Discharges From

Nursing Homes:

1977 National Nursing

Home Survey

Statistics are presented on characteristics of

persons discharged from nursing homes during

1976. Data are presented in terms of discharge

status (live or dead) and duration of stay,

according to demographic characteristics,

living arrangements after discharge for live

discharges, health status, health services

received, primary source of payment, and

charges for care.

Data From the National Health Survey

Seriae 13, No. 54

DHHS Publication No. (PHS) 81-1715

U.S. Department of Health and Human Services

Public Health Service

Office of Health Research, Statistics,

and Technology

National Center for Health Statistics

Hyattsville, Md.

August 1981
Library of Congress Cataloging in Publication Data

Zappolo, Aurora.

Discharges from nursing homes.

(Vital and health statistics. Series 13)

(Data from the national health survey (Series 13); no. 54) (DHHS

publication; no. (PHS) 81-1 715)

1. Nursing homes–United States–Utilization–Stat istics. 1. Title.

II. Series. I I 1. Serias: Data from the National Health Survey (Series 13);

no. 54. IV. Series: DHHS publication; no. (PHS) 81-1715.

RA997.Z36 362.1 ‘6’0973 81-607016

ISBN 0-8406-0216-2 AACR2
National Center for Health Statistics

DOROTHY P. RICE, Director

ROBERT A. ISRAEL, Deputy Director

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

and Epidemiology

GAIL F. FISHER, Ph.D., Associate Director for the

Cooperative Health Statistics System

GARRIE J. LOSEE, Associate Direc(orfor Data Processing

and Services

ALVAN O. ZARATE, Ph. D., Assistant Director for

International Statistics

E. EARL BRYANT, Associate Director for Interview and

Examination Statistics

ROBERT C. HUBER, Associate Director for Management

MONROE G. SIRKEN, Ph. D., Assocbte Director for Research

and Methodology

PETER L. HURLEY, Associate Director for Vital and Health

GzreStatistics

ALICE HAYWOOD, Information Officer

Division of Health Care Statistics

W. EDWARD BACON, Ph. D., Director

EVELYN S. MATHIS, Chie~ Long-Term GzreStatistics

Branch

MANOOCHEHR K. NOZARY, Chief Technical Services

Branch

Library of Congress Catalog Card Number 81-607016
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Background and qualificationsof data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Facility characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. - . . . . . . . . ..s”s”

Discharge characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Demographic characteristics and Iivingarrangements afterdischarge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Health status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...”....

Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Health services received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Paymentfor care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Death in nursing homes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Listofdetailed tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Appendixes

1. Technical notesonmethods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

II. Definition ofcertain termsused in this report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ill. Selected survey instruments used in the 1977 National Nursing Home Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IV. Criteria for classifying nursing homes according to level of nursing care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

List of Text Tables

A.

B.

c.

D.

E.

F.

G.

H.

J.

Number and percent distribution of nursing home discharges bydischarge status, according toyear: United States . . . . .

Percent of nursing home discharges who were discharged alive, by facility ownership and year: United States. . . . . . . . .

Cumulative percent of nursing homedischarges byage and median age, by dischargestatus: United States, 1976. . . . . . .

Number and percent distribution of nursing home discharges, by partial indexof dependency inactivities ofdaily living:

United States, 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent distribution of nursing home discharges by discharge status and duration of stay, accordingto

primary diagnosis atadmission: United States, 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent distribution of live discharges by living arrangements after discharge, according to primary diagnosis at admission:

United States, 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent distribution of nursing home discharges by duration of stay, according to selected functional

,statuses: United States, 1976. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent distribution of nursing home dischargesby time since Iast physician visit and services given atlast

physician visit, according toduration ofstay: United States, 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of nursing home discharges and average total monthly charge, by primary source of payment: United States,

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

1

1

1

2

4

4

4

5

7

9

12

14

15

40

49

53

74

<

2

3

4

5

6

7

7

9

9

...

Ill
K. Average total monthly charge for nursing home discharges, by primary diagnosis at admission and partial index of dependency inactivities of daily living: United States, 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

L. Average total monthly charge for nursing home discharges, by health services received: United States, 1976 . . . . . . . . . . 10

M. Number and percent distribution of deaths among persons age 65 years and over by location of death, according to sex

andage: United States, 1976.... . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

N. Number and percent distribution of deaths among persons age 65 years and over by unadjusted and adjusted statistics,

accord ingtosex andage: United States, 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Symbols

. . . Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500

*

Figure does not meet standards of

reliability or precision (more than

30-percent relative standard error)

# Figure suppressed to comply with

confidential ity requirements

iv
Discharges From

Nursing Homes:

1977 National Nursing Home Survey

by Aurora Zappolo, Division of Health Care Statistics

Introduction

Overview

This report presents detailed data on characteristics of persons discharged from nursing homes

during 1976. The data are estimates based on a

sample of nursing home discharges from the 1977

National Nursing Home Survey.

The National Nursing Home Survey is a nationwide sample survey that covers nursing home facilities

and costs, and characteristics of residents, discharges,

and staff. It is the second survey in an ongoing system

conducted by the National Center for Health Statistics. The first National Nursing Home Survey was

conducted between August 1973 and April 1974. The

1977 survey data were collected from May though

December 1977. Included in the survey were nursing

care homes, personal care homes (with and without

nursing), and domiciliary care homes as classified by

the 1973 Master Facility Inventory. 1 In addition, all

nursing homes that opened for business between

1973 and December 1976 were included.

A number of reports based on the 1977 National

Nursing Home Survey have been published. Provisional estimates from the survey were published as

Advance Data Reports. The first one compares

resident and discharge data,z and the second one

presents facility and staff data.s The first detailed

report from the 1977 National Nursing Home Survey

is a comprehensive summary volume that presents

final estirnates.A It was followed by a report that

presents nursing home estimates for California, Illinois, Massachusetts, New York, and Texas,5 and by

other reports that analyze staff,G resident,7 and

facilitys data.

Background and qualifications of data

Data in this report summarize characteristics of

persons discharged from nursing homes in terms of

their discharge status (live or dead) and duration of

stay. In earlier surveys, discharge status was only

available in the form of nationwide summary counts;

analysis by individual characteristics was not possible.

Duration-of-stay data for persons completing their

nursing home stay were never before available. Items

in this report include demographic characteristics

(age, marital status at discharge, and sex), living

arrangements after discharge for live discharges,

health status (primary diagnosis at admission, chronic

conditions or impairments, mobility, continence, and

use of special aids or devices), health services received

(time since last physician visit, services provided at

last physician visit, level of care, therapy, and special

diet), primary source of payment, and charges for

care.

Data on 1976 discharges were collected by

interviews with nurses who were most familiar with

the relevant medical records. The 1976 discharge data

were used over those of 1977 in order to provide

information covering a full calendar year. Since the

data cover a full calendar year, and therefore represent the 1976 universe of discharge events, patients

discharged more than once during the year are

counted separately for each discharge. Although no

information is available on the frequency of multiple

admissions and discharges that occurred over the

year, rough estimates are possible by examining data

on post-discharge living arrangements. This point is

addressed later in this report.

A description of the survey design, data collection, and estimation procedures is presented in

appendix I. Since the data in this report are national

estimates based on a sample rather than a complete

enumeration, they are subject to sampling errors.

Appendix I also includes sampling errors and methods

for examining hypotheses. Definitions of key terms

used in this report appear in appendix II, facsimiles of

selected survey instruments used in the survey are

shown in appendix III, and criteria for classifying

facilities within the scope of the survey are presented

in appendix IV.
Facility characteristics

In earlier nursing home surveys, counts of total

discharges were collected, but detailed discharge data

were not collected. Prior to the inception of the

National Nursing Home Survey (NNHS) system, there

was a series of surveys of nursing homes and similar

places known as Resident Places Surveys (RPS).

RPS-1, conducted during April-June 1963, obtained

counts of discharges during calendar year 1962. The

universe for RPS- 1 was mental hospitals and institutions that provided nursing, personal, or domiciliary

care to the aged and chronically ill. For this analysis,

facilities that provided hospital care were excluded.

RPS-2, conducted during May-June 1964, collected similar data. However, publications from that

survey concentrate on detailed resident characteristics

and do not present findings on discharges. Therefore,

comparisons of counts with RR-2 are not possible.

RPS-3, conducted during June-August 1969,

focused on nursing and personal care homes. Counts

of discharges during calendar year 1968 were collected. In addition to discharge counts in these

surveys, information on whether the persons discharged were alive or dead was collected.

The 1977 National Nursing Home Survey discharge data may be compared with earlier survey data

with the following reservation. Discharge counts from

the 1977 survey are second-stage estimates based on a

complete enumeration of all 1976 discharges. In

earlier surveys the interviewer asked the facility

administrator to report the number of discharges.

Therefore, the totals may not be as accurate as those

based on a complete listing. Similarly, the number of

persons who died while residing in a nursing home is

based on estimates from a sample of discharges in the

1977 survey, using information in the individual

medical record. However, the earlier surveys merely

asked a single question for the entire facility. Finally,

the RPS-1 nursing home death count specifically

included those who died in a hospital before formal

discharge from the nursing home. Although this

concept was unchanged, RPS-3 and the 1977 NNHS

are not so explicit, suggesting potential differences in

response.

While recognizing these points, it is still possible

to draw some conclusions about patterns of’nursing

home discharge data, Discharges nearly tripled between 1962 and 1976, from 378,300 to 1,117,500

(table A). During that time, the number of nursing

homes increased only from 16,370 to 18,900, but the

number of nursing home beds increased 2% times,

reflecting the growth in nursing home size.

The number of live discharges greatly exceeded

that of dead discharges in all National Center for

Health Statistics nursing home surveys. However, the

proportion of persons discharged alive increased from

61 percent in 1962 to 67 percent in 1968 and to 74

percent in 1976 (table A). Even though the 1962

questionnaire included instructions to count as nursing home deaths those persons who died in a hospital

or elsewhere while still on the nursing home register,

the data demonstrate a pattern toward increasing

likelihood of live discharge (table A). This increase in

live discharges has resulted in similar proportions of

live discharges from nursing homes with different

types of ownership. The 1962 data indicate that

proprietary and voluntary nonprofit facilities were

less likely to have live discharges than were

Table A. Number and percent distribution of nursing home discharges

by dkcharge status, according to year: United States

A II Discharge status

Year

. ...

discharges

Total Live Dead

Number Percent distribution

19621 . . . . . . . . . . . . . . . 378,300 100.0 60.9 39.1

19681 . . . . . . . . . . . . . . . 900,500 100.0 66.9 33.1

19762 . . . . . . . . . . . . . . .

31J17,5(30 I ()().() 73.9 25.9

1 Dab from interview with facility administrator.

2 Data estimated from sample of facility ‘S d ischargea.

Slncludas discharges whose status was unknown.

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

2
government facilities (59 percent, 58 percent, and71

percent, respectively); in the 1968 data, the proportions were 67 percent, 69 percent, and 58 percent,

respectively; and in the 1976 data, the proportions

were 75 percent, 71 percent, and 72 percent, respectively (table B).

Tables 1 and 2 present more detailed data on

discharge status and duration of stay by facility

certification, size, and ownership. Duration of stay

for discharges is associated with the facility’s certifi

cation status. Under titles 18 and 19 of the Social

Security Act, a facility may be certified as a skilled

nursing facility (SNF), an intermediate care facility

(ICF), or both. A greater proportion of discharges

occur within a month of admission to a facility in the

SNF-only group (44 percent) than to a combined

SNF and ICF (32 percent), a facility in the ICF-only

group (20 percent), or a noncertified facility (26

percent). Among skilled nursing facilities (whether in

the SNF-only or SNF and ICI? group), the proportion

discharged within a month is further affected by

facility size. A greater proportion of patients in small

skilled nursing facilities (i.e., less than 50 beds) were

discharged within a month than from any other size

category. Fully 64 percent of discharges from small

SNF-only’s and 54 percent of discharges from small

combined SNF and ICF’S were discharged within a

month (table 1). “

Live discharges were more likely than dead

discharges to have short durations of stay for facilities

in the SNF-only group. In such facilities, 48 percent

of live discharges, compared with 34 percent of dead

Table B. Percent of nursing home dischargeswho were discharged

alive, by facility ownership and year: United States

Ownership

Year

Proprietary Voluntary Government nonprofit

19621 . . . . . . . . . . . . . 59.0 58.0 71.2

19681 . . . . . . . . . . . . . 66.7 69.9 58.3

19762 . . . . . . . . . . . . . 74.8 71.1 72.4

1Data from interview with facility administrator.

2Data e~imated from sample of facility’s discharges.

discharges, occurred after a stay of less than a month.

Although other certified facilities appeared to have

more live than dead discharges with short durations

of stay, the data are not statistically significant.

Ownership does not seem to be related to

duration of stay except within the SNF-ordy group:

39 percent of discharges from proprietary facilities in

the SNF-only group occurred within a month of

admission, compared with 59 percent of discharges

from voluntary nonprofit facilities and 53 percent of

discharges from government-owned facilities. The

relationship between ownership and duration of stay

becomes stronger when live and dead discharges are

compared. Discharges from voluntary nonprofit facilities, in particular, show wide variation: 47 percent of

live discharges, compared with 20 percent of dead

discharges, had resided in the facility less than a

month.
Discharge characteristics

Demographic characteristics and living arrangements

after discharge

Nursing home discharges in 1976 were predominantly live discharges. The 825,500 live discharges

(74 percent) had spent an average of 60 days in the

nursing home. The 289,800 dead discharges had spent

an average of 130 days in the nursing home (table 3).

This greater duration of stay by those discharged

dead from the nursing home is related to their greater

age. Twenty-six percent of the live discharges were 85

years of age or over, compared with 40 percent of the

dead discharge% The discharges’ median age was 79

years for live discharges and 83 years for dead

discharges (table C).

Discharges were more likely to be female (64

percent) than male (37 percent). Furthermore, the

discharges with the longest durations of stay were

even more likely to be female: 75 percent of those

with durations of stay of 5 years or more were

female, compared with only 60 percent of those with

durations of stay of less than 3 months (table 3).

Overall, about a third of the discharges had spent

less than a month in the nursing home. Married

persons were more likely than others to be discharged

in the first month. Forty-three percent of the married

persons, compared with only 31 percent of those of

Table C. Cumulative percent of nursing home discharges by age and

median age, by discharge status: United States, 1976

Discharge

Age All status

discharges

Live Dead

Cumulative percent

Alleges . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0

65 years and over . . . . . . . . . . . . . 87.8 85.8 93.7

75 years and over . . . . . . . . . . . . . 69.6 66.2 79.4

85years and over . . . . . . . . . . . . . 29.7 26.1 39.9

Age in years

Median age . . . . . . . . . . . . . . . . . . 80 79 83

other marital statuses combined (widowed, divorced

or separated, never married, and unknown), had

durations of stay of less than a month. This relationship (i.e., a greater proportion of married persons

than others having short durations of stay) holds for

both live and dead discharges. This suggests that

people may provide home care for their discharged

spouses and may delay putting them into nursing

homes when they are terminally ill.

The availability of informal care is also reflected

in living arrangements after discharge. Fifty-one

percent of live discharges who went to a private or

semiprivate residence had nursing home stays of less

than a month, compared with 26 percent of those

discharged to another health facility, such as a

hospital or another nursing home (table 3).

As noted in the Introduction, the item on living

arrangements after discharge can be used as a rough

measure of multiple nursing home admissions and

discharges. Of the 825,500 live discharges in 1976,

108,600, or 13 percent, were discharged to another

nursing home. Further, the data show that 12 percent

of live discharges with durations of stay of less than a

year were discharged to another nursing home. Thus a

maximum of 12 percent of the live discharges may be

considered as potential double counts in the discharge

file, or as current residents falling into the resident

sample.

Health status

Information was collected on the discharges’

health status during nursing home confinement.

Health status measures include primary diagnosis at

admission, chronic conditions and impairments,

mobility status and continence status, and use of

special aids or devices.

Forty-four percent of the discharges were admitted with a primary diagnosis related to the circulatory

system, frequently arteriosclerosis or stroke. Another

11 percent were admitted for a mental disorder or

senility without psychosis. Forty-three percent were

4
admitted due to some other primary diagnosis.

Overall, seven diagnoses accounted for 60 percent of

primary diagnoses at admission: arteriosclerosis,

stroke, cancer, hip fracture, congestive heart failure,

chronic brain syndrome, and diabetes (table 4).

Chronic conditions or impairments recorded during the nursing home stay provide a clearer picture of

the magnitude of certain health problems, since

multiple counts were permitted. Forty-one percent of

nursing home discharges had arteriosclerosis, 35

percent had some type of “heart trouble~’ 21 percent

had stroke effects, 20 percent were senile, and 19

percent had chronic brain syndrome (table 4).

About half of the discharges were in the least

dependent categories of both the mobilitya and

continence variables. Forty-eight percent of the discharges were able to walk, with or without assistance;

27 percent were chairfast; and 21 percent were

bedfast. Because of insufficient information in the

patient record, mobility status was unknown for 5

percent of the discharges. Forty-nine percent of the

discharges had no difficulty controlling either bowels

or bladder; 27 percent had difficulty controlling both

bowels and bladder; and 11 percent had ostomies

(table 5).

Mobility and continence are two components of a

standard index of dependency in activities of daily

living. Generally, other components would include

bathing, dressing, using the toilet room, and eating.

However, pretesting for the 1977 survey indicated

that only mobility and continence were in the patient

records often enough to allow reIiable estimation of

these items. Both theoretical background and research experience with dependencies indicate that the

interaction of multiple dependencies is, a factor in

creating the need for long-term-care services. With

that in mind, a partial index of dependency in

activities of dtiy living was created, which may

suggest the magnitude of multiple dependencies if the

full complement of items were available. This partial

index shows that mobility and continence tend to be

related. Over half (60 percent) of the discharges were

dependent in one or both items. However, far more

were dependent in both mobility and continence (35

percent) than in only mobility (13 percent) or only

continence (another 13 percent) (table D).

Mobility and continence were also related to

primary diagnosis at admission; mental patients were

less likely than others to be dependent in either item.

Fifty-two percent of those admitted with mental

disorders or senility were not dependent in either

mobility or continence, compared with 35 percent of

those admitted with diseases of the circulatory

‘Because of the questionnaire desi~ it is not possible to determine the

number of those who walked truly independently from those who required assistance in walking. For purposes of this report only, anyone

who walked with or without assistance is considered “independent.”

Table D. Number and percent distribution of nursing home discharges,

by partial index of dependency in activities of daily living:

United States, 1976

Partial Index Number Percent

distribution

Total . . . . . . . . . . . . . . . . . . . . . . . . 1#11 7,500 100.0

Not dependent in mobility

~r~ontinencel,2 . . . . . . . . . . . . . . . 448,600 40.1

Dependent in mobility only . . . . . . . . . 141,200 12.6

Dependent in continence only . . . . . . . 142,000 12.7

Dependent in both mobility and

continence . . . . . . . . . . . . . . . . . . . 385,600 34.5

I IJnknowns were considered not dependent for the purpose of this

index.

Zlncludes dischargeswho walked with assistance.

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

system and 40 percent of those admitted with other

primary diagnoses (table 6).

Use of special aids or devices is another indicator

of health status. The list of special aids or devices

used in this survey includes common aids and devices

(such as eyeglasses), as well as less common apparatuses (such as mechanical feeding devices). Multiple

entries were permitted to account for the use of more

than one aid or device. Over half of the discharges (53

percent) wore eyeglasses, 38 percent used a wheelchair, and 16 percent used a walker. Roughly 1 in 5

discharges had been restrained from self-injury or

injuring others by means of a geriatric chair, cuffs,

posey belt, or similar device. Use of restraining

devices was related to both mobility and continence

status: Fewer persons independent in either item

were restrained than were those dependent in one or

both items. When the partial index (which combines

mobility and continence) is used, only 4 percent of

persons independent in both mobility and continence

were restrained, while 40 percent of persons dependent in both were restrained (table 5).

Outcome

The outcome of nursing home care may be

addressed in terms of discharge status (live or dead),

living arrangement after discharge, and duration of

stay. Predictably, outcome of nursing home care was

related to health status. Overall, three-fourths of the

discharges were alive. Table 4 shows that those who

had been admitted to the nursing home with a

primary diagnosis of cancer were the least likely to be

discharged alive (51 percent). (Exceptions to this

statement are congestive heart failure (62 percent)

and those diagnoses which could not be tested due to

unreliable numbers: senility with and without

psychosis, and mental retardation.) Cancer was also

distinguished as the only primary diagnosis category

for which patients received what may be considered hospice care, that is, short-term care for the

5
terminally ill. As table E shows, about 1 in 4 persons

admitted to nursing homes in 1976 with a primary.

diagnosis of cancer was discharged within a month

due to death. In contrast, only 5 percent of patients

admitted with ari.eriosclerosis and 7 percent of

patients with stroke as a primary diagnosis had this

outcome.

Those with primary diagnoses labeled “mental

disorders and senility without psychosis” were the

least likely to be discharged alive within a month

after admission: only 18 percent of these persons

were discharged within a month, compared with 24

percent of those whose primary diagnosis was diseases

of the circulatory system and 31 percent of those

whose primary diagnosis was anything other than a

mental or circulatory diagnosis (table E).

For live discharges, those with primary diagnoses

of mental disorders and senility without psychosis

were less likely than those with circulatory or other

primary diagnoses to return to a private or semiprivate residence (24 percent compared with 34

percent and 44 percent, respectively). Persons with

hip and other bone fractures were the most likely of

any specific diagnosis to return to a private or

semiprivate residence (57 percent) (table F). (Exceptions to this statement are Parkinson’s disease,

other mental disorders, other respiratory disorders,

and those diagnoses which could not be tested due

to unreliable numbers: senility with and without psychosis, chronic brain syndrome, and mental

retardation.)

The relationship between dependency status and

discharge status, although dramatic, must be interpreted carefully. Of persons not dependent in either

mobility or continence, fully 91 percent were discharged alive. Of persons with one dependency, 78-80

percent were discharged a.liv~ and of persons dependent in both categories, only 50 percent were discharged alive (table 5). Since the questions on mobility and continence pertain to the overall nursing

home stay rather than to admission status, there is

a logical relationship with discharge status. However, a causal relationship cannot be inferred because

the dependency status may merely reflect deterioration–possibly leading to death–during nursing home

residency.

The relationship between dependency status and

duration of stay is not as clear as that between

dependency status and discharge status. Roughly the

same proportion of persons who could walk or were

bedfast were discharged within a month of admission

(36 percent and 35 percent, respectively). The continence measure did reflect a predictable relationship:

36 percent of persons having no difficulty with either

bowels or bladder, compared with 24 percent of

persons with difficulty controlling bladder only and

27 percent of persons with difficulty controlling both

bowels and bladder, were discharged within a month.

Also, those with difficulty controlling bowels only

were more likely to be discharged within a month (46

percent) than were others with continence problems.

Finally, the partial index of dependency, which

combines mobility and continence, shows somewhat

fewer of the doubly dependent than the independent

with short durations of stay (less than 1 month): 29

percent compared with 37 percent of those who were

dependent in neither mobility or continence

(table G).

Table E. Number and percent distribution of nursing home discharges by discharge status and duration of stay, according to primary

diagnosis at admission: United States, 1976

Live discharges Dead discharges

Primary diagnosis at admission All

discharges 1 Less than 1 month Less than 1 month

1 month or more 1 month or mora

Diseases of thecirculatory system. . . . . . . . . . . . . . . . . . . . . .

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

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

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

Other diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hip fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Diseases of thecirculato~ ~stam . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Other diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hip fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

486,200

197,200

139,400

125,700

480,400

82,700

91,600

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Number

117,800 221,300

37,700 98,800

37,000 60,700

23,100 71,800

150,900 221,600

25,100 43,600

25,900 21,000

Percent distribution

24.2 45.5

19.1 50.1

26.6 43.6

18.4 57.1

31.4 46.1

30.4 52.7

28.3 22,9

33,500

10,600

10,200 *

36,700*

22,200

6.9

5.4

7.3

*

7.6

*

24.2

113,000

50,100

31,300

27,900

70,300

11,500

22,500

23.2

25.4

22.4

22.2

14.6

3.9

24.6

I Includes discharges with unknown discharge Status.

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

6
Table F. Percent distribution of live discharges by living arrangements after discharge, according to primary diagnosis

at admission: United States, 1976

Another hea[th facility

Private or Unknown

Primary diagnosis at admission Total semiprivate Another General or Mental Other heaIth or other

residence Total nursing short-stay hospital facility or

home hospital

arrangement

unknown

Percent distribution

All diagnoses . . . . . . . . . . . . . . . . . . . . . . 100.0 37.1 58.6 13.2 41.1 1.5 2.9 4.2

Diseases of the circulatory system . . . . . . . . . 100.0 34.3 62.9 13.4 46.4 ●

2.7 2.8

Arteriosclerosis . . . . . . . . . . . . . . . . . . . 100.0 34.3 63.2 15.1 45.3 * * *

Stroke . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 34.3 64.1 11.6 47.0 *

5.1 *

Mental disorders and senility without

psychosis . . . . . . . . . . . . . . . . . . . . . . . . 100.0 23.5 70.0 15.5 40.4 9.2 ●

6.5

Other diagnoses . . . . . . . . . . . . . . . . . . . . . 100.0 43.6 53.0 12.3 37.6 ●

2.7 3.:

Hip fracture . . . . . . . . . . . . . . . . . . . . . 100.0 57.0 38.9 8.7 28.2 * ●

Cancer . . . . . . . . . . . . . . . . . . . . . . . . 100.0 30.1 68.0 23.6 42.2 * *

NOTE: Figures maynotadd tototels due to rounding.

Table G. Number and percent distribution of nursing home discharges by duration of stay, according to selected functional statuses

United States, 1976

Duration of stay

Functional status AII

discfrargesl Total Less than ? month

1 month or more

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

Mobility

Walkswith orwithoutassistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ChairFast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bedfast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Continence

Nodifficukycontrollingbowels orbladder . . . . . . . . . . . . . . . . . . . . . . . . . . .

Difficulty controlling bowels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Difficultycontrolling bladder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Difficulty controlling both bowels and bladder . . . . . . . . . . . . . . . . . . . . . . . . .

@tomyineitherbowelo rbladder2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown astoboth bowelandbladder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Partial index of dependency in activities of daily living3

Notdependentin mobility orcontinence4 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dependent in mobilityonly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dependent incontinenceonly. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dependentin bothmobilityand continence . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number

1,117,500

533,400

297,100

228,700

57,200

551,000

26,500

75,400

304,000

121,800

38,800

448,800

141,200

142,000

385,600

Percent distribution

100.0 33.6 66.4

100.0 35.6 64.4

100.0 27.9 72.1

100.0 35.0 65.0

100.0 38.6 61.4

100.0 36.5 63.5

100.0 45.5 54.5

100.0 24.5 75.5

100.0 28.7 73.3

100.0 39.4 60.6

100.0 37.3 62.7

100.0 37.0 63.0

100.0 35.1 64.9

100.0 32.5 67.5

100.0 29.4 70.6

~]nclude~ discharges with unknown discharge status.

2s7.4 percent of these persons had had an ostomy which affected only the bladder.

3(Jnknowns were considered notdapandent forthe purpose of this index.

4]ncludes discharges who walkad with aSSiStSnCa.

NOTE: Figures maynotadd tototels dueto rounding.

Health servicesreceived

Health services received by the nursing home

patient prior to discharge were some of the most

readily available items from the medical record.

Health services include physician, nursing, andtherapy services. Physician visit data were twofold: time

since last physician visit and services given at last

visit-examination, treatment, prescription, orders for

laboratory tests, or other services. Nursing care was

addressed in terms of level of care and special diet

received during the7 daysprior todischarge. Therapy

service data covered type of therapy-physical, recreational, occupational, and speech or hearingtherapy;

counseling by a social worker or mental health

worker; reality orientation; and other service-during

the last month of residency.

About half of the nursing home discharges received a physician visit during the week of discharge.

Three-fourths received a visit during the last month

7
before discharge, while 6 percent had no physician

visits. Generally, the service given during the last

physician visit wds an examination (78 percent).

Almost half (47 pet-cent) of all discharges received a

prescription from t.lie physician, 15 percent received

some type of treatment, 16 percent had laboratory

tests arranged, and 7 percent received some other

services (table 7).

Fifty-six percent of the discharges received intensive nursing care during the last week of residency,

defined as one or more of the following services:

bowel or bladder retraining, catheterization, full bed

bath, intravenous injections, and oxygen therapy.

About a third received other nursing care services,

defined as one or more of the following: application

of sterile dressing or bandages; blood pressure reading; enema; hypodermic injections; irrigation; and

checking temperature, pulse, and respiration. About

11 percent received only personal care (medication

prescribed by physician, rub or massage, or special

diet) or none of the listed services (table 7).

Special diets were received by 42 percent of the

discharges. The most common were low sodium (13

percent), diabetic (10 percent), and soft (8 percent)

diets. Although the special diet is not technically a

nursing service according to the level of care defined

earlier, it may be delivered by the nursing staff, so it

is dealt with here (table 7).

Thirty-six percent of the discharges received some

type of therapy service during the last month in the

nursing home. Physical therapy was the most commonly provided service (21 percent), followed by

recreational therapy (13 percent). A social worker

provided counseling to 8 percent of the discharges

during the month (table 7).

The 118,000 discharges who received only personal care or none of the listed services during the

week prior to discharge were also the least likelv to

receive a physician visit during that week: Only 25

percent of discharges receiving personal care had a

physician visit during the week prior to discharge,

compared with 52 percent of persons who received

intensive nursing care and 47 percent of persons who

received other nursing care. Fewer persons receiving

personal care received examinations or prescriptions

than did those receiving other types of care. Of the

former group, 53 percent received an examination,

and 31 percent received a prescription, compared

with 82 percent receiving an examination and 51

percent receiving a prescription among those under

intensive nursing care, and 79 percent receiving an

examination and 45 percent receiving a prescription

among those under other nursing care (table 7).

