Data from the

NATIONAL HEALTH SURVEY

Nursing Home Costs–1972

United States: National Nursing Home Survey

August 1973-April1974

Data on 1972 costs are related to selected facility, staff, and resident characteristics. Cost components are presented according to

ownership, certification, ske, geographic region, and their interrelationships. The distribution of facilities, resident days, admissions, live discharges, deaths, occupancy rates, selected service

characteristics, full-time equivalent employees, full-time equivalent

employees per 100 beds, labor cost per full-time equivalent employee, reported chronic conditions and impairments, primary diagnosis at last examination and at admission, measures of activities

of daily living, primary reasons for admission, IeveI of patient

care, and primary source of payment are presented by facility

cost intervals. Based on data colIected in the 1973-74 National

Nursing Home Survey.

DHEW Publication No. (PHS) 79-1789

U.S. Department of Health, Educationr and Welfare

Public Health Service

Office of the Assistant Secretary for Health

National Center for Health Statistics

Hyattsville, Md. November 1978

Series 13

Number 38
—-.. — .. ., .. . . —.

,“

/

I

Library of Congress Cataloging in Publication Data

Meiners, .Mark R.

lNursincghome costs—1 972 United States.

(Vitai and health statistics: Series 13, L)atfi from the National IIcalth Sut!e;, Data on

heaIth resources utilization; no. 38) (DHEW’ publication; (PIfS) 79-1 789)

1. Nursing homes–United States–Costs--Statistics. I. Title. II. Series: United States.

National Center for Health Statistics. Vital and health statistics: %rics 13, I)at;l from the

National Health Survey, Dzita on health resources utilization; no.

States. Dept. of Health, Education, and Welfare. DHEW’ publication;

[DNLN!: 1. Nursing homes-Economics-United States --Statistics.

sis–United States--Statistics. W2A N 148vm no. 38]

RA407.3.A349 no. 38 [RA997]

ISBN 0-8406 -0136-0 [338. -+’3]

38. III. Series: United

(PHS) 79- I 789.

2. Coh[s Jlld L!)st .ulLLly302.1’1’0973s

78-16003

..— .
NATIONAL CENTER FOR HEALTH STATISTICS

DOROTHY P. RICE, Director

ROBERT A. ISRAEL, Deputy Director

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

GAIL F. FISHER, Ph. D., Associate Directorfor the Cooperative Health Statistics System

ELIJAH L. WHITE, Associate Director for Data Systenzs

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

ROBERT C. HUBER, Associate Director for Management

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

PETER L. HURLEY, Associate Director for Operations

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

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

ALICE HAYWOOD, Information Officer

DIVISION OF HEALTH RESOURCES UTILIZATION STATISTICS

SIEGFRIED A. HOERMANN, Director

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

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

STEWART C. RICE, Chief Family Planning S tatistics Branch

JAMES E. DeLOZIER, Chief Ambulatory Care Statistics Branch

MANOOCHEHR K. NOZARY, chief Technical Services Branch

Vital and Health Statistics-Series 13-No. 38

DHEW Publication No. (PHS) 79-1789

Library of Congress Catalog Card Number 78-16003
CONTENTS

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

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

Background and Qualifications of Data .............................................................................................

Cost Components ...................................................................................................................................

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

Cost Components by Facility Characteristics ....................................................................................

Ownership ...................................................................................................................................

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

Size ........................................r ...................................................................................................

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

Interrelationships of Ownership, Cetification, Stie, ~dRe@on Chmteristics .........................

Cost Intervals .........................................................................................................................................

Facility Characteristics by Cost Intervals ..........................................................................................

Distribution of Facilities .............................................................................................................

Total Cost and Major Cost Components ......................................................................................

Dk.tnbution of Beds ....................................................................................................................

Output Measures .........................................................................................................................

Selected Service Characteristics ........................................................... .......................................

Staff Characteristics by Cost IntervaIs ...............................................................................................

Resident Characteristics by Cost IntervaIs ........................................................................................

Conditions and Imp-ents .......................................................................................................

Primary D]agnosis ........................................................................................................................

Activities of Dnily LWing .............................................................................................................

Other Selected Resident Characteristics .......................................................................................

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

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

Appendixes

I. Technical Notes on Metiods .....................................................................................................

1.

A.

IL Definition of Cert&n Terns Used in Thk Repofi ......................................................................

III. Selected Questionnaires Used intie1973-74 National Nursing Home Suwq ..........................

FIGURE

Cost per resident day fornursing homes andpercent oftoticost bycomponen@: Utited Stites,

1972 ............................................................................................................................................

LIST OF TEXT TABLES

Number and percent distribution of nursing homes in business 2 years or more, by ownership,

certification, size, and geographic region: United States, 1973-74 ...............................................

Total cost per resident day and number and percent distribution of resident days for nursing

homes in business 2 years or more, by ownership, certification size, and region: United States,

1972 ............................................................................................................................................

1

1

I

3

3

5

6

7

8

8

9

10

10

10

10

11

11

12

14

15

16

16

17

18

20

21

65

81

84

5

4

4

...

111
SYMBOLS

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

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

Quantity zero--—---–—--— -------------- -

Quantity more than O but less than 0.05------ 0.0

Figure does not meet standards of

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

iv
NURSING HOME COSTS–1972

Mark R. Meiners, formerly with the Division of HeaIth Resources Utilization Statistics

INTRODUCTION

SCOPE OF REPORT

In response to the absence of reliable national information on what it was costing nursing homes to supply the growing demand for

long-term care and what factors influenced these

costs, the National Center for Health Statistics

extended its 1973-74 National Nursing Home

Survey to coIlect nursing home costs. This report presents the cost estimates from that survey

and interrelates these data to reveal the relationships that exist between costs and the following

pertinent facility, staff, and resident characteristics:

Facility characteristics-ownership, certification, size, geographic region, resident days,

admissions, live discharges, deaths, occupancy rate, and selected service characteristics.

Staff characteristics-full-time equivalent

employees, full-time equivalent employees

per 100 beds, labor cost per full-time equivalent emplovee.

Resident characteristics–reported chronic

conditions and impairments, primary diagnosis at last examination and at admission,

measures of activities of daily living, primary

reason for admission, level of patient care,

and primary source of payment.

BACKGROUND AND

QUALIFICATIONS

OF DATA

The 1973-74 National Nursing Home Survey

was designed and developed by the Division of

Health Resources Utilization Statistics in conjunction with a group of experts in various fields

encompassing the broad area of long-term care.

It was specifically designed as the first in a continuing series of surveys to satisfy the diverse

data needs of those who establish standards for,

plan, and provide long-term care. The survey was

conducted during the period August 1973-April

1974 in a sample of nursing homes in the coterminous United States which qualified by Center

criteria as either a nursing home or a personal

care home with nursing (appendix II). Facilities

that provided persomd or custodial care at the

time the sample was drawn were not included,

even if they subsequently began to provide some

Ievel of nursing care to residents.

Reports based on data collected in the

1973-74 National Nursing Home Survey that

focus on operating and financial characteristics

of the facilities, 1 social and demographic characteristics of the residents,z utilization of nursing

homes,~ the health status of residents,A general

characteristics of the facilities,5 and charges amd

sources of payment for residents in nursing

homes6 have been published.

Data from the national sample were collected via a combination of mail and personal

interview survey techniques. Data on characteristics of the facilities and the data used to estimate the number of full-time equivalent employees were collected by interviewing the administrator. Within each sampIe facility, data for a

sub sample of residents were collected by personal interview of the nurse who usually provided care for the resident. Generally, the nurse

referred to the resident’s medical record in answering the questions. The cost data were col1
lected by first securing the administrator’s written release authorizing the facility’s accountant

or bookkeeper to complete the Expense Questionnaire. If the requested financial information

was not kept on the premises, the Expense Questionnaire was mailed or hand-delivered to the

accountant or bookkeeper who, upon completing it, mailed it back to the survey headquarters.

If the requested financial information was kept

on the premises, an effort was made to have the

Expense Questionnaire completed before the

interviewer left the facility. Because of the complex nature of the Expense Questionnaire, a certified public accountant was available via a tollfree telephone to answer any technical questions

that arose.

Although the survey was conducted during

the period August 1973-April 1974, all data on

costs incurred by the facility for providing care

were collected for calendar year 1972 or for the

most recently completed fiscal year prior to the

survey if the facility’s accounting records were

on a different fiscal year basis. This was necessary because facility data on costs are usually

kept on an annual basis either for tax, reimbursement, or regulatory purposes, and cost data

collected for a shorter period tend to be subject

to seasonal bias. To be compatible with cost

data, output-related measures (i.e., resident

days, admissions, live discharges, and deaths)

were also collected for 1972, and the number of

beds were adjusted to reflect 1972 levels using

the 1973-74 figures. All other characteristics

presented in this report represent the situation

as it existed at the time of the survey. The assumption has been made throughout that the

1973-74 facility, resident, and staff characteristics were substantially similar to those existing

during 1972.

The facility cost data discussed in this report

are from the subset of nursing homes surveyed

from August 1973 to April 1974 that had been

in business for 2 years or more.a On the recommendation of the economic advisors to the survey, the Expense Questionnaire was administered only at those facilities that had been in

business for at least 2 years. It was felt that

aNinety-four percent or about 14,800 of the estimated 15,700 facilities in the survey were in business 2

years or more.

expenses for newly opened facilities tend to include “startup” costs for purchasing drugs, supplies, and equipment and therefore do not reflect the “standard” cost of providing health

care. Implicit in this approach is the assumption

that the cost data from the survey are most usefully analyzed on an average (i.e., per unit of

output) basis. In keeping with this assumption,

the cost data will be presented and anaJyzed in

this report on a per resident day basis. The number of resident days is used as the measure of

output over which costs are averaged because

the long-term nature of the care provided in

nursing homes is best represented by a measure

that counts each day during which services were

provided rather than the number of times services were begun (as with admissions) or ended

(as with discharges).

It should be noted that the cost per resident

day ratios differ from those published in an earlier report, “Selected Operating and Financial

Characteristics of Nursing Homes, United States:

1973-74 National Nursing Home Survey”l because the method used to calculate them was

different. The earlier report used the simple

arithmetic mean of the cost per resident day

for each facility. This amounts to dividing the

individual facility’s costs by the days of resident

care it provided and then averaging these ratios

among all facilities in a particular classification.

This method is consistent with the way data are

handled in frequency distributions–i.e., each

facility has a cost per resident day experience.

The cost per resident day figures in this report

were calculated by aggregating separately the

costs and the resident days of facilities in a particular classification and then dividing these

aggregates to determine the cost per resident day

for that classification. This method was chosen

for the ratio estimates in this report because the

generalized relative standard error curves used to

estimate the statistical variation in the data were

found to have a smaller bias than those for the

simple arithmetic mean.

A detailed description of the sampling

frame, the sample design, and the survey procedures used is presented in appendix L Appendix

I also includes imputation procedures and estimation techniques. Since the data in this report

are national estimates based on a sample and are

subject to sampling errors, tables and charts of

2
standard errors and illustrations of their use are

provided in appendix I.

Two methods of hypothesis testing are used

in this report. The z-test is used to determine

whether differences between two statistics

(means, ratios, percents, etc.) are statistically significant. Where data are presented by continuous intervals of a variable, a weighted least

squares regression approach is used to test for

overaJ1 patterns of association. For example, this

report presents selected facility, staff, and resident characteristics by the facility total cost per

resident day intervals of less than $10.00,

$10.00-$14.99, $15.00-$19.99, $20.00-$24.99,

and $25.00 or more. It should be noted that a

significant positive or negative association can be

present although some intervals do not show a

significant difference when compared with adjacent intervals in the characteristic of interest.

These methods are discussed more fully in appendix I, and reference to them is useful for

understanding the inferences made throughout

this report. Unless otherwise mentioned, alI statistical comparisons mentioned in this report

were tested using a 95-percent confidence interval (i.e., the probability is no more than 1

chance in 20 that the differences noted here as

being statistically significant would not be confirmed by a complete enumeration of all facilities). Definitions of terms used in this report are

given in appendix H, and facsimiles of the Expense Questionnaire and the other data collection instruments used in this survey are shown in

appendix III.

COST COMPONENTS

OVERVIEW

Approximately 14,800 or 94 percent of the

nursing homes providing some level of nursing

care in the United States during the period

August 1973-April 1974 had been in business 2

years or wore (table A). In 1972, these facilities

provided some 347,913,000 resident days of

care at a cost per resident day of $16.43 (table

B). Nearly 60 percent, or $9.82, of this total

went for labor costs (figure 1). A four-way

breakdown of labor costs is available from the

Expense Questionnaire-nursing payroll, professional payroll, other payroIl, and fringe benefits.

Wages (i.e., nursing, professionzd, and other payroll) accounted for about 92 percent of all labor

expenses for a cost of $9.01 per resident day.

The high degree of dependence of the nursing

home industry on nursing personnel as the primary provider of care is emphasized by the fact

that nursing payroll, at $5.55 per resident day,

made up about 62 percent of total wages and

about a third of all expenses. The professional

payroll, that is, the wages paid to physicians and

other professionals (excluding contracted services) providing direct health care to residents,

was the smallest component of labor costs.

About 1 percent of total costs, amounting to 184

per resident day, went for professional payroll.

This was barely 2 percent of the wage bilL The

remaining 36 percent of the wage bill went to

administrative, clerical, food service, housekeeping, and maintenance personnel as weIl as to any

other staff not performing nursing, medical, or

therapeutic functions. This “other” payroll

group accounted for 20 percent of total costs

for a cost of $3.28 per resident day. Fringe

benefits, the nonwage component of labor costs,

were defined to incIude those expenses incurred

by the facility for the current or future benefit

of its employees. It included such things as

employer contributions to the Federal Insurance

Contribution Act, Federal and State Unemployment Insurance, and health and life insurance

premiums. At 81 # per resident day, fringe benefits accounted for about 8 percent of labor costs

and 5 percent of total cost.

In addition to labor costs there are two

other major cost groupings-operating costs and

fixed costs–and a residuzd category -miscelkmeous costs—for which data were collected. The

operating cost group is comprised of expenses

other than those for labor, which tend to vary

because they are dependent on the level of out- .

put or services provided during some limited

time period such as the 1972 fiscal year. Operating costs accounted for about 21 percent of

total costs, amounting to a per resident day cost
Table A. Number and percent distribution of nursing homes in

business 2 years or more, by ownership, certification, size,

and geographic region: 1 United States, 1973-74

Table B. Total cost per resident day and number and percent

distribution of resident days for nursing homes in business

2 years or more, by ownership, certification, size, and geographic region: 1 United States, 1972

Ownership, certification, size,

and geographic region

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

Ownership

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

Nonprofit .................................................

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

Certification

Both Medicare and Medicaid* ........ ........ ..

Medicaid only:

SNH’S3 ...... ........ ........ ..........................

lCF's ............. ........................ ..............

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

Size —

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

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

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

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

Geographic region

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

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

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

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

Number

14,800

—

11,200

2,500

1,100

3,800

3,300

4,300

3,300

6,000

5,200

3,000

600

2,900

5,200

4,100

2,600

Percent

distribution

100.0

75.7

16.9

7.4

26.0

22.1

29.2

22.6

40.8

35.0

20.3

3.9

19.8

35.1

27.6

17.5

lE~timates are for nursing homes that had been in business 2

years or more at the time of the survey. Expenses for newly

opened facilities were not collected because they incIude

“startup” costs for purchasing drugs, supplies, and equipment

and, therefore, do not reflect the standard cost of providing

health care.

.20f these facilities, 7 percent were certified for Medicare

onl .

3 Of these facilities, 33 percent were certified as both SNH’S

and ICF’S.

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

to facilities of $3.39. The expense categories

within the operating cost group include food

and other dietary items; drugs; supplies and

equipment; purchased maintenance of buildings,

grounds, and equipment; laundry and linen;

health-care-related services purchased from outside sources; non-health-care-related services purchased from outside sources; and utilities. Of

these expenses, the $1.35 spent per resident day

on food and other dietary items was the largest

amount, accounting for nearly 40 percent of

operating costs or about 8 percent of total costs.

Ownership, certification, size,

and geographic region

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

Ownership

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

Nonprofit ................................

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

Certification

Both Medicare and Medicaid*..

Medicaid only:

SNH’S3 ...............................

ICF’S ..................................

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

—Size

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

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

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

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

Geographic region

Northeast ....’.............................

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

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

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

Total

cost

per

resident

day

$16.43

16.01

16.68

18.42

20.59

15.69

11.95

14.16

13.90

15.61

16.72

20.34

21.96

15.04

14.12

15.52

Resident days

Number

(thousands)

347,913

235,830

72,080

40,002

128,162

92,150

80,051

47,549

55,667

119,320

121,583

51,343

77,516

119,835

90,921

59,640

Percent

distribution

100.0

67.8

20.7

11.5

36.8

26.5

23.0

13.7

16.0

34.3

34.9

14.8

22.3

34.4

26.1

17.1

1Estimates are for nursing horn es that had been in business 2

years or more at the time of the survey. Expenses for newly

opened facilities were not collected because they include “startUP” costs for purchasing drugs, supplies, and equipment and,

therefore, do not reflect the standard cost of providing health

cmeZof these facilities, 7 percent were certified for Medicare

only.

30f these facilities, 33 percent were certified as both SNH’S

and ICF’S.

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

At 49# and 48# per resident day, utility costs

and the costs of supplies and equipment each

contributed another 14 percent of operating

costs or about 3 percent of total costs. The

remaining operating cost groups were in the

range of 16q!-25q! per resident day.

The fixed-cost group % comprised of expenses for which the facility is responsible, at

some set level, regardless of the amount of oulput or services provided during fiscal year 1972.

4
cOST COMPONENTS

LABOR ........................................................................

Nursing payroll .........................................................................

Professional payroll ..................................................................

Other payroll ............................................................................

Fringe beneftts .........................................................................

OPERATING ...............................................................

Food and other dietary items ..................................................

Drugs .......................................................................................

Supplies and equipment ...........................................................

Buildings, grounds, and equipment purchased maintenance ....

.

Laundry and linen ....................................................................

Health services from outside sources ........................................

Nonhealth servicesfrom outside sources.................................

Utilities ............................................................... ...................

FIXED ........................................................................

Equipment rental ....................................................................

Insurance ................................................................................

Taxes and licenses........ ..........................................................

Interest and finance charges ....................................................

Depreciation ...........................................................................

Rent on buildings and land .....................................................

Amoruzation of leasehold improvement . ... ... ...... ... ..........

MISCELLANEOUS ....................................................

0 10 20 30 40 50 60 70

PERCENT OF TOTAL COST

I Ewmalcs arc for nursq homesth~t had been m husincss 2 yearsor morex the t]mc of the survey. Ex.

p.mscsfcv newly upencd fwbtics !vcrc not collcctcd bccmxc they Include %mtup” costs for purchasing

drugs. WPPIICS.and equ!pment and thcrcforcdonot rctlcctthe standardcostof prav,dmghm!thcm.

w Cost per resident day

Figure 1. Cost per resident day for nursing homes and percent of total cost by components:’ United States, 1972

nance charges, depreciation, “rent on building

and land, and amortization of leasehold improvements. As a group, fixed costs were $2.52

per resident day and accounted for about 15

percent of total costs. About 75 percent of fixed

costs were attributed to three categories. Depreciation charges cost 669! per resident day, rent

on building and land cost 644 per resident day,

and interest and finance charges cost 601# per

resident day. Taxes and Iicenses (324) and insurance (204) accounted for an additional 13 and 8

percent, respectively, of fixed costs.

Fixed-cost categories include equipment rental, The residual category, miscellaneous exinsurance, taxes and licenses, interest and fi- penses, was included to capture those costs that

could not be classi~led elsewhere. These costs

amounted to 69# per resident day or about 4

percent of total costs.

COST COMPONENTS BY

FACILITY CHARACTERISTICS

Tables 1-4 present the detailed cost data

available from the survey according to the facility characteristics of ownership, certification,

size, and region. Of the facility characteristics

5
available from the survey which might be expected to have some impact on the cost of providing long-term care in nursing homes, these arc

of basic importance. They provide some indication of the relationship between costs and the

facility’s operating motivation, level of care provided, scale of operation, and regional cost-ofIiving differentials.

Ownership

Three types of ownership control are represented in this report—proprietary, voluntary

nonprofit, and government. Proprietary facilities

are generally assumed to be motivated to provide services in a manner that will maximize

their revenues at a minimum cost. The incentives

for efficiency implicit in the profit motive are

considered less likely to be present in nonprofit

and government facilities. These facilities are

more apt to have philanthropic objectives or

considerations of prestige such as facility growth

or reputation as their primary operating motive.

In addition, the types of services provided by

government-sponsored nursing homes are motivated by the public interest and can be expected

to receive public funding should revenues be

insufficient to cover costs. In any case, the

absence of the profit motive in nonprofit and

government nursing homes is expected to result

in higher labor and operating costs per resident

day. Fixed costs, however, are expected to be

lower in nonprofit and government nursing

homes because these facilities benefit from preferential tax treatment and the availability of

subsidy funds in the form of loans, grants, and

interest subsidies from the Hill-Burton program

for the construction of nonprofit health facilities. These expectations are generally consistent

with the data presented in this section.

The majority (76 percent) of the 14,800

facilities for which cost estimates were made

operated under proprietary auspices (table A).

Another 17 percent, operated as nonprofit facilities and the remaining 7 percent operated as government facilities. Facilities in these ownership

categories accounted for 68, 21, and 12 percent,

respectively, of the 347,913,000 resident days

of care provided at a cost of $16.01, $16.68,

and $18.42 per resident day, respectively (table

B). Although the cost difference was statistically

significant only when the proprietary and government facilities were compared, a closer look

at the major subgroups of total cost is more

revealing.

The total amount spent on labor per resident

day varied significantly by ownership. Government facilities had higher labor costs per resident day ($ 13. 12) than either nonprofit

($10. 14) or proprietary ($9. 16) facilities had

(table 1). The difference was also significant

between proprietary and nonprofit facilities.

Despite this difference in total labor costs, there

was little difference in the amounts spent by

nonprofit and proprietary facilities on the

important nursing component. Nursing payroll

cost proprietary facilities $5.42 per resident day

and nonprofit facilities spent $5.29 per resident

day. The amount spent by government :facilities

on nursing staff ($6.85), however, was substantially larger.

Operating costs as a group were less for proprietary facilities ($3.20) than for either nonprofit or government facilities. The operating

costs for the nonprofit facilities ($3 .83) and the

government facilities ($3.77), however, were not

significantly different. The differences by ownership in the amounts spent on the’ components

of operating costs were generally not noteworthy.

As expected, the proprietary facilities had

higher fixed costs on a per resident day basis

($2.90) than either the nonprofit or government

facilities had. Government facilities in particular

tended to have low fixed costs per resident day

($1. 10) even in comparison with those experienced by the nonprofit facilities ($2.09). One

possible explanation for the extraordinarily low

fixed costs reported by the government facilities

is the tendency for these facilities to underreport or ignore certain fixed costs because they

are not included as part of the bookkeeping

records of the facility. County nursing hc)mes, in

particular, have been known to have their building provided by the county government. Often

in this situation the fixed costs associated with

the building are included in the county’s general

expenditure records and not in the nursing home

records. Although the respondents were requested to allocate to the appropriate cost cate-
gory an estimate of the reasonable value of

donated services, supplies, or space, the survey

procedures had no way to guarantee that these

expenses were properly allocated to the nursing

home.

Certification

In 1966, the Medicare and Medicaid programs began to provide financial coverage of

care for the elderly in nursing care institutions.

In 1973-74, nearly 8 out of 10 (77 percent) of

the facilities providing some level of nursing care

in the United States were participating in either

the Medicare or Medicaid program or both.1 Participating Medicare facilities, designated as extended care facilities (EC F), provided inpatient

skilled nursing care and related services to Medicare enrollees eligible for post-hospital benefits.

To be certified by the Medicare program, a facility had to meet specific regulatory standards

required by the Medicare legislation (title XVIII

of the Social Security Act) in effect at the time

of the survey. The Medicaid program offered

coverage for both skilled and intermediate nursing care services to the medically indigent. Nursing homes participating in the Medicaid program

were certified as either skilled nursing homes

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

or as both according to the requirements of the

Medicaid legislation (title XIX of the Social

Security Act). In July 1973, the extended care

facility designation under Medicare and the

skilled nursing home designation under Medicaid

were replaced by the term “skilled nursing facility” (SNF). Both types of facilities were required to meet the same standards. In this report, the extended care facility and skilled nursing home designations are used since most of the

survey was conducted prior to the legislation

that created the skilled nursing facility.

Of the facilities that were certified some

were certified under both the Medicare and the

Medicaid programs. Other facilities certified

only by the Medicaid program were certified to

participate as both an SNH and an ICF. In order

to provide detailed data by certification status,

some small certification subgroups were combined with larger ones when both provided similar levels of care. Thus, the 3,800 facilities in

this report classified as having been certified by

both Medicare and Medicaid include 7 percent

that were certified by Medicare only. Similarly,

the 3,300 facilities in this report classified as having been certified by Medicaid as SNH’S included

33 percent that were also certified as ICF’S.

Seventy-seven percent of the nursing homes

for which cost estimates were made were certified by Medicare, by Medicaid, or by both programs; about 51 percent of them were certified

for Medicaid only (table A). Facilities certified

by both Medicare and Medicaid or by Medicare only (BM&M) accounted for 26 percent of

the facilities and provided about 128,162,000

(37 percent) of the resident days of care at a

cost of $20.59 per resident day (tables A and B).

Facilities certified as SNH’S by Medicaid with no

Medicare certification made up 22 percent of

the facilities and provided about 92,150,000 (27

percent) of the resident days of care at a cost of

$15.69 per resident day. Facilities certified only

as ICF’S accounted for 29 percent of the facilities and provided about 80,051,000 (23 percent)

of the resident days of care at a cost of $11.95

per resident day. Twenty-three percent of the

facilities were not certified for Medicare or

Medicaid. These facilities provided about

47,549,000 (14 percent) of the resident days of

care at a cost of $14.16 per resident. Each total

cost per resident day difference is statistically

significant except that between the $15.69 of

the SNH group and the $14.16 of the noncertified group.

The pattern of relationships between each of

the major cost components by certification was

similar to that indicated above for total costs

(table 2). The large difference in total costs per

resident day between the BM&M group and any

of the other certification groups was distributed

among the major cost components in such a way

that Iabor, operating, fixed, and miscellaneous

costs were each significantly larger on a per resident day basis than their respective categories in

any of the other certification groups. These

higher costs apparently resulted from the expense of meeting the standards for staffing, construction, equipment, and provision of services

required for Medicare certification. For facilities

certified only for Medicaid (the SNH group and

the ICF group) the data are similarly consistent

7
with the assumption that higher standards result

in higher expenses. Labor, operating, fixed, and

miscellaneous costs were each significantly larger

per resident day for the SNH group than their

respective cost category in the ICF group.

Size

The size or scale of nursing home operations

is represented throughout this report by four

bed-size breakdowns–less than 50 beds, 50-99

beds, 100-199 beds, and 200 beds or more. The

choice of the number of beds as an index of

nursing home size is based on more than simple

convenience. The number of beds in health care

facilities is frequently used as a rough indicator

of the supply of care. A familiar example is the

bed-population ratio as an indicator of the

amount of facility-based health services available. The assumption is, of course, that there is a

strong relationship between the number of beds

and the volume of other service characteristics in

the facility. In the case of nursing homes, it is

likely that the building space, equipment, personnel, and other factors used in providing services have been adjusted to be compatible with

the number of beds regularly maintained for

resident care.

When computed within the four size groupings, total cost per resident day increased with

scale. Facilities with less than 50 beds provided

55,667,000 (16 percent) of the resident days of

care at a cost of $13.90 per resident day (table

B). Facilities whose size ranged from 50 to 99

beds provided 119,320,000 (34 percent) of the

resident days of care at a cost of $15.61 per

resident day. Facilities having 100 to 199 beds

provided 121,583,000 (35 percent) of the resident days of care at a cost of $16.72 per resident day. Only about 4 percent of the facilities

had 200 beds or more, although they provided

around 15 percent (51,343,000) of the resident

days of care. At $20.34 per resident day, these

facilities provided the most costly nursing home

services. Additional discussion of the relationship between total costs and size is given in the

section that considers the interrelationships of

size with other facility characteristics.

A positive relationship to size was also evident when the labor, operating, and fixed components were individually considered using the

test of trend described in appendix I (table 3).

The pattern, however, differed somewhat for

each of the components. For labor and operating costs, the positive trend was most influenced

by the largest facilities. Labor costs in facilities

with less than 100 beds tended to be similar on a

per resident day basis and the same was true of

operating costs in facilities of less than 200 beds.

In contrast, fixed costs tended to be simikw in

facilities with 50 or more beds. The slight drop

in fixed costs per resident day for facilities with

200 beds or more cannot be confirmed as statistically significant when the standard errors of

the estimates are considered.

Geographic Region i

Nursing homes, like most other firms, show

regional variation in their costs due to general

cost-of-living differences or to differences in the

supply and demand of one or more of their factors of production (i.e., labor, capital, and

materials). The data are presented in this report

by the following U.S. Bureau of the Census geographic regions: Northeast, North Central,

South, and West. About 35 percent of the nursing homes for which cost estimates were made

were located in the North Central Region; the

South, Northeast, and West Regions had about

28, 20, and 18 percent of the facilities, respectively (table A). At $21.96 per resident day for

some 77,516,000 resident days, the cost c~fnursing home services was substantially higher in the

Northeast than in any of the other regions (table

B). The individual comparisons between the

other regions, however, showed no statistically

significant differences in total cost per resident

day. Facilities in the West provided an estimated

59,640,000 days of care at a cost of $15.52 per

resident day. Facilities in the North Central

Region provided 119,835,000 resident days of

care at a cost of $15.04 per resident day. Facilities located in the South provided 90,921,000

resident days at a cost of $14.12 per resident

day.

Of the major components, Iabor costs were

primarily responsible for the large disparity

between costs in the Northeast and those in the

rest of the country (table 4). At $13.82 per resident day, labor costs in the Northeast were

about 53 percent higher than the next highest
figure forthis category ($9.06 inthe North Central Region). The operating, fixed, and miscellaneous components also contributed to the

higher costs in the Northeast, although not significantly so in the case of the latter two components when compared to the West.

Interrelationships of Ownership,

Certification, Size, and Region

Characteristics

Considering the impact of ownership, certification, size, and region on the costs of producing nursing home services shows that these

costs tended to be highest in government facilities, in facilities with Medicare certification (the

BM&M group), in large facilities, and in facilities

located in the Northeast. It should be kept in

mind, however, that these findings do not take

into account the effect of the interrelationships

of these and other factors on costs. For example, traditional economic theory postulates a

U-shaped relationship between average costs and

size. Theoretically, as the scale of production

expands over the lower range of output, certain

economies (e.g., quantity discounts, full use of

labor and equipment) are realized that result in

decreasing average costs of production. After

some point, however, diseconomies associated

with the management of large-scale production

are thought to predominate, resulting in increasing average costs. The data in table 3, however,

show a continuing increase of total cost per resident with increasing bed-size groups. The positive relationship between cost and size was probably due in part to the greater number of services that larger facilities tended to offer. Some

services are economically feasible only in facilities that are Iarge enough to spread the costs so

that the resident will be able to afford them.

The additional costs associated with a broader

scope of services may overshadow opportunities

for more efficient use of labor and equipment

that are available as the scale of operations increases.

The effects of the interrelationships of certification, ownership, size, and region on the

major components of costs are presented in

tables 5 and 6. The nonprofit and government

facilities have been grouped in these tables to

allow for more reliable detail on the interrelationships. Reviewing these data reveak the

importance of considering the interrelationships

of these factors. Some of the conclusions about

the relationship between costs and the facility

characteristics of certification, ownership, size,

and region remain the same; however, others are

altered when the interrelationships of these factors are considered. Earlier it was noted that the

relationship between certification and cost was

such that the BM&M group had higher total

costs per resident day than facilities in any of

the other certification groups and that among

facilities certified only for Medicaid, those certified as SNH’S had higher costs on a per resident

day basis than those certified only as ICF’S. The

interrelationships presented in tables 5 and 6

reveal that these findings remain the same regamiless of the type of ownership, size, or regionaI Iocation of the facilities. Similarly, where

comparisons can be reliabIy made, the fact that

facilities in the Northeast had higher total costs

per resident day than those in the other regions

continues to hold when the type of certification

and ownership are considered.

Focusing on the impact of size on nursing

home costs given the other factors, however,

serves to caution the reader about the need to

consider the interrelationships in the data. The

positive cost-size relationship found earlier is less

clearcut when the interrelationship of size with

certification or ownership characteristics is considered. Patterns reflective of what would generally be expected in the presence of economies

and diseconomies to scale (the U-shaped relationship between average costs and size described earlier) are found for those facilities in

the BM&M group, for facilities not certified, and

for facilities operated under nonprofit or government auspices. Within the four bed-size groups

(less than 50 beds, 50-99 beds, 100-199 beds,

and 200 beds or more) the Medicare facilities

had total costs per resident day of $21.66,

$20.00, $19.85, and $23.03, respectively; the

not-certified facilities had total cost per resident

day estimates of $14.17, $14.41, $12.43, and

$16.87, respectively; and the nonprofit and government facilities had cost per resident day estimates of $16.13, $17.14, $15.67, and $19.87,

respectively. From the standpoint of total cost

9
per resident day, an optimum size facility for recognizing the potential impact of additional

each of these groups appears to be the range of cost determinants.

100-199 beds. However, the standard errors of The remaining sections of this report will

the estimates are such that the necessary com- present data that focus on the relationship beparisons are not statistically significant. None- tween nursing home costs and some additional

theless, these data highlight the importance of facility, staff, and resident characteristics.

COST INTERVALS

The characteristics of ownership, certification, size, and region are acknowledged to be of

basic importance in understanding the variation

in nursing home costs; there are other factors

that are also of interest. The next sections present some additional facility, staff, and resident

characteristics that will be discussed with respect

to their relationship to costs. The data are presented in tables that focus on the variation in

the characteristics as the facilities vary from low

to high in their total cost per resident day experience. Five total cost per resident day intervals—

less than $10.00,$10.00-$14.99, $15.00-$19.99,

$20.00-$24.99, and $25.00 or more–are used.

FACILITY CHARACTERISTICS

BY COST INTERVALS

Distribution of Facilities

The number and percent distribution of the

nursing homes within the five total cost per resident day intervals are presented in table 7. Facilities with costs in the range of $10.00-$14.99

per resident day were the most prevalent, accounting for about 36 percent of all facilities.

About 18 percent of the facilities had costs of

$20.00 or more, and these were evenly split

between those in the $20.00-$24.99 range and

those with costs of $25.00 or more.

As might be expected from the earlier discussion, the lowest cost facilities (less than

$10.00 per resident day) were more oriented

toward proprietary ownership, the ICF certification group, small size, and location outside the

Northeast. By ownership, about 81 percent of

the facilities in the lowest cost group were proprietary compared with about 76 percent for all

facilities. By certification, about 46 percent of

the facilities with costs of less than $10.00 per

resident day were in the ICF group compared

with about 29 percent of the total. Facilities

that were not certified were also disproportionately represented in this cost group (about 41

percent compared with about 23 percent of all

facilities). By bed size, about 60 percent of the

lowest cost group had less than 50 beds compared with about 41 percent nationally. Regionally, those facilities in the North Central Region

were most prevalent in the lowest cost group

(about 45 percent compared with 35 percent of

all facilities).

At the upper end of the cost intervals (more

than $25.00 per resident day) the proprietary

facilities were still dominant, but their proportion (57 percent ) decreased substantially relative

to that for the nonprofit (29 percent) and government facilities (14 percent). Likewise, the

characteristics of Medicare certification (the

BM&M group), 100 beds or more, and location

in the Northeast were more prevalent among

facilities with costs of $25.00 or more than was

the case when all facilities were considered.

About 57 percent of the highest cost facilities

were in the BM&M group compared with 26 percent of all facilities; 32 percent had 100 beds or

more compared with 24 percent nationally, and

37 percent were in the Northeast Region compared with only 20 percent nationally.

Total Cost and Major Cost

Components

Following the same format introduced

above, the amount and percent distribution of

total cost per resident day and its major components for nursing homes within the five total

cost per resident day intervals are presented in

table 8. Besides serving as background to the

other tables, the primary purpose of this table is

to explore the variability that occurs between

low- and high-cost facilities in the proportion of

costs devoted to the major cost components.

Nationally, about 60 percent of all expenses

10
incurred by nursing homes in the provision of

care were attributable to labor costs; operating,

fixed, and miscellaneous costs accounted for

another 21 percent, 15 percent and 4 percent,

respectively. Variability in these proportions

among facilities in the five cost-interval groups is

minimal and not significant when the standard

errors of the estimates are considered. These

data indicate that there is little or no relationship between” the proportion of costs devoted to

the major cost components and the propensity

to provide low-cost rather than high-cost care.

Distribution of Beds

The number of beds and average number of

beds in nursing homes within the five total cost

per resident day intervals are presented in table

9. The 14,800 facilities had an estimated

1,083,300 beds, or an average of 73 beds per

facility in 1972. Proportionately fewer beds (66

per facility) were provided under proprietary

auspices than under either nonprofit (91 per

facility) or government (11 O per facility) auspices. Among the certified facilities, average bed

size varied; certification ranged from a low of 56

beds in facilities in the ICF group to a high of

106 beds in facilities in the BNWM group; the

SNH group averaged 88 beds. The facilities that

were not certified averaged only 44 beds.

Applying the test for trend (see appendix I) to

the average number of beds per facility by the

five cost groups confirms the earlier findings of a

positive cost-size relationship when all facilities

are considered. The increase, however, was not

continuous across all five cost groups. Individual

comparisons revealed three significantly different groups. The number of beds per facility

varied from 49 beds in the lowest cost group, to

75 beds in facilities where costs were in the

$10.00-$19.99 interval, to 99 beds in facilities

with costs of $20.00 or more per resident day.

Output Measures

As mentioned in the Introduction, the output-related measures available from the survey

are the number of resident days, admissions, live

discharges, and deaths. Given the long-term

nature of the care provided in nursing homes,

the number of resident days of care provided

within some time frame tended to be the best

single indicator of the ag~egate amount of services provided and was used throughout this

report to put the cost data on a per-unit basis.

The total number of discharges (Iive discharges

and deaths) or the number of admissions, less

useful as aggregate output measures because of

the Ionger length of stay of nursing home residents (compared to hospitals), nonetheless are

useful as indicators of the flow of care in nursing

homes. For exampIe, a rapid turnover of residents might be expected to increase per resident

day costs because of the additional administrative expense involved in handIing new cases.

The number of admissions, live discharges,

deaths, and resident days within the five total

cost per resident day intervals by ownership, certification, size, and region are presented in tables

10, 11, 12, and 13, respectively. Each table also

presents the measure in question on a per-bedsavailable basis to allow for the variation in the

size of the facilities within a grouping.

The facilities covered in this report had an

estimated 1,019,200 admissions in 1972, or

about 94 admissions per 100 beds. The number

of admissions per 100 beds tended to be highest

for proprietary facilities (105 ), for facilities in

the BM&M group (140), for facilities in the

50-199 bed-size group (104, calculated by combining the 50-99 bed group and the 100-199 bed

group, which were not significantly different in

their ratios of admissions per 100 beds), and for

facilities located in the I\Test (128). When the

numbers of admissions per 100 beds for all facilities are compared across the total cost per resident day intervak, a significant positive relationship between admissions per 100 beds and costs

appears. The number of admissions per 100 beds

ranged from a low of 52 for facilities with total

costs of less than $10.00 per resident day to a

high of 166 for facilities with total costs of

$25.00 or more per resident day.

Not surprisingIy, the combined number of

live discharges and deaths during 1972

(1,020,600) closely approximated the number

of admissions (1,019,200) during that period.

Discharges and admissions measure the flow of

services from opposite ends of the health care

process and we expect their totak to be simikr

barring any major fluctuations in the occupancy

rate of facilities. In 1972, there were an. estimated 706,600 residents who were discharged

11
alive and another 314,000 who died. This

amounted to 65 live discharges and 29 deaths

per 100 beds. As with admissions, the number of

live discharges per 100 beds was highest for proprietary facilities (74), for facilities in the

BM&M certification group ( 103), for facilities in

the 50-199 bed-size group (72), and for facilities

located in the West (9 7). When compared across

the total cost per resident day intervals, the

number of live discharges per 100 beds increased

with the increase in the cost interval from a low

of 30 in the lowest cost facilities to a high of

132 in the highest cost facilities.

With respect to the number of deaths per 100

beds, the standard errors of the estimates are

such that man y of the differences by ownership,

certification, size, and region are not statistically

significant. A few exceptions, however, can be

mentioned. The 32 deaths per 100 beds in proprietary facilities is significantly larger than the

23 deaths per 100 beds found when the figures

for nonprofit and government facilities are combined. Although, the number of deaths per 100

beds in the SNH group (22) and the ICF group

(21 ) are not significantly different from one

another, each is significantly less than the numbers for the BM&M group (35) and the not-certified group (39 ). Finally, combining the figures

for facilities in the 50-99 bed-size group with

those for facilities in the 100-199 bed-size group

(the respective numbers of deaths per 100 beds,

28 and 29, are not significantly different) revealed a negative relationship between facility

ske and deaths per 100 beds. Facilities with less

than 50 beds had 40 deaths per 100 beds, facilities with 50-199 beds had 28 deaths per 100

beds, and facilities with more than 200 beds had

21 deaths per 100 beds. No significant variation

in the number of deaths per 100 beds across the

cost groups could be confirmed.

As mentioned earlier, the number of resident

days of care provided by the facilities for which

cost estimates were made was 347,913,000 in

1972. With the prop?r adjustments, putting the

number of resident days on a per-bed basis resulted in a measure of the occupancy rate. The

occupancy rate was computed for this report by

using the following formula:

~Aggregate number of resident days of care provided in 1972 X 100

~Estimated number of beds m 1972 X 366

Assuming the number of beds available during a

certain period represents the capacity at which

facilities are prepared to provide care, the occupancy rate described above represents the level

of capacity utilization for 1972. Generally, the

more full y the available capacity is used (i.e., the

higher the occupancy rate) the smaller the cost

per day of care, because the fixed costs associated with a given capacity are spread over more

units of output. The overall occupancy rate for

the facilities was 88 percent and showed the

expected negative relationship with per resident

day costs decreasing from 93 percent in the lowest cost group to 76 percent in the highest cost

group.

Selected Service Characteristics

Good measures of the quality of care provided in health facilities have not been well developed. AS a result, the analyst is forced to rely

on measures that for one reason or another are

considered indicative of quality health care. In

this context, the level or scope of services is

often considered synonymous with the quality

of care. Table 14 focuses on a number of selected service characteristics used in this report

as indicators of the quality or level of care provided by nursing homes. The total cost per resident day as well as the number and percent distribution of facilities within the five cost intervals are presented according to the following

service characteristics: professional rehabilitation services provided; services included as part

of the basic charge to the resident; training programs conducted in cooperation with an educational institution for persons not on the staff of

the facility; number of shifts with a registered

nurse (RN) in charge and on duty; and occupation of the supervisor of all clinical services.

Each of these measures is included for the purpose of exploring the relationship between the

quality or level of services and facility costs.

Data on whether facilities provided professional rehabilitation services were gathered by

asking the administrator the following question:

“Does this facility provide any of the following

professional rehabilitation services on the premises?” Physical therapy; occupational therapy;

12
recreational therapy; speech and hearing therapy; counseling by social worker, psychologist,

or mentaJ health worker; as well as an “other”

category were listed, and it was emphasized thaL

the therapists must be licensed or registered in

their specific professions (see question 20 of the

Facility Questionnaire, appendix III). Physical

therapy and counseling were the rehabilitation

services most likely to be offered on the premises by nursing homes. About 52 percent of the

facilities offered these services. Thirty percent

offered recreational therapy, 28 percent offered

speech and hearing therapy, and 23 percent offered occupational therapy on the premises.

Each of these rehabilitation services was, in general, more Iikely to be offered in. higher cost

facilities. When compared across the five total

cost per resident day intervals, the proportion of

facilities providing each type of therapy was positively related to cost. (The difference between

the highest two cost groups in the proportion

offering physical therapy, occupational therapy,

and speech and hearing therapy is not statistically significant.)

Additional information on the services a

facility is committed to provide to all its residents was gathered by asking the administrator

the following question: “Does this facility include as part of its basic charge to each resident

the charges for: (a) physician services, (b) private-duty nursing, (c) other nursing services, (d)

therapy, (e) drugs, (f) medical supplies, (g)

special diet, (h) other” (see question 28 of the

Facility Questionnaire, appendix III). The distinction here is between the basic and the total

charge that the facility makes for the care it

provides. The basic charge for each resident

covers the set of services that the facility is prepared to provide all its residents during their stay.

The total charge includes the basic charge and

any other charges made. The services most commonly included in the basic charge are lodging

and meals. Additional services such as those

listed in the question may also be included in

the basic charge although it is generally more

likely that they are provided and billed for on an

as-needed basis. Including a service in the basic

charge tends to assure that it is readily available

to any resident in the facility. To the extent that

the listed services are included in the basic

charge, the level or quality of care offered to all

residents is expected to be higher and this in

turn is expected to be positively related to costs.

Of the alternatives listed, special diet, nursing services other than private-duty nursing, and

medical supplies were most likely to be included

as part of the basic charge. Eighty-nine percent

of the facilities incIuded special diet, 78 percent

included nursing services other than private-duty

nursing, and 56 percent included medical supplies as part of the basic charge. Therapy, drugs,

physician services , and the services of a privateduty nurse were much less likely to be included

in the basic charge. These items were included

by only 26 percent, 17 percent, 11 percent, and

6 percent of the facilities, respectively. When the

information on the services included as part of

the basic charge was related to the facility cost

data, a higher cost per resident day was found

for those facilities that included nursing services,

therapy, drugs, physician services, or the services

of a private-duty nurse as part of their basic

charge than for those that did not include these

services in the basic charge. The data also show

that for each of the services listed in the question (with the exception of private-duty nurse

where the comparison cannot be reliably made)

there was a significantly higher percent of the

facilities in the highest cost group providing the

service as part of the basic charge than in the

Iowest cost group. Ninety-six percent of the

facilities with total costs per resident day of

more than $25.00 provided a special diet as part

of the basic charge compared to 85 percent of

the facilities with total costs per resident day of

Iess than $10.00. With nursing services, the same

comparison showed 84 percent in the highest

cost group and 70 percent in the lowest cost

group. For medical supplies, the comparison was

62 percent to 50 percent, for therapy services it

was 40 percent to 18 percent, for drugs it was

28 percent to 14 percent, and for physician services it was 23 percent to 7 percent.

Health care facilities that conduct training

programs are generally thought to provide a

more comprehensive scope of sen’ices, and the

resulting quality of care and costs are expected

to be higher than for facilities not providing

training. To determine which nursing homes

conducted training programs, the administrator

13
was asked the following question: “Does this

facility conduct training programs for people

not on your staff in cooperation with an educational institution?” Twenty-nine percent of the

facilities for which cost estimates were made

responded positively to this question. The data

tend to confirm the expectation that higher cost

facilities are more likely to conduct training programs. Only 17 percent of the facilities with

costs of less than $10.00 per resident day conducted training programs compared with 29 percent in facilities with costs of $10.00 to $19.99

and 41 percent in facilities with costs of $20.00

or more.

The number of shifts with an RN in charge

of nursing care and on duty was determined

from the series of questions that asked, for each

of the three daily shifts, whether the person in

charge of nursing care was on call or on duty (no

evening or night shift was also an acceptable

answer) and what the level of skill of that person

was (see questions 23a-23c of the Facility Questionnaire, appendix III). Registered nurse was

the highest skill level listed among the alternatives. Thirty-one percent of the facilities had no

shifts with an on-duty RN in charge of nursing

care, 29 percent had one shift, 17 percent had

two shifts, and 23 percent had three shifts meeting that criterion.

The number of shifts with an on-duty RN in

charge of nursing is a useful indicator of the

level or quality of care because having more

shifts (e.g., day, evening, and night shifts versus

only a day shift), having someone on duty

(rather than on call) for a shift, or having the

person in charge be skilled as an RN (rather than

a Iicensed practical nurse (LPN), nurse’s aide, or

other staff member) lrnphes a higher relative level or quality of care. The relationship of

this measure to facility costs is predictable. The

total cost per resident day ranged from a low of

$11.35 in facilities with no shifts with an RN in

charge and on duty to a high of $20.63 in facilities having all three shifts with an RN in charge

and on duty. Facilities with one or two shifts

meeting the criteria had costs of $13.70 and

$16.14 per resident day, respectively.

Another indicator of the level or quality of

care provided by a facility is the type of staff

member exercising daily, on-duty supervision

over all clinical services in the facility (see question 25a-b of the Facility Questionnaire, appendix 111). The alternatives listed were administrator, physician, registered nurse, and other. “Clinical services” are those medical and nursing services that are part of the day-to-day activities of

the home. “Supervision” was defined to mean

an active role in watching over these activities in

a continuous, responsible fashion. Thus, for the

purposes of the survey, the term “supervisor”

referred to others besides specialists such as

physicians, RN’s or LPN’s. The supervisor could

have been (and sometimes was) an administrator

not specifically trained as a clinical specialist to

whom, however, such clinical specialists reported and were responsible. If the supervisor of

clinicaJ services was the administrator it was

asked if the administrator was also a physician,

an RN, or an LPN. This information was used to

group facilities on the basis of the highest clinical (i.e., physician, RN, or LPN) qualification of

the on-duty supervisor of cIinical services. Therefore, in table 14 in those cases where the facility’s on-duty supervisor of clinical services was

an administrator who was also a qualified physician, RN, or LPN, the facility was grouped with

the comparable clinical specialist group rather

than with the administrator group.

In the majority of homes (62 percent), the

staff member with daily, on-duty supervision

over all clinical services was an RN. In another

14 percent of the facilities, the on-duty supervisor was an administrator with no medical title.

Physicians supervised clinical services in 3 percent of the facilities, and some other staff member supervised clinical services in the remaining

21 percent. When these data are related to the

facility cost data, the result is consistent with

what might be expected. Facilities with a physician providing on-duty supervision of all clinical

services had substantially higher costs per resident day ($24. 18) than those whose supervisor

was an RN ($16.56), an administrator ($15.64),

or some other staff member ($12.77).

STAFF CHARACTERISTICS BY

COST INTERVALS

The cost structure of nursing homes is dominated by labor costs. About $6 of every $10

spent by nursing homes in the process of provid14
ing long-term care went for payroll expenses.

Table 15 focuses on the relationship between

staffing patterns and facility costs. The number

of staff providing care in nursing homes is presented in terms of full,time equivalent (FTE)

employees. Thirty-five hours of paxt-time employees’ work are conventionally taken as equival ent to one full-time employee. Part-time

employees were converted to FTE employees by

dividing the number of hours worked per week

by 35. By using the number of FTE employees

rather than the number of total employees, the

variation between facilities in the proportion of

part-time staff is held constant. The information

used to calculate the number of FTE’s was collected on the Staff Control Record (see appendix III).

There were an estimated 604,800 FTE employees or about 55 per 100 beds in the facilities

for which cost estimates were made. About 62

percent of these were employed as pat of the

nursing staff. Nurse’s aides, the most prevalent

type of staff member in nursing homes, accounted for 74 percent of the nursing staff and

46 percent of all staff. Estimates indicated about

26 nurse’s aides per 100 beds. The second most

prevalent group of employees were those in the

“all other” category, which includes the clerical,

food service, housekeeping, and maintenance

personnel as well as any other employee not performing nursing, administrative, medical, or

therapeutic functions. This group made up 32

percent of the total number of FTE employees,

amounting to about 18 per 100 beds. The remaining 6 percent of the total FTE employees

were administrative, medical, and therapeutic

personnel. This came to about 3 FTE employees

from this group per 100 beds.

When the number of FTE employees per

100 beds is compared across the five cost intervals, a clearly positive trend is revealed, with the

exception of the administrative and medical

group. In total, the number of FTE employees

ranged from 40 per 100 beds in the lowest cost

facilities to 73 per 100 beds in the highest cost

facilities. The positive trend for total FTE employees was also significant regardless of the

ownership, certification, bed size, or regional

grouping of the facilities.

Although the total number of FTE employees tended to increase with costs, the rate of

increase varied among the employee groups. This

resulted in some significant differences in the

proportional distribution of these groups when

the lowest and highest cost facilities were compared. Facilities with costs of $10.00 or less per

resident day had only about 1 percent of their

staff employed as therapists and another 4 percent employed as RN’s. IrJ contrast, facilities

with costs of $25.00 or more had about 3 percent employed as therapists and 10 percent

employed as RN’s. The increased proportion of

these higher sidled staff members in the highcost facilities was primarily offset by a 10-percentage-point drop in the proportion of staff

employed as nurse’s aides. The lowest cost facilities employed 49 percent of their staff as nurse’s

aides and only 39 percent of the highest cost

facilities’ staff were nurse’s aides.

A greater proportion of higher skilled staff

would result in proportionately higher labor

costs per employee which, in turn, have a positive effect on total costs. This expectation is

consistent with the data in table 16, which

focuses on the relationship between the yearly

labor cost per FTE and the five total cost per

resident day intervals. Labor cost per FTE

ranged from a low of $3,968 per year in facilities with total costs of less than $10.00 per resident day to a high of $8,188 per year in facilities with total costs per resident day of $25.00

or more. The positive relationship is significant

regardless of the ownership, certification, bed

size, or regional classification (for the West Region the trend is significant at the 0.10 rather

than the 0.05 level).

RESIDENT CHARACTER ISTICS

BY COST INTERVALS

The cost of providing care in nursing homes

is, of course, influenced by the characteristics of

the residents served. Some variation in costs

results simply from short-term differences in the

case mix handled by the facility. More importantly, however, cost variation among facilities

results from the facility’s plans and expectations

as to the needs of the residents to whom it

wants to sell its services. Given their plans and

expectations, nursing homes will choose such

things as the types of services, staffing patterns,

and the amount of capacity necessary to fulfill

15
these needs. It is on this basis that the resident

characteristics at the time of the survey can be

related to the 1972 cost data. The relationship

between nursing home costs and selected resident characteristics are explored in the remaining sections of this report.

Conditions and Impairments

The number of nursing home residents and

the rate per 100 residents in the five total cost

per resident day groups by their reported

chronic conditions and impairments are presented in table 17. Based on the findings of previous NCHS surveys of nursing homes, 11 conditions were selected as the most relevant to the

population under study, particularly in terms of

their prevalence. Referring to the resident’s

medical record, the nurse most familiar with the

resident’s care was asked to respond to the following question: “Does he/she have any of the

following conditions or impairments?” Since

most residents had more than one chronic condition or impairment, the nurse was asked to name

all that applied. About 95 percent of the residents had at least 1 of the 11 conditions; the

average number of conditions per resident was

2.2.

Senility was by far the most prevalent condition reported. Fifty-eight percent of the residents of nursing homes in business 2 years or

more were considered to be senile. After senility, the most frequently reported condition was

arthritis or rheumatism (reported for 35 percent

of the residents), followed by heart trouble (34

percent) and mental illness (18 percent). Fourteen percent or less of the residents were reported to have the following conditions: amputation of extremities or limbs or permanent stiffness or any deformity of foot, leg, fingers, arms,

or back (14 percent); diabetes (13 percent);

paralysis or palsy due to stroke (11 percent);

glaucoma or cataracts (11 percent); chronic

trouble with back or spine (10 percent); mental

retardation (7 percent); and paralysis or palsy

not related to stroke, arthritis, or rheumatism (6

percent).

Variation across the total cost per resident

day intervals in the percent distribution of residents with these chronic conditions and impairments is evident. In several cases, the variation

appeared to be systematic, indicating a potential

relationship between the costs of providing care

and the reported conditions and impairments of

the residents. The conditions of mental illness

and mental retardation, for example, were more

likely to be treated in low-cost facilities. A significant negative trend in the proportion of residents with these conditions was found as the

total cost per resident day increased. In the lowest cost facilities, 25 percent of the residents

were mentally ill and 11 percent were mentally

retarded. In the highest cost facilities, only 12

percent were mentally ill and only 4 percent

mentally retarded. Higher cost facilities were

more likely to handle residents with the conditions paralysis or palsy due to stroke, glaucoma

or cataracts, diabetes, and heart troubl[e. A significant positive trend can be seen in the proportion of residents with each of these four conditions as the cost per resident day increases. In

the lowest cost facilities, residents with these

conditions respectively accounted for, 9 percent,

10 percent, 11 percent, and 27 percent of residents; the comparable proportions for the highest cost facilities were 14 percent, 13 percent,

15 percent, and 39 percent.

Primary Diagnosis

Table 17 also presents the number of nursing

home residents and rate per 100 residents in the

five total cost per resident day intervals by their

primary diagnosis at last examination and at

admission. To complement the data on reported

chronic conditions and impairments, the nurse

respondent was asked to consult the medical

record of each sample resident to obtain the prz”-

nwry diagnosis at last examination and at admission. For each of these specific timle references, the primary diagnosis was then classified

according to the categories listed in item 8 of

the Resident Questionnaire (see appendix III).

This classification was fashioned to correspond

to the major disease categories of the ICDA, 8th

revision.7 The major category, diseases of the

circulatory system, was subdivided according to

the ICDA classification into heart attack, stroke,

hardening of the arteries, and other diseases of

the circulatory system.

The primary diagnosis at last examination

was intended to determine the condition that

was currently the most serious one affecting the

resident. Consideration of the relationship be16
tween costs and the various categories reveals a

si~ificant positive trend in the proportion of

residents with the primary diagnoses at last

examination of stroke; hardening of the arteries;

and accidents, poisoning, and violence and a significant negative trend in the proportion of residents with the primary diagnosis of mental disorders. The primary diagnosis at admission was

intended to indicate the primary medical reasons

why persons initially sought institutionalization.

Relating these data to costs revealed a significant

positive trend in the proportion of residents

with the admission primary diagnoses of stroke

and accidents, poisonings, and violence and a significant negative trend in the proportion of residents with the primary diagnosis of mental disorders.

Activities of Daily Living

The Resident Questionnaire included a series

of questions designed to help evaluate the resident’s needs with respect to six activities of

daily living (ADL)-bathing, dressing, going to

toilet, transfen-ing, continence, and feeding (see

question 14 of the Resident Questionnaire,

appendix III). For each of these functions, the

nurse most familiar with the resident’s care was

asked to indicate the one of several alternative

categories that best described the resident’s level

of dependency. For each activity, the levels were

listed in ascending order ranging from needing

no assistance to needing major assistance. The

number of alternative levels ranged from three

for going to toilet to seven for transferring.

One use of the ADL questions in the survey

was suggested by the work of Dr. Sidney Katz

and his colleagues.8 )9 They used information on

the level of assistance needed in performing each

activity to determine whether a person should

be considered dependent or independent in that

activity. This information was in turn used to

develop an index that permits the ranking of

individuals according to their performance in the

six activities of daily Iiving. The index has seven

levels of independence (A through G) and each

successive level indicates greater dependency.

The general form of the index is:

A – No ADL dependencies.

B – Dependent in only one ADL.

C – Dependent in bathing and one additional ADL.

D – Dependent in bathing, dressing, and one

additional ADL.

E – Dependent in bathing, dressing, going to

toilet, and one additional ADL.

F – Dependent in bathing, dressing, going to

toilet, transferring, and one additiomd

ADL.

G – Dependent in all six ADL’s.

An “other” category is included for those

individuals dependent in at least two functions,

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

Using the approach suggested by Katz and

his colleagues, the number of nursing home residents and rate per 100 residents within the five

total cost per resident day intervals according to

measures of dependence in activities of daily

living are presented in table 18.b Focusing first

on the individual items of the ADL index shows

that the percent distribution of residents dependent in each of the six activities was consistent with the general form of the ADL index.

Nursing home residents were most likely to be

dependent in the functions related to bathing

(71 percent) and least likely to be dependent in

the functions related to feeding (18 percent).

The dependency rate for dressing was 59 percent; for going to toilet, 53 percent; for transferring, 52 percent; and for continence, 34 percent.

When the dependency rate for each ADL function is compared across the five total cost per

resident day intervals, the most striking relationship is found in comparing the rates in the lowest cost facilities to those in any of the other

cost groups. The lowest cost facilities had a significantly smaller proportion of residents dependent in each of the ADL functions than was

the case for any of the other cost groups (with

the exception of feeding, where the difference

between the percents in the lowest and highest

cost group cannot be confirmed as statistically

bDePendencY ~ the six ADL functions was determined from question 14 of the Resident Questionnaire

(appendix III) by the following cutoff points (i.e., greater

levels indicating debility): bathing, dressing, and feeding-kvel 2; going to toilet, transferring, and continence—level 1.

17
significant). It appears, therefore, that one of

the factors contributing to lower costs in the

least expensive facilities is the lower dependency

of their residents.

The lower part of table 18 presents the ADL

index that ranked the individuals according to

their performance in all six ADL’s. Ninety-four

percent of the residents had a pattern of dependencies that classified them in one of the seven

levels of the index. Only 6 percent of the residents could not be classified in the index. About

24 percent of the residents were rated as completely independent, and 14 percent were rated

as completely dependent in the six ADL’s. As

with the individual components of the ADL

index, the index itself serves best as an indicator

of the differences between residents in the lowest cost facilities and the residents in the other

facilities. Facilities with costs of under $10.00

per resident day generally had proportionately

more of the less dependent residents (levels A,

B, and C of the ADL index) and less of the more

dependent residents (levels E, F, and G of the

ADL index) than was the case for the other

facilities. Across the other cost groups, the differences in the proportion of residents at the

various levels of the index were generally not

statistically significant.

Other Selected Resident

Characteristics

Table 19 presents the number and percent

distribution of residents in the five total cost per

resident day intervals by the primary reason for

admission and the level of patient care. Table 20

presents the number and percent distribution of

residents in the five total cost per resident day

intervals by the primary source of payment.

Data gathered on the primary reason for the

resident’s admission to the facility had four possible responses: physical reasons (e.g., illness or

need for treatment); social reasons (e.g., no

family or lack of family interest); behavioral

reasons (e.g., disruptive behavior, mental deterioration); economic reasons (e.g., no money

and/or resources). (See question 7 of Resident

Questionnaire in appendix III.) The majority of

the nursing home residents (81 percent) entered

the facility primarily for physical reasons (table

19). Eleven percent entered the facility for

behavioral reasons, 7 percent for social reasons,

and 1 percent for economic reasons.

Among the five cost groups, significant variation in the proportion of residents admitted for

physical, behavioral, and social reasons existed.

Residents in higher cost facilities were more

likely to have been admitted for physicaI reasons

and less likely to have been admitted either for

behavioral or for social reasons, As facility costs

per resident day varied from less than $10.00 to

$25.00 or more, the proportion of residents

admitted for physical reasons steadily increased

from 70 percent to 88 percent, and the proportion of residents admitted for behavioral reasons

steadily decreased from 17 percent to 6 percent.

Although the declining proportion of residents

admitted for social reasons was not quite as

steady across the cost groups, the decline was

significant, ranging from 12 percent in the lowest cost facilities to 5 percent in the highest cost

facilities.

Information on the level of care the residents actually received was elicited by asking the

nurse if the resident had received any of a list of

services within the past 7 days (see appendix II

for a complete list of services). The responses

were classified into the five following levels of

patient care and each subsequent category represented a lower level of care:

Intensive nursing care

Limited nursing care

Routine nursing care

Personal care

No nursing or personal care

Forty-one percent of the residents received

intensive nursing care, 10 percent received

limited nursing care, 33 percent received routine

nursing care, and 16 percent received personal

care services (table 19). Only about 1 percent of

the residents received no nursing or personzd

care, probably because the scope of the survey

included only those facilities providing some

level of nursing care.

Among facilities with total costs of $10.00

or more per resident day, there was little variation in the proportion of residents receiving the

various levels of care. Compared to these facili18
ties, however, facilities with total costs per resident day of Iess than $10.00 had proportionately fewer residents receiving intensive care

and more residents receiving personal care. Only

29 percent of the residents in the lowest cost

facilities received intensive nursing care compared with between 42 and 46 percent for facilities in the other cost groups. Personal care was

received by 23 percent of the residents in the

lowest cost facilities compared with between 14

and 16 percent of the residents in the other cost

groups.

Data on the resident’s primary means of paying for care (i.e., source of payment) were based

on the response to question 26a of the Resident

Questionnaire in appendix III. The nine possible

sources were: own income or family support,

Medicare (title XVIII of the Social Security

Act ), Medicaid (title XIX of the Social Security

Act), other public assistance or welfare, church

support, Veterans Administration (VA) contract, initial payment/life care, no charge, and

miscellaneous sources. It should be noted that

data on the primary source of payment were

collected only for those residents who had been

in the facility l.month or more. This reduced by

about 6 percent the number of residents in the

facilities for whom cost information was collected.

Medicaid was the most frequent primary

source of payment used (table 20). About 48

percent of the residents received care financed

primarily by Medicaid. The next most frequent

primary source of payment was the resident’s

own income or family support (37 percent) followed by other public assistance or welfare (11

percent ). Only a small minority of the residents

used Medicare for primary payment (1 percent).

About 3 percent of all residents used other

sources (church support, VA contract, initizd

payment/life care, no charge for care, and other

sources) as the primary source of payment.

Differences among cost groups in the proportion of residents \vith the alternative primary

sources of payment are most noticeable at the

extremes. The resident’s own income or family

support was significantly less likely to be the

primary source of payment in facilities with

costs of $25.00 or more per resident day than in

lower cost facilities. Only 31 percent of the residents in the highest cost facilities used their own

incomes or family support as the primary payment source compared with from 36 to 41 percent in the other cost groups. hledicaid, on the

other hand, was significantly less likely to be the

primary source of payment in facilities \vith

costs of less than $10.00. Only 34 percent of the

residents in the lowest cost facilities used Medicaid as the primary payment source compared

with from -!7 to 53 percent in the other cost

groups. The lowest cost facilities, however, had a

much Iarger proportion of residents using other

public assistance or welfare procgrams. Twentyfive percent of the residents in the facilities with

costs of less than $10.00 pcr resident day used

other public assistance or welfare as their primary source of payment compared \vith from 7

to 9 percent in the other cost groups.

000

19
REFERENCES

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

United States: 1973-74 National Nursing Home Survey.

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

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

Dec. 1975.

2Nationa1 Center for Health Statistics: Characteristics, social contacts, and activities of nursing home residents, United States: 1973-74 National Nursing Home

Survey. L’ital and Health Statistics. Series 13-No. 27.

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

Administration. Washington. U.S. Government Printing

Office, May 1977.

3 National Center for Hea]th Statistics: Utilization of

nursing homes, United States: National Nursing Home

Survey, August 1973-April 1974. Vital and Health Statistics. Series 13-No. 28. DHEW Pub. No. (HRA) 77-

1779. Health Resources Administration. Washington.

U.S. Government Printing Office, July 1977.

4National Center for Health Statistics: Profile of

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

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

1790. Health Resources Administration. Washington.

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

5 National Center for Health Statistics: Nursing

homes in the United States: 1973-74 National Nursing

Home Survey. Vital and Health Statistics. Series 14-

No. 17. DHEW Pub. No. (HRA) 78-1812. Health Resources Administration. Washington. U.S. Government

Printing Office, Oct. 1977.

6Nationai Center for Health Statistics: Charges for

care and sources of payment for residents in nursing

homes, United States: National Nursing Home Survey,

August 1973-April 1974. Vital and Health Statistics.

Series 13-No. 32. DHEW Pub. No. (PHS) 78-1783.

Public Health Service. Washington. U.S. Government

Printing Office, Nov. 1977.

7National Center for Health Statistics: Eighth Reuision International Classification of Diseases, A dapted

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

Public Health Service. Washington. U.S. Government

Printing Office, 1967.

8Katz, S., et al.: Studies of illness in the aged.

J.A~~~Ll~ (12): 914-919, Sept. 1963.

., et al.: Progress in development of the

Index of ADL. Gerontologs”st 10 (pt. 1): 20-30, Spring,

1970.

10van Nostrand, J. F.: Development of Survey

Methodology To Measure Cost and Quality of Care in

Nursing Homes. Paper presented at 101st Annual Meeting of American Public Health Association, San Francisco, Nov. 8, 1973.

11 National Center for Health Statistics: Development

and maintenance of a National Inventory of Hospitals

and Institutions. Vital and Health Statistics. PHS Pub.

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

12National 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.

13NationaI Center for Health Statistics: The agency

reporting system for maintaining the National Inventory

of Hospitals and Institutions. Vital and Health Statistics.

PHS Pub. No. 1000-Series l-No. 6. Public Health Service. Washington. U.S. Government Printing Office, Apr.

1968.

14Nation~ Center for Health Statistics: Irlstitutions

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

1000-Series 12-No. 1. Public Health Service. Washington. U.S. Government Printing Office, July 1965.

15National Center for Health Statistics: Arrangements

for physician services to residents in nursing and personal care homes, United States, May-June 1964. Vital

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

No. 13. Public Health Service. Washington. U.S. Government Printing Office, Feb. 1970.

16Nation~ Center for Health Statistics: Selected

characteristics of nursing homes for the aged and chronically ill, United States, June-August 1969. Vital and

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

(HRA) 74-1708. Health Resources Administration.

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

1974.

17 National Center for Health Statistics: Inpatient

health facilities as reported from the 1971 Master

Facility Inventory Survey. Vital and Health Statistics.

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

Health Resources Administration. Washington. U.S.

Government Printing Office, Mar. 1974.

20
LIST OF DETAILED TABLES

1. Cost per resident day for nursing home care and percent distribution by cost components, according to ownership: United

States, 1972 ............................ ........................................... ....................................................................................................... 23

2. Cost per resident day for nursing home care and percent distribution by cost components, according to certification: United

States, 1972 ............................................................................................................................................................................... 24

3. Cost per resident day for nursing home care and percent distribution by cost components, according to size: United States,

1972 ...................................... .............................................................. ...................................................................................... 25

4. Cost per resident day for nursing home care and percent distribution by cost components, according to geographic region:

United States, 1972 ................................................................................................................................................................... 26

5. Number of resident days and amount and percent distribution of major cost components per resident day, according to

certification, ownership, and size: United States, 1972 ............................... ............................................................................... 27

6. Number of resident days and amount and percent distribution of major cost components per resident day, according to

certification, ownership, and geographic region: United States, 1972 ........................................................................................ 29

7. Number and percent distribution of nursing homes within total cost per resident day intervals, by ownership, certification,

size, and geographic region: United States, 1972 ....................................................................................................................... 31

8. Number and percent distribution of total cost per resident day and its major components for nursing homes within total cost

per resident day intervals, by ownership, certification, size, and geographic region: United States, 1972 .................................. 33

9. Number of beds and average number of beds in nursing homes within total cost per resident day intervals, by ownership,

certification, size, and geographic region: United States, 1972 .................................................................................................. 39

10. Number of admissions and admissions per 100 beds in nursing homes within total cost per resident day intervals, by

ownership, certification, size, and geographic region: United States, 1972 ................................................................................ 41

11. Number of live discharges and live discharges per 100 beds in nursing homes within total cost per resident day intervals, by

ownership, certification, size, and geographic region: United States, 1972 ................................................................................ 43

12. Number of deaths and deaths per 100 beds in nursing homes within total cost per resident day intervals, by ownership,

certification, size, and geographic region: United States, 1972 .................................................................................................. 45

13. Number of resident days and occupancy rate in nursing homes within total cost per resident day intervals, by ownership,

certification, size, and geographic region: United States, 1972 ............................................................................. ..................... 47

14. Total cost per resident day, number of resident days, and number and percent distribution of nursing homes within total

cost per resident day intervals, by selected service characteristics: United States, 1972 ............. ................................................ 49

15. Number of full-time equivalent employees and full-time equivalent employees per 100 beds within 1972 facility total cost

per resident day intervals, by ownership, certif ication, size, and geographic region: United States, August 1973-April 1974 .... 50

16. Yearly labor cost per full-time equivalent employee within total cost per resident intervals, by ownership, certif ication, size,

and geographic region: United States, 1972 ................ ...................................................... ......................................................... 56

17. Number of nursing home residents and rate per 100 residents within 1972 facility total cost per resident day intervals, by

reported chronic conditions and impairments and primary diagnosis at last examination and at admission: United States,

August 1973-April 1974 ............................................................................................. ................................... ............................ 57

18. Number of nursing home residents and rate per 100 residents within 1972 facility total cost per resident day intervals, by

measures of dependence in activities of daily living (AD L): United States, August 1973-April 1974 ..... .................................... 60

21
19. Number and percent distribution of nurs!ng home residents within 1972 facility total cost per resident day intervals, by

primary reason for admission and level of patient care: United States, August 1973-April 1974 ............................................... 61

20. Number and percent distribution of nursing home residents within 1972 facility total cost per resident day intervals, by

primary source of payment: United States, August 1973-April 1974 ......................................................................................... 62

22
Table 1. Cost per resident day for nursing home care and percent distribution by cost components according to ownership: 1 United

States, 1972

~

Al I

Propri- NonownerGovernships etary profit ment

Cost component

Cost per resident day Percent distribution

Total cost ......................... .. ............ ......... $16.43 $16.01 $16.68 $18.42 100.0 100.0 100.0 100.0

Labor costs ............................................... .......... ..... 9.82 9.16 10.14

9.33

5.29

0.23

3.81

0.81

3.83

13.12 59.8

54.8

33.8

1.1

20.0

4.9

20.6

57.2

52.7

33.9

0.8

18.1

4.5

20.0

60.8 71.2

Wages .. ................................................ ...............

Nursing payroll ......................................... ....

Professional payroll ......................................

Other payroll ................................................

Fringe benefits ...................................................

9.01

5.55

0.18

3.28

0.81

3.39

8.44

5.42

0.13

2.90

0.72

3.20

11.61

6.85

0.43

4.53

1.30

3.77

55.9

31.7

1.4

22.8

4.9

23.0

64.1

37.2

2.3

24.6

7.1

Operating costs ........................................................ 20.5

Food and other dietary items ................... .. ........

Drugs .................................................................

Supplies and equipment .....................................

Buildings, grounds, and equipment purchased

maintenance ...................................................

Laundry and linan ..............................................

Services purchased from outside sources:

Services related to health care .......................

Services not related to health care ................

Utilities ..............................................................

1.35

0.25

0.48

0.25

0.17

0.16

0.24

0.49

2.52

1.30

0.22

0.44

0.24

0.18

0.16

0.20

0.45

2.90

1.49

0.29

0.50

0.28

0.14

0.19

0.35

0.60

2.09

1.38

0.33

0.68

0.28

0.16

0.12

0.30

0.52

1.10

8.2

1.5

2.9

1.5

1.0

1.0

1.5

3.0

15.3

8.1

1.4

2.8

1.5

1.1

1.0

1.3

2.8

18.1

8.9

1.7

3.0

1.7

0.8

1.1

2.1

3.6

12.5

7.5

1.8

3.7

1.5

0.9

0.7

1.6

2.8

Fixed costs ............................ .................................. 6.0

Equipment rental ...............................................

Insurance ........... ...................................... ..........

Taxes and licenses ..............................................

Interest and finance charges ...............................

Depreciation ............................................ ..........

Rant on building and land ................... ...............

Amortization of leasehold improvements ...........

0.05

0.20

0.32

0.60

0.66

0.64

0.05

0.69

0.07

0.20

0.42

0.69

0.61

0.69

0.02

0.75

0.02

0.21

0.09

0.53

0.90

0.18

0.16

0.62

0.3

1.2

2.0

3.7

3.9

3.9

0.3

4.2

0.4

1.3

2.6

4.3

3.8

5.5

0.1

4.7

0.1

1.3

0.5

3.2

5.4

1.1

1.0

3.7

0.14

“0.04

0.23

0.67

‘0.01

‘0.01

0.43

0.8

‘0.2

1.2

3.6

*0. I

●0. I

Miscellaneous costs .............. .................................... 2.3

lE5~im~tes me for ~ur5ing homes that had been k business 2 years or more at the time of the sWveY- Expenses for ne~ly opened

faciIitiea were not collected because they include “startup” costs for purchasing drugs, supplies, and equipment and therefore do not

reflect the standard cost of providing health care. Figures are based on 347,913,000 resident days of care for 1972. Of this total, 68

percent was provided by proprietary facilities, 21 percent by nonprofit facilities, and 12 percent by government facilities.

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

23
Table 2. Cost per resldem day for nursing home care and percent distribution by cost components, accordnng to certlflcat!on:l United States, 1972

Both

Medicaid only I

‘e’”f’ catton

youps :m~::- 1’

A

IPI 01

cem-

+;..4

Cost component

card’

1-

ties

Cost per resident day Percent distribution

Do .0 100.0 100.0

61,4 62.7

56.9 57.7

35.2 35.4

1.1 1.2

20.7 21.0

4.5 5.0

20.1 19.4

9.0 8,5

1.2 1.2

2.7 2.7

1.7 1.5

1.1 1.1

0,5 0.5

1,0 1.0

3,2 2.9

14,7 14.3

0.2 0.3

1,4 1.3

1,7 1.7

3.6 3.7

4.3 4.0

3.4 3.1

0.1 0.2

3.7 3,6

;20.59 100,0

12.04

10.91

6.82

0.21

3.88

1.13

4,14

143

0.36

0.62

0.27

0.21

0.30

041

0.54

3.45

$13.95 $15.69

8,57 9.B3

7.94 9.05

4.91 5.55

0.15 0,19

2,88 3.30

063 0.79

2B1 3.04

1.26 1.33

0.16 0.19

0.37 0.42

0.23 0.24

015 0,17

0.07 0,08

0.14 0,15

0.44 0.45

2,05 2.25

0.03 0.04

0.19 0.20

0.24 0.27

0,50 0.5B

0.59 0.63

0,47 0.50

0,02 0.03

0.52 0.57

611.95

7.12

6,66

4.1 B

‘0.09

2.40

0.45

2.55

1.17

0.13

0.31

0.21

0.13

0.05

0.12

0,42

1,82

$14.16

-

8,34

7.78

4.48

“0.23

3.08

0.56

3.49

P16.43 100.0 100.0

9.82

9.01

5.55

0.18

3,28

0.81

3.39

59.8

54.8

33.8

1.1

20.0

4.9

20.6

58.5 59.6 5B.9

53.0

33.1

1,0

18,8

5.5

20.1

55.7

35 .()

‘0.8

20.1

3.8

21.3

54.9

31.6

●1.6

21.8

4.0

24.7

1.35

0.25

0.48

0.25

017

0.16

0,24

0.49

252

1.44

0.24

0.50

0.29

0.13

0.14

0,18

0,56

1,74

8.2

1.5

2.9

1,5

1.0

1,0

1.5

3.0

15.3

7.0

1.8

3.0

1.3

1.0

1.5

2.0

2.6

16.8

9 f)

1,’1

2,6

1.8

1,1

o.Li

1.[1

3.5

15:!

10.2

1.7

3.5

2,1

0.9

1.0

1.3

4.0

—.

12.3

‘0.03

0.21

0.21

0.42

0.63

0.21

‘0.01

0.59

0.3

1.2

2.0

3.7

3.9

3.9

0.3

4,2

0.4

1.0

2.1

4.0

3.8

5,0

0.4

4.6

—

0.2

1.6

1 .s

3.3

4.6

3.6

‘0.1

3.9

‘0.2

1,5

1.5

3.0

4.5

1.5

“0.1

4.2

0.05

0.20

0.32

0.60

0.66

0.64

0.05

0.69

0.09

0.20

0.44

0.81

0.78

1,04

0,09

095

0,02

0,19

0,21

0.40

0.55

0.43

.0.01

0.46

—-

1Estimates are for nursing homes that had been in business 2 years or more at the time of the survey. Expenses for newly opened facilities were not collected because they

include “start up” costs for purchasing drugs, SUPPIIOS,and eclu:pm,ent and therefore do not reflect the, st~ndard cost of providing health care. Figures are based on 347,913,000

. ..id.. t d.vs of care for 1972 Of thjs total, 37 percent was prwded by the both M.dic are and Meal,cmd group, 27 percent by the SNH grow, 23 percent by the ICF group,

and 14 percent by the not.cert)fied gm”p.

20f these facilitra, 7 percent were certifted for Med!care only

30f these facilities, 33 percent were certifv?d as both SNH’S a“d ICI k

NOTE.. I,ngures may not .dd 10 totals due to ro”ndmg.

24
Table 3. Cost per resident day for nursing home care and percent distribution by cost components, according to size: 1 United States. 1972

Cost component T

All Less

size than

youps 50 beds

All Less

50-99 100-199

200

size than

beds beds

beds

groups 50 beds or more

200

beds

or more

50-99 I

100-199

beds beds

II I I I

Cost per resident day Percent distribution

IF

100.0 100.0 ;

59.8 61.3

54.8 57.2

33.8 36.2

1.1 ‘0.9

20.0 20.0

4.9 4.2

20.6 22.3

8.2 9.3

1.5 1.3

2.9 3.2

1.5 1.8

1.0 0.8

1.0 1.2

1.5 1.2

513.90 100.0 100.0 100.0

8.52

7.95

5.03

“0.13

2.78

0.58

3.10

1.29

0.18

0.45

0.25

0.11

0,16

0.16

0.50

1.73

“0.02

0.23

0.29

0.28

0.55

0.34

“0.01

0.55

$15.61

6.91

8.27

5.19

0.13

2.95

0.84

3.31

$16.72

9.80

6.99

5.61

0,16

3.22

0.81

3.36

Total cost ............ ..... .......... ..... ..... ............ ...

Labor costs ..................... ..... ..... ........ .. ..... ..... ...............

Wages ................... ..... ..... ............. ..... .......... .. ..........

Nursing payroll ......... ... ..... ..... ............... ............

Professional payroll .. .................. ..... ..... ....... .....

Othar payroll ................. ..... ..............................

Fringe benefits ... ..... ......................... .......... ..... .......

Operating cOsts........ ..... .......... .................... ..... ..... .......

Fcmd and other dietary items .................................

B16.43

9.82

9.01

5.55

0.18

3.28

0.81

3.39

$20.34

13.37

11.95

6.84

0.41

4.71

1.41

3.98

57.1

53.0

33.3

0.8

18.9

4.1

21.2

58.6 65.7

53.8

33.6

1.0

19.3

4.8

20.1

58.8

33.6

2.0

23.2

8.9

19.6

8.5

1.5

2.7

1.7

1.1

1.0

1.7

3.0

17.0

8.0

1.6

3.0

1.4

1.0

1.0

1.3

2.9

16.8

7.3

1.6

3.0

1.5

1.0

0.8

1.7

2.7

11.9

0.3

0.8

1.1

2.6

3.7

3.2

“0.1

2.9

1.35

0.25

0.48

0.25

0.17

0.16

0.24

0.49

2.52

0.05

0.20

0.32

0.60

0.66

0.64

0.05

0.69

1.32

0.24

0.42

0.26

0.17

0.16

0.27

0.47

2.65

1.34

0.26

0.50

0.23

0.17

0.17

0.21

0.49

2.61

1.48

0.32

0.61

0.31

0.20

0.16

0.35

0.55

2.42

Supplies and equipment ......... ............. ..... ..... .........

Buildings, grounds, and equipment purchased

maintenance ........... ............ ........ .................... ....

Laundry and linen ...... ............... ..... .......... ..... ..... ....

Services purchased from outside sources:

Services related to health care ........ ..... ..... ..... ....

Services not related to health care . ..... ..... ..... ....”

Utilities .. ................ ............ ....... ..... ..... ..... ..... ..... ....

Fixed costs ........... ................... ..... ........................... ....

Equipment rental ..... ............ .............................. ....

Insurance ........ ............ ....... ....................................

Taxes and licenses ..... .. .................... ............... ........

Interest and finance charges ....... .... ...... .......... ..... ...

Depreciation ... ............ .................... ..... ..... ..... ..... ...

Rent on building and land .......... ..... ..... ..... ..... ..... ...

Amortization of leasehold improvements .. ..... ..... ...

Miscel Ianecms costs ................... ..... ............ ..... ..... ..... ...

t

3.0 3.6

15.3 12.5

0.3 “0.1

1.2 1.7

2.0 2.1

3.7 2.0

3.9 4.0

3.9 2.5

0.3 ‘0.1

0.06

0.21

0.31

0.63

0.65

0.68

0.10

0.74

0.06

0.18

0.38

0.74

0.69

0.74

0.02

0.75

0.05

0.18

0.23

0.53

0.77

0.65

‘0.02

0.58

0.4

1.4

2.0

4.1

4.2

4.3

0.6

4.7

0.4

1.1

2.2

4.4

4.1

4.4

0.1

4.5

lEstimates me for nursing homes that had been in business 2 years or more at the time of the survey. Expenses for newly Opened facilities were not collected

because they include “startup”’ costs for purchasing drugs, supplies, and equipment and therefore do not reflect the standard cost of providing health care. Figures

are based cm 347,913,000 resident days of care for 19~2. Of this total, 16 percent was provided in facilities with [e= than so beds. 34 Percent in facilities of SO to

99 beds, 35 percent in facilities of 100 to 199 beds, and 15 percent in facilities of 200 beds m more.

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

25
Table 4. Cost per resident day for nursing home care and percent distribution by cost components, according to geographic region, 1 Un!ted States, 1972

Al I North- North

regions east Central South West

All North- North

regions east Central Cost component South West

Cost per resident day Percent distribution

$21.96

_

13.62

$15.04

9.06

$14.12

8.12

100.0 100.0

59.8 62.9

54.8 58.8

33.8 33.6

1.1 1.5

20.0 21.7

4.9 6.1

20.6 19.1

8.2 7.0

1.5 1.3

2.9 3.0

1.5 1.6

1.0 1.0

1.0 0.8

1.5 1.7

3.0 2.6

15.3 14.1

0.3 0.4

1.2 1.1

2.0 1.8

3.7 3.6

3.9 3.4

3.9 3.8

0.3 0.1

4.2 3.8

Total cOst . ... ... .... .... .... ... . ... .... .... ... .. .. .... .... ..

Labor costs ... .... ... .... .... .... ... .... ..... ... ....... .... ... . ... .... .... ..

Wages ... .... .. .... .... .... .. .. ... ..... .. .... .... .... ... . ... .... .... ... . ..

Nursing payroli .... .... .... .... ... .... .... .... ..... .. .... ... . ..

Professional payroll . ..... ...... .... .... .. .. ... . ... .. .. ... . ..

Other payroll ... .... .... ...... ..... .... ....... .... .... .. .. ... . ..

Fringe benefits .. .. ...... .... .... .. ..... .... .... ... . ... . ... .... .... ..

Operating cOsts .... ... ... ..... ..... ...... .... .... .... ... . ... .... .... ... . ..

Food and other dietary items ... ... . ...... ..... .... .... .... ..

Drugs .. .... ... ... .. .. .. .. .... .... ....... . .. .... ..... ...... .. .. .... .... ..

Supplies and equipment ..... ... ... .. .. .... .... .... ....... ..... .

Buildings, grounds, and equipment purchased

maintenance .... ...... .... .... . ..... ..... .... ... ... .. .. .... .. .. ..

Laundry and l!nen .. .. .. ... . .... .... .. .. .. .... .... ... .. ..... ..... ..

Services purchased from outside sources:

Services related to health care . .. .. .. .. ... .... .... ... . ..

services not related to health care . .... .... .... .... ..

Utilities ... ... ... .... .... .... .. .... ..... .... ..... .... .. .... .... .... .... ..

Fixed cOss .. .... .... .... ....... .... ...... .. ... .... .... .... .. .. .. ..... .... ..

Equipment rental .. ... . ..... .... .. .... .... .. .. .. .. ... .... .... ... . ..

Insurance ... ... .... .... ... . ..... .. .... .... .... .... .. .. ... .... .... ... . ..

Taxes and licenses ..... . ... ..... .. .... .... .... .... .... ..... ...... ..

Interest and finance charges .. ... .... ..... ... ... .. .. .... .... ..

Depreciation .. .... ....... . .. ..... .... .. .... .... .... ... . ...... .... ..

Rent on building and land ... .. .. ..... .... .... ... .. ... .. ..... ..

Amortizaticm of leasehold improvements .. .. ... ..... ..

Miscellaneous cOsts .. ....... . ... .... .... ... .. .. .... .... .... ...... .... . ..

$16.43

_

9.82

$15.52

8.72

100.0

—

60.2

100.0

_

57.5

100.0

56.2

9.01

5.55

0.18

3.28

0.81

3.39

12.48

7.38

0.33

4.77

1.34

4.20

8.41

5.07

0.17

3.17

0.65

3.20

7.59

4.91

“0.1 2

2.56

0.53

3.11

7.88

5.14

‘0.10

2.64

0.85

3.18

55.9

33.7

1.1

21.1

4.3

21.3

53.8

34.8

‘0.9

18.1

3.8

22.0

——

9.4

1.8

2,8

1.6

1.2

0.9

1.4

3.2

15,9

50.8

33.1

‘0.6

17.0

5.5

20.5

1.35

025

0.48

0.25

0.17

0.16

0.24

0.49

2.52

0.05

0.20

0.32

0.60

0.66

0.64

0.05

0.69

1.54

0.29

0.66

0.36

0.22

0.18

0.38

0.58

3.10

1.30

0.24

0.46

0.22

0.15

0.14

0.17

0.51

2.24

0.03

0.19

0.26

0.60

0.71

0.43

0.02

0.55

1.32

0.25

0.39

0.22

0.17

0.12

0.19

0.45

2.24

1.23

0.21

0.42

0.24

0.14

0.24

0.30

0.41

2.79

8.6

1.6

3.1

1.5

1.0

0.9

1.1

3.4

14.9

7.9

1.4

2.7

1.6

0.9

1.6

1.9

2.6

18.0

0.08

0.26

0.41

0.78

0.73

0.83

0.02

0.84

0.04

0.20

0.24

0.53

0.63

0.46

0.13

0.65

0.08

0.14

0.42

0.49

0.56

1.09

‘0.02

0.83

02

1.2

1.8

4.0

4.8

2.8

0.1

3.7

0.3

1.4

1.6

3.8

4.5

3.3

1.0

4.6

0.5

0.9

2.7

3.2

3.6

7.1

‘0.1

5.4

lEstimates are for nursing homes that had been in business 2 years or more at the time of the survey. Expenses for newly opened facilities were not

collected because they include “startup” costs for purchasing drugs, supplies, and equipment and therefore do not reflect the standard cost of providing

health care. Figures are based on 347.913,000 resident days of care for 1972. Of this totaI. Northeast facilities movided 22 uercent, North Central facifitiea

provided 34 pe;cent, South facilities provided 26 percent, and West facilities provided 17 percent.

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

26
Table 5. Number of resident days and amount and percent distribution of major cost components per rasident day, accm’ding to certificatic.n,

ownership, and size:l United States, 1972

Certification, ownership, and size

Number

of

resident

days

(thousands)

Cost component

Al I tvpes of certification Amount per resident day Percent distribution

$9.82

~

8.52

8.91

9.80

13.37

9.16

$3.39

3.10

3.31

3.36

3.98

3.20

$2.52

~

1.73

2.65

2.81

2.42

2.90

59.8

~

61.3

57.1

58.6

65.7

57.2

20.6

~

22.3

21.2

20.1

19.6

20.0

15.3

~

12.4

17.0

16.8

11.9

18.1

All types of ownership ............ 347,913

55,667

119,320

121,583

51,343

235,330

$16.43

~

13.90

15.61

16.72

20.34

16.01

$0.69

~

0.55

0.74

0.75

0.58

0.75

100.0

~

100.0

100.0

100.0

100.0

100.0

4.2

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

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

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

200 beds cmmore ....................................

4.0

4.7

4.5

2.9

Proprietary ................................... 4.7

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

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

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

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

41,743

86,294

87,324

20,470

112,082

13.16

15.03

17.16

21.06

17.30

8.05

8.44

9.67

12.30

11.20

2.75

3.04

3.38

3.96

3.&

1.84

2.79

3.25

4.01

1.74

0.53

0.75

0.85

0.80

0.55

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

61.2

56.2

56.4

58.4

64.7

20.9

20.2

19.7

18.8

22.0

14.0

18.6

18.9

19.0

10.1

4.0

5.0

5.0

3.8

Nonprofit and government ........... 3.2

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

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

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

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

13,925

33,026

34,259

30,872

128,162

5,888

37,989

59,494

24,792

96,718

16.13

17.14

15.67

19.87

20.59

21.66

20.00

19.85

23.03

19.71

9.94

10.14

10.18

14.07

12.04

13.81

10.82

11.54

14.71

11,01

4.16

4.01

3.33

4.00

4.14

4.78

4.21

3.84

4.39

3.90

1.39

2.28

1.68

1.37

3.45

2.23

3.84

3.45

3.17

3.78

0.63

0.71

0.48

0.43

0.95

0.84

1.14

0.93

0.77

1.02

0.65

1.11

1.01

0.93

0.75

61.6

59.2

65.0

70.8

58.5

~

63.8

54.1

58.1

63.9

55.9

25.8

23.4

21.3

20.1

20.1

~

22.1

21.1

19.8

19.1

19.8

8.6

13.3

10.7

6.9

16.8

~

10.3

19.2

17.4

13.8

19.2

13.3

20.1

18.8

19.9

10.5

3.9

4.1

3.1

2.2

4.6

~

3.9

5.7

4.7

3.3

5.2

Both Medicare and Medicaidz

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

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

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

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

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

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

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

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

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

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

3,144

30,552

49,552

13,470

31,444

18.43

18.99

19.51

22.40

23.29

11.73

10.25

10.95

12.80

15.22

3.59

3.82

3.89

4.22

4.89

2.45

3.81

3.67

4.45

2.44

100.0

100.0

100.0

100.0

100.0

63.6

54.0

56.1

57.1

65.3

19.5

20.1

19.9

18.8

21.0

3.5

5.8

5.2

4.2

Nonprofit and government ........... 3.2

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

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

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

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

25.39

24.14

21.55

23.77

15.69

G

15.07

14.90

18.80

15.21

2,744

7,437

9,941

11,322

92,150

9,499

31,633

33,419

17,599

56,092

16.21

13.14

14.50

16.98

9.83

~

9.65

9.20

8.87

12.90

9.09

6.15

5.82

4.18

4.59

3.04

~

2.87

3.00

2.84

3.60

2.79

2.62

2.72

2.77

3.37

1.97

3.93

2.36

1.65

2,25

=F

2.29

2.52

1.87

2.69

1.05

1.25

0.50

0.57

0.57

0.46

0.58

0.67

0.43

0.64

0.51

0.58

0.77

0.51

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

63.8

54.4

67.3

71.4

62.7

65.0

61.0

59.5

88.6

59.8

24.2

24.1

19.4

19.3

19.4

19.3

19.9

19.1

19.1

18.3

7.8

16.3

11.0

6.9 ~

14.3

12.6

15.2

16.9

9.9

17.7

13.6

17.2

19.5

17.4

4.1

5.2

2.3

2.4

3.6

Medicaid onlv: SNH’S3

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

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

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

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

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

3.1

3.8

4.5

2.3

Proprietary ................................... 4.2

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

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

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

200 beds .x more ....................................

7,511

21,499

23,143

5,940

15.18

14.32

15,16

18.71

9.99

8.56

8.67

11.57

2.06

2.47

2.95

3.26

100.0

100.0

100.0

100.0

65.8

59.8

57.2

61.8

17.3

19.0

18.3

18.0

3.4

4.1

5.1

2.7

See footnotes at end of table.

27
Table 5. Number of resident days and amount and percent distribution of major cost components per resident day, according to certification,

ownership, and size: 1 United States, 1972 —Corr.

Certification, ownership, and size

Number

of

resident

days

(thcrusands)

Cost component

Medicaid Amount per resident day

EE

Percent distribution only: SNH’s3–Con.

Ncmproflt and government ........... 34,058 $16.52 $11.10 $3.46 $1.51

●1,988

10,134

10,276

11,659

80,051

23,918

33,541

18,510

4,082

56,457

$0.45 100.0 67.2 20.9 9.1 2.7

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

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

100-199 baas,.....................................

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

●13.62

16.64

14.31

18.85

11.95

11.43

11.74

12.33

14.89

11.61

‘8.40

10.56

9.33

13.58

7.12

~

6.98

6.86

7.32

9.08

6.74

“3 .83

3.58

2.99

3.72

2.55

2.43

2.52

2.56

3.47

2.43

‘1.15

1.92

1.56

1.16

1.82

1.53

1.91

1.96

2.07

1,95

*0.24

0.58

0.44

0.39

0.46

0.48

0.46

0.49

“0.26

0.49

‘100.0

100.0

100.0

100.0

100.0

~

100.0

100.0

100.0

100.0

100.0

61.7

63.5

65.2

72.0

59.6

~

61.1

58.4

59.4

61.0

58.1

‘28.1

21.5

20.9

19.7

21.3

21.3

21.5

20.8

23.3

20.9

●8.4

11.5

10.9

6.2

15.2

~

13.4

16.3

15.9

13.9

16.8

14.6

17.6

18.9

‘1 4.8

11.8

‘1.8

3.5

3.1

2.1

3.8

Medicaid only: ICF’S

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

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

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

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

200 beds m more ....................................

4.2

3.9

4.0

‘1.7

Proprietary ....... .... ........ ............. 4.2

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

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

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

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

19,533

25,383

10,746

’794

23,595

11.44

11.35

12.06

●18.11

12.75

6.85

6.50

6.81

‘1O.75

8.02

2.39

2.40

2.48

“4.04

2.83

1.67

2.00

2.28

“2.88

1.50

0.53

0.45

0.49

“0.63

0.40

100.0

100.0

100.0

‘100.0

100.0

59.9

57.3

56.5

59.4

62.9

20.9

21.1

20.6

‘22.3

22.2

4.6

4.0

4.1

*3.5

Nonprofit and government ........... 3.1

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

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

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

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

4,385

8,~ 58

7,764

3,288

47,550

16,362

16,157

10,160

4,870

24,564

11.41

12.98

12.69

14.12

14.16

x

14.41

12.43

16.87

13.41

7.59

7.99

8.02

8.69

8.34

x

8.14

7.21

11.83

7.60

2.63

2.89

2.67

3.34

3.49

x

3.46

3.20

3.74

3.12

0.93

1.63

1.51

1.92

1.74

~

1.75

2.09

1.55

0.91

2.10

“0.26

0.47

0.49

‘0.18

0.59

0.61

0.72

0.46

0.39

0.58

100.0

100.0

100.0

100.0

100.0

~

100.0

100.0

100.0

100.0

100.0

66.5

61.6

63.2

61.5

58.9

K

56.5

58.0

70.1

56.7

23.0

22.3

21.0

23.7

24.6

-Z%-

24.0

25.7

22.2

23.3

8.2

12.6

11.9

13.6

12.3

~

12.4

14.5

12.5

5.4

15.7

*2.3

3.6

3.9

‘1.3

4.2

~

4.3

5.0

3.7

2.3

4.3

Not certified

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

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

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

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

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

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

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

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

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

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

11,555

8,860

3,883

●266

22,986

13.33

13.63

13.06

“15.05

14.95

7.80

7.50

7.23

‘8.1 5

9.13

3.21

3.02

3.06

●3.65

3.87

1.82

2.32

2.39

“2 .58

1.35

0.49

0.79

‘0.38

‘o .68

0.60

100.0

100.0

100.0

~loo.o

100,0

58.5

55.0

55.4

54.2

61.1

24.1

22.2

23.4

‘24.3

25.9

13.7

17.0

18.3

‘1 7.1

9.0

3.7

5.8

*2.9

*4.5

Nonprofit and government ........... 4.0

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

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

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

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

4,808

7,297

6,278

4,603

16.21

15.36

12.07

16.97

9.17

8.92

7.24

12,04

4.57

4.00

3.37

3.74

1.59

1.81

0.95

0.81

0.88

0.64

0.50

*O.38

100.0

100.0

100.0

100.0

56.6

58.1

60.0

70.9

28.2

26.0

27,9

22.0

9.8

11.8

7,9

4.6

5.4

4.2

4.1

●2.2

1Estimates are for nursing homes that had been in business 2 years or more at the time of the survey. Expenses for newly opened facilities were not

coilected because they include “startup” costs for purchasin~ drum, suuplies, and eauioment and therefore do not reflect the standard cost of rrrovidim!

health care.

. . . .

20f these facilities, 7 percent were certified for Medicare only.

30f these facilities, 33 percent were certified as both SNH ‘Sand ICF’a.

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

28
Table 6. Number of resident days and amount and percent distribution of maior cost components per resident day, according to cartificetion.

ownership, and geographic region: 1 United States, 1972

Cost component

of

rasldent

days

(thOusands)

347,913

77,516

119,835

90,921

59,640

235,830

Certification, ownership, and

geographic region

All types of certification Amount par resident day Percent distribution

$16.43

7r

$9.82

21.96 13.82

15.04 9.06

14.12 8.12

15.52 8.72

$3.39

4.20

3.20

3.11

3.18

3.20

$2.52

3.10

2.24

2.24

2.79

2.90

All types of ownership ............ 59.8 20.6 15.3

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Both Medicare and Medicaidz

$0.69 100.0 4.2

0.84

0.55

0.65

0.83

0.75

100.0

100.0

100.0

100.0

100.0

62.9

60.2

57.5

56.2

57.2

19.1

21.3

22.0

20.5

20.0

14.1

14.9

15.9

18.0

18.1

17.7

18.4

16.9

20.0

10.1

3.8

3.7

4.6

5.3

4.7

4.2

4.4

6.0

5.5

3.2

16.01 II 9.16

+

22.49 13.41

14.37 8.15

13.56 7.66

15.30 8.45

17.30 11.20

21.05 14.53

15.94 10.27

16.06 9.74

16.39 9.79

20.59 12.04

41,743

86,294

87,324

20,470

112.082

4.15

2.94

2.94

2.95

3.81

4.29

3.53

3.70

4.07

4.14

3.97

2.65

2.29

3.06

1.74

1.59

1.68

2.07

1.75

3.45

0.95

0.63

0.68

0.84

0.55

0.65

0.45

0.55

0.78

0.95

1.14

0.83

0.79

1.00

1.02

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

59.6

56.7

56.5

55.2

64.7

69.0

64.4

60.6

59.7

56.5

60.9

60.8

55.5

55.2

55.9

18.5

20.5

21.7

19.3

22.0

13,925

33,026

34,259

30,872

128,162

20.4

22.1

23.0

24.8

Zo.’l

=

18.7

20.0

22.4

20.6

19.8

7.6

10.5

12.9

10.7

16.8

16.1

15.2

17.7

18.4

19.2

3.1

2.8

3.4

4.8

4.6

4.3

4.0

4.4

5.8

5.2

4.8

4.9

5.2

5.8

3.2

All typas of ownarship ............

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

North Cantral ..........................................

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

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

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

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

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

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

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

Nonprofit and gcxernmant ...........

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

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

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

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

Medicaid only: SNI-I’S3

33,734

30,251

26,256

37,921

96,718

26.57 16.17

20.53 12.49

17,92 9.94

17.17 9.47

4.96

4.10

4.01

3.54

3.90

4.29

3.12

3.18

3.16

19.71 II 11.01 3.78

25,028

19,410

20,001

32,279

31,444

8,706

10,841

6,256

5,642

92,150

26.48 15.30

18.50 10.25

17.21 9.35

16.76 9.17

4.90

3.71

3.87

3.26

4.89

5.01

3.63

3.11

3.35

2.44

1.27

0.90

0.89

0.98

0.75

100.0

100.0

100.0

100.0

100.0

57.8

55.4

54.3

54.7

65.3

18.5

20.1

22.5

19.5

21.0

18.9

19.6

18.1

20.0

10.5

t

23.29 15.22

26.82 18.67

24.19 16.49

20.23 11.84

19.56 11.20

5.14

4.80

4.48

5.12

3.04

~

3.56

3.05

2.79

2.51

2.79

2.25

2.21

3.43

2.10

2.25

2.33

2.44

1.92

2.33

2.69

0.76

0.69

0.49

1.15

0.57

0.57

0.s1

0.66

0.53

0.64

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

69.6

68.2

58.5

57.3

62.7

67.0

61.4

60.1

58.4

59.8

19.2

19.8

22.1

26.2

19.4

=

18.2

19,6

20.7

19.5

18.3

8.4

9.1

17.0

10.7

14.3

~

11.9

15.7

14.3

18.1

17.7

2.8

2.9

2.4

5.9

3.6

2.9

3.3

4.9

4.1

4.2

Ail types of ownership ............

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

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

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

Wast ........................................................

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

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

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

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

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

See footnotes at end of table.

T

15.69 9.63

19.57 13.11

15.66 9.56

13.46 8.08

12.90 7.53

25,364

27,968

25,292

13,525

58,092 15.21 II 9.08

13,618

15,507

19,386

9,580

20.09 12.59

15.42 9.21

12.68 7.40

13,09 7.36

3.46

2.80

2.62

2.39

3.40

2.78

2.08

2.75

0.63

0.63

0.68

0.58

100.0

100.0

100.0

100.0

62.7

59.7

58.4

56.2

17.2

18.2

19,9

18.3

16.9

18.0

16.4

21.0

3,1

4.1

5.4

4.4

29
Table 6. Number of resident days and amount and percent d!str(butlon of major cost components per res!dent day, according to certification,

ownership, andgeograph]c reg]on:l United Stetes, 1972—Con.

Cost component

Number

of

res!dent

days

(thousands)

Certification, ownership, and

geographic region

Amount per resident day Percent distribution

Medicaid onlv: SNH’s3–Con.

Nonprofit and government $16.52 11,10 63.46 ;1 ,51

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

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

South

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

Medicaldonlv: ICF’S

34,058 $045 100.0 67.2

72.3

63.4

64.6

63.9

59.6

63.8

58.9

58.7

58,3

58,1

20.9 9.1

5.7

12.9

8.7

10.4

15.2

12.8

15.3

16.0

16.2

16.8

14.9

18.0

16.5

16.2

11.8

8.6

11.9

13.4

“16.0

12.3

10.7

12.5

13.2

13.3

15.7

12.7

17.0

14.8

‘24.8

9.0

9.3

8.8

9.2

*9.3

2.7

2,6

2.3

3.7

*3.2

3.8

3.6

3.9

3.7

5.2

4.2

11,746

12,461

5,906

3,945

80,051

18.98

15.73

16.01

12.45

11.95

13.72

9.98

10.35

7.95

7.12

3.69

3.36

3.67

2.79

2.55

1.08

2.03

1.39

1.30

1.82

0.49

0.36

0.60

‘0.40

0.46

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100,0

19.4

21.4

22.9

22.4

21.3

9,364

36,158

29,287

5,242

56,457

16.11

11,74

11,03

1109

11,61

10.28

6.92

6.47

6.46

6.74

3.18

2.56

2.39

2.25

2,43

2,07

1,80

1,76

1,80

1.95

2.15

2.07

1.82

1.76

1.50

0.58

0.46

0.41

0.58

0.49

19.7

21.8

21.7

20.3

20.9

19,3

21.1

21.6

20,0

22.2

20,7

22.7

22,0

21.3

24.6

7,081

21,078

23,777

4,520

23,595

14.43

11,51

1101

1084

12.75

21.32

12.06

11.09

“12.70

14.16

8.95

6.48

6.39

6.33

8.02

2,78

2.43

2.38

2,17

2.83

0.56

0.53

0.42

0.57

0.40

100,0

100.0

100.0

100.0

100.0

62,0

56.3

58.0

58.4

62.9

3.9

4.6

3,8

5.3

3.1

‘3.1

3.0

3.2

“5.4

4.2

2,283

15,080

5,510

“722

47,550

14.40

7.53

6.82

‘7,28

8.34

10.71

7.50

8.29

8.55

7.60

4,42

2.74

2,44

‘2.71

3.49

4.21

3.18

3.65

3.36

3.12

1.83

1.43

1.49

12.03

1.74

1.88

1.58

1.96

1.89

2.10

2.49

1,96

2.10

‘2.50

1.35

‘0.67

0.36

0.35

“0.68

0.59

0.77

0.41

0.94

‘0.44

0.58

0.73

0.36

0.91

‘0.35

0.60

100.0

100.0

100.0

‘100.0

100.0

100.0

100.0

100.0

100.0

100.0

67,5

62.4

61.5

*57,3

58.9

60.9

59.2

55.9

60.0

56.7

61.6

55.7

55.4

‘52.6

61.1

9,054

25,458

10,086

2,952

24,564

17.58

12.66

14.84

14.25

13.41

23.9

25.1

24.6

23.6

23.3

21.9

24.2

23.4

19.2

25.9

4.4

3.2

6.3

+3.1

4.3

3,434

12,442

7,821

‘1,067

22,986

19,58

11.50

14,22

‘10.08

14,95

12.06

6.40

7.88

‘5.30

9.13

4.29

2.78

3.33

‘1.94

3.87

100.0

100.0

100.0

‘100.0

100.0

3.7

3.1

6.4

*3.5

4.0

5,620

13,016

●2,465

“1,885

16.36

73.77

‘16.77

“16.61

9.88

8.54

“9.55

‘10.39

4.18

3.56

*4.63

‘4.17

1.52

1.21

‘1.54

‘1 ,55

0.80

0.45

“1.05

‘0.49

100.0

100.0

100.0

‘100.0

60.4

62.0

56.9

‘62.6

25.4

25.9

27.6

25.1

4.9

3.3

6.3

+3.0

lEstimates are for nursin~ homes that had been in business 2 years or more atthe time of the survey. Exuenses fornewly opened facilitit?s were not

collected because they inclu~e “startup” costs for purchasing drugs, supplies, and equipmeht and therefore d; not reflect the standard cost of providing

health care.

20 fthese facilities, 7 percent were certified for Medicare only.

30 fthesefacilities,33 percent were certified as both SNH’s and ICF’S.

NOTE: Figures maynotadd tototals due to rounding.

30
Table 7. Number and percent distribution of nursing homes within total cost perresident day, intervals, by ownership, certification,

size, and geographic region: 1 United States, 1972

Ownership, certification, size, and geographic region

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

Ownership

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

Nonprofit ...................................... ........................................................

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

Certification

Both Medicare and Medicaid2 ...............................................................

Medicaid only:

SNH’S3 ................................ .................................... ........................

iCF's ................................................................................................

Not cartified ....................... ..................................................................

Size

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

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

100-199 bads ........................................................................................

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

Geographic region

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

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

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

Wast ......................................................................................................

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

Ownership

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

Nonprofit ..............................................................................................

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

Certification

Both Medicare and Medicaid2 ...............................................................

Medicaid only:

SNH’S3 ............................................................................................

lCF's .............................................................................................. ..

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

Size

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

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

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

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

See footnotes at end of table.

Total cost per resident day intervals

14.800

11,200

2,500

1,100

3,800

3,300

4,300

3,300

6,000

5,200

3,000

600

2300

5,200

4,100

2,600

100.0

75.7

16.9

7.4

26.0

22.1

29.2

22.6

40.8

35.0

20.3

3.9

3,400

2,800

400

200

“loo

300

1,600

1,400

2,000

1,000

400

300

1,500

1,200

400

100.0

81.3

12.0

6.6

●3.O

9.9

46.3

40.8

60.3

28.1

10.6

“0.9

Number of facilities

5,400

4,100

900

400

800

1,500

2,100

900

1,900

2,200

1,100

*loo

700

1,800

1,800

1,100

3,400

2,700

500

200

1,500

900

400

700

1,400

1,100

800

200

900

1,100

700

700

Percent distribution

100.0

76.9

16.3

6.8

15.0

28.3

39.6

17.1

36.1

40.8

20.4

●2.7

100.0

80.4

14.6

5.0

43.2

25.4

10.8

20.6

40.0

31.5

23.8

4.8

1,300

800

300

200

700

300

●loo

*loo

200

500

400

*loo

600

300

300

200

100.0

62.4

24.8

12.8

54.3

22.8

+11.3

*11,6

15.5

41.7

34.2

*8.6

1,300

800

400

200

800

300

●loo

200

500

400

300

*loo

500

500

200

200

100.0

56.9

29.4

13.7

57.4

19.7

●8.7

14.1

36.0

31.8

22.7

●9.4

31
Table 7. Number and uercent distribution of nursing homes within total cost per resident day intervals, by ownership, certification,

size, and geographic region: 1 United States, 1972–Con.

Ownership, certification, size, and geographic region

tAll

intervals

Total cost per resident day intervals

Geographic region I

Percent distribution

Northeast .............................................................................................. I 19.8 II 7.8 I 13.6 [ 25.4 I 45.2 I 36.8

North Central ................................................................ ........................ 35.1 45.2 33.5 33.0 20.9 34.8

South .................................................................................................... 27.6 35.3 32.7 20.9 20.0 12.0

West ...................................................................................................... 17.5 11.7 20.1 20.8 13.9 16.4

lE~timates are for ~ur$ing homes that had been in businew 2 years or more at the time Of the 5UWeY. Expenses for newly opened

facilities were not collected because they include “startup” costs for purchasing drugs, supplies, and equipment and therefore do not

reflect the standard cost of providing health care.

20 f these facilities, 7 percent were certified for Medicare only.

30f these facilities, 33 percent were certified ss both SNH’S and ICF’S.

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

32
Table 8. Amount and percent distribution of total cost per resident day and its major components for nursing homes within total cost

per resident day intervals, by ownership, certification, size, and geographic region:l United States, 1972

Total cost per resident day intervals

Ownership, certification, size, geographic region,

and type of cost

All Less

inter- $1o.oo- $15.00- $20.00- $2:;00

vals ~;;~ $14.99 $19.99 $24.99 more

FACILITY CHARACTERISTICS

All facilities

Total cost ....... .. ...... .. ...... ...... .. ............ .. ...... ...... ........ ...... .......

Labor costs ...... .............. .......... ............ .............. .. .... ........ ........ ...... .......

Operating costs .............. .......... ............ .. ............ ............................ .......

Fixed costs ...... .................................... ...... .. .. ...... ...... ...... .. ............ ...... ..

Miscellaneous costs ...............................................................................

OWNERSHIP

Proprietary

Cost per resident day

$16.43 $8.24 $12.46 $17.08 $22.12 $35.63

9.82

3.39

2.52

0.69

16.01

4.74

1.97

1.23

0.29

8.37

7.44

2.58

1.92

0.52

12.53

10.03

3.55

2.75

0.75

17.03

13.57

4.50

3.24

0.81

21.99

21.63

6.95

5.39

1.67

Total cost ................................................................................... 35.68

9.16

3.20

2.90

0.75

16.68

4.73

1.93

1.43

0.28

7.91

7.29

2.49

2.16

0.58

12.32

9.73

3.36

3.11

0.82

17.18

12.36

4.39

4.35

0.90

22.26

20.28

6.79

6.60

1.99

36.02

Labor costs ...........................................................................................

Operating costs .....................................................................................

Fixed costs ..... .......................................................... .............................

Miscellaneous costs ...............................................................................

Nonprofit

Total cost ...................................................................................

10.14

3.83

2.09

0.62

18.42

4.58

2.04

0.97

0.32

8.07

7.44

2.84

1.60

0.44

12.25

8.53

2.66

0.88

0.18

13.32

10.42

4.14

1.98

0.64

17.27

11.91

3.99

1.07

‘0.29

17.06

13.96

5.13

2.31

0.86

22.32

21.86

7.51

5.29

1.36

35.06

25.27

6.73

2.00

1.07

35.34

21.07

6.87

5.65

1.75

Labor costs ...........................................................................................

Operating costs .....................................................................................

Fixed costs ............................................................................................

Miscellaneous costs ...............................................................................

Government

Total cost ...................................................................................

Labor costs ................................ .............. ................................ .............

Operating costs ........................................ .............................................

Fixed costs ............................................................................................

Miscellaneous costs .................. .................................... .........................

CERTIFICATION

13.12

3.77

1.10

0.43

20.59

5.20

2.09

0.50

‘0.28

8.28

16.67

4.00

1.16

0.49

22.13

Both Medicare and Medicaidz

Total cost ........................................... ................ ...... ..................

Labor costs .......................................................... .................................

Operating costs .....................................................................................

Fixed costs ............................................................................................

Miscellaneous costs ...............................................................................

See footnotes at end of table.

12.04

4.14

3.45

0.95

4.69

1.65

1.62

*O .33

7.73

2.69

2.33

0.57

9.71

3.50

2.99

0.86

13.13

4.58

3.60

0.82

33
Table 8. Amount and percent distribution of total cost per resident day and its major components for nursing homes within total cost

per resident day intervals, by ownership, certification, size, and geographic region: 1 United States, 1972–Con.

Total cost per residant day intervals

Ownership, certification, size, geographic region,

and type of cost

All Less

inter- than

I I

$10.00- $15.00- $20.00- $2:;00

vals $10.00 $’4”99 $19.99 $24.99 more

CERTIFICATION–Con,

Cost per resident day

Medicaid only: SNH’S3

Total cost ................................................................................... $15.69 $8.77 $12.48 $17.07 $22.09

10.51

3.37

2.64

0.55

17.11

$31.87

9.83

3.04

2.25

0.57

11.95

5.39

1.96

1.15

0.28

8.49

7.55

2.51

1.90

0.53

11.85

14.46

4.10

2.68

0.86

22.29

21.75

5.18

4.16

0.78

*32.22

Medicaid only: ICF’S

Total cost ...................................................................................

7.12

2.55

1.82

0.46

14.15

4.86

1.92

1.40

0.31

7.62

7.19

2.47

1.74

0.45

12.42

10.17

3.66

2.57

0.71

17.15

13.65

4.56

3.42

‘0.67

22.00

“18.40

“7.09

*4 .73

*2.01

46.52

27.86

10.81

5.53

2.32

39.55

Not certified

Total cost ...................................................................................

8.34

3.49

1.74

0.59

13.90

4.31

2.11

0.94

0.26

7.79

7.25

2.93

1.67

0.57

12.25

7.71

2.48

1.52

0.54

12.34

10.36

4.14

1.94

0.71

16.93

13.20

5.43

2.66

*0.71

*2 I .96

SIZE

Less than 50 beds

Total cost ...................... .............................................................

8.52

3.10

1.73

0.55

15.61

4.50

1.99

1.03

0.27

8.45

10.16

3.66

2.35

0.76

16.81

‘13.38

*4.61

++3.10

‘0.87

22.33

25.30

9.67

3.44

1.13

37.21

50-99 beds

Total cost ...................................................................................

8.91

3.31

2.65

0.74

16.72

9.80

3.36

2.81

0.75

4.83

1.97

1.36

0.29

8.48

7.20

2.62

2.02

0,50

12.50

7.38

2.52

2.02

0.57

9.54

3.59

2.89

0.80

17.34

10.06

3.42

3.04

0.82

13.22

4.60

3.54

0.98

21.99

13.02

4.56

3.55

0.86

19.90

7.61

7.13

2.57

34.55

100-199 beds

Total cost .................................................. .................................

20.17

6.57

6.12

1.69

4.92

1.95

1.31

0.30

See footnotes at end of table.

34
Table 8. Amount and percent distribution of total cost per resident day and its major components for nursing homes within total cost

per resident day intervals, by ownership, certification, size, and geographic region: 1 United States, 1972–Con.

Total cost per resident day intervals

All Less

inter- than $1o.oo- $15.00 - $20.00 - ‘2:;00

vals $10.00 $14.99 $19.99 $24.99 more

Ownership, certification, size, geographic region,

and type of cost

SIZE–Con.

Cost per resident day

200 beds or more

Total cost ................................................................................... $20.34 *$8.07

4.68

2.07

*0.95

“0.37

8.32

$13.15 $17.08 $22.12 $34.24

8.15

2.80

1.85

0.35

13.27

8.33

2.87

1.45

0.62

12.47

7.59

2.60

1.85

0.44

12.04

10.73

3.69

2.18

0.48

17.71

15.07

4.23

2.31

0.51

22.25

23.37

5.96

3.85

1.06

34.02

Labor costs ................... ............ .......................................... ..................

Operating costs ........................................ .............................................

Fixed costs ........... ...................... .............. .............................................

Miscellaneous costs ...............................................................................

GEOGRAPHIC REGION

13.37

3.98

2.42

0.58

21.96

Northeast

Total cost ................................. ..................................................

Labor costs .................. .. ............ .............. .............................................

Operating costs .....................................................................................

Fixed costs .... ........ ........ ............ .. ............ ..............................................

Miscellaneous costs ...............................................................................

North Central

14.14

4.26

3.14

0.72

21.85

21.53

6.15

5.01

1.34

37.57

13.82

4.20

3.10

0.84

15.04

4.82

2.28

0.93

*0.28

8.32

4.81

1.98

1.25

0.29

8.04

11.01

3.40

2.59

0.71

17.08

10.03

3.64

2.73

0.69

16.90

Total cost ................. ..................................................................

Labor costs .................................................... .......................................

Operating costs .....................................................................................

Fixed costs ............................................................................................

Miscellaneous costs .................................. ........................... ..................

South

Total cost ...................................................................................

13.50

4.54

3.12

0.69

22.21

12.78

5.07

3.40

0.96

22.01

23.40

7.61

5.06

1.49

41.22

21.28

8.53

8.84

2.57

35.41

9.06

3.20

2.24

0.55

14.12

8.12

3.11

2.24

0.65

15.52

8.72

3.18

2.79

0.83

4.57

1.89

1.29

0.28

8.34

7.11

2.56

1.83

0.54

12.79

7.37

2.47

2.39

0.56

9.77

3.86

2.49

0.78

16.53

Labor costs ...........................................................................................

Operating costs .... .................................................................................

Fixed costs ............................................................................................

Miscellaneous costs ...............................................................................

West

Total cost ...................................................... ...................... .......

9.20

3.27

3.21

0.85

12.58

4.55

3.64

1.24

18.19

8.77

5.20

3.25

100.0

60.7

19.5

15.1

4.7

35

4.89

1.94

1.16

‘0.35

Labor costs ......................................... ...................... ............................

Operating costs ...... ........ ...... .................................................................

Fixed costs ............................................................................................

Miscellaneous costs ........................ .................................................... ...

FACILITY CHARACTER ISTICS

All facilities

Percent distribution

100.0II 100.0 100.0 T

100.0 100.0

58.7 61.4

20.8 20.3

16.1 14.6

4.4 3.7

Total cost ....... .............. ............ ........ ....................................-

59.8 II57.6

20.7 24.0

15.4 14.9

4.2 3.5

59.7

20.7

15.4

4.1

Labor costs ... .............. ...................... .. ..................................................

Operating costs ...........<.. .................. .. ............ ..................... ..... .............

Fixed costs ............................................................................................

Miscellaneous costs ...............................................................................

S&e footnotes at end of table.
Table 8. Amount and percent distribution of total cost per resident day and its major components for nursing homes within total cost

per resident day intervals, by ownership, certification, size, and geographic region:l United States, 1972–Con.

Ownership, certification, size, geographic region,

and type of cost

OWNERSHIP

Proprietary

Total cost per resident day intervals

All Less

inter- than

$1o.oo- $15.00 - $20.00 - $&’J

vals $10.00 $14.99 $19.99 $24.99 more

Percent distribution

100.0 100.0

56.5

23.1

17.1

3.4

100.0

100.0

58.2

19.9

17.2

4.7

100.0

100.0

57.2

19.7

18.3

4.8

100.0

100.0

56.2

19.9

19.8

4.1

100.0

100.0

56.9

19.0

18.5

5.6

100.0

57.2

20.0

18.1

4.7

100.0

60.8

23.0

12.5

3.7

100.0

57.9

25.9

12.2

4.0

100.0

60.4

23.1

13.0

3.6

100.0

60.7

24.1

11.5

3.7

100.0

62.7

23.1

10.4

3.9

100.0

60.7

20.9

14.7

3.8

100.0

71.2

20.5

6.0

2.3

100.0

64.4

25.9

6.2

*3.5

100.0

69.7

21.8

7.2

1.4

100.0

69.0

23.1

6.2

+1.7

100.0

74.7

17.9

5.2

2.2

100.0

72.1

19.2

5.7

3.0

100.0

59.6

19.4

16.0

5.0

100.0

58.5

20.1

16.8

4.6

100.0

62.7

19.4

14.3

3.6

56.7

19.9

19.5

‘3.9

100.0

61.4

22.4

13.1

3.2

58.0

20.2

17.5

4.3

100.0

60.5

20.1

15.2

4.2

56.9

20.5

17.5

5.0

100.0

61.6

19.8

15.5

3.2

59.3

20.7

16.3

3.7

100.0

65.4

18.6

12.1

3.9

68.3

16.2

13.0

2.5

36
Table 8. Amount and percent distribution of total cost per resident day and its major components for nursing homes within total cost

per resident day intervals, by ownership, certification, size, and geographic region: 1 United States, 1972–Con.

Total cost per resident day intervals

Ownership, certification, size, geographic region,

and type of cost

CERTIFICATION–Con.

Percent distribution

Medicaid only: ICF’S

Total cost ................ ................................................................... 100.0 100.0 100.0 100.0 100.0 *100.O

Labor costs ............................... ................................................ ............

Operating costs ... ..................................................................................

Fixed costs ............................................ .............. ..................................

Miscellaneous costs ................. ...................................................... ........

59.6

21.3

15.2

3.9

100.0

57.2

22.6

16.5

3.7

100.0

56.5

27.7

12.3

3.5

100.0

57.7

25.6

13.3

3.5

100.0

60.7

20.8

14.7

3.8

100.0

59.5

21.4

15.0

4.1

100.0

60.4

24.1

11.3

4.2

100.0

60.0

21.6

13.9

4.5

100.0

61.2

20.4

15.3

*3.0

100.0

60.0

24.7

12.1

*3.2

*100.O

*60.9

*2 I .0

*14.1

*4.0

100.0

*57.1

*22.O

*I 4.7

*6.2

100.0

59.9

23.2

11.9

5.0

100.0

64.0

24.5

8.7

2.9

100.0

Not certified

Total cost ...................................................................................

58.4

23.6

13.4

4.6

100.0

62.9

20.3

12.4

4.4

100.0

Labor costs ............... .......................... ..................................................

Operating costs .... .............................. ...................................................

Fixed costs .......... ..................................................................................

Miscellaneous costs ............................................. ..................................

58.9

24.6

12.3

4.2

100.0

SIZE

Less than 50 beds

Total cost ....... .............. ..............................................................

Labor costs .................................... ...... .............. ...... .............................

Operating costs .............. .......................................................................

Fixed costs .................. ..........................................................................

Miscellaneous costs .......................................................................... .....

61.3

22.3

12.4

4.0

100.0

50-99 beds

Total cost ........................................ .................... .............. .........

Labor costs ...........................................................................................

Operating costs ........................................ ...... .............. ............ .. ...........

Fixed costs ...... ......................................................................................

Miscellaneous costs .. .............................................................................

100-199 beds

57.1

21.2

17.0

4.7

100.0

57.2

23.3

16.1

3.4

100.0

58.4

21.2

16.3

4.1

100.0

56.8

21.3

17.2

4.7

100.0

59.2

20.6

15.8

4.4

100.0

53.5

20.5

19.2

6.9

Total cost ...................................... ............................................. 100.0

Labor costs ...........................................................................................

Operating costs ...... ................ ........ ...... .............. ............ ................ .......

Fixed costs .......................................... ..................................................

Miscellaneous costs ...............................................................................

58.6

20.1

16.8

4.5

100.0

58.0

23.0

15.4

3.6

100.0

59.1

20.2

16.2

4.6

100.0

58.0

19.7

17.5

4.7

100.0

59.2

20.7

16.1

3.9

100.0

58.4

19.0

17.7

4.9

100.0

68.3

17.4

11.2

3.1

200 beds or more

Total cost ...................................................................... .............

68.1

19.1

10.4

2.3

Labor costs .................... .......................................................................

Operating costs .....................................................................................

Fixed costs ......................................... ...... .............................................

Miscellaneous costs ...............................................................................

65.7

19.6

11.9

2.8

58.0

25.7

●1 1.8

*4.6

62.0

21.3

14.1

2.7

62.8

21.6

12.8

2.s

See footnotes at end of table.

37
Table 8. Amount and percent distribution of total cost per resident day and its major components for nursing homes within total cost

.1 United States, 1972–Con. per resident day intervals, by ownership, certification, size, and geographic region.

Ownership, certification, size, geographic region,

and type of cost

GEOGRAPHIC REGION

Northeast

Total cost ................................................................. ..................

North Central

Total cost ............................................................................ .......

South

Total cost ...................................... .............................................

West

Total cost ...................................................................................

Total cost per resident day Intervals

All Less

inter- than

$1o.oo- $15.00- $20.00-r$2:;00

vals $10.00 $14.99 $19.99 $24.99 more

100.0

62.9

19.1

14.1

3.8

100.0

60.2

21.2

14.9

3.7

100.0

!57.5

22.0

15.9

4.6

100.0

56.2

20.5

18.0

5.3

100.0

58.0

27.4

11.2

*3.4

100.0

57.8

23.8

15.0

3.5

100.0

56.9

23.5

16.1

3.5

100.0

58.7

23.3

13.9

“4.2

Percent distribution

100.0

62.7

21.7

10.9

4.7

100,0

60.9

20.8

14.8

3.5

100.0

59,0

21.2

15.2

4.5

100.0

57.6

19.3

18.7

4.4

100.0

62.2

19.2

14.6

4.0

100.0

58.7

21.3

16.0

4.0

100.0

57.8

22.9

14.7

4.6

100.0

55.7

19.8

19.4

5.1

100.0

63.5

19.1

14,1

3.2

100.0

61.8

20.8

14.3

3.2

100.0

57.6

22.8

15.3

4.3

100.0

57.1

20.7

16.6

5.6

100.0

63.3

18.1

14.7

3.9

100.0

62.3

20.3

13.5

4.0

100.0

51.6

20.7

21.5

6.2

100.0

51.4

24.8

14.7

9.2

lEStimateS are for ~urSing h~meS that had been in business 2 years or more at the time of the surveY, Exuenses for ‘ewly opened

facilities were not collected %ecause they include “startup” costs ‘for purchasing drugs, supplies, and equipm&rt and therefore d-o not

reflect the standard cost of providing health care.

20f these facilities, 7 percent were certified for Medicare OnlY.

30f these facilities, 33 percent were certified as both SNFl ‘Sand ICF’S.

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

38
Table 9. Number of beds and everage number of beds in nursing homes within total cost per resident day intervals, by ownership,

certification, size, and geographic region: 1 United States, 1972

Ownership, certification, size, and geographic region

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

Ownership

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

Nonprofit ............................................................ ......................

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

Certification

Both Medicare and Medicaid2 ...................................................

Medicaid only:

SNH’S3 ................................................................................

lCF's ............................................. ............................... ........

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

Size —

Less than 50 &ds ......................................................................

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

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

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

Geographic region

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

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

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

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

Total cost per resident day intervals

All

Less

$1o.oo- $15.00- $20.00-

$25.00

than

intervals $10.00 $14.99 $19.99 $24.99 ‘r more

Number of beds

1,083,300

735,500

226,100

121,600

407,400

287,500

241,400

146,900

168,900

364,800

378,600

171,000

233s00

374,300

284,600

190,600

164,900

110,100

36,000

18,800

8,900

24,100

77,500

54,400

49,900

62,600

44,300

8,100

13,700

82,100

53,200

15,900

392,100

278,500

78,400

35,200

89,400

135.300

124,300

43,100

60,900

150,900

134,900

45,500

33,400

140,800

135,000

82,900

265,800

197,100

48JO0

20,500

144,400

69,600

24.400

27,600

37.900

79,200

103,100

45,700

61,800

86,000

57,500

60,500

134,900

77,300

33,400

24,200

74,300

39,900

9,400

11,300

“6,700

39,100

56,500

32,700

62,200

33,200

23,400

16,200

125,400

72,600

30,000

22,900

90,400

18,600

“5,800

10,500

13,.500

33,100

39,800

39,000

62,600

32,300

15,500

15,000

See footnotes at end of table.

39
Table 9. Number of beds and average number of beds in nursing homes within total cost per resident day intervals, by ownership,

certification, size, and geographic region: 1 United States, 1972—Con.

Ownership, certification, size, and geographic region

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

Ownership

Certification

Both Medicare and Medicaid2 ...................................................

Medicaid only:

SNH ‘S3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Size —

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

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

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

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

Geographic region

Total cost per resident day Intervals

Al I

Less

$1o.oo- $15.00- $20.00-

1

$25.00

than

intervals $10.00 $14.99 $19.99 $24.99 0’

more

Average number of beds

73.3

65.6

90.8

110.0

106.0

88.0

55.9

44.0

28.1

70.5

126.1

296.2

79.8

72.2

69.8

73.9

48.6

39.9

88.3

*83.6

‘87.6

72.0

49.4

39.2

24.4

65.7

122.8

‘250.6

●51 .7

53.5

44.4

40.3

73.2

67.5

90.0

96.7

111.0

89.3

58.6

46.9

31.5

69.0

123.6

‘309.7

45.7

78.3

77.0

77.0

78.6

72.5

97.3

+122.1

99.1

80.9

66.6

39.5

28.0

74.7

128.0

‘283.4

72.7

77.0

81.3

85.7

104.3

95.4

104.9

●147.1

105.2

136.5

‘64.5

“75.8

*33.4

71.7

128.8

‘296.0

105.6

123.5

91.0

“90.4

93.4

95.0

75.8

‘124.6

117.3

70.4

*49.8

55.4

27.9

77.3

130.4

‘308.4

126.8

69.1

●95.9

*68. 1

lEstimates are for nursing homes that had been in business 2 years or more at the time of the ww. ~w-es for newly opened

facilities were not collected because they include “startup” costs for purchasing drugs, supplies, and equipment and therefore do not

reflect the standard cost of providing health care.

20f these facilities, 7 percent were certified for Medicare O1l]Y.

30f these facilities, 33 percent were certified as both SNH’S and ICF’S.

NOTE: Figures may not add to totals due to rounding

40
Table 10. Number of admissions and admissions per 100 beds in nursing homes within total cost per resident day intervals, by

ownership, certification, size, and geographic region: 1 United States, 1972

Ownership, certification, size, and geographic region

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

Ownership

ProprietaW ................................................................................

Nonprofit ................................................ ..................................

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

Certification

Both Medicare and Medicaid2 ...................................................

Medicaid only:

SNH’S3 ................. .................... .............. .......... ...................

lCF's ................... .................................................................

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

Size —

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

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

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

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

Geoarauhic reaion

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

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

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

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

Total cost per resident day intewals

,, , 1 1

Al I

Less

than $1o.oo- $15.00- $20.00-

intervals $10.00 $14.99 $19.99 $24.99

Number of admissions

1,019,200

773,600

148,700

96,800

571,100

197,400

156,500

94,100

133,000

366,800

403,400

116,000

223,900

274,400

277,000

243,900

85,400

64,800

● 12,600

*8,000

“9,500

13,000

40,500

22,400

20,100

37,600

24,100

●3,600

“4,800

38,800

32,500

“9300

309,300

234,200

43,900

31,200

91,100

97,400

93,000

27,800

35,500

126,700

120,500

26,600

23,400

84,700

121,000

80,100

275,000

234,300

29,900

* 10,800

195,600

48,000

13,800

17,600

32,000

91,100

117,600

34,300

51,500

73,200

65,300

85,000

141,700

103,400

23,100

15,200

104,000

26,400

“6,300

*5,000

●6,900

48,200

64,200

22,500

50,400

31,400

32,700

27,300

$25.00

or

more

207.800

136,900

39,200

31,700

170,900

* 12,600

‘2,900

21,400

38,500

63,200

77,000

29,000

93,700

46,300

25,500

42,200

See footnotes at end of table.

41
Table 10. Number of admissions and admissions per 100 beds in nursing homes within total cost per resident day intervals, by

ownership, certif Icatlon, size, and geographic region: 1 United States, 1972—Con.

Ownership, certification, size, and geographic region

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

Ownership

Certification

Both Medicare and Medicaid2 ...................................................

Medicaid only:

SNH’S3 ............................... ...............................................

lCF's ....................................................................................

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

Size

.

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

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

100.199beds ............................................................................

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

Geographic region

Al I

intervals

94.1

105.2

65.8

79.6

140.2

68.7

64.8

64.1

78.7

100.6

106.5

67.8

95.7

73.3

97.4

128.0

Total cost per resident day intervals

Less

than

$10.00

$1o.oo-

$14.99

$15.00 - $20.00- 1

$25.00

$19.99 $24.99 ‘r more

Number of admissions per 100 beds

51.8

58.9

*35.O

*42.5

‘106.9

++54.1

52.2

41.1

40.2

60.2

54.3

“44.5

●35.2

47.3

61.1

‘58.1

78.9

84.1

56.0

88.5

101.9

72.0

74.8

64.5

58.3

84.0

89.3

58.5

70.1

“ 60.2

89.7

96.6

1034

118.8

61.9

*52.7

135.5

68.9

“56.6

‘63.7

84.2

115.1

114.1

75.0

83.3

85.1

113.4

140.4

105.1

133.8

69.2

*62.7

140.0

66.2

*67.3

*44.O

“103.9

123.3

113.5

68.8

81.0

94.5

140.1

168.7

165.7

188.7

130.7

138.6

189.0

‘67.6

“49.5

●203.2

285.4

191.2

193.5

74.4

149.6

143.4

164.6

282.2

lEStimates are for ~ur5ing homes that had been in business 2 years or more at the time Of the SUS’VeV.Emenses for newlv ouened

facilities were not collected %ecause they include “startup” costs ‘for purchasing drugs, supplies, and eq~ipmekt and therefo;e ~o not

reflect the standard cost of providing health care.

2C)f these facilities, 7 percent were certified for Medicare only.

30f these faci]itie5, 33 percent were certified as both SNI-I’S and ICF’S.

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

42
Table 11. Number of live discharges and live discharges per 100 beds in nursing homes within total cost per resident day intervals, by

ownership, certification, size, and geographic region: 1 United States, 1972

Ownership, certification, size, and geographic region

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

Ownership

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

Nonprofit .................................. ............................................... ....

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

Certification

Both Medicare and Mediceid2 ......................................................

Medicaid only:

SNH’S3 ...................................................................................

lCF's ................................................ .. .....................................

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

Size —

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

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

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

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

Geographic region

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

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

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

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

All

intervals

706,600

545,900

91,700

69,000

419,900

125,900

99,800

60,900

92,000

252,400

282,800

79,500

156,400

175,200

189,300

185,600

Total cost per resident day intervals

Less

than $1o.oo-

$10.00 $14.99

49,900

39,100

*6,200

*4,600

‘6,500

“8,600

22,100

*12,700

●1

2

1

,100

,900

,400

*2,500

*3,200

21,500

18,400

“6,900

$15.00- $20.00-

$19.99 $24.99

I

Number of live discharges

202,100

155,200

21,700

25,200

62,100

62,100

63,800

14,100

22,700

81,500

81,500

16,400

* 12,200

51,100

81,400

57,400

193,000

167,300

19,800

“5,800

141,100

32,100

‘8,500

‘1 1,300

19,600

66,300

83,000

24,100

34,000

48,700

46,100

64,100

95,900

73,200

14,100

*8,600

74,000

15,300

*3,800

‘2,700

“4,700

33,300

43,300

14,600

31,800

20,100

22,900

21,700

$25.00

or

more

165,800

111,100

29,800

24,800

136,300

‘7,800

● 1.600

20,100

33,800

49,500

60,700

21,800

75,200

33,800

20,600

36,200

See footnotes at end of table.

43
Table 11. Number of live discharges and live discharges per 100 beds in nursing homes within total cost per resident day intervals, by

ownership, certlf ication, size, and geographic region: 1 United States, 1972—Con.

Ownership, certification, size, and geographic region

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

Certification

Size

Geographic region

Total cost per resident day intervals

All

Less

$1o.oo- $! 5.00- $20.00-

$25.00

than

intervals $10.00 $14.99 $19.99 $24.99 more

‘r

Number of live discharges per 100 beds

65.2

74.2

40.6

56.7

103.1

43.8

41.4

41.5

54.5

69.2

74.7

46.5

66.9

46.8

66.5

97.4

30.2

35.5

+17.1

‘24.7

*72.6

*36.8

28.4

‘23.4

*22,2

34.9

*32.5

*3 I .5

*23.3

26.1

34.5

*43 .0

51.5

55.7

27.7

71.5

69.5

45.9

51.3

*32.6

37.4

54.0

60.4

36.1

*36.5

36.3

60.3

69.2

72.6

84.9

41.1

‘28.1

97.7

46.1

“35.0

*4 I .0

51.7

83.7

80.5

52.7

55.0

56.6

80.2

105.9

71.1

94.7

‘42.3

“35.5

99.6

*38.4

*40.6

*24.2

*71.1

85.3

76.5

*44.7

51.1

60.6

98.0

“103.5

132.2

153.1

99.5

108.6

150.7

*4 I .7

*27.7

*191.2

250.6

149.7

152.4

55.8

120.0

104.7

*132.6

241.8

lF,~tlma~e~ are for nursing homes that had been in business 2 years or more at the time of the SUIVY. Expenses for new]~ ODened

facilities were not collected because they include “startup” costs for purchasing drugs, supplies, and equipment and therefo;e do not

reflect the stsndard cost of providing health care.

20f these facilities, 7 percent were certified for Medicare onlY.

30f these facilities, 33 percent were certified as both SNH’S and lCF’S.

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

44
Table 12. Number of deaths and deaths per 100 beds in nursing homes within total cost per resident day intervals, by ownership,

certification, size, and geographic region: 1 United States, 1972

Ownership, certification, size, and geographic region

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

Ownership

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

Nonprofit ...................... ...... ................ .................................... .....

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

Certification

Both Medicare and Medicaid2 ........... ...........................................

Medicaid only:

SNH’S3 ...................................................................................

lCF's .......................................................................................

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

Size

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

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

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

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

Geographic region

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

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

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

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

All

intervals

314,000

233,000

51,200

29,700

141,900

64,400

50,700

57,000

67,400

101,900

109,300

35,400

62,200

116,300

77,400

58,000

Total cost per resident day intervals

Less

than

$10.00

.55,700

47,000

‘5,200

‘3,500

●2,100

*4,200

15,000

34,300

34,700

*12,200

“7,800

’900

‘1,800

42,100

‘9,600

“2,200

$1o.oo- $15.00- 520.00- $25.00

$14.99 $19.99 $24.99 ‘r

more

Number of deaths

95,400

68,100

18,900

“8,400

25,800

30,400

27,300

*I 1,800

13,500

40,500

33,200

*8,200

*1 0,400

30,000

33,400

21,600

81,400

65,700

‘10,800

●4,900

52,600

17,300

“4,900

‘6,600

●1 1,600

25,200

33,200

●11 ,500

16,500

23,800

19,300

21,800

42,300

27,400

●8,600

‘6,300

29,000

‘8,700

“2,000

‘2,600

‘3,200

*12,700

19,400

*7,000

15,600

●9,800

‘9,500

*7,400

39,200

24,900

‘7,800

‘6,600

32,400

‘3,700

‘1,500

“1,600

*4,400

*11 ,400

15.700

‘7,800

18,000

*1 0,600

●5,600

*5,1 00

See footnotes at end of table.

45
Table 12. Number of deaths and deaths per 100 beds in nursing homes within total cost per resident day intervals, by ownership,

certif!catlon, size, and geographic region:l United States, 1972—Con.

Ownership, certification, size, and geographic region

Total cost per resident day intervals

All

Less

$1o.oo- $15.00- $20.00-

$25.00

than

Intervals $10.00 $14.99 $19.99 $24.99 more ‘r

Number of deaths per 100 beds

29.0

31.7

22.6

24.4

34.8

22.4

21.0

38.8

39.9

27.9

28.9

20.7

26.6

31.1

27.2

30.4

33.7

42.7

*14.3

*18.6

*23.9

*17.5

19.4

63.1

69.6

*19.4

*17.7

*11.4

*12.9

51.3

*18.O

*13.8

24.3

24.4

24.1

“23.8

28.9

22.5

22.0

“27.4

*22.2

26.8

24.6

‘18.0

*31.1

21.3

24.8

26.0

30.6

33.3

*22.3

*23.8

36.4

24.9

‘20.0

’24.1

*30.5

31.8

32.2

*25.1

*26.7

27.7

33.6

36.0

31.4

35.4

*25.7

‘26.2

39.1

*2 I .7

*21.O

*23.2

*48.8

*32.5

34.3

*21.4

25.1

*29.5

“40.8

“45.7

31.3

34.3

*25.9

“28.9

35.8

“20.0

*25.9

*1 5.5

*32.4

*34,5

*39.4

‘20.0

28.7

●32.8

‘35.9

*33.8

.—

1~$tilnate$ are for nur5ing homes that had been in business 2 years or more at the time of the surveY. Expenses for newl!~ opened

facilities were nut cul]ected because they include “startup” costs for purchasing drugs, supplies, and equipment and therefore do not

reflect the standard cust of providing health care.

20f these t’acilitlcs, ‘7percent were ccrtificd for Medicare Only.

30f these fticil]ties, 33 percent were certified M both SNH’S and lCF’S.

NOTE: Figures m;iy not :Idd to k)tu]s due t<)rounding.

46
Table 13. Number of resident days and occupancy rate in nursing homes within total cost per resident day intervals, by ownership,

certification, size, and geographic region: 1 United States, 1972

Ownership, certification, size, and geographic region

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

Ownership

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

Nonprofit ...................................... .....................................................

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

Certification

Both Medicare and Medicaid2 ....... .....................................................

Medicaid only:

SNH’S3 .................................... .................................... .................

lCF's .............................................................................................

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

Size

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

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

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

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

Geoaraohic reaion

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

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

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

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

See footnotes at end of table.

All

intervals

347,913

235,830

72,080

40,002

128,162

92,150

80,051

47,549

55,667

119,320

121,583

51,343

77,516

119,835

90,921

59,640

Total cost per resident day intervals

Less

than

$10.00

$10.00- $15.00-

$14.99 $19.99

$20.00-

$24.99

Number of resident days (thousands)

56,157

37,567

12,477

6,113

3,177

8,259

26,341

18,379

17,362

20,912

14,989

2,893

4,701

28,531

17.459

5,466

128,361

90,461

25,844

12,055

29,442

43,049

41,806

14,064

20,479

50,684

44,286

12,912

11,497

45,025

44,515

27,323

86,096

64,000

15,163

6,932

46,380

23,015

7,769

8,831

12,435

25,972

33,318

14,370

20,847

28,061

18,355

18,833

42,339

23,772

10,539

8,027

23,318

12,742

2,932

3,347

●2,049

12,444

18,034

9,811

20,003

10,180

7,348

4,807

$25.00

or

more

34,961

20,030

8,056

6,875

25,846

5,084

● 1,203

2,828

3,342

9,307

10,955

11 #356

20,468

8,037

3,244

3,212

47
Table 13. Number of resident days and occupancy rate in nursing homes within total cost per resident day intervals, by ownership,

certification, size, and geographic region: 1 United States, 1972–Con.

Ownership, certification, size, and geographic region

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

Ownership

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

Nonprofit ...........................................................................................

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

Certification

Both Medicare and Medicaid2 ............................................................

Medicaid only:

SNH’S3 .......................... .......... ............ ........................................

lCF's .............................................................................................

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

Size —

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

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

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

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

Geographic region

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

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

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

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

Total cost per resident day intervals

All

Less I

$1o.oo- 1

$15.00- $20.00- $2:;00

‘ntewa’s $:POO $14.99 $19.99 $24.99 more

87.8

87.6

87.1

89.9

86.0

87.6

90.6

88.4

90.1

89.4

87.7

82.0

90.6

87.5

87.3

85.5

93.0

93.2

94.6

89.0

97.3

93.7

92.8

92.3

95.0

91.3

92.4

97.9

93.5

95.0

89.7

93.7

Occupancy rate4

89.4

88.8

90.0

93.5

90.0

86.9

91.9

89.1

91.9

91.8

89.7

77.5

94.0

87.4

90.1

90.0

88.5

88.7

85.8

92.3

87.8

90.4

87.0

88.4

89.6

89.6

88.3

85.9

92.1

89.1

87.2

85.0

85.7

84.0

86.2

90.5

85.7

87.2

85.2

81.2

*84.1

87.0

87.2

82.0

87.8

83.9

86.0

81.2

76.2

75.4

73.4

82.2

78.1

74.5

*56.4

73.5

67.6

76.9

75.2

79.5

89.3

68.0

57.2

58.6

lE~timates are for nursing homes that had been in business 2 years or more at thetimeof the su~eY. Expenses for newlY opened

facilities were not collected because they include “startup” costs for purchasing drugs, supplies, and equipment and therefore do not

reflect the standard cost of providing health care.

20f these facilities, 7 percent were certified for Medicare onlY.

30f these facilities, 33 percent were certified as both SNI-I’S and ICF’S.

4X Aggregate number of resident days of care provided in 1972 x 100

.2 Estimated number of beds in 1972 X 366

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

48
Table 14. Total cost per resident day, numbar of resident days, and number and percent distribution of nursing homes within total cost per resident day intervals, by selected

service characteristics: 1 United States, 1972

Total

cost

per

resiNumber

of

Total cost per resident day intervals

Selected facility service

charactm isties All Less

inter- $1o.oo- $15.OG $20.00- ‘25”W

Vals ~;;; $14.99 $19.99 $24.S8 ~:re

resident

days

(thouday sands1

Number of facilities Percem distribution

3,40f3

7C0

2,700

200

3,200

All facilities ............ 16.zX 5,400 3,400 1,30C

=

18.55

12.6C

20.40

14.63

19.51

14.59

19.87

14.51

18.02

13.78

18.14

16.30

20.19

15.74

!9.15

16.24

16.71

15.22

18.17

15.WJ

18.14

15.97

16.44

16.40

16.47

76.05

17.76

15.56

11.35

13.70

16.14

KI.63

15.64

24.18

16.56

12.77

347,9CXI

223,500

124,400

108,400

239,5420

129,500

218,400

724,400

223,500

217,300

130,600

24,500

323,400

53,700

294,230

21,800

326,100

281,900

66,0W

112,100

236,600

73,100

274,800

314,800

33,100

137,400

210,500

136,900

211,0Q0

55,300

93,300

67,500

131,800

36,230

18,W0

249,600

41,100

14,800

=

7,8oo

7,000

3,400

I 1,400

4,500

I 0,300

4,2oO

10,600

7,700

7,000

700

I4,1OO

1,600

13,200

600

14,000

I 1,500

3,300

3,900

10,900

2,400

12,330

8,2oo

6,!S430

I3,1OO

1,700

4,200

Io,5fnt

4,5W

4,300

2,500

3,400

2,100

400

9,2oo

3,200

1,30Q 100.C 10+3.0 100.0 100.0 100.0 100.0

Professional rehabilitation

services provided

Physical therapy:

Ye., .................................. 2,300

3,000

804

4,600

1,300

4,1 w

1,700

4,300

2,500

2,800

200

5,100

4Cm

5,000

300

5,100

4,200

1,200

1,500

3,s00

SQo

4,500

3,200

2,?00

4,800

1,700

3,700

1,500

1,800

1,100

800

600

0

3,700

1,100

2,500

800

1,300

2,100

1,50+3

1,900

l,6ciJ

1,8CJ3

2,3M

l,lfm

m

3,200

400

3,000

m

3,200

2,800

600

800

2,600

400

3,000

1,600

1,600

2,900

400

SW

2,5JJ0

60+3

1,100

1,000

50U

“loo

2,400

500

1,100

200

600

700

600

700

Soo

600

900

41X

“102

1,200

300

1,000

“lSit

1,200

1,000

2W

400

800

300

1,CQo

700

m

1,100

“loo

500

7W

‘1OQ

200

300

7MI

“1Q2

‘loo

1,000

“loo

1,100

300

600

800

600

700

600

700

1,000

400

“loo

1,2U0

300

1,000

●1OO

1,mo

1,100

200

500

800

400

1,000

80Q

500

1,300

“lW

m

600

“200

2U0

mo

Wo

“loo

“loo

1,Wo

100

52.6

47.4

22.9

77.1

30.4

69.6

28. ‘1

71.9

52.3

47.7

4.6

95.2

10.9

69.1

5.5

94.5

77.8

22.2

26.1

73.9

16.5

83.5

55.8

44.2

88.5

11.5

28.8

71.2

30.5

29.4

17.1

23.0

13.9

6;;

21.3

21.6

78.4

9E

12.3

87.7

6.5

93.5

30.1

69.9

“2.1

97.9

6.8

93.2

“3.5

86.5

69.6

30.4

18.0

82.0

13.8

86.2

50.4

49.6

85.0

16.0

17.1

62.9

62.3

26.7

6.6

2.4

22.9

1.3

35.9

39.9

43.8

56.2

14.2

85.8

23.9

76.1

19.7

80.3

47.3

52.7

4.4

96.6

7.5

92.5

5.4

94.6

78.3

21.7

27.2

72.8

16.3

63.7

60.1

39.9

69.6

10.2

31.3

66.7

2s.7

35.0

21.0

15.2

11.0

0.7

68.4

20.0

74.1

25.9

36.9

63.1

45.5

54.5

47.5

52.5

68.1

31.9

5.8

94.2

12.0

88.0

4.6

95.4

81.3

18.7

23.9

76.1

12.2

87.8

52.4

47.6

843.9

13.1

26.8

73.2

16.1

33.5

19.1

29.3

13.4

●3.4

69.3

13.6

87.1

12.9

43.4

56.6

46.6

53.4

50.1

49.9

69.3

30.7

●6.9

93.1

20.1

78.9

“9.0

91.0

81.6

16.4

34.4

65.6

24.6

75.4

54.7

45.3

66.9

‘11.1

41.9

5S.1

“ 5.3

12.3

24.0

58.4

‘9.0

“6.7

74.6

●9.5

79.3

20.7

42.3

57.7

48.2

51.8

46.8

53.2

72.1

27.9

“8.3

91.7

23.3

76.7

●1O.2

89.8

63.7

16.3

40.3

59.7

27.7

72.3

61.6

36.4

95.7

“4.3

40.4

58.6

“ 12.8

14.2

16.3

56.7

‘9.1

“8.7

721

“1O.1

Occupational therapy:

Yes ....................................

No .....................................

Recreatmnal therapy:

Yes., ..................................

No .....................................

Speech and hearing therapy:

Yes ....................................

3,000

200

3,200

1,000

2,400

‘loo

3,300

20U

3,200

●loo

3,300

2,400

1,000

600

2,6W

!Wl

2,9W

1,700

1,700

2,s00

&Jo

600

2,800

2,100

1,000

●loo

m

o

1,200

1,400

Counseling:

Yes ....................................

Other rehabilitation services:

Yes, ...................................

No .....................................

Services included as part of

bmc charge m rewdem

Physicim services:

Yes ....................................

No .....................................

Private-duty muse:

Yes ....................................

Train ing prcqrams conducted

fornonsmff people in

cooperation with an

educational insfitutlon

Yes .........................................

NO ................... .......................

Number of shiftt with an

RN in charge and cm duty

No shifts .................................

One shift .................................

Two shifts ...............................

Three shifts .............................

Staff member supervising

all clmlcal services

Administr3t0r2 . .. .. . . .. . .. . .. . . . . . . . .

Physician3 ..............................

Registered nurse3 ...................

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

lF.stimates are for nurdngh.mnes that had bee” in bu.ti”ess 2 years cmrnomat the time of the survey. Expensm fornetiy opened fac~kties wemnotwUected bemuse they indude “startup)’ costs for pmchasing drugs, s“ppties, and equipment and therefore do not reflect the standard cost of providing heatth care.

2Exctudes those administrators who were also qudifsed as a physician, RN. or LPN.

31ncludes those who wereakoa dministmtors.

NOTE: Figtwes maynotadd tototals d”etc. rounding.

49
Table 15. Number of full-time equivalent employ eesandfull-time equivalent employees perl 00 beds within 1972 facility total cost per

resident day intervals, by ownership, certification, size, and geographic region: 1 United States, August 1973-April 1974

Total cost per resident day intervals (1972)

II I I r I Ownership, certification, size, geographic region,

and type of employee All I

Less

than $10.00- $15.00- $20.00- $2:;00

intervals $10.00 $14.99 $19.99 $24<99 more

FACILITY CHARACTERISTICS

All facilites

Full-time equivalent employees

Total ..................................................... ...................... ...... 604,800 67,100 198,700 156,700 90,100 92,200

-

Administrativer medical, and therapeutic .......................................... 33,600 4,500

4,000

600

41,000

2,600

5,400

33,000

21,600

44,200

9,900

7,400

2,500

128,400

12,100

18,400

98,000

60,500

137,100

8,400

5,500

2,900

99.900

5,000

2,800

2,200

54.800

5,700

Administrative and medica12 .......................................................

Therapeutic ...............................................................................

22,600

11,000

377,000

44,700

52,900

279,400

194,300

3,000

2,700

52,900

9,100

7,600

36,100

33,500

Nursing .............................................................................................

Registered nurse ..........................................................................

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

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

12,500

14,300

73,100

48,400

8,400

7,300

39,200

All other4 .................... .............................. ....................................... 30,300

OWNERSHIP

Proprietary

Total ......................................................... ............................. 384,400 110,100 45,900 47,200

Administrative, medical, and therapeutic ............................. ...... .......

Nursing .............................................................................................

All other ...........................................................................................

22,400

252,600

109,400

137,900

7,200

75,600

55,100

82,500

3,300

28,500

12,400

15,500

800

8,000

6,700

7,400

7,100

91,800

38,200

41,000

6,100

72,900

31,000

32,700

2,800

29,900

13,200

24,800

3,100

29,500

14,500

23,900

Nonprofit

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

Administrative, medical, and therapeutic ..........................................

Nursing .............................................................................................

All other ............ .............................................................. .................

2,000

23,600

15,400

20,700

1,600

18,700

12,400

13,900

1,200

13,300

10,200

19,400

1,500

12,100

10,400

21,100

Government

Administrative, medical, and therapeutic ..........................................

Nursing .............................................................................................

All other ................................... ........................................................

4,000

48,800

29,700

251,800

400

4,500

*2,500

5,200

800

13,000

6,900

46,300

700

8,300

4,900

85,000

900

11,700

6,800

50,900

1,100

11,300

8,600

64,400

CERTIFICATION

Both Medicare and Medicaid5

Administrative, medical, and therapeutic ..........................................

Nursing .............................................................................................

All other .................................................... ...................... .................

13,700

160,700

77,300

300

3,200

* 1,700

2,200

30,600

13,500

4,100

56,500

24,400

3,000

31,700

16,200

4,200

38,700

21,500

See footnotes at end of table.

50
Table 15. Number of full-time equivalent employees and full-time equivalent employees per 100 beds within 1972 facility total cost per

resident day intervals, by ownership, certification, size, and geographic region: I United States, August 1973-April 1974–COn.

Ownership, certification, size, geographic region,

and type of amployee

CERTIFICATION–Con.

Medicaid only: SNH’S6

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

Administrative, medical, and therapeutic ..........................................

Nursing .............................................................................................

All other ...........................................................................................

Medicaid only: ICF’S

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

Administrative, medical, and therapeutic ..........................................

Nursing .............................................................................................

All other ......................................................................................... ..

Not certified

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

Administrative, madical, and therapeutic ..........................................

Nursing .............................................................................................

All othar .............................................. ................................... ..........

SIZE

Less than 50 beds

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

Administrative, medical, and therapeutic ........... ...............................

Nursing .............................................................................................

All other ..................... ............................ ........ ..................................

50-99 beds

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

Administrative, medical, and therapeutic ..................... ... ..................

Nursing ................................................................................ .............

All other .............................................................................. .............

100-199 beds

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

Administrative, medical, and therapeutic ..........................................

Nursing .............................................................................................

All other ............................... ............................................................

See footnotes at end of table.

Total cost per resident day intervals (1972)

All Less $1o.oo- $15.00 - $20.00- $2:;00

‘nterva’s $%:0 $14.99 $19.99 $24.99 more

Full-time equivalent employees

167,000

8,400

103,900

54,700

116,200

6,600

72,100

37,500

69,900

4,900

40,200

24,800

95,200

7,300

58,400

29,500

198,200

10,900

124,800

62,500

211,900

10,100

135,800

66,100

r

10,600

500

6,600

3,500

32,600

2,200

20,400

10,000

18,800

1,600

10,800

6,400

20,100

2,100

12,300

5,600

25,200

1,400

15,800

8,000

18,400

900

11,000

6,400

69,400

3,200

45,600

20,600

62,300

3,300

39,400

19,600

20,800

1,200

12,800

6,800

31,800

2,000

20,400

9,400

75,700

4,100

48,800

22,800

70,600

2,900

46,700

21,000

41,400

2,300

26,000

13,100

12,500

700

7,200

4,500

17,800

1,300

10,200

6,300

25,300

2,000

16,100

7,300

45,000

2,300

29,400

13,400

60,100

2,900

38,800

18,300

28,400

1,500

17,300

9,600

4,900

300

‘2,800

*1,800

5,900

300

*3,000

●2,600

3,800

*200

*2,300

* 1,200

29,800

1,800

17,700

10,300

34,500

1,700

21,700

11,000

17,200

800

8,500

7,900

4,000

*200

‘2,300

*I ,500

6,600

500

3,400

●2,600

14,300

1,000

7,200

6,000

22,500

1,400

13,100

7,900

28,400

1,700

17,500

9,300

51
Table 15. Number of full-time equivalent employees and full-time equivalent employees per 100 beds within 1972 facility total cost per

resident day intervals, by ownership, certlf ication, size, and geographic region: 1 United States, August 1973-April 1974–Con.

Total cost per resident day intervals (1972 )

Ownership, certlficatlon, size, geographic re~ion,

and type of employee All

intervals

Less

than

$10.00

$1o.oo-

$14.99

SIZE–Con.

200 beds or more

Full-time equivalent employees

Total ...................................................................................... 99,500

5,300

58,000

36,200

154,700

9,700

92,300

52,700

203,500

3,500

*loo

“1 ,800

“1,500

6,700

500

3,300

‘2,800

33,200

2,100

20,700

10,500

21,300

20,600

1,000

12,500

7,200

17,700

1,200

10,800

5,800

71,800

3,500

44,500

23,800

68,600

3,300

46,100

19,200

40,700

2,000

27,000

11,600

26,300

1,300

15,500

9,400

38,300

2,300

24,300

11,700

51,000

3,100

30,900

17,000

35,900

1,500

23,400

10,900

31,500

1,500

21,200

8.800

22,100 27,000

1,600

15,100

10,300

48,800

Administrative, medical, and therapeutic ..........................................

Nursing .............................................................................................

All other ...........................................................................................

1,200

13,100

7,800

43,200

GEOGRAPHIC REGION

Northeast

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

Administrative, medical, and therapeutic ..........................................

Nursing .............................................................................................

All other ...........................................................................................

2,500

25,600

15,100

22,000

1,400

13,300

7,300

14,600

3,300

28,200

17,000

25,400

North Central

Total ......................................................................... ............j

Administrative, medical, and therapeutic ..........................................

Nursing ........................ .....................................................................

All other ...........................................................................................

11,300

123,100

69,100

148,200

1,300

13,500

10,500

7,900

South

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

Administrative, medical, and therapeutic ..........................................

Nursing .............................................................................................

All other ......................... ....................................................... ...........

7,500

97,300

43,500

98,400

5,100

64,300

29,000

1,500

13,500

6,200

6,000

400

3,400

*2,100

700

9,300

4,600

10,300

500

6,600

3,300

400

4,900

“2,600

10,000

.—

700

6,100

3,200

West

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

Administrative, medical, and therapeutic ......................... .................

Nursing ................................................................ .............................

All other ...........................................................................................

Full-time equivalent employees per 100 beds

FACILITY CHARACTERISTICS

All facilities

Total .................................................... ............................. 55.2 II 40.4 1 50.1 ] 58.2 I 65.4 I 73.1

Administrative, medical, and therapeutic ............. .............................

2.4 1.9 2.0 2.0 2.4

0.3 0.6 1.1 1.6 2.2

Administrative and medicalz .......................................................

Therapeutic .................................... ...........................................

2.1

1.0

See footnotes at end of table.

52
Table 15. Number of full-time equivalent employees and full-time equivalent employees per 100 beds within 1972 facility total cost per

resident day . ~ Llnited States, August 1973-April 1974–Con. intervals, by ownership, certification, size, and geographic region.

Total cost per resident day intervals (1972)

Ownership, certification, size, geographic region,

and type of employee All

ntervals

Less

than

$10.00

$1o.oo-

$14.99 I

$15.00- s20.00-

$19.99 $24.99

$25.00

or

more

1

FACILITY CHARACTERISTICS

Full-time equivalent employees per 100beds

All facilities–Con.

Nursing ....................................... .................................... ..................

Registered nurse ................................................................... .......

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

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

All other4 .........................................................................................

OWNERSHIP

34.4 24.7 32.4 37.1 39.8 42.0

4.1

4.8

25.5

17.7

1.5

3.3

19.9

13.0

3.0

4.6

24.7

15.2

4.7

5.3

27.1

18.0

6.1

5.3

28.4

22.0

7.3

6.0

28.7

26.6

Proprietary

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

Administrative, medical, and therapeutic ..........................................

Nursing .............................................................................................

All other ........................................................... ................................

Nonprofit

51.7 40.1 48.6 55.0 58.3 64.5

3.0

34.0

14.7

60.3

3.0

25.9

11.3

41.9

2.5

32.6

13.5

51.9

3.0

36.5

15.5

67.4

3.5

38.0

16.8

72.7

4.3

40.3

19.9

Total ............ ............... ...................... ........ ............................. 79.3

Administrative, medical, and therapeutic ..........................................

Nursing ........................................................................... .. ................

All other ...........................................................................................

.

Government

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

Administrative, medical, and therapeutic ..........................................

Nursing .............................................................................................

All other ...........................................................................................

CERTIFICATION

Both Medicare and Medicaids

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

Administrativer medical, and therapeutic ..........................................

Nursing ....................................................... ......................................

All other ...........................................................................................

Medicaid only: SNH’S6

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

Administrative, medical, and therapeutic ..........................................

Nursing .............................................................................................

All other ...........................................................................................

See footnotes at end of table.

3.1

33.0

24.1

67.2

2.3

21.6

18.0

39.5

2.5

29.9

19.5

58.0

3.3

38.5

25.6

67.4

3.7

39.0

30.0

77.6

5.0

39.9

34.4

92.8

3.2

39.7

24.2

63.1

2.1

23.9

●13.4

54.6

2.3

36.5

19.2

51.8

3.5

40.0

23.8

58.2

3.8

46.6

27.2

67.8

4.8

50.0

38.0

70.7

3.3

39.1

18.8

56.9

2.7

34.1

*1 7.9

43.3

2.5

34.2

15.1

50.4

2.8

38.6

16.7

58.6

3.9

42.3

21.6

67.3

4.6

42.5

23.6

92.4

2.8

35.4

18.6

2.1

26.8

14.3

2.4

33.1

14.9

3.2

36.8

18.5

3.5

41.1

22.8

4.4

45.4

42.6

53
Table 15. Number of full-time equivalent employees and full-time equivalent employees per 100 beds within 1972 facility total cost per

resident day intervals, by ownership, certification, size, and geographic region: 1 United States, August 1973-April 1974–Con.

Total cost per resident day intervals (1 972)

Ownership, certification, size, geographic region,

and type of employee All

intervals

Less

than $1o.oo-

$10.00 $14.99

$15.00-

$19.99

$20.00-

$24.99

$25.00

or

more

CERTIFICATION–Con.

Full-time equivalent employees per 100 beds

Medicaid only: ICF’S

Total ................. ..................................................................... 47.7

2.7

29.6

15.4

47.5

41.7

2.8

26.1

12.8

34.9

49.5

2.6

31.3

15.6

47.6

50.6 52.4 69.4

Administrative, medical, and therapeutic ........................ ..................

Nursing .............................................................................................

All other ................................................................. ..........................

Not certified

2.8

29.4

18.5

64.2

2.7

*30. I

‘19.6

52.5

‘4.0

“39.6

*25.8

Total ...................................................................................... 62.1

Administrative, medical, and therapeutic ..........................................

Nursing .............................................................................................

All other ...........................................................................................

SIZE

Less than 50 beds

3.3

27.3

16.8

56.6

3.0

20.0

11.8

40.9

2.7

29.3

15.6

51.8

4.7

36.8

22.7

66.9

5.3

42.5

19.2

56.3

2.5

*26.4

*23.5

58.7

*3.7

*36.4

*18.5

75.3

4.7

32.5

‘24.8

105.0

7.4

53.1

44.5

68.4

4.4

34.7

17.5

54.0

4.4

25.1

11.4

39.8

3.2

33.3

15.4

50.0

Administrative, medical, and therapeutic ..........................................

Nursing ................................... ..........................................................

All other .......... .................................................................................

100-199 beds

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

3.0

34.0

17.0

54.8

2.6

35.1

17.1

57.4

2.2

24.9

12.7

40.6

2.7

32.2

15.1

51.0

2.8

36.7

16.7

57.3

4.4

44.7

26.1

59.8

4.2

40.0

24.2

70.4

.—

4.2

43.3

23.0

68.8

Administrative, medical, and therapeutic ..........................................

Nursing .............. .............................. .... . ......................................

All other ...........................................................................................

200 beds or more

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

Administrative, medical, and therapeutic ..........................................

Nursing. ...................................................................... .... . ...........

All other ...........................................................................................

See footnotes at end of table.

1.9

24.4

14.2

41.7

2.1

33.7

15.2

45.7

2.7

37.1

17.5

56.5

3.0

37.7

19.1

64.7

3.0

33.5

20.9

*1.8

*21.9

*18.O

2.1

27.7

16.0

2.8

33.4

20.3

3.7

38.3

22.8

4.2

38.4

26.2

54
Table 15. Number of full-time equivalent employees and full-time equivalent employees per 100 beds within 1972 facility total cost per

.I IJnited States, August 1973-April 1974–Con. resident day intervals, by ownership, cx?rtification, size, and geographic region.

Ownership, certification, size, geographic region,

and type of employee

GEOGRAPHIC REGION

Total cost per resident day intervals (1972)

$25.00

or

more

Less

than

$10.00

All

intervals

$1o.oo-

$14.99

$15.00-

$19.99

$20.00-

$24.99

Full-time equivalent employeas per 100 beds

Northeast

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

Administrative, medical, and therapeutic ..........................................

Nursing .............................................................................................

All other ...........................................................................................

North Central

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

Administrative, medical, and therapeutic ............. .............................

Nursing ............................................ ......................................... ........

All other ........................... ............ .................................................. ..

South

65.6 46.4 53.2 62.0 68.6

3.9

40.7

24.0

62.8

76.8

5.2

44.4

27.3

78.6

4.1

39.1

22.3

53.7

3.7

23.3

●19.4

40.5

3.5

32.4

17.3

50.6

3.7

39.4

18.9

58.3

3.0

32.5

18.2

51.2

2.5

25.3

12.7

39.8

2.4

31.3

16.8

49.6

3.5

35.3

19.4

60.9

3.9

38.0

20.9

61.6

4.0

42.3

32.3

Total ............................................ ............ .............................. 51.9

Administrative, medical, and therapeutic ........................................ ..

Nursing .............................................................. ........................ ...... .

All other ..................................................... ......................................

2.6

33.6

15.0

51.5

2.9

25.3

11.6

37.0

2.4

33.3

13.9

49.0

2.6

39.8

18.5

51.7

2.9

39.3

19.4

64.0

2.9

32.0

*1 7.0

67.3

West

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

Administrative, medicel, and therapeutic ................................ ........ ..

Nursing ........................ .....................................................................

All other .................................... ...................................... .................

2.7

33.6

15.2

2.6

21.1

●13.3

2.4

32.5

14.0

2.5

34.7

14.5

2.9

40.9

20.2

4.7

41.1

21.4

lEstimateS are for nusing homes that had been in business 2 years or more at the time of the ?.UrVeY.Expenses for newlY opened

facilities were not collected because they include “startuu” costs for purchasing drugs, supplies, and equipment and therefore do not

reflect the standard cost of providing heaith care.

21ncludes administrators, physicians, dentista, pharmacists, dietitians, medical records administrators and other professional staff.

31n~ludes occupational therapists, physical therap~ts, speech pathologists, audiologists, actwities dmectors, social workers, and their

assistants.

41n~1udes clerical, food ser~ce, housekeeping, and maintenance personnel m well as any other Staff nOt performing nUrSing,

administrative, medical, or therapeutic functions.

Sof these facilities, 7 percent were certified for Medicare OIdY.

60f these facfities, 33 percent were certified as both SNH’S and lCF’S.

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

55
Table 16. Yearly labor cost per full-time equivalent employee within total cost per resident intervals, by ownership, certification, size,

and geographic region: 1 United States, 19722

Ownership, certification, size, and geographic region

All facil ities ...........................................................................

Ownership

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

Nonprofit ..............................................................................................

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

Certification

Both Medicare and Madicaid3 ...............................................................

Medicaid only:

SNH’S4 ............................................................................................

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

—Size

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

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

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

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

Geographic region

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

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

Total cost per resident day intervals

Al I Less

inter- than $10.00- $15.00- $20.Cro- $2:;00

vals $10.00 “4.99 $19.99 $24.99 more

Yearly labor cost per full-time equivalent employee

$5,641

5,614

5,290

6,352

6,718

5,421

4,901

5,673

4,982

5,362

5,615

6,860

6,915

5,331

4,977

5,278

$3,968

4,016

3,677

4,288

2,885

4,203

3,927

4,204

3,885

4,009

4,018

3,882

3,405

4,126

3,751

4,486

$4,801

4,809

4,688

4,969

4,910

4,676

4,824

4,905

4,973

4,817

4,623

5,086

6,393

4,758

4,608

4,943

$5,504

5,653

4,825

5,925

5,284

5,840

6,341

5,191

4,990

5,496

5,573

5,858

5,986

5,510

4,994

5,492

$6,368

6,390

5,924

6,880

6,006

6,483

8,126

7,469

7,259

5,522

6,798

6,683

6,536

6,227

6,436

5,866

$8,188

8,599

7,346

8,227

8,434

6,415

5,589

11,998

5,933

8,232

7,760

9,788

9,010

7,386

8,677

5,829

lEstimates are for nursing homes that had been in business 2 years or more at the time Of the WrveY. Expenses for new:~Yopened

facilities were not collected because they include “startup” costs for purchasing drugs, supplies, and equipment and therefore do not

reflect the standard cost of providing health care.

2Assumes that the number of full-time equivalent employees in nursing homes during the survey period (August 1973-April 1974)

was substantially simikw to the number in nursing homes in 1972.

30f these facilities, 7 percent were certified for Medicare only.

40f these facilities, 33 percent were certified as both SNH’S and ICJ?’S.

56
,,

Table 17. Number of nursing home residents and rate per 100 residents within 1972 facility total cost per resident day intervals, by

reported chronic conditions and impairments and primary diagnosis at last examination and at admission. ‘1 United States, August

1973-April 1974

Reported chronic conditions and impairments

andprimary diagnosis at Iast examination

and at admission

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

Reported chronic conditions and impairments

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

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

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

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

Paralysis or palsy due to stroke ....................................................

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

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

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

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

Amputation of extremities or limbs; or permanent stiffness or

any deformity of foot, leg, fingers, arms, or back ......... ............

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

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

Primary diagnosis at last examination

Senility, oldage, other symptoms andilldefined conditions ......

Heart atiack .................................................................................

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

Hardening of the a~eries ..............................................................

Diseases of the circulatory system other than hardening of the

arteries, stroke, and heart attack ..............................................

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

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

Diseases of themusculoskeletal system and connective tissue .....

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

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

Endocriner nutritional, and metabolic diseases ............................

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

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

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

Other diagnoses3 ..........................................................................

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

Primary diagnosis at admission

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

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

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

Hardening of the arteries ..............................................................

Diseases of the circulatory system other than hardening of the

arteries, stroke, and heart attack ..............................................

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

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

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

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

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

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

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

See footnotes at end of table.

Total cost per resident day intervals (1972)

All

Less

$10.00- $15.00- $20.00- $25.00

than

intervals $10.00 $14.99 $19.99 $24.99 more

‘r

Number of residents

905,200

525,500

163,900

59,500

314,700

101.400

56,400

96,000

120,900

89,000

124,500

304,400

48,900

120,400

46.600

95,700

207,300

34,300

41,200

93,400

62,200

41,000

19,200

21,100

53,100

18,000

13,500

13,600

7,400

90,100

49,800

112,000

190,700

29,900

80,000

99,100

53,000

378300

19,900

19,600

50,400

139,200

76,200

34,400

15,700

48,100

11,900

8,300

13,600

15,300

12,300

17,600

37,800

6,600

21,000

7,400

11,500

26,700

6,000

4,400

24,000

8,900

6,400

2,800

*1 ,400

8,500

3,100

‘1,500

2,700

‘ 1,800

16,500

7,500

13,600

25,700

5,400

8,100

26,300

7,000

5,500

2,400

* 1,200

8,500

328,600

203,100

64,500

22,900

125,000

36,300

22,200

32,900

44,100

35,000

49,500

110,500

13,800

42,300

17,200

34,400

76,500

12,000

13,000

34.300

26,700

14,900

6,800

7,700

18,500

6,400

4,800

4,000

2,900

31,600

17,800

40,500

72,400

9,700

28,600

37,500

22,000

13,500

7,200

7,000

17,300

223,300

131,600

36,400

12,300

72,500

25,700

12,400

22,400

31,000

21,000

29,900

78,500

13,700

27,400

12,000

26,300

51,000

8,800

10,900

22,100

13,700

10,100

4,800

5,300

12,400

4,400

4,100

3,400

‘ 1,500

19,600

13,300

30,100

45,700

7,500

21,400

21,700

11,700

9,400

5,400

5,200

11,500

112,500

62,800

16,800

4,800

38,800

13,400

8,100

13,800

15,900

11,400

14,900

38,100

8,500

14,100

4,900

11,400

27,600

4,400

6,800

8,100

7,700

5,600

2,300

3,900

7,600

*1 ,900

● 1,700

“1,700

’600

8,800

5,600

13,700

24,700

3,900

12,000

8,200

7,300

5,400

2,300

3,400

7,200

101,500

51,800

11,900

3,800

30,300

14,100

5,400

13,300

14,700

9,300

12,70Cl

39,500

6,300

16,400

5,100

12,100

25,500

3,100

6,100

4,900

5,200

4,000

2,500

2,900

6,200

2,300

*1 ,400

● 1,800

“600

13,700

5,500

14,100

22,100

3,500

9,900

5,400

5,000

3,500

2,700

2,800

6,000

57
Table 17. Number of nursing home residents and rate per 100 residents within 1972 facility total cost per resident day intervals, by

raported chronic conditions and impairments and primary diagnosis at last examination and at admission. “1 United States, August

1973-April 1974–Con.

Reported chronic conditions and impairments

and primary diagnosis at last examination

and at admission

Primary diagnosis at admission–con,

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

Diseases of the ganitourinary system ............................................

Other diagnoses2 ................................................ ..........................

Unknown d(agnoses ................................................................... ..

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

Reported chronic conditions and impairments

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

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

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

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

Paralysis or palsy due to stroke ....................................... .......... ...

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

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

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

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

Amputation of extremities or limbs; or permanent stiffness or

any deformity of foot, leg, fingers, arms, or back .... ..................

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

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

Primary diagnosis at last examination

Senility, old age, other symptoms and ill-defined conditions .......

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

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

Hardening of the arteries ..............................................................

Dkeases of the circulatory system other than hardening of the

arteries, stroke, and heart attack .......... .....................................

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

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

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

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

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

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

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

Disaases of the digestive system ...................................................

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

Other dagnoses3 ................................................... .......................

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

Primary diagnosis at admission

Senility, old age, other symptoms and Ill-defined conditions ......

Haart attack .................................................................................

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

Hardening of the aReries ........................................... ...................

Diseases of the circulatory system other than hardening of the

arterias, stroke, and heart attack ...............................................

See footnotes at end of table.

Total cost per resident day intervals (1972)

All

Less $1o.oo- $15.00- $20.00- $25.00

than

intervals $10.00 $14.99 $19.99 $24.99 ‘r

more

18,700

13,200

20,500

5,200

. . .

58.1

18.1

6.6

34.8

11.2

6.2

10.6

13.4

9.8

13.8

33.6

5.4

13.3

5.1

10.6

22.9

3.8

4.6

10.3

6.9

4.5

2.1

2.3

5.9

2.0

1.5

‘1.5

0.8

10.0

5.5

12.4

21.1

3.3

2,700

“1,800

3,900

*1 ,200

. . .

54.8

24.7

11.3

34.6

8.6

5.9

9.8

11.0

8.8

12.6

27.1

4.8

14.4

5.3

8.3

19.2

4.3

3.1

17.2

6.4

4.6

2.0

*1.O

6.1

2.2

*1.1

‘1.9

*1.3

11.8

5.4

9.8

18.5

3.8

Number of residents

6,300 I

5,300

4,300 3,700

5,900 6,100

● 1,500 *1 ,300

Rate per 100 resident:

61.8

19.6

7.0

38.0

11.0

6.8

10.0

13.4

10.7

15.1

33.6

4.2

12.9

5.2

10.5

23.3

3.6

4.0

10.4

8.1

4.5

2.1

2.3

5.6

1.9

1.5

1.2

0.9

9.6

5.4

12.3

22.0

2.9

. . .

58.9

16.3

5.5

32.4

11.5

5.6

10.0

13.9

9.4

13.4

35.2

6.1

12.3

5.4

11.8

22.8

3.9

4.9

9.9

6.1

4.5

2.2

2.4

5.5

2.0

1.8

1.5

“0.7

8.8

6.0

13.5

20.4

3.4

*2,200

‘2.100

2,700

* 500

. . .

55.8

14.9

4.3

34.5

11.9

7.2

12.3

14.1

10.1

13.2

33.9

7.5

12.6

4.3

10.1

24.5

3.9

6.1

7.2

6.8

4.9

2.0

3.4

6.8

++1.7

*1.5

+1 .5

*0.6

7.8

5.0

12.1

21.9

3.5

‘2,200

*1 ,300

* 1,800

* 700

. . .

51.0

11.7

3.7

29.9

13.9

5.3

13.1

14.5

9.1

12.5

38.9

6.3

16.2

5.1

11.9

25.1

3.0

6.0

4.8

5.1

3.9

2.5

2.9

6.1

2.2

*1.3

*1.7

*0.6

13.5

5.4

13.9

21.8

3.4

58
Table 17. Number of nursing home residents and rate per 100 residents within 1972 facility total cost per resident day intervals, by

reported chronic conditions and impairments and primary diagnosis at last examination and at admission: 1 United States, August

1973-April 1974–Con.

Reported chronic conditions and impairments

and primary diagnosis at Iast examination

and at admission

Primarv diagnosis at admission–Con.

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

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

Diseases of themusculoskeletal system and connective tissue .....

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

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

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

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

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

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

Other diagnos=2 ............................................................... ...........

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

Total cost per resident day intervals (1972)

All

Less

$1o.oo- $15.00- $20.00- $25.00

than

intervals $10.00 $14.99 $19.99 $24.99 more

‘r

1

8.8 5.8

11.0 18.9

5.9 5.0

4.1 3.9

2.2 1.7

2.2 *0.9

5.6 6.1

2.1 1.9

1.5 ●1.3

2.3 2.8

0.6 *0.8

Number per 100 residents

8.7

11.4

6.7

4.1

2.2

2.1

5.3

1.9

1.3

1.8

‘0.5

9.6

9.7

5.2

4.2

2.4

2.3

5.1

* 2.4

*1.7

2.7

“0.6

10.7

7.3

6.5

4.8

2.0

3.1

6.4

2.0

1.9

2.4

0.5

9.7

5.3

4.9

3.5

2.7

2.7

5.9

*2.2

*1.3

●1.8

“0.7

lEstimate~ are for nursing home5 that had been in business 2 years or more at the time of the s~veY- Expenses for newly opened

facilities were not collected because they include “startup” costs for purchasing druga, supplies, and equipment and therefore do not

reflect the standard cost of providing health care.

2C~lumns donotadd tototals because most residents hadmore than one reported condition or impairment.

31nc1udes disease5 of the blood and blood.forming ~rgans, d&asm of the skin and subcutaneous tissue, congenital riIIOSTdieS,

infective and parasitic diseases, certain careesof perinatal morbidity, complications of pregnancy and childbirth, an dother diagnoses not

listed above.

59
Table 18. Number of nurs!ng home residents and rete per 100 residents within 1972 facility total cost per resident day intervals, by

measures of dependence inactivities of daily living (ADL):l United States, August 1973-April 1974

Activities of daily living dependence categories and index

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

ADL dependence categories

Bathing ....................... ................................................................

Dressing .......................................................... .............................

Going to toilet .............................................................................

Transferring ................................................................................

Continence. ..................................................................................

Feeding. ................ .......................................................................

ADL dependence index3

A–No ADL dependencies ............................................................

B–Dependent in only one ADL ...................................................

C–Dependent in bathing and one additional AD . ......................

D-Dependent in bathing, dressing, andoneadditional ADL ......

E–Dependent in bathing, dressing, going totoilet, andone additional ADL ...............................................................................

F–Dependent in bathing, dressing, going to toilet, transferring,

and one additional ADL ...........................................................

G–Dependent in all six ADL's .....................................................

0ther4. ........................................................................................

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

ADL dependence categories

Bathing ........................................................................................

Drassing .......................................................................................

Going to toilet .............................................................................

Transferring .................................................................................

Continence ...................................................................................

Fading . ...... .................................................................................

ADL dependence index3

A–No ADL dependencies ............................................................

B–Depandant in only one ADL ...................................................

C–Dependent in bathing and one additional ADL ......................

D–Dependent in bathing, drassing, and ona additional ADL ......

E–Dependent in bathing, dressing, going to toilet, and one additional ADL ...............................................................................

F–Dep~ndent in bathing, dressing, going to toilet, transferring,

and one additional ADL ...........................................................

G–Dependent in all six AD Us .....................................................

Other4. ........................................................................................

Total cost per rasident day intervals (1972)

All

Less

$1o.oo- $15.00- $20.00-

$~5.f30

than

intewals $10.00 $14.99 $19.99 $24.99 ‘r more

Number of residents

640,200

532,800

476,700

467,200

306,000

159,600

213,000

115,200

76,500

40,400

129,100

144,800

130,400

55,900

70.7

58.9

52.7

51.6

33.8

17.6

23.5

12.7

8.4

4.5

14.3

16.0

14.4

6.2

87,700

66,200

53,400

52,100

37,000

19,300

45,200

22,200

14,100

6,200

13,400

16,600

15,200

6,300

. . .

—,.

63.0

47.5

38.4

37.4

26.6

13.8

32.5

15.9

10.1

4.5

9.6

11.9

10.9

4.5

328,600

239,700

198,000

174,500

171,400

115,400

63,000

70,700

44,400

29,700

13,600

46,300

52,300

51,300

20,200

223,300

163,000

139,900

126,500

123,100

82,500

40,600

48,100

24,800

18,000

10,900

33,800

40,400

33,600

13,700

Rate per 100 residents

. . .

73,0

60,3

53.1

52,1

35.1

19.2

21.5

13.5

9.1

4.1

14.1

15.9

15.6

6.1

. . .

73.0

62.6

56.6

55.1

36.9

18.2

21.5

11.1

8.0

4.9

15.1

18.1

15.0

6.1

112,500

80,300

67,800

63,600

63,900

38,500

20,000

26,100

12,300

7,600

4,700

18,500

19,400

16,700

7,200

. . .

71.4

60.3

56.5

56.8

34.2

17.8

23.2

11.0

6.7

4.1

16.5

17.2

14.8

6.4

101,500

69,400

60,900

58,700

56,800

32,700

16,700

22,900

11,400

7,100

5,000

17,100

‘16,000

13,600

8,400

. . .

68.4

60.0

57.B

55.9

32.2

16.4

22.5

11.2

7.0

4.9

16.9

15.8

13.4

8.3

1~timate~ are for nursing homes that had been in business 2 years or more at the time of the surveY. Expenses for newlY opened

facilities were not colIected because they include “startup” costs for purchasing drugs, supplies, and equipment and therefore do nbt

reflect the standard cost of providing health care.

2Depen&n~y jn the six ADL functions was determined from question 14 of the Resident Questionnaire (aPPendix 1~1) ~Y the

following cutoff points (i.e., greater levels indicating debility): bathing, dressing, and feedhg-level 2; going to toilet, transferring, and

continence-level 1. Columns do not add to totals because residents could be dieabled in more than one ADL.

3T’he form of the ADL jndex is suggested by the work of Dr. Sjdney Katz m-d hiscolleagues(Seereferences 8 and 9 Of thisreport).

41ncludesthose individualsdependent in at leastt~~ functions, but not ~lusifi~le into level c, D, E, or F.

60
Table 19. Number and pertent distribution af nursing home residents within 1972 facility total cost per resident day intervals, by

primary reason for admission and level of patient care: 1 United States, August 1973-April 1974

Primary reason for admission and level of patient care

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

Primary reason for admission

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

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

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

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

Level of patient care

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

Limited nursing care ................................................................. ...

Routine nursing care ................... .................................................

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

No nursing or personal care ..........................................................

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

Primary reason for admission

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

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

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

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

Level of patient care

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

Limited nursing care ............................................................ ........

Routine nursing care ............................................ ........................

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

No nursing or personal care ..........................................................

Total cost per resident day intervals (1972)

All Less

$1o.oo- $15.00- $20.00-

$25.00

than intervals $10.00 $14.99 $19.99 $24.99

more

0’

Number

905,200

734,200

61,100

100,300

9,500

369,700

89,200

293,900

144,300

8,100

100.0

81.1

6.8

11.1

1.1

40.8

9.9

32.5

15.9

0.9

139,200

97,500

16,100

23,600

“2,100

40,600

13,800

49,400

32,200

3,200

100.0

70.0

11.6

16.9

*1.5

29.1

9.9

35.5

23.2

2.3

328,600

267,2oo

20,000

38,500

2,900

138,100

33,200

110,900

44,800

*1 ,500

223,300

185,300

12,300

23,100

2,700

97,300

19,900

69,300

35,300

*1,500

Percent distribution

100.0

81.3

6.1

11.7

0.9

42.0

10.1

33.7

13.6

‘0.5

100.0

83.0

5.5

10.3

1.2

43.6

8.9

31.0

15.8

*0.7

112,500

94,800

8,000

8,800

“900

51,800

11,700

31,600

15,900

*1,500

100.0

84.3

7.1

7.8

“0.8

46.0

10.4

28.1

14.1

*1.3

101,500

89,400

4,800

6,500

*900

41,900

10,600

32,600

16,000

’400

100.0

88.0

4.7

6.4

‘0.9

41.3

10.4

32.2

15.7

‘0.4

lEstimate~ are for ~ur~ing homes that had been in business 2 years or more at the time of the SUrveY. Expenses for newlY opened

facilities were not collected because they include “startup” costs for purchasing drugs, supplies, and equipment and therefore do not

reflect the standard cost of providing health care.

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

61
Table 20. Number and percent distribution of nursing home residents within 1972 facility total cost per resident day intervals, by

primary source of payment: 1 United States, August 1973-April 1974

Primary scrurce Of payment

All residents2 .................................................................

All residents2 .................................................................

Total cost per resident day intervals (1 972)

All

intervals

Less

than

$10.00

$1o.oo- $15.00- $20.00-

$25.00

$14.99 $19.99 $24.99 ‘r more

852,700

318,400

9,100

406,300

93,600

25,300

133,300

50,300

*loo

45,600

33,500

3,800

Number

==I==

113,900 I 84,700

*1,100 “2,200

160,300 101,100

29,300 14,800

8,500 5,300

Percent distribution

100.0II 100.0 I 100.0I 100.0

106,500

r

91,600

41,300 28,100

2,700 3,000

50,500 48,700

8,100 8,000

3,900 3,800

I 100.0I 100.0

37.3 37.7 36.4 40.7 38.8

r

30.7

1.1 *0. I ‘0.4 1.1 2.5 3.3

47.6 34.2 51.2 48.6 47.4 53.1

11.0 25.1 9.4 7.1 7.6 8.8

3.0 2.9 2.7 2.6 3.7 4.2

1Estimates are for nursing homes that had been in business 2 years or more at the time of the surveY. Expenses for newlY Opened

facilities were not collected because they include “startup” costs for purchasing drugs, supplies, and equipment and therefore do not

reflect the standard cost of providing health care.

21ncludes only those residents in the nursing home for 1 month or more at the time Of the SUrveY.

31ncludes church support, VA contract, initial payment/life care, no charge, and miSCdkiWXSS SOurceS.

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

62
APPENDIXES

I.

IL

III.

L

IL

III.

IV.

v.

VI.

WI.

VIII.

Ix.

x.

XL

CONTENTS

Technical Notes on Metiods .........................................................................................................

Survey Desi~ ..........................................................................................................................

Sampliig Frame ................................................................................................................

Sampliig Design ................................................................................................................

Data Collection Procedures for the 1973-74 National Nursing Home Survey ....................

“General Qufllfications .............................................................................................................

Nonresponse and Imputation of Missing Data ....................................................................

Rounding of Numbers ........................................................................................................

Data Processbg ..................................................................................................................

Estimation Procedures .......................................................................................................

Reliabfity of Estkates ...........................................................................................................

Hypothesis Testing ..................................................................................................................

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

Terms Relating to FaciEties .....................................................................................................

Terms Relating to Residents ....................................................................................................

Terms Relating to Employees ..................................................................................................

Selected Questionnaires Used in the 197$74 National Nursing Home Survey ..............................

Letter to Atitistmtor ...........................................................................................................

Faeilky Questionnaire ................................................f ...........................................................

Expense Questionnaire ............................................................................................................

Resident Control Record .........................................................................................................

65

65

65

66

67

68

68

68

68

68

68

77

81

81

82

83

84

84

87

95

103

Resident Questionnaire ........................................................................................................... , ~K

Staff Classification Cmd .......................................................................................................... ;~~

Staff Control Record ............................................................................................................... 114

LIST OF APPENDIX TABLES

Distribution of facilities in the 1973-74 National Nursing Home Survey universe and disposition

. . .

of sample facrhties according to prnnary sarnplmg strata: Cotermmous Umted States ............... 66

Summary of data collection procedures ....................................................................................... 68

Standard errors of average total cost per resident day ................................................................... 71

Standard errors of average labor cost per resident day .................................................................. 71

Standard errors of average other (operating, fixed, and miscellaneous) cost per resident day ....... 72

Standard errors of percentages of total costs ................................................................................ 72

Standard errors of percentages of labor costs ................................................................................ 73

Standard errors of percentages of other (operating, fixed, and miscellaneous) costs ..................... 73

Standard errors of percentages for facilities .................................................................................. 74

Standard errors of percentages for beds ........................................................................................ 74

Standard errors of percentages of residents ................................................................................... 75

63
XII. Standard errors of percentages for admissions, live discharges, and deaths .................................... 75

XIII. Standard errors of occupancy rates............................................................................................... 76

XIV. Worksheet for weighted least squares regression of admissions per 100 beds, by total cost per

L

11.

III.

resident day: United States, 1972 .............................................................................................. 80

LIST OF APPENDIX FIGURES

Relative standard error curves for estimated numbers of admissions and live discharges, deaths,

beds, residents, and facilities ...................................................................................................... 70

Relative standard error curves for estimated number of resident days .......................................... 77

Relative standard error curves for estimated number of full-time equivalent employees ............... 78

64
TECHNICAL

SURVEY DESIGN

APPENDIX I ,

NOTES ON METHODS

From August 1973 to April 1974, the Division of Health Resources Utilization Statistics

(DHRUS) conducted the Nationzd Nursing

Home Survey (NNHS)–a sample survey of nursing homes, their residents, and staff in the coterminous 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.10 It was specifically designed as the first of a series of surveys to satisfy the diverse data needs of those

who establish standards for, plan, provide, and

assess long-term care services.

Sampling Frame

The 1973-74 NNHS focused on nursing

homes that provided some level of nursing care.

Only facilities providing nursing care were included because detailed questions on faciIity

services and resident health status were relevant

only to these facilities. They included both nursing care homes and personaI care homes with

nursing, while personal care homes and domiciliary care homes were excluded. Facilities were

either freestanding establishments or nursing

care units of hospitals, retirement centers, and

similar institutions. A definition of nursing care

and detailed criteria for classifying facilities providing such care are presented in appendix IL

The survey universe consisted of two groups

of facilities: those providing some level of nursing care as classified in the 1971 Master Facility

Inventory (MFI) and those opening for business

in 1972. The major group (93 percent) was composed of all nursing homes providing some level

NOTE: A list of references follows the text.

of nursing care as classified by the 1971 MFI.

The MFI is a census of all inpatient health facilities conducted every 2 years by mail by the

National Center for Health Statistics (NCHS).

A detailed description of how the MFI was developed, its content, and procedures for updating its coverage has been pubfished.1 1‘1s

In order for data collection to begin in August, the sampling frame was “frozen” in the

spring of 1973 so that the sample could be selected in ample time to permit the scheduling of

nationwide data collection. To obtain as current

a sample frame as possible, all nursing homes

that opened for business during 1972 were also

included in the universe. (Facilities opening in

early 1973 could not be included since data

about them were not yet available.) The facilities that opened in 1972 made up the second,

and smaller< (7 percent), group of facilities in the

universe. Although the universe included only

facilities providing nursing care, all facilities

opened in 1972 were included because the Ievel

of nursing care they provided was unknown

prior to the survey. Once the NNHS was conducted, facilities not meeting the criteria were

classified as out of scope (see table I for details).

Although the NNHS was conducted in

1973-74, it should be noted that estimates will

not correspond precisely to figures from the

1973 MFI census for several reasons. Ii comparison to the MFI, the NNHS universe excIuded the

following: (1) personal care homes and domiciliary care homes; (2) facilities that opened in

1973; and (3) facilities that, between 1971 and

1973, upgraded the level of care they provided,

thereby meeting the “nursing care” criteria

when surveyed in the 1973 MFI. Data from the

65
Table 1. Distribution of homes in the 1973-74 National Nursinq Home Survey universe and disposition of sample homes according to

primary sampling strata: -Coterminous ‘United States

Number of homes in sample

Certification status and size of home

All types ...................................................................................................

Both Medicare and Medicaid and Medicare only ...........................................

Unknown beds ... ............................................................ ...........................................

Less than 25 beds .......................................................... ............. ..............................

25-49 beds ......... ........ ...............................................................................................

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

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

200-299 beds ........... ..................... ............................................................................

300499 beds .................. ................................................................................ ..........

500 beds or more ............. ........ ...... ...........................................................................

Medicaid only ..................... ..................................... ......................................

Unknown beds ..................................... ...... ...... ............................ ........................ .....

Less than 15 beds ......................................................... ............................................

15-24 beds .......................................... ...... ..................... ........................... ................

2549 be& ........................................... .................................................... .................

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

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

200-299 beds .................. .................................................... ......................................

300-499 beds ......................................................... ............. ......................................

500 beds or more ..... .................................................................................................

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

Unknown beds ..........................................................................................................

Less than 15 beds .....................................................................................................

15-24 beds ................................................................................................................

25-49 beds ..................... ...... .....................................................................................

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

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

200-299 beds ...................................... ........................... ...........................................

300-499 beds ............................................................... ................ .............................

500 beds or more ........... ........................... .......................... ......................................

Universe

(sampling

frame) 1

17,6B5

4,089

2

149

538

1,713

1,385

224

68

20

7,473

3

250

967

2,253

2,688

1,108

145

43

16

6,113

19

1,279

1,062

1,575

1,334

652

120

52

20

Total

homes

2,118

803

0

4

35

228

370

100

46

20

790

0

5

36

123

293

241

52

24

16

525

0

23

38

87

145

141

43

28

20

out of

scope

or out

of business

147

20

0

0

0

7

8

4

1

0

34

0

1

5

11

4

3

5

3

2

93

0

10

9

13

19

21

12

4

5

In scope and

in business

Non- ~e

respond- spending ing

63 I 1$08

26 ] 757

-L

o 0

1 3

1 34

7 214

11 351

3 93

2 43

1 19

24 732

0 0

:2 2

‘1 30

:3 108,

8 281

6 232

3 44

1 20

() 14

13 I 419

()

o

()

3

5

4

0

11

c)

o

13

29

71

121

116

31

23

15

1The ~niver~e consisted ~f ~uming homes providing some level of nursing care as classifiedin the1971M3?1andhmna~Omnedfor

businessin 1972.

NNHS are also subject to sampling variability;

data from the MFI are not, since the MFI is a

census.

Sampling Design

The sampling was a stratified two-stage probability design: The first stage was a selection of

establishments and the second stage was a selection of residents and employees of the sample

establishments. In preparation for the first-stage

sample selection, establishments listed in the

MM were sorted into three types of strata based

on Medicare and Medicaid certification: (1) both

Medicare and Medicaid and Medicare only, (2)

Medicaid only, and (3) not certified. Facilities in

each of these three strata were sorted into bedsize groups, producing 26 primary strata as

shown in table I. The nursing homes in the universe were ordered by type of ownership, geographic region, State, and county. The sample

66
was then selected systematically after a random

start within each primary stratum. Table I shows

the distribution of establishments in the sampling frame and the final disposition of the sample with regard to response and in-scope status.

The number of facilities estimated by the survey

(15,749) is less than the universe figure (1 7,685)

because some facilities went out of business or

became out of scope between the time the universe was “frozen” and the survey was conducted. Differences ranging from 2,100-2,900

between survey estimates and universe figures

occurred in the 1963,14 1964,15 and 196916

nursing home surveys for the same reason.

The second-stage selection of residents and

employees was carried out by the interviewers at

the time of their visits to the establishments in

accordance with specific instructions given for

each sample establishment. The sample frame

for residents was the total number of residents

on the register of the establishment on the evening prior to the day of the survey. Residents

who were physically absent from the facility because of overnight leave or a hospitaI visit but

had a bed maintained for them at the establishment were included in the sample frame. An

average of 10 residents were in the sample per

facility.

The sampling frame for employees was the

Staff Control Record on which the interviewer

listed the names of all staff (including those employed by contract) and sampled professional,

semiprofessional, and nursing staff. Those generally not involved in direct patient care, such as

office staff, food service, housekeeping, and

maintenance personnel, were excluded from the

sample. The interviewer used predesignated sampling instructions that appeared at the head of

each column of this form. An average of 14

staff persons were in the sample per facility.

Data Collection Procedures for the

1973-74 National Nursing Home Survey

The 1973-74 NNHS utilized eight questionnaires. (See appendix III for copies of questionnaires relevant to this report. For all other data

collection instruments, see reference 1.) The

eight questionnaires were:

Administrator letter and worksheet

Facility Questionnaire

Expense Questionnaire

Resident Control Record

Resident Questionnaire

Staff Questionnaire-Parts I and II

Staff Control Record

Data were coIlected according to the foUowing procedure:

1.

2.

3.

A letter was sent to the administrators of

sample facilities informing them of the

survey and the fact that an interviewer

would contact them for an appointment.

On the back of the Ietter was a worksheet that the administrator was requested to fill out prior to the interviewer’s visit. This worksheet asked for

those data (such as total admissions and

discharges, inpatient days of care, etc.)

that required both access to records and

some time in compiling. IncIuded with

this introductory letter were.. letters of

endorsement from the Americ& Nursing

Home Association and the American Association of Homes for the Aging urging

the administrators to participate in 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 following procedures were followed: The

intem’iewer completed the Facility Questionnaire when he interviewed the administrator or owner of the facility.

After completing this form, the interviewer secured the administrator’s permission to send the Expense Questionnaire to the facility’s accountant. (If

financial records were not kept by an

outside firm, the Expense Questionnaire

was filled out by the administrator, with

the interviewer present.) The interviewer

completed the Staff Control Record (a

list of all currently employed staff both

full and part time), selected the sample

of staff from it, and prepared Staff Questionnaires, Parts I and II, which were left

67
If

for each sample staff person to complete, seal in addressed and franked envelopes (one for each part of the questionnaire), and return either to the

interviewer or by mail. The interviewer

then completed the Resident Control

Record (a list of all residents currently in

the facility), selected the sample of residents from it, and filled a Resident Questionnaire for each sample person by interviewing the member of the nursing

staff familiar with care provided to the

resident. The nurse referred to the resident’s medical records. No resident was

interviewed directly.

the Expense Questionnaire was not returned within- 2 we;ks, the interviewer telephoned the accountant requesting its prompt

return. If the Staff Questionnaires were not returned in 1 week, the interviewer contacted the

staff member and requested the return of the

form.

Table II presents a summary of the data

collection procedures:

Table Il. Summary of data collection procedures

Questionnaire

Facility .........

Expense ... .. ...

Resident ........

Staff ..............

Respondent

Administrator

Facil ity ’s accountant

Member of nursing staff

familiar with care provided to the resident or

resident’s medical records

(10 sampled residents per

facility)

Sampled staff member (14

per facility)

Interview

situation

Personal

interview

Selfasumerated

questionnaire

Personal

interview

Self-enumerated

questionnaire

GENERAL QUALIFICATIONS

Non response and Imputation

of Missing Data

Response rates differed for each type of

questionnaire as indicated:

68

Response

Questionnaire rate

Facility........................................................ 97 percent

Expense....................................................... 88 percent

Resident...................................................... 98 percent

Staff ............................................................ 82 percent

Generally, response rates were higher for

questionnaires administered in a personal interview situation (Facility and Resident) as compared with those that were self-enumerated (expense and staff). Statistics presented in this

report were adjusted for failure of a facility to

respond. Data were also adjusted for nonresponse that resulted from failure to complete

one of the questionnaires (Expense, Resident,

Staff) or from faiIure to complete an item on a

questionnaire. Those items left unanswered on a

partially completed questionnaire (Facility, Expense, Resident, Staff) were generally imputed

by assigning a value from a responding unit with

major characteristics identical to those of the

nonresponding unit.

Rounding of Numbers

Estimates of facilities, beds, admissions, discharges, deaths, full-time equivalent employees,

and residents have been rounded to the nearest

hundred. Estimates of resident days have been

rounded to the nearest thousand. Because of

rounding, detailed figures within tables do not

always add to totals. Percents and ratios were

calculated on the basis of original, unrounded

figures and will not necessarily agree precisely

with percents and ratios that might be calculated

from rounded data.

Data Processing

A series of checks was performed during the

course of the survey, This included field followups for missing and inconsistent data, some

manual editing of the questionnaires, extensive

editing conducted by computer to assure that all

responses were accurate, consistent, logical, and

complete. Once the data base was edited, the

computer was used to calculate ancl 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 establishments and establishment data not related to size

is inflated by the reciprocal of the probability

of selecting the sample establishment and adjusted for the nonresponding establishments

within primary certification-size strata. Two ratio adjustments, one at each stage of selection,

were also used in the estimation process. The

first-stage ratio adjustment (along with the

above inflation factors) was included in the estimation of establishment data related to size, resident data, and staff data for all primary certification-size strata from which a sample of

facilities was drawn. The numerator was the

number of totaI beds according to the Master

Facility Inventory data for all facilities in the

stratum. The denominator was the estimated

number of the total beds obtained through a

simple inflation of the Master Facility Inventory

data for the sample homes in the stratum. The

effect of the first-stage ratio adjustment was to

bring the sample in closer agreement with the

known universe of beds. The second-stage ratio

adjustment was included in the estimation of

resident and staff data within establishments.

The second-stage ratio adjustment is the product

of two fractions: The first is the inverse of the

sampling fraction for residents (or staff) upon

which the selection is based; the second is the

ratio of the number of sample residents (or staff)

for whom questionnaires were completed within

the facility.

RELIABILITY OF ESTIMATES

As in any survey, the results are subject to

reporting and processing errors and errors due to

nonresponse. To the extent possible, these

types of errors were kept to a minimum by

methods built into survey procedures.

Since statistics presented in this report are

based on a sample, they will differ somewhat

from figures that would have been obtained if

a complete census had been taken using the

same schedules, instructions, and procedures.

The standard error is primarily a measure of

the variability that occurs by chance because

only a sample, 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

generaly decreases.

The relative standard error of an estimate is

the standard error of the estimate divided by the

estimate itself and is expressed as a percentage

of the estimate. According to NCHS standards,

reliable estimates are those that have a relative

standard error of 25 percent or less. For example, curve C of figure I shows the relative standard errors for the estimated number of residents.

For a relative standard error of 25 percent or

less, the minimum number of residents is 2,300.

Thus, resident estimates must be 2,300 or larger

in order to meet the standards of reliability.

Similarly, in fi~re I the estimates of number of

facilities must be 180 or larger in order to have a

relative standard error of 25 percent or Iess. In

this report, asterisks are shown next to estimates

with more than a 25-percent relative standard

error.

Because of the relationship between the relative standard error and the estimate, the standard error of an estimate can be found by multiplying the estimate by its relative standard error.

Both values can be determined from the curves

in figures I, II, and III. For example, curve B of

figure I shows the relative standard error curve

for beds. Table 9 shows that the total number

of beds in all homes with less than 50 beds was

168,900. The relative standard error corresponding to this estimate on curve B is approximately

4.75 percent. The standard error is 168,900

(0.0475) = 8,023.

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 Iess 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

large. For

that it is less than 2 1/2 times as

example, the average facility labor

69
100

90

80

70

60

50

40

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

,. j .,...+..+ I

. .

,!,

SIZE OF ESTIMATE

Figure 1. Relative standard error curves for estimated numbers of admissions and live discharges, deaths, beds, residents, and facilities

cost per resident day for the 72,080,000 resident days in nonprofit homes was $10.14. From

table IV, linear interpolation yields an approximate standard error of 391 for nonprofit facilities. The chances are 95 out of 100 that the

true value is contained in the interval $10.14

f2.O (39#) (i.e., between $9.36 and $10.92), and

99 out of 100 for the interval $10.14 f 2.5

(39#) (i.e., between $9.09 and $11.19).

The standard error of one statistic is generally different from that of another, even when

the two come from the same survey. In order to

derive standard errors that would be applicable

to a wide variety of statistics and that could be

prepared at a moderate cost, a number of

approximations are required. As a result, tables

III-XIII and figures I-III provide genera-l standard

errors and relative standard errors for a wide

variety of estimates rather than the specific error

for a particular statistic.

The particular figure or table to which one

refers to obtain a standard error is contingent on

the type of estimate (e.g., residents) and whether

the estimate is a level or a percent. Tables III-V

show the standard errors of average total costs,

average labor costs, and other cost per resident

day estimates, respectively. Tables VI-VIII show

the standard errors of estimated percentages of

total costs, labor costs, and other costs, respectively. Tables IX-XII show the standard errors

of estimated percentages of facilities; beds; residents; and admissions, live discharges, and

deaths, respectively. Table XIII shows the standard errors of occupancy rate estimates. Figure I

shows the relative standard error curves for estimated numbers of admissions, live discharges,

deaths, beds, residents, and facilities. Figure 11

shows the relative standard error curves for estimated number of resident days. Figure III

shows the relative standa~d error curves for estimated number of fuI1-time equivalent (FTE)

employees.

70
Table II 1. Standard errors of average total cost per resident day

Average total cost per resident day

$0.25 $0.50 $2.00 $4.00 $6.00 $a.oo 510.00 $12.00 $14.00 $16.00 $18.00 $20.00 $25.00

Estimated number

of resident days

Standard error in dollars

‘2.54

●2.32

*2.01

1.79

1.64

1.51

1.42

1.33

1.26

0.89

0.72

0.62

0.55

0.50

0.46

0.43

0.40

0.38

0.25

0.19

0.18

‘2.91

●2.65

2.29

2.05

1.87

1.73

1.62

1.52

1.44

1.01

0.82

0.71

0.63

0.57

0.52

0.48

0.45

0.43

0.27

0.21

0.18

“3.27

2.98

2.58

2.30

2.10

1.94

1.82

1.71

1.62

1.14

0.92

0.79

0.70

0.63

0.58

0.54

0.50

0.47

0.30

0.21

0.19

●3.63

3.31

2.86

2.56

2.33

2.16

2.02

1.90

1.80

1.26

1.02

0.87

0.77

0.70

0.64

0.59

0.55

0.52

0.32

0.22

0.18

4.36

3.88

3.44

3.07

2.80

2.59

2.42

2.28

2.16

1.51

1.22

1.04

0.92

0.83

0.76

0.70

0.65

0.61

0.36

0.22

0.17

4.73

4.32

3.73

3.33

3.04

2.81

2.63

2.47

2.34

1.64

1.32

1.13

0.99

0.90

0.82

0.75

0.70

0.65

0.38

0.23

0.16

5.68

5.18

4.48

4.00

3.65

3.37

3.15

2.97

2.81

1,96

1.58

1.35

1.19

1.07

0.97

0.89

0.83

0.77

0.44

0.24

0.16

2,500,000 .....................

3,000,000 .....................

4,000 ,000 ..................

5,000,000 .....................

6,000,000 .....................

7,000 ,000 .....................

8,000,000 .....................

9,000,000 ....................

10,000,000 ...................

20,000 ,000 ...................

30,000 ,000 ...................

40,000,000 ...................

50,000,000 ...................

60,000 ,000 ...................

70,000,000 ...................

80,000 ,000 .................<.

90,000,000 ...................

100,000,000 .................

200,000,000 .................

300,000,000 .................

350,000,000 .................

●0.48

“0.44

‘0.38

“0.34

‘0.31

“0.29

‘0.27

‘0.25

“0.24

‘0.1 7

‘0.1 4

“0.12

‘0.1 1

*O.1O

+’0.09

‘0.09

‘0.08

‘0.08

0.05

0.04

0.04

‘0,67

‘0,61

“0.53

●0.47

*0.43

‘0.40

“0.37

“0.35

‘0.33

“0.24

+0.1 9

+0,1 7

+0.1 5

+0.1 4

●0.1 3

0.12

0.11

0.11

0.08

0.06

0.06

●1.26

●1.15

*1 .00

‘0.89

‘0.82

‘0.76

●0.71

“0.67

“0.63

0.45

0.36

0.32

0.28

0.26

0.24

0.22

0.21

0.20

0.14

0.12

0.11

*1 .76

●1,61

*1 .39

*1 .24

●1.13

●1.05

0.98

0.93

0.88

0.62

0.50

0.44

0.39

0.35

0.33

0.31

0.29

0.27

0.19

0.15

0.14

‘2.1 7

‘ 1.98

●1.71

●1.53

1.40

1.29

1.21

1.14

1.08

0.76

0.62

0.55

0.47

0.43

0.40

0.37

0.35

0.33

0.22

0.18

0.17

3.99

3.64

3.15

2.82

2.57

2.37

2.22

2.09

1.98

1.38

1.12

0.96

0.85

0.76

0.70

0.64

0.60

0.56

0.34

0.22

0.18

Table IV. Standard errors of average labor cost per resident day

Average labor cost per resident day

Estimated number

of resident days $0.25 $0.50 $1.00 $2.00 $3.00 $4.00 $6.00 woo $10.00 $12.00 $14.00 $16.00

Standard error in dollars

2,500,000, ................

3,000,000 .. ........ .. .....

4,000,000 .......... .......

5,000,000 ......... .. ......

6,000,000 .................

7,000,000 .. .......... .....

8,000,000 .................

9,000,000 .. ...............

10,000,000 ...............

20,000,000 .. ........ .. .. .

30,000,000 ............ .. .

40,000,000 ... .. ........ ..

50,000,000 ...............

60.000,000 ...............

70,000,000 ...............

80,000,000 ....... ........

90,000,000 ...............

100,000,000 .............

200,0003000 ............ .

300,000,000 .... .........

350,000,000 ..... ........

‘0.53

‘0.49

*0.42

‘0.38

‘0.34

‘0.32

‘0.30

‘0.28

‘0.27

0.19

0.75

0.13

0.12

0.’11

0.10

0.09

0.09

0.08

0.06

0.05

0.05

*0,28

‘0.26

“0.22

“0,20

‘0,1 8

+0.77

‘0.16

●0. I 5

*0,14

*O.1O

“0.08

*0.07

‘0.06

0.06

0.05

0.05

0.05

0.04

0.03

0,03

0.02

‘0.39

‘0.35

+0.31

‘0.27

‘0.25

“0.23

*0.22

‘0.20

+0.1 9

*0.14

0.11

0.10

0.09

0.08

0.07

0.07

0.06

0.06

0.04

0.04

0.03

‘0.75

“0.69

‘0.59

“0,53

0.48

0.45

0.42

0.40

0.38

0.26

0.22

0.19

0.17

0.15

0.14

0.13

0.12

0.12

0.08

0.07

0.07

‘0.94

“0.86

0.74

0.66

0,61

0.56

0.52

0.49

0.47

0.33

0.27

0.23

0.21

0.19

0.17

0.16

0.15

0.14

0.10

0.08

0.08

*1.12

1.02

0.89

0.79

0.72

0.67

0.63

0.59

0.56

0.39

0.32

0.28

0.25

0.22

0.21

0.19

0.18

0.17

0.12

0.09

0.09

1.48

1.35

1.17

1.05

0.96

0.88

0.83

0.78

0.74

0.52

0.42

0.36

0.32

0.29

0.27

0.25

0.23

0.22

0.14

0.11

0.70

1.86

1.69

1.47

1.31

1.19

1.11

1.03

0.97

0.92

0.65

0.52

0.45

0.40

0.36

0.33

0.31

0.29

0.27

0.17

0.13

0.11

2.24

2.04

1.77

1.58

1.44

1.33

1.24

1.17

1.11

0.78

0.63

0.54

0.48

0.43

0.39

0.36

0.34

0.32

0.20

0.14

0.12

2.63

2.40

2.08

1.85

1.69

1.56

1.46

1.38

1.30

0.91

0.74

0.63

0.56

0.50

0.46

0.42

0.40

0.37

0.23

0.15

013

3.03

2.76

2.39

2.14

1.95

1.80

1.68

1.58

1.50

1.05

0.85

0.72

0.64

0.58

0.53

0.49

0.45

0.42

0.25

0.17

0.14

3.43

3.13

2.71

2.42

2.21

2.04

1.91

1.80

1.70

1.19

0.96

0.82

0.72

0.65

0.60

0.55

0.51

0.48

0.28

0.18

0,15

71
Table V, Standard errors of average other (operating, fixed, and miscellaneous) cost per resident day

Estimated number

of resident days

Average other cost per resident day

$0.25 $0.50 $1.00 $2.00 $3.00 $4.00 $6.00 $8.00 $10.00

Standard error in dollars

*0.12

*o.1 1

‘0.09

‘0.08

‘0.08

‘0.07

“0.07

0.06

0.06

0.04

0.03

0.03

0.03

0.02

0.02

0.02

0.02

0.02

0.01

0.01

‘0.17

‘0.15

‘0.13

0.12

0,11

0,10

0.09

0.09

0.08

0.06

0.05

0.04

0.04

0.03

0.03

0.03

0.03

0.03

0.02

0.02

‘0.26

0.24

0.20

0,18

0,17

0.15

0.14

0.14

0.13

0.09

0.07

0.06

0.06

0.05

0.05

0.05

0.04

0.04

0.03

0.02

0.45

0.41

0.35

0.31

0.29

0.27

0.25

0.23

0.22

0.16

0.13

0.11

0.10

0.09

0.08

0.08

0.07

0.07

0.05

0.04

0.65

0.59

0.51

0.46

0.42

0.38

0.36

0.34

0.32

0.22

0.18

0.16

0.14

0.12

0.11

0.11

0.10

0,09

0.06

0.05

Table V 1. Standard errors of percentages of total costs

Base of estimated percent

(total costs)

0.85

0.78

0.67

0.60

0.55

0.51

0.47

0.45

0.42

0.30

0.24

0.20

0.18

0.16

0.15

0.14

0.13

0.12

0.08

0.06

1.28

1.17

1.01

0.90

0.82

0.76

0.71

0.67

0.63

0.44

0.36

0.30

0.27

0.24

0.22

0.20

0.19

0.18

0.11

0.09

1.71

1.56

1.35

1.21

1.10

1.02

0.95

0.89

0.85

0.59

0.47

0.40

0.36

0.32

0.29

0.27

0.25

0.23

0.15

0.11

2.16

1.97

1.70

1.52

1.38

1.28

1.19

1.12

1.07

0.74

0.60

0.51

0.45

0.40

0.37

0.34

0.31

0.29

0.18

0.14

Estimated percent

1 2 5 10 20 30 40

or 99 or 98 or 95 or 90 or 80 or 70 or 60 50

Standard error in percentage points

2.53

2.26

2.06

1.91

1.79

1.68

1.60

1.13

0.92

0.80

0.71

0.65

0.60

0.57

0.53

0.50

0.36

0.29

0,25

0.23

0,21

3.56

3.18

2.90

2.69

2.51

2.37

2.25

1.59

1.30

1.12

1.00

0.92

0,85

0.80

0.75

0.71

0.50

0,41

0.36

0.32

0 .?30

5.53

4.95

4.52

4.18

3.91

3.69

3.50

2.48

2.02

1.75

1.57

1.43

1.32

1.24

1.17

1.11

0.78

0.64

0.55

0.50

0.46

7.62

6.81

6.22

5.76

5.39

5.08

4.82

3.41

2.78

2.47

2.16

1.97

1.82

1.70

1.61

1.52

1.08

0.88

0.76

0.68

0.64

10.16

9.09

8.29

7.68

7.18

6.77

6.42

4.54

3.71

3.21

2.87

2.62

2.43

2.27

2.14

2.03

1.43

1.17

1.02

0.91

0.85

11.64

10.41

9.50

8.80

8.23

7.76

7.36

5.20

4.25

3.68

3.29

3.00

2.78

2.60

2.45

2.33

1.65

1.34

1.16

1.04

0.97

12.44

11.13

10.16

9.41

8.80

8.29

7.87

5.56

4.54

3.93

3.52

3.21

2.97

2,78

2.62

2.49

1.76

1.44

1.24

1.11

1.04

12.70

11.36

10.37

9.60

8.98

8.47

8.03

5.68

4.64

4.02

3.59

3.28

3,04

2.84

2.68

2.54

1.80

1.47

1.27

1.14

1.06
Table VI 1. Standard errors of percentages of labor costs

Base of estimated percent

(labor costs)

20,000,000 ....................................................................................

30,000,000 ....................................................................................

40,000,000 ....................................................................................

50,000,000 ......................................................................... ...........

60,000,000 ....................................................................................

70,000,000 ....................................................................................

80,000,000 ....................................................................................

90,000,000 ................................................................................... .

100,000,000 ................................................................................ ..

200,000,000 ..................................................................................

300,000,000 ..................................................................................

400,000,000 ..................................................................................

500,000,000 ..................................................................................

600,000,000 ..................................................................................

700,000.000 ..................................................................................

800,000,000 ..................................................................................

900,000,000 ..................................................................................

1)000,000,000 ...............................................................................

2,000,000,000 ...............................................................................

3,000,000,000 ...............................................................................

Estimated percent

1 2 5 10 20 30 40

or 99 or 98 or 95 or 90 or 80 or 70 or 60 50

Standard error in percentage points

2.15

1.76

1.52

1.36

1.24

1.15

1.07

1.01

0.96

0.68

0.56

0.48

0.43

0.39

0.36

0.34

0.32

0.30

0.21

0.18

3.02

2.47

2.14

1.91

1.75

1.62

1.51

1.43

1.35

0.96

0.78

0.68

0.61

0.55

0.51

0.48

0.45

0.43

0.30

0.25

4.71

3.85

3.33

2.98

2.72

2.52

2.36

2.22

2.11

1.49

1.22

1.05

0.94

0.86

0.80

0.74

0.70

0.67

0.47

0.38

6.48

5.29

4.58

4.10

3.74

3.47

3.24

3.06

2.90

2.05

1.67

1.45

1.30

1.18

1.10

1.02

0.97

0.92

0.65

0.53

8.64

7.06

6.11

5.47

4.99

4.62

4.32

4.07

3.87

2.73

2.23

‘1.93

1.73

1.58

1.46

1.37

1.29

1.22

0.86

0.71

9.90

8.08

7.00

6.26

5.72

5.29

4.95

4.67

4.43

3.13

2.56

2.21

1.98

1.81

1.67

1.57

1.48

1.40

0.99

0.81

Table V I I 1. Standard errors of percentages Of Other (operating, f ixed, and miscellaneous) costs

Base of estimated percent

(other costs)

4,000,000 ......................................................................................

6,000,000 ......................................................................................

8,000,000 ......................................................................................

10,000,000 ....................................................................................

20,000,000 ....................................................................................

30,000,000 ....................................................................................

40,000,000 .............................................. ......................................

50,000,000 ....................................................................................

60,000,000 ....................................................................................

70,000,000 ........................................................................ ............

80,000,000 .... .................................................................... ............

90,000,000 ....................................................................................

100,000,000 ..................................................................................

200,000,000 ..................................................................................

300,000,000 ..................................................................................

400,000,000 ............................................................................ ......

500,000,000 ..................................................................................

600,000,000 ............................................ ......................................

700,000,000 ..................................................................................

800,000,000 ,................. ...............................................................

900,000,000 ..................................................................................

l.ooo.ooo.ooo .......................................................................... .....

10.59

8.64

7.49

6.70

6.11

5.66

5.29

4.99

4.73

3.35

2.73

2.37

2.12

1.93

1.79

1.67

1.58

1.50

1.06

0.86

10.80

8.82

7.64

6.83

6.24

5.78

5.40

5.09

4.83

3.42

2.79

2.42

2.16

1.97

1.83

1.71

1.61

1.53

1.08

0.88

Es.timated percent

1 2 5 10 20 30 40

or 99 or 98 or 95 or 90 or 80 or 70 or 60 50

Standard error in percentage points

2.11

1.72

1.49

1.33

0.94

0.77

0.67

0.60

0.55

0.50

0.47

0.44

0.42

0.30

0.24

0.21

0.19

0.17

0.16

0.15

0.14

0.13

2.97

2.42

2.10

1.88

1.33

1.08

0.94

0.84

0.77

0.71

0.66

0.63

0.59

0.42

0.34

0.30

0.27

0.24

0.22

0.21

0.20

0.19

4.62

3.78

3.27

2.92

2.07

1.69

1.46

1.31

1.19

1.10

1.03

0.97

0.92

0.65

0.53

0.46

0.41

0.38

0.35

0.33

0.31

0.29

6.36

5.20

4.50

4.02

2.85

2.32

2.01

1.80

1.64

1.52

1.42

1.34

1.27

0.90

0.73

0.64

0.57

0.52

0,48

0.45

0.42

0.40

8.49

6.93

6.OO

5.37

3.80

3.10

2.68

2.40

2.19

2.03

1.90

1.79

1.70

1.20

0.98

0.85

0.76

0.69

0.64

0.60

0.57

0.54

9.72

7.94

6.87

6.15

4.35

3.55

3.07

2.75

2.51

2.32

2.17

2.05

1.94

1.37

1.12

0.97

0.87

0.79

0.73

0.69

0.65

0.61

10.39

8.49

7.35

6.57

4.65

3.80

3.29

2.94

2.68

2.48

2.32

2.19

2.08

1.47

1.20

1.04

0.93

0.85

0.79

0.73

0.69

0.66

10.61

8.66

7.50

6.71

4.74

3.87

3.35

3.00

2.74

2.54

2.37

2.24

2.12

1.50

1.22

1.06

0.95

0.87

0.80

0.75

0.71

0.67

73
Table IX. Standard errore of percentages for facilities

Base of estimated percent

(number of establishments)

loo ..........................................................................................

2oo . . .... . ... .. .... . .... . .. .. .. .... .... . . .... .. ... .. ... . .. ... . ..... . . .... .. . ... ... . ... .. . ....

3oo .. .... .. .. .... .. . ..... .... ... ... .... .. ..... . .. ... ... . .... . .. ... .. ... .. . ... ... .. . .... . . ....

4m . .. ... ... .. .... .. ...... . .. .... . . .... . .. ..... .... .. .. .. ... . .. .... . .. ... .. .. .. .. .. .... . . ....

5oo . ... ... .. .. .... . . .. ... . ... ..... . . .... .. .... .. . .... ... ..... . .. ... .. .. .. ... .. .. .. .. ... . .. ...

600 .. . .... .. .. ... ... . .... . ... .... .. ..... . . .... .. .. ... .. .. ... . .... .. .. .. .. ... .. ... . .. .... . ... .

7m . .... .. ... . .... . .. .... .. .. ... .. . .... .. ..... .. . ... ... .. ... .. . .... .. .. .. ... . ... ... . ... .. . ...

800 .. .. . .. .. .. .. ... . .. .... . .. .. ... . .. ... . ... ... .. .. .. .. . . .... . . .... ... .. ... . .. ... .. . .... .. ...

9w . . .. ..... .. ..... . . .... .. .. .. ... . .... .. . ..... . .. ... .. . .... .. . .... .. .. .. .. .. .... . . .... .. .. ..

l.ooo . .. .. . .. .... . .. .... .. .. ... .. .. .... .. .... .. .. .. .... . ... .. .. .... .. . ... .. .. .. .. .. .... .. . ..

2.wo . . .. .. .. . ..... . ..... .. . ..... . . .... . .. ... ... . ... ... . .... . . .... ... . ... .. .. ... . . .... .. .. ..

3.mo . . .... .. . .... .. . ... ... . .... .. . .... . .. .... . ... .. ... . .... . .. ... ... .. ... .. . ... .. . ... .. ... .

4.000 .. ... .. .. ... .. . .. .. .. .. ... ... . ... .. . .... .. .. ... .. .. .... . . .... ... .. .. ... . .... . . .... . .. ..

5.mo . . ... ... ..... . .. .... . .. . .... . . .... . .. ... ... . ..... . ..... . .. .... .. . .... .. . .... . . .... .. ...

6.000 .. .... .. . ..... . .. ... . .. .... .. . .... . .. .... .. . ... ... . .... . .. .... .. . .... .. . .... . . .... . ... .

7.mo . . ... .. . . .... . .. .... .. .. .. .. . . .... . ... .... .. .... .. . ..... .. .. .. .. .. .. .. .. .... . . .... .. .. .

8.000 . . ... ... . .... . .. ... ... .. .. ... . .... . . .... .. .. .... .. . .... . .. ... .. ... .. ... . .... . . .... .. .. .

9.000 . .... .. .. .... .. .. .... . . .... .. . .... .. .. ... ... . ... .. .. .... . ... .. ... . .... . . .... .. ... .. .. ..

lo.ooo . .. .. . . .... .. .. .... .. .. ... . .. .... .. ..... . .. .. .. . .. .... . .... .. .. .. .. .. . ..... . . .... .. . .

20.000 .. .. .. . .... . .. .. .. .. . ..... .. .... .. .. .... . .. ... .. . ..... .. .... . ... .... . . .... .. . .... . ...

Estimated percent

1 2 5 10 20 30 40

or 99 or98 or 95 or 90 or 80 or 70

K

50

or 60

3.33

2.36

1.93

1.67

1.49

1.36

1.26

1.18

1.11

1.05

0.75

0.61

0.53

0.47

0.43

0.40

0.37

0.35

0.33

0.24

4.69

3.32

2.71

2.35

2.10

1.92

1.77

1.66

1.56

1.48

1.05

0.86

0.74

0.66

0.61

0.56

0.52

0.49

0.47

0.33

7.30

5.16

4.22

3.65

3.27

2.98

2.76

2.58

2.43

2.31

1.63

1.33

1.15

1.03

0.94

0.87

0.82

0.77

0.73

0.52

error in

10.05

7.11

5.80

5.03

4.50

4.10

3.80

3.55

3.35

3.18

2.25

1.84

1.59

1.42

1.30

1.20

1.12

1.06

1.01

0.71

Table X. Standard errors of percentages for beds

Base of estimated percent

(number of beds)

7.000 . . .. .... . .. .. .. .. .. .... . . .... ... . .... ... ..... ... ... ... . ... ... . .... . . .... . ... .. .. . . .... .

8.~0 . .. .. ... ... .. .. ... . .... . . .... ... .. .. ... . .... . .. .... .. .. ... ... .... . . ..... . ... .. ... . .... .

9.000 . .. . .... .. .. ... ... . .... .. . .... . .. ... ... . ..... . . .... .. .. ... .. . ..... . . .... .. .. .. ... . .....

lo.om .....................................................................................

20.000 . . ..... . ... .. .. . .. .... . . .... ... . ... .. .. ... . . ..... ... . .... .. . ... .. .. ... .. ... .. .. . .....

30;ooo . .. .. .. ... . .... .. . ..... ... .. ... . .... . .. .... . .. ... ... . ..... .. .... .. . ... .... . .. .. .. ....

40.0m . ... ... .. . . .... .. . .... . .... .. .. .. .... .. ... ... .... ... . ... ... .. ... . .. .... . ... .. .. .. ....

50.000 . . ...... . ... .... . .. ... . ... ... ... . .... . . .... . .. ... ... . .... .. . .... . .. ... .. ... ... . . .....

60;W0 . . . ...... .. ... ... . .... . ... ... . .. .... . .. .... .. ... . ... . .... .. . .... . .. ... ... . ... .. . .....

70.0m .. ... .. ... .. .... . . .. .. .. .. .... .. . ... .. . ..... ... ... .. . ... .. .. .... . . .... . ... .. ... . .....

80.000 . . . ..... . .. ..... . . .... . ... .. ... .. ... .. . .... . ... .. ... . ..... . . .... . .. ... .. .. ... .. .. ... .

90.000 . . .. .... .. .. .... . .. .... .. .. .. ... . .... ... ... .. ... . .... . .... . .. ... . .. ... .. .. ... .. . .... .

loo.ooo .. .... .. .. .... . ..... . ... .... .. . ... .. . .... . ... ... .. .. .. .. .. .... . .. ... .. .. .. ... . .... .

2oo.ooo . .... .. .. ..... . . .... . ... .. .. . . .... .. . .... . ... .. ... .. ... .. . .... . .. ... .. . .... . .. ... ..

3oo.ooo . .... .. .. .... . .. .... . ... .. .. .. .... .. . .... . .. ... ... .. .. .. .. .... . . .... .. .. ... .. . ... ..

4m.ooo . .... .. .. ... ... .... .. .. .... .. .. ... .. . .... . . .. .. ... . ... ... . .... . . .... .. .. .. ... . .... .

5oorooo .. .... .. . ... .. .. .... . ...... .. .... .. . ..... . .. ... .. .. ... .. .. ... . .. .... . .. .... .. . .... .

6M.~0 . .... . .. ... .. . . ..... . .. .. .. .. .... .. .. ... .. ... .. ... . .... . .. ... .. . .... .. . ... ... . .... .

7oo.ooo . .... ... . .. ... . .... . .. .... .. .. ... ... ..... . .. ... ... . ... .. .. .... . . .... . ... .. ... . .... .

8W.000 . .... .. . ... .... . ... .. ... .. ... .. ... . .. ... .. .. ... ... . ... ... . .... . . ... .. ... ... . .. .... .

9oo.ooo . ... .. ... ... .. .. .... .. . ... . ... .... .. ..... . .. .... . ... .. .. .. .... . .. ... .. .. .. .. .. .... .

1 .ooo.ooo . .... . ... .. .. .... . ... ... .. . .... .. . .... . .. .... .. . ... .. . ..... . . .... .. .. .. ... . .....

2.wo.ooo . ... .. .. ... . ..... ... .... .. . .... . . .... . .. .... .. .. .... . .. ... .. . .... .. . ... ... . .....

ercentage points

13.41

9.48

7.74

6.70

6.00

5.47

5.07

4.74

4.47

4.24

3.00

2.45

2.12

1.90

1.73

1.60

1.50

1.41

1.34

0.95

15.36

10.86

8.87

7.68

6.87

6.27

5.80

5.43

5.12

4.86

3.43

2.80

2.43

2.17

1.98

1.64

1.72

1.62

1.54

1.08

16.42

11.61

9.48

8.21

7.34

6.7IO

6.21

5.80

5.47

5.19

3.67

3.00

2.60

2.32

2.12

1.96

1.84

1.73

1.64

1.1[;

—.

16.76

11.85

9.67

8.38

7.49

6.84

6.33

5.92

5.59

5.30

3.75

3.06

2.65

2.37

2.16

2.00

1.87

1.77

1.68

1.18

Estimated percent

1 2 5 10 20 30 40

or 99 or 98 or 95 or 90 or 80 50

or 70 or 60

Standard error in percentage points

2.46

2.30

2.17

2.06

1.46

1.19

1.03

0.92

0.84

0.78

0.73

0.69

0.65

0.46

0.38

0.33

0.29

0.27

0.25

0.23

0.22

0.21

0.15

3.47

3.24

3.06

2.90

2.05

1.67

1.45

1.30

1.18

1.10

1.02

0.97

0.92

0.65

0.53

0.46

0.41

0.37

0.35

0.32

0.31

0.29

0.20

5.39

5.05

4.76

4.51

3.19

2.61

2.26

2.02

1.84

1.71

1.60

1.50

1.43

1.01

0.82

0.71

0.64

0.58

0.54

0.50

0.48

0.45

0.32

7.43

6.95

6.55

6.21

4.39

3.59

3.11

2.79

2.54

2.35

2.20

2.07

1.96

1.39

1.13

0.98

0.88

0.80

0.74

0.69

0.65

0.62

0.44

9.90

9.26

8.73

8.28

5.86

4.78

4.14

3.70

3.38

3.13

2.93

2.76

2.62

1.85

1.51

1.31

1.17

1.07

0.99

0.93

0.87

0.83

0.59

11.34

10.61

10.00

9.49

6.71

5.46

4.74

4.24

3.87

3.59

3.36

3.16

3.00

2.12

1.73

1.50

1.34

1.23

1.13

1.06

1.00

0.95

0.67

12.13

11.34

10.69

10.15

7.17

5.86

5.07

4.54.

4.14

3.83

3.59

3.38

3.21

2.27

1.85I

1.601

1.43

1.31

1.21

1.13

1.07

1.01

0.72

12.38

11.58

10.91

10.35

7.32

5.98

5.18

4.63

4.23

3.91

3.66

3.45

3.27

2.32

1.68

1.64

1.46

1.34

1.24

1.16

1.08

1.04

0.73

74
Table X 1. Standard errors of percentages of residents

Estimated percent

Base of estimated percent

(number of residents) 1

I

2

I

5

or 99 or 98 or 95

10 I20 I

30

or 90 or 80 or 70

40

I

50

or 60

Stpndard error in percentage points

3.79

2.68

2.19

1.90

1.70

1.20

0.98

0.85

0.76

0.69

0.64

0.60

0.57

0.54

0.38

0.31

0.27

0.24

0.22

0.20

0.19

0.18

0.17

0.17

5.90

4.17

3.41

2.95

2.64

1.87

1.52

1.32

1.18

1.08

1.00

0.93

0.88

0.83

0.59

0.48

0.42

0.37

0.34

0.32

0.30

0.28

0.26

0.24

8.12

5.75

4.69

4.06

3.63

2.57

2.10

1.82

1.62

1.48

1.37

1.28

1.21

1.15

0.81

0.66

0.57

0.51

0.47

0.43

0.41

0.38

0.36

0.35

10.83

7.66

6.25

5.42

4.84

3.43

2.80

2.42

2.17

1.98

1.83

1.71

1.61

1.53

1.08

0.88

0.77

0.69

0.63

0.58

0.54

0.51

0.48

0.46

12.41

8.78

7.17

6.21

5.55

3.92

3.20

2.78

2.48

2.27

2.10

1.96

1.85

1.76

1.24

1.01

0.88

0.78

0.72

0.66

0.62

0.59

0.56

0.53

2.000 ....................................................................................... 2.69

1.90

1.56

1.35

1.21

0.85

0.70

0.60

0.54

0.49

0.46

0.43

0.40

0.38

0.27

0.22

0.19

0.17

0.16

0.14

0.13

0.13

0.12

0.10

13.27

9.38

7.66

6.63

5.93

4.20

3.43

2.97

2.65

2.42

2.24

2.10

1.98

1.88

1.33

1.08

0.94

0.84

0.77

0.71

0.66

0.63

0.59

0.57

13.54

9.58

7.82

6.77

6.06

4.28

3.50

3.03

2.71

2.47

2.29

2.14

2.02

1.92

1.35

1.11

0.96

0.86

0.78

0.72

0.68

0.64

0.61

0.57

4;ooo .......................................................................................

6;OO0.......................................................................................

8.000 .......................................................................................

1o.ooo .....................................................................................

20.000 .....................................................................................

30.000 .....................................................................................

40;om .....................................................................................

50.000 .....................................................................................

60.W0 .....................................................................................

70.000 .....................................................................................

80;OO0.....................................................................................

90.000 .....................................................................................

loo.ooo ...................................................................................

2oo.ooo ...................................................................................

3oo.ooo ...................................................................................

4oo.ooo ...................................................................................

5oo.ooo ...................................................................................

600.000 ...................................................................................

7o08000 ...................................................................................

800.000 ...................................................................................

9w.ooo ...................................................................................

1.ooo.ooo ................................................................................

l.loo.ooo ................................................................................

Table X 11. Standard errors of percentages for admissions, live discharges, and deaths

Base of estimated percent

(number of admissions and discharges)

Estimated percent

20

or 80

30

or 70

Standard error in percentage points

8.66

6.13

5.00

4.33

3.87

3.54

3.27

3.06

2.89

2.74

1.94

1.58

1.37

1.23

1.12

1.04

0.97

0.91

0.87

0.61

lo.ooo.....................................................................................

20.000 .....................................................................................

30.0m .....................................................................................

40.000 .....................................................................................

50.000 .....................................................................................

60.000 .....................................................................................

70.000 .....................................................................................

80.000 .....................................................................................

90.000 .....................................................................................

loo.ooo ...................................................................................

2oo.ooo ...................................................................................

3oo.ooo ...................................................................................

4m.ooo ...................................................................................

5oo.ooo ...................................................................................

600.000 ...................................................................................

7oo.ooo ...................................................................................

800.000 ...................................................................................

9oo.ooo ...................................................................................

1,000,000 ................................................................................

2.000.000 ................................................................................

2.87

2.03

1.66

1.44

1.28

1.17

1.09

1.02

0.96

0.91

0.64

0.52

0.45

0.41

0.37

0.34

0.32

0.30

0.29

0.20

4.04

2.86

2.33

2.02

1.81

1.65

1.53

1.43

1.35

1.28

0.90

0.74

0.64

0.57

0.52

0.48

0.45

0.43

0.40

0.29

6.29

4.45

3.63

3.15

2.81

2.57

2.38

2.22

2.10

1.99

1.41

1.15

0.99

0.89

0.81

0.75

0.70

0.66

0.63

0.44

11.55

8.17

6.67

5.77

5.17

4.72

4.37

4.08

3.85

3.65

2.58

2.11

1.83

1.63

1.49

1.38

1.29

1.22

1.15

0.82

13.23

9.36

7.64

6.62

5.92

5.40

5.00

4.68

4.41

4.18

2.96

2.42

2.08

1.87

1.71

1.58

1.48

1.39

1.32

0.84

14.15

10.00

8.17

7.07

6.33

5.77

5.35

5.00

4.72

4.47

3.16

2.58

2.24

2.00

1.83

1.69

1.58

1.49

1.41

1.00

14.44

10.21

8.34

7.22

6.46

5.89

5.46

5.10

4.81

4.57

3.23

2.54

2.28

2.04

1.86

1.73

1.61

1.52

1.44

1.02

75
Est{mated number

of beds

Table X I I 1. Standard errors of occupancy rate

Occupancy rate percentage

10 20 30 40 50 60 70 80 90 100

Standard error in percentage points

*8.04

*6.36

“6.00

*5.69

‘4.02

*3.28

*2.84

*2.54

2.32

2.15

2.01

1.89

1.80

1.27

1,03

0,89

0.80

0.73

0.68

0.63

0.60

0.57

0.53

“11.16

*8.82

“8.31

*7,88

“5.57

4.54

3.93

3.51

3.21

2.97

2.77

2.61

2.47

1.74

1.41

1.21

1.07

0.97

0,90

0.83

0.78

0.74

0.68

‘13.67

‘10.80

‘10.18

‘9.66

6.82

5.56

4.81

4,29

3,91

3.62

3.38

3.18

3.01

2.10

1.69

1.44

1.27

1.14

1.04

0.96

0.89

0,84

0,76

‘15.96

*12.61

*11.89

“11.27

7.96

6.48

5.60

5.00

4.55

4.21

3.93

3.70

3.50

2.42

1.93

1.63

1.43

1.27

1.15

1.05

0.96

0.89

0.79

‘18.16

*14.34

“13.52

*12.82

9.04

7.36

6.36

5.67

5.17

4.77

4.45

4.18

3.96

2.72

2.16

1.81

1.57

1.38

1.23

1.11

1.01

0.92

0.78

‘20.31

‘16.05

*15.12

14.34

10.11

8.23

7.11

6.34

5.77

5.32

4.96

4.66

4.41

3.02

2.38

1.98

1.70

1.48

1.31

1.16

1.03

0.92

0.73

*22.46

‘17.74

16.72

15.86

11.17

9.09

7.85

6.99

6.36

5.87

5.47

5.14

4.86

3.31

2.59

2.15

1.83

1.58

1.38

1.20

1,05

0.90

0.64

*24.62

19.44

18.32

17.38

12.24

9.96

8.59

7.65

6.96

6.42

5.98

5.62

5.31

3.60

2.81

2.31

1.95

1.67

1.44

1.24

1.06

0.88

0.52

‘26.79

21.15

19.93

18.90

13.31

10.83

9.34

8.32

7.56

6.97

6.49

6.10

5.76

3.89

3.02

2.48

2.08

7.77

1.51

1.28

1.07

0.86

0.45

*28.97

22.88

21.56

20.44

14.40

11.70

10.09

8.99

8.17

7.53

7.01

6.58

6.22

4.19

3.25

2.65

2.22

1.88

1.59

1.33

1.10

0.88

0.58

as adrn;ssions per 100 beds can be calculated as

in the following example: Suppose the standard

error (OR ~) for the ratio of admissions per 100

beds is desired for nursing homes with less than

50 beds. In table 10, the total number of admissions per 100 beds for facilities with less than 50

beds is 78.7, which is equal to a total of 133,000

admissions divided by 168,900 beds times 100.

The relative standard error of 133,000 admisApproximate standard errors of ratios such I& = VX2 s VY?2 - 2?” J& ‘Vyf

= (.0500)2+ (0.475)2

= .0025+ .0023 = .0047

VRI =JDW7 = .0686.

The ammoxirnate standard en-or of the ratio

sions is (from figure I, curve A) approximately

5.00 percent, and the relative standard error of

168,900 beds (from figure I, curve B) is approximately 4.75 percent. The square root of the

sum of the squares of these two relative standard errors minus their covariance provides an

approximation for the relative standard error of

the ratio. In other words, letting VXJ be the

relative standard error of number of total admissions, VYJ be the relative standard error of number of beds, r be the sample correlation coefficient between total admissions and beds

(conservatively estimated to be zero), and Vq~ be

the relative standard error of the ratio R‘ = X /Y’:

. .

of totaI admissions per 100 beds may now be

obtained by multiplying the relative standard

error by the ratio:

OR, =.R’ X V~r = 78.7 X .0686 = 5.40

The sample correlation coefficient (r) for

calculating the standard error estimates of the

ratios presented in this report is assumed to be

zero except in the case of admissions per 100

beds, occupancy rate, and cost per resident day

ratio estimates where the correlation coefficient

used was 0.5.

76
3“FPFIW

10

2“FFHTI+ 9

8

7

6

5

4

3

2

1.0

.9

.8

.7

.6

.5

.4

“3H—H—H—t

I 1 I 1 1 ! I

.2

I+HM

.1J I I I I I I

I 11111 II I I I I I I I I I 1 1 1 I !1111 1 1 ! 1 1 1 1 1 I 1 1 I I 1111

I I 111111111 I I I [ I I I I II

1111111111 I I I I I 11111111111

1 1 I 1 1 { 1111 1 x 1 1 I 1 I 1 1 1 1 I I Ill

1 1 i 1 1 1 Iftl I 1 I 1 n 1 1 1 1 ! 1 t I 11}

,

I , r I I I , I , , , 1 , 1

2 34 56789A 2 34 56789A 2 3 456789A

10 100 7,000

SIZE OF ESTIMATE (IN MILLIONS)

Figure II. Relative standard error curves for estimated number of resident days

HYPOTHESIS TESTING not to reJect_tie null hypothesis. (For the~wo

means Xl , X2, the null hypothesis is_Ho: Xl =

Two methods of hypothesis testing were X2 with the alternative HA : Xl #X2.) The

used in this report: st~dard error of the difference of the two estiZ-test. –To test the difference between two mates is approximately the square root of the

statistics (mean percent, etc.) the standard nor- sum of the squares of the standard erro~s (SE) of

mal test was performed to determine whether or each of the estimates. Thus, if SE (Xl) is the

77
1

i=

Cn

(x

o

K

c

Lu

LLl

>

i=

Z

u

lx

m

I I I

3

2

A: Total full-time equivalent employees; #

full-time equivalent nursers aides and

nonprofessional employees

B: Professional and semiprofessional

full-time equivalent employees; full-time

equivalent registered nurses, and licensed

Dractical nurses

0.1I

I 1 I I I [ I 1 11111111[1 1 1 1 1 I 1 1 1 111111 [[11 1 1 1 ) 1 1 [ 1 1! 11111111 1 1 1 1 1 1 I 1 1 11111~

A

2 3 4 56789A 23 4 567894 23 4 5a7a9~ 2 3 4 66789A

100 1,000 10,000 100,000 1,0008000

SIZE OF ESTIMATE

Figure I Il. Relative standard error curves for estimated number of full-time equivalent employees

standard error of xl and SE2 (X2 ) is the standard error of X2, the standard error of the difference (Xl - X?z ) 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_null hypothesis is rejected (i.e., the two

means Xl and X2 are different) if the probabilityy of a type-I error is less than 5 percent; that

is, if

For example, from table 1, the labor cost

per resident day for the 235,830,000 resident

days in proprietary facilities was $9.16; the

labor cost per resident day for the 72,080,000

resident days in nonprofit facilities was $10.14.

From table III, linear interpolation yields an

approximate standard error of 174 for proprietary facilities and 39# for nonprofit facilities.

78
Since

10.14-9.16

‘=/@=G7

= 2.30>1.96,

the labor cost per resident day in proprietary

facilities was lower than the labor cost per resident day in nonprofit facilities.

Weighted least squares as a test for trendl–If

there exists a strong relationship between two

variables (e.g., total cost per resident day and

admissions per 100 beds), then a useful test for

this relationship would be to fit a regression line

to the data to determine the slope and then to

determine whether or not this slope is significantly greater than zero. That is, a regression

line of the fo~ Y = cx+ ~iXi + ~i is to be fit to

the data where in this case Y = admissions per

100 beds; X = total cost per resident day; ~ =

“Y-intercept,” that is, value of admissions per

100 beds if total cost per resident day equaled

zero; /3 = slope of Y on X, that is, the rate of

change in admissions per 100 beds per unit

change in total cost per resident day; and finally,

e = unexplained error.

The data available from the National Nursing

Home Survey present certain very basic problems

that discourage the use of classical regression

procedures. Among these problems are violation

of the assumptions of independence of the original observations, violation of homoscedasticity,

that is, equal variances of the dependent variable

within each category of the independent variable, perhaps violation of the normality assumption, and so forth. Dr. Paul Levy, formerly of

NCHS, has worked out a “modified regression

model which makes no assumptions about the

original observations and which makes no

stronger assumptions about the sample estimates

than are made in testing whether two means are

equal when the estimated means and their standard errors are obtained from complex surveys. “b

The proposed model is as follows:

1. Let ~i be the estimated mean and S7 be

its estimated standard error for the ith

group.

bFrom an unpublished memorandum by Dr. Levy.

2.

3.

4.

5.

Let Xi be the midpoint of the independent variable for the group.

Assume 5’Yi is based on a large enough

number of observations that it can be

assumed it is, in fact, equ~ to Uyi and

thus has no sampling error.

Further assume that

E(~~) = ~ + ~Aj

V(YJ = S;i fori=l, 2, ..., K,

where K is the number of groups.

Finallv,.- it is assumed that the 7j’s are

norms.lly distributed and they are statistically independent of each other.

The weighting procedure proposed weights

all observations by the reciprocal of the variance. That is,

W:=.L

‘ s$i

and the mean

and the mean

The sIope is computed in a manner similar to

the classical least squares regression, by

lowing formula:

~wi(xi - 2)7;

b=

~ W,(xi - x)’

Computationally, this is easily computed

the folby

79
The variance of the slope is ~W,XiFi = 137.834

NOW, since

~wi(xi-X)20$ ~W, = 0.11327 Uj =

[z Wixi-z)]z ( ~wjxi = 1.4620

~wiy. = 9.355

~wix: = 22.9747

J@ 9

G;i ~= 12.9072

this formula can be simplified to ~ = 82.5903

~;=p

~w,(x,-X)2 1 b=4.163

.=

“ l~wi(x,-X)’] 2 ~w (X - ii

and computationa.lly

=q2 Sb = .494

~=.!. =8.43 .

Sb

Thus, since the z-value is quite large, a positive association is demonstrated between admissions per 100 beds and total cost per resident

day.

An approximate normal deviate test can now

be performed by

b

~.—.

Sb

This would test the hypothesis that ~ = O or,

alternatively, compute confidence intervals for ~.

As an example, admissions per 100 beds by

total cost per resident day is recorded as shown

in table XIV. Applying this described method

to the data shown, we have

It should be noted that a significant positive

or negative association can be present despite

the fact that some intervals do not show a significant difference when compared with adjacent intervals in the characteristic of interest.

For example, the number of admissions per 100

beds in the cost interval $15.00-$19.99 (103.4)

is not significantly different (using the z-test)

from the number in the interval $20.00-$24.99

(105.1) despite the fact that there is an overall

significant y positive relationship between admissions per 100 beds and total cost per resident

day.

Tabla X IV. Worksheet for weighted least squares regression of admissions per 100 beds, by total cost per resident day: United States,

1972

Midpoint Standard

of total Admis- error of

Total cost per resident day

cost per sions admis- .S??

resident per 100

W,=$

sions [

day in- beds

Y;

per 100

terval beds

Less than $lO.OO ..........................................................................................

$10.00-$14.99

5.0 51.8 5.7 32.49 .03078

............................................................................................. 12.5 78.9 4.7 22.09 .04527

$15.00-$19.99 ............................................................................................. 17.5 103.4 6.8 46.24 .02163

$20.00-$24.99 ............... .............................................................................. 22.5 105.1 9.8 96.04 .01041

$25.00 or more .................................................................................... ........ 25.0 165.7 13.9 193.21 .00518

80
DEFINITION

Terms Relating to Facilities

APPENDIX II

OF CERTAIN TERMS USED IN THIS REPORT

Facilities included in the survey. –lnstitutions included in the 1973-74 Nursing Home

Survey were those classified as either nursing

care homes or personal care homes with nursing

according to data collected in the 1971 Master

Facility Inventory Surveyl 7 conducted by the

National Center for Health Statistics.

Definitions for these two classes of nursing

homes were as follows:

Nursing care home

Fifty percent or more of the residents received nursing care during the week prior to

the survey. (Nursing care is defined as the

provision of one or more of the foJ.lowing

services: taking temperature-pulse-respiration

or blood pressure; full bed bath; application

of dressings or bandages; catheterization; intravenous, intramuscular, or hypodermic injection; nasal feeding; irrigation; bowel and

bladder retraining; oxygen therapy; and

enema.)

At least one full-time (35 or more hours per

week) registered nurse (RN) or Iicensed

practical nurse (LPN) was employed.

Personal care home with nursing

Some, but less than 50 percent, of the residents received nursing care during the week

prior to the survey.

At least one full-time RN or LPN was employed, or some of the residents received

nursing care during the week prior to the

survey.

NOTE: A list of references follows the text.

No fuI1-time RN or LPN was employed.

The institution either provided administration of medicines or supervision over selfadministered medicines, or provided assistance with three or more activities for daily

Iiving (such as help with tub-bath or shower;

help with dressing, correspondence, or shopping; help with walking or getting about;

and help with eating).

Certification status. –Certification status refers to the facility certification by the Medicare

and/or Medicaid programs.

Afedicare refers to the medical assistance

provided in title XVIII of the Social Security

Act. Medicare is a heahh insurance program

administered by the Social Security Administration for persons aged 65 years and over

who are eligible for benefits.

Extended care facility refers to certification

as an extended care facility under Medicare.

Medicaid refers to the medical assistance

provided in title XIX of the Social Security

Act. Medicaid is a State-administered program for the medically indigent.

Skilled nursing home refers to certification

as a WIed nursing home under Medicaid.

Intermediate care facility refers to certification as an intermediate care facility under

Medicaid.

Not certified refers to facilities which are

not certified as providers of care either by

Medicare or Me&caid.

Type of ownership. –Type of

fers to the type of organization

and operates the nursing home.

ownership rethat controls

81
Proprietary facility is a facility operated

under private commercial ownership.

Nonprofit facility is a facility operated

under voluntary or nonprofit auspices, including both church-related facilities and

those not church related.

Government facility is a facility operated

under Federal, State, or local government

auspices.

Bed. –This term refers to a bed set up and

regularly maintained for patients or residents.

Beds maintained for staff and beds maintained

exclusively for emergency services are excluded.

Geographic region. –Classification of facilities by geographic area is provided by grouping

the States (excluding Alaska and Hawaii) into

regions. These regions correspond to those used

by the U.S. Bureau of

follows :

Region

Northeast .........

North Central ...

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

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

Maine,

mont,

Island,

York,

vania

the Census and are as

States included

New Hampshire, VerMassachusetts, Rhode

Connecticut, New

New Jersey, PennsylMichigan, 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, F1orida, Kentucky, Texas, Tennessee, Alabama, Mississippi, Arkansas, Louisiana, Oklahoma

Montana, Idaho, Wyoming,

Colorado, New Mexico, Ar;-

zona, Utah, Nevada, Washington, Alaska, Oregon, California, Hawaii

Terms Relating to Residents

Resident. –A resident is a person who has

been formally admitted but not discharged from

an establishment. All such persons were included

82

in the survey whether or not they were physically present at the time of the survey.

Reported chronic conditions and impairmerits. —A reported condition was considered to

be the affirmative response by the respondent

to any and all categories of item 9 of the Resident Questionnaire. The respondent, who was

the nurse most familiar with the care provided

to the resident, reported the existence of these

chronic conditions and impairments based upon

knowledge of the resident’s health and by checking of the resident’s medical record.

Primary diaposis at last examination. –T’he

primary diagnosis was the condition reported by

the respondent in answer to item 8 of the Resident Questionnaire. The list of conditions corresponds to ICDA eighth revisions With the

assistance of the interviewer, the respondent was

instructed to extract from the resident’s medical

record the primary diagnosis recorded at the last

examination.

Level of care received. –These levels are defined in terms of the nursing services actually

received by the resident. Based on the services

listed in item 12 of the Resident Question.naire,

the following classifications were made, each

succeeding level being exclusive of the previous

levels:

Intensive nursing care

Catheterization

Oxygen therapy

Intravenous injections

Tube feeding

Bowel/bladder retraining

Full bed bath

Limited nursing care

Application of sterile dressings

Irrigation

Hypodermic injections

Routine nursing care

Enema

Blood pressure reading

Temperature-pulse-respiration checked
Personal care

Rub or massage

Special diet

Administration of treatment or medication

Assistance in personal hygiene or eating

No nursing or personal care

None of the preceding services were

received

Primay source of payment. –Primary source

of payment refers to private income or medical

assistance used as payment for residents’ stay in

the nursing home.

Own income or family support is any private

source of income from investments, Social

Security, or pension plans.

Medicare refers to payment from the Medicare program just described.

Medicaid refers to payment from the Medicaid program just described.

Other public assistance refers to Old Age Assistance, Aid to the B1ind, Aid to the Permanently and Totally Disabled, and Aid to

Families With Dependent Children.

Other refers to all other methods of payment or support including church support,

VA contract, initial payment for life caxe,

and cases for which no charge was made.

Terms Relating to Employees

Employee. –This term refers to any person

who was on the staff of the facility or was employed under contract. It includes any paid

worker, proprietor, or member of a reli#ous

order who contributes his services.

Full-time. –Employees who worked 35 hours

or more in the week prior to the survey are

designated “full-time.”

Part-time. –Employees who worked less than

35 hours in the week prior to the survey are

designated “part-time.”

Full-time-equivalent. –For the purposes of

the report, 35 hours of “part-time” employees’

work per week are counted as equivalent to one

“full-time” employee.

000

83
APPENDIX Ill

SELECTED QUESTIONNAIRES’ USED IN THE 1973-74

NATIONAL NURSING HOME SURVEY

@

.,,. ,1,, ,

*. , ,,

i@$! ‘) DEPARTMENT OF HEALTH. EDUCATION, AND WELFARE

.*”’ PUBLIC HEALTH SERVICE

,,,

HEALTH RESOURCES ADMINISTRATION

ROCKVILLE, MARYLAND 2D852

NATIONAL CENTER FOR

HEALTH STATISTICS

Dear Administrator:

The National Center for Health Statistics (NCHS) of the U. S. Public

Health Service is conducting a sample survey of resident facilities

providing nursing and personal care to obtain basic data on their

policies, services, and staff. This survey is being conducted as a

part of the Department of Health, Education, and Welfare’s nursing

home improvement program. The information from this survey will be

used to compile statistics on the number and kinds of such facilities

in the United States. Enclosed are two summary reports from previous

surveys, which are illustrative of the kinds of data to be obtained

from this survey. These statistics will be used to meet the needs of

Congress, State legislatures, Federal, regional, and local health

planners, national health associations, and many others who plan and

provide health services to the aged.

As you can see from these reports, it is not possible to identify any

particular facility. We wish to as sure you that any information which

permits the identification of the services provided by your facility,

or the residents and staff will be held strictly confidential. This

information will be used only by persons engaged i.n and for the purposes

of the survey, and will not be disclosed or released to others for any

purpose. Because the NCHS is committed to provide a factual basis for

planning national programs designed to advance the health of the American

people, limited basic information abOut your facility (such as name,

address, size, type, and ownership) will be made available upon request

to the NCHS.

Within about one week an interviewer will contact you for an appointment;

this person will be with Applied Management Sciences, the firm under

1See reference 1 for copies of all questionnaires used in the survey.

84
Federal contract to conduct this survey. In preparation for this call,

please review the worksheet printed on the back of this letter. These

questions request necessary information which may take time to assemble

from your records. I have enclosed them so that you may do this at

your convenience prior to the interviewer’s visit.

This survey includes a small, carefully selected nationwide sample of

nursing homes and similar facilities. Because this ntirsing home repre -

s ents several facilities of similar type, your participation is vital in

obtaining accurate and complete data”.

in this effort.

We wo;ld app-reciate your cooperation

Sincerely yours,

Edward B. Perrin,

Acting Director

Ph. D.

85
THE FOLLOWING QUESTIONS ON ADMISSIONS AND DISCHARGES CONCERN CALENDAR YEAR 1972,

WHICH IS THE PERIOD OF JANUARY 1, 1972 THROUGH DECEMBER 31, 1972.

From —— through —.

Month Year Mont h Year

● HOW MANY PERSONS WERE ADMITTED TO THIS FACILITY DURING 1972?

Admmsions

● HOW MANY PERSONS WERE DISCHARGED FROM THIS FACILITY DURING 1972, EXCLUDING DEATHS?

Dlwhwgos

● HOW MANY PERSONS DIED DURING 1972 WHILE RESIDENTS OR PATIENTS OF THIS FACILITY?

Daath$

● IN 1972, WHAT WERE THE TOTAL INPATIENT DAYS OF CARE PROVIDED? (THE SUM OF THE DAILY PATIENT CENSUS

COUNT FROM 1/1/72 THROUGH 12/31 /72.)

Days

● HOW MANY ROOMS FOR RESIDENTS DOES THIS FACILITY HAVE THAT CONTAIN:

a. 1 bed only a None

b, 2 beds O None

c, 3 beds ❑ No”.

d. 4 or more beds n N.me

RETAIN THIS FORM AND DATA FOR THE INTERVIEWER TO COLLECT.

86
FACILITY QUESTIONNAIRE I OMB # 06S-S-72172 I

1973 Nursing Home Survey 1

Expires 7-31-74

National Center for Health Statistics

I

Health Resources Administration

Rockville, Maryland

TELEPHONE NUMBER

AreaCode Number

Name and address label

ccl-1 CC2 0211-1 .X12

SECTION A - FACILITY INFORMATION

1.a.

2a.

Is THE CORRECT

(nameof facility on bbell

NAME FOR YOUR FACILITY?

34-1 ❑ yes

“2 •1 no+ b. WHAT IS THE CORRECT NAME? /(

Is THE CORRECT

(address on Iabal)

MAILING ADDRESS FOR YOUR FACILITY? A

m4).WHATISTHEENTIRECORREd’ ~

35-1 ❑ yes

-2 •1

MAILING ADDRESS7

Correct Name of Facility if Different from Above

Number Street P.O. Box, ROuta,

9tc.

City or Town County

State Zip Code

●3. WHICH CATEGORY BEST DESCRIBES THE TYPE OF SERVICE THIS FACILITY OFFERS THE MAJORITY OF ITS

RESIDENTS OR PATIENTS? (Mark (X) only one box.)

S6-1❑ a. Nursing home (includes Mtii@re =tified Extended Care Facilities and M~i=id =rtifi* Skilled Nursing Homed

-2 ❑ b. I ntermcdiate care facility (includes Madica”kl certif ied I mwmediate Care Facilitiad

-3 •1 c. Convalescent or rest home

4nd. Home for the eged .

{

-5 ❑ e. Extended are unit of a hospital

[

auf. Nursing care unit of a ratiremant center

“7 •1 9. Other rasidant facility (Describe) 37-

INTERVIEWER: IF BOX e OR f IS CHECKED, RECORD DATA ONLY FOR THE UNIT AND NOT FOR THE ENTIRE FACILITY.

●4a WHAT IS THE TYPE OF OWNERSHIP WHICH OPERATES THIS FACILITY? (Mark (X) only one box.)

3S,39 -23 ❑ a.

-24 ❑ b.

-25 ❑ C.

-~ ❑ d.

-21 ❑ e.

-22 f-J f.

-11 ❑ g.

-12 ❑ h.

-13 ❑ i.

-14 ❑ j.

-15 ❑ k.

-16 ❑ 1.

-17 ❑ m.

-18 ❑ n.

-19 ❑ 0.

Individual 1

Partnership

\/

4.b.

Corporation

Church related

Non~ofit mrporation

J

Other nonprofit ownership

State

County

City

City*ounty

Hospital District

U.S. Public Health .%rvice

Armad Forces

Veterans Administration

Other Faderal Agency - -Specify

IS THIS HOME A MEMBER OF A GROUP OF HOMES OPERATING

UNDER ONE GENERAL AUTHORITY OR GENERAL OWNERSHIP?

40-1 ❑ yes

-20 ~

Form 73 NHs-1

87
5. DOES YOUR FACILITY ACCEPT: (Mark (X) only one box.)

44-1 ❑ Males only?

-2 ❑ Females only?

“3 ❑ Both males and female3?

6a. DOES YOUR FACILITY ACCEPT PERSONS OF ALL AGES, INCLUDING IN FANTSAND CHILDREN?

45-1 Q Yes (Sktp to Question 7)

-2

L

No

b. WHAT IS THE MINIMUM AGE ACCEPTED? ❑ Nomo”IrmIm.wor _ yrs.

CC46,47

c. WHAT IS THE MAXIMUM AGE ACCEPTED? ❑ No ma.ximumagecx yrs.

CC4S,49

7. WHAT IS THE TOTAL NUMBER OF BEDS REGULARLY MAINTAINED FOR RESIDENTS? (INCLUDE ALL BEDS SEr UP

AND STAFFED FOR USE WHETHER OR NOT THEY ARE IN USE BY RESIDENTS AT THE PRESENT TIME. DO NOT

INCLUDE BEDS USED BY STAFF OR OWNERS OR BEDS USED EXCLUSIVELY FOR EMERGENCY PURPOSES, ~ELY

DAY CARE, OR SOLELY NIGHT CAR E.)

Total beds

CC50

8a. WAS

54-2

.1

THERE AN INCREASE OR DECREASE IN THE TOTAL NUMBER OF BEDS DURING THE LAST YEAR?

❑ No LSkiptoQ.estion9)

T

Yes

b. Increase of

CC55

c. Decrease of

CC58

beds

9a. WHAT WAS THE TOTAL NUMBER OF RESIDENTSON THE REGISTER OF THIS FACILITY LAST NIGHT? (INCLUDE ALL

RESIDENTS, EVEN THOUGH THEY MAY HAVE BEEN TEMPORARILY AWAY OR ON OVERNIGHT LEAVE, DO NOT

INCLUDE STAFF OR OWN ERS.)

Total restdents

CC61

b. HOW MANY OF THESE WERE:

[11 Males? ❑ Nmwor

CC65

(2) Females7 ❑ None or

CC69

CAR D 2

ccl 1-2

10,a. IS THIS FACILITY PARTICIPATING IN THE MEDICARE (TITLE XVIII) PROGRAM?

[

b. WHAT IS THE PROVIDER NUMBER7

❑ No ,mv,der # ,IV6!.

CC13

12-1 ❑ Yes~ c. HOW MANY BEDS ARE CERTIFIED FOR MEDICARE?

beds

CC19

d, HOW MANY OF THESE CERTIFIED BEDS WERE OCCUPIED BY MEOICARE

PATIENTS LAST NIGHT?

❑ F&am or beds

CC23

‘2 ❑ NO (Sk!p to Question 1 I I

Form 73 NHS-1

88
11.a. IS THIS FACILITY PARTICIPATING IN THE MEDICAID (TITLE XIX) PROGRAM?

/’ ❑ Yes ~ No (Skip to Quastion 12)

29-1

b.(1) DOES IT HAVE ANY SKILLED NURSING BEDS?

❑ No ❑ Yes~

[

b.(2)

302 -1

/

b.(3)

WHAT IS THE PROVIDER NUMBER?

Sc31 n

u

No provider # given

HOW MANY BEDS ARE CERTIFIED AS SKILLED NURSING BEDS?

❑ Nomor beds

se44

/

[

b.(4) HOW MANY OF THESE CERTIFIED BEDS WERE

OCCUPIED BY MEDICAID PATIENTS LAST NIGHT?

❑ Nme.x back

CC4B

c.(1) DOES IT HAVE ANY INTERMEDIATE CARE BEDS?

❑ N.

52-2

❑ Ye, ~

[

c.(2) WHAT IS THE PROVIDER NUMBER?

-1 CC53 ❑ No providar # givan

c.(3) HOW MANY BEDS ARE CERTIFIED AS INTERMEDIATE CARE BEDS?

u Nom or beds

CC66

L

c.(4) HOW MANY OF THESE CERTIFIED BEDS WERE

OCCUPIED BY MEDICAID PATI ENTS LAST NIGHT?

❑ None or ~c,o bads

SECTION B - CLASSIFICATION INFORMATION (CONFIDENTIAL)

ASSURANCE OF CONFIDENTIALITY - All information which would permit identification of the individual facility will be held in

strict confidence, will be used only by persons engaged in and for the purposss of the survey, and will not be disclosad or

released to others for any purposes.

12.a. WAS THIS BUILDING ORIGINALLY CONSTRUCTED FOR USE AS A NURSING HOME, REST HOME, CONVALESCENT

HOME, HOME FOR THE AGED?

CARD 3

ccl 1-3 ❑ Yes

12-1

(Skip to next page)

b. WHAT WAS THE ORIGINAL PURPOSE AND USE OF THIS BUILDING?

13-1 •1

“2 •1

-3 •1

~cl

-5 •1

~D

Private home (i.e., single family dwelling)

Duplex (2 to 4 units]

Apartment housa (6 or more units)

Hotel or motel

Hos+ital

Other E.pacify) 14-

{Mark {X) only one box.]

Form 73 NHS-1

89
Intwvlwor:

S- &ok of

THE FOLLOWING QUESTIONS ON ADMISSIONS AND DISCHARGES CONCERN CALENDAR YEAR 1972,

:~m;n&ator WHICH IS THE PERIOD OF JANUARY 1, 1972 THROUGH DECEMBER 31, 1972. IF YOUR ANSWERS TO

for atmstlons THESE QUESTIONS COVER A PERIOO OTHER THAN CALENDAR YEAR 1972, WHAT IS THIS OTHER TIME PERIOD?

13 through 77.

From —— through —.

Month Year Month Year

ccf5,16 CC17,16 CC19,20 CC21,22

13. HOW MANY PERSONS WERE ADMITTED TO THIS FACILITY DURING 1972?

Admm,ions

CC23

14. HOW MANY PERSONS WERE DISCHARGED FROM THIS FACILITY DURING 1972, EXCLUDING DEATHS?

DIacharges

CC27

15: HOW MANY PERSONS DIED DURING 1972 WHILE RESIDENTS OR PATIENTS OF THIS FACILITY?

Deaths

CC31

16. IN 1972, WHAT WERE THE TOTAL INPATIENT DAYS OF CARE PROVIDED? (THE SUM OF THE DAILY PATIENT CENSUS

COUNT FROM ltl172 THROUGH 12/31 /72.)

Days ❑ (mark [Xl f estimated)

CC35 41-1

17. HOW MANY ROOMS FOR RESIDENTS DOES THIS FACILITY HAVE THAT CONTAIN:

a. ❑ No”. IX 1bed only

CI%14

b. ❑ None or 2 beds

CC46

c. ❑ None or 3 beds

CC52

d. ❑ None or 4 or more beds

CC56

“18. ARE ANY OF THE FOLLOWING SERVICES ROUTINELY PROVIDED TO RESIDENTS IN ADDITION TO ROOM AND BOARD?

a. Supwvismn over medications whmh may be self-adminmered 60-1 ❑ Yes -2 ❑ No

b. Medicat tons and treatmems adm l“t$.tered i“ accorda”~e with 61-1 ❑ Yes -2 ❑ No

physicians’ orders

c. Rub and mass-e 62-1 ❑ Yes -2 ❑ No

d. Help w!th tub bath or shower 63-1 ❑ Yes -2 ❑ No

e. Help with dressing 64-1 ❑ Yes -2 ❑ No

f. Help with correspondence or shopping 65-1 ❑ Yes -2 ❑ No

9. Help with walk!ng or gtit)ng about 66-1 ❑ Yes -2 D No

h. Help with eat!ng 67-1 ❑ Yes -2 ❑ No

OR

i. None of the above sewices routinely provided, room and 68-1 ❑ Yes

Imard provided only

Form ‘13NHs.l

90
●19. DURING THE PAST SEVEN DAYS, HOW MANY RESIDENTS RECEIVED EACH OF THE FOLLOWING SERVICES7

CARD 4

CC114

a. Nasal feeding b. B Iced pressure reading

ccl 2

d. Catheterization e. Full bed-bath

CC24

g. Oxygen therapy h. Application of dresCC36 sing or bandage

j. Hypodermic injection k. Irrigation

CC4S

CC16

CC40

CC52

c. Enema

f. 80wal or bladder

ratrainimg

i. Tempcrature-pulserespiration

1. Intravenous injection

CC20

CC32

CC44

.x56

’20. DOES THIS FACILITY PROVIDE ANY OF THE FOLLOWING PROFESSIONAL REHABILITATION SERVICES ON THE

PREMISES? (THE THERAPISTS MUST BE LICENSED OR REGISTERED IN THEIR SPECIFIC PROFESSIONS.)

a. Physic4 therapy

b. Occupational therapy

c. Recreational therapy

d. Speech and hearing therapy

a. Counseling by social worker, psychologist, or mental health

worker

f. Other rehabilitation services (Specify)

66-

60-1

61-1

62-1

63-1

64-1

65-1

❑ Yes

❑ Yes

n Yes

❑ Yes

❑ Yes

❑ Yes

-2 ❑ No

-2 ❑ No

.2 ❑ No

-2 ❑ No

-2 •1 No

-2 ❑ No

21. DOES THIS FACILITY CONDUCT TRAINING PROGRAMS FOR PEOPLE NOT ON YOUR STAFF IN COOPERATION

WITH AN EDUCATIONAL INSTITUTION?

❑ Yes ~ No

67-1

22. WHAT ARE THE ACTUAL HOURS FOR EACH SHIFT? (Cucte am or pm)

CARD 5

Ccl 1-5 a. Day S hift from

b. Evenimg Shift from

c. Night Shift from

am

to

am

ccl 2 pm CC18 pm

am to am

CC20 pm CC24 pm

am to am

CC2B pm CC32 pm

❑ No such shift

❑ No such sh,ft

Form 73 NHs-1

91
23a. 1. FOR THE DAY SHIFT YESTERDAY, WAS THE PERSON IN CHARGE OF NURSING CARE (FOR THE ENTIRE

FACILITY): (Mark (X) Only One Box)

36-1 ❑ ON CALL .2 ❑ ON DUTY - that ISawake,

/

, residents a2

dressed, and sewing the

39-1

-2

23.b. 1.

-3

4

WHAT IS THE LEVEL OF a.3. WHAT HOURS DID TtJl&PERSON

SKILL OF THIS PERSON? WORK YESTERDAY? (Circle

(Mark [X) Only One Box) am or pm.)

am am ❑ Registwad N.rsa from to —.—

CC41 pm CC45 pm

❑ Licemti Practical Nurse

❑ N.rs#sAide

❑ other 43-

SpecifyOccupation

FOR THE EVENING SHIFT YESTERDAY, WAS THE PERSON IN CHARGE OF NURSING CARE (FOR THE ENTIRE

FACILITY): (Mark (X) Only One Box)

/

49-1 ON CALL .2

L

ON DUTY - that is awake, -3

Q

NO SUCH SHIFT

dressed, and sewing the (Skip to Part 23.c.)

residents

b.2. WHAT IS THE LEVEL OF b.3.

SKI LLOF THIS PERSON?

(Mark (X) Only One Box)

WHAT HOURS DID THIS PERSON

WORK YESTERDA~rcte

am or pm.)

50-1 •1

“2 •1

-3 ❑

“cl

am am

Registered Nurse from to ——

CC52 pm cc% pm

Licensed Practical Nurse

Nursa’s Aida

Other 51-

Spacifv Occupation

23.c. 1. FOR THE NIGHT SHIFT YESTERDAY, WAS THE PERSON IN CHARGE OF NURSING CARE (FOR THE ENTIRE

FACILITY): {Mark (Xl OnIv One Box)

j7°NcALL”2F: “3uN0sucHs

61-1

-2

-3

-?

&(Skip to Q.estm” 24)

WHAT IS THE LEVEL OF c.3. WHAT HOURS DID THIS PERSON

SKILL OF THIS PERSON? WORK YESTERDA~rclB

(Mark (Xl Only One Box) am or pm.)

•1

•1

El

❑

am am

Registered Nurse from to ——

CC63 pm 67 pm

Llcensad Practical Nurse

Nurse’s Aide

Other 62-

Specify Occupation

24. HOW MANY DIFFERENT PHYSICIANS CURRENTLY ATTEND THEIR OWN PRIVATE PATIENTS IN THIS FACILITY?

(DO NOT COUNT PHYSICIANS WHO ARE ONLY ON THE STAFF OF THE FACILITY OR ARE ONLY EMPLOYED

UNDER CONTRACT.)

Physicians

CC71

Form 73 NHs-1

92
25a. WHAT TYPE OF STAFF MEMBER EXERCISES DAILY, ON-DUTY SUPERVISION OVER ALL CLINICAL SERVICES

IN THIS FACILITY? (Mark (X) Only One Box.)

Administrator . . . . . . . . . 76-1 ~b. IS THE ADMINISTRATOR ALSO A:

physician 76-1 ❑ Yes .2 ❑ No

registered nurse 77.1 Q Yes .2 ❑ No

licensed practical 78-1 ❑ Yes -2 ❑ No

nurse

Physician . . . . . . . . . . . . 75-2 ❑

Registered Nurse . . . . . . .

-30

Other . . . . . . . . . . . . . . 4

7

Specify 78-

’26. DOES THIS FACILITY PROVIDE ANY OF THE FOLLOWING SERVICES TO PERSONS WHO ARE NOT RESIDENTS OF

THIS FACILITY?

a. Day care (services provided during the day to persons who

CARD 6 do not deep in the home overnight. DaY care services can

Ccl I-a incltie nursing care, physical or occupational therapy,

recreational activities, at least ona full meal a day) . . . . . . 12-1 ❑ Yes -2 ❑ No

b. Meals either home delivered or in a group setting . . . . . . 13-1 ❑ Yes -2 ❑ No

c. Transportation andlor escort services. . . . . . . . . . . . . . 14-1 ❑ Yes -2 a No

d. Homemaker or chore services . . . . . . . . . . . . . 15-1 0 Yes -2 ❑ No

e. Information andlor raferral for health needs . . . . . . . . 16-1 ❑ Ye* -2 ❑ No

f. Friendly visiti~ . . . . . . . . . . . . . . . . . . . . . . . ...17-1 D Yes “2 •1 No

9. Daily telephone checking sewice . . . . . . . . . . . . . . . . 18-1 ❑ Yes -2 ❑ No

h. Arrangement or provision of recreational activities . . . . . . 19-1 ❑ Yes -2 ❑ No

i. Laundry service . . . . . . . . . . . . . . . . . . . . . . . ...20-1 /J Yes “2 •1 No

i. Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...21-1

P

Yes -2 ❑ No

Specify 22.

27a. DOES THIS FACILITY KEEP A WAITING LIST OF PERSONS TO BE ADMITTED WHEN A BED BECOMES AVAILABLE?

0-1 “s ❑ No (Skip to Quest,o. 28)

-2

b. HOW MANY PEOPLE ARE ON THIS WAITING LIST?

❑ None or — Pawle

CC24-26

c. DO YOU PROVIDE ANY SERVICES TO THE PERSONS ON THIS WAITING LIST?

P

Yes

27-1

❑ No (Skip to Qw?stion 28)

-2

* c.(1) WHICH OF THE FOLLOWING SERVICES DO YOU PROVIDE?

a.

b.

c.

d.

e.

f.

9.

h.

i.

L

Form 73NHS.1

Day care (sarwces provided during the day to parsons who

do not sleep in the Iwme overnight. Day care services can

include nursing care, physical or occupmional therapy,

racraatkmal activities, at least one full meal a day) . . . . . . 28-1 ❑ Ye, .2 ❑ No

Meals either home delivered or m a group setti~ , . . ...28.1 ❑ Yes -2 ❑ No

Transportation andlor escort services . . . . . . . . . . . . . 30.1 ❑ Yes .2 ❑ No

Homemaker orchoresm-vices ., . . . . . . . . . . . ...31-1 ❑ Yes .2 ❑ No

Information andlor referral for health needs . . . . , , . . 32-1 ❑ Yes -2 ❑ No

Friendly visitic.g . . . . . . . . . . . . . . . . . . . . . . ..33.1 ❑ Yes -2 ❑ No

Daily telephone checking service . . . . . . . . . . . . . . . . 34-I ❑ Yes -2 ❑ No

Arrangement or provision of recreational activities . . . . . 35-1 ❑ Ye, .2 ❑ No

Laundry swvice. . . . . . . . . . . . . . . . . . . . . . . ...36.1 ❑ Yes -2 ❑ No

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...37.1

P

Yes -2 ❑ No

Specify 38-

93
’28. DOES THIS FACILITY INCLUDE AS PART OF ITS BASIC CHARGE TO EACH RESIDENT THE CHARGES FOR:

a.

b.

c.

d.

e.

f.

9.

h.

Yes No

Phys!cmnserwces . . . . . . . . . . . . . ., .,29-1 ❑ -2 •1

Private duty nursing . . . . . . . . . . . . . . . . . . ,. #-l •1 -2 •1

Other nursing wvmes. . . . . . . . . . ., ...,......41-1 •1 “2 •1

Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . ...42-1 •1 -2 •1

Orugs . . . . . . . . . . . . . . . . . . . . . . . . ...43-1 •1 “2 ❑

Medical supplies . . . . . . ...44-1 •1 “2 ❑

Specialdiet . . . . . . . . . . . . . . . . . . . . . . . . . ...45-1 •1 -2 ❑

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...46-1

P

-2 •1

Specify 47-

29. HASTHIS NURSING HOME BEEN IN BUSINESSATTHISADDRESS FOR LESSTHANTWOYEARS? (COUNTFROMTHE

TIME ITFIRSTOPENED ATTHISADDRESSAS ANURSING HOME EVENTHOUGHTHE OWNERSHIP ORTHE SERVICES

OFFEREDMAY HAVE CHANGED.)

r’ Yes

50-1

Do Not Administer Expense Questionnaire

94
EXPENSE QUESTIONNAIRE

1973 Nursing Home Survey

National Center for Health Statistics

Health Resources Administration E!El

Rockville, Maryland

Dear Accountant:

The National Center for Health Statistics (NCHS) of the U. S. Public Health Service is conducting a

survey of all resident facilities providing nursing and personal care to obtain basic data on their operating

expenses, services, and staff. This survey is being conducted as a part of the Department of Health,

Education, and Welfare’s nursing home improvement program. The information from this survey will

be used to compile statistics on the number and kinds of such facilities in the United States. These

statistics will be used to meet the needs of Congress, State legislatures, Federal, regional, and local

health planners, national health associations, and many others who plan and provide health services

to the aged.

This booklet contains the Expense Questionnaire, together with the account descriptions of the cost

categories included in the questionnaire. In addition, there is a full-time Certitled Public Accountant

whose services are free of charge available via toll free telephone (800-6384856) to answer your questions

about completing this questionnaire. However, we ask that you first attempt to complete the attached

questionnaire (which immediately follows in this booklet), using this instruction booklet. If you still have

questions, please use the free telephone contact (listed above) to acquire answers ptior to completing

the questionnaire.

Please note at the bottom of this page that authorization is given for you to release the requested

information. We wish to assure you that any information which permits the identification of the

individual facility will be held in strict confidence, will be used only by persons engaged in and

for the purposes of the survey, and will not be disclosed or released to others for any purposes.

Please complete this questionnaire and return it in the enclosed postage-paid envelope within 5 working

days. Your cooperation in this survey will be greatly appreciated.

Sincerely yours,

Edward B. Perrin, Ph. D.

Acting Director

I hereby authorize of

(Accountant’s. Name) (Accountant’s Address and Telephone)

{

IJ fiscal year

to list the ❑ 1972 Calendar year 1

expenses in operating the

Facility Name)

of

(Facility Address)

Date

(Signature) (Title)

Form 73N HS-2

95
INSTRUCTIONS FOR COMPLETING THE EXPENSE QUESTIONNAIRE

PLEASE READ THESE INSTRUCTIONS CAREFULLY BEFORE YOU BEGIN TO ANSWER

THE EXPENSE QUESTIONNAIRE WHICH IS ATTACHED TO THIS BOOKLET

The definitions in this manual highlight the substance of each cost grouping as well as

related groupings of expenses to be excluded from specific cost definitions.

Donated services, supplies, space, etc., are to be priced at their reasonable value and added to

the cost category to which applicable.

Where a home is an affiliate of another facility, such as a hospital, and the records of the home

are a part of the total accounting system, allocation techniques may be required to identify certain of the

costs such as payroll, rent, supplies, and insurance. This is acceptable providing a sound basis is established

for the allocation.

While it is preferred that the report be on the calendar year ending December 3?, 1972, you

may cover a different twelve-month period if you are on a fiscal year basis. The cost data, of course,

must be for the same time frame as the related statistical data included in other phases of this survey.

This is for the purpose of including all of the costs of delivering health care, disregarding whether the

services were paid for or (as in homes staffed by members of a religious order) donated,

Expenses may be reported on either a cash or accrual basis; however, there must be a

consistency in the system applied throughout the entire period under report.

The cost categories in this questionnaire are aimed at the total cost of care for patients, and

are matched to statistical data being collected for parallel purposes. Typical functions 1cost information

(e.g., administrative, clerical, medical cost categories) will not provide.an appropriate framework for the

study and shou Id consequently not be used.

—

The expense categories used in this questionnaire are also not intentied to be a recommended

cost structure for homes; they are tailored to a single specific use in the survey. It is recognized that

certain of the costs, such as supplies, foods, drugs, and equipment specifically purchased for sale to

patients, may not, within the present expense structure of a home, be recorded as expense. Again, this

survey is for the purpose of capturing all costs incident to providing health care In a home and therefore

must include services and supplies dire~y charged to patients.

In general, it is essential that all recorded expenses incurred by the ~tome be included in the

expense categories, as well as the value =donated items not recorded in the account structure. Excluded

from costs, however, are any losses sustained in the sale or disposition of fixed assets and other extraordinary losses not related to the current cost of providing health care.

Form 73N HS-2

96
EXPENSE QUESTIONNAIRE

L I

1973 Nursing Home Survey

National Center for Health Statistics

Health Resources Administration

Rockville, Maryland

ccl -2

ASSURANCE OF CONFIDENTIALITY - All information which would permit identification

ESTABLISHMENT NO.

of the individual facility will be held in strict confidence, will be used only by persons engaged in

and for the purposes of the survey, and will not be disclosed or released to others for anY purposes.

CC2

A. PLEASE LIST BELOW THE 1972 CALENDAR YEAR EXPENSES FOR OPERATING THE FACILITY, IF EXPENSES

ARE NOT FOR THE 1972 CALENDAR YEAR, SPECIFY PERIOD COVERED:

CARD 1 from to

ccl 1-1 month year month year

ccl 2 ccl 4 CC16 CC18

B. REFER TO THE ENCLOSED DEFINITIONS WHEN COMPLETING THIS FORM. FOR FURTHER CLARIFICATION

PLEASE CALL FREE OF CHARGE THE FOLLOWING PHONE NUMBER: 800-638-0856.

EXPENSE CATEGORY AMOUNT

1.

CARD 2

ccl 1-2

2.

3.

4.

5.

6.

7.

—

(See Note 1on next page) {If NONE, please enter “O”)

Payroll Expense [Do not include contracted services):

a. Wages and Salaries (gross amount including

employees’ F! CA, vacation and sick pay,

taxes, etc.):

(1) Nursing staff payroll expense . . . . . . . . . . . ..$

(include RNs, LPNs, Practical nurses, CC21

a.kles, orderlies, student nurses, and

other nursing staff)

(2) Physicians, other professionals and semiprofessionals payroll expense . . . . . . . - . . . . $

CC31

{3) All other staff payroll expense . . . . . . . . . . $

(All employees not listed in (1) and (2) CC41

including salary or wit hdrawa k for

self -employed proprietor-owner*)

SUBTOTAL (add lines a.(l), a.(2), and

a.(3) . . . . . . . . . . . . . . . . . . . . . . . . . ..- . . . . . . ..$

CC51

b. Fringe Benefits (state unemployment, . . . . . . . . . . . . . . . . . . . . ..$

group health and life insurance and all other CC61

Wyroll aml non-payroll benefits for all

employees on the staff)

TOTAL PAYROLL EXPENSE (add

subtotal lineand line lab.).... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$

CC71

Equipment Rant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$

CC21

Insurance (include professional-public liability and . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$

othar insurance) CC31

Taxes andlicenses (include franchise tax) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..-. ..$

CC41

lntarest and Financing Charges. . . . . . . . . . . . . . . . . . . . . . . . . . . . ..-- . . . . . . . ..-. .$

CC51

Depreciation Chargea (Buildings and Equipment) . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

cc61

Rent on Building and Land.... . . . . . . . . . . . . . . . . . . . . . . . . . ..- . . . . . . . . . . ..$

cc? 1

“ If self-employed proprietorawner isnon-salar iad, please estimate salary.

Form 73N HS-2

97
CARD 3

ccl 1-3

8.

9.

10.

11.

12.

13.

CAR D 4

ccl 1-4

14.

15.

16.

Amortlzatlon of Leasehold lmpmvements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$

CC21

Foodand Other Dletaryltems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$

(include non-contracted services only) .X31

Drug Expenses (cost ofdrugs emher purchased . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$

or obtained by contract, or purchased for patients

and told directly to them)

cdl

Supplies and Equipment (cost ofsuppllesand . . . . . . . . . . . . . . . . . . . . . . . .,. ,.. . . . ..$

equipment either purchased or obtained by CC51

rnntract, or purchased for patients and so Id

directly to them)

Purchased Maintenance of Buildings, Gro””ds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$

and Equipment C&l

Laundry and Linen Expense (include non- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$

contracted serwces only) CC71

Purchased Department Functions:

a. MMIWI, therapy, educational laboratory . . . . . . . , . . . . . . . . . s

and other professional services obtained CC21

by wntract.

b. All other contracted services (include house. . . . . . . . . . . . . . . . . . . . $

keeping, linen, food, or other services not CC31

obtained in-house)

TOTAL PURCHASED DEPARTMENT FUNCTIONS (add lines . . . . . . . . . . . . . . . . . . . .$

14.a and 14.b) (%41

Utilities (telephone, gas, water, and electricity ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$

CC51

Other and Miscellaneous Expense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$

(include dues, Subscriptions, travel, awe. Cc61

mobile, advertising, other services not

incl,,ded elsewhere, medical and non-medcal

fees, unclass! fled). See Note 2 below.

TOTAL EXPENSES (addexpense mtqoryline items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$

1 through 16) CC71

Please check the addn io n of subcategories and rota I expenses.

Note 1.

Note 2,

If your accounting system does not generate cost items as cctcgorized above, please use your best estimate

of allocation among the Il”e items.

If Other and Miscellaneous Expense comprises 10 percent or more of the total expenses, please give details below

of major amounts which constitute 20 percent or more of Line 16.

Descrlptlon Amount

If Your questions are not answered by the instructions, you may contact a certified public accountant free of charge at the

following toll-free number for answers:

(800) 638-0856

Thank you,

Form 73N HS-2

98
DEFINITIONS

1. PAYROLL EXPENSE

a. Wages and Salaries

Wages and salaries are generally defined as gross earnings paid an employee including payment for annual and sick

leave, overtime, bonuses and other remuneration of a payment nature received by the employee. The wages and salaries represent

theamount earned andreported to the Internal Revenue Semiceon hisorher W-2statement. Self-employ edproprietors, while

not salaried as employees, are to be included in this definition either in the amount reported on the tax return as self-employed

salary, or as a reasonable amount, related to the technical or non-technical services provided.

Employee salaries and wages, by the above definition, exclude payments for professional or non-professional services

obtained under contract, or fees paid doctors onafee-for-service basis. Also excluded from Wages and Salaries are Fringe Benefits

as definedin 1 b(Payroll Expense -Fringe Benefits) below.

Non-funded employee benefits such as meals and living quarters, if provided an employee, and considered a part of the

gross salary received, are to be included in gross wages and salaries.

Wages and salaries are to be reported on the gross basis, without deductions for FICA, Federal and State taxes, and other

deductions from an employee’s gross pay.

(1) Nursing and Staff Payroll Expense

Nursing staff payroll expense is defined as the total wage and salary compensation given those employees who

administer nursing care to patients.

This category includes registered nurses, licensed practical nurses, practical nurses, nurses’ aides, orderlies, and student

nurses.

(2) Physicians and Other Professionals Payroll Expense

Physicians and other professionals payroll expense is defined as wage and salary compensation given those professional

employees who provide direct health care to patients.

This category includes physicians, psychiatrists, dentists, optometrists, therapists, psychologists, podiatrists, audiologists, etc.

(3) All Other Staff Payroll Expense

All other staff payroll expense is cfefined as wage and salary compensation given all employees not specifically

categorized in (1) or (2) above.

This category includes medical and dental technicians, social service workers, X-ray assistants, lab assistants, and

administrative personnel including a self-employed proprietor-owner.

Nursing staff, physicians and other professionals are excluded from this category.

Any employee who spends 75 percent or more of his time in any one of the three areas mentioned above should have

@Jof thewage andsalary compensations charged tothat expense category. Further allocation is acceptable if It isafeatureo+

your accounting system.

b. Fringe Benefits

Fringe benefits areexpenses incurred bythe home forthecurrent and future benefit of home employees. These

expenses, notadded tothewages and salaries of theemployees, include such items asgroup health, hospital ization, employer’s

portion of FICA, Federal and State Unemployment Insurance, andlife insurance premiums (exclusive of premiums paid where

(a) the Home is the beneficiary or (b) on the life of the proprietor-owner).

Excluded from this cost category are payments for vacation, maternity and sick pay, terminal payments, employee’s

share of FIC-ving facilities provided employees where such facilities preestablished forthebenefit of the home.

2. EQUIPMENT RENT

Equipment rent is defined as all costs incurred for the rental or leasing of equipment. Charges to this category

would include therental orleasing of furniture, typewriters, computers, X-ray machines orother forms of equipment. Exclude

from this category all Iease-purchase agreements and deferred payment plans onthe purchase of equipment. These Iatter:yv$

purchases will be treated through the Depreciation Cost Category (expense category 6).

Form 73N F!s.2

99
3. INSURANCE

Insurance is defined as the cost of premiums for policies necessary to the normal operation of nursing homes.

These charges include fidelity bonds, fire and extended coverage, malpractice, property and bodily injury liability, and

automobile insurance where transportation is included as a service of the facility.

Exclude insurance paid for the benefit of employees, such as employee life or group hospitalization, as well as key man

life insurance. Seedefinition ofexpensecategoryl (b) fordiWribution ofemployee benefit insurance paid. lfthe home's

accounting system ison the accrual basis, exclude any prepaid costs and inckrde only thepremiums on the current year’s portion.

4. TAXES AND LICENSES

Taxes and licenses are defined as costs paid or due to Federal, state, county, and local governments for taxes levied or licenses

required.

This category includes licenses obtained for the right to do business and taxes on real estate, personal property, excise and

business franchise taxes.

Amounts remitted to Federal, state, county, and local governments for income taxes withheld from wages and salaries must

be excluded.

5. INTEREST AND FINANCING CHARGES

Interest and financing charges are defined as costs incurred as interest or finance charges on loans, notes, or other forms of

indebtedness.

These charges include amounts of interest on notes payable, mortgages payable or Iongterm purchase agreements. The

initial cost of financing or refinancing a loan, however, is to be excluded as an extraordinary cost not related to the normal cost

of providing health service. Also to beexcluded from this expense category areplacement feeson Ioansand costs related to

penalty clauses on early retirement of mortgages or other loans.

Penalties paid to Federal, state, county, or local governments for improper filing of tax or information returns should be

excluded.

6. DEPRECIATION CHARGES

Depreciation is defined as the distribution of the cost of tangible capital assets, lesssalvage (if any), over the estimated

life of the asset.

Charges to this category should exclude amortization as defined in expense category 8.

Depreciation charges are to be limited to the straight-line method rather than an amount that may be acceptable under the

Federal tax law(double-declining, sum-of-the years digits, oneandone-half straight-line, etc.).

Tangible capital assets, currently being purchased under a lease-purchase agreement, are to be depreciated rather than treated

asa rental payment. Exclude from this category any equipment of anominal amount expensed in Equipment (Cost category 11, ).

7. RENT ON BUILDING AND LAND

Rent on building and land is defined as all costs incurred for space occupied pursuant to leases or rental agreements.

Included in this category is the cost of ail buildings or real estate rented or leased by the home.

Charges to this category should exclude lease-purchase agreements and payments made on a mortgage covering the building

or land.

!.?. AMORTIZATION OF LEASEHOLD IMPROVEMENTS

Amortization of leasehold improvements is defined as the writeoff of improvements to leased premises over the remaining

life of the lease or the useful life of the improver,.ent, whichever is shorter.

Improvements to leased premises which have a remaining lease or useful life of one year or less should be expensed directly

when incurred.

Included in this category are improvements to leased premises such as wall partitions, permanent counters and cabinets,

tile floors and wall coverings, and plumbing fixtures.

Exclude from this category any improvements of a nominal amount charged to repairs and maintenance and included in

another cost category in this questionnaire.

Form 73NHS.2

100
9. FOOD AND DIETARY ITEMS

Dietary and food items purchased for preparation on the home’s premises are to be charged to this account.

Income received on the sale of meals to non-patients and staff (when charged) will be deducted from the recorded gross

cost of the food and dietary items.

Where food inventories are maintained, the cost of food consumed will be the basis for the recording of cost (inventory at

beginning of year plus purchases, less ending inventory.) Freight and sales taxes, whether included in the purchase, or as a separate

item (freight only), are to be charged to the cost of food and dietary items, rather than to be charged to “Taxes and Licenses”

(sales tax) or “Other and Miscellaneous Expense” (freight).

This cost category excludes related food costs, such as food preparation (wages), cost of kitchen operation, menu preparation,

and paper supplies related to the serving of meals.

The mst of meals purchased from hospitals or other outside services is excluded from this cost category (see 14 (b), Contracted

Services - Food) whether or not under contract.

Food purchased (to be prepared by the home) for sale to specific patients is also to be charged to this account.

10. DRUG EXPENSES

Drug expenses represent the cost (or value when donated) of drugs consumed out of inventory or purchased for patients

andresold tothem. Drugs notunder inventory control wili reconsidered expensed when purchased.

For purposes of this definition, drugs include both prescription type medicines as well as non-prescription items such as

aspirin, laxatives, and vitamins. Excluded from this definition are such non-mdicine items ascotion, bandWes, syringes, and other

items which donotmeet thecommon definition ofdrugs, andarecategorized under supplies, item 11, below.

Recognizing that medical supplies may be co-mingled in the cost account with drug items, an allocation technique may be

adopted for the purposes of determining the separate cost of drug expenses.

The cost of drugs includes freight costs as well as sales taxes added to the purchase price of drugs.

Drug cost is not to be reduced by revenues from patients whether sold out of the nursing home inventory or purchased

specifically for thefise.

11. SUPPLIES AND EQUIPMENT

a. Supplies

Includes the purchase or donatea value of aH supplies exclusive of drug supplies (see 10.) and food and other dietary

itelns (see 9.)

Supplies include, but are not limited to, supplies used in food preparation and serving (dishes, kitchen ware, paper

supplies, etc.), office supplies, medical suppkes, laundry, linen and blanket supplies, uniforms, the purchase of minor equipment

(staplers, ash trays, etc.) classified as supplies, and repair and maintenance supplies and parts (cleaning supplies, light bulbs, small

tools, etc.).

Under normal conditions, suppliv: of the nature of those classified for inclusion in this cost category are not maintained

under inventory control except as a minimum level which may be used as a re-order point. The accounting system of the h3m~ will

dictate whether these costs will be developed on a “delivery basis” or on “issued” basis. Either method will be acceptable.

In those instances where the nursing home is affiliated with another facility such as a hospital and there is no separation

o; accounting record? m allocation cost distribution method, consistent with sound accounting practices and principles, will be

acceptable.

b. Equipment

Includes the purchase or donatmn of items classified as equipment, but because of the nominal cost or nature of the

items, they are —not capitalized.

Equipment in this grouping include, but are no: limited to, appr.cp~iate items of medical equipment, furniture and

fixtures of a nominal value not maintained under asset control, repair and maintenance equipment, kitchen equipment, and

administrative equipment.

Form 73NHS-2

101
Equipment purchased specifically for sale to a patient, regardless of the cost or nature of the purchase, is to be

included !n this category. Reasoning behind this decision is that title belongs to the patient and, accordingly, the home has no

basis for depreciating the equipment. Accordingly, alJequipment purchased for patients will be recorded in this cost category. The

revenues derived from the sale of the equipment to the patients will not be credited as an offset to the cost recorded in Supplies

and Equipment,

Exclude from this category any equipment which is being depreciated in cost category 6,

12. PURCHASED MAl NTENANCE OF BUl LDING, GROUNDS, AND Equipment

This cost grouping Includes contract costs for elevator maintenance, equipment appliance maintenance, ground maintenance,

contracts to maintain plum bing, electrical systems, and similar type service requirements. Excluded from this grouping are contracts

forsuch services as trash removal, cleaning services, andother housekeeping services. Thecost for these Iattercontracts istobe

recorded in 14 (b), Purchased Department Functions -. All Other Contracted Services.

Maintenance costs, not under contract, to be recorded in this cost category include the expense of plumbers, electricians,

ground maintenance, carpenters, general repairmen (appliance repairs, etc.), andsimilar non-contractual maintenance services.

13. LAUNDRY AND LINEN EXPENSE

This account relates tothe cost of outside service only, rather than the cost of purchasing Iinens, towels, blankets, uniforms,

etc. This cost may or may not be undera service contract and may include the rental cost of the supplies provided under a contract.

Laundry and linen expense, as classified in this cost category, excludes services for this function provided by nursing home

staff. Personnelcosts forth isservicewlll be charged to l.a. (3), Wages and Salaries -- AllOther Staff Payroll Expense.

Separate charges for laundry or linen lost or damaged by the nursing home under a service-rental agreement will be reflected

in this grouping.

14. PURCHASED DEPARTMENT FUNCTIONS

Purchased department functions aredefined asthose services which areobtained by the home through acontract withan

outside entity.

a. Medical,therapy, educational laboratory and other professional services obtained by contract

‘i his category includes services contracted with physicians, therapists, laboratories, pharmacies, nurses, and other

professional service providers.

‘I nis category excludes all maintenance contract services and other non-professional contract services.

b. All Other Contracted Services

All Other Contracted Serwces include contracts for housekeeping, linen service, food and dietary service, ambulance

service and anyother non-professlona lcontract service not specifically mentioned above.

This category excludes maintenance service contracts and professional contract services.

15. UTILITIES

Utilit!es are defined as charges for telephone and telegraph, gas, fuel, oil, water, and electricity,

Charges to this category should exclude any utility charges, such as telephone, that are reimbursed by patients or employees

orcharges that are paid bythelessor under the Iease agreement.

16. OTHER AND MISCELLANEOUS EXPENSES

Thlsexpense category isacatchall torecord allcosts notclassified inl. through 15. above. Costs included in this grouping

are dues and subscriptions, printing costsradvertise;ents, travel costs, automobile expenses, non-classified medical and non-medical

fees (example -audit and Iegalfees), postage and casual Iabornot charged toother expense categories.

Form 73NHS-2

102
RESIDENT CONTROL RECORD Sheet_ of Sheets

1973 Nursing Home Survey

Nat!onal Cemer for Health Statisucs

Health Resources Admmistratmn

Rockville, Maryland EEEl

ESTABLISHMENT NO.

TOTAL RESIDENTS IN HOME .clJIIImIn

CC12-15 CC2 ccl 1-1

IN SAMPLE

CC16-19

RESIDENTS IN NURSING HOME

SAMPLE

DESIGNATION

NAME OF RESIOENT SAMPLE

DESIGNATION

NAME OF RESIDENT

b

LINE

NO.

c

LINE

NO.

c

Sw

TE

Sw

TE

a

I

a I b

01

02

26

27

I

03 28

04 29

05 30

06 31

1

I 07 I 32

08 33

09 T

10 35

11 36

12 F I

13 38

38

40

41

42

43

44

45

46

47

48

48

14

15

16

17

18

19

20

21

22

23

24

25 60

Form 73NHS.6 If More Lines Are Needed CONTINUE ON THE BACK
RESIDENT CONTROL RECORD

RESIDENTS IN NURSING HOME

SAMPLE NAME OF RESIDENT SAMPLE NAME OF RESIDENT

DESIGNATION DESIGNATION

LINE LINE

NO.

Sw

NO.

w

TE TE

a b c a b c

51 76

52 77

53 78

54 79

55 60

56 81

57 82

58 63

59 64

60 85

61 86

62 87

63 86

64 88

65 80

66 91

67 92

68 93

69 84

70 95

71 96

72 97

73 98

74 88

75 00

Form 73NHs+ If More Linm Are Needed Use A Naw RESI DENT CONTROL RECORD

And Renumber The Lines Baginning With # 101

104
RESIDENT QUESTIONNAIRE

1973 Nursing Home Survey

National Center for Health Statistics

Health Resources Administration

PF=l

Rockville, Maryland

1-7

ASSURANCE OF CONFIDENTIALITY – All information which would permit identification

ESTABLISHMENT NO.

of the individual wi II be held in strict ccmf idence, will be ussd only by persons engaged in and for

the purpeses of the survey, and will not be disclosed or released to others for any purpcses.

CC2

LINE NO.

ccl 1

ccl 4-1

1. WHAT IS – DATE OF BIRTH?

mnnorn

Month Day Year Age

ccl 5,16 17, 18 18-21 CC22-24

2. WHAT IS – SEX? ❑ Male ~ Female

25-1

3. WHAT IS – ETHNIC BACK- 2G1 ❑ CaucasiOn -2 ❑ Negro -3 ❑ Oriental

GROUND? [Mark (X) Only

one box) -4 ❑ Spanish American .5 ❑ American Indian -6 ❑ Other

4. WHAT IS – CURRENT MARITAL 27-1 H Married .2 ~ Widowed

STATUS? (Mark (X) only

-3 ❑ Divorced

one box) -4 ❑ Separated .5 ❑ Never Married

5. WHAT WAS THE DATE OF – CURRENT ADMISSION TO THIS PLACE? DOEI Month Day Year

CC28, 29 30-31 32-34

6a. WHERE DID – LIVE AT THE TIME OF ADMISSION? (Mark (X) only one box)

(1) In a boarding home 35-1

(2) In another nursing home or related facility -2

(3) In a mental hospital or other long-term specialty hospital -3

(41 In a general or shorn-stay hospital -4

(5) In a private apartment or house -5

(6) Other place, (Specify) -6

36.

(7) Don’t know -7

❑

•1

•1

•1

}

•1 ~b

❑ ’

•1

(1)

(2)

(3)

(4)

(5)

(6)

AT THE TIME OF ADMISSION

DID – LIVE WITH: (Mark (X)

all that apply)

Yes

spouse? 37-1 ❑

Children? 38-1 ❑

Other relatives? 39-1 ❑

Unrelated persons? 4C-1 ❑

Lived alone? 41-1 ❑

Don’t know? 42-1 ❑

7. WHAT IS THE PRIMARY REASON FOR – ADMISSION TO THE HOME? (Enter “l” in box for primary reason; if secondary

reason given, enter “2”.1

43- l-J Physical reasons (e.g., illness or need for treatments]

@n Social reasons (e.g., no fwnily, or lack of family interest)

45- ❑ Behavioral reasons (e.g., disruptive behwior, mental deteriomtion)

46- ❑ Economic reasons (e.g., no money andlor resources]

Form 73N HS-7

No

-2 •1

“2 •1

-2 •1

-2 •1

-2 •1

105
8. WHAT WAS THIS RESI DENT’S PRIMARY DIAGNOSIS: (Mark (Xl only one box in each column)

a. AT ADMISSION? b. AT THE TIME OF–LAST EXAMINATION?

49,50 •1 aol

•l a02

Ila03

❑ a04

U a05

❑ affi

•l .07

•1 am

❑ .09

•l a10

•1 all

•l a12

❑ a13

•l a14

•1 ,15

❑ a16

•l .17

•l a18

•1 a19

•l .20

•l a21

Cl a22

51,52 ❑ bOl

❑ b02

❑ b03

❑ b04

❑ b05

❑ lbos

❑ b07

❑ b08

❑ b09

❑ b10

❑ bll

❑ b12

❑ b13

❑ b14

❑ b15

❑ b16

❑ b17

❑ b18

❑ b19

❑ b20

❑ b21

O b22

Senility, old age, and other symptoms and illdefined conditions (e.g., coma, uremia)

Heart attack [e.g., ischemic heart disease)

Stroke (e.g., cerabrovascular diseases)

Harden ing of aneries (e.g., arteriosclerosis, disaases of the arteries, areriolas, capillaries)

Other diseases of the circulatory system (e.g., NOT heart attack, stroke, or hardening of the arteries)

Accidents, poisonings, and violence (e.g., fracture of hip, other broken bones, burns, concussion)

Mental disorders (a.g., mental retardation, psychosas, neuroses, mental illness, emotional problems)

Dlseasas of the muscu Ioskeletat system and connective tissue (e.g., arthritis, rheumatism, back pain)

Endacrine, nutritional, and metabolic diseases (e.g., goiter, diabetes, gout)

Diseas?$ of the respiratory system (e.g., pnaumonia, emphysema)

Neoplasms [e.g., cancer, tumors]

Diseases of the nervous system and sanse organs (e.g., Parkinson’s disease, glaucoma, cataracts,

blindness, mu Itiple sclerosis, spastic paral ysis, epilepsy)

Diseasas of the digastive system (e.g., cirrhosis of liver, ulcer, intestinal obstruction)

Infective and parasitic diseasas (e.g., T. B., polio, syphilis)

Diseases of the genitourinary system (e.g., nephrosis, chron ic pelvic infection, hyperplasia of prostate)

Diseases of the skin and subcutaneous tissue (e.g., cellulitis, abscess, chronic ulcar)

Diseases of the blood and blood-forming organi (e.g., anemia)

Congenital anomalities (e.g., hydrocephalus)

Complications of pregnancy, childbirth and the puerperium (e.g., infections, hemorrhage, toxemias)

Car’tain caums of perinatal morbidity and mortality (e.g., birth injury or immaturity of infant)

Don’t know

Othar (Spacify) 64-

~Spacify: 53-

9. DOES – HAVE ANY OF THE FOLLOWING CONDITIONS OR IMPAIRMENTS? (Mark (X) all that apply)

CC55-65 -1 ❑ a. Senility (includes decline in intellect, memory, and judgement, loss of orientation, difficulty in speaking; feebleness.)

-2 •1 b. Mental illness (Psychiatric or emotional problarns)

“3 •1 c. Mental retardation

-4 ❑ d. Arthritis or rheumatism

‘5%

Paralysis or palsy other than arthritis

e. (1) IS THIS THE RESULT OF A STROKE?

-6 ❑ f. Glaucoma or cataracts

-7 •1 g. Diabates

“8 c1 h. Any CHRON IC trouble with back or spine

-9 •l i. Amputation of extramitias or limbs; or permanent stiffness or any deformity of the foot, lag, fing%rs, arm, or back

-0 •l j. Heart trouble

OR

-auk Resident has none of the above conditions or impairments

❑ Yes

66-1

Form 73N HS-7

106
10. DOES THIS RESIDENT REGULARLY USE ANY OF THE FOLLOWING AIDS?

No Yes

CARD 2

14-2 a. Walker 15-2 ❑ -I ❑

b. Crutches 16.2 ❑ -I ❑

c. Braces 17.2 ❑ -1 ❑

d. Wheelchair 18-2 ❑ -1 ❑

e. Artificial Limb 19-2 ❑ -1 ❑

f. Self-feeder 20-2 ❑ -I ❑

9.Any other aids (do not count glasses or hearing aids) 21.2 ❑ .1

Y

Specify 22-

11. DURING THE LAST MONTH, HOW MANY TIMES DID–RECEIVE ANY OF THE FOLLOWING THERAPY SERVICES? (INCLUDE

ONLY SERVICES PROVIDED By A LICENsED OR REGISTERED PROFESSIONAL WHETHER INSIOE OR OUTSIOE THE I-IOME.)

NUMBER OF

TIMES

a.

b.

c.

d.

e.

f.

Physical therapy

Recreational therapy

Occupational therapy

Speech therapy

Hearing therapy

Professional counseling by social

worker, psychologist or other

mental health worker

❑

❑

❑

❑

❑

None. mCC23

None or I

CC26

Noneor =

CC27

NOneOr D

CC29

NOneOr =

CC31

❑ Noneor ~

CC33

12. DURING THE PAST 7 DAYS, WHICH OF THESE SERVICES DID–RECEIVE? (Mark (X) all that applv)

CC35-62 -01 ❑ a.

-02 ❑ b.

-03 ❑ c.

-04 ❑ d.

-05 ❑ e.

.06 D f.

-07 •1 9.

-~ ❑ h.

-08 ❑ i.

-10 ❑ j.

.11 ❑ k.

-12 ❑ 1.

-13 ❑ m.

OR

-14 ❑ n.

Rub or massage

Administration of treatment by stcff

Special diet

Application of sterile dressings or bandcges

Temperature-pulse-respiration

Full bed-bath

Enema

Catheterization

Blood pressure reading

Irrigation

Oxygm therapy

Intravenous injection

Hypodermic injection

None of the abwe services received

Form 73 NHS-7

107
13. DURING THE PAST 7 DAYS, DID – RECEIVE ANY MEDICATIONS?

CARD 3 ❑ No L9kiptoCluestion 14} Yes

14-3 15-2

WHICH TYPES OF MEDICATIONS DID – RECEIVE? (Mark (X) All That Apply)

CCIS-45 -01 ❑ a.

-02 ❑ b.

-03 ❑ c.

-04 ❑ d.

-05 ❑ e.

-M ❑ f.

-07 ❑ g.

-IX ❑ h.

-03Ui.

-10 ❑ j.

-11 ❑ k.

-12 ❑ 1.

-13 ❑ m.

-14 ❑ n.

-15 ❑ 0.

Tranqulllzers (e.g., Thorazine, Mellarill

Hypnotics – Se&atives (e.g., Nembuta 1,Seconal, Phenobarbital, B utisol, Placidyl, Chloral H ydrate}

Stool softeners (e.g., PeriCOlace)

Anti-Depressant (e.g., Elavil)

Anti-Hypertenswes (e.g,. Ismelin)

Diuretics (e.g., Diuril, Esidrex)

Analgesics (e.g., Aspirin, Darw.n, Demerol, Percodan, Empirin with Codeine]

Diabetic agents (e.g., Orinase, I nsu Iin]

Anti-inflammatory agents (e.g., Cortisone, Sodium Salicylate, Butazolidin, Indocin)

Anti-in fectives (I.e., antibiotics]

Anti-Anginal drugs (e.g., Nitroglycerin, Peritrate)

Cardiac G Iycosides (e.g,, Oigitalis, Lanox in)

Anticoagulants (e.g., Dicumarol, Warfarin)

Vitamins or iron

Other types of medications not listed above

14. THE FOLLOWING ACTIVITIES FOR DAILY LIVING LIST VARIOUS LEVELS OF CARE THAT MAY BE NEEDED BY A

RESIDENT. PLEASE INDICATE THE ONE THAT BEST DESCRIBES THE LEVEL OF CARE NEEDED BY ~RESIDENT.

FOR EACH ACTIVITY, THE LEVELS ARE GIVEN IN ASCENDING ORDER: IN OTHER WORDS, THE LEVEL DESCRIBING

THE MINIMUM CARE IS FIRST AND THE LEVEL DESCRIBING THE MOST CARE IS LAST. IF YOU ARE UNDECIDED

WHICH OF TWO LEVELS TO INDICATE, CHOOSE THE ONE DESCRIBING THE LESSER AMOUNT OF CARE:

a. CONSIDERING THE FOLLOWING FOUR HYGIENE ACTIVITIES (WASHING FACE AND HANDS, BRUSHING TEETH OR

DENTURES, COMBING HAIR, AND SHAVING OR APPLYING MAKE-UP) DOES THIS RESIDENT:

(Mark (X) Only One BOX)

46-1❑

-2 ❑

-3 u

-4 •1

-5 •1

Perform all four with no asmtance?

Perform all four with no assistance, but needs help in getting andlor putting away equipment?

Perform three or four with no assistance, but requires help with a complete bath?

Require assistance with one or two of these hygiene activities?

Require assistance with all four of these hygiene activities?

b. CONCERNING DRESSING, DOES THIS RESIDENT:

(Mark IX) Only One Box)

47-1 ❑ Gat clothes from closets and drawers and completely dress without assistance?

-2 ❑ Get clOthes frOm CIOS@Sand drawers and completely dress with some assistance (tying shoes, fastening braces, closing b“tto”$ or

zippers in back of garments) 7

-3 ❑ Receive as$istanc@ in 9etting clothes, or in dressing (do not count tying shoes, fastening braces, closing buttons or zippers in back

of garments as assistance]?

‘4 •l Stay partly or completely undressed?

c. CONCERNING FEEDING, DOES THIS RESIDENT:

(Mark (X) Only One Box)

48-1 •1

-2 •1

-3 •1

-4 •1

-5 •1

Feed self without assistance?

Feed self with minor assistance (cutting meat or buttering bread)?

Receiva major assistance in feeding (do not count tuning meat or buttering bread)?

Require intravenous feeding?

Require tube feeding?

108
d. CONCERNING AMBULATION TO REACH THE TOILET ROOM, IS THIS RESIDENT:

(Mark (X) Only One Box)

51-1 ❑ Able to go to the toilet room without nurses’ e.ssistarwe (may USEcane, walker, wheelchair, or othar object of support), may

manage bedpan or commoda at night?

.—

-2 ❑ Receiving nurses’ assistance in going to the toilet room (do not count USEof cane, walker, of other objact of supixrrt),

using bedpan or commode at night, or cleaning self or arranging clothes after elimination?

‘3 ❑ Unable to w to the toilet room for the elimination pmcm&

e. CONCERNING MOVING IN AND OUT OF A BED OR CHAIR, IS THIS RESIDENT:

Receiving no assistance?

Walking with assistance of one person?

Walking with assistance of two persons?

UP in a chair with assistance once in 8 hours?

UP in a chair with assistance twice in 8 hours?

Bedfast with assistance in turning every two hours?

Bedfast with assistance in turning every hour?

(Mark {X) Only Ocw BOX}

52-1 ❑

-2 •1

-3 •1

1

-40

-5 ❑

k

e.(1) DOES – HAVE

-6 ❑ BED SORES?

-7 •1J

f. CONCERNING CONTINENCE, IS THIS RESIDENT:

(Mark (X) Only One Box)

In control of both bowels and bladder?

An ostomy patient?

In control of bladder only?

In control of bowels onl y?

Not in cOfltml of bowels or bladdar? -5 ❑J

55-1

-2

54-1❑

-2 •1

L

-3 •1

4U f.(l)

53-1

7 ‘es 7

No

(continue with part f.)

IS – RECEIVING BOWEL AND/OR

BLADDER RETRAINING?

❑ Yes(Skipto Qwsstion 15..)

t

No

f.(2) WOULD RETRAINING GIVE THIS

RESIDENT CONTROL OVER

BOWELS AND/OR BLADDER?

❑ Yes ~ No ~Do”btful

56-1

15a. DOES THIS RESIDENT EXHIBIT ANY OF THE b. DOES THIS RESIDENT EXHIBIT THIS BEHAVIOR

FOLLOWING BEHAVIOR? MORE OFTEN THAN ONCE A WEEK OR ONCE A WEEK

No

(1) Depressed 57-2 ❑ -1

[2) Agitated, nervous 59-2 ❑ -1

(3) Abusive, aggressive 61-2 ❑ .1

[4) Confused, senile 63-2 ❑ -1

(5) Disturbed sleep 65-2 ❑ -1

(6) Other problem behwior 67-2 ❑ -1 @ (Specify) 68-

More often than

once a week

58-1 ❑

60-1 ❑

62-1 ❑

64-1 ❑

66-1 ❑

~ 69-i ❑

Once a week

or less

“2 •1

-2 •1

“7- El

“2 •1

-2 •1

-2 •1

Form 73NHS-7

109
16a. DURING THIS RESIDENT’S STAY HERE, WHEN DID - LAST SEE A PHYSICIAN FOR TREATMENT, MEDICATION, OR FOR

AN EXAMINATION?

= -0’ “ ““’”’0”’7””’

Has Never Seen A Doctor While Here (Skip to

b. AT THAT TIME, DID – RECEIVE:

Yes No

(1) An examination? 22-1 ❑ -2 •1

(2) Treatment? 23-1 ❑ -2 •1

(3) Prescription? 24-1 ❑ -2 •1

(4) Other? 25-1

%

-2 c1

Spacify 26-

C. DID THE PHYSICIAN ATTEND THE RESIDENT: (Mark (X) Only One Box)

27-1 ❑ as a private physician?

“2 ❑ fOr the qitwlf which furnishes the medical Care?

‘3 ❑ temPrarilV as a replacement for the resident’s private physician who Wm unable to attend the resident?

‘4 ❑ under sOme other arrangement? (specify) 28-

d. DOES A PHYSICIAN EXAMINE THIS RESIDENT: (Mark (X) Only One Box)

29-1 a only when called?

‘2 ❑ i~e9ularlY, but without being called?

-3

\

on a scheduled basis?

d. (1) HOW OFTEN DOES THE PHYSICIAN EXAMINE THE RESIDENT?

(Mark (X) Only One Box.)

30-1 ❑ once a week

.2 ❑ every 2 weeks

-3 ❑ once a month

-4 ❑ avery three months

-5 ❑ once a year

-6 ❑ other (Specify) 31-

17a. DOES – WEAR EYE GLASSES?

Yes No

32-1 9 9

-2

b. IS – SIGHT WITH GLASSES: (Mark (X) Only One Box) c. IS – SIGHT: (Mark (X) Only One BOX]

33-1 ❑ not impaired ? (e.g., can read ordinary newspaper 33-1 a not impaired? (e.g., can read ordinary newspaper

print) print without glasses)

‘2 U PartiallY impaired? (e.g., can watch television 8 to ‘2 ❑ partial IY impaimd? (e.g., can watch tekwisio” 8 to

12 feet across the room] 12 feet across the room)

-3 ❑ s~ereiY Impaired? (e.g., can recognize the features -3 ❑ severely impaired? (e.g., can recognize the features

of familiar persons if they are within 2 to 3 feet) of familiar persons if they are within 2 to 3 feet)

-4 ❑ cOmpltiely lost? (e.g., blind) -4 ❑ completely lost? [e.g., blind)

18a. DOES -USE A HEARING AID?

Yes No

9

34-1 v-2

b. IS- HEAR INGWITH A HEARING AID: c. IS –HEARING: (Mark (X) Only One Box)

(Mark (X) Only One Box)

35-1 ❑

“2 cl.

-3 •1

-4 •1

not Impaired? (e.g., can hear a telephone conversation 35-1 ❑ on an ordinary telephone)

partially Impamed? (e.g., can hear most of the things “2 •1

a person says)

severely impaired? (e.g., can hear only a few words a

-3 El

person SWS or loud noises)

completely lost? (e.g., deaf) -4 •1

not impaired? (e.g., can hear a telephone conversation

on an ordinary telephone}

partially impaired? (e.g., can hear most of the things

a person says)

severely impaired? (e.g., can hear only a few words a

person says or loud noises)

completely lost? (e.g., deaf) Form 73NHS-7

110
19. IS – ABI LITY TO SPEAK: (Mark (X} Only One Box)

38-1 ❑ not impaired? (e.g., is able to be understood; can carry on a normal conversation)

‘2 ❑ P~tiallY impaired? (e.9., is able to be understood but has difficulty pronmmcing ~ome ~ord~)

-3 Cl @erely impair~? (e.9.r =nnOt carv On a nO~al cOnv~atiOn: is un*rstO~ only with difficulty)

-4 •l completely lost? (e.g.,is mme)

20a. DOES THIS RESIDENT HAVE DENTURES?

•1 Yes

7

~ NO (Skip to Question 21a.1

39-1

b. DOES – USE THE DENTURES?

IJ Y. ~ No

4@l

21a. DURING THE LAST MONTH, DID – LEAVE THE HOME FOR ANY RECREATIONAL OR LEISURE ACTIVITIES?

/9 ‘e’

b. FOR WHICH OF THE FOLLOWING ACTIVITIES

DID – LEAVE THE HOME? (Mark (X) All That Apply)

CC42-52 -1 ❑

-2 •1

-3 ❑

-4 •1

“5 ❑

-6 ❑

-7 •1

-8 ❑

“9 •1

“o •1

Get books, etc., from the library

Attend plays, movies, concerts, etc.

Attend arts and crafts classesoutside the home

Visit museums, parks, fairs, etc.

Goon shopping trips organized by the home

Goon independent shopping trips organized

by the resident or visitors

Visit a beauty shop or barber shop

Visit community clubs (such as community ten.

ters, senior citizen clubs, serviceclubs, bridge

clubs, unions, etc.)

Attend religious senricesor other religious =tivities

Go for a walk

#4N0

c. WHY DIDN’T – LEAVE THE HOME TO PARTICIPATE IN

ANY ACTIVITIES DURING THE LAST MONTH? (Mark (X)

All That Apply)

CC42-52 -1 ❑

-2 ❑

“3 •1

-4H

-5 ❑

-60

-7 •1

-so

Resident was too ill or was not abb ~ move

well enough to participate

Resident was not interested

Staff was unable to determine resident’s interests

at this point

Smff feels that the resident’s behavior

will not be tolerated outside the home

No one was available to accompany the resident

Resident cannot afford these activities

Lack of transportation

Other, (Specify) 53-

-& ❑ Other, (Specify) 53-

22a. DURING THE PAST YEAR, HAS THIS RESIDENT BEEN ON ANY KIND OF LEAVE OVERNIGHT OR LONGER,

EXCLUDING LEAVE FOR MEDICAL REASONS?

❑ Yes ❑ No (Skip to Chmtion 23a.)

? -2

~ Do”’t k“ ow [Skip to Question 2sa.)

54-1

b. WHERE DID – USUALLY GO WHEN ON LEAVE? (Mark (x) Only One Box}

55-1 •1

“2 •1

-30

-40

-5 •1

-6 ❑

-7 •1

To own home or apartment

To home of family or relatives

To home of unrelated friends

To foster home

To boardinghouse or room

To another place,(Specify) 56-

Oon’t know

c. ABOUT HOW OFTEN DID THIS RESI DENT GOON LEAVE? (Mark (X) Only One Box)

—

57-1 ❑

-2 •1

-3 •1

-40

-5 ❑

-6 ❑

-7 •1

Form 73NHs-7

Nearly every waak

About once a month

About once every two months

Several times a year

About once a yeer or less

Other (Specify) 58-

Don’t know

111
23a. DOES – HAVE ANY VISITORS?

b. HOW FREQUENTLY DO VISITORS SEE THE RESIDENT? (Mark (X} Only One Box)

16-1 ❑ Nearly every week ‘5 ❑ AbOut once a year or IeS

‘2 ❑ About once a month -6 a Other (Specify) 77-

‘3 ❑ AbOut once every two momhs -7 ❑ Oon’t know

-4 ❑ Saveral times a year

24. HOW MANY BEDS ARE IN – ROOM? (Mark (X) Only One Box)

18-1 ❑ One bed (i.e., the resident’s own bed) -4 ❑ Four beds

-2 ❑ Two beds -5 ❑ Five or more bads

-3 ❑ Three beds

25a. HAS THIS RESIDENT LIVED IN THIS FACILITY FOR ONE FULL MONTH OR LONGER?

❑ Yes ~ NOT

19-1

Stop; go on to next

questionnaire.

b. LAST MONTH, WHAT WAS THE BASIC CHARGE FOR THIS RESIDENT’S LODGING, MEALS, AND NURSING CARE

NOT INCLUDING PRIVATE DUT-SING OR OTHER SPECIAL CHARGES?

❑ No charge isnmde for care (Skip to Westio” 26s.) $

c

CC20-25

c. LAST MONTH, WHAT WAS THE TOTAL CHARGE FOR THIS RESIDENT’SCARE, INCLUDING ALL CHARGES FOR

SPECIAL SERVICES, DRUGS, AN=CIAL MEDICAL SUPPLIES?

❑ No char ge is made for care (Skip to Question 26a.) $

●

CC26-31

(1) DID THIS AMOUNT INCLUDE SPECIAL CHARGES FOR

No Yes

(a) physic!an services? 32-2 ❑ -’ •1

(b) prvate duty nursing? 33-2 D

“’ •1

(c) therapy? 34-2 ❑ -1 •1

(d) drugs? 35-2 ❑ -1 •1

(e) special medical suppli%? 36-2 ❑ -’ •1

(f) special diet? 37-2 ❑ “’ •1

(9) other?

P

3a-2 n -1

Specify -39

26a. WHAT WERE ALL THE SOURCES OF PAYMENT FOR THIS RESIDENT’S CARE LAST MONTH?

[Mark (X) All Th%%ply)

CC404B ❑ (1) Own income or family ❑ (4) Other p“blic assistance ❑ (7) initial @.aymentsupport (private plans, or welfare Iife care

retirement funds, social

security, etc.) ❑ (5) Church SUpPOll ❑ (8)~:::9E is made

❑ (2) Medicare (Title XVIII) ❑ (6) VA mmtract

❑ (3) Meckaid (Tnle XIX)

❑ {9) Other (Specify) ~ ~9-

b. WHAT WAS THE PRIMARY SOURCE OF PAYMENTS FOR – CARE LAST MONTH?

(Mark (Xl Only One Box.)

50-1 ❑ Other public assistance -7 ❑ Initml paymentor welfara life care

-2 •1

-3 •1

Own income or family -40

support (private plans,

retirement fu rids, social

security, etc.) -5 •1

Madicare (Title XVI 11) -sD

Medicaid (Title XIX)

Church support -8 D No charge is made

for care

VA contract

-9 ❑ Other (Spacify) ~

-.5?.

Form 73NHs-7

112
STAFF CLASSIFICATION CARD

1973 Nursing Home Survey

National Center for Health Statistics

Health Resources Administration

Rockville, Maryland

WHICH OF THE FOLLOWING JOB CATEGORIES BEST FITS THE JOB WHICH THIS EMPLOYEE DOES IN THIS FACILITY?

01.

02.

03.

04.

05.

06.

07’.

08.

09.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

ADMINISTRATOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PHYSICIAN (M. D. OR D. O.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DENTIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PHARMACIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

REGISTERED OCCUPATIONAL THERAPIST . . . . . . . . . . . . . . . . . . . .

REGISTERED PHYSICALTHERAPIST . . . . . . . . . . . . . . . . . . . . . . . . . .

ACTIVITIES DIRECTOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DIETITIAN OR NUTRITIONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

REGISTERED MEDICAL RECORD ADMINISTRATOR . . . . . . . . . . . . . .

SOCIALWORKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SPEECHPATHOLOGISTAND/OR AUDIOLOGIST . . . . . . . . . . . . . . . . . .

OTHER PROFESSIONAL OCCUPATIONS (INCLUDES INTERN,

RESIDENT, THERAPEUTIC RECREATOR) . . . . . . . . . . . . . . . . . . . . . .

OCCUPATIONTHERAPISTASSISTANT . . . . . . . . . . . . . . . . . . . . . . . .

PHYSICALTHERAPISTASSISTANT . . . . . . . . . . . . . . . . . . . . . . . . . .

SOCiALWORKERTECHNICIAN/ASSISTANT . . . . . . . . . . . . . . . . . . . .

OTHER MEDICAL RECORD ADMINISTRATORS ANDTECHNICIANS . . . .

REGISTEREDNURSE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

LICENSED PRACTICALNURSEOR LICENSED VOCATIONAL NURSE . . .

NURSE’SAIDEANDORDERLY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CLERICAL, BOOKKEEPING,OR OTHEROFFICESTAFF . . . . . . . . . . . .

FOODSERVICE PERSONNEL(COOK, KITCHENHELP,ETC.) . . . . . . . .

HOUSEKEEPING AND MAINTENANCE PERSONNEL (MAID,

LAUNDRYMAN, MAINTENANCE MAN, ETC.) . . . . . . . . . . . . . . . . . . . .

JOBOTHERTHAN THOSELISTEDABOVE (PLEASE SPECIFY JOB

TITLE ON THEINDIVIDUALLINE OF STAFF CONTROL RECORD) . . . .

GROUP A

Enter in Column i

of Staff Control Record

GROUP B

Enter in Column

of Staff rhrtrol Rec

GROUP C

rd

Enter in Column k

of Staff Control Record

GROUP D

EnterinColumnl

of Staff C.antrol Record

GROUP E

Enter in Column m

of Staff Control Ramrd

113
STAFF CONTROL RECORD

w,,,, !!, __

1973 Nur,,ng Hom,e S.rvW

Nat,on,l C,ntu lot He,lth Sta,,st, c,

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NR

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If mom him are“e.ded CONTINUE ON BACK Con8in.c sampling pattern ON BACK

114
—

INI

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Fc.m ,3NHS-,

115
VITAL AND HEALTH STATISTICS Series

Series 1, Programs and Collection Procedures. -Repnrts which describe the general programs of the National

Center for Hesfth Statistics and its offices and divisions and data collection methods used and include

definitions and other material necessary for understanding the dmta.

Series 2. Data Evaluation and Methods Research. –Studies of new statistical methodology including experimental tests of new survey methods, studies of vital statistics collection methods, mew analytical

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

Series 3. Arzalytical Studies. –Reports presenting malytical or interpretive studies based on vital and health

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

Series 4. Documents and Committee Reports. –Final reports of major committees concerned with vital and

health statistic~ and documents such m recommended model vital registration laws and revised birth

and death certi~lcates.

Series 10. Data From the Health Interuiew .$woey. –Statistics on illness, accidental injuries, disability, use of

hospital, medical, dental, and other services, and other health-reIated topics, all based on data collected

in a continuing national household interview survey.

Stv-ics 11. .Data From the Health Examination Survey and the Health and Nutrition E:camirr,ation Survey. –Data

from direct e:mmination, testing, and meawrement of national samples of the civilian noninstitutionalized population provide the basis for two types of reports: (1) estimates of the medically defined

prevalence of zpecific diseases in the United Statm and the distributions of the population with respect

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

various measurements without reference to an explicit finite univer~e of persons.

Series 12. Data From the Institutionalized Population Surzwys. –Discontinued effective 1975. Future reports from

these surveys will be in Series 13.

Series 13. Data on Health Resources Utilization. –Statisticz on the utilization of heafth manpower and facilities

providing long-term care, ambulatory care, hospital care, snd family planning services.

Series 14. Data on Health Resources: A4anpo wer and Facilities. –Statistics on the numbert, geographic distribution, and characteristics of health resourctw including physicians, denti~ts, nurses, other health

occupations, hospitals, nursing homes, and outpatient facilities.

Series 20. Data on Mortality. –\7arious statistics on mortality other than as included in regulm annual or monthly

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

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

sample surveys of those records.

Series 21. Data on Aratality, Mamiage, and Divorce. —Various statistics on natality, marria~e, and divorce other

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

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

available from the vital records based on sample surweys of those records.

Series 22. Data From the National Mortality and ,Vutality Surueys. -Discontitmed effective 1975. Future reports

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

.!%rt”es23. Data From the National SurLwy of Family Grc#wth. –Statistics on fertility, family formation ~d dissolution, fasrdy pkmning, and related matemai and infant heafth topics derived from a biennial survey

of a nationwide probability sample of ever-married women 15-44 years of age.

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

National Center for Health Statistics

Public Health Service

EIyattsville, hlci. 207i32
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