Data from the

NATIONAL HEALTH SURVEY

Profile of ChronicIllness

in Nursing Homes

UnitedStates:

NationalNursingHome Survey

August1973-Apnl1974

Statistics on reported chronic conditions and impairments; primary

diagnosis at last examination and at admission; behavioral problems;

.

impairments in vision, hearing, and speech; and use of dentures

and special aids. Based on information collected in the 1973-74

National Nursing Home Survey. Comparisons made with data from

previous nursing home surveys and from surveys of the noninstitutional population.

DHEW Publication No. (PHS) 78-1780

Series 13

Number 29

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

Public Health Service

National Center for Health Statistics

Hyattsville, Md. December 1977
Library of Congress Cataloging in Publication Data

Ingram, Donald K

Profile of chronic illness in nursing homes, United States, August 1973 -ApriI 1974.

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

health resources utilization; no. 29) (DHEW publication; no. (PHS) 78-1780)

Bibliography: p.

1. Nursing home patients–United States–Statistics. 2. Chronic diseases–Unitecl States–

Statistics. 1. United States. National Center for Health Statistics. II. Title. III. Series: United

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

the National Health Survey, Data on health ~esources utilization; no. 29. IV. Series: United

States. Dept. of Health, Education, and Welfare. DHEW publication; no., (PHS) 78-1780.

RA407.3.A349 no.29 [RA997] 362.1’1’0973s

ISBN 0-8496-0096-8 [312.3] 77-22564
NATIONAL CENTER FOR HEALTH STATISTICS

DOROTHY P. RICE, Director

ROBERT A. ISRAEL, Deputy Director

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

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

ELIJAH L. WHITE, Associate Director for Data Systems

JAMES T. BAIRD, JR., Ph.D., Associate Director for International Statistics

ROBERT C. HUBER, Associate Director for Mmagernerzt

MONROE G. SIRKEN, Ph.D., Ass~ciate Director for Mathematical Statistics

PETER L. HURLEY, Associate Director for Operations

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

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

ALICE HAYWOOD, Information Officer

DIVISION OF HEALTH RESOURCES UTILIZATION STATISTICS

SIEGFRIED A. HOERMANN, Director

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

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

JAMES E. DeLOZIER, ChieJ Ambulatory Care Statistics Branch

MANOOCHEHR K. NOZARY, Chief Technical Services Branch

Vital and Health Statistics-Series 13-No. 29

DHEW Publication No. (PHS) 78-1780

Library of Congress Catalog Card Number 77-22564
CONTENTS

The Survey .............................................................................................................................................

Overview of Findiigs .........................................................................................................................

Overview of the Report ......................................................................................................................

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

The Population ........................................................................................................................................

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

Certification Status of Facility ...........................................................................................................

The Profiie of ChroNc Illness ..................................................................................................................

Reported Conditions .........................................................................................................................

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

Certification Status of FaciMy .....................................................................................................

Prhnary Diagnosis ........................... ......... ................................................................................................

Primary Dmgnosis at Last Exatiation ...............................................................................................

Prhnary Diagnosis at Admission ..........................................................................................................

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

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

Certification Status of Facility ..........................................................................................................

Impairments in Vkion, Hearing, and Speech and Use of Dentures ...........................................................

Vision ...............................................................................................................................................

Hearing .............................................................................................................................................

Speeeh ..............................................................................................................................................

Use of Dentures ................................................................................................................................

Special Aids ................................................................................................................................. ...........

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

Certification Status of FaciM y ...........................................................................................................

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

Appendixes .-

1.

2.

3.

4.

5.

L Technieal Notes on Method ..........................................................................................................

II. Definitions of Certain Terms Used in TMs Report .......................................................................

111.Resident Questionnaire Used in the 1973-74 National Nursing Home Survey ..............................

LIST OF FIGURES

Percent distribution of nursing home residents by age: United States, August 1973-April 1974 ........

Prevalence rates per 1,000 nursing home residents for selected reported chronic conditions, by

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

Rate per 1,000 nursing home residents for seleeted primary dmgnoses at last examination, by age:

United States, August 1973-ApriI 1974 .............................................................................................

Comparison of rates for those primary diagnoses showing significant changes between admission

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

Percent of nursing home residents with behavioral problems by problem and frequeney: United

States, August 1973-April 1974 ........................................................................................................

1

1

2

2

3

3

4

5

5

7

9

9

9

13

14

15

16

;:

17

19

19

20

20

20

24

48

56

58

3

8

12

14

15

...

111
6. Percent distribution of nursing home residents by vision status, according to age and sex: United

States, August 1973-April 1974 ........................................................................................................ 16

7. Percent of nursing home residents using eyegb=ses, by age and sex: United States, August 1973-

April 1974 ................................................................................................................................. ....... 17

8. Percent distribution of nursing home residents by hearing status, according to age and sex: United

States, August 1973-Aprif 1974 ........................................................................................................ 18

9. Percent of nursing home residents using a hearing aid, by age and sex: United States, August 1973-

April 1974 ........................................................................................................................................ 18

10. Percent distribution of nursing home residents by speech status, according to age and sex: United

States, August 1973-April 1974 ....................................................................................................... 19

11. Percent distribution of nursing home residents by use of dentures, according to age and sex:

United States, August 1973-April 1974 ........................................................................................... 19

LIST OF TEXT TABLES

A. Number, percent dktribution, and median age of nursing home residents b y age, according to sex:

United States, August 1973-April 1974 ............................................................................................ 4

B. Number of nursing homes and number and percent distribution of nursing home residents by sex

and age, according to certification status of home: United States, August 1973-April 1974 .............. 4

C, Number and percent of nursing home residents by selected reported chronic condhions and impairments: United States, 1973-74, 1969, and 1964 ............................................................................... 6

D. Number and percent distribution of nursing home residents b y primary diagnosis at last examination

and rank m August 1973-Aprd 1974 and June-August 1969: Uruted States ..................................... 10

E. Number and percent distribution of nursing home residents by sex and age, according to special aids

used: United States, August 1973-Aprif 1974 ................................................................................... 21

SYMBOLS

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

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

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

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

Figure does not meet standards of

reliability or precision ------------------------

*
PROFILE OF CHRONIC ILLNESS IN NURSING HOMES

Donald K. Ingram, Formerly of Division of Health Resources Utilization Statistics

THE SURVEY

OVERVIEW OF FINDINGS

Presented in this report are descriptive

statistics which provide a profile of the health of

the over 1 million persons in the United States

who reside in 15,700 nursing homes. Based on

the results of a nationwide survey conducted

between August 1973 and April 1974, the size

of this institutionalized population is estimated

at 1,075,800 persons—approximately 1 person

out of every 200 living in the country. If only

persons 65” years and- over are counted, it is

estimated that 5 percent of the Nation’s older

population resided in a nursing home at the time

of the survey. About 11 percent of the nursing

home population were younger than 65 years,

S2 years being the median age.

It is the inability to care adequately for

chronic illness outside an institution which has

been assumed to be the primary reason motivating the great number of admissions to nursing

homes. Statistics on chronic illness among

persons living outside institutions support this

assumption.1 During 1972 approximately 26

million persons, representing 13 percent of the

noninstitutionalized population, were reported

to be limited in their daily activities as a result

of a chronic condition. The impact of chronic

illness was felt most severely in the elderly

segment of the noninstitutionalized population.

In particular, around 9 million elderly persons,

or 43 percent of those 65 years and older, had a

chronic health problem that limited their daily

activity in some way. For nearly 4 million of the

elderly, chronic illness was severe enough to

cause a limitation in their mobility, and over 1

million were confined to the house. With such a

great prevalence of chronic illness among the

elderly in general it is understandable that many

of those who found it difficult, if not impossible, to be cared for at home eventually were

admitted to nursing homes.

Inside nursing homes the health profile of

the residents is dominated by chronic illness.

The current survey found that practically all

residents had to cope with at least one type of

chronic condition or impairment. Fifty-eight

percent reportedly suffered from senility. Two

other major chronic conditions were heart

trouble and arthritis or rheumatism, both of

which affected about 34 percent of the nursing

home population. In addition, sensory impairments were very prevalent. For about 13 percent

of all residents vision was either severely

impaired or completely lost; around 32 percent

had impaired hearing. The speech of about 26

p’ercent of the population was considered

impaired. Around 64 percent had dentures. Behavioral problems were also associated with

chronic illness. Approximately 42 percent of the

residents were descnb ed as agitated or nervous,

while 39 percent were reported to act depressed

at least once a week. The high Ievel of chronic

illness was also reflected in the use of special

aids. About half of the poptiation used at least

one type of special aid. For about 35 percent of

1
all residents this aid was a wheelchair, and

around 15 percent used a walker for moving

about.

OVERVIEW

OF THE REPORT

The health status of the nursing home population during August 1973-April 1974 is the

focus of this report. In effect, to examine the

health status of this institutionalized population

was to examine the profile of chronic illness

among its members. The survey data provided

several different perspectives through which the

profile of chronic illness could be analyzed.

The prevalence of various chronic conditions

and impairments provided the primary perspective. One source of prevalence data was the

information on 11 major chronic conditions and

impairments reported by the nurse or other staff

member most familiar with the resident’s health

condition. Another source was drawn from the

medical. records of the resident. Of interest was

the primary diagnosis noted at the last examination as well as at the time of admission. In

addition to these prevalence data on medical

problems, the profile of chronic illness was also

viewed from the perspective of the behavioral

problems affecting the residents. Finally, the

relative extent of chronic disability was assessed

by two other measures of chronic impairments.

One such source was derived from the detailed

information which dealt with the extent of

visual, hearing, speech, and dental impairments.

This included data on the use of eyeglasses,

hearing aids, and dentures. The last source concerned data on the use of special aids such as

wheelchairs, walkers, canes, braces, and

crutches.

The analysis of these main variables provided

the statistical profile of chronic illness which

constitutes the scope of this report. Secondary

variables providing additional detail to the analysis include the age and sex of residents. The

one facility variable analyzed in detail was certification status. Certification status refers to

whether or not the facility was certified for

Medicare (Title XVIII of the Social Security

Act), Medicaid (Tkle XIX of the Social Security

Act), or both. A detailed description of

classification is provided in appendix II.

SOURCES AND

QUALIFICATIONS OF DATA

this

The data presented in this report were

obtained in a sample survey conducted by the

National Center for Health Statistics (NCHS) between August 1973 and April 1974. This survey

is referred to in the report as the 1973-74

National Nursing Home Survey (1973-74

NNHS). Detailed information concerning the development of the survey and its methodology

are presented in appendix I.

The 1973-74 NNHS represents an expansion

of previous NCHS surveys of nursing homes and

related facilities which were on an ad hoc basis.

Background on the establishment of these

surveys has been reported previously.z The first

was a mail-out survey conducted during 1963. It

was succeeded by two interview surveys conducted during 1964 and 1969.

Since the information herein was derived

from a sample survey, the reader should be

aware of the exact sources of the data and the

qualifications which bear upon their interpretation. There are three appendixes provided to

aid in understanding the more technical aspects

of the survey operation and methodology.

Contained in appendix I is a general description of the survey, including the sample design

and the survey procedures. Since the statistics in

this report are estimates based on a sample of

nursing homes, they are of course subject to

sampling variability. Therefore the reader should

pay particular attention to the tables of standard

errors located in appendix I. The survey terminology is found in appendix II. Definitions of

various terms should be noted as they are essential to the proper interpretation of the data. In

particular the reader is directed to the criteria

for classifying nursing homes. The information

on the facilities was obtained in a personal interview with the administrator. Responses to items

contained in the Facility Questionnaire were

used to determine the certification status of the

institution. The Resident Questionnaire was

used to gather information on a sample of resi2
dents within each facility. This was administered

during a personal interview with a nurse, usually

the one who provided care for the sample resident. During the interview the respondent was

asked to refer to the resident’s medical record. A

facsimile of the Resident Questionnaire is exhibited in appendix III.

This repo;t represents a followup to previous

NCHS rep&ts o; the health of ~ursi;g home

residents.s -G Wherever appropriate, comparisons

were made with data from the 1964 and

1969 nursing home surveys previously described.

Special care should be taken in analyzing these

comparisons, however, since there were differences in scope. The 1964 and 1969 surveys

included all nursing homes, whereas the 1973-74

NNHS included only those homes providing

THE

In order to m-ovide a backdro~ to

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

homes were excluded). This exclusion should

have minimal impact on comparisons, however,

because residents of personal care homes comprised only about 5-6 percent of the total

resident population of the 1964 and 1969

surveys.

The Health Interview Survey (HIS) provides

the main source of data for comparisons with

the noninstitu tionalized population. This

national household survey, also conducted by

NCHS, relies upon the respondent’s knowledge

of his own health condition. Differences in survey material and method of data collection

should be taken into account, especially since

data are not supplied by medically trained personnel from the medical record.

POPULATION

the * .

chronic illness profile of nursing home residents,

this section will highlight some demographic

features of this institutionalized population.

There were an estimated 15,700 nursing homes

in operation during the survey period. The size

of the resident population within these facilities

totaled 1,075,800 persons.

AGE AND SEX

The age distribution of the nursing home

populatio~ has always been a very skew;d one.

As shown in figure 1, the population for the

1973-74 survey period was no exception. The

median age of the population was 82 years. The

modal age class was 75-84 years, which accounted for 36 percent of all residents.

In addition to the skewness in the age distribution, the nursing home population has also

been traditionally characterized by its preponderance of female residents. An estimated 70

percent of the population was female, compared

;O 30 percent ;vh~ were male. The sex ratio was

50

40

~ ~o

:

N 20

10

Under 45 45.54 55*4 -65.74 7584 05.94 95 years

Yearn years w=~ vears w= years and 0“,1

AGE

Figure 1. Percent distribution of nursing home residents by age:

United States, August 1973-April 1974

42 men for every 100 women. In contrast, the

proportion of male residents under 65 was twice

that of female residents.

In general, female residents were also older

than male residents (table A). The median age of

women was 82 years, while the median age of

men was 78 years.

3
Table A. Number, percent distribution, and median age of nursing home residents by age, according to sex: United States, August 1973-

April 1974

Sex Number of AH ages

Under 65 65-74 75-64 85 years Median

residents years years years and over age

Percent distribution

Both saxes............................................... 1,075,800 100.0 10,6 15,2 35,8 38,4 82

Male .............................................................. 318,100 100.0 16.5 20.5 32.2 30.9 78

Femala .......................................................... 757,700 100.0 8.2 12.9 37,3 41.6 82

CERTIFICATION STATUS

OF FACILITY

The nursing homes included in the 1973-74

NNHS were:

. Those certified as extended care facilities by

Medicare (Title XVIII of the Social Security

Act).’

. Those certified as skilled nursing homes by

Medicaid (Title XIX of the Social Security

Act).a

● Those certified as intermediate care facilities

by Medicaid.

aThe extended care facility and skilled nursing home

designations are used in this report because most of the

survey waa conducted prior to the legislation which

created the skilled nursing facility.

● Those not certified by either program but

providing some level of nursing care.

Of the homes which were—certified, some were

certified under both the Medicare and the

Medicaid programs. Other homes certified by

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

intermediate care facility. In order to provide

detailed data by certification status, some small

certification subgroups were combined with

larger ones when both provided a similar level of

care. Thus those 406,900 residents classified in

table B as residing in facilities certified by

both Medicare and Medicaid (BM&M) include

23,500 which were in facilities certified by

Medicare only. Similarly, the 292,500 residents

in facilities certified by Medicaid as skilled

Table B. Number of nursing homes and number and percent distribution of nursing home rasidents by sex and age, according to certification status of home: Unitad States, August 1973-April 1974

Certification status

All homes ......................

Both Medicare & Medicaid.,

Medicaid only

Skilled nursing home ........

I ntermadiate care

facility,,..,,.,,..,,..,,.,..........

Not certified ,,,,,,,,,,,,,.,, .......

Number of

nursing

homes

15,700

4,200

3,500

4,400

3,600

Sex Age

Number of

residents Both Male Female All Under 65 65-74 75-84 85 years

sexes ages years yaars years and over

T

1,075,800 100.0

1406,900” I 00,0

2292,500 100.0

236,700 100.0

139,800100,0

29.6

27.7

29.7

32,4

29,8

70.4

72.3

70.3

67.6

70.2

Percent distribution

J___L 100.0 9.8 15.3

100.0 12.5 15.8

100.0 12.9 13.9

35.8

37.1

35.6

34.0

35,2

38.4

38.4

39.3

37.8

37,9

123,500 of the residents were in facilities certified by Medicare OnlY.

2129,600 of the residents were in facilities certified as both SNH and ICF.

4
nursing homes (SNH’S) included 129,600 which

were in homes also certified as intermediate care

facilities (ICF’S).

Although the homes certified by both

Medicare and Medicaid or by Medicare only (the

BM&M group in this report) comprised about 27

percent of all homes, they housed about 38 percent of all residents. Similarly, those certified as

skilled nursing homes by Medicaid (the SNH’S in

this report) comprised only about 22 percent of

the Nation’s nursing homes but had 27 percent

of the population in residence. Those homes

certified only by Medicaid as intermediate care

facilities (the ICF’S in this report) comprised 28

percent of all homes but had only about 22 percent of all residents. Finally, homes not certified

for Medicare or Medicaid comprised 23 percent

of all homes but housed about 13 percent of the

residents.

Sex and age of the residents did not vary

greatly across the facility types (table B). The

only significant differences were found in ICF’S

and not certified homes, which had significantly

greater proportions of younger residents than

found in the other two types of facilities.

THE PROFILE OF CHRONIC ILLNESS

This section provides a quantitative index of

chronic illness in the nursing home population

during the 1973-74 survey period. Prevalence

patterns by age and sex of the residents and by

certification status of the facilities can be drawn

directly from the data collected on the reported

chronic conditions and impairments, on the

condition identified as the primary diagnosis at

admission and at the last examination, and on

the reported behavioral problems affecting the

residents. In addition, an assessment of chronic

disabilities can be made by analyzing data on

particular impairments related to vision, hearing,

and speech and on use of dentures and special

aids.

REPORTED CONDITIONS

Listed in table C are the chronic conditions

for which reported prevalence was sought from

the nurse respondents. This information was obtained from item 9 of the Resident Questionnaire. Based on the findings of previous NCHS

surveys of nursing homes, it was thought that

these 11 conditions were the most relevant to

the population under study, particularly in

term; o~ their prevalence. Abou; 95 percent of

the residents had at least one of these

conditions, wit h the average number of

conditions per resident at 2.2.

Previous reports have shown that residents

are likely to have multiple conditions.s YG For the

1969 survey the mean was computed to be 3.4

conditions, however, that survey used a more extensive and open-ended listing of reported conditions. An estimated 98 percent of all residents

were reported to have at least one of the conditions in that listing. Because the 1973-74 NNHS

did not include all the chronic conditions used in

the previous surveys, the comparison of averages for these two time periods is not valid.

By far, senility was found to be the most

prevalent condition among nursing home residents. Well over half the population was

reported to have this chronic illness. As observed

in table C, the rate of 58 percent was similar to

that reported in the 1969 survey and over twice

the rate reported 10 years earlier in the 1964

survey. For the noninstitutionalized population

during July 1966-June 1968, senility was reported in HIS as the major reason that 154,000

persons, or 9 percent of those persons aged 55

years and over, received home care.T

As discussed in a previous report, the classification of senility as a disease entity presents

many nosological difficulties.s Senility may

refer specifically to advanced types which in5
Table C. Number and percent of nursing home residents by selected reported chronic conditions and impairments: United States.

1973-74,1969, and 1964

Reported chronic conditions

and impairments

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

Arthritis or rheumatism .............................................................................

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

Mental illness4 ...........................................................................................

Amputation of extremities or limbs, or permanent stiffness or any

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

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

Paralysis due to stroke ...............................................................................

Glaucoma or cataracts ...............................................................................

Any chronic trouble with back or spine ....................................................

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

Paralysis or palsy not related to stroke, arthritis, or rheumatism ................

None of these conditions ...........................................................................

1973-74

Number of

residents

627,000

368,500

360,500

200,400

150,000

142,700

122,100

110,900

106,100

72,800

66,200

57,700

Percentl

56.3

34.3

33.5

18.6

13.9

13.3

11.3

10.3

9.9

6.8

6.2

5.4

T

19692 19643

Percent 1

56.4

33.2

36.3

18.1

23.8

11.9

25.1

. . .

10.0

. . .

9.8

. . .

26.8

22.1

28.2

18.2

15.6

8.0

12.0

6.2

. . .

. . .

4.7

. . .

1Figures may not total to 100 percent because residents mriy have had more than one condition.

*see reference 4 for source of estimate.

SSee reference 5 for source of estimate.

4Estimates for 1969 and 1964 include mentally retarded residents; for 1973-74 the estimate for mental retardation is presented

separately.

volve psychosis, such as chronic brain syndrome

or senile dementia, and consequently are classified as mental disorders under the E~ghth

Revision International Classification of Diseases,

Adapted for Use in the United States (ICDA).8

Under more generalized lay terminology, senility

may refer simply to symptoms such as a decline

in intellect, memory, and judgment, a loss of

orientation, difficulty in speaking, or feebleness.

In the 1973-74 NNHS this later definition was

used. Thus senility was considered as a very

broad category encompassing disease etiology

and symptomology generally associated with deteriorating effect of the aging process on mental

functioning. Since senility has been linked with

other diseases, most notably with cerebral arteriosclerosis, and with impairments in perception

and sensation, there may have been many

physical causes leading to a prevalence rate of 58

percent in the nursing home populations There

is also the possibility that the term senility as

defined in the survey represented a classification

so broad that

this condition

the respondent may have equated

with old age when responding.

After seniIity the most frequently reported

conditions were arthritis or rheumatism (34 percent) and heart trouble (34 percent). Arthritis or

rheumatism is a category which represents a

variety of diseases that are generally considered

to be associated with the degeneration and resultant inflammation of joint tissue.

For noninstitutionalized persons 65 years

and over during 1969-70 it was the leading cause

of limitation of activity, affecting 21 percent of

the persons limited in activity.g As seen in table

C, the proportion of the current nursing home

population reported to have arthritis or rheumatism (34 percent) was around the level

reported in the 1969 survey. In the 5 years between the 1964 and 1969 surveys, however, the

proportion increased from 22 to 33 percent,

although the age distribution of the population

remained relatively constant.

During 1973-74 heart trouble was third in

the ranking of prevalence. The rate of 34 percent from the current survey was nearly the

same as the 1969 rate, but higher than the 1964

rate (28 percent). Like senility, heart trouble rep6
resents a very broad often ill-defined disease

category. This classification can include rheumatic heart disease, hypertensive heart disease,

ischemic heart diseasej and other diseases of the

circulatory system. Thus some respondents may

have included residents with arteriosclerosis, or

hardening of the arteries, and possibly some of

those suffering from cerebrovascular disease, or

stroke. Nevertheless, heart trouble would undoubtedly remain among the top three

conditions for reported prevalence in the nursing

home population even if these miscellaneous

categories were eliminated. During 1972 heart

conditions were reported by the Health Interview Survey (HIS) as the most prevalent condition among noninstitutionalized persons with

limitations of activity.1 It was second only to

arthritis or rheumatism as an activity limiting

condition among persons 65 years and over

during 1969-70.9

At 19 percent, mental illness was the fourth

most reported condition in the 1973-74 nursing

home population. Although the prevzdence rate

remained constant since 1964, this comparison

ignores the fact that in the current survey

mental retardation was a distinct category separat e from mental illness, whereas in the

previous two surveys both mental illness and

men tal retardation were combined in one

category (labeled mental illness). Although in

the 1973-74 NNHS only 7 percent of the residents were reported as mentally retarded, the

addition of mentally retarded residents to those

with mental illness gives a total of 25 percent

with mental disorders. This represents a substantial increase from the 1969 prevalence rate

of 18 percent. Among the 1969-70 noninstitutionaIized population ordy about 4 percent of all persons with activity limitations

reported mental and nervous conditions as the

chronic condition causing their Iimitation.g

The fifth most prevalent chronic condition

among nursing home residents was another

broad category–amputation of extremities or

limbs; or permanent stiffness or any deformity

of the foot, leg, fingers, arm, or back (to be

abbreviated amputation, stiffness, or deformity).

As shown in table C, 14 percent of all residents

were included under this category as having at

least one of these orthopedic impairments. This

rate is similar to that for 1964 but represents a

10 percent drop since 1969. The factors influencing this decline were not apparent.

An estimated 13 percent of the nursing

home population were reported to be diabetic.

Among those with activity limitations in the

noninstitutionalized population during 1969-70,

HIS reported diabetes as the cause of the

limitation for 4 percent of those persons 65

years and over.g

Eleven percent or less of the nursing home

population were reported to have the following

conditions: paralysis or palsy due to stroke (11

percent), glaucoma or cataracts (10 percent),

chronic trouble with back or spine (10 percent),

mental retardation (7 percent), and paralysis or

palsy not related to stroke, arthritis, or rheumatism (6 percent).

Age and Sex

Comparisons across age and sex groups in

the nursing home population yielded some interesting patterns in the prevalence of the 11

reported conditions. As illustrated in Figure 2,

the prevalence of several of the conditions increased markedly with age. The top three in

overall prevalence-senility, arthritis or rheumatism, and heart trouble—alI approximated a

fourfold increase when rates for residents under

65 years of age were compared with those residents 85 years and over. Particularly noteworthy

was the fact that around 7 out of every 10 of

the older residents were reported to be senile.

