.–– —

Utilization Patterns

and Financial

Characteristicsof

Nursing Homes in

the United States:

1977National Nursing

Home Survey

Utilization patterns and financial data coilected in the 1977 National Nursing Home Survey (NN HS) are presented according to standard sets of descriptive variables. Data are

presented that measure utilization, staffing

patterns, cost of providing care, and profitability. National information on revenues are

available for the first time from this survey.

The 1977 NNHS covered all types of nursing

homes in the coterminous United States.

Data From the National Health Survey

Series 13, No. 53

DHHS Publication No. (PHS) 81-1714

U.S Department of Health and Human

Services

Public Health Service

Office of Health Research, Statistics, and

Technology

National Center for Health Statistics

Hyattsville, Md.

August 1981
7

Library of Congress Cataloging in Publication Data

Bloom, Barbera

Utilization patterns and financial characteristics of nursing homes in

the United States, 1977.

(Vital and haalth statistics: Serias 13, Data from the National

Health Survey; no. 53) (DHHS publication: no. (PHS) 81-1714)

Bibliography: p.

Supt. of Dots. no.: HE 20.6206:13/53

1. Nursing homas-Unitad States-Utilization-Statistics. 2. Nursing homes-United States-Finance-Statistics. 1. Unitad States.

~ National Center for Health Statistics. II. Title. I I 1. Series: United

‘S1ates. National Center for Health Statistics. Vital and health statistics: Series 13, Data from the National Haalth Survey, Data on health

~

resources utilization; no. 53. IV. Series: United States. Dept. of

I

,,

I

Health and Human Services. DHHS publication; no. (PHS) B1 -1714.

[DNLM: 1. Nursing homes–Economics-United States. 2. Nursing

homes–Utilization–United Statas. W2 A N14Bvm no. 53]

., RA407.3.A349 no. 53 [R A997] 80@35876

~ ISBN 0-640542154 362.1’1 “0973s [362.1’S’09731

,

,,

.—

For sale by tbe Superintendent of Documents, U.S. Government Printiug Office, Washington, D.C. 20402
National Center for Health Statistics

DOROTHY P. RICE, Director

ROBERT A. ISIUEL, Deputy Director

JACOBJ. FELDMAN,Ph.D.,Associdte Director for Analysis

and Epidemwlo#

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

Cooperative HealthStatistics System

GARRIE J. LOSEE, Associate Dtiector for Data I?ocessing

and Services

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

InternationalStatistics

E. EARL BRYANT,Associate Directorfor Interview and

ExaminationStatistics

ROBERT C. HUBER,Associate Directorfor Mmagement

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

and Methodology

PETER L. HURLEY, Associate Director for Vitaland Health

tire Statistics

ALICE HAYWOOD,Information Officer

Division of Health Care Statistics

W. EDWARDBACON,Ph.D., Director

EVELYN S. MATHIS, Chief, Long-Term CareStatistics

Branch

Library of CongressCatalog Card Number 80-606876

ii
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Scope ofreport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Background andqualifications ofdata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Utilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Facility characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Residentdays, certified residentdays, and admissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Occupancy rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Discharges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Turnover rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Median duration ofstay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Financial Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Costand revenue components.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Costper residentday intervals.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Costper residentday analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Patient mix andcost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Staffingand cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Revenue perresidentday analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Profitanalysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Listofdetailed tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Appendixes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

i. Technical notes onmethods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Il. Definitions ofcertain termsusedin thisreport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Ill. Selected survey instruments used inthe1977Nationai NursingHomeSurvey . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

IV. Criteria forclassifying nursinghomes according to ievelof nursingcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

Listof Text Figures

1. Amount and percent distribution of total costs and total revenues per resident day for nursing homes by major components: United States, 1976... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

2. Percent distribution of nursing homes by total cost per resident day: United States, 1976 . . . . . . . . . . . . . . . . . . . . . 5

3. Cost per residentday fornursinghomes and percent oftotal costbycomponents: UnitedStates,1976 . . . . . . . . . . . . 14

...

Ill
List of Text Tables

A. Average number of beds per nursing home by selected nursing home characteristics: United States, 1977 . . . . . . . . . . .

B. Number of nursing homes and number and percent of nursing home chain facilities, by selected nursing home characteristics: United States, 1973 -74 and 1977 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

C. Percent change in resident days, admissions, and annual occupancy rate from 1972 to 1976: United States . . . . . . . . . .

D. Number of discharges and percent discharged alive from nursing homes, by selected nursing home characteristics: United

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

E. Number of budgeted vacant staff positions in nursing homes, by staff category: United States, 1977 . . . . . . . . . . . . . .

F. Number of nursing homes with budgeted vacancies and number of nursing staff vacancies, by geographic region and type

ofstaff: United States, 1977.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

G. Total revenue and cost for nursing homes, by selected nursing home characteristics: United States, 1976 . . . . . . . . . . .

H. Number of resident days and total cost and total revenue per resident day for nursing homes, by certification and bed

size: United States, 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Symbols

. . . Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500

*

Figure does not meet standards of

reliability or precision

6

8

8

10

11

11

12

16

# Figure suppressed to comply with

I

confidentiality requirements

iv
——Utilization Patterns and

Financial Characteris~cs-of

Nursing Homes.————.in the.United .—

S-ti-tes: —..1977 National Nursing

Home Survey

by Barbara Bloom, Division of Health Care Statistics

Introduction

Scope of report

This report based on the 1977 National Nursing

Home Survey conducted by the National Center for

Health Statistics will analyze selected measures of

utilization and financial data by facility characteristics for nursing homes in the contiguous United

States.

The utilization measures to be discussed are

number of nursing homes, beds, residents, admissions,

resident days of care, annual occupancy rate, median

duration of stay, turnover rate, full-time equivalent

staff per 100 beds, and vacant staff positions.

The fiiancial measures to be discussed are total

cost and revenue, cost and revenue per resident day,

net income, cash flow, and profitability categories.

The facility characteristics to be examined are as

follows:

Ownership. –A facility can operate under one of

three types of ownership-proprietary, voluntary nonprofit, or government. A proprietary or for-profit

facility is operated under private commercial ownership. A voluntary nonprofit facility is operated under

voluntary or nonprofit auspices including both

church- and nonchurch-related facilities. A government facility is operated under Federal, State, or

local government auspices.

Certification. –A facility or distinct part of a facility may be certified under one or more Government

reimbursement programs (Medicare, Medicaid) or

may operate without certification status. In 1965,

Medicare legislation (Title XVIII of the Social Security Act) enacted a Federal program to provide up to

100 days of inpatient skilled nursing care and related

services following a hospital stay to enrollees who

were either over 65 years of age or disabled. The

Medicaid legislation (Title XIX of the Social Security

Act), enacted in the same year, provided an unlimited

number of inpatient days of care on either the skilled

nursing or intermediate care level to those categorically needy recipients as specified by individual State

plans. A facility or distinct part of a facility may be

certified to operate under the Medicare program as a

skilled nursing facility (SNF), the Medicaid program

as an SNF, the Medicaid program as an intermediate

care facility{ (ICF), or may be not certified, or any

combination of the above.

The SNF services are ordered by and under the

direction of a physician for individuals who need

skilled nursing care (i.e., services provided directly by

or requiring the supervision of skilIed nursing personnel) or other skilled rehabilitative services on a daily

basis which as a practical matter can only be provided

to an inpatient in an SNF. The SNF services may be

provided under either the Medicare or Medicaid

program.1

The ICF services are health-related care and

services provided on a regular basis to individuals who

do not require the degree of care and treatment that a

hospital or SNF is designed to provide, but who,

because of their mental or physical condition, do

require care and services above the level of room and

board that can be made available to them only

through institutional facilities.l

In this report nursing homes have been grouped

into four hierarchical categories according to intensity of services based on certification: SNF only, SNF

and ICF, ICF only, and not certified. The SNF’S only

provide the most intensive leveI of care required by

law and, therefore, represent the highest level of

certit3cation in this hierarchy. Facilities that have

dual certification as SNF’S and ICF’S provide both the

most intensive and the intermediate levels of care.

Thus SNF’S and ICF’S represent the second highest

level of certification in this hierarchy. The ICF’S

only provide only intermediate levels of care and,

therefore, rank below the SNF and ICF category in

this hierarchy. Noncertified facilities that were not

required to meet Medicare or Medicaid standards

were ranked as the lowest level in this hierarchy.

1
(Note that noncertified facilities are a heterogeneous

group. These homes can provide a full range of

services from the most intensive to the least intensive

levels of care. Noncertified facilities simply choose

not to participate in either the Medicare or Medicaid

program.)

Bed size. –For this report, nursing homes in the

1977 National Nursing Home Survey (NNHS) have

been categorized into five bed-size groups–less than

20 beds, 20-49 beds, 50-99 beds, 100-199 beds, and

200 beds or more. Data within the categories of less

than 20 beds and 20-49 beds can be collapsed into

the category of less than 50 beds for comparability to

utilization and cost reports from earlier surveys. For

analytical purposes, data in this report are presented

for the combined category of less than 50 beds when

numbers for the category of less than 20 beds were

not reliable.

Location. –In the 1977 NNHS, facility location

was divided into two categories: nursing homes were

classified by the U.S. Bureau of the Census geographic regions (Northeast, North Central, South, and

West) as in previous years and, for the first time, were

also classified by the Federal Government’s Standard

Federal Administrative (SFA) Regions I-X. The 10

SFA Regions do not collapse into the 4 Census

Bureau geographic regions.

Affiliation. –For this report nursing homes in the

1977 NNHS have been categorized into three affiliation groups–chains, independents, and government.

Chain facilities are proprietary or voluntary nonprofit

homes that operate as members of a group of

facilities under one general authority or ownership.

Independent facilities are proprietary or voluntary

nonprofit homes that do not operate as members of a

group of facilities under one general authority or

ownership. Government facilities are homes operated

under Federal, State, or local government authority.

Background and qualifications of data

The 1977 NNHS, designed and developed by the

Division of Health Resources Utilization Statistics, is

the second survey in the ongoing NNHS system. This

national sample survey of nursing homes–their residents, discharges, and staff–was conducted by the

National Center for Health Statistics (NCHS) from

May through December 1977.

The sample design for the 1977 NNHS was a

stratified two-stage probability sample. The first stage

was a selection of facilities. Facilities were selected

from the universe of nursing homes classified by the

1973 Master Facility Inventory (MFI) as nursing

homes, personal care homes with nursing, personal

care homes without nursing, and domiciliary care

homes. For the 1977 NNHS, the MFI universe listing

or sampling frame had been supplemented by a listing

of all nursing homes that opened for business

2—

between the time the 1973 MFI was conducted and

December 1976 when the universe was frozen. The

second stage was a selection of each of the following:

residents, discharges, and staff from the sample

facilities. The second-stage sampling of residents,

discharges, and staff was carried out by interviewers

according to specific instructions for each type of

sample facility.

Data were collected according to several procedures. Data on the characteristics of the facility were

collected by interviewing the administrator. Data for

a sample of residents on the facility’s roster during

the survey were collected by interviewing the nurse

who was most familiar with the care provided to the

resident. When responding, the nurse referred to the

patient’s medical record. Data for a szmple of

discharges occurring in 1976 were collected by

interviewing the nurse most familiar with the relevant

medical records. Data on a sample of employees who

provided direct or health-related services were collected by leaving a questionnaire for the sampled

person to complete and return by mail. Data on

facility costs of providing care in 1976 were obtained

from the facility’s accountant or administra~tor who

either completed the questionnaire and returned it by

mail or submitted the appropriate financial statements.

The previously mentioned differences in design,

coverage, and reference periods produced data from

two viewpoints. Estimates of the number and characteristics of facilities, residents, and employees reflect

the situation on any day during the survey period

May-December 1977. Estimates of the number and

characteristics of discharges, measures of utilization

(resident days, admissions, occupancy rates), and

costs and other financial variables provide data for

the full calendar year of 1976. For cost and resident

days, however, fiscal year data were allowable.

When comparing data from the 1977 NNHS with

data from the 1973-74 NNHS, the first survey in the

ongoing system, the reader should be aware of the

following:

1.

2.

The 1977 NNHS included all types of nursing

homes. This represents a broadening of the scope

of coverage over that of the 1973-74 NNHS. The

earlier survey excluded facilities providing only

personal or domiciliary care. Because the impact

of including these facilities in the 1977 NNHS is

expected to be small (they comprised only about

2 percent of all nursing homes in the 1973 MFI

and housed only about 1 percent of the beds and

residents), no special adjustments were made in

this report when comparing data from the 1977

NNHS with the data from the 1973-74 NNHS.

The procedures used to estimate the number of

full-time equivalent (FTE) employees differed

slightly from those used in the previous NNHS
3.

4.

5.

because the 1977 estimates are based on a samule

of employees providing direct or health-rela~ed

services from each sample facility and the

1973-74 estimates are based on all staff in each

sample facility.

In the 1977 NNHS, estimates of the number of

discharges and their characteristics were made

from a sample of the patients formally discharged

from the nursing home during 1976. In the

1973-74 NNHS, the number of discharges in 1972

was determined by directly asking the administrator for this information. Caution is also recommended when comparing estimates of discharges

with estimates of admissions from the 1977

NNHS. Estimates of admission for 1976 and

1972 were collected by asking the administrator

for this information.

The procedures for collecting the cost data in the

1977 NNHS differed from those used in the

1973-74 NNHS. In the earlier survey the Expense

Questionnaire was only given to those facilities in

business for 2 years or more; in the current survey

all facilities received the Expense Questionnaire.

The effect of this change on the cost per resident

day estimates is minimal. In the 1977 NNHS, no

significant difference was found between the total

cost per resident day for all facilities ($23.9 1) and

the total cost per resident day for facilities in

business for 2 years or more ($23.99). Therefore,

little problem exists with direct comparisons

between the estimates for 1972 and 1976.

The 1977 NNHS includes several new items not

available in the 1973-74 NNHS such as characteristics of discharges (not merely number of discharges as in 1973-74), revenue data, data by SFA

Regions I-X, and certified days of care.

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 linear regression approach is

used to test for overall patterns of association. For

example, this report presents selected characteristics

by the facility total cost per resident day interval: of

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

$20.00-$24.99, $25.00-$29.99, $30.00-$34.99, and

$35.00 or more. A significant positive or negative

association can be present although some intervals do

not show a significant difference when compared

with adjacent intervals for the characteristics of

interest. Unless otherwise qualified, all statements of

statistical comparison mentioned in this report have

been tested by using a confidence interval of 95

percent, that is, the probability that a difference

noted here as being statistically significant would be

confirmed by a complete census of all facilities in at

least 19 out of 20 chances. Not all variables presented

in the tables were tested; therefore, if a particular

item is not mentioned, it does not mean that the item

was tested and found to be insignificant.

Because all the estimates are based on a sample of

nursing homes rather than on a census or complete

enumeration, the data are subject to sampling errors.

For further details on sampling error, sample design,

methods of data collection, and hypothesis testing

refer to the appendixes. Appendix I presents information on survey design, data collection, and estimation

procedures. Appendix II presents definitions of key

terms used in this report, appendix III presents a

reproduction of the principal survey instruments, and

appendix IV lists criteria for classifying nursing

homes according to level of nursing care.

Previous publications based on data collected in

the 1977 NNHS included a general summary;z a

report on nursing home utilization in California,

Illinois, Massachusetts, New York, and Texas–the

five States with the largest portions of nursing home

beds;s and a report on the health status of residents.4

A future report will provide an indepth analysis of

discharge data.
Highlights

For the survey period May-December 1977, an

estimated 18,900 nursing homes contained 1,402,400

beds and served 1,303,100 residents in the coterminous United States.

Of these facilities, 76.8 percent were proprietary

and 75.0 percent were certified by Government

reimbursement programs (Medicare or Medicaid or

both). Approximately threequarters of the nursing

homes contained less than 100 beds, and 20 percent

contained less than 20 beds per facility. Twenty-eight

percent were members of a group of facilities

operating as a chain.

During 1976. nursin~ homes lmovided

451,522,560 resident days o~ care, a 3&percent

incre$se over 1972. The number of admissions increased by 23 percent from 1,110,800 in 1972 to

1,367,400 in 1976.

In 1976, the annual occupancy rate of alllnursing

homes was 88.8 percent. In this year, all nursing

homes discharged 1,117,500 persons of who]m threequarters (73.9 percent) were alive and one-quarter

(25.9 percent) were dead. The median duration of

stay (DOS) for discharges was 75 days.

In 1977, an average of 46.2 FTE employees per

cost Revenue

miscellaneous

costs

Total costs per resident day: $23.91

k_Nonpatient care

revenues

Total revenues per resident day: $23.97

Figure 1. Amount and percent distribution of total costs and total revenues per resident day for nursing homes by major components:

United States, 1976
100 beds provided direct, health-related services to

residents. Of these, 41.1 FTE employees per 100 beds

were nursing staff including registered nurses (4.8

employees per 100 beds), licensed practical nurses

(6.1 employees per 100 beds), and nurse’s aides (30.3

employees per 100 beds). Five FTE employees per

100 beds were administrative, medical, and therapeutic staff.

During the calendar year 1976 all nursing home

care in the United States cost $10,796 million or

$23.91 per resident day. This cost of care was 45.5

percent higher than the cost in 1972 ($16.43 per resident day).

The major components of nursing home costs

were labor, operating, and fixed expenses. There was

a residual category of miscellaneous expenses. In

1976, 60 percent of the costs of providing care in

nursing homes were labor expenses ($14.27 per

resident day), 22 percent were operating expenses

($5.1 5 per resident day), 14 percent were fixed costs

($3.41 per resident day-), and- 5.percent were miscellaneous costs ($1.08 per resident day) (figure 1).

Approximately 85 percent of all nursing homes in

the United States had a total cost per resident day of

less than $30.00 (figure 2). Approximately one-third

of all facilities had a total cost per resident day of less

than $15.00. Nursing home costs were influenced by

many factors including facility characteristics, patient

mix, and staffing.

Nursing home revenues were available for the first

time in the 1977 NNHS. Total nursing home revenues

40

r

30

~

E

2

mc.-

$ 20

‘5

z

~

&

n 10

0

I

$15.00 $19.99 $24.99 $29.99 more

Total cost per resident day

Figure 2. Percent distribution of nursing homes by total cost per

resident day: United States, 1976

in 1976 were $10,821 million ($23.97 per resident

day), resulting in a total net income of $25 million

($0.06 per resident day). Ninety-five percent of

nursing home revenues were payments received for

patient care and 5 percent were nonpatient care

revenues.
Utilization

Facility characteristics

In 1977, about threequarters (77percent) of all

nursing homes were operated on a for-profit ‘basis, 18

percent were operated on a voluntary nonprofit basis,

and 6 percent were government operated (table 1).

Proprietary homes contained 69 percent of all beds

and served 68 percent of all residents. Proprietary

homes had a significantly smaller average number of

beds per home (67) than nonprofit facilities (88) or

government facilities (13 1) (table A).

Seventy-five percent or 14,200 of all nursing

homes in the continental United States were certified

to operate under either Medicare or Medicaid or both.

Approximately one-fifth (19. 2 percent) of all nursing

homes were certified as SNF’S only, which met the

regulatory standards for the most intensive level of

care under Medicare or Medicaid legislation or both.

These facilities, which contained 21.0 percent of all

nursing home beds, provided the most intensive level

of care to 20.7 percent of the residents in 1977.

However, only 3.7 percent of the facilities, caring for

only 1.4 percent of nursing home residents, participated in the Medicare SNF reimbursement program

alone. Why so few facilities choose to participate

exclusively in Medicare can be explained partly by

the more stringent reimbursement policies (for example, the 100-day limit on payment). The typical

SNF only (Medicare or Medicaid or both) contained

81 beds. Nearly one-quarter (24.2 percent) of all

nursing homes were certified as both SNF’S and ICF’S

under Medicare or Medicaid or both. The SNF’S and

ICF’S contained the largest proportion of beds (39.2

percent) and provided services to the largest proportion of residents (40.5 percent). The typical facility

certified for skilled nursing and intermediate care also

had the largest average bed size of 120 beds per

home. The 6,000 facilities certified as ICF only under

the Medicaid program represent the largest proportion of nursing homes (31.6 percent). These facilities

contain about one-quarter (27.9 percent) of available

Table A. Average number of beds per nur~ng home ‘by ss!lacted nursing home characteristics: United States, 1977

Average

Nursing home characteristic number

of beds

Allrmrsing homes . . . . . . . . . . . . . . . . . . . . . . .

Ownership

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

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

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

Certification

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

Skilled nursing facility and intermediate care

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

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

Noncertified . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bed size

Lessthan 20 beds . . . . . . . . . . . . . . . . . . . . . . . .

2049 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Location

Geographic region:

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

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

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

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

Standard Federal Administrative Region: “

Region I . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region I l . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region Ill . . . . . . . . . . . . . . . . . . . . . . . . . .

RegionlV . . . . . . . . . . . . . . . . . . . . . . . . . .

Ragion V . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region Vl . . . . . . . . . . . . . . . . . . . . . . . . . .

Region V1l . . . . . . . . . . . . . . . . . . . . . . . . . .

Region Vlll . . . . . . . . . . . . . . . . . . . . . . . . .

RegionlX . . . . . . . . . . . . . . . . . . . . . . . . . .

Region X . . . . . . . . . . . . . . . . . . . . . . . . . . .

Affiliation

Chain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Independent . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

.

74

67

88

131

81

120

65

35

11

35

72

130

296

81

82

79

53

58

99

83

73

88

88

71

78

42

68

94

61

131

6
nursing home beds and serve about one-quarter (28.3

percent) of nursing home residents. The category of

ICF only, with an average size of 65 beds per home, is

the smallest of the certified homes.

The remaining 25.0 percent of all nursing homes

are not certified under either the Medicare or

Medicaid reimbursement program. Therefore, these

facilities are not required to comply with the Medicare or Medicaid nursing home regulations and

reporting systems. Although they constitute onequarter of all homes, noncertified facilities contain

only 11.9 percent of all beds and provide care to only

10.6 percent of all residents. The average noncertified

facility has a smaller bed size (35 beds per facility)

than a certified facility.

Approximately 75 percent of all nursing homes

contained less than 100 beds. The number of facilities

in the United States was relatively evenly distributed

among the bed-size categories of less than 20 beds

(20.6 percent), 20-49 beds (21.7 percent), 50-99 beds

(30.8 percent), and 100-199 beds (22.3 percent). The

largest facilities of 200 beds or more, however,

represented a significantly smaller proportion of all

nursing homes (4.6 percent), but contained 18.2

percent of available beds, and served 17.9 percent of

all residents. The largest proportion of beds (39.0

percent) and residents (38.8 percent) was located in

facilities within the category of 100-199 beds. The

smallest proportion of beds (3.0 percent) and residents (2.8 percent) was located in facilities containing

less than 20 beds.

Although small homes (those with less than 20

beds) contained only 3.0 percent of the available beds

and served only 2.8 percent of all residents, these

facilities represented one out of every five nursing

homes in the United States in 1977. The typical small

nursing home was run on a for-profit basis. With 90.6

percent of small facilities in the proprietaryownership category, these facilities were more likely

to be proprietary than a facility in any other bed-size

group (table 2). Small facilities were predominantly

not certified. Although onequarter of all nursing

homes in the United States were not certified, 63.4

percent of the facilities with less than 20 beds fell

into this category. Small facilities tended to be

located in the West, particularly in SFA Region IX

(42.0 percent).

At the other end of the spectrum the large

facilities, those with 200 beds or more, which served

almost one-fifth of nursing home residents, only

represented 4.6 percent of all nursing homes. The

large-facilities category had a significantly smaller

proportion of proprietary homes (52.3 percent) than

the other bed-size categories. Large facilities tended

to be certified at the highest levels with 25.5 percent

certified as SNF only and 54.8 percent certified as

SNF and ICF. In fact, as bed size increases the

proportion of facilities that are highly certified (i.e.,

SNF only and SNF and ICF) also increases. Large

facilities usually were located in the Noriheast (36.0

percent) or North Central (37.0 percent) geographic

regions.