Therapy service did not vary significantly according to level of care: Therapy was received by 31

percent of the discharges in the personal care group in

the last month, 36 percent of persons under intensive

nursing care, and 38 percent of persons under other

nursing care (table 7).

The relationship between health services received

and the patient’s health status is not as clear as some

might expect. For example, the variation in the

frequency of physician visits by primary diagnosis at

admission is minimal. The proportion of persons with

primary diagnoses of mental disorders or senility

without psychosis who received a physician visit the

week before discharge (41 percent) was not significantly different from the proportion of those with

primary diagnoses of diseases of the circulatory

system (47 percent). However, the former were

significantly less likely than persons with other

diagnoses (51 percent) to receive a physician visit the

week before discharge (table 8).

Similarly, there were somewhat fewer physical

examinations ~iven by the physician during his or her

last visit to those with primary diagnoses o:f mental

disorders or senility without psychosis (73 percent)

than to those with primary diagnoses of diseases of

the circulatory system (81 percent). Also, fewer

persons with primary diagnoses of mental discarders or

senility without psychosis (11 percent) received

orders for laboratory tests than did persons with

diseases of the circulatory system (16 percent) or

other diagnoses (17 percent). There was no statistically significant difference among the three diagnostic

categories in the proportion of discharges who received prescriptions, treatments, or other services

(table 8). Those with durations of stay of under 1

month were more likely to receive a physician visit

the week before discharge but were less likely to have

a physical examination during the visit. Sixty-one

percent of those discharged less than a month after

admission received a physician visit during the week

before discharge, compared with 48 percent of

persons discharged after 1-3 months, 36 percent of

persons discharged after 3-6 months, and 39 percent

of persons discharged after 6 months. Seventy-one

percent of persons discharged within a month after

admission received an examination, compared with

81 percent of persons discharged after 1-3 months, 82

percent of persons discharged after 3-6 months, and

81 percent of persons discharged after 6 months or

more (table H).

The level of care the patient received during the

week before discharge reflects greater differentiation

by primary diagnosis. Sixty percent of those whose

primary diagnosis at admission was a disease of the

circulatory system and 57 percent of those with

“other” primary diagnoses received intensive nursing

care during the week before discharge, compared with

only 44 percent of persons with a primary diagnosis

of mental disorders or senility without psychosis.

Persons with cancer as a primary diagnosis (part of

the general “other” group) had the highest proportion of any diagnostic category to receive intensive

nursing care: 72 percent. (Exceptions to this statement are other circulatory diagnoses and senile

psychosis, 59 percent and 64 percent, respectively,

8
Tabla H. Number and percent distribution of nursing home discharges by time sinca last physician visit and services given at last physician

visit, according to duration of stay: United Statas, 1976

Time since last physician visit Services given at last physician visitq

All 2 weeks No physiDuration of stay discharges Less 1 week to less 1 month cian visits Exami- Treat- Prescrip Orders

than to less than 1 or more while in for Iabora- ~~r~~~s

1 week than 2 facility or

nation ment tion

month tory tests

unknown

Total . . . . . . . . . . . . . . . . . 1,117,500 531,500 144,700 158,600 122,400 160,300 867,800 184,700 525,100 178,2CN3 81,600

Lessthanl month . . . . . . . . 376,200 228,000 44,300 24,900 . . . 77,900 266,300 51,100 170,800 58,500 21,400

lmonthto lessthan 3..,... 224,200 108,700 30,300 37,300 24,900 24,900 181,900 32,100 103,600 31,300 18,200

3 months to lassthan 6 . . . . . 134,900 48,100 21,300 26,900 26,100 12,500 110,700 24,900 67,000 22,500 9,800

6months or more . . . . . . . . . 383,200 148,700 48,800 69,400 68,500 47,800 308,900 56,600 183,700 68,000 32,200

Percent distribution

Total . . . . . . . . . . . . . . . . . 100.0 47.6 13.0 14.2 11.0 14.3 77.7 14.7 47.0 16.0 7.3

Lessthanl month . . . . . . . . 100.0 60.8 11.8 6.7 . . . 20.8 71.0 13.6 45.5 15.6

1 month to lessthan 3 . . . . . .

5.7

100.0 47.6 13.5 16.6 11.1 11.1 81.2 14.3 46.2 14.0 8.1

3 months to lessthan 6 . . . . . 100.0 35.6 15.8 20.0 19.3 9.3 82.1 18.5 49.6 16.7 7.2

6months ormore . . . . . . . . . 100.0 38.8 12.7 18.1 17.9 12.5 80.6 14.8 47.9 17.2 8.4

1F iguras do not add to mmls beceusa multiple responsas were permi=ed.

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

and those diagnoses which could not be tested due to

unreliable numbers: senility without psychosis, mental retardation, and unknown diagnoses.) Those with

mental disorders or senility were least likely to

receive a special diet (28 percent), compared with 48

percent of persons with primary diagnoses related to

the circulatory system and 41 percent of persons with

other primary diagnoses (table 9).

Persons with hip fractures (62 percent) or other

bone fractures (66 percent) were most likely to

receive one or more types of therapy, the most

general type being physical therapy (table 9). (Exceptions to this statement are diagnostic categories that

could not be tested due to unreliable numbers—other

circulatory diagnoses, senility with and without

psychosis, mental retardation, Parkinson’s disease,

and unknown-and other mental disorders (49

percent).)

Payment for care

This section discusses the primary source of

payment for discharges and the average monthly

charge for care. Overall, 35 percent of the discharges

were primarily supported by Medicaid, 38 percent by

their own income or family, 17 percent by Medicare,

4 percent by other government assistance or welfare,

and 7 percent by other sources, including religious

and voluntary organizations, Veterans Administration

contract, initial payment for life care arrangements,

or they were not charged for their care. The Medicaid

group was evenly divided between those classified as

receiving skilled care (18 percent) and intermediate

care (17 percent).

The average monthly charge for all discharges was

$789 in 1976. The amount varied considerably by

primary source of payment. Discharges whose primary source of payment was Medicaid intermediate

care had an average monthly charge of $579, wljle

those primarily using their own income or family

support were charged $747. Those primarily sup

ported by Medicaid as skilled-care patients were

charged $767, and those primarily supported by

Medicare were charged $1,300 (table J). These differences may be related to health status and its

ramifications, such as duration of stay and health

services required. However, the average monthly

charge for discharges did not vary statistically by

classes of primary diagnosis at admission (table K).

Although there is some variation in charges by

physician, nursing, and therapy services provided, it is

not as strong as might be expected (table L). Charges

Table J. Number of nursing home discharges and average total

monthly charge, by primary source of payment: United Statesr 1976

Average

Primary source of paymen t

Number of m tal

discharges monthly

charge

Allsourcas . . . . . . . . . . . . . . . . . . . . . . 1,117,500 $789

Own income or family support . . . . . . . . . 419,500 747

Medicare . . . . . . . . . . . . . . . . . . . . . . . 189,600 1,300

Medicaid:

Skilled . . . . . . . . . . . . . . . . . . . . . . . 201,600 767

Intermediate . . . . . . . . . . . . . . . . . . . 191,000 579

Other government assistance or welfare . . . 42,400 524

Allothersourcesl . . . . . . . . . . . . . . . . . 73,300 462

I Includes religious organizations, foundations, Volunteer agencies,

Veterana Administration contract, initial paymant-life care funda, and

other sources or no charge.

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

9
Table K. Average total monthly charge for nursing home discharges,

by primary diagnosis at admission and partial index of dependency

in activities of dai Iy living: United States, 1976

Average

Health status total

monthly

All discharges . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Primary Diagnosis at Admission

Diseases of the circulatory system

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

Congestive heartfailure . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Heart attack, ischemic heart disease . . . . . . . . . . . . . . .

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

Mental disorders and senility without psychosis

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

Senilepsychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherpsychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

%inilityw ithoutpsychosis. . . . . . . . . . . . . . . . . . . . .

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

Alcoholism andothermentel disorders . . . . . . . . . . . . .

Other diagnoses’

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

Diseases of the musculoskeletal system and connective

tissues

Arthritisand rheumatism . . . . . . . . . . . . . . . . . . .

Diseases of the newous system and sense organs:

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

Accidents, poisoning, and violence:

Hipfracture . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherbonefracture . . . . . . . . . . . . . . . . . . . . . . .

Endocrine, nutritional, and metabolic diseases:

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

Neoplasm:

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

D iseasas of the respiratory system:

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

Diagnosis unknown

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

Partial Index of Dependency in Activities

of Daily Living2

Nondependent in mobility orcontinence3 . . . . . . . . . .

Dependent inmobilityonly . . . . . . . . . . . . . . . . . . . .

Dependent incontinence only . . . . . . . . . . . . . . . . . .

Dependent in both mobility and continence . . . . . . . . .

$789

770

747

730

629

799

896

887

637

*

495

748

*

*

545

646

667

*

938

861

713

917

767

822

816

798

764

’763

1only diagno~~ of sufficient magnitude are noted.

2Unknown~ Were considered not dependent for tha PurPOse OT ‘his

j.lldex.

Slncludes dischargeswho walked with aS?.iStanCe.

were higher for persons receiving physician visits

during the week before discharge ($878), but they

did not vary statistically by level of nursing care or by

whether any therapy services had been received

during the month before discharge. Surprisingly,

charges were also not statistically different for dischargesby dependency status: $816 forpersonswho

Table L. Average total monthly charge fornursing home discharges,

byhealth aervices received: United States, 1976

Average

Health services received total

monthly

charge

Alldischarges . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Physician service

Time since last Dhvsician visit:

Lessthan l week . . . . . . . . . . . . . . . . . . . . . . . . .

lweekto lessthan2 . . . . . . . . . . . . . . . . . . . . . .

2weeksto lessthanl month. . . . . . . . . . . . . . . . .

lmonthtolessthan 3..... . . . . . . . . . . . . . . . .

3monthsto lessthan6 . . . . . . . . . . . . . . . . . . . . .

6monthstolessthan 12...... . . . . . . . . . . . . . .

lyearormore . . . . . . . . . . . . . . . . . . . . . . . . . .

Nophysicianvisitewhile infacili~yl . . . . . . . . . . . .

Services given at last physician visiti z

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

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

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

Ordersfor laboratory tests... . . . . . . . . . . . . . . . .

Otherservices . . . . . . . . . . . . . . . . . . . . . . . . . . .

Level ofcare received *

Nursingcare:

Intensive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Personal careornone . . . . . . . . . . . . . . . . . . . . . . . .

Therapy sewice

Notherapy serviceduring laetmonthl . . . . . . . . . . . . .

Therapy serviceduring last month . . . . . . . . . . . . . . . .

Physicaltherapy . . . . . . . . . . . . . . . . . . . . . . . . .

Recreational therapy . . . . . . . . . . . . . . . . . . . . . .

Occupational therapy . . . . . . . . . . . . . . . . . . . . . .

Speech or hearingtherapy . . . . . . . . . . . . . . . . . . .

Counseling bysocialworker . . . . . . . . . . . . . . . . . .

Counseling bymental health worker . . . . . . . . . . . .

Realityoriantation . . . . . . . . . . . . . . . . . . . . . . . .

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

Special diet within Iast 7 days

No special diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Special diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lowsodium . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diabetic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

soft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Weight less . . . . . . . . .. . . . . . . . . . . . . . . . . . . .

Bland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

$789

878

731

702

641

774

*

*

738

793

764

765

753

787

793

820

671

753

853

955

774

983

995

861

693

754

725

756

835

910

781

854

*

771

809

llncludes a small numbarof unknowns.

2Exc[udes those who recaived no physician visits since antering faCilitY’.

were not dependent in either mobility or continence.

$798 for persons dependent in ordymobility, $’764

for persons dependent in ordy continence, and$763

forpersons dependent inboth.

Greater differentiation in charges for care appeara

when facility characteristics are examined. Monthly

charges for discharges from facilitiesinthe Northeast

were substantially higher ($l,098 )thanfrom :facilities

in any other region ($743 for the North Central,

$654 for the South, and $695 for the West). In

addition, as table 10 shows, charges for discharges

from facilities in the SNF-only group ($962) and

10
combined skilled nursing and intermediate care primary diagnoses or for those who received different

facilities ($8 11) were higher than for facilities in the levels of health care services, the dtiferences in

ICF-only group ($565) and for noncertified facilities charges may be for routine and administrative re-

($430). Since there was not much statistically signifi- quirements unrelated to the individual patient’s

cant variation in charges for patients with different needs.

11
Death in nursing homes

Some of the weceding sections have dealt with

the discharge status (live or dead) of nursing home

discharges. It was noted that the proportion of

nursing home patients discharged alive has increased,

and the proportion discharged dead has decreased

(table A). Also, the average duration of stay for dead

discharges exceeded that for live discharges (130 days

compared with 60 days) (table 3). Discharge status

was further shown to be related to primary diagnosis

at admission and dependency status. In this section,

nursing home deaths are discussed in relation to all

deaths in the United States and to the location of

those deaths.

In 1976, 290,000 deaths occurred in nursing

homes, of which 271,000 were among persons 65

years and over. These nursing home deaths accounted

for roughly 22 percent of the 1.2 million deaths

among the entire U.S. population 65 years and over

in 1976. An even greater proportion of deaths among

persons 85 years and over occurred in nursing homes:

116,000, or 38 percent, of the 304,500 deaths among

persons 85 years and over in the United States in

1976.

For persons 65 years and over and 85 years and

over, the proportion of the deaths in nursing homes

among elderly women exceeds that for elderly men:

44 percent of deaths among women 85 years and over

occurred in nursing homes, compared with 28 percent

of deaths among men 85 years and over (table M).

Location at death has relevance to health resources data by showing the different utilization rates

for certain parts of the population (such as the

elderly and women) and by showing patterns of

transfer between types of inpatient health facilities.

In general, a greater proportion of both elderly

men and women die in hospitals than in nursing

homes. For both sexes combined, 45 percent of

elderly persons’ deaths in 1976 occurred in “hospitals,

compared with 22 percent of deaths among elderly

persons in nursing homes, However, two facts show

the variation in location of death by age and sex.

One, deaths among persons 85 years and over were

Table M. Number and percent distribution of deaths among persons age 65 years and over by location of death, according to sex and age:

United States, 1976

Both sexes Male Female

Location of deeth

65 years 85 years 65 yeers 85 years 65 years 85 years

and over and over end over and over and over and over

Number

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,245,100 304,500 624,800 113,100 620,300 191,400

Nursing homes . . . . . . . . . . . . . . . . . . . . . . . . . 271,400 115,500 90,300 31,100 181,200 84,500

Short-stay hospitals . . . . . . . . . . . . . . . . . . . . . . 563,700 117,100 285,600 50,000 278,000 67,100

Parcent distribution

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

Nursing homes . . . . . . . . . . . . . . . . . . . . . . . . . 21.8 37.9 14.4 27.5 29.2 44.1

Short-stay hospitals . . . . . . . . . . . . . . . . . . . . . . 45.2 38.4 45.7 44.1 44.8 35.0

I Figures do not add to totals because they include all deaths regardless Of 10catiOn.

SOURCES: National Center for Health Statistics Final mortality statistics, 1976. Monthly Vital Statistics Report. Vol. 26-No. 12, Supp. DHEW Pub.

No. (PHS) 78-1120. Public Health Service. Hyatteville, Md. Mar. 30, 1978; and National Centar for Health Statistics: Unpublished data from the 1976

Hospital Discharge Survey.

12
evenly divided between hospitals and nursing homes:

38 percent each. Two, deaths among women in that

“age bracket were greater in nursing homes than in

hospitals: 44 percent compared with 35 percent

(table M).

The 1977 National Nursing Home Survey included information on the type of place or facility to

which a live discharge went after discharge, and, if the

discharge was sent to another health facility, whether

he or she was known to have died there. Of the

484,000 persons discharged live to another health

facility, 91,000 (19 percent) were known to have

died there. To estimate the number of nursing home

discharges whose outcome of care was death (even if

they were discharged in terminally ill states to

hospitals to die), the 91,000 deaths in other health

facilities were added to the 271,400 deaths that

actually occurred in nursing homes. Since only

known deaths in the other health facilities were

reported, these data represent a minimum estimate.

Nevertheless, these counts are useful in developing a clearer picture of nursing home utilization rates.

The adjusted nursing home death rate shows that 29

percent of deaths among persons age 65 years and

over and 49 percent of deaths among persons age 85

years and over followed a stay in a nursing home. For

women age 85 years and over, the adjusted death rate

is 55 percent (table N). These data on nursing home

deaths and location of death for elderly persons in

the United States indicate that nursing homes play an

important role in providing service to elderly persons

in their final years.

Table N. Numbar and percent distribution of daaths among persons age 65 years and ovar by unadjusted and adjustad statistics,

according to sex and age: United States, 1976

Both sexes Male Female

Type of statistic

65 years 85 years 65 years 85 years 65 years 85 years

and over and over and over and over and over and over

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

Nursing homes:

Unadjusted . . . . . . . . . . . . . . . . . . . . . . . . .

Adjusted . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Nursing homes:

Unadjusted . . . . . . . . . . . . . . . . . . . . . . . . .

Adjusted . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number

1,245,100 304,500 624,800 113,100 620,300 191,400

271,400 115,500 90,300 31,100 181,200

356,300

64,500

149,800 123,400 44,000 232,800 105,700

Percent distribution

100.0 100.0 100.0 100.0 100.0 100.0

21.8 37.9 14.4 27.5 29.2 44.1

28.6 49.1 19.7 38.8 37.5 55.2

1 F iguras do not add to totals because they include all deaths regardless Of 10catiOn.

SOURCES: National Center for Health Statistics: Final mortelity statistics, 1976. Monthly Vital Statistics Report. Vol. 26-No. 12, SupP. DHEW Pub.

No. (PHS) 78-1120. Public Health Service. Hyattsville, Md. Mar. 30, 1978; and National Center for Health Statistics The 1977 Nationel Nursing

Home Survey. Adjusted numbers of deeths in nursing homes were computed by adding nursing home deaths and known deaths among live nursing

home discharges to those of other health facilities.

13
References

1National Center for Health Statistics: Inpatient health facilities as reported from the 1973 MFI Survey, by A. Sirrocco.

~ Vital and Health Statistic~. Series 14-No. 16. DHEW Pub. No.

(HRA) 76-1811. Health Resources Administration. Washington. U.S. Government Printing Office, May 1976.

‘National Center for Health Statistics: A comparison of nursing home residents and discharges from the 1977 National

Nursing Home Survey, United States, by E. Hing and A. ZapPO1O.Advance Data From Vital and Health Statistics, No. 29.

DHEW Pub. No. (PHS) 78-1250. Public Health Service. Hyattsville, Md., May 17, 1978.

3Nationrd Center for Health Statistics: An overview of nursing

home characteristics, provisional data from the 1977 National

Nursing Home Survey, by M. Meiners. Advance Data From

Vital and Health Statistics, No. 35. DHEW Pub. No. (PHS)

78-1250. Public Health Service. Hyattsville, Md., Sept. 6,1978.

4National Center for Health Statistics: The National Nursing

Home Survey, 1977 Summary for the United States, by J. F.

Van Nostrand et al. Vital and Health Statistics. Series 13-No.

43. DHEW Pub. No. (PHS) 79-1794. Public Health Service.

Washington. U.S. Government Printing Office, July 1979.

5National Center for Health Statistics: Nursing home utilization in California, Illinois, Massachusetts, New York, and

Texas, 1977 National Nursing Home Survey, by D. J. Foley.

Vital and Health Statistics. Series 13-No. 48. DHHS Pub. No.

(PHS) 81-1799. Public Health Service. Washington. U.S. Government Printing Office, Ott. 1980.

6National Center for Health Statistics: Employees ~ nursing

homes in the United States, 1977 National Nursing Home Survey, by A. Sirrocco. Vital and Health Statistics. Series 14-No.

25. DHHS Pub. No. (PHS) 81-1820. Public Health Service.

Washington. U.S. Government Printing Office, Feb. 1981.

7National Center for Health Statistics: Characteristics of

nursing home residents, health status, and care received:

1977 National Nursing Home Survey, by E. Hing. Vital and

Health Statistics. Series 13-No. 51. DHHS Pub. No. (PHS) 81-

1712. Public Health Service. Washington. U.S. Government

Printing Office, Apr. 1981.

8National Center for Health Statistics: Utilization ancl financial characteristics of nursing homes in the United States:

1977 National Nursing Home Survey, by B. Bloom, Vital and

Health Statistics. Series 13-No. 53. DHHS Pub. No. (PHS) 81-

1714. Public Health Service. Washington. U.S. Government

Printing Office. In preparation.

9National Center for Health Statistics: Development and maintenance of a National Inventory of Hospitals and Institutions.

Vital and Health Statistics. PHS Pub. No. 1000-Series l-No. 3.

Public Health Service. Washington. U.S. Government Printing

Office, Feb. 1965.

10National Center for Health Statistics: Design and methodology of the 1967 Master Facility Inventory Survey. Vital and

Health Statistics. PHS Pub. No. 1000-Series l-No. 9, Public

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

Jan. 1971.

11National Center for Health Statistics: The agency reporting

system for maintaining the National Inventory of Hclspitals

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

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

Government Printing Office, Apr. 1968.

12National Center for Health Statistics: Nursing home costs–

1972, United States: National Nursing Home Survey, August

1973-April 1974, by M. Meiners. Vital and Health Statistics.

Series 13-No. 38. DHEW Pub. No. (PHS) 79-1789. Public

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

NOV. 1978.

13Katz, S. et al.: Studies of illness in the aged. JAMA.

185(12): 914-919, Sept. 1963.

A Katz s. et al.: pro~ess in Development of the ~nc~ex of

ADL. ;erontolo@t. 10 (pt. 1): 20-30, Spring 1970.

15National Center for Health Statistics: Eighth Revision International Classification of Diseases, Adapted for Use in the

United States. PHS Pub. No. 1693. Public Health Service.

Washington. U.S. Government Printing Office, 1967.

14
List of detailed tables

1. Number and percent distribution of nursing home discharges

by discharge status and duration of stay, according to facility

certification and bed siz= Unitad States, 1976. . . . . . . . .

2. Number and percent distribution of nursing home discharges

by discharge status and duration of stay, according to facility

certification and ownership: United States, 1976. . . . . . . .

3. Number and percent distribution of nursing home discharges

by duration of stay, according to discharge status and selected charecteristic~ United Statas, 1976. . . . . . . . . . . .

4. Number and percent distribution of nursing home discharges

by discharge status and duration of stay, according to selected health statuses: United States, 1976 . . . . . . . . . . .

5. Number and percent distribution of nursing home discharges

by madian duration of stay, discharge status, and use of special aids or devices, according to selected functional statusas:

United States,1976 . . . . . . . . . . . . . . . . . . . . . . . . .

6. Number andparcent distribution of nursing homedischarges

by type of dependency and partial index of dependency in

activities of daily Iiving, according tosalected health statuses:

United Statas., 1976 . . . . . . . . . . . . . . . . . . . . . . . . .

7.

16

18 8.

20

9.

23

10.

27

28

Number and percent distribution of nursing homedischarges

by selected health services receivad, according to median

duration of stay, discharge status, Ieval of care during last7

days, and partial index of dependency in activities of daily

living: United States, 1976 . . . . . . . . . . . . . . . . . . . . . 32

Number and percent distribution of nursing home discharges

by time since last physician visit and services givan at last

physician visit, according to primary diagnosis at admission:

United States, 1976 . . . . . . . . . . . . . . . . . . . . . . ...34

Number and percent distribution of nursing home discharges

by level of care during last 7 days, special diet within last 7

days, and therapy service during last month, according to

primary diagnosis at admission: Unitad Statesr 1976. . . . . . 36

Average total monthly charga and average amount paid by

primary source for nursing home discharges, by primary

source of payment and selected nursing home characteristics:

Unitad States, 1976 . . . . . . . . . . . . . . . . . . . . . . . . . 38

.

15
Table 1. Number and percent distribution of nursing homa discharges by discharge status and duration of stay, according to facility

certification and bed size: United Statas, 1976

Facdity certification and bed sfze 1

All dischaqes2

Total Less than 1 month to 3 months to 6 months

1 month less than 3 /ess than 6 or more

All nursing homes

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

Lessthan50beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

200 bedsmmOm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skdled nursing facdity only

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

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

5&99 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10G199beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

200 bedsmmme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skilled nursing factlity and intermediate care facility

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

Lessthan50beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5B99beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

200 bedscwmcire, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Intermediate care facility Only

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

Lessthan50beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

200 bxlsOrmOre . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Not certified

Tota l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lessthan 50&ds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

200 bedsor more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Al I nursing homes

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

Lessthan50 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

10&199 beds,............,,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

200 bedsor more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skilled nursing facility only

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

Lessthan50 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

lCIO-199&ds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

200 bedsormore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skdled nursing facll(ty and intermediate care facil!ty

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

Les.sthan 50 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

50-99 bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

200 bedsormore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Intermediate care facility only

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

Lessthan50beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

200 badsormore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Not certified

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

Lessthan50 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

50-99 bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

200 bedsor more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,117.500

150,000

323,800

479,500

164,200

379,000

54,800

111,200

156,700

56,200

446,400

23,900

110,300

226,300

87,800

210,400

37,400

76,900

85,000

11,200

79,600

33,900

25,300

11,500

8,900

100.0

100.0

100.0

100.0

100.0

f 00.0

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

375,200

62,200

107,900

f 61,900

43,100

168,200

34,900

48,500

68,800

16,0d0

143,900

13,000

36,500

71,400

23,100

42,500

6,300

14,300

20,200

.

20,600

8,0Q0

8,500

.

.

33.6

41.5

33.3

33.8

26.3

44.4

63.7

43.6

43.9

28.4

32.1

54.1

33.1

31.6

26.2

20.2

17.0

18.6

23.7

.

25.9

23.6

33.8

.

●

Number

224,200

28,000

61,700

100,300

34,100

80,900

8,2CH3

24,300

36,000

12,300

91,600

5,300

19,800

47,800

18,600

34,400

5,800

12,300

14,400

“

17.400

8,700

5,300

.

.

Percent distribution

20.1

18.7

19.1

20.9

20.8

21.3

15.0

21.9

23,0

21.8

20.4

22.3

18.0

21.1

21.2

16.3

15.6

15.9

17.0

●

21.8

25.5

20.7

●

●

134,900

12,000

43,400

56,400

23,200

36,000

.

12,400

11,500

9,600

61,200

●

16,700

32,500

10,500

30,000

●

11,800

11,400

.

7,700

●

.

●

.

12:

8.0

13,4

11.8

14,1

9.5

.

11.1

7.3

17.1

13.6

.

15.2

14.4

11.9

14.3

.

15.4

13.4

.

9.7

.

●

.

●

383,200

47,800

110,800

160,900

63,700

93,900

9,100

26,000

40,500

18,400

151,800

.

37,200

74,600

35,800

103,600

20,500

38,500

39,000

5,600

33,900

14,000

9,100

6,600

●

34.3

31.9

34.2

33.6

38.8

24.8

16.7

23.4

25.8

32.7

33.9

●

33.8

33.0

40.7

49.2

54.8

50.0

45.9

50.2

42.6

41.3

35.9

59.2

●

lFacilitv characteristicsfm 1977.

Zlncludes discharges with unknown discharge status.

NOTE: FiWrasmay nOtaddtO tOtalsdue tO rounding.

16
Tablal. Number andparcant distribution of nursing homadischarws bydimha~tiatus andduration ofway, wmrdingtofaciliW

certification and bed size: United States, 1976—Con.

Live discharges Dead discharges

Total Less than 1 month to 3 months to 6 months

1 month

Tots/ Less than 1 month to 3 months to 6 months

less than 3 less than 6 or more 7 month less than 3 Iess than 6 or more

Number

250,900 289,800

30,200 31,300

67,600 92,500

109,800 123,200

43,300 42,700

825,500

118,700

230,500

355,900

120,500

293,900

47,600

78,400

123,200

44,700

320,900

17,500

79,800

162,600

60,900

47,800

25,300

52,800

61,100

8,600

63,100

28,300

19,500

9,000

8,200

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

299,400

57,100

82,300

127,800

32,200

139,900

33,700

37,400

56,600

12,200

108,300

10,900

27,100

53,700

16,600

33,100

5,100

10,500

16,200

●

18,100

7,400

7,300

.

●

36.3

48.1

35.7

35.9

26.7

47.6

70.8

47,7

45,9

27.3

33.8

62.2

34.0

33.0

27.3

22.4

20.2

19.9

26.5

●

28.7

26.2

37.3

●

●

171,800

21,600

48,400

76,000

25,800

I 03,500

9,700

32,300

42,200

19.200

75,400

5,100

25,600

33,800

10,700

52,000

6,400

13,100

24,300

8,100

31,100 131,400

17,800

43,100

50,600

19,900

30,800

.

10,300

12,700

.

52,700

.

15,100

23,500

12,200

37,700

6,700

15,000

12,500

●

10,100

.

●

.

.

45.3

56.2

46.5

41.3

46.6

36.7

●

32.0

38.0

.

41.7

.

49.7

37.1

48.3

60.2

71.7

62.3

52.6

●

61.3

●

●

●

●

.

10,700

14,100

.

65,300

6,300

18,200

30,700

10,100

25,900

●

7,400

8,100

8,300

62,800 84,300 26,300 15,300 9,800

●

*

●

.

5,500 7,200

15,500 32,100

27,700 33,800

14,100 11,400

.

11,200

12,200

●

.

6,000

5,300

●

65,800

●

17,000

32,400

13.000

46,300

●

13,600

25,500

8,200

98,400 126,400 35,100

●

9,400

17,500

6,200

25,80Q

●

.

15,300

5,600

12,800

.

●

7,0Q0

.

●

6,400

22,100 30,5U0

51 ,Wo 63,300

23,100 26,200

26,100

.

9,500

10,800

●

22,700

●

9,300

7,700

.

65,800 62,700 9,400

.

.

●

.

8,200 7,300

.

.

.

.

11,800 12,100

23,400 24,200

26,400 23,600

. .

●

●

●

✎

14,600

7,700

●

●

●

6,500

.

.

●

●

23,800 16,400 ● .

10,800 5,600

6,500 5,800

● .

● ●

.

.

*

●

.

●

.

.

.

.

Percent distribution

20.6 30.4 100.0

18.2

21.0

21.4

21.4

12.5

8.2

14.0

11.9

15.9

2s0 17.9

20.5

14.2

19.7

19.0

10.7

●

11.5

11.5

●

25.4 100.0

29.3 1 m.o

30.9 100.0

38.0 100.0

16.2

27.7

27.5

25.1

22.2

13.2

23.2

24.9

22.7

8.8

.

9.4

6.6

18.5

21.4 100.0 33.6

.

34.9

36.3

.

18.1

●

18.7

15.9

●

11.6

.

.

●

.

11.7 100.0

19.8 100.0

22.5 100.0

31.5 1 OQ.o

20.5

●

21.3

19.9

21.4

15.1

●

17.0

15.7

13.5

30.7 100.0

●

100.0

27.7 100.0

31.4 100.0

37.9 100.0

27.8

*

30.7

27.7

23.6

20.4

.

●

24.2

21.3

10.2

.

.

11.0

●

17.7

●

17.9

17.7

●

15.4

.

17.7

12.5

.

44.5 100.0

48.7 100.0

44.4 100.0

43.3 1 Oi).o

●

100.0

15.0

.

.

.

●

13.2

.

●

.

.

11.6

.

.

.

.

23.1

27.1

.

●

●

10.4

.

.

.

●

37.8 100.0 ● ● ●

37.5 100.0

33.2 100.0

●

100.0

.

.

●

✎

●

☛

.

.

.

.

100.0 ●

17
Table2. Num&rand percent distribution ofnursing home discharges bydischarge smtusand duration ofway, according to facility

certification and ownership: Unitad States, 1976

Facititv certification end o wnership 1

All discharges

Total Less than 1 month to 3 months to 6 months

1 month less than 3 less than 6 or more

All nursing homes

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

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

Voluntary nonprofit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skilled nursing faclltty only

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

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

Voluntary nonprofit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skilled nursingfacility and intermediate care facility

Total, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Voluntaw nonprofit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,, ,. .,.

Government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Intermediate care facd n y only

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

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

Voluntary nonprofit, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Not certified

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

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

Voluntary nonprofit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Governmen t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

All nursing homes

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

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

VOlunta~ nOnprOfit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skillad nursing facility ody

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

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

Voluntary nonprofit......,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skilled nursing f=il ity and intermediate care facil ity

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

PrOprieta~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Voluntary nonprofit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Intermediate care fscility only

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

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

Voluntary nonprofit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Not certified

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

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

Voluntary nonprofit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,117,500

803,100

225,100

89,200

379,000

265,6oO

85,500

27,900

448,400

320,100

93,100

35.200

210,400

168,200

27,800

14,500

79,600

49,200

18,800

11,700

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

375,200

256,700

88,000

30,400

168,200

102,900

50,600

14,700

143,900

105,400

28,9oo

9,600

42,500

36,200

.

●

20,600

12,200

5,000

.

33.6

32.0

39.1

34.1

44.4

38.7

59.2

52.6

32.1

32.9

31.0

27.2

20.2

21.5

●

●

25.9

24.7

26.9

.

Number

224,200

164,800

43,400

15,900

80,900

62,600

14,900

.

91,600

64,500

19,200

7.900

34,400

28,000

.

.

17,400

9,700

5,000

.

Percent distribution

20.1

20.5

19.3

17.8

21.3

23.6

17.5

.

20.4

20.1

20.6

22.6

16.3

16.7

.

.

21.8

19.8

26.7

.

134,900

107,900

19,300

7,800

36,000

28,700

6,000

●

61,200

48,400

8,600

●

30,000

24,800

.

“

7,700

5,900

●

●

12.1

13.4

8.6

8.7

9.5

10.8

7.0

●

13.6

15.1

9.3

.

14.3

14.7

●

.

9.7

12.0

.

●

383,200

273,700

74,400

35,100

93,900

71,400

14,000

8,600

151,800

101,800

36,400

13,600

103,800

79,200”

16,100

8,300

33,900

21,400

7,800

.

34.3

34.1

33.0

39.4

24.8

26.9

16.4

30.8

33.9

31.8

39.1

38,6

49.2

47.1

58.0

57.2

42.6

43.5

41.8

●

1 Facility characteristics for 1977.

2 Includ.s discharges with unknown d ihchwgs status.

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

18
Tabla 2. Number and percent distribution of nursing home discharges by discharge statusand duration of stay, according to facility

certification and ownarship: United States, 1976–Con.

Live discharges Dead discharges

Total Less than 1 month to 3 months to 6 months Total Less than 1 month to

1 month

3 months to

less than 3 less than 6

6 months

or more 1 month less than 3 less than 6 or more

825,500

600,900

160,000

64,700

293,900

200,600

69,900

23,200

320,900

239,200

58,700

22,900

147,800

120,200

17,500

10,100

63,100

40,800

13,800

8,500

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

299,400

201,900

75,100

22,300

139,900

80,900

46,700

12,300

108,300

81,900

20,800

5,500

33,100

28,100

.

.

18,100

11,100

.

.

36.3

33.6

46.9

34.6

47.6

40.3

66.8

53.2

33.8

34.2

35.5

24.2

22.4

23.4

●

,,

28.7

27.1

.

.

171,800

124,400

34,000

13,300

65,300

48,700

13,300

.

65,800

47,000

13,000

5,800

26,100

20,500

●

●

14,600

8,100

.

.

20.8

20.7

21.3

20.6

22.2

24.3

19.0

●

20.5

19.7

22.1

25.4

17.7

17.1

●

.

23.1

20.0

.

.

103,500

83,700

13,100

6,700

25,900

21,000

.

.

46,300

39,mo

6,200

.

22,700

18,900

●

●

6,500

.

.

.

12.5

13.9

8.2

10.3

8.8

10.5

.

.

15.1

16.3

10.6

●

15.4

15.7

.

.

10.4

.

.

.

Numter

250,900 289,800

191,(300 200,300

37,700 65,100

22,300 24,300

62,900 84,300

50,200 63,900

6,300 15,600

6,300 .

98,400 126,400

71,300 79,900

16,700 34,300

8,4W 12,200

65,800 62,700

52,700 46,000

8,200 10,200

. ●

23,800 16,400

16,800 8,400

. .

● .

Percentdistributic.n

30.4 100.0

31.8 . 100.0

23.6 100.0

34.5 100.0

21.4 100.0

25.0 100.0

9.0 100.0

27.3 100.0

30.7 100.0

29.8 100.0

31.9 100.0

36.8 100.0

44.5 100.0

43.8 100.0

47.0 100.0

. ●

37.8 100.0

41.3 100.0

. .

. ●

75,400

54,400

13,0WJ

7,900

28,3W

22,000

.

●

35,100

23,200

6,000

.

9,4m

8,100

.

.

.

.

.

.

26.0

27.2

19.9

32.7

33.6

34.5

●

.

27.6

29.0

23.4

.

15.0

16.9

●

.

●

*

.

.

52,000

40,200

9,300

●

15,300

13,800

●

25,800

17,500

6,200

●

8,200

7,500

.

.

●

●

.

.

17.9

20.1

14.3

.

18.1

21.3

*

20.4

21.8

18.0

●

13.2

15.6

●

.

.

●

.

●

31,100

23,800

6,200

.

9,800

7,300

●

●

12,800

9,400

●

●

7,300

5,900

●

.

●

10.7

11.9

9.5

.

11.6

11.5

.

●

10.2

11.8

.

.

11.6

12.2

●

●

.

131,400

81,900

36,700

12,800

30,900

21,000

7,700

●

52,700

28,800

17,700

5,200

37,700

26,500

7,900

●

10,100

●

●

*

45.3

40.9

58.3

52.8

36.7

32.8

49.2

●

41.7

37.3

51.6

42.4

80.2

55.2

76.6

●

61.3

.

.

●

19
Table3. Number andpercent distribution of nursing home discharges byduration of Say, according todischarge status and selected

characteristics: United States, 1976

Median Duration of stay

Dischargestatusand duration

selectedcharacteristics of stay All Lessthan 1 month 3 months 6 months 1 year 3 years

‘stays to less 5 yea~

in days 1month to less to less to less to less

than 3 than 6 than 72 than 3

or more

than 5

Number

134,900

●

●

10,500

11,000

12,600

25,400

32.400

19,300

13,900

*

80

47,200

87,700

31,200

73,800

7,400

18,300

●

103,500

●

●

7,300

9,700

9,700

19,400

24,900

14,700

9,500

*

79

36,000

67,500

22,700

55,600

*

15,700

*

29,700

69,700

15,100

47,800

●

*

12,500

*

Alldischargesl . . . . . . . . . . . . . . . . . . . . .

Age

Under 45years . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . .

55-64years . . . . . . . . . . . . . . . . . . . . . . . .

65-69years . . . . . . . . . . . . . . . . . . . . . . . .

70-74years . . . . . . . . . . . . . . . . . . . . . . . .

7579yaars . . . . . . . . . . . . . . . . . . . . . . . .

80-84yaars . . . . . . . . . . . . . . . . . . . . . . . .

85-89years . . . . . . . . . . . . . . . . . . . . . . . .

90-94years . . . . . . . . . . . . . . . . . . . . . . . .

95yearsandover . . . . . . . . . . . . . . . . . . . .

Medianageinyears . . . . . . . . . . . . . . . . . .

Sex

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

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

Marital status at discharge

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

Widowed . . . . . . . . . . . . . . . . . . . . . . . . .

Divorcedorseparated . . . . . . . . . . . . . . . . .

Nevermarried . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . .

Livedischarges . . . . . . . . . . . . . . . . . . . . .

Aga

Under45years . . . . . . . . . . . . . . . . . . . . .

45-54years . . . . . . . . . . . . . . . . . . . . . . . .

55-64years . . . . . . . . . . . . . . . . . . . . . . . .

65-69years . . . . . . . . . . . . . . . . . . . . . . . .

70-74years . . . . . . . . . . . . . . . . . . . . . . . .

75-79years . . . . . . . . . . . . . . . . . . . . . . . .

80-64years . . . . . . . . . . . . . . . . . . . . . . . .

85-89years . . . . . . . . . . . . . . . . . . . . . . . .

90-94years . . . . . . . . . . . . . . . . . . . . . . . .

95yearsandover . . . . . . . . . . . . . . . . . . . .

Medianageinyaars . . . . . . . . . . . . . . . . . .

Sex

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

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

Marital status at discharge

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

Widowed . . . . . . . . . . . . . . . . . . . . . . . . .

Divorcadorseparated . . . . . . . . . . . . . . . . .

Naver married . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . .

Living arrangement after discharge

private orsemiprivate residen~e . . . . . . . . .

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

Anothernursing home . . . . . . . . . . . . . .

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

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

Other health facility or unknown . . . .

Number who died in other health

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

Unknown orotherarrengement . . . . . . . . . .

See footnotes at end of table.

75

37

56

70

62

47

56

83

99

1,117,500

33,900

33,500

68,800

81,300

122,300

204,600

241,200

210,200

90,500

31,100

80

407,700

709,800

255,900

628,400

75,200

127,200

30,800

825,500

32,400

29,600

55,000

66,400

95,500

159,700

171,300

145,200

55,500

14,900

79

307,600

517300

197,900

445,800

62,600

98,000

21,300

308,700

484,200

108,600

339,500

12,000

24,000

91,100

34,700

375,200

16,400

11,700

21,900

28,900

49,700

75,600

81,300

63,400

20,000

●

78

149,200

225,900

110,900

196,800

23,200

33,100

11,100

299,400

15,500

10,300

16,100

22,800

42,000

63,200

61,200

49,800

14,500

.

78

118,200

181,100

89,900

154,300

20,400

26,500

8,300

155,700

127,300

35,300

80,800.

*

9,700

16,800

16,300

224,200

●

7,400

16,900

19,300

28,100

45,300

44,700

38,800

13,600

*

78

89,400

134,700

61,200 ,

112,800

20,300

24,600

●

171,800

*

*

14,600

15,800

22,100

36,800

32,200

27,000

8,100

●

78

68,8CQ

103,000

48,600

81,800

17,000

20,600

*

83,000

81,800

15,300

59,900

●

*

14,200

*

I 11,700

*

*

*

*

12,400

20,300

23,900

22,700

9,400

*

80

42,000

69,800

21,400

65,400

*

14,800

*

82,800

●

*

*

*

7,900

14,500

18,600

17,200

*

●

80

32,700

50,100

15,300

46,800

*

12,300

*

21,600

59,200

11,800

44,100

*

,

15,100

*

156,900 68,400 46,200

*

*

*

*

*

7,900

8,200

11,800

*

●

84

11,400

34,800

*

29,900

+

10,500

*

20,200

*

*

*

●

*

*

*

*

*

●

79

*

14,900

*

11,600

*

,

*

●

18,000

*

12,600

*

*

*

*

*

+

7,600

12,400

14,000

23,100

32,800

37,200

17,300

7,300

17,90CI

17,20CI

9,50CI

●

169

379

. . .

60

88

40

96

68

113

76

60

37

56

73

62

42

48

65

74

140

169

. . .

55

65

38

73

63

99

71

30

124

82

48,100

108,800

20,3001

48,0001

21,800

104,700

8,900

17,700

*

7,500

45,000

●

8,200

●

108,600 41,300

*

*

*

*

*

10,800

10,200

16,400

19,300

23,900

11,100

●

*

*

*

*

11,600

9,500

*

*

81 83

34,500

72,100

12,100

29,200

15,800

69,600

*

*

26,100

*

*

*

12,700.

*

12,300

91 Joo

15,700

69,800

●

*

*

36,900

11,300

24,500

*

*

103

139

160

60

215

41

19,600

*

7,400

*

20
Tabla3. Number andpercent distribution of nursing home discharges byduretionof stay, according todischarge status and selected

characteristics: United States, 1976-Con.

Median Duration of stay

Discharge status and duration

selected characteristics of stay All Less than 1 month 3 months 6 months 1 year 3 yaars

to less 5 years

in days Stays 1 month to kss to less to less to less

than 3 than 6 than 12 than 3 than 5

or more

Dead discharges . . . . . . . . . . . . . . . . . . . . .

Age

Under 45years . . . . . . . . . . . . . . . . . . . . .

45-54years . . . . . . . . . . . . . . . . . . . . . . . .

55-64years . . . . . . . . . . . . . . . . . . . . . . . .

65-69years . . . . . . . . . . . . . . . . . . . . . . . .

70-74years . . . . . . . . . . . . . . . . . . . . . . . .

75-79years . . . . . . . . . . . . . . . . . . . . . . . .

80-64years . . . . . . . . . . . . . . . . . . . . . . . .

8%89yeare . . . . . . . . . . . . . . . . . . . . . . . .

90-84years . . . . . . . . . . . . . . . . . . . . . . . .

95yearsandover . . . . . . . . . . . . . . . . . . . .

Medianageinyears . . . . . . . . . . . . . . . . . .

Sex

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

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

Marital status at discharge

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

Widowed . . . . . . . . . . . . . . . . . . . . . . . . .

Divorcedorseparated . . . . . . . . . . . . . . . . .

Nevermarried . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . .

Alldischargesl . . . . . . . . . . . . . . . . . . . . .

Age

Under45years . . . . . . . . . . . . . . . . . . . . .

45-54years . . . . . . . . . . . . . . . . . . . . . . . .

55-64years . . . . . . . . . . . . . . . . . . . . . . . .

65-69years . . . . . . . . . . . . . . . . . . . . . . . .

70-74years . . . . . . . . . . . . . . . . . . . . . . . .

75-79years . . . . . . . . . . . . . . . . . . . . . . . .

80-64years . . . . . . . . . . . . . . . . . . . . . . . .

85-89years . . . . . . . . . . . . . . . . . . . . . . . .

90-84years . . . . . . . . . . . . . . . . . . . . . . . .

95yearsandover . . . . . . . . . . . . . . . . . . . .

Medianageinyears . . . . . . . . . . . . . . . . . .

Sex

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

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

Marital status at discharge

Married

Widowed.;IIIIII;;;;;;; :;;;;;:;;;;

Divorcedorseparated . . . . . . . . . . . . . . . . .

Nevermarried . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . .

See fcmtnotes at and of table.

A

130

*

●

37

40

91

110

119

263

302

791

. . .

64

175

58

177

112

308

135

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

289,600

*

*

13,600

14,900

26,600

44,900

69,600

64,600

35,000

15,900

83

99,400

190,400

57,700

181,700

12,600

28,700

9,100

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

75,400

*

*

●

*

7,700

12,400

20,100

13,700

●

*

60

30,800

44,600

21,100

42,400

●

●

●

33.6

48.3

35.0

31.8

35.5

40.6

36.9

33.7

30.2

22.1

*

. . .

36.6

31.8

43.3

31.3

30.8

26.0

36.1

52,000

*

*

●

●

●

8,500

12,300

11,600

●

●

82

20,200

31,700

12,400

30,800

●

●

●

Number

31,100

●

*

*

*

●

●

7,500

●

●

●

81

11,200

19,800

8,300

18,000

*

*

●

28,800

*

●

●

*

●

●

●

*

●

81

9,300

19,500

●

18,600

●

●

*

20.1

●

22.2

24.6

23.7

23.0

22.1

18.5

18.4

15.0

*

. . .

21.9

19.0

23.9

17.9

27.0

19.3

●

12.1

●

*

15.3

13.5

10.3

12.4

13.5

9.2

15.3

*

. . .

11.6

12.4

12.2

11.7

9.8

14.4

●

10.0

●

*

*

●

10.2

9.9

9.9

10.8

10.4

*

. . .

10.3

9.8

8.4

10.4

*

11.6

*

49,700

●

●

●

*

●

13,500

13,200

●

●

84

13,600

36,100

●

34,900

●

●

*

14.0

●

*

11.0

15.2

11.4

11.3

13.6

17.7

19.1

23.6

. . .

11.8

15.3

8.5

16.7

11.8

13.9

*

26,900

*

*

*

*

●

7,500

*

*

86

8,200

18,700

*

18,700

*

*

●

6.1

●

*

●

*

*

*

7.4

8.2

10.5

●

. . .

5.0

6.8

2.9

7.2

*

6.4

●

26,000

*

*

*

*

*

*

8,600

*

*

87

●

20,000

*

18,300

*

*

●

4.1

*

●

*

*

●

3.9

3.4

5,6

●

*

.,.

2.8

4.9

*

4.8

*

8.3

●

21
Table3. Number andpercent distribution of nursing home discharges byduration oftiay, amording todischarge Satusandsele(:ted

characteristics United States, 1976—Con.

Median Duration of stay

Discharge status and duration

1 month selected characteristics of stay All Less than 3 months 6 months 1 year 3 years

to less to less 5 years

in days stays 1 month to less to less to less

than 3 than 6 than 12 than 3

or more

than 5

Livedischarges . . . . . . . . . . . . . . . . . . . . .

Age

Under 45years . . . . . . . . . . . . . . . . . . . . .

45-54years . . . . . . . . . . . . . . . . . . . . . . . .

55-64years . . . . . . . . . . . . . . . . . . . . . . . .

65-69yaara . . . . . . . . . . . . . . . . . . . . . . . .

70-74years . . . . . . . . . . . . . . . . . . . . . . . .

75-79years . . . . . . . . . . . . . . . . . . . . . . . .

80-84yaars . . . . . . . . . . . . . . . . . . . . . . . .

85-89years . . . . . . . . . . . . . . . . . . . . . . . .

90-84years . . . . . . . . . . . . . . . . . . . . . . . .

95yearsandover . . . . . . . . . . . . . . . . . . . .

Medianageinyears . . . . . . . . . . . . . . . . . .

Sex

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

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

Marital status at discharge

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

Widowed . . . . . . . . . . . . . . . . . . . . . . . . .

Divorcedorseparatad . . . . . . . . . . . . . . . . .

Nevermarried . . . . . . . . . . .. . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . .

Living arrangement after discharge

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

Anotherhealth facility . . . . . . . . . . . . . . . .

Anotharnursinghome . . . . . . . . . . . . . .

Ganeral orshort-stay hospital . . . . . . . . . .

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

Other health facility orunknown . . . . . . .

Number who died in othar haalth

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

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

Deaddischarges . . . . . . . . . . . . . . . . . . . . .

Age

Undar45years . . . . . . . . . . . . . . . . . . . . .

46-54years . . . . . . . . . . . . . . . . . . . . . . . .

55-64years . . . . . . . . . . . . . . . . . . . . . . . .

65-69years . . . . . . . . . . . . . . . . . . . . . . . .

7@74yeers . . . . . . . . . . . . . . . . . . . . . . . .

75-79years . . . . . . . . . . . . . . . . . . . . . . . .

80-84years . . . . . . . . . . . . . . . . . . . . . . . .

85-89years . . . . . . . . . . . . . . . . . . . . . . . .

80-84years . . . . . . . . . . . . . . . . . . . . . . . .

95yearsandover . . . . . . . . . . . . . . . . . . . .

Medianageinyears . . . . . . . . . . . . . . . . . .

sex

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

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

Marital status at discharge

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

Widowed . . . . . . . . . . . . . . . . . . . . . . . . .

Divorcedorseparated . . . . . . . . . . . . . . . . .

Nevarmarried . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . .

. . .

. . .

. . .

. . .

. . .

..<

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

,..

100.0

100.0

100.0

100.0

100.0

100.0

100.0

?00.0

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

100.0

100.0

100.0

100.0

100.0

100.0

36.3

47.9

34.9

29.3

34.4

43.9

39.6

35.7

34.3

26.1

●

. . .

38.4

35.0

45.4

34.6

32.6

27.1

38.7

50.8

26.3

32.5

23.8

*

40.4

18.5

47.1

26.0

●

●

*

*

29.1

27.6

28.8

21.1

*

●

. . .

31.0

23.4

36.5

23.3

●

●

●

Percent distribution

20.8

*

*

26.5

23.8

23.1

23.0

18.8

18.6

14.7

*

. . .

22.4

19.9

24.6

18.4

27.1

21.0

●

27.1

16.9

14.1

17.6

*

*

15.5

●

17.9

*

*

*

*

*

18.9

17.6

18.0

*

*

. . .

20.4

16.7

21.5

17.0

*

●

*

12.5

+

*

13.3

14.6

10.2

12.2

14.5

10.1

17.0

●

. . .

11.7

13.0

11.5

12.5

●

16.0

*

9.7

14.4

13.9

14.1

●

*

13.7

*

10.7

*

*

+!

*

*

●

10.8

●

●

*

. . .

11.3

10.4

14.3

9.9

*

*

●

10.0

*

●

*

●

8.2

9.1

10.9

11.9

●

●

. . .

10.6

9.7

1:;

●

12.6

.

7.1

12.2

10.9

13.0

*

*

16.6

*

9.9

*

●

*

●

*

●

●

●

●

. . .

9.3

10.3

●

10.2

*

*

●

12.9

*

*

●

16.3

10.7

10.3

11.3

16.4

20.0

*

. . .

11.2

13.9

8.0

15.6

*

12.9

*

4.0

18.9

14.5

20.6

*

*

21.5

●

17.1

*

●

*

*

*

19.3

20.4

,

*

,..

13.7

18.9

*

19.2

●

*

*

5.0

*

6

*

*

*

6.;

C.!j

i,

<e

. . .

3.$1

5.6

*

5.8

*

*

*

*

7.6

10.4

7.2

*

*

8.1

*

9.3

●

*

●

*

*

11.6

●

*

. . .

8.3

9.8

●

10.3

+!

*

●

—.

2.4

*

●

*

*

*

*

*

●

●

*

. . .

●

2.9

*

2.6

*

*

*

*

3.7

*

3.7

*

*

*

*

9.0

*

*

+

*

●

*

13.4

●

*

. . .

6.1

10.5

*

10.1

*

*

●

1 I“CI “ales, unknown disch.ar9e satus.

NOTE: Figures maynotadd totomjs duetoroundjng.

22
Table4. Number andpercent distribution of numinghome diwharges bydischa~e ~atusand duration ofstay, -ording towlected kalthstatums:

United States, 1976

Median Dischatgastatus DurSt?oiSof stay

Healthstatusq dutation All

of stay dischargasz Lessthan 1 month

Liva Dead 3t~~~hs 6months

in days 1 month to less

than 3 than 6

or mom

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

Primary Diagnosis at Admission

Diseasasof thecirculatory system

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

Congestiveheartfailura . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Heartattack, ischemic heart disease . . . . . . . . . . . . . . . . .

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

Mental disorders and senility

without psychosis

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

Senilepsychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherpsychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chronicbrainayndroma . . . . . . . . . . . . . . . . . . . . . . . . .

.%militywithoutpsychosis . . . . . . . . . . . . . . . . . . . . . . .

Mentalretardation . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Alcoholism andother mental disorders . . . . . . . . . . . . . . .

Other diagnosas3

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

Diseases of the muscu Ioskeletal systam and

connactivetissuex

Arthritisandrheumatism . . . . . . . . . . . . . . . . . . . . . .

Diaeasas of the nervous system and

sansaorgarw

parkinson’sdiaaaa? . . . . . . . . . . . . . . . . . . . . . . . . . .

Accidants, poisonings, and violenm

Hipfracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherbonefractura . . . . . . . . . . . . . . . . . . . . . . . . .

Endocrine, nutritional, and metabolic disaaaa$

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

Neoplasm%

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

Diseases of the respiratory system:

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

Diagnosis unknown

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

Chronic Conditions and lmpairmants4

Diseases of the circulatory system

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

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

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

Paralysis or palsy, other than arthritis,

related to stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hearttrouble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental disorders and senility

without psychosis

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

Chronicbrainsyndroma . . . . . . . . . . . . . . . . . . . . . . . . .

senility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Alcoholism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drugaddiction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insomnia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

See footnotes at end of table.

75

94

87

146

109

70

38

58

168

400

200

210

112

601

58

49

67

120

53

48

117

27

44

47

124

95

76

86

82

136

171

187

277

59

●

250

1,117,500

486,200

59,300

197,200

23,100

139,400

40,400

26,800

125,700

10,800

23,100

52,700

9.400

78500

22,200

480,400

28,500

.

10,900

82,700

26,500

45,200

91,600

41,500

25,100

455,500

168,0Q0

228,700

54,000

380,400

64,600

2CS5,300

226,600

18,600

35,700

●

16.500

825,500

339,200

36,700

136,500

17,800

97,800

28,300

22,100

84,900

20,8;

34,400

●

●

20,300

372,500

25,000

8,800

68,700

24,300

36,700

46,900

32,300

19,000

309,100

126,000

155,700

37,900

275,600

55,200

139,800

143,800

15,600

31,200

●

13,600

288,800

146,500

22,600

60.700

●

41,500

11,900

●

30,400

●

●

18,300

●

●

●

107,000

●

●

14.000

●

8,500

44,700

9,200

●

146,200

41,700

72,800

16,100

114,100

9,000

66,500

82,800

●

*

●

●

376,200

151,600

19,900

48,300

7,900

47,300

18,500

9,700

25,600

●

●

10,200

●

●

7,300

187,800

12,400

*

27,600

9,700

13,100

48,100

15,800

10,100

123,500

49,500

73,000

13,500

131,700

17,204Y

47,800

46,200

●

●

●

224,200

88.100

I o.3m

31,100

●

32,500

●

●

21,200

●

●

7,500

●

●

●

109,200

●

●

22,900

10,300

7,200

18,200

10,600

●

79,100

32,900

50,700

12,800

72,400

10,500

33,400

34,900

●

12,800

●

●

134,900

56,900

●

27,700

●

12,700

●

+

16.700

●

●

●

●

●

●

60,100

●

●

11 ,4W

●

●

11,000

●

●

53,600

18,600

22,300

7,300

47,400

7,900

23,100

28,500

●

●

●

●

383,200

188,700

22,700

90,100

10,400

46,900

12,600

●

62,200

●

11,700

27,900

●

●

●

123,300

9,600

●

20,600

●

17,800

14,300

11,000

9,100

199,300

67,000

82,600

20,400

138,900

28,800

101,900

114,100

10,500

8,200

●

23
Table4. Number andpercent distribution of nursing home discharges bydiacherge etatusand duration of atay, according toselected health statuses:

United States, 1976–Con.

Healthstatusl

Median Dischargestatus Duration of stay

duration All

of stay discharges Lessthan 1month

Live Dead to less 3t~$hs 6 months

in days 1month

than 3

or more

than 6

Chronic Conditions and Impeirmants4-Con.

Other chronic conditions and impairments

Diseases of the musculoskeletal system and

mnnactive tissues:

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

Chronic back, spine problems, excluding

stiffness and deform ity . . . . . . . . . . . . . . . . . . . . . .

Permanent stiffness or deformity of beck, arms,

legs, or extremities, including feet, toes,

hands,orfingers . . . . . . . . . . . . . . . . . . . . . . . . . .

Missing arms, legs, or extremities, including

faet, toes, hands, or fingers . . . . . . . . . . . . . . . . . . .

Diseases of the nervous system and sense organs

Blindness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cataracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Daafnees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Parkinson’sdisease . . . . . . . . . . . . . . . . . . . . . . . . . .

Paralysis or palsy, other than arthritis,

unrelatedtostroke . . . . . . . . . . . . . . . . . . . . . . . . .

Accidents, poisonings, and violence:

Hipfractura . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otharbonefracture . . . . . . . . . . . . . . . . . . . . . . . . .

Endocrine, nutritional, and metabolic diseaeey

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

Neoplasms

cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the respiratory system:

Chronic raspiratorydisease . . . . . . . . . . . . . . . . . . . . .

Diseasesofthedigestive system:

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

Diseases of the blood and blood-forming

organs:

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

Diseases of the skin and subcutaneous tissue:

Bedsores . . . . . . . . . . . . . . . . . . . . .

Conditions other than above:

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

Kidneytrouble . . . . . . . . . . . . . . . . .

None of these conditions

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

Condition unknown

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

See footnotes at end of table.

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

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

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

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

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

114

119

124

182

177

79

743

143

118

62

85

48

85

35

65

209

56

57

149

66

34

37

163,100

30,800

69,400

31,300

45,400

20,200

50,100

50,800

29,900

21,900

127,200

66,400

156,800

125,200

99,600

50,800

65,100

36,000

102,200

120,900

37,500

11,800

124,500

24,100

48,500

25,200

31,800

14,100

37,500

35,000

22,300

18,200

97,800

56,200

116,600

67,400

73,000

33,800

48,200

18,800

69,100

88,300

32,600

8,400

Number

38,500

●

20,900

●

13,400

*

12,600

15,700

7,700

●

29,500

9,900

39,800

57,800

26,600

17,000

T7,000

17,200

32,900

32,400

*

●

46,700

7,700

13,900

*

10,100

*

13,600

14,900

8,000

*

34,600

25,900

47,900

69,400

34,800

10,600

23,000

11,200

24,800

39,400

17,900

●

29,700

*

16,400

*

+

*

*

7,800

*

*

30,900

19,000

32,000

23,900

22,200

7,800

16,700

10,100

16,000

26,000

8,500

●

17,200

,

8,600

*

●

●

7,500

*

●

*

19,000

8,300

18,100

14,500

10,900

●

7,500

*

14,400

16,800

●

*

69,500

13,700

30,500

15,600

22,600

7,700

22,500

24,300

12,600

*

42,700

13,200

58,700

27,400

31,700

27,300

17,900

9,000

47,000

38,700

8,200

*

24
Table4. Numbarand percent distribution of nursing homdscharges bydischarge natusand dur~ion of Way, according to Sleeted health statuws:

United Statesr 1976–Con.

Median Dischatgestatus Duration of stay

Healthstatusq duration All

of stay discharges Lessthan 1 month 3 months

Live Dead 6 months

in days 1month to less to less

or more than 3 than 6

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

Primary Diagnosis at Admission

Disea~s of the circulato~ system

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

Congestiveheartfailure . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Heartattack, ischemic heartdisaaae . . . . . . . . . . . . . . . . .

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

Mental disorders and senility

without psychosis

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

.%nilepsychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other psychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chronicbrainsyndrome . . . . . . . . . . . . . . . . . . . . . . . . .

Senilitywithoutpvfchosis . . . . . . . . . . . . . . . . . . . . . . .

Mentalretardation . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Alcoholismand other mental disorders . . . . . . . . . . . . . . .

Other diagnoses3

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

Diseases of the musculoskeletal system and

connective tissues

Arthritisandrheumatism . . . . . . . . . . . . . . . . . . . . . .

Diseasesof the nervous systemandsense Organ$

Parkinson’sdisease . . . . . . . . . . . . . . . . . . . . . . . . . .

Accidents, poisonings, and violence:

Hipfracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherbonefracture . . . . . . . . . . . . . . . . . . . . . . . . .

Endocrine, nutritional, and metabolic diseases:

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

Neoplasnw

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

Diseases of the respiratory system:

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

Diagnosis unknown

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

Chronic Conditions and lmpairments4

Diseases of the circu Iatrxy system

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

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

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

Paralysis or palsy, other than arthritis,

relatedtostroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hearttrouble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental disorders and senility

without psychosis

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

Chronicbrain syndrome . . . . . . . . . . . . . . . . . . . . . . . . .

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

Mental n?tardation . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Alcoholism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drugaddiction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insomnia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

See footnotes at end of table.

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

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

73.9

69.8

61.9

69.2

77.1

70.1

70.0

82.5

75.5

●

89.8

65.3

●

●

91.4

77.5

87.6

80.6

83.1

91.9

81.3

61.2

77.9

75.6

67.9

75.0

68.1

70.2

70.6

85.4

67.8

63.5

83.8

87.4

●

82.4

Percent distribution

25.9

30.1

38.1

30.8

●

29.8

29.5

*

24.2

*

●

34.7

%

●

*

22.3

*

*

16.9

*

18.7

48.8

22.1

*

32.1

24.8

31.9

29.8

28.2

74.0

32.2

36.5

●

*

●

*

33.6

31.2

33.5

24.5

34.2

33.9

45.7

38.4

20.4

●

●

19.4

●

●

33.1

39.1

43.4

●

33.4

36.8

29.0

52.5

38.3

40.3

27.1

29.6

31.9

24.9

33.7

26.7

23.2

21.3

+

29.8

●

●

20.1

18.3

17.4

15.8

●

23.3

●

●

16.8

*

●

14.2

●

●

●

22.7

●

*

27.7

38.8

16.0

19.9

25.5

●

17.4

19.6

22.2

23.7

18.5

16.3

16.2

15.4

●

35.8

●

●

12.1

11.7

●

14.1

●

9.1

*

●

13.3

●

*

●

●

*

●

12.5

●

●

13.7

●

,

12.0

●

*

11.8

11.1

9.8

13.6

12.1

12.3

11.2

13.0

●

*

*

it

34.3

38.8

38.3

46.7

46.1

33.7

31.2

●

49.5

●

50.7

53.0

*

●

*

25.7

33.8

●

25.1

*

39.3

15.6

26.5

36.1

43.8

39.9

36.1

37.7

35.6

44.7

49.4

50.3

58.1

22.9

62.;

25
Table4. Number andparcent distribution ofnursing home dischar@s bydischarge stmusand duration &*y, according toselected health statuses:

United States, 1976-Con.

Median Discharge status Duration of stay

Hea/th statusl duration All

dischargas2 f month of stay

Live Dead

Less than 3 t~”hs 6 months

to less in days 1 month

than 3

or more

than 6

Chronic Conditions and lmpairments4-Con.

Other chronic conditions and impairments

Diseases of the muscuIoskeletal system and

connective tissues

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

Chronic beck, spine problems, excluding

Stiffness and deform icy...... . . . . . . . . . . . . . . . .

Permanent stiffness or deformity of back, arms,

legs, or extrem ities, including feet, toes,

hands, or fingers . . . . . . . . . . . . . . . . . . . . . . . . . .

Missing arms, legs, or extremities, including

feet, toe$, hands, or fingers . . . . . . . . . . . . . . . . . . .

Diseases of the nervous systam and sense organs:

Blindness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

cataracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Deafness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Parkirsson’sdisease . . . . . . . . . . . . . . . . . . . . . . . . . .

Paralysis or palsy, other than arthritis,

unrelatedtostroke . . . . . . . . . . . . . . . . . . . . . . . . .

Accidents, poisonings, and violence:

Hipfracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherbonafracture . . . . . . . . . . . . . . . . . . . . . . . . .

Endocrine, nutritional, and metabolic diseases:

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

Neoplesms:

cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the respiratory system:

Chronicrespiratorydieaase... . . . . . . . . . . . . . . . . . .

Diseasesofthedigestive system:

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

Diseases of the blood and blood-forming

organs:

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

Diseases Of the skin and subcutaneous tissue:

Bedsores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Conditions other than above:

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

Kidneytrouble . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

None of these conditions

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

Condition unknown

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

76.4

78.3

69.9

80.4

70.1

69.9

74.8

68.9

74.3

83.3

76.9

84.6

74.4

53.9

73.3

86.6

73.9

52.2

67.6

73.0

86.8

77.1

Percent distribution

23.6

●

30.1

●

29.6

●

25.2

30.9

25.7

●

23.1

14.9

25.4

48.1

28.7

33.4

26.1

47.8

32.1

26.8

+

●

28.7 18.2

25.0 *

20.0 23.6

● *

22.3 *

* *

27.0 *

29.4 15.3

26.9 *

* *

27.2 24.3

39.0 28.6

30.6 20.4

47.4 19.1

34.9 . 22.3

20.8 15.4

35.3 25.6

3t.o 28.0

24.3 15.6

32.6 21.5

47.7 22.6

● ●

10.5

●

12.5

●

●

●

14.9

,

●

●

14.9

12.5

11.6

11.6

11.0

●

11.6

●

14.J

13.9

*

●

42.6

44.4

43.9

49.7

49.8

38.3

44.9

47.9

42.2

●

33.5

19.9

37.5

21.8

31.8

53.7

27.5

24.9

46.0

32.0

21.8

*

lDi~ase categories ba$ed on Eighth Revision lntarnational Clessificetionof Diseases, Adapted for Ueeinthe United Statas(lCDA).

Zlncl”dee diwhergeswith unknown discharge status.

313”IV d iag”ows of suff iciant magnitude are nOted.

4Fig~re~ may notaddtotoml baca”wdi~harge may have had more than 1 reported condition or impairment.

NOTE: Figures may notaddto totelsdue to rounding.

26
Table5. Numbsrand percent distribution of nursing home discharges bymdian duration dtiay, dwharge matus, anduwofs~cial aids

ordevices, according toselected functional statu.sw United States, 1976

Discharge status .%ecia! aids or devicm use#

Median

durat!on All

discharWsl Crutches ‘~-~” d%%%, of stay Eye- Hear;ng Wheel- GM Other

Live Dead Walker or in days glasses aid chair feeding PO*Y belt, aids or

braces device or simtlar devices

devices

Functional status

I,11 7,500 825,500 289,8oo

Number

567,900 62,600 421,200 101,800 180,500

135,600

25,8CQ

13,0J30

.

II 3,atn3

.

17,8@3

29,300

12,300

.

101,200

14,900

40,400

23,900

la.2

25.5

8.7

5.7

.

20.6

,

23.6

9.6

10.1

.

22.6

10.6

28.4

6.2

30,600 1a,l 00 234,000

52,900

112,700

66,700

.

42,600

.

15,900

12a,600

41,900

.

I a,800

24,500

35,800

154,800

20.9

9.9

37.9

2a.o

.

7.a

.

21.1

41.6

34.4

.

4.2

17.4

26.2

40.1

77,100

30,9Ca

26,900

17,800

.

33,400

.

.

20,800

15,400

●

23,500

10,300

9,000

34,300

6.9

5.a

9.0

7.7

●

6.1

●

●

6.9

12.7

●

5.2

7.3

6.3

8.9

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

Mobility

Walks with or without assistance . . . . . .

Chairfast . . . . . . . . . . . . . . . . . . . . . .

bedfast . . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . .

Continence

NO difficulty controlling bowuls or

bladder . . . . . . . . . . . . . . . . . . . . .

Difficulty controlling Imvwls . . . . . . . .

Difficulty controlling blt.ck+w . . . . . . . .

Difficulty controlling both bowels

and btadder . . . . . . . . . . . . . . . . . . .

Ostomy in either bmwsls or bladd# . . .

Unknown as to both bowels and

bladder . . . . . . . . . . . . . . . . . . . . .

Partial index of dertendenc in

J

activities of daily living

Not depmt&nt in mobility Or

c0ntitwnce5 . . . . . . . . . . . . . . . . . .

Dependent in mobility only . . . . . . . . .

Oependent in continence only . . . . . . . .

Depmdent in both mobility and

continence . . . . . . . . . . . . . . . . . . .

75

62

107

74

62

60

34

106

132

45

64

60

65

6a

104

. . .

. .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

,..

. . .

. . .

. . .

533,400

297,100

229,700

67,200

477,100 55,000

210,500 65,700

92,200 137,200

45,800 10,900

303,500 31,603 122,003 62,400

162,200 18,500 222,3M 7,700

102,20a 9,100 70,700 7.200

20,300 .

7,600 .

.

11,700

. .

20,000 “

. .

551.000

26.500

491,900 58,200

20.400 .

315,000 23,700 la2,400 73,102

16,600 ● 11,600 .

49,100 .

33,8oo 8.200

21.300 .

● .

● . 75;400 54;10021,200

3CA,000

121,800

164,200 139,500

68,7(XI 52,900

150,200 15,700 152,4CQ 14,000

50,500 7,300 55,700 .

● 8,aoo

● ●

38,800 26,200 12,100 ● ✎ ✎ ✎ ●

448,600

141,200

142,000

408.600 38.600 241,100 22,9CWJ 77,603 58,600

80,402 ‘ 89,81XI .

82,400 12,000 50,700 17,200

16,600 .

, .

● .

loe,500 31;700

114,200 27,300

385,600 193,200 192,200 184,090 21,600 203,XJ0 9,500 ●

15,400

Perc8nt distribution

Tota l . . . . . . . . . . . . . . . . . . . . . . . 52a 5.a 37.7 9.1

Mobility

Walks with or without assistanea . . . . . .

Chairfast . . . . . . . . . . . . . . . . . . . . . .

bedfast . . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . .

Cmtirtence

No difficulty controlling bowls or

bladder . . . . . . . . . . . . . . . . . . . . .

Difficulty Controlling bowels . . . . . . . .

Difficulty controlling bladdw . . . . . . . .

Diiiculty controlling both bowels

and bladdw . . . . . . . . . . . . . . . . . . .

Osmmy in either bowals or blncMnr3 . . .

Unknown as to both tmv.wlsand

bladd.sr . . . . . . . . . . . . . . . . . . . . .

Partial index of dependency in

activities of daily living4

Not cbpsndent in mobility’ or

c0ntirmnce6 . . . . . . . . . . . . . . . . . .

Depm&nt in mobility only . . . . . . . . .

Ospen*nt in continefm only . . . . . . . .

Dependent in both mobility and

continence . . . . . . . . . . . . . . . . . . .

100.0 73.9 25.9 2.7 1.6

100.0

1OQ.o

103.0

100.0

89.4 10.3

70.8 29.2

40.2 59.7

80.1 19.1

56.9 6.0 22.9 15.4

E4.6 6.2 74.8 2.a

3.8 ‘

2.6 ●

●

5.1

. .

44.5 4.0 30.8 3.1

34.9 ‘

● ●

100.0

100.0

100.0

a9.3 10.6

77.0 .

71.7 26.1

57.2 5.2 29.5 13.3

62.6 9 44.5 .

65.2 .45.0 10.8

3.9 .

. .

. .

100.0

100.0

54.0 45.9

55.4 43.4

49.4 5.2 YJ.1 4.6

41.5 6.0 45.8 .

.

2.a

* .

a7.7 31.1 . ● ● ● .

1Cao

100.0

100.0

91.1 a.6

77.6 22.4

80.4 19.2

53.8 5.1 17.3 15.6

56.9 ● 63.6 ●

Sa.o 6.5 3s.7 12.1

3.7 .

● .

. .

100.0 50.1 49a 47.7 5.6 52.7 2.5 .

4.0

Ylnclu&s unknown dischmw status.

zPatimts may h.w used mom th.n 1 w-1.1 ●id or dwice, so thm sum of the *id% ●nd dwlms ●xc8ads ttw dlscham totals.

387.4 pwcmt of them Persons had had an .astomv which aff~cmd onlv the bladder.

4Unkn0wns wura consldwmd not depmdnnt for th. purpow of this index.

5ht.lud#s dlschwws who wdkad with assistance.

NOTE: Fi91Jr*s m.v not .dd to tomls du. to rounding.

27
-——

Table 6. Number and percent distribution of nursing home discharges by type of dependency and partial index of dependency in activities

Of daily Iiv ing, according to selected health statuses: IJn itad Statas, 1976

Health statusl

Partial index of dependency in

activities of dailv living4

All

discharges

Not

dependent Dependent

Dependent Dependent

Mobdity2 Con tinerrce3

in conin either

in both

in mobility tinence

mobility or onlv

mobility and

ordv

continence

continence

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

Primary Diagnosis at Admisslcm

Diseases of the c}rculato~ system

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,

Congestiveheartfaiiure . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Heart attack, ischemic heartdiseasa . . . . . . . . . . . . . .

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

Mental dworders and senility

without psychosis

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

Senilepsychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherpsychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chronicbrainsyndrome . . . . . . . . . . . . . . . . . . . . . . . . . . .

Senilitywithoutpsychosis.. . . . . . . . . . . . . . . . . . . . . . . . . .

Marital retardation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Alcoholism andother mental disorders . . . . . . . . . . . . . .

Other diagnoaes5

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

Omaasesofthemusculoskeletal system

and connective tissues:

Arthritisandrheumatism . . . . . . . . . . . . . . . . . . . . . . . . .

Disaasesof the nervous syatam and

sense organs:

Parkinson’sdisease . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Accidents, poisonings, and violence:

Hipfracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherbonefractura . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Endocrine, nutritional, and metabolic

diseases

Oiabates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neoplasms

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

Diseasesof the respiratory systam:

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

Diagnosis unknown

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

Chronic Conditlonsand Impairmentsa

Diseasesof the circulatory system

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

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

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

Paralysis or palsy, other than arthritis,

relatedtostroke . . . . . . . . . . . . . . . . . . . .

Hearttrouble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental disorders and senility

without psychosis

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

Chmnicbrainsyndrome, . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Alcoholism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drugaddiction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insomnia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,,,,.

See fcmtrmtes at and of table.

1,117,500

486,200

59,300

197,200

23,100

139,400

40,400

26,800

125,700

10,800

23,100

52,700

9,400

7,500

22,200

480,400

28,500

10,900

82,700

26,500

45,200

91,600

41,500

25,100

455,500

168,000

228,700

54,000

390,400

64,600

208,300

226,600

18,600

35,700

●

16,500

526,800

245,200

29,100

95,800

8,300

84,300

17,100

10,700

45,100

●

*

25,500

*

*

*

229,900

10,200

●

39,100

8,000

22,400

59,600

15,900

,

246,700

83,900

140,900

42,100

197,900

18,200

110,700

131,700

,

●

☛

9,300

527,700

252,500

30,000

101,900

10,800

84,700

15,900

9,200

55,800

●

*

32,000

●

*

*

214,100

10,800

●

30,100

●

20,400

55,800

17,100

●

249,700

87,200

141,800

35,900

200,300

22,200

131,900

145,100

9,500

10,900

*

8,600

Number

448,600

172,300

21,100

73,400

9,200

38,300

17,500

12,800

64,900

*

17,700

19,100

●

,

15,400

193,700

15,200

●

35,800

15,300

15,900

20,000

20,300

17,700

146,300

57,800

58,400

8,200

134,500

39,800

61,700

63,200

8,000

23,000

*

*

141,200

61,400

8,200

21,900

●

16,400

*

●

*

*

,

*

*

*

,

72,600

*

●

16,800

,

8,900

15,800

,

*

59,500

23,000

28,500

10,000

55,600

*

12,600

18,400

*

●

*

●

142,000

68,700

9,100

28,000

●

16,800

,

,

15,800

*

*

8,100

●

*

,

56,800

●

.

7,900

*

*

12,000

*

●

62,500

26,400

29,400

*

58,000

.

33,800

31,700

*

*

●

*

385,600

183,800

20,900

73,900

*

67,900

10,000

*

40,000

*

+

23,800

*

*

*

157,300

7,700

●

22,300

●

13,500

43,900

11,700

●

187,200

60,800

112,400

32,000

142,300

15,600

98,100

113,300

,

*

*

7,600

28
Table6. Num&rand percent di3ribution ofnursing home diwhargasby~~of dapandency andpertial index ofdependency in activities

of daily Iiving, according toaslected health statuaas United States, 1976-Con.

Health statusl

Type of dapendancy

Partial index of dependency in

activities of daily living4

All Not

discharges dependent Dependent

Depen&wt Dependent

Mobility2 Continence in either

in cOn- in both

in mobility

mobility or

tinence mobility and

only

contirranca

only continence

Chronic Conditions and ImpairmentsG–Con.

Other chronic conditions and impairments

Diseasesof the musculoskeletal system and

connective tissues

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

Chronic beck, spine problems, excluding

stiffnessanddeformity . . . . . . . . . . . . . . . . . . . . . . . . .

Permanent stiffnass or deformity of beck,

arms, legs, or extremities, including

feet,toes,hands,orfingers... . . . . . . . . . . . . . . . . . . . .

Missing arms, legs, or extremities,

including faet, teas, hands, or fingers . . . . . . . . . . . . . . . .

Diseasesof the nervous system and

senseorgan%

Blindnam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cetaraats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Deafness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Parkinson’sdisease . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Paralysis or palsy, other than arthritis,

unrelatedtostroke . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Accidents, poisonings, and violence:

I+ipfracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherbonefracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Endocrine, nutritional, and metabolic

disease%

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

Neopiasms:

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

Disaasesofthe respiratm’y ~stem:

Chronicrespiratorydiseasa.. . . . . . . . . . . . . . . . . . . . . . .

Diseasesof the digestive system:

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

Dissasesof the blood and blood-forming

organs

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

Diseasesof the skin and subcutaneous

tissu=

Bedsores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Conditions other than above:

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

Kidneytrouble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

None of these conditions

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

Condition unknown

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

SesIfcmtnotas et end of table.

163,100

30,600

69,400

31,300

45,400

20,200

50,100

50,800

29,900

21,900

127,200

86,400

156,800

125,200

99,600

50,800

65,1OO

36,000

102,200

120,900

37,500

11,800

74,000

14,100

42,300

25,100

24,100

B,l 00

19,100

24,.500

14,800

14,500

64,200

27,800

79,600

78,700

46,400

28,700

32,700

29,500

59,800

67,500

7,900

●

71,900

13,000

41,900

15.900

24,800

8,500

19,300

28,600

16,900

16,500

56,500

25,700

78,800

75,700

49,100

32,700

32,600

28,500

58,900

88,700

●

●

69,000

12,500

19,500

●

16,600

10,200

24,000

17,000

9,51M

●

48,900

30,200

57.700

30,000

37,600

15,200

23,400

●

28,100

23,900

27,100

8,700

22,100

●

8,000

10,100

*

●

●

●

●

●

21 ,BOO

10,500

20,300

19,600

12,700

●

9,100

●

14,200

8,400

●

,

20,100

*

7,600

,

●

●

*

9,300

*

●

14,100

8,400

19,500

16,600

15,400

,

9,100

●

13,300

28,600

,

●

51 ,BOO

8,700

34,300

15,100

20,100

*

12,200

19,300

11,200

12,300

42,400

17.300

59,300

59,100

33,700

26,700

23,600

27,800

45,700

59,000

●

●

29
Table6. Number andpercent distribution of nuraing home discharges bytypeof dependency andpsrtial index ofdependency in activities

of daily Iiving, according toselected health statuses: United States, 1976—Con.

Partial index of dependency in

activities of daily living4

Health status 1

All Not

discharges dependent Dependent Dependent Dependent

Mobilisy2 Continence in conin either in mobility

in both

tinence

mobility or

mobility and

only

only

continence continence

Percent distribution

47.2

51.9

50.6

51.7

46.6

60.8

39.2

34.2

44.4

●

●

60.6

●

*

●

44.6

37.9

+

36.4

,

45.1

60.9

41.2

●

40.1 12.6 12.7 34.5 Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Primary Diagnosis at Admission

Diseasesof the circu Iatory system

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

Congestive heartfailure . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Heartattack, ischemic heartdisaas@ . . . . . . . . . . . . . . . . .

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

Mental disorders arrd senility

without psychosis

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

Senilepsychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherpsychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chronicbrainsyndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Senilitywithoutpsychosis . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Alcoholism andothermantal disorders . . . . . . . . . . . . . . . . . .

Othar diegnoaes5

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

Diseasesof the musculoskeletal system

end connective tissues:

Arthritisand rheumatism.. . . . . . . . . . . . . . . . . . . . . . . .

Diseasesof the narvous system and

senseorgans:

Parkinson’sdisaase . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Accidents, poisonings, and violence:

Hipfracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Othertmnefracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Endocrine, nutritional, and metabolic

diseases

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

Neoplasm%

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

Diseasesof the respiratory system:

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

Diagnoses unknown

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

Chronic Conditions and lmpairments6

Diseasesof the circulatory system

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

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

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

Paralysis or palsy, other than arthritis,

relatedtostroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hearttrouble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental disorders and senility

without psychosis

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

Chronicbrainsyndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Mental n?tardation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Alcoholism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drugaddiction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insomnia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sea footnotes at end of table.

30

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

47.1

50.4

49.0

48.6

35.9

60.4

42.3

39.9

35.8

●

●

48.4

●

●

●

47.9

35.8

●

47.3

30.3

49.6

65.1

38.2

●

54.2

49.9

61.6

77.8

50.7

28.2

53.7

56.1

●

●

●

56.0

35.4 12.6

13.8

11.1

*

.11.7

*

●

14.1

15.4

14.2

●

12.1

●

*

37.8

35.3

37.5

*

48.7

24.8

●

35.6

37.2

39.9

27.5

43.3

47.7

*

12.6

+ ●

● ●

,

15.4

* ●

● +

● *

31.8

*

,

45.2

,

*

,

51.6

●

76.6

36.2

*

●

69.4

40.3 15.1 11.8 32.7

53.4 ● ● 27.1

* * ● ,

43.2

57.9

20.4 9.5

● ●

26.9

●

35.2

21.9

48.9

19.6 *

17.2 13.1

● ●

30.0

47.9

28.3

100.0 70.5 ● ● .

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

●

100.0

54.8

51.9

62.0

32.1

34.4

25.5

13.1

13.7

12.5

13.7

15.7

12.9

41.1

36.2

49.1

66.4

51.3

15.1

34.5

18.5

14.2

*

14.9

59.3

36.4

*

16.4

14.0

●

●

*

●

24.1

47.5

50.0

*

*

*

46.0

34.3

63.9

S4.o

51.1

30.4

●

52.1

61.6

29.9

27.9

43.2

64.5

,

●

●

6.1

8.1

●

,

,

,
Table6. Numkrand percent distribution ofnursing home &mharges MWWof depandancy and partial indaxof dependency in activities

of daily Iiving, according tosalected health statuses: United States, 1976–Con.

Health statusl

Type of depanskncy Partial indax of dependency in

activities of daily /ivin#

Aft Not

discharws depandwt Dependent

Dependent Dependent

Mobility2 C0ntinance3 in con- in both in either in mobility tinanca mobility or

mobility and

only

continenm only continanca

Chronic Conditions and lmpeirments6-Con.

Other chronic conditions and impairments

Diseasesof the muaculoskeletal system and

connective tissues:

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

Chronic back, apine problems, excluding

stiff nassand deformity . . . . . . . . . . . . . . . . . . . . . . . . .

Permanent stiffness or deformity of back,

arms, legs, or extremities, including

feet,toes,hands,orfingers... . . . . . . . . . . . . . . . . . . . .

Missing arms, legs, or extremities,

inchsdingfeet,t oes,hands,orfingws . . . . . . . . . . . . . . . .

Diseasesof the nervous system and

senseorgarw

Blindness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cataracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Deafness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Parkinson”sdiaaasa . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Paralysis or pelay, other than arthritis,

unralatedtostroke . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Accidents, poisonings, and violence

I-lipfractura . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherlmnefractum . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Endocrina, nutritional, and rnetabol ic

disease%

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

Naoplasm$

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

Diaeesaaof the respiratory system:

Chronicrespiratorydisease.... . . . . . . . . . . . . . . . . . . . .

Diwases of tha digestiva system:

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

Diseasesof the blood and blood-forming

organs

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

Diseasesof the skin and sutxutenaous

tissue

Bedwes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Conditions othar than abovw

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

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

Nona of thasa renditions

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

Condition unknown

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

45.4

45,7

61.0

80.2

53.2

40.0

38.0

46.2

49.4

66.0

50.5

41.9

50.8

62.9

46.6

58.4

60.2

81.9

56.5

55.8

21.0

●

44.1

42.1

60.4

50.8

54.7

42.1

38.4

56.4

56.4

75.2

44.4

38.7

50.3

60.5

49.3

64.4

50.1

81.9

57.7

73.3

●

●

Percent distribution

42.3

40.4

28.1

●

36.5

50.6

47.8

33.5

31.8

*

38.4

45.5

36.8

23.9

37.9

29.8

35.9

●

28.5

19.7

72.3

73.9

13.6

●

11.6

32.1

*

●

●

●

●

●

17.2

15.8

12.9

15.6

12.8

●

14.0

●

13.9

7.0

●

●

12.3

*

10.9

●

●

●

●

18.3

●

●

11.1

12.6

12.4

13.2

15.5

●

13.9

●

13.0

24.5

●

●

31.8

28.1

. 49.4

48.1

44.4

●

24.3

38.0

37.6

!%.3

33.3

26.1

37.8

47.2

33.8

52.7

36.2

77.1

44.7

46.8

●

*

lDi~a~group ~at~or]esbamd on Eighth Revision lntamational Classification of Diaaaeae, AdaPtadfor Uaairsthe Unitad Statea(lCDA).

2Refer$todi~har@ whowaachairfaat orbadfa$t.

3ROfera to di~harge whO had cliff icu Ity controlling oithar bowols, bladder, or both, Or who had an OStOmY.

41Jdmownsweraconaidared notdepondant forth* purpoaaof this indax.

5~nlv diag”o~s of sufficient mawrituda ● rm nomd.

6Figure~maY ”otadd~ot0~l b~au~di~har~ mayha~hadmoretia” 1 roportad condition Orimpairmant.

NOTE: Figuras maynotadd tototals duo to rounding.

31
w

M

Table7. Num&rand percent distribution ofnursing homedischarges bysalacted health servicas received, according tomedian duration ofstay, discharge status,

levalof careduring last 7days, andpanial index ofdependency inactivities ofdaily living: United States, 1976

Discharge status Level of care Partial index of dependency in

during last 7 days

Median

cctiv;ties of daily Iivingz

Hea/th service duration All

discharges 1

Nursing care

Not

of stay Personal dependent Dependent

Dependent Dependent

in days Live Dead

in cOn- in both

lntencare in either in mobility

Other or none mobility or only tinence mobility and

sive continence

only con tinence

Allhealthwvices . . . . . . . . . . . . . . . . . . . . . . . . . .

Physician service

Time since last physician visit:

Lessthan lwaak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

lweekto lassthan 2........ . . . . . . . . . . . . . . . . . . . . .

2waaksto lass than l month . . . . . . . . . . . . . . . . . . . . . . . .

lm0nthtolassthan3 . . . . . . . . . . . . . . . . . . . . . . . . . .

3m0nths tO1easthan 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6months tolessthan 12 . . . . . . . . . . . . . . . . . . . . . . . . . . .

Iyearor more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nophysician visits while in facility . . . . . . . . . . . . . . . . . . .,

Unknown ifany physician visits. . . . . . . . . . . . . . . . . . . . .

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

Sewicas given at last physician visit: 3,4

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

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

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

Orders forlaberatory tact . . . . . . . . . . . . . . . . . . . . . . . . . .

Other sewices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Therapy sawice

Notharapy sarvica during lastmonth. . . . . . . . . . . . . . . . . . . . .

Unknown ifanytherapy sewice . . . . . . . . . . . . . . . . . . . . . . . .

Therapy st?wice during last month3. . . . . . . . . . . . . . . . . . . . . .

Physical therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Recreational therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Occupational therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Spaachorhearing therapy . . . . . . . . . . . . . . . . . . . . . . . . . .

Counsshgby socialwo rker . . . . . . . . . . . . . . . . . . . . . . . . .

Counseling bymental health worker . . . . . . . . . . . . . . . . . . .

Reality orientation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Other haalth services

Flushotwithin last 12month%5

Recaivad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Didnotreceive or unknown . . . . . . . . . . . . . . . . . . . . . . . . .

Caught fluwithin last 9months . . . . . . . . . . . . . . . . . . . .

Spatial diet within last 7 days

No special diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Special diet5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Low sodium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diabetic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

soft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Weight less . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

bland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

():her . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

See footnotes atend of table.

75

43

67

135

203

206

865

●

13

132

. . .

85

90

62

90

97

94

22

63

47

11s

62

29

59

S3

90

23

931

956

930

62

65

54

448,600

201,700

54,200

55,000

45,600

7,400

●

,

29,000

50,600

2

324,400

42,900

191,400

49,800

25,400

223,700

46,100

176,700

99,200

66,300

26,300

●

37:’600

14,600

17,600

11,100

35,000

55,400

●

287,600

150,600

55,400

42,300

21,600

●

17,000

25,700

141,200

64,300

16,000

24,300

11,700

●

●

●

10,100

11,500

3

112,700

17,900

65,400

26,600

12,500

65,600

●

48,700

31,600

21,200

*

●

11,700

.

●

●

13,9m

22,300

●

64,700

56,500

20,500

17,300

7,900

*

●

! 0,400

142,000

66,900

24,800

21,000

13,100

●

.

●

●

7,600

4

I 17,300

21,500

73,600

29,800

13,200

74,900

●

63,200

33,600

23,300

14,300

●

14,900

●

7,600

●

14,300

16,200

●

78,200

63,600

21,800

13,300

12,400

●

●

: ~,zoo

385,600

198,500

49,700

56,300

23,000

●

●

●

18,100

27,300

3

313,400

62,400

194,600

72,000

30,500

260,500

11,800

113,300

67,000

33,500

17,900

●

24,600

●

17,400

.

56,100

58,200

●

190,200

195,400

43,600

41 ,60Q

49,600

●

10,600

~~,go~

1,117,500 825,500 269,600 627,600 371,800 116,000

29,500

12,700

16,900

14,900

●

●

●

9,700

32,300

1

62,600

10,200

37,000

9,400

●

54,100

27,100

36,800

17,200

17,400

.

●

●

●

●

.

9,900

18,500

●

97,200

20,800

9,1CX7

●

●

●

●

●

531,500

144,700

156,600

93,400

16,700

6,400

●

63,100

97,200

3

379,300

107,100

121,300

73,7m

13,400

.

●

52,500

69,100

3

151,800

37,400

37,200

19,500

●

.

●

10,600

26,600

3

327,600

67,800

67,900

40,200

9,300

●

●

30,000

36,200

3

174,200

44,300

53,600

38,300

●

.

●

23,300

26,700

4

867,800

164,700

525,100

178,200

81,600

634,800

104,200

363,200

132,80(7

63,700

232,100

60,500

141,600

45,400

18,000

511,700

118,400

321,600

116,000

48,600

293,300

36,100

166,300

52,900

27,600

644,900

70,600

402,000

231,300

144,200

65,900

16,600

66,200

21,200

46,600

24,300

443,200

53,700

328,700

194,100

116,200

54,1OO

14,700

73,900

19,400

34,900

16,600

201,000

16,400

72,500

38,800

27,500

11,700

●

14,200

.

11,700

●

382,700

20,100

224,800

133,000

73,800

37,700

10,300

52,6W

*

33,300

17,900

206,000

23,300

140,500

61,100

53,000

25,000

●

28,900

10,400

12,100

●

119,400

152,100

9,000

71,500

88,600

●

47,800

54,900

●

74,600

66,200

●

34,700

45,500

●

650,800

466,600

141,500

114,700

91,800

11,400

39,500

420,200

495,700

329,800

110,200

68,700

55,900

9,700

31,800

m nnn “.-,”””

153,600

136,(xJO

31,200

25,700

35,300

●

7,800

~~,$oo

331,500

286,100

78,900

67,300

64,300

●

23,300

m- .,”win--

222,200

149,600

53,400

42,000

26,000

●

14,200

-23,300

104

71

57

77

52
Table7. Numhrand percent distribution ofnursing home discharges bysalected health sawicas received, according tomedian duration ofstay, discharge status,

level ofcareduring last 7days, andpartial index ofdependency inactivities ofdaily living: United States, 1976–Con.

Discharge status

Level of care Partial index of dependency in

during last 7 days activities of daily Iivingz

Median

Hea/th service duration All Nursing care

Not

discharges

Dependent

of stay Personal dependent Dependent

Dependent

in cOn - in both

in days Live Dead hrten- care in either in mobility

Other or none

tinence

mobility or

mobility and

sive only only

continence

continence

All health services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Physician service

Time since lastphysicianvisit:

Lessthan l week . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

lweektolessthan2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Zweeksto lessthan l month . . . . . . . . . . . . . . . . . . . . . . . .

lmontht01assthan3 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3monthsto lessthan 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6months tolessthan 12 . . . . . . . . . . . . . . . . . . . . . . . . . . .

lyaarormore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No physician visits whila in facility . . . . . . . . . . . . . . . . . . . .

Unknown ifany physician visits . . . . . . . . . . . . . . . . . . . . . .

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

Services given at last physician visit:s,d

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

Traatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Orders forlaboratory tests . . . . . . . . . . . . . . . . . . . . . . . . . .

Other sewices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Therapy service

Notherapy service during lastmonth. . . . . . . . . . . . . . . . . . . . .

Unknown ifanytherapy service . . . . . . . . . . . . . . . . . . . . . . . .

Therapy sewiceduring last month3 . . . . . . . . . . . . . . . . . . . . . .

Physical therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Recreaticmalt herapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Occupational therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Spaachor haaringtherapy . . . . . . . . . . . . . . . . . . . . . . . . . .

Counseling bysocitd worker . . . . . . . . . . . . . . . . . . . . . . . . .

Counseling by marital health worker . . . . . . . . . . . . . . . . . . .

Reality orientation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Other haalth services

Flu shot within last 12 month$5

Received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Didnotraceive orunknown . . . . . . . . . . . . . . . . . . . . . . . . .

Caught fkrwithin last9months . . . . . . . . . . . . . . . . . . . .

Special diet within last 7 days

Nospecial diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Special diet5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lowsodium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diabetic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

soft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Weight less . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

...

...

...

.. .

.. .

...

.. .

...

...

...

. ..

...

...

...

...

. ..

.. .

,..

.. .

...

...

...

.. .

...

.,.

.. .

,..

...

.. .

,..

,..

...

...

.. .

...

...

.. .

.. .

100,0

47.6

13.0

14.2

S.4

1.5

.s

.

5.6

8,7

. . .

7’7.7

14.7

47.0

16.0

7.3

57.7

6.3

36.0

20.7

12.9

5.9

1,5

7.9

1.9

4.2

2.2

10.7

13.6

.s

5S.2

41.8

12.7

10.3

8.2

1.0

3.5

10.s

I 00.0

46.0

13.0

14.7

8.9

1.6

●

●

6.4

S.4

. . .

76.9

12.6

46.4

16.1

7.7

53.7

6.5

39.8

23,5

14.1

6.6

1.8

8,9

2.4

4.2

2.3

8.7

11.7

●

60.0

40.0

13.3

10.7

6.8

1.2

3.8

8.4

100.0

52.4

12.9

12.8

6.7

●

.

●

3.7

9.3

.

so, 1

20.9

4s.9

15.7

6.2

69.4

5.6

25.0

12.7

9.5

4.0

●

4.9

●

4.0

●

16.6

18.9

●

53.1

46.9

10.6

8.9

12.2

●

2.7

17.6

100,0

52.2

14.0

14,0

6.4

1,5

●

●

4,8

6.1

. . .

SI .5

18.9

51.3

18.5

7.7

61.0

3.2

35.8

21.2

11.s

6.0

1.8

8.4

●

5.3

2.8

11.9

14.0

●

52.8

47.2

12.6

10.7

10.2

●

3.7

14.6

Percent distribution

100.0

46,8

11.9

14.5

10.3

●

●

●

6.3

7.2

. . .

78.9

9.7

44.7

14.2

7.4

55.9

6.3

37.8

21.8

14.3

6.7

●

8.0

2,8

3.2

,

9.3

12.2

●

59.s

40.2

14.4

11.3

7.0

●

?4

I W.o

25.0

10.7

14.3

12.7

●

●

.

8.2

27.4

. . .

53.2

8.7

31.3

7.9

●

45.9

23.0

31.2

14.6

14.8

●

●

●

●

●

●

6.4

15.7

●

82.4

17.6

7.7

●

●

●

●

.

100.0

45.0

12,1

12.3

10.2

1.7

●

●

6.5

11.3

. . .

72.3

9.6

42.7

11.1

5.7

49,9

10.7

39.4

22.1

14.6

6,3

●

8.2

3.3

3,9

2.5

7.6

12.3

●

66.4

33.6

12.4

9.4

4.8

●

3.8

5,7

100.0

45.6

11.3

17,2

6.3

●

●

●

7.1

8.2

.,,

78.8

12.7

46.3

18.8

8.9

60.7

●

34.5

22.4

15.0

●

●

6.3

●

●

●

9.9

15.8

●

60.0

40.0

14.5

12.3

5.6

●

●

7.3

I 00.0

47.1

17.5

14,8

9.2

●

●

●

●

5.5

. . .

82.6

15.1

51.8

21.0

9.3

52,8

●

44.5

23.6

16.4

10.1

●

10.5

●

6,4

,

10.1

11.4

●

55.1

44,9

15.3

9.4

8.7

●

●

11.4

100.0

51.5

12.9

15.1

6.0

●

●

●

4.7

7.1

.

81.3

21.4

50.5

16.7

7.9

67.5

3.1

28.4

17.4

8.7

4.6

●

6.4

●

4.5

●

14.6

15.1

●

49.3

50.7

11.4

10.8

12.9

●

2.8

17.6

w

SAs

1I “cl”~a~ di~~hargas With ““k”own discharga $tatllt

21J”k”0~”s were Co”.tldarad “Qt dependant for the Purposa of this index.

3FiguraS do not add to *OUIS bacau~ m“ltipla rasponsos were permitted.

4E@uda~ d,~h.grga$ ~hO ra~elvad “O physk.lan Vidt$ whila in faCilhY.

5Excludes discharges who were in tha facilitv less than 12 months.

NOTE: Figuras mav not add to totals due to roundirw.
Table 8. Number and percent distribution of nursing home discharges by time since last physician visit and servicesgiven at last physician visit,

according to primary diagnosis at admission: United States, 1976

Time since last physician visit Services given at last visitq,2

All No physiPrimary diagnosis at admission Less

Orders

discharges 1 week cian visit

than

Exami- Treat- Prescrip for labora- Other whife in

1 week

or more

facility or

nation men t tion tory services

unknown services

All diagnoses . . . . . . . . . . . . . . . .

Diseasesof the circulatory system

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

Congestive heart failure . . . . . . . . .

Arteriosclerosis , . . . . . . . . . . . . . .

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

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

Heart attack, ischemic heart

disease . . . . . . . . . . . . . . . . . . .

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

Mental disorders and senility

without psychosis

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

Senilepsychosis . . . . . . . . . . . . . .

Otherpsychosis . . . . . . . . . . . . . .

Chronic brainsyndroma . . . . . . . . .

sanilit ywithoutpsychosis . . . . . . .

Mental retardation. . . . , . . . . . . . .

Alcoholism and other mental

disorders . . . . . . . . . . . . . . . . . .

Other diagnoses

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

Diseasesof the musculoskeletel system

and connective tissues

Arthritis and rheumatism . . . . . .

DiseasesOf the nawous system and

senseorgans

F’arkinson’sdisease . . . . . . . . . .

Accidents, poisonirigs,and violence:

Hipfracture . . . . . . . . . . . . . . .

Otherbonefractura . . . . . . . . . .

Endocrine, nutritional, andmatabolic

diseases

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

Neoplasms

CarSca r . . . . . . . . . . . . . . . . .

Diseasesof the respiratory system:

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

Diagnosisunknown

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

See footnotes at end of table.

1,117,500

486,200

59,300

197,200

23,100

139,400

40,400

26,800

125,700

10,800

23,100

52,700

9,400

7,500

22,200

480,400

28,500

10,900

82,700

26,500

45,200

91,600

41,500

25,100

531,500

230,600

30,000

86,600

8,500

71,400

19,200

14,800

51,500

9,50;

22,700

*

●

10,800

245,900

14,200

●

44,100

13,000

18,600

53,600

20,900

●

425,700

194,500

22,500

87,300

11,200

49,500

15,200

8,800

54,700

*

10,000

22,600

5,700

●

7,600

173,400

10,600

58300

30.900

9,600

20,000

25,100

14,900

●

160,300

61,100

6,800

23,300

●

18,500

5,900

●

19,500

*

*

7,500

●

*

●

61,100

●

*

7,700

*

6,500

12,900

5,700

18,500

Number

867,800

394,500

47,900

162,700

18,500

110,700

33,500

21,300

91,500

7,400

15,300

41,700

7,300

5,700

14,100

376,700

20,500

9,000

69,300

18,100

35,300

73,100

31,700

5,100

164,700

75,200

8,900

32,100

*

22,900

*

●

18.300

*

*

9,800

*

●

*

70,500

*

*

9,600

*

6,800

17,300

8,700

*

525,100

236,400

31,000

99,200

12,900

65,300

16,100

12,000

56,200

*

10,100

24,800

5,000

*

7,600

229,700

12,100

5,500

42,100

11,100

23,100

48,200

23,000

*

1788200

80,100

12,300

32,100

5,300

21,600

5,800

*

14,100

*

*

5,200

*

*

*

83,400

5,100

*

13,500

*

14,100

13,500

8,000

*

81,600

33,600

*

12,800

*

11,900

*

●

9,100

*

*

*

*

*

*

38,100

*

*

7,400

*

*

6,200

*

●

34
Table8. Number andparcent difiribution ofnursing home dimharges ~timesince latiphysician visit and~rvicas given atlaw physician visit,

according toprima~diagnosis at admission: United Statas,1976—Con.

Time since Iastphysician visit Services given at last Visitq 12

All No physiPrimary diagnosis at admission

discharges Less cian visit Orders

1 week Exami- Treat- Prescripthan

for laborawhile in Other

1 week

or more

facility or

nation ment tion tory servicas

unknown

sewices

All diagnoses . . . . . . . . . . . . . . . .

“ Diseasas of thecirculatory system

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

Congestive heartfaihsre . . . . . . . . .

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

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

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

Heart attack, ischemic heart

disease . . . . . . . . . . . . . . . . . . .

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

Mantel disorders and senility

without psychosis

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

Sanilepsychosis . . . . . . . . . . . . . .

Otherpaychosis . . . . . . . . . . . . . .

Chronic breinsyndrome . . . . . . . . .

Senility without psychosis . . . . . . .

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

Alcoholism and other mental

disorders . . . . . . . . . . . . . . . . . .

Other diagnosas

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

Diseases of the muscu Ioskeletal system

and connective tissues:

Arthritis and rheumatism . . . . . .

Diseases of the nervous systam and

senseorgarw

Parkinson’sdisease . . . . . . . . . .

Accidents, poisonings, and vio lance:

Hipfrecture . . . . . . . . . . . . . . .

Otherbonefracture . . . . . . . . . .

Endocrina, nutritional, and matabolic

disease%

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

Neoplasms:

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

Diseasas of tha respiratory system:

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

Diagnosis unknown

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

47.6

47.4

50.6

43.9

36.9

51.2

47.6

55.1

41.0

●

41.2

43.0

●

●

48.8

51.2

49.8

*

53.3

49.2

41.2

58.5

50.4

*

38.1

40.0

37.9

44.3

48.5

35.5

37.6

33.0

43.5

●

43.3

42.8

60.8

●

34.2

36.1

37.3

48.5

37.3

36.4

44.3

27.4

35.9

●

Percent distribution

14.3

12.6

11.5

11.8

●

13.3

14.7

●

15.5

●

*

14.2

●

●

●

12.7

*

●

9.3

●

14.5

14.1

13.6

73.7

77.7

81.1

80.7

82.5

80.0

79.4

82.8

79.6

72.8

68.4

66.1

79.0

78.4

76.3

63.4

78.4

71.9

82.5

83.8

68.5

78.2

79.8

76.5

20.4

14.7

15.5

15.0

16.3

●

16.4

*

*

14.6

●

●

18.6

●

●

●

14.7

*

●

11.6

●

15.1

18.9

20.9

●

47.0

48.6

52.2

50.3

55.7

46.8

40.0

44.7

44.7

*

43.5

47.0

53.8

●

34.2

47.8

42.8

50.0

50.8

42.0

51.1

52.6

55.6

●

16.0

16.5

20.7

16.3

22.8

15.5

14.3

*

11.3

*

*

9.9

*

*

●

17.4

17.9

*

16.3

●

31.2

14.7

19.4

*

7.3

6.9

*

6.5

*

8.6

*

*

7.3

●

*

*

*

*

●

7.9

*

*

8.9

*

*

6.8

*

●

lNumbarsdo not addtoto~lsbecausa MUltipkreSpOmtSS werawmitted

2E~clude$ d@harg@s who received no physician ViSitS while in facility.

NOTE: Figures maynotadd tototals dueto rounding. *

35
Table9. Number andpercent distribution of nursing home discharges by level of care during last 7days, special diet within last 7 days,

and therapy sewiceduring laWmonth, according toprima~diagnosis at admission: United States, 1976

Leve/ of care during last 7 days Spesial diet Therapy service during Jastmonth within last 7 days

Primary diagnosis at admissron A// Nursing care

discharges

Therapy service2

Personal No

Spesial No therapy

In ten- care or special djetl ;;:;osw; RecreaOther none

Phys!cal OccupaSIve diet Totals therapy tional tional

therapy therapy

All diagnoses.,...........,,,.. ... ,,,

Disaaws of the circu Iatory system

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

Ccmgestive heart failure . . . . . . . . . . . . . . . . .

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

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

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

Heart attack, ischemic heart disease . . . . . . . . .

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

Mental disorders and senility

without psychosis

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

Senile psychosis . . . . . . . . . . . . . . . . . . . . . .

Other psychosis . . . . . . . . . . . . . . . . . . . . . .

Chmnicb rains yndrome . . . . . . . . . . . . . . . .

Senility without psychosis . . . . . . . . . . . . . . .

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

Alcoholism andother mental disorders . .

Other diagnoses

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

Dis?ases of themusculoskeletal system and

conrtectwe tis.sue~

Arthritis and rheumatism , . .

Dissases of the nervous system a“d senx

organs:

Parkinson’s di.sease ...,.,... ,., .,,.,.

Accidents, poisonings, and violence

Hip fracture . . . . . . . . . . . . . . . . . . . . .

Other bone fracture, . . . . . . . . . . . . . . .

Endocrine, nutritional, and metabolic

diseases

Dialxwes . . . . . . . . . . . . . . . . . . . . . . . .

Neoplasms:

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

Diseases of the respiratory system:

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

Diagnosis u“k”ow”

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

See footnotes at end of toble.

1,117,500

486,200

59,300

197,200

23,100

139,400

40,400

26,800

125,700

10,800

23,100

52,700

9,400

7,500

22,200

480,400

28,500

10,900

82,700

28,500

45,200

91,600

41,500

25.100

627,600

292,100

35,100

119,400

12,400

87,000

22,300

15,900

55,600

6,900

5,500

29,200

.

.

7,000

275,000

15,100

5,100

47,100

13,400

22,400

65,700

24,700

●

371,800

160,900

19,500

63,900

8,800

44,600

15,400

8,700

42,700

.

8,300

18,000

.

.

7,900

163,500

10,500

.

28,100

10,400

20,400

20,000

13,200

●

118,000

33,200

.

13,900

.

7,900

●

●

27,400

.

9,300

5,500

●

.

7,200

41,900

.

.

7,500

.

.

5,900

●

15,400

650,900

254,300

28,400

109,100

14,200

88,200

20,700

13,800

90,200

7,800

18,800

34,000

7,500

5,200

10,900

285,200

19,300

7,100

58,000

19,100

6,500

53,100

26,200

21,200

Number

466,600

231,900

30,900

88,100

8,900

71,200

19,70d

13,000

35,500

.

●

18,700

●

●

5,300

195,200

9,200

.

24,700

7,400

38,600

38,500

15,300

●

715,500

325,400

39,200

135,700

15,500

64,700

28,400

21,800

81,500

7,200

13,600

37,700

6,200

5,500

11,200

264,400

15,800

6,600

31,800

9,100

29,800

68,700

32,200

24,200

402,000

160,800

20,200

61,500

7,600

54,7W

12,000

●

44,200

●

9,500

15,100

●

●

10,900

196,000

12,700

.

51,000

17,400

15,300

22,900

9,200

●

231,300

85,000

5,500

26,200

●

44,000

5,100

●

12,200

.

●

6,300

●

●

.

134,100

10,300

●

46,200

14,400

6,700

9,400

●

144,200

61,400

10,300

29,600

*

13,500

.

..

19,900

.

.

5,70CI

●

●

5,70CI

62,3001

.

.

11,900

●

6,800

8,700

●

.

65,900

30,800

.

9,500

●

15,300

●

.

8,100

●

,

●

●

.

26,900

●

.

6,000

●

.

.

●

.

.

36
Table9. Number andpercent distribution of nursing home discharges bylevel ofcareduring lati7days, swcial dietwithin last 7days,

andtherapy *wiceduring last month, according toprimaw tiwnosis atadmision: United States, 1976-Con.

Primary diagnos;s at ,?dmiksion

Level of care during last 7 days special diet Therapy service during last month

within last 7days

All Nursing care

discharges

Therapy servlce2

Personal No Special No therapy

lntan- care or special dietl services or Physical f?ecrea- OccupaOther sive none diet unknown Tota13 therapy tiOna/ tional

therapy therapy

All diagnoses . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the circulatory system

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

Congestive heart failure . . . . . . . . . . . . . . . . .

Arteriosclerosi s . . . . . . . . . . . . . . . . . . . . .

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

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

Heart attack, ischemic heart disease . . . . . . . . .

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

Mental disorders and senility

without psychosis

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

.Semilepsychosi s . . . . . . . . . . . . . . . . . . . . .

Other psychosis . . . . . . . . . . . . . . . . . . . . . .

Chronic brain svndrome . . . . . . . . . . . . . . . .

senility without psychosis . . . . . . . . . . . . . . .

Mentsl retardation . . . . . . . . . . . . . . . . . . . .

Alcoholism and other mental disorders . . . . . .

Other diagnoses

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

Diseases of the musculoskeletal system

and connective tissues

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

Diseases of the newous system and sense

organ%

Parkinson’s disease . . . . . . . . . . . . . . . . . .

Amidents, poisonings, and violenm

Hip fracture . . . . . . . . . . . . . . . . . . . . . .

Other bone fracture . . . . . . . . . . . . . . . . .

Endocrine, nutritional, and metabolic

diseasx

Disbates . . . . . . . . . . . . . . . . . . . . . . . .

Neoplasm$

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

Diseases of the respiratcwy sy~em:

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

Diagnosis unknown

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

56.2

60.1

59.2

60.5

53.6

62.4

55.3

59.3

44.2

63.9

23.9

55.5

●

.

31.7

57.2

53,1

46.7

56.9

50.7

49.6

71.7

59.5

.

33.3

33.1

32.9

32.4

38.1

32.0

36.2

32.4

34.0

●

35.7

34.1

.

●

35.7

34.0

37.0

*

34.0

39.3

45.3

21.8

31.8

●

10.6

6.8

.

7.1

.

5.7

●

●

21.8

.

40.4

10.4

●

●

32.6

8.7

.

.

9.1

.

.

6.4

●

61.4

58.3

52.3

47.9

55.3

61.3

46.9

61.2

51.4

71.7

72.2

81.5

64.5

79.9

69.0

76.0

59.4

67.6

64.8

70.1

72.2

14.5

5s.0

63.1

64.2

41.8

47.7

52.1

44.7

38.7

51.1

48.8

46.6

28.3

●

.

35.5

●

●

24.0

40.6

32.4

●

29.8

27.8

85.5

42.0

36.9

●

64.0

66.9

6s.0

6S.8

67.2

60.7

70.2

82.0

64.9

66.7

59.0

71.4

66.5

73.8

50.6

59.2

55.4

60.3

38.4

34.4

66.1

75.0

77.7

86.1

36.0

33.1

34.0

31.2

32.8

39.3

29.8

.

35.1

.

41.0

28.6

●

●

49.4

40.8

44.6

●

61.6

65.6

33.9

25.0

22.3

.

20.7

17.5

9.3

13.3

.

31.6

12.5

●

9.7

●

.

11.9

.

●

●

27.9

36.2

.

65.9

54.4

14.9

10.3

●

12.9

12.6

17.4

15.1

.

9.7

●

.

‘16.9

.

.

10.7

●

●

25.8

13.0

.

●

14.4

●

15.2

9.5

●

●

5.9

6.3

●

4.8

●

10.9

●

●

6.4

.

.

●

●

●

5.6

●

●

7.3

●

●

●

●

●

lExdudes discharges who wore in the facility less than 12 months.

2Numb4rs do not add t.a totals bacause multiple rm!xmses ware permitted.

31ncludes thoaa who mcelved speech or hearing therapy, cmunsal ing by social worker m mental health worker, realitv orientation, Or other therapy sarvice.

NOTE: Figuras may not add to totils due to rounding.

37
Table 10. Avaraga total monthly charga and avarage amount paid by primary sourca for nursing homa discharges, by primary source of paymant

and eelectad nursing home characteristics: Unitad States, 1976

Primary source of paymant for dischar~s in 1976

All sources

Own income

or family support Madicare

Nursing home characteristic 1

Madicaid Medicaid Other government

All other

skilled intermediate assistance

source#

or wal fare

Monthly

Paid by

Monthly

Paid by

Monthly

Paid by

Monthly Paid by

Monthly Paid by Paid by Paid by

charge

primary

charge

primary

Monthly Monthly

charge

prima~

charge

primary

charge

primary primary primary

sourca source source source

charge

source

charge

source source

Alldischargr x........,.,,.

Ownarship

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

VoluntaW nonprofit . . . . . . .

Government . . . . . . . . . . . . . .

Certification

Skilled nursing facility only ., . .

Skilled nursing f=ility and

intermediate care fecility . . .

Intermediate cerefacilityoniy . .

Noncertified . . . . . . . . . . . . .

Bad size

Leesthan50&ds . . . . . . . . . .

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

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

200hdsormora . . . . . . . . . .

Location

Geographic region:

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

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

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

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

Standard Faderal Administrative

Region:

Region I . . . . . . . . . . . . . .

Region 11. . . . . . . . . . . . . .

Region ill . . . . . . . . . . . . .

Region lo..........,,.

RegionV . . . . . . . . . . . . . .

Region VI . . . . . . . . . . . . .

RagionVll . . . . . . . . . . . .

RegionVlll . . . . . . . . . . . .

Regiors lX . . . . . . . . . . . . .

Ragion X . . . . . . . . . . . . . .

Type off acii ity

Nursingcare . . . . . . . . . . . . . .

Another . . . . . . . . . . . . . . . .

$789

732

992

790

962

811

565

430

807

705

809

878

1,098

743

654

695

789

1,088

1,194

628

790

660

548

623

713

652

803

677

$720

664

926

704

891

729

511

405

743

647

739

786

1,012

682

590

628

716

973

1,136

563

724

599

505

561

647

580

731

628

$747

731

781

853

902

794

586

507

730

696

764

655

983

690

629

757

920

1,084

643

622

725

598

568

●

812

658

769

574

$716

705

748

760

859

759

569

493

685

673

737

807

944

687

605

714

896

1,037

814

599

700

574

553

●

762

623

73s

558

$1,300

1,083

1,811

1,336

1,349

1,256

●

●

1,690

1,106

1,321

1,227

1,681

1,259

1,191

931

*

1,316

1,900

910

1,283

1,436

●

*

934

●

1,294

1,346

$1,197

949

1,728

1,246

1,270

1,126

●

●

1,582

1,013

1,224

1,087

1,575

1,162

1,080

831

*

1,124

1,831

798

1,194

1,334

*

●

833

●

1,189

1,253

Avaraga amount

$767

728

873

912

853

704

●

●

581

689

716

1,012

1,086

682

663

633

●

1,289

762

669

687

●

●

*

641

●

~y~

*

$666

630

756

816

754

600

●

●

495

601

616

889

S64

568

564

544

●

1,158

674

588

590

*

●

●

!563

*

~~ ~

*

$579

589

619

593

5S2

636

537

●

554

542

591

639

702

576

528

540

●

778

●

562

611

504

●

●

●

●

5.sJ~

532

$484

474

520

505

476

532

449

*

483

453

486

538

583

471

444

471

●

641

*

470

504

425

●

*

*

●

~fj~

449

$524

524

●

●

585

●

●

●

●

514

*

●

*

●

●

●

●

●

●

●

●

●

+

*

●

●

557

●

$448

446

●

●

520

●

●

●

●

450

●

*

●

●

●

●

●

●

●

*

●

*

●

●

*

●

“-I.I -?, L

●

$462

511

508

●

558

585

●

●

548

447

480

●

*

557

*

408

●

●

*

●

610

*

●

●

412

●

509

●

$425

480

472

*

514

550

*

●

498

406

446

*

●

516

●

364

●

●

●

●

●

●

*

*

375

*

465

●

1Nursing h~~e charac~ari~tic~ for 1977.

21nclude5religiou~ organi~a~i~n~, fo"ndati~ns, volun~aer agencies, veteran~Ad~jnistratiOn contract, initial payment.life care funds, andother sources or no charge.
Appendixes

.,,

Contents

1. Technical notes on methods . ...’.. . . . . . . . . . . . ../...... . . . . . . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . .

Survey design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Samplingframe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .

Sampling design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Data collection proceduresforthe 1977 Natienal Nursing l-lomeSurvey . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

General qualifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonresponse and imputationof missingdata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rounding ofnumbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Data processing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estimation procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reliability ofestimates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hypothesis testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Il. Definitions ofcertain termsusedin this report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Terms relating tofacilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Terms relating todischarges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ill. Selected survey instruments used inthe1977National Nursing HomeSurvey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Facility questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Discharged resident samplinglist. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Discharged resident questionnaire. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IV. Criteria for classifying nursing homes accordingto level ofnursingcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Appendix Figure

1. Relative standard errorsofestimated numbers ofdischarges and facilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

List of Appendix Tables

1.

Il.

Ill.

Iv.

v.

40

40

40

40

42

44

44

44

44

44

45

48

49

49

50

53

53

64

66

74

46

Number of facilities in the 1977 National Nursing Home Survey universe andsample, by disposition and sampling strata:

Conterminous United States, 1977. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Summary ofdata collection procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Standard errorsof percentagesfordischarges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Standard errors ofaveragemonthly charge fordischarges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Classification of facilitiesbytype ofservice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7!5

39
Appendix L Technical notes on methods

Survey design

From May 1977 through December 1977, the

Division of Health Resources Utilization Statistics

(DHRUS) conducted the 1977 National Nursing

Home Survey (NNHS)–a sample survey of nursing

homes, their residents, discharges, and staff in the

conterminous United States. The survey was designed

and developed by DHRUS in conjunction with a

group of experts in various fields encompassing the

broad area of long-term care. The NNHS was the second of a series of surveys designed to satisfy the

diverse data needs of those who establish standards

for, plan, provide, and assess long-term care services.

The first survey was conducted from August 1973

through April 1974.

Sampling frame

The 1977 NNHS covered all types of nursing

homes including nursing care homes, personal care

homes with nursing, personal care homes, and domiciliary care homes. Places that provided room and

board only were excluded. Facilities were either freestanding establishments or mu-sing care units of hospitals, retirement centers, or similar institutions where

the unit maintained financial and resident records

separate from those of the larger institutions. Detailed

criteria for classifying facilities included in the survey

are presented in appendix IV.

The universe for the 1977 NNHS consisted of two

groups of homes: those classified as nursing homes in

the 1973 Master Facility Inventory (MFI)l and

nursing homes opening for business since 1973. The

major group (92 percent) was composed of all nursing

homes as classified in the 1973 MFI. The MFI is a

census of all inpatient health facilities conducted

every 2-3 years by mail by the National Center for

Health Statistics. A detailed description of how the

MFI was developed, its contents, and procedures for

NOTE: A list of references follows the text.

updating and assessing its coverage has been published.g-l 1

In order for data collection to begin in May of

1977, the sampling frame was “frozen” in December

of 1976 so that the sample would be selected in

ample time to permit the scheduling of nationwide

data collection. To obtain as current a sample frame

as possible, all nursing homes that opened for business after the 1973 MFI was conducted were also included in the universe. (Nursing homes that opened

after December 1976 could not be included since

data about them were not yet available.) The nursing

homes that opened after the 1973 MFI but before

December 1976 comprised the second and smaller

(8 percent) group of facilities in the universe. Information about this second group of facilities was

limited compared with the first group which was

listed in the 1973 MFI.

Estimates from the 1977 NNHS will not correspond precisely to figures from the 1976 MFI[ census

for several reasons. In addition to the differences in

time period, the surveys used different data collection

mechanisms. The MFI is a mail survey but the NNHS

is conducted by personal interview. Thus the NNHS

methodology permitted more detailed identification

and exclusion of facilities that were out of scope. Because the NNHS is a sample survey, its data are subject to sampling variability; because the MFI is a

census, its data are not. In general, however, the data

from the two sources are compatible.

Sampling design

The sampling was basically a strati.fled two-stage

probability design. The first stage was a selection of

facilities and the second stage was a selection of each

of the following: residents, persons discharged in

1976, and employees from the sample facilities. In

preparation of the first-stage sample selecticm, two

different procedures were used: one for facilities

listed in the MFI with known bed size and another

for newly opened facilities whose bed size and service

40
type were unknown. The procedure for facilities in

the MFI with known bed size consisted of sorting

these facilities into two types of service strata:

(1) nursing care homes and (2) facilities providing all

other types of service (including personal care homes

with nursing, personal care homes, domiciliary care

homes, and facilities with unknown service type).

Nursing homes in each of these two service strata

were then sorted into bed-size groups, producing the

first 16 primary strata shown in table I. Within each

primary stratum, nursing homes were ordered by type

of ownership, geographic region, State, and county.

The sample within the first 16 strata was then selected systematically after a random start within each

primary stratum. The procedure for newly opened

facilities whose size and service type were unknown

was a double-sampling scheme. In the first step, a

random subset of one-third of these facilities (587

nursing homes) was selected, and bed-size information was determined for them by telephone contact.

Using the newly gathered information on bed size,

this subset of facilities was then sorted into bed-size

groups producing the last 8 strata shown in table I.

Within each of these bed-size strata, nursing homes

were ordered by geographic region, State, and ZIP

code. (Although the fust group of facilities from the

MFI was ordered by type of ownership and county,

this subset was not arranged the same way because

information on these variables was not available.) In

the second step, the final sample within the last 8

strata was then selected systematically after a random

start within each primary stratum. Table I shows the

entire distribution of facilities in the sampling frame

and the final disposition of the sample with regard to

response and inscope status.

The number of nursing homes estimated by the

survey (18,900) is less than the universe figure

(23, 105), as well as the number of nursing homes in

Table 1. Number of facilities in the 1977 National Nursing Home Survay universe and sample, by disposition and sampling strata:

Conterminous United States, 1977

Sample

Universe

Sampling strata (;:wll out of scope

In scope and in business

All

facilities

or out of

business Non- Responding

responding

Alltypes of service . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Lessthan15beds . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

300-599 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

600 badsor more . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Another types ofservice2 . . . . . . . . . . . . . . . . . . . . . .

Lessthan15 beds . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

26-49 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

10G199beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

300-599 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

600 bedsor more . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown typeof sewice . . . . . . . . . . . . . . . . . . . . . . .

Bedsize known3 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lessthan15 beds . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

200-299 bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

300-599 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

600 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bedsiza unknown . . . . . . . . . . . . . . . . . . . . . . . . . . .

23,105

13,230

676

1,195

3,168

4,775

2,864

402

133

17

8,116

3.431

1,166

1,108

1,202

913

173

92

31

1,759

587

107

96

128

113

122

16

5

0

1,172

1,698

1,292

11

30

158

398

477

134

67

17

318

35

17

34

60

91

34

31

16

. . .

88

3

4

12

16

40

8

5

0

. . .

Number of facilities

166

95

3

8

25

17

18

6

12

6

57

13

5

11

5

11

4

4

4

. . .

14

1

3

6

1

2

0

1

0

. . .

81

68

0

1

6

17

32

6

6

0

8

0

0

0

1

3

2

1

1

. . .

5

0

1

0

1

2

1

0

0

. . .

1,451

1,129

8

21

127

364

427

122

49

11

253

22

12

23

54

77

28

26

11

. . .

69

2

0

6

14

36

7

4

0

. . .

lThe “niver~e ~~nsi~~edof the nursing homes as ~la~~ifiadin the 1973 Mawer Facility Inventory and facilities opened for business from 1973 to 1976.

zln~l~de~ personal care hOme~ (with or without nursing), domiciliary cara homes, and facilities with unknown sarvicetYPe.

31n order to improva estimates of the 1,759 facilities for which both ~ervice ~pe and becisize were unknown, bed sizes Wera determined fOr a

ona-third sample (587 facilities). These facilities were then stratified by bad size before sample selection.

41
the 1976 MFI (20,185), for several reasons. Some

facilities went out of bushess or became ineligible for

the scope of the survey between the time the universe

was frozen and the survey was conducted. A facility

was considered out of scope if it did not provide nursing, personal or domiciliary care services (e.g., facilities providing only room and board) or if it was a

nursing care unit or wing of a hospital, retirement

center, or similar institution without separate financial and resident records for that unit. The NNHS

methodology included a thorough procedure for identifying out-of-scope facilities. For these same reasons,

the 1973-74 NNHS estimate differed from the universe figure by 1,900.12 In addition, the large number

of newly opened facilities in the sampling frame, for

which limited information on services provided was

available, resulted in a larger proportion of facilities

(10 percent) later identified as out of scope in comparison with the 1973-74 NNHS (7 percent).

The second-stage sampling of residents, discharges

in 1976, and employees was carried out by the interviewers at the time of their visits to the ‘facilities in

accordance with specific instructions given for each

sample facility. The sample frame for residents was

the total number of residents on the register of the

facility on the evening prior to the day of the survey.

Residents who were physically absent from the

facility due to overnight leave or a hospital visit but

had a bed maintained for them at the facility were included in the sample frame. An average of five residents per facility were in the sample.

The sample frame for discharges was the total

number of persons discharged alive or dead during

calendar year 1976. Persons who were discharged

more than once during 1976 were listed for each discharge. It is possible that a current resident was included in the discharge sampling frame if he or she

was discharged during 1976. An average of four discharges per facility were in the sample.

The sampling frame for employees was the Staff

Sampling List on which the interviewer listed the

names of all staff providing direct or health-related

services (including contract personnel employed last

month) and sampled contract, administrative, medical, therapeutic, and nursing staff. Those generally

not involved in direct patient care, such as office

staff, food service, housekeeping, and maintenance

personnel were excluded from the sample. The interviewer used predesignated sampling instructions that

appeared at the head of each column of this form. An

average of 10 staff per facility were in the sample.

In order to reduce respondent burden, restrictions

were placed on the number of residents, discharges,

and staff sampled in each facility. Sampling rates

were predesignated by the size classification of the

facility but sampling rates were

sary to assure that the samples

NOTE: A list of references follows the text.

42

altered when necesdid not exceed the

specified maximum of 8 for residents, 8 for discharges, and 23 for employees.

Data collection procedures for the 1977

National Nursing Home Survey

The 1977 NNHS utilized eight questionnaires (see

appendix 111for facsimiles of questionnaires relevant

to this report):

Facility Questionnaire

Expense Questionnaire and Definition Booklet

Staff Sampling List

Staff Questionnaire

Current Resident Sampling List

Current Resident Questionnaire

,Discharged Resident Sampling List

Discharged Resident Questionnaire

Data were collected according to

procedures:

the following

1.

2.

3.

A letter was sent to the administrator ot”sample

facilities informing him of the survey and the fact

that an interviewer would contact him for an appointment. Included with this introductoqi letter

were letters of endorsement from the American

Association of Homes for the Aging, the American College of Nursing Home Administrators, the

American Health Care Association, and the National Council of Health Care Services urging the

administrator to participate in the survey. .Asummary report from the previous survey in 1973-74

was also enclosed to illustrate the kind and use of

data obtained from the survey.

Several days to 1 week after the letters had been

mailed, the interviewer telephoned the sample

facility and made an appointment with the

administrator.

At the time of the appointment the Facility Questionnaire was completed by the interviewer who

questioned the administrator or owner of the

nursing home. After completing this form, the

interviewer secured the administrator’s authorization for completion of the Expense Questionnaire. Possible respondents to the Expense Questionnaire include accountants, administrators of

the facilities, and other knowledgeable staff members. Results from the survey indicate that the

respondents were evenly divided into two groups:

(1) accountants located outside the facility and

(2) administrators and other staff members, such

as bookkeepers, based in the facility. Where data

in prepared fiiancial statements were comparable

to data requested in the Expense Questio:nnake,

the respondent provided the facilit y’s financial

statement to a specially trained NNHS accountant
who abstracted data to complete the Expense

Questionnaire. This occurred in one-third of the

cases. The interviewer completed the Staff Sampling List (a list of all currently employed staff

who provided direct or health-related services),

selected the sample of staff from it, and prepared

Staff Questionnaires. These were left for each

sample staff person to complete, seal in an

addressed and franked envelope, and return either

to the interviewer or by mail. The interviewer

completed the Current Resident Sampling List (a

list of all residents currently in the facility), selected the sample of residents from it, and completed a Resident Questionnaire for each sample

resident by interviewing the member of the

nursing staff most familiar with care provided to

that resident. The nurse referred to the resident’s

medical record when responding. No resident was

interviewed directly. The interviewer then completed the Discharged Resident Sampling List (a

list of all persons discharged alive or dead in

1976), selected a sample of discharges from it,

and completed a Discharged Resident Questionnaire for each -sample person by interviewing a

member of the nursing staff who referred to

medical records. In larger facilities, a team of two

or three interviewers conducted the survey in

order to reduce the length of time required in the

facility.

Followup on the Staff Questionnaire was initiated 2 weeks after the date of interview. Followup on the Expense Questionnaire was initiated

3 weeks after the date of interview.

Table II presents a summary of the data collection procedures.

Tabla 11. Summary of data collection procedures

Questionnaire Respondent Interview situation

Facility Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . .

Expanse Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . .

Staff Sampling List . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Staff Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Current Resident Sampling List.. . . . . . . . . . . . . . . . . . . .

Current Resident Questionnaire . . . . . . . . . . . . . . . . . . . . .

Discharged Resident Sampling List . . . . . . . . . . . . . . . . . . .

Intarviewer with administrator

Administrator, owner, accountant,

or bookkeeper

Interviemr with staff members

Sampled staff members

Intewiewer with staff member who

refars to Currant Resident Census

Intewiewer with nurse who refers

to medical record

Intewiewer with staff member who

rafers to discharge records from

1976

Interview

Self-enumerated

Informal intewiew or copied from

records

Self-enumerated

Informal intewiew or copied from

racords

Interview

Informal intewiew or copied from

records

Discharged Resident Questionnaire . . . . . . . . . . . . . . . . . . . Intewiewer with nurse who refars

to medical racord

Interview

43
General qualifications

Nonresponse and imputation

of missing data

Response rates differed for each type of questionnaire:

Response

rate

Questionnaire (percent)

Facility 95

Expense 85

Current Resident 99

Discharged Resident 97

Staff 81

Generally, response rates were higher for questionnaires administered in a personal interview situation (Facility, Current Resident, and Discharged

Resident) as compared with those that were selfenumerated (Expense and Staff). Statistics presented

in this report were adjusted for failure of a facility to

respond (i.e., to complete the Facility Questionnaire)

and for failure to complete any of the other questionnaires (Expense, Current Resident, Discharged Resident, or Staff). Those items left unanswered on a

partially completed questionnaire (Facility, Expense,

Current Resident, Discharged Resident, Staff) were

generally imputed by assigning a value from a responding unit with major characteristics identical to

those of the nonresponding unit.

Rounding of numbers

Estimates of facilities and discharges have been

rounded to the nearest hundred. For this reason, detailed figures within tables do not always add to

totals. Percents were

rounded figures and

cisely with percents

rounded data.

Data processing

calculated on the or&inal, unwill not necessarily agree prethat might be calculated from

A series of checks were performed during the

course of the survey. This included field followups

for missing and inconsistent data, some manual

editing of the questionnaires, and extensive editing as

44

conducted by I computer to assure that all responses

were accurate, consistent, logical, and complete. Once

the data base was edited, the computer was u’sed to

calculate and assign weights, ratio adjustments, recodes, and other related procedures necessary to produce national estimates from the sample data.

Estimation procedures

Statistics reported in this publication are derived

by a ratio estimating procedure. The purpose of ratio

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

the variability of the estimate. The estimation of

number of facilities and facility data not related to

size are inflated by the reciprocal of the probability

of selecting the sample facilities and adjusted for the

nonresponding facilities within primary type of

service-size strata. Two ratio adjustments, one at each

stage of sample selection, were also used in the estimation process. The first-stage ratio adjustment

(along with the preceding inflation factors) was included in the estimation of facility data related to

size, and of all resident, discharge, and staff data for

all primary types of se~ice-size strata.b The numerator was the total beds according to the MFI data for

all facilities in the stratum. The denominator was the

estimate of the total beds obtained through a simple

inflation of the MFI data for the sample facilities in

the stratum. The effect of the first-stage ratio adjustment was to bring the sample in closer agreement

with the known universe of beds. The second-stage

ratio adjustment was included in the estimation of all

resident, discharge, and staff data. It is the product of

two fractions: the fiist is the inverse of the sampling

fraction for residents (discharges or staff) upon which

the selection is based; the second is the ratio of the

number of sample residents (discharges or staff) in

the facility to the number of residents (discharges or

staff) for whom questionnaires were completed within the facility.

bFor nursing homes with unkuown bed size and service type, the firststage ratio adjustment was not included in the estimation of facihty,

resident, discharge, and staff data.
Reliability of estimates

As in any survey, the results are subject to both

sampling and nonsampling errors. Nonsampling errors

include errors due to response bias, questionnaire and

item nonresponse, and processing errors. To the extent possible, the latter types of errors were kept to a

minimum by methods built into survey procedures

such as standardized interviewer training, observation

of interviewers and field followups for missing and inconsistent data, manual and computer editing, 100-

percent verification of all keypunching, and other

quality checks. Because survey results are subject to

both sampling and nonsampling errors, the total error

is larger than errors due to sampling variability alone.

Because statistics presented in this report are

based on a sample, they will differ somewhat from

figures that would have been obtained if a complete

census had been taken using the same schedules,

instructions, and procedures.

The standard error is primarily a measure of the

variability that occurs by chance because only a

sample, rather than the entire universe, is surveyed.

The standard error also reflects part of the measurement error, but it does not measure any systematic

biases in the data. It is inversely proportional to the

square root of the number of observations in the

sample. Thus as the sample size increases, the standard error generally decreases.

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

would be obtained from a complete census by less

than the standard error. The chances are about 95 out

of 100 that the difference is less than twice the

standard error and about 99 out of 100 that it is

less than 2% times as large.

The relative standard error of an estimate is the

standard error of the estimate divided by the estimate

itself and is expressed as a percent of the estimate.

Relative standard errors of estimated number of

facilities and discharges are shown in figure I. In this

report, estimates with a relative standard error of

more than 30 percent of the estimate itself are considered “unreliable.” For example, curve A of figure I

shows the relative standard errors of estimated number of discharges. For a relative standard error of

30 percent or less, the minimum number of discharges

is 5,000. Thus, discharge estimates smaller than 5,000

are considered “unreliable” and are replaced with an

asterisk.

Because of the relationship between the relative

standard error and the estimate, the standard error of

an estimate can be obtained by multiplying the estimate by its relative standard en-or. For example, in

curve B of figure I, an estimate of210 facilities has a

relative standard error of 30 percent. Its standard

error is 0.30 X 210= 63.

The particular figure or table to which one refers

to obtain a standard error is contingent on the type

of estimate (e.g., discharges) and whether the estimate is a level or a percent. Table III shows the standard errors for percent estimates used in this report for

discharges. Table IV shows the standard errors for the

average monthly charge for discharges. The illustrations that follow show how to use the tables to find

the standard error of an estimate.

L?lustration of use of table III to find approximate

standard errors of percentages of estimates. –Table 4

shows that 51.2 percent of the 91,600 discharges

whose primary diagnosis at admission was cancer

were discharged alive. Linear interpolation between

values shown in table 111yields an approximate standard error of 3.61 percent for 51.2 percent with a base

of 91,600.

L?lustration of use of table IV to find approximate

standard errors of rates. –Table 10 shows that the

average monthly charge in 1976 for discharges from

proprietary nursing homes was $732 with a base number of 803,100 discharges (table 2). Linear interpolation between values shown in table IV yields an

approximate standard error of $87 for the estimate

of $732 with a base of 803,100 discharges.

45
.

10J

80

70

60

50

40

30

20

10

9

8

7

6

5

4

3

2

1.0

::

.7

.6

.5

.4

.3

.2

.1

100

90

80

70

60

50

40

30

20

1:

8

7

6

5

4

3

2

1j

.8

.7

.6

.5

.4

.3

.2

.1

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

Size of estimate

Figure 1. Relative standard errors of estimated numbers of discharges and facilities
Table II 1. Standard errors of permntages for discharges

Base of percent Estimatad percent

(discharges) 1 or99 2or98 5or95 10 or 90 20 or 80 30 or 70 40 or 60 50

Standard error in percentage points

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.07 4.32 6.73 9.28 12.35 14.15 15.12 15.44

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.17 3.06 4.76 6.55 8.73 10.00 10.69 10.91

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.54 2.16 3.36 4.63 6.17 7.07 7.58 7.72

40,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.09 1.53 2.38 3.27 4.37 5.00 5.35 5.48

60,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.89 1.25 1.84 2.67 3.56 4.08 4.37 4.48

80,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.77 1.06 1.68 2.32 3.09 3.54 3.78 3.86

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.69 0.97 1.50 2.07 2.76 3.16 3.38 3.45

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.49 0.8s 1.06 1.46 1.95 2.24 2.39 2.44

400,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.34 0.48 0.75 1.04 1.38 1.58 1.69

600,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.73

0.28 0.39 0.61 0.85 1.13 1.28 1.38 1.41

800,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.24 0.34 0.53 0.73 0.98 1.12 1.20 1.22

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.22 0.31 0.48 0.65 0.87 1.00 1.07 1.08

1,100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.21 0.29 0.45 0.62 0.83 0.95 1.02 1.04

Table IV. Standard errors ofaverage monthly charge fordischarges

Base of ratio Average monthly chatge

(discharges) $100 $200 $400 $600 $800 $1,000

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *

30,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

40,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

60,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

80,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

20CS,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

400,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

600,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

800,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

I,ouo,uoo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

57

48

43

38

35

33

28

28

25

24

24

Standard error in dol tars

97 136

83 118

76 108

67 97

63 91

60 87

53 79

50 74

49 72

46 72

48 71

175

153

140

126

119

114

104

98

86

95

95

214

187

172

155

146

141

129

122

120

119

118

47
Hypothesis testing

To test the difference between two statistics

(mean, percent, etc.), the standard normal test should

be performed to determine whether or noJt tgreject

the null hypothesis (for_the tyo means X1, X2, the

null hypothesis is HO : Xl = X2 with the alternative

HA : ~1 # X2). The standard error of the difference

of the two estimates is approximately the square root

of the sum of the squares of the standard error of

each of t~e estimate~ Thus, if SE (~1) is the st~ndard

error of Xl and SE(X2) is the stgndarQ error X2, the

standard error of the difference (Xl - X2) is

(This formula will represent the actual standard error

for the difference between separate and uncorrelated

characteristics although it is only a rough approximation in most other cases.) The ~ull hy~othlesis is rejected (that is, the two means X1 and X2 are different) if the probability of a type I error is less than

5 percent; that is, if

z = 3?,–Z*

> 1.96

~SE2 (~1 ) + SE2 (12)

SE(~l - X2) = ~SE2 (~1 ) + SE2 (72)

48
Appendix Il. Definitions

of certain terms used

in this report

Terms relating to facilities

Facility. –Nursing homes included in the 1977

National Nursing Home Survey were those classified

by the 1973 Master Facility Inventory (MFI) as

nursing care homes, personal care homes with nursing, personal care homes, and domiciliary homes.

Also included are nursing homes opened for business

between the time the 1973 MFI was conducted and

December 1976. A nursing home must have three

beds or more and may be either free standing or a

distinct unit of a larger facility. (See appendix IV for

details.)

Bed. –A bed is one that is set up and staffed for

use whether or not it was in use by a resident at

the time of the survey. Not included are beds

used by staff or owners, or beds used “exclusively

for emergency purposes, solely day care, or solely

night care.

Certified bed. –A certified bed is one that is

certified: (a) as skilled under the Medicare

program, under the Medicaid program, or

both; or (b) as intermediate under the Ivfedicaid program. (See definition under “Certification” for details.)

Certification. –Certification refers to the facility

certification by the Medicare and/or Medicaid

program(s).

Medicare. –Medicare refers to the medical

assistance provided in title XVIII of the Social

Security Act. Medicare is a health insurance

program administered by the Social Security

Administration for persons aged 65 years and

over and for disabled persons who are eligible

for benefits.

Medicaid. –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 facility. –Skilled nursing facility refers to certification as a skilled nursing

facility under Medicare, under Medicaid, or

under both programs.

Intermediate care facility. -Intermediate care

facility refers to certification as an intermediate care facility under Medicaid.

Not certified. –Not certified refers to facilities

that are not certii3ed as providers of care

either by Medicare or Medicaid.

Facility type. –The criteria for classifying nursing

homes are based on the following factors: the percentage of residents receiving nursing care in the

week prior to the day of the survey, the availability of registered professional or Iicensed practical nurses, the administration of medications

and treatments in accordance with physician’s

orders, the supervision over medications that may

be self-administered, and the provision of assistance with certain personaI services.

Nursing care.–(See appendix IV for detailed

criteria.)

AU other. –Other types of facilities include

those providing personal care with nursing,

personal care, or domiciliary care. (See appendix IV for detailed criteria.)

Location

Geographic region. –Facilities are classified by

geographic area by grouping the conterminous

States into regions. These regions correspond

to those used by the U.S. Bureau of the

Census:

Region States included

Northeast . . . . . Maine, New Hampshire, Vermont, Massachusetts, Rhode

Island, Connecticut, New

York, New Jersey, Pennsylvania

49
North Central . .

South . . . . . . . .

West . . . . . . . . .

Michigan, Ohio, Indiana,

Illinois, Wisconsin, Minnesota, Iowa, Missouri, North

Dakota, South Dakota,

Kansas, Nebraska

Delaware, Maryland, District of Columbia, Virginia,

West Virginia, North Carolina, South Carolina, Georgia, Florida, Kentucky,

Texasj Tennessee, Alabama,

Mississippi, Arkansas, Louisiana, Oklahoma

Montana, Idaho, Wyoming,

Colorado, New Mexico, Arizona, Utah, Nevada, Washington, Oregon, California.

(Alaska and Hawaii are excluded.)

Standard Federal Administrative Regions. –

Facilities are classified by Standard Federal

Administrative Regions by grouping the conterrninous States into 10 regions. These regions correspond to those used throughout

the Federal Government:

Region

Region I . . . . . .

Region II... . . .

Region III . . . . .

Region IV . . . . .

Region V. . . . . .

Region VI.....

Region VII . . . .

Region VIII. . . .

Region IX . . . . .

States included

Connecticut, Maine, Massachusetts, New Hampshire,

Rhode Island, Vermont

New York, New Jersey.

(Puerto Rico and Virgin

Islands are excluded.)

Delaware, Maryland, Pennsylvania, Virginia, West Virginia, District of Columbia

Alabama, Florida, Georgia,

Kentucky, Mississippi, North

Carolina, South Carolina,

Tennessee

Illinois, Indiana, Michigan,

Minnesota, Ohio, Wisconsin

Arkansas, Louisiana, New

Mexico, Oklahoma, Texas

Iowa, Kansas, Missouri, Nebraska

Colorado, Montana, North

Dakota, South Dakota,

Utah, Wyoming

Arizona, California, Nevada.

(Hawaii, Guam, Trust Territory of Pacific Islands, and

American Samoa are excluded.)

Region X. . . . . . Idaho, Oregon, Washington.

(Alaska-is excluded.)

Ownership.–Type of ownership refers to the type

of organization that controls and operates the

nursing home.

Proprietary facility. –A proprietary facility is

operated under private commercial ownership.

Nonprofit facility. –A nonprofit facility is

operated under voluntary or nonprofit

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

Government facility. –A government facility

is operated ‘under Fede;al, State, or loc~

government auspices.

Terms relating to discharges

Discharge. –A discharge is a person who was formally discharged from a nursing home during 1976.

Both live and dead discharges are included. Theoretically, the same person can be counted men-e than

once if he was discharged more than once from a

nursing home during 1976.

Charges and Primary Source of Payment

Charge, monthly. –The monthly charge is the

total amount charged to the person during his

last full calendar month prior to discharge

from the facility. It includes all basic charges

plus all charges for private duty nursing, drugs,

and special medical supplies.

Primary source of payment. –The primary

source of payment refers to the one payment

source that paid the greatest amount of the

patient’s charge during the last full calendar

month in the facility prior to discharge.

Own income or family support. –Own income

or family support includes health insurance,

retirement funds, and social security.

Medicare. –Medicare refers to money received

under the Medicare program. (See facility

“Certification” for details.)

Medicaid - skilled. –Medicaid-skilled refers to

money received under the Medicaid program

for skilled nursing care. (See facility “Certification” for details.)

Medicaid - intermediate. –Medicaid-in~termediate refers to money received under th~eMedicaid program for intermediate nursiiig care.

(See facility “Certification” for details.)

Other government assistance or welfare. –

Other government assistance or welfare refers

50
to sources of government aid (either Federal,

State, or local) other than Medicare or Medicaid.

All other sources. –All other sources include

religious organizations, foundations, volunteer

agencies, Veterans Administration contracts,

initial payment arrangements, life care arrangements, miscellaneous sources, and nocharge arrangements.

Demographic Items and Outside Living Arrangements

Age. –The age of a discharge is his age at the

time of discharge.

Discharge status. –The discharge status is

whether the person was discharged from the

nursing home alive or dead.

Duration of stay. –The duration of stay is the

period of time between the date of admission

and the date of discharge.

Living arrangement after discharge for live

discharge. –The living arrangement after discharge refers to the type of residence where

the person lives after discharge.

Another nursing home. –Another nursing

home includes domiciliary or person~

care facilities, intermediate care facilities,

and skilled nursing facilities.

Other health facility. –Other health facility includes chronic disease, rehabilitation, geriatric and other long-term-care

hospitals, and facilities for the mentally

retarded.

Private or semiprivate residence. –Private

or semiprivate residence includes houses

or apartments, rented rooms, boarding

houses, and retirement homes.

Marital status at time of discharge. –Marital

status is status of the discharge at the time of

his release from the nursing home.

Health Services

Level of care received. –These levels of care

are defined in terms of the nursing services

actually received by the discharge during the

7 days prior to the discharge date. Based on

the services listed in item 11 and responses to

item 10b of the Discharged Resident Questionnaire, the following classiilcations were

made. Each succeeding level is exclusive of

the previous levels:

Intensive nursing care.–Intensive nursing

care includes receiving at least one of the

following services:

Bowel/bladder retraining

Catheterization

Full bed bath

Intravenous injections

Oxygen therapy

Note that tube or intravenous feeding, included in the comparable defiition for

residents, is not included in this definition.

Other nursing care.–Other nursing care includes receiving at least one of the following services:

Application of sterile dressings or

bandages

Blood pressure reading

Enema

Hypodermic injections

Irrigation

Temperature - pulse -respiration check

Personal care or none. –Personal care includes receiving at least one of the following services:

Medication prescribed at last physician visit

Rub or massage

Special diet

None includes those discharges who received none of the preceding services.

Note that the medication service in

this defiition is not identical to that

for residents (administration of treatment or medications). Further, the

service of help with bathing, dressing,

or eating (included in the comparable

definition for residents) is not included in this deftition.

Therapy service. –Therapy service refers to

whether the discharge received any therapy

services provided by a licensed, registered, or

professionally trained therapist during the

calendar month prior to the discharge. These

services may have been provided either inside

or outside the facility.

Time since last physician visit. –This is the

length of time between the date of discharge

and the last time the person saw a physician

(M.D. or D.O.) while still a resident of the

facility for treatment, medication, or examination.

Health Status

Activities of daily living. –The activities of

daily living were collected for discharges in

the areas of continence and mobility only,

based on information in the medical record

on performance at the time of discharge.

51
Continence

No difficulty controlling bowels or

bladder. –The discharge did not have

any difficulty in controlling either his

bowels or bladder at the time of discharge.

Difficulty controlling bowels. –The

discharge had difficulty controlling

his bowels at the time of discharge.

Difficulty controlling bladder. –The

discharge had difficulty controlling his

bladder at the time of discharge.

Ostomy in either bowels or bladder. –

The discharge had undergone a surgical procedure that resulted in the creation of an artificial opening for the

elimination of waste.

Mobility

Walks with or without assistance. –

The discharge was able to walk at the

time of discharge, either with or without assistance of special equipment or

another person. This excludes those

discharges who were chairfast, bedfast, or whose status was unknown.

C’hairfast.–The discharge was confined to a chair at the time of discharge.

Bedfast. –The discharge was confined

to a bed at the time of discharge.

Partial index of dependency in activities of

daily living. –The partial index of dependency

in activities of daily living is modeled after the

seven-level “hierarchy” of dependence developed by Dr. Sidney Katz. 13Y14 The partial index is a measure that permits overall classification of individuals according to their

dependency at the time of discharge in performing the two activities of daily living just

described. Although the complete index

covers 6 activities, the partial index covers

only 2 because information on the others was

not available in the medical records of discharges. The partial index has 4 categories

with categories 2 and 3 approximating the

category “dependent in only 1 activity” in

the complete index. Two activities, ordered in

“hierarchy” sequence, present the criterion

for classifying a discharge as dependent:

Mobility. –Mobility dependency refers to

those discharges who were chairfast or

bedfast.

NOTE: A list of references follows the text.

52

Continence. –Continence dependency refers to those discharges who had d.ifflculty

controlling bowels, bladder, or ‘both; or

had an ostomy.

Chronic conditions and inzpairments.--Chronic

conditions and impairments include those

long-term physical and mental problems of

the discharge selected by the nursing staff

respondent from a list of 37 conditions and

impairments (see item 8 of the Discharged

Resident Questionnaire). The respondent

based the selection upon a check of the medical record and more than one condition or

impairment could be reported.

Primary diagnosis at admission.–The primary

diagnosis at admission was the one condition

reporteh by the nursing staff respondent as

the major diagnosis noted at the time of admission. The list of conditions corresponds to

the Eighth Revision International Classification of Diseases, Adapted for Use in the

United States. 15 The respondent repc)rted the

information based on the discharge’s medical

record.

Primary Source of Payrnerzt.-(See “Charges and

Primary Source of Payment.”)

Special Aids or Devices Used.–This includes only

those special aids or devices used on a regular

basis (see list in item 13 of the Discharged Resident Questionnaire). Definitions for selected

special aids and devices are presented:

Cuffs. –Cuffs are hand or foot devices consisting of a fabric cuff that goes around waist or

ankle, with a second strap attaching cuff to

side rafl or belt. It is used to protect the resident from injuring himself.

Geriatric chair.–A geriatric chair is alpadded

chair or a combination chair/table with small

wheels and with a high back. It is designed to

support the resident.

Mechanical feeding device. –A mechanical

feeding device is any adaptive equipment that

helps the resident to feed himself.

Posey belt or similar device. –A posqy belt or

similar device is a device that may be used

either in a bed or a wheelchair to secure

chest, waist, or legs.

Walker.–A walker is a device that the resident

uses on his own to support himself while

walking.

Other. –Other special aids or devices include

slings, artificial limbs, orthopedic shoes,

shower chairs, page turners, and devices other

than those listed in the tables.
Appendix Ill. Selected survey

instruments used in the

1977 National Nursing Home Survey

Facility questionnaire

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE

Health Resources Administration

National Center for Health Statistics

1977 National Nursing Home Survey

FACILITY QUESTIONNAIRE

——

OMB # 6a. S75025 APPROVAL EXPI RES 12-31-77

A. Telephone Number = - ~ B.lntervievferNama

Area Code Number

C. Date of Interview CIIIID

lCiam

D. Start Time

Mo. Day Year 2Clpm

INTER VIEWER NOTE: Please read the Faci/ity.Questionnaire Prompt Card BEFORE you beg;n the intervjew.

1. ACCORDING TO OUR RECORDS, THE NAME OF THIS FACILITY IS: (Read name of faci/ityon /abe/.)

a. IS THERE AN ERROR IN THIS NAME?

I ❑ Yes 2 ❑ No (Skip to 0.2)

b. WHAT IS THE CORRECT NAME OF THIS FACILITY?

2. ACCORDING TO OUR RECOROS, THE MAILING ADDRESS OF THIS FACILITY IS: (Read address on /abe/.)

a.

b.

IS THERE AN ERROR IN THIS ADDRESS?

I ❑ Yes 2 n No (Skip to Q.3)

WHAT IS THE CORRECT MAILING AODRESS OF THIS FACILITY?

Number Street P.O. Box, Route, etc.

City or Town County

State Zip Code
3. HAS THIS NURSING HOME BEEN IN BUSINESS AT THls ADDREs FOR TWO YEARS OR LONGER? COUNT FROM THE

TIME IT FIRST OPENEO AT THIS ADORESS ASA NURSING HOME, EVEN THOUGH THE OWNERSHIP OR THE SERVICES

OFFEREO MAY HAVE CHANGEO.

I ❑ Yes 2!3N0

4. ARE ANY OF THE FOLLOWING SERVICES ROUTINELY PROVIOEO TO RESIOENTS IN AOOITIONTO ROOM ANO

a.

b.

c.

d.

e.

f.

9.

h.

i.

INTER VIEWER: This facility is out-of-scope of the survey. Please terminate interview,+ I

BOAI?O:

SUPERVISION OVER MEDICATIONS WHICH MAY BE SE LF-AOMINISTEREO? , . . . . . . 1 ❑ Yes

MEDICATIONS ANO TREATMENTS ADMINISTERED IN ACCORDANCE WITH

PHYSICIAN’S ORDERS? . . . . . . . . . . . . . . . . . . . . . . . . . ..ln Yes

RUB ANOMASSAGE? . . . . . . . . . . . . . . . . . . . . . . . . . . .lnYes

HELP WITH TUB BATH OR SHOWER?. . . . . . . . . . . . . . . . . . . . . . lnYes

HELP WITH DRESSING? . . . . . . . . . . . . . . . . . . . . . . . . . ..ln Yes

HELPWITH CORRESPONDENCE OR SHOPPING? . . . . . . . . . . . . . . . . . . I ❑ Yes

HELP WITH WALKING OR GETTING ABOUT? . . . . . . . . . . . , . . . . . . . lnYes

HELP WITH EATING? . . . . . . . . . . . . . . . . . . . . . . . . . . ..ln Yes

OR

NONE OF ABOVE SERVICES ROUTINELY PROVIOED, ONLY ROOM AND BOARD PROVIDED? . I ❑ Yes

20No

20No

20No

2!3N0

20No

20No

20No

20No

5a. IS THIS FACILITY A DISTINCT NURSING HOME U&T OF A HOSPITAL, ANOTHER HEALTH INSTITUTION, OR A

RETIREMENT CENTER?

I ❑ Yes 2 ❑ No (Skip to Q.6a)

b. HOW MANY BEDS ARE IN THE ENTIRE FACILITY INCLUOING THE NURSING HOME UNIT?

I I I

READ.’ FOR THE REMAINOER OF THE INTERVIEW, THE QUESTIONS REFER ONLY TO THE NURSING HOME UNIT.

!54
h I Shmv Fhdrwrd #’l ~ WHAT IS THE TYPE OF OWNERSHIP WHICH OPERATES THIS FACILITY?

01 ❑ Individual

02 ❑ Partnership

‘1

For profit

03 ❑ Corporation

b. IS THIS FACILITY A MEMBER OF A GROUP OF FACILITIES OPERATING

04 ❑ Church related UNDER ONE GENERAL AUTHORITY OR GENERAL OWNERSHIP?

os ❑ Nonprofit corporation I

I•lYes 20No

06 ❑ Other nonprofit ownership J

070 State

oa •l County

09 ❑ City

10 ❑ City.County

II ❑ Hospital District

12 ❑ U.S. Public Health Service

I a H Armad Forces

1.4 ❑ Veterans .Adrriinistration

15 ❑ Other Federal Agancy, Specify

7s, 00ES YO UR FACILITY ACCEPT BOTH MALES AND FEMALES?

I D Yes (Sk/p to Q.8a) znNo

b. 00ES IT ACCEPT ONLY MALES OR ONLY FEMALES?

1 ❑ Only males

2 ❑ Only females

8m HAS YOUR FACILITY SET A MINIMUM AGE BELOW WHICH NO ONE IS ACCEPTED?

I ❑ Yes 2 ❑ No (Skip to Q.8C)

b, WHAT IS THAT MINIMUM AGE?

W Years

c. HAS YOUR FACILITY SET A MAXIMUM AGE ABOVE WHICH NO ONE IS ACCEPTED?

1 ❑ Yes 2 ❑ No (Skip to Q.9)

d. WHAT IS THAT MAXIMUM AGE?

L1-1 Years

9. DOES YOUR FACILITY ACCEPT PERSONS WHO ARE PRIMARILY DIAGNOSEU AS:

a. MENTALLY ILL OR EMOTIONALLY OISTURBED? . . . . . . . . . . . . . . . . . I 13yes 20No

b. MENTALLY RETARDED? . . . . . . . . . . . . . . . . .. . . . . . . . ..l13Yes 20No

c. ALCOHOLICS? . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..llZYes 2!3N0

d. DRUG ADDICTS? . . . . . . . . . . . . . . . . . . . . . . . . . . . ..l13Yes 20No

e. SENILE? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..l UYes 20No

55
10. WHAT lSTHETOTAL NUMBER OF BEOSREGULARLY MAINTAINEO FOR RESlOENTS?

INCLUOE ALL BEOS SET UP ANO STAFFEO FOR USE WHETHER OR NOT THEY ARE IN USE BY RESIOENTS AT THE

PRESENT TIME. DO NT INCLUOE BEDS USED BY STAFF OR OWNERS OR BEOS USEO EXCLUSIVELY FOR EMERGENCY PURPOSES, SOLELY OAY CARE, OR SOLELY NIGHT CARE.

Total beds H

11. WHAT IS THE NUMBER OF BEOS IN THIS FACILITY THAT ARE LICENSEO BY THE HEALTH DEPARTMENT OR OTHER

RESPONSIBLE AGENCY?

Total licensed beds I I I

12a.’ WAS THERE A CHANGE IN THE TOTAL NUMBER OF BEOS REGULARLY MAINTAINED OURING 1976?

I •l Yes 2 ❑ No (Skip to Q. 73)

b. IN WHICH MONTHS WAS THE NUMBER OF BEOS CHANGED?

C, (Ask for each chartge:j IN (month), WAS THAT AN INCREASE OR O EC REASE?

d. (Ask for each change:) HOW MANY BE OS?

I

Month lncreas~ (Number added} Decrease (Number eliminated) ——.—— I

w 1111 I I

w 1111 I I

l-t-l 1111 I I I

13. IS THIS FACILITY CERTIFIEO BY BOTH MEDICARE ANO MEDICAID, MEDICARE ONLY, MEDICAIO ONLY, OR

NEITHER?

I ❑ Both Medicare and Medicaid

2 ❑ Medicare only

3 ❑ Medicaid only (Skip to Q. 16)

4 ❑ Neither (Skip to Q.24)

14s. HOW MANY BEDS ARE CERTIFIEO UNOER MEOICARE? H beds

b. ARE THESE BEOS A PHYSICALLY DISTINCT UNIT FROM THE REST OF THE FACILITY? I ❑ Yes 20No

15. Show Fiashkard #2 WHICH OF THE REIMBURSEMENT METHOOS AUTHORIZED BY MEOICARE IS USED BY THIS

FACILITY?

In

20

30

90

RCCAC Method (Departmental-Relationship of Charges to Charges Applied to Cost Method; i.e., costs are apportioned by

applying a percentage representing the beneficiaries’ share of total charges, on departmental basis, to total costs for the

respective departments.)

Combination Method (For routine wrvices such as room, board, and nursing services the providers total allowable costs are

apportioned on the basis of the relative number of patient days for beneficiaries and for other patients, For non-routine or

ancillary services, the providers allowable costs are apportioned on the basis of a percentage representing the beneficiaries’

share of the total charges to all patients for these services.)

Other, Specify

Don’t Know

INTER VIEWER NOTE: Skip to f2.23a if “Medicare only” in Q. 13.

56
16. IS THIS FACILITY CERTIFIED AS AN SNF, THAT IS A SKILLED NURSING FACILITY, BY THE MEDICAID PROGRAM?

I •l Yes 2 ❑ No (Skip to Q. 19)

17a. HOW MANY BEDS ARE CERTIFIED UNOER MEDICAID AS SNF BEDS? U beds

b, ARE THESE BEOS A PHYSICALLY DISTINCT UNIT FROM THE REST OF THE FACILITY?

I ❑ Yes 20No

1Sa. I Show Flashcard #3 ] WHICH OF THE FOLLOWING REIMBURSEMENT METHOOS FOR ~F-MEDICAID PATIENTS IS

USED BY THE FACILITY?

I a Flat Rate Only ~ b.WHAT IS THE FLAT RATE? $ ~c. Per ~mday

per 2 ❑ week

per 30 month

p2r 40 other, specify

2 ❑ Flat Rate Plus Point System for Ancil Iary Services ~d. WHAT IS THE FLAT RATE PORTION?

3 ❑ Cost Plus Allowabla Profit S ~c. per ,Uday

4 ❑ Other, Specify

per 2 ❑ week

per 30 month

9 ❑ Don’t Know per 40 other, specify

19. IS THIS FACILITY CERTIFIED AS AN ICF, THAT IS AN INTERMEDIATE CARE FACILITY, BY THE MEDICAIO

PROGRAM?

I U Yes 2’ ❑ No (Skip to Note above 0.22)

2Da. HOW MANY BEDS ARE CERTIFIED UNDER MEDICAID AS ICF BEDS? U beds

b. ARE THESE BEDSA PHYSICALLY DISTINCT UNIT FROM THE REST OF THE FACILITY? I ❑ Yes 20No

21a.]ShcSwF/aahcard #3 ] WHICH OF THE FOLLOWING REIMBURSEMENT METHODS FOR ~-MEDICAID PATIENTS

IS USED BY THE FACILITY?

I ❑ Flat Rate Only ~ b.WHAT IS THE FLAT RATE? $ ~c. per ,Dday

per 2 ~ week

per 3 ❑ month

per 4 ❑ other, specify

2 ❑ Flat Rate Plus Point System for Ancillary Services — d.WHAT IS THE FLAT RATE PORTION?

3 ❑ Cost Plus Allowable Profit $ ~~ 8. per I ❑ day

per 2 ❑ week

4 ❑ Othar, Specify

per 3 ❑ month

9 ❑ Don’t Know per 4 ❑ other, specify

INTER VIEWER NOTE: Skip to 0.23a if the facility is certified by only one program and at only one level of cara.

22. SOMETIMES THE SAME BED IS CERTIFIED BY MORE THAN ONE PROGRAM. WITH REGARD TO THESE SO CAL LEO

“SWING BEDS”, HOW MANY BEDS IN YOUR FACILITY ARE CERTIFIED:

a. ASSNF BEDS UNDER BOTH MEDICARE AND MEDICAID? IIIIJ

b. AS BOTH ICF AND SNF BEOS UNDER MEDICAID? 11111

c. AS MEOICAID-ICF AND MEDICARE*SNF BEDS? Ii Ill

d, UNDER ALL THREE PROGRAMS THAT IS, MEDICARE-SNF, MEDICAID4NF, AND MEDICAIDJCF? ~

57
23a. DO YOU HAVE ANY BEOS NOT CERTIFIED BY EITHER MEOICAID OR MEOICARE?

I •l Yes 2 ❑ NO (Skip to Q.24]

b. HOW MANY OF THESE BEDS OOES YOUR FACILITY HAVE?

~ Beds

24. HOW MANY PERSONS WERE ADMITTED TO THIS FACILITY DURING 1976?

~ admissions none ❑

25a. ROES THIS FACILITY ACCEPT TEMPORARY ADMISSIONS OF PERSONS WHOSE USUAL CARETAKERS ARE ILL, ON

VACATION, OR OTHERWISE UNAVAILABLE?

I ❑ Yes 2 ❑ No (Skip to Q-26)

b. HOW MANY TEMPORARY RESIDENTS WERE ADMITTED TO THIS FACILITY OURING 1976?

~ ternrmtwy admissions none ❑

26a. WE WOULD LIKE TO OBTAIN INFORMATION ON DAYS OF CARE PROVIDED BY THE FACILITY FOR YOUR MOST

RECENTLY COMPLETEO FISCAL YEAR, THAT IS, THE TWELVE MONTH PERlOO ON WHICH YOU COMPUTE THE

FACI LITY’S EXPENSES. IS THIS INFORMATION AVAILABLE FOR A FISCAL YEAR?

I ❑ Yes 2 ❑ No (Skip to t2.26c)

b. WHAT WAS THIS TIME PERIOD?

Mo. Year Mo. Year

from W W through W W

(If this is Ieas than a twalve month period, please word the number of months in this box.) w

~

c.

d.

FOR WHAT TIME PERIOO IS THIS INFORMATION AVAILABLE?

Mo. Year Mo. Year

from ~ W through W W

(If this is less than a twelve month period, pleew word the number of months in this box.)

FOR THIS PERlOO, WHAT WERE THE TOTAL INPATIENT DAYS OF CARE PROVIDED, THAT IS THE SUM OF THE

DAILY PATlENT CENSUS COUNT BY TYPE OF CERTIFICATION?DO NOT INCLUDE CASES THAT ARE DAY CARE

ONLY.

(1) Total Days: ~ days ❑ Mark (X) if estimated

(2) SNF-Medicare I I I I I 1 1 I days ❑ Mark (X) if estimated O not applicable

(3) SNF-Medicaid ~ days ❑ Mark (X) if estimated ❑ not applicable

(4) lCF-Medicaid ~ days ❑ Mark (x) if estimated ❑ notappli~ble

(5) AlI.Other Days ~ days ❑ Mark (x) if e$timated ❑ not applicable

58
Confidential information

hrterviewer, Read: Information contained on this form which would permit identification of any individual or establishment has

been collected with a guarantee that it will be held in strict confidence, will be used only for purposes stated for this study, and

will not be disclosed or released to others without the consent of the individual or the establishment in accordance with Section

308(d) of the Public Health Service Act (42 USC 242m).

27a. COUNTING FROM THE TIME IT WAS ORIGINALLY CONSTRUCTED, HOW OLO IS THIS BUILDING? (hrterviewer: Round

fractions to nearest whole year. If interval is given, record mid-point and mark ‘7f estimatefl box.)

W Years (Mark (X) box ❑ if estimated) ❑ Don’t Know

b. WAS THIS BUILDING ORIGINALLY CONSTRlfCTED SPECIFICALLY FOR USE AS A NURSING HOME? (/interviewer: Other

c.

d.

terms for nursing homes are rest home, home for the aged, mentally ill, or mentally retarded.)

I ❑ Yes (Skip to Q.27d) 20No 9 ❑ Don’t know (Skip to Q.27d)

WHAT WAS THE ORIGINAL PURPOSE OR USE OF THIS BUILDING?

1 ❑ private home, apartment, hotel/motel

2 ❑ Hospital, sanitarium, or other health related building

3 ❑ Other, Specify

NOT COUNTING PAINTING OR PAPERING, HAS THE STRUCTURE OF THIS BUILDING EVER BEEN RENOVATEO OR

REMODELEO?

1 ❑ Yes 2 ❑ No (Skip to Q.28) 9 D Don’t know (Skip to Q.28)

e. \ Show F/aahcard#4 WHICH OF THE FOLLOWING CHANGES f. IN WHAT YEAR WAS THE MOST RECENT

WERE MAD E? (Mark (X) all that apply; then ask 27f for each change.) (change]?

Year in Process Don’t Know

(1) Addition to the building constructed . . . . . . . . ❑ Wfz •1

(2)Firesafety equipment/construction added or changsd . . ❑ mu ❑

(3) Interior remodeling . . . . . . . . . . . . . . ❑ ~1 ❑ ❑

(4) Other, Specify ❑ l-do ❑

28. HOW MANY ROOMS FOR RESIOENTS 00 ESTHIS FACILITY HAVE THAT CONTAIN:

a. 1 BED ONLY? bd rooms None ❑

b. 2 BEDS? I-1-Ll rooms None ❑

c. 3 BEOS? ~ rooms None ❑

d. 4 OR MORE BEOS? l-l-d rooms None ❑

59
29a. FOR THE DAY SHIFT YESTERDAY, WAS THE PERSON IN CHARGE OF NURSING CARE FOR THE ENTIRE FACILITY—

ON CALL OR ON DUTY, THAT IS AWAKE, ORESSED, ANO SER\’”’lG THE RESIOENTS?

I ❑ On Call (Skip to 0.3Ue)

z ❑ On Duty

b. WHAT IS THE LEVEL OF SKILL OF THIS PERSON?

I ❑ Registered Nurse

2 ❑ Licensed Practical Nurse

3 ❑ Nurse’s Aide or Orderly

4 ❑ Other (Specify Occupation) ——— —

c. WHAT HOURS 010 T~PERSON ACTUALLY WORK YESTEROAY? (Mark (X/am orpml

from Ei J Gl ~~~ 10 El t El ~~~

30s.

b.

c.

FOR THE EVENING SHIFT YESTERDAY, WAS THE PERSON IN CHARGE OF NURSING CARE FOR THE ENTIRE

FACILITY ON CALL OR ON OUTY?

I ❑ OnCall (Skip to Q,31a)

z.DOn Duty

3 ❑ No Such ShHt LSkip to Q.31a)

WHAT IS THE LEVEL OF SKILL OF THIS PERSON?

I ❑ Registered Nurse

2 ❑ Licensed Practical Nursa

s ❑ N urse’s Aide or Orderly

4 ❑ Other (Specify Occupation)

WHAT HOURS DID THIS PERSON ACTUALLY WORK YESTEROAY? (Mark (X) am orpm)

from Cl:Cl ~~~toEl:GZ~~~

—

31a. FOR THE NIGHT SHIFT YESTERDAY, WAS THE PERSON IN CHARGE OF NURSING CARE FOR THE ENTIRE FACILITY

ON CALL OR ON DUTY?

1 ❑ On Cail (Skip to 0.32)

2 ❑ On Duty

3 ❑ No Such Shift (Skip to CL32)

b. WHAT IS THE LEVEL OF SKILL OF THIS PERSON?

I ❑ Registered Nurse

2 ❑ Ltcensea Practical Nurse

3 ❑ Nurse’s Aide or Orderly

a ❑ Other (Specify Occupation)

c. WHAT HOURS DID T~S PERSON ACTUALLY WORK YESTEROAY? (Mark (XJ am orpm}

from GZl:EZl ~~~toCJ:Gl~~~

32. HOW MANY DIFFERENT PHYSICIANS CURRENTLY ATTENO THEIR OWN PRIVATE PATIENTS IN THIS FACILITY?

(Do not count physicians who are on the staff of the facility or are employed under con tract.)

~ Physicians or !dnone

60
33a. DOES THE FACILITY HAVE A MEDICAL DIRECTOR?

I ❑ Yes 2 n No (Skip to 0.34)

b. ] Show Flashcard +5 1 UNDER WHICH OF THESE TYPES OF ARRANGEMENTS IS THE MEDICAL OIRECTION OF THIS

FACILITY PROVIDED?

I ❑ An individual physician

2 ❑ A physician partnership or.group practice

3 n Several individual physicians

4 ❑ An H. M.O., medical school, or medical society

s ❑ Hospital Staff

6 ❑ Other, Specify

34. OOESTHIS FACILITY ROUTINELY PROVIOE ON THE PREMISES ANY OF THE FOLLOWING THERAPIES BY A

LICENSEO, REGISTERED, OR PROFESSIONALLY TRAINED THERAPl~:

a. PHYSICAL THERAPY? . . . . . . . . . . . . . . . . . . . . . . . . . .. In Yes 20No

b. OCCUPATIONAL THERAPY? . . . . . . . . . . . . . . . . . . . . . . . ..ln Yes 20No

c. RECREATIONAL THERAPY?.. . . . . . . . . . . . . . . . . . . . . . ..l CIYes 20No

d. SPEECH AND HEARING THERAPY? . . . . . . . . . . . . . . . . . . . . . . lCIYes 20No

e. COUNSELING/THERAPY BY PSYCHIATRIST, PSYCHOLOGIST, OR MENTAL HEALTH WORKER? I •l Yes 20No

f. COUNSELING BY SOCIAL WORKER?. . . . . . . . . . . . . . . . . . . . . . lnYes 20No

g. OTHER REHABILITATION THERAPIES? Specify I 0 Yes 20No

35a. DOES THIS FACILITY KEEP A WAITING LIST OF PERSONS TO BE ADMITTEO WHEN A BED BECOMES AVAILABLE?

I ❑ Yes 2 a No (Skip to Q.36a)

b. HOW MANY PEOPLE ARE PRESENTLY ON THIS WAITING LIST?

b-d people or ❑ None

36s. 00 ESTHIS FACILITY PROVIOE ANY SERVICES TO PERSONS WHO ARE ~T RESIOENTS OF THE FACILITY?

I ❑ Yes 2 ❑ No (Skip to 0.36)

b. FOR WHICH OF THE FOLLOWING CATEGORIES OF NONRESIDENTS DO YOU PROVIDE SERVICES

(1) Ofappropriata) PERSONS ON THE WAITING LIST? . . . . . . . . . . . . . . . . I •l Yes 20No

(2) DISCHARGEO RESIDENTS? . , . . . . . . . . . . . . . . . . . . . . . lnYes 20No

(3) ANY PERSON WHO APPLIES?. . . . . . .. . . . . . . , . . . . . . . . 10 Yes 20No

(4) ANY OTHER TYPE OF NO N.RESIDENT? Spacify I Cl Yes 20No

61
37. I S/Sow flashcard #6 ] WHICH OF THE FOLLOWING SERVICES DO YOU PROVIDE TO NONRESIDENTS? (Mark (X) all

that apply.)

a. ❑ Day care (services provided during the day to persons who do not sl,eepin the facility overnight.)

b. ❑ Physical therapy

c. ❑ Occupational, recreational, or speech and hearing therapy

d. ❑ Psychiatric cara

e. ❑ Homa health care services

f. G Maals aithar homa delivared or in a group satting

g. ❑ Transportation and/or axort services

h. ❑ Homamakar or chore sarvices

i. ~ Information and/or raferral for haalth naad$

j. ❑ Friandly visiting’

k, n Dally talaphone checking sarvice

1, ❑ Arrangamant or provision of recreational actlvitias

m. ❑ Laundry survlca

n. ❑ Other, Specify ___

38, 00 ESTHIS FACILITY HAVE ANY VACANT STAFF POSITIONS IN ITS BUOGET THAT IT IS CURRENTLY TRYING TO

FILL?

1 ❑ Yes 2 ❑ No (Skip to Nota below Q.39)

36. show Flaatward #7 HOW MANY VACANT FULL TIME AND PART TIME STAFF POSITIONS ARE IN THE BUDGET FDR

THE FOLLOWING OCCUPATIONS? FULL TIME IS DEFINED AS 35 HOURS DR MORE PER WEEK.

a.

b.

c.

d.

e.

f.

9.

h.

i.

i.

k.

1.

m.

Administrator/Asst. Administrator . . . . .

Physician (M.D. or D.O.), Residanta and Interns

Dantists . . . . . . . . . . . . . .

Pharmacists . . . . . . . . . . . . .

RegisteredOccupational Therapista. . . , .

Registered Physical Therapists . . . . . .

Speech Pathologist and/or Audiologista . . .

Activities Directors . . . . . . . . . .

Dietitians or Nutritionists . . . . . . . .

Registered Medical Remrds Administrators . .

Social Workers . . . . . . . . . . .

Other Professional Occupations . . . . . .

Registered Nurses (R. N.) . . . . . . . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

.. .

. . .

. . .

. . .

. . .

n. Licensed Practical Nurses ( L.P.N.) or Licensed Vocational

Nuraas(L.V.N.) . . . . . . . . . . . . . .

0. Nurses Aides/Ordarlies . . . . . . . . . . . .

p. Office Staff . . . . . . . . . . . . . . .

q. Food Service Personnel . . . . . . . . . . . .

r. Housekeeping/Maintenance Personnal . . . . . . .

s. Other, Specify

Full Time

w

LI

1-1-1

w

w

w

w

w

w

w

L-1

Part Time

w

w

b-l

w

w

w

1-d

w

❑ None

❑ None

❑ None

❑ None

n None

❑ None

❑ None

❑ None

❑ None

n None

❑ None

❑ None

❑ None

❑ None

❑ None

❑ None

❑ None

❑ None

❑ None

.

62
Nameof the Respondent Titla

I ❑ lam

E. End Time F. Time Eiwad ~ Min.te$

2Clpm

THANK YOU FOR YOUR TIME AND COOPERATION

INTER VIEWER NOTE: After completing the above ims ~d thnk;ng the rewxxlent, continue the interviewing process with Prompt

Card #3.

* U.S. GoVERNMENT PRINTING OFFICE: 1S77-724.674/66S 3.1

63
Discharged resident

sampling list

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE Sheet

Health Resources Administration

_of _Sheett 1

ohm# 6a-s75025

APPROVAL EXPIRES 12-31-77 -J

National Center for Health Statistics

1977 National Nursing Home Survey DISCHARGED RESIDENT SAMPLING LIST Control No. =2

Canfidmrtial Information

Information contoined on this form which woas!dpermit Idontifimtlorr of ●ny individual or establishment haa IsWt oollected with a guarantea that it will be hold in otriot aonfldonae, will be used only for purpoooa atoted for this aqsdy, and will not be disdoaad or ro160sedto

othors without tho consent of tho iradividuol or tho ●atobliahmenl in oarasrdanoewith Seation 30B(d). of tho Public Health Servica Aot

(42 USC 242m).

=

A. Start Time

loom

— B. TWO of idontlfior used: lnN6me 2 ❑ other, specify

C. Ssmplo Doaignation: swl_L_LJ TE ti

D. Rosidonts Discharged During 1976: Fadlity Total H

E. Now SW ●nd TE

Numberx 1 IJ Yos 20No

I I i

F. Total in Bamplo L.L-l I

G. End lima

ilJom

H. Tim. Elopaed ~ Minutes

2nPm I

Circla Line Nos. of Rosidonts in Samplo

LINE

NO, Residant Identifier

Dato of

Disdtorga

Mo. Day I

01 I Ill

J

04

05

06

07

06

09

10

11

13 I I

14

15

16

17

I

t 20 I I 1

22 I

23

24

25

DISCHARGED RESIDENTS

LINE

Rasident Idontifiar

Date of

NO. Discharga

Mo, Day

26

27

28

28

30

31

32

33

34 I

36 I

36

37

3a

1401 I I I

1

42

A? I I H

48

49

60 +

1

-. I 1 1 I

If MOM IIMs ●ro tIWdad CONTINUE ON THE sACK

64
DISCHARGED RESIDENT SAMPLING LIST-CD NTINUED

Circle Line Nos. of Residents in Sample

DISCHARGED RESIDENTS

LINE Date of

NO. Discharge

Mo. Day

51

52

53

54

55

56

57

56

59

60

61

62 I Ill I I

63 I

64 I Ill

66 I Ill

I ,

67

68 I Ill

Ill

70

71

72 I Ill

,

73

74

75

LINE Date of

NO. Discharge

I 1 Mo. Dav

77

78

79

60

Ill

Ill

1 ,

I

89

w I I

91

Ill

84

1951 Ill

1971 Ill t

t 98 I

1881 Ill

I

100

If more IIMS - nnded usc a new shoot and renumber the IIMS beginning

with #101. Renumbar lines on ●dditional shoots 201, 301, ●te.

65
Discharged resident

questionnaire

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE OMB # 68-S75025

Health Resources Administration APPROVAL EXPIRES 12.31.77

National Center for Health Statistics DISCHARGED RESIDENT INJESTIONNAIRE

1977National Nursing Home Survey Control No, Gd

Confidential Information

1

Information contained on this form which would permit identification of any individual or esteblishmant has baen collected with a guarantaathet it will beheld instriawnfidence,will kusadonlyf orpurposass titedfort hi$study,and will not badisclosed orraleasedto

othars without tha consent of the individual or tha astiblishmant jn ac~rdanm with Satiion 308(d) of the Public Health Service Act

(42 USC 242m).

A. Rasident Line No. B. Date of interview C. Data of Discharga

D.

11111

Interviewer Name

$ipGJ~

E. Start

pGJliJ

Tima

I ❑ lam

1

2Cipm

J

1. WHAT WAS THE DATE OF ADMISSION PRIOR TO THE DISCHARGE DATE OF (Date of Discharge)?

—

l.__&JL&JLL_J

—

2. WHAT WAS THE SEX OF THIS RESIDENT?

I ❑ Male 2 ❑ Female

3. WHAT WAS— DATE OF BIRTH?

LIJl&.J bJ_l#_lor Ll_#

4. WHAT WAS— MARITAL STATUS AT DISCHARGE?

I ❑ Married 2 ❑ Widowed 3 ❑ Divorced 4 ❑ Separated s ❑ Never Married 9 ❑ Don’t know

5. WAS— DISCHARGED ALIVE?

f.-..

- ..::’.:

I ❑ Yes

2 ❑ No (Skip to instruction above Q.7)

9 ❑ Don’t know (Skip to irratruction above Q.7)

66
6a. WHERE DID —STAY IMMEDIATELY AFTER DISCHARGE FROM THIS FACILITY?

I ❑ Private residence(houseor apartment) (Skip to instruction above Q.7)

2 ❑ Rented room, boarding house (Skip to instruction abow Q.7J

3 ❑ Retirement home (Skip to instruction abom 0. 7)

4 ❑ Another health care facility

s ❑ Other arrangements,Specify (Skip to instruction abow Q.7)

9 ❑ Don’t know (Skip to instruction above 0,7)

b, I Show F/aahcard #f ] WHAT TYPE OF FACILITY WAS IT?

I ❑ Domiciliary or personal care facility

2 ❑ Intermediate Caie Facility (ICF)

3 D Skilled Nursing Facility (SNF)

4 ❑ Facility for mentally retarded

s ❑ General or short term hospital

6 ❑ Mental hospital

7 ❑ Chronic disease,rehabilitation, geriatric or other long4erm care hospital

a ❑ Other, Specify (SkIP to instruction abow 0.7)

9 ❑ Don’t know (Skip to inswuction abow. Q.7)

c, Dm- DIE IN THIS OTHER HEALTH CARE FACILITY?

I ❑ Yas z ❑ .No 9 ❑ Don’t know

/rrterviawtw, Reed.’ “SINCE THIS RESIDENT HAS BEEN DISCHARGED, THE REMAINING QUESTIONS REFER TO HEALTH

STATUS AT THE TIME OF DISCHARGE, THAT IS, ON (Dafa of Diashwge in itemC).” -——.

lNTEi?ViEWER NOTE: If the m$ident wg in ttrehoma Ieaathen twlw monthaprhw to disctwge, mark thi~box ❑ and skip to 0.8.

Otherwiae,$continuew;th Q.7a,

78.

b.

c.

d.

DID —RECEIVE A FLU SHOT WITHIN THE TWELVE MONTHS PRIOR TO (Dam of Dia&erge)?

1 n Yes 2 ❑ No (Skip too. 7c} v ❑ Don’t Know - No Record (Skip to Q.7c.)

WHEN DID— RECEIVE THE FLU SHOT?

U W ❑ Don’t know

mo. yr.

DID —CATCH THE FLU DURING THE NINE MONTHS PRIOR TO (Data of Diwhar#?

10 Yes 2 ❑ NO (Ski@to 0.8) s a Don’t Know -No Record (Skb to 0.8.)

WHEN DID —CATCH THE FLU?

~ W ❑ Don’t know

mo. yr.

67
—

8. Show Flashcard #2 DID —HAVE ANY OF THE FOLLOWING CONDITIONS OR IMPAIRMENTS? (Mark (X) all that

apply)

n None of these conditions

A. Mental Conditions/l mpairments

0 (1) Senility

n (2) Mental Retardation

❑ (3) Mental Illnass

❑ (4) Chronic Brain Syndrome

INTER VIEWER NOTE: If the respondent reports that the resident was both mentelly retarded

end mentally W, mark this box ❑and read: HAVE I RECORDED CORRECTLY THAT—

WAS MENTALLY ILL AND MENTALLY RETARDED? /f necessary, correct.

B. Physical Conditions/lmpairments

❑ (5)

❑ (6)

❑ (7)

❑ {B)

❑ (9)

❑ (10)

❑ (11)

❑ (12)

❑ (13)

❑ (14)

❑ (15)

❑ (16)

❑ (17)

❑ 08)

❑ (19)

•l (20)

•1 (21)

❑ (22)

❑ (23)

❑ (24)

❑ (25)

❑ (26)

a (27)

❑ (28)

❑ (29)

❑ (30)

Hardening of the Arteries

Stroke

Hypertension

Heart Troubia

Edema (Fluid Retention)

Arthritis/Rheumatism

Paralysis or Palsy other than arthritis - stroke related

Paralysis or Palsy other than arthritis - unrelated to stroke

Parkinson’s Disease

Kidney Trouble/Chronic Urinary Tract Infections

Constipation

Insomnia

Diabetes

Cancer

Deafness

Blindness

Glaucoma

Cataracts

Chronic Respiratory Disease

Anemia

Bedsores

Hip Fractures

Other Fractures

Alcoholism

Drug Addiction

Chronic Back/Spine Problems (excluding Stiffness and Deformity)

Permanent Stiffness or Deformity of:

❑ (31) back

❑ (32) arms

•l (33) legs

❑ (34) extremities (feet, toes, hands or fingers)

Missing Limbs or Extremities:

❑ (35) arms

❑ (36) legs

❑ (37) extremities (feat, toes, hands or fingers)

❑ Don’t know —

68
9. 3how Fladrcard #3 ACCORDING TO~EDICAL RECORD, WHAT WAS THE PRIMARY DIAGNOSIS AT THE TIME

OF ADMISSION, THAT IS, ON (Data of Admission in 0. 1)?

A. Heart and Other Circulatory Problems

01 a CongestiveHeart Failure (C.H,FJ

02 ❑ Hardening of the Atteries (Arteriosclerosis, A.S.H.D.)

03 ❑ Heart Attack, Ischemic Heart Disease(Acute Myocardial infarction.M.l.)

04 ❑ High Blood Pressure(Hypertension)

os ❑ Phlebitis

06 n pulmonary Embolism

07 ❑ Rheumatic Heart Diseasa

oa ❑ Stroke (CerebrovasoularDisaase-C.V.A.)

09 ❑ Other Circulatory Problems, Specify

B, Mental Disorders

10 ❑ Chronic Brain Syndrome

II ❑ Mental Retardation

12 ❑ Neurosis

13 ❑ Psychosis(Schizophrenia, Paranoia, Manic Depression,etc.)

14 ❑ Senile Psychosis(senile Dementia)

15 ❑ Senile, Not Psyohotic

16 ❑ Other Mental Disorders, Specify

C. Other Diagnoses

17 n Alcoholism

la ❑ Anemia

19 n Arthritis/Rheumatism

20 ❑ Asthma

21 R Blindness

22 ❑ Bone Fracture, other than Hip

23 ❑ Bronchitis

24 ❑ Cancer (Malignant Neoplasm)

25 •l Cataracts

26 ❑ Cirrhosisof the Liver

27 El Deafness

za ❑ Diabetes

m ❑ Drug Addiction

30 ❑ Emphysema

31 ❑ Epilepsy

32 ❑ Glaucoma

33 ❑ Gout

34 ❑ Hip Fracture

35 n Multiple Sclerosis

36 ❑ Parkinson’sDisease

37 •l Pneumonia

3a •l Polio

39 n Respiratory, other than Pneumonia

40 ❑ Syphilis

41 ❑ Ulcers

42 ❑ Other, Specify

99 ❑ Don’t know

69
lfh. DURING THIS PARTICULAR STAY. WHEN DID —LAST SEE A PHYSICIAN FOR TREATMENT, MEDICATION, OR

FOR AN EXAMtNATION?

L__& & ~ or ❑ Never saw a doctor during this stay (Skip to Q. 11) ❑ Don’t know (Skip to Q. 11)

b. AT THAT TIME Dill —RECEIVE:

Es No Don’t Know

{1) AN EXAMINATION?

(2) A PRESCRIPTION (INCLUDING REFILLS)?

In 20 9CI

10 20 90

(3) TREATMENT?

(4) OflDERS FOR LABORATORY TESTS?

In 20 9n

(5) ANY OTHER SERVICES?

1.U 20 90

10

i

20 90

11. \ Show Flashcard #4 DURING THE LAST 7 DAYS BEFORE DISCHARGE, THAT K, FROM (Date 7 days prior to discharge

date) TO (Data of Diswhar&),WHICH OF THESE SERVICES DID— RECEIVE? (Mark (X) all that apply)

❑ a. Blood pressura reading

❑ b. Temperature-pulse-respiration

❑ c. Application of sterile dressings or bandages

❑ d. Full bad-bath

❑ e. Rub or massage

❑ f. Enema

❑ g. Catheterization

❑ h. Bowel retraining

❑ i. Bladder retraining

•l j. irrigation

❑ k. Oxygen tharapy

•l L Intravenous injaction

❑ m. Hypodermic injection

❑ n. Administration of other medical treatment by staff

❑ O.Sc=2cial diet

I

(1) WHAT TYPE OF DIET WAS IT? (Mark (X) all that app/y)

❑ a. diabetic ❑ b. low sodium ❑ c. bland ❑ d. SOft ❑ e.low cholesterol

❑ f. weight loss n g. waight gain ❑ h. Other, Specify

❑ None of the above services racaived

❑ Don’t know —

70
lh DURING (Last calendar month fwforu dixhard OF 1978. DID —RECEIVE ANY THERAPY SERVICES EITHER INSIDE

b.

OR OUTSIDE OF THIS FACILITY FROM Ai;cENSED,’REGISTERED, OR PRoFEBBIONALLY TRAINEO THERAPIST?

I ❑ Yes 20No (Skip to Q, 13) 9 •J Don’t know (Skip so 0. 13)

Show Fkwhcard #5 ~ WHICH TYPES OF THERAPY DID— RECEIVE DURING THAT MONTH? (Merk (X) all rhat

I I

a,oply)

(1) Physical therapy c1

(2) Occupational therapy ❑

(3) Recreational therapy c

(4) Spebchand hearingtherapy ❑ ,

(5) Counseling/therapy by a psychiatrist, psychologist,or other mental health worker ❑

(6) Counselingby socialworker ❑

(7) Reality orientation n

(8) Other therapy services,Specify ❑

13. I Show Flashcard #6 ! DID —REGULARLY USE ANY OF THESE AIDS? {Mark (X) ●ll tfwtappiy)

❑ a, Eye glasses ❑ i. Artificial limb

❑ b, Hearing aid ❑ j. Mechanical feeding davice

❑ c, Wheelchair ❑ k. Orthopedic she.

❑ d. Cane ❑ LGeriatric chair

❑ e. Walker ❑ m. PoseYbelt or similar devices

❑ f. Crutches •l n. Cuffs

n g. Braces 00. Other ●ids or davices,%edfy

❑ h. Slings

❑ NO ●ids used

❑ Don’t know

14a.WAS —BEDFAST?

I •l Yes(Skip to Q. 15) 20No 9 ❑ Don’t know

b. WAS —CHAIRFAST?

I •l Yes 2nNo 9❑ Don’t know

15. 010 —HAVE ANY DIFFICULTY IN CONTROLLING— BOWELS?

I ❑ Yes

2nNo 3❑ Not applicable, had an ostomy 9❑ Don’t know

16. DID —HAVE ANY DIFFICULTY IN CONTROLLING— BLADDER?

I ❑ Yes

2nNo

3 ❑ Not applicable, had ostomy, indwelling cathater, or external device

9 ❑ Don’t know

71
htterviewar, Read: THE REMAINING QUESTIONS DEAL WITH CHARGES AND PAYMENT SOURCES. DO YOU HAVE THIS

INFORMATION?

I ❑ Yes (Go to note above Q. 17)

2 n No (Determ!ne who has information and tian you have completed all the Discharged Residant Questionnaires,intarview that

person for the information usingPrompt Card #l 1.)

F. End Time

I ❑ lem

G. Time elapsed I-U-l Min.tas

21Jpm

10am

H. Stert Tima

2Clpm

INTER VIEWER NOTE: Before proceeding. refer to the admissiondata in Q. 1. If resident wasadmitted ~r the first day of tha calendar

month preceding the data of discharge,mark this box ❑ and skip to Q, 18. Otherwise, continue with Q. 17.

17. FOR THE MONTH OF (last calandar month before discharge), WHAT WAS THE TOTAL CHARGE BILLED FOR —CARE,,

INCLUDING ALL CHARGES FOR PRIVATE DUTY NURSING, ORUGS, ANO SP~CIAL MEDICAL SUPPLIES?

{

2 KI Day

3 ❑ Waek

$m.oo per 4 ❑ Month

5 ❑ Other period, Spacify

❑ No charge made for care, Explain:

I ❑ Facility assumad cost

2 ❑ Initial payment/life carearramment

3 ❑ Othar, Specify

❑ Don’t know (Not billed yet, etc.)

-

18. FROM (Date of Admission) THROUGH @rte of Discharge),WHAT WAS THE TOTAL CHARGE BILLED FOR— CARE,

INCLUDING ALL CHARGES FOR PRIVATE DUTY NURSING, DRUGS, ANO SPECIAL MEDICAL SUPPLIES?

{

I ❑ Entire raporting period

2 ❑ Day

$ m .00 per 3 a Week

4 ❑ Month

5 ❑ Other period, Specify

❑ No charge made for care, explain:

1 a Facility assumed cost

2 •l Initial payment/lifa care arrangement

3 ❑ Other, Specify

❑ Oon’t know (Not billed yet, etc.)

19. I Show Flashcard#7 I WHAT WERE ~ THE SOURCES OF PAYMENT FOR— CARE OURING THIS TIME? (Mark (X)

all that appIy)

a a. Own incoma, family support, haalth insurance, O g. VA contract

ratirament funds, social security, ate. ❑ h. Initial payment-lifa csra funds

❑ b. Medicare ❑ i. No charge made for care (Facility assumed cost)

❑ c. Madiceid-s- nursing a j. Payment source not determined (Skip to nota

❑ d. Medicaid-intermediate care bdOW Q.Z?)

❑ e. Other government assistance or welfare n k. Othar, Specify

❑ f. Raligious organizations, foundations, voluntaer

agencies O Don’t know

72
20. Show Flashcard #7 WHAT WAS THE PRIMARY SOURCE OF PAYMENT FOR —CARE DURING THIS TIME?

01❑ a. Own income, family support, heelth insurance, 07 ❑ g. VA Wfltram

retirement funds, social security, etc. oa❑ h. Initial payment-life oare funds

02❑ b, Medicare 090 i. No charge made for care [Facility assumedcost)

IOU j. Payment sourcenot determiner~(Skip to note

04 ❑ d. Medicaid.intermediate care below 0.21)

05 ❑ e, Other government assistanceor welfare 11❑ k. Other, Specify

oa❑ f. Religiousorganizations, foundations, volunteer

agencies 12❑ Don’t know

21. WHAT WAS THE AMOUNT PAID BY THE PRIMARY SOURCE OF PAYMENT OURING THIS TIME?

$ m .00 ❑ Don’t know

INTER VIEWER NOTE: Be sure to fill in the items below and continue to next DischargedResio%t C?uastionnaira.

I 13am

L End lime J. lima Elapsed I-U_l Mirs.tas

2Clpm

* U.S. 00vIRNMENT PRINTING OFFIC1 1977_724-C7a/60S 3.1

73
Appendix IV. Criteria for classifying

nursing homes according to

level of nursing care

The criteria for classifying facilities are based on

several factors: (1) the number of persons receiving

nursing care during the week prior to the day of the

survey; (2) administration of medications and treatments in accordance with physician’s orders;

(3) supervision over medications that may be selfadministered; (4) the routine provision of the following criterion personal services: rub and massage, help

with tub bath or shower, help with dressing, correspondence, shopping, walking or getting about, and

help with eating; and (5) the employment of registered professional or licensed practical nurses. On the

basis of these factors, four types of facilities were

distinguished and are defined as follows:

Nursing care home. –A facility is a nursing care

home if nursing care is its primary and predominant

function. Those meeting the following criteria are

classified as nursing care homes in this report:

1. One or more registered nurses or licensed practical nurses were employed.

2. 50 percent or more of the residents received

nursing care during the week prior to the survey.

(Nursing care is defined as the provision of one or

more of the following services: nasal feeding,

catheterization, irrigation, oxygen therapy, full

bed bath, enema, hypodermic injection, intravenous injection, temperature-pulse-respiration

check, blood pressure reading, application of

dressings or bandages, and bowel and bladder

retraining.)

Personal care home with nursing. –A facility is a

personal care home with nursing if personal care is its

primary and predominant function, but some nursing

care is also provided. If a facility met either of the

following criteria, it was classified as a personal care

home with nursing:

1.

74

Some but less than 50 percent of the residents

received nursing care during the week prior to the

survey, and there was one registered professional

or licensed practical nurse or more on the staff.

2. Some of the residents received nursing care durimz

the week prior to the survey, no registered nurse;

or licensed practical nurses were on the staff, but

one or more of the following conditions, were

met:

a.

b.

c.

Medications and treatments were administered in accordance with physician’s orders.

Supervision over self-administered medications was provided.

Three or more personal services were routinely provided.

Personal care home. –A facility is a personal care

home if its primary and predominant function is personal care and no residents received nursing care

during the week prior to the survey. Places in which

one or both of the following criteria were met are

classified as personal care homesin this report whether

or not they employed registered nurses m licensed

practical nurses:

1.

2.

Medications and treatments were administered in

accordance with physician’s orders, or supervision

over medications that may be self-administered

was provided.

Three or more of the criterion personal services

were routinely provided.

Domiciliary care home. –A facility is a domiciliary

care home if its primary and predominant function is

domiciliary care but the facility has a responsibility

for providing some personal care. If the criteria for a

nursing care home or personal care home are not met

but one or two of the criterion personal services are

routinely provided, the facility is classified as a domiciliary care home in this report.

In the classification process, a criterion was considered as not having been met if the necessary information for that criterion was unknown. For instance,

if the type of nursing staff was unknown for a particular place, it was considered as not having met the

criteria of having one or more registered nurses or

licensed practical nurses on the staff. Establishments
indicating that some nursing care was provided but nursing care to some but less than 50 percent of their

not giving the number of persons to whom this care patients or residents. Table V shows in detail the

was provided were considered as facilities providing classification of the facilities.

Table V. Classification of facilities by type of service

Classification variable Classification critaria

Percent of total residents who recaivad nursing care during 50 percent or more

Soma but less than

thawaek prior tothedayofsuwey. . . . . . . . . . . . . . 50 percent

None

Number of registered or licensed practical nurses. . . . . . . 1+

Does the facility provide:

(a) Administration of medicine or treatments according

todoctor’s orders . . . . . . . . . . . . . . . . . . . . .

or . . .

(b) Supervision over self-edministared medicine?. . . . .

Does the facility offer assistance with three activities or

more fordaily living? . . . . . . . . . . . . . . . . . . . . . . . . .

Does the facility offer assistance with one or two activities

fordaiiy living? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Doas the facility offer room and/or board as its only

service? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Facility I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Nc

Yes

. . .

. . .

. . .

Pcn

None 1+

No . . .

Yes

. . .

. . .

Pcn

No . . .

Yes . . .

. . . . . .

Pc Pcri

Yes

. . .

. . .

. . .

Pcn

None

Yes

. . .

. . .

Pcn

No Yes

No . . .

Yes No . . .

. . . Yes . . .

Pc D pc

None

No

Yes No

. . . Yes No

. . . . . . Yes

Pc D B

lNC = Nursing care home.

Pcn E Personal care with nursing home.

Pc = Personel care home.

D = Domiciliary care home.

B = Boarding or rooming house (out of scope).

75
Vital and Health Statistics series descriptions

SERIES 1.

SERIES 2.

SERIES3.

SERIES 4.

SERIES 10.

SERIES 11.

SERIES 12.

SERIES 13.

Programs and Collection Procedures.-Reports describing

the general programs of the National Centrsr for Health

Statistics and its offices and divisions and the data collection methods u~ed. They also include definitions and

other material necessary for understanding the data.

Data Evaluation and Methods Remarch.–Studies of nev~

statistical methodology including experimental tests of

new survey methods, studie~ of vital statistics collection

methods, new analytical techniques, objective evcduatiorw

of reliability of collected data, and contributions to statistical theory.

Analytical and Epidemiological Studies. –Reports presenting analytical or interpretive mudies Imwd on vital

and health statistim, carrying the ana!ycic further than

the expository types of report? in the other ~eries.

Documents and Committee Reports.-Fr nal reportz of

major committees concerned with vital and health statistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

Data From the Nationa I Health Interview Survey .–Stati~-

tics on illness, accidental injunes, disability, use of hospital, medical, dental, ond other mrvicec, and other

health-related topicc, all bawd on data collected in the

continuing national household interview survey.

Data From the National Health Examination Suwey and

the National Health and Nutrition Examination Suwey.–

Data from direct examination, testing, and meamrement

of national samples of the civilian noninstitutiona lized

population provide the basiz for (1) estimates of the

medically defined prevalence of cpecific diseaws 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.

Data From the Institutionalized Population Sunreys.-Di~-

continueci in 1975. Reports from the= surwys are included in Series 13.

Data on Health Resources Utilization. –Statistic$ on the

utilization of hea!th manpovwr and facilities providing

long-term care, ambulatory care, hospital care, and family

planning services.

SERIES 14. Data on Health Resources: Manpower and Facilities.–

Statimic$ on the numbers, geographic distribution, and

characteristics of health resources including physicians,

dentists, nurses, other health occupations, hospitals,

nursing homes, and outpatient facilities.

SERIES 15. Data From Special Surveys. -Statistics on health and

health-related topics collected in special surveys that

are not a part of the continuing data systems of the

National Center for Health Statistics.

SERIES 20. Data on Mortality .–Various statistics on mortality other

than as included in regular annual or monthly reports.

E@cial analysss by causs of death, age, and other demographic variables; geographic and time series analyses;

and statistics on characteristics of deaths not available

from the vital records based on sample surveys of those

records.

SERIES 21. Data on Natality, Marriage, and Divorce. –Various statistics on natality, marriage, and divorce other than as

included in regular annual or monthly reports. Special

analysm IYJ d~mographic variables; geographic and time

~~rie~ anafy~es; studiez of fertility; and statistics an

characteristic~ of births not avai[akrle from the vital

recordz bawd on samp!e sur-wys of those records.

SERIES 22. Data From the National Mortality and Natality Suweys.–

Discontinued in 1975. Reports from these sample suweys

bawd on vita! records are included in Series 20 and 21,

respect wd y.

SEFtl ES 23. Da@ From the National Suwey of Family Growth.–

Statistics on fertility, family formation and dissolution,

family planning, and related maternal and infant health

topicc ckived from a periodic suwey of a nationwide

probability sample of ever-married women 1544 years

of age.

For a Iict of titles of raports published in these series, write to:

Scientific and Technical Information Branch

National Center for Health Statistics

Public Health Sewice

Hyattsville, Md. 20782
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Office of Health Research, Statistics, and Technology

National Center for Health Statistics

3700 East-West Highway

Hyattsville, Maryland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

from the Office of Health Research, Statistics, and Technology

DHHS Publication No. (PHS) 81-1715, Series 13, No. 54

POSTAGE AND FEES PAID

U.S. DEPARTMENT OF HHS

HHS 396

Cl

*

-rllkl class m

for a listing of publications in the VITAL AND HEALTH STATISTICS SERIES call 301-436-NCHS