Glaucoma or cataracts also approximated a fourfold increase between the youngest and the

oldest groups. As a result of these trends, the

four conditions mentioned above rank-ordered

as the most prevalent among older residents.

In contrast to the pattern of increased prevalence, several conditions markedly decreased

with age—mental illness; mental retardation;

paralysis not related to stroke, arthritis, or rheumatism; and amputation, stiffness, or deformity.

In general these were the ones with the highest

prevalence rates among younger residents, or

those under 65 years. Mental illness and mental

retardation were the most prevalent conditions

reported for younger residents. The prevalence

o f mental retardation showed the steepest

7
7W Mental illness

r

7GCI Mental retardation

r 6CQ

t

500 ~

400

30+1

200

lCO

o L

245,7

300 . .

200

i“”

Irnl %5

/

., 27,6 ,,.~

o

Paralysis or paky

730 not related to stroke,

F

arthritis, or rheumatism

600

Paralysis or palsy

700

r

due to stroke 700 Glaucoma or cataracts

r

700 Arthritis or rheumatism

r603

. 1-

600

500

1

500

t

4m

t

400

t

300

t

3W

t

200 200

L -dldl

Iel.s

1439

100

.:+: 100 ,55 100 !F46 ......

6Z8

~..

. . ;. 526 368 385 +3:

:. ;.: ~.:.

o

.:.:.:

0

,, .

0

,.. .:.x

Amputation of extremities

7CKI or limbs, or p?rmanent

F

stiffness or any de.

formity of foot, leg,

6W S@ers, arm, or back

7@l

Any chronic trouble

[

with back or spine

600

500 *

7cm Dmb?tes

r

700 Heart trouble

600

F

5(YI

t

5ml

t4W

3W

200

10U

0

4W

t

3W

t

~ 200

K

lW

o

Under 65. 75. ’35

65 74 84 years

years years , years ~~~r

200

t

200

100

0

,COS 1079

0

Under 65. 75- 65

65 74 S4 years

and

‘ears ‘cam ‘ears over

Under 65. 75- 85

65 74

~ years

and

‘ears ‘ears ‘ears over

Under 65- 75-

85

65 74 84

years

and

years years years over

Figure 2. Prevalence rates per 1,000 nursing home residents for selected reported chronic conditions, by age: United States, August

1973-April 1974

decline with age. Figure 2 depicts a drop in rate of reported conditions; but these were relatively

of nearly twentyfold between the youngest and small in comparison to the age differences. An

the oldest age groups. overaH sex-age comparison on prevalence of reComparing male and female residents as ported conditions can be found in table 1.

groups, differences were found in the prevalence Mental retardation was the only condition

8
for which the prevalence rate among male

residents was distinctly higher than that

reported for females. The rate of 100 per 1,000

males was nearly twice the rate for females (54

per 1,000). Other conditions for which the prevalence rate among men exceeded that for

women included amputation, stiffness, or deformity, and paralysis or palsy both due to

stroke and other causes.

Female residents experienced higher prevalence rates on five of the reported conditions–

arthritis or rheumatism, senility, heart trouble,

glaucoma or cataracts, and chronic back or spine

trouble, The greatest sex differential was

estimated for arthritis or rheumatism, 379 cases

per 1,000 women as compared to 256 per 1,000

males.

Certification Status of Facility

Provided in table 2 are the prevalence

patterns of reported conditions according to the

certification status of the home. For several conditions these patterns varied considerably among

the different types of facilities. Regardless of

certification status senility remained as the most

frequently reported condition.

Both Medicare and Medicaid (BM&M) certified homes accounted for the highest rates of

residents with paralysis or palsy due to stroke,

heart trouble, and paralysis or palsy not due to

stroke. At 14 percent the rate of stroke aftereffects among residents of BM&M’s was slightly

higher than that for the SNH’S or ICF’S, while it

was considerably higher than the rate of 8 percent reported for residents of not certified

facilities. In general this pattern was repeated for

residents with heart trouble and those with

other types of paralysis or palsy. In these cases,

however, the differences in rates between

BM&M’s and SNH’S were not statistically significant.

Conversely, residents in BM&M’s accounted

for the lowest rates of mental illness and mental

retardation. With rates over 9 percent, mentally

retarded residents were much more prevalent in

ICF’S and homes not certified than they were in

other facilities. Other conditions which varied to

any significant degree by certification

were diabetes and amputation, stiffness,

status

or deformity. The lowest rates for both these

conditions were reported among residents of not

certified homes, with estimates of about 10 percent.

Although not statistically significant for

several conditions, the figures suggest that

BM&M’s and SNH’S tended to provide care for

residents with more medically serious conditions

such as heart trouble or paralysis or palsy;

whereas ICF’S and not certified homes had larger

shares of residents with conditions such as

mental illness and mental retardation which require custodial care.

PRIMARY DIAGNOSIS

To complement the data on reported

chronic conditions and impairments, the nurse

respondent was asked to consult the medical

record of each sample resident to obtain medical

information based on a physician’s diagnosis.

The respondent was asked to extract the primary diagnosis from both the most current examination and from the examination given when

the resident was admitted. For each of these

specific time references the primary diagnosis

was then classified according to the categories

listed in item 8 of the Resident Questionnaire.

This classification was fashioned to correspond

to the major disease categories of the ICDA.8

Exception to this format was made in the major

category Diseases of the Circulatory System. As

noted in table D, this category was subdivided

according to the ICDA classification into heart

attack,’ stroke, hardening of the arteries, and

other diseases of the circulatory system.

Primary Diagnosis at Last Examination

A primary diagnosis at last examination was

obtained for 99 percent of the population. Since

by definition only one condition was noted,

these estimates are not to be considered actual

prevalence rates. Instead, this question was intended to determine the condition which was

currently the most serious one affecting the resident. It is assumed that the difference between

the rates

respond

of a reported condition and its corng primary diagnosis is a rough

9
Table D. Number and percent distriubtion of nursing home residents by primary diagnosis at last examination and rank in August 1973-

April 1974 and June-August 1969: United States

Primary diagnosis at last

examination in rank order

for 1973-74

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

Hardening of the atieries ............................................

Senility, old age, or other symptoms and illdefined

conditions .........m......................................................

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

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

Diseases of the musculoskeletal system and

connective tissue ......................................................

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

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

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

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

Dis@asesof the circulatory system other than

hardening of the arteries, stroke or heart attack .......

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

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

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

Other diagnoses4 ........................................................

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

Unknown diagnoses ....................................................

Diseases of the blood and blood-forming organs,.,......

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

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

Infective and parasitic diseases ...................................

1973-74

Rank

. . .

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

Number of

residents

. . .

241,800

146,800

115,800

113,400

73,100

64,200

55,700

49,300

48,100

39,400

25,600

22,200

20,500

16,100

15,600

9,600

7,600

6,000

3,100

*

Percent

distribution

. . .

22.5

3.6

0.8

0.5

6.8

6.0

5.2

4.6

4:5

3.7

2.4

2.1

1.9

1.5

1.5

0.9

0.7

0.6

0.3

*

Rank

1

.-.

3

2

-..

5

4

.-.

7

6

---

11

12

10

-..

13

9

14

15

16

8

1969]

Number of

residents

298,400

. . .

77,200

64,600

. . .

49,500

57,700

. . .

36,700

39,400

. . .

16,900

14,900

18,100

. . .

8,900

24,400

3,900

2,800

1,900

28,700

Percent

distribution

39.1

. . .

10.1

11.1

..-

6.5

7.6

-..

4.8

5.2

. . .

2.2

2.0

2.4

. . .

1.2

3.2

0.5

0.4

0.3

3.8

lsee reference 11 forsource of estimates.

2’~n the ~~7~-74 ~ationa~ ~wsing ~ome sumeY, this categorY was subdivided into s.pe~ific categories of hardening Of the arterieS,

stroke, heart attack, andother diseases of the cuculatory system. These categories were not reported separately in the 1969 survey.

s~ncludes mental retardation and mental illness.

z~nc~udes certain ~ause5 of per~atal morbidity, complications of pregnancy and childbirth, and other diagnoses not listed.

indication of overall severity. For example, the

more severe the condition the less difference

there should be between its reported prevalence

rate and its frequency as a primary diagnosis.

Table 3 provides a cross-tabulation of primary

diagnosis at last examination and reported conditions to permit this comparison.

Table D provides a rank ordering of primary

diagnosis at last examination and a comparison

with data from the 1969 survey.10 Hardening of

the arteries was the primary diagnosis for 23 percent of all the residents and was highly related

to reported conditions (table 3). It was the most

frequent primary diagnosis for the following

conditions: senility; arthritis or rheumatism;

glaucoma or cataracts; amputation, stiffness, or

deformity; and heart trouble. For all other conditions (except mental retardation) it was the

second most frequent primary diagnosis.

Although senility was reported to affect 58

percent of the nursing home population, its

frequency as a primary diagnosis was far less. At

14 percent it was the second most frequent primary diagnosis. (Actually, the percent of

residents whose primary diagnosis was senility

was slightly less than 14 percent because the

classification also included old age, other

symptoms, and ill-defined conditions such as

coma and uremia.) The difference in the reported rate (58 percent) and the frequency of

primary diagnosis (14 percent) is due to the fact

that senility had been considered a secondary

rather than a primary condition at the last examination. There is also the possibility, mentioned

10
earlier, that the respondents could have overreported this condition because it was so

broadly defined.

Mental disorder was the major diagnosis for

an estimated 11 percent of the residents. This

rate is only about half of that reported as a

chronic condition (19 percent). Table 3 shows

that only about 38 percent of those residents

with reported mental illness and 53 percent of

those with reported mental retardation had

mental disorders as their primary diagnosis. Apparently there were more severe conditions

affecting residents with reported mental

problems.

The fourth most prevalent primary diagnosis

was stroke. Nearly 11 percent of all residents

had this condition as the primary diagnosis at

their last examination. This rate was nearly comparable to its reported prevalence rate of 11

percent, a fact indicating the severity of this

chronic condition. Diseases of the musculoskeletal system and connective tissue comprised

a category that included many other chronic

conditions besides arthritis or rheumatism. As

seen in table D, the diagnosed rate for this ICDA

category was 7 percent, far below that of the

reported rate for arthritis or rheumatism at 34

percent. The category of diseases of the nervous

system and sense organs represented a primary

diagnostic rate of 6 percent. This diagnosis

should have encompassed two major reported

conditions—glaucoma or cataracts and paralysis

and palsy not related to stroke, arthritis or rheumatism,

Although approximately 34 percent of all

residents reportedly had heart trouble, only an

estimated 5 percent had heart attack as their

primary diagnosis. With an overall ranking of

seventh in prevalence, this diagnosis specifically

referred to those residents with ischemic heart

disease. Tenth in overall ranking, residents with

diseases of the circulatory system other than

hardening of the arteries, stroke, and heart attack accounted for about 4 percent of all

primary diagnoses. Adding this to the rate for

heart attack would yield better comparability

wit h the classifllcation for reported heart

trouble,” but the total of around 9 percent would

still fall far short of the reported prevalence

figure (34 percent). An examination of table 3

reveals the reason for this discrepancy. Hardening of the arteries was by far the ,most

prevalent diagnosis of residents with reported

heart trouble.

The category of accidents, poisonings, and

violence was eighth in the rank ordering of primary diagnoses, with a rate of 5 percent. It was

assumed that the great majority of the residents

in this category had suffered from some type of

bodily injury, most particularly a fracture

resulting from accidents. In support of this assumption, a fracture of the femur had been

reported for about 3 percent of the 1964

nursing home population.q

In ninth position in overall ranking of primary diagnoses, the category of endocrine,

nutritional, and metabolic diseases yielded a rate

of nearly 5 percent. Based on table 3, there was

little doubt residents with diabetes comprised

the largest proportion of this rate. The reported

rate of diabetes (13 percent) was almost 3 times

greater than the diagnosed rate for the broader

category of endocrine, nutritional, and metabolic diseases, which possibly included other

conditions such as goiter.

The remaining 10 categories of primary

diagnoses account for only 12 percent of the

total. Each was estimated to have a rate of about

2 percent or less.

With regard to comparisons between the

1973-74 NNHS and the 1969 survey, table D

shows that relatively little change occurred in

the pattern of primary diagnoses. About the

only conspicuous difference was that for the

rate of infective and parasitic diseases. This

category, which includes primarily acute diseases, occupied a significant position among

primary diagnoses in 1969; it ranked eighth and

included 4 percent of the residents. In 1973-74,

however, the rate was not even reportable

because so few residents were in this category. A

comparison to the 1969 survey can be made for

a primary diagnosis involving diseases of the

circulatory system by combining the four subcategories used in the 1973-74 survey

–hardening of the arteries, stroke, heart attack,

and other diseases of the circulatory system. The

resulting total rate of 42 percent for 1973-74

was only slightly higher than the 39 percent obtained in the 1969 survey.

11
Senility, old age, or

g 400

~r

other symptoms and

Il[de fined conditions

Dl=ases of the circulatory

*m

system other than harden-

$

I

ing of the arteries, stroke,

or heart attack

0

~ 300

u

4W Heart attwk

r300

t-[

200

100

L

w

41.1 ‘3 ::.:.:

0. :::::::

Accidents, poisonings,

400

r

and violence

3W

t2SQ

100 t

4Q3 Stroke

r

o

300

2CW

100 _

o

Mental

disorders

185.1

L

72.1

30s

%....:

Hardening of

400

r

the arteries

3oil

200

lCO

o

400

Olseases of the

[

musct doskeletal system

and connective tissue

SOD

200

t

100 70,1 14 ~

483 ‘s . . . .. .

.. . .. .

E%91--mm

.. . .. .

0

..:.%

Endocrin% nutritional, Di~ases of the

I:LUnder 65. 75.

years

85 :LUnd8r 65. 75- 85 :L:L Under 65. 75- 65

65 74 84 6S 74 84

years L& 65-

65 74 64 ‘::

75- 65

and 74 64 years

‘ears ‘ears ‘ears over

years years years ~~~r and

years years years over ‘Mrs ‘M’s ‘ears over

Figure 3. Rate per 1,000 nursing home residents for selected primary diagnoses at last examination, by age: United States, August 1973-

April 1974

Age and sex. –The frequency of many primary diagnoses varied greatly with age. Figure 3

illustrates the age trends for selected diagnoses.

Mental disorders were the most prevalent conditions affecting residents under 65 years. As

depicted in figure 3, the primary diagnosis rate

of mental disorders dropped dramatically as age

increased, from 396 per 1,000 under 65 years to

31 per 1,000for 85 years or older. The rate for

diseases of the nervous system and sense organs

at 156 cases per 1,000 was the second most

frequent primary diagnosis for the younger residen ts. This classification, too, showed an

unmistakable decline in rate with age to 35 cases

per 1,000for those 85 years and over.

Stroke was the third most frequent primary

diagnosis among residents under 65 years of age

and the third ranked diagnosis for those over 65. .

The highest rates were for residents 65-74 and

75-84 years of age; the lowest, for residents

under 65 years and those 85 years and over.

Hardening of the arteries ranked seventh

among the young residents and showed the

greatest increase in rates with age to rank first

among older residents. Nearly 30 percent of

those 85 years and over had this disease as their

primary diagnosis at last examination. The next

largest increase with age was in the category of

senifity, old age, other symptoms, and iII-defined

conditions. With a rate of 185 per 1,000, these

conditions were the second most prevalent primary diagnoses for residents 85 years and over.

In contrast, the rate was 21 per 1,000 for those

under 65 years.

12
Other diagnoses with increased rates with

age were diseases of the musculoskeletal system

and connective tissue; heart attack; and diseases

of the circulatory system other than heart attack, stroke, and hardening of the arteries.

In contrast, diseases of the respiratory

system showed a small but significant decrease

with age. Primary diagnosis by sex and age is

presented in table 1. One of the diagnoses representing the greatest overalI sex differential was

hardening of the arteries. The rate for males was

190 per 1,000; the rate for females, 239 per

1,000. This difference appeared mainly among

residents at least 65 years old. Female residents

also experienced the highest rate of senility, old

age, or other symptoms and ill-defined conditions. In addition, women had a higher rate of

musculoskeletal diseases and accidents,

poisonings, and violence than men had.

In contrast, men had higher rates than

females for mental disorders and stroke. The

rate for mental disorders was 143 per 1,000

males versus 93 per 1,000 females. When examined across age groups, this difference was not

consistent. The sex difference in rates for stroke

was more evident among residents over 65 years

of age.

Among the less prevalent diagnoses there

were two significant sex differences that were

clearly evident. The rate for male residents with

either diseases of the respiratory system or diseases of the genitourinary system was 3 times

higher than that for female residents. Sex

comparison on these conditions by age was not

possible because of the small numbers in the

younger age groups.

Certification status of facility. –Comparisons

of how the current primary diagnosis varied

according to certification status can be made

from data presented in table 2. A primary

diagnosis of stroke was observed to occur more

frequently among residents of BM&M’s than

among residents of the other types of facilities.

In fact, with a rate of 13 percent it was the

second most prevalent primary diagnosis in these

institutions, whereas it was the fourth or fifth

leading diagnosis in other homes. Hardening of

the arteries, which was the most freuuent Drimary diagnosis for all facilities,

greatest rate of 25 percent among

.

was at ‘ its

residents of

SNH’S. Accidents, poisonings, and violence constituted a primary diagnosis for which the rate

among residents of BM&M homes was unmistakably greater than that for residents in the

other facilities. The rate of 7 percent was 2

times higher than that in other types of homes.

In contrast, the pattern of primary diagnosis

for mental disorders showed the lowest rate of 8

percent among residents of BM&M’s. The

highest rate of 16 percent was found in not

certified homes, where mental disorders were

the second most frequent primary diagnosis. Not

certified homes also had the highest rate for

diseases of the musculoskeletal system and

connective tissue.

An overall rate for diseases of the circulatory

system can be obtained by combining rates for

heart attack, stroke, hardening of the arteries,

and other diseases of the circulatory system.

This procedure is possible since only one

diagnosis per resident was given. Examining this

overall rate by certification status, it is evident

that diseases of the circulatory system were

most prevalent among residents of BM&M’s and

SNH’S, with rates of 45 percent and 44 percent,

respectively. The rate was 40 percent in ICF’S

and only 33 percent in not certified homes. An

opposite pattern is obtained when the categories

for mental disorders and senility, old age, or

other symptoms and ill-defined conditions are

combined to provide a category for “mental

problems. ” In this case, 32 percent of the residents in not certified homes are included in this

cat egory, whereas about 28 percent in ICF’S are

included, 24 in SNH’S, and only 20 percent in

BM&M’s.

Primary Diagnosis at Admission

Information abstracted from medical records

permitted classification of the primary diagnosis

at the time of admission for over 99 percent of

the residents. These data were considered to

indicate the primary medical reasons for persons

initially seeking institutionalization. Presented in

figure 4 are the few primary diagnoses which

showed significant differences between the rate

at admission and that at last examination. Tables

1 and 2 provide additional data on the pattern

of primary diagnosis at admission according to

13
m

.

m ‘rimaXRmsis

examination

89,0

.%ilitv. old me Oiseasaof

or other synl;.” Accidents, the musculo- Hardening of lmlsono &eIeUI ~SWm

toms and ill- Stroke

defined condi. the arseries and connective

tions violence tissue

Figure 4. Comparison of rates for those’ primary diagnose

showing significant changas between admission and last examination: United States, August 1973-April 1974

the age and sex of the residents and the certification status of the facility. The patterns

emerging, from an analysis of these variables

generally reaffirmed the findings established

from the data on primary diagnosis at last examination.

Comparing the admitting diagnoses to the

current, the greatest difference in rates occurred

in the category of accidents, poisonings, and

viol enc e. The difference showed that the

number of residents in this category at admission was nearly twice the number at last

examination. Nearly 9 percent of persons in

nursing homes during the 1973-74 survey period

were admitted as a result of injuries received

from accidents, poisonings, and violence. Examined across, age groups, this category showed the

greatest difference between admission and current diagnosis among women, among residents

85 years and over, and among residents in

BM&M’s.

Rates for stroke represented another notable

difference between diagnosis at admission and at

last examination. Stroke was more likely to be

the primary diagnosis at admission than at the

most current examination. As shown in table 2,

the prominence of stroke as an admission

diagnosis was noted more particularly among

residents of BM&M’s. Taken together, stroke

and accidents, poisonings, and violence

apparently accounted for over a fifth of all

admissions to these facilities.

In contrast to this pattern, the difference in

rates for residents whose primary diagnosis was

senility, old age, or other symptoms and illdefined conditions was in the opposite direction.

This primary diagnosis was more frequent at the

most recent examination that at admission. The

same trend occurred for the primary diagnoses

hardening of the arteries and diseases of the

mus CU1Oskeletal system. When these three

diagnoses were examined by age groups, the

greatest differences in rates between the most

recent and the admission diagnosis occurred in

the eldest age group, 85 years and over.

Any remaining differences in rates between

diagnosis at time of admission and time of last

examination were not significant. For example,

the mtes for mental disorders were practically

the same.

BEHAVIORAL PROBLEMS

Information on specific behavioral problems

listed in item 15 of the Resident Questionnaire

provided an additional source of prevalence data

related to the state of the resident’s mental

health. The respondent reported how frequently

the resident was depressed, agitated or nervous,

abusive or aggressive, or confused or senile, had

disturbed sleep, or exhibited other behavioral

problems.

As shown in figure 5, the most prevalent

problem was being confused or senile. This was

the only behavioral problem affecting a majority

of the residents, 57 percent being the estimated

rate of occurrence. This figure was comparable

to the rate of 58 percent for reported senility

(see previous section on reported conditions for

details). Despite the high prevalence rate, only

about 10 percent were reported to exhibit this

behavior more often than once a week. Agitation or nervousness was the second most prevalent behavioral problem. It affected over 42

percent of all residents, with 13 percent being

affected more often than once a week. Depression was reported for 39 percent of the nurs14
- Toral

80

60

40

10

0

Aglrated Ab.MveConSused O& Osher

D*PMzssd or or or turbed behavioral

newous a~ressive s8nl16 deep problems

BEHAVIORAL PROBLEM

Fimsre 5. Percent of nursina home residents with behavioral

‘problems by problem an: frequency: United States, August

1973-April 1974

ing home population. In terms of the “severity”

of the behavioral problems (i,e., those occurring

more often than once a week), depression had

the highest reported frequency of 14 percent.

Disturbed sleep affected a substantially smaller

proportion of the population. About 19 percent

of all residents apparently had problems affecting their sleep. For around 5 percent this condition occurred more often than once a week. The

least prevalent of these problems was abusive or

aggressive behavior. Only 17 percent of all residents were reported to display this type of

behavior.

Besides the specific problems mentioned,

about 5 percent of all residents had other behavioral problems. Included in this category were

behavioral problems due to alcoholism, drug

addiction, and unspecified reasons. These problems, however, affected only 1 percent of the

population more often than once a week.

For purposes of comparison over time, the

only available data on behavioral problems from

nursing home surveys were from a 1956 survey

of 13 States.1 1 An estimated 56 percent of the

residents in that survey were reported to act

confused part or most of the time. This rate

nearly matched that from the current survey.

For data on behavioral problems in the noninstit u ti o n alized population, the only available

source was the 1960-62 Health Examination

Survey.1 z An estimated 51 percent of all

persons aged 65 years and over suffered feelings

of nervousness. Thk rate compared with the rate

of 42 percent of the nursing home population

reported to be agitated or nervous.

Age and Sex

There were three behavioral problems that

occurred more often among residents under 65

years of age than among older residents. In table

4 it can be seen that the youngest residents were

more likely to be depressed (46 percent), to be

agitated or nervous (52 percent), and to be

abusive or aggressive (23 percent). The rate of

occurrence of all three problems appeared to decline at every age level, although this trend was

not statistically significant throughout. In contrast to the youngest residents, the eldest residents were reported as the least depressed (34

percent), the least agitated or nervous (37 percent), and the least abusive or ag~essive (15 percent). Ranging from a rate of 10 percent in the

youngest group to 4 percent in the eldest group,

the category of other behavioral problems

showed a similar trend. Residents 85 years and

over were more often described as confused or

senile. In fact, about 54 percent of this age

group were reported to exhibit this behavior

once a week or less. In comparison, only around

27 percent of those under 65 years of age fell

into this category. The rate of occurrence for

disturbed sleep did not reveal a significant age

pattern.

There were significant sex differences in the

prevalence of only three behavioral problems.

Analagous to the pattern of reported senility,

the frequency of confused or senile behavior was

59 percent among female residents, while it was

53 percent among male residents. Depression

was also slightly more prevalent among women,

40 percent compared to 36 percent for men. On

the other hand, it was very clear that males

tended toward more frequent occurrence of abusive or aggressive behavior. Their rate for this

problem was 22 percent compared to 14 percent

for females. This difference was significant for

both younger and older residents.

15
Certification Status of Facility

The certification status of a facility was related to the prevalence pattern of behavioral

problems (table 5). The lowest rate of occurrence for every one of the specified problems

was reported for residents in not certified

homes. (The difference between the rates for

abusive or aggressive behavior in not certified

homes as compared to BM&M’s was not statistically significant, however.) Although residents

of SNH’S appeared to have the greatest levels of

depression (41 percent), abusive or aggressive behavior (18 percent), confused or senile behavior

(60 percent), and disturbed sleep (20 percent)

the differences among ICF’S, SNH’S, and

BM&M’s were. relatively small ~d often insignificant compared to the decidedly lower occurrence for not certified homes. Residents of ICF’S

had the greatest rate of agitation or nervousness

(45 percent). Table 6 presents data on conditions and primary diagnoses of residents with

behavioral problems.

IMPAIRMENTS IN VISION, HEARING, AND

SPEECH AND USE OF DENTURES

To complement the data on reported conditions and pnmmy diagnosis, information was

4s0 collected on sensory impairments. Referring

to questions 17, 18, and 19 of the Resident

Questionnaire (appendix III), the respondent

was asked whether visual, hearing, and speech

impairments existed and if so whether they were

partial, severe, or complete. To provide as reliable a status rating as possible, definitions were

provided to the respondent. For instance, in

order to rate a resident’s vision status as partially

impaired, the respondent had to judge whether

the resident was able to watch television from 8

to 12 feet across the room. To rate a resident’s

speech as severely impaired, the respondent had

to judge that the resident could not carry on a

normal conversation and was understood only

with difficulty. Questions 17, 18, and 19 of the

Resident Questionnaire (appendix III) should be

consulted for the definitions used to rate the

extent of the resident’s sensory impairments. In

addition to the ratings of sensory impairments,

information was also obtained on the use of

eyeglasses, hearing aids, and dentures.

Vision

As shown in figure 6, the majority of residents (54 percent) were considered to have unimpaired vision, i.e., they could read ordinary

newspaper print. About 34 percent of the population had partially impaired vision, while 10

percent had a vision impairment that was considered severe. An estimated 30,400 residents, or

about 3 percent of the population, were judged

to be blind.

Overall the impairment pattern was similar

for males and females. In contrast, differences in

the extent of impairment for several age groups

were distinctly significant. While the proportion

of blind residents was nearly equal for all age

groups, the proportion of residents 85 years and

over with severe visual impairments (14 percent)

was nearly triple that for residents younger than

65 (5 percent). Table 7 provides additional data

on visual impairments according to whether or

not the resid;nt wore eyeglasses.-

AGE

2>

Under 65 60 21,7 70 e

pm .....

2,6

years

2

years .....

36,

and over....

SEX ~

2.7)

I I I I I I I 1 I I I

o 10203040506070 S0601W

PERCENT DISTRIBUTION

Figure 6. Percent distribution of nursing home residents by

vision status, according to age and sex: United States,

August 1973-Aprii 1974

16
Under 65. 76. 85

All 66 74 84 years

ages

Male Fm-ml.s

years y8ar5 years ~~r

AGE SEX

Figure 7. Percent of nursing home residents using eyeglasses,

‘by age and sex: United St&es, August 1973-Aprfi 1974

Eyeglasses were reportedly used by 62 percent of the population. Figure 7 illustrates how

the utilization of eyeglasses varied by age and

sex. Since visual impairments are typically associated with the aging process, it was not surprising to find the utilization rate increased with

age up to the 75-84 year group; but no difference was observed between those aged 75-84

and those 85 years and older. Utilization differed between the sexes also, with female residents

having the higher utilization rate. This pattern

was probably due in part to the preponderance

of older females in the resident population.

Table 8 provides the prevalence pattern of

visual impairments according to certification status. Among residents in BM&M’s, SNH’S, and

ICF’S, the differences in the degree of impairment were either relatively small or insignificant. The degree of tisual impairments in not

certified homes, however, appeared to be considerably less than that found in the other types

of facilities. The proportion of residents in not

certified homes with unimpaired vision was 62

percent, compared to 55 percent in ICF’S, 51

percent in SNH’S, and 52 percent in BM&M’s.

Compared to the 1969 nursing home population, overall vision status for the 1973-74 survey period population appeared to have improved somewhat.s A greater proportion of the

1969 population was counted as severely impaired (17 percent versus 10 percent). The proportion of blind residents was similar for both

surveys (3-4 percent), as was the proportion of

eyeglass users (60-62 percent).

Utilization of eyeglasses by nursing home

residents has generally been at a much lower rate

than that rep orted for the older noninstitutionalized population. In three different surveys conducted during 1960-62, 1965-66, and

1971 the rate was estimated to be over 90 percent for noninstitutionalized persons 65 years

and over. 13’15 When comparing vision status,

the older noninstitutionalized population has

not reported the prevalence of visual impairments anywhere near the 47 percent prevalence of the nursing home population. In 1971

only 5 percent of the noninstitutionalized population 65 years and over had a visual impairment considered serious enough to prevent

the person from reading newsprint.1 G

Hearing

Impairments to hearing were less common

among nursing home residents than were impairments to sight. Figure 8 illustrates that

about 68 percent of the population were considered unimpaired in audition, i.e., they could

hear a telephone conversation on an ordinary

telephone. For around 26 percent of all residents, hearing was judged to be partially impaired. Severe impairments affected only about

5 percent of the population. And only 10,800

persons, or around 1 percent, were judged to be

deaf.

As seen in figure 8, sex differentials in the

degree of hearing impairment were insignificant.

In contrast, age differences in the degree of impairment were well defined. Ordy about 12 percent of the residents under 65 years of age were

impaired, whereas about 45 percent of those 85

years and over were reported to have some type

of hearing impairment.

Although about 32 percent of the population was rated as impaired in hearing, only a

comparatively smill proportion, 4 percent, were

reported to use a hearing aid. As depicted in

figure 9, there was a pattern of increased utilization of hearing aids with age. There was no

significant difference in utilization by sex, however.

17
-..’ ~%% =i!%r!l = it%r.

yews.....

;1

65.74

07

years .....

,

65 Wws

SEX 1,2

Male.....

0

~

m

PERCENT DISTRIBUTION

Figure 8. Percent distribution of nursing home residents by

hearing status, according to age and sex: United States,

August 1973-April 1974

e.n

4.4

Under 65- 75. S6

All 65 74 ~ years

w

Male Female

years years years ~j

AGE SEX

Figure 9. Percent of nursing home residents using a hearing

aid, by age and sex: United States, August- 1973-Aprfi

1974

18

Comparison of audition status on the basis

of the use of hearing aids reveals some interesting patterns as shown in table 7. For about

31 percent of the residents using hearing aids,

the use of the aid apparently resulted in eliminating the auditory impairment. For the remaining 69 percent, some impairment was evident in spite of the use of the hearing aid.

Among those residents not using a hearing aid,

69 percent did not need one since they were

considered unimpaired in hearing. As for the remaining 30 percent who had an auditory impairment, the reason for a hearing aid not being

used could not be determined from the data.

Whether or not the impairment could have been

alleviated by the use of an aid remains unknown.

As shown in table 8, when the prevalence of

auditory impairments was compared according

;O the certification status of the facilities, the

pattern which emerged was similar to one previously discussed for visual impairments. Little

difference in the degree of impairment appeared

among residents in BM&M ‘s, SNH’S, and ICF’S.

The prevalence of auditory impairments among

the residents of not certified homes was noticeably less than that found among the residents of

the other types of homes. An estimated 75 percent of the residents in not certified homes were

unimpaired in hearing, while 65 percent in

SNH’S, 67 percent in BM&M’s, and 68 percent in

ICF’S were assigned this status.

Based on comparisons with data from the

1969 survey, it seemed that audition status, like

vision status, improved in the 1973-74 nursing

home populations Proportionately, there were

10 percent more residents in 1969 who had

hearing impairments than reported by the cur.

rent survey (43 percent versus 32 percent). The

greatest difference was among those residents

with severe impaknents, including deafness. In

1969 this proportion was 13 percent, twice that

of the more current estimate. This apparent improvement in audition status occurred in spite of

any distinct increases in the use rate of hearing

aids.

When compared to findings from surveys of

the noninstitutionalized population, nursing

home residents had more hearing impairments.

During 1971 hearing problems were reported by

27 percent of those persons in the nonin-
stitutionalized population aged 65 years and

over. 17

Speech

For the first time in an NCHS survey of

nursing homes data were collected on the extent

to which a resident’s speech was impaired, Figure 10 illustrates that 74 percent of all residents

had no speech impairment reported. Of those

remaining, the ability to speak was judged to be

partially impaired for an estimated 14 percent of

the population and to be severely impaired for

about 8 percent. Mute residents numbered

32,100 and comprised 3 percent of the population.

As depicted in figure 10, the pattern of

speech defects varied appreciably with age.

Unlike vision and audition impairments, speech

impairments were more prevalent among

younger residents, particularly those under 65

years. The proportion of younger residents who

had severely impaired speech or were mute was

nearly 3 times that for residents 85 years and

over. Although less pronounced, there was also a

- M.,* ~ :5$ = w% = irn%ed

,11ages.......

/Under 65 ,i5.6, ,8,2

y.ars ..... .

Ea5

3

65.74

years.....

76’64

years.....

,

85 years

and over..

SEX ~

2

Famaln,..

~

o 10 20 30 40 50 60 70 60 90 100

PERCENT DISTRIBUTION

Figure 10. Percent distribution of nursing home residents by

speech status, according to age and sex: United States,

August 1973-April 1974

sex difference in the pattern of speech defects.

Twenty-nine percent of the males had some level

of impairment as compared to 24 percent of the

females.

Similar to the pattern found for vision and

audit ory impairments across facility types,

speech impairments were less prevalent in not

certified homes. Table 8 reveals that 80 percent

of the residents in not certified homes were not

impaired in speech, while 74 percent of residents

in ICF’S and 73 percent in BM&M’s and SNH’S

were included in this category.

According to the 1971 HIS, about 10 percent of all persons living outside institutions

were reported to have a speech defect, which

included cleft palate, harelip, stammering, stuttering, and other speech problems.1 G

Use of Dentures

Item 20 of the Resident Questionnaire pertained to the use of dentures. This information

had not been collected in any previous NCHS

survey of nursing homes. The resulting data are

presented in figute 11. A sizable majority of

_ Noden.res - #~#&: -H~3m~

AGE

All ages......

Under 65

years

65-74

wars .....

75.s4

years

85 ye,m

and over..

SEX

Male.....

Female....

PERCENT DISTR16UTION

Figure 11. Percent distribution of nursing home residents by use

of dentures, according to age and sex: United States, August

1973-April 1974

19
residents (59 percent ) had dentures and used

them, while 36 percent dld not have dentures.

An estimated 5 percent of the population had

dentures but did not use them.

As expected, the use of dentures was related

to age. Whereas only 26 percent of those residents under 65 years had dentures, 74 percent

of those 85 years and over had dentures. Utilization also varied by sex; about 15 percent more

women than men had dentures. According to

the data provided in table 8, there was little discemable difference in the use of dentures across

the various certification statuses.

SPECIAL AIDS

Data on the use of special aids were analyzed

to provide an indication-of the extent of chronic

disabilities within the nursing home population.

Each respondent was asked to specify from

among the aids listed in table E those which the

resident regularly used.

As shown in table 9, the total number of

residents using one or more aids was estimated

to be 558,300, 52 percent of the population.

The total number of aids in use was estimated to

be 662,700, an indication that some residents

used more than one special aid.

As shown in table E, some aids were in much

greater use than others. The wheelchair was the

most frequently used special aid. Approximately

35 percent of all residents were reported to use

this device regularly. About 15 percent of the

population used a walker for aid in ambulation,

while about 6 percent relied upon a cane for

assistance. The remaining aids for which specific

information was collected all had. utilization

rates of less than 2 percent. The category “other

aids” (geriatric chairs, special shoes, triangle

bars, and unclassified aids) included 2 percent of

all residents.

Compared to previous nursing home surveys,

the utilization pattern of special aids has not

changed appreciably.G ~18 The utilization rate of

wheelchairs changed relatively little between

1969 (31 percent) and the 1973-74 survey period (35 percent) following a large increase from

1964, when only 21 percent of the population

were reported to use this device. The walker was

the one aid which continued to show a steady

and considerable increase in utilization. In 1964

only about 9 percent of the population used

walkers, in 1969 only 12 percent used this aid,

and in the 1973-74 survey period the rate rose to

15 percent. Utilization of the remaining special

aids has remained about the same over the years

Comparison of the utilization of special aids

between nursing home residents and the noninstitutionalized population indicates the high

degree of chronic disability of the nursing home

population. Rates for wheelchairs and walkers

showed the greatest differences in utilization

and, thus, in the indicated level of disability for

the two populations. According to the 1969

HIS, 3 percent of the noninstitutionalized population 65 years or older used either wheelchairs

or walkers.1 g In contrast, 35 percent of the

nursing home population used wheelchairs and

15 percent used walkers.

Age and Sex

The pattern of utilization for some special

aids varied as a function of age. For those using

wheelchairs, table E illustrates that the rate remained practically unchanged (32-34 percent)

until the oldest age group where the rate increased significantly (38 percent). There were

clear and consistent increases, though, in the

rates for walkers (from 6 to 17 percent) and

canes (from 3 to 8 percent). In contrast, the use

of braces shows a marked decrease between the

under 65 and the 85 and over age group (from 4

down to 1 percent). Although the use of

crutches appeared to decrease with age, the

trend was not significant.

There were some sex differences in the utilization of special aids. Although female and male

residents did not differ significantly in their utilization of the wheelchair, females were considerably more likely to be using walkers (17

versus 10 percent). ‘Their utilization of the

self-feeder was also significantly higher. On the

other hand, males had significantly higher utilization of crutches and canes.

Certification Status of Facility

By examining the utilization of special aids

according to certification status in table 10, it is

20
Table E. Number and percent distribution of nursing home residents by sex and age, according to special aids used: United States, August

1973-April 1974

Special aid used2

Number of No aid 1 aid

Sex and age residents usad O;ydre Wheel- ArtifiWalker Cane Crutches Braces Self Other

chair cial

limb feeder aids

Number of

rasldents ......... 1,075,800 517,500 558,300 374,800 156,400 68,800 9,300 16,700 4,400 11,400 20,8Q0

Both sexes I I

All ages.,...,, ..... 1,075,800 48,1 51.9

Under 65 years .,,,,, 114,300 58.8 41.2

65.74 years...,., . ..... 163,100 55.1 44.9

75-84 years.., ......... 384,900 48.4 51.6

85 years and over.. 413,600 42.1 57.9

Male

All ages...,,,,,,,.. 318,100 50,2 49.8

Under 66 years, ..... 52,400 60.3 39.7

65-74 yews., .......... 65,100 56.4 43.6

75-84 years ............ 102,300 47.4 52.6

85 years and over.. 98,300 43.7 56.3

Under

AI=-LW!LL

66 years,,..,. 61,900 57,5 42.5

65-74 years ............ 98,000 54.3 45.7

75-84 years ............ 282,600 48.8 51.2

85 years and over.. 315,300 41.6 58.4

Percent of residents3

34.8 I 14.5

32.2 6.2

31.2 10.4

33.9 15.5

37.9 17.5

T

33.7 10.0

30.2 5.1

31.3 7.4

35.1 11.0

35.8 13.2

35.3 I 16.5

6.4 I 0.9

2,8 *

4.9 1.4

6.8 0.8

7.6 *

8.6 1.5

T

* *

7.0 *

9.6 *

11.7 *

5.5 0.6

1.6

4.0

2.2

1.5

0.6

1.6

*

*

*

*

1.6

4.1

2.5

1.6

0.7

0.4

*

*

*

*

0.8

*

*

*

*

*

*

*

*

*

1.1

*

*

1.1

1.0

0.8

*

*

●

☛

1.2

*

*

1.1

1.2

1.9

2.6

1.6

1.9

2.0

1.8

—

*

*

●

*

2.0

*

*

1.9

2.0

—

llnc~udes ~11~e~idents whether or not a special aidisused.

!Jhcludes eyeglasses and hearing aids.

3 Figur~s may not total to 100 percent because residents may have more than one sPecial aidcvident that differences existed in the utilization

of special aids across the facility types. The

greakst difference appeared between BM&M’s,

where about 60 percent of the residents used

one or more special aids, and not certified

homes, where only 40 percent of the residents

used an aid.

A look at the pattern by type of aid revealed

that most of the difference in overall utilization

was attributable to the use of wheelchairs. In

BIYL%M’s approximately 44 percent of all residents used a wheelchair. This rate ~vas 10 percent higher than for SNH’S, about 14 percent

higher than for ICF’S, and 21 percent higher

than for residents of not certified homes, LittIe

difference, most of it insignificant, appeared

among the certification types when the utilization of any of the other types of aids was

examined. Data on the chronic conditions and

primary diagnoses of residents using special aids

are presented in table 11.

—ooo —

21
REFERENCES

1National Center for Health Statistics: Limitations of

activity and mobility due to chronic conditions, United

States, 1972. Vital and Health Statistics. Series 10-No.

96. DHEW Pub. No. (HRA) 75-1523. Health Resources

Administration. Washington, U.S. Government Printing

Office, Nov. 1974.

2National Center for Health Statistics: Design and

methodology for a national survey for nursing homes.

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

l-No. 7. Public Health Service. Washington. U.S. Government Printing Office, Sept. 1968.

3National Center for Health Statistics: Chr~nic illness

among residents of nursing and personal care homes,

United States, May-June, 1964. Vital and Health Statistics. PHS Pub. No. 1000-Series 12-No. 7. Public Health

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

Mar. 1967.

4National Center for Health Statistics: Prevalence of

chronic conditions and impairments among residents of

nursing and personal care homes, United States, MayJune 1964. Vital and Health Statistics. PHS Pub. No.

1000-Series 12-No. 8. Public Health Service. Washington. U.S. Government Printing Office, July 1967.

5National Center for Health Statistics: Chronic conditions and impairments of nursing home residents,

United States, 1969. Vital and Health Statistics. Series

12-No. 22. DHEW Pub. No. (HRA) 74-1707. Health

Resources Administration. Washington. U.S. Government Printing Office, Dec. 1973.

6~ation~ Center for Health Statistics: Measures of

chronic illness among residents of nursing and personal

care homes, United States, June-August 1969. 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.

7National Center for Health Statistics: Home care for

persons 55 years and over, United States, July 1966-

June 1968. Vital and Health Statistics. Series 1O-NO. 73.

DHEW Pub. No. (HSM) 72-1062. Health Services and

Mental Health Administration. Washington. U.S. Government Printing Office, July 1972.

8 National Center for Health Statistics: .Eightlz Revkion 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.

‘National Center for Health Statistics: Limitation of

activity due to chronic conditions, United States, 1969

and 1970. Vital and Health Statistics. Series 10-No. 80.

DHEW Pub. No. (HSM) 73-1506. Health Services and

Mental Health Administration. Washington. U.S. Government Printing Office, Apr. 1973.

1‘National Center for Health Statistics: Charges for

care and sources of payment for residents in nursing

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

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

(HRA) 74-1706. Health Resources Administration.

Washington. U.S. Government Printing Office, July

1973.

11 Commission on Chronic Illness: Nursing homes,

the!r patients and their care. Monograph 46. PHS Pub.

No. 503. Public Health Service. Washington. U.S.

Government Prking Office, 1956.

12National Center for Health Statistics: Selected

symptoms of psychological distress, United States,

1960-62. Vital and Health Statistics. PHS Pub. No.

1000-Series 1 l-No. 37. Public Health Service. Washington. U.S. Government Printing Office, Aug. 1970.

13N&ond Center for Health Statistics: History and

examination findings related to visual activity among

adults, United States, 1960-62. Vital and Health Statistics. PHS Pub. No. 1000-Senes 1l-No. 28. Public Health

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

Mar. 1968.

14Nation~ Center for He~th Statistics: Ch=acteristics

of persons with corrective lenses, United States, July

1965-June 1966. Vital and Health Stat&tics. PHS Pub.

No. 1000-Series 10-No. 53. Public Health Service.

Washington. U.S. Government Printing Office, June

1969.

15 National Center for Health Statistics: Current estimates from the Health Interview Survey, United States,

1971. Vital and Health Statistics. Series 1O-NO. 79.

DHEW Pub. No. (HSM) 73-1505. Health Services and

Mental Health Administration. Washington. U.S. Government Printing Office, Feb. 1973.

16 Nationa.1 Center for Health Statistics: Prevalence of

selected impairments, United States, 1971. Vital and

Health Statistics. Series 10-No. 99. DHEW Pub. No.

(HRA) 75-1526. Health Resources Administration.

Washington. U.S. Government Printing Office, May

1975.

17National Center for Health Statistics: Persons with “

impaired hearing, United States, 1971. Vital and Health

Statistics. Series 1O-NO. 101. DHEW Pub. No. (HRA)

22
76-1528. Health Resources Administration. Washington.

U.S. Government Printing Office, Nov. 1975.

18 National Center for Health Statistics: Use of special

aids in homes for the aged and chronically ill, United

States, May~une 1964. Vital and Health Statistics. PHS

Pub. No. 1000-Series 12-No. 11. Public Health Se~ice.

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

1968,

19 National Center for Health Statistics: Use of special

aids, United States, 1969. Vital and Health Statistics.

Series 1O-NO. 78. DHEW Pub. No. (HSM) 73-1504.

Health Services and Mental Health Administration.

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

1972.

20 Van Nos&~d, J. F.: Development of SurveY

Methodology to Measure Cost and Quality of Care in

Nursing Homes. Paper presented at 101st Annual

Meeting of American Public Health Association, San

Francisco, Nov. 8, 1973.

21 National Center for Health Statistics: Development

and maintenance of a national inventory of hospitals and

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

1000-Series 1-No, 3, Public Health Service. Washington.

U.S. Government Printing Office, Feb. 1965.

22 National Center for Health Statistics: Design and

methodology of the 1967 hfaster Facility Inventory

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

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

U.S. Government Printing Office, Feb. 1965.

23 National Center for Health Statistics: The Agency

Reporting System for Maintaining the National Inventory of Hospitals and Institutions. Vital and Health

Statistics. PHS Pub. No. 1000-Series 1-No. 6. Public

Health Service. Washington. U.S. Govemmert Printing

Office, Apr. 1968.

24 Nat.ional Center for Health Statistics: Institutions

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

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

U.S. Government Printing Office, July 1965.

25 National Center for Health Statistics: Arrangements

for physicians services to residents in nursing and

personal care homes, United States, May-June 1969.

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

12-No. 13. Public Health Service. Washington. U.S.

Government Printing Office, Feb. 1970.

2‘National Center for Health Statistics: Selected

characteristics of nursing homes for the aged and

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

and Health Statistics. Series 12-No. 23. DHEW Pub. No.

(H RA) 74-1708. Health Resources Administration.

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

1974.

27 National Center for Health Statistics: Selected

operating and fiiancial characteristics of nursing homes,

United States, 1973-74 National Nursing Home Survey.

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

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

Des. 1975.

28 National Center for Health Statistics: Inpatient

health facilities as reported from the 1971 Master

Facility Inventory Survey. Vital and Health Statistics.

Series 14-No. 12. DHEW Pub. No. (HRA) 74-1807.

Health Resources Administration. Washington. U.S.

Government Printing Office, Feb. 1970.

23
1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

Ll~ I UF IJt I AILtU lAULtS

.f%mber of nursing home residents and rate per 1,000 residents by sex, reported chronic conditions end impairments

and primary diagnosis at last examination and at admission, and age: United States, August 1973-April 1974 ................

Number and percent distribution of nursing home residents by reported chronic conditions and impairments and primary diagnosis at last examination and at admission, according to certification status of home: United States, Au.

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

Percent distribution of nursing home rasidents by primary diagnosis at last examination, according to reported chronic

conditions and impairments: United States, August 1973-April 1974 ..............................................................................

Number and perc6nt of nursing home residents with behavioral problems by type of problem, according to sex and age:

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

Number and percent of nursing home residents with behavioral problems by type of problem, according to certification

status of home: United States, August 1973-April 1974 .....................m...,.....,....,,. ...........................................................

Number and percent of nursing home residents with behavioral problems by type of problem, according to raported

chronic conditions and impairments and primary diagnosis at last examination: United Statas, August 1973-April

1974 ................................................................................................a............u........e...............=.......................e................

Number and percent distribution of nursing home residents by vision, haaring, speech, and use of denture status, according to sex and age: United States, August 1973-April 1974 ....................................................................................

Number and percent distribution of nursing home residents by vision, hearing, speech, and use of danture status, according to certification status of home: United States, August 1973-April 1974 ............................................................

Number and percent of nursing homa residents by special aids used, according to sex and age: United States, August

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

Number and percent of nursing home residents by special aids used, according to certification status of home: United

States, August 1973-April 1974 ......................................................................................................................................

Number and percent distribution of nursing home residents by special aids used, according to reported chronic condi.

tions and impairments and primary diagnosis at last examination: United States, August 1973-April 1974 ...................

25

30

32

33

35

36

37

38

40

42

43

24
Table 1, Number of nursing home residents and rste per 1,000 residents by sex, reported chronic conditions

and impairments and primary diagnosis at last examination and at admission, and age: United States, August

1973 -A&ii 1974 - - -

Sex, reported chronic conditions

and impairments, and primary

diagnosis at laat examination

and at admission

BOTH SEXES

Number of residents -------------------

Renorted chronic conditions and impairments

Senility ------------------------------------

Mental illness ------------------------------

Mental retardation --------------------------

Arthritis or rheumatism ---------------------

Paralyais or palsy due to stroke ------------

Paralysis or palsy not related to stroke,

arthritia , or rheumatism -------------------

Glaucoma or cataracts -----------------------

Diabetes ------------------------------------

Any chronic trouble with back or spine ------

Amputation of extremities or limbs, or

permanent stiffness or any deformity of

foot, leg, fingers, arm, or back -----------

Heart trouble --------------------------------

None of the above ---------------------------

Primary diagnoais at laat examination

Senility, old age, or other symptoms and

ill-defined conditions ---------------------

He;;; eattack --------------------------------

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

Hardening of the arteries -------------------

Diseasea of the circulatory system other

than hardening of the arteries, stroke,

or heart attack ----------------------------

Accidents, poisonings, and violence ---------

Mental disorders ----------------------------

Diseases of the musculoakeletal ayatem and

connective tissue --------------------------

Endocrine, nutritional, and metabolic

diseases -----------------------------------

Diaeasea of the respiratory systsm ----------

Neoplasms -----------------------------------

Diseases of the nervous system and aenae

organs -------------------------------------

Diseases of the digestive ayatem ------------

Infective and parasitic diseases ------------

Diseases of the genitourinary system --------

Diseases of the skin and subcutaneous

tissue -------------------------------------

Diseases of the blood and blood-forming

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

C=~%ital anomalies ------------------------

Other diagnosesl ----------------------------

Unknown diagnoses --------------------------- I

Number

of

residents

1,075,800

627,200

200,400

72,800

368,500

122,100

66,200

110,900

142,700

106,100

150,000

360,500

57,700

146,800

55,700

113,400

241,800

39,400

49,300

115,800

73,100

48,100

22,200

25,600

64,200

20,500

15,60;

6,000

7,600

3,100

1:,;::

Y

1,075,80011114,3001 163,1001384,9001

Rate per 1,000 residents

583.0

186.3

67.7

342.5

113.5

61.6

103.1

132.6

98.6

139.4

335.1

53.6

136.5

51.8

105.4

224.7

36.6

45.8

107.6

67.9

44.7

20.6

23.8

59.7

19.0

14.;

5.6

;:$

1:.:

.

189.1

348.5

345.7

109.7

106.6

161.5

38.5

112.0

74.7

189.2

110.2

64.5

20.6

-$!

94.0

36.6

39.:

395.8

48.3

44.0.x

27.9

156.0

-~

%

*

*

*

19.1

22.1

>t

482.2

293.0

94.5

232.4

166.1

75.5

62.8

168.1

86.6

160.8

2;;.;

.

85.2

41.1

138.0

151.7

31.4

35.8

185.1

58.5

59.5

33.3

29.4

78.4

18.6

*

;.<

~.

*-

15.;

*

623.2

171.9

27.6

363.2

129.1

52.6

95.6

148.8

100.8

133.0

354.7

53.9

140.9

55.3

120.6

237.2

39.9

45.8

72.1

70.7

46.9

22.9

23.6

49.3

17.9

16.;

6.1

7.6

15.:

9.3

413,600

694.3

112.8

17.5

431.1

80.1

36.8

143.9

109.4

107.9

123.2

403.9

47.0

184.6

64.1

81.5

293.9

40.4

51.4

30.5

74.4

37.1

13.7

20.7

35.4

20.1

15.;

*

8.8

12.;

9.8

See footnote at end of table.

25
Table 1. Number of nursing home residents and rate per 1,000 residents by sex, reported chronic conditions

and impairments and primary diagnosis at last examination and at admiesion, and age: United States, AUgUSC

1973-April 1974—Con.

Sex, reported chronic conditions

and impairment, and primary

diagnosia at laat examination

and at admission

BOTH SEXES-Con.

Primary diagnoaia at admisaion

Senility, old ?ge, or other

sYmPtomS and 111-clefined conditions --------

Heart attack --------------------------------

Stroke --------------------------------------

Hardening of the arteries -------------------

Diseases of the circulatory system other

than hardening of the arteries, stroke,

or heart attack ----------------------------

Accidents , poisonings, and violence ---------

Mental disorders ----------------------------

Diseaaea of the musculoskeletal system and

connective tissue --------------------------

Endocrine, nutritional, and metabolic

diseasea -----------------------------------

Diseases of the respiratory system ----------

Neoplaams -----------------------------------

Diaeases of the nervous system and sense

organs -------------------------------------

Diseases of the digestive system ------------

Infective and parasitic diseasee ------------

Diseases of the genitourinary system --------

Diseasea of the skin and subcutaneous

tissue -------------------------------------

Diseases of the blood and blood-forming

organs -------------------------------------

Congenital anomalies ------------------------

Other diagnoseel ----------------------------

Unknown diagnoses ---------------------------

MALE

All residents -------------------------

Reported chronic conditions and impairments

Senility ------------------------------------

Mental illness ------------------------------

Mental retardation --------------------------

Arthritis or rheumatism ---------------------

Paralysis or palsy due to stroke ------------

Paralysia or palsy not related to strok&,

arthritis, or rheumatism -------------------

Glaucoma or cataracts -----------------------

Diabetes ------------------------------------

Any chronic trouble with back or epine ------

Amputation of extremities or limbs; or

permanent atiffness or any deformity of

foot, leg, fingers, arm, or back -----------

Heart trouble -------------------------------

None of the above ---------------------------

Ntnnber

of

residents

110,700

59,600

132,800

219,900

34,300

95,700

122,100

62,600

44,700

23,100

24,200

60,500

21,800

2,300

15,300

5,000

6,700

2,800

24,800

6,900

318,100

169,900

63,700

31,600

81,300

42,000

23,600

28,500

39,100

23,800

48,600

100,400

19,400

----- .

102.9

55.4

123.4

204.4

31.8

89.0

113.5

58.2

41.6

21.5

22.5

56.2

20.3

1$;

4.7

;::

23.0

6.4

318,100

534.0

200.1

99.5

255.6

131.9

74.3

89.6

122.9

74.8

152.8

315.5

60.9

Kate per

15.0

104.;

27.4

55.;

421.0

47.0

;;.;

28:1

147.9

*

*

*

*

*

22.~

52,400 [

Rate per

170.4

334.8

362.4

79.2

104.9

167.4

40.4

101.6

71.0

203.2

1;; .;

.

L,uuu reaxaents

68.7

46.4

165.9

138.3

23.9

54.6

194.6

51.3

50.9

31.9

28.0

74.3

18.2

*

*

*

*

21.;

*

65,100 [

104.0

58.9

142.3

212.4

36.5

89.9

77.3

63.7

;;.;

23:0

46.3

19.4

*

15.8

6.4

*

22.;

5.3

102,300

1,000 residenta

482.4

274.8

104.1

180.2

193.4

78.7

147.;

68.0

176.5

280.3

69.0

615.8

164.1

37.9

298.1

147.9

61.6

85.5

137.3

77.6

151.6

350.0

57.0

1;: .:

94:2

272.1

35.4

111.0

30.2

58.8

36.6

16.8

18.3

32.9

22.6

15.:

*

8.2

24.;

9.7

98,300

677.0

116.3

355.:

88.8

34.9

141.5

102.8

78.5

111.6

415.2

54.5

See footnote at end of table.

26
Table 1. Number of nursing home residents and rate per 1,000 residents by aex, reported chronic conditions

and impairment and primary diagnoais at laat examination and at admission, and age: United States, Augua t

1973-April 1974—Con.

Sex, reported chronic conditions

and impairments, and primary

diagnosis at last examination

and at admission

MALE— Con.

Primary diegnosia at last examination

Senility, old age, or other symptoms and

ill-defined conditions ---------------------

Heart attack --------------------------------

Stroke --------------------------------------

Hardenimg of the arteries -------------------

Diseases of the circulatory system other

than hardening of the arteriea, stroke,

or heart attack ----------------------------

Accidents, poisoninga, and violence ---------

Mental disorders ..:--------------------------

Diseases of the musculoakeletal aystam and

connective tiaaue --------------------------

Endocrine, nutritional, and metabolic

diseases -----------------------------------

Diseasea of the respiratory system ----------

Neoplaams ------.-- ----------------------- ---

Diseases of the ‘nervous system and sense

organ~-------------------------------------

Diseasea of the digestive syatem ------------

T.nfective and paraaitic diseases ------------

Diseases of the genitourinary system --------

D~~;;~s of the skin and subcutaneous

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

Diseases of the blood and blood-forming

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

C%&%ital anomalies ------------------------

Other diagnoses 1----------------------- -----

Unknown diagnoses ---------------------------

Primary diagnosis at admission

Senility, old age, other

symptoms and ill-defined conditions --------

Heart attack --------------------------------

Stroke --------------------------------------

Hardening of the arteries -------------------

Diseases of the circulatory system other

than hardening of the arteries, stroke,

or heart attack --------------------------- -

Accidents, poisonings, and violence ---------

Mental disorders --------------- -------------

Diseases of the musculoskeletal system and

connective tissue --------------------------

Endocrine, nutritional, and metabolic

diseases -----------------------------------

Diseases of the respiratory sYstam ----------

Neoplasms-----------------------------------

Diseaaes of the nervous system and sense

organs-------------------------------------

Diseases of the digestive system ------------

Infective and parasitic diseaaea ------------

Diseases of the genitourinary system --------

Diseases of the skin and subcutaneous

tissue -------------------------------------

Diseasea of the blood and blood-forming

organs -------------------------------------

Congenital anomalies ------------------------

Other dia nosesl ----------------------------

Unknown dfagnoses ---------------------------

Number

of

residents

All Under

65 65-74 75-84 85 yeara

agea

years

yeara years and over

35,900

14,500

38,000

60,600

11,000

9,700

45,400

16,300

12,900

12,100

9,700

22,400

6,700

*

8,900

*

*

*

5,200

2,900

27,300

17,200

44,900

54,800

1,000

16,700

49,400

13,300

11,400

12,200

9,200

20,900

7,000

*

9,500

*

*

7,40:

*

112.8

45.5

119.5

190.4

34.6

30.6

142.7

51.2

40.4

38.0

30.6

70.4

21.1

*

28.0

*

*

16.;

9.0

85.9

54.0

141.2

172.3

31.3

52.5

155.2

41.7

35.7

38.3

29.1

65.7

22.0

29.;

>.

*

23.;

*

Rate per 1,000 residents

*

96.;

>k

48.:

419.4

*

*

*

*

152.8

*

*

*

*

*

*

*

*

*

108.;

*

60.;

454.4

34.9

*

*

*

141.7

*

>.

~.

*

*

*

*

*

67.0

41.4

156.0

130.1

*

201.;

45.3

53.2

57.(J

73.7

23.5

*

*

*

*

*

*

*

54.9

51.9

188.9

112.4

41.:

207.7

37.3

43.3

50.4

*

70.9

23.3

*

*

*

*

*

JA

*

125.4

49.5

132.2

226.9

41.2

27.1

73.6

56.1

39.0

43.9

30.9

56.3

*

35.:

*

*

*

*

*

86.6

60.9

159.4

196.9

40.4

52.0

86.8

45.7

39.2

44.9

29.9

54.4

*

36.:

*

*

25.:

*

179.9

60.9

94.4

275.7

42.1

27.9

28.0

57.5

38.4

23.4

32.8

39.0

*

35.:

*

*

*

*

*

145.2

72.0

108.4

264.8

39.7

56.0

32.0

44.0

33.9

28.7

28.3

33.6

25.9

41.;

*

*

22.;

*

See footnote at end of table.

27
Table 1. Number of nursing home residents and rate per 1,000 residentsby sex, reportedchronicconditions

and impairmentsand primarydiagnosisat last examinationand at admission,and age: United States,August

1973-April1974— Con.

Sex, reported chronic conditions

and impairments, end primary

diagnosis at last examination

end at admission

FEMALE

All residents-------------------------

Reported chronic conditions and

Imoalrments , –.——.. —____

Senility------------------------------------

Mental illness------------------------------

Mental retardation --------------------------

Arthritis or rheumatism ---------------------

Paralysis or palsy due to stroke------------

Paralysis or palsy net related to stroke,

arthritis, or rheumatism -------------------

Glaucoma or cataracts -----------------------

Diabetes ------------------------------------

Any chronic trouble with back or spine------

Amputation of extremities or limbs; or

permanent stiffness or any deformity of

foot, leg, fingers, arm, or back-----------

Heart trouble -------------------------------

None of the above---------------------------

Primary diagnosis at last examination

Senility, old age, or other symptoms and

ill-defined conditions ---------------------

Heart attack--------------------------------

Stroke--------------------------------------

Hardening of the arteries -------------------

Diseases of the circulatory system other

than hardening of the arteries, stroke,

or heart attack----------------------------

Accidents, poisonings, and violence ---------

Mental disorders ----------------------------

Diseases of the musculoskeletal system

and connective tissue ----------------------

Endocrine, nutritional, and metabolic

diseases -----------------------------------

Diseases of the respiratory system----------

Neoplasms -----------------------------------

Diseases of the nervous system and sense

organs-------------------------------------

Diseases of the digestive system------------

Infective and parasitic diseases ------------

Diseases of the genitourinary system--------

Diseases of the skin and subcutaneous

tissue-------------------------------------

Diseases of the blood and blood- forming

organs-------------------------------------

Congenital anomalies ------------------------

Other diagnosesl ----------------------------

Unknown diagnoses ---------------------------

Number

of

residents

757.700

457,300

136,800

41,100

287,200

80,100

42,600

82,400

103,600

82,300

101,400

260,100

38,300

11,100

41,200

75,400

181,200

28,400

39,500

70,400

56,800

35,300

10,100

15,900

41,800

13,800

6,70;

4,000

5,400

10,90:

6,800

All Under

65 65-74 75-84 85 years

ages

years

years years and over

757,700 61,900 98,000 282,600 315,300

Rate per 1,000 residents

603.6

180.5

54.3

379.0

105.8

56.2

108.8

136.8

108.6

133.8

343.3

50.6

146.4

54.4

99.5

239.1

37.5

52.1

92.9

74.9

46.5

13.3

21.0

55.2

18.2

8.;

5.3

7.1

*

14.3

8.9

205.0

360.0

331.6

135.4

108.1

156.5

120.;

77.9

177.2

1;$.;

*

91.;

38.8

32.;

375.8

57.7

55.0

*

*

158.8

*

*

*

*

*

*

*

*

482.1

305.0

88.1

267.1

147.9

73.4

66.6

181.8

99.0

150.3

266.3

57.6

97.3

40.9

126.1

166.1

32.1

42.1

173.9

67.3

63.7

*

28.6

81.4

*

*

*

*

*

*

*

*

625.E

174.t

23.E

386.E

122.2

;;.:

1521~

109.:

126.3

356.4

52.7

146.6

57.4

116.5

240.9

39.4

52.6

71.5

76.0

49.8

15.3

21.0

46.8

17.8

9.:

*

7.8

14.:

8.9

!$$;.;

16:7

454.7

77.4

37.4

144.6

111.4

117.1

126.8

4::.:

186.1

65.1

77.5

299.6

39.8

58.8

31.2

79.7

36.6

10.7

16.9

34.2

19.6

8.;

*

8.1

11.;

10.2

See footnote at end of table.
Table 1. Number of nursing home residents and rate per 1,000 residents by sex, reported chronic conditions

and impairment and primary diagnoais at last examination and at admission, and age: United States, August

1973-April 1974—Con.

Sex, reported chronic conditions

and impairments, and primary

diagnosis at last examination

and at admission

F)INALE— Con.

Primarv diaznosis at admission

Senility, old age, or other symptoms and

ill-defined conditions ---------------------

kJe;e;eattack--------------------------------

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

Hardening of the arteries -------------------

Diseaeea of the circulatory systam other

than hardening of the arteries, stroke,

or heart attack ----------------------------

Accidents, poisonings, and violence ---------

Mental disorders ----------------------------

Dieeases of the musculoakeletal system and

connective tissue --------------------------

Endocrine, nutritional, and metabolic

diseases -----------------------------------

Diseases of the respiratory syatam ----------

Neoplasms -----------------------------------

Diseases of the nervous system and sense

organs -------------------------------------

Diseases of the digestive system ------------

Infective and parasitic diseaaea ------------

Diseasee of the genitourinary ayate.m--------

D~i;~u~ of the akin and subcutaneous

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

Diseases of the blood and blood-forming

organs -------------------------------------

Congenital anomalies ------------------------

Other diagnoses ----------------------------

Unknown diagnoses ---------------------------

Number All Under

of 65 65-74 75-84

residents agea

years

years years

83,400

42,500

87,900

165,100

24,300

79,000

72,800

49.,300

33,400

10,900

14,900

39,600

14,800

5,80;

3,300

4,700

17,40:

5,500

Rate per 1,000 residenta

110.1

56.0

115.9

217.9

32.1

104.3

96.0

65.1

44.0

14.4

19.7

52.2

19.5

7.;

4.3

6.;

23.0

7.2

*.

.1.

102.0

A50.;

392.8

57.2

45.2*

*

153.2

*

*

J<

*

*

*

*

->

77.9

42.7

150.6

155.6

26.1

63.2

185.9

60.7

55.8

*

25.5

76.5

*

*

.:.

.~.

x.

*

*

*

110.3

58.1

136.1

218.0

35.1

103.7

73.9

70.2

;;.;

20:5

43.4

19.3

8.;

*-

A21.:

.:.

85 years

and over

138.0

67.5

89.S

274.4

34.0

128.2

29.6

63.4

37.4

13.0

15.2

32.7

21.6

7.;

*

*

24.;

10.5

lIncludes certain causes of perinat al morbidity ~ complications of pregnant y and childbirth, and other

diagnoses not listed above.

29
Table 2. Number and percent distribution of nursing home residentsby reportedchronicconditionsand impairmentsand primarydiagnosisat last examinaticms and at admission,accordingtocertificationstatusof

home: United States,August 1973-April1974

Reportedchronicconditionsand

impairmentsand primarydiagnoses

at last examinationand at

admission

All residents----------------------------

Reportedchronicconditionsand imuairments3

Senility---------------------------------------

Mental illness---------------------------------

Mental retardation-----------------------------

Arthritisor rheumatism------------------------

Paralysisor palsy due to stroke---------------

Paralysisor palsy not relatedto stroke,

arthritis,or rheumatism----------------------

Glaucomaor cataracts--------------------------

Diabetes---------------------------------------

Any chronictroublewith back or spine---------

Amputationof extremitiesor limbs; or

permanentstiffnessor any deformityof

foot, leg, fingers,arms, or back------------

Heart trouble----------------------------------

None of the above------------------------------

Primarvdiaznosis at last examination

Senility,old age, or other symptomsand

ill-definedconditions-----------------------

Heart attack-----------------------------------

Stlx?ke-----------------------------------------

Hardeningof the arteries----------------------

Diseasesof the circulatorysystemother than

~~ing of the arteries,stroke,and heart

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

Accidents,poisonings,and violence------------

Mental disorders-------------------------------

Diseasesof the musculoskeletalsystemand

connectivetissues---------------------------

Endocrine,nutritional,and metabolicdiseasesDiseasesof the respiratorysystem-------------

Neoplasms--------------------------------------

DiKeasesof the nervoussystem, sense organs---

Diseasesof the digestivesystem---------------

Diseasesof the genitourinarysystem-----------

Other diagnoses4-------------------------------

Unknowndiagnoses------------------------------

Primarydiagnosisat admission

Senility,old age, or other symptomsand

ill-definedconditions-----------------------

Heart attack-----------------------------------

Stroke-----------------------------------------

Hardeningof the arteries----------------------

Diseaseaof the circulatorysystem other than

sing of the arteriea,stroke,and heart

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

Accidents’,poisonings,and violence------------

Mental disorders-------------------------------

Diseasesof the musculoskeletalsystem and

connectivetissue-------------=-------------

Endocrine,nutritional,and metabolicdiaeasesDiseasesof the respiratorysystem-------------

Neo~lasma-----------------------------------

Diseasesof the nervous systemand sense

organs---------------------------------------

Diseasesof the digestivesystem---------------

Diaeaaeaof the genitourinarysystem-----------

Other diagnosee+-------------------------------

Unknnwndiagnoses------------------------------

All

homes

1,075,800

627,200

200,400

72,800

368,500

122,100

66,200

110,900

142,700

106,100

150,000

360,500

57,700

146,S00

55,700

113,400

241,800

39,400

49,300

115,800

73,100

48,100

22,200

25,600

64,200

20,500

15,600

34,700

9,600

110,700

59,600

132,800

219,900

34,300

95,700

122,100

62,600

44,700

23,100i

24,2001

60,500

21,800

15,300

41,600

6,900

Certification status

Medicaid only

Both Medicare and Medicaidl Skilled Intermediate Ceryfied

nursing care

home facility

onlyz only

Numbe]

406,900

235,900

58,900

18,300

125,600

55,400

27,100

40,900

57,400

38,700

56,700

149,600

23,900

50,300

19,400

53,700

92,900

15,200

26,900

30,500

22,000

18,100

9,500

12,400

24,200

7,700

6,700

15,100

$r

34,700

21,600

61,100

77,500

14,300

50,400

29,800

20,500

15,200

10,500

12,400

21,900

9,300

7,900

17,400

*

of residents

292,50(

179,30(

60,10(

20,10(

106,10[

32,20(

18,30(

34,30(

43,40(

30,70(

44,90(

101,10[

13,70[

39,00(

16,40(

28,00(

74,40C

8,SOC

10,10C

30,90C

20,20C

14,40C

6,20C

6,10C

17,30C

6,00C

4,80C

7,60C

2,40C

30,60C

18,300

33,800

67,800

7,400

22,000

31,800

18,000

14,400

5,600

5.300

16,800

6,500

4,200

s,200

*

236,70{

141,40(

52,801

21,501

9O,1OI

23,70(

14,00(

23,20(

28,70(

24,10(

34,40(

71,40(

9,60(

34,90(

14,20(

21,50(

50,70(

8,80(

7,80(

31,70(

18,20(

10,7OC

3,80(

4,30(

15,60(

3,60C

2,50(

5,50(

3,00C

26,40(

14,40C

26,00C

50,60C

7,40C

15,50C

36,00C

14,600

10,400

4,600

3,400

15,200

3,000

5,70:

*

139,800

70,700

28,800

12,900

;$;::

Y

6,800

12,600

13,300

12,500

14,000

38,400

10,600

22,500

5,700

10,200

23,700

6,700

4,500

22,700

12,600

4,900

2,700

2,900

7,200

3,200

6,60:

*

19,000

5,300

11,900

24,000

5,300

7,800

24,600

9,500

4,700

3,00;

6,600

3,000

10,40:

*

See footnotesat end of table,

30
Table 2. Number and percent distribution of nursing home residents by reported chronic conditions and impairments and urimary diagnosis at last examinations and at admission,

home: United States, August 1973-April 1974-Con.

according to certification status of

Reported chronic conditions and

impairments and primary diagnoses

at last examination and at

admission

Reported chronic conditions and impairments:

Senility---------------------------------------

Mental illness---------------------------------

Mental retardation-----------------------------

Arthritis and rheumatism-----------------------

Paralysis or palsy due to stroke---------------

Paralysis or ualsy not related to stroke,

arthritis, or rheumatism---------------------

Glaucoma or cataracts--------------------------

Diabetes ---------------------------------------

Any chronic trouble with back or spine---------

Amputation of extremities or limbs; or

permanent stiffness or any deformity of foot,

leE, fingers, arms, or back ------------------

Heart trouble----------------------------------

None of the above------------------------------

Primary diagnosis at last examination

All primary diagnoses--------------------

Senility, old age, or other symptoms and

ill-defined conditions-----------------------

Heart attack-----------------------------------

Stroke-----------------------------------------

Hardening of the arteries----------------------

Diseases of the circulatory system other than

hardening of the arteries, stroke, and

heart attack---------------------------------

Accidents, poisonings, and violence------------

Mental disorders-------------------------------

Diseases of the musculoskeletal system and

connective tissue----------------------------

Endocrine, nutritional, and metabolic diseasesDiseases of the respiratory system-------------

Neoplasms--------------------------------------

Diseases of the nervous system and sense

or~ans---------------------------------------

Diseases of the digestive system---------------

Diseases of the genitourinary system-----------

Other diagnosesq-------------------------------

Unknown diagnoses------------------------------

Primary diagnosis at admission

All primary diagnoses--------------------

Senility, old age, or other symptoms and

ill-defined conditions-----------------------

Heart attack-----------------------------------

Stroke-----------------------------------------

Hardening of the arteries----------------------

Diseases of the circulatory system other than

hardening of the arteries, stroke, and heart

attack---------------------------------------

Accidents, poisonings, and violence ------------

Mental disorders-------------------------------

Diseases of the musculoskeletal system and

connective tissues---------------------------

Endocrine, nutritional, and metabolic diseasesDiseases of the respiratory system-------------

Nenplasms--------------------------------------

Diseases of the nervous system and sense

organs---------------------------------------

Diseases of the digestive system---------------

Diseases of the genitourinary system-----------

Other diagnoses4-------------------------------

Unknown diagnoses------------------------------

Al1

homes

Certification status

tTt Medicaid only

Both Medicare Skilled Intermediate cer~i~ied and Medicaidl nursing care

home facility

only2 only

58.:

18.(

3::!

11.:

1::!

13.:

9.5

13.!

33.:

5.[

100.(

13.6

,

1:::

22.?

3.7

1::!

::!!

;::

6.0

1.9

1.5

::;

100.0

10.3

1;:;

20.4

::;

11.4

z::

;:;

5.6

2.0

1.4

3.9

0.6

Percent distribution3

58.0

14.5

3::;

13.6

18::

14.1

9.5

13.9

36.8

5.9

100.0

12.4

4.8

13.2

22.8

3.7

6.6

7.5

M

2.3

3.0

5.9

1.9

1.6

3.7*

100.0

8.5

1;::

19.1

*

61.:

20.!

6.!

36.:

11.(

6.:

11.:

14.[

10.:

15./

34.(

4.;

100.c

13,:

5.6

9.6

25.4

3.C

1::2

::;

$::

5.9

2.0

1.7

2.6

0.8

100.0

10.5

1:::

23.2

2.5

1;::

$:

1.9

1.8

5.7

2.2

1.4

2.8

*

59.[

22.:

9.1

38.1

10.(

;::

12.1

10.2

14.:

30.2

4.C

100.0

14.8

$::

21.4

::;

13.4

::;

1.6

1.8

6.6

1.5

;:;

1.3

100.0

11.1

6.1

11.0

21.4

:::

15.2

:::

2.0

1.4

6.4

1.2

2.:

*

50.6

20.6

3;::

7.8

4.9

9.0

::;

10.0

2;.;

100.0

16.1

4.1

1;::

4.7

12::

9.0

3.5

2,0

2.1

5.1

2.3

4.;

*

100.0

13.6

R

17.2

M

17.6

6.8

3.4

2.;

4.7

2.2

7.:

*

123,500 of the residents were in facilities certified by Medicare only.

2129,600 of the residents were in facilities certified as both SNS and ICF. 3FiWreS may not add to 100 percent because residents may have had more than one reported conditiOn Or impairment.

41ncludes diseases of the blood and blood-forming organs, diseases of the skin and subcutaneous tissue,

congenital anomalies, infective and parasitic diseases

of pregnanty and childbirth,

, certain causes of perinatal morbidity, complications

and other diagnoses not listed above. 31
Table 3. Percent distribution of nursing home residents by primary diagnosis at last examination, according to reported chronic conditions and impairments: United States, August 1973-April 1974

Primary diagnosis at

last examination

Number of residents------------------------

All diagnoses------------------------------

Senility, old age, or other ,symptomsand illdefined conditions------------------------------

Heart attack-------------------------------------

Stroke-------------------------------------------

Hardening of the arteries------------------------

Diseases of the circulatory system other than

~~ing of the arteries, stroke, and heart

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

Accidents, poisonings, and violence--------------

Mental disorders---------------------------------

Diseases of the musculoskeletal systernand

connective tissue-------------------------------

Endocrine, nutritional, and metabolic diseases---

Diseases of the respiratory system---------------

Neoplasms----------------------------------------

Diseases of the nervous system and sense organs--

Diseases of the digestive system-----------------

Diseases of the genitourinary system-------------

Other diagnoses2---------------------------------

Unknown diagnoses--------------------------------

Primary diagnosis at

last examination

Number of residents------------------------

All diagnoses------------------------------

Senility, old age, or other symptoms and illdefined conditions------------------------------

Heart attack-------------------------------------

Stroke-------------------------------------------

Hardening of the arteries------------------------

Diseases of the circulatory system other than

~~~g of the arteries, stroke, and heart

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

Accidents, poisonings, and violence--------------

Mental disorders---------------------------------

Diseases of the musculoskeletal system and

connective tissue-------------------------------

Endocrine, nutritional, and metabolic diseases---

Diseases of the respiratory system---------------

Neoplasns----------------------------------------

Diseases of the nervous system and sense organs--

Diseases of the digestive system-----------------

Diseases of the genitourinary system-------------

Other diagnosesz---------------------------------

Unknown diagnose=--------------------------------

Reported chronic conditions and impairments

I 1 , 1 I

Arthritis paralysiS paralysis

Senility Mental Mental or or palsy

illness retardation due to ore~l: y,

rheumatism stroke .

I I I I I

627,200 200,400 72,800 368,500 122,100 66,200

Percent distribution

100.0

22.0

1:::

26.2

:::

7.5

4.7

3.7

1.7

:::

:::

1.9

*

100.0 I 100.0

10.6 4.8

*

2::

17.0 ::;

2.2 *

3%3 52.;

3.1

3.8 3.:

*

;::

5.6 10.;

1.8 *

1.: 5.:

*

100.0

13.1

6.1

2;:2

?:;

4.5

17.3

3.7

1.6

::;

2.0

1.4

2.5

*

100.0

6.2

6;:;

12.3

2.3

*

*

2.4

2.9

*

2.:

*

*

*

*

Reported chronic conditions and impairments

100.0

6.1

*

16.;

6.;

9.9

;.;

.*

32.;

*

4.?j

Xaucoma An;r;~ic

or Diabetes Ar@&On, Heart N~a~f

:ataracts with back trouble

or spine

110,900 I 142,700I 106,100 I 150,000 ( 360,500 ] 57,700

Percent distribution

100.0

12.7

6.1

2:::

::!

5.3

::;

*

1?::

*

2.;

*

100.0

8.6

1:::

18.6

3.1

3.4

7.0

4.0

29.3

1.:

3.5

*

2.:

*

100.0

10.1

5.3

21::

;:1

5.4

21.6

3.0

3.;

6.7

*

3.;

100.0

8.3

1;:?

19.4

3.3

;:;

1:.:

.*

1.9

8.0

*

4.:

*

100.0

10.1

14.0

10.6

30.8

5.5

::!

4,7

g.:

1:7

3.1

1.6

1.5

2.0

*

100.0

4.6

*

12::

l::!

*

5.:

8.7

!:!

l;.:

.

~For complete category titles, see table 1.

Includes diseases of blood and blood-forming organs,diseases of the skin and subcutaneous tissue, congenital anomalies, infective and parasitic diseases, certain causes of perinatal morbidity, complications of pregnancy and childbirth, and other diagnoses not listed above.

32
Table 4. Number and percentof nursing home residentswith behavioralproblemsby type of problem, accordingto sex and age: United States,August 1973-April1974

Behavioralproblems

All residentsl---------------------------

Depressed--------------------------------------

Once a week or less--------------------------

Nore often than once a week------------------

Agitatedor nervous----------------------------

Once a week or less--------------------------

More often thsn once a week------------------

Abusive or aggressive--------------------------

Once a week or less--------------------------

More often than once a week------------------

Confusedor senile-----------------------------

Once a week or less--------------------------

More often then once a week------------------

Disturbedsleep--------------------------------

Once a week or less--------------------------

More often than once a week------------------

Other behavioralproblems----------------------

Once a week or less--------------------------

More often than once a week------------------

Depressed--------------------------------------

Once a week or less--------------------------

More often than once a week------------------

&i.~atedor nervous----------------------------

Once a week or less--------------------------

More often than once a week------------------

Abusive or aggressive--------------------------

Once a week or less--------------------------

More often than once a week------------------

Confusedor senile-----------------------------

Once a week or less--------------------------

More often than once a week------------------

Disturbedsleep--------------------------------

Once a week or less-------..-----------.------

More often than once a week------------------

Other behavioralproblems----------------------

Once a week or less--------------------------

More often than once a week------------------

Both sexes

All Under 65-74 75-84 85 years

ages 65 years years years and over

Number of residents

,075,800

418,800

263,900

154,900

455,400

318,100

137,300

177,800

114,100

63,700

613,200

510,800

102,400

201,400

144,500

56,900

55,800

45,300

10,500

38.9

24.5

14.4

42.3

29.6

12.8

16.5

10.6

5;:;

47.5

9.5

18.7

13.4

5.3

H

1.0

114,300

52,500

31,600

20,900

59,900

:;,:3:

26;200

16,000

10,200

38,000

30,500

7,400

20,100

14,600

5,500

11,200

9,100

*

163,100

70,900

44,600

26,300

75,800

52,000

23,800

29,500

19,300

10,200

80,800

65,600

15,200

32,200

22,700

9,600

10,700

8,200

2,500

384,900

154,600

100,200

54,500

166,200

117,500

48,800

60,800

39,400

21,400

228,300

190,900

37,400

74,900

54,800

20,000

19,700

16,300

3,400

Percent of residents2

46.o

27.6

18.3

52.4

37.4

15.0

22.9

14.0

3%;

26.7

6.5

17.6

12.8

4.8

;:;

*

;;.$

16:1

46.5

31.9

14.6

18.1

11.8

4;::

40.2

9.3

19.8

13.9

5.9

6.5

5.0

1.5

40.2

26.0

14.1

43.2

30.5

12.7

15.8

10.2

52:!

4;.;

19:5

14.2

5.2

5.1

“::;

413,600

140,700

87,500

53,200

153,400

105,800

47,600

61,300

39,400

21,900

266,200

223,800

42,400

74,200

52,.400

21,800

14,300

11,700

2,600

34.0

21.2

12.9

37.1

25.6

11.5

1$.:

.

6;:2

54.1

10.2

17.9

12.7

5.3

3.5

:::

See footnotes.atend of table.

33
Table 4. Number and percent of nursing home residentswith behavioralproblems by type of prolem, according to sex and age: United states. Auzust ~973-AD~i~ 1974—con.

Behavioral problems

All residentsl------------

Depressed-----------------------

Once a week or less-----------

More often than once a week---

Agitated or nervous-------------

Once a week or less-----------

More often than once a week---

Abusive or aggressive-----------

Once a week or less-----------

More often than once a week---

Confused or senile--------------

Once a week or less-----------

More often than once a week---

Disturbed sleep-----------------

Once a week or less-----------

More often than once a week---

Other behavioralproblems-------

Once a week or less-----------

More often than once a week---

Depressed-----------------------

Once a week or less-----------

More often than once a week----

Agitated or nervous-------------

Once a week or less-----------

More often than once a week---

Abusive or aggressive-----------

Once a week or less-----------

More often than once a week---

Confused or senile--------------

Once a week or less-----------

More often than once a week---

Disturbed sleep-----------------

Once a week or less-----------

More often than once a week---

Other behavioral problems------Once a week or less-----------

More often than once a week---

.- --. . ....

i

Male I

Female

All Under 65 years All Under 65 years

ages 65 years and over ages 65 years and over

Number of residents

318,100

114,000

71,200

42,900

133,700

91,300

42,400

70,900

42,700

28,200

170,000

137,900

32,100

57,000

41,200

15,800

18,600

14,600

4,000

1

35.9

22.4

13.5

42.0

28.7

13.3

22.3

13.4

5!::

43.4

10.1

17.9

13.0

5.0

H

1.3

52,400

20,900

13,100

7,800

26,900

19,200

7,600

14,600

8,600

6,OOO

16,200

13,500

2,700

8,000

6,200

*

5,800

4,800

*

265,700

93,200

58,100

35,100

106,800

72,000

34,800

56,300

34,100

22,200

153,800

124,400

29,400

49,000

35,000

14,000

12,800

9,800

3,000

757,700

304,700

192,700

112,000

321,700

226,800

94,900

106,900

71,400

35,500

443,200

372,900

70,300

144,300

103,300

41,000

37,200

30,700

6,500

Percent of residence2

39.8

25.0

14.9

51.3

36.7

14.6

27.8

16.4

11.4

31.0

25.8

J::

11.8

11.:

9.1

$r

35.1

21.9

13.2

40.2

27.1

13.1

21.2

12.8

5;:;

46.8

11.1

18.4

13.2

::;

3.7

1.1

40.2

25.4

14.8

42.5

29.9

12.5

14.1

%?

58.5

49.2

1;::

13.6

:::

4.1

0.9

61,900

31,700

18,500

13,200

33,000

23,600

9,500

11,600

7,400

4,200

21,700

17,000

4,700

12,000

8,400

3,600

5,300

4,300

*

51.2

29.9

21.3

53.4

38.1

15.3

18.7

ljo:

35:1

2;.:

19:4

13.6

:::

6.9

*

II

695,800

273,100

174,200

98,900

288,600

20),::;

95;300

64,000

31,300

:;;,;3):

65;600

132,300

94,900

37,400

31,800

26,400

5,400

39.3

25.0

14.2

41.5

29.2

12.3

13.7

;:;

60.6

51.2

1;:;

13.6

;:;

0;8

lIncludesall residents whether or not they had behavioral problems.

21ncludes only those residentswith behavioral problems.Figures may not total to 100 because

residentsmay have had more than one behavioral problem.
Table 5. Number and percent of nursing home residents with behavioral problems by type of

problem, according to certification status of home: United States, August 1973-April 1974

Behavioral problems

All residents3-----------------

Depressed--.-------------------------

Once a week or less----------------

More often than once a’week--------

Agitated or nervous------------------

Once a week or less----------------

More often than once a week--------

Abusive or aggressive----------------

Once a week or less----------------

More often than once a week--------

Confused or senile-------------------

once a week or less----------------

More often than once a week--------

Disturbed sleep----------------------

Once a week or less----------------

More often than once a week--------

Other behavioral problems------------

Once a week or less----------------

More often than once a week--------

Depressed----------------------------

Once a week or less----------------

More often than once a week--------

Agitated or nervous------------------

Once a week or less----------------

More often than once a week--------

Abusive or aggresive-----------------

Once a week or less----------------

More often than once a week--------

Confused or senile-------------------

Once a week or less----------------

More often than once a week--------

Disturbed sleep----------------------

Once a week or less----------------

More often than once a week--------

Other behavioral problems------------

Once a week or less----------------

More often than once a week--------

II Certification status

I

Al 1

homes Both

Medicare

and ~

Medicaid

Medicaid only

Skilled

nursing

homes2

Intermediate

care

facilities

Number of residents

1,075,80011 406,900

418,800

263,900

154,900

455,400

318,100

137,300

177,800

114,100

63,700

613.200

510;800

102.400

201;400

144,500

56,900

55,800

45,300

10,500

163,600

106,700

56,900

170,100

118,800

51,400

65,600

42,300

23,400

234,900

198,700

36,200

75,000

53,900

21,100

22,000

18,500

3,600

292,500

120,900

79,900

40,900

127,500

90,800

36.700

53;300

36,200

17,000

175,700

148,600

27,100

59,300

43,300

16,000

16,900

13,800

3,100

236,700

92,200

54,300

37,900

107,400

73,800

33,600

39,700

23,800

15,900

135,900

109,300

26,600

45,400

32,300

13,100

10,200

7,900

*

Not

certified

139.800

42,100

23,000

19,200

50,300

34,700

15,600

19,100

1;,:::

66:800

54;200

12,600

21,600

15,000

6,600

6,700

5,100

*

Percent of residents with behavioral problems4

38.9

24.5

14.4

42.3

29.6

12.8

16.5

10.6

5?::

47*5

1::?

13.4

5.3

U

1.0

.40.2

26.2

14.0

41.8

29.2

12.6

16.1

10.4

5;:;

48.8

1!::

13.2

R

4.5

0.9

41.3

27.3

14.0

43.6

31.0

12.5

18.2

12.4

6~:?

50.8

2:::

14.8

5.5

5.8

4.7

1.1

39.0

22.9

16.0

::.;

14:2

16.8

10.1

5%;

46.2

11.2

19.2

13.6

5.6

4.3

3.4

*

30.1

16.4

13.7

36.0

24.8

11*2

13.7

8.4

4;::

38.8

1?:!!

10.8

4.7

4.8

3.7

*

1

~23,500 of the residents were in facilities certified by Medicare only.

129,600 of the residents were in facilities certified as both SNH and ICF.

31ncl~des all residents whether or not they had behavioral problems.

4Figures may not totalto100 because residents may have had more than one behavioral problem.

35
Table 6. Number and percentof nursinghome residentswith behavioralproblemsby type of problem,according

to reportedchronicconditionsand impairmentsand primarydiagnosisat last examination:United States,

August 1973-April1974

Reportedchronicconditionsand impairments end primarydiagnosisat last

exsmination

All residents------------------------

Reportedchronicconditionsand

pairments

Senility-----------------------------------

Mental illness-----------------------------

Mental retardation-------------------------

Arthritisor rheumatism--------------------

Paralyeisor palsy due to stroke-----------

Paralysisor palsy not relatedto stroke,

arthritis,or rhematism------------------

Glaucomaor cataracts----------------------

Diabetes-----------------------------------

Any chronictroublewith back or spine-----

Amputationof extremitiesor limbs; or

permanentetiffnessor any deformityof

foot, leg, fingers,arms, or back---------

Heart trouble------------------------------

None of the above--------------------------

Primarydiagnosisat last examination

Senility,old age, or other symptoms and

ill-definedconditions--------------------

Heart attack-------------------------------

Stroke-------------------------------------

Hardeningof the arteries ------------------

Diseases of the circulatory system other

then hardening of the arteries, stroke,

and heart attack--------------------------

Accidents, poisonings, and violence --------

Mental disorders ---------------------------

Diseases of the musculoskeletal system

and connective tissue---------------------

Endocrine, nutritional, and metabolic

diseases ----------------------------------

Dieeases of the respiratory eystem---------

Neoplasms ----------------------------------

Diseases of the nervous system and sense

organs------------------------------------

Diseases of the digestive eystem-----------

Diseases of the genitourinary system-------

Other diagnoees3---------------------------

Unknown diagnoses --------------------------

Number

of

residents

13075,80C

627,200

200,400

72,800

368,500

122,100

66,200

110,900

142,700

106,100

150,000

360,500

57,700

146,800

55,700

113,400

241,800

39,400

&9,300

115,800

73,100

48,100

22,200

25,600

64,200

20,500

15,600

34,700

9,600

Behavioral problems

Abusive Con- Other

De- Agita- ~r fused Dis- behavpressed ted or

aggres -

turbed ioral

nervous

or

sive senile sleep problems

Percent of residents with behavioral problemsz

38.9

41.8

54.4

37.7

43.0

46.9

46.1

42.7

42.7

49.8

46.9

42.2

23.5

34.2

40.6

43.7

35.8

::.:

44:1

37.2,

40.1~

41.8

49.5

42.9

43.2

$.;

25:1

42.3

48.3

65.4

54.9

44.3

41.2

49.0

43.7

43.0

50.8

46.7

43.5

21.5

42.4

42.0

39.4

41.2

;;.$

56:8

34.6

38.7

43.7

39.3

49.9

38.9

:;.;

27:4

16.5

19.6

31.2

25.2

16.2

15.4

17.1

17.5

16.4

18.0

20.7

16.2

7.0

17.2

13.5

14.5

15.7

16.6

14.2

26.4

12.8

16.5

15.1

12.1

18.5

12.6

21.0

10.5

*

57.0

82.7

69.5

48.2

59.5

57.0

52.3

59.8

56.7

58.5

58.9

61.1

3.2.4

79.7

54.3

57.1

64.9

49.4

50.3

55.0

39.1

48.7

44.1

48.5

45.3

47.6

53.0

34.5

33.1

18.7

22.6

29.2

18.3

22.3

18.8

20.2

23.3

18.8

26.4

22.9

22.0

8.9

19.4

21.2

17.1

18.7

18.2

17.0

20.0

17.4

15.8

23.1

24.2

17.9

20.3

21.7

16.5

*

5.2

1?::

::;

4.1

:::

:.:

.

::;

*

4.2

4.;

4.4

6.1

11.;

4.3

*

*

*

5.8

*

*

*

*

~Includesall residentswhether or not they had behavioralproblems.

Figuresmay not total to 100 percentbecauseresidentsmay have had more than one behavioralproblem.

s~cludes diseasesof the blood and blood-formingorgans,diseases of the skin and subcutaneous tissue,

congenital anomalies, infective and parasitic diseases , certain causes of perinatal morbidity, complications

of pregnancy and childbirth, and other diagnoses not listed above.
T.abk!7. Number and percentdistributionof nursinghome residentsby vision,hearing, speech,and use of

dentures=tus, Tccording to sex and age: United States,August 1973-April1974

Sex Age

Vision,hearing,speech,and II I

use of denturesstatus

Number of

residents

* Ill Number of residents------ 114,300 163,100 384,900 413,600

Vision status

All residents------------

1,075,80C

1,075,80C

Percentdistribution

100.0 100.0 100.0 100.c 100. c 100. c 100.0

Sight not impaired-------------

Sight partiallyimpaired-------

8ight severelyimpaired--------

Sight completelylost----------

575,50C

362,00C

107,9OC

30,40C

53.5

33.7

10.0

2.8

100.0

56.5

31.5

9.0

3.0

100.0

52.2

34.6

10.5

2.7

100.0

70.6

21.7

5.C

2.7

100.0

62,.2

28.8

6.3

2.6

100.0

53.E

35.[

8.9

2.:

100.c

;;.:

14:0

3.5

100.0

49.9

35.9

13.0

1.1

100.0

All residentsusing

eyeglasses---------------- 670,400

371,400

226,60C

66,50C

6,00C

55.4’

33.8

9.9

0.9

100.0

50.3

33.4

10.2

6.0

100.0

67.8

26.1

5.1

1.0

100.0

30.6

44.4

22.7

*

100.0

69.4

2:.:

0:9

100.0

74.3

14.4

8.3

3.0

100.0

57.0

32.0

9.9

1.0

100.0

54.9

34.4

9,9

0.8

100.0

65.6

28.8

5.4

*

100.0

63.3

29.3

6.5

*

100.0

Sight not impaired-------------

Sight partiallyimpaired-------

Sight severelyimpaired--------

Sight completelylost----------

57.1

33.8

8.4

0.7

100.0

All residentsnot using

eyeglasses---------------- 405.40C

Sight

Sight

Sight

Sight

not impaired-------------

partiallyimpaired-------

severelyimpaired--------

completely10st----------

Hearingstatus

All residents------------

204,10a

135,500

41,400

24,500

1,075,800

55.9

30.9

8.0

5.2

100.0

66.9

26.7

5.2

1.2

100.0

32.1

42.6

23.7

*

100.0

:;.;

11:5

6.5

100.0

68.2

25.8

5.1

0.9

100.0

30.0

:;.;

.*

100.0

73.2

18.0

4.7

4.0

100.0

61.2

28.3

2:;

100.0

47.0

37.5

9.9

5.6

100.0

34.5

41.2

15.9

8.4

100.0

55.2

34.8

8.7

1.4

100.0

27.1

48.0

22.5

*

100.0

Hearingnot impaired-----------

Hearing partiallyimpaired-----

Hearing severelyimpaired------

Hearing completelylost--------

All residentsusing

hearingaids--------------

729,600

280,300

55,200

10,800

88.4

;.:

.>~

100.0

*

*

*

9,

100.0

80.3

17.0

1.9

*

100.0

45.1.*

*

*

100.0

70.0

25.5

::;

100.0

32.6

42.2

23.1

>:

100.0

45,900

14,100

20,400

10,400

*

Hearingnot impaired-----------

Hearingpartiallyimpaired-----

Hearing severelyimpaired------

Hearing completelylost--------

All residentsnot using

hearing aids-------------- 1,029,900

715,500

259,900

4$,;;;

,

Hearingnot impaired-----------

Hearing partiallyimpaired-----

Hearing severelyimpaired------

Hearing completelylost--------

68.3

2:.;

1:1

100.0

70.6

16.8

9.3

3.3

100.0

46.8

48.7

4,5

70.0

24.9

4.3

0.9

100.0

75.8

13.4

7.9

2.8

100.0

31.7

63.1

5.3

88.9

9.0

>,<

9:

100.0

58.6

18.2

15.5

7.6

100.0

74.2

22.3

3.4

81.1

16.7

1.5

*

100.0

70.7

15.9

;.:

.

100.0

48.6

47.7

3,7

71.4

24.9

3.0

0.7

100.0

57.2

33.8

;:;

100.0

Speech status

All residents------------ 1,075,800

799,100

155,200

89,500

32,100

Speechnot impaired------------

Speechpartiallyimpaired------

Speech severelyimpaired-------

Speech completelylost---------

76.2

13.9

7.4

2.5

100.0

30.5

64.4

5.1

78.2

13.3

6.7

1.8

100.0

25.9

68.1

5.9

37

Use of denturesstatus

All residents------------ 1,075,800

1

36.1

58.8

5.0

388,800

632,800

54,200

NO dentures--------------------

Denturesand used them---------

Denturesbut did not use them--
Table 8. Number and percent distribution of nursing home residents by vision, hearing, speech, and uee of dentures status, according to certification status of home: United States, August 1973-April 1974

Vision, hearing, speech, and use of

dentures status

Vision status

All residents------------------------------

Sight not impaired-------------------------------

Sight partially impaired-------------------------

Sight severely impaired--------------------------

Sight completely lost----------------------------

All residents using eyeglasses ---------------

Sight not impaired-------------------------------

Sight partially impaired-------------------------

Sight severely impaired--------------------------

Sight completely lost----------------------------

All residents not using eyeglasses-----------

Sight not impaired-------------------------------

Sight partially impaired-------------------------

Sight severely impaired--------------------------

Sight completely lost----------------------------

Hearing status

All residents ------------------------------

Hearing not impaired -----------------------------

Hear@g partially impaired -----------------------

~;:; ::~::l~g~:::::::::::::::::::::::::

All residents using hearing aids -------------

Hearing not impaired-----------------------------

Hearing partially impaired-----------------------

Hearing severely impaired------------------------

Hearing completely lost--------------------------

All residents not using hearing ai.ds---------

Hearing not impaired-----------------------------

Hearing partially impaired-----------------------

I@=Z; ::~glpg~:::::::::::::::::::::::::

Speech status

All residents ------------------------------

Speech not impaired------------------------------

Speech partially impaired------------------------

Speech severely impaired-------------------------

Speech completely lost---------------------------

Use of dentures status

All residents ------------------------------

No dentures --------------------------------------

Dentures and used them---------------------------

Dentures hut did not use them--------------------

Certification status

Medicaid onlv

All homes Both

Medicare

and

Medicaidl nursing I

care

homes2 facilities I

1,075,800

;:;,;;:

107:900

30,400

670,40C

371,40C

226,60C

66,500

6,000

405,400

204,100

135,500

41,400

24,500

1,075,800

729,600

280,300

55,200

10,800

45,900

14,100

20,400

10,400

*

1,029,900

715,500

259,900

44,700

9,700

1,075,800

799,100

155,200

89,500

32,100

1,075,800

388,800

6::,:::

>

Number of residents

406,900

210,900

145,300

39,700

10,900

253,700

132,700

93,700

25,100

*

153,200

78,200

51,700

14,600

8,600

406,900

272,700

109,600

20,600

3,900

16,500

5,000

7,100

3,900

*

390.400

267,700

102,500

16,800

3,500

406,900

297,700

61,200

36,400

11,600

406,900

139,600

2;;,;::

,

292,500

148,400

101,900

33,600

8,700

184,000

97,000

64,700

21,000

*

108,500

292,500

190,800

82,000

16,S00

2,800

13,200

3,700

6,100

3,300

*

279.300

187,100

75,900

13,500

2,800

292,500

212,800

44,300

25,700

9,700

292,500

102,200

175,700

14,600

236.700

129,600

75,400

23,500

8,300

140,600

82,400

43,900

12,800

*

96,100

47,200

31,500

10,700

6,800

236,700

161,400

60,200

12,200

2,900

9.200

2,700

4,400

*

*

227,400

158,700

55,800

10,400

2,600

236,700

176,100

33,700

18,700

8,100

236,700

95,500

131,300

9,900

139,800

86,600

39,400

11,200

2,600

92,200

59,300

24,300

7,600*

47,600

27,300

15,100

3,500

*

139,800

104,700

28,500

5,500

*

7.000

2,600

2,800

*

*

132,700

102,100

25,700

4,100

*

139,800

112,500

15,900

8,700

2,600

139,800

51,400

82,200

6,200

See footnotes at end of table.

3a
Table 8. Number and percent distribution of nursing home residents by vision, hearing, speech, and use Of dentures status, according to certification status of home: United States, August 1973-April 1974—Con.

Certification status

Vision, hearing, speech, and use of

dentures status ill homes

Vision status Percent distrihuticm

All residents ------------------------------ 100.0 100. c 100.0 100.0 100.0

Sight not impaired-------------------------------

Sight partially impaired-------------------------

Sight severely impaired--------------------------

Sight completely lost----------------------------

All residents using eyeglasses---------------

53.5

33.7

10.0

2.8

100,0

51.8

35.7

9.8

2.7

100.c

50.7

34.8

11.5

3.0

54.7

31.8

9.9

3.5

61.9

28.2

8.0

1.9

100.0 100.0 100.0

55.4

33.s

9.9

0.9

100.0

50.3

33.4

10.2

6.0

100.0

67.8

26.1

5.1

1.0

100.0

52.3

36.9

9.9

,t

100.c

51.1

33.7

9.5

5.6

100.0

67.0

26.9

5.1

1.0

100,0

52.7

35.2

11.4

7’,

100.0

47.4

34.3

11.6

6.7

58.6

31.2

9.1

>1

64.1

26.3

8.3

>,,

Sight not impaired-------------------------------

Sight partially impaired-------------------------

Sight severely im aired--------------------------

Sight completely !cwt----------------------------

All residents not using eyeglasses----------- 100.0 100.0

Sight not impaired-------------------------------

Sight partially impaired-------------------------

SiKht severely impaired--------------------------

Sight completely lost----------------------------

49.1

32.8

11.1

7.1

57.2

31.7

7.4

$t

Hearing status

All residents------------------------------ 100.0 100.0 100.0

65.2

28.0

5.s

1.0

68.2

25.4

5.1

1.2

74.9

20.4

4.0

Hearirw not impaired-----------------------------

Hearing partially impaired-----------------------

Hearing severely impaired------------------------

Hearin~ completely lost--------------------------

*

All residents using hearing aids------------- 100.0 100.0 100.0

Hearing not impaired-----------------------------

HearinK partially impaired-----------------------

Hearing severely impaired------------------------

Hearing completely lost--------------------------

All residents not using hearing aids---------

30.6

44.4

22.7

>’(

100.0

69.4

25.2

4.3

0.9

100.0

74.3

14.4

8.3

3.0

100.0

36.1

5s.s

5.0

30.3

43.3

23.5

>,(

100,0

68.6

26.3

4.3

0.9

100.0

73.2

15.0

8.9

2.8

100.0

34.3

59.9

5.8

28.3

46.2

25.0

29.7

47.2

>k

,k

36.9

39.7*

>’C

100.0 100.0 100.0

67.0

27.2

4.s

1.0

69.8

24.5

4.6

1.1

76.9

19.4

3.1

Hearing not impaired-----------------------------

Hearing partially impaired-----------------------

Hearing severely impaired------------------------

Hearinx completely lost--------------------------

Speech status

All residents------------------------------ 100.0 100.0 100.0

Speech not impaired------------------------------

Speech partially impaired------------------------

Speech severely im aired-------------------------

Speech completely cost---------------------------

72.7

15.1

8.8

3.3

74.4

14.3

7.8

3,4

80.4

11.4

6.3

1.9

Use of dentures status

All residents------------------------------ 100.0 100.0 100.0

NO dentures --------------------------------------

Dentures and used them ---------------------------

Dentures but did not use them--------------------

35.0

60.0

5.0

40.4

55.5

4.2

36.8

58.S

4.4

~

~23,500 of the residents were in facilities certified by Medicare only.

129,600 of the residents were in facilities certified as both SNH and ICF.
Table 9. Number and percent of nursing home residents by special aids used, according to sex and

age: United States, August 1973-April 1974

Special aid used

No 1 aid

aid or

used more

used Wheelchair Walker Cane Crutches

Sex and age

Both sexes

All ages -----------------------

Number of residents

517,500 374,800 156,400

67,200

89,900

186,300

174,100

159,800

558,300 68,800 9,300

47,100

73,200

198,500

239,500

36,800

50,900

130,500

156,600

107,300

7,100

17,000

59,800

72,500

3,200

8,000

26,200

31,400

27,400

4,60;

9,800

11,500

41,400

Under 65 years-----------------------

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

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

85 years and over --------------------

*

2,400

3,000

*

Male

All ages------------------------- 158,400 31,700 4,600

Under 65 years-----------------------

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

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

85 years and over--------------------

31,600

36,700

48,500

42,900

357,700

35,600

53,200

137,800

131,100

48.1

58.8

55.1

48.4

42.1

50.2

20,800

28,400

53,800

55,400

15,800

20,400

35,900

35,200

267,500

2,700

4,800

11,200

13,000

*

*

*

*

Female

All ages------------------------- 400,000 124,700 4,700

26,300

44,800

144,700

184,100

21,000

30,500

94,500

121,400

4,400

12,200

;;,;:;

>

Under 65 years -----------------------

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

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

85 years and over --------------------

3,50:

16,400

19,800

*

*

*

*

Both sexes Percent of residents

51.9

41.2

44.9

51.6

57.9

49.8

All ages----------------------- 34.8 14.5 6.4 0.9

1::;

15.5

17.5

10.0

Under 65 years----------------------

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

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

85 years and over-------------------

32.2 n

6.8

7.6

1.;

0.8

*

31.2

33.9

37.9

Male

All ages ------------------------ 33.7 8.6 1.5

Under 65 years ----------------------

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

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

85 years and over-------------------

60.3

56.4

47.4

43.7

47.2

57.5

54.3

48.8

41.6

39.7

43.6

52.6

56.3

52.8

42.5

45.7

51.2

58.4

30.2

31.3

35.1

35.8

5.1

1;:!

13.2

16,5

1;::

17.2

18.9

* *

*

*

*

7.0

1?:$!

Female

All ages------------------------ 35.3 5.5 0.6

Under 65 years----------------------

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

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

85 years and over-------------------

34.0

31.1

33.5

38.5

3.:

5.8

6.3

*

*

*

*

40
Table 9. Number and percent of nursing home residents by special aids used, according to sex and

age: United States, August 1973-April 1974—Con.

Sex and age

Both sexes

I

All ages----------------------

Special aid used

Braces Artificial Self- Other

limb feeder aids

Number of residents

16,700 4,400 11,400 20,900

Under 65 years----------------------

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

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

85 years and over-------------------

Male

All ages------------------------

Under 65 years----------------------

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

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

85 years and over-------------------

Female

All ages------------------------

Under 65 years----------------------

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

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

85 yeara and over-------------------

Both sexes

All ages----------------------

4,600

3,600

5,700

2,700

*

*

3,000

2>700

7,100

8,100

4,300

4,300

5,000 2,500 2,500 5,600

*

*

*

*

*

*

*

*

*

*

*

*

11,700 8,900 15,300

2,500

2,400

4,400

*

3,20;

3,700

*

5,50;

2,300 6,300

Percent of residents

1.6 0.4 I 1.9

1 t

Under 65 years----------------------

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

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

85 years and over-------------------

Male

All ages-------------------------

Under 65 years----------------------

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

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

85 years and over-------------------

Female

All ages------------------------

4.0

2.2

::2

1.6

* * *

7’C * *

* * *

* * *

*

1.6 1.2 2.0

Under 65 years----------------------

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

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

85 years and over-------------------

4.1

2.5

1.6

0.7

*

1.;

1.2

*

*

1.9

2.0

41
Table 10. Number and percent of nursing home residents by special aids used, according to certificationstatus of home: United States, August 1973-April 1974

Special aid used

All residents3--------

No aid----------------------

1 aid or more---------------

wheelchair------------------

Walker----------------------

Cane------------------------

Crutches--------------------

Braces----------------------

Artificial limb-------------

Self-feeder-----------------

Other aid-------------------

No aid----------------------

1 aid or tnore---------------

Wheelchair------------------

Walker----------------------

Cane------------------------

Crutches--------------------

Braces----------------------

Artificial limb-------------

Self-feeder-----------------

Other aid-------------------

All

homes

,075,800

517,500

558,300

374,800

156,400

68,800

9,300

16,700

4,400

11,400

20,900

::.;

34:8

14.5

::2

1.6

0.4

1.1

1.9

Certificationstatus

Medicaid only

Both

Medicare Inter- Not

and Skilled certified

Medicaidl nursing mediate

homesz

care

facilities

Number of residents

406,900

161,900

244,900

178,500

65,200

22,700

2,500

7,700

$:

3,700

7,600

292,500

142,900

149,600

98,700

39,700

20,300

2,300

4,80~

7,50:

236,700

128,300

108,400

67,300

33,500

14,800

2,800

2,800

4,40:

4,400

Percent of residents4

39.8

60.2

43.9

16.0

5.6

0.6

1.9

.:

0.9

1.9

48.9

51.1

33.8

13.6

7.0

0.8

1.7

*

2.:

54.2

45.8

28.4

14.2

6.3

1.2

1.2

$;

R

139,800

84,400

55,400

30,300

18,000

10,900

*

*

*

*

*

;3.:

21:7

12.9

7.8

*

*

*

*

-k

123 500 of the residentswere in facilitiescertifiedby Medicare only.

2123 600 of the residentswere in facilitiescertified as bothSNH and ICF.

31nc~udes all residentswhether or not a special aid was used.

4Figuresmay not total to 100 percent because residentsmay have used more than one

special aid.

42
Table 11. Number and percent distributionof nursinghome residents by spe~ialaids used, according to reportedchronic conditionsand impairmentsand primary diagnosisat last examination: United States,August 1973-April1974

Reported chronic conditionsand

impairmentsand primary diagnosis

at last examination

All residents----------------

Reported chronic conditionsand

impairments

Senility-----.---------------------

Mental illness---------------------

Mental retardation-----------------

Arthritisor rheumatism------------

Paralysisor paLsy due to stroke---

Paralysis or palsy not related to

stroke,arthritis,or rheumatism--

Glaucomaor cataracts--------------

Diabetes---------------------------

Any chronictroublewith back or

spine-----------------------------

Amputationof extremitiesor

limbs; or permanent stiffnessor

any deformityof foot, leg,

fingers,arm, or back-------------

Heart trouble----------------------

None of the above------------------

Primary diagnosisat last

examination

Senility,old age, or other

symptomsand ill-defined

conditions------------------------

Heart attack-----------------------

Stroke--------------------------- --

Hardeningof the arteries----------

Diseasesof the circulatorysystem

other than hardeningof the

arteries,stroke,and heart attack------------------------------

A~ccnts, poisonings,or vie-

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

Mental disorders-------------------

Diseasesof the musculoskeletal

system and connectivetissue------

Endocrine,nutritional,and

metabolic diseases----------------

Diseasesof the respiratorysystem--------------------------- ----

Neoplasms--------------------------

Diseasesof the nervous system and

sense organs----------------------

Diseasesof the digestivesystem---

Diseases of the genitourinarysystem-------------------------------

tern------------------------------Other diagnoses3-------------------

Unknown diagnoses------------------

II Specialaid used

Number 1~

of No 1 aid residents aid or more Wheelchair

used used

1,075,80C

627,20C

200,40C

72,800

368,500

122,100

66,200

110,900

142,700

106,100

150,000

360,500

57,700

146,800

55,700

;;;,M;

>

39,400

49,300

115,800

73,100

48,100

22,200

25,600

64,200

20,500

15,600

34,700

9,600

517,50C

294,70C

126,700

48,700

141,10C

35,500

23,600

49,900

63,400

35,400

41,300

161,300

35,400

74,500

26,500

38,200

120,300

20,200

10,700

90,200

22,300

21,700

12,700

12,700

26,800

10,300

6,700

16,900

6,000

Number of residents

558,30(

332,50(

73,70(

24,00(

227,40(

86,60(

42,60(

61,1OC

79,30C

70,70C

L08,70C

L99,20C

22,30C

72,300

29,200

75,200

L21,400

19,300

38,600

25,600

50

26

9

L30

800

400

500

000

37,400

10,200

8,900

16,000

3,600

374,800

235,700

51,100

18,300

143,800

68,400

33,900

37,600

53,500

46,400

80,900

132,600

11,400

48,600

16,300

58;000

78,900

11,000

27,400

18,400

31,200

17,500

6,100

8,200

27,000

6,400

6,500

10,600

*

156,400

83,700

17,800

4,300

77,200

17,700

7,900

19,300

23,800

24,300

23,900

56,800

8,800

18,900

9,900

16,900

32,700

5,300

15,100

4,900

18,500

9,000

2,800

3,600

8,400

3,100

4,40:

*

68,800

34,300

7,500

32,70:

7,100

3,100

11,600

10,000

9,000

10,000

28,400

3,400

7,300

5,600

6,600

17,900

4,000

2,50:

7,100

3,700

*

*

4,000

*

*

*

*

~ See footnotesat end of table.

.

43
Table 11. Number and percent distribution of nursing home residents by special aids used, according to reported chronic conditions and impairments and primary diagnosis at last examination: United States, August 1973-April 1974-Con.

Reported chronic conditions and

impairments and primary diagnosis at

last examination

All residents-------------------------------

Reported chronic conditions and impairments

Senility------------------------------------------

Mental illness------------------------------------

Mental retardation--------------------------------

Arthritis or rheumatism --------------------------

Paralysis or palsy due to stroke------------------

Paralysis or palsy not related to stroke,

arthritis, or rheumatism-------------------------

Glaucoma or cataracts-----------------------------

Diabetes------------------------------------------

Any chronic trouble with back or spine------------

Amputation of extremities or limbs; or permanent

stiffness or any deformity of foot, leg,

fingers, arm, or back----------------------------

Heart trouble-------------------------------------

None of the above---------------------------------

Primary diagnosis at last examination

Senility, old age, or other symptoms and illdefined conditions-------------------------------

~t~:eattack --------------------------------------

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

Hardening of the arteries-------------------------

Diseases of the circulatory system other than

hardening of the arteries, stroke, and heart

attack-------------------------------------------

Accidents, poisoninga, or violence----------------

Mental disorders----------------------------------

Diseasea of the musculoskeletal system and

comective tissue---------------------------------

Endocrine, nutritional, and metabolic diseasea----

Diseases of the respiratory system----------------

Dis~ases of the nervous system and sense organs---

Diseases of the digestive system------------------

Diseases of the genitourinary system--------------

Other diagnoses3----------------------------------

Unknown diagnoses---------------------------------

Special aid used

Art~~i.ial Self- Crutches Braces .Other

feeder aids

Number of residents’

9,300

3,600

*

4,20:

*

*

*

*

*

3,800

3,000

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

16.700

6,000

2,400

5,00:

7,400

2,400

*

3,60:

6,200

4,400

*

*

6,30:

*

*

*

*

*

*

*

*

*

*

*

*

*

4.400

*

*

*

*

*

*

*

*

*

4,400

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

11,400

;,;:;

s

5,10:

*

*

*

2,90:

2,400

3,600

*

2,700

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

20,900

14,600

4,400

7,50;

3,400

*

2,30;

3,000

5,000

6,800

*

3,400

2,80:

4,400

*

*

*

*

*

*

*

*

*

*

*

See footnotes at end of table.

44
Table 11. Number and percent distribution of nursing home residents by special aids used, ac.

cord%ng to reported chronic conditions and impairments and primary diagnosis at last examination: United States, August 1973-April 1974-Con.

Reported chronic conditions and impairments

and primary diagnosis at last examination

All residents----------------------------

Reported chronic conditions and impairments

Senility---------------------------------------

Mental illness---------------------------------

Mental retardation-----------------------------

Arthritis or rheumatism------------------------

Paralysis or palsy due to stroke---------------

Paralysis or palsy not related to stroke,

arthritis, or rheumatism----------------------

Glaucoma or cataracts--------------------------

Diabetes---------------------------------------

Any chronic trouble with back or spine---------

Amputation of extremities or limbs; or

permanent stiffness or any deformity of foot,

leg, fingers, arm, or back--------------------

Heart trouble----------------------------------

None of the above------------------------------

Primary diagnosis at last examination

Senility, old age, or other symptoms and illdefined conditions----------------------------

Heart attack-----------------------------------

Stroke-----------------------------------------

Hardening of the arteries----------------------

Diseases of the circulatory system other than

~~ing of the arteries, stroke, and heart

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

Accidents, poisonings, or violence-------------

Mental disorders-------------------------------

Diseases of the musculoskeletal system and

connective tissue-----------------------------

Endocrine, nutritional, and metabolic diseasesDiseases of the respiratory system-------------

Neoplasms--------------------------------------

Diseases of the nervous system and sense

organs----------------------------------------

Diseases of the digestive system---------------

Diseases of the genitourinary system-----------

Other diagnoses3-------------------------------

Unknown diagnoses------------------------------

Total

100.0

100.0’

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

I

Special aid used

No 1 aid

aid o;s~dre Wheelchair Walker Cane

used

Percent distribution

48.1

47.0

63.2

67.0

38.3

29.1

35.6

45.0

44.4

33.3

27.5

44.8

61.4

50.7

47.6

33.7

49.8

51.1

21.7

77.9

30.1

45.0

57.4

49.4

41.7

50.4

43.0

51.4

62.2

53.0

36.8

33.0

61.7

70.9

64.4

55.1

55.6

66.7

72.5

55.3

38.6

49.3

52.4

66.3

50.2

48.9

78.3

22.1

69.5

55.0

42.6

50.6

58.3

49.6

57.0

48.6

37.8

34.E

37.t

25.5

25.2

39.C

56.0

51.1

33.9

37.5

43.8

54.0

36.8

19.8

33.1

29.3

51.2

32.6

27.9

:;.:

.

42.8

36.3

27.4

32.2

42.0

14.5

13.3

.%;

21.0

14.5

11.9

17.4

16.7

22.9

15.9

15.8

15.3

12.9

17.7

14.9

13.5

13.5

30.7

4.2

25.4

18.7

12.6

14.1

13.1

15.1

13.:

*

6.4

5.5

3.8

*

H

1::;

k:

6.7

;:;

1::!?

5.9

7.4

9.9

2.;

9.8

7.:

*

6.3

*

*

*

*

See footnotes at end of table.

45
Table 11. Number and percent distributionof nursinghome residents by special aids used, ac.

cordingto reportedchronic conditionsand impairmentsand primarydiagnosisat last examination: United States,August 1973-April1974—Con.

Reported chronic conditionsand

impairmentsand primary diagnosisat

last examinationand at admission

All residents--------------------------------

ReDorted chronicconditionsand iumairmentsz

Senility-------------------------------------------

Mental illness-------------------------------------

Mental retardation---------------------------------

Arthritisor rheumatism----------------------------

Paralysisor palsy due to stroke-------------------

Paralysisor palsy not related to stroke,

arthritis,or rheumatism--------------------------

Glaucomaor cataracts------------------------------

Diabetes-------------------------------------------

Any chronic troublewith back or spine-------------

Amputationof extremitiesor limbs, or permanent

stiffnessor any deformityof foot, leg, fingers,

arm, or back--------------------------------------

Heart trouble--------------------------------------

None of the above----------------------------------

Primary diagnosisat last examination

Senility,old age, or other symptomsand illdefinedconditions-------------------------------

~t;;;eattack---------------------------------------

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

Hardeningof the arteries--------------------------

Diseasesof the circulatorysystem other than

hardeningof the arteries,stroke,and heart

attack--------------------------------------------

Accidents,poisonings,or violence-----------------

Mental disorders-----------------------------------

Diseases of the musculoskeletalsystem and

connectivetissue---------------------------------

Endocrine,nutritional,and metabolicdiseases-----

Diseasesof the respiratorysystem-----------------

Neoplasnw--------------------------- ---------------

Diseasesof the nervous system and sense organs----

Diseasesof the digestivesystem-------------------

Diseases of the.genitourinarysystem---------------

Other diagnoses3-----------------------------------

Unknown diagnoses ----------------------------------

Specialaid used

Crutches Braces Artificial Self- Other

limb feeder aids

0.9

0.6

*

1.?

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

Percent distribution~

1.6

1.0

1.2

*

;::

3.6

*

3.;

4.2

1.:

k

5.;

*

*

*

*

*

*

*

*

>Y

*

*

*

*

0.4

*

*

*

*

*

*

*

*

*

2.9

*

---

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

l.l

1.2

1.2

1.:

*

*

*

2.;

1.6

1.0

*

1.1

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

1.9

::;

2.:

2.8

*

*

;::

3.3

1.9

*

2.3

2.2

1.8

*

*

*

*

*

*

*

*

*

*

*

---

lFiguresmay not sm to total because residentsmay have used more than one sPecialaid.

‘Figuresmay not total to 100 percent because residentsmay have had more than one reported

conditionor impairment.

s~cludes diseases of the blood and blood-fo~ing organs, diseases of the skin and subcutaneoustissue, congenitalanomalies, infectiveand parasiticdiseases, certain causes of

pe&atal morbidity, complicationsof pregnancyand childbirth and other diagnosesnot listed

.

46
APPENDIXES

CONTENTS

I. Technical Notes on Method ..........................................................................................................

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

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

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

Sampfing Design ...............................................................................................................

Data Collection Procedures for 1973-74 National Nursing Home Survey ..........................

General QuaMications ............................................................................................................

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

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

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

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

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

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

Terms Relating to Residents and Health Status ......................................................................

Terms Related to Facilities ....................................................................................................

Types of Facilities Included in The Survey ......................................................................

Certification Status ..........................................................................................................

III. Resident Questionnaire Used in The 1973-74 National Nursing Home Survey ............................

LIST OF APPENDIX TABLES

L Dktribution of facilities in the 1973-74 National Nursing Home Survey universe and disposition

of sample facilities according to primary sampfing strata and bed size of facility: conterminous

United States ..............................................................................................................................

II. Data collection procedures ..........................................................................................................

III. Standard errors of percentages of residents .................................................................................

48

48

48

48

50

50

51

51

52

52

52

52

56

56

56

56

57

58

49

51

54

LIST OF APPENDIX FIGURES

L Relative standaxd error of estimated number of residents .............................................................. 53

47
APPENDIX I

TECHNICAL NOTES ON METHOD

SURVEY DESIGN

General

From August 1973 to April 1974 the

Division of Health Resources Utilization Statistics (DHRUS) conducted the National Nursing

Home Survey (NNHS)–a sample survey of

nursing homes and their residents 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.z O It was specifically designed as the first of

a series of surveys to satisfy the diverse data

needs of those who establish standards for, plan,

provide, and assess long-term care services.

Sampling Frame

The 1973-74 NNHS focused on nursing

homes which provided some level of nursing

care. Only facilities providing nursing care were

included because detailed questions on facility

services and resident health status were relevant

only to these facilities. They included both

nursing care homes and personal care with

nursing ‘homes, while personal care homes and

domiciliary care homes were excluded. Facilities

were either freestanding establishments or

nursing care units of hospitals, retirement

centers, and similar institutions. A definition of

nursing care and detailed criteria for classifying

facilities providing such care are presented in appendix II.

The survey universe consisted of two groups

of facilities: those providing some level of

nursing care as classified in the 1971 Master

Facility Inventory (MFI) and those opening for

business in 1972. The major group (93 percent)

was composed of all nursing homes providing

some level of nursing care as classified by the

1971 MFI. The MFI is a census of all inpatient

health facilities conducted every 2 years by mail

by the National Center for Health Statistics. A

detailed description of how the MFI was developed, its content, and procedures for updating and assessing its coverage has been

published.z l‘28

In order for data collection to begin in

August, the sampling frame was “frozen” in the

spring of 1973 so that the sample could be selected in ample time to permit the scheduling of

nationwide data collection. To obtain as current

a sample frame as possible, all nursing homes

which opened for business during 1972 were

also included in the universe. (Facilities opening

in early 1973 could not be included since data

about them were not yet available.) The facilities which opened in 1972 comprised the

second, and smaller (7 percent), group of facilities in the universe. Although the universe included only facilities providing nursing care, all

facilities opened in 1972 were included because

the level of nursing care they provided was unknown prior to survey. Once the NNHS was

conducted, facilities not meeting the criteria

were classified as out of scope (see table I for

details).

Although the NNHS was conducted in

1973-74, it should be noted that estimates will

not correspond precisely to figures from the

1973 MFI census for several reasons. In comparison to the MFI, the NNHS universe excluded

the following facilities: (1) personal care homes

4a
Table 1. Distribution of facilities in the 1973-74 National Nursing Home Survey universe and disposition of sample facilities according

to primary sampling strata and bed size of facility: conterminous United Statas

Certification status and size

of home

All types of strata .........................................

Both Medicare end Medicaid and

Medicare only ....................................................

Unknown number of baas ......................................

Less than 25 bads ....................................................

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

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

100-199 bads ..........................................................

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

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

500 beds or more ....................................................

Medicaid only ......... ............................................

Unknown number of beds .......................................

Less than 15 beds ....................................................

15.24 beds ..............................................................

2549 beds .............................. ................................

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

100-199 bads ..........................................................

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

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

500 beds or more ....................................................

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

Unknown number of beds .......................................

Less than 15 bads ....................................................

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

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

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

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

200.299 beds ..........................................................

300499 ..........................................................,,,.. ,..

500 beds or more ....................................................

17,685

4,099

2

149

538

1,713

1,385

224

68

20

7,473

3

250

967

2,253

2,688

1,108

145

43

16

6,113

19

1,279

1,062

1,575

1,334

652

120

52

20

Number of facilities in samde

Total

facilities

2.118

803

0

4

35

228

370

100

46

20

790

0

5

36

123

293

241

52

24

16

525

0

23

38

87

146

141

43

28

20

out of

scope or

out of

business

147

20

0

0

0

7

8

4

1

0

34

0

1

5

11

4

3

5

3

2

93

0

10

9

13

19

21

12

4

5

In scopa and

in business

Nonresponding

63

26

0

1

1

7

11

3

2

1

24

0

2

1

3

8

6

3

1

0

13

0

0

0

3

5

4

0

1

0

Responding

1,908

757

0

3

34

214

351

93

43

19

732

0

2

30

109

281

232

44

20

14

419

0

13

29

’71

121

116

31

23

15

lThe ~niver~e ~on~~ted of ~ursing homes p~~vidingsome level of nursing care as classified in the 1971 MFI and those opened for

business in 1972

49
and domiciliary care homes, (2) facilities which

opened in 1973, and (3) facilities which, between 1971 and 1973, upgraded the level of care

they provided, thereby meeting the “nursing

care” criteria when surveyed in the 1973 MFI.

Data from the NNHS are also subject to

sampling variability, while data from the MFI

are not since the MFI is a census.

Sampling Design

The sampling was a stratified two-stage probability design: The first stage was a selection of

establishments and the second stage was a selection of residents and employees of the sample

establishments. In preparation for the first-stage

sample selection, establishments listed in the

MFI were sorted into the following types of

strata based on Medicare and Medicaid certification: (1) Both Medicare and Medicaid! and

Medicare only, (2) Medicaid only, and (3) Not

certified. Facilities in each of these three strata

were sorted into bed size groups, producing 26

primary strata as shown in table I. The nursing

homes in he universe were ordered by type of

ownership, geographic region, State and county.

The sample was then selected systematically

after a random start within each primary

stratum. Table I shows the distribution of establishments in the sampling frame and the final

disposition of the sample with regard to response and in-scope status. The number of facilities estimated in the survey (15,749) is less than

the universe figure (17,685) because some facilities went out of business or out of scope

between the time the universe was “frozen” and

the survey was conducted. Differences ranging

from 2,100-2,900 between survey estimates and

universe figures occurred in the 1963,24 19642 E

and 196926 nursing home surveys for the same

reason.

The second-stage selection of residents and

employees was carried out by the interviewers at

the time of their visits to the establishments in

accordance with specific instructions given for

each sample establishment. The sample frame

for residents was the total number of residents

on the register of the establishment on the evening prior to the day of the survey. Residents

who were physically absent from the facility due

to overnight leave or a hospital visit but had a

bed maintained for them at the establishment

were included in the sample frame. An average

of 10 residents per facility were in the sample.

The sampling frame for employees was the

Staff Control Record, on which the interviewer

listed the names of all staff employees (including

those employed by contract) and sampled professional, semiprofessional, and nursing staff.

Those generally not involved in direct patient

care, such as office staff and food service, housekeeping, and maintenance personnel were excluded from the sample. The interviewer used

predesignated sampling instructions that appeared at the head of each column of this form.

An average of 14 persons per faclity were in the

sample.

Data Collection Procedures for 1973-74

National Nursing Home Survey

Th; 1973-74 NNHS utilized the following

questionnaires and forms:

Administrator Letter and worksheet

Facility Questionnaire

Expense Questionnaire

Resident Control Record

Resident Questionnaire

Staff Questionnaire–Parts I and II

Staff Control Record

(See appendix III for a copy of the Resident

Questionnaire. For all other data collection instruments, see reference 27,)

Data were collected according to the following procedures:

1. A letter was sent to the administrators of

sample facilities informing them of the

survey and the fact that an interviewer

would contact them for an appointment.

On the back of the letter was a worksheet which the administrator was requested to fill out prior to the

interviewer’s visit. This worksheet asked

for those data that required access to

records and some time for compiling

(such as total admission and discharges,

and inpatient days of care). Included

with this introductory letter were letters

o f endorsement from the American

50
Nursing Home Association and the

American Association of Homes for the

Aging urging the administrators to participate in the survey.

2. Several days to 1 week after the mailing

of the letters, the interviewer telephoned

the sample facility and made an appointment with the administrator.

3. At the time of the appointment the Facility Questionnaire was completed by

the interviewer who interviewed the

administrator or owner of the facility.

Atter completing this form, the interviewer secured the administrator’s permission to send the Expense

Questionnaire to the facility’s accountant. (If financial records were not

kept by an outside firm, the Expense

Questionnaire was filled in by the administrator with the interviewer present. )

The interviewer completed the Staff

Control Record (a list of all current

employees both full- and part-time), selected the sample from it and prepared

Staff Questionnaires, Parts I and II, which

were left for each sample person to complete, seal in addressed and franked

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

completed the Resident Control Record

(a list of all residents currently in the

facility), selected the sample of residents

from it, and filled in a Resident Questionnaire for each sample person by

interviewing the member of the nursing

staff familiar with care provided to the

resident. The nurse referred to the resident’s medical records. No resident was

interviewed directly.

If the Expense Questionnaire was not returned within 2 weeks, the interviewer telephoned the accountant, requesting its prompt

return. If the Staff Questionnaires were not returned in 1 week, the interviewer contacted the

staff member and requested the return of the

form.

Table II presents a summary of the data collection procedures.

Table 11. Data collection procedures

Questionnaire

Facility ............

Expense ...........

Resident ...........

Staff .................

Respondent

Administrator

Facility’s accountant

Member of nursing staf

familiar with care

provided to the residen

and with access to

resident’s medical

records (1 O samples

residents per facility )

Sampled staff member

(14 per facility)

Interview

situation

Personal intarview

Self-enumerated

questionnaire

Personal intarview

Self-enumerated

questionnaire

GENERAL QUALIFICATIONS

Nonresponse and Ireputation

of Missing Data

Response rates differed for each type of

questionnaire as indicated below:

Questionnaire Response rate

Facility ............................................... 97percent

Expense ............................................. 88 percent

Resident ............................................ 98 percent

Staff .................................................. 82 percent

Generally response rates were higher for

questionnaires administered in a personal interview situation (facility and resident) as compared to those which were self-enumerated

(expense and staff). Statistics presented in this

report were adjusted for failure of a facility to

respond. Data were also adjusted for nonresponse which re suited from failure to

complete one of the questionnaires (expense,

resident, staff) or from failure to complete an

item on a questionnaire. Those items left unanswered on a partially completed questionnaire

(facility, expense, resident, staff) were generally

51
imputed by assigning a value from a responding

unit with major characteristics identical to those

of the nonresponding unit.

Rounding of Numbers

Estimates of residents have been rounded to

the nearest hundred. For this reason detailed

figures within tables do not always add to totals.

Percents were calculated on the basis of unrounded figures and will not necessarily agree

precisely with percents which may be calculated

from rounded data.

Data Processing

A series of checks were performed during

the course of the su~ey. This included field followups for missing and inconsistent data, some

manual editing of the questionnaires, extensive

editing conducted by computer to assure that all

responses were accurate, consistent, logical, and

complete. Once the data base was edited, the

computer was used to calculate and assign

weights, ratio adjustments, and recodes and for

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 establishments and establishment data not related to size

are inflated by the reciprocal of the probability y

o f selecting the sample establishment and

adjusted for the nonresponding establishments

within primary certification-size strata. Two

ratio adjustments, one at each stage of selction,

were also used in the estimation process. The

first-stage ratio adjustment (along with the

above inflation factors) was included in the estimation of establishment data related to size,

resident data, and staff data for all primary certification-size strata from which a sample of facilities was drawn. The numerator was the total

beds according to the Master Facility Inventory

data for all facilities in the stratum. The denominator was the estimate of the total beds obtained through a simple inflation of the Master

Facility Inventory data for the sample homes in

the stratum. The effect of the first-stage ratio

adjustment was to bring the sample in closer

agreement with the known universe of beds. The

second-stage ratio adjustment was included in

the estimation of resident and staff data within

establishments. The second-stage ratio adjustment is the product of two fractions —the first is

the uninverse of the sampling fraction for residents (or staff) upon which the selection is

based; the second is the ratio of the number of

sample residents (or staff) in the establishment

to the number of residents (or staff) for whom

questionnaires were completed within the facility.

RELIABILITY OF ESTIMATES

As in any survey, the results are subject to

reporting and processing errors and errors due to

nonresponse. To the extent possible, these types

of errors were kept to a minimum by methods

built into survey procedures.

Since statistics presented in this report are

based on a sample, they will differ somewhat

from figures that would have been obtained if a

complete census had been taken using the same

schedules, instructions, and procedures.

The standard error is primarily a measure of

the variability that occurs by chance because

only a sample is surveyed rather than the entire

universe. The standard error also reflects part of

the measurement error, but it does not measure

any systematic biases in the data. It is inversely

proportional to the square root of the number

of observations in the sample. Thus as the

sample size increases, the standard error generally decreases.

The relative standard error of an estimate is

obtained by dividing the standard error of the

estimate by the estimate itself and is expressed

as a percentage of the estimate. According to

NCHS standards, reliable estimates are those

which have a relative standard error of 25 percent or less. For example, figure I shows ‘the

relative standard errors for the estimated

number of residents. For a relative standard

52
Figure1. RELATIVE STANDARD ERROR OF ESTIMATED NUMBER OF RESIDENTS

r.n

w

1-

2

Lu

0

m

u

Q

z

cc

0

m

a

I.1.l

n

a

a

n

z

<

$

Lu

>

10J

80

70

60

50

40

30

20

18

8

7

6

5

4

3

2

1

:;

.7

.6

.5

.4

.3

.2

.1

$~“// ,

, 1 l\ t , I , , , r -1. .

+

I 1 1 w I I r ----t - f I I

I

I I I I 1- <1 I I I

r-. 1 1 I 11 1I 1 lx II I 1 1 I Imr r

t I I , , I I 1 I 1 I 1 t-l+iw , 1 1 1 , r 1 1 t 1 1111,111 # , 1 I 1 [ I I , & 11111111 [ 1 1 i 1 1 1 1 # , t 111111, 1 1 1 [

w80

70

60

50

- 40

30

20

~ ; : : ; : ;-:

10

9

8

7

-6

-5

4

-3

-2

; .1

-.8

-,7

-.6

-.5

-.4

-.3

- -.2

.1

A 2 3456789A 2 3456789A 2 345678’A 2 34’’’A’A

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

SIZE OF ESTIMATE

Illustration of use of fkure I. As shown in table 9, a walker was used by an estimated 156,400 residents in 1973-74. The relative . .-”

standard error of this estimate as read in figure I is approximately 2.90 percent, and the standard error is 4536 (2.90 percent of

156,400).
error of 25 percent or less, the minimum

number of residents IS 2,300. Thus resident estimates must be 2,300 or larger in order to meet

the standards of reliability. In tables in this report asterisks are shown for any cell with a

number of less than 2,300 or a percentage which

represents a number less than 2,300, i.e., with

more than a 25-percent relative standard error.

Because of the relationship between the relative standard error and the estimate, the standard error of an estimate can be found by

multiplying the estimate by its relative standard

error. Both values can be determined from the

curve in figure I. For example, table 2 shows

that the total number of residents with a primary diagnosis of stroke was 113,400. The relative standard error corresponding to this

estimate in figure I is approximately 3.40 percent. The standard error is 113,400 x (.0340) =

3856. The chances are about 68 out of 100 that

an estimate from the sample differs from the

value which would have been 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 1/2

times as large.

The standard errors of percentages of residents are presented in table III. For example,

about 36 percent of the 318,100 male residents

were depressed once a week or less (table 4).

Linear interpolation between values in table III

yields an approximate standard error of 1.03

percent. Thus the chances are 95 out 100 that

the estimate is contained in the interval 36 percent *2. O (1.03 percent) (i.e., between 33.9 percent and 38.1 percent) and 99 out of 100 for

the interval 36 percent *2.5 (1.03 percent) (i.e.,

between 33.4 percent and 38.6 percent).

Statistical tests to determine whether the

differences between selected characteristics are

statistically significant can be performed by

Table I I 1. Standard errors of percentages of residents

Base of estimated percent

(number of residents)

2,000 .....................................

4,000 .....................................

6,000 .....................................

8,000 .....................................

10,000 ...................................

20,000 ...................................

30,000 ...................................

40,000 ...................................

50,000 ...................................

60,000 ..................................,

70,000 ...................................

80,000 ...................................

80,000 ...................................

100,000 .................................

200,000 .................................

300,000 .................................

400,000 .................................

500,000 .................................

600,000 .................................

700,000 .................................

800,000 .................................

900,000 .................................

1,000,000 ..............................

1,100,000 ,.,,,,,...,.. ,.,..,,.. ........

1 or 99

2.69

1.90

1.56

1.35

1.21

0.85

0.70

0.60

0.54

0.49

0.46

0.43

0.40

0.38

0.27

0.22

0.19

0.17

0.16

0.14

0.13

0.13

0.12

0,10

2 or 98

3.79

2.68

2.19

1.90

1.70

1.20

0.98

0.85

0.76

0.69

0.64

0.60

0.57

0.54

0.38

0.31

0.27

0.24

0.22

0.20

0.19

0.18

0.17

0.17

5 or 95

5.90

4.17

3.41

2.95

2.64

1.87

1.52

1.32

1.18

1.08

1.00

0.93

0.88

0.83

0.59

0.48

0.42

0.37

0.34

0.32

0.30

0.28

0.26

0.24

Estimated percent

100r90

8.12

5.75

4.69

4.06

3.fi3

2.57

2.10

1.82

1.62

1.48

1.37

1.28

1.21

1.15

0.81

0.66

0.57

0.51

0.47

0.43

0.41

0.38

0.36

0,35

20 or 80

10.63

7.66

6.25

5.42

4.84

3.43

2.80

2.42

2.17

1.98

1.83

1.71

1.61

1.53

1.08

0.88

0.77

0.69

0.63

0.58

0.54

0.51

0.48

0.46

30 or 70

12.41

8.78

7.17

6.21

5.55

3.92

3.20

2.78

2.48

2.27

2.10

1.96

1.85

1.76

1.24

1.01

0.88

0.78

0.72

0.66

0.62

0.59

0.56

0.53

40 or 60

13.27

9.38

7.66

6.63

5.93

4.20

3.43

2.97

2.65

2,42

2.24

2.10

1.98

1.88

1.33

1.08

0.94

0.84

0.77

0.71

0.66

0.63

0.59

0.57

50

13.54

9.58

7.82

6.77

6.06

4.28

3.50

3.03

2.71

2.47

2.29

2.14

2.02

1.92

1.35

1.11

0.96

0.86

0.78

0.72

0.68

0.64

0.61

0,57

Dlustration of use of table IL In the text it was noted that about 36 percent of the 318,100 male residents in the United States were reported to act depressed at least once a week. Linear interpolation between values shown in table II will yield an approximate standard

error of 1.03 percent for an estimate of 36 percent with a baae of 318,100.

54
examining the confidence interval for the difference of the estimates in question. If the

confidence interval does not overlap with zero,

the estimates are considered statistically different. This test can be used, for exampIe, to

determine if the rate of depression is greater for

females than for males. Of the 757,700 female

residents, 40.2 percent were reported to act

depressed at least once a week. The approximate

standard error of this estimate is 0.68 percent

(from table III). Similarly, the standard error of

the 35.9 percent of the 318,000 males reported

to act depressed at least once a week was 1.02

percent.

- The standard error of a difference is approximately the square root of the sum of the

sauares of the standard errors of each of the .

estimates. In other

two estimates,

words, letting X and Y be the

S.E. (X–Y) =~S.E.2 (X) + S.E.’(Y)

(This formula will represent the actual standard

error quite accurately for the difference between separate and uncorrelated characteristics, although it is only a rough approximation

in most other cases.)

Thus the standard error of the difference of

the two percentages is approximately

S.E. (40.2% – 35.9%) = /(1.02)2 + (.68)2

-.—-

S.E. (4.3%) = 1.23

Since the confidence interval of the difference

(4.3 percent f 1.96 (1.23)) does not overlap

with zero, the chances are 95 out of 100 that

the rate of depression is greater for females than

for males. In 95 out of 100 cases the difference

between the percentages will be positive

between 1.9 and 6.7 percentage points.

—ooo —

and lie
APPENDIX II

DEFINITIONS OF CERTAIN TERMS USED IN THIS REPORT

TERMS RELATING TO

RESIDENTS AND HEALTH STATUS

Resident. –A person who had been formally

admitted but not discharged from an establishment was a resident. All such persons were

included in the survey whether or not they were

physically present in the facility at the time of

the survey.

Age. –Age at date of survey was age of resident.

Reported chronic conditions and impairments. —A reported condition was considered to

be the affirmative response by the respondent to

any and all categories of item 9 of the Resident

Questionnaire. The respondent, who was the

nurse most familiar with the care provided to

the resident, reported the existence of these

chronic conditions and impairments from knowledge of the resident’s health and a check of the

resident’s medical record.

Primary diagnosis. –The primary diagnosis

was the one condition reported by the respondent in response to item 8 of the Resident Questionnaire. The list of conditions corresponds to

the ICDA.8 With the assistance of the interviewer, the respondent was instructed to extract

from the resident’s medical record the primary

diagnosis recorded at the last examination and at

admission.

Special aid. –A special aid is a device used to

compensate for defects resulting from disease,

injury, impairment, or congenital malformation.

Aids included in the survey were wheelchairs,

walkers, crutches, braces, artificial limbs, selffeeders, and other aids as were specified in item

10 of the Resident Questionnaire.

Behavioral pro blem. –A behavioral problem

referred to the respondent’s report that the resident exhibited any of the following behaviors:

depressed, agitated or nervous, abusive or aggressive, confused or senile, disturbed sleep, and

other problems.

TERMS RELATED

TO FACILITIES

Types of Facilities Included

in the Survey

Institutions included in the 1973-74

National Nursing Home Survey were those classified as either nursing care homes or personal

care homes with nursing according to data collected in the 1971 Master Facility Inventory

Survey29 conducted by the National Center for

Health Statistics.

Definitions for these two classes of nursing

homes were as follows:

Nursing Care Home

● Fifty percent or more of the residents received nursing care during the week prior to

the survey. (Nursing care is defined as the

provision of one or more of the following

services: taking temperature, pulse, respiration; or blood pressure; full bed bath; application of dressings or bandages; catheterization; intravenous, intramuscular, or

hypodermic injection; nasal feeding; irrigation; bowel and bladder retraining; oxygen

therapy; and enema.)

w
. At least one ftdl-time (35 or more hours per

week) registered nurse (RN) or licensed practical nurse (LPN) was employed.

Personal Care Home with Nursing

● Some, but less than 50 percent, of the

residents received nursing care during the

week prior to the survey.

. At least one full-time RN or LPN was employed.

or

. Some of the residents received nursing care

during the week prior to the survey.

● No full-time RN or LPN was employed.

. The institution either:

Provided administration of medicines or

supervision over self-administered medicines,

or

Provided assistance with three or more

activities for daily living (such as help

with tub bath or shower; help with dressing, correspondence, or shopping; help

with walking or getting about; and help

with eating).

Certification Status

Medicare. –Refers to the medical assistance

provided in Title XVIII of the Social Security Act. Medicare is a health insurance program administered by the Social Security

Administration for persons aged 65 and

older who are eligible for benefits.

Medicaid. –Refers to the. medical assistance

provided in Title XIX of the Social Security

Act. Medicaid is a State-administered program for the medically indigent.

Skilled nursing home (SNH). –Refers to

certification as a skilled nursing home

under Medicaid.

Intermediate care facility (ICF). –Refers

to certification as an intermediate care

facility under Medicaid.

Not certified. –Refers to facilities which

are not certified as providers of care

either by Medicare or Medicaid.

57
APPENDIX Ill

RESIDENT QUESTIONNAIRE USED

IN THE 1973-74 NATIONAL NURSING HOME SURVEY

.

RESIDENT QUESTIONNAIRE

1973 Nursing Home Survey =

National Center for Health Statistic

Health Resources Administration

Rockville, Maryland

1-7

ASSURANCE OF CONFIDENTIALITY – All information which would permit identification

ESTABLISHMENT NO.

of tha indivkfuel will be held in strict mnfkfence, will be uaad only by persons engegad in and for

the purposes of the survey, end will not ~ disclosed or released to others for any purposes.

mz

LINE NO,

I

cc14-1

ccl 1

1. WHAT IS – DATE OF BIRTH?

nnn”rn

Month Day Yeer ,ALIE

ccl 5,16 17, 18 19-21 (x22-24

2. WHAT IS – SEX? ❑ Male ~ Female

25-1

3. WHAT IS –-ETHNIC BACK- 261 ❑ Caucation -2 ❑ Negro -3 ❑ Oriantal

GROUND? (Mark (X) Only

one box) -4 ❑ Spanish American -5 ❑ American I mlian -6 ❑ Other

4. WHAT IS – CURRENT MARITAL 27-1 ❑ Marriad -2 Q widowed -3 ❑ Divorced

STATUS? (Mark (X) only

one box) 4 ❑ Sepamted -5 ❑ Navar Marriad

5. WHAT WAS THE DATE OF – CURRENT ADMISSION TO THIS PLACE?

non

Month Oay Yeer

m28. 29 3(k31 32-34

6a. WHERE DID – LIVE AT THE TIME OF ADMISSION? (Mark (X) ~lYOflEbOX)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

In a boarding home 35-1

In enothaf nursing home or related facility -2

In e mental hoepital or other long-term specielty hospital -3

In a general or short-stay hoepltal 4

In a private apartment or house -5

Other place, (Specify) -6

s

Don’t know -7

•1

s

6b. AT THE TIME OF ADMISSION

❑

DID – LIVE WITH: (Mark (X)

ell thet epply)

•1

•1

•1

•1

(1)

(2)

{3)

(4)

(5)

(6)

spouse? 37-1

Children? 38-1

Other relatives? 39-1

Unreletad persons? 40-1

Livad alone? 41-1

Don’t know? 42-1

i’. WHAT IS THE PRIMARY REASON FOR – ADMISSION TO THE HOME? (Enter “l” in box for primary raason; if secondary

reason given, enter “2”,)

‘w-a

Wn

45- ❑

46-D

Form 73N I-W-?

58

Physical reasons (e.g., illness or need for treatments)

Social reasons (e.g., no femily, or lack of family interast)

Behavioral reescms (e.g., disruptive behwior, mantel detafiomtion)

Economic reasons (e.g., no money amdlor resourcas)
8. WHAT WAS THIS RESIDENT’S PRIMARY DIAGNOSIS: (Mark (X) only one box in each column)

a. AT ADMISSION? b. AT THE TIME OF–LAST EXAMINATION?

49,50 •l aOl 51,52 ❑ bOl

•l a02 ❑ b02

❑ .03 ❑ b03

•1 4)4 ❑ b04

•1 ?05 ❑ b05

•1 ,(F3 ❑ b06

•1 ,07 ❑ b07

•1 ao9 ❑ b08

•l a09 ❑ b08

•1 ,10 ❑ b10

•1 ,11 ❑ bll

•l a12 ❑ b12

•l a13 ❑ b13

•1 a14 ❑ b14

•1 ,15 ❑ b15

❑ .16 ❑ b16

•l a17 ❑ b17

❑ a18 ❑ b18

•1 aI19 ❑ b19

•1 a20 ❑ b20

•1 *21 ❑ b21

\

a22 ❑ b22

Specify:

Senility, old age, and other symptoms and illdefined conditions (e.g., coma, uremia)

Heart attack (e.g., ischemtc heart disaass)

Stroke (e.g., cerebrovascular dissssss)

Hardening of arteries (e.g., arteriosclerosis, diwasss of the arteries, arerioles, capillaries)

Other diseases of the cmwkrtory system (e.g., NOT heart attack, stroke, or hwdening of the arteriss)

Accidents, poisonings, and violence (e.g., fracture of hip, other broken bones, burns, concussion)

Mental disorders (e.g., mental retardation, psychoses, neuroses, mental illness, emotional problems)

Diseases of the musculoskeletat system and connective tissue (e.g., arthritis, rheumatism, back pain)

Endocrine, nutritional, and metabolic diseases (e.g., ~iter, diabetes, gout)

Diseases of the respiratory system (e.g., pneumonia, smphysema)

Neoplasms (e.g., cancer, tumors)

Diseaws of the nervous system and sense organs (e.g., Parkinson’s disesae, glaucoma, catarwts,

blindness, multiple sclerosis, spastic paralysis, epilepsy)

Oiseass of the digestive system (e.g., cirrhosis of liver, ulcer, intestinal obstruction)

Infective and parasitic diseases (e.g., T.B., polio, syphilis)

Diseaaes of the genitourinary system (e.g., nephrosis, chronic pelvic infection, hyperplasia of prostate)

Diseases of the skin and subcutaneous tissue (e.g., cellulitis, abscess, chronic ulcer)

Diseases of the bload and blood-forming organs (e.g., anemia)

Congenital anomalities (e.g., hydrocephalus)

Complications of pregnancy, childbirth and the puerperium (e.g., infections,hemorrhage, toxemias)

Certain causas of peritmtal morbidity and mortaliw (e.g., birth injury or immaturity of infant)

Don’t know

Othar (Specify) 54-

53-

9. DOES - HAVE ANY OF THE FOLLOWING CONDITIONS OR IMPAIRMENTS? (Mark (X) all that apply)

CC55-65 -1 ❑ a.

-2 •1 b,

“3 •1 c.

-4 ❑ d.

“5% e. (1) IS THIS THE RESULT OF A STROKE?

Senility (includes decline in intellect, memory, and judgement, loss of orientation, difficulty in speaking; feebleness.)

Mental illness (Psychiatric or emotional problems)

Mental retardation

Arthritis or rheumatism

Paralyais or palsy other than arthritis

❑ Yes

65-1

-6 ❑ f. Glaucoma or cataracts

-7 •1 g. Diabetes

-B ❑ h. Any CHRONIC trouble with back or spine

-9 •l i. Amputation of extremities or limbs; or permanent stiffness or any deformity of the foot, leg, fingsrs, arm, or bsck

.0 •l i. Heart trouble

OR

-auk Resident has none of the above conditions or impairments

Form 73N HS-7

59
10, DOES THIS RESIDENT REGULARLY USE ANY OF THE FOLLOWING AIDS?

CARD 2

No

14-2 a. Walker 15-2❑

b. Crutches 16-2 ❑

c. Braces 17-2 ❑

d. Wheelchair ‘fs-2 ❑

e. Artificial Limb 19-2 ❑

f. Self-feeder 20-2 ❑

9. Any other aids (do not count glaam or hearing aids) 27-2 ❑

Yes

-1 •1

“1 •1

-1 •1

-f ❑

-1 •1

-1 •1

-1 ‘i

Specify 22-

11. DURING THE LAST MONTH, HOW MANY TIMES DID–RECEIVE ANY OF THE FOLLOWING THERAPY SERVICES? (INCLUDE

ONLY SERVICES PROVIDED BY A LICENSED OR REGISTERED PROFESSIONAL WHETHER INSIDE OR OUTSIDE THE klOME.)

NUMBER OF

TIMES

a.

b.

c.

d.

e.

f.

Physical therapy

Recreational therapy

Occupational therapy

Speech therapy

Hearing therapy

Profeselonal counaellng by social

worker, psychologist or other

mental health worker

❑ Nmeor [ I

CC23

❑ Nonaor I I

m25

❑ Nmeor 1 ce27

❑ None or I J CC29

❑ None or 1

CC31

❑ None or I 1

CC33

12. DURING THE PAST 7 DAYS, WHICH OF THESE SERVICES DI D–RECEIVE? (Mark (X) aII that appIy)

Form 73NHS-7

60

CC35-62 -01 ❑ a.

-02 ❑ b.

.03 ❑ c.

-04 ❑ d.

-05 ❑ e.

-m ❑ f.

-07 fJ g.

-W ❑ h.

-03 ❑ i.

-lo ❑ j.

-11 ❑ k.

-12 ❑ 1.

-13 f-J m,

OR

-14 ❑ “.

f!

Rub or macsage

Administration of treatment by staff

Special diet

Application of sterile dressings or bandagea

Temparaturspulaeweapiration

Full bed-bath

Enema

Catheterization

Blood prassure reading

Irrigation

Oxygen therapy

Intravenous injection

l-lypodermic injection

None of the above sewices raceived
13. DURING THE PAST 7 DAYS, DID – RECEIVE ANY MEDICATIONS?

CARCJ 3

T

‘g ‘“(sk~ ‘es

WHICH TYPES OF MEDICATIONS DID – RECEIVE? (Mark (X) All That Apply)

CC16-45 -01 ❑ a.

.02 ❑ b,

-03 ❑ c.

-04 ❑ d.

-05 ❑ e,

-06 ❑ f,

-07 ❑ g.

-fM ❑ h.

-09Hi.

.10 ❑ j.

-11 ❑ k.

-12 ❑ L

-13 ❑ m,

-14 ❑ n.

-15 ❑ o.

Tranquilizers (e.g., Thorazine, Mellarll)

Hypnotics - Sedatives (e.g., Nembutal, Seconal, Phenobarbital, Butisol, Plecidyl, Chloral Hydrate)

Stool softenars (e.g., Pari-COlaca)

Anti-Depressant (e.g., E Iavil)

Anti-Hyparten$ives (e.g,. Iemelin)

Diuretics (e.g., Diuril, Esidrex)

Analgesics (e.g., Aspirin, Darvun, Demerol, Percodan, Empirin with Codeine)

Diabetic agents (e.g., Orinase, Ineulin)

Anti-inflammatory agents (e.g., Cortisone, Sodium Salicylate, Butazolidin, Indocin)

Anti-infactives (i.e., antibiotics)

Anti-Anginal drugs (e.g., Nitroglycerin, Peritrate)

Cardiac G Iycosides (e.g., Oigitalis, Lanoxin)

Anti-Coagulante (e.g., Dicumarol, Warfarin)

Vitamins or iron

Other types of medications no: listed above

14. THE FOLLOWING ACTIVITIES FOR DAILY LIVING LIST VARIOUS LEVELS OF CARE THAT MAY BE NEEDED BY A

RESIDENT. PLEASE INDICATE THE ONE THAT BEST DESCRIBES THE LEVEL OF CARE NEEDED BY~RESIDENT.

FOR EACH ACTIVITY, THE LEVELS ARE GIVEN IN ASCENDING ORDER: IN OTHER WORDS, THE LEVEL DESCRIBING

THE MINIMUM CARE IS FIRST AND THE LEVEL DESCRIBING THE MOST CARE IS LAST. IF YOU ARE UNDECIDED

WHICH OF TWO LEVELS TO INDICATE, CHOOSE THE ONE DESCRIBING THE LESSER AMOUNT OF CARE:

a. CONSIDERING THE FOLLOWING FOUR HYGIENE ACTIVITIES (WASHING FACE AND HANDS, BRUSHING TEETH OR

DENTURES, COMBING HAIR, AND SHAVING OR APPLYING MAKE-UP) DOES THIS RESIDENT:

(Mark (X) Only One Box)

46-1 ❑

-2 ❑

= •1

“4 •1

-5 •1

Perform all four with no assistance?

Perform all four with no aaeiatance, but naack help in getting andlor putting away aquipment?

Perform three or four with no assistance, but requires help with a complete bath?

Raquire asslstanw with one or two of theaa hygiene activities?

Raquire assistance with all four of thesa hygiene activities?

b. CONCERNING DRESSING, DOES THIS RESIDENT:

(Mark (X) Only One Box)

47-1 ❑ Get clothes from cloaexs and drawers and completely draaa without assistance?.

‘2 ❑ ~t clOthes from d05EtS and drawers and completely dress with some assistance (tying shoes, fastening bracas, closing buttons Or

ztppera in back of garments)?

‘3 ❑ Reeeh a~istenceinWttin9 clothes, or in dressing (do not count tying shoes, fastening braces, closing buttons or zippars in back

of garments as assietanca)?

‘4 ❑ StaY Pa~lY or COmpl@ely undressad?

o. CONCERNING FEEDING, DOES THIS RESIDENT:

(Mark (X) Only One Box)

4s-1❑

-2 ❑

-3 •1

-40

-6 ❑

Feed self without easiatence?

Faad zalf with minor aaaiatance (cutting maat or buttering bread)?

Receive major assistance in faading (do not count cutting meat or buttering bread)?

Require intravenous faading?

Requlra tube fesding?

Form 73NHS-7

61
d. CONCERNING AMBULATION TO REACH THE TOILET ROOM, IS THIS RESIDENT:

(Mark (X) Only One Box)

51-1 ❑ Able to go to the toilet room without nurses’ assistance (may use cane, walker, wheelchair, or other object of support), may

manage bedpan or commode at night?

_—

‘2 ❑ Receiving nurs~’ *i5tanCe in 90in9 to the toilet room (do not count IMI of WOW, walker, Or otw object of SUppo~),

using bedpan or commode at night, or cleaning self or arranging clothes after elimination?

‘3 ❑ Unable to w to the toilet room for the elimination prc,c.ess?

e. CONCERNING MOVING IN AND OUT OF A BED OR CHAIR, IS THIS RESIDENT:

(Mark (X) Only One Box)

Receiving no assistance? 52-1 ❑

Walking with assistance of one person? -2 •1

Walking with assistance of two persons? -3 •1

UP in a chair with assistance once in 8 hours?

)

-4 ❑

UP in a chair with assistance twice in 8 hours?

8edfast with assistance in turning every two hours?

-5 ❑

F

e.(1) DOES – HAVE

-6 ❑ BED SORES?

Bedfast with assistance in turning every hour? -7 ❑J

f. CONCERNING CONTINENCE, IS THIS RESIDENT:

In control of both bowels and bladder?

An ostomy patient?

In control of bladder only?

In control of bowels on] y?

Not in control of bowels or bladder?

53-1

Y ‘es ?

No

(co;tinue with p&t f.)

(Mark (X) Only One Box)

54-1 H

-2 ❑

F

-3 •1

-4 ❑ f.(1) IS – RECEIVING BOWEL AND/OR

BLADDER RETRAINING?

“5 ❑ 55-1 ❑ Yes (Skip to Question 15aJ

-2

t

No

f.(2) WOULD RETRAINING GIVE THIS

RESIDENT CONTROL OVER

BOWELS ANDIOR BLADDER?

❑ Yes ~ No ~ Doubtful

56-1

15a. DOES THIS RESIDENT EXHIBIT 4NY OF THE

FOLLOWING BEHAVIOR?

b. DOES THIS RESIDENT EXHIBIT THIS BEHAVIOR

MORE OFTEN THAN ONCE A WEEK OR ONCE A WEEK

No

(1) Depressed 57-2 ❑ -1

(2) Agitated, nervous 59-2 ❑ -1

(3) Abusive, aggressive 61-2 ❑ -1

(4) Confused, senile 63.2 ❑ -1

(5) Oisturbed sleep 65-2 ❑ -1

(61 Other problem behavior 87-2 ❑ -1

OR LESS?

Yes

—

& (Specify) 68-

More often than

once a week

58-1 ❑

60-1 ❑

62-1 ❑

64-1 ❑

66-1 ❑

~ 69-t ❑

Once a week

or less

“2 •1

-2 •1

-2 •1

-2 •1

-2 •1

“2 •1

Form 73NHs-7

62
168.

CARD 4

144

b,

c.

d.

‘iz--

b.

DURING THIS RESIDENT’S STAY HERE, WHEN DID - LAST SEE A PHYSICIAN FOR TREATMENT, MEDICATION, OR FOR

AN EXAMINATION?

Month DaY ,Year

J==J= ‘R “ ‘“e”’””””’

Has Nsver Seen A Doctor While Here (Skip to

AT THAT TIME, DID - RECEIVE:

Yea

(1) An examination? 22-1 ❑ “2 B

(2) Traatment? 23-1 ❑ -2 •1

(3) Prescription? 24-1 ❑ -2 •1

(4) Other? 25-1

%

“2 •1

Specify 2sDID THE PHYSICIAN ATTEND THE RESIDENT: (Mark (X) OIW one BOX)

27-1 ❑ m a private physician?

‘2 ❑ fOr the =itzdf which fumishas the medical CWe?

.3 ❑ temporarily as a replacement for the rasident’s private physician who was unable to attend the raaident?

-4 ❑ undar some other arrangement? (SPaeifY) 28-

DOES A PHYSICIAN EXAMINE THIS RESIDEN :

{ (Merk (X) ONyOneBox)

28-1 H only when called?

“2 ❑ ime9ularlY, but without being died?

-3

\

on a echadule-d basis?

d. (1) HOW OFTEN DOES THE PHYSICIAN EXAMINE THE RESIDENT?

(Merk (X) OnlyOneBox.)

3@-1 ❑ once e weak

-2 ❑ awry 2 waaks

-3 H once a month

-4 ❑ avery thrae months

-5 ❑ once a year

-S ❑ other (Speoify) 31-

DOES - WEAR EYE GLASSES?

Yac No

v’ 32-1 7

-2

1S - SIGHT WITH GLASSES: (Mark (X) Only Ona Box) C. IS – SIGHT: (Mark (X) OnlyOnaBOXI

33-1 ❑

“2 •1

-3 •1

I 40

I

not impairad? (e.g., can read ordinary newepsper 33-1 ❑

print)

partially impairad? (e.g., cen watch television 8 to -2 •1

12 feet across the room)

severely impaired? (e.g., can recognize the features “3 •1

of familiar parsans if they are within 2 to 3 fast)

not impaired? (e.g., can read ortitnav nawwepar

print without glassas)

partielly impaired? (e.g., can watch television 8 to

12 feet across the room)

severely impaired? (e.g., can recognize the featur=

of familiar p.mons if they are within 2 to 3 feet)

completely lost? (e.g., blind) -4 ❑ COmPlat.lY lost? (.3.% blind)

18a. DOES - USE A HEARING AID?

Yes

34-1 9 “b. IS–HEARING WITH A HEARING AID:

(Mark (X) Only One BOX)

35.1 ❑

“2 ❑

-3 •1

40

No

%’ -2

c. IS –HEARING: (Mark (X) Only One Box)

not impaired? (a.g., can haar a telephOne ~nver=tiOn 354 ❑

on an ordinsry telephone)

partially impeirad? (a.g., ean haar most of the things -2 •1

a person ssys)

ssverely impdrd? (e.g., an haar only a few words a “3 •1

parson says or loud noisas)

completely lost? (e.g., daaf) -40

not impairad? (e.g., csn hear a telephone converestion

on an ordinary telephone)

pertially impakad? (a.g., can haar most of the thiw!s

a person ssys)

severely impsirsd? (e.g., can hear On[y a f~ ~rde a

parson says or loud noises)

completely lost? (e.g., deaf)

Form Z3NHS-7

63
19. IS – ABI LITY TO SPEAK: (Mark (X) Only One Box)

36-1 ❑ not impaired? (e.g., is able to be understood; can carry on a normal conversation)

‘2 ❑ P~tiallY impaired? (e.9., is able to be understmd but has difficulty pronouncing soma words)

-3 u ~erely im~ir~? (e.9., cannot carry on a normal conversation; is undwstocd only with difficulty)

‘4 •l ~mpletely lost? (e.g., is mute)

20a. OOES THIS RESIDENT HAVE DENTURES?

❑ Yes

7

~ NO (Skip to Q.estio” 21..)

39-1

b. DOES,– USE THE DENTURES?

a Y. ~ No

4@l

21a. DURING THE LAST MONTH, DID – LEAVE THE HOME FOR ANY RECREATIONAL OR LEISURE ACTIVITIES?

A ‘“s

b. FOR-WHICH OF THE FOLLOWING ACTIVITIES

DID - LEAVE THE HOME? (Mark (X) All That APPW)

CC42-52 -1 ❑

“7- ❑

-3 •1

-’la

-5 •1

-60

-~ ❑

-8 ❑

-9 •1

-0 ❑

Get books, etc., from the library

Attend plays, movies, concerts, etc.

Attend arts and crafts claases outside the home

Visit museums, parks, fairs, ate.

Goon shopping trips organized by the home

Goon independent shopping trips organized

by the resident or visitors

Visit a beauty shop or barber shop

Visit community clubs (such as community ten.

ters, senior citizen clubs, service clubs, bridge

clubs, unions, etc.)

Attend raligious services or other religious activities

Go for a walk

AN”

c. WHY DIDN’T – LEAVE THE HOME TO PARTICIPATE IN

ANY ACTIVITIES DURING THE LAST MONTH? (Mark(Xl

All That Apply)

CC42-52 -1 ❑

-7- •1

-3 •1

-40

-5 •1

$0

-7 •1

-60

Rasident was too ill or wcs not able to mova

well enough to participate

Resident wac not interestti

Staff was unable to determine resident’s interests

at this point

Staff feels that the residant’s behavior

Will IIOt be tolerated outsida the homa

No one was available to accompany the residant

Resident cannot afford these activities

Lack of transportation

Other, (Specify) 53-

-& ❑ Other, (Specify) 53.

22a. DURING THE PAST YEAR, HAS THIS RESIDENT BEEN ON ANY KIND OF LEAVE OVERNIGHT OR LONGER,

EXCLUDING LEAVE FOR MEDICAL REASONS?

❑ Yes

?

~ No (Skip to Question 23a.) ❑ Donh kmwv (Skip to Question 23a.)

54-1 -3

b. WHERE DID – USUALLY GO WHEN ON LEAVE? (Mark (X) Only One Box)

55-1 ❑ To own home or apartment

-2 ❑ TO home of family or retativcs

‘3 ❑ TO hOme of unrelated friends

-4 ❑ To foster home

‘5 ❑ To boardinghouse or room

-6 ❑ TO another place, (Specify) 56-

-7 ❑ Oon’t know

c. ABOUT HOW OFTEN DID THIS RESIDENT GOON LEAVE? (Mark (X) Only One Box)

57-1 ❑ Nearly every week

‘2 ❑ AbOut once a mcmth

‘3 ❑ AbOut once every two months

-’$0

-5 •1

-6 ❑

-7 •1

Form 73NHS-7

Several times a year

About once a year or less

Other (Specify) 58-

Oon’t know

64
23a. DOES – HAVE ANY VISITORS?

b, HOW FREQUENTLY DO VISITORS SEE THE RESIDENT? (Mark (X) Only One Box)

16-1 ❑ Nearly wery week ‘5 ❑ AbOut once a year or Ie=

-2 ❑ About once a month .6 ❑ Other (Specify) 17-

‘3 ❑ About once every tWIJ mOnth~ -7 ❑ Don’t know

-4 H Several times a yew

24. HOW MANY BEDS ARE IN – ROOM? (Mark (X) Only One Box)

18-1 ❑ One bad (i.a., the resident’s own bed) -4 ❑ Four bads

-2 ❑ Two bads -5 ❑ Five w mom beds

-3 ❑ Threa beds

25a. HAS THIS RESIDENT LIVED IN THIS FACILITY FOR ONE FULL MONTH OR LONGER?

❑ Yes ~ NOT

1s-1

Stop; goon to next

questionnaire.

b. LAST MONTH, WHAT WAS THE BASIC CHARGE FOR THIS RESIDENT’S LODGING, MEALS, AND NURSING CARE

NOT INCLUDING PRIVATE DUT~SING OR OTHER SPECIAL CHARGES?

❑ No charge isrmxleforcsfa (Skip to Q.estio” 2Sa.) $

●

CC20-25

c. LAST MONTH, WHAT WAS THE TOTAL CHARGE FOR THIS RESIDENT’S CARE, INCLUDING ALL CHARGES FOR

SPECIAL SERVICES, DRUGS, AN~CIAL MEDICAL SUPPLIES?

❑ Nociwgs kmadeforcera (SklptoQ.esticm 2Ss.) $

●

CC26-31

(1) DID THIS AMOUNT INCLUDE SPECIAL CHARGES FOR

No Yas

(al physician servicm? 32-2 ❑ “’ •1

(b) privata duty nursing? 33-2 0

-’ c1

(c) thampy? 34-2 ❑ “’ c1

(d) dregs? 35-2 ❑ -1 •1

(e) special medical supplies? 362 ❑ -’ ❑

(f) special diet? 37-2 ~

-’ ❑

(9) other?

P

3s-2 ❑ -1

Spacify -39

26a. WHAT WERE *THE SOURCES OF PAYMENT FOR THIS RESIDENT’S CARE LAST MONTH?

(Mark(X) All ThatApply)

b.

CC404S ❑ (1) own inmme or fs.mily

support (prWata plans,

retirammst fundt, social

sacurity, ate.)

❑ (2) Medicare(Title W/ill)

❑ (3) Madicaid (Title XIX)

❑ (4) Otharpublicmsistance

or welfare

❑ (7)::tiirwmsant.

❑ (5) Church SUPPOl_t ❑ (S)~N0:9s is made

❑ (6) VA mntrsct ❑ (9) Othar (SpacifY) ? 49-

WHAT WAS THE PRIMARY SOURCE OF PAYMENTS FOR – CARE LAST MONTH?

(Mark(X) OnlyOneSex.)

60-1 ❑

-2 •1

-30

Own incoma or family -1 ❑ Other public ●ssistance -7 ❑ hJtiir~ymentsupport (prhmta plans, or welfara

retirement funds, social

security, etc.) -5 ❑ Church support -S ❑ No chsrga is msdo

fos care

Medicare (Title XVI 11) -6 ❑ VA mntmct

-9 ❑ Other (Sfmcify) 7

Madicaid (Title XIX) 51- -.

Fosm 73NHS-7

65
RESIDENT CONTROL RECORD

RESIDENTS IN NURSING HOME

SAMPLE NAME OF RESIDENT SAMPLE NAhlE OF RESIDENT

DESIGNATION DESIGNATION

LINE LINE

NO.

SW

NO.

Sw

TE_ TE

a b c a b c

51 76

52 77

53 78

54 79

55 w

56 81

57 82

58 83

59 64

60 85

61 66

62 87

63 88

64 68

65 al

66 91

67 92

68 93

69 84

70 95

71 96

72 97

73 98

74 88

75 00

Form 73NHS-S If More Lines Are Needed Use A New RESIDENT CONTROL RECORD

And Renumber The Lines Beginning With #101

66 it U.S. GOVERNMENT PRINTING OFFICE: 1978-260.93742
VITAL AND HEALTH STATISTICS PUBLICATIONS SERIES

Formerly public Health Service fiblication No. 1000

Series 1. Programs and Collection Procedures. –Reports which describe the generaf programs of the National

Center for Health Statistics and its offices and divisions, data collection methods used, definitions, and

other materiaf necessary for understanding the data.

Sen”es 2. Data Evaluation and Methods Research. -Studies of new statistical methodology including experimental

tests of new survey methods, studies of vital statistics collection methods, new analytical techniques,

objective evacuations of reliability of collected data, 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 expository types of reports in the other series.

Series 4. Documents and Committee Reports. –Final reports of major committees concerned with vital and

health statistics, and documents such as recommended model vital registration laws and revised birth

and death certificates.

Series 10. Data from the Health Interview Survey .–Statistics on illness; accidental injuries; disability; use of

hospital, medical, dental, and other services; and other health-related topics, based on data collected in

a continuing national household interview survey.

Series 11. Data from the Health Examination Survey. –Data from direct examination, testing, and measurement

of national samples of the civilian, non institutionalized 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 Survey s.–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 annuaf or monthly

reports. Special anafyses by cause of death, age, and other demographic variables; geographic and time

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

sample surveys of those records.

Sesies 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 Nati~nal Mortality and Natality Surveys. –Discontinued effective 1975. Future reports

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

Series 23. Data from the National Survey of Family Growth .–Statistics on fertility, family formation and dissohstion, family planning, and related maternal and infant health topics derived from a biennial survey of

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

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

National Center for Heafth Statistics

Public Health Service

Hyattsville, Md. 20782
U.S. DEPARTMENT OF HEALTH. EDUCATION, AND WELFARE

I%bl,c Health Serv,ce

Nm%,ondCenter for Health Sta,,.tm.

C..ta Bu,ldwvd

3700 E.,t-Wmt H,Shwa”

H“att,v,lle. Maryland 20702

OFFICIAL BUSINESS

PEN ALTV FOR PRIVATE USE, S3043

PoSTAGE AND FEES PAID

u S, DEPARTMENT OF HEW

HEW 390

THIRD CLASS

0*- IL*MAU

BLK. RATE I

For publicat,m,s ,. the

VitIZland 11..lt/r St.ti$tics

Sacs call 301-436-NGIIS. I

$’