When examined by geographic location, the 1977

NNHS showed that of the four census regions, the

North Central Region had the highest proportion of

nursing homes (31. 1 percent), beds (34.5 percent),

and residents (34.5 percent). The South Region

ranked second with significantly larger percents of

homes, beds, and residents than the Northeast or the

West Regions. As expected, SFA Region V including

Illinois, Indiana, Michigan, Minnesota, Ohio, and

Wisconsin had significantly more nursing homes (20.9

percent), beds (24.7 opercent), and residents (24.4

percent) than any other SFA Region.

Proprietary and voluntary nonprofit nursing

homes can be operated either independently or as

members of a group of facilities operating under one

general authority or general ownership, that is,

chains. These categories do not apply to facilities

operated by Federal, State, or local governments. In

1977, 5,300 nursing homes operated as chains under

one general ownership or general authority. The

percent of chain facilities remained the same as in

1973-1974 (table B).

The typical chain facility was operated on a

for-profit basis in 1977. Chain homes were more

likely to be proprietary (84.5 percent) than all

nursing homes in the United States (76.8 percent)

were. Chain homes were also more likely to be

certified under Medicare or Medicaid (88.7 percent)

than the independents (68.3 percent), and less likely

to be not certified (11.3 percent) than the independents (31.6 percent). Chain homes were more

likely to be certified as SNF’S and ICF’S (29.3

percent) or as ICF’S only (38.7 percent) than the

independents were (21. 8 and 28.1 percent, respectively). No significant difference was found between

the proportion of chain SNF’S (20.7 percent) and

independent SNF’S (18.4 percent) (table 3).

On the average, chain facilities were larger (94

beds per home) than the independents (61 beds per

home), but smaller than government facilities (13 1

beds per home). Only 2.0 percent of the chains and

5.2 percent of government facilities had less than 20

beds; 30.1 percent of independents fell into this

bed-size category. (Although the percent of chains in

this category (2.0 percent) had a very small base and,

therefore, a very large standard error, a significant

difference was found between the chain and independent categories.) Moreover, very few chains (4.8

percent) or independents (3.4 percent) had 200 beds

or more as compared with government homes that

had 17.8 percent of the facilities in this category.

Nursing home chains were predominantly located

in the North Central (34.7 percent) and South (35.0

percent) geographic regions where 27.7 percent and

7
Table B. Number of nursing homes and number and percent of nursing home chain facilities, by selected nursing home characteristics:

United States, 1973-74 and 1977

1973-741 1977

Nursing home characteristic Number of Chain facility Number of Chain facility

nursing nursing

homes Number Percent homes Number Percent

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

Ownership

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

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

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

Certification

Skilled nursingfacility only . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .

SkiIled nursing facility andintermediate care facility . . . . . . . . . . . . . , .

Intermediatecarefacility oniy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Noncertified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.

Bed size

Lessthan 20beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-49 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Location

Geographic region:

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

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

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

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

Standard Federal Administrative Region:

Region I . . . . . . . . . . . . . . . . . . .

Regionll . . . . . . . . . . . . . . . . . .

Region ill . . . . . . . . . . . . . . . . . .

Region IV . . . . . . . . . . . . . . . ,..

Region V

RegionVljjl;In;::cRl:nI :::

RegionVll . . . . . . . . . . . . . . . . .

Region VllI . . . . . . . . . . . . . . . . .

Region IX . . . . . . . . . . . . . . . . . .

RegionX . . . . . . . . . . . . . . . . . .

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

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

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

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

15,700

11,900

2,700

1,200

5,300

2,400

4,400

3,600

~,800

4,600

5,500

3,200

600

3,100

5,600

4,100

2,900

. . .

. . .

. . .

. . .

. . .

. . .

-..

.-.

. . .

. . .

4,800

4,000

700

2,000

900

1,200

600

*loo

1,100

2,000

1,400

200

700

1,500

1,400

1,200

.-.

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

30.2

33.9

27.3

38.1

38.8

27.8

16.0

*6.O

23.5

35.4

44.6

27.5

23.2

26,0

33.3

41.6

---

. . .

. . .

. . .

. . .

-..

. . .

. . .

. . .

. . .

18,900

14,500

3,400

1,000

3,600

4,600

6,000

4,700

3,900

4,100

5,800

4,200

900

3,900

5,900

4,900

4,200

1,700

1,500

1,400

2,400

4,000

1,800

1,700

700

3,200

500

5,300

4,500

800

1,100

1,600

2,100

600

*loo

900

2,100

1,900

300

700

1,800

1,900

900

400

200

300

800

1,300

900

600

300

500

200

28.1

30.9

24.6

30.3

34.1

34.3

12.6

*2.7

22.3

36.0

46.2

29.2

18.2

31.4

37.8

21.2

22.9

14.3

18.8

33.0

31.8

48.9

31.8

36.3

15.3

38.9

lFigure~e~clude persOnai care hOmes.

NOTE: Figures may notaddto totals becauseof rounding.

22.1 percent of the independents were located. For

all nursing homes in the United States, chain facilities

were most likely to be located in SFA Region V,

which includes Illinois, Indiana, Michigan, Minnesota,

Ohio, and Wisconsin (23.6 percent)as compared with

other SFA Regions.

Resident days, certified resident days,

and admissions

Several traditional measures of nursing home

utilization are importantin assessing the status ofthis

rapid growth sector of the Nation’s health care

delivery system. They are number of resident days,

certified resident days, number ofadmissions, annual

occupancy rate, number and status ofdischarges, rate

ofpatient flow orturnoverrate, andmedian DOS.

During calendar year 1976, nursing homes inthe

United States provided 451,522,500 resident daysof

8

careto 1,367,400 persons admitted to those facilities.

These numbers represent significant increases over the

1972 figures (table C).

Of the total number of resident day, of care

provided in 1976, 2.9 percent were Medicare SNFTable C. Percent change inresident days, admissions, and annual

occupancy rate from 1972to 1976: United States

Resident days, Percent

admissions, and 19721 ?9762

annual occupancy rate

change

Resident days . . . . . . . . . . 347,913,000 451,522,500 +30

Admissions . . . . . . . . . . . . 1,110,800 1,367,400 +23

Annual occupancy rate . . 86.5% 88.8% + 2

1Fi~ures exclude personai care homes.

2Estimatas for resident days, occupancy rate, and cost or revenua Par

rasident day differ slightly from estimatas presanted in referanca 2 because of a deta processing error. See “Date Processing” in appendix I

for details.
certified days (i.e., resident days of care paid for

under the Medicare program); 25.4 percent were

Medicaid SNF-certified days (i.e., resident days of

care paid for under the Medicaid SNF program); and

34.5 percent were Medicaid ICF-certified days (i.e.,

resident days of care paid for under the Medicaid ICF

program). The remaining resident days, 37.3 percent,

were not certified (i.e., not paid for under either the

Medicare or the Medicaid program) (table 4).

No significant differences were found in the

proportion of Medicare SNF-certified days for proprietary, voluntary nonprofit, or government facilities. However, the proportion of all Medicare SNF’S

only that were proprietary (89.4 percent) exceeded

the national percent for all proprietary homes (76.8

percent). Refer to table 5 for further details on the

classification of nursing homes by ownership according to certifkation.

Voluntary nonprofit facilities provided significantly fewer Medicaid ICF-certKled days (28.4 percent) than either proprietary (36.0 percent) or

government facilities (36.6 percent). The nonprofit

homes did provide significantly more days of care

that were not reimbursed under Title XVIII or Title

XIX (44.4 percent) than other homes. One theory is

that nonprofit facilities are more apt to have philanthropic motives; therefore, they are more likely to

provide care to residents with less stable sources of

payment than Federal or State government programs.

Bed size also had a significant effect on the

proportion of certified days. As the bed size of the

facility increased, the likelihood of providing certified

as opposed to noncertified resident days of care also

increased. Therefore, the larger the facility, the more

likely it was to rely on Government reimbursements.

Occupancy rate

Another measure of the utilization of nursing

homes is the occupancy rate of the beds in the home.

This rate was computed by using the following

formula:

E

Aggregate number of days of care provided

to residents in 1976 X 100

~ Estimated number of beds in 1976X 366

The number of beds in 1976 was estimated by

adjusting the number of beds in 1977 to reflect any

change in beds in 1976. An annualized occupancy

rate based on resident days of care was used because

it gives a more stable measure than a rate based on

the number of beds occupied the night prior to the

survey.

The annual occupancy rate for all nursing homes

in the United States was 88.8 percent in 1976.

Although the occupancy rate by certification ranged

from 87 percent for ICF’S only to 91 percent for

SNF’S only, no significant differences were found.

Moreover, no signflcant differences were found in

the occupancy rate by type of ownership, size, or

geographic region (table 6).

Discharges

In 1976, 1,117,500 patients were discharged from

nursing homes in the United States largely from facilities certified by Medicare or Medicaid or both (92.9

percent). Seventy-four percent of all discharges were

alive. No significant differences were found in the

percent of live discharges when examined either by

type of ownership or bed size. However, facilities that

were certii5ed for the most intensive level of care,.

SNF only, and facilities that were not certified under

Medicare or Medicaid had signit3cantly higher percents of live discharges (77.5 percent and 79.2 percent, respectively) than facilities certiiled as SNF’S

and ICF’S (71.6 percent) and ICF only (70.2 percent)

(table D). These data do not necessarily indicate that

the care provided in the former facilities is better;

they can indicate that a different patient population

is served.

Turnover rate

The turnover rate is a relative measure of patient

flow through the nursing home system. In this report

on the 1977 NNHS, turnover rate or rate of patient

flow was calculated as the number of discharges per

100 beds. (Note: In previous reports from the

1973-74 NNHS, turnover rate was defined as the

number of admissions per 100 beds. Because of

methodological differences in collecting data on

admissions and discharges discussed in the section

“Qualifications of Data,” it was determined that

discharges per 100 beds provided a better measure

than admissions per 100 beds.)

In 1976 no differences existed in patient turnover

among proprietary, voluntary nonprofit, and governmentfacilities. When examining the data by bed-size

category, it was found that facilities with less than 20

beds had a turnover rate of 48.9 per 100 beds, which

was significantly less than that for any other size

facility, except for facilities of 200 beds or more. No

difference was found in the turnover rate between the

smallest size facilities (48.9 per 100 beds) and the

largest size facilities (64.9 per 100 beds).

As noted in a previous report, nursing home

utilization patterns are particularly influenced by

certillcation status.5 The regulations distinguishing

SNF and ICF care followed different models. The

SNF care is oriented to rehabilitation (the medical

model adapted to a less intensive need for services

than is present in hospitals). The ICF care is oriented to maintenance (the health-care related services

model with emphasis on personal rather than medical

9
Table D. Number of discharges and percent discharged alive from

nursing homes, by selected nursing home characteristics:

United States, 1976

Number Percarr t

Nursing home characteristic of discharged

discharges alive

Ali nursing homes . . . . . . . . . . . . . . . .

Ownership

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

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

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

Certification

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

Skilled nursing facility and intermediate

carefacility . . . . . . . . . . . . . . . . . . .

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

Noncertified . . . . . . . . . . . . . . . . . . .

Bed size

Lessthan 20beds . . . . . . . . . . . . . . . .

20-49 beds . . . . . . . . . . . . . . . . . . . . .

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

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

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

Location

Geographic region:

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

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

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

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

Standard Federal Administrative Region:

Regionl . . . . . . . . . . . . . . . . . . . .

Region al . . . . . . . . . . . . . . . . . . . .

Regiors ill . . . . . . . . . . . . . . . . . . .

Region IV . . . . . . . . . . . . . . . . . . .

Region V . . . . . . . . . . . . . . . . . . . .

Region Vi . . . . . . . . . . . . . . . . . . .

RegionVll . . . . . . . . . . . . . . . . . .

Region Vlll . . . . . . . . . . . . . . . . . .

Region IX . . . . . . . . . . . . . . . . . . .

Region X . . . . . . . . . . . . . . . . . . . .

1,117,500

803,100

225,100

89,200

379,000

448,400

210,400

79,600

20,400

128,600

323,800

479,500

164,200

247,100

336,600

270,900

262,800

54,200

113,900

102,600

131,000

273,600

119,800

58,200

31,800

188,300

44,200

73.9

74.8

71.1

72.4

77.5

71.6

70.2

79.2

85.1

78.2

71.2

74.2

73.4

71.1

71.8

73.0

80.0

67.6

74.1

68.3

70.3

73.1

78.2

65.8

73.6

82.3

72.5

NOTE: Figures maynotadd tototels because of rounding.

care). Because of this difference in emphasis, the

turnover rate is expected to be higher for SNFand

lower for ICF care.

Facilities certified as SNF’S only had the most

rapid patient flow; for 1976, 129.8 persons were

discharged for every 100 beds. The SNF’sand ICF’s,

providing both rehabilitative and maintenance care,

had the second highest turnover tateof8 2.5per 100

beds. The ICF’S only, providing maintenance care,

had a significantly lowerpatient flow of54.4per 100

beds. The noncertified facilities rate (47.4 per 100

beds) did not differ from ICF’S only.

Median duration of stay

The difference in the SNF rehabilitation model

and the ICF maintenance model has a signii3cant

effect on the median duration of stay (DOS) also. An

inverse relationship is found between median DOS

and the turnover rate among certification statuses:

the higher the certification level (i.e., the more

intensive the services provided), the shorter the DOS.

The median DOS for SNF’S only was 38 days; for

SNF’S and ICF’S, the median DOS was 82 days; for

ICF’S only the median DOS was 176 days.

Voluntary nonprofit facilities had a significantly

shorter median DOS (5Odays) than either proprietary

homes (80 days) or government homes (84 days)

although no significant difference by type of ownership was found in the rate of patient flow. Moreover,

nursing homes that were located in the West Region

had the shortest DOS of 39 days.

Examination of facilities according tc) bed-size

category revealed that facilities with less than 20

beds and with 200 beds or more had a significantly

longer median DOS (107 days and 103 days, respectively) than any other size.facility. Homes within the

20+9 bed-size category had the shortest DOS (39

days).

Staff

Utilization of nursing homes is partly a function

of the demand for nursing home services as evidenced

by such measures as the occupancy and turnover

rates. Utilization is also a function of the supply of

nursing home services available as evidenced by the

number of facilities, beds, and staff.

The FTE employees are the best measure of examining staffing patterns of nursing homes because

the variation between the facilities in the proportion

of part-time staff is held constant. Thirty-five hours

of part-time employees’ work are equivalent to one

full-time employee. Part-time employees were converted to FTE employees by dividing the number of

hours worked by 35.

In 1977, a total of 647,700 FTE employees

provided direct or health-related services to residents

in nursing homes in the United States, m- approximately one employee for every two nursing home

beds. Of these employees, 577,000 were nursing staff

and 70,600 were administrative, medical, or therapeutic staff (table 7).

Proprietary nursing homes employed significantly

less total FTE staff (43.4 per 100 beds) than

voluntary nonprofit facilities (53.7 per 100 beds). The

rate of FTE staff in for-profit homes (43.4 per 100

beds) did not differ significantly from the government homes’ rate (49.7 per 100 beds). The same

pattern held true for FTE nursing staff. Proprietary

homes had fewer FTE nursing staff (38.8 per 100

beds) than the nonprofit facilities (47.2 per 100

beds), but the same as government facilities (44.6 per

100 beds). The rate of FTE registered nurses (RN’s)

in the for-profit homes (4.2 per 100 beds) was significantly lower than the rate for either nonprofit (6.4

10
per 100 beds) or government (5.8 per 100 beds)

homes.

Facilities that were certified at the highest levels

(i.e., SNF only and SNFand ICF), had significantly

higher rates of both total FTE staff (52.7 and 51.8

per 100 beds, respectively) and FTE nursing staff

(46.8 and 46.9 per 100 beds, respectively) than

facilities that were either certified at a lower level

(ICF only) or were not certified. Moreover, ICF’S

only employed significantly more total FTE staff

(40.7 per 100 beds) than noncertified homes (29.2

per 100 beds) and more FTE nursing staff (36.0 per

100 beds) than noncertified homes (24. 1 per 100

beds). For FTE RN’s, the pattern was similar. As the

level of intensity of care decreased from SNF only to

SNF and ICF to ICF only, the rate of FTE RN’s per

Table E. Number of budgeted vacant staff positions in nursing homes,

by staff category: United States, 1977

Staff category

Number

of vawnt

staff

positions

Alltypes.ofstaff . . . . . . . . . . . . . . . . . . . . . . . 24,900

Administrative and medical ., . . . . . . . . . . . . . . 1.200

Therapeutic . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,900

Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,900

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,900

100 beds decreased significantly from 7.1 to 5.9 to

2.9 as expected because of Medicare and Medicaid

regulations. No signMcant differences were found in

the rates of RN’s per 100 beds between ICF’S only

(2.4) and noncertified homes (2.8).

Small nursing homes in the category of less than

20 beds employed fewer FTE nursing staff (23.4 per

100 beds) and fewer FTE RN’s (2.8 per 100 beds)

than any other size facilities. On the other hand, the

smaller the facility, the larger the rate of FTE

administrative, medical, and therapeutic staff, from

10.1 per 100 beds for the category of less than 20

beds to 3.9 per 100 beds for the category of 200 beds

or more. The impression was that the small facilities,

which were largely proprietary and not certified, were

a “mom and pop” operation where the owner was

reported to be an administrator and also performed

the nursing functions.

The 1977 NNHS reported 24,900 budgeted

vacant staff positions in nursing homes throughout

the United Sizdes (table E). Thirty-five percent of all

nursing homes reported unfilled staff positions in

their facilities, the majority of which were nursing

staff vacancies (15,900) (table F). Nursing shortages

similar to shortages of physicians and other highly

trained health personnel are partly problems of

distribution. For example, the rate of FTE nursing

staff ranges from 28.0 per 100 beds in SFA Region

VI to 49.4 per 100 beds in SFA Region III.

Table F. Number of nursing homes with budgeted vacancias and number of nursing staff vacancies, by geographic region and type of staff:

United States, 1977

Geographic region

Nursing staff

Ail regions Northeast North

Centrai

South West

Number of nursing homes with vacancies

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,600 1,100 2,500 1,600 ‘ 1,400

Numlxr of nursing staff vacancies

Allnursing staff vacancies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,900 3,300 6,200 3,300 3,100

Registered nurses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,300 1,100 1,400 1,200 700

Licansad practical nurses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,700 800 2,000 1,200 600

Nurses’ aides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,800 1,400 2,700 1,000 ‘ 1,800

NOTE: Figures may not add to totals because of rounding.

11
Finan~al data

Cost and revenue components

In 1976, nursing home costs were $10,796

million (table G). Nursing home costs consisted of

three major components–labor, operating, and fixed

costs. Miscellaneous costs were included in a residual

category. In 1976, as in 1972, the major nursing

home expense was labor, representing 60 percent of

the total cost per resident day (figure 3). The labor

component of $14.27 per resident day included

wages and salaries of $12.74 per resident day and

payroll taxes and fringe benefits of $1.53 per resident day. Wages and salaries were subdivided into

three categories. The nursing staff payroll expense of

$7.80 per resident day represented 61 percent of all

wages and salaries and about one-third of total

facility costs. Salaries of RNs, LPN’s, practical

nurses, nurse’s aides, orderlies, and student nurses

were included in this category. The professional

payroll expense was the smallest portion of labor

costs. Physician and other health professional payroll

expenses (excluding contracted services) of $0.40 per

resident day represented only 3 percent of all wages

and salaries, and barely 2 percent of total facility

costs. The remaining 36 percent of wages and salaries

were for other staff payroll including administrative,

clerical, food service, housekeeping, and maintenance

personnel. Payroll taxes and fringe benefits, the

second part of the labor expense, included expenses

incurred by the facility for the current and future

benefit of facility employees such as group health

insurance and the employer’s portion of the Federal

Insurance Contributions Act.

Labor and operating expenses are variable costs,

that is, costs that the facility incurs, which are

dependent on the volume of output or services provided. In 1976, operating expenses representing

22 percent of total cost per resident day were the

second largest nursing home expense. This cost

component included food and other dietary items;

drugs; supplies and equipment; purchased mainte12

Table G. Total revenue and cost for nursing homes, by selected nu rsina home characteristics: United States. 1976

Nursing home characteristic Revenue cost

Amount in millions

All nursing homes . . . . . . . . . . . . . . ...1.

Ownership

Proprietary . . . . . . . . . . . ..c. . . . . . . . .

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

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

Certif icet ion

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

Skilled nursing facility and intermediate

care facility . . . . . . . . . . . . . . . . . . . . . .

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

Non certified . . . . . . . . . . . . . . . . . . . . . .

Bed size

Lessthan 20 beds . . . . . . . . . . . . . . . . . . .

20-49 beds . . . . . . . . . . . . . . . . . . . . . . .

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

100.199 beds . . . . . . . . . . . . . . . . . . . . . .

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

Location

Geographic region:

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

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

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

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

Standard Faderal Administrative Region:

Ragion l . . . . . . . . . . . . . . . . . . . . . . .

Region I l . . . . . . . . . . . . . . . . . . . . . .

Region ill . . . . . . . . . . . . . . . . . . . . . .

Region IV . . . . . . . . . . . . . . . . . . . . . .

Region V . . . . . . . . . . . . . . . . . . . . . .

Region VI . . . . . . . . . . . . . . . . . . . . . .

Region V1l . . . . . . . . . . . . . . . . . . . . .

Region Vlll . . . . . . . . . . . . . . . . . . . .

Region IX . . . . . . . . . . . . . . . . . . . . . .

Region X . . . . . . . . . . . . . . . . . . . . . .

Affiliation

Chain . . . . . . . . . . . . . . . . . . . . . . . . . . .

Independent . . . . . . . . . . . . . . . . . . . . . .

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

NOTE: Figures may not add to totals becausa of rounding.

$10,821

7,165

2,513

1,144

2,978

4,643

2,285

915

184

952

3,112

4,190

2,382

3,535

3,405

2,313

1,567

839

2,041

1,004

1,119

2,594

869

720

274

1,099

261

3,629

6,048

1,144

$10,796

6,954

2,574

1,268

2,921

4,677

2,269

929

183

932

3,095

4,129

2,456

3,570

3,407

2,271

1,547

843

2,058

1,010

1,117

2,598

837

718

275

1,084

255

3,538

5,991

1,267
Cost components

Labor .............................................. ......... ............ ...... ............ 7)

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

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

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

Payroll tax and fringe benafits ............................ ...... .......... ....

Operating ........................ ...................... ........ ...... ...................

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

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

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

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

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

Nursing sarvices from outsida sourcas .............. .. ............ .........

Other health services from outaide sources ........ ...... .............. .

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

Fixed .. ....................... ...................................................... .......

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

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

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

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

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

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

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

Miscellaneous ................................................ ...... ...... .............

o 10 20 30 40 50 60 70

Percent of total cost

NOTE: Numbers in parentheses indicete cost per resident day.

Figure 3. Cost per resident day for nursing homes and percent of total cost by components: United States, 1976

nance of buildings, grounds, and equipment; laundry The residual category, miscellaneous expense,

and linen; and nursing and other health care services

purchased from outside sources. Of these expenses,

the food and dietary expense of $2.14 per resident

day was the largest amount, accounting for 42

percent of the operating cost or 9 percent of the total

cost. Of the operating expenses, 18 percent were

utilities costs ($0.92 per resident day) and 16 percent

were the costs of supplies and equipment ($0.81 per

resident day). The remaining operating expense items

ranged from $0.06 to $0.42 per resident day.

The fixed-cost component ($3.4 1 per resident

day) reflects those costs that the facility would incur

at some set level regardless of the volume of output

or of services provided during 1976. Fixed costs

included equipment rental, insurance, taxes and

licenses, interest and finance charges, depreciation,

rent on buildings and land, and amortization of

leasehold improvements. About three-quarters of

fixed costs were attributed to interest and finance

charges ($0.88 per resident day), depreciation ($0.88

per resident day), and rent on buildings and land

($0.89 per resident day). The remaining fixed-cost

items ranged from $0.02 to $0.40 per resident day.

amounted to $1.08 per resident day or 5 percent of

the total cost. This catch-all grouping recorded all

other costs not previously classified, for example,

advertising, travel costs, and audit fees.

Revenues per resident day were divided into two

categories: patient care revenues, which included

payments received from all sources for routine or

ancillary health care services and represented 95

percent of all revenues, and nonpatient care revenues,

which included payments received from all sources

that were not directly related to patient health care

such as financial contributions or donations, vending

machine concessions, dividends, or capital gains.

Nonpatient revenues of $1.11 per resident day

accounted for the remaining 5 percent of all nursing

home revenues.

Cost per residentday intervals

Nursing home characteristics of type of ownership, certilcation, size, location, and affiliation are

important factors in the variations in nursing home

costs. The percent distribution of nursing homes by

these facility characteristics within seven total cost

I

I

13
per resident day intervals is presented in table 8.

Twenty-one percent of all nursing homes had costs in

the median range of $20.00-$24.99 per resident day.

The lowest cost facilities tended to operate under

proprietary ownership. Relatively more for-profit

homes (38.5 percent) had a total cost per resident

day of less than $15.00 than either nonprofit (13.3

percent) or government (22.9 percent) homes. Similarly, fewer proprietary nursing homes (9.9 percent)

had a high total cost of $30.00 or more per resident

day than nonprofit (30.7 percent) or government

(24.2 percent) facilities. No significant difference was

found between the proportion of high-cost voluntary

nonprofit homes and government homes.

Noncertified facilities (64.4 percent) were more

likely to have low costs of less than $15.00 per resident day than facilities certified under any program. (Refer to table 5, which shows that 83 percent

of noncertified homes are operated under proprietary

ownership.) Homes certified to provide the intermediate level of care, ICF only, were more likely

(36.6 percent) to be low cost than the higher

certification level homes. It is expected that homes

providing more intensive levels of care would fall into

the higher cost categories. Similarly, more high-level

certification homes, SNF’S only (25.2 percent) and

SNF’S and ICF’S (18.2 percent), had high costs of

$30.00 or more per resident day than ICF’S only (7.2

percent) or noncertified (10.0 percent) homes.

Small bed size of less than 20 beds was also a

good predictor of low cost. About threequarters of

the homes in this bed-size category had costs of less

than $15.00 per resident day compared with onethird of the homes in the 2049 bed-size group and

one-tenth of the homes in the 200 beds or more category. Furthermore, a large bed size was a good predictor of high cost. The category of 200 beds or more

was more likely (36.2 percent) to experience high

costs of $30.00 or more per resident day as compared

with any other bed-size group–1 00-199 beds (17.0

percent), 50-99 beds (14.4 percent), 20+9 beds (14.8

percent), or less than 20 beds (5.6 percent). These

higher costs may be partly related to the high percent

of homes with 200 beds or more providing the most

intensive level-of care, SNF only (25.5 percent).

Examination of facility costs by geographic region showed that a greater proportion of homes in

the West Region (44.4 percent in the less than $15.00

per resident day interval) were operating at a lower

cost than in any other geographic location. Homes

located in the Northeast Region, however, were most

likely (29. 1 percent) to be high-cost facilities with

costs of $30.00 or more per resident day as compared

with homes in the North Central (11.7 percent), the

West (11.2 percent), or the South Regions (6.7

percent).

Facilities of independent affiliation (37.5 percent) were more likely to have low costs of less than

$15.00 per resident day than homes that were either

part of a chain operation (24.2 percent) or that were

run under government auspices (22.9 percent). At the

upper end of the cost intervals, no statistically

significant differences were found in the proportion

of homes by affiliation, although 24.2 percent of

government homes had costs of $30.00 or more per

resident day compared with 13.8 percent of the

independents and 13.2 percent of the chain facilities.

Cost per resident day analysis

Ownership. –In 1976 proprietary nursing homes

provided 315,225,700 resident days of care at a total

cost of $6.9 billion or $22.06 per resident day. These

facilities, which are assumed to provide services in a

manner that will maximize profits, had significantly

lower total costs per resident day than either voluntary nonprofit homes ($27.5 6 per resident day) or

government facilities ($29.54 per resident day). Generally, this trend was also observed on examination of

the major components of the total cost (table !3).

Proprietary homes had significantly lower total

labor costs ($12.52 per resident day) than either

nonprofit ($16.9 3 per resident day) or govenunent

homes ($21 .33 per resident day). (Note that as

discussed in a previous section entitled “Staff,”

proprietary nursing homes employed jlewer FTE staff

per 100 beds than nonprofit homes.) Government

homes spent significantly more on labor costs than

voluntary nonprofit homes. This finding is not

surprising in view of the Government’s standardized

national salary schedules and the greater amount

spent on fringe benefits.

As a group, operating costs were also significantly

lower for proprietary facilities ($4.67 per resident

day) than for nonprofit ($6.49 per resident day) or

government homes ($5.80 per resident day). The

difference between nonprofit and government operating costs was not significant.

For the fixed-cost category, however, proprietary

homes reported higher costs ($3.78 per resident day)

than nonprofit ($3.03 per resident day) or government homes ($1.49 per resident day). This finding

was expected because of the preferential tax treatment and the availability of subsidy funds througlh

loans and grants for nonprofit and government facilities as discussed in an analysis of 1972 NNHS data.G

Certification. –A nursing home’s certification directly affects the costs that a facility will incur. For

example, certification as an SNF entails meeting

certain standards of staffing, construction, equipment, and provision of services that certificaticm as an

ICF or noncertification does not require. Nursing

home data for 1976 showed that certification level

was an excellent forecaster of nursing home costs.

In all cases, for total cost and for each component—labor, operating, fixed, and miscellaneous

14
costs—a significant association existed between certification level and cost. As level of intensity of care

decreased from SNF only to SNF and ICF to ICF

only to not certified, the cost per resident day

decreased. For example, the total labor cost was

$18.07 rer resident day for SNF only, $16.03 per

resident day for SNF and ICF, $10.66 per resident

day for ICF only, and $9.99 per resident day for

noncertified homes. Note that significant differences

were found between the categories of SNF only, SNF

and ICF, and ICF only. However, no significant

difference existed between the categories of ICF only

and noncertified, although an overall significant trend

or pattern of association as determined by the

regression test discussed in the section entitled

“Background and Qualifications of Data” did exist.

As previously discussed, facility ownership and

certification level are major factors affecting nursing

home costs. The interrelationship between ownership

and certification also impacts on nursing home costs.

Examination of this cost impact reinforces the

importance af these two factors as predictors of

nursing home costs. For each type of ownership an

overall significant pattern of association between

certification type and total cost per resident day was

found. As the level of intensity of care decreased,

total cost per resident day decreased, except in

government noncertified facilities. For example, proprietary SNF’S only spent $27.89 per resident day,

proprietary SNF’S and ICF’S spent $24.25 per resident day, proprietary ICF’S only spent $17.60 per

resident day, and proprietary noncertified homes

spent $14.79 per resident day (table 10). Moreover,

some impact on costs within certification type was

found. For SNF’S only, proprietary facilities had a

significantly lower total cost per resident day

($27.89) and total labor cost per resident day

($16.20) than nonprofit facilities ($37.95 total cost

per resident day and $23.13 total labor cost per

resident day).

Bed size. –In 1976, a positive relationship existed

between nursing home costs per resident day and

bed size. Total cost per resident day increased as bed

size increased from less than 20 beds ($12.82 per

resident day) to 20-49 beds ($19.99 per resident

day) to 50-99 beds ($22.56 per resident day) to

100-199 beds ($23.92 per resident day) to 200 beds

or more ($30.41 per resident day) (table 11).

Facilities in the smallest bed-size category (less than

20 beds) had significantly lower total costs ($12.82

per resident day) than facilities of any other size.

Small homes also had significantly lower labor ($6.58

per resident day) and fixed costs ($1.60 per resident

day) than homes in other bed-size categories. Large

facilities (200 beds or more) also had different cost

patterns than homes in other bed-size categories.

Large homes had significantly higher total ($30.41

per resident day), labor ($19.42 per resident day),

and operating costs ($6.22 per resident day) than

homes in other bed-size categories.

Bed size, similar to other nursing home characteristics that have an impact on costs, cannot be

viewed in a vacuum. Traditional economic theory

postulates that the data would reflect a basic

U-shaped curve in the presence of economies and

diseconomies of scale. Theoretically, as a facility

provides increasingly more resident days of care,

certain economies (e.g., quantity discounts and full

use of labor and eq~pment) are realized that result in

decreasing average costs of providing that care. After

some point, however, diseconomies associated with

the management of large-scale operations are thought

to predominate, resulting in increasing average costs

(p. 96). However, the data did not support the

theory. The interrelationship between bed size and

certification as shown in table H reflected the overall

positive bed size-cost relationship presented in table

11 while leveling off within the middle bed-size categories.

Location. –Nursing homes, similar to most other

firms, showed regional variations in theti costs as

presented in table 12. Region II, which included New

York and New Jersey, had a significantly higher total

($41 .76 per resident day), labor ($25.59 per resident

day), operating ($8.90 per resident day), and fixed

cost ($5.98 per resident day) than any other SFA

Region. These differences were because of cost-ofIiving fluctuations and marketplace variations in the

supply and demand of labor and other factors of

production.

Affiliation. –Chain operations as compared with

the independently run facilities offer the advantages

of (1) greater efficiency, (2) expected lower costs,

and (3) shared financial burden.

1.

2.

3.

When a home office manages several facilities,

greater efficiency results from the sharing of

management expertise-a limited resource. Facilities with centralized administrative procedures

can more readily shift personnel such as highly

skilled nursing staff if the need arises. Centralized

purchasing of supplies and equipment is also more

efficient than individual purchasing.

Cost savings would be expected for chain facilities

as a result of the economies-of-scale of purchasing

larger quantities of goods and services than independently operated homes purchase.

A centrally operated group of facilities is better

able to share the burden of temporary losses in

one of its homes than the independent entrepreneur. Overall corporate profits can support or

balance the losses of an existing facility with

particular problems, whereas an individual owner

faced with such losses might be forced into

bankruptcy. The company headquarters with

profits from existing members would also be

15
Table H. Number of resident days and total cost and total revenue per resident day for nursing homes, by certification and bed size:

United States, 1976

Certification and bed size Number of Toral co$t Tote! revenue

resident days per resident day per resident day

Skilled nursing facility only

Lessthan20 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . * 1,546,200 *$I 5.71 * $117.12

20-49 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,712,200 30.77 31.91

50-99 beds . . . . . . .’....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30,006,600 27.12 27.52

‘iOO-199beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34,916,500 29.53 30.52

200bedsormore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20,785,500 36.22 36.09

Skilled nursing facility and intermediate care facility

Lessthan20beds . . .’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “545,100 *22.57 ‘11.60

20-49 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,385,700 24.75 25.22

50-99 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41,607,500 24.70 24.67

100-199 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64,668,300 25.41 25.66

200 bedsormore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45,079,300 30.54 29.45

Intermediate care facility only

Lessthan20beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,452,700 12.34 12.49

20-49beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20303,700 17.48 17.64

50-99beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 498168,500 18.92 19.09

100-199 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42,921,900 17.75 17.96

200 bedsor more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,076,200 23.81 22.65

Not certified

Lessthan20beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,732,000 11.88 12.38

20-49 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,643,500 13.71 13.64

50-99 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,404,200 19.69 19.6o

100-199beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,142,800 18.23 17.82

200bedsor more.....,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,824,100 20.21 18.57

NOTE: Estimates for resldentdeys, occupancy rate, and coat or revenue perresident daydiffer sllghtly from aatimates presented inrofarence2 because of a date processing error. Sae “Data Processing” in appendix I fordeteils.

better able to bear the heavy start-up costs of a

new chain facility andto carry the fixed costsof

the new facility until the break-even point is

reached.

Examination of cost data by facility affiliation

showed that chain costs were apparently lower than

independent costs, but that no significant difference

existed in the total cost per resident day between

chain facilities ($22.22 per resident day) and independent facilities ($24.02 per resident day). This

finding remains the same regardless of ownership,

certification, size, or geographic location. Generally,

government facility costs were higher than either

chain- or independent-facility costs. When components of cost were examined, no significant differences were found between chain and independent

homes regarding operating cost ($4.75 and$5.30 per

resident day, respectively) or fixed costs ($3.57 and

$3.63 per resident day, respectively). For labor

expenses, however, chain homes did have signflcantly

lower costs ($12 .59 per resident day) than independenthomes ($14.12 perresident day) (table 13).

The overall finding that chain facilities did not

have significantly lower costs than independent facilities did not support the hypothesis of expected

lower costs for chains. One possible explanation

based on certification and bed-size differences was

suggestedby the previous findings. Itwas shown that

homes providing more intensive levels of care were

more likely to be the highest cost facilities. Significantly more chain (88.7 percent) than independent

homes (68.4 percent) were certified by Medicare or

Medicaid. It was also shown that larger horneswere

more likely to be the highest cost facilities. On the

average, chain facilities were significantly larger (94

beds per home) than independent facilities (61 beds

per home). The chain cost data, however, did not

support this explanation because no differences were

found between chain and independent homes within

the same certification or bed-size categories. Other

explanations may be suggested by examining the

impact on costs by the varying number of facility

chain members.

Patient mix and cost

The cost of providing care in nursing homes is

partly a function of the type of patient served.

Patient type determines the services to be :required as

well as the staff and equipment to meet these

requirements. Thus variations in the proportion of

patient types or patient mix result in variations in

nursing home costs.

One method of categorizing patient type, the

index of dependency in the Activities of Dlaily Living

(ADL), was developed by Dr. Sidney Katz.T Y8Dr.

16
Katz used information on the level of assistance

needed in performing each of the six ADL tasks—

bathing, dressing, going to the toilet, transferring,

continence, and eating-to determine whether a person should be considered dependent or independent

in that activity. Then this information was used to

develop an index that permits the ranking of individuals according to their performance in all six ADL

tasks. The ADL index has seven levels of independence (A through G) and each successive level indicates

greater dependency. The general form of the ADL

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 additional ADL

G–Dependent in all six ADL’s

An “other” category is included for those individuals dependent in at least two fhnctions, but not classii3able as “C,” “D,” “E,” or “F.” For this report,

the ADL index was condensed into three dependency

levels of care:

. Level 1 included A (no ADL dependencies) and B

(dependent in only one ADL).

. Level 2 included C (dependent in bathing and one

additional ADL), D (dependent in bathing, dressing, and one additional ADL), and E (dependent

in bathing, dressing, going to toilet, and one

additional ADL).

. Level 3 included F (dependent in bathing, dressing, going to toilet, transferring, and one additional ADL) and G (dependent in all six ADL’s).g

For analysis, the “other” category representing less

than 9 percent of all residents was eliminated from

the dependency categorization, but was included in

the total number of residents. Table 14 presents the

number and percent of nursing home residents by

dependency levels for selected nursing home characteristics within four cost intervals.

Of the 1,303,100 nursing home residents in 1977,

21.9 percent were classified within the level 1

dependency status (i.e., having a low level of dependency); 30.3 percent were classified within the level 2

dependency status (i.e., having a moderate level of

dependency); and 38.9 percent were classified within

the level 3 dependency status (i.e., having a severe

level of dependency in the activities of daily living).

For the total number of residents in the United States

a significantly greater proportion of the low-level

dependents (39.3 percent) were found in nursing

homes within the lowest cost interval (less than

$15.00 per resident day) when compared with the

national total (21.9 percent). Low-level dependents

also represented a significantly smaller proportion of

residents (17.7 percent) than the national total (21.9

percent) in the highest cost facilities ($25.00 or more

per resident day). For severe-level dependents, the

opposite was true. A significantly greater proportion

of severe-level dependents (43.0 percent) than the

national total (38.9 percent) was found in the highest

cost homes and a significantly smaller proportion of

severe-level dependents (25.4 percent) than the

national total (38.9 percent) was found in the lowest

cost facilities.

Proprietary nursing homes provided care for

significantly more severely dependent residents (39.8

percent) than nonpro@ homes (35.6 percent), although, as detailed earlier, the for-profit homes had

significantly lower total costs per resident day.

Among all proprietary homes, however, costs did

increase as the proportion of severely dependent

residents increased. For-profit homes within the

lowest cost interval provided care for significantly

more low-level dependents (37.8 percent) than the

total for all proprietary homes (20.9 percent) and for

significantly fewer severely dependent residents (26.7

percent) than the total for all proprietary homes

(39.8 percent). Similarly, for-profit homes in the

highest cost interval provided care for significantly

more severely dependent residents (46.3 percent)

than the total for all proprietary homes (39.8

percent) and for significantly fewer low-level dependents (14.3 percent) than the total for all proprietary

homes (20.9 percent).

As expected, nursing home certification predicted

patient mix. As level of intensity of care decreased,

the proportion of low-level dependents increased

significantly from 12.9 percent for SNF only to 17.7

percent for SNF and ICF to 24.9 percent for ICF

only to 48.0 percent for noncertiiled homes. Moreover, as level of intensity of care decreased, the proportion of severely dependent residents decreased significantly from 49.0 percent for SNF only to 41.8

percent for SNF and ICF to 34.4 percent for ICF

only to 20.3 percent for noncertified homes.

Within the lowest cost SNF’S only, there were

significantly more low-level dependents (32.3 percent) than the total for all SNF’S only (12.9 percent)

and significantly fewer severely dependent residents

(34.3 percent) than the total for all SNF’S only (49.0

percent). Moreover, within the highest cost SNF’S

only there were significantly more severely dependent

residents (54.2 percent) than the total for all SNF’S

only (49.0 percent) and significantly fewer low-level

dependents (8.0 percent) than the total for all SNF’S

only (12.9 percent).

17
In summary, as a facility provides care for greater

numbers of severely dependent residents, the cost of

providing that care increases. Also, one of the factors

contributing to lower costs in the least expensive

homes is the greater number of residents with a low

level of dependency. Thus patient mix does indeed influence the cost of care.

Staffing and cost

The nursing home industry, as other service

industries, is highly dependent on labor. In 1976,

labor expense was the largest component (60 percent)

of nursing home cost, and nursing staff expense

represented 61 percent of wages and salaries. Therefore, variations in staffing patterns for nursing staff,

including RN’s, LPN’s, and nurse’s aides, would be

expected to have a significant impact on nursing

home cost.

In 1977, 41.1 FTE nursing staff per 100 beds

were found in all nursing homes in the United States.

A positive significant pattern of association was

found between FTE nursing staff per 100 beds and

nursing home cost. The FTE nursing staff increased

from 24.9 per 100 beds in homes within the less than

$15.00 cost per resident day interval to 40.5 per 100

beds in homes within the_$l 5.00-$19.99 cost per resident day interval to 48.5 per 100 beds in homes

within the $20.00-$24.99 cost per resident day interval to 49.2 per 100 beds in homes within the $25.00

or more cost per resident day interval. Moreover, significantly fewer FTE nursing staff (24.9 per 100

beds) than the national total (41. 1 per 100 beds)

were employed in the ‘lowest cost facilities and significantly more FTE nursing staff (49.2 per 100 beds)

than the national total (41. 1 per 100 beds) were employed in the highest cost facilities (table 15).

Proprietary nursing homes employed significantly

fewer FTE nursing staff (38.8 per 100 beds) than

nonprofit homes (47.2 per 100 beds) whereas the

proprietary homes provided care for a greater proportion of highly dependent residents as noted in a

previous section. The lowest cost proprietary homes

employed significantly fewer FTE nursing staff (25.0

per 100 beds) than the national total (38.8 per 100

beds), but the highest cost proprietary homes employed significantly more FTE nursing staff (46.4 per

100 beds) than the national total (38.8 per 100 beds).

Among the highest cost facilities no significant

differences were found in the FTE nursing staff rates

for proprietary and voluntary nonprofit homes.

Nursing home certification predicted staffing patterns. Homes that provided the most intensive levels

of care employed more FTE nursing staff as detailed

in a previous section. For SNF’S only, as cost per

resident day increased, increasingly more FTE nursing

staff was employed. For SNF’S only in the less than

$15.00 cost per resident day interval, 17.0 FTE

nursing staff per 100 beds were employed; in the

$15.00-$19.99 cost per resident day interval, 43.1

FTE nursing staff per 100 beds were employed; in the

$20.00-$24.99 cost per resident day interval, 52.3

FTE nursing staff per 100 beds were employed; and

in the $25.00 or more cost per resident day interval,

54.4 FTE nursing staff per 100 beds were employed.

In summary, the highest cost facilities emplloyed

more nursing staff, and the lowest cost homes

employed significantly fewer FTE nursing staff per

100 beds. Variations in nursing staff patterns do

influence cost.

Revenue per resident day analysis

In 1976 proprietary nursing homes collected. $7.2

billion dollars in revenue or $22.73 per resident day.

Almost 99 percent of the revenues in proprietary

homes were received for patient care. Although

patierit care revenues represented only 90.6 percent

of the revenues for nonprofit homes and 85.1 percent

of the revenues for government homes, these differences were not significant.

Proprietary facilities had significantly lower total

revenues ($22.73 per resident day) than voluntary

nonprofit homes ($26.9 1 per resident day). There

was no difference in total revenues for proprietary

homes ($22.73 per resident day) and for government

homes ($26.66 per resident day); however, the total

revenues for the combined category of voluntary

nonprofit and government homes ($26. 83 per resident day) were higher than the for-profit homes.

All certified nursing homes received a total of

$9.9 billion in revenues in 1976, and noncertified

homes received $0.9 billion. Approximately 96 percent of the revenues in certified homes were payments received for patient care. Only 88 percent of

the revenues for noncertified homes were included in

that category, but the difference was not significant.

In every category, as level of intensity of care

decreased, revenues per resident day decreased. The

SNF only total revenue per resident day was $30.71,

SNF and ICF revenue per resident day was $26.34,

ICF only revenue was $18,50 per resident day,

and the revenue per resident day for noncertified

homes was $16.71. Note that significant differences

were found between the categories of SNF only:, .SNF

and ICF, and ICF only. However, no sigrnficant

difference was found between ICF’S only and noncertified homes, although an overall significant pattern

of association existed.

The interrelationship between ownership and

certification has the same impact on nursing home

revenues that it has on costs. For each type of

ownership an overall significant pattern of association

was found between certification and total revenue per

resident day. As the level of intensity of care

decreased, total revenue per resident day decreased,

18
except in government noncertified facilities. For

example, revenues per resident day were $28.75 for

proprietary SNF’S only, $24.89 for proprietary SNF’S

and ICF’S, $18.18 for proprietary ICF’S only, and

$15.38 for proprietary noncertified homes. In addition, some impact on costs existed within certification type. For SNF’S only, proprietary facilities had

significantly lower total revenues ($28.75 per resident

day) than the nonprofit facilities ($38.52 per resident

day).

A positive relationship existed between nursing

home revenues per resident day and bed size. Total

revenue per resident day increased as bed size

increased from less than 20 beds ($12.89 per resident

day) to 2049 beds ($20.42 per resident day) to

50-99 beds ($22.69 per resident day) to 100-199 beds

($24.27 per resident day) to 200 beds or more

($29.50 per resident day). Small homes of less than

20 beds collected significantly less revenue per resident day than any other size homes, and large homes

of 200 beds or more collected significantly greater

revenues per resident day than other size homes.

However, as in the case of nursing home costs, the

possible impact of other factors should be considered.

On a regional basis,. nursing home revenues ranged

from $16.93 per resident day in SFA Region VIII,

which includes Colorado, Montana, North Dakota,

South Dakota, Utah, and Wyoming, to $41.43 per

resident day in SFA Region 11, which includes New

York and New Jersey. The revenues for Region II

($41 .43 per resident day) were significantly higher

than for any other region, as were the costs.

Examination of nursing home revenues by facility

affiliation showed that revenues ranged from $22.79

per resident day for chain homes to $24.25 per

resident day for independent homes to $26.66 for

government homes. None of these differences were

significant.

Refit analysis

In 1976, the net income (i.e., revenue minus cost)

for alI nursing homes in the United States was $0.06

per resident day. Proprietary homes had a positive net

income or paper profit of $0.67 per resident day;

nonprofit and government homes had a negative net

income or loss on paper (-$0.66 and -$2.89 per resident day, respectively). Only government homes,

however, had an actual loss or negative cash flow (i.e.,

net income plus depreciation) of -$1.94 per resident

day (table 16).

Net income varied by certification from $0.59 per

resident day for SNF’S only to -$0.27 per resident

day for facilities that were not certified. Cash flow

ranged from $1.60 per resident day for SNF’S only to

$0.30 per resident day for facilities that were not

certified.

By bed-size categories, net income was $0.07 per

resident day for less than 20 beds, $0.43 per resident

day for 20-49 beds, $0.13 per resident day for 50-99

beds, $0.35 per resident day for 100-199 beds, and

-$0.92 per resident day for 200 beds or more. All

bed-size categories had positive cash flows.

In 1976, 63 percent of all nursing homes in the

United States earned a profit (revenues exceeded

costs); 35.7 percent sustained a loss (costs exceeded

revenues). Of all nursing homes, 18.1 percent were

highly profitable (revenues exceeded costs by at least

10.1 percent). On the other hand, 12.2 percent of all

nursing homes were highly unprofitable (costs exceeded revenues by at least 10.1 percent). Significantly more highly profitable homes (18. 1 percent)

than highly unprofitable homes (12.2 percent) were

found (table 17).

In 1976, significantly more proprietary homes

(71.5 percent) than nonprofit (38.7 percent) or government homes (22.9 percent) were profitable. Moreover, significantly more proprietary homes (20.7 percent) were in the highest profit category as compared

with nonprofit (1 1.0 percent) or government (3.8

percent) homes although the percent of government

homes in this category had a very small base and,

therefore, a very large standard error. Fewer proprietary homes (9.8 percent) than nonprofit (18.4

percent) or government homes (27.3 percent) sustained large losses.

Roughly equivalent proportions of certified nursing home categories were highly profitable ranging

from 12.3 to 16.5 percent. Significantly more homes

not certified by Medicare or Medicaid (29.4 percent)

were grouped in this highest profit category. About

18 percent of the noncertified homes sustained

“large” losses as compared with homes certified as

SNF’S only (9.5 percent), SNF’S and ICF’S (10.0

percent), and ICF’S only (11.6 percent). However,

these differences were not statistically significant.

As in the case of noncert~led homes, homes in

the smallest bed-size interval seemed to fall into two

distinct categories-highly profitable or highly unprofitable. More homes in the less than 20 bed-size

category (31.4 percent) were highly profitable than

any other bed-size homes. On the other hand, more

homes in the smallest bed-size category (23.3 percent) sustained larger losses than any other bed-size

homes.

Overall, signii3cantly more chain-afftiated homes

(70.5 percent) were profitable in 1976 than independent (63.4 percent) or government homes (22.9

percent). No significant difference was found, however, between the proportion of chain (29.1 percent)

and independent homes (35.6 percent) that sustained

overall losses. Moreover, no significant differences

were found between the proportions of highly profitable and highly unprofitable chain and independent

homes.

19
References

1Medicaid

ment of

regulations reorganization

H;alth. Educat;on. and

and rewriting. DepartWelfare. Health Care

Financing Admini&tration. Federal Register. (pt. V): Sept. 29,

1978. pp. 45,225-45,228.

2National Center for Health Statistics: The National Nursing

Home Survey: 1977 summary for the United States. Vital and

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

79-1794. Public Health Service. Washington. U.S. Government

Printing Office, July 1979.

3National Center for Health Statistics: Nursing home utilization in California, Illinois, Massachusetts, New York, and

Texas: 1977 National Nursing Home Survey. Vital and Health

Statistics. Series 13-No. 48. DHHS Pub. No. (PHS) 80-1799.

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

Office, Aug. 1980.

4National Center for Health Statistics: Health status of nursing

home residents: 1977 National Nursing Home Survey. Vital

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

81-1712. Public Health Service. Washington. U.S. Government

Printing Office, Dec. 1980.

5National Center for Health Statistics: An overview of nursing

home characteristics. Provisional data from the 1977 National

Nursing Home Survey, by M. Meiners. Advance Data j?om

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

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

1978.

6Nationsl Center for Health Statistics: Nursing home costs–

1972, United States. National Nursing Home Survey, by M.

Meiners. Vital and Health Statistics. Series 13-No. 38. DHEW

Pub. No. (PHS) 79-1789. Public Health Service. Washington.

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

7Katz, S., et al: Studies of

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

illness in the aged. J.A..M.A. 185

8Katz, S., et al: Progress in development of the index of ADL.

Gerontologist 10 (pt. 1): 20-30, Spring 1970.

‘National Center for Health Services Research: An .4pproach

to the Assessment of LTC: Final Report, by P. M. Denson,

E. W. Jones, B. McNitt, et al. Report No. NCHSR. 77-226.

National Technical Information Service. Springfield, Vs., Dec.

1976.

10Nation~ Center for Health Statistics: Inpatient health

facilities as reported from the 1973 MFI Survey, by A.

Sirrocco. Vital and Health Statistics. Series 14-No. 16. DHEW

Pub. No. (HRA) 76-1811. Health Resources Administration,

Washington. U.S. Government Printing Office, May 1!>76.

11National Center for Health Statistics: Development and

maintenance of a National Inventory of Hospitals and Institutions. Vital and Health Statistics. PHS Pub. No. 100CH3eries 1-

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. I%blic

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

Jan. 1971.

13National 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.

20
Listof detailedtables

1. Number and percent distribution of nursing homas, beds, and 10. Revenue and cost per resident day by major components for

residents, by selected nursing home characteristics: United nursing homes, by certification and ownership: United States,

States, 1977 . . . . . . . . . . . . . . . . . . . . . . . . . . . ...22 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...34

2. Numbarand percent distribution of nursing homes by selected 11.

nursing home characteristics, according to bad size: United

States, 1977 . . . . . . . . . . . . . . . . . . . . . . . . . . . ...23 12.

3. Numbarand percent distribution ofnursing homasbysalected

nursing home characteristics, according to nursing home affiliation: UnitadStatea., 1977. . . . . . . . . . . . . . . . . . . ..24 13.

4. Num~rand per@ntdistribution ofresident daysandmmifiad

residant days, by salected nursing home characteristics: United

States, 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . ...26

Revenue and cost per resident day for nursing homas and parcant distribution, by bed size: Unitad States, 1976 . . . . . . .35

Revanue and cost perresident day for nursing homes and percent distribution, by Standard Faderal Administrative Ragion:

UnitedStates,1976 . . . . . . . . . . . . . . . . . . . . . . ...36

Residant days, revenue perresident day, andamount and percant distribution of major components per resident day, by

affiliation and other selected nursing home characteristics:

UnitedStates, 1976 . . . . . . . . . . . . . . . . . . . . . . ...37

5. Number andparcent distribution of nursing homes by owner- 14. Number andparcant distribution ofnursing home residents by

ship, according to certification: United Statas, 1977 . . . . . . 28 dapandency status, according to cost par resident day intervals

6. Selected measures of nursing home utilization, by selected and selected nursing home characteristics: United States,

nursing home characteristics: United States, 1976 . . . . . . . . 29 1977 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...40

7. Number and rate par 100 beds of nursing home full-time 15. Number of nursing home full-time equivalent employaes par

aquivalant employees, by occupational categories and salectad 100 kds within cost per resident day intervals, by selected

nursing home characteristics: United Stetes,1977 . . . . . . . . 30 nursing homa characteristics: United Statesr 1977 . . . . . . . .43

8. Percent distribution of nursing homes within total cost per resi- 16. Ravenue, cost, nat income, and cash flow par resident day for

dent day intervals, by selected nursing home charectaristicx nursing homas, by selected nursing home characteristics:

United States, 1977 . . . . . . . . . . . . . . . . . . . . . . ...31 United Statas, 1976 . . . . . . . . . . . . . . . . . . . . . . ...44

9. Revenue and cost par resident day for nu[sing homes and per- 17. Percant of nursing homes within 1976 profit and/or loss catacent distribution, by ownarehip and certification: United gories, by selected nursing home characteristics: United States,

States,1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . ...32 1977 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...45

21
Tablel. Number andpercent distribution of nursing homes, kds, andresidants, byselected nursing home characteristics: United States. 1977

Nursing homes Beds Residents

Nursing home characteristic

Number Percent

Number Percent Number Percent

distribution distribution distribution

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

Ownership

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

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

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

Certification

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

Madicare and Medicaid . . . . . . . . . .

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

Medicaid . . . . . . . . . . . . . . . . . . . .

Skilled nursing facility and intermediate

care facility . . . . . . . . . . . . . . . . . . .

Medicare SNF and Medicaid SNF

andlCF . . . . . . . . . . . . . . . . . . .

Medicaid SNF and ICF . . . . . . . . . .

Medicare SNF and Medicaid ICF . . . .

Intermediate care facility only . . . . . . .

Not Certified . . . . . . . . . . . . . . . . . . .

Bed size

Lessthan 20twds . . . . . . . . . . . . . . . .

20-49 bads . . . . . . . . . . . . . . . . . . . .

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

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

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

Locat i&

Geographic region:

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

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

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

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

Standard Federal Administrative Region:

Region I . . . . . . . . . . . . . . . . . . . .

Regionll . . . . . . . . . . . . . . . . . . .

Region ill . . . . . . . . . . . . . . . . . . .

RagionlV . . . . . . . . . . . . . . . . . . .

Region V . . . . . . . . . . . . . . . . . . .

Region VI . . . . . . . . . . . . . . . . . . .

Region V1l . . . . . . . . . . . . . . . . . .

Region Vlll . . . . . . . . . . . . . . . . . .

Region IX . . . . . . . . . . . . . . . . . . .

RegionX . . . . . . . . . . . . . . . . . . .

Affiliation

Chain . . . . . . . . . . . . . . . . . . . . . . . .

Independent . . . . . . . . . . . . . . . . . . .

Govarnmant . . . . . . . . . . . . . . . . . . .

18,900

14,500

3,400

1,000

3,600

2,100

700

800

4,600

2,300

2,100

200

6,000

4,700

3,900

4,100

5,800

4,200

900

3,900

5,900

4,900

4,200

1,700

1,500

1,400

2,400

4,000

1,800

1,700

700

3,200

500

5,300

12,600

1,000

NOTE: Figures may notaddto totals because of rounding.

100.0

76.8

17.7

5.5

19.2

11.3

3.7

4.2

24.2

12.3

10.8

1.1

31.6

25.0

20.6

21.7

30,8

22.3

4.6

20.5

31.1

26.0

22.4

9.1

7.8

7.3

12.9

20.9

9.7

9.2

3.7

16.8

2.7

28.1

66.4

5.5

1,402,400

971,200

295,600

135,700

294,000

204,500

27,000

62,600

549,400

319,500

218,700

11,300

391,600

;167,400

41,700

141,200

417,800

546,400

255,400

314,900

483,900

381,500

222,100

98,900

145,600

115,000

177.600

345,900

162,300

122,800

54,900

134,900

44,600

496,800

769,900

135,700

100.0

69.3

21.1

9.7

21.0

14.6

1.9

4.5

39.2

22.8

15.6

0.8

27.9

11.9

3.0

10.1

29.8

39.0

18.2

22.5

34.5

27.2

15.8

7.1

10.4

8.2

.72.7

24.7

11.6

8.8

3.9

9.6

3.2

35.4

54.9

9.7

1,303,100

888,800

281,800

132,500

269,600

190,300

17,800

61,500

527,800

303,700

213,800

10,300

368,200

137,500

37,000

130,900

397,000

505,200

233,000

292,100

449,400

354,700

207,000

85.600

138,300

107,800

175,300

3ta,200

‘f42,700

115,800

50,900

124,000

44,600

450,900

719,800

132.500

100.0

68.2

21.6

10.2

20.7

14.6

1.4

4.7

40.5

23.3

16.4

0.8

:28.3

‘10.6

2.8

‘10.1

:30.5

:38.8

‘17.9

22.4

34.5

:27.2

‘15.9

6.6

‘10.6

8.3

‘13.4

:24.4

‘11.0

8.9

3.9

9.5

3.4

34.6

!35.2

‘10.2

22
Tabie2. Number andpercent distribution of nursing homes byselected nursing homachar=tariwi=, according to&d size: United States, 1977

Bed size

Nursing home characteristic

All sizes Less than 20-49 5@99 100-199 200 beds

20 beds beds beds beds or more

Allnursin gnome s . . . . . . . . . . . . . . . . . . . .

Ownership

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

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

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

Certification

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

Skilled nursing facility and

intermediate care facility . . . . . . . . . . . . . . .

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

Noncertified . . . . . . . . . . . . . . . . . . . . . . . .

Location

Geographic ragion:

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

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

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

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

Standard Fedaral Administrative Region:

Region I . . . . . . . . . . . . . . . . . . . . . . . . .

Regionil . . . . . . . . . . . . . . . . . . . . . . . .

Region ill . . . . . . . . . . . . . . . . . . . . . . . .

Region IV . . . . . . . . . . . . . . . . . . . . . . . .

RegionV . . . . . . . . . . . . . . . . . . . . . . . .

Region VI . . . . . . . . . . . . . . . . . . . . . . . .

RagionVll . . . . . . . . . . . . . . . . . . . . . . .

Region Vlll . . . . . . . . . . . . . . . . . . . . . . .

Region IX . . . . . . . . . . . . . . . . . . . . . . . .

Region X . . . . . . . . . . . . . . . . . . . . . . . .

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

Ownership

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

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

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

Certification

Skillad nursing facility only . . . . . . . . . . . . . .

Skilled nursing facility and

intermediatacarafacility . . . . . . . . . . . . . . .

Intermediate carafacilityonly . . . . . . . . . . . .

Notcartified . . . . . . . . . . . . . . . . . . . . . . . .

Location

Geographic ragion:

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

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

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

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

Standard Federal Administrative Region:

Region I . . . . . . . . . . . . . . . . . . . . . . . . .

Regionll . . . . . . . . . . . . . . . . . . . . . . . .

Region ill . . . . . . . . . . . . . . . . . . . . . . . .

Region [V . . . . . . . . . . . . . . . . . . . . . . . .

RagionV . . . . . . . . . . . . . . . . . . . . . . . .

Region VI . . . . . . . . . . . . . . . . . . . . . . . .

RegionVll . . . . . . . . . . . . . . . . . . . . . . .

Ragion Vlli . . . . . . . . . . . . . . . . . . . . . . .

RagionlX . . . . . . . . . . . . . . . . . . . . . . . .

RegionX . . . . . . . . . . . . . . . . . . . . . . . .

18,900

14,500

3,400

1,000

3,600

4,600

6,000

4,700

3,900

5,900

4,900

4,200

1,700

1,500

1,400

2,400

4,000

1,800

1,700

700

3,200

100.0

76.8

17.7

5.5

19.2

24.2

31.6

25.0

20.5

31.1

26.0

22.4

9.1

7.8

7.3

12.9

20.9

9.7

9.2

3.7

16.8

2.7

3,900

3,600

●loo

500

●loo

800

2,500

900

600

700

1,800

500

300

400

400

400

*loo

200

●1W

1,700

.-.

100.0

90.6

8.1

●1.4

13.8

●2.O

20.8

63.4

23.2

15.1

17.3

44.4

12.0

8.3

9.0

9.3

9.5

*1.9

5.6

●2.5

42.0

-..

Numberofnursing homes

4,100 5,800

3,100 4,300

800 1,100

200 400

800 1,200

400 1,600

1,700 2,300

1,200 700

1,000 800

1,400 2,200

900 1,700

700 1,200

500 400

400 200

300 200

500 800

1,000 1,200

200 800

300 ,800

●loo 300

500 700

“loo 200

Percant distribution

100.0 100.0

76.0 73.3

19.8 19.6

4.2 7.1

19.6 21.4

9.8 27.6

41.4 38.8

28.3 12.2

25.7

34.1

22.8

17.4

12.9

9.4

7.9

13.5

25.7

5.4

7.4

●2.6

12.2

●3.1

13.3

37.7

29.0

20.0

6.9

4.0

4.0

13.8

21.2

14.0

14.4

5.4

12.5

3.9

4,200

3,100

900

200

800

2,000

1,100

300

800

1,400

1,500

500

300

300

400

700

1,000

700

300

200

300

*loo

100.0

74.6

20.3

5.1

19.6

47.7

26.7

6.0

19.7

32.8

34.8

12.7

6.4

7.8

8.8

15.5

23.8

15.9

8.2

4.0

6.1

*3.4

900

500

200

200

200

500

*loo

*loo

300

300

200

*loo

*

200

*loo

*loo

300

*loo

*

●

●

*

100.0

52.3

26.2

21.4

25.5

54.8

●9.8

*9.9

36.0

37.0

18.7

“8.4

*

23.4

*12.3

*8.2

33.2

●6.1

●

*

*

*

NOTE: Figures maynotadd tototalsbacausaof rounding.

23
Table3. Number andpercant distribution of nursing homes byselected nursing home characteristics, according tonursing home affiliation:

United States, 1977

Affiliation

Nursing home characteristic

Ail Chain independent Government

affiliations

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

Ownership

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

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

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

Certif icat ion

Skilled nursingfacilityonly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skilled nursing facility andintermediata care facility . . . . . . . . . . . . . . . . .

Intermediatecarefacility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Noncertified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bed size

Lessthan 20bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2049 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Location

Geographic region:

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

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

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

West . . . . . . . . . . . ...<... . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Standard Federal Administrative Region:

Region I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Regionll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region ill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

RegionV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region VI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region Vll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region Vlll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region IX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

RegionX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Ownership

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

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

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

Certification

SIdlled nursingfacility only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skilled nursing facility andintermediate care facility . . . . . . . . . . . . . . . . .

Intermediatecarefacility only.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Notcartified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bed size

Lassthan 20beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-49 bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

200badsor more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18,900

14,500

3,400

1,000

3,600

4,600

6,000

4,700

3,900

4,100

5,800

4,200

3,900

5,900

4,900

4,200

1,700

1,500

1,400

2,400

4,000

1,800

1,700

700

3,200

100.0

76.8

17.7

5.5

19.2

24.2

31.6

25.0

20.8

21.5

30.8

22.3

4.6

Numbar of nursing homes

5,300 12,600

4,500 10,100

800 2,500

-.. . . .

1,100 2,300

1,600 2,700

2,100 3,500

600 4,000

*loo 3,800

900 3,000

2,100 3,300

1,900 2,100

300 400

700 3,100

1,800 3,500

1,900 2,800

900 3.200

400

200

300

800

1,300

900

600

300

500

200

1,300

1,200

1,100

1,500

2,400

900

900

400

2,700

300

Percent distribution

100.0 100.0

84.5 79.9

15.5 20.1

. . . .-.

20.7 18.4

29.3 21.8

38.7 28.1

11.3 31.6

●2.O 30.1

17.1 23.7

39.5 26.4

36.6 16.3

4.8 3.4

1,000

...

...

1,000

200

300

400

200

*loo

200

400

200

200

*loo

600

300

*1OO

*

*

*loo

200

300

*loo

300

*

*

*

100.0

. . .

. . .

100.0

20.9

25.8

37.4

15.8

*5.2

16.4

39.9

20.7

17.8

NOTE: Figures may notaddto totals because of rounding.

24
Table3. Number andpercent distribution of nursing homes bywlected nursing home characteristi=, amorting tonursing homeaffiliation:

United States, 1977–Con.

Affiliation

Nursing home characteristic

All Chain Independent Government

affiliations

Location Percent distribution

Geographic region:

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.5 13.3 24.4 *9.9

North Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31.1 34.7 27.7 53.4

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26.0 35.0 22.1 27.6

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.4 16.9 25.8 *9.1

Standard Federal Administrative Region:

Region I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.1 7.4 10.3 ●

Regionll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.8 4.0 9.6 *

Region ill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3 4.9 8.4 ●7.O

Region IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.9 15.2 11.7 15.6

RegionV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.9 23.6 19.1 28.0

Region VI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.7 16.9 6.8 ●7.5

RegionVll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.2 10.4 7.4 24.4

Region Vlll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.7 4.8 3.3 ●

Region IX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.8 9.1 21.1 ●

RegionX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.7 3.7 2.2 *

NOTE: Figures maynotadd tototals because of rounding.

25
Table4. Number andparcant distribution of resident daysand certified resident days, byseletid nursing home chara@eristicx

United States, 1976

Certified

All

Nursing home characteristic Not

resident Medicare Medicaid

days

certified

SNF

SNF ICF

All nursing homes . . . . . . . .

Ownership

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

Voluntary nonprofit . . , . .

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

Certification

Skilled nursing facility only . .

Skilled nursing facility and

intermediate care facility . .

Intermediate care facility only

Non certified . . . . . . . . . . . .

Bed size

Les-sthan20 beds . . . . . . . .

20-49 beds . . . . . . . . . . . . .

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

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

200 badsor more . . . . . . . .

Location

Geographic region:

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

North Central . . . . . . . . .

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Standard Federal Administrative Ragion:

RegiOnl . . . . . . . . . . . . . . . . . . . . . . . .

Region I l . . . . . . . . . . . . . . . . . . . . . . . .

Region Ill . . . . . . . . . . . . . . . . . . . . . . .

Region IV . . . . . . . . . . . . . . . . . . . . . . .

Region V . . . . . . . . . . . . . . . . . . . . . . . .

Region VI . . . . . . . . . . . . . . . . . . . . . . .

Region V1l . . . . . . . . . . . . . . . . . . . . . . .

Region Vlll . . . . . . . . . . . . . . . . . . . . . .

Region IX . . . . . . . . . . . . . . . . . . . . . . .

Region X . . . . . . . . . . . . . . . . . . . . . . . .

Affiliation

Chain . . . . . . . . . . . . . . . . . . . . . . . ...’..

Independent . . . . . . . . . . . . . . . . . . . . . . . .

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

See footnotes at end of table.

451,522,500

315,225,700

93,391,200

42,905,500

96,967,000

176,286,000

123,523,000

54,746,500

14,275,900

46,645,100

137,186,800

172,649,500

80,765,100

102,611,200

157,793,500

120,106,100

71,011,700

32,443,700

49,276,200

35,565,300

578540,300

113,043,000

48,846,800

39,579,000

16,164,700

44,794.500

14,268,900

159,216,200

249,400,800

42,905,500

12,983,200

8,689,600

3,283,100

●1,010,600

6,348,700

6,622,100

●o

● 12,500

“95,400

*1,1 86,000

3,202,600

5,687,000

2,812,200

4,539,000

3,377,000

2,385,700

2,681,500

+499,300

3,022,700

‘ 1,394,900

*I ,242,300

3,065,600

‘769,700

“311,200

‘205,300

2,232,700

*239,500

4,812,900

7,159,800

* 1,010,600

Number

114,539,200

79,949,600

22,198,100

12,391,400

53,422,100

60,602,500

*416,000

‘98,600

“732,700

5,969,200

29,870,000

47,190,000

30,777,100

35,497,900

29,429,500

22,109,300

27,502,500

8,553,100

20,162,700

8,625,200

16,431,300

26,505,400

3,839,700

*I ,730,600

5,471,200

18,594,400

4,625,600

39,206,100

62,941,700

12,391,400

155,784,600

113,592,300

26,490,400

15,702,000

2,801,200

63,923,000

87,775,700

*I ,284,800

2,842,800

18,723,900

47,938,200

61,831,500

24,448,200

29,002,300

60,T 74,400

55,777,000

10,830,900

‘13,422,900

11,510,100

10,798,400

18,196,500

42,211,400

31,532,700

16,295,900

4,614,800

3,020,600

4,183,300

61,585,800

76,496,800

15,702,000

168,:221,800

113JOO0,600

41,419,600

13;B01 ,600

34,395,000

45,144,700

35,331,300

53,350,700

10,604,900

20,766,000

56,176,000

57;947,300

22,727,600

33,578,200

64,812,500

39,834,100

29,996,900

9,968,500

14,580,800

14,755,100

21,670,200

41,260,500

12,704,700

21,241,300

5,873,400

20,946,800

5,220,500

53,611,400

100,808,800

13,801,600

26
Table4. Numbarand percant distribution of resident daysand m~ifiad resident days, by=letiad nursing home charactarifiics

United States, 1976–Con.

certified

All

Nursing home characteristic Not resident Medicare Medicaid

days

certified

SNF

SNF ICF

Parcent distribution

Allnursin gnome s . . . . . . . . . . . . . . . . . . . 100.0 2.9 25.4 34.5 37.3

Ownarship

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

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

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

100.0

100.0

100.0

2.8 25.4

3.5 23.8

* 2.4 28.9

36.0

28.4

36.6

35.8

44.4

32.2

Certification

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

Skillad nursing facility and

intermediate care facility . . . . . . . . . . . . . .

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

Notcartified . . . . . . . . . . . . . . . . . . . . . . . .

100.0 6.5 55.1 2.9 35.5

100.0

100.0

100.0

3.8 34.4

*0.O * 0.3

*0.O *0.2

36.3

71.1

*2.3

25.6

28.6

97.5

Bed size

Lessthan 20 beds . . . . . . . . . . . . . . . . . . . .

20-49 beds . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

100.0

100.0

100.0

100.0

100.0

*0.7 *5.1

*2.5 12.8

2.3 21.8

19.9

40.1

34.9

35.8

30.3

74.3

44.5

40.9

33.6

28.1

3.3 27.3

3.5 38.1

Location

Geographic region:

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

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

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

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

Standard Federal Administrative Region:

Regionl . . . . . . . . . . . . . . . . . . . . . . . .

Region al . . . . . . . . . . . . . . . . . . . . . . . .

Region ill . . . . . . . . . . . . . . . . . . . . . . .

Region IV . . . . . . . . . . . . . . . . . . . . . . .

Region V . . . . . . . . . . . . . . . . . . . . . . . .

Region Vi . . . . . . . . . . . . . . . . . . . . . . .

Region V1l . . . . . . . . . . . . . . . . . . . . . . .

Region Vlll . . . . . . . . . . . . . . . . . . . . . .

Ragion IX

RegionX.II::I:IIIIInl 1:::::::::

100.0

100.0

100,0

100.0

4.4 34.6

2.1 18.7

2.0 18.4

3.8 38.7

28.3

38.1

46.4

15.3

32.7

41.1

33.2

42.2

‘100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

*1.5

6.1

*3.9

●2.2

2.7

26.4

40.9

24.3

28.6

23.4

7.9

*4.4

33.8

41.5

32.4

41.4

23.4

30.4

31.6

37.3

64.6

41.2

28.5

6.7

29.3

30.7

28.6

41.5

37.7

36.5

26.0

53.7

36.3

45.8

36.6

●1.6

●0.8

*1.3

5.0

*1.7

Affiliation

Chain . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Independent . . . . . . . . . . . . . . . . . . . . . . . .

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

100.0

100.0

100.0

3.0 24.6

2.9 25.2

*2.4 28.9

38.7

31.5

36.6

33.7

40.4

32.2

NOTES: Estimates for resident days, occupency rete, and coat or revenue per resident day diffar slightly from estimates presented in reference 2

because of adete processing error. See’’Daia Processing” in appendix I for details.

Figures may not add to totals because of rounding.

27
Table5. Number andparcent distribution of nursing homes byownership, amording to certification: United Statas,1977

Ownership

—

Certification All Proprietary Voluntary Government

ownerships nonprofit

Number of nursing homes

All certifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18,900 14,500 3,400 1,000

Skilled nursingfacility only... . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,600 2,800 600 200

Medicare and Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,100 1,600 400 200

Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 700 600 *loo ..-

Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800 600 200 * 100

Skilled nursing facility andintermediate care facility . . . . . . . . . . . . . 4,600 3,100 1,200 30(1

Medicare SNFandMedicaidSNF andlCF . . . . . . . . . . . . . . . . . . . 2,300 1,700 500 *100

Medicaid SNFandlCF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,100 1,200 700 *loo

Medicare SNFand MedicaidlCF . . . . . . . . . . . . . . . . . . . . . . . . . . 200 200 * . . .

Intermediatecarefacility only. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,000 4,700 900 400

Non certified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,700 3,900 600 200

Percent distribution

Allcartifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 76.8 17.7 5Jj

Skilled nursingfacility only.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 76.4 17.6 6.0

Medicare and Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 74.3 18.2 7.!j

Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 89.4 *1 0.6 . . .

Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 71.0 21.8 *7;2

Skilled nursing facility andintermediate care facili'W . . . . . . . . . . . . . . 100.0 67.6 26.5 5{3

Medicare SNFandMedicaidSNF andlCF . . . . . . . . . . . . . . . . . . . 100.0 73.1 20.5 * 6.4

MedicaidSNF andlCF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 60.1 34.0 *5J3

MedicareSNF andMedicaidlCF . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 80.2 *1 9.8 . . .

Intermediatecarefacility only. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 79.2 14.3 6Jj

Noncertified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 83.0 13.5 3.!5

NOTE: Figures maynotadd tototalsbecausaof rounding.

.

28
N

So

Table6. &le@edmeasures Ofnursing homeutilization, ~salected nursing homecharacteristics: United Statas,1976

Discharges

Number Annual Medien Admissions

Nursing home chetacteristic of occu- duration Tote12 Live Dead -

rasidan t pency of stay

days rate 7 in deys

Number Rate per Number Rate per Number Rate per Number Rata per

100 beds 100 beds 100 beds 100 beds

All nursing homas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ownership

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

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

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

Certification

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

SkiHad nursing facility and intermediate care

facility . . . . . . . . . . . ...0... . . . . . . . . . . . . . . . . . . .

Intermediate care fecility only . . . . . . . . . . . . . . . . . . . . .

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

Bed size

Lessthan20 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-49 baas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

100-199 bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

200 badsor more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Location

Geographic region:

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

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

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

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

Standard Federal Administrative Region:

Ragion I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region VI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region Vll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ragion Vlll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region IX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

RagionX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

451,522,500

315,225,700

93,391,200

42,905,500

96,967,000

176,286,000

123,523,000

54,746,500

14,275,900

46,645,100

137,186,800

172,649,500

80,765,100

102,611,200

157,793,500

120,106,100

71,011,700

32,443,700

49,276,200

35,565,300

57,540,300

113,043,000

48,646,800

39,579,000

16,164,700

44,794,500

14,268,900

88.8

89.4

87.4

87.4

90.8

88.6

87.3

89.1

93.5

89.7

90.4

87.6

87.2

90.1

89.7

87.3

87.3

90.0

93.2

85.7

91.4

90.1

82.5

88.4

80.3

90.7

87.4

75

80

50

64

38

82

176

111

107

39

81

66

103

78

99

95

39

107

123

36

96

91

102

144

68

35

58

1,367,400

1,012,000

252,300

103,000

390,300

639,700

222,800

114,600

19,800

136,600

423,600

589,000

198,300

283,200

366,100

295,200

422,900

70,300

133,800

106,700

142,200

295,100

128,100

64,500

36,500

268,000

121,900

98.4

105.0

86.4

76.8

133.7

117.6

57.6

68.3

47.4

96.2

102.1

109.4

78.4

91.0

76.2

78.5

190.2

71.4

92.7

94.2

82.7

86.1

79.2

52.7

66.4

198.6

273.3

1,117,500

803,100

225,100

B9,200

379,000

448,400

210,400

79,600

20,400

129,600

323,800

479,500

164,200

247,100

336,600

270,900

262,800

54,200

113,900

102,600

131,000

273,600

119,800

58,200

31,800

188,300

44,200

80.4

83.3

77.1

66.5

129.8

82.5

54.4

47.4

48.9

91.2

78.0

89.1

64.9

79.4

70.1

72.1

118,2

55.0

78.9

90.5

76.2

79.8

74.0

47.6

57.8

139.5

99.1

B25,500

600,900

160,000

64,700

293,900

320,900

147,800

63,100

17,400

101,300

230,500

355,900

120,500

175,700

241,700

197,900

210,300

36,600

64,400

70,100

92,000

199,900

93,700

38,300

23,400

155,000

32,000

59.5

62.3

54.8

48.2

100.7

59.0

38.2

37.6

41.6

71.3

55.6

66.1

47.6

56.5

50.3

52.6

94.6

37.2

58.4

61.8

53.5

58.3

57.9

31.3

42.5

114.8

71.7

289,800

200,300

65,100

24,300

84,300

126,400

62,700

16,400

‘3,000

28,300

92,500

123,200

42,700

70,500

93,800

72,900

52,500

17,600

28,700

32,500

38,900

72,400

26,000

19,900

8,400

33,300

12,100

20.9

20.8

22.3

18.1

28.9

23.2

16.2

9.8

●7.2

19.9

22.3

22.9

16.9

22.7

19.5

19.4

23.6

17.9

19.9

28.7

22.6

21.1

16.1

16.3

15.3

24.7

27.1

1 ZAggregate number ofdaysof care providad toresIdantsin 1976X 100.

Z Estimated number of beds in 1976 X 366

21ncludes e small ~rsmber Of unknowns.

NOTES: Figures meynotedd tototals because of rounding.

Nurairm homa characteristics for 1977.

Estimates for residant days, occupancy rate, and C05t or revenue per resident dev differ slightly from estimates presented in reference 2 due to a data processing error. See “Data Processing”

in eppendlx I for deteils.
Taole7, Numbarand rate per fOObedsof nursing home futl-time equivalent employ ees, byoccupational categories andw/ected nursing h(]me

characteristics: United States, 1977

Occupational category

Ail fuil-t!me Admin/strafwe,

equivalent medical, and

employees 1 thempeu tm Nursing

Nursing home characteristic

Total

Registered Licensed

Rate

Nurse’s aide

Rate nurse practical nurse

Number

per

Number

per

100 100 Rate Rate Rate Rate

beds beds Number

per

Number

per

Number

per

Number

per

100 100 700 100

beds beds beds beds

Allemployeesz . . . . . . . . . . . . . .

Ownership

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

Voluntary nonprofit . . .

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

Cerlif ication

Skilled nursing facility only . . .

Skiiled nursing facil Ity and intermediate care facilty . . . . . . . . .

Intermediate care facility only . . . .

Notcertlfled . . . . . . . . . . . . . . . .

Bed size

Lessthan20 beds . . . . . . . . . . . .

2049 beds . . . . . . . . . . . . . . . . .

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

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

200 bads or more . . . . . . . . . . . . .

Location

Geographic region:

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

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

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

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

Standdrd Federal Administrative

Region:

RegiOnl . . . . . . . . . . . . . . . .

Fiegion lo . . . . . . . . . . . . . . . .

Region Ill . . . . . . . . . . . . . . .

RegiOnlV . . . . . . . . . . . . . ,.

Region V . . . . . . . . . . . . . . . .

RegionVl . . . . . . . . . . . . . . .

Flegion V1l . . . . . . . . . . . . . . .

Region Vlll . . . . . . . . . . . . . .

RegionlX . . . . . . . . . . . . . .

Region X . . . . . . . . . . . . . . . .

647.700 46.2

421,500 43.4

158.700 53.7

67,500 49.7

154,900 !52.7

284,600 51.8

159,200 40.7

48,900 29.2

14,000 33.5

69,400 49.2

203,400 48.7

254,900 46.6

106,000 41.5

162,000 51.4

226,700 46.8

162,600 42.6

96,300 43.4

45,200 45.8

73,000 50.2

63,600 65.3

92,900 52.3

167,800 48.5

50,900 31.4

51,700 42.1

21,500 139.2

60,800 45.0

20,200 45.2

70,600

44,500

19,200

6,900

17,200

26,700

18,200

8,500

4,200

! 1,000

22,500

22,900

10,000

19,400

22,900

16,000

12,400

5,100

9,300

6,700

8,9oo

16,300

5,500

5,600

2,800

8,300

2,100

5.0

4.6

6.5

5.1

5.9

4.9

4.7

5.1

10.1

7.8

5.4

4.2

3.9

6.1

4.7

4.2

5.6

5.1

6.4

5.8

5.0

4.7

3.4

4.6

5.1

6.1

4.8

577,000

376,900

139,600

60,500

137,700

257,900

141,000

40,400

9,700

5$3,500

180,900

232,000

95,900

142,700

203,800

146,600

83,900

40,200

63,700

56,800

84,000

151,500

45,400

46,100

18,700

52,500

18,000

41.1

38.8

47.2

44.6

46.8

46.9

36.0

24.1

23.4

41.4

43.3

42.5

37.6

45.3

42.1

38.4

37.8

40.6

43.8

49.4

47.3

43.8

28.0

37.6

34.1

38.9

40.4

66,900

40,300

18,800

7,800

20,900

32,100

9,300

4,600

1,200

6,700

19,900

25,700

13,400

24,800

20,200

11,100

10,800

7,100

11,000

8,800

6,700

16,100

2,500

3,300

2,800

6,500

2,200

4.8

4.2

6.4

5.8

7.1

5.9

2.4

2.8

2.8

4.8

4.8

4.7

5.3

7.9

4.2

2.9

4,9

7.2

7.6

7.6

3,8

4,6

1.5

2.6

5.2

4,8

4.9

85,100

55,300

19,500

10,300

19,500

35,800

24,800

4,900

1,800

10,200

25,100

33,400

14,600

20,300

26,700

27,000

11,100

5,200

9,600

8,100

13,700

19,700

10,800

6,500

2,000

7,200

2,300

6.1

5.7

6.6

7.6

6.6

6.5

6.3

3.0

4.3

7.2

6.0

6.1

5.7

6.4

5.5

7.1

5.0

5.2

6.6

7.1

7.7

5.7

6.7

5.3

3.6

5.3

5.2

424,900

281,300

101,300

42,400

97,300

190,000

106,800

30,800

6,800

41,600

135,800

172,900

67,900

97,600

156,900

108,500

62,000

27,900

43,100

39,900

63,6010

115,700

32,1010

36,3010

I 3,9010

38,8CItJ

13,5CI0

30.3

29.0

34.3

31.2

33.1

34.6

27.3

18.4

16.2

29.4

32.5

31.6

26.6

31.0

32.4

28.4

27.9

28.2

29.6

34.7

35.8

33.5

‘19.8

28.6

25.3

28.8

30.3

135 hours of part-time employees’ work is considered equivalent to 1full-time employee. Part-time amployeas ware convartad to fU1l-time eqLliVaient amployees b~ dividing tha numbar of hours worked per week by 35.

Zlncludea oniy amp,oyaas providing dir~~thealth.related se,vi~as tora$ida”~$,

NOTE: Figures may not add tototelsbacause of rounding. Only relevant fornumbarof staff and not forralas.

30
Table8. Parwntdiwribution ofnursing homswithin total cost ~rmsi&nt dayintemals, ~wletiednursinghom

characteristics United States, 1977

C&X per resident S&Yinterval

Nursing home cheraciaristic All Less

than

%:: %% :2y=; ‘2500- $30.o@ $35.00 intervals S1O.OO .

$29.99 $34.99 or more

Allnursinghomas . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ownership

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

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

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

Certification

Skillednursingfacility only . . . . . . . . . . . . . . . . . . . . .

Skilled nursing facility and

intermediate care facility . . . . . . . . . . . . . . . . . . . . . .

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

Noncertified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bed size

Lessthan 20bads . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-49beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Location

Geographic region:

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

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

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

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

Standard Federal Administrative Region:

Region I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region ill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

RegionlV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ragion V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

RegionVl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region V1l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

RegionVlll . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

RegionlX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Affiliation

Chain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Independsmt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

14.4

17.7

●3.6

●1.O

11.7

●2.4

8.3

36.0

43.9

14.7

4.8

●1 .9

+5.5

6.5

7.0

15.6

28.9

●6.1

*1 0.3

15.7

19.5

●;:

●7.7

●19.7

35.2

‘0.7

7.4

18.2

●1.0

18.9

20.8

9.7

21.9

11.3

●3.9

28.3

28.4

29.4

16.T

21.0

11.0

●5.3

17.2

23.3

19.4

14.5

19.4

16.0

● 7.3

14.4

10.1

34.1

47.8

●12.0

14.7

●27.7

17.4

19.3

21.9

Percent distribution

21.8

22.6

20.2

‘14.6

12.1

24.6

34.6

11.0

11.1

20.9

26.5

27.2

●14.6

9.4

26.1

34.2

15.1

16.7

●2.2

●1O.5

30.2

22.8

45.3

31.8

“28.0

10.8

●28.8

27.3

20.1

●14.6

20.6

19.6

24.4

22.8

25.6

35.9

16.2

7.0

6.0

21.4

24.3

28.0

●22.O

18.3

23.1

19.5

20.8

21.6

●7.9

25.6

26.0

33.9

●10.3

+2.0

●12.7

“E:

24.7

18.8

22.8

10.1

9.4

11.4

●15.5

14.2

15.0

5.5

7.6

“3.9

11.6

8.9

15.0

●16.3

19.5

8.7

4.6

8.6

25.4

14.2

● 12.3

●5.1

10.8

+1.4

+5.0

●4.8

10.1

●3.3

10.0

9.7

●15.5

4.9

3.8

9.7

●5.2

9.3

5.9

●2.4

●3.2

‘0.8

6.8

4.9

5.9

●9.1

9.3

5.4

●1.9

●3.1

●6.9

14.6

●4.8

●1.4

7.4

●1.7

●2.1

+4.0

‘0.7

5.9

4.4

●5.2

9.4

6.1

21.0

●19.O

15.9

12.3

4.8

6.8

●4.8

8.0

9.5

11.1

27.1

19.8

6.3

4.8

8.1

●3.8

34.7

23.9

●3.5

7.9

●5.O

●3.7

●21 .7

●5.1

●3.2

7.3

9.4

●19.O

NOTE: Because parcents shown hwowaro estimated using only thasubsot of ceses responding to tha Expanaa Questionnaire, figures differ slightly

from those presented In table 1. Homes notrespondlng totio Expanm Qumtlonnalro worowoighM morohaavily than in table 1 beceuseof nonresponse.

31
Table9. Rbvenue andcost perresident deyfornursing homes andpercent distribution, byownership andcertification: United States, l976

Ownership

All

nursing Skilled nursing

k“-.. Voluntary Skilled nursing facility and

Intermediate

0.,....:-.-.,, Government care facility Not

facilitv onlv intermediate only certified

care facility

,,”,,,-. r ,“p,,.J,a, y

nonprofit

Revenue

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

Patientcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonpatientcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

cost

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

Labor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Wagasand salaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nursingpayroll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Professimralpayroll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherpayroll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Payrolltaxasandfringebenefits . . . . . . . . . . . . . . . . . . . . . . . . . . .

Operating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .

Foodandotherdietary items. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Suppliesandequipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Maintenance of buildings, grounds, and equipment

-purchasedfromoutsidesources . . . . . . . . . . . . . . . . . . . . . . . . . . .

Laundryandlinen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Health careservices purchased from outside sourcas. . . . . . . . . . . . . . .

Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherhealth care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Fixed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Equipmentrentel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Taxesand licanees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interestandfinancecharges.. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Rentonbuildingand land . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amortizationof leasehold improvements . . . . . . , . . . . . . . . . . . . . .

Miscellanarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sae footnotes at end of tabla.

$23.97

22.85

1.11

23.91

14.27

12.74

7.80

0.40

4.54

1.53

5.15

2.14

0.30

0.81

0.42

0.27

0.30

0.06

0,24

0.92

3.41

0.05

0.28

0.40

0.88

0.88

0.89

0.02

1.08

$22.73

22.42

0.30

22.06

12.52

11.24

7.14

0.24

3.66

1.28

4.67

1.96

0.25

0.71

0.39

0.25

0.28

0.07

0.21

0.83

3.78

0.06

0.27

0.55

0.90

0.72

1.25

0.03

1.09

$26.91

24.37

2.53

27.56

16.93

15.15

8.92

0.56

5.68

1.78

6.49

2.69

0.40

1.04

0.52

0.30

0.40

0.05

0.34

1.15

3.03

*0.02

0.35

0.08

1.12

1.36

0.08

●0.01

1.11

Amount per resident day

$26.66

22.68

3.97

29.54

21.33

18.48

10.22

1.19

7.06

2.86

5.80

2.23

0.40

1.07

0.40

0.34

0.22

*0.01

0.20

1.15

1.49

*0.03

0.19

‘0.02

0.26

0.95

‘0.04

●0.01

0.92

$30.77

29.76

0.95

30.12

18.07

15.91

10.18

0.54

5.19

2.16

6.25

2.40

0.43

0.99

0.48

0.38

0.53

0.10

0.43

1.04

4.41

0.08

0.32

0.65

1.10

1.01

1.23

‘0.02

1.39

$26.34

25.07

1.27

26.53

16.03

14.28

8.73

0.49

5.06

1.75

5.55

2.23

0.34

0.97

0.42

0.30

0.33

0.07

0.26

0.97

3.78

0.05

0.28

0.40

1.05

1.03

0.94

‘0.02

1.16

$18.50

17.66

‘0.64

18.37

10.66

9.68

5.64

●0. I 5

3.69

0.98

4.09

1.88

0.18

0.56

0.37

0.17

0.12

0.03

0.09

0.80

2.72

0.03

0.27

0.28

0.69

0.69

0.73

●0.02

0.68

$16.71

14.72

1.98

16.98

9.99

9.06

5.02

0.40

3.64

0.94

4.33

1.92

0.19

0.55

0.40

0.19

0.21

‘0.04

0.17

0.87

1.97

“0.02

0.22

0.27

0.38

0.57

0.49

* 0.03

0.69
Table9. Revenue andcost ~rresident day fOrnursing homes and~rcent distribution, byownership andcetiification: United States, l976-Con.

Ownership Certification

—.

All

Revenue and cost components nursing Skilted nursing

Voluntary Skilled nursing

Intarmadiete

homes Proprietary Govarnmant facility and Not

nonprofit facility only

care facility

intarmadiata only certified

care facility

Revenue

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

Patientcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonpatientcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

cost

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

Labor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Wagasandsalaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nursingpayroll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Professional payrcrll . . . . . . . . . . . . . . . . . . . . . . . . . .. $.....

Otherpayroll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Payrolltaxesandfringebanafits . . . . . . . . . . . . . . . . . . . . . . . . . . .

Of.xrrating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Foodandothardiatary itams . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Suppliesandaquipmant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Maintenance of buildings, grounds, and equipment

purchaaad from outside sources . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Haalthcaraswvicespurchasadfrom outsidasources . . . . . . . . . . . . . .

Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherhealthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Fixed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Taxesand lioanws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Intarestandfinancacharges.... . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Rentonbuilding and land . . . . . . . . ! . . . . . . . . . . . . . . . . . . . . . .

Arnortizationof Ieasahold improvements . . . . . . . . . . . . . . . . . . . . .

Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

100.0

95.4

4.6

100,0

69.7

53.3

32.6

1.7

19.0

6.4

21.6

8.9

1.2

3.4

1.7

1.1

1.3

0,3

1.0

3,9

14.3

0.2

::;

3.7

3.7

3.7

0.1

4.5

100,0

98.7

1.3

100.0

56.7

51.0

32.4

1.1

17.5

5.8

21.2

8.9

1.1

3.2

1.8

1.1

1.3

0.3

1.0

3.7

17.1

0.3

1.2

2.5

4.1

3.3

5.7

0.1

4.9

1Ocr.o

90.6

9.4

100.0

61.4

55.0

32.3

2.0

20.6

6.5

23.5

9.7

::;

1.9

1.1

1.4

0.2

1.2

4.2

11.0

0.1

1.3

0.3

4.1

4.9

0.3

0.0

4.0

Percentdistritxstion

100.0 100.0

85.1 96.9

14.9 3.1

100.0

72.2

62.5

34.6

4.0

23.9

9,7

19.6

7.5

:::

1.3

1.2

0.7

‘0.0

0.7

3.9

5.0

●ocl

0.6

+0.1

0.9

3.2

●0.1

“0.0

3.1

100.0

60.0

52.8

33.8

1.8

17.2

7.2

20.8

8,0

1.4

3.3

1.6

1.3

1.8

0.3

1.4

3.4

14.6

0.3

1.0

2.1

3.6

3.4

4.1

●0.1

4.6

100.0 100.0

95,2 96.6

4.8 3.4

100.0 100.0

60.4 58.1

53.8 52.7

32.9 31,8

1.9 0.8

19.1 20.1

6.6 5.4

20.9 22.3

8.4 10.3

1.3 1.0

3.7 3.0

1.6 2.0

1.1 0.9

1.2 0.7

0.3 0.2

1.0 0.5

3.6 4.3

14.3 14.8

0.2 0.2

1.1 1.5

1.5

H 3.8

3.9 3.8

3.5 4.0

●ool *O.1

4.4 4.9

1m.o

66.1

11.9

100.0

56.9

53.3

29.6

● 2.3

21.4

5,5

25.5

11.3

1.1

3.2

2.3

1.1

1.2

*0.2

1.0

5,1

11,6

●0.1

1.3

1.6

2.2

3.4

2.9

*0.2

4.0

NOTES: Estimates for rasldent days, occupancy rata, and cost or revenue par resldant day diffarsllghtly from estlmatis presented inreferanca 2bacause ofadati proceming error. Sea JJDataProc-

●asing” inappandix I fordatalls.

Figures may not add to totals bacauseof rounding.

cd

w
Table lO. Revenue andcost parrasident day bymajor components fornursing homes, byce~ification and ownership: Unitad Statas,1976

Total Cost component

revenue

Total Labor Operating Fixed Miscellaneous

Certification and ownership

All f acii ities Amount par resident day

$12.52 $4.67 $3.78

16.93 6.49 3.03

21.33 5.80 1.49

$22.73

26.91

26.66

$22.05

27.56

29.54

$1.09

l.li

0.92

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

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

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

Skilled nursing facility only

1.37

1.45

1.55

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

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

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

26.75

38.52

33.53

27.69

37.95

36.04

16.20 5.70 ,4.61

23.13 8.76 4.60

26.61 6.20 1.66

Skilled nursing facility and intermediate cara facility

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

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

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

24.68

28.22

30.38

24.25

28.16

33.68

13.72 5.02 4.33

16.28 6.54 3.20

24.32 6.33 1.93

1.17

1.15

1.10

Intermediate care facility only

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

Voluntary nonprofit . . ...”. . . . . . . . . . . . . . . . . .

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

16.18

20.75

16.93

17.60

21.23

19.56

9.88 3.80 2.99

12.85 5.22 2.29

13.38 4.52 1.17

o.gl.4

o.a7

0.49

Not certified

15.38

16.17

24.40

14.79

17.80

26.91

8.02 3.71 2.41

10.10 5.34 1.45

19.99 5.87 0.60

0.66

O.gll

0.46

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

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

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

NOTE: Estimates for resident days, occupancy rate, and cost or rwanue par resident day differ Slightly from estimates presented inreference2 because of adetaprocessing error. See'' Date Processing'' ln appendix 1 fordatails.

34
Table Il. Revenue andcoSper resident day fornursing homes and Wrcentdiwribution, @&dsiz= United States, 1976

Bed size

All Less than 20-49 50-99 100-799 200 beds

bed sizes 20 beds beds beds beds or more

Revenue

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

patientcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonpatientcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

cost

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

Labor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Wagesandsalaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nursingpayroll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Otherpayroll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Payroll taxesandfringe benefits . . . . . . . . . . . . . . . . . . . . . . .

Operating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Foodandotherdietary items. . . . . . . . . . . . . . . . . . . . . . . . .

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

Suppliesandequipment . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Maintenance of buildings, grounds, and equ ipment

purchasedfromoutsidesources . . . . . . . . . . . . . . . . . . . . . .

Leundryandlinen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Health care services purchased from outside sources . . . . . . . . . .

Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherhealth care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Fixed . ..e . . . ..e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Equipmentrental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Taxesandlicenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interestandfinancecharges.. . . . . . . . . . . . . . . . . . . . . . . . .

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

Rentonbuildingand land.... . . . . . . . . . . . . . . . . . . . . . . .

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

Mi~ellanecws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Revenue

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

Patientcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonpatientcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

cost

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

Labor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Wagesandsalaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nursingpeyroll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Otherpayroll . . . . . . . . . . . . . . . . . . . . . . . . .. I......

Payrolltexesandfringebenefits . . . . . . . . . . . . . . . . . . . . . . .

Operating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Foodandotherdietary items.. . . . . . . . . . . . . . . . . . . . . . . .

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

Suppliesandequipment . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Maintenance of buildings, grounds, and equipment

purchasedfromoutsideeources . . . . . . . . . . . . . . . . . . . . . .

Laundryandlinen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Health care sewices purchased from outside sources . . . . . . . . . .

Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherhealthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Fixed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Equipmentrantel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insurance . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Taxesandlicenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interestandfinancecharges. . . . . . . . . . . . . . . . . . . . . . . . . .

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

Rantonbuildingand land.... . . . . . . . . . . . . . . . . . . . . . . .

Amortization ofl.?asehold improvements . . . . . . . . . . . . . . . . .

Mi=ellaneOus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$23.97

22.85

1.11

23.91

14.27

12.74

7.80

0.40

4.54

1.53

5.15

2.14

0.30

0.81

0.42

0.27

0.30

0.06

0.24

0.92

3.47

0.05

0.28

0.40

0.88

0.88

0.89

0.02

1.08

100.0

95.4

4.6

100.0

59.7

53.3

32.6

1.7

19.0

6.4

21.6

8.9

1.2

3.4

1.7

1.1

1.3

0.3

1.0

3.9

14.3

0.2

1.2

1.7

3.7

3.7

3.7

0.1

4.5

$12.89

12.06

‘0.83

12.82

6.58

6.03

3.68

●O.11

2.25

● 0.55

4.08

2.10

●0.11

0.48

0.30

+0.08

+0.13

+0.01

●0.1 3

0.88

1.60

“0.00

0.23

0.28

0.25

0.51

0.29

‘0.06

0.55

100.0

93.6

●6.4

100.0

51.4

47.1

28.7

● 0.8

17.5

●4.3

31.8

16.4

‘0.8

3.7

2.3

●0.7

+1.1

“0.0

●1.O

6.9

12.5

●0.O

1.8

2.0

U

2.2

● 0.4

4.3

AmOuntperresident day

$20.42

19.42

‘ 0.99

19.99

11.79

10.67

6.83

“0.20

3.64

1.12

4.69

2.15

0.21

0.54

0.49

0.24

0.25

“0.05

0.21

0.81

2.45

‘ 0.03

0.31

0.30

0.52

0.71

0.55

“0.03

1.06

$22.69

22.02

0.66

22.56

13.36

12.06

7.40

0.33

4.34

1.29

4.87

2.04

0.26

0.76

0.37

0.26

0.31

0.05

0.25

0.87

3.29

0.04

0.29

0.40

0.84

0.92

0.80

“0.02

1.04

100.0

95.1

●4.9

100.0

59.0

53.4

34.2

+1.0

18.2

5.6

23.5

10.8

1.0

2.7

2.5

1.2

1.3

● 0.2

1.0

4.1

12.3

●0.1

1.6

1.5

2.6

3.5

2.7

●O.1

5.3

100.0

97.1

2.9

1W.o

59.2

53.5

32.8

1.4

19.2

5.7

21.6

9.1

1.2

3.4

1.6

1.2

1.4

0.2

1.1

3.9

14.6

0.2

1.3

1.8

3.7

4.1

3.5

●0.1

4.6

$24.27

23.48

0.79

23.92

13.69

12.47

7,76

0.27

4.44

1.42

5.09

2.08

0.29

0.83

0.42

0.28

0.30

0.07

0.23

0.90

3.77

0.06

0.29

0.43

1.08

0.88

1.02

“0.02

1.17

100.0

86.7

3.3

100.0

58.1

52.1

32.5

1.1

18.5

5.9

21.3

8.7

1.2

3.5

1.7

1.2

1.2

0.3

1.0

3.8

15.7

0.2

1,2

1.8

4.5

3.6

4.3

●0.I

4.9

$29.50

26.80

‘ 2.69

30.41

19.42

16.83

9.84

0.95

6.04

2.58

6.22

2.41

0.45

1.09

0.47

0.31

0.35

0.09

0.27

1.13

3.71

0.08

0.24

0.44

0.85

1.00

1.08

‘0.02

1.06

100.0

90.9

+9.1

100.0

63.8

55.3 .

32.4

3.1

19.9

8.5

20.5

7.9

1.5

3.6

1.5

1.0

1.2

0.3

0.9

3.7

12.2

0.3

0.8

1.5

2.8

3.3

3.5

+0.1

3.5

NOTE: Estimates for resident days, occupancy rata, and costar revenue per resident day differ slightly from estimates presented inreferenca 2becauseof a data

processing error. See’’Data Processing” in appendix I fordetiils.

35
Table 12, Revenue endcost perresident day fornursing homes andpercent distribution, by Standard Federal Administrative Region: Unitad States, 1976

United States, 1976

Standard Federal Administrative Region

Revenue and cost components

Ragion Region Region Region Region Region Region Region

I II

Ragion Region

Ill iv v VI Vli Vlll Ix x

Revenue

ToteI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patientcere . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ncmpetlentcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

cost

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

Labor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Wagesendsslaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nursingpayroll . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Professionalpeyroll . . . . . . . . . . . . . . . . . . . . . . . . .

Otherpayroll . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Payroll taxesandfringe benefits . . . . . . . . . . . . . . . . . . .

Operating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Foodandotherdiatary items . . . . . . . . . . . . . . . . . . . . .

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

Suppliesandequipment . . . . . . . . . . . . . . . . . . . . . . . . .

Maintenance of buildings, grounds, and equipment

purchasedfrom outsidesourcas . . . . . . . . . . . . . . . . .

Laundryandlinen . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Heakhcereservices purchased from

wtsidesources . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherhealthc.are . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Fixed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Equipmentrental . . . . . . . . . . . . . . . . . . . . . . ..T . . . . .

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

Taxesandlicenseses . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interestandfinancecharges.. . . . . . . . . . . . . . . . . . . . .

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

Rentonbuildingandlend. . . . . . . . . . . . . . . . . . . . . . .

Amortizationof leasahddi mprcwements . . . . . . . . . . . . .

Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Revenue

ToteI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

patientcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nmtpatientcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

cost

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

Labor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Wagesandsalaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nursingpeyroll . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Professionalpayroll . . . . . . . . . . . . . . . . . . . . . . . . .

Otherpayroll . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Payroil taxesandfringetwwfits . . . . . . . . . . . . . . . . . . .

Operating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fwdandotherdietary items. . . . . . . . . . . . . . . . . . . . .

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

Suppliesandequipment . . . . . . . . . . . . . . . . . . . . . . . . .

Maintenance of buildings, grounds, and equipment

purchesedfrom outsidescmrces . . . . . . . . . . . . . . .

Laundryand linen . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Healthcares&vices purchasadfrom

autsidesources . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherhealthcare . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Fixed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Equipmentrental . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Taxesandlicenses . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interestandfinancecharges . . . . . . . . . . . . . . . . . . . . . .

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

Rentmsbuildingandland . . . . . . . . . . . . . . . . . . . . . . .

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

Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$25.86

24.95

“0.91

26.00

15.16

13.62

8.38

‘0.28

4.97

1.54

5.53

2.43

0.20

0.68

0.50

0.35

0.29

“0.07

0.22

1.08

4.14

‘0.03

0.36

0.56

1.20

0.96

0.98

● 0.04

1.17

100.0

96.5

●3.5

100.0

58.3

52.4

32.2

“1.1

19.1

5.9

21.3

9.3

0.8

2.6

1.9

1.4

1.1

‘0.3

0.8

4.1

15.9

+0.1

1.4

2.2

4.6

3.7

3.8

●0.I

4.5

$41.43

39.56

1.87

41.76

25.59

22.31

13.34

1.17

7.79

3.29

8.90

3.35

0.61

1.46

0.79

0.52

0.53

‘0.05

0.48

1.64

5.98

0.11

0.37

0.79

1.47

1.24

1.97

‘0.02

1.29

100.0

95.5

4.5

! 00.0

61.3

53.4

32.0

2.8

18.7

7.9

21.3

8.0

1.5

3.5

1.9

1.3

1.3

●0.1

1.2

3.9

14.3

0.3

0.9

1.9

3.5

3.0

4.7

‘0.0

3.1

$28.24

25.83

2.41

28.41

16.7S

15.02

9.14

● 0.43

5.45

1.77

6.41

2.48

0.50

1.11

0.55

0.30

0.37

‘0.04

0.33

1.11

3.78

+0.07

0.33

0.32

1.10

1.36

0.56

‘0.04

1.44

100.0

91.5

8.5

100.0

59.1

52.9

32.2

●1.5

19.2

6.2

22.6

5.7

1.8

3.9

1.9

1.1

1.3

+0.2

1.2

3.9

13.3

‘0.2

1.2

1.1

3.9

4.8

2.0

●0.1

5.1

Amount per resident day

$19.45

18.64

“0.82

19.41

11.33

10.30

6.47

‘0.26

3.57

1.03

4.50

1.85

0.32

0.82

0.23

0.27

0.25

“0.06

0.19

0.75

2.55

‘0.06

0.22

0.22

0.67

0.63

0.74

●0.01

1.03

100.0

95.8

●4.2

100.0

58.3

53.0

33.3

‘1.3

18.4

5.3

23.2

9.6

1.6

4.2

1.2

1.4

1.3

●0.3

1.0

3.9

13.2

● 0.3

1.1

1.1

3.4

3.3

3.8

“0.1

5.3

$2?.95

21.88

1.09

22.9S

14.16

12.71

7.74

0.36

4.60

1.46

4.71

1.97

0.22

0.75

0.35

0.25

0.27

0.06

0.21

0.88

3.13

‘0.03

0.29

0.38

0.86

0.93

0.62

‘ 0.01

0.98

$17.79

17.13

‘0.66

17.14

10.03

9.14

5.46

‘0.38

3.31

0.88

3.86

1.74

0.23

0.50

0.39

0.14

0.14

+0.04

0.10

0.71

2.44

‘0.04

0.25

0.21

0.59

0.63

0.70

●0.01

0.81

Percent distribution

100.0

95.2

4.8

100.0

61.6

55.3

33.7

2:::

6.3

20.5

8.6

1.0

3.3

1.5

1.1

1.2

0.2

0.9

3.8

13.6

●0.1

1.3

1.7

3.7

4.1

●?O

4.3

100,0

96,3

“3.7

100,0

58.5

53.3

31.8

*2.2

19.3

5.2

22.5

10.1

1.3

2.9

2.3

0.8

0.8

‘0.2

0.6

4.1

14.2

‘0.2

1.4

1.2

3.5

3.7

4.1

●0.1

4.7

$18.18

17.05

●1.13

18.13

10.64

9.70

5.87

“0.1 5

3.67

0.94

4.02

1.82

0.15

0.60

0.34

0.18

0.11

“0.03

0.09

0.82

2.52

+0.01

0.24

0.27

0.86

0.81

0.32

‘0.00

0.95

100.0

93.8

“6.2

100.0

58.7

53.5

32.4

● 0.9

20.3

5.2

22.2

10.0

0.8

3.3

1.9

1.0

0.6

+0.2

*0.5

4.5

13.9

●0.1

1.3

1.5

4.7

4.5

1.8

‘0.0

5.3

$16.93

16.58

“0.35

17.04

10.36

9.45

5.72

‘0.20

3.53

0.90

3.46

1.76

●0.1 5

0.51

0.20

●0.1 3

‘0.1 5

“0.08

“0.08

0.56

2.39

“0.03

0.20

0.24

0.90

0.78

0.22

●0.01

0.8g

100.0

98.0

+2.0

100.0

60.8

55.5

33.6

●1.2

20.7

‘ 5.3

20.3

10.3

‘0.9

3.0

1.2

●0.7

● 0.9

“0.4

‘0.5

3.3

14.0

‘0.2

●1.2

●1.4

5.3

4.6

●1.3

●0.1

4.9

$24.54

24.05

● 0.49

24.20

13.47

11.79

7.69

0.24

3.85

1.68

5.30

2.14

0.32

0.75

0.48

0.28

0.55

0.15

0.40

0.77

* 4.0s

‘0.07

0.29

0.65

0.67

0.71

1.65

+0.05

1.35

100.0

98.0

●2.O

100.0

55.7

48.7

31.8

+1.0

15.9

7.0

21.9

8.8

1.3

3.1

2.0

1.2

2.3

0.6

1.7

3.2

16.9

“0.3

1.2

2.7

2.8

2.9

6.8

●0.2

6.6

$18.31

16.82

● 1.48

17.87

11.04

8.55

5.86

+0.1 9

3.51

1.50

3.52

1.61

+’0.12

0.72

●0. I 8

‘0.1 o

‘0.22

“0.08

*0.1 6

0.57

2.41

“0.04

‘0.1 3

0.32

0.35

0.41

1.13

*o. 03

0.90

100.0

91.9

● 8.1

100.0

61.8

53.4

32.7

1.1

19.6

* 8.4

19.7

9.0

+0.7

4.0

●1.O

“0.6

●1.2

‘0.4

90.9

3.2

13.5

“0.2

●0.7

1.8

2.0

2.3

6.3

“0.2

NOTE: Estimates for rasident days, occupancy rate, and cost Or revenue per resident day differ slightly from estimates presented in reference 2 because of a data

processingerror. See’’Data Processing” in appendix I for details.

36
Table 13. Resident days, revenue perresident day, andamOunt and~rcent distritition Ofmajor components ofcostp6r resident day, byaffiliation andother selectad nursing hom~characteristic$

United States, 1976

Number Cost component

Affiliation and nursing home characteristic Total

of resident

days

revenue

Total Lebor Operating Fixed Mi.sce[- Total Lebor Operating Fixed MiscalIaneous Ianeous

CHAIN

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

Ownership

Proprietary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,

Voluntary nonprofit . . . . . . . . . ..0.... ,. .,....

Certification

Skilled nursingfacilityOnly . . . . . . . . . . . . . . . . . . .

Skillad nursing facility and intermediate care

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

Intermediate care facility mrly . . . . . . . . . . . . . . . . .

Notcertifiad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bed size

Lessthan 20 beds . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-49beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Location

Geographic region:

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

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

South . . . . , . . . ! , , . . . . , . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . .

Standard Federal Administrative Region:

Region I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region lV .,...,,,......,.. . . . . . . . . . . . . .

Region V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region Vl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

RegionVll . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region ViIl . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region IX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

See footnotes at end of table.

w

4

159,216,200

133,263,iO0

25,952,900

36,520,800

60,287,400

50,705,700

11,692,200

●413,800

11,246,400

48,744,700

77,415,200

21,396,100

24,071,900

54,109,100

54,520,200

26,514,900

12,425,400

8,417,900

9,961,500

22,993,100

37,556,900

24,794,300

15,216,000

7,393,100

16,187,700

5,270,300

$22.79

22.29

25.38

28.07

25.51

17.48

15.35

●1O.31

17.90

21.56

23.41

26.16

33.37 .

21.82

19,42

22.17

24.92

44.36

31.45

19.05

22.34

17.25

20.64

14.25

27.04

18.52

Amount par resident day

$22.22

21.44

26.24

27.26

25.13

16.84

14.84

●8.98

17.04

21,05

22,74

25.99

33.29

21.13

18.68

21.68

25.01

44.09

30.68

18.65

21.81

16.27

19.61

14.29

26.35

18.03

$12.59

12.01

15.59

15.69

14.18

9.40

8.59

●3,76

9.88

12.01

12,66

15.26

19.20

12.01

10.34

12.43

74.19

26.12

16.90

10.37

12.44

8.99

11.05

8.09

14.77

11.29

,$4.75

4.41

6.50

5.63

5.44

3.55

3.69

*3,70

3,63

4.57

4.85

5.44

7.21

4.47

4.14

4.36

4.82

9.99

7.06

4.12

4.61

3.65

4.15

2.97

5.34

3.46

$3.57

3.70

2.95

4.41

4.04

2.80

1.92

●0.99

2.55

3,17

3.85

4.09

5.24

3.41

2.98

3.62

4.58

6.32

4.75

2.82

3,52

2.69

3.14

2.23

4.71

2.38

$4.30

1.32

1.20

1.54

1.46

1.09

0.64

●0.54

0.98

1.29

1.39

1.19

1.63

1.25

1.22

1.28

1.41

1,65

1.98

1.35

1.24

0.95

1.27

0.99

1,54

0.90

Parcent dlstributio~

f 00.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100,0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

56.7

56.0

59.4

57.5

56.4

55.8

57.9

*4 I .8

58,0

57.1

55.7

58,7

57.7

56.8

55.3

57.3

56.7

59.3

55.1

55.6

57.1

55.2

56.4

56.6

56.0

62.6

21.4

20.6

24.8

20.6

21.7

21.1

24.9

●41 .2

21.3

21.7

21.3

20,9

21.7

21.2

22.2

20.1

4

9.3

2.7

23.0

22,1

21.1

22.4

21.2

20.8

20.3

19.2

16.1

17.2

11.2

16.2

16.1

16.6

12,9

*11.O

15.0

15.1

16.9

15.7

15.8

16.1

16.0

16.7

18.3

14.3

15.5

15.1

16.1

16.5

16.0

15.6

17.9

13.2

5.8

6.2

4.6

5.6

5.8

6.5

4.3

“6.0

5.7

6.1

6.1

4.6

4.9

!3.9

6.5

5.9

5.7

3.7

6.4

7.2

5.7

5.8

6.5

7.0

5.8

5.0
CJ

or

Table 13. Resident days, ravanue perresident dey, andamount andpercant distribution of majOrcompOnents OfcOstpar resi&nt day, byaffiliation andother salected nursing home characteristics:

United States, 1976–Con.

Number Cost component

Affiliation and nursing home characteristic

Total

of residen t

days

revenue

Total Labor Operating Fixed Miscel- Total Labor Operating Fixed Miscellaneous Ianeous

INDEPENDENT

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

Ownership

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

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

Certification

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

Skilled nursing facility and intermediate care

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

lntarmediate care facility only . . . . . . . . . . . . . . . . .

Noncertified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bed size

Less than 20 beds . . . . . . . . . . . . . . . . . . . . . . . . . . .

2049 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

100-199 bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2001xrdsormore . . . . . . . . . . . . . . . . . . . . . . . . . . .

Location

Geographic region:

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

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

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

Waft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Standard Fadera[ Administrative Ragion:

Region I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ragionll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region ill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ragion V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region VI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ragion Vll . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region Vlli . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

RagionlX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Seefootnotes atendoftable.

249,400,800

181,962,500

67,438,300

53,866,600

97,003,900

62,530,200

36,000,200

13,495,600

33,120,500

79,260,600

85,388,700

38,135,400

67,909,100

81,575,400

58,710,200

41,206,100

18,6B6,100

34,801,900

20,672,300

31,136,400

59,785,900

22,053,500

18,367,100

7,425,200

28,625,900

7,846,600

Amount par rasident daY Percent distribution

A- . -- *- . -- A----

W4.4S

23.05

27.49

$32.16

26.07

19.58

15.64

12.94

21.27

22.87

25.59

30.73

34.98

21.10

18.28

21.31

26.06

41.49

27.42

19.08

22.52

16.85

17.03

19.62

22.58

17.04

WZ4.UZ

22.51

28.07

$31.34

26.00

19.41

15.72

12.72

20.92

22.75

25.22

30.65

34.93

20.74

18.04

21.02

26.13

41.49

27.10

19.12

22.16

16.31

16.65

19.33

22.30

16.62

li14.lz

12.89

17.45

$18.64

15.56

11.24

8.49

6.47

12.35

13.39

14.80

18.38

20.69

12.46

10.55

11.68

15.18

24.83

15.75

11.17

13.35

9.63

9.70

11.93

12.13

9.80

$5.30

4.B6

6.49

$6.68

5.47

4.46

4.23

4.09

4.96

4.92

5.37

6.65

7.62

4.36

4.34

4.70

5.89

8.90

6.30

4.57

4.60

3.75

3.71

3.97

5.18

3.28

$3.63

3.84

3.06

$4.74

3.9B

2.91

2.26

1.62

2.52

3.50

4.04

4.65

5.42

3.07

2.36

3.59

4.01

6.63

3.70

2.52

3.31

2.23

2.53

2.75

3.84

2.66

$0.97

0.92

1.08

$1.28

0.98

O.BO

0.75

0.54

1.09

0.94

1.00

0.9B

1.20

0.85

0.79

1.05

1.05

1.12

1.35

0.B6

0.91

0.69

0.72

0.66

1.15

0.89

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

58.8

57.3

62.2

59.5

59.9

57.9

54.0

50.9

59.1

58.8

58.7

60.0

59.2

60.1

58.5

55.6

58.1

59.8

58.1

58.4

60.2

59.1

58.2

61.7

54.4

59.0

22.1

21.6

23.1

21.3

21.0

23.0

26.9

32.1

23.7

21.6

21.3

21.7

21.8

21.0

24.0

22.4

22.6

21.5

23.3

23.9

20.7

23.0

22.3

20.5

23.2

19.7

15.1

17.1

10.9

15.1

15.3

15.0

14.4

12.7

12.0

15.4

16.0

15.2

15.5

14.8

13.1

17.1

15.4

16.0

13.7

13.2

14.9

13.7

15.2

14.2

17.2

16.0

4.0

4.1

3.8

4.1

3.8

4.1

4.7

4.2

5.2

4.1

4.0

3.2

3.4

4.1

4.4

5.0

4.0

2.7

5.0

4.5

4.1

4.3

4.3

3.5

5.2

5.3
Table 13. Resident days, revenue ~rresident day, endamOunt and~rcent distriWtiOn OfmajOr cOm~nents OfcOstper resident &y, byaffiliation andother selected nursing hOme characteristics:

United States, 1976–Con.

Number Cost component

Affiliation and nursing home characteristic Total

of resident

days

revenue

Total Labor Operating Fixed Miscel- Total Labor Operating Fixed MiscalIaneous laneous

GOVERNMENT

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

Ownership

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

Certification

Skillednursingfacility Only..... . . . . . . . . . . . . . .

Skilled nursing facility and intermediate care

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

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

Not cartified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bed size

Lessthan20bads . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-49bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

100-199bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Location

Geographic ragion:

Northeast . . . . . . . . . . . . . . , . ,. . . , . . , . , . . . .

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

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

West . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Standard Federal Administrative Region:

Region I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region ~agionl,,II . . . . . . . . . . . . . . ..m . . . . . . . . . . . . . .

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

RagionlV . . . . , . . , . , . . . . . . . , , , , . . . , . , . . .

RegionV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region VI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region Vll . ..!.,.... . . . . . . . . . . . . . . . . . . .

Region Vlll . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region IX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

42,905,500

42,805,500

6,579,600

18,984,700

10,287,100

-7,054,100

“366,600

2,278,200

9,181,600

9,645,600

21,233,600

10,630,200

22,109,000

6,875,700

3,280,600

●1,332,300

6,056,500

4,931,500

3,410,800

15,700,200

●1,998,900

5,996,000

‘1,346,300

‘980,900

*1,1 52,000

$26.66

26.66

33.53

30.38

16.93

24.40

● 13.9B

“20.52

27.07

19.55

30,65

33.54

22.78

26.28

31.26

*3 I .78

37.00

25.21

25.59

26.02

*34.88

15.47

●16.74

“43.08

*25.97

Amountparresidant day

$29.54

29.54

36,04

33.6B

19.56

26.91

●20.70

●21.08

28.93

21.84

34.44

37.31

25.87

28.08

32.21

●33.34

40.11

29.33

27,28

28.90

●37.1 1

18.90

*19.54

●46.29

*25.68

$21.33

21,33

26.61

24.32

13.38

19.99

● 13.92

● 12.98

20.24

15.67

25.46

26.99

18.73

20.08

23.17

●23.91

29,26

20.87

19.25

21.40

27.41

12.51

‘14.09

●32.43

*18.42

$5.80

5.80

6.20

6.33

4.52

5.87

●4.33

6.08

6.03

4.61

6,25

6,96

5.12

6.22

5,77

●6,91

7.38

5.54

6.46

5.36

7.56

4.61

*3.37

●8.20

●5.39

$1.49

1.49

1.68

1.93

1.17

0.60

●1,59

●1.02

2.04

0.73

1.65

2.10

1.31

1.23

1.27

*1 .80

1.75

2,16

1.11

1.49

●1.74

0.91

*1.27

*1 .39

●0.92

$0.92

0,92

1.55

1.10

0.49

0.46

●0.66

● 1.00

0.62

0.83

1.07

1,26

0.71

0.54

2.00

*0.72

1.72

0.77

0,46

0,64

“0.40

0.88

*0.82

*4.27

● 0.95

Percent distribution

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100,0

100.0

100.0

100.0

100.0

100.0

100.0

100,0

100.0

100.0

100.0

100.0

100,0

100.0

100.0

100.0

100.0

72.2

72,2

73.8

72.2

68.4

74.3

*67.3

61.6

70.0

71.7

73.9

72,3

72.4

71.5

71.9

71,7

72.9

71.2

70.6

74.0

73.9

66.2

72.1

70.1

71.7

19.6

19.6

17.2

18.8

23,1

21.8

*20.9

28.9

20.9

21.1

18.1

18,6

19.8

22.1

17.9

20,7

18.4

18.9

23,7

18,6

20.4

24.4

*1 7,2

17.7

21.0

5.0

5.0

4.7

5.7

6.0

●2.2

●7.7

4.8

7.0

3.3

4.8

5.6

5.1

4.4

●3.9

●5.4

4.4

7.3

*4.1

5.2

*4.7

4.8

*6.5

*3.O

●3.6

3.1

3.1

4.3

3.3

2.5

●1.7

●4. 1

4.7

2.1

3.8

3.1

3.4

2.7

*1.9

6.2

●2.2

4.3

●2.6

*1.7

2.2

●1.1

4.6

●4.2

●9.2

●3.7

NOTES: Estimates for resident deys, occupancy rate, and cost or revenue per resident day differ slightly from estimates presented inreference 2beceuse ofadata processing error. See` JDate Processing” in appendix I fordeteils.

Figures ma~ not add to totels because of rounding.

U

co
Table 14. Number andpercent distribution of nursing home residents ~&pn&nq tiatu$, ~orting tomm~rmsi&nt tiyintervals andmletied nursing home

characteristics United States, 1977

Number Dependence statusi

Cost per resident dav interval and

nursing home characteristic of

residents

All

IW.QIS2

Level 13 Leval + Level 35

Ail cost intervals

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

Ownership

proprietary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Certification

Skilled nursing fscility only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skilled nursing fscility andintermediate care facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Noncertified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bed size

Lessthan 20 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-49 kds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

50-99 hds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

100-199 hds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

200 badsor more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Location

Geographic region

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

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

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

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

Standard Federal Administrative Region:

Region I..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ragion II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

RegionlV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region V

RWion Vl” I::: :::l:l:::I::n R:J: 1::1111 l::: ::ul::: :::: :n:l::ll 11111111:1

Region Vll

Rwion Vlll”:: :: II II R: I:l:::I:IR: :::: :::nu:: :::: ::n:uu:l::lu::u:l :::::::

Region IX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than $15.00

To@l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ownership

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

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

Government, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Certification

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

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

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

Noncertified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bed size

Las.tthan 20twds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2(M9beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

50.99 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

100.199 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

200 badsor more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Location

Geographic rcgiom

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

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

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

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

Standard Federal Administrative Region

Region I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region I l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region Ill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

RegionlV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region Vl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ragion Vll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region Vlll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region IX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

S*O footnotas ●t ●nd of tabb.

1,303,100

628,800

281,800

132,500

289,800

527,6410

368,200

137,500

37,000

130,900

397,000

505,200

233,000

282,1 m

449,400

354,700

207,000

85,600

138,300

107,800

175,300

318,200

142,700

115,s00

50,900

124,W0

44,600

192,200

148,300

31,700

12,200

18,300

18,ooO

94,s00

81,200

1B,800

30,100

74,300

53,400

15,700

18,500

74,400

66,900

30,400

S,600

7,700

7.300

24,1 GO

25,100

39,500

43,200

14,100

15,600

6,700

POrcant distribution

100.0

100.0

100,0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100,0

100.0

100.0

100.0

1C4J.O

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

21.9

20.9

24.2

23.S

12.9

17.7

24.9

48.o

53.4

28.0

20.s

18.9

21.9

21.8

21.7

21.6

23.0

27.9

19.2

23.2

19.3

19.9

22.2

26.0

26.7

21.0

26.2

39.3

37,8

45.0

42.6

32.3

36.2

31.2

54.8

57.6

44.9

32.0

36.6

50.0

68.9

34.4

33.3

45.7

73.6

69.5

63.8

48.6

37.7

20.1

28.4

41.8

59.4

%36.7

30.3

30.6

30.7

27.2

27.0

31.5

32.9

24.8

25.5

28.6

31.1

30.6

29.1

28.9

31.5

30.2

29.6

26.8

27.0

31.3

32.1

30.0

29.8

34.8

33.9

28.7

29.4

27.9

27.7

27.1

32.9

25.4

23.5

31.8

24.0

25.6

33.2

28.1

26.7

●17.1

21.4

34.2

25.7

21.6

“18.3

●23.6

●23.2

26.7

31.7

25.9

37.7

“21 .5

●16.8

“31 .6

3a9

39.8

35.6

39.6

49.0

41.8

34.4

20.3

9.8

34.2

40.7

41.3

37.8

39.7

3s.1

40.2

37.3

37.4

42.1

39.0

41.2

40.6

38.3

32.4

34.2

37.8

37.0

25.4

26.7

21.0

●21 .1

34.3

32.3

30.1

13.4

●5.1

15.6

33.3

27.4

24.0

“s.0

25.8

30.9

22.5

●8,6

“4.5

“1 0.5

15.3

23.7 “

43.6

27.8

33.6

“9.7

●26.7

40
Table 14. Number and percent distribution of nursing home residents by dependency status, according to cost per resident day intervals and selected nursing home

characteristics United States, 1977-Ccm.

Depen&twy stawsq

Cast per resident day interval and Number

nursing home characteristic of

residents All

IW?IS2

Lewl 13 Level @ Level @

$15.W-$19.99

100.0

Percent distribution

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2e6,100 20.1 31.7

Ownership

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

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

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

200,500

53,300

12,300

100.0

100.0

100.0

18.4 31.2

28.0 33.3

●I 3.8 31.1

42.0

30.5

41.3

Certification

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

Skilled nursing facility andintermediate care facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

36,800

88,700

119,800

9.800

100.0

100.0

100.0

100.0

18.8 25.1

17.1 34.3

22.7 31.3

●23.5 ●33.3

46.1

39.2

38.6

‘30.5

Bed size

Lessthan 20teds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-19 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

100-188 imds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

3,600

22,900

95,800

116,200

25,600

100.0

100.0

100.0

100.0

100.0

*83.O “7<5

17.9 34.2

17.5 32.8

19.9 30.9

23.9 32.0

●3.1

42.4

42.1

39.2

36.9

Location

Geograph k region:

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

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

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

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..7...........................::. . . . . . .

Standard Federal Administrative Region:

Region I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region Ill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region Rwio”vl V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Region V1l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region Vlll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

~qio”x Region IX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

12,200

102,300

108,600

42,800

100.0

100.0

100.0

100.0

57.3

21.2

15.6

18.3

● 30.9

33.1

32.6

28.8

‘1 8.1

37.3

44.0

40.6

8,800

“ 700

9,2(MJ

50,300

60,700

51,900

37,400

15,200

19,900

12,rx)o

100.0

100.0

100.0

1W.o

100.0

100.0

100.0

100.0

100.0

100.0

61.6

●33.3

*23.4

12.7

19.7

16.9

24.7

*1 6.6

●13.5

●28.1

+1 6.8

●33.3

“33.4

35.4

30.7

29.7

“19.4

“ 33.3

38.7

44.9

38.9

42.3

35.4

40.1

39.4

39.4

34.6

39.7

25.0

30.4

$20.00-$24.99

Tota l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280,600 1 (M.O 17.2 29.5 44.1

0wmar5hip

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

Voluntwyn onprofit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

203,200

61,800

25,700

100.0

100.0

100.0

15.2

23.2

18.0

28.3

31.0

27.8

48.1

36.1

47.1

Certification

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

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

Intermdiate care facility only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Notcwtified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

48.0

45.8

36.5

34.7

68,700

157,500

50,230

16,303

100.0

100.0

100.0

100.0

12.1

15.0

27.5

30.2

23.6

39.2

32.7

●21.3

8ed size

tithan20 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-49 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

100-199M6.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

200 bnds or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Location

Geographic region:

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

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

south . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

west . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Smndard Federal Administrative Regiom

Region I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region VI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region VII . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region Vlll . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region IX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4,3Lm

24,300

95,300

122,800

44,000

1Oao

100.0

100.0

1W.o

100.0

●18.2

19.8

16.2

16.6

19.5

%!.0.8

25.3

30.3

30.5

27.3

●39.6

39.0

43.8

45.9

42.8

46,300

113,600

65,800

65,700

100.0

100.0

100.0

100.0

21.7

16.2

18.2

14.7

28.7

29.4

27.5

32.4

41.8

44.6

48.5

42.2

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

18.2

●34.3

25.1

26.5

“22.0

34.3

28.0

28.5

●19.7

‘32.6

●40.9

32.4

33.2

47.7

●39.2

33.9

50.7

45.9

40.0

●31 .2

●34.8

42.2

44.7

21,400

7,300

28,600

48,300

105,600

11.400

13.4

16.1

●28.8

%28.8

●16.2

13.0

●14.7

5;600

8,300

48,000

12,200

Sea footnotes at and of table.

41
Table 14. Number and parcant distribution of nursing home residents bv depencbmcy status, according to cost per re$idmt day intervals and selected nursing home,

characteristics United States. 1977—&m.

. .

Number Dapandencv statusl

Cost per resident day interval and

of nursing home characteristic

residents All

Lw.#

Level 13 Level 24 Level 35

$25.00 ormore

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

Ownership

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

Voluntwyn onprofit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Gwarnment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Certification

Skilled nursing facility O“IY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skilled nursing facility andinternwdiate care facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Noncertified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bud size

L&ssthan 20tmds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2049 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6W99hds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

100-199 bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2Wkds ormore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Location

Geographic region:

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

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

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

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

Standard Federal Administrative Region:

Region I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region I l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ragionlll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region VI

RWion Vll IJIjl II: EIll EIJlll:Il 1111:11: II II IUIIUUIU::UJII:J:J ::::::::::

Region Vlll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Regionl X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NO cost reported

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

Ownership

Proprietary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..’...... . . . . . . . . . . . . . . .

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

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

Citification

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

Skilled nursing facility andintermediate care facility . . . . . . . . . . . . . . . . . . . . . . . . . . . .

intermediate care facility only.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Notcartifiad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bed size

Less than 20 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2049 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

100-199 b8ds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Location

Geographic region:

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

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

South, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

kVe5t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Standard Federal Administrative Region:

R~ion l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region Ill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region W . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region Vl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region Vll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region Vlll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region IX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

376,1 W

1S2,300

123,1 M

70,700

121,000

185,900

44,000

25,200

‘2,600

24,600

82,600

143,100

123,200

190,400

96,600

47,900

40,900

36,500

111,100

55,600

22,600

79,600

13,300

15,700

7,100

30,s00

3,600

17B,7 00

154,500

11,900

11,600

26,s00

66,700

59,400

25,200

7,700

29,100

49,000

67,700

24,600

25,600

62,200

63,300

27,100

10,100

11,300

9,000

32,100

47,200

26,700

14,000

6,200

11 ,s00

9,700

Percent distribution

100.0 17.7

100.0 14.3

100.0 18.3

100.0 25,5

100.0 B.O

100.0 18.0

100.0 27.7

100.0 45.s

100.0 “60.0

100.0 19.6

100.0 17.4

100.0 15.7

100.0 1S.9

100.0 14.5

100.0 22.7

100.0 23.3

100.0 14.0

100.0 16.5

100.0 12.8

100.0 17.5

100.0 16.2

100.0 22.0

100.0 39.7

100.0 27.6

100.0 ●27.6

100.0 “8.7

100.0 ‘2s.8

100.0 22.5

100.0 23.2

100.0 ●18.4

100.0 . , ●17.6

100.0 15.4

100.0 18.8

100.0 18.5

100.0 49.0

100.0 48.6

100.0 32.3

100.0 24.6

100.0 14.3

100.0 21.7

100.0 25.7

100.0 16.0

100.0 21.1

100.0 37.5

100.0 ‘20.4

100.0 36.9

100.0 *19.7

100.0 19.8

100.0 15.4

100.0 20.s

100.0 ●17.5

100.0 ●29.7

100.0 45.8

100.0 “32.6

29.5

30.5

30.0

26.4

26.8

31.9

32.4

19.6

“28.2

24.4

30.4

29.0

30.6

30.4

29.8

22.6

32.9

32.0

28.0

30.7

30.5

2S.6

●16.3

34.7

“40.1

33.4

‘19.5

33.5

34.3

34.7

‘20.7

29.9

31.4

36.5

31.0

‘30.1

30.2

35.0

35.5

29.8

27.0

32.0

39.s

2s.2

●26.1

“22.7

“30.0

38.3

34.1

45.9

27.2

“31 .8

● 24.1

●25.6

43,0

46.3

41.0

37.7

54.2

40.5

32.2

26.5

44.B

46.7

45.7

37,9

44.1

37.0

48.5

45.4

41.6

46.2

44.8

49.4

3B.5

36.5

29.0

“ 24.4

50.6

“42.0

35.3

33.7

39.0

52.3

41.9

42.2

31.9

17.8

●11.1

33.9

33.1

38.7

39.1

36.4

43.8

30.s

25.0

41.0

‘30.1

41.5

35.5

43.7

22.9

42.9

●31 .1

●21 .B

“29.4

lUnknOwns were cmwidered ncxdependent fmthepurpma of this index.

21ncludes residents who were dependent In at least 2 functicms but not classifiable into any of these caw!gorie$.

3Notdepend?nt in bathing, dressing, using toilet rcmm, mobility, continence, .x eating or dependent in only 1 activity.

4Dependent intiam’l”ga”dl .qdditlO"al acthAWOrdependentl" bmhing,dr easi"g,a"d 1 additional actlvlW ordependint lnbathing, dressing, using tOiletrOOm, and 1 additi.anal activity.

5Depandmt in bathing, dresd”g, using toilet room, moblllty, and 1 additional activity ordeprmdant In al16 activities.

NOTE: F,oures may”otadd tototalsbecauseof rounding.

42
Tabla 15. Numbrof nursing home full-time equivalent employ ees'Wrl OObdswithin co=wrresident dayintervals, W*lected nursing home

characteristics: United States, 1977

Nursing home characteristic

Cost per resident day interval

All

‘;;5t~ $15.00-$19.99 $20.00-$24.99 ‘25-00 r~;o~;; in tawals2 or more

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

Ownership

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

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

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

Certification

Skillednursingfacilityonly . . . . . . . . . . . . . . . . . . . . . . .

Skilled nursing facility andintermediate care facility . . . . . . .

Intermediatecarefacilityonly. . . . . . . . . . . . . . . . . . . . . .

Notcertifiad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bed size

Lessthan 20beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20-49 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

50-991wds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Location

Geographic region:

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

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

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

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

Standard Federal Administrative Region:

Region I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Regionll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region ill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

RegionV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region VI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

RegionVll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region Vlll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region IX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

RegionX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

41.1

38.8

47.2

44.6

46.8

46.9

36.0

24.1

23.4

41.4

43.3

42.5

37.6

45.3

42.1

38.4

37.8

40.6

43.8

49.4

47.3

43.8

28.0

37.6

34.1

38.9

40.4

Number of full-time equivalent employees per 100 beds

24.9

25.0

26.7

●18.5

17.0

33.6

29.0

18.8

●I 2.1

25.0

29.6

25.7

17.6

14.6

28.1

25.4

20.4

‘20.0

●6.2

●15.2

24.2

24.2

27.8

32.3

29.5

●12.3

●33.6

40.5

40.4

38.6

52.1

43.1

46.1

37.6

21.4

*21 .0

43.8

44.3

39.9

30.2

●I 9.8

42.0

40.0

44.4

●20.4

●1O.3

●33.5

51.8

41.0

30.1

42.3

45.6

42.4

50.6

48.5

47.1

52.8

49.8

52.3

49.6

45.5

35.4

●7I .3

55.6

50.8

47.0

42.2

53.1

47.0

54.0

42.8

48.9

●51 .5

57.8

60.5

47.2

28.3

●45.2

●32.7

43.5

47.1

49.2

46.4

54.8

47.3

54.4

50.0

44.3

30.8

“53.0

54.3

54.5

49.5

43.7

51.5

50.7

43.6

42.3

51.0

48.6

55.5

55.3

64.1

22.4

36.0

24.1

49.3

‘38.0

31.9

31.0

38.2

*38.O

32.6

37.6

30.3

22.2

*1 8.1

32.7

30.0

37.4

26.0

30.0

35.3

31.1

28.6

29.3

28.4

37.2

34.2

33.9

26.4

40.3

●37.O

28.4

24.2

135 hours of part-time employees’ work Isconsidered equIvalenttol full-time employm. pan-time employees Were cOnvertd tOfU[!-time OqU]Valent

employees by dividing the number of hours worked per week by 35.

21ncludes only employees by dividing the number of hours work~d per week by 35.

.

43
Table 16. Revenue, cost, netincome, andcash flow perresident day fornursing homesrby wlected nursing home characteristi~:

United States, 1976

Net incomeq C%h flo wz

Nursing home characteristic Revenue cost (paper profit (actual profit

or loss) or loss)

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

Ownership

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

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

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

Certification

Skilled nursingfacility only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skilled nursing facility andintermediate care facility . . . . . . . . . . . . . . . . .

Intermediate carefacilityonly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Noncertified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bed siza

Lessthan 20bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2049 bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Location

Geographic region”

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

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

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

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

Standard Federal Administrative Region:

Region I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Regionll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region ill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Region Vl

Region Vll

Region Vll

RegionlX

Region X

Chain . . . . .

lnde~endent .

Affiliation

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

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

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

$23.97

22.73

26.91

26.66

30.71

26.34

18.50

16.71

12.89

20.42

22.69

24.27

29.50

34.46

21.58

19.26

22.07

25.86

41.43

28.24

19.46

22.95

17.79

18.18

16.93

24.54

18.31

22.79

24.25

26.66

Amount par resident day

$23.91 $0.06 $().93

22.06 0.67 1.39

27.56 -0.66 O.;ro

29.54 -2.88 -1.94

30.12 0.59 1.60

26.53 -0.19 0.84

18.37 0.13 0.82

16.98 -0.27 0.:40

12.82 0.07 0.59

19.99 0.43 1.13

22.56 0.13 1.05

23.92 0.35 1,:>1

30.41 -0.92 0.09

—

34.79

21.59

18.91

21.79

26.00

41.76

28.41

19.41

22.98

17.14

18.13

17.04

24.20

17.87

-0.34

-0.01

0.35

0.28

-0.14

-0.33

-0.17

0.04

-0.03

0.65

0.05

-0.12

0.34

0.43

0.93

0.88

0.99

0.94

0.82

0.91

1.20

0.67

0.90

1.:28

0.86

0.67

1.05

0.85

22.22 0.57 1.37

24.02 0.23 1.15

29.54 -2.89 -1 .!34

1 R~ven”e Minus ~~~.

2Ne~inc~~~pl”~ depr~ciati~n.

NOTE: Estimates for residant days, occupancy rata, end cost or revenua parresldent daydiffer slightly from estimates presented inrefarsmce2 beceuseof a date processing error. See “Dete Processing” in appendix I for details.

44
Table 17. Percent of nursing homes within 1976profit and/or lossca~ories, bysalmted nursing home characterimics: United Statesr 1977

Cost exceeds revenue by- Revenue exceeds cost by–

Nursing home characteristic

Total

0-2.5 2.6-5 5.1-10 10.1 0-2,5 2.6-5 5.1-10 fo. 1

percent percent percent percent percent percent percent percent

or more or more

Ali nursing homes . . . . . . . . . . . . . . . . . . . . . .

Ownership

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

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

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

Certification

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

Skilled nursing facility and intermediate care

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

Intermediate carefacilityonly . . . . . . . . . . . . . .

Noncertified . . . . . . . . . . . . . . . . . . . . . . . . .

Bed size

Lessthan 20beds . . . . . . . . . . . . . . . . . . . . . .

2049 beds . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Location

Geographic region:

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

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

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

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

Standard Federal Administrative Region:

Region I . . . . . . . . . . . . . . . . . . . . . . . . . .

Region ii . . . . . . . . . . . . . . . . . . . . . . . . . .

Region ill . . . . . . . . . . . . . . . . . . . . . . . . .

Region IV . . . . . . . . . . . . . . . . . . . . . . . . .

Region V . . . . . . . . . . . . . . . . . . . . . . . . . .

Region VI . . . . . . . . . . . . . . . . . . . . . . . . .

RegionVll . . . . . . . . . . . . . . . . . . . . . . . .

Region Vlll . . . . . . . . . . . . . . . . . . . . . . . .

Region IX . . . . . . . . . . . . . . . . . . . . . . . . .

Region X . . . . . . . . . . . . . . . . . . . . . . . . . .

Affiliation

Chain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Independent . . . . . . . . . . . . . . . . . . . . . . . . . .

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

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

10.5

‘9.4

16.9

*5.9

11.8

12.6

10.6

7.3

7.1

13.2

10.5

11.3

*10.2

15.5

8.6

8.8

10.0

17.1

15.4

* 10.3

8.8

6.6

*8.6

●8.8

*13.2

11.7

*7.6

8.4

11.8

*5.9

6.5

3.7

14.0

21.7

6.1

8.3

7.7

●3.4

7.6

8.8

7.8

*7.7

H

6.4

●4.7

*4.7

*6.2

●6.6

*7.2

8.4

*5.O

*9.1

*3.3

*3.3

●18.7

8.1

4.6

21.7

Percent of nursing homes

6.5

4.7

11.5

*15.4

8.7

6.9

4.5

6.8

6.3

“6.4

7.2

5.3

*14.2

8.7

4.0

5.6

8.5

●5.3

*1 0.3

*12.5

“5.5

*5.1

*5.8

*2.4

“22,7

‘3.9

*8.8

*4.1

6.7

●15.4

12.2

9.8

18.4

27.3

9.5

10.0

11.6

17.5

23.3

8.8

9.9

7.8

*1 5.2

8.8

10.9

13.5

15.9

11.5

●5.2

*1 3.4

14.7

13.8

*9.2

*5.6

* 25.2

15.3

*2.7

8.5

12.5

27.3

11.2

12.0

8.5

*9.4

7.0

18.2

14.0

●4.3

*5.1

12.1

13.2

12.1

*1 6.6

16.3

14.0

8.4

5.8

19.0

●13.2

● 15.8

●7.4

14.1

●6.4

14.2

*5.9

●4.3

●17.8

10.8

11.5

*9.4

20.6

24.8

6.9

* 5.4

27.2

18.2

19.7

18.8

20.6

20.6

19.8

24.8

*6.1

20.9

18.5

18.5

25.4

22.4

21.4

*14.5

18.4

19.6

20.2

17.3

●9.9

30.1

*13.1

22.6

21.1

●5.4

13.2

14.0

12.3

*4.3

12.9

12.6

16.3

10.1

6.2

11.9

17.0

15.6

*12.8

8.5

15.5

15.4

12.4

*5.9

●8.3

●13.3

14.0

16.2

19.6

14.6

●12.5

11.3

*19.9

15.5

13.0

*4.3

18.1

20.7

11.0

*3.8

16.5

12.3

14.6

29.4

31.4

17.9

13.0

14.0

*13.4

14.4

18.3

22.1

17.1

12.3

.

19.8

*9.1

23.2

14.6

25.1

26.7

*7.1

20.1

*1 0.1

21.6

17.8

●3.8

NOTE: An insignificant number of nursing homes had cost equal to revenue (1.2 percent); for this reason the sum of categories will not aqual the

total.

45
Appendixes

Contents

1.

Il.

Technical notes on methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Survey design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sampling frame . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sampling design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Datacollection proceduresforthe 1977 National NursingHomeSurvey . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

General qualifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonresponse and imputation ofmissing data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rounding ofnumbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Data processing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estimation procedures :...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reliability ofestimates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hypothesis testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Definition ofcertain termsusedin this report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Terms relating tofacilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Terms relating tostaff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Terms relating toresidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Terms relating todischarges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ill. Selected survey instrumentsusedin the 1977 National Nursing Home Survey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Letter to administrator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Letters of endorsement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Facility Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Letter to accountant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Expense Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Definition Bookletfor Completing the Expense Questionnaire. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Staff Classification Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Letter to staff member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Staff Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IV. Criteria forclassifying nursing homes according to level ofnursingcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Listofappendix figures

1. Relative standard error cuwesof estimated admissions, discharges, beds, residents, and facilities. . . . . . . . . . . . . . . .

Il. Relative standard errorcurveof estimated residentdays ofcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ill. Relative standard errorcurvesof estimated employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

List of appendix tables

1. Number of facilities in the 1977 National Nursing Home Survey universe and sample, by disposition and sampling

strata: CoterminousUnited States, 1977 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

48

48

48

48

50

52

52

52

52

52

54

66

69

69

70

71

72

73

73

75

79

91

93

96

101

102

103

107

55

56

57

49

46
Il.

Ill.

Iv.

v.

vi.

V1l.

Vlil.

lx.

x.

xl.

X11.

XIII,

Xiv.

xv.

Xvi.

Xvll.

Summary ofdata collection procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Standard errors ofpercentages forhomes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Standard errors ofpercentages forresidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Standard errors ofpercentages fordischarges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Standard errors of percentages for total employees and nurse’s aides. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Standard errors ofpercentages forprofessional employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Standard errors ofpercentages for beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...

Standard errors ofpercentages foradmissions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Standard errors of percentages for total costs and total revenues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Standard errors ofpercentages forlaborcosts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Standard errors of percentages for other (operating, fixed, and miscellaneous) costs. . . . . . . . . . . . . . . . . . . . . . . .

Standard errors ofpercentages forresidentdays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Standard errors for average total cost per resident day and average revenue per resident day . . . . . . . . . . . . . . . . . .

Standard errors for average labor costs plus labor components per resident day. . . . . . . . . . . . . . . . . . . . . . . . . . .

Standard errors for average operating, fixed, and miscellaneous costs per resident day . . . . . . . . . . . . . . . . . . . . . .

Standard errors foroccupancy rate.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

XVI II. Worksheet for weighted I,east squares regression of full-time equivalent (FTE) nursing staff per 100 beds, by total cost

perresident day: United States, 1977. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

51

58

58

59

59

60

60

61

61

62

62

63

63

64

64

65

67

XIX. Classification of facilities bytype of service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

47
Appendix L Technical notes

on methods

Survey design

From May through December 1977, the Division

of Health Resources Utilization Statistics (DHRUS)

conducted the 1977 National Nursing Home Survey

(NNHS)-a sample survey of nursing homes, their

residents, discharges, and staff in the conterminous

United States. The survey was designed and developed by DHRLJS in conjunction with a group of

experts in various fields encompassing the broad area

of long-term care. The NNHS was the second of a

series of surveys designed to satisfy the diverse data

needs of those who establish standards for, plan,

provide, and assess long-term care services. The first

survey was conducted from August 1973 through

April 1974.

Sampling frame

The 1977 NNHS covered all types of nursing

homes including nursing care homes, personal care

homes with nursing, personal care homes, and domiciliary care homes. Places that provided room and

board ordy were excluded. Facilities were either

freestanding establishments or nursing care units of

hospitals, retirement centers, or similar institutions

where the unit maintained financial and resident

records separate from those of the larger institutions.

Detailed criteria for classifying facilities included in

the survey are presented in appendix IV.

The universe for the 1977 NNHS consisted of two

groups of homes: those classified as nursing homes in

the 1973 Master Facility Inventory (MFI)1O and

nursing homes opening for business since 1973. The

major group (92 percent) was composed of all nursing

homes classified in the 1973 MFI. The MFI is a

census of all inpatient health facilities conducted by

mail every 2-3 years by the National Center for

NOTE: A list of references follows the text.

Health Statistics. A detailed description of how the

MFI was developed, its contents, and procedures for

updating and assessing its coverage has been pubIished.1 1-13

So that data collection could begin in,May 1977,

the sampling frame was “frozen” in December 1976

thus allowing the sample to be selected in am~le time

to permit the scheduling of national data collection.

To obtain as current a sample frame as possible, all

nursing homes that opened for business after the

1973 MFI was conducted were also included in the

universe. (Nursing homes that opened after December

1976 could not be included because data were not

available.) The nursing homes that opened after the

1973 MFI but before December 1976 comprised the

second and smaller (8 percent) group of facilities in

the universe. Information about this second group of

facilities was limited when compared with the first

group listed in the 1973 MFI.

Estimates from the 1977 NNHS will rmt correspond precisely to figures from the 1976 MFI census

for several reasons. In addition to the differences in

the time period, the surveys used different data

collection mechanisms. The MFI is a mail survey, but

the NNHS is conducted by personal interview. Thus

the NNHS methodology permitted more detailed

identification and exclusion of facilities that were out

of scope. Because the NNEIS is a sample survey, its

data are subject to sampling variability; because the

MFI is a census, its data are not. Generally, the data

from the two sources are compatible.

Sampling design

The sampling was a stratified two-stage probability design. The first stage was a selection of facilities

and the second stage was a selection of each of the ,

following: residents, persons discharged in 1!?76, and

employees from the sample facilities. In preparation

of the first-stage sample selection, two different

procedures were used: one for facilities listed in the’

48
MFI with known bed size and another for newly

opened facilities whose bed size and service type were

unknown. The procedure for facilities in the MFI

with known bed size consisted of sorting these

facilities into two types of service strata: (1) nursing

care homes and {2) facilities providing all.other- types

of service (including personal care homes with nursing, personal care homes, domiciliary care homes, and

facilities with unknown service type). Nursing homes

in each of these two service strata were then sorted

into bed-size groups, producing the first 16 primary

strata shown in table 1. Within each primary stratum,

nursing homes were ordered by type of ownership,

geographic region, State, and county. The sample

within the first 16 strata was then selected systematically after a random start within each primary

stratum. The procedure for newly opened facilities

whose size and service type were unknown was a

double-sampling scheme. In the first step, a random

subset of one-third of these facilities (587 nursing

homes) was selected, and bed-size information was

determined for them by telephone contact. By using

the newly gathered information on bed size, this subset of facilities was then sorted into bed-size groups

producing the last 8 strata shown in table I. Within

each of these bed-size strata, nursing homes were

ordered by geographic region, State, and ZIP code.

(Although the fiist group of facilities from tie MFI

was ordered by type of ownership and county, this

subset was not arranged the same way because information on these variables was not available.) In the

second step, the final sample within the last 8 strata

was then selected systematically after a random start

within each primary stratum. Table I shows the entire

distribution of facilities in the sampling frame and the

final disposition of the sample regarding the response

and inscope status.

The number of nursing homes estimated by the

survey (18 ,900) is less than the universe figure

(23, 105), as well as the number of nursing homes in

Table 1. Number of facilities in the 1977 National Nursing Home Survey universe and sample, by disposition and sampling strata:

Cotarminous United States, 1977

Sampling strata

Sample

Universe

(saa:J#r Out of scope

in scope and in business

All

facilities or out of

business Non- Responding

responding

Number of facilities

Alltypes of service . . . . . . . . . . . . . . . . . . . . . . . . . . . 23,105 1,698 166 81 1,451

Nursing care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13,230 1,292 95 68 1,129

Lessthan 15 beds . . . . . . . . . . . . . . . . . . . . . . . . . 676 11 3 0 8

15-24 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,195 30 8 1 21

25-49 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,168 158 25 6 127

50-99 bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,775 398 17 17 364

100-199 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,864 477 18 32 427

200-299 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . 402 134 6 6 122

300-599 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 67 12 6 49

600 badsormora . . . . . . . . . . . . . . . . . . . . . . . . . 17 17 6 0 11

Another types ofservice2 . . . . . . . . . . . . . . . . . . . . . . 8,116 318 57 8 253

Lessthan 15 beds . . . . . . . . . . . . . . . . . . . . . . . . . 3,431 35 13 0 22

15-24 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,166 17 5 0 12

25-49 bads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,108 34 11 0 23

50-99 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,202 60 5 1 54

100-199 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . 913 91 11 3 77

200-299 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 34 4 2 28

300-599 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 31 4 1 26

600 beds ormore . . . . . . . . . . . . . . . . . . . . . . . . . 31 16 4 1 11

Unknown typeof service . . . . . . . . . . . . . . . . . . . . . . . 1,759

Bedsizeknown3 . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . .

587 88 .1.4 5 .69

Lessthan 15 beds . . . . . . . . . . . . . . . . . . . . . . . . . 107 3 1 0 2

15-24 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 4 3 1 0

2549 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 12 6 0 6

50-99 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 16 1 1 14

100-199 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 40 2 2 36

200-299 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 8 0 1 7

300-599 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 5 1 0 4

600 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 0 “o o

Bed size unknown . . . . . . . . . . . . . . . . . . . . . . . . .

0

1,172 . . . . . . . . . . . .

lThe “niver~e c~n~i~ted of the “urs]ng homes ~S ~lessified in the ‘s973 Master Facility Inventory and facilities openad for business from 1973 to 1976.

21ncludaS personal care hOmes (with or wjthout nursing), domiciliary care homes, and facilities with unknown service tYPe.

31n order to imProve astjmate$ of tha 1,759 facilities for which both service type and bed size were unknown, bed sizes were determined fOr a onethird sample (587 facilities). These facilities were than stratified by bed size bafore sample selection.

49
the 1976 MFI (20,185), for several reasons. Some

facilities went out of business or became ineligible

for the scope of the survey between the time that the

universe was frozen and the survey was conducted. A

facility was considered out of scope if it did not

provide nursing, personal, or domiciliary care services

(e.g., facilities providing only room and board) or if it

was a nursing care unit or wing of a hospital, retire-

&e-nt center, or similar institution without separate financial and resident records for that unit.

The NNHS methodology included a thorough procedure for identifying out-of-scope facilities. For these

same reasons, the 1973-74 NNHS estimate differed

from the universe figure by 1,900.6 In addition, the

large number of newly opened facilities in the

sampling frame, for which limited information on

services provided was available, resulted in a larger

proportion of facilities ( 10 percent) later identified as

out of scope in comparison with the 1973-74 NNHS

(7 percent).

The second-stage sampling of residents, discharges

in 1976, and employees was carried out by the

interviewers at the time of their visits to the facilities

according to specific instructions given for each

sample facility. The sample frame for residents was

the total number of residents on the register of the

facility on the evening prior to the day of the survey.

Residents who were physically absent from the

facility because of overnight leave or a hospital visit

but had a bed maintained for them at the facility

were included in the sample frame. An average of five

residents per facility was in the sample.

The sample frame for discharges was the total

number of persons discharged alive or dead during the

1976 calendar year. Persons who were discharged

more than once during 1976 were listed for each

discharge. It is possible that a current resident was

included in the discharge sampling frame if he or she

was discharged during 1976. An average of four discharges per facility was in the sample.

The sampling frame for employees was the Staff

Sampling List on which the interviewer listed the

names of all staff providing direct or health-related

services (including contract personnel employed last

month) and sampled contract, administrative, medical, therapeutic, and nursing staff. Those generally

not involved in direct patient care, such as office

staff, food service, housekeeping, and maintenance

personnel were excluded from the sample. The

interviewer used predesignated sampling instructions

that appeared at the head of each column of this

form. An average of 10 staff per facility was in the

sample.

To reduce respondent burden, restrictions were

placed on the number of residents, discharges, and

NOTE: A list of references follows the text,

staff sampled in each facility. Sampling rates were

predesignated by the size classification of the facility,

but sampling rates were altered when necessary to

ensure that the samples did not exceed the specified

maximum of 8 for residents, 8 for discharges, and 23

for employees.

Data collection procedures for the 1977

National Nursing Home Survey

The 1977 NNHS utilized eight questionna~ires (see

appendix III for facsimiles of the facility, expense,

and staff questionnaires; see reference 2 for facsimiles

of all questionnaires and worksheets):

Facility Questionnaire

Expense Questionnaire and Definition Booklet

Staff Sampling List

Staff Questionnaire

Current Resident Sampling List

Current Resident Questionnaire

Dis~harged Resident Sampling List

Discharged Resident Questionnaire

Data were collected according to the following procedures:

1.

2.

3.

The letter to the administrator of sample facilities

was sent informing him of the survey and that an

interviewer would contact him for an appointment. Included with this introductory letter were

letters of endorsement from the American Association of Homes for the Aging, the American

College of Nursing Home Administrators, the

American Health Care Association, and the National Council of Health Care Services urging the

administrator to participate in the survey. A

summary report from the previous survey in

1973-74 was also enclosed to illustrate the kind

and use of data obtained from the survey.

Several days to 1 week after the letters had been

mailed, the interviewer telephoned the sample

facility and made an appointment with the

administrator.

At the time of the appointment the Facility

Questionnaire was completed by the interviewer

who questioned the administrator or owner of the

nursing home. In some cases, the Facility Worksheet was used to determine days of care. After

completing this form the interviewer secured the

administrator’s authorization for completion of

the Expense Questionnaire. Possible respondents

to the Expense Questionnaire include accountants, administrators of the facilities, and other

knowledgeable staff members. Results from the

survey indicate that the respondents were evenly

divided into two groups: (1) accountants located

50
outside the facility and (2) administrators and

other staff members, such as bookkeepers, based

in the facility. Where data in prepared financial

statements were comparable to data requested in

the Expense Questionnaire, the respondent provided the facilit y’s financial statement to a

specially trained NNHS accountant who abstracted data to complete the Expense Questionnaire. This situation occurred in 40 percent of the

cases. The interviewer completed the Staff Sampling List (a list of all currently employed staff

who provided direct or health-related services),

selected the sample of staff from it, and prepared

Staff Questionnaires. These forms were left for

each sample staff person to complete, seal in an

addressed and franked envelope, and return either

to the interviewer or by mail. The interviewer

completed the Current Resident Sampling List (a

list of all residents currently in the facility),

selected the sample of residents from it, and

completed a Resident Questionnaire for each

sample resident by interviewing the member of

the nursing staff most familiar with care provided

to that resident. The nurse referred to the

resident’s medical record when responding. No

resident was interviewed directly. The interviewer

then completed the Discharged Resident Sampling List (a list of all persons discharged alive or

dead in 1976), selected a sample of discharges

from it, and completed a Discharged Resident

Questionnaire for each sample person by interviewing a member of the nursing staff who

referred to medical records. In larger facilities, a

team of two or three interviewers conducted the

survey to reduce the length of time required in

the facility.

Followup on the Staff Questionnaire was initiated 2 weeks after the date of interview. Followup on the Expense Questionnaire was initiated

3 weeks after the date of interview.

Table II presents a summary of the data collection procedures.

Table 11. Summary of date collection procedures

Questionnaire Respotd?nt Interview situation

Facility Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . Interviewer with administrator Interview

Expense Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . Administrator, owner, accountant Self-enumerated

or bookkeeper

Staff Sampling List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Interviewer with staff memkers Informal intewiew or copied from

records

Staff Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sampled staff mambers Self-enumerated

Current Resident Sempling List . . . . . . . . . . . . . . . . . . . . . Interviewer with staff member who Informal interview or copied from

refers to Current Resident Census records

Current Resident Questionnaire , . . . . . . . . . . . . . . . . . . . . Intewiewer with nurse who refers Interview

to medical record

Discharged Resident Sampling List . . . . . . . . . . . . . . . . . . . Interviewer with staff member who Informal interview or copied from

refers to discharge records from records

1976

Discharged Resident Questionnaire . . . . . . . . . . . . . . . . . . ., Intewiewer with nurse who refers Interview

to medical record

51
General qualifications

Nonresponse and imputation of missing data

Response rates differed for each type of questionnaire:

Response

rate

Questionnaire (percent)

Facility . . . . . . . . . . . . . . . . . . . . . . . . . 95

Expense . . . . . . . . . . . . . . . . . . . . . . . . 85

Current Resident . . . . . . . . . . . . . . . . . . . 99

Discharged Resident . . . . . . . . . . . . . . . . . 97

Staff . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Generally, response rates were higher for questionnaires administered in a personal interview situation (Facility, Current Resident, and Discharged

Resident) as compared with those that were selfenumerated (Expense and Staff). Statistics presented

in this report were adjusted for failure of a facility to

respond (i.e., to complete the Facility Questionnaire)

and for failure to complete any of the other questionnaires (Expense, Current Resident, Discharged Resident, or Staff). Those items left unanswered on a

partially completed questionnaire (Facility, Expense,

Current Resident, Discharged Resident, Staff) were

generally imputed by assigning a value from a responding unit with major characteristics identical to

those of the nonresponding unit.

Rounding of numbers

Estimates of facilities, residents, discharges, and

employees have been rounded to the nearest hundred.

Estimates of total costs and revenues were rounded to

the nearest million. For this reason, detailed figures

within tables do not always add to totals. Percents

were calculated on the original, unrounded figures,

and will not necessarily agree precisely with percents

that might be calculated from rounded data.

Data processing

A series of checks were performed during the

course of the survey. These checks included field followups for missing and inconsistent data, manual

editing of the questionnaires, and extensive editing

conducted by a computer to ensure that all responses

were accurate, consistent, logical, and complete. Once

the data base was edited, the computer was used to

calculate and assign weights, ratio adjustments,

recodes, and other related procedures necessary to

produce national estimates from the sample data.

After the publication of “The National Nursing

Home Survey: 1977 summary for the United States,”

Series 13-No. 43,2 a keypunching error concerning

the resident days figure was discovered. Although this

involved only one case, it affected all tables presenting resident days, occupancy rate, or average costs or

revenues per resident day. After correction, the total

resident days decreased by 0.3 percent from

452,878,700 to 451,522,500. Similarly, after correction, the annual occupancy rate decreased by 0.2 percent from 89.0< to 88.8. Because the denominator

decreased, the average total cost per resident day increased by 0.3 percent from $23.84 per resiclent day

to $23.91 per resident day.

lMimation procedures

Statistics reported in this publication are derived

by a ratio-estimating procedure. The purpose of ratio

estimation is to account for all relevant information

in the estimation process, thereby reducing the

variability of the estimate. The estimation of number

of facilities and facility data not related to size is

inflated by the reciprocal of the probability c~fselecting the s~ple facilities and adjusted for thti nonresponding facilities within primary type of service-size

strata. Two ratio adjustments, one at each stage of

sample selection, were also used in the estimation

process. The fiist-stage ratio adjustment (along with

52
the preceding inflation factors) was included in the

estimation of facility data related to size, and of all

resident, discharge, and staff data for all primary

types of service-size strata.a The numerator was the

total beds according to the MFI data for all facilities

in the stratum. The denominator was the estimate of

the total beds obtained through a simple inflation of

the MFI data for the sample facilities in the stratum.

aFor nursing homes with unknown bed size and service type, the fiiststage ratio adjustment was not included in the estimation of facility,

resident, discharge, and staff data.

The effect of the fust-stage ratio adjustment was to

bring the sample in closer agreement with the known

universe of beds. The second+tage ratio adjustment

was included in the estimation of all resident, discharge, and staff data. It is the product of two fractions: the first is the inverse of the sampling fraction

for residents (discharges or staff) on which the selection is based; the second is the ratio of the number of

sample residents (discharges or staff) in the facility

to the number of residents (discharges or staff) for

whom questionnti.es were completed within the

facility.

53
Reliability of estimates

As in any survey, the results are subject to both

sampling and nonsampling errