Under’ 65 years 65-74 7584 85 years All ages 65 years and over years years and over 

Number 

927,806 95,800 832,000 

382,700 11,300 371,400 

39,300 * 39,100 

202,800 

39,900 

‘2,200 

l 3,000 

200,500 

36,900 

67,400 4,100 63.300 

16,600 

16.700 

l 

l 1,100 

16,000 

15,600 

181,200 44,000 137.200 

16,800 l 16,000 

39,800 16,600 23,200 

71 ,100 5,900 65,200 

20,300 l 20,000 

22,100 16,000 6,100 

11,000 4.300 6,800 

303,500 33,000 270,500 

48,700 13,000 45,700 

16,500 l 15,300 

24,000 l 23,100 

9,200 l 9,000 

53,800 4,700 49,100 

17,700 * 16,700 

15,500 *1,400 14,100 

60,500 7.600 52,900 

466.000 9.300 456,700 

210,900 12,400 198,500 

145,800 10,100 135,700 

52,500 5,300 47,200 

325,900 11,200 314,700 

131,200 342,600 358,200 

43,800 148,700 179.000 -

l 2,700 15,300 

14.500 79,900 

5,700 14,800 

16,000 29,100 

*2,300 4,500 

“2,500 5;200 

34,200 57,000 

l 2,900 7,600 

13,100 7,900 

10,800 28,200 

l 1 ,600 7,800 

3,600 l 2,000 

l 2,300 *3,400 

46,100 113,300 

5,600 18,200 

4,600 7,600 

*1,700 9,100 

*1,600 5,100 

10,900 23,800 

3,900 6,700 

*2.400 4.400 

7,200 23,600 

41,200 186,600 

28,100 85,600 

29,200 59,900 

13,800 20,800 

35,400 125,400 

21,000 

106,100 

16,400 

18,200 

9.200 

8,000 

46,000 

5,500 

l 2,200 

26,100 

10,500 l 

l 

i11.100 

21,900 

l 3,000 

12,300 . 

*2,300 

14,500 

6,100 

7,300 

22,100 

228,900 

84,800 

46.700 

12,600 

153,900 

49 
Table 8.’ Number and rate per 1,000 nursing home residents, by sex, selected health statuses, and age: United States, 1977-Con. 

Age 

Sex and selected health status1 

CHRONIC CONDITIONS OR IMPAIRMENTS4-Con. 

Mental disorders and senility without psychosis 

Mental il mess ......................................................................... 

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

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

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

Alcoholism ............................................................................. 

Drug addiction ....................................................................... 

Insomnia.. .............................................................................. 

Other chronic conditions or impairments 

Diseases of the musculoskeletal system and connective 

tissues: 

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

Under 65 years 65-74 75-84 85 years All ages 65 years and over years years and over 

99.500 30,900 68,600 27,600 27,800 

236,400 14,400 221,900 30.500 94,500 

322,700 6,300 316,400 31,700 131,200 

43,900 28,000 15,900 8,300 5,900 

9,600 

“2,400 

3,500 

* 

6,100 

*I ,600 

“2,700 * 

*2,600 * 

91,900 10,800 81 ,I 00 12,900 32,900 

260,700 8,400 252,300 23,400 98,700 

Chronic back/spine problems, excluding stiffness and 

deformity ....................................................................... 45,700 5,800 39,900 4,000 18,400 

Permanent stiffness or deformity of back, arms, legs, or 

extremities, including feet, toes, hands, or fingers.. ........ 131,700 17,ooa 114,700 15,700 47,i 00 

Missing arms, legs, or extremities, including feet, toes, 

hands, or fingers ............................................................. 15,000 l 2,300 12,700 * 1,900 4.9oc 

Diseases of the nervous system and sense organs: 

Blindness ........................................................................... 52,300 *3,000 49,300 3,800 17,6OC 

Glaucoma.. ........................................................................ 25,400 *I ,500 23,900 4,100 9.3oc 

Cataracts ........................................................................... 57,400 I ,500 55,800 4,200 21,8OC 

Deafness.. .......................................................................... 60,200 3,700 56,500 ‘2,800 14.2OC 

Parkinson’s disease ............................................................ 40,600 * 2,6OC 38,000 10,700 16,9OC 

Paralysis or palsy, other than arthritis, unrelated to 

stroke ............................................................................. 30,500 15,200 15,300 4,200 7.2OC 

Accidents, poisonings, and violence: 

Hip fracture ...................................................................... 93,600 +2,5OC 91 ,I 00 7,000 36.5OC 

Other bone fracture .......................................................... 37,100 *1,4oc 35,700 4,700 15,6OC 

Endocrine, nutritional, and metabolic diseases: 

Diabetes ............................................................................ 142,100 11.9oc 130,100 26,600 59,ooc 

Neoplasms: 

Cancer ............................................................................... 40,100 *2,ooc 38,100 6,500 16,3OC 

Diseases of the respiratory system: 

Chronic respiratory disease ............................................... 41,900 3,8OC 38,100 5,500 14,501 

Diseases of the digestive system: 

Constipation ..................................................................... 233,000 22.1 oc 210,900 31,600 79,4oc 

Diseases of the blood and blood-forming organs: 

Anemia ............................................................................. 53,300 3,5oc 49,800 6,200 21,60( 

Diseases of the skin and subcutaneous tissue: 

Bedsores .... . ....................................................................... 24,300 3,5oc 20,800 2.9011 9,5oc 

Condi;izas other than above: 

... ......... ........ ........................................................... 179,400 11,700 167,600 19,400 71,000 

Kidney trouble.. ................................................................ 89,300 8,900 80,400 12,200 34,700 

None of these conditions 

Total ...................................................................... 7,800 “1,300 6,500 +1.300 3,800 

See footnotes at end of table. 

13,100 

96,900 

153,500 

‘1,700 l 

l 

35,300 

130,200 

17,500 

51,900 

5,900 

27,900 

10,500 

29,800 

39,500 

10,400 

3,900 

47,600 

15,500 

44,500 

15,200 

18,100 

99,800 

22,000 

8,509 

77,200 

33,500 

* 1,400 

50 
Table 8. Number and rate per 1,000 nursing home residents, by sex, selected health statuses, and age: United States, 1977-Con. 

Age 

Sex and selected health status1 Under 65 years 65-74 75-84 85 years All ages 65 years and over years years and over 

Rate per 1,000 population 

Both sexes.............................................. 1 .ooo.c 1 .ooo.o 1 .ooo.o 1 ,ooo.o 1 ,ooo.o l,ooo.o 

PRIMARY DIAGNOSIS AT LAST EXAMINATION 

Diseases of the circulatory system 

Total ...................................................................... 396.6 135.4 437.7 333.3 427.4 497.3 

Congestive heart failure.. ........................................................ 40.5 l 7.2 45.8 20.9 42.5 60.8 

Arteriosclerosis ...................................................................... 202.9 22.8 231.2 106.4 227.8 293.3 

Hypertension .............................................. -. ........................ 36.6 21.7 39.0 35.6 37.6 42.0 

Stroke .................................................................................... 79.6 61.0 82.4 131.0 90.2 51.4 

Heart attack, ischemic heart disease.. ..................................... 17.3 l 19.2 ‘14.8 14.1 26.5 

Other ..................................................................................... 19.6 c17.5 20.2 24.5 15.2 23.3 

Mental disorders and senility without psychosis 

Total ...................................................................... 204.2 459.2 164.1 247.2 163.1 126.1 

Senile psychosis ..................................................................... 16.2 l 17.7 16.6 20.8 15.1 

Other psychosis.. .................................................................... 44.0 150.8 27.2 87.3 21.2 ‘5.3 

Chronic brain syndrome ......................................................... 74.a 65.5 75.3 73.0 80.0 71.6 * Senility without psychosis ..................................................... 20.4 23.2 l 10.0 24.2 28.3

?e Mental retardation ................................................................. 32.6 179.4 9.5 32.7 l 6.0 

Alcoholism and other mental disorders.. ................................ 17.0 53.7 11.2 27.7 11.0 *3.7 

Other diagnoses* 

Total ...................................................................... 329.8 322.7 330.9 357.5 335.3 313.8 

Diseases of the musculoskeletal system and connective 

tissues: 

Arthritis and rheumatism .................................................. 43.2 21.5 46.6 30.3 46.9 53.8 

Diseases of the nervous system and sense organs: 

Parkinson’s disease.. .......................................................... 17.9 l 09.4 19.2 29.7 23.0 10.4 

Accidents, poisonings, and violence: 

Hip fracture ...................................................................... 22.5 l 8.3 24.7 ‘14.0 23.4 31.0 

Other bone fracture .......................................................... 8.2 l 8.7 l 8.2 11.6 l 5.9 

Endocrine, nutritional, and metabolic diseases: 

Diabetes.. .......................................................................... 55.0 47.9 56.1 71.8 63.6 41 .o 

Neoplasms: . 

Cancer.. ............................................................................. 22.2 *13.8 23.5 31.1 23.0 20.3 

Diseases of the respiratory system.. ........................................ 23.8 x15.5 25.1 33.0 21.9 24.7 

Diagnosis unknown3 

Total ...................................................................... 69.4 82.6 67.3 62.0 74.2 62.8 

CHRONIC CONDITIONS OR IMPAIRMENTS4 

Diseases of the circulatory system 

Arteriosclerosis ...................................................................... 476.0 98.9 535.3 329.2 535.3 632.0 

Hypertension ......................................................................... 209.4 126.2 222.5 204.6 234.9 218.2 

Stroke .................................................................................... 164.2 111.2 172.6 227.8 187.4 131.2 

Paralysis or palsy, other than arthritis, related to stroke.. ...... 62.0 62.5 62.0 108.2 68.5 33.5 

Heart trouble ......................................................................... 344.5 123.1 379.4 277.2 367.9 439.3 

See footnotes at end of table. 

51 
Table 8. Number and rate per 1,000 nursing home residents, by sex, selected health statuses, and age: United States, 1977~Con. 

Age 

Sex and selected health status1 

CHRONIC CONDITIONS OR IMPAIRMENTS4-Con. 

Mental disorders and senility without psychosis 

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

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

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

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

Alcoholism.. ........................................................................... 

Drug addiction.. ..................................................................... 

Insomnia ................................................................................ 

Other chronic conditions or impairments 

Diseases of the musculoskeletal system and connective 

tissues: 

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

Chronic back/spine problems, excluding stiffness and 

deformity.. ..................................................................... 

Permanent stiffness or deformity of back, arms, legs, or 

extremities, including feet, toes, hands, or fingers.. ........ 

Missing arms, legs, or extremities, including feet, toes, 

hands, or fingers ............................................................. 

Diseases of the nervous system and sense organs: 

Blindness.. ......................................................................... 

Glaucoma .......................................................................... 

Cataracts.. ......................................................................... 

Deafness.. .......................................................................... 

Parkinson’s disease.. ............................................. .: ........... 

Paralysis or palsy, other than arthritis, unrelated to. 

stroke ............................................................................. 

Accidents, poisonings, and violence: 

Hip fracture ...................................................................... 

Other bone fracture .......................................................... 

Endocrine, nutritional, and metabolkc diseases: 

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

Neoplasms: 

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

Diseases of the respiratory system: 

Chronic respiratory disease ............................................... 

Diseases of the digestiue system: 

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

Diseases of the blood and blood-forming organs: 

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

Diseases of the skin and subcutaneous tissue: 

Bedsores.. .......................................................................... 

Conditions other than above: 

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

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

None of these conditions 

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

See footnotes at end of table. 

All ages 

Under 65 years 

65 years and over 

65-74 

years 

75-84 

years 

85 years 

and over 

Rate per 1,000 population 

113.8 308.9 83.1 197.9 77.7 34.9 ’ 

249.1 169.6 261.6 228.1 278.7 259.8 

319.5 56.8 360.9 219.0 366.3 421.8 

6l.2 301.6 23.4 71.3 18.9 l 5.6 

28.3 80.0 20.2 62.7 16.1 ‘4.5 

2.8 l 7.7 *2.0 * * * 

96.3 98.2 96.0 97.9 95.5 

245.9 70.7 273.5 161.0 263.8 

46.4 54.8 45.1 29.7 49.7 

139.3 172.8 134.0 129.7 134.8 

24.9 29.3 24.2 36.6 22.7 

55.4 33.9 58.8 31.8 50.5 

26.1 *12.7 28.2 30.1 26.6 

61.4 *18.0 68.2 35.6 63.3 

69.4 32.6 75.2 29.2 56.1 

44.5 19.9 48.4 76.9 52.9 

35.7 142.5 18.9 33.1 20.8 

83.5 28.6 92.1 46.8 89.0 

35.5 21.9 37.6 28.7 40.3 

145.5 117.0 150.0 180.9 162.7 

48.9 21.8 53.1 52.6 53.7 

66.4 55.8 68.0 74.8 65.5 

240.3 192.9 247.8 225.7 236.3 

54.2 28.3 58.3 43.0 61.4 

26.9 36.6 25.4 19.4 30.2 

179.2 105.7 190.7 141.5 192.5 

101.0 83.5 103.8 100.0 106.5 

10.a 23.2 7.9 *7.8 10.5 L 

95.6 

336.4 

47.6 

135.3 

19.9 

80.1 

29.1 

88.7 

116.5 

30.4 

10.2 

116.5 

39.1 

122.2 

52.5 

67:5 

270.0 

62.2 

23.4 

212.0 

102.8 

*5.3 

52 
Table 8. Number and rate per 1,000 nursing home residents, by sex, selected health statuses, and age: United States, 1977-Con. 

Sex and selected health status’ All ages Under 65 years 65-74 7584 85 years 

65 years and over years years and over 

Rate per 1,000 population 

Male ................................................................. 1,000.0 1,ooo.o 1,ooo.o 1 ,ooo.o 1,000.0 1 ,ooo.o 

PRIMARY DIAGNOSIS AT LAST EXAMINATION 

Diseases of the circulatory system 

Total ..................................................................... 357.3 156.2 412.9 332.9 -t- 409.1 487.7 

Congestive heart failure .......................................................... 35.9 i 42.4 *i1 .I 36.4 69.0 

Arteriosclerosis ...................................................................... 164.1 l 22.1 203.4 99.5 212.7 281.8 * Hypertension ......................................................................... 20.8 23.7 l 23.1 ‘22.0 l 26.6 

Stroke .................................................................................... 96.3 82.6 100.1 145.4 105.0 54.0 

Heart attack, ischemic heart disease.. ..................................... 15.8 * 19.1 l *17.3 l 29.1 

Other ........................................................... . ......................... 24.4 *25.1 24.2 ‘33.5 *15.6 l 27.3 

Mental disorders and senility without psychosis 

Diseases of the musculoskeletal system and connective 

tissues: 

29.3 

Total ...................................................................... 226.5 459.6 162.0 225.6 153.8 117.3 

Senile psychosis .............. . ...................................................... 

Other psychosis.. .................................................................... 

11.8 

46.7 

* 

123.7 

13.4 

25.4 

l 

67.2 

*16.7 

*15.8 

‘14.2 

* 

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

Senility without psychosis ..................................................... 

67.6 

16.8 

70.0 

* 

66.9 

20.9 

57.6 l 73.4 

*27.8 

66.4 

l 24.2 

Mental retardation ................................................................. 54.1 194.0 15.4 l 41.6 l l 

Alcoholism and other mental disorders.. ................................ 29.5 64.2 19.9 44.8 ‘13.8 l 

Other diagnoses2 

Total ...................................................................... 336.4 297.4 347.2 367.7 348.4 327.8 

Arthritis and rheumatism .................................................. 20.1 * 22.9 l c‘25.5 

Diseases of the nervous system and sense organs: * Parkinson’s disease ................. ........................................... 18.2 21.6 l 20.7 ‘25.2 117.7 

Accidents, 

Hip fracture ...................................................................... 

Other bone fracture .......................................................... 

14.0 

*3.9 

‘* 

l 

16.0 l 

*15.9

* ‘14.8 * *17.8* 

Endocrine, nutritional, and metabolic diseases: 

Diabetes ............................................................................ 47.6 47.1 47:8 53.5 47.2 43.5 

Neoplasms: 

Cancer.. ............................................................................. 29.8 ‘I 7.3 33.2 133.9 

Diseases of the respiratory system.. ..................................... .:. 41.3 ‘16.8 48.1 57.3 

Diagnosis unknown3 

Total ...................................................................... 79.8 86.7 77.9 73.8 

poisonings, and violence: 

0

CHRONIC CONDITIONS OR IMPAIRMENTS4 

Diseases of the circulatory system 

Arteriosclerosis ...................................................................... 411.0 101.6 496.6 354.2 508.7 604.9 

Hypertension ......................................................................... 165.2 122.7 177.0 189.1 192.9 145.4 

Stroke.. .... .............................................................................. 181.7 118.2 199.2 237.0 222.9 134.7 

Paralysis or palsy, other than arthritis, related to stroke.. ...... 75.6 71.4 76.8 113.1 89.9 l 27.7 

Heart trouble’. ........................................................................ 327.8 130.4 382.4 289.6 372.8 476.3 

See footnotes at end of table. 

53 
Table 8. Number and rate per 1,000 nursing home residents, by sax, selected health statuses, and age: United States, 1977-Con. 

Age 

Sex and selected health status1 

Under 65 years 65-74 75-84 85 years All ages 65 and over and 

CHRONIC CONDITIONS OR IMPAIRMENTS4-Con. 

Mental disorders and senility without psychosis 

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

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

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

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

Alcoholism.. ........................................................................... 

Drug addiction ....................................................................... 

Insomnia.. .............................................................................. 

Other chronic conditions or impairments 

Diseases of the musculoskeletal system and connective 

tissues: 

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

Chronic back/spine problems, excluding stiffness and 

deformity.. ..................................................................... 

Permanent stiffness or deformity of back, arms, legs, or 

extremities, including feet, toes, hands, or fingers.. ........ 

Missing arms, legs, or extremities, including feet, toes, 

hands, or fingers.. ........................................................... 

Diseases of the nervous system and sense organs: 

Blindness ........................................................................... 

Glaucoma.. ........................................................................ 

Cataracts.. ......................................................................... 

Deafness.. .......................................................................... 

Parkinson’s disease.. .......................................................... 

Paralysis or palsy, other than arthritis, unrelated to 

stroke.. ................. . ......................................................... 

Accidents, poisonings, and violence: 

Hip fracture ...................................................................... 

Other bone fracture .......................................................... 

Endocrine, nutritional, and metabolic diseases: 

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

Neoplasms: 

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

Diseases of the respiratory system: 

Chronic respiratory disease ............................................... 

Diseases of the digestive system: 

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

Diseases of the blood and blood-forming organs: 

Anem ia ............................................................................. 

Diseases of the skin and subcutaneous tissue: 

Bedsores.. .......................................................................... 

Conditions other than above: 

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

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

D 

None of these conditions 

Total ...................................................................... L 

See footnotes at end of table. 

years years years over 

Rate per 1,000 population 

130.2 293.2 85.1 177.2 67.8 ‘27.8 

235.2 191.8 247.2 221.3 286.4 217.6 

249.6 45.7 306.0 182.1 319.9 395.7 

95.8 312.7 35.8 84.1 ‘24.1 l 

* 72.7 131.7 56.5 132.2 40.1 

* I * * * * 

89.6 81.6 91.8 97.6 94.1 83.8 

159.2 50.1 189.4 132.2 195.8 230.9 

39.5 47.8 37.2 *28.9 38.3 42.9 

132.8 167.6 123.2 146.5 126.9 97.8 

46.4 +35.5 49.4 72.7 46.3 “33.2 

53.2 37.6 57.5 -36.5 47.8 88.8 * 23.0 26.7 *28.2 *25.0 *27.8 

60.4 ‘20.3 71.5 *40.9 62.3 110.6 

80.7 *25.8 95.9 *42.3 97.5 140.4 

46.4 l 56.0 69.3 62.8 ‘35.3 

42.5 122.9 20.2 *34.8 *20.2 l 

40.5 l 31.7 43.0 ‘35.8 40.1 53.1 

24.3 *30.7 22.6 ‘I 7.6 *25.6 ‘23.0 

126.6 108.1 131.7 144.8 136.3 114.3 

62.6 *22.5 73.7 57.4 70.8 91.8 

118.8 74.8 131.0 128.4 130.7 133.7 

213.7 148.3 231.8 200.4 249.2 236.0 

46.0 l 18.3 53.7 *35.3 56.7 65.7 

* 28.9 *36.9 26.7 37.3 *22.5 

144.1 86.0 160.2 131.6 150.8 197.6 

113.0 72.9 124.0 111.6 120.9 139.2 

13.8 *34.2 “8.1 * * l 

54 

i 
Table 8. Number and rate per 1,000 nursing home residents, by sex, selected health statuses, and age: United States, 1977-Con. 

Sex and selected health status1 Under 65 years 85 years Al I ages 65 years and over and over 

Rate per 1,000 population 

Female .. . .. .. .. .. .. .... .. .. ... ... .. .... .... .. .... .... .... .. ... .. . .. 1 ,ooo.o 1 .ooo.o 1 .ooo.o 1 ,ooo.o 7,ooo.c 1 .ooo.o 

PRIMARY DIAGNOSIS AT LAST EXAMINATION 

Diseases of the circulatory system 

412.5 117.8 446.4 333.4 434.a 499.7 

Congestive heart failure:. ........................................................ 42.4 l 46.9 *20.8 44.6 58.7 

Arteriosclerosis ...................................................................... 218.6 ‘23.5 241 .O 110.6 233.2 296.3 

Hypertension ......................................................................... 43.0 ‘31.5 44.4 43.2 43.2 45.9 

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

Heart attack, ischemic heart disease.. ..................................... 

72.6 

17.9 

42.7

i 76.1 

19.2 

122.3 

‘17.6 

84.9 

13.a 

50.8 

25.8 

Other ..................................................................................... 18.0 *11.1 18.8 *19-o 15.1 22.2 

Mental disorders and senility without psychosis 

Total ...... ... ... .. . .... . .. ... . . .... .. .. .. ..... ... .. .. ... .. . .... .. ... .. ... . 195.2 458.8 164.9 260.5 166.4 128.4 . 

Senile psychosis ..................................................................... 18.1 * 19.2 *22.0 22.2 15.3 

Other psychosis.. ........................................ ............................ 42.9 173.7 27.9 99.5 23.1 l 6.2 

Chronic brain syndrome.. ....................................................... 76.6 61.7 78.3 82.4 82.3 72.9 

Senility without psychosis ...................................................... 

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

21.9 

23.9 

l 

167.0 

24.0 

7.4 

f12.1 

27.2 

22.9 

.*5.9 

29.4

* 

Alcoholism and other mental disorders.. ................................ 11.9 44.8 8.1 *17.2 *10.0 c 

Other diagnoses2 

327.1 344.2 325.1 351.2 330.6 310.3 

Diseases of the musculoskeletal system and connective 

tissues: 

Arthritis and rheumatism ... .. .. .. .. .. .. .. .. .. .. .. .. .. .... . . .... .. .. .. .. .. . 52.5 *31.3 54.9 42.7 53.2 61 .I 

Diseases of the nervous system and sense organs: 

Parkinson’s disease ... .. .... .. .. ... ..._........................................ 17.8 9 18.4 35.2 22.3 ‘08.5 

Accidents, poisonings, and violence: 

Hip fracture ... .. . . .... . ... ... . . ... ... . ... . ... .... .... . .... .... . .. ... . ... . .. . . ... . 25.9 l 27.8 l 12.9 26.5 34.4 

Other bone fracture ... .. .. .. .... . . ..... . .. .. .. .. .. .. .. ... . .. .... . ... .. .. .. .. . 9.9 10.8 *11.9 14.9 “6.6 

Endocrine, nutritional, and metabolic diseases: 

Diabetes .... ... .. .. .... . ... .. . .. . ... . .. .... .. . ... ... . ... .. . ..... . . ... . .. .... . ... .. . . 58.0 48.7 59.1 82.9 69.5 40.4 

Neoplasms: 

Cancer ... .. .. .. .... .... .. .. .. .. .... .. .. .. .. .. . . .... . . .... .. .. .. .. .. .... .. .... . . .... .. ,19.1 l 20.0 29.5 19.5 17.1 

Diseases of the respiratory system . .. . ... .. . ... .. . ... ... .. ... .. . ... . . .... .. . 16.7 “14.5 17.0 *18.2 12.8 20.5 

Diagnosis unknown3 

Total ..... .. .. .. .. .... .. .. .. .. . . .. .... .. .. .. .. . .... . .. ... . .. .. .. .. .. .. ... . . 65.2 79.2 63.6 54.8 69.0 61.6 

* 

CHRONIC CONDITIONS OR IMPAIRMENTS+ 

Diseases of the circulatory system 

Arteriosclerosis ... .. .. .... . .. ... .... .... .. .... .. .... . ... .. .. .. .... .. .. .. .. .. .. .. .. ... 502.2 96.5 548.9 314.0 544.8 639.0 

Hypertension ...... .. .. .. .. .. .... .. .... .. .. .... .. .... .. .... .. .. .. .. .. .... .. .... .. .. .. . 227.3 129.3 238.6 214.0 249.9 236.8 

Stroke ... . ..... . . ..... .. . .. .. . . .... .. ... .. . ... .. ... . ... .. .. .... . ... .. ... ... .. .. .. .. .. .... . 157.2 105.3 163.1 222.3 174.8 130.3 

Paralysis or palsy, other than arthritis, related to stroke . . .. .. .. 56.5 55.0 56.7 105.1 60.8 35.0 

Heart trouble ... ... .. .... . . .... . . .. .. .. ... ... .. .. ... . . .... .... ... .. . ... . .. .... . . .... . . 351.3 116.8 378.3 269.6 366.1 429.8 

See footnotes at end of table. 

55 
Table 8. Number and rate per 1,000 nursing home residents, by sex, selected health statuses, and age: United States, 1977-Con. 

-. Age 

Sex and selected health status’ Under 65 years 65-74 75-84 85 years All ages 65 years and over years years and over 

CHRONIC CONDITIONS OR IMPAIRMENTS4-Con. 

Mental disorders and senility without psychosis 

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

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

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

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

Alcoholism ............................................................................. 

Drug addiction.. ..................................................................... 

Insomnia.. .............................................................................. 

Other chronic conditions or impairments 

Diseases of the musculoskeletal system and connective 

tissues: 

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

Chronic back/spine problems, excluding stiffness and 

deformity ....................................................................... 

Permanent stiffness or deformity of back, arms, legs, or 

extremities, including feet, toes, hands, or fingers.. ........ 

Missing arms, legs, or extremities, including feet, toes, 

hands, or fingers.. ........................................................... 

Diseases of the nervous system and sense organs: 

Blindness ........................................................................... 

Glaucoma.. ........................................................................ 

Cataracts ........................................................................... 

Deafness.. .......................................................................... 

Parkinson's disease ............................................................ 

Paralysis or palsy, other than arthritis, unrelated to 

stroke ............................................................................. 

Accidents, poisonings, and violence: 

Hip fracture ...................................................................... 

Other bone fracture .......................................................... 

Endocrine, nutritional, and metabolic diseases: 

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

Neoplasms: 

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

Diseases of the respiratory system: 

Chronic respiratory disease ................................ . .............. 

Diseases of the digestive system: 

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

Diseases of the blood and blood-forming organs: 

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

Diseases of the skin and subcutaneous tissue: 

Bedsores.. .......................................................................... 

Conditions other than above : 

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

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

None of these conditions X 

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

:e per 1,000 population 

107.2 322.2 82.4 210.6 81.2 36.7 

254.8 150.8 266.8 232.3 276.0 270.6 

347.8 66.1 380.3 241.6 382.9 428.5 

47.3 292.2 19.1 63.4 17.1 *4.7 

IO.4 36.1 7.4 +20.3 "7.5 * 

+2.6 * f1.9 * * * 

99.0 112.4 97.5 _ 98.1 96.0 98.7 

281 .O 88.1 303.2 178.6 288.0 363.5 

49.3 60.8 47.9 30.2 53.8 48.8 

-. 

141.9 177.2 137.9 119.4 137.6 144.9 

16.2 *24.0 15.3 *14.6 14.2 16.5 . 

56.3 '30.8 59.3 28.8 51.5 .’ 77.9 

27.4 l 15.5 28.8 31.3 27.1 29.4 

61.8 l 16.1 _ 67.1 32.3 63.7 83.1 

64.8 38.4 67.9 *21.1 41.4 110.3 

43.8 l 26.6 45.7 81.5 49.4 29.1 

32.9 159.1 18.4 32.1 21 .c 10.8 

100.8 *26.1 109.4 53.5 106.5 132.8 

40.0 l 14.4 43.0 35.5 45.5 43.2 

153.1 124.6 156.4 203.0 172.1 124.3 

43.2 *213 45.8 49.8 47.i 42.5 

45.2 39.7 45.8 42.1 42.; 50.6 ' 

251 .I 230.7 253.4 241.2 231 .E 278.7 

57.5 36.8 59.9 47.6 63.1 61.3 

26.2 36.4 25.0 21.8 27.E 23.6 

193.3 122.5 201.5 147.6 207.: 215.7 

96.2 92.5 96.6 92.9 101.; 93.5 

8.4 +3.8 7.8 l 9.8 11.1 *3.9 

IDisease group categories are based on Eighth Revision International Classi.ticafion of Diseases,Adapted for Use in the United States 

PCDA). . 

20nly diagnoses of sufficient magnitude are noted. 

31ncludes those who received no physician visit whiie in facility. 

4Figures may not add to totals because resident may have had more than one reported chronic condition or impairment. 

56 

I 
Table 9. Number and rate per 1,000 nursing home residents, by selected health statuses, race or ethnicity, and primary source of payment: United States, 1977 

Race or ethnicity Primary source of payment 

Selected health status1 White Black 

hot (not 

Hispanic12 Hispanic) 

Number 

Total ................................................................... 1.303.100 1.200.900 81,400 20,800 500,900 28,200 260,700 362,600 83,400 69,200 

PRIMARY DIAGNOSIS AT LAST EXAMINATION 

Diseases of the circulatory system 

Total .................................................................................. 516.800 476.000 34,800 6,000 203.890 11,300 110,300 152.000 23,200 16,200 

Congestive heart failure.. ................................... . ................................. 52,800 47,800 3,700 ‘1,300 19,100 l 1 ,600 10,400 17,800 l 3,200 l 

Arteriosclerosis ............................................... ,................................... 

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

264,400 

47,700 

247,400 

44,900 

15,100 

l 2,700 

‘1,900 l 

104,300 

20,300 

“2,500 l 

61,400 

5,100 

78,200 

18,300 

9,600 

l 2,000 

8,300 

l 1,900 

Stroke.. ............................................................................................... 103,500 90,400 11,200 l 2,000 42,300 5,500 23,900 24,000 4,600 l 3,300 

Heart attack, ischemlc heart disease.. .................................................. 22,500 21,200 l l 7,900 l 4,200 6,800 l 2,600 l 

Other .................................................................................................. 25,800 24,300 I l 9,800 l 5,400 6,900 l 1,300 + 1,500 

Mental disorders and senility without psychosis 

Total .................................................................................. 266,100 241,100 21,000 4,000 90,400 “1,400 47,200 87,400 25,300 14,300 

Senile psychosis .................................................................................. 21,200 19,600 l I 11,500 4,500 l l 

Other psychosis.. ................................................................................. 

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

57,400 

96,400 

52,400 

86,400 

4,400 

8,600 

l 

l 1 ,400 

14,800 

36,300 l 

22,800 

25,600 

7,200 

6,800 

3,400 

4,700 

Senility without psychosis .................................................................. 26,600 24,800 ‘1,800 12,000 7,300 l 2,800 l 1,200 

Mental retardation .............................................................................. 42,400 37,600 3,900 l 7,600 l 19,700 6,000 ‘2,600. 

Alcoholism and other mental disorders ............................................... 22,100 20,300 ‘1,400 l 8,200 ‘2;800 7,500 l 2,000 l 1,700 

Other diaanoses4 

Total ...... ......... ..... . ........... .........,... ....a...... ......... ................ . 429,700 399,500 21,100 9,100 167,600 11,000 91,500 108,300 24,100 27,200 

Diseases of the musculoskeletel system and connective tissues: 

Arthritis end rheumatism .. .. ...... .... .......... .. .... ...... .. .. .... .. .............. ... 56,200 54,400 l 1,500 l 23,300 l 10,000 16,000 l 3,300 “3,200 

Diseases of the nervous system and sense organs: 

Parkinson’s disease .,.......................................................,............... 23,300 22,906 l l 10,300 5,400 5,200 9,600 l 

Accidents, poisonings, and violence: 

Hip fracture ......... ...... ...... .. .a..... ..........a.... ... ... .. ..... ....... ........ ....a..... 29,300 28,500 l 14,100 l 3,300 5,500 4,400 I l 

Other bone fracture .,.,.....I.,.I........,,...........,,,.....,............,...,.......... 10,600 10,100 l 5,200 l ‘1,600 l l ,600 l l 1 ,300 

Endocrine, nutritional,and metabolic diseases: 

Diabetes .... .......... ,.. ... ... ...... ........ ............. ... ........... ... ..... ............... .. 71,700 62,600 6,100 l 3,000 23,800 17,500 24,700 l 2,900 l 2,800 

Neoplasms: 

Cancer .. .. .... .. .. .. .. .. ...... .... .... ........ ............. ... .. ... ... ... .. ... .... .........,.... .. 

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

28,900 

31,000 

26,800 

29,500 

l 1,400 l 

I 

I 12,100 

11,500 

l 1 ,700 c 5,100 

6,600 

6,400 

7,700 

l 1,3w 

l 2,100 

‘2,300 

l 2,000 

Diagnosis unknown5 

Total ......... ....... .... .... ............ ...... .. ....... ........ ........ ............... 90,500 84,300 4,400 ‘1,700 39,100 l 2,500 11,700 14,900 10,800 11,500 

See footnotes at end of table.

8 
Table 9. Number and rate per 1,000 nursing home residents, by selected health statuses, race or ethnicity, and primyy source of payment: United States, 1977-Con.

-

T Race or ethnicity Primary source of payment

Selected health status1 Total OW ” Medicaid 

income v or family 

support Skilled 

I 

Intermediate 

CHRONIC CONDITIONS OR IMPAIRMENT@ 

Number r Diseases of the circulatory system 

Arteriosclerosis ................................................................................... 620,200 581 ,100 33,500 5,600 246,800 10,900 137.100 170,400 27,300 27,700 

Hypertension ...................................................................................... 272,900 246,100 22,700 4,000 103,400 3,900 56,900 80,400 15,500 12,900 

Stroke ................................................................................................. 214,000 190,100 20,500 l 3,400 84,000 8,500 49,900 52,000 11,100 8,500 

Paralysis or palsy, other than arthritis, related to stroke.. ................... 60,800 68,500 10,300 l 2,100 30,300 ‘3,200 22,500 18,800 l 3,100 l 3,000 

Heart trouble ...................................................................................... 449,000 417,700 24,100 7,200 174,200 8,000 97,900 123,400 25,500 20,000 

Mental disorders and senility without psychosis 

Mental illness ...................................................................................... 148,300 134,300 11,800 l 2,300 46,500 l 600 23,100 53,600 16,000 8,500 

Chronic brain syndrome.. .................................................................... 324,700 291,900 27,600 5,100 120,600 4,900 76,800 88,500 18,200 15,600 

Senility ............................................................................................... 416,400 384,200 27.700 4,500 171,000 5,200 84,700 112,200 26,400 16,900 

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

Alcoholism.. ........................................................................................ 

Drug addiction.. .................................................................................. 

79,800 

36,900 

3,700 

70,400 

31,000 

l 3,300 

7,600 

4,600 l 

l 1 ,800 

l 1,300 l 

13,900 

11,600 

l l ,600 

l 

l 

12,600 37,400 

6,700 10,900 l l 

10,200 

l 1 ,800 

4,900 

5,300 l 

Insomnia.. ........................................................................................... 125,500 116,600 6,500 l 2,400 49,500 -1,700 26,000 31,100 10,000 7,100 

Other chronic conditions or impairments 

Diseases of the musculoskeletal system and connective tissues: 

Arthritis and rheumatism.. ............................................................. 320,500 303,700 12,700 4,100 125,900 4,500 63,700 90,000 18,600 17,700 

Chronic back/spine problems, excluding stiffness and 

deformity.. .................................................................................. 60,500 56,900 ‘3,100 * 23,500 ‘I ,600 12,000 15,400 ‘3,400 4,700 

Permanent stiffness or deformity of beck, arms, legs, 

or extremities, including feet, toes, hands, or fingers.. ................ 181,500 164,800 14,600 l 2,200 64,000 l 3,200 47,200 43,300 11,500 12,300 

Missing errns, legs, or extremities, including feet, toes, hands, 

or fingers.. ................................................................................... 32,400 25,300 5,800 l 1 ,300 10,600 l 10,200 7.100 l 2,1 00 l 1 ,500 

Diseases of the nervous system and sense organs: 

Blindness.. ................................................................................... .:. 72,200 62.500 7,800 l 1,900 21,200 l 19,200 22,400 -4,700 4,300 

Glaucoma.. ..................................................................................... 34.000 31,800 l 1,900 l 12,200 l 7,200 10,600 l 1,500 l 2,400 

Cataracts.. ...................................................................................... 80,000 74,000 4,900 l 29,700 t 20,100 19,400 4,400 5,300 

Deafness.. ....................................................................................... 90,400 88,100 l 1 ,600 l 35,000 ‘1,900 17,200 25,800 4,500 6,100 

Parkinson’s disease ......................................................................... 58,000 56,000 1,600 ‘* 24,500 l 13,800 13,700 l 3,100 l 1,800 

Paralysis or palsy, other than arthritis, unrelated to stroke.. .......... 46,500 41,100 4,500 l 12,000 l 15,200 11,400 3,500 l 3,400 

Accidents, poisonings, and violence: 

Hip fracture ................................................................................... 

Other bone fracture ....................................................................... 

108,800 

46,300 

105,500 

44,600 

l 2,600 

l 1,400 

l 

l 

46,600 

16,800 

5,300 

‘1,800 

25,800 

11,400 

23,500 

11,200 

3,800 

l 1,900 

3,800 

l 3,300 

Endocrine, nutritional, and metabolic diseases: 

Diabetes ......................................................................................... 169,600 168,100 15,400 6,100 62,600 ‘2,800 48,300 57,000, 9,700 9,100 

Neoplasms: 

Cancer.. .......................................................................................... 63,600 59,500 l 3,1 00 l 26.500 l 2,700 12,300 15,500 l 2,900 3,700 

Diseasesof the respiratory system: 

Chronic respiratory disease ............................................................ 86,500 80,700 4,200 l 1 ,600 26,800 l 20,700 26,200 6,400 5,400 

Diseases of the digestive system: 

Constipation .................................................................................. 313,200 293,400 16,700 l 3,000 122,200 5,300 71,200 84.400 16,100 13,900 

See footnotes at end of table. 
Table 9. Number and rate per 1,000 nursing home residents, by selected health statuses, race or ethnicity, and primary source if payment: United States, 1977-Con. 

II Race or ethnicity I Primary source of payment 

Selected health status1 Total White Black Other All 

hot (not government other 

II Hispanic)* I Hispanic) assistance or sources3

II welfare 

CHRONIC CONDITIONS OR IMPAIRMENT+-Con. 

Other chronic conditions or impairments-Con. 

None of these conditions 

13,000 11,400 

Diseases of the blood and blood-forming organs: 

Aneniie ........... ....... ...... ..... .. ......... ... .. .... ..... .. .... ......... ......... .. .... ...... 

Diseases of the skin and subcutaneous tissue: 

70,600 11 65,000 3,600 l 2,1 00 25,900 l 17,600 19,900 l 2,400 4,100 

Bedsores ............... ..... .... ...................... .... ..... .. ... ... ..... ............ ....... .. 

Conditions other than above: 

35,100 31,200 3,800 l 10,600 l 2,300 10,700 6,100 l 2,100 l 3,400 

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

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

233,500 

131,700 

218,200 

119,000 

12,000 

10,000 

l 3,200 

‘2,700 

91,300 

47,800 

5,000 

‘3,300 

46,500 

34,100 

65,800 

30,700 

12,700 

9,000 

12,300 

6,800 -II-l l 5.700 l l 2,200 * 1,400 l 1 ,300 92,000 

Rate per 1,000 population 

1 1 ,ooo.o l,ooo.o 1.ooo.o 1 ,ooo.o 1 ,ooo.o 1,ooo.o 1 ,ooo.o 1 ,ooo.o 

PR1MAR.Y DIAGNOSIS AT LAST EXAMINATION .-

Diseases of the circulatory system 

Total .................................................................................. 427.6 286.9 406.9 430.2 423.2 419.2 278.5 233.5 

Congestive heart failure ....................................................................... 40.5 39.8 45.3 ‘62.4 38.2 “61.7 39.7 49.1 ‘37.8 l 

Arteriosclerosis ................................................................................... 202.9 206.0 185.4 “89.9 208.2 l 96.8 235.5 215.7 115.0 120.2 

Hypertension ...................................................................................... 36.6 37.4 l 33.5 l 40.5 l 19.5 50.6 l 23.8 ‘27.0 

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

Heart attack, ischemic heart disease .................................................... 

Other .................................................................................................. 

79.5 

17.3 

19.8 

75.2 

17.7 

20.3 

137.7I) 

* 

l 94.0 l 

l 

84.5 

15.8 

19.6 

207.9 

1) 

l 

91.5 

16.1 

20.8 

66.1 

18.7 

19.0 

55.4 

l 30.9 

+15.6 

“47.4 l 

l 21 .4 

Mental disorders and senility without psychosis 

Total .................................................................................. - 258.5 192.4 180.5 l 55.2 181.0 241 .I 303.6 207.0 

Senile psychosis .................................................................................. l l 22.9 15.2 12.4 l l 

Other psychosis.. ................................................................................. 53.6 l 29.5 35.0 63.0 86.2 49.7 

Chronic brain syndrome.. .................................................................... 105.8 “67.7 72.5 l 84.9 70.6 81.3 68.1 

Senility without psychosis .................................................................. ‘22.4 24.1 ‘12.6 20.1 ‘33.2 l 18.0 

Mental retardation .............................................................................. 48.4 l 16.3 l 22.6 54.4 72.0 ‘37.2 

Alcoholism and other mental disorders ............................................... l 1 7.7 l 16.3 l 10.7 20.6 l 23.4 l 25.1 

See footnotes at end of table. 
8 

Table 9. Number and rate per 1,000 nursing home residents, by selected health statuses, race or ethnicity, and primary source of payment: United States, 1977-Con. 

Race or ethnicity Primary scarce of payment 

Selected health status1 Total Black Medicaid Other All 

(not government 

Hispanic) @ ‘-:lled Inter- assistance or othar l-imediate welfare sourcesz 

PRIMARY DIAGNOSIS AT LAST EXAMINATION-Con. 

Rate per 1,000 population 

Other diagnoses4 

Total . . . . . . ..__._....................................................................... 329.8 332.7 259.6 437.5 334.6 419.5 350.9 298.7 288.7 392.9 

Diseases of the musculoskeletal system and connective tissues: 

Arthritis and rheumatism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43.2 45.3 l 18.1 . 46.5 l 38.4 44.0 l 39.7 ‘45.8 

Diseases of the nervous system and sense organs: 

Parkinson’s disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.9 19.0 l l 20.5 20.6 14.2 ‘18.9 I 

Accidents, poisonings, and violence: 

Hip fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.5 23.7 l 28.2 ‘125.2 21 .o 12.1 l l 

Other bone fracture . . . . . . . . . . . . .._........................................................ 8.2 8.4 l 10.5 l l 6.0 l 4.5 l ‘19.0 

Endocrine, nutritional, and metabolic diseases: 

Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55.0 52.1 74.9 ‘145.6 47.5 67.1 68.0 ‘34.9 l 41 .l 

Neoplasms: 

Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.2 22.3 ‘17.2 l 24.2 l 65.3 19.4 17.5 l 15.9 ‘32.7 

Diseases of the respiratory system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23.8 24.6 . l 22.9 l 25.3 21.2 024.9 l 29.3 

Diagnosis unknown5 

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69.4 70.2 54.4 ‘83.2 78.0 l 95.1 44.9 41 .o 129.3 166.5 

CHRONIC CONDITIONS OR IMPAIRMENT+ 

Diseases of the circulatory n/stem 

Arteriosclerosis ................................................................................... 476.0 483.9 412.0 268.1 492.7 416.1 526.0 469.9 327.7 399.9 

Hypertension ...................................................................................... 209.4 204.9 279.3 194.8 206.4 148.4’ 218.2 221.7 185.7 186.0 

Stroke.. ............................................................................................... 164.2 158.3 251.3 l 163.9 167.8 324.2 191.3 143.5 132.8 122.3 

Paralysis or palsy, other than arthritis, related to stroke.. ................... 62.0 57.0 126.5 l 100.5 60.5 ‘121.8 86.3 51.9 l 36.7 l 42.7 

Heart trouble ...................................................................................... 344.5 347.9 295.4 345.3 347.8 305.0 375.6 340.3 305.0 288.8 

Mental disorders and senilitv without osvchosis 

Mental illness ...................................................................................... 113.8 111.8 144.9 l 108.8 92.8 l 22.7 88.7 147.9 191.4 123.4 

Chronic brain syndrome.. .................................................. . ................. 249.1 243.1 338.9 247.2 240.8 187.4 294.5 244.2 218.6 224.7 

Senility ............................................................................................... 319.5 319.9 339.6 218.2 341.4 198.6 325.0 309.3 316.2 243.8 

Mental retardation .............................................................................. 61.2 58.7 92.8 l 86.9 27.8 l 48.5 103.2 122.7 70.4 

Alcoholism.. ........................................................................................ 28.3 25.8 56.4 +62.2 23.2 l 25.6 30.1 l 21 .3 76.8 

Drug addiction.. .................................................................................. 2.8 l 2.7 l l l 3.1 l l l 

Insomnia.. ................................................... . ....................................... 96.3 97.1 79.9 l 116.7 98.9 ‘64.0 99.8 85.8 119.6 103.2 

See footnotes at end of table. 

. 
Table 9. Number and rate per 1,000 nursing home residents, by selected health statuses, race or ethnicity, and primary source of payment: United States, 1977-Con. 

Race or ethnicity ! Primary source of payment 

Selected health status1 Total OW” Medicaid Other All income government other or family Medicare 

Skilled Inter- assistance or sources3 support mediate welfare 

CHRONIC CONDITIONS OR IMPAIRMENTS”-Con. 

Rate per 1,000 populatior

Other chronic conditions or impairments 

Diseases of the musculoskeletal system and connect&tissues: 

Arthritis and rheumetlsm ............................................................... 245.: 252.9 156.1 195.6 251.4 171.7 244.4 

Chronic back/spine problems, excluding stiffness and 

deformity ..................................................................................... 46.4 47.4 l 37.7 l 46.9 l 59.4 45.9 

Permanent stiffness or deformity of back, arms, legs, 

or extremities, including feet, toes, hands, or fingers.. ................ 139.3 137.2 179.2 l 1 04.5 127.7 l 1 22.0 180.9 

Missing arms, legs, or extremities, including feet, toes, hands, 

or fingers.. ................................................................................... 24.9 21 .I 70.9 l 64.6 21.2 l 39.2 

Diseases of the nervous system and sense organs: 

Blindness ........................................................................................ 55.4 52.0 98.3 l 91.4 42.3 l 73.6 

Glaucoma ....................................................................................... 26.1 26.4 ‘23.6 l 24.3 l 27.8 

Cataracts.. ...................................................................................... 61.4 61.6 59.6 l 59.3 l 77.0 

Deafness.. .............................. . ....................................................... 69.4 73.4 l 19.7 l 69.9 l 72.1 66.0 

Parkinson’s disease ......................................................................... 44.5 46.6 l 19.7 c 48.9 l 52.9 

Paralysis or palsy, other than arthritis, unrelated to stroke ............ 35.7 34.2 55.1 l 23.9 l 58.4 

Accidents, poisonings, and violence: 

Hip fracture ................................................................................... 83.5 87.8 l 32.3 l 93.0 203.1 98.9 

Other bone fracture! ....................................................................... 35.5 37.1 ‘16.7 l 33.4 l 68.6 43.7 

Endocrine, nutritional, and metabolic diseases: 

Diabetes.. ....................................................................................... 145.5 140.0 189.1 293.7 125.3 9105.7 185.3 

Neoplasms: 

Cancer.. .......................................................................................... 48.8 49.5 l 37.9 l 52.9 ‘103.5 47.1 

Diseasesof 

Diseases of the respiratory system: 

Chronic respiratory disease ............................................................ 66.4 67.2 51.4 l 76.9 53.4 l 79.3 

Diseases of the digestive system: 

Constipation ................................................................. .;. .............. 240.3 244.3 205.4 l 144.3 243.9 203.7 273.2 

Diseases of the blood and blood-forming organs: 

Anemia .......................................................................................... 54.2 54.1 44.1 l QQ.O 51.6 l 67.3 

the skin and subcutaneous tissue: 

Bedsores.. ....................................................................................... 26.9 25.9 46.5 * 21.2 *88.0 40.9 

Conditions other than above: 

Edema.. .......................................................................................... 179.2 181.7 147.9 l 1 53.2 182.2 189.3 178.3 

Kidney trouble ............................................................................... 101.0 99.1 122.4 “131.3 95.4 ‘127.3 130.7 

None of these conditions 

Total .................................................................................. 10.0 9.5 l l 11.4 l l 8.3 

248.3 222.7 255.9 

42.5 l 40.4 68.4 

119.5 138.0 177.7 

19.5 l 25.2 l 22.2 

61 .B l 55.9 62.1 

29.3 l 1 7.4 ‘34.4 

53.4 53.2 76.8 

71 .l 53.4 87.9 

37.8 ‘37.7 ‘28.5 

31.4 42.2 l 48.6 

64.7 45.0 55.4 

30.8 ‘22.4 47.4 

157.2 115.8 ‘131.0 

42.6 l 35.2 53.7 

72.2 76.4 77.4 

232.7 193.4 200.7 

54.9 ‘28.4 58.7 

16.8 l 25.3 ‘48.6 

181.4 152.2 177.1 

84.6 107.7 98.2 

‘3.9 l 16.0 l 28.5 

1DIsease group categories are based on Eighth Revlslon International Classification of D&x.ws, Adapted for (IAT?in the United States (ICDA). 

*Includes a small number of unknowns. .. 

3Includes religious organizations, foundations, volunteer agencies, Veterans’ Administration contracts, initial payment-life care funds, other sources, and no charge.

40111~ diagnoses of sufficient magnitude are noted. 

51rlcIudes those who received no physician visit while in facility.

6Figures may not add to totals because resident may have had more than o’ne reported chronic condition or impairment. 
Table 10. Number and percent distribution of nursing home residents by selected functional statuses, according to sex and age: 

United States, 1977 

Sex I Age 

Selected functional status Total 

Male Female Under 65 years 6574 75-84 85 years 

65 years and over years years and over 

Number 

Total ................................................................. 1.303.1 oc 375,300 927,800 177.100 1 ,126,OOO 211,400 14,700 449,900 

vkiQJ.l statusl 

Sight not impaired ............................................................ 875,6OC 261,600 614,000 143,400 732,200 159,300 315,400 257,500 

Sight partially impaired2.. ................................................. 247,ooc 65,500 181,500 19,400 227,700 28,300 91 ,100 108,200 

Sight severely impaired ..................................................... 85,800 19,000 66,800 3,800 82,000 7,000 28,200 46,800 

Sight completely lost ........................................................ 38,400 11,400 27,000 3,900 34,600 5,400 12,100 17,000 

Unknown.. ........................................................................ 56,300 17,800 38,500 6,700 49,600 11,200 18,000 20,500 

Hearing status1 

Hearing not impaired ........................................................ 906,000 258,700 647,400 155,100 751,000 171,300 332,800 246,800 

Hearing partially impairadz.. ............................................. 282.9OC 80,800 202,100 11,600 271,300 24,000 98,500 148,800 

Hearing severely impaired ................................................. 

Hearing completely lost .................................................... 

56.30(3 

9.300 

16,900

l 3,000 

39,500 

6,300 

l 

1,900 

55,600 

7,400 

4,000 

‘1,400 

13,900

l 2,800 

37,600 

‘3,300 

, 

Unknown.. ........................................................................ 48.5OC 15,900 32,600 7,700 40,800 10,600 16,800 13,400 

Speech status 

Speech not impaired ......................................................... 983,900 268,700 715,200 110,500 873,400 148,400 362,800 362,200 

Speech partially impaired*. ............................................... 160,100 52,400 107,700 27,800 132,300 32,000 53,500 46,800 

Speech severely impaired .................................................. 83,800 29,800 54,000 20,800 63,100 15,500 26,000 21,500 

Speech completely lost ..................................................... 

Unknown .......................................................................... 

61,300 

I 4,i oa 

19,700 

4,800 

41,600 

9,300 

15,300

l 2,800 

45,900 

11,400 

10,200 

5,400 

20,200

l 2,1 00 

15,500 

3,900 

Communication status 

Communicates verbally ..................................................... I ,I I 7,000 325,000 791,900 147,900 969,100 183,000 398,000 388,100 

Communicates nonverbally ............................................... 128.20(3 35,800 92,400 23,200 105,000 19,500 45,100 40,400 

Cannot talk.. ..................................................................... 

Is too ill ............................................................................ 

24.900 

24.300 

8,500 

6,700 

16,400 

17,600 

6,300

l 3,1 00 

18,600 

21,300 

3,500 

5,600 

10,100 

7,200 

5,000 

8,400 

Mental or emotional problems.. ........................................ 47,500 12,600 34,900 10,200 37,300 6,600 15,900 14,700 

Does not speak English, other, unknown .......................... 3 I ,500 8,000 23,500 3,600 27,900 3,700 12,000 12,200 

Does not communicate ..................................................... 58,000 14,500 43,500 6,100 51,900 8,900 21,500 21,500 

Dentures 

No dentures ...................................................................... 489,200 179,900 309,300 124,400 364,800 103,500 140,100 121,200 

Dentures and used them.. .................................................. 686,700 157,400 529,300 38,300 648,400 86,300 279,900 282,200 

Dentures but did not use them.. ........................................ 

Dentures but unknown if used .......................................... 

64,100 

8,600 

15,700

l 2,400 

48,400 

6,200 

4,400 l 

59,700 

7,600 

8,300I 23,600 

“2,700 

27,700 

3,900 

Unknown.. ........................................................................ 54,500 19,800 34,700 9,100 45,500 12,200 18,400 14,900 

Behavioral problems 

Depressed or withdrawn.. .................................................. 460.00(3 128,100 331,900 83,300 376,700 87,100 158,100 131,500 

Agitated, nervous, or hyperactive.. .................................... 440,400 116,800 323,700 75,700 364,700 69,300 161,400 134,000 

Abusive, aggressive, or disruptive.. ........................... ,........ 221.500 73,400 148,100 41,000 180,500 33,800 77,600 69,000 

Wandering ......................................................................... 149,200 43,300 105,900 18,600 130,600 23,000 61,400 46,200 

Other behavioral problems.. .............................................. i 14,300 34,800 79,500 20,100 94,100 17,100 40,000 37,000 

Bathing 

Independent3.. .................................................................. 178,500 72,100 106,400 49,800 128,700 39,800 51,500 37,300 

Requires assistance.. .......................................................... 1 ,I 24,600 303,200 821,400 127,300 997,300 171,600 $13,200 412,600 

Dressing 

Independent3.. .................................................................. 398,200 141,800 256,400 79,400 318,800’ 81,900 128,000 108,900 

Requires assistance (includes those who do not dress) ...... 904,900 233,500 671,400 97,700 807,200 129,500 336,700 341,000 

See footnotes at end of table. 

62 
Table 10. Number and percent distribution of nursing home residents by selected functional statuses, according to sex and age: 

United States, 1977-Con. 

Selected functional status 

Using toilet room 

lndependent3.. .................................................................. 

Requires assistance.. .......................................................... 

Does not use toilet room.. ................................................. 

Mobility 

Walks independently3. ...................................................... 

Walks with assistance.. ...................................................... 

Chairfast ........................................................................... 

Bedfast.. ............................................................................ 

Continence 

No difficulty controlling bowels or bladder3 .................... 

Difficulty with bowel control ........................................... 

Difficulty with bladder control. ........................................ 

Difficulty with control of both bowel and bladder.. ......... 

Ostomy in either bowels or bladder4 ................................ 

Eating 

Independent3.. .................................................................. 

Requires assistance (includes those who are tube-fed) ....... 

Total 

Male Female Under 

65 years 

65 years 

and over 

65-74 

years 

75-84 

years 

85 years 

and over 

618,500 208,700 409,700 109,400 509,000 112,200 212,500 184,300 

553,500 131,100 422,400 49,800 503,700 79,900 207,600 216,200 

131,200 35,500 95,700 17,900 113,300 19,300 44,500 49,500 

441,500 152,800 288,700 94,900 346,500 91,200 154,100 101,200 

374,900 100,700 274,100 27.800 347,000 45,200 141,800 160,000 

417,200 142,500 314,700 45,200 372,000 64,400 146,200 161,500 

69,600 19,300 50,300 9,200 60,400 10,500 22,600 27,300 

713,300 219,600 493,800 120,500 592,800 131,900 245,700 215,200 

48,500 13,400 35,100 5,300 43,300 7,800 18,400 17,100 

117,400 31,300 86,100 10,300 107,100 13,700 43,500 49,900 

337,000 83,500 253,500 29,800 307,200 43,600 125,000 138,600 

86,800 27,600 59,200 11,300 75,600 14,400 32,100 29,100 

878,200 270,800 607.400 130,700 747,500 154,100 307,500 285,800 

424,900 104,500 46,400 378,500 57,200 157,200 164,100 

Vision status1 

Sight not impaired ............................................................ 

Sight partially impaired2.. ................................................. 

Sight severely impaired ..................................................... 

Sight completely lost ........................................................ 

Unknown .......................................................................... 

Hearing status1 

Hearing not impaired ........................................................ 

Hearing partially impaired*. ...... ........................................ 

Hearing severely impaired ................................................. 

Hearing completely lost .................................................... 

Unknown.. ........................................................................ 

Speech status 

Speech not impaired ......................................................... 

Speech partially impaired”. ............................................... 

Speech severely impaired .................................................. 

Speech completely lost ..................................................... 

Unknown .......................................................................... 

Communication status 

Communicatesverbally ..................................................... 

Communicates nonverbally.. ............................................. 

Cannot talk.. ..................................................................... 

Is too ill ............................................................................ 

Mental or emotional problems.. ........................................ 

Does not speak English, other, unknown .......................... 

Does not communicate.. ................................................... 

See footnotes at end of table. 

Percent distribution 

100.0 100.0 100.0 100.0 100.0 100.0 100.0

A 

67.2 69.7 66.2 81 .O 65.0 75.4 67.9 

19.0 17.5 19.6 10.9 20.2 13.4 19.6 

6.6 5.1 7.2 2.2 7.3 3.3 6.1 

2.9 3.0 2.9 2.2 3.1 2.6 2.6 

4.3 4.8 4.1 3.8 4.4 5.3 3.9 

69.5 68.9 69.8 87.6 66.7 81 .O 71.6 

21.7 

4.3 

21.5 

4.5 

21.8 

4.3 

6.6 

t 

24.1 

4.9 

11.4 

1.9 

21.2 

3.0 

0.7 l 0.8 0.7 1.1 0.7 +0.7 l 0.6 

3.7 4.2 3.5 4.4 3.6 5.0 3.6 

75.5 71.6 77.1 62.4 77.6 70.2 78.1 

12.3 14.0 11.6 15.7 11.7 15.1 11.5 

6.4 7.9 5.8 11.7 5.6 7.3 5.6 

4.7 5.2 4.5 8.7 4.1 4.8 4.4 

1.1 1.3 1.0 *1.6 1 .o 2.5 ‘0.5 

85.7 86.6 85.4 83.5 86.1 86.6 85.7 

9.8 9.5 10.0 13.1 9.3 9.2 9.7 

1.9 2.3 1.8 3.6 1.7 1.7 2.2 

1.9 1.8 1.9 l 1.7 1.9 2.7 1.6 

3.6 3.4 3.8 5.8 3.3 3.1 3.4 

2.4 2.1 , 2.5 2.0 2.5 1.8 2.6 

4.4 3.9 4.7 3.4 4.6 4.2 4.6 

100.0 

57.2 

24.1 

10.4 

3.8 

4.5 

54.9 

33.1 

8.4 

l 0.7 

3.0 

80.5 

10.4 

2’ 

0:9 

86.3 

9.0 

1.1 

1.9 

3.3 

2.7 

4.8 

63 
Table 10. Number and percent distribution of nursing home residents by selected functional statuses, according to sex and age: 

United States, 1977-Con. 

Sex Age 

Selected functional status Tota I 

Male Female Under 65 years 65-74 75-84 85 years 

65 years and over years years and over 

Dentures Percent distribution 

No dentures ...................................................................... 37.5 47.9 33.3 70.2 32.4 48.9 30.2 26.9 

Dentures and used them.. .................................................. 52.7 42.0 57.0 21.6 57.6 40.8 60.2 62.7 

Dentures but did not use them.. ........................................ 4.9 4.2 5.2 2.5 5.3 3.9 5.1 6.2 

Dentures but unknown if used.. ........................................ 0.7 l 0.6 0.7 t 0.7 l l 0.6 0.9 

Unknown .......................................................................... 4.2 5.3’ 3.7 5.1 4.0 5.8 4.0 3.3 

Behavioral problems 

Depressed or withdrawn.. .................................................. 35.3 34.1 35.8 47.0 33.5 41.2 34.0 29.2 

Agitated, nervous. or hyperactive.. ........... Li’. ..................... 33.8 31.1 34.9 42.7 32.4 32.8 34.7 29.8 

Abusive, aggressive, or disruptive.. .................................... 17.0 19.6 16.0 23.2 16.0 16.0 16.7 15.3 

Wandering ......................................................................... 11.4 11.5 11.4 10.5 11.6 10.9 13.2 10.3 

Other behavioral problems.. .............................................. 8.8 9.3 8.6 11.4 8.4 8.1 8.6 8.2 

Bathing 

Independent3.. .................................................................. 13.7 19.2 11.5 28.1 11.4 18.8 11.1 8.3 

Requires assistance.. .......................................................... 86.3 80.8 88.5 71.9 88.6 81.2 88.9 - 91.7 

Dressing 

-t 

Independent3.. .................................................................. 30.6 37.8 27.6 44.8 28.3 38.8 27.5 24.2 

Requires assistance (includes those who do not dress) ...... 69.4 62.2 72.4 55.2 71.7 61.2 72.5 75.8 

Using toilet room 

Independent3.. ................................................................... 47.5 55.6 44.2 61.8 45.2 53.1 45.7 41 .o 

Requires assistance.. .......................................................... 42.5 34.9 45.5 28.1 44.7 37.8 44.7 48.0 

Does not use toilet room.. ............................................. t .. 10.1 9.5 10.3 10.1 10.1 9.1 9.6 11.0 

Mobility 

Walks independently3 ................... . ................................... 33.9 40.7 31.1 53.6 30.8 43.2 33.2 22.5 

Walks with assistance ........................................................ 28.8 26.8 29.5 15.7 30.8 21.4 30.5 35.6 

Chairfast ........................................................................... 32.0 27.3 33.9 25.5 33.0 30.5 31.5 35.9 

Bedfast.. ............................................................................ 5.3 5.1 5.4 5.2 5.4 5.0 4.9 6.1 

Continence 

No difficulty controlling bowels or bladder3.. ................... 54.7 58.5 53.2 68.0 52.6 62.4 52.9 47.8 

Difficulty with bowel control ........................................... 3.7 3.6 3.8 3.0 3.8 3.7 4.0 3.8 

Difficulty with bladder control.. ....................................... 9.0 8.3 9.3 5.8 9.5 6.5 9.4 11.1 

Difficulty with control of both bowel and bladder.. ......... 25.9 22.2 27.3 16.8 27.3 20.6 26.9 30.8 * 

Ostomy in either bowels or bladder4 ................................ 6.7 7.4 6.4 6.4 6.7 6.8 6.9 6.5 

Eating 

Independent3.. ............................................. .I:. ................. 67.4 72.2 65.5 73.8 66.4 72.9 66.2 63.5 

Requires assistance (includes those who are tube-fed) ....... 32.6 27.8 34.5 26.2 L 33.6 27.1 33.8 36.5 

%tatus at best correction, that is, with corrective lenses or hearing aid, if applicable. -. 

21ncludes a small number of residents who were impaired but whose level of impairment is unknown. 

31ncludes a small nuinber of unknowns. 

4A total of 81.4 percent of these residents had an ostomy that affected only the bladder. 

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

, 

64 

8 
Table 11. Number and percent distribution of nursing home residents by index of dependency in activities of daily living, according to selected resident characteristics: 

United States, 1977 

l-r Index of dependency in activities of daily living’ 

IIndependent Dependent 

in bathing, Dependent Dependent in bathing, 

dressing, Dependent Dependent in bathing, in bathing, ,dressing, 

Total using toilet in only in bathing dressing, dressing, using toilet Dependent 

room, one and one and one using toilet room, in all six Other2 

other other room, and mobility, activities mobility, activity activity activity one other and one continence, 

end eating activity other Iactivity I Number 

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..a....... a.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.303.100 124,500 181,000 158,900 110,400 125,000 203,600 303,300 118,400 

sQ& 

Male . . . . . . . . . . . . . . *.*.* . . . . . *. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :.. 375,300 50,800 58,800 51,800 27,500 27,700 52,400 71,800 38,900 

Female . . . . . *. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *.. . . . . **..*a. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 927,800 73,700 104,400 107,300 83,000 97,400 151,200 231,400 79,400 

-

ACE

Under 85 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . 177,100 41,500 27,800 22,800 12,800 11,800 22,800 27,700 10,400 

85 years and over . . . . . . . . 9. . . . . *. . . . . . . . . *. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..,... 1 ,128,OW 83,000 133,400 138,200 97,700 113,200 181,000 275,500 108,000 

85-74 years . . . . . . . . . . *. . . . . . . . . . . . . ..*..*.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,.... 211,400 29,500 34,900 28,300 14,300 20,900 32,100 37,300 14,100 

75.84 years . ...* . . . . . .+. . . . . . . 9. . . . . . **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,.... 484,700 33,800 57,300 54,500 44,800 48,700 70,900 112,800 42,000 

85 wars and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449,900 19,800 41,200 53,400 38,800 43,800 78,008 125,400 49,900 

Raw or ethnicity 

White (not HispanicI a.... . . . . . . . . . . . . . . . . ..*..*...* . . . . . *. . . . . . . . . . . . . . . ..*.*......* . . . . .* . . . . . . . . . . . . . . . . . . . . . .. . . . . 1,200,900 114,100 151,300 145,400 102,000 115,800 184,500 280,300 107,400 

Black (not Hispanic) .,,,....,,,,......,.................,..,..,................,,..,...............,....,..,.,.,.,.,..., 81,400 7,800 7,300 10,400 .7,100 8,000 15,500 18,800 8,900 

Hispanic and other . . . . . . . . . . . . . . . . . *.*...**,*.* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20,800 l 2,800 l 2,400 l 3,100 l 1 ,300 “1,300 3,600 4,300 l 2,1 00 

Marital status 

Married .,....,......,,..,..,.,.,.,.,..,,,..,,,..,,..,..,..,,.,..,,.,...,,,..,,.......,.....,,.....,.,..............,........... 156,400 12,000 13,400 11,400 10,400 14,700 30,200 47,800 15,400 

Widowed3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 810,700 52,200 91,300 97,100 76,600 82,700 135,200 200,800 75,900 

Divorced or separated.. ................................................................................................ 87,500 18,400 14,100 12,400 8,300 8,300 11,400 13,200 6,400 

Never married.. ............................................................................................................ 249,500 41,800 42,200 38,000 18,200 21,400 28,800 41,600 19,700 

Primary source of payment 

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

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

500,900 

28,200 

50,700 l 88,200 l 59,800 l 

40,300 

l 1,500 

48,800 

5,100 

80,000 

4,800 

108,100 

10,900 

47.200 

l 2,200 Medicaid: 

Skilled .................................................................................................................... 280,700 8,400 14,800 23,300 20,400 27,100 52,400 86,800 28,800 

intermediate.. ......................................................................................................... 382,800 35,000 58,200 58,000 37,400 31 ,100 49,000 86,900 28,900 

Other government assistance or welfare ....................................................................... 83,400 18,300 11,800 10,200 7,100 5,000 10,800 17,400 4,800 

All other sources4 ....................................................................................................... 89.200 13,800 9,200 8,900 3,700 8,100 8,800 14,300 8,700 

See footnotes at end of table. 

8 
Table 11. Number and percent distribution of nursing home residents by index of dependency in activities of daily living, according to selected resident characteristics: 

United States, 1977-Con. 

I Index of dependency in activities of daily living1 

Dependent 

Dependent in bathing, 

Dependent in bathing, dressing, 

Selected resident characteristic dressing, using toilet Dependent in only using toilet room, in all six Other” room. One 

mobility, activity room, and mobility. activities 

continence, one other and one 

and eating activity other 

I, I 

Percent distribution 

activity L Total ____________________....................................................................................... I Y

100.0 9.6 12.4 12.2 8.5 9.6 15.6 

100.0 13.5 15.1 13:6 7.3 7.4 14.0 19.1 9.8 

100.0 7.9 11.3 11.6 8.9 10.5 16.3 24.9 8.6 

Age -

Under 65 years.. .......................................................................................................... 100.0 23.4 15.6 12.9 7.2 6.7 12.8 15.7 5.8 

65 years and over ........................................................................................................ 100.0 7.4 11.9 12.1 8.7 10.1 16.1 24.5 9.4 

65-74 years.. ........................................................................................................... 100.0 14.0 16.5 13.4 6.7 9.9 15.2 17.6 6.7 

7584 years.. ........................................................................................................... 100.0 7.2 12.3 11.7 9.6 10.5 15.3 24.3 9.0 

85 years and over ................................................................................................... 100.0 4.4 9.2 11.9 8.6 9.7 17.3 27.9 11.1 

Race or ethnicity 

White (not HispanicI ................................................................................................. 100.0 9.5 12.6 12.1 8.5 9.6 15.4 23.3 8.9 

Black (not Hispanic). ................................................................................................... 

Hispanic and other ...................................................................................................... 

100.0 

100.0 

9.3 

l 13.3 

9.0 

l 11.5 

12.8 

l 1 5.0 

8.7 

l 6.2 

9.8 

l 6.3 

19.1 

17.0 

22.9 

20.7 

8.5 

l 10.0 

Marital status 

Married.. ...................................................................................................................... 100.0 7.8 6.6 7.4 6.7 9.5 19.4 30.8 9.9 

Widowed3 ................................................................................................................... 100.0 6.4 11.3 12.0 9.3 10.2 16.7 24.8 9.4 

Divorced or separated.. ................................................................................................ 100.0 21 .o 16.2 14.2 7.2 7.2 13.0 15.1 6.1 

Never married.. ............................................................................................................ 100.0 16.8 16.9 15.2 7.3 8.6 10.7 16.6 7.9 

Primary source of payment 

Own income or family support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 10.1 13.2 11 .Q 8.0 9.7 16.0 21.6 9.4 

Medicare . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 l l l ‘5.7 19.5 17.7 41.5 l 8.3 

Medicaid: 

100.0 3.2 5.7 9.0 7.8 10.4 20.1 32.9 11.0 

Intermediate.. ......................................................................................................... 

Other government assistance or welfare ....................................................................... 

All other sources4 ....................................................................................................... 

100.0 

100.0 

100.0 

9.6 

19.6 

19.7 

16.1 

14.2 

13.3 

16.0 

12.2 

9.9 

10.3 

8.6 

5.4 

8.6 

6.0 

11.6 

13.5 

12.9 

9.7 

18.5

EI 7.49 ”:: lUnknowns were considered independent for the purpose of this index. 

‘Includes residents who were dependent in at least two activities but who were not classifiable into any of the categories. 

3Includes a small number of unknowns. 

41ncludes religious organizations, foundations, volunteer agencies. Veterans’ Administration contracts, initial payment-life care funds. other sources, and no charge. 

NOTE: Figures may not add to totals due to rounding. 
n-L-- 

Table 12. Number and percent distribution of nursing home residents by level of care received during 7 days prior to survey date, 

according to age, length of stay since admission, mobility status, and index of dependency in activities of daily living: 

United States, 1977 

II Level of care received 

Neither 

Item Total 

II “‘*n-sing care I Personal nursing 

nor care 

Intensive “I.(lBr personal 

Total ................................................................................................................... . 1.303.100 

-Age

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

6574 years .......................................................................................................................... 

7584years .......................................................................................................................... 

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

Length of stay since admission 

Less than 3 months.. ............................................................................................................ 

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

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

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

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

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

Mobility status 

Walks independently1 .......................................................................................................... 

Walks with assistance ................................................................................................... v.. .... 

Chairfast .............................................................................................................................. 

Bedfast.. ............................................................................................................................... 

Index of dependency in activities of daily living* 

Independent in bathing, dressing, using toilet room, mobility, continence, and eating ......... 

Dependent in only one activity ...................................... . ..................................................... 

Dependent in bathing and one other activity ....................................................................... 

Dependent in bathing, dressing, and one other activity ........................................................ 

Dependent in bathing, dressing, using toilet room, and one other activity ........................... 

Dependent in bathing, dressing, using toilet room, mobility and one other activity.. ........... 

Dependent in all six activities ............................................................................................... Other3 ................................................................................................................................. 

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

Age -

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

6574 years ........................................................................................................................... 

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

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

Length of stay since admission 

Less than 3 months ... _........................................................................................................... 

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

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

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

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

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

See footnotes at end of table, 

177,100 

211,400 

464,700 

449,900 

189,300 

122,100 

163,100 

427,800 

192,900 

207,900 

441,500 

374,900 

417,200 

69,600 

124,500 

161,000 

158,900 

110,400 

125,000 

203,600 

303,300 

116,400 

100.0 

100.0 

100.0 

7 00.0 

100.0 

100.0 

100.0 

100.0 

100.0 

100.0 

100.0 

Number ’ 

571,400 530.200 187,800 

a59,800 69,100 42,800 

84,700 92,900 30,400 

209,500 192,800 58,800 

217,300 175,300 55,700 

95,600 68,300 23,400 

52,600 52,100 16,100 

71,000 64,300 26,300 

187,300 178,500 58,500 

84,300 78,200 27,700 

80,600 88,800 35,800 

87,800 231,600 109,900 

149,100 176,000 48.100 

274,700 114,600 27,900 

59,900 7,900 *1,900 

6,700 61,200 44,800 

26,900 95,300 36,900 

33,600 92,100 33,200 

34,600 59,000 16,800 

57,000 53,400 14,600 

133,200 56,200 14,100 

231,500 58,200 13,600 

47,800 54,700 13,700 

14.4 

33.8 39.0 24.2 

40.1 43.9 14.4 

45.1 41.5 12.7 

48.3 39.0 12.4 

50.5 36.1 12.4 

43.1 42.7 13.1 

43.5 39.4 16.1 

43.8 41.7 13.7 

43.7 40.5 14.3 

38.8 42.7 17.2 

care 

13,800 

5,300 

f3.400 

3,500 

“1,600 

l 2,000 

l 1,300 

“I ,600 

3,500

l 2,700

l 2,700 

12,100 

l 1 ,700+ 

11,700 

*1,900 

l 

1 .I 

3.0 

*1.6 

0.7 

l 0.4 

l 1 .l 

.I.1 

l 1.0 

0.8 

11.4 

l 1 .3 

67 

7 
Table 12. Number and percent distribution of nursing home residents by level of care received during 7 days prior to survey date, 

according to age, length of stay since admission, mobility status, and index of dependency in activities of daily living: 

United States, 1977-Con. 

Level of care received 

item Total 

Mobility status Percent distribution 

Walks independently1 ........................................................................................................... 100.0 19.9 52.5 24.9 2.i 

Walks with assistance ............................................................................................................ 

Chairfast ............................................................................................................................... 

100.0 

100.0 

39.8 47.0 

65.8 27.5 

12.8 

6.7 

x0.4

I 

100.0 86.0 11.3 l 2.7 

Index of dependency in activities of daily living2 

Independent in bathing, dressing, using toilet room, mobility, continence, and eating.......... 

Dependent in only one activity .,..........,...................................................................,............ 

5.4 49.2 

16.7 59.2 

36.0 

22.9 

9.4 

l 1.2 

Dependent in bathing and one other activity ..... .. ... ... .. .... .... .. .. . .... .... . .... .... . ... . .... .. ... .. .. ... .. .... 21.2 57.9 20.9 

Dependent in bathing, dressing, and one other activity .... . ... . .... . ... . .... ... .. .. .. .... .. ... . ... . .... .. .. .. .1 31.3 53.5 15.2 

Dependent in bathing, dressing, using toilet room, and one other activity ... .. .. .... . .... . ..... ... .. . 45.6 42.7 11.7 

Dependent in bathing, dressing, using toilet room, mobility, and one other activity............. 65.4 27.6 6.9 

Dependent in all six activities ..... . ... . .... .. ...... . ... . ... .. .... .. .. ... .. ... .. .. .. .... . .... ..... .. ... ... . .... .... . .. .. .... .. 76.3 19.2 4.5 

Other3 .. .... .... ... . .. .. . ... .. ... .. ... .. .... .... . .. ... ... .. ... .. . ... . .. .. ... .. ... ... . ... . .. ..:...........,...................... 41 .l 47.0 II..8 

ltncludes a small number of unknowns. 

2Unknowns were considered independent for the purpose of this index. 

3lncludes residents who were dependent in at least two activities but who were not classifiable into any of the categories. 

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

68 
-- 

Table 13. Number and percent distribution of nursing home residents by level of care received during 7 days prior to survey date, according to selected health statuse;: 

United States, 1977 

Level of care received 

Selected health status’ 

Total . ..... .. ....... .. *.a. .. .b.... ....... . ...... .. .... .. ....... ....... ... ..... .... 

PRIMARY DIAGNOSIS AT LAST EXAMINATION 

Diseases of the circulatory system 

Congestive heart failure ................................................................................ 

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

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

Stroke .................................................................... .” a..;................................ 

Heart attack, ischemic heart disease .............................................................. 

Other.. .......................................................................................................... 

Mental disorders and senility without psychosis 

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

Senile psychosis............................................................................................ 

Other psychosis ............................................................................................ 

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

Senility without psychosis ............................................................................ 

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

Alcoholism and other mental disorders ......................................................... 

Other diagnoses2 

Total .... ...... .. .... .. *.*.....*.....* . .. ..... ..... ...... .. ... ... .. .. ..... ..... .. .. .... ... ..... ... 

Diseases of the musculoskeletal system and connective tissues: 

Arthritis and rheumatism ..... **..... . .. .... ....... ...*.*.**..*.*.. ... ... *.a*. .. .....+............ 

Diseases of the nervous system end sense organs: 

Parkinson’s disease ....*. .-. .*.*.*......... ... *.... ..... .... .. ... ..... . .. .. ...*.......**.*..*..* ..,.., . 

Accidents, poisonings, and violence: 

Hip fracture ..... ..... .*.... ......a. ...... *.. ... ...... ...... ...... ... .... ... .... ..... ..... .. .... .. ... ... . 

Other bone fracture .. ... ....... .... .... . *..... .... *..... .... a....... .. ..I...... .. ..... .. .. ..... ..... 

Endocrine, nutritional, end metabolicdiseases: 

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

Neoplasms: 

Cancer ... ... .... .. .. .*..*...a. .. ....... ........ ... ... ....... ... ...... .... ... .. ,............. .... .... .... ... 

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

See footnotes at end of table. 

All 

residents 

1.303.1 oc 571.4oc 530,200 187,800 

I 516 80C 262,700 210,300 51,900 

_ 52.8OC 24,500 23,600 4,700 

264.4OC 132,100 101,000 30,000 

47.7oa 13,400 29,800 4,500 

103,5oa 63,300 32,000 7,600 

22,500 8,300 12,400 “1,800 

25,800 11,100 1 ! ,400 l 3,300 

266,100 98,800 105.400 57.300 

21,200 10,900 7,300 l 3,000 

57,400 8,400 29,600 18,100 

96,400 50,400 32,100 12,900 

26,600 12,600 9,300 4,500 

42,400 13,000 16,300 11,500 

22,100 3,600 10,900 7,200 

429,700 189,200 182,500 55,000 

56,200 22,200 26,600 7,400 

23,300 13,200 7,200 l 2,900 

29,300 15,400 10,300 ‘3,300 

10,600 6,000 l 3,200 l 

71,700 25,300 38,800 7,600 

28,900 16,500 9,700 l 2,500 

31,000 14,400 12,900 3,700 

~ 

13,800 1oo.c 

l 1,900 .I 0o.c 

I 0o.a 

41,300 100.0 

100.0 

t 100.0 

4,500 

‘1,300 l 

l 

l l ,600 l 

‘3,100 

l 

* 

l 

loo.0 

100.0 

100.0 

100.0 

100.0 

100.0 

r 100.0 

100.0 

100.0 

100.0 

100.0 

100.0 

100.0 

100.0 

100.0 

100.0 

100.0 

Percent distribution 

43.; 40.7 14.4 1.1 

48.8 40.7 10.0 f0.4 < 

46.4 44.8 8.8 

49.9 38.2 11.3 l 0.5 

28.1 62.5 9.4 

61.2 30.9 7.4 l 

36.8 55.0 l 8.2 

43.0 44.1 l 12.9 

37.1 39.6 21.5 1.7 

51,.3 34.4 l 14.3 

14.6 61.7 31.5 l 2.2 

52.3 33.3 13.4 I 

47.3 34.8 16.8 l 

30.7 38.3 27.2 l 3.7 

16.2 49.1 32.8 l 

44.0 42.5 12.8 l 0.7 

39.6 47.2 13.2 

56.6 30.9 l 12.5 

52.7 

56.5 

35.2 

l 30.1 

l 11.4

* 

l 

l 

35.3 54.1 10.6 

57.1 33.6 l 8.5 l 

46.3 41.7 12.1 
Table 13. Number and percent distribution of nursing home residents by level of care received during 7 days prior to survey date, according to selected health statuses: 

United States, 1977-Con. 

Le;el of care received Level of care received 

Selected health status1 All 

residents 

All 

residents 

‘Nursing care 

Personal 

Neither 

nursing m 

PRIMARY DIAGNOSIS AT LAST EXAMINATION-Con. 

Number Percent distribution 

Diagnosis unknown3 

Total.. ........................................................................................... 90,500 30,600 32,000 23.600 4,300 10o.a 33.9 35.3 26.1 4.8 

CHRONIC CONDITIONS OR IMPAIRMENTS4 

Diseases of the circulatory system 

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

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

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

620,200 

272,900 

214,000 

308,300 

119,000 

124,400 

239,600 69,700 

124,100 29,000 

72,400 18,600 

l 2,700 l 

l 

100.0 

io0.a 

100.0 

49.7 38.6 11.2 

43.6 45.5 10.6 

58.2 33.8 7.7 

‘0.4 l 

l 

Paralysis or palsy, other than arthritis, related to stroke ............................... 

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

80,800 

449,000 

55,000 

201,500 

21,800 4,100 

198,000 48,800 l 

1oo.c 

100.0 

68.0 27.0 5.0 

44.9 44.1 10.9 l 

Mental disorders and senility without psychosis 

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

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

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

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

Alcoholism ................................................................................................... 

Drug addiction.. ............................................................................................ 

Insomnia.. ..................................................................................................... 

148,300 

324,700 

416,400 

79,800 

36,900 

3,700 

125,500 

40,200 

176,400 

222,700 

27,800 

8,600 

l 1,600 

55,100 

69,400 

110,900 

149,400 

31,900 

19,100 

l 1 ,700 

53,300 

36,400 

35,800 

42,900 

18,200 

7,300 l 

16,900 

l 2,200 

l 1,600 

“1,300 

l 1,900 

l 1,900 

l 

io0.a 

io0.a 

io0.a 

100.0 

loo.0 

100.0 

100.0 

27.1 46.8 

54.3 34.2 

53.5 35.9 

34.8 40.0 

23.4 51.7 

l 45.2 s47.4 

43.9 42.5 

24.6 

11.0 

10.3 

22.8 

19.8 l 

13.5 

l 1.5 

l 0.5 

l 0.3 

l 2.4 

l 5.1 

l 

Other chronic conditions or impairments 

Diseases of the musculoskeletal system and connective tissues: 

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

Chronic back/spine problems, excluding stiffness and deformity ............. 

320,500 

60,500 

137,800 

31,800 

144,400 37,300 

22,700 5,800 

l 

* 

100.0 

io0.a 

43.0 45.0 11.6 

52.5 37.6 9.6 

l 

l 

Permanent stiffness or deformity of back, arms, legs, or extremities, 

including feet, toes, hands, or fingers.. .................................................. 181,500 107,200 55,700 17,600 l io0.a 59.0 30.7 9.7 l 

Missing arms, legs, or extremities, including feet, toes, hands, or 

fingers ................................................................................................... 32,400 17,500 12,200 l 2,500 l 10o.a 53.9 37.5 l 7.7 l 

Diseases of the nervous system and sense organs: 

Blindness ................................................................................................. 

Glaucoma ................................................................................................ 

Cataracts.. ................................................................................................ 

Deafness .................................................................................................. 

Parkinson’s.diseasa .................................................................................... 

Paralysis or palsy, other than arthritis, unrelated to stroke.. .................... 

72,200 

34,000 

80,000 

90,400 

58,000 

46,500 

37,500 

11,500 

34,100 

37,100 

30,000 

29,000 

27,500 6,800 

16,100 6,200 

32,400 12,700 

40,600 12,200 

20,100 7,700 

11,800 5,700 

l 

l 

l 

l 

l 

100.0 

100.0 

10o.a 

100.0 

100.0 

1oo.c 

51.9 38.1 9.4 

33.8 47.4 18.2 

42.6 40.4 15.9 

41 .o 44.9 13.5 

51.8 34.6 13.2 

62.3 25.4 12.3 

l 

* 

l 

l 

l 

Accidents, poisonings, and violence: 

Hip fracture ............................................................................................. 108,800 58,000 40,700 9,600 l 100.0 53.3 37.4 8.8 i 

Other bone fracture ................................................................................. 46.300 24,600 15,700 5,700 x 1oo.c 53.2 34.0 12.4 l 

See footnotes at end of table. 
Table 13. Number and percent distribution of nursing home residents by level of care received during 7 days prior to survey date, according to selected health statuses: 

United States, 1977-Con. 

II Level of care received 

Selected health status1 Neither 

Personal nursing

IIInten- nor persive. I

Other care 

sonal care 

CHRONIC CONDITIONS OR IMPAIRMENTS4-Con. 

Other chronic conditions or impairments-Con, 

Endocrine, nutritional, and metabolic diseases: 

Diabetes ... .... .*...... .... .. .. ... *......... ... ...... .. .... ...... .. .**.*.... .. a......... .... ...... ..... .... 189,600 79,700 88,600 20,800 42.0 46.7 11.0 l 

Neoplesms: 

Cancer .... ..... .... .. ......... . ........ ..... .... ...... ... .... .. .... ....... ... .. .. ... ..... ....... ..... ... ... 63,600 32,300 24,700 6,400 50.8 38.8 10.0 l 

Diseases of the respiratory system: 

Chronic respiratory disease .... ... .... ..... ... .... ..... .. ........ .... .. ... .... .. ......... .... .... 86,500 41,700 33,400 11,200 48.3 38.6 12.9 l 

Diseases of the digestive system: 

Constipation .*a...... ..... ... ....... *.,......,,,,........... .... .. .. ... .. ... ..... ..... ....... .... ..... .. 313,200 160,000 120,500 32,400 51.1 38.5 10.4 . . * 

Diseases of the blood and blood-forming organs: 

Anemia .. ... ...... ...I .... ..... .... ....... .. ... ..... .... ... ...... .. .......... .. .. ... ....... ........ .... .... 70,600 35,000 31,200 4,300 49.5 44.1 6.1 l 

Diseases of the skin and subcutaneous tissue: 

Bedsores... .. ...... .......... .... ..... ...... ..... ..... .. .. .. ..... ......... ... .. ... ....... ...... ...... .... . 35,100 25,400 7,700 * 2,000 72.4 22.0 l 5.6 

Conditions other than above: 

Edema ........ ...... ...... ...... ... ....... .. .. ........ .. .... ...... .. ......... .. ... ... ... .... ........ .... ... 233,500 113,600 97,300 22,600 48.7 41.7 9.7 

Kidney trouble ..... .... .... .... .. .... ... ... ..... .... ... ... ........ ...... .. .... ..... ...... ..... ..... ... 131,700 77,800 42,400 11,500 59.1 32.2 8.7 

None of these conditions 

Total .... ......... **.*..a. .... ...... .....* ... ... .... ....... . *.. ..*... ..... ...... .... ..... .. ... .. .. 13,000 l 2,400 4,600 4,800 ‘18.2 35.3 37.0 I 

‘Disease group categories are based on E&hth Revision,International Clamiffcaffon of Diseases,Adapted for Usein the United States 

20nly diagnoses of sufficient magnitude are noted. 

31ncludes those who received no physician visit while in facility. 

(ICDA). 

4Figures may not add to totals because resident may have had more than one reported chronic condition or impairment. 
� 

Table 14. Number and percent distribution of nursing home residents by selected health services received, according to primary source 

of payment: United States, 1977 

Primary source of paymant 

Selected health service All 

Own 

income Medicare 

Medicaid Othar 

government All 

othar sources or family lnter- Skilled assistance or souriesl support mediate welfare 

Number 

I .303,100 500,900 26,200 260,700 362,600 83,400 69,200 

Time since last physician visit 

Lessthan 1 week ............................................................................ 268,500 94,000 10,300 65,500 69,300 16,000 13,400 

1 to lessthan 2 weeks . ... ... .. ...... .. ....... ... ....... ... ....... ......... .. .... .. .. .. ... . 219,000 76,800 5,800 56,200 57,000 10,800 ‘1 2.300 

2 weeks to less than 1 month .... .. .... .. ........ .. .. .... .. ... .... ... .... ... ... ...... .. 370,000 136,000 6,400 85,900 104,800 22,100.. 14,900 

1 to less than 3 months ...... ... ..... ... .. ....... ... ........ .. .. .. .. .. ... ... ... . ...... .... 291,100 117,700 ‘1 ,400 40,100 101,100 18,000 12,900 

3to less than 6 months .... .. ... . ... ... ... ....... ... ..... .. .... ....... ... ........ .. ....... 58,200 31,300 ‘2,800 14,700 4,900 4,500 * �

6 months to less than 1 year .. ... .... .... .. .... .... ...... .... ...... .. ...... .. .... .... .. 22,300 11,400 4,800 3,500 *1 ,300 

1 year or mOre . .... ...... ...... ....... ... .. .... .... .......... .... .. .... .. .. .... .. .... .. ...... . 17,500 8,9oO � ‘2,600 3.64)0 � ‘ 1,500 

No physician visits since entering facility . .. ... ....... ....... ... . ...... ... . .... 56,700 24,900 +2,100 6,500 7,100 7,600 8,400 

Time between last two physician visits 

Lessthan 1 week ............................~............................................... 83,000 27,900 6,300 19,600 16,800 3,900 6,500 

1 to lessthan 2 weeks ..................................................................... 89,000 33,200 ‘3,200 21,100 19,900 4,900 6,600 

2 weeks to lessthan 1 month ..................................................... ..... 367,400 129,500 5,000 107,300 92,300 18,700 14,500 

1 to kassthan 3 mOnths................................................................... 470,000 171,600 � 2,400 88,200 164,500 26,900 16,400 

3 to lassthan 6 months................................................................... 

6 months to lessthan 1 year ........................................................... 

61,200 

23,200 

32,500 

11,300 

4,100* 17,600 

6,300 

3,500 

‘3,200 

‘3,400 

“1 ,900 

1 year or more ................................................................................ 23,900 10,800 � 4,200 4,100 +3,1 00 � 

Has not received two physician visits since entering facility . ......... 128,800 59,200 6,700 9,100 32,000 11,700 10;200 

1,101,700 429,900 20,000 225,700 309,500 64,000 52,600 

188,600 68,800 4,900 40,500 48,700 12,600 13,100 

792,900 292,800 15,800 172,500 229,400 46,800 35,600 

243,700 64,000 6,800 55,000 70,400 14,500 13,000 

72,600 24,600 “2,800 17,900 18,700 ‘4,500 4,000 

Location of last physician visit4 

169,300 85,500 3,500 10,800 43,100 17,300 9,000 

,077,100 390,500 20,600 ?43,300 312,400 58,600 51,800 

Arrangement for physician sarvices4 

Physician on call ............................................................................. 169,000 92,400 � 1,600 6,500 41,600 16,600 10,200 

Ragularly scheduled physician visits ............................................... I,057,500 374,800 22,400 244,300 309,400 57,400 49,200 

Other arrangement2 ........................................................................ 19,900 8,800 + ‘3,300 4,400 “1,900 �I ,300 

Status of personal physician within facil ity4 

Private physician............................................................................. 827,000 347,400 17,000 152,800 228,900 47,000 34,000 

Physician assignadby or works for facility ..................................... 386,700 116,400 6,800 94,200 119,100 25,200 25,000 

Other status2 .................................................................................. 32,700 12,200 7,200 7,500 3,600 * 1,900 

Level of care receivad 

Nursing cara: 

lntensiva ..... .. .. .. ... ... .... ...... .. ..... ... . ... .... .. .. .. ... .... ... ........ .. .... ... ... ... 571,400 212,300 17,700 I 44,300 138,700 32,800 25,700 

Other ... ...... ... ..... ... ... ... ....... ....... ... .. ........ .... ... .......... ..... .. .. ..... ... .. 530,200 203,000 6,000 89,500 177,300 29,400 24,900 

Personal care . ... .... ...... ... ... .... ... ... .... ... ... .... ......... ... .. .... .. ...... .. .. .... .. ... 187,800 79,100 � 2,500 26,100 44,900 19,100 16,000 

Neither nursing nor personal care .. ... ....... ....... .. .. .. .... .. .. .... .... .. ... ..... 13,800 6,500 � *1 ,700 ‘2,1 00 ‘2,700 

See footnotes at end of tabie. 

72 
Table 14. Number and percent distribution of nursing home residents by selected health services received, according to primary source 

of payment: United States, 1977-Con. 

-

T Primary source of payment 

Own Selected health service All income 

sources or family 

support 

Therapy services Number 

No therapy service during last month2 ........................................... 647,100 329,800 11,100 151,100 245,700 61,000 48,300 

Therapy service during last month3.. .............................................. 456,000 171,100 15,100 109,600 116,900 22,400 20,900 

Physical therapy ........................................................................ 178,900 62,300 12,800 48,700 37,000 8,100 10,000 

Recreational therapy ................................................................. 

Occupational therapy ......... I.. ................................................... 

Speech therapy .......................................................................... 

Counseling by social worker ...................................................... 

Counseling by mental health worker.. ........................................ 

Reality orientation .................................................................... 

Other therapy services ............................................................... 

261,300 

76,700 

12,200 

91,400 

17,800 

86,500 

22,200 

99,300 

28,100 

3,700 

30,400 

4,800 

34,500 

9,200 

5,800 66,100 70,700 

3,600 17,700 19,000 l 3,900 l 2,500 

l 2,1 00 21,400 28,000 l +3,100 5,600 

‘2,200 I 21,200 21,700 

3,800 4,900 

11,400 

5,500 l 

4,800 

‘1,800 

3,600 

*1,600 

7,900 

l 2,800 l 

4,600 

l 1 ,900 

l 3,300 

l s,ooo 

Other health services 

Flu shot within last 12 months5: 

Received .................................................................................... 545,900 202,700 l 106,900 176,000 35,600 23,500 

Did not receive .......................................................................... 

Caught flu within last 9 months.. ............................................... 

282,700 

23,900 

97,800 

9,300 

+1,600 70,900 84,400 

l 3,000 8,000 

17,900 

*2,400 

10,100t 

Special diet within last 7 days: 

No special diet*. ........................................................................ 735,600 303,100 14,400 115,800 206,600 52,200 43,600 

Special diet3 .............................................................................. 567,500 197,800 11,800 144,900 156,000 31.300 25,700 

Low sodium.. ........................................................................ 185,100 69,200 5,000 46,400 47,600 8,600 8,300 

Diabetic ................................................................................ 163,200 54,400 ‘2,200 42,600 50,600 6,600 6,900 

Soft ...................................................................................... 103,600 35,900 “2,200 27,400 22,700 9,100 6,300 

Weight loss ............................................................................ 

Bland .................................................................................... 

40,400 

44,400 

11,500 

15,400 

l 10,300 14,500 l 12,400 11,300 

l 2,700 

l 3,400 

l 

l 

Other .................................................................................... 101,500 36,400 l 3,300 30,300 23,000 4,500 3,900 

Percent distribution 

Total.. ............................................................................. 100.0 100.0 100.0 100.0 100.0 100.0 100.0 

Time since last physician visit 

Lass than 1 week ............................................................................ 20.6 18.8 39.3 . 25.1 19.1 19.2 19.3 

t 1 to less than 2 weeks.. ................................................................... 16.8 15.3 22.3 21.6 15.7 12.9 17.8 

2 weeks to less than 1 month.. ........................................................ 28.4 27.1 24.2 32.9 28.9 26.5 21.6 

1 to less than 3 months.. ................................................................. 22.3 23.5 “5.2 15.4 27.9 21.6 18.6 

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

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

1 year or more.. .............................................................................. 

4.5 

1.7 

1.3 

6.3 

2.3 

1.8 

l 1.1 4.1

* l 1.3 I 11.0 1.0 

5.8 

4.2 c 

6.5 

l 1.8 

‘2.2 

No physician visits since entering facility*. ..................................... 4.4 5.0 ‘7.8 2.5 2.0 9.1 12.2 

Time between last two physician visits 

Less than 1 week ............................................................................ 6.4 5.6 24.1 7.5 5.2 4.7 9.4 

1 to less than 2 weeks.. ................................................................... 6.8 6.6 +‘I 2.3 8.1 5.5 5.9 9.5 

2 weeks to less than 1 month.. ........................................................ 28.2 25.8 19.3 41.2 25.5 22.4 21 .o 

1 to less than 3 months.. ................................................................. 36.1 34.3 c9.3 33.8 45.4 32.2 23.7 

3 to less than 6 months.. ................................................................. 4.7 6.5 1.6 4.9 4.2 ‘5.0 

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

1 year or more.. .............................................................................. 

1.8 

1.8 

2.3 

2.2 

t 1.7

* 1.6 1.1 

‘3.8 

l 3.7 

’ ‘2.8

* 

Has not received two physician visits since entering facility* .......... 9.9 11.8 25.5 3.5 8.8 14.0 14.8 

Services given at last visit3e4 

Examination ................................................................................... 84.5 85.8 76.3 66.6 85.3 76.7 76.0 

Treatment.. ..................................................................................... 14.5 13.7 18.6 15.5 13.4 15.1 18.9 

Prescription .................................................................................... 60.8 58.5 60.4 66.2 63.3 56.0 51.4 , 

Orders for lab tests.. ....................................................................... 18.7 16.8 25.8 21.1 19.4 17.4 18.8 

Other .............................................................................................. 5.6 4.9 l 1 0.8 6.9 5.2 5.4 5.8 

See footnotes at end of table. 

73 
Table 14. Number and percent distribution of nursing home residents by selected health services received, according to primary source 

of payment: United States, 1977-Con. 

Primary source of payment 

Selected health service own Medicaid Other All All income Medicare government 

sources or family Intersupport Skilled mediate 

Location of last physician visit4 Percent distribution 

Outside facility ............................................................................... 13s 17.1 13.5 4.1 11.9 20.7 13.0 

Inside facility2 ................................................................................ 82.7 77.9 78.6 93.3 86.1 70.2 74.8 

Arrangement for physician services4 

, 

Physician on call ............................................................................. 13.0 18.4 l 6.2 2.5 11.5 19.9 14.8 

Regularly scheduled physician visits.. ............................................. 81.1 74.8 85.4 93.7 85.3 68.7 71 .I 

Other arrangement*. ....................................................................... 1.5 1.8 l fl.3 1.2 *2.3 .I.9 

Status of personal physician within facility4 

Private physician.. ........................................................................... 63.5 69.4 65.0 58.6 63.1 56.3 49.1 

Physician assigned by or works for facility ..................................... 29.7 23.2 25.9 36.1 32.9 30.3 36.0 

Other status*. ................................................................................. 2.5 2.4 l 2.8 2.1 4.4 ‘2.7 

Level of care received 

Nursing care: 

Intensive.. .................................................................................. 43.8 42.4 67.4 55.3 38.3 39.3 37.1 

Other ......................................................................................... 40.7 40.5 22.9 34.3 48.9 35.3 35.9 

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

Neither nursing nor personal care ................................................... 

14.4 

1.1 

15.8 

1.3 

l 9.6 10.0

* 

12.4 

f0.5 

22.9 

“2.5 

23.1 

x3.9 

Therapy services 

No therapy service during lest month* ........................................... 65.0 65.8 42.5 58.0 67.8 73.1 69.8 

Therapy service during last month3.. .............................................. 35.0 34.2 57.5 42.0 32.2 26.9 30.2 

Physical therapy ........................................................................ 13.7 12.4 48.6 18.7 10.2 9.7 14.5 

Recreational therapy ................................................................. 20.0 19.8 22.0 25.4 19.5 13.7 11.4 

Occupational therapy ................................................................ 5.9 5.6 13.7 6.8 5.2 6.6 f4.0 

Speech therapy .......................................................................... 0.9 0.7 l 1.5 10.7 l x 

Counseling by social worker ...................................................... 

Counseling by mental health worker.. ........................................ 

7.0 

1.4 

6.1 

0.9 

l 8.1 8.2

* ‘1.2 

7.7 

1.6 

5.8 

l 2.2 

6.7 

l 2.7 

r 

Reality orientation .................................................................... 

Other therapy services ............................................................... 

6.6 

1.7 

6.9 

1.8 

l 8.5 8.1 

t 1.4 

6.0 

1.4 

4.3 

x1.9 

“4.7 

“2.8 { 

Other health services 

Flu shot within last 12 months? * Received .................................................................................... 41.9 40.5 41 .o 48.5 42.6 34.0 

Did not receive .......................................................................... 21 .J 19.5 l 6.1 27.2 23.3 21.5 14.5 

Caught flu within last 9 months.. ............................................... 1.8 1.9 l 1.1 2.2 *2.9 l 

Special diet within last 7 days: 

No special diet*. ........................................................................ 56.4 60.5 55.0 44.4 57.0 62.5 62.9 

Special diet”. ............................................................................. 43.6 39.5 45.0 55.6 43.0 37.5 37.1 

Low sodium.. ........................................................................ 14.2 13.8 19.3 17.8 13.1 10.3 11:9 

Diabetic.. .............................................................................. 12.5 10.9 “8.3 16.3 14.0 7.9 9.9 

Soft ...................................................................................... 7.9 7.2 ‘8.4 10.5 6.3 10.9 9.0

Weight I loss.. .......................................................................... 3.1 2.3 l 4.0 4.0 13.3 

Bland .................................................................................... 3.4 3.1 I 4.7 3.1 l 4.1 x 

Other.. .................................................................................. 7.8 7.3 l 12.4 11.6 6.4 5.4 5.6 

1Includes religious organizations, foundations, volunteer agencies, Veterans’ Administration contracts, initial payment-life care funds, other sources, and 

no charge. 

*Includes a small number of unknowns. 

3Figures do not add to totals because multiple responses were permitted.

4Excludes those who received no physician visit after entering facility.

5Excludes those who were in the facility less than 12 months. 

74 
Table 15. Number and percent distribution of nursing home residents by selected physician services received at last visit, according to 

selected health statuses: United States, 1977 

Time since last physician Services given at last visit3r4 visit 

No 

Selected health status1 Total LESS physician Orders 

than 1 month visits Examina- Treat- Prescrip for lab Other 

1 month or more since tion “lent tion tests entering 

facility2 

Total . . . . .._.......................................... 1.303.100 857,500 389,000 56,700 1 ,101,700 188,600 792,900 243.7OC 72,600 

PRIMARY DIAGNOSIS AT LAST 

EXAMINATION 

Diseases of the circulatory system 

Total.. ............................................................... 516,800 356,200 160,600 466,000 78,200 337,400 102,600 28,100 

Congestive heart failure.. .................................................. 52,800 35,800 17.000 47,300 8,700 34,900 13,200 4,300 

Arteriosclerosis ................................................................. 264,400 180,500 83,900 240,700 36,700 171,800 46,200 12,500 

Hypertension.. .................................................................. 47,700 30,300 17,400 43,400 6,500 30,100 10,800 3,800 

103,500 76,000 27,500 91,600 14,800 67,300 21,300 4,600 

Heart attack, ischemic heart disease ................................. 

Other.. .............................................................................. 

22,500 

25,800 

15,000 

18,600 

7,500 

7,200 

21,400 

21,700 

5,600 

6,000 

14,800 

18,400 

5,600 

5,500 

l 

l 1,900 

Mental disorders and senility without psychosis 

Total.. ............................................................... 266.100 182.600 83.500 227,900 27,800 164,000 33,800 11,100 

Senile psychosis.. .............................................................. 21,200 14,000 7,200 19,100 l 2,300 15,100 3,800 l 

Other.psychosis.. .............................................................. 57,400 41,400 15,900 44,800 l 3,1 00 38,600 6,200 ‘3,100 

Chronic brain syndrome.. ................................................. 96,400 69,800 26,600 86,800 12,600 60,400 12,800 4,600 

Senility without psychosis.. .............................................. 26,600 17.200 9,500 22,200 3,500 12,400 ‘3,300 l 

Mental retardation.. .......................................................... 42,400 25,900 16,600 35,100 3,700 21,600 4,900 l 

Alcoholism and other mental disorders ............................ 22,100 14.400 7,800 19,900 ‘2,600 15,900 ‘2,900 l 1,400 

Other diagnoses5 

Total.. ............................................................... 429,700 297,800 131,900 378,500 78,600 272,400 99,400 30,800 

Diseases of the musculoskeletal system and 

connective tissues: 

Arthritis and rheumatism.. .......................................... 56,200 32,700 23,600 61,200 6,700 37,100 8,800 ‘2,600 

Diseases of the nervous system and sense organs: 

Parkinson’s disease ...................................................... 23,300 16,700 6,700 20,700 ‘1,800 13,900 5,700 l 

Accidents, poisonings, and violence: 

Hip fracture ................................................................. 29,300 22,700 6,600 25,500 4,300 15,300 4,200 ‘2,800 

Other bane fracture.. ................................................... 10,600 7,400 ‘3,200 9,100 4,000 4,700 l 2,1 00 ‘2,100 

Endocrine, nutritional, and metabolic diseases: 

Diabetes ...................................................................... 71,700 50,600 21,100 63.100 9,500 47,900 32,700 *3,200 

Neoplasms: 

cancer ......................................................................... 28,900 22,500 6,400 24,700 6,500 19,000 7,300 l 1,800 

Diseases of the respiratory system.. .................................. 31,000 21,900 9,200 28,000 5,500 21,200 6,600 l 1 ,700 

Diagnosis unknown6 

Total ................................................................. 90,500 20.800 12,900 56,700 29,300 4,000 19,100 7,800 l 2,500 

CHRONIC CONDITIONS OR IMPAIRMENTS’ 

Diseases of the circulatory system 

Arterlosclerosls.. ............................................................... 620,200 415,900 183,100 21,200 540,900 96,200 395,700 123,700 35,000 

Hypertension.. .................................................................. 272,900 180,000 82,500 10,500 234,600 44,400 174,800 65,400 16,900 

Stroke .............................................................................. 214,000 149,100 58,100 6,800 185,400 33,400 137,400 44.700 11,100 

Paralysis or palsy, other than arthritis, related 

to stroke.. ...................................................................... 80,800 55,900 21,500 l 3,400 70,000 12,900 52,600 17,600 4,500 

Heart trouble.. .................................................................. 449,000 300,600 132,400 16,000 389,900 76,000 292,300 98,100 26,500 

See footnotes at end of table. 

75 
Table 15. Number and percent distribution ,of nursing home residents by selected physician services received at last visit, according to 

selected health statuses: United States, 1977~Con. 

Location of last ” Arrangement for physician 

physicianVisit services4 

Selected health status1 

Outside Inside 

facility facility’ 

Number 

169,300 1,077,100 169,000 ,057,500 

PRIMARY DIAGNOSIS AT LAST 

EXAMINATION 

Diseases of the circulatory system 

Total.. ............................................................................................................................. 67,700 469,100 60,700 449,400 

Congestive heart failure.. ................................................................................................................ 6,100 46,700 7,700 44,500 

Arteriosclerosis.. ............................................................................................................................ : 26,100 238,300 27,300 233,200 

Hvoertension.. ................................................................................................................................ 

Heart attack, ischemic heart disease . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Other . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...................... 

Mental disorders and Denilitv without rwchosis 

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

Senile psychosis.. ............................................................................................................................ 

Other psychosis .............................................................................................................................. 

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

Senility without psychosis .............................................................................................................. 

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

Alcoholism and other mental disorders.. ........................................................................................ 

Other diagnoses5 

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

Diseases of the muruloskelatal system and 

connective tissues: 

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

Diseases of the nervous System and sense organs: 

Parkinson’s disease .................................................................................................................... 

Accidents, poisonings, and violence: 

Hip fracture.. ............................................................................................................................. 

Other bone fracture.. ................................................................................................................. 

Endocrine, nutritional, and metabolic diseases: 

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

Neoplasms: 

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

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

Diagnosis unknown6 

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

CHRONIC CONDITIONS OR IMPAIRMENTS’ 

Diseases of the circulatory system 

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

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

Paralysis or palsy, other than arthritis, related 

to stroke . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . ............. 

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

See footnotes at end of table. 

6,700 39,000 7,300 39,400 

9,700 93,900 10.300 92,600 

3,700 18,900 l 2,700 19,600 

3,500 22.400 5,400 20,100 

31,600 234,400 33,300 228,300 

l 7,4DO 19,800 ‘2.800 18,300 

7,600 49,800 8.100 48,700 

8,100 88,300 9;700 84,900 

l 3,300 23,300 : 3,500 22,400 

6,900 36,600 6,900 35,600 

4,600 17,600 : l 3,400 18,400 

70,600 359,100 67.800 354.600 

6,900 47,300 9,800 45,700 

l 2,900 20,400 l 2,1 00 20.800 

4,800 24,400 5,100 23,600 

2,100 8,600 ‘1,800 8,900 

8,400 63,300 . 7,900 63,600 

6,300 23,600 l 2,400 25,900 

6,000 2$,100 6,500 24,900 

9,200 24,500 7,100 25,200 

68,200 530,800 75,100 516,400 

39,200 223,200 35,600 222,80(1 

21,700 165,500 24,700 180,800 

7,300 70,100 7,500 69.4OC 

58,100 374,900 60,900 365.20(1 

19,900 

6,600 

l 

3,900 

l 

l 

I) 

I 

4,500 

l 

I 

‘1,800 l 

1 

l 

7.400 

l 

l 

l 

I 

x 

. 

l 1 .400 

7,500 

4,000 

l 1,700 

l 

6,900 

76 
Table 15. Number and percent distribution of nursing home residents by selected physician services received at last yisit, according to 

selected health statuses: United States, 1977-Con. 

Time since last physician Services given at last visit3*4 visit 

I NO 

Selected health status’ Total physician LeSS 1 month visits Examina­ than 

1 month or more since tion 

entering 

facility* 

CHRONIC CONDITIONS OR 

IMPAIRMENTS’-Co”. 

Mental disorders and senility withotit psychosis 

Mental illness......... .. .. .. ...._................................................ 148,300 101,200 44,200 ‘2,900 122,400 16,100 93,100 22,lOC 8,100 

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

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

Mental retardation _........................................................... 

324,700 

416,400 

79,800 

228,800 

268,200 

49,500 

87,200 

132,600 

27,600 

8,600 

15,600 

'2,700 

286,800 

360,200 

64,900 

50,000 

64.000 

10,100 

211,500 

280,900 

42.800 

59.6OG 

75.5oc 

11.7oc 

15,100 

21,800 

l 3,000 

Alcoholism ................ ........... .. .......................................... 

Drug addiction ......._......................................................... 

36,900 

3,700 

23,900 

l 2,800 

11,100 . '2,000 l 

31,900 

'2,900 

6,800 l 23,500 

l 2,600 

8,300 . '2.800 . 

125,500 85,700 34,700 5.100 105,100 19.400 80,300 23,000 9,200 

Other chronic conditions or impairments 

Diseasesof the musculoskeletal system and 

connective tissues: 

Arthritis and rheumatism .......................... .. ................ 320,500 208,100 99,300 13.100 273,600 49,500 206,600 62,400 19,200 

Chronic back/spine problems. excluding stiffness 

and deform& .... .I............. ............... .I...................... 60,500 40.700 17,200 l 2,600 52,900 11,500 40,000 10.4oc 3,900

Permanent stiffness or deformity of back, arms. 

legs, or extremities, including feet, toes, hands, 

or fingers .................................................................. 181,500 120,000 55,000 6,500 156,000 30,100 123,000 35.1 oa 14,300

Missing arms. legs, or extremities, including feet, 

Diseases of the newus system and sense organs: 

Blindness ..................................................................... 

Glaucoma.. .................................................................. 

cataracts ..................................................................... 

Deafness.. .................................................................... 

Parkinson’s disease ...................................................... 

72,200 

34,000 

80,000 

90,400 

58,000 

48,900 

21,300 

51,200 

58,100 

39,300 

20,300 

11,300 

25,700 

28,900 

15,600 

l 3,1 00 

‘1,500 

l 3,1 00 

l 3,400 

‘3,100 

62,100 

29,400 

68,500 

76,300 

48,500 

11,700 

4,400 

12,400 

13,000 

6,300 

44,800 

20,300 

49,400 

57,600 

35,200 

13,500 

5,600 

16,500 

16,200 

13,500 

'3,400 

l 2,200 

5,500 

5,700

"2.500 

Paralysis or palsy, other than arthritis, unrelated 

to stroke ................................................................... 46,500 35,000 10,100 '1,400 39,300 10,500 31,400 7,500 '2,600 

Accidents, poisonings, and violence: . 

Hip fracture ................................................................. 

Other bone fracture.. ................................................... 

108,800 

46,300 

74,200 

29.100 

30,400 

14,500 

4,100 

l 2,600 

92,800 

39,200 

17.100 

9.900 

69,800 

26,700 

22,100 

7,800 

8,300 

4,900 

Endocrine, nutritional, and metabolic diseases: 

Diabetes ...................................................................... 189,600 131,200 50,900 7,500 161,800 29,800 123,200 68,200 11,700 ' 

Neoplasms: 

Cancer ......................................................................... 63,600 45,700 15,700 92,200 52,800 12,100 40,500 14,100 l 3,200 

Diseasesof the respiratory system: 

Chronic respiratory disease.......................................... 86,500 60,300 23,100 *.3,100 75,900 17,100 56,600 20,000 5,900 

Diseasesof the digestive synem: 

.Constipation ................................................................ 313,200 217,000 85,300 10,900 268,300 49,800 266,300 59,900 20,100 

Diseases of the blood and blood-forming organs: 

Anemia ................... ........... .. .................. .................. .. .. 70,600 50,800 18.300 l 1 ,400 58,300 13,400 51,600 i 9,200 4,900 

Diseasesof the skin and subcutaneous tissue: ’ 

Bedsores ...... .............................................. ....... .. ......... 35,100 26,000 6,900 '2,200 28.500 8,700 24,600 6,400 '2,300 

toes, hands, or fingers.. ............................................. 32,400 22,300 9,100 l 27,500 8,300 20,300 7,500 '2,300 

Conditions other than above: 

Edema ..... ........ ......_..................................................... 233,500 149,800 76,000 7,700 200,100 40,200 157,500 80,200 14,500 

Kidney trouble ........... ............... ................ ........... ....... 131,700 90,200 37,100 4,400 115,200 23,400 88,700 32,900 6.300 

None of these conditions 

L 13,000 4,900 4,200 4,000 7,900 '1,500 5,200 l 1,300 . 

See footnotes at end of table. 

77 

1 
Table 15. Number and percent distribution of nursing home residents by selected physician services received at last visit, according to 

selected health statuses: United States, 1977-Con. 

Location of last Arrangement for physician 

physician visit4 services4 

I 

Selected health status] Regularly 

Physician scheduled Other 

on call physician arrangement” 

visits 

CHRONIC CONDITIONS OR 

IMPAIRMENTS’-Con. Numb& 

Mental disorders and Senilifv without psvchosis 

Mental illness.. ................................................................................................................................ 22,500 122.9oc 22,500 121,300 l 1,600 

Chronic brain syndrome.. ............................................................................................................... 25,000 291 ,ooc 32,700 278,200 5,200 

Senility ........................................................................................................................................... 45,000 355,9oc 55,700 340,300 4,900 

Mental retardation.. ........................................................................................................................ 12,000 65.1 OC J 1,800 63,700 *1,500 l Alcoholism ..................................................................................................................................... 5,900 29,ooc 3,700 30,200 

Drug addiction ............................................................................................................................... l l z,aoa (I l 2,700 

Insomnia ........................................................................................................................................ 14,600 105.8OC 14,700 104,200 * 1,500 

Other chronic conditions or impairments 

Diseases of the musculoskeletal system and 

connective tissues: 

Arthritis and rheumatism . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43,500 263.9OC 46,600 256,300 4,500 

Chronic back/spine problems, excluding stiffness 

and deformity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 7,400 50,500 7,100 49,900 I 

Permanent stiffness or deformity of back, arms, 

legs, or extremities, including feet, toes, hands, 

or fingers . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. .. . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . ........ 15,700 159,300 21,000 151,800 *2,200 

Missing arms, legs, or extremities, including feet, 

toes, hands, or fingers .. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,400 27,000 4,900 26,500 

Diseases of the nervous system and sense organs: I

Blindness . . . . . . . . . . . . . . . .._................................................................................................................. 7,200 62,OOC 6,800 61,800 l

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......... 5,100 27,400 4,400 28,000 I

cataracts .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........... 12,100 64,800 9,800 66,400 l

12,100 74,900 12,500 73,700 x

Parkinson’s disease .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . 7,200 47,7oc 5,000 49,300 

Paralysis or palsy, other than arthritis, unrelated I

to stroke . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . ......... 4,300 40,800 4,800 39,300 

Accidents, poisonings, and violence: l

13,300 91.3oc 15,000 88,400 

Other bone fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . 4,700 38,900 5,300 37,900 

Endocrine, nutritional, and metabolic diseases: 

Diabetes .,....................,................,............................................................................................ 21,400 160,600 23,000 157,300 l 1,800 

Neoplasms: 

Ctl”CW . . . . . . . . . . . .. . . .. .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............... 10,000 51.4oc 6,500 53,600 l 1,400 

Diseases of the respiratory system: * Chronic respiratory disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . 10,100 73.3oc 10,200 72.100 

Diseases of the digestive system: 

Constipation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .. . . . . . ...... 32,400 269,800 33,800 264,800 3,600 

Diseases of the blood and blood-forming organs: l 

l 

7,000 62,200 7,800 60,300 

Diseases of the skin and subcutaneous tissue: 

Bedsores .. . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . ............ ‘2,100 30.800 l 2,200 30,200 l 

Conditions other than above: 

Edema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............... 27,500 198,200 32,900 189,800 l 3,100 

Kidney trouble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 17,300 110.00c 16,400 109,900 l 

None of these conditions 

3.600 5,500 1‘2,300 5,900 

See footnotes at end of table. 

78 

I 
Table 15. Number and percent distribution of nursing home residents by selected physician services received at last visit, according to 

selected health statuses: United States, 1977-Con. 

II Time since last physician Services given at last visit3v4 visit I

I 

II NO I I Selected health status1 Total Less physician Orders 

than 1 month visits Examina- Treat- Prescrip- for lab 

1 month Or more since tion n-lent tion tests entering 

facility2 

INDEX OF DEPENDENCY IN ACTIVITIES 

OF DAILY LIVINGa 

Independent in bathing, dressing, using toilet room, 

mobility, continence, and eating ..,............,.............: .,... 124,500 64,000 46,300 14,200 92,500 14,700 62,500 19,400 6,800 

Dependent in only one activity .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161,000 97,200 56,300 7,500 134,400 18,900 89,400 27,900 8,300 

Dependent in bathing and one other activity . . . . . . . . . . .._....... 158,900 101,300 51,100 6,600 130,900 20,100 93,200 29,800 8,300 

Dependent in bathing, dressing, and one other . actlvlty . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110,400 72,100 34,500 3,800 96,100 17.600 68,800 21,700 7,900 

Dependent in bathing, dressing, using toilet room, 

and one other activity . . . . . . . . . . . . .._.................................... 125,000 86,900 33,700 4,500 105,700 21 ,100 76,800 23,200 8,100 

Dependent in bathing, dressing, using toilet room, 

mobility, and one other activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203,600 138,900 56,700 8,000 175,300 29,400 126,20d 39,100 12,700 

Dependent in all six activities . . . . . . .._........_......................... 303,300 216,900 78,000 8,400 265,500 49,100 198,700 59,900 15,100 

Other9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116,400 80,000 32,600 3,800 101,200 17,700 77,300 22,700 5,300 

Percent distribution 

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 65.8 29.8 4.4 84.5 14.5 60.8 18.7 5.6 

PRIMARY DIAGNOSIS AT LAST 

EXAMINATION 

Diseases of the circulatory system 

Total. ................................................................ 100.0 68.9 31 .l 90.2 15.1 65.3 19.9 5.4 

Congestive heart failure .................................................... 100.0 67.8 32.2 89.5 16.4 66.0 25.1 8.2 

Arteriosclerosis.. ............................................................... 100.0 68.3 31.7 91.0 13.9 65.0 17.5 4.7 

Hypertension. ................................................................... 100.0 63.6 36.4 91 .o 13.5 63.2 22.8 8.0 

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

Heart attack, ischemic heart disease ................................. 

100.0 

100.0 

73.4 

66.6 

26.6 

33.4 

88.5 

94.8 

14.3 

24.7 

65.0 

65.7 

20.6 

24.8 

4.4I 

Other.. .............................................................................. 100.0 72.1 27.9 84.0 23.2 71.3 21.3 ‘7.3 

Mental disorders and senility without psychosis 

100.0 68.6 31.4 85.6 10.4 61.6 12.7 4.2 

Senile psychosis ................................................................ 100.0 66.1 33.9 90.0 l 11.0 71.4 17.8 I 

Other psychosis.. .............................................................. 100.0 72.2 27.8 78.1 ‘5.4 67.3 10.7 l 5.5 

Chronic brain syndrome.. ................................................. 100.0 72.4 27.6 90.1 13.0 62.7 13.3 4.7 

Senility without psychosis.. .............................................. 100.0 64.4 35.6 83.4 13.0 46.5 l 12.3 l 

Mental * retardation.. .......................................................... 100.0 60.9 39.1 82.7 8.7 50.9 11.6 

Alcoholism and other mental disorders.. .......................... 100.0 64.9 35.1 89.7 l l 1.8 71.8 l 13.1 l 6.2 

Other diaanosas5 

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 69.3 30.7 88.1 18.3 63.4 23.1 7.2 

Diseases of the musculoskeletal system and 

connective tissues: 

Arthritis and rheumatism . . . . . . .._................................... 100.0 58.1 41.9 91.0 12.0 66.0 15.6 ‘4.7 

Diseases of the nervous system and sense organs: 

Parkinson’s disease . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 71.4 28.6 88.6 l 7.9 59.6 24.3 l 

Accidents, poisonings, andviolence: 

Hip fracture . . . . . . . . , . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 77.5 22.5 87.0 14.6 52.1 14.5 ‘9.4 

Other bone fracture . . .._................................................ 100.0 69.7 ‘30.3 85.9 37.1 44.1 l 19.4 l 19.5 

Endocrine, nutritional, and metabolic diseases: 

Diabetes . . .. . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 70.6 29.4 88.0 13.3 66.8 45.6 ‘4.5 

See footnotes at end of table. 

79 
Table 15. Number and percent distribution of nursing home residents by selected physician services received at last visit, according’to 

selected health statuses: United States, 1977-Con. 

Location of last Arrangement for physician 

physician visit4 I services” 

Selected health status] Regularly 

Outside Inside Physician scheduled Other 

facility facility2 on call physician arrangement2 

visits 

INDEX OF DEPENDENCY IN ACTIVITIES 

OF DAILY LIVING* 

Independent in bathing, dressing, using toilet room. 

mobility, continence, and eating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29,500 80,800 24,300 83,500 l 2,500 

Dependent in only one activity ,............,............................................,............,............,.,........,.,..... 36,300 117,300 25,900 124,300 l 3,300 

Dependent in bathing and one other activity . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . 27,100 125.200 24,200 125,600 “2.500 

Dependent in bathing, dressing, and one other 

activity . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . ................ 15,700 90,900 14,200 91,400 l 

Dependent in bathing, dressing, using toilet room, 

and one other activity ..,.........................................................................................,..........,.......... 11,900 108,600 15,800 103,200 l l ,600 

Dependent in bathing, dressing, using toilet room, 

mobility, and one other activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 17,900 177,700 21,300 171,000 ‘3,200 

Dependent in all six activities . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . .. . . . . . . . . . . . . . . . .. . . . . . . . . . . . .. . . . . . . . . . .. . . .. . . . . . . . . . . . . . . . . . 16,300 278,600 29,900 261,300 3,700 

Other9 .. . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . .. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................... 14,500 98,100 13,300 97,200 l 2,1 00 

Percent distribution 

13.0 82.7 13.0 81 .l 1.5 

PRIMARY DIAGNOSIS AT LAST 

EXAMINATION 

Diseases of the circulatory system 

11.2 88.8 11.8 87.0 1.3 

Congestive heart failure .................................................................................................................. 11.6 88.4 14.6 84.2 l 

Arteriosclerosis.. ............................................................................................................................. 9.9 90.1 10.3 88.2 1.5 

Hvoartension.. ................................................................................................................................ 18.2 81.8 15.3 82.6 ” 

9.3 90.7 9.9 89.5 t Heart attack, ischemic heart disease ............................................................................................... 16.2 83.8 “12.0 87.2, l 

Other.. ............................................................................................................................................ 13.5 86.5 21 .o 77.7 x 

Mental disorders and senility without psychosis 

Total.. ............................................................................................................................ 11.9 88.1 ‘12.5 85.8 1.7. 1, 

Senile psychosis ............. .A. ........................................................................................................... l 6.6 93.4 ‘13.1 86.3 l 

Other psychosis.. ............................................................................................................................ 13.0 87.0 14.2 84.8 l 

Chronic brain syndrome.. ............................................................................................................... a.4 91.6 10.1 88.0 ‘1.9 

Senility without psychosis.. ............................................................................................................ l l 2.5 87.5 13.1 84.2 l 

Mental retardation.. ........................................................................................................................ 16.3 83.7 13.8 84.0 

Alcoholism and other mental disorders .......................................................................................... 20.7 79.3 15.2 83.3 I 

Other diagnoses5 

Total.. .................................................................................................................................. 16.4 83.6 15.8 82.5 1.7 

Diseases of the musculoskeletal system and 

connective tissues: 

Arthritis and rheumatism .......................................................................................................... 15.9 84.1 17.3 81.3 l 

Diseases of the nervous system and sense organs: 

Parkinson’s disease .................................................................................................................... l 12.6 87.4 ‘9.2 89.1 l 

Accidents, poisonings, and violence: 

Hip fracture ............................................................................................................................... 16.5 83.5 17.3 80.6 l 

Other bone fracture.. ................................................................................................................. 19.5 80.5 ‘16.7 83.3 

Endocrine, nutritional, and metabolic diseasas: 

Diabetes .................................................................................................................................... 11.8 88.2 11.1 88.5 I 

See footnotes at end of table. 

x 

80 
Table 15. Number and percent distribution of nursing home residents by selected physician services received at last visit, according to 

selected health statuses: United States, 1977-Con. 

II Time since last physician Services given at lastvisit3m4 I 

NO 

Selected health status1 physician -LOrders visits Prescrip- for lab Other since tion tens entering 

facility2 

PRIMARY DIAGNOSIS AT LAST 

.EXAMINATION-Con. Percent distribution 

Other diagnos&-Con. 

Neoplasms: 

cancer ......................................................................... 100.0 77.9 22.1 85.6 22.4 66.0 25.2 l 6.2 

Diseases of the respiratory system.. .................................. 100.0 70.5 29.5 90.3 17.7 68.3 21.4 l 5.4 

Diagnosis unknown6 

Total.. ............................................................... 100.0 23.0 14.3 62.7 32.3 4.4 21.1 8.6 ‘2.8 

CHRONIC CONDITIONS OR IMPAIRMENTS’ 

Diseases of the circulatory system 

Arteriosclerosis.. ............................................................... 100.0 67.1 29.5 3.4 87.2 15.5 63.8 19.9 l 5.6 

Hypertension.. .................................................................. 100.0 65.9 30.2 3.8 85.9 16.3 23.9 6.2 

Stroke .............................................................................. 100.0 69.7 27.2 3.2 86.6 15.6 2: 20.9 5.2 

Paralysis or palsy, other than arthritis, related 

to stroke.. ...................................................................... 100.0 69.1 26.6 ‘4.2 86.6 i-5.9 65.0 21.8 5.5 

Heart trouble.. .................................................................. 100.0 669 29.5 3.6 86.8 16.9 65.1 21.9 5.9 

Mental disorders and senility without psychosis 

Mental illness .................................................................... 100.0 68.2 29.8 c2.0 82.5 10.9 62.8 - 14.9 5.4 

Chronic brain syndrome ................................................... 100.0 70.5 26.9 2.7 88.3 15.4 65.1 18.4 4.6 

Senility ............................................................................. 100.0 64.4 31.8 3.7 86.5 15.4 62.7 18.1 5.2 

Mental retardation ............................................................ 100.0 62.0 34.5 l 3.4 81.3 12.6 53.6 14.7 3.8 

Alcoholism ....................................................................... 100.0 64.7 29.9 ‘5.4 86.5 18.5 63.8 22.5 7.5 

Drug addiction ................................................................. 100.0 ‘76.3 l l ‘78.8 l l 72.5 l l 

Insomnia .......................................................................... 100.0 68.3 27.6 4.1 83.7 15.4 64.0 18.3 7.3 

Other chronic conditions or impairments 

Diseases of the musculoskeletal system and 

connective tissues: 

Arthritis and rheumatism ............................................ 100.0 64.9 31 .o 4.1 85.4 15.4 64.5 19.5 6.0 

Chronic back/spine problems, excluding stiffness 

and deformity .......................................................... 100.0 67.3 28.4 c4.3 87.4 19.0 66.1 17.1 6.4 

Permanent stiffness or deformity of back, arms, 

legs, or extremities, including feet, toes, hands, 

or fingers.. ................................................................ 100.0 66.1 30.3 3.6 85.9 16.6 67.8 19.3 7.9 

Missing arms. legs, or extremities, including feet, 

ioes, hands, or fingers.. ............................................. 100.0 68.7 28.2 l 84.8 25.5 62.7 23.3 ‘7.0 

Diseases of the nervous system and sense organs: 

Blindness ..................................................................... 100.0 67.7 28.1 l 4.2 86.0 16.2 62.0 18.7 l 4.8 

Glaucoma .................................................................... 100.0 .62.6 33.2 l 4.3 86.3 13.0 59.6 16.5 ‘6.6 

cetaacts ..................................................................... 100.0 64.0 32.1 l 3.9 85.6 15.5 61.8 20.6 

Deafness.. .................................................................... 100.0 64.3 31.9 ‘3.8 84.4 14.3 63.8 17.9 i:: 

Parkinson’s disease ...................................................... 100.0 * 67.8 26.8 ‘5.4 83.5 10.8 60.6 23.3 l 4.2 

Paralysisor palsy, other than arthritis, unrelated 

to stroke.. ................................................................. 100.0 75.4 21.6 l 3.0 84.6 22.7 67.5 16.1 ‘5.5 

Accidents, poisonings, and violence: 

Hip fracture.. ............................................................... 100.0 68.3 28.0 3.8 85.3 15.7 64.2 20.4 7.6 

Other bone fracture.. ................................................... 100.0 62.9 31.4 95.7 84.7 21.3 57.6 16.9 l-O.5 

Endocrine, nutritional, and metabolic diseases: 

Diabetes ...................................................................... 100.0 69.2 26.8 4.0 85.3 15.7 65.0 36.0 6.2 

See footnotes at end of table. 

81 -
Table 15. Number and percent distribution of nursing home residents by selected physician services received at last visit, according to 

selected health statuses: United States, 1977-Con. 

-

T Loo;oF 1 Arrangem;Wtf;physician 

Selected health status1 Regularly 

Outside Inside Physician scheduled 

facility facility2 on call physician 

PRIMARY DIAGNOSIS AT LAST 

EXAMINATION-Con. 

Other diagnoses5-Con. 

Neoplasms: 

cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............... 

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

Diagnosis unknown6 

CHRONIC CONDITIONS OR IMPAIRMENTS’ 

Diseases of the circulatory system 

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

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

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

Paralysis or palsy. other than arthritis, related 

Mental disorders and senility without psychosis 

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

Chronic brain svndroma ................................................................................................................. 

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

Alcoholism.. ................................................................................................................................... 

Drug addiction ............................................................................................................................... 

Insomnia ........................................................................................................................................ 

Other chronic conditions or impairments 

Diseases of the muxuloskeletal system and 

connective tissues: 

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

Chronic back/spine problems, excluding stiffness 

and deformity ,,.................................................................................,.................................... 

Permanent stiffness or deformity of back, arms, 

legs, or extremities, including feet, toes, hands, 

or fingers . . . . . . . . . . . . . . . . . .. ..,.....................: . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Missing arms, legs, or extremities, including feet, 

toes, hands, or fingers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . 

Diseases of the nervous system and sense organs: 

Blindness .. . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . ........... 

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .......... 

Cataracts . . . . . . . . . . . . . . .._._................................................................................................................ 

Parkinson’s disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Paralysis or palsy, other than arthritis, unrelated 

to stroke . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... 

Accidents, poisonings, and violenca: 

Hip fracture . . . . . . . . . . . . .. .. .. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....... 

Other bone fracture .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . 

Endocrine, nutritional, and metabolic diseases: 

See footnotes at end of table. 

visits 

I I 

Percent distribution 

1 a.4 81 .E ‘8.2 89.7 

16.0 84.C 17.9 80.2 

10.2 27.1 7.9 27.9 

11.0 85.6 12.1 83.3 

14.4 81 .E 13.1 81.6 

10.2 86.7 11.5 84.5 

9.0 86.i 9.3 85.8 

12.9 83.E 13.6 81.3 

15.2 82.9 15.2 81.8 

7.7 89.E 10.1 85.7 

10.8 85.E 13.4 81 .J 

15.0 81 .E 14.8 79.9 

16.0 78.6 9.9 81.9 l l ‘76.6 l ?3.6 

11.7 84.3 11 .J 83.0 

13.6 82.3 14.5 80.0 

12.3 83.4 11.8 82.5 

8.6 87.8 11.6 83.6 

13.6 83.3 15.1 81 .J 

10.0 85.8 9.3 85.5 

15.1 80.6 13.0 82.4 

15.1 81 !I 12.2 83.0 

13.4 82.E 13.8 81.5 

12.3 82.3 8.7 84.9 

9.2 87.0 10.4 94.5 

12.3 84.0 13.8 81.3 

10.2 94.1 11.5 81.8 

11.3 84.7 12.1 83.0 

Other 

arrangement2 

l 

x 

l 1.6 

1.2 

1.5 

l 0.8 

l 

1.5 

Il.1 

1.6 

1.2 

f1.9 

‘2.9 

“1.2 

1 .h 

l 

‘1.2 

l 

l 

l 0.9 

82 
Table 15. Number and percent distribution of nursing home residents by selected physician services received at last visit, according to 

selected health statuses: United States, 1977-Con. 

-

Time since lest physician 

visit T Services given et lest visit3v4 

I No 

Selected health status1 Total LeSS physician Orders 

for lab Other 

tests 

22.1 ‘5.0 

23.1 ‘6.8 

19.1 6.4 

27.2 6.9 

18.2 ‘6.4 

21.5 6.2 

25.0 4.8 

l 9.6 l 

15.6 5.5 

17.3 5.2 

18.7 5.2 

19.7 7.2 

18.6 6.5 

19.2 6.2 

19.7 5.0 

19.5 4.5 

than 1 month visits ExaminaI month or more since tion 

entering 

Prescription 

facility’ 

L 

Percent distribution 

71.8 24.7 l 3.5 83.C 

69.7 26.7 l 3.6 87.i 

69.3 27.2 3.5 85.i 

72.0 26.0 02.0 826 

74.1 19.6 l 6.4 81.3 

64.1 32.5 3.3 85.7 

68.5 28.2 3.3 87.5 

I 

63.7 

65.5 

65.9 

73.0 

70.0 

67.5 

67.4 

39.7 

50.2 

55.5 

58.7 

62.3 

61.4 

62.0 

65.5 

66.4 

CHRONIC CONDITIONS OR 

IMPAIRMENTS’-Con. 

Other chronic conditions or impairments-Con. 

Neoplasms: 

cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . 

Diseases of the respiratory system: 

Chronic respiratory disease . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . .. . . . 

Diseases of the digestive system: 

Constipation .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,. . . . . . . . 

Diseases of the blood and blood-forming organs: 

Anemia ,......................,................................................ 

Diseases of the skin and subcuteneous tissue: 

Bedsores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Conditions other than above: 

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

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

None of these conditions 

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

INDEX OF DEPENDENCY IN ACTIVITIES 

OF DAILY LIVING” 

Independent in bathing, dressing, using toilet room, 

mobility, continence, and eating . . . . . .._............................ 

Dependent in only one activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Dependent in bathing and one other activity . . . . . . . . . . . . . . . . . . . . 

Dependent in bathing, dressing, and one other 

activity . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Dependent in bathing, dressing, using toilet room, 

and one other activity .,.............................................,.... 

Dependent in bathing. dressing. usina toilet room. 

mobility, and one other acti&y ... . .................. .: ........... 

Dependent in all six activities.. ......................................... 

Otherg.. ............................................................................ 

See footnotes at end of table. 

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 

18.9 

19.8 

15.9 

19.0 

24.8 

17.2 

17.8 

37.4 32.0 30.6 60.4 911.4 

51.5 37.2 11.4 74.4 11.9 

60.4 35.0 4.7 83.4 11.7 

63.7 32.1 4.1 82.3 12.6 

65.3 31.2 3.4 87.1 16.0 

69.5 26.9 3.6 84.5 16.8 

68.2 27.8 3.9 86.1 14.5 

71.5 25.7 2.8 87.5 16.2 

68.7 28.0 3.3 87.0 15.2 

83 
Table 15. Number and percent distribution of nursing home residents by selected physician services received at last visit, according to 

selected health statuses: United States, 1977-Con. 

Location of last Arrangement for physician 

physician visit4 I services4 

Regularly 

Outside Inside Physician scheduled Other 

facility facility* on call physician arrangement* 

visits 

CHRONIC CONDITIONS QB 

IMPAIRMENTS7-Con, 

Other chronic conditions or impairments-Con. 

Diseases of the respiiatory system: 

Chronic respiratory disease . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Diseases of the digestive system: 

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

Diseases of the blood and blood-forming organs: 

Diseases of the skin and subcutaneous tissue: 

Bedsores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . ..... ... .... 

Conditions other than above: 

None of these conditions 

JNDEX OF DEPENDENCY IN ACTIVITIES 

OF DAILY LIVINGa 

Independent in bathing, dressirig, using toilet room, 

mobility, continence, and eating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . .. . . 

Dependent in only one activity . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . 

Dependent in bathing and one other activity . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . 

Dependent in bathing, dressing. and one other 

aCtw,ty . .. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . ................ 

Dependent in bathing, dressing, using toilet room, 

and one other activity .. . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . 

Dependent in bathing, dressing, using toilet room, 

mobility, and one other activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . 

Dependent in all six activities . . . . . . . . . . .. . . . . . . . . . . . .. . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . 

Other9 . . . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................... 

Percent distribution 

15.7 80.8 10.1 

11.7 84.7 11.8 

10.4 86.2 10.8 

9.9 88.1 11.0 

l 6.0 87.7 l 6.1 

11.8 84.9 14.1 

13.1 83.5 12.4 

26.9 42.5 l 17.6 

23.7 64.9 19.6 

22.5 72.8 16.1 

17.1 78.8 15.2 

14.2 82.3 12.9 

9.6 86.9 12.6 

8.8 87.3 10.5 

5.4 91.9 9.9 

12.5 84.3 11.4 

84.2 

83.4 

84.6 

85.3 

65.9 

81.3 

83.5 

45.6 

67.1 

77.2 

79.0 

82.7 

82.5 

84.0 

86.2 

83.5 

12.2 

l 

1.2 

l 

l 

l 1.3 l 

l 

l 2.0 

l 2.0 

l 1.6 

l 

l 1 .3 

l 1.6 

1.2 

l 1.8 

lDisease group categories are based on Eighth Revision International Classification of Diseases, A&pied for Usein the United States (ICDA).

*Includes a small number of unknowns. 

3Figures do not add to totals because multiple responseswere permitted. 4Excludes those who received no physician visit after entering facility. 

50111~ diagnoses of sufficient magnitude am noted. 

5Includes those who received no physician visit while in facility. 

‘Figures may not add to tot& because resident may have had more than one reported chronic condition or impairment. aUnknowns were considered independent for the purpose of this index. 

gIncludes residents who were dependent in at least two activities but who ware not classifiable into any of the categories. 

84 
c 

Table 16. Number of nursing home residents receiving medication and percent distribution by type of medication received, according to sex and age: United S tates, 

1973-74 

Both sexes Male Female 

Type of medication 

received All Under 65-74 76-64 85 years All Under 65-74 75.84 8.5 years All Under 65.74 75-84 85 years 

ages ‘65 years years Vea,S and over ages 65 years Vea,S pXS and over ages I 65 years p3XS VIXKS and over 

Number 

Number of residents receiving one 

or more types of medications.. .032.000 11 .lOWOO I 166,100 t 389,900 1 397.100 1 302,200 I 49,300 1 62,100 I 97,400 1 93,300 1 739,800 1 59,600 t 94,000 1 272,500 I 303,700 

Percent distribution 

Total’....................... I 100.0 100.0 A 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 

Tranquilizers.. ........................... 

Hypnotic-sedatives ......... L.. ........ 

Stool softeners.. ........................ 

Antidepressants.. ....................... 

Antihypertensives ..................... 

Diuretics ........... . ....................... 

Analgesics. ................................ 

Diabetic agents.. ........................ 

Anti-inflammatory agents.. ....... 

Anti-infectives ........................... 

Antianginal drugs ..................... 

Cardiac glycosides ..................... 

Anticoagulants .......................... 

Vitamins or iron.. ...................... 

Other ........................................ 

54.5 47.9 40.8 46.9 43.3 37.3 48.1 61.7 55.2 49.6 41.9 

37.6 34.9 32.3 32.1 29.8 30.0 35.4 35.5 38.9 38.7 33.1 

33.5 35.6 36.4 32.8 34.5 36.4 36.7 31.2 35.5 36.8 36.4 

10.9 9.0 7.3 7.1 9.6 13.4 12.8 9.6 7.9 

11.9 12.7 11.6 ~so 10.0 i-i 12.5 7.9 12.3 13.7 12.3 

24.0 30.6 32.8 23:6 26.0 29:5 30.9 18.0 26.2 32.2 33.8 

34.9 38.0 37.5 32.0 34.3 33.3 38.5 33.9 38.0 39.3 38.8 

13.1 11.1 7.9 9.1 10.3 10.2 10.1 14.4 11.4 

7.8 8.3 7.1 7.5 2; 8.0 7.1 8.1 to” 

ii: 8.5 10.9 11.3 12.1 8.8 ::5 8.3 7.4 

:*:: 5.3 4.9 4.7 5.7 5.4 i-ii ‘1.7 4.2 4.7 

20:9 27.8 32.3 24.9 28.5 33.3 26:8 7.8 20.3 275:: 32.0 

1.3 0.8 1.2 1.8 ‘0.8 1.1 + l 1.4 I .6 

33.9 3::; 41 .l 33.6 34.1 38.0 39.3 33.4 36.5 38.4 4;:: 

46.7 46.7 45.1 48.2 49.4 47.2 45.4 47.9 46.2 45.7 44.5 

lFigures do not add to totals because residents may have received more than one type of medication. 
Table 17. Number and percent distribution of nursing home residents by type of medication received, according to chronic conditions 

or impairments, primary diagnosis at last examination, and primary reason for admission: United States, 1973-74 

Number of Type of medication received 

Chronic conditions or impairments, primary Number residents 

diagnosis at last examination, and primary of receiving 

reason for admission residents1 one or more Tranquil- Hypnotic- stool Anti- Anti- Analmedications2 izers sedatives softeners depres- hyper- Diuretics gesics sants tensives 

Total.. ................................................... 1,075,800 1,032,OOO 492,600 355,200 359,500 31,300 119,900 296,700 377,500 

Chronic conditions or impairments 

Senility.. ............................................................... 627,200 605,300 313,000 206,100 219,700 53,200 69,100 172,800 212,400 

Mental illness.. ...................................................... 200,400 192,500 133,500 71,100 64,000 25,200 18,800 40,000 61,700 

Mental retardation.. .............................................. 72,800 68,100 43,300 21,300 19,800 6,200 5,000 12,600 16,400 

Arthritis or rheumatism.. ...................................... 368,500 358,300 163,000 127,600 138,800 33,000 46,200 120,900 172,800 

Paralysis other than arthritis.. ............................... 188,300 182,600 82,600 66,800 76,900 18,300 26,500 50,700 71,500 

Glaucoma or cataracts .......................................... 110,900 107,600 47,000 39,100 43,200 8,900 15,300 35,400 47,000 

Diabetes.. .............................................................. 142,700 141,300 61,700 48,700 51,300 13,100 20,600 50,400 50,300 

Chronic trouble with back or spine.. ..................... 106,100 103,200 47,900 39,900 42,400 10,100 14,200 32,500 56,800 

Amputation of extremities or limbs, 

or permanent stiffness, or any 

deformity of the foot. leg, fingers, 

arm, or back ................................ ,. .................... 150,000 145,200 67,300 54,000 56,800 13,900 17,800 38,300 67,300 

Heart trouble.. ...................................................... 360,500 354,600 157,900 130,800 132,100 33,600 53,300 140,300 138,900 

None of the above ................................................ 57,700 51,700 17,600 16,600 14,300 2,800 6,000 12,300 18,200 

Primary diagnosis at last examination 

Senility, old age, and ill-defined 

condltmns.. 

Chronic conditions or impairments 

.......................................................... 146,800 138,900 70,100 41,200 49,700 10,600 11,500 35,100 41,800 

Heart attack.. ........................................................ 55,700 54,800 24,200 20,600 20,600 5,000 8,900 26,800 21,400 

Stroke.. ................................................................. 113,400 109,600 46,300 40,800 43,300 10,500 18,700 33,500 38,700 

Hardening of the arteries ...................................... 241,800 233,300 108,500 77.100 83,000 21 ,100 30,700 75,000 84,000 

Other diseases of the circulatory 

system ............................................................... 39,400 38,300 15,200 13,900 11,800 3,200 9,200 16,200 13,600 

Accidents, poisonings, and violence.. .................... 49,300 47,500 20,700 18,300 17,400 3,600 4,200 10,000 24,400 

Mental disorders ................................................... 115,800 108,300 81,200 34,400 28,400 12,300 6,600 15,100 22,000 

Diseases of the musculoskeletal system 

and connectwa tissue.. ....................................... 73,100 70,100 27,600 24,100 24,800 6,100 8,200 23,500 39,800 

Endocrine, nutritional, and metabolic 

diseases.. ............................................................ 48,100 47,600 17,900 16,300 15,600 4,000 7.000 15,800 17,100 

Diseases of the respiratory system ........................ 22,200 22,100 10,200 8,000 6,900 ‘I ,400 1,800 6,500 9,100 

Neoplasms ............................................................ 25,600 25,100 10,700 11,700 9,200 *I ,600 2,300 6,600 13,800 

1 Diseases of the nervous system and 

sense organs.. ..................................................... 64,200 61,500 30,500 24,300 23,100 6,100 4,600 14,100 22,400 

Diseases of the digestive system.. .......................... 20,500 20,000 7,400 7,100 7,000 l 1 ,400 l 1 ,300 5,400 8,500 

Diseases of the genitourinary system .................... 15,600 15,100 6,500 5,300 6,200 l 1 ,000 ‘I ,300 4,000 7,000 

Other diseases.. ..................................................... 34,700 31,300 12,400 9,900 10,300 2,800 2,700 7,000 11,300 

Didn’t know diagnosis .......................................... 9,600 8,300 3,100 2,100 2,200 t ‘800 2,200 2,600 

Primary reason for admission 

Physical ................................................................ 870,700 843,000 II 381,300 300,700 307,300 73,600 102,300 258,800 329,700 

Social.. .................................................................. 69,400 61,500 23,700 15,600 16,600 4.800 8,000 15,500 18.500 

Behavioral.. ........................................................... 125,000 117,300 83,100 36,500 32,400 12,100 8,000 19,600 26;OO0 

Economic ............................................................. 10,700 10,200 4,500 2,300 3,100 l 800 l 1,600 2,800 3,300 

Percent distribution 

Total.. ................................................... . . 100.0 47.7 34.9 34.8 8.9 11.6 28.8 36.i \I= 

Senility ................................................................. . 100.0 51.7 34.0 36.3 8.8 11.4 28.5 35.1 

Mental illness.. ...................................................... . . . 100.0 69.4 36.9 33.3 13.1 9.8 20.8 32.0 

Mental retardation ................................................ . 100.0 63.6 31.3 29.1 9.1 7.4 18.5 24.0 

Arthritis or rheumatism.. ...................................... . 100.0 45.5 35.6 38.7 9.2 12.9 33.7 48.2 

Paralysis other than arthritis.. ............................... . . . 100.0 45.2 36.6 42.1 10.0 14.5 27.7 39.1 

Glaucoma or cataracts .......................................... . 100.0 43.7 36.4 40.2 8.2 14.2 33.0 43.7 

See footnotes at end of table. 

86 
, 

Table 17. Number and percent distribution of nursing home residents by type of medication received, according to chronic conditions 

or impairments, primary diagnosis at last examination, and primary reason for admission: United States, 1973-74-Con. 

Type of medication received 

Chronic conditions or impairments, primary 

diagnosis at last examination, and primary Xabetic Anti- Anti- Anti- Cardiac Anti- Vitamins 

reason for admission agents inflammatory infectives angina1 glycosides coagulants Or Other 

agents drugs iron 

Total ................................................................. :.... 102,000 80,300 91,500 270,900 12,100 1177,300 

Chronic conditions or impairments 

Senility .................................................................................. 54,100 44,000 56,000 27,100 153,200 5,500 227,500 279,500 

Mental illness.. ....................................................................... 18,100 11,800 14,500 7,200 34,500 l 1 ,500 55,900 87,900 

Mental retardation ................................................ . ................ 5,400 2,500 4,700 l 1 ,500 5,700 l 21,200 30,300 

Arthritis or rheumatism.. ....................................................... 30,500 45,400 31,500 19,500 104,200 4,200 151,700 157,300 

Paralysis other than arthritis .................................................. 17,400 13,200 21,800 8,700 44,900 3,000 55,500 92,500 

Glaucoma+r cataracts ........................................................... 10,700 10,100 10,800 5,800 32,400 *1,200 45,400 57,500 

Diabetes ................................................................................. 93,400 11,100 13,800 7,400 45.7 00 2,200 50,500 50,500 

Chronic trouble with back or spine.. ...................................... 8,000 15,700 10,900 5,300 28,500 ‘1,200 45,800 51,000 

Amputation of extremities or limbs, 

or permanent stiffness, or any 

deformity of the foot, leg, fingers 

arm, or back ....................................................................... 

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

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

17,000 

40,400 

l 700 

13,400 

31,800 

3,000 

17,000 

32,900 

4,700 

5.70; 

31,900 

l l ,500 

32,500 

185,100 

7,000 

l 1.500 

7.1 oc 

l 

55,900 

143,500 

19,800 

,

, 74,500 

159,400 

23,900 

Primary diagnosis at last examination 

Senility, old age, and ill-defined 

conditions ........................................................................... 8,400 8,900 9,800 5,000 31,400 l 7oc 54,800 54,000 

Heart attack. .......................................................................... 4,ooc 4,900 4,500 7,400 32,700 l 1 ,5oc 20,500 25,400 

Hardening of the arteries ....................................................... 17,400 17,000 17,900 13.100 75,200 2.7OC 93,100 110,000 

Stroke .................................................................................... 9,900 5,9OP 12,100 5,200 28,200 2.5OC 35,500 

I

I

/

,

I 

52,100 

Other diseases of the circulatory 

system ................................................................................ 2,900 2.8OC 3,400 2,200 13,900 l 1 ,2oc 14,000 17,500 

Accidents, poisonings, and violence ....................................... 3,300 3,7oc 5,300 l 1 ,000 10,500 “50C 19,200 21,900 

Mental disorders .................................................................... 5,500 3.5oc 5,000 1,800 10,400 l 32,500 I 45,600 

Diseases of the musculoskeletal system 

and connective tissue .......................................................... 3,5OC 13,lOC 5,200 3,000 15,000 II , 31,200 

Endocrine, nutritional, and metabolic 

diseases ............................................................................... 35,100 4,100 4,500 2,200 12,800 15.200 19,100 

Diseases of the respiratory system ......................................... l 1,200 2,400 3,200 ‘1,100 7,900 8.300 13,000 

Neoplasms ............................................................................. ‘1,500 2,100 4,300 l 800 5,000 9,800 12,600 

Diseases of the nervous system and 

sense organs.. ...................................................................... 3,400 5,000 5,400 1,800 9,800 23,000 37.100 

Diseases of the digestive system.. ........................................... “900 1,900 1,900 l 700 5,400 9,200 10.100 

Diseases of the genitourinary system ..................................... ‘900 l 1,400 4,300 ‘700 4,100 4,900 8,700 

Other diseases ........................................................................ 

Didn’t know diagnosis ........................................................... 

2,500 (I 2,300 c 3,700 ‘1,100 5,100 

l 900 l l 1 ,500 

14,500 

2,100 

14,500 

3,300 

Primary reason for admission 

Physical ................................................................................. 88,500 70,500 81,700 41 ,100 241,000 325,500 197,700 

Social.. ................................................................................... 4,400 5,300 3.500 2,900 13,100 22,700 24,500 

Behavioral.. ............................................................................ 8,100 3,800 5,800 2.900 14,400 35,500 51,100 

Economic.. ............................................................................ ‘900 ‘500 l “700 2,400 3,500 3,900 

Percent distribution 

Total.. .................................................................... 9.9 7.8 8.9 4.5 25.3 Z 37.5 45.3 

Chronic conditionsor impairments 

Senility .......................................... : ....................................... 8.9 9.3 4.5 27.0 0.9 37.5 45.2 

Mental illness.. ............................... .c.. .................................... 9.4 7.5 3.7 17.9 l 0.8 34.8 45.7 

Mental retardation ................................................................. 7.9 5.9 l 2.2 9.8 l 31.1 44.5 

Arthritis or rheumatism ......................................................... 8.5 8.8 5.5 29.1 1.2 42.3 45.7 . 

Paralysis other than arthritis.. ................................................ 9.5 11.9 4.8 24.5 1.5 35.9 50.7 

Glaucoma or cataracts ........................................................... 10.0 10.0 5.4 30.1 ‘1.2 43.2 I 53.5 

See footnotes at end of table. 

87 
Table 17. Number and percent distribution of nursing home residents by type of medication received, according to chronic conditions 

or impairments, primary diagnosis at last examination, and primary reason for admission: United States, 1973-74-Con. 

Number of Type of medication received 

Chronic conditions or impairments, primary Number residents 

i diagnosis at last examination, and primary 

reason for admission ,, 

Chronic conditions or impairments-Con. Percent distribution 

Diabetes.. .............................................................. . . 100.0 43.7 34.5 36.3 9.2 14.6 35.7 35.6 

Chronic trouble with back or spine.. ..................... . . . 100.0 46.4 38.7 41 .l 9.8 13.7 31.5 55.0 

Amputation of extremities or limbs, 

or permanent stiffness, or any 

deformity of the foot, leg, fingers, 

arm, or back 1..................................................... . . 100.0 46.3 37.5 39.1 9.5 12.3 26.3 46.4 

Heart trouble.. ...................................................... . . . 100.0 44.6 36.9 37.3 9.5 15.0 39.6 39.2 

None of the above ................................................ . 100.0 34.0 32.0 27.6 5.4 11.6 23.9 35.2 

Primary diagnosis at last examination 

Senility, old age. and ill-defined 

conditions.. ........................................................ . . . 100.0 50.5 29.7 35.8 7.6 8.3 2%.3 30.1 

Heart attack.. ........................................................ . . 100.0 44.1 37.7 37.7 9.2 16.3 48.9 39.0 

Stroke.. ................................................................. . . . IbO.0 42.2 37.2 39.5 17.1 30.5 36.3 

Hardening of the arteries ...................................... . . . 100.0 46.5 33.0 35.6 Xi 13.2 32.1 36.0 

Other diseases of the circulatory 

system ............................................................... . . . 100.0 39.8 36.4 30.8 8.3 24.1 42.3 36.6 

\ Accidents, poisonings, and violence.. .................... . 100.0 43.5 38.4 36.5 7.6 8.9 21 .l 61.4 

Mental disorders ................................................... . . 100.0 74.9 31.8 26.2 11.4 6.1 14.0 20.3 

Diseases of the musculoskeletal system 

and connective tissue.. ....................................... 100.0 39.4 34.4 35.4 8.7 11.7 33.4 56.8 

Endocrine, nutritional, and metabolic 

diseases .............................................................. . . . 100.0 37.6 34.2 32.7 8.4 14.6 33.2 35.8 

Diseases of the respiratory system ........................ 100.0 46.1 36.1 31.2 ‘6.4 7.9 29.3 40.9 

Neoplasms.. .......................................................... . . . 100.0 42.8 46.7 36.7 l 6.6 9.1 26.4 54.9 

Diseases of the nervous system and 

sense organs.. ..................................................... . . 100.0 49.6 39.4 37.5 9.9 7.5 23.0 36.4 

Diseases of the digestive system.. .......................... . . 100.0 37.0 35.4 36.0 l 7.0 l 6.6 26.9 42.4 

Diseases of the genitourinary system .................... . . . 100.0 42.9 35.2 41.1 “6.7 l 8.3 26:3 46.2 

Other diseases.. ..................................................... . . 100.0 39.6 31.6 33.0 9.1 8.7 22.4 36.3 

Didn’t know diagnosis .......................................... 100.0 37.1 26.7 26.6 I ‘10.2 26.2 31.2 

Primary reason for admission 

Physical ................................................................ 100.0 45.2 35.7 36.5 8.7 12.1 30.7 39.1 

Social.. .................................................................. . . . 100.0 38.6 25.4 27.1 7.8 13.0 25.2 30.2 

Behavioral.. ........................................................... . . 100.0 70.8 31.2 27.6 10.3 6.9 16.7 22.2 

Economic ............................................................. . . . 100.0 44.0 22.4 30.5 “7.8 ‘15.3 27.6 32.3 

See footnotes at end of table. 

88 
Table 17. Number and percent distribution of nursing home residents by type of medication received, according to chronic conditions 

or impairments, primary diagnosis at last examination, and primary reason for admission: United States, 1973-74-Con. 

Type of medication received 

dhronic conditions or impairments, primary 

diagnosis at last examination, and primary 

reason for admission Xabatic 

egents 

Antiinflammatory 

agents 

Antiinfectives 

Antiangina1 

drugs 

Cardiac 

glycosides 

Anticoagulants 

Vitamins 

Or 

iron 

Other 

Chronic conditions or impairments-Con. 

Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66.1 7.8 9.8 5.3 31.9 1.5 35.7 42.9 Chronic trouble with back or spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.8 15.2 10.6 6.1 27.7 v.2 44.3 49.4 

Amputation of extremities or limbs, 

or permanent stiffness, or any 

deformity of the foot, leg,fingers, 

arm, or back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.7 9.3 11.7 3.9 22.4 ‘1.1 38.5 51.4 

Heart trouble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.4 9.0 9.3 9.0 525 2.0 40.5 47.8 

None of the above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Y.4 5.7 9.0 ‘3.1 13.5 l 38.3 46.2 

Primary diagnosis at last examination 

Senility, old age, and ill-defined 

conditions.. ......................................................................... 6.1 6.4 7.1 3.6 22.6 00.5 39.4 38.9 

Heart attack ........................................................................... 7.2 8.9 8.2 13.4 59.8 l 2.7 37.5 48.2 

Stroke.. .................................................................................. 9.0 6.3 11.0 4.7 25.7 2.3 32.4 47.6 

Hardening of the arteries.. .................. ;.:. .............................. 7.4 7.3 7.7 5.6 32.7 1.2 39.9 47.1 

Other diseases of the circulatory , 

system ................................................................................ 7.6 7.4 8.8 5.5 36.3 03.0 38.5 45.6 

Accidents, poisonings, and violence ....................................... 7.0 7.9 11.1 l 2.1 22.1 ‘1.3 40.4 46.2 l Mental disorders .................................................................... 6.0 3.2 4.7 1.7 9.6 30.0 42.1 

Diseases of the musculoskeletal system and connectiye tissue.. ........................................................ 5.2 18.7 7.4 4.3 21.3 l 43.6 44.5 

Endocrine, nutritional, and metabolic .

diseases ............................................................................... 73.8 8.6 9.4 4.7 26.9 34.0 40.1 l

Diseases of the respiratory system ......................................... l 5.3 10.7 14.5 -4.7 35.7 37.5 58.5 l

Neoplarms ............................................................................. l 5.9 8.3 17.3 l 3.3 19.8 39.2 60.2 

Diseases of the neryous system and * sense organs.. ...................................................................... 5.5 8.1 8.8 3.0 15.9 37.4 60.3 c

Diseases of the digestive system ............................................. ‘4.5 9.4 9.4 ‘3.6 26.9 45.9 50.6 l

Diseases of the genitourinary system ..................................... ‘6.2 l 9.1 28.6 ‘4.9 27.2 32.6 57.5 l Other diseases ........................................................................ 8.3 7.4 12.0 -3.5 19.4 46.5 46.7 

Didn’t know diagnosis.. ......................................................... l l l 11.1 l l 17.6 25.6 40.4 

Primary reason for admission 

Physical .............................................................................. ., . 10.5 8.4 9.7 4.9 28.6 1.3 38.6 47.2 l

Social ..................................................................................... 7.1 8.6 5.9 4.8 21.3 37.0 40.0 

Behavioral .............................................................................. 6.9 3.3 5.0 2.4 12.3 l 0.6 31.2 43.5 * Economic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -8.9 l 6.1 l 6.6 23.3 34.3 38.3 

1Excludes residents in personal care homes. 

ZFigures do not add to totals because residents may have received more than one type of medication. 

89 
Table 18. Number and percent distribution of nursing home residents by number of categories of medication received, according to 

chronic conditions or impairments, primary diagnosis at last examination, and primary reasan for admission: United States, 

1973-74 

Chronic conditions or impairments, primary All 

II Number of categories of medication 

diagnosis at last examination, end primary residents None One TWO Three Four Five Six Seven reason for admission or more 

Number 

Total ................................................. 1.075.800 43,800 123,400 207,600 240,000 201,900 137,900 69,600 51,600 

Total ................................................. 4.1 11.5 19.3 22.3 18.8 12.8 6.5 4.8 

Chronic conditions or impairments 

Senility .............................................................. 100.0 3.5 11.1 19.1 22.6 19.1 13.3 6.5 4.8 

Mental illness.. ................................................... 100.0 4.0 12.7 20.0 21.8 17.8 12.1 8.5 5.1 

Mental retardation.. ........................................... 100.0 6.5 17.9 25.1 22.5 15.1 6.9 3.5 2.5 

Arthritis or rheumatism ..................................... 100.0 2.8 8.1 16.2 21.8 20.0 15.9 8.4 6.9 

Paralysis other than arthritis.. ............................ 100.0 3.0 9.6 18.6 21.2 19.8 14.4 7.9 5.5 

Glaucoma or cataracts.. ..................................... 100.0 3.1 

Chronic conditions or impairments 

Senility.. ............................................................ 627,200 21,900 69,800 119,600 141,600 119,600 83,700 40,900 30,200 

Mental illness.. ................................................... 200,400 8,000 25,400 40,200 43,600 35,700 24,300 12,900 10,300 

Mental retardation.. ........................................... 72.800 4,700 13,100 18,300 16,300 11,000 5,000 2,500 1,800 

Arthritis or rheumatism.. ................................... 368,500 10,200 29,800 59,600 80,400 73,700 58,400 30,800 25,690 

Paralysis other than arthritis.. ............................ 188,300 5.700 18,100 35,100 39,900 37,200 27,100 14,800 10,300 

Glaucoma or cataracts.. ..................................... 110,900 3,400 10.100 17,900 22,100 17,600 8,700 9,200 

Diabetes. ........................................................... 142,700 “I ,500 7,600 20,400 29,100 30,800 24,900 12,800 15,800 

Chronic trouble with back or spine.. ................. 106,100 2,900 7,500 16,000 21,300 19,900 18,900 9,800 9,700 

Amputation of extremities or limbs, 

or permanent stiffness, or any 

deformity of the foot, leg, fingers, 

arm, or back.. ................................................. 150,000 4,800 14,700 27,000 32,000 28,400 21,400 10,900 10,900 

Heart trouble.. ................................................... 360,500 5,900 21,700 50,200 73,900 77.100 63,100 37,000 31,600 

None of the above.. ........................................... 57,700 6,000 9,800 14,300 11,800 8,500 4,000 2,400 “900 

Primary diagnosis at last examination 

Senility, old age, and ill-defined 

conditions ...................................................... 146,800 8,000 21,700 32,500 34,000 24,900 15,000 7,100 3,700 

Heart attack ...................................................... 55,700 l 900 2,900 7,000 10,700 11,600 10,400 6,400 5;800 

Stroke ............................................................... 113,400 3,700 11,900 21 ,100 26,000 22,800 14,600 7,800 5,600 

Hardening of the arteries.. ................................. 241,800 8,400 23.800 44,600 55.600 47,800 33,200 15,600 12,700 

Other diseases of the circulatory 

system ............................................................ 39,400 ‘1,100 3,500 7,200 8,100 8,000 5,900 3,200 2,400 

Accidents, poisonings, and violence.. ................. 49,300 1,800 5,300 9,200 11,100 10,200 6,900 2,700 “2,000 

Mental disorders.. .............................................. 115,800 7,400 21,700 30,000 25,900 16,700 7,900 3,700 2,400 

Diseases of the musculoskeletal system 

and connective tissue.. .................................... 73.100 2,900 6,800 12,900 15,900 13,700 10,700 6,100 4,000 

Endocrine, nutritional, and metabolic 

diseases.. ......................................................... 48,100 l 3,500 6,600 11,600 9,600 7,800 3,900 4,600 

Diseases of the respiratory system.. ................... 22,200 x f2,OOO 3,500 5,400 4,800 3,500 ‘1,800 .I ,100 

Neoplasms.. ....................................................... 25,600 x ‘2,000 4,200 6,100 5,600 3,800 l 2,1 00 *1,200 

Diseases of the nervous system end 

sense organs.. .................................................. 64,200 2,700 6,900 13,800 13,500 11,900 8,200 4,600 2,800 

Diseases of the digestive system.. ....................... 20,500 l 2,500 3,700 4,800 3,900 2,900 ‘1,700 l 

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

Other diseases.. .................................................. 

Didn’t know diagnosis.. ............................. ..- .. 

15,600 

34,700 

9,600 

I 

3,500 

*I ,300 

l 1,300 

5,300 

“2,100 

2,800 2,800 

6,700 6,600 

l 1,900 Cl ,900 

3,600 

5,700 

l 1,100 

2,400 

3,900 

l 700 

l 1,000 

* 1,7001 

‘1,200 

l 1 ,400X’ 

Primary reason for admission 

Physical ............................................................. 870,700 27,700 86,300 158,400 196,300 172,400 121,200 61,700 46,600 

Social ................................................................ 89,400 8,000 13,400 14,600 13,400 10,000 5,400 2,900 Cl ,700 

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

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

125,000 

10,700 

7,700* 21,500 

l 2,200 

32,000 28,400 

2,600 l 1 ,900 

18,100 

* 1,400 

10,000 

‘1,200 

4,600* 2,800I 

Percent distribution 

100.0 =I9.1 16.1 19.8 19.9 15.9 7.9 8.3 

90 
Table 18. Number and percent distribution of nursing home residents by number of categories of medication received, according to 

chronic conditions or impairments, primary diagnosis at last examination, and primary reason for admission: United States, 

1973-74-Con. 

Chronic conditions or impairments, primary All 

Number of categories of medication 

diagnosis at last examination, and primary residents None One Two Three Four Five Six Seven reason for admission or more 

Chronic conditions or impairments-Con. 

Diabetes ............................................................ 100.0 l 1.0 5.3 14.3 20.4 21.5 17.4 8.9 11.0 

Chronic trouble with back or spine.. ................. 100.0 2.8 7.1 15.1 20.1 18.8 17.8 9.2 9.1 

Amputation of extremities or limbs, 

or permanent stiffness, or any 

deformity of the foot, leg,fingers, 

arm, or back.. ................................................. 100.0 3.2 9.8 18.0 21.3 18.9 14.3 7.3 7.2 

Heart trouble.. ................................................... 100.0 I.6 6.0 13.9 20.5 21.4 17.5 10.3 8.8 

None of the above. ............................................ 100.0 10.3 17.0 24.8 20.5 14.8 6.9 4.1 l 1 .5 

Primary diagnosis at last examination 

7 Senility, 

conditions ...................................................... 100.0 5.4 14.8 22.1 23.1 16.9 10.2 4.8 2.5 

Heart attack ...................................................... 1001) “1.6 5.2 12.5 19.3 20.9 18.6 11.4 10.3 

Stroke ............................................................... 100.0 3.3 10.5 18.6 22.9 20.1 12.8 6.8 4.9 

Hardening of the arteries.. ................................. 100.0 3.5 9.9 18.4 23.0 19.8 13.7 6.5 5.3 

Other diseases of the circulatory 

system ............................................................ 100.0 l 2.9 8.9 18.3 20.5 20.3 14.9 8.2 6.0 

Accidents, poisonings, and violence.. ................. 100.0 3.6 10.9 18.7 22.6 20.6 14.0 5.6 4.1 

Mental disorders ........ ........................................ 100.0 6.4 18.8 25.9 22.4 14.4 6.8 3.2 2.1 

Diseases of the musculoskeletal system 

old age, and ill-defined 

and connective tissue.. .................................... 100.0 4.0 9.3 17.7 21.8 18.8 14.7 8.3 5.5 

Endocrine, nutriti&al, and metabolic 

diseases.. .......... ..!. ........................................... 100.0 7.3 13.8 24.1 19.9 16.3 8.2 9.6 

Diseases of the respiratory system.. ................... 100.0 l 8.9 15.9 24.5 21.8 15.7 8.0 l 5.0 

Neoplasms ......................................................... 100.0 * 7.9 16.3 23.7 . 22.0 15.0 8.4 l 4.6 

Diseases of the nervous system and 

sense organs .................................................... 100.0 4.2 10.7 21.5 21 .o 18.5 12.7 7.1 4.3 

Diseases of the digestive system.. ....................... 100.0 l 12.3 18.0 23.4 19.2 14.0 ‘8.3 l 

Diseases of the genitourinary system.. ............... 100.0 c +8.5 17.8 17.7 23.3 15.6 ‘6.5 f7.4 

Other diseases.. .................................................. 100.0 10.0 15.4 19.3 18.9 16.3 11.4 l 4.8 l 4.0 

Didn’t know diagnosis ....................................... 100.0 l 13.9 22.3 20.2 19.7 l ll.B ‘7.6 l l 

Primary reason for admission 

Physical. ............................................................ 100.0 3.2 9.9 18.2 22.5 19.8 13.9 7.1 5.4 

Social ................................................................ 100.0 11.5 19.3 21 .o 19.4 14.4 7.8 4.1 2.5 

* 

Behavioral ......................................................... 100.0 6.1 17.2 25.6 22.7 14.5 8.0 3.7 2.2 

Economic .......................................................... 100.0 l 21.0 24.7 17.3 l 1 3.3 111.5 t l 

L 

91 
Table 19. Number and percent distribution of nursing home residents by therapy services received, according to selected health statuses: 

United States, 1977 

I I 

Therapy service 

Uumber of Number of 

residents residents counsel- .. 

Selected health status1 Total receiving receiving 

one or Physical Recrea- Occupa- CO”“S& ing by Reality “0 tional tional ing by “lental orienta­ social therapy” “lore types therapy therapy therapy worker health tion of therapy3 worker 

1,303,100 847,100 456.000 178,960 261,300 76,700 91,400 17.800 86,500 

PRIMARY DIAGNOSIS AT LAST 

EXAMINATION 

Diseases of the circulatory system 

Total ......................................................... 516,800 329,700 187,100 77.100 107,500 29,700 35,900 ‘2.700 36.800 

Congestive heart failure.. ........................................... 52,800 -33,500 19,300 5,900 11,200 l 2,100 5,500 t 4,300 

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

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

264,400 

47,700 

175,200 

31,600 

89,200 

16,100 

29,500 

6,700 

57,400 

7,900 

13.100 

l 2,400 

17,000 

l 2,600 

I 

I 

20,500 

l 2,900 Stroke ....................................................................... 

Heart attack, ischemic heart disease .......................... 

103,500 

22,500 

57,600 

15,700 

45,900 

6,800 

28,800 

l 2,400 

21,200 

4,200 

9,400 

l 1,500 

7,400 

‘1,800 

l 7,000 l 

Other.. ....................................................................... 25,800 16,100 9,700 3,900 5,600 I “1,700 ‘1,600 

Mental disorders and senility without psychosis 

Total ......................................................... 266,100 173,500 92,600 20,200 58,500 15,700 16.000 10.100 23.200 

Senile psychosis ......................................................... 21,200 14,100 7.000 l 4,200 l l I ‘3,000 

Other psychosis ......................................................... 57,400 36,800 20,600 ‘1,900 12,200 4,400 4,800 4,100 3,900 

Chronic brain syndrome.. .......................................... 96,400 62,500 34,000 9,600 22,300 5,000 6,400 * 1,600 10,000 

Senility without psychosis.. ....................................... 

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

Alcoholism and other mental disorders.. ................... 

26,600 

42,400 

22,100 

20,200 

24,600 

15,500 

6,400 

17,900 

6,700 

‘1,900 

3,900 

l 2,1 00 

4,000 

12.300 

3,500 

l 

4,000 

l 1 ,700 

l 

l 3,000 l l 1,900 l 

l 2,7PO

l 1,600 

l 2,000 

Other diagnosis4 

Total ......................................................... 429.700 270.600 159.100 75,600 86,300 28,000 35,700 3,700 23,300 

Diseases of the musculoskeletal system 

and connective tissues: 

Arthritis and rheumatism ..................................... 56,200 36,300 19,900 9,800 9,900 *2,900 4,200 (I l 3,300 

Diseases of the nervous system and sense organs: 

Parkinson’s disease ............................................... 23,300 15,400 7,900 l 3,100 4,700 l 1,500 l 1,800 l l 1 ,600 

Accidents, poisonings, and violence: 

Hip fracture.. ........................................................ 29,300 12,900 16,400 13,600 8,200 ‘1,800 l 1,800 ‘1,700 

Other bone fracture.. ............................................ 10,600 5,800 4,800 3,900 l 2,000 l 1 ,400 ‘1,800 l 

Endocrine, nutritional, and metabolic diseases: 

Diabetes. .............................................................. 71,700 47,200 24,500 8,200 14,900 4,500 5,500 4,000 

Neoplasms: 

Cancer.. ................................................................ 28,900 17.800 11,100 4,000 5,000 “1,700 3,500 l 1 ,300 

Diseases of the respiratory system.. ........................... 31,000 22,900 8,100 4.400 4,700 l 1,600 +1,400 l 1,400 

Diagnosis unknown5 

Total ......................................................... 90,500 73,200 17,200 6,100 9,000 3,400 3,900 l 1 ,400 l 3,200 

CHRONIC CONDITIONS OR IMPAIRMENT+ 

Diseases of the circulatory system 

Arteriosqlerosis.. ........................................................ 620,200 404,700 215,500 82,600 128,700 35,900 42,400 5,100 48,700 

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

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

272,900 

214,000 

175,800 

124,100 

97,100 

89,900 

45,100 

52,200 

51,800 

40,400 

13,200 

15,500 

17,400 

18,500 

v.100 

l 2,000 

17;200 

15,000 

Paralysis or palsy, other than arthritis, 

related to stroke ..................................................... 80,800 46,300 34,500 21 ,100 16,100 7,600 7,400 l 6,400 

Heart trouble.. ........................................................... 449,000 294,100 154,800 60,900 94,200 23,800 34,300 ‘2.700 32,100 

See footnotes at end of table. 

92 
Table 19. Number and percent distribution of nursing home residents by therapy services received, according to selected health statuses: 

United States, 1977-Con. 

Therapy service 

Selected health stat& 

CHRONIC CONDITIONS OR 

IMPAIRMENTSb-Con. 

Mental disorders and senility without psychosis 

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

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

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

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

Alcoholism ................................................................ 

Drug addiction. ......................................................... 

Insomnia ................................................................... 

Other chronic conditions or impairments 

Diseases of the musculoskaletal system and 

connective tissues: 

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

Chronic back/spine problems, excluding 

stiffness and deformity.. .................................... 

Permanent stiffness or deformity of back.arms, 

legs, or extremities, including feet, toes, 

hands, or fingers.. .............................................. 

Missing arms, legs, or extremities, including 

feet, toes, hands, or fingers.. .............................. 

Diseases of the nervc~us system and sensa organs: 

Blindness .............................................................. 

Glaucoma.. ........................................................... 

Cataracts .............................................................. 

Deafness.. ............................................................. 

Parkinson’s disease ............................................... 

Paralysis or palsy, other than arthritis, unrelated 

to stroke.. .......................................................... 

Accidents, poisonings, and violence: 

Hip fracture.. ........................................................ 

Other bone fracture. ............................................. 

Endocrine, nutritional, and metabolic diseases: 

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

Neoplasms: 

cancer .................................................................. 

Diseases of the respiratory system: 

Chronic respiratory disease.. ................................. 

Diseases of the digestive system: 

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

Diseases of the blood and blood-forming organs: 

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

Diseases of the skin and subcutaneous tissue: 

Bedsores.. ............................................................. 

Conditions other than above: 

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

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

None of these conditions 

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

See footnotes at end of table. 

uumber of 

residents 

Total receiving 

no 

therapy2 

148,300 95,000 

324,700 206,000 

416,400 290,200 

79,800 48,400 

36,900 23,000 

3,700 l 2,600 

125,500 79,900 

320,500 208,800 

60,500 38,000-. 

181,500 104,300 

32,400 19,200 

72.200 50,300 

34,000 21,500 

80,000 52,900 

90,400 65,000 

58,000 38,900 

46,500 27,600 

108,800 60,800 

46,300 27,200 

189,600 120,800 

63,600 40,400 

86,500 59,100 

313,200 200,700 

70,600 42,700 

35,100 20,800 

233,500 157,500 

131,700 86,100 

13,000 10,300 

Number of 

residents 

receiving 

one or 

more types 

of therapy3 

53,400 11,100 31,900 9,400 10,400 

118,600 41,000 73,900 19,100 25,700 

126,200 43,400 74,000 16,900 25,500 

31,400 7,600 21,300 7,400 6,300 

13,900 I 4,800 f 7,400 l ‘3,100 f ‘3,200 l 

45,500 18,900 26,000 7,200 12,500 

111,700 50,800 63,300 21,800 22,700 

22,500 9,300 14,000 4,500 5,200 

77,200 39,800 42,600 16,000 17,100 

13,200 7,100 6,200 ‘1,900 l 2,600 

21,900 8,900 13,400 4,300 4,300 

12,500 4,800 7,100 3,500 ‘2.900 

27,200 10,500 15,300 5,500 6,400 

25,400 10,500 14,200 ‘3,000 3,900 

19,100 8,300 12.000 4.200 3,900 

18,800 10,600 9,900 4,100 4,700 

48,000 30,800 25,900 5,500 5,400 

19,100 12,200 10.100 4,900 3,700 

68,700 27,800 41,500 12,900 16,300 

23,200 9,100 11,600 4,000 6,300 

27,400 12,600 15,600 4,000 6,200 

112,500 48,700 65,400 16,000 29,000 

27,900 12.000 15.600 5,600 7,200 

14,300 8,100 7,800 4,000 ‘3,300 

76,000 33,000 45,200 11,900 16,300 

45,600 21,800 23,300 7,300 10,400 

8,800 9,800 

3,900 32,800 

3,600 37,000 

l 2,500 3,900 l l 2,600 

l 1,500 9.80;) 

l 2,900 21,600 

x l 3,300 

l 15,500 

l 1 ,600 

4,100

l 2,800 

4,300 

4,900 

3,800 

l l 2,600 

* 8,800 l ‘3.000 

l 2.1 00 11,900 

x 3,900 

l 5,200 

l 2,300 23,800 

l 6,300 

I l 2,600 

l 1,300 17,600 

l 1,600 10,100 

l 2,700 l l . c l l 

93 
Table 19. Number and percent distribution of nursing home residents by therapy services received, according to selected health statuses: 

United States, 1977-Con. 

Therapy Service 

Number of Number of 

residents residents COU”SelSelected health status’ Total receiving receiving 

Physical Recrea- Occupa- counsel- ing by Reality “0 one or tional tional ing by mental orienta. therapy2 “wre types therapy therapy therapy social health tion of theraw’ worker worker 

INDEX OF DEPENDENCY IN ACTIVITIES 

OF DAILY LIVING’ 

Independent in bathing, dressing, using toilet 

room, mobility, continence, and eating . . . . . . . . . . . . . . . . . . . 124,500 91,500 33,000 l 2,800 20,600 6,000 7,200 6,200 l 2,900 

Dependent in only one activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161,000 109,100 51,900 12,200 32,400 9,000 12,800 l 3,1 00 7,200 

Dependent in bathing and one other activity . . . . . . . . . . . . . 158,900 108,200 50,700 11,200 32,500 8,700 10,700 l 1,300 11,700 

Dependent in bathing, dressing, and one other . actwlty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . 110,400 71,000 39,400 14,200 24,700 4,700 7,700 l 1,800 6,600 

Dependent in bathing, dressing, using toilet room, 

and one other activity . . . . . . . .. . . . . . . . . . . . .. . . . . . . . . . . . .. . . . . . . . . . . 125,000 68,800 56,200 30,600 29,700 8,700 9,300 . 10,400 

Dependent in bathing, dressing, using toilet room, 

mobility, and one other activity . . . . . . . . .. . . . . . . . . . . . . . . . . 203,600 122,600 81,000 40,900 43,700 15,200 15,000 *I ,300 13,800 

Depenjent in all six activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303,300 201 ,I 00 102,200 51,300 53,700 15,500 20,400 l 1,700 26,200 

116,400 74,800 41,600 15,600 24,100 8,900 8,300 *I ,300 7,700 

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . 1oo.c 65.0 35.0 13.7 20.0 7.0 1.4 6.6 

PRIMARY DIAGNOSIS AT LAST 

EXAMINATION 

Diseases of the circulatory system 

==I=

1oo.c 63.8 36.2 14.9 20.E 5.i 6.9 “0.5 1 7.1 

Congestive heart failure.. ........................................... 1oo.c 63.4 36.6 11.1 21.2 ‘4.1 10.4 t 8.1 

Arteriosclerosis.. ........................................................ 100s 66.3 33.7 11.2 21.7 5.c 6.4 l 7.7 

Hypertension.. ........................................................... 100s 66.2 33.8 13.9 16.6 l SC ‘5.4 c l 6.2 

Stroke ....................................................................... 100s 55.6 44.4 27.6 20.4 9.1 7.1 l 6.8 

Heart attack, ischemic heart disease .......................... 100s 69.8 30.2 ‘10.5 18.i ‘6.E =7.9 l 

Other.. ....................................................................... 1oo.c 62.4 37.6 15.1 21.6 l ‘6.5 l 6.1 

Mental disorders and senility without psychosis 

Total ......................................................... 100s 65.2 34.8 7.6 22.a 5.8 6.0 3.8 6.7 

Senile psychosis.. ....................................................... 1oo.c 66.8 33.2 . 19.9 l l l l 14.1 

Other psychosis.. ....................................................... 1oo.c 64.1 35.9 l 3.4 21.3 7.5 6.4 7.2 6.9 Chronic brain syndrome.. .......................................... 1oo.c 64.8 35.2 9.9 23.1 5.2 6.6 l 1.7 10.4 

Senility without psychosis.. ....................................... 100s 75.6 24.2 l 7.0 I 5.0 . l l 10.2 

Mental retardation.. ................................................... 1 0o.c 57.9 42.1 9.1 29.0 9.E l 7.1 l 4.4 ‘3.7 

Alcoholism and other mental disorders.. ................... 100s 69.8 30.2 l 9.5 15x “7.E (I l “9.0 

Other diagnoses4 

Total ......................................................... 100s 63.0 37.0 17.6 20.1 6.5 8.3 0.9 5.4 

Diseases of the musculoskeletal system 

and connective tissues: 

Arthritis and rheumatism ..................................... 1 OOA 64.6 35.4 17.4 17.7 l 5.1 7.5 . 5.9 

Diseases of,the nervous system and sense organs: 

Parkinson’s diseare ............................................... 100.0 65.9 34.1 l 13.5 20.3 ‘6.3 7.7 l 

Accidents, poisonings, and violence: 

Hip fracture.. ........................................................ 100.0 44.0 56.0 46.5 28.2 l 6.2 6.3 , 5.9 

Other bone fracture.. ............................................ 100.0 54.7 45.3 36.5 l 18.9 v3.4 x17.0 , . x 

Endocrine. nutritional, and metabolic diseases: 

100.0 65.8 34.2 11.4 20.8 6.3 7.7 l 5.6 

See footnotes at end of table. 

94 
Table 19. Number and percent distribution of nursing home residents by therapy services received, according to selected health statuses: 

United States, 1977-Con. 

I Therapy service 

rmber of 

!sidents 

xziving CounselSelected health status1 Total receiving ” _-- __ ing by Reality ““e or no m mental orientatherapy’ more type !S 

of therapy .3 health tion 

worker 

I I I I 

PRIMARY DIAGNOSIS AT LAST 

EXAMINATION-Co”. 

Percent distribution 

Other diaq”oses4-Con. 

Neoplasms: 

CanCW . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . 100.0 61.7 38.3 13.8 17.4 ‘5.7 12.3 l s4.4 

Diseases of the respiratory system _............................ 100.0 74.0 26.0 14.2 15.2 l 5.1 l 4.5 l 94.4 

Diasnosis unknown5 

Total ......................................................... 100.0 81 .O 19.0 6.7 10.0 ‘3.7 4.3 ‘1.5 +3.5 

CHRONIC CONDITIONS OR IMPAIRMENTS6 

Diseases of the circulatory system 

Arteruxcleros~s.. ........................................................ 100.0 65.3 34.7 13.3 20.8 5.E 6.8 0.8 7.8 

Hypertension.. ........................................................... 100.0 64.4 35.6 16.5 19.0 4: 6.4 l 0.8 6.3 

Stroke ....................................................................... 100.0 58.0 42.0 24.4 18.9 7.: 8.6 l 0.9 7.0 

Paralysis or palsy, other than arthritis, 

related to stroke ..................................................... 100.0 57.3 42.7 26.1 18.9 9.: 9.2 l 8.0 

Heart trouble ...................................................... i.. .... 100.0 65.5 34.5 13.6 21 .o 5.; 7.6 ‘0.6 7.2 

Mental disorders and senility without psychosis 

Mental illness.. ........................................................... 100.0 64.0 36.0 7.5 21.5 6.4 7.0 5.9 6.6 

Chronic brain syndrome.. .......................................... 100.0 63.5 36.5 12.6 22.8 5.5 7.9 1.2 10.1 

Senility.. ................ . ................................................... 100.0 69.7 30.3 10.4 17.8 6.1 0.9 8.9 

Mental retardation.. ................................................... 100.0 60.7 39.3 9.5 26.7 2 7.9 ‘3.1 4.9 

Alcoholism.. .............................................................. 

Drug addiction .......................................................... 

100.0 

100.0 

62.4 

l 70.8 

37.6 l 13.1 I 20.0 l 

‘8.4 l ‘8.6 l 

l *6.9 l 

Insomnia ................................................................... 100.0 63.7 36.3 15.0 20.7 5.7 9.9 l 1.2 7.8 

Other chronic conditions or impairments 

Diseases of the musculoskeletal system and 

connective tissues: 

Arthritis and rheumatism ..................................... 100.0 65.1 34.9 15.9 19.8 6.E 7.1 “0.9 6.7 

Chronic back/spine problems, excluding 

stiffness and deformity.. .................................... 100.0 62.8 37.2 15.3 23.1 7.5 8.5 l 15.5 

Permanent stiffness or deformity of tack, arms, 

legs, or extremities, including feet, toes, 

hands, or fingers.. .............................................. 100.0 57.5 42.5 21.9 23.5 8.E 9.4 l 8.5 

Missing arms, legs, or extremities, including 

feet, toes, hands, or fingers.. ............................ 100.0 59.2 40.8 21.9 19.2 l 6.0 ‘8.0 l 5.1 

Diseases of the nervous system and sense organs: 

Blindness .............................................................. 100.0 69.7 30.3 12.3 18.5 5.9 6.0 l 5.6 

Glaucoma ............................................................. 100.0 63.2 36.8 14.2 20.8 10.1 ‘8.4 l 8.1 

Cataracts .............................................................. 100.0 66.0 34.0 13.1 19.1 6.8 8.1 l 5.4 

Deafness.. ............................................................. 100.0 71.9 28.1 11.6 15.7 l 3.3 4.3 l 5.4 

Parkinson’s disease ............................................... 100.0 67.1 32.9 14.3 20.6 7.3 6.8 l 6.5 

Paralysis or palsy, other than arthritis, 

unrelated to stroke.. .......................................... 100.0 59.5 40.5 22.7 21.4 8.7 10.2 l c5.5 

Accidents, poisonings, and violence: 

Hip fracture .......................................................... 100.0 55.9 44.1 28.3 23.8 5.0 5.0 l 8.1 

Other bone fracture.. ............................................ 100.0 58.7 41.3 26.4 21.8 10.6 7.9 l l 6.4 

Endocrine, nutritional, and metabolic diseases: 

Diabetes ............................................................... 100.0 63.7 36.3 14.7 21.9 6.8 8.6 l 1.1 6.3 

See footnotes at end of table. 

95 
Table 19. Number and percent distribution of nursing home residents by therapy services received, according to selected health statuses: 

United States, 1977-Con. 

Therapy service 

Number of Number of 

residents residents 

CounselSelected health status1 Total receiving receiving 

Physical Recrea- Occupa- counsel- ing by Reality “0 one or 

more types therapy tional tional inQ w mental orienta- therapy2 of therapy2 therapy therapy social health tion war ker worker 

I I I I I I 

CHRONIC CONDITIONS OR 

IMPAIRMENTS6-Con. Percent distribution 

Other chronic conditions or impairments--Con. 

Neoplasms: 

cancer . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 63.5 36.5 14.2 18.2 6.2 10.0 I 6.1 

Diseases of the respiratory system: 

Chronic respiratory disease . . . . . . . . . . . . . . . . . . . .. .t . . . . . . . . . . . . 100.0 68.4 31.6 14.6 18.0 4.6 7.2 l 6.0 

Diseases of the digestive system: 

Constipation .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 64.1 35.9 15.6 20.9 5.1 9.3 '0.7 7.6 

Diseases of the blood and blood-forming organs: 

Anemia .,.........,............,.......,..........,..........,.......... 100.0 60.4 39.6 16.9 22.1 8.0 10.2 l 8.9 

Diseasesof the skin and subcutaneous tissue: 

Bedsores . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .. .. .. . . . . 100.0 59.4 40.6 23.0 22.2 11.3 99.3 l 7.5 

Conditions other than above: 

Edema . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 67.5 32.5 14.1 19.4 5.1 7.0 +0.5 7.6 

Kidney trouble .. . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 65.4 34.6 16.6 17.7 5.5 7.9 l 1.2 7.7 

None of these conditions ! 

Total . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 79.3 l 20.7 l l l l l I) 

. 

INDEX OF DEPENDENCY IN ACTIVITIES 

OF DAILY LIVING’ 

Independent in bathing, dressing, using toilet 

room, mobility, continence, and eating . . . . . . . . . . . . . . . 100.0 73.5 26.5 l 2.2 16.5 4.8 5.8 5.0 "2.3 

Dependent in only one activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 67.8 32.2 7.6 20.1 5.6 7.9 "1.9 4.5 

Dependent in bathing and one other activity .,........... 100.0 68.1 31.9 7.1 20.5 5.5 6.7 "0.8 7.4 

Dependent in bathing, dressing, and one other . actlwty . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 64.3 35.7 12.9 22.3 4.2 6.9 l 1.6 6.0 

Dependent in bathing, dressing, using toilet room, 

and one other actwty . . .. . . . . . . . . . . . .. .. . . . . . . . . . . . .. .. . . . . . . . . . . . 100.0 55.1 44.9 24.4 23.7 6.9 7.4 I 8.4 

Dependent in bathing, dressing, using toilet room, 

mobility, and one other acitvity . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 60.2 39.8 26.1 21.5 7.5 7.4 l 0.6 

Dependent in all six activities .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 66.3 33.7 16.9 17.7 5.1 6.7 "0.6 

Other8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . . . . . 100.0 64.3 35.7 13.4 20.7 7.7 7.1 '1.1 

lDisease group categories are based on Eighth Revision International CIassification of Diseases, Adapted for Use in the United States (ICDA).

21ncludes small number of unknowns. 

3Figures do not add to totals because multiple responses were permitted. 

40nly diagnoses of sufficient magnitude are noted. 

SIncludes those who received no physician visit while in facility.

6Figures may not add to totals because resident may have had more than one reported chronic condition or impairment.

7Unknowns were considered independent for the purpose of this index. 

*Includes residents who were dependent in at least two activities but who were not classifiable into any of the categories. 

96 
Table 20. Number and percent distribution of nursing home residents by selected health services received, according to facility certification, bed size, and ownership: 

United States, 1977 

Certification I Bed size I Ownership 

Selected health service 

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

Time since last physician visit 

Less than 1 week.. ............................................... 

1 to less than 2 weeks.. ....................................... 

2 weeks to less than 1 month.. ............................ 

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

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

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

1 year or more .................................................... 

No physician visits since entering facilityl.. ........ 

Time between last two physician visits 

Less than 1 week.. ............................................... 

1 to less than 2 weeks.. ....................................... 

2 weeks to less than 1 month .............................. 

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

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

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

1 year or more .................................................... 

Has not received two physician visits since 

entering’.......................................................... 

Services given et last visit2*3 

Examination ....................................................... 

Treatment.. ......................................................... 

Prescription.. ............................................. . ......... 

Orders for lab tests.. ............................................ 

Other .................................................................. 

Location of last physician visit3 

Outsidefacility ................................................... 

Inside facilityI.. .................................................. 

Arrangement for physician services3 

Physician on call ................................................. 

Regularly scheduled physician visits.. .................. 

Other arrangementl.. .......................................... 

Status of personal physician within facility3 

Private physic;an ................................................. 

Physician assigned by or works for facility .......... 

Other status1 ...................................................... 

See footnotes at end of table. 

Total Skilled Skilled 

nursing intermediate Non- Less than 50.99 100-l 99 200 beds Propri- Voluntary Govern- nursing intermediate care facility certified 50 beds beds beds or more etary nonprofit ment facility care facility 

1,303,100 269,600 527,800 

266,500 70,200 119,900 

219,000 54,000 96,300 

370,000 63,900 166,700 

291,100 42,600 103,300 

56,200 3,900 14,900 

22,300 l 3,700 

17,500 l 3,300 l 2,700 

56,700 10,500 16,300 

63,000 23,400 39,600 

69.000 21,600 38,000 

367,400 94,500 176,400 

470,000 69,200 169,300 

61,200 

23,200 

4,300 

l 2,300 

17,700 

4,500 

23,900 4,500 6,700 

126,600 19,100 36,900 

1,101,700 226,900 440,500 

166,600 39,700 61,600 

792,900 166,300 346,100 

243,700 49,700 106,600 

72,600 15,100 34,000 

169,300 20,900 35,200 

1,077,100 236,200 474,200 

169,000 16,000 36,200 

1.057.500 236,100 466,200 

19,900 4,900 5,100 

627,000 162,700 309,500 

366,700 66,700 169,600 

32,700 7,600 10,300 

Number 

366,200 137,500 167,900 397,000 505,200 233,000 666,600 261.600 132,500 

53,300 25,000 24,400 77,200 107,400 59,500 174,300 60,100 34,100 

47,400 19,300 21,200 63,500 92,300 42,000 151,700 45,400 21,600 

94,400 25,000 45,900 113,600 141,200 69,300 262,900 73,700 33,400 

115,600 29,400 47,900 96,400 104,400 42,300 196,200 66,100 26,700 

25,400 13,900 9,900 19,300 22,700 6,300 34,700 16,200 7,300 

9,900 

7,300 

7,600 

4,100 

4,600 

3,600 

6,000 

l 3,200 

6,600 

6,100 

‘3,000 

l 2,400 

14,500 

10,500 

5,400 

5,200 

l 2,300 

‘1,600 

14,6Op 13,200 10,200 17,600 20,500 6,200 42,000 9;600 5,100 

12,400 7,400 7,500 21,300 25jOO 29,300 37,600 26,300 16,900 

16,700 10,400 6,500 22,700 35,700 24,100 53,500 22,600 12,900 

66,900 27,500 35,400 113,300 147,400 71,300 260,300 72,100 35,000 

161,300 30,200 60,300 149,300 169,200 71,200 336,200 96,100 38,600 

27,400 11,900 11,600 16,400 23,200 7,600 36,400 16,000 6,600 

10,500 

6,200 

5,900 

6,400 

5,300 

7,100 

7,400 

5,900 

6,700 

6,200 

l 1,600 

l 2,700 

14,400 

17,700 

5,300 

4,600 

3,500 

‘1,300 

46.200 24,600 23,600 41,000 47,300 16,600 91,500 27,100 10,300 

323,400 110,900 145,100 334,600 431,200 190,600 762,900 236,700 102,100 

46,200 19,100 16,600 56,600 65,600 47,400 117,200 44,700 26,700 

210,300 70,300 66,000 242,600 306,600 163,700 552,600 169,100 71,300 

66,300 18,600 27,600 73,600 92,500 49,600 167,600 53,600 22,500 

15,700 7,600 6,500 .16,300 26,400 21,400 41,600 20,100 10,900 

69,200 44,100 43,700 52,600 56,000 17,000 114,700 41,600 12,900 

264,400 60,300 114,000 326,700 428,600 207,600 732,100 230,500 114.500 

75,300 41,400 30,200 55,700 56,400 24,700 104,300 43,300 21,300 

272,400 76,600 124,700 317,600 416,900 196,300 727,600 225,700 103,900 

.5,600 4,100 l 2,600 6,000 7,400 3,600 14,700 l 3,200 “2,100 

261,600 73,100 115,600 276,200 336,600 96,400 624,100 160,100 42,600 

63,300 45,100 34,600 92,200 136,000 123,800 197,900 107,100 61,700 

6,600 6,200 7,200 6,600 12,100 4,700 24,900 4,900 l 2,900 
Table 20. Number and percent distribution of nursing home residents by selected health services received, according to facility certification, bed size, and ownership: 

United States, 1977-Con. 

Selected health service 

Level of care received 

Nursing care: 

Intensive ........................................................ 

Other ........................ . .................................... 

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

Neither nursing nor personal care.. ...................... 

Therapy services 

No therapy service during last monthl.. .............. 

Therapy service during last month’ .................... 

Physical therapy. ............................................ 

Recreational therapy.. .................................... 

Occupational therapy.. ................................... 

Speech therapy .............................................. 

Counseling by social worker.. ......................... 

Counseling by mental health worker.. ............ 

Reality orientation.. ....................................... 

Other therapy services.. .................................. 

Other health &ices 

Flu shot within last 12 months4 

Received ........................................................ 

Did not receive.. ............................................. 

Caught flu within last 9 months.. ................... 

Special diet within last 7 days 

No special diet1 ............................................. 

Special diet’ .................................................. 

Low sodium.. ............................................ 

Diabetic .................................................... 

Soft.. ......................................................... 

Weight loss.. .............................................. 

Bland ........................................................ 

Other.. ...................................................... 

See footnotes at end of table. 

II I I 

Certification Bed size Ownership 

Total ““.. 

571,400 149,400 240,700 144,300 37,100 61,200 181,400 228,200 100,700 396,000 118,300 57,100 

530,200 87,200 215,000 177,800 50,200 65,000 170,100 209,700 85,300 362,600 117,300 50,200 

187,800 

13,800 

32,100 . 69,900 

l 2,300 

42,400 

3,700 

43,400 

6,900 

38,500 

l 3,200 

43,100 61,400 

l 2,400 5,900 

44,700

l 2,300 

123,000 

7,300 

42,600 

3,500 

22,100

l 3,000 

847,100 59,000 318,300 267,400 102,500 123,800 271 ,100 329,100 123,200 601,300 176,600 69,200 

456,000 10,600 209,500 100,800 35,100 44,000 125,900 176,100 109,900 287,400 105,300 63,300 

178,900 44,600 93,600 30,000 10,700 8,500 46,400 72,700 51,300 103,000 44,500 31,300 

261,300 66,700 119,000 67,300 18,200 31,700 72,400 96,900 60,200 173,800 55,400 32,100 

76,700 

12,200 

18,100 

l 3,300 

38,800 

7.100 

14,500 

l 1,300 

5,400 I 5,700 l 19,700 26,200 

l 2,600 3,900 

25,100 

5,300 

40,700 

7.100 

22,000 

l 2,200 

14,100 

‘2,800 

9i,400 15,200 45,500 25,500 5,200 8,900 25,800 32,600 24,100 65,000 21,500 14,900 

17,800 3,600 6,300 4,200 3,600 ‘2,600 4,000 4,600 6,700 10,000 l 3,400 4,500 

86,500 

22,200 

21,300 

3,800 

39,900 

11,600 

22,300 

3,900 

‘2.900 

l 3,000 

6,900 

l 1 ,300 

25,000 37,200 

5,400 8,700 

17,400 

6,900 

55,400 

11,400 

23,900 

6,300 

7,200 

4,600 

545,900 90,200 218,200 176,300 61,200 72,800 173,500 202,400 97,200 343,300 137,100 66,500 

282,700 

23,900 

66,600 

l 2,600 

103.900 

11,000 

77,400 

6,600 

34,800 

3,800 

41,000 

4,000 

80,600 108,700 

5,200 11,200 

52,400 

3,500 

205,600 

16,900 

55,200 

4,100 

21,900 

l 2,900 

735,600 39,400 279,200 215,900 101,000 111,800 226,800 276,600 120,300 507,900 162,600 65,100 

567,500 30,200 248,600 152,300 36,500 56,100 170,200 228,500 112,700 380,900 119,200 67,400 

185,100 46,600 81,200 43,500 13,700 17,400 50,300 75,300 42,100 121,000 44,000 20,100’ 

163,200 35,400 69,200 48,600 10,000 16,9OlJ 44,100 67,200 33,100 108,900 33,700 20,500 

103,600 

40,400 

21,600 

6,600 

47,800 

21,300 

26,300 

10,300 

7,900

l 2,300 

7,800 

4,500 

33,400 42,800 

12,600 14,800 

19,700 

8,500 

74,000 

24,700 

15,300 

9,500 

14,200 

6,200 

44,400 11,100 18,800 11,100 ‘3,300 4,100 16,200 16,200 7,800 26,900 12,300 5,100 

101,500 25,800 46,500 25,400 3,800 10,600 29,200 40,300 21,400 66,600 23,300 11,500 
Table 20. Number and percent distribution of nursing home residents by selected health services received, according to facility certification, bed size, and ownership: 

United States, 1977-Con.

-

Tr Certification I Bed size I Ownership 

Selected health service Total Skilled Skilled 

nursing- Intermediate NOW Less than 50-99 loo-199 200 beds Propri- Voluntary Govern- nursing intermediate care facility certified 50 beds beds beds or more etary nonprofit ment facility care facility 

Percent distribution 

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 

Time since last physician visit 

Less than 1 week.. ............................................... 20.6 26.1 22.7 14.5 18.2 14.6 19.5 21.3 25.5 19.6 21.3 25.7 

1 to less than 2 weeks ......................................... 16.8 20.0 18.6 12.9 14.0 12.6 16.0 18.3 18.0 17.1 16.1 16.4 

2 weeks to less than 1 month.. ............................ 28.4 31.1 31.6 25.8 18.2 27.3 28.6 28.0 29.7 29.6 26.2 25.2 

1 to less than 3 months.. ..................................... 22.3 15.8 19.6 31.5 21.4 28.6 24.3 20.7 18.2 22.3 23.5 20.2 

3 to less than 6 months.. ..................................... 4.5 1.5 2.8 6.9 10.1 5.9 4.9 4.5 2.7 3.9 5.8 5.5 

6 months to less than 1 year.. ............................. 1 .J l 0.7 2.7 5.5 2.7 1.7 ‘1.3 1.6 1.9 ‘1.7 

1 year or more .................................................... 1.3 l 1.2 +0.5 2.0 3.0 2.3 48” l 1.0 1.2 l 1.3 

No physician visits since entering facility1 .......... 4.4 3.9 3.5 4.0 9.6 6.1 4.5 ::7 3.5 4.7 3.9 

Time between last two physician visits 

Less than 1 week.. ............................................... 6.4 8.7 7.5 3.4 5.4 4.5 4.9 12.6 4.3 9.3 14.3 

1 to less than 2 weeks ......................................... 6.8 8.1 5.1 7.6 3.9 : 7.1 10.3 6.0 9.7 

2 weeks to less than 1 month.. ............................ 28.2 35.0 3:: 18.7 20.0 21.1 28:5 29.2 30.6 29.3 2: 26.4 

1 to lass than 3 months.. ..................................... 36.1 33.1 35:9 43.8 22.0 35.9 37.6 37.5 30.5 37.7 34:1 29.3 

3 to less than 6 months.. ..................................... 4.7 1.6 3.3 7.4 8.6 7.0 4.6 4.6 3.3 4.1 6.4 5.1 

6 months to less than 1 year.. ............................. 1.8 l 0.8 0.9 2.9 4.3 3.1 1.9 1.7 l 0.8 1.6 1.9 2.6 

1 year or more .................................................... 1.8 1.7 1.3 1.7 4.7 4.2 1.5 1.6 l 1.2 2.0 1 .J l 1.0 

Has not received two physician visits since 

entering1 .......................................................... 9.9 7.1 7.0 13.1 17.9 14.2 10.3 9.4 7.2 10.3 9.6 7.8 

Services given at last visit2J 

Examinatiori ....................................................... 84.5 84.2 83.5 87.8 80.6 86.4 84.3 85.4 81.8 85.8 84.0 77.1 

Treatment.. ......................................................... 14.5 14.7 15.5 13.1 13.9 9.9 14.8 13.0 20.3 13.2 15.9 20.1 

Prescription.. ....................................................... 60.8 61 .J 65.6 57.1 51 .l 52.4 61.2 61 .l 65.9 62.2 60.0 53.8 

Orders for lab tests.. ............................................ 16.7 18.4 20.2 18.6 13.7 18.6 18.6 18.3 21.3 18.9 19.0 17.0 

Other .................................................................. 5.6 5.6 6.4 4.3 5.7 3.9 4.6 5.2 9.2 4.7 7.1 8.3 

Location of last physician visit3 

Outside facility ................................................... 13.0 7.7 6.7 18.8 32.0 26.0 13.2 11.1 7.3 12.9 14.8 9.7 

Inside facility1 .................................................... 82.7 88.3 89.9 77.2 58.4 67.9 82.3 84.8 89.2 82.4 81.8 86.4 

Arrangement for physician services3 

Physician on call ........................................ .I ....... 13.0 6.9 20.5 30.1 18.0 14.0 11.6 10.6 11.7 15.4 16.1 

Regularly scheduled physician visits.. .................. 81.1 8z 88.7 74.0 57.3 74.3 80.0 82.9 64.2 81.9 80.1 78.4 

Other a?rangement1............................................ 1.5 1:8 1 .o 1.6 3.0 f1.7 1.5 1.5 1.6 1.7 l 1.1 l 1.6 

Status of personal physician within facility’ 

Private physician ................................................. 63.5 67.8 58.6 71 .l 53.2 68.9 70.1 66.6 41.4 JO.2 56.8 32.3 

Physician assigned by or works for facility .......... 29.7 25.5 35.9 22.6 32.8 20.7 23.2 26.9 53.1 22.3 38.0 61.6 

Other status1 ...................................................... 2.5 2.8 2.0 2.3 4.5 4.3 2.2 2.4 2.0 2.8 1.8 l 2.2 

See footnotes at end of table. 
Table 20. Number and percent distribution of nursing home residents bv selected health services received, according to facility certification, bed size, and ownership: 

United States, 1977-Con. 

Certification Bed size Ownership 

Selected health service Total Skilled Skilled 

nursing- Intermediate NO”. Less than 5049 100-199 200 beds “‘:. nursing intermediate care facility certified 50 beds beds teds or more facility 

Level of care received 

Nursing care: 

Intensive ........................................................ 

Other ............................................................. 

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

Neither nursing nor personal care.. ...................... 

Therapy services 

No therapy services during last month1 .............. 

Therapy services during last month*. .................. 

Physical therapy.. ........................................... 

Recreational therapy.. .................................... 

Occupational therapy.. ................................... 

Speech therapy .............................................. 

Counseling by social worker.. ......................... 

Counseling by mental health worker.. ............ 

Reality orientation.. ....................................... 

Other therapy services.. .................................. 

Other health services 

Flu shot within last 12 months4 

Received ........................................................ 

Did not receive ............................................... 

Caught flu within last 9 months.. ................... 

Special diet within last 7 days 

No special diet’ ............................................. 

Special diet” .................................................. 

Low sodium .............................................. 

Diabetic.. .................................................. 

Soft.. ......................................................... 

Weight loss ................................................ 

Bland ........................................................ 

Other ........................................................ 

llncludes a small number of unknowns. 

cere facility 

43.8 55.4 45.6 39.2 

40.7 32.4 40.7 48.3 

14.4 11.9 13.2 11.5 

1.1 l l 0.4 1.0 

65.0 59.0 60.3 72.6 

35.0 41.0 39.7 27.4 

13.7 16.5 17.7 8.1 

20.0 24.8 22.5 15.6 

5.9 6.7 7.3 3.9 

0.9 ‘1.2 1.3 l 0.3 

7.0 5.6 8.6 6.9 

1.4 1.4 1.2 1.1 

6.6 7.9 7.6 6.1 

1.7 1.4 2.2 1.1 

Percent d&rib Iut ian 

26.9 36.5 45.7 

36.5 38.7 42.8 

31.6 22.9 10.9 

5.0 l 1.9 l 0.6 

74.5 73.8 68.3 

25.5 26.2 31.7 

7.8 5.0 11.7 

13.3 18.9 18.2 

3.9 3.4 5.0 l l l 0.6 

3.8 5.3 6.5 

2.6 ‘1.5 

l 2.1 4.1 ::3” 

l 2.2 ‘0.7 1.4 

44.5 43.4 43.7 

25.3 24.4 20.3 

2.7 2.4 1.3 

73.5 66.6 57.1 

26.5 33.4 42.9 

10.0 10.4 12.7 

7.3 11.2 11.1 

5.7 4.6 8.4 

l 1.6 2.7 3.2 

l 2.4 2.4 4.1 

2.8 6.3 7.3 

45.2 43.2 44.6 42.0 43.1 

41.5 36.6 40.8 41.6 37.9 

12.2 19.2 13.8 15.1 16.7 

1.2 +1.0 0.8 1.3 l 2.3 

65.1 52.8 67.7 62.6 52.3 

34.9 47.2 32.3 37.4 47.7 

14.4 22.0 11.6 15.8 23.6 

19.2 25.8 19.6 19.7 24.2 

5.2 10.8 4.6 7.8 10.6 

0.8 2.3 0.8 l 0.8 92.1 

6.4 10.3 6.2 7.6 11.3 

0.9 2.9 1.1 l 1.2 3.4 

7.4 7.5 6.2 8.5 5.4 

1.7 3.0 1.3 2.2 3.5 

40.1 41.7 38.6 48.7 49.4 

21.5 22.5 23.1 19.6 16.5 

2.2 1.5 1.9 1.5 l 2.2 

54.8 51.6 57.1 57.7 49.1 

45.2 48.4 42.9 42.3 50.9 

14.9 18.1 13.6 15.6 16.2 

13.3 14.2 12.3 12.0 15.5 

8.5 8.4 8.3 5.4 10.7 

2.9 3.7 2.8 3.4 4.7 

3.2 3.3 3.0 4.4 3.9 

8.0 9.2 7.5 8.3 8.7 

41.9 33.5 

21.7 24.7 

1.8 l 1.0 

56.4 51.7 

43.6 48.3 

14.2 17.3 

12.5 13.1 

7.9 8.0 

3.1 2.5 

3.4 4.1 

7.8 9.6 

47.9 

21 .o 

1.8 

58.6 

41.4 

11.8 

13.2 

7.2 

2.8 

3.0 

6.9 

*Figures do not add to totals because multiple responses were permitted. 

gExcludes those who had received no physician visit after entering facility. 

4Excludes those who were in the facility less than 12 months. 
APPENDIXES 

CONTENTS 

I. Technical Notes on Methods .......................................................................................................... 102 

Survey Design.. .......................................................................................................................... 102 

General Qualifications ................................................................. .............................................. 106’ 

Reliability of Estimates ............................................................................................................. 107 

Hypothesis Testing .................................................................................................................... 110 

IL Definition of Certain Terms Used in This Report ............................................................................ 113 

IIL Selected Questionnaires Used in the 1977 National Nursing Home Survey ..................................... 118 

Current Resident Sampling List.. ............................................................................................... 119 

Current Resident Questionnaire ................................................................................................ 121 

IV. Criteria for Classifying Nursing Homes According to Level of Nursing Care...; . ... . .... . . .... . . .... . . .... ... . 137 

LISTOF APPENDIX FIGURES 

I. Relative standard errors of estimated number of residents.. ............... i.. ......................................... 108 

II. Approximate relative standard errors of estimated percents of residents.. ...................................... 109 

LIST OF APPENDIX TABLES 

I. Number of facilities in the 1977 National Nursing Home Survey universe and sample, by disposition and sampling strata: Conterminous United States, 1977 .. ... . .. ... . . ... .. . ... .. .. .. .. .. .. ... ... .. . ... .. .. .. .. 104 

II. Summary of data collection procedures .. ... . .. ... . .. ... . ... . .. .. .. . ... .. ..1..................................................... 106 

III. Worksheet for weighted least squares regression of mean time since last physician visit, by length 

of stay since current admission: United States, 1977 . .. . .. ... . .. .... . .... . .... . . .... .. . ... . . ... .. .. .. . ... .. .. .. ..!....... 111 

IV. Classification of facilities by type of service .. .. .. .. .. .. ... . ... . .. ... . .. .. .. . .... . .. .. .. .. ... . .. .. .. . ... .. .. .. .. .. ... . . .... . . ... 138 

101 

1 
APPENDIX I 

TECHNICAL NOTES ON METHODS 

SURVEY DESIGN 

From May 1977 through December 1977, 

the Division of Health Resources Utilization 

Statistics (DHRUS) conducted the 1977 National Nursing Home Survey (NNHS)-a sample 

survey of nursing homes, their residents,. discharges, and staff in the conterminous United 

States. The survey was designed and developed 

by DHRUS in conjunction with a group of experts in various fields encompassing the broad 

area of long-term care. The NNHS was the second of a series of surveys designed to satisfy 

the diverse data needs of those who establish 

standards for, plan, provide, and assess longterm care services. The first survey was conducted from August 1973 through April 1974. 

Sampling Frame 

The 1977 NNHS covered all types of nursing 

homes including nursing care homes, personal 

care homes with nursing, personal care homes, 

and domiciliary care homes. Places that provided room and board only were excluded. 

Facilities were either freestanding establishments or nursing care units of hospitals, retirement centers, or similar institutions where the 

unit maintained financial and resident records 

separate from those of the larger institutions. 

Detailed criteria for classifying facilities included 

in the survey are presented in appendix IV. 

The universe for the 1977 NNHS consisted 

of two groups of homes: those classified as nursing homes in the 1973 Master Facility Inventory 

(MFI)5 and nursing homes opening for business 

since 1973. The major group (92 percent) was 

NOTE: A list of references follows the text. 

composed of all nursing homes as classified in 

the 1973 MFI. The MFI is a census of all inpatient health facilities conducted every 2-3 years 

by mail by the National Center for Health Statistics. A detailed description of how the MFI 

was developed, its contents, and procedures for 

updating and assessing its coverage has been 

published.46d8 

In order for data collection to begin in May 

of 1977, the sampling frame was “frozen” in 

December of 1976 so that the sample would 

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 that opened for business after the 1973 

MFI was conducted were also included in the 

universe. (Nursing homes that opcncd after 

December 1976 could not be included since data 

about them were not yet available.) The nursing 

homes that opened after the 1973 MFI but before December 1976 comprised the second and 

smaller (8 percent) group of facilities in the 

universe. Information about this second group 

of facilities was limited compared with the first 

group which was listed in the 1973 MFI. 

Estimates from the 1977 NNHS will not correspond precisely to figures from the 1976 MFI 

census for several reasons. In addition to the 

differences in time period, the surveys used different data collection mechanisms. The MFI is 

a mail survey but the NNHS is conducted by 

personal interview. Thus thc,NNIIS mcthodology permitted more dctailcd identification and 

exclusion of facilities that were out of scope. 

Because the NNHS is a sample survey, its data 

are subject to sampling variability; bccausc the 

MFl is a census, its data arc not. In general, 

however, the data from the two sources arc 

compatible. 

_ 

102 
Sampling Design 

The sampling was basically a stratified twostage probability design. .The first stage was a 

selection of facilities and the second stage was a 

selection of each of the following: residents, persons discharged in 1976, and employees from 

the sample facilities. In preparation of the firststage sample selection, two different procedures 

were used: one for facilities listed in the MFI 

with known bed size and another for newly 

opened facilities whose bed size and service type 

were unknown. The procedure for facilities in 

the MFI with known bed. size consisted of sorting these facilities into two types of service 

strata: (1) nursing care homes and (2) facilities 

providing all other types of service (including 

personal care homes with nursing, personal care 

homes, domiciliary care homes, and facilities 

with unknown service type). Nursing homes in 

each of these two service strata were then sorted 

into bed-size groups, producing the first 16 primary strata shown in’ table I. Within each primary stratum, nursing homes were ordered by 

type of ownership, geographic region, State, and 

county. The sample within the first-16 strata 

was then selected systematically after a random 

start within each primary stratum. The procedure for newly opened facilities whose size and 

service type were unknown was a doublesampling scheme. In the first step, a random subset of one-third of these facilities (587 nursing 

homes) was selected, and bed-size information 

was determined for them by telephone contact. 

Using the newly gathered information on bed 

size, this subset of facilities was then sorted 

into bed-size groups producing the last 8 strata 

shown in table I. Within each of these bed-size 

strata, nursing homes were ordered by geographic region, State, and ZIP code. (Although 

the first group of facilities from the MFI was 

ordered by type of ownership and county, this 

subset was not arranged the same way because 

information on these variables was not available.) In the second step, the final sample 

within the last 8 strata was then selected systematically after a random start within each primary stratum. Table I shows the entire distri-. 

bution of facilities in the sampling frame and the 

final disposition of the sample with regard to 

response and inscope status. 

The number of nursing homes estimated by 

the survey (18,900) is less than the universe 

figure (23,105), as well as the number of nursing 

homes in the 1976 MFI (20,185), for several 

reasons. Some facilities went out of business or 

became ineligible for the scope of the survey 

between the time the universe was frozen and 

the survey was conducted. A facility was considered out of scope if it did not provide nursing, personal or domiciliary care services (e.g., 

facilities providing only room and board) or if 

it were a nursing care unit or wing of a hospital, 

retirement center, or similar institution without 

separate financial and resident records for that 

unit. The NNHS methodology included a 

thorough procedure for identifying out-of-scope 

facilities. For these same reasons, the 1973-74 

NNHS estimate differed from the universe figure 

by 1,900.g In addition, the large number of 

newly opened facilities in the sampling frame, 

for which limited information on services provided was available, resulted in a larger proportion of facilities (10 percent) later identified as 

out of scope in comparison with the 1973-74 

NNHS (7 percent). 

The second-stage sampling of residents, discharges in 1976, and employees was carried out 

by the interviewers at the time of their visits to 

the facilities in accordance with specific instructions given for each sample facility. The sample 

frame for residents was the total number of residents on the register of the facility 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 facility were included in the sample frame. An average of five 

residents per facility were in the sample. 

The sample frame for discharges was the 

total number of persons discharged alive or dead 

during calendar year 1976. Persons who were 

discharged more than once during 1976 were 

listed for each discharge. It is possible that a current resident was included in the discharge sampling frame if he or she were discharged during 

1976. An average of four discharges per facility 

were in the sample. 

The sampling frame for employees was the 

Staff Sampling List on which the interviewer 

listed the names of all staff providing direct. 

or health-related services (including contract 

103 
Table I. Number of facilities in the 1977 National Nursing Home Survey universe and sample, by disposition and sampling strata: 

Conterminous United States, 1977 

Sample 

Universe 

Sampling strata (sampling All framejl facilities 

Number of facilities 

All types of service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23,105 1,698 166 81 

Nursing care .. . .._................................................................ 13,230 1,292 95 68 1,129 

Less than 15 beds ........................................................................ 676 11 3 0 .,8 

15-24 beds.. ................................................................................. 1;195 30 8 1 21 

25-49 beds.. ................................................................................. 3,168 158 25 6 127 

50-99 beds.. ................................................................................. 4,775 398 17 17 364 

loo-199 beds.. ............................................................................. 2,864 477 18 32 427 . 

200299 beds ............................................................................... 402 134 6 6 122 , 

300-599 beds.. ............................................................................. 133 67 12 6 49 i 

600 beds or more.. ....................................................................... 17 17 6 0 11 

All other types of service2 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,116 318 57 8 253 

Less than 15 beds ........................................................................ 3,431 35 13 0 22 

15-24 beds ................................................................................... 1,166 17 5 0 12 

2549 beds.. ........................................................................ .:. ...... 1,108 34 11 0 23 

50-99 beds ................................................................................... 1,202 60 5 1 54 

loo-199 beds.. ............................................................................. 913 91 11 3 77 I 

200299 beds ............................................................................... 173 34 4 2 28 

300-599 beds.. ............................................................................. 92 31 4 1 26 

600 beds or more.. ....................................................................... 31 16 4 1 11 

Unknown type of service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 1,759 . . . . . . . . . . . . 

Bed size known3.. ........................................................................ 587 88 14 5 69 < 

Less than 15 beds ........................................................................ 107 3 1 0 2 

15-24 beds ................................................................................... 96 4 3 1 0 

2549 beds ................................................................................... 128 12 6 0 6 : 

50-99 beds ................................................................................... 113 16 1 ’ 1 14 

loo-199 beds.. ............................................................................. 122 40 2 2 36 

200-299 beds ............................................................................... 16 8 0 1 7 

300-599 beds ............................................................................... 5 5 1 0 4 

600 beds.. .................................................................................... 0 0 0 0 , 0 

Bed size unknown.. ...................................................................... 1,172 . . . . . . * . . . . . 

‘The universe consisted of the nursing homes as classified in the 1973 Master Facility Inventory and facilities opened for business 

from 1973 to 1976. 

‘Includes personal care homes (with or without nursing), domiciliary care homes, and facilities with unknown service type. 

31n order to improve estimates of the 1,759 facilities for which both service type and bed size were unknown, bed sizes were 

determined for a one-third sample (587 facilities). These facilities were then stratified by bed size before sample selection.

personnel employed last month) and sampled this form. An average of 10 staff per facility 

contract, administrative, medical, therapeutic, 

and nursing staff. Those generally not involved 

were in the sample. 

In order to reduce - -.__---._. respondent burden, rein direct patient care, such as office staff, food strictions were placed on the number of resiservice, housekeeping, and maintenance person- dents, discharges, and staff sampled in each 

nel were excluded from the sample. The inter- facility. Sampling rates were predesignated ,.by 

viewer used predesignated sampling instructions the size classification of the facility but sampling 

that appeared at the head of each column of rates were altered when necessary to assure that 

104 
the samples did not exceed the specified maximum of 8 for residents, 8 for discharges, and 23 

for employees. 

Data Collection Procedures for the 1977 

National Nursing Home Survey 

The 1977 NNHS utilized eight questionnaires (see appendix III for facsimiles of selected 

questionnaires) : 

Facility Questionnaire 

Expense Questionnaire and Definition Booklet 

Staff Sampling List 

Staff Questionnaire 

Current Resident Sampling List 

Current Resident Questionnaire 

Discharged Resident Sampling List 

Discharged Resident Questionnaire 

Data were collected according to the following procedures: 

1. A letter was sent to the administrator of 

sample facilities informing him of the 

survey and the fact that an interviewer 

would contact him for an appointment. 

Included with this introductory letter 

were letters of endorsement from the 

American Association of Homes for the 

Aging, the American College of Nursing 

Home Administrators, the American 

Health Care Association, and the National Council of Health Care Services 

urging the administrator to participate in 

the survey. A summary report from the 

previous survey in 1973-74 was also enclosed to illustrate the kind and use of 

data obtained from the survey. 

2. Several days to 1 week after the letters 

had been mailed, the interviewer telephoned the sample facility and made an 

appointment with the administrator. 

3. At the time of the appointment the 

Facility Questionnaire was completed by 

the interviewer who questioned the administrator or owner of the nursing 

home. After completing this form, the ’ 

interviewer secured the administrator’s 

authorization for completion of the 

Expense Questionnaire. Possible respondents to the Expense Questionnaire 

include accountants, administrators of 

the facilities, and other knowledgeable 

staff members. Results from the survey 

indicate that the respondents were 

evenly divided into two groups: (1) accountants located outside the facility 

and (2) administrators and other staff 

members, such as bookkeepers, based in 

the facility. Where data in prepared financial statements were comparable to 

data requested in the Expense Questionnaire, the respondent provided the facility’s financial statement to a specially 

trained NNHS accountant who abstracted data to complete the Expense 

Questionnaire. This occurred in onethird of the cases. The interviewer completed the Staff Sampling List (a list of 

all currently employed staff who provided direct or health-related services), 

selected the sample of staff from it, and 

prepared Staff Questionnaires. These 

were left for each sample staff person to 

complete, seal in an addressed and 

franked envelope, and return either to 

the interviewer or by mail. The interviewer completed the Current Resident 

Sampling List (a list of all residents currently in the facility), selected the sample of residents from it, and completed 

a Resident Questionnaire for each sample resident by interviewing the member 

of the nursing staff most familiar with 

care provided to that resident. The nurse 

referred to the resident’s medical record 

when responding. No resident was interviewed directly. The interviewer then 

completed the Discharged Resident Sampling List (a list of all persons discharged 

alive or dead in 1976), selected a sample 

of discharges from it, and completed a 

Discharged Resident Questionnaire for 

eadi sample person by interviewing a 

member of the nursing staff who referred 

105 
to medical records. In larger facilities, 

a team of two or three interviewers 

conducted the survey in order to reduce the length of time required in the 

facility. 

Followup on the Staff Questionnaire 

was initiated 2 weeks after the date of 

interview. Followup oii the Expense 

Questionnaire was initiated 3 weeks after 

the date of interview. 

Table II presents a summary of the data collection procedures. 

GENERAL QUALIFICATIONS 

Nonresponse and Imputation of 

Missing Data 

Response rates differed for each type of 

questionnaire: Response 

rate 

Questionnaire (percent) 

Facility 95 

Expense 85 

Current Resident 99 

Discharged Resident 97 

Staff 81 

Generally, response rates were higher for 

questionnaires administered in a personal interview situation (Facility, Current Resident, and 

Discharged Resident) as compared with those 

that were self-enumerated (Expense and Staff). 

Statistics presented in this report were adjusted 

for failure of a facility to respond (i.e., to complete the Facility Questionnaire), and for failtire 

to complete any of the other questionnaires 

(Expense, Current Resident, Discharged Resident, or Staff). Those items left unanswered on 

a partially completed questionnaire (Facility, 

Expense, Current Resident, Discharged Resident, Staff) were generally imputed by assigning 

a value from a responding unit with major characteristics identical to those of the nonrespbnding 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 original, unrounded figures and will not necessarily agree 

precisely with percents that might be calculated 

I. 

from rounded data. 

Table II. Summary of data collection procedures 

Questionnaire Respondent Interview situation 

Facility Questionnaire ........................................................... Interviewer with administrator Interview 

Expense Questionnaire .......................................................... Administrator, owner, accountant Self-enumerated 

or bookkeeper 

Staff Sampling List ..... .. .. ..... . .. .... .. ..... .. . ..... .. . .. ... . .. .... .. .. .... . . ... Interviewer with staff members Informal interview or copied from 

records 

Staff Questionnaire ................................................................ Sampled staff members 

Current Resident Sampling List.. ........................................... Interviewer with staff member who Informal interview or copied from 

refers to Current Resident Census records 

Current Resident Questionnaire . .._......................................... Interviewer with nurse who Interview 

refers to medical record 

Discharged Resident Sampling List .... .. .. .... .. . ... ... . .... . .. .... .. .. ... Interviewer with staff member who 

refers to discharge records from 

Informal interview or copied from 

records 

1976 

Discharged Resident Questionnaire . . ... .. .. .... . ... .... .. .... .. . .... .. .. .. Interviewer with nurse who Interview 

refers to medical record 

106 
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, and extensive editing as conducted by computer to 

assure that all responses were accurate, consistent, logical, and complete. Once the data base 

was edited, the computer was used to calculate 

and assign weights, ratio adjustments, recodes, 

and other related procedures necessary to produce national estimates from the sample data. 

Estimation Procedures 

Statistics reported in this publication are derived by .a ratio estimating procedure. The purpose of ratio estimation is to take into account 

all relevant information in the estimation process, thereby reducing the variability of the estimate. The estimation of number of facilities and 

facility data not related to size are inflated 

by the reciprocal of the probability of selecting 

the sample facilities and adjusted for the nonresponding facilities within primary type of 

service-size strata. Two ratio adjustments, one at 

each stage of sample selection, were also used in 

the estimation process. The first-stage ratio 

adjustment (along with the preceding inflation 

factors) was included in the estimation of facility data related to size, and of all resident, discharge, and staff data for all primary types of 

service-size strata.b The numerator was the total 

beds according to the MFI data for all facilities 

in’ the stratum. The denominator was the estimate of the total beds obtained through a simple 

inflation of the MFI data for the sample facilities 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 all resident, discharge, and staff data. It is the product of two 

fractions: the first is the inverse of the sampling 

fraction for residents (discharges or staff) upon 

which the selection is based; the second is the 

bFor nursing homes with unknown bed size and 

service type, the first-stage ratio adjustment was not included in the estimation of facility, resident, discharge, 

and staff data. 

ratio of the number of sample residents (discharges or staff) in the facility to the number 

of residents (discharges or staff) for whom questionnaires were completed within the facility. 

RELIABILITY OF ESTIMATES 

As in any survey, the results are subject to 

both sampling and nonsampling errors. Nonsampling errors include errors due to response 

bias, questionnaire and item nonresponse, and 

processing errors. To the extent possible, the 

latter types of errors were kept to a minimum 

by methods built into survey procedures such as 

standardized interviewer training, observation of 

interviewers and field followups for missing and 

inconsistent data, manual and computer editing, 

loo-percent verification of all keypunching, and 

other quality checks. Because survey results are 

subject to both sampling and nonsampling 

errors, the total error is larger than errors due to 

sampling variability alone. 

Because statistics presented in this report are 

based on a sample, they will differ somewhat 

from figures that wouhi 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 reffects part of 

the measurement error, but it does not measure 

any systematic biases in the data. It is inversely 

proportional to the square root of the number 

of observations in the sample. Thus as the sample size increases, the standard error generally 

decreases. Provisional estimates of the standard 

errors are presented in this report because final 

estimates are not yet available. 

The chances are about 68 out of 100 that an 

estimate from the sample differs from the value 

that would be obtained from a complete census 

by less than the standard error. The chances are 

about 95 out of 100 that the difference is less 

than twice the standard error and about 99 ‘out 

of 100 that it is less than 2% times as large. 

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 estimate. Relative standard errors of estimated number of residents are obtained from 

figure I, or calculated by the formula: 

107 
Figure I. Relative standard errors of estimated number of residents 

10: 

a 

I!3 

5 

4 

3 

2 

z 

a ‘k? 

a 

6

7” 

a 

w 5 

4 

3 

2 

1 .o 

:: 

.7 

.6 

.5 

.4 

.3 

.2 

3 4 5 6789A 2 3 4 56789A 2 3 4 5 6789A 2 3 4 56709A 2 3 4 56789 

100 1,000 10,000 100,000 1 ,ooo,ooo 

SIZE OF ESTIMATE 

Illustration of use of figure I: An estimate of 3,500 residents (on scale at bottom of figure) has a relative standard error of 

30 percent (read. from scale at left of figure) or a standard error of 1,050 (30 percent of 3,500). 

0 
Figure II. Approximate relative standard errors of estimated percents of residents 

(Base of percent shown on curves) 

100 

90 

60 

70 

60 

50 

30 

.4 

.3 

.2 

.l 

A 2 3 4 56789’A . 2 3 4 5’6 7 89A 2 3 4 5 6789A, 

1 IO 106 1,000 

ESTIMATED PERCENT 

Illustration of use ,ofS;sure II: An estimate of 20 percent (on scale at bottom of figure), 

based on an estimate of 1,303,100 residents, has a relative standard error of 3.2 percent (read 

from scale at left of figure) or a standard error of 0.64 percentage points (3.2 percent of 20 

percent). 

In this report, estimates that have a reIative 

standard error of more than 30 percent are con­ sidered “unreEabIe ,, Ceti& umefiabIe esti. . 

mates, however, are presented with an asterisk, 

where X is the number of residents of interest. while other unreliable estimates are suppressed. 

109 
Unreliable estimates that are presented are those 

with a relative standard error less than 50 percent but more than 30 percent of the estimate. 

Figure I shows the relative standard errors of 

estimated number of residents. For a relative 

standard error of 30 percent or more, the maximum estimate of residents is 3,500. For a relative standard error of 50 percent or less, the 

minimum estimate of residents is 1,300. Thus, 

unreliable estimates between 1,300 and 3,500 

are presented with an asterisk to indicate their 

unreliability. Estimates with a relative standard 

error of 50 percent or more (i.e., estimates less 

than 1,300) are considered extremely unreliable 

and have been replaced with an asterisk. 

Because of the relationship between the relative standard error and the estimate, the standard error of an estimate can be obtained by 

multiplying the estimate by its relative standard 

error. For example, in figure I an estimate of 

3,500 residents has a relative standard error of 

30 percent. Its standard error is 0.30 l 3,500 = 

1,050. 

Approximate relative standard errors (in percent) for estimates of percentages of residents 

can be calculated from figure I as follows. Obtain the relative standard error of the numerator 

and denominator. Square each of the relative 

standard errors, subtract the resulting value for 

the denominator from the resulting value for the 

numerator, and extract the square root. This 

calculation has been made for several percentages and bases and is presented in figure II. 

Alternatively, the formula 

RSE (p) = pyG-J . 1oo 

can be used to calculate RSE for any percentage 

(p) and base X (number of residents). 

Standard errors were calcuiated for specific 

estimates of residents’ average age at admission, 

and mean and median length of stay since admission; the standard errors are presented in tables 

C, H, and 7, along with the estimates. 

HYPOTHESIS TESTING 

Two methods of hypothesis testing were 

used in this report: 

2 t&.-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 X1, X,, the null hypothesis is H0 : X, = 

X, with the alternative HA : X, # X,). The 

standard error of the difference of the two estimates is approximately the square root of the 

sum of the squares of the standard errors of each 

of the estimates. Thus if SE(X,) is the standard 

error of X, and SE(X2) is the standard error 

of x9, the standard error of the difference 

(Xl -k2) is SE(X, -X,) = dSEn(X,) + SE2(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 X, and X2 are different) if the probability of a type I error is less than 5 percent, i.e., if 

x, -x, ’ 

> 1.96 

’ = 1/SE2 (X,) + SE2 (X2 ). 1 

For example, table 2 shows that 10.1 percent of the 375,30,0 male residents lived alone in 

a private residence before entering the nursing 

home, while the similar proportion of the 

927,809 female residents was 13.8 percent. Interpretation of figure II yields an approximate 

standard error of 0.89 for the 10.1 percent estimate of males living alone, and an approximate 

standard error of 0.65 for the 13.8 percent of 

females. Since 

13.8 - 10.1 

z= = 3.36 > 1.96 

d(.89)2 + (.65)2 

the proportion of females living alone prior to 

entering the nursing home was greater than that 

for males. 

Weighted least squares as a test for trend.-If 

there exists a strong relationship between an 

independent variable (e.g., length of stay) and 

mean time since last physician visit, 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 

110 
-- 

Table III. Worksheet for weighted least squares regression of mean time since last physician visit, by length of stay since current 

admission: United States, 1977 

Mean Standard 

Midpoint time error of 

of length- mean Wi=l 

Length of stay since current admission of-stay since time since s-2 

last last Yi $ I vow 

visit visit 

Less than 3 months ...................................................................................... 2.0 20.4 1.8 3.24 .30864 

3 to less than 6 months.. .............................................................................. 4.5 33.5 4.3 16.49 .05408 

6 months to less than 1 year ........................................................................ 9.0 

24.0 

34.6 

40.4 

2.1 

2.0 

4.41 

4.00 

.22676 

-25000 

(months) physician physician 

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

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

5 vears or more ............................................................................................ 

is significantly greater than zero. That is, a regression line of the form Y = a + PjXj + ej is to 

be fit to the data, where in this case F = mean 

time since last physician visit, X = length of stay, 

(Y= “Y-intercept,” i.e., value of mean time since 

last physician visit if length of stay equaled zero, 

/3 = slope of Y on X, i.e., the rate of change in 

mean time since last physician visit 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 

that discourage the use of classical 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 that 

makes no assumptions about the original observations and that 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.“C 

The proposed model is as follows: 

1. Let q be the estimated mean and Sjr. be 

its estimated standard error for the’& 

group. 

c From an unpublished memorandum by Dr. Levy. 

48.0 47.5 3.7 13.69 .07305 

60.0 48.2 3.8 14.44 -06295 

2. Let Xi be the midpoint of the independent variable for the group. 

3, Assume SyZ is based on a large enough 

number of observations that it can be assumed it is, in fact, equal to 07.1 and thus 

has no sampling error. ’ 

4. Further assume that 

E(K)=a!+flXj 

V(Y;:) =S$ for i=l,2 ,..., K, i 

where K is the number of groups. 

5. Finally, it is assumed that the 3’s are 

normally distributed and they are statistically independent of each other. 

The weighting procedure proposed weights all 

observations by the reciprocal of the variance. 

That is, wj = l/s; and the mean X= E WjXj/‘Z: Wj 

and the mean ?= Z wj ‘i;;i/Zwj. 

The slope is computed in a manner similar to 

the classical least squares regression, by the following formula: 

ZWj(Xj-X) Y;: 

b; 

Z: Wj (Xj - ~)* 

Computationally, this is easily computed by 

111 

i 
The variance of the slope is 

NOW since wj = l/$, this formula can be simplified to 

2 Wj (Xj - X)2 1 = a; = 

[CWj(Xj-~)2]2 EWj(Xj-Z)2 

and computationally 

000 

An approximate normal deviate test can now be 

performed by Z = b/S,. This would test the 

hypothesis that (3= 0 or, alternatively, compute 

confidence intervals for (l. 

As an example, the mean time since last physician visit by current length of stay is recorded 

as shown in table III. Applying this described 

method to the data shown, we have: 

~WjXjY;: = 700.37905 x = 4.23211 

ZWj = 0.98178 r = 33.44832 

ZI WjXj = 4.15500 b = .99412 

~WjY;: = 32.83889 s, = .04207 

ZWiX: = 582.30444 2 = b/S, = 23.63014 

Thus, since the 2 value is quite large, a positive 

association is demonstrated between the mean 

time since last physician visit and the resident’s 

current length of stay in the facility. 

112 
APPENDIX I I 

DEFINITION OF CERTAIN TERMS USED IN THIS REPORT 

Terms Relating to Residents ceived under the Medicaid program 

Resident.-A resident is a person on the ros- for intermediate nursing care. I 

ter of the nursing home as of the night before Other government assistance OT,wel­ the survey. Included are all residents for whom fare. -Other government assistance

beds are maintained even though they may be or welfare refers to sources of gov­ temporarily away on overnight leave or in a ernment aid (either Federal, State, hospital. or local) other than Medicare or 

Medicaid. Charges and Primary Sou.rce of Payment 

Charge, monthly.-The monthly charge All other sources.-All other sources 

is the total amount charged to the resi- include rehgious organizations, 

dent by the facility in the last completed foundations, volunteer agencies, Vetcalendar month prior to the survey. It erans Administration contracts, iniincludes all basic charges plus all charges tial payment arrangements, life care 

for private duty nursing, drugs, and arrangements, miscellaneous sources, 

special medical supplies. and no-charge arrangements. 

Primary source ‘of payment.-The pri- Demographic Items and Outside Living mary source of payment refers to the Arrangements one payment source that paid the greatest amount of the resident’s charge in Age.-The age of the resident is age at 

the last completed calendar month prior the date the survey was conducted, calto the survey. culated from information on date of 

birth. Own income or family support.-

Own income or family support in- Length of stay since current admission.­

cludes health insurance, retirement Length of stay since current admission 

funds, and social security. refers to the period of stay starting from 

the date of the resident’s most recent Medicare. -Medicare refers to money admission to the facility to the date of

received under the Medicare program. the survey interview. 

Medicuid - skilled. -Medicaid - skilled Marital status.-Marital status is that of 

refers to money received under the a resident at the time of the survey.

Medicaid program for skilled nursing 

care. Race or ethnicity.-Race or ethnicity refers to the resident’s primary racial or 

Medicaid - intermediate. - Medicaid- ethnic heritage as perceived by the staff 

intermediate refers to money re- informant. 

113 
White (not His@nic).-White (not Hispanic) refers to a person having origins 

in any of the original peoples of Europe, 

North Africa, or the Middle East. 

Black (not Hz$anic).-Black (not Hispanic) refers to a person having origins 

in any of the black racial groups of 

Africa. 

H@anic.-Hispanic refers to a person of 

Mexican, Puerto Rican, Cuban, Central 

or South American, or other Spanish 

culture or origin, regardless of race. 

Other.-Other refers to a person having 

origins in the American Indian, Alaska 

native, or Asian or Pacific Islander 

groups described as follows: 

American Indian or Alaska native.-

An American Indian or Alaska native 

is a person having origins in any of 

the original peoples of North America 

and who maintains cultural identification through tribal affiliation or 

community recognition. 

Asian or Pacific Islander.-An Asian 

or Pacific Islander is a person having 

origins in any of the original peoples 

of the Far East, Southeast Asia, the 

Indian subcontinent, or the Pacific 

Islands. This area in&d&s, for example, China, India, Japan, Korea, the 

Phillippine Islands, and Samoa. 

Health Services 

Level of care received.-These levels of 

care are defined in terms of the nursing 

services actually received by the resident 

during the 7 days prior to the survey 

date. Based on the services listed in item 

18 and responses to items 13b, 14, 27a, 

28a, and 29a of the Resident Questionnaire, the following classifications were 

made. Each succeeding level is exclusive 

of the previous levels: 

Intensive nursing cure. -Intensive 

nursing care includes receiving at 

least one of the following services: 

Bowel/bladder retraining 

Catheterization 

Full bed bath 

Intravenous injections 

Oxygen therapy 

Tube or intravenous feeding 

Other nursing care. -Other. nursing 

care includes receiving at least one 

of the following services: 

Application of sterile dressing or 

bandages 

Blood pressure reading 

Enema 

Hypodermic injections 

Irrigation 

Temperature - p&e - respiration 

check 

Personal care.-Personal care includes 

receiving at least one of the following services: 

Administration of treatment or 

medications 

Help with bathing, dressing, or 

eating 

Rub or massage 

Special diet 

Neither nursing nor personal care.-

Neither nursing nor personal care 

denotes that none of the preceding 

services were received. 

Medications during last 7 days 

Any medication for condition.-Any 

medication for condition refers to 

any medication, prescription or nonprescription, that a resident received 

within 7 days prior to the survey 

date for any of the reported conditions or impairments listed in cluestion 13 of the Resident Questionnaire. This does not include physical 

treatment or apparatus. 

Tranquilizer. -Tranquilizer refers to 

whether a resident received a 

114 
tranquilizer within 7 days prior to 

the survey date. 

Vitamin or mineral.-Vitamin or 

mineral refers to whether a resident 

received a vitamin or mineral supplement within 7 days prior to the survey date. 

Physician services 

Time since last physician visit.-This 

is the length of time between the survey date and the last time the resident saw a physician (doctor of 

medicine or osteopathy) while a 

resident of the facility for treatment, 

medication, or examination. Physician visits include those occurring 

both inside and outside the facility. 

Time between last two physician 

visits.-This is the time between the 

last physician visit and the visit immediately prior to this, both of 

which took place while the person 

was a resident of the facility. 

Special diet within Last 7 days.-The 

“other” category includes low cholesterol and weight gain diets, as well as 

others not specifically mentioned in item 

18 of the Resident Questionnaire. 

Therapy service.-Therapy service refers 

to whether the resident has received any 

therapy services provided by a licensed, 

registered, or professionally trained 

therapist during the calendar month 

prior to the survey. These services may 

have been provided either inside or outside the facility. 

Health Status 

Activities of daily living.-The activities 

of daily living are six everyday activities 

(Bathing, Continence, Dressing, Eating, 

Mobility, and Using Toilet Room) for 

which the nursing staff respondent reported the resident’s current performance in terms of his need for the help of 

special equipment or another person. 

Bathing 

Independent. -The resident does 

not currently require any assistance in bathing. This category 

also includes those cases in which 

the information is unknown. 

Requires assistance--The resident bathes with the help of special equipment and/or another 

person. 

Continence 

No difficulty controlling bowels 

or bladder--The resident does 

not currently have any difficulty 

in controlling either bowels or 

bladder. 

Difficulty controlling bowekThe resident currently has difficulty in controlling his bowels. 

Difficulty controlling bladder.-

The resident currently has difficulty in controlling his bladder. 

Ostomy in either bowels or bladder. -The resident has undergone 

a surgical procedure that results 

in the creation of an artificial 

opening for the elimination of 

waste. 

Dressing 

Independent. -The resident does 

not currentIy require any assistance in dressing. This category 

also includes those casesin which 

the information is unknown. 

Requires assistance, includes 

those who do not dress.-The 

resident currently dresses with 

the heIp of speciaI equipment 

and/or another person. This category also includes those cases in 

which the resident remains partially or totally undressed. 

Eating 

Independent. -The resident does 

not currently require any 

115 
assistance in eating. This category 

also includes those cases in which 

the information is unknown. 

Requires assistance, includes 

those who are tube or intravenously fed. -The resident currently eats with the help of special equipment and/or another 

person. This includes those residents requiring assistance with 

the cutting of meat and buttering 

of bread, as well as those who require tube or intravenous feeding. 

Mobility 

Walks independently. -The resident does not currently require 

any assistance in walking. This 

category also includes those cases 

in which the information is unknown. 

Walks with assistance.-The resident currently walks with the 

help of special equipment and/or 

another person. 

Chairfast. -The resident is currently confined to a chair. 

Bedfast. -The resident is currently confined to a bed. 

Using toilet room 

Independent. -The resident does 

not currently require any assistance in using the toilet ‘room. 

This category also includes those 

cases in which the information 

is unknown. 

Requires assistance.-The resident currently uses the toilet 

room with the help of special 

equipment and/or another person. 

Does not use toilet room.-The 

resident does not currently use 

the toilet room because of an 

ostomy, being chairfast, or similar reason. 

Index of dependency in activities of 

daily living.-The index of dependency 

in activities of daily living, based on the 

work of Dr. Sidney Katz,38,3g is a measure that permits the overall classification 

of individuals according to a “hierarchy” 

based on dependency in performing the 

six activities of daily living just described. The index has seven levels of 

dependence with each successive level 

indicating greater dependency. The 

index category, “other,” includes residents who were dependent in at least 

two functions but not classifiable into 

any of the categories of the “hierarchy.” 

The following list of activities is ordered 

in “hierarchy” sequence and presents the 

criterion for classifying a resident as’ 

dependent: 

Bathing.-This refers to those residents who require assistance. 

Dressing.-This refers to those residents who require assistance, including those who do not dress. 

Using toilet room.-This refers to 

those residents who require assistance or do not use toilet room. 

Mobility. -This refers to those residents who walk with assistance, are 

chairfast, or are bedfast. 

Continence.-This refers to those 

residents who have difficulty controlling bowels, bladder, or both; or 

have an ostomy. 

Eating.-This refers to those residents who require assistance, including those who are tube or intravenously fed. 

Chronic conditions and impairments. -

Chronic conditions and impairments include those long-term physical and 

mental problems of the resident selected 

by the nursing staff respondent from a 

list of 37 conditions and impairments 

NOTE: A list of references follows the text. 

116 
(see item 13a of the Resident Questionnaire). The respondent based the selection upon knowledge of the resident’s 

health and a check of the resident’s 

medical record. More than one condition 

or impairment could be reported. 

Primary diagnosis at last examination.-

The primary diagnosis at last examination was the one condition reported by 

the nursing staff respondent as the major 

diagnosis noted at the resident’s latest 

medical kxamination. The list of conditions corresponds to the Eigtth Revision 

International Classification ‘of Diseases, 

Adapted for Use in the United States.49 

The respondent reported the information based on the resident’s medical 

record. 

Sensory impairments 

Hearing.-Hearing is the resident’s 

ability to hear, when wearing a hearing aid, if applicable. 

Partially impaired. -A resident’s 

hearing is partially impaired if he 

can hear most of the things a person says. This includes a small 

number of residents whose hearing is impaired, but whose level 

of impairment is unknown. 

Severely impaired.-A resident’s 

hearing is severely impaired if he 

can hear only a few words a persons says or loud noises. 

Completely lost.-A resident’s 

hearing is completely lost if he is 

deaf. 

Speech. -Speech is the resident’s 

ability to talk. 

Partially impaired. --A resident’s 

000 

speech is partially impaired if he 

can usually be understood but 

has difficulty with some words. 

This includes a smalI number of 

residents whose speech is imd paired but whose level .of impairment is unknown. 

Severely impaired.-A resident’s 

speech is severely impaired if he 

can be understood only with difficulty and cannot carry on a 

normal conversation. 

Completely lost.-A resident’s 

speech is compIeteIy lost if it is 

unintelligible or if the resident 

cannot speak. 

vision.-Vision is the resident’s ability to see, when wearing glasses, if 

applicable. 

Partially impaired--A resident’s 

vision is partially impaired if he 

cannot read newspaper print, but 

can watch television 8-12 feet 

away. This includes a small num- _ 

ber of residents whose vision is 

impaired but whose level of 

impairment is unknown. 

Severely impaired. -A resident’s 

vision is severely impaired if he 

cannot watch television 8-12 feet 

away, but can recognize the features of familiar persons i.f they 

are within 2-3 feet. 

Completely lost.-A resident’s 

vision is completely lost if he is 

blind. 

Primary Source of Payment.L(See “Charges 

and Primary Source of Payment.“) 

117 
APPENDIX III 

SELECTED QUESTIONNAIRES USED IN THE 

1977 NATIONAL NURSING HOME SURVEY 

NOTE: See reference 1 for copies of all instruments used in the survey. 

118 
Current Resident Sampling List 

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE OMB .# W-575025 

PUBLIC HEALTH SERVICE Sheet-of-Sheets APPROVAL EXPIRES 12-31-77 1 

Health Resources Administration 

National Center for Health Statistics 

1977 National Nursing Home Survey CURRENT RESIDENT SAMPLING LIST Control No. 1 I I 1 I 1 

Confid6ntial Information 

Information contained on this form which would permit identification of any individual or establishment has been collacted with a guarantee that it will be held in strict confidence, will be used only for purposes stated for this study, and will not be disclosed or released to 

others without the consent of the individual or the establishment in accordance with Section 268(d) of the Public Health Service Act 

(42 USC 242mL 

1 Dam 

A. Start Time 6. Tylja of Identifier us-ad: 10 Name 2 0 Other, Specify allam 

I C. Sample Designation: SWI TELUJI D. Current Residents: Facility Total U’ I 

I E. New SW and TE 

Numbers: 1 q Yes 2uNo F. Total in Sample W

I 

I io8m 

G. End Time H. Time Elapsed u Minutes 

2Clpm 

Circle Line Nos. of Residents in Sample 

01 

02 

03 28 

04 29 

I 05 I I 30 

I 31 

32 

33 

34 

19 ’ 

20 

21. 

1 24 1 I 

If mar. Ilnar a,. n*.d*d CONTltiUE ON THE BACK 

119 
CURRENT RESIDENT SAMPLING LIST-CONTINUED 

Circle Line Nos. of Residents in Sample 

52 

53 

54 

62 

63 

GA. 

65 ) 

66 I 

67 

68 

69 

70 

71 I I 

72 1 

73 I 

RESIDENTS IN NURSING HOME 1 

Resident identifier 

1 76'1 1 I 

I 771 I 

I 781 I 

79 -

801 I 4’ 

t 811 

88 1 

99 I 1 

91 ( 

92 I I 

I 941 I 

95 1 

96 1 

I 971 I 

98 

99 

100 

,I more ,,nss are “W-ad “se a new Sh.3.1 and rsnumbar the lines 

bsglnnlng with #lOl. R.nu”7b.r ,,nes on addltlonal sheets 201. 

301, MC. 

120 
Current Resident Questionnaire 

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE 

PUBLIC HEALTH SERVICE 

Health Resources Administration 

National Center for Health Statistics CURRENT RESIDENT QUESTlONNAlRE 

1977 National Nursing Home Survey 

Confidential Information -

A. Resident Line No. B. Date of Interview C. 

OMB d 68.575025 

APPROVAL EXPIRES 12-31-77 

Control No. 1 I I t I 1 

1 q am Lzl Start Time 

2Opm 

D. interviewer Name d 

1. WHAT IS THE SEX OF THIS RESIDENT? I 0 Male 2 q Female 

2. WHATIS- DATE OF BIRTH? W W ~J-L! or m mo. dav year age 

3. piixiiq WHAT IS-ETHNIC BACKGROUND? 

10 White (Not of Hispanic Origin) 4 @ Asian or Pacific Islander 

2 0 Black (Not of Hispanic Origin) s 0 Hispanic 

3 0 American Indian or Alaska Native a 0 Don’t Know 

4. WHAT IS-CURRENT MARITAL STATUS? 

I 0 Married 2 0 Widowed a 0 Divorced 4 0 Separated 5 0 Never Married a q Don’t know 

5. IS-A TEMPORARY RESIDENT WHOSE USUAL CARETAKER IS ILL, ON VACATION, OR OTHERWISE 

UNAVAILABLE? 

I q Yes 2 O’No a 0 Don’t know 

6. WHAT WAS THE DATE OF- CURRENT ADMISSION TO THIS FACILITY? w w w mo. dav year 

7. WHO ARRANGED FOR-ADMISSION? (Mark (Xl all thatapply) 

0 a. The resident himself 0 h. Friend 

0 b. Spouse 0 i. Attending physician or psychiatrist 

0 c. Children c] j. Social service worker or agency 

0 d. Parents 0 k. Staff of previous institution 

0 e. Brother or sister 0 I. Minister or church-related social service 

0 f. Other relatives urn. Other, Specify 

0 g. Guardian, attorney 0 Don’t know 

. 

. 

121 
Ea. WHERE WAS- STAYING IMMEDIATELY~BEFORE ENTERING THIS FACILITY? 

I 0 Private residence (house or apartment) 

z 0 Rented room, boarding house 

3 0 Retirement home 

4 0 Another health facility (Skip to 0, &?dJ 

s 0 Other arrangement, Specify (Skip to 0. 9J 

e q Don’t know (Skip to 0. 9J 

b. AT THAT TIME, WAS- LIVING WITH OTHERS OR ALONE? 

1 0 With others 

2 0 Alone (Skip to 0. 91 

e 0 Don’t. know (Skip to 0. 91 

c. WHO 010 -LIVE WITH THEN? (Mark (XJ all thatapp/yJ 

0 (1) Spouse 0 (51 Grandchildren 

0 (2) Children 0 (6) Other relatives 

0 (3) Parents i (7) Unrelated persons 

0 (4) Brother or sister Don’t know 

1 Skip to 0. 9 1 

d. 1 Show Flashcard #2 ] WHAT TYPE OF FACILITY WAS IT? 

1 0 Domiciliary or personal care facility 

z 0 Intermediate Care Facility (ICF) 

3 0 Skilled Nursing Facility (SNF) 

4 0 Facility for mentally retarded 

s q General or short term hospital 

6 0 Mental hospital 

7 0 Chronic disease, rehabilitation, geriatric or other long-term care hospital 

a 0 Other, Specify 

e 0 Don’t know 

e. WHERE WAS-STAYING IMMEDIATELY BEFORE ENTERING THAT FACILITY? 

I 0 Private residence (house or apartment) 

z 0 Rented room, boarding house 

3 0 Retirement home 

4 0 Another health facility 

s 0 Other arrangement, Specify 

e 0 Don’t know 

9. WILL -BE OISCHARGEOWITHIN THE NEXT SIX MONTHS? 

1 q Yes 2 0 No (Skip to 0.12) e 0 Don’t know (Skip to 0.121 

10. IN HOW MANY MONTHSWILL -BE DISCHARGED? 

1 q Within the month 

2 0 Between one and three months 

3 q Between four and six months 

e q Don’t know 

122 
111. WHERE WILL -STAY IMMEDIATELY AFTER DISCHARGE FROM THIS FACILITY? 

I 0 Private residence (house or apartment) 

a 0 Rented room, boarding house 

a 0 Retirement home 

4 0 Another health facility {Skip to 0. I1.d) 

s q Other arrangement, Specify (Skip to Q. 121 

9 0 Don’t know (Skip to 0.72) 

b. WHEN-IS RELEASED,WILL- LIVE WITH OTHERS OR ALONE? 

I 0 With others 

2 0 Alone (Skip to CL 12) 

9 q Don’t know (Skip to 0.12) 

c. WHO WILL- LIVE WITH? {Mark (Xl all that appIy) 

cl(l) spouse 0 (5) Grandchildren 

0 (2) Children 0 (6) Other relatives 

Cl (3) Parents q (7) Unrelated parsons 

q (4) Brother or sister 0 Don’t know 

1 SkiptoQ.12 1 

d. Show Flashcard R2 WHAT TYPE OF FACILITY IS IT? 

1 q Domiciliary or personal care facility 

2 0 Intermediate Care Facility (ICF) 

3 fl Skilled Nursing Facility (SNF) 

4 0 Facility for mentally retarded 

s 0 General or short term hospital 

s 0 Mental hospital 

7 0 Chronic disease, rehabilitation, geriatric or other long-term care hospital 

a 0 Other, Specify 

a 0 Don’t know 

12. j-zzizq WHAT IS THE PRIMARY REASONTHAT- IS CURRENTLY A RESIDENT IN THIS FACILITY? 

I 0 Limited social resources (no family or guardian available or willing) 

2 0 Limited economic resourcas (little or no money, no place to live) 

3 q Mentally ill 

4 0 Mentally retarded 

5 0 Disruptive bahavior 

a 0 Poor physical health (requires nursing services, personal care or rehabilitation) 

7 0 Other reason, Spacifv 

a 0 Don’t know 

123 
130. 1 Show Flashcard if4 1 DOES- CURRENTLYHAVE 13b. DURING THE LAST 7 DAYS, FROM LAST fdayl 

ANY OF THE FOLLOWING CONDITIONS OR IMPAIRMENTS? THROUGH YESTERDAY, DID- RECEIVE 

(Mark IX) all thaf apply, complete all of part a; then ask b for each ANY MEDICATIONS FOR (condition)? 

condition reported.) 

0 None of these conditions (Skip to 0.19 

Mental Conditions/impairments y& No Don’t know 

0 (1) Senility ................. 10 20 90 

0 (2) Mental Retardation ............. IO 20 90 

0 (3) Mental Illness ............... 10 20 90 

0 (4) Chronic Brain Syndrome ........... 10 20 90 

INTER VIEWER NOTE: If the respondent reports that the risident 

is both mentally retarded and mentally ill, mark this box 0 and 

read: HA VE I RECORDED CORRECTLY THAT- IS 

MENTALLY ILL AND MENTALLY RETARDED? If necessary, 

correct. 

Physical Conditions/Impairments 

c] (5) Hardening of the Arteries ........... 10 20 90 

0 (6) Stroke . ................ 10 20 90 

0 (71 Hypertension 10 20 90 

0 (8) Heart Trouble : : : : : : : : : : : : : : : 10 20 90 

q (9) Edema (Fluid Retention) ........... 10 20 90 

q (10) Arthritis/Rheumatism . 10 20 90 

0 (11) Paralysis or Palsy other than a;th;itis - strdke’relateb ’ ’ 10 20 90 

0 (12) Paralysis or Palsy other than arthritis - unrelated to stroke IO 20 90 

0 (13) Parkinson’s Disease .. .. .. 10 20 90 

0 (14) Kidney Trouble/Chronic Urinary Tract Infections ......... 10 20 90 

0 (15) Constipation ............... 10 20 90 

q (16) Insomnia ................ IO 20 90, 

0 (17) Diabetes ................ 10 20 90 

0 (18) Cancer ................. 10 20 90 

0 (19) Deafness ................ 10 20 90 

0 (20) Blindness ................ IO 20 90 

0 (21 I Glaucoma ................ IO 20 90 

•J (22) Cataracts .. 10 20 90 

0 (23) Chronic Respiratory Disease ...................... 10 20 90 

0 (24) Anemia ................. ic! 20 90 

0 (25) Bedsores . 10 20 90 

0 (261 Hip Fractures : ............................ 10 20 90 

0 (27) Other Fractures .............. IO 20 90 

0 (28) Alcoholism IO 20 90 

a(291 Drug Addiction.................... : : : : : 10 20 90 

0 (30) Chronic Back/Spine Problems (excluding Stiffness 

and Deformity) ............. IO 20 90 

Permanent Stiffness or Deformity of: 

q (31) back. ................. 10 20 90 

Of321 arms .................. 10 20 90 

q (33) legs .. .. . IO 20 90 

a(341 extremities (feet, toes, handsor fmgers; : : : : : : 10 20 90 

Missing Limbs or Extremities: 

Of351 arms .................. IO 20 90 

u (36) legs .. .. .. 10 20 90 

a(371 extremities (feet, toes, handsor fingers; : : : : : : 10 20 90 

124 
14. IN ADDITION TO ANY MEDICATIONS MENTtDNED IN THE PREVIOUS QUESTION, DID -RECEIVE: 

Yes No Dori’t know - -

a. ANY TRANQUILIZERS IN THE LAST 7 DAYS7 10 20 90 

b. ANY VITAMINS DR MINERALS IN THE LAST 7 DAYS? 20 90 

c. ANY OTHER MEDICATIONS? 20 90 

(1) FOR WHAT CONDITIONS? 

15a. DURING THIS RESIDENT’S STAY HERE, WHEN DID -LAST SEE A PHYSICIAN FOR TREATMENT, MEDICATION, 

OR FOR AN EXAMINATION? 

0 Has never seen a doctor while here lskip to Note above 0.17) 0 Don’t Know (Skip to 

22 k+ kior Note above 0.17) 

b. AT THAT TIME DID -SEE THE PHYSICIAN INSIDE OR OUTSIDE OF THIS F&CILITY? 

I 0 Inside this facility 2 0 Outside this facility 9 0 Don’t Know 

c. AT THAT TIME DID -RECEIVE: Yes * Don‘t know -

AN EXAMINATION? 10 20 90 

A PRESCRIPTION(INCLUDING REFILLS)? 10 20 90 

TREATMENT? IO 20 90 

ORDERS FOR LABORATORY TESTS? 10 20 90 

ANY OTHER SERVICES? 

ln$2fy 2o ‘IX 

d. DID THE PHYSICIAN ATTEND THE RESIDENT AS A PRIVATE PHYSICIAN, FOR THE FACILITY, OR UNDER SOME 

OTHER ARRANGEMENT? 

1 0 As the resident’s private physician 

2 0 For the facility itself which furnishes medical care 

a 0 Under some other arrangement, Specify 

9 0 Don’t Know 

e. DOES A PHYSiCIAN EXAMINE THIS RESIDENT ONLY WHEN CALLED, ON A REGULAR SCHEDULE, OR ON SOME 

OTHER BASIS? I 

1 0 Only When Called 2 0 On a Regular Schedule a 0 Other, Specify 9 0 Don’t Know 

f. PRIOR TO THE LAST VISIT REPORTED ABOVE WHEN DIDCEE A PHYSICIAN IN THIS FACILITY? 

not see a phys&ian prior to the visit reported in 15a. 0 Don’t Know 

125 
16. show F/&card #5 ] ACCORDING TOUEDICAL RECORD,WHAT WAS THE PRIMARY OlAGNOSlS AT THE TIME 

OF-LAST MEDICAL EXAMINATION, THAT IS, ON Ispec;fy dategiven in 0.15d7 

A. Heart and Other Circulatory Problems 

01 0 Congestive Heart Failure (C.H.F.) 

02 0 Hardening of the Arteries (Arteriosclerosis, A.S.H.D.) 

03 0 Heart Attack, lschemic Heart Disease (Acute Myocardial Infarction-M.I.) 

04 0 High Blood Pressure (Hypertension) 

0s 0 Phlebitis 

ca 0 Pulmonary Embolism 

07 0 Rheumatic Heart Disease 

ca 0 Stroke (Cerebrovascular Disease-C.V.A.) 

ce 0 Other Circulatory Problems, Specify 

B. Mental Disorders 

10 0 Chronic Brain Syndrome 

11 0 Mental Retardation 

12 0 Neurosis 

13 0 Psychosis (Schizophrenia, Paranoia, Manic Depression, etc.) 

14 0 Senile Psychosis (Senile Dementia) 

15 0 Senile, Not Psychotic 

16 0 Other Mental Disorders, Specify 

C. Other Diagnoses 

17 0 Alcoholism 

la q Anemia 

19 0 Arthritis/Rheumatism 

so q Asthma 

21 0 Blindness 

aa 0 Bone Fracture, other than Hip 

23 0 Bronchitis 

24 Cl Cancer (Malignant Neoplasm) 

a5 q Cataracts 

ae 0 Cirrhosis of the Liver 

a7 0 Deafness 

aa 0 Diabetes 

ae 0 Drug Addiction 

30 q Emphysema 

31 0 Epilepsy 

aa 0 Glaucoma 

33 aGout 

34 0 Hip Fracture 

35 0 Multiple Sclerosis 

36 0 Parkinson’s Disease 

37 Cl Pneumonia 

33 q lPolio 

3s 0 Respiratory, other than Pneumonia 

40 0 Syphilis 

41 0 Ulcers 

42 0 Other, Specify 

9s 0 Don’t Know 
INTERVIEWER NOTE: If this resident has bean in this facility less than twelve months prior to the interview date, mark this box 0 

and skip to 0.18. Otherwise. continue with 0.17a. 

17a. DID -RECEIVE A FLU SHOT WITHIN THE LAST TWELVE MONTHS, THAT IS, SINCE (month) OF LAST YEAR? 

I q lYes 2 q No (Skip to 0.17~) 9 a Don’t Know-No Record (Skip to 0.17~) 

b. WHEN DID -RECEIVE THE FLU SHOT? 

F m q Don? Know 

yr. 

0. JIIO -CATCH THE FLU DURING THE LAST NINE MONTHS, THAT IS, SINCE (month) OF LAST YEAR? 

I q Yes 2 0 No (Skip to Q. 18) e 0 Don’t Know-No Record (Skip to Q. 181 

d. WHEN DID- CATCH THE FLU? 

m m q Don’t Know 

mo. yr. 

1 i. Show Flashcard #6 DURING THE LAST SEVEN DAYS, THAT IS, FROM LAST (day) THE (date). THROUGH YESTERDAY. 

WHICH OF THESE SERVICES DID -RECEIVE? (Mark (Xl all thatapply) 

q a. Blood pressure reading 

0 b. Temperature-pulse-respiration 

0 c. Application of sterile dressings 

0 d. Full bed-bath 

q e. Rub or massage 

of. Enema 

0 g. Catheterization 

0 h. Bowel retraining 

q i. Bladder retraining 

Cl j. Irrigation 

q k. Oxygen therapy 

0 I. Intravenous injection 

am. Hypodermic injection 

or bandages 

0 n. Administration of other medical treatment by staff 

0 o. Special diet \ 

(1) WHAT TYPE OF DIET IS IT? (Mark IX) a/f thatapply) 

0 a. Diabetic 0 b. low sodium Cc. bland 0 d. soft q e. low cholesterol 

0 f. weight loss 0 g. weight gain 0 h. other, Specify 

0 None of the above services received 

127 
19a. DURING (/asrmonrhJ, DID- RECEIVE ANY THERAPY SERVICES EITHER INSIDE OR OUTSIDE OF.THIS FACiLlTY 

FROM A LICENSED, REGISTERED, OR PROFESSIONALLY TRAINED THERAPIST? 

1 OYes 2 0 No (Skip to Q.ZOJ e 0 Don’t Know (Skip to 0.20) 

b. Show Flashcard /7 WHICH TJPES OF THERAPY DIO- c. WHAT WERE THE TOTAL HOURS OF 

RECEIVE DURING (lastmonth)? (Mark (X) ail rharapply;Complere (therapy namel THAT - RECEIVED 

ail of part 6; Then ask c for each therapy service reported.) 0 UR I NG (last month)? (Note: If l&s than one 

hour, record 01.) 

Hours Den’t know 

(1) Physical therapy n W 0 

(2) Occupational therapy 0 W 0 

(3) Recreational therapy cl W 0 . . 

14) Speech and hearing therapy q 0 

(5) Counseling/therapy by a psychiatrist, psychologist, 

or other mental health worker 0 

(6) Counseling by social worker 0 

(7) Reality orientation 0 

(8) Other therapy services 

Specify 0

20. Show Flashcard #‘8 

u a. Eye glasses 

u b. Hearing aid 

fl c. Wheelchair 

nd. Cane 

me. Walker 

0 f. Crutches 

q g. Braces 

0 h. Slings 

0 i. Artificial limb 

cl r. 

DOES- REGULARLY USE ANY OF THESE AIDS? /Mark IX) allrhatapply! 

0 j. Mechanical feeding device 

0 k. Orthopedic shoe 

0 I. Geriatric chair 

am. Posey.belt or similar devices 

U n. Cuffs 

0 o. Other aids or devices, Specify ..._ 

0 No aids used 

128 
INTER VIEWER NOTE: Read phrase about “wearing glasses”and “hearing aid’: where appropriate, based on responses to 0.20. 

21.9. DOES- HAVE ANY DIFFICULTY IN SEEING [WEN WEARLNG CLASSESJ? 

1 q Yes ? 0 No (Skip to 0.22) 9 0 Don’t know (Skip ro 0.221 

b. Show Flashcard #9 IS- SIGHT fj,v,fH GLASSESj PARTIALLY, SEVERELY, OR COMPLETELY IMPAIRED, 

AS DEFINED ON THIS FLASHCARD? 

1 0 Partially impaired-cannot read newspaper print but can watch television 8 to 12 feet away. 

z 0 Severely impaired-cannot watch TV 8 to 12 feet away, but can recognize the features of familiar persons if they are within 

2-3 feet 

a q Completely lost-blind \ 

9 q Don’t know 

22a. DOES- HAVE ANY DIFFICULTY IN HEARING (WHeN WEARING A I-lEAf#JG Alb)? 

1 q lYes 2 q No (Skip to a.231 a 0 Don’t know (Skip to Q.23) 

b. Show Flashcard /lo IS- HEARING (Wm HEARINGAI~)PARTIALLY,SEVERELY, OR COMPLETELY 

IMPAIRED AS DEFINED ON THIS FLASHCARD? 

1 0 Paitially impaired-can hear most of the things a person says 

2 0 Severely impaired-can hear only a few words a person says or loud noises 

a 0 Completely lost-deaf 

9 0 Don’t know 

23a. DOES- HAVE ANY DIFFICULT\i IN SPEAKING? 

i q lYes 2 0 No (Skip to 0.24) e 0 Don’t Know (Skip to 0.241 

b. Show Flashcard #l i IS- SPEECHPARTIALLY, SEVERELY, OR COMPLETELY IMPAIRED, AS DEFINED ON 

THIS FLASHCARD? 

I 0 Partially impaired-can usually be understood but has difficulty with some words 

2 0 Severely impaired-can be understood only with difficulty and cannot carry on a normal conversation 

a 0 Completely impaired-speech is unintelligible or cannot speak 

e 0 Don’t Know 

24a. DOES- CURRENTLY COMMUNICATE PHYSICAL NEEDS VERBALLY OR NON-VERBALLY? 

1 0 Verbally (Skip to 0.251 2 q Nonverbally a 0 Does not communicate (Skip to Q-251 

b. ISTHE COMMUNICATION NONVERBAL BECAUSESOME OTHER REASON? 

I q Does not speak English 

2 0 Cannot talk 

3 0 Is too ill 

o 0 Mental or emotional problem 

5 0 Other, Specify 

e 0 Don’t Know . 

DOES NOT SPEAK ENGLISH, CAN’T TALK, IS TOO ILL, OR 

129 
253. DOES-HAVE DENTURES? 

1 q Yes 2 17 No /Skip to 0.26) 9 q Don’t Know (Skip to 0.26) 

b. DOES-USE THE DENTURES REGULARLY? 

I q Yes z0No 9 0 Don’t Know 

2Ba. 1 Show Flashcard 112 DOES-HAVE ANY OF THESE b. IS,EXTRA NURSING TIME REllUlRED 

BEHAVIOR PROBLEMS?(Mark 1X) all thatapply. comp/eteperte, BECAUSE-IS (behavior problem)? 

then ask part b of each reported behavior problem in a.) 

(1) Depressed or withdrawn 0 1 q Yes z.ONo 

(2) Agitated, nervous, hyperactive 0 1 q Yes 20No 

(3) Abusive, aggressive, disruptive 0 i q Yes 20No 

(4) Wandering 0 1 q Yes 20No 

(5) Having other behavior problems q I q Yes ‘2 ON0 

No behavior problems 0 (Skip to 0.27) 

2la. DOES-CURRENTLY REQUIRE ANY ASSISTANCE IN BATHING? 

1 q Yes 2 0 No (Skip to 0.281 9 0 Don’t know (Skip to 0.28) 

b. DOES-BATHE WITH THE HELP OF: 

(1) SPECIAL EOUIPMENT? . . . . . . . . . . . . . . 1 0 Yes 20No 

(2) ANOTHER PERSON?. . . . . . . . . . . . . . . I 0 Yes 20No 

29a. DOES-CURRENTLY REQUIRE @tJ ASSISTANCE IN DRESSING? 

1 q Yei 

2 q No (Skip to 0.29) 

3 0 Remains partially or completely undressed (Skip to 0.29) 

a 0 Don’t know (Skip to 0.29) 

b. DOES- DRESSWITH THE HELP OF: 

(1) SPECIAL E(lllIPMENT? . . . . . . . . . . . . . . 1 0 Yes 20No 

(2) ANOTHER PERSON?. . . . . . . . . . . . . . . 10 Yes 20No 

29a. DOES-CURRENTLY REQUIRE ANY ASSISTANCE IN EATING? (c onsider cutting of meat and buttering of bread as 

assistance.) 

/ I q Yes 

2 0 No (Skip to 0.30) 

3 0 Requires tube or intravenous feeding (Skip fo 0.30) 

9 0 Don’t Know (Skip to 0.30) 

b. DOES- EATllTH THE HELP OF: 

(1) SPECIAL EQUIPMENT? . . . . . . . . . . . . . . 1 0 Yes 20No 

(2) ANOTHER PERSON?. . . . . . . . . , , . . . . 1 0 Yes z0No 

130 
301. IS- EEPFAST? 

I 0 Yes (Skip to 0.33) 20No 

b. IS- ‘CHAIRFAST? 

I 0 Yes (Skip tv 0.31) nclhlo 

c. DOES-CURRENTLY REQUIRE -ANY ASSISTANCE IN WALKING? 

I q iYes 2 0 No (Skip to Q-31). a 0 Don’t know (Skip to 0.311 

d. DOES-WALK , WITH THE HELP OF: 

(1) SPECIAL EQUIPMENT? . . . . . . . . . . . . 1 0 Yes 20No 

(2) ANOTHER PERSON?. . . . . . . . . . . . . 1 q Yes 20No 

318. DDES7-60 OUTSIDE THE GROUNDS OF THIS FACILITY? 

i q lYes 2 0 No (Skip to 0.32) 9 0 Don’t know (Skip to 0.321 

b. WHEN? GOES OUTSIDE THE GROUNDS, DOES- REQUIRE THE HELP OF 

(1) SPECIAL EDUIPMENT? . . . . . . . . . . . . I •i Yes 20No ’ 

(2) ANOTHER PERSON?. . . , . . . . . . . . . 10 Yes 20No 

32a. DOES-CURRENTLY REDUIRE m ASSISTANCE USING THE TOILET ROOM? . 

i q lYes 2 q No (Skip ro 0.331 

3 0 Does not use toilet room (Ostomy patient, chairfast, etc.) (Skip to 0.331 

9 0 D?n’t Know (Skip to 0.33) 

b. dDES -REDUlRETHE HELP OF: 

(1) SPECIAL EDUIPMENT? . . . . . . . . . . . . 1 0 Yes 20No 

(2) ANOTHER PERSON?. . . . . . . . . . . . . 10 Yes 20No 

338. DDES- CURRENTLY HAVE ANY DIFFICULTY IN CONTRDLLING- BOWELS? 

i q Yes 

/ 2 0 No (Skip to 0.341 

a 0 Not applicable-has had an ostomy (Skip to 0.341 

9 0 Don’t Know (Skip to Q.34) 

b. HOW FREQUENTLY DOES- HAVE THIS DIFFICULTY? 

I 0 Daily 

2 0 Several times a week 

3 0 Once a week 

4 0 Less than once a week 

9 0 Don’t Know 

131 

l 
Ma. DOES- CURRENTLY HAVE ANY DIFFICULTY IN CONTROLLING- -BLADDER? 

I q Yes 

2 0 No (Skip to 0.35) 

a 0 Not applicable-has indwelling catheter, ostomy, or external device (Skip to 0.35) 

e 0 Don’t Know (Skip to 0.35) ’ 

b. HOW FREQUENTLY DOES- HAVE THIS DIFFICULTY? 

1 0 Daily 

a 0 Several times a week 

a 0 Once a week 

4 0 Less than once a week 

a 0 Don’t Know 

c. DOES THIS OCCUR ONLY AT NIGHT? 

1 q lYes 2 q No e 0 Don’t know 

35. DURING /lastmonth) DID- PARTICIPATE IN ANY ORGANIZED RECREATION ACTIVITIES IN THIS FAClLlTY? 

1 q Yes ZUNO 9.0 Don’t know 

36a. DURING (lastmonth), DID- LEAVE THE FACILITY FOR ANY RECREATIONAL OR LEISURE ACTIVITIES? 

I UYes 2 0 No (Skip to 0.37) e 0 Don’t Know (Skip to Q.38) 

b. 1 Show Flashcard #I3 FOR WHICH OF THE FOLLOWING ACTIVITIES DID- LEAVE THE FACILITY? (Mark IX) 

all fhat apply) 

0 (1) Go on shopping trips 

0 (2) Go to visit familv or friends 

0 (3) Attend religious services or other religious activities 

0 (4) Visit a beauty shop or barber shop 

0 (5) Visit community clubs (civic clubs, service clubs, bridge clubs, unions, etc.) 

0 (6) Attend movies;plays, concerts, etc. 

0 (7) Attend arts and crafts classes 

0 (8) Go to library 

0 (9) Visit museums, parks, fairs, etc. 

q (lO) Goforawalk 

0 (11) Leave facility with familv or friends (activity unknown) 

0 (12) Other, Specify 

Don’t Know 

132 
37. Show Flashcard #14 WHAT WERE THE REASONSTHAT -DIDN’T LEAVE THE HOME TO PARTICIPATE IN ANY 

ACTIVITIES DURING (lastmonth)? (Mark (Xl all thatapply) 

q a.’ Participated in activities inside the facility 

0 b. Not able due to illness/disability 

0 c. Refused, not interested 

0 d. Confused, disoriented, frightened . 

0 e. Behavior problem 

0 f. Cannot afford the activities 

0 g. No one avaiiable to accompany the resident 

0 h. Lack of transportation 

q i. Recent admission 

0 j. Other, Specify 

0 Don’t Know 

38a. DURING THE PAST 12 MONTHS, HASTHIS RESIDENT BEEN ON ANY KIND OF LEAVE OVERNIGHT OR LONGER, EXCLUDING LEAVE FOR MEDICAL REASONS? 

I q Ves 2 0 No (Skip to 0.39) a q Don’t know (Skip to a.401 

b. WHERE DID -GO WHEN ON THE MOST RECENT LEAVE? 

1 0 To own home or apartment 

2 OTo home of family or relatives 

3 0 To home of unrelated friends 

4 0 To boardinghouse or foster home 

s 0 To another place, Specify 

a 0 Don’t know 

c. IN WHAT MONTH WAS THAT LAST LEAVE? 

Month W 

d. ABOUT HOW LONG WAS THAT LEAVE? 

I 0 Overnight 

2 q Two days/a weekend 

3 0 3-6 days 

4a7to13days 

s 0 Two weeks or more 

a 0 Don’t know 

1 Skb to 0.40 1 

. 

133 
39. Show Fleshcard iv;5 1 WHY OIONTT- GO ON OVERNIGHT LEAVE? (Mark (Xl all th?tappIy) 

0 a. Not able due to illness/disability 

0 b. Refused, not interested 

0 c. Confused, disoriented, frightened 

0 d. Behavior problem 

0 e. No place to go/no people to visit 

0 f. Lack of transportation 

0 g. Laws/regulations, payment policy forbid overnight leave 

0 h. Laws/regulations, payment policy discourage overnight leave 

0 i. Recent admission 

q j. Other, Specify 

0 Don’t know 

40a. OOES- HAVE ANY VISITORS FROM OUTSIDE THE FACILITY? 

i q Yes 2 0 No (Skip to 0.41) s 0 Don’t Know (Skip to 0.411 

b. Who ARE THESE VISITORS? (Mark (Xl a// thatapplyl 

Cl(l) Spouse 013) Grandchildren 065) Brother or sister n(7) Friends, minister, co-workers 

o(2) Children 014) Parents o(6) Other relatives O(8) Volunteers from religious, civic, 0 Don’t know 

or other charitable organizations 

c. HOW FREQUENTLY OOES- HAVE VISITORS? 

01 0 Daily 06 0 About once every two months 

02 0 At least once a week 07 Cl Several times a year 

oa 0 Nearly every week oa 0 About once a year 

04 3 About every two weeks OS 0 Other, Specify 

os q About once a month ss 0 Don’t know 

41. HOW MANY BEDS ARE IN -ROOM? 

I 0 One bed (i.e.. the resident’s own bed) 

2 0 Two beds 

a 0 Three beds 

4 0 Four beds 

5 0 Five or more beds 

42. HOW LONG HAVE YOU 

- PROVIDED CARE FOR-?

1 q less than 1 month 

2 0 l-3 months 

a 0 4-6 months 

4 q 7-11 months 

s 0 12 months or more 

e 0 I do not provide care 

134 
-- 

Interviewer, Read: THE REMAlNlNG FEW QUESTIONS DEAL WITH CHARGESAND PAYMENTSOURCES. Do YOU HAVE THIS 

INFORMATION? 

I 0 Yes IGo to note above 0.43) 2 0 No (Determine who has information and when you have completed& the Current 

Resident Questionnaires, interview that person for the informaiion, using 

Prompt Card I1 1.) 

Fill in ela,psed time since start of interview. 

E. End Time 

1 q iam 

zC7pm 

F. Time elapsed m Minutes 

I Clam 

G. Stert Time 

1 0 pm 

INTER VIEWER NOTE: Before proceeding, refer to the admission date in Q.B. If the resident was admitted -after the first day of last 

month, mark this box aand skip to 0.44. Otherwise, continue with 0.43. 

43. FOR THE MONTH OF (lastmonth), WHATWASTHETOTAL CHARGE BILLED FOR- CARE, INCLUOING AL’1 

CHARGES FOR PRIVATE DUTY NURSING, DRUGS, AND SPECIAL MEDICAL SUPPLIES? 

anDay 

a 0 Week 

$ I .OO per 4 q Month 

i s 0 Other period, Specify’ 

0 No charge is made for care, explain: 

1 0 Facility assumes cost 

2 Cl Initial payment/life care arrangement 

a 0 Other, Specify 

0 Don’t Know (Not billed yet, etc.) 

/-Tzzq 

44. FROM (Date of Admission) THROUGH YESTERDAY, WHAT WAS THE TOTAL CHARGE BILLED FOR-CARE, INCLUDING ALL CHARGES FOR PRIVATE DUTY NURSING, DRUGS, AND SPECIAL MEDICAL SUPPLIES? 

I 0 Entire Reporting Period 

2 q Day 

$ I .OO per a 0 Week 

4 0 Month 

1 a 0 Other period, Specify 

0 No charge is made for care, explain: 

I 0 Facility assumes cost 

2 0 Initial payment/life care arrangement 

s 0 Other, Specify 

ODon’t Know (Not billed yet, etc.) 

135 
45. Show Flashcard #16 ] WHAT\?IERE UTHE SOURCESOF PAYMENT FOR- CARE DURING THISTIME? /Mark 

IX) all that applyl 

0 a. Own income, family support, health insurance, 0 g. VA contract 

retirement funds, social security, etc. 0 h. Initial payment-life care funds 

0 ,b. Medicare 0 i. No charge made for care (Facility assumes cost) 

0 c. Medicaid-w nursing 0 j. Payment source not yet determined. (Skip to Note 

0 d. Medicaid-intermediate care below 0.47) 

0 e. Other government assistance or welfare 0 k. Other, Specify 

0 f. Religious organizations, foundations, volunteer agencies 

46. Show Flashcard %16 WHAT WAS THE PRIMARY SOURCEOF PAYMENT FOR- CARE DURING THISTIME? 

01 0 a. Own income, family support, health insurance, 07 q g. VA contract 

retirement funds, social security, etc. oa 0 h. Initial payment-life care funds 

02 0 b. Medicare oe 0 i. No charge made for care (Facility assumes cost) 

oa 0 c. Medicaid-% nursing IO 0 i: Payment source not yet determined (Skip to Note 

04 0 d. Medicaid-intermediate care below 0.47) 

OS 0 e. Other government assistance or welfare [7 k. Other, Specify 

06 0 f. Religious organizations, foundations, volunteer agencies 

47. WHAT WASTHE AMOUNT PA10 BY THE PRIMARY SOURCEOF PAYMENT DURING THISTIME? 

$ LL.Ld .oo 

INTER VIEWER NOTE: Se sure to f/II in the items below and continue to the next Current Resident Questionnaire. 

1 Dam 

H. End Time I. Time elapsed LLd Minutes 

2Opm 

136 
APPENDIX IV 

CRITERIA FOR CLASSIFYING’NURSING HOMES 

ACCORDING TO LEVEL OF NURSING CARE 

The criteria for classifying facilities are based 

on several factors: (1) the number of persons receiving nursing care during the week prior to the 

day of the survey; (2) administration of medications and treatments in accordance with physician’s orders; (3) supervision over medications 

that may be self-administered; (4) the routine 

provision of the following criterion’ personal 

services: rub and massage, help with tub bath or 

shower, help with dressing, correspondence, 

shopping, walking or getting about, and help 

with eating; and (5) the employment of registered professional or licensed practical nurses. 

On the basis of these factors, four types of facilities were distinguished and are defined as 

follows: 

Nursing care home-‘-A facility is a nursing 

care home if nursing care is its primary and predominant function. Those meeting the following criteria are classified as nursing care homes in 

this report: 

1. One or more registered nurses or licensed 

practical nurses .were employed. 

2. 50 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: nasal feeding, catheterization, irrigation, oxygen therapy, full 

bed bath, enema, hypodermic injection, 

intravenous injection, temperature-pulserespiration check, blood pressure reading, application of dressings or bandages, 

and bowel and bladder retraining.) 

Personal care home with nursing.-A facility 

is a personal care home with nursing if personal 

care is its primary and predominant function, 

but some nursing care is also provided. If a facility met either of the following criteria, it was 

classified as a personaI care home with nursing: 

1. Some but less than 50 percent of the 

residents received nursing care during the 

week prior to the survey, and there was 

one registered professional or licensed 

practical nurse or more on the staff. 

2. Some of the residents received nursing 

care during the week prior to the survey, 

no registered nurses or licensed practical 

nurses were on the staff, but one or 

more of the folIowing conditions were 

met: 

a. Medications and treatments were administered in accordance with physician’s orders. 

b. Supervision over self-administered 

medications was provided. 

C. Three or more personal services were 

routinely provided. 

Personal care home.-A facility is a personal 

care home if its primary and predominant function is personal care and no residents received 

nursing care during the week prior to the survey. 

Places in which one or both of the folIowing 

criteria were met are classified as personal’care 

homes in this report whether or not they employed registered nurses or licensed practical 

nurses: 

1. Medications and treatments were administered in accordance with physician’s 

orders, or supervision over medications 

137 
during the week prior to the day of survey .,....,...,.. 50 percent 

Number of registered or licensed practical nurses ,...,. 1+ None 1t None None 

Does the facility provide: 

(a) Administration of medicine or treatments according to doctor’s orders ... .. ... . ... . .. . .. .. .. . ... . Yes No Yes No Yes No 

or 

lb) Supervision over self-administered medicine?... 

Does the facility offer assistance with three activities or more for daily living? .. . .... ... .. .. ... . .... .. ... .... . .. ’ . Yes No . Yes No . . Yes No 

Does the facility offer assistance with one or two 

activities for daily living? . .... . ... .. .... . ... .. ... . .... . .... .... . . ’ ’ ’ ’ ’ .Yes . . . . Yes No . . . Yes No 

Does the facility offer room and/or board as its only Yes . . . . . . . Yes service? .. .. .. ... .... ... .... . .... ... .. .... .. .. . ... .. .... ... .. .... . .... .. ... . ’ . ’ ’ 

Facility1 ,................................................................... NC Pen Pen PC Pen PCll Pen PC D PC PC D B 

lNc=Nursing care home. 

Pcn=Personal care with nursing home. 

Pc=Personal care home. 

D=Domiciliary care home. 

B=Boarding or rooming house (out of scope). 

000 

that may be self-administered was providcd. 

2. ‘l’hrce or more of the criterion personal 

services were routinely provided. 

Domiciliaq care home. -A facility is a domiciliary cart home if its primary and predominant 

function is domiciliary care but the facility has a 

responsibility for providing some personal care. 

If the criteria for a nursing care home or personal care home arc not met but one or two of 

the criterion personal services are routinely provided, the facility is classified as a domiciliary 

care home in this report. 

Table IV. Classification of 

Classification variable 

Percent,of total residents who received nursing care 50 percent or more 

In the classification process, a criterion was 

considered as not having been met if the necessary information for that criterion was unknown. For instance, if the type of nursing staff 

was unknown for a particular place, it was considered as not having met the criteria of having 

one or more rqgistcrcd nurses or licensed practical nurses on the staff. Establishments indicating 

that some nursing care was provided but not giving the riumber of persons to whom this care 

was provided were considered as facilities providing nursing care to sorhc but less than 50 percent of their patients or residents. Table IV 

shows in detail the classification of the facilities. 

facilities by type of service 

Classification criteria 

Some but less than None 

138 
WTAL AND HEALTH STATISTICS Series 

Series 1. Programs and Collection Procedures.-Reports which describe the general programs of the National 

Center for Health Statistics and its offices and divisions and data collection methods used and include 

definitions and other material necessary 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 analytical 

techniques, objective evaluations of reIiability of collected data, and contributions to statistical theory. 

Series 3. Analytical Studies. -Reports presenting analytical or interpretive studies based on vital and health 

statistics, carrying the analysis further than the espository 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 From the Health Interview Survey.-Statistics on illness, accidental injuries, disability, use of 

hospital, medical, dental, and other services, and other health-related topics, all based on data collected 

in a continuing national household interview survey. 

Series 11, Data From the 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 medically defined 

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

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

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

Series 12. Data From the Institutionalized Population Surveys.-Discontinued effective 1975. Future reports from 

these surveys will be in Series 13. 

Series 13. Data on Health Resources Utilization.-Statistics on the utilization of health manpower and facilities 

providing long-term care, ambulatory care, hospital care, and family planning 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, hospitals, nursing homes, and outpatient facilities. 

Series 20. Data on Mortality. -Various statistics on mortality other than as included in regular annual or monthly 

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

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

sample surveys of those records. 

Series 21. Data on Natality, Marriage, and Divorce.-Various statistics on natality, marriage, and divorce other 

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

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

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

Series 22. Data From the National Mortality and Natality Surveys.-Discontinued effective 1975. Future reports 

from these sample surveys based on vital records will be included in Series 20 and 2 1, respectively. 

Series 23. Data From the National Survey of Family Growth.-Statistics on fertihty, family formation and dissolution, family planning, and related maternal and infant heaIth topics derived from a biennial survey 

of a nationwide probability sample of ever-married women 15-44 years of age. 

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

National Center for Health Statistics 

Public Health Service 

Hyattsville, hid. 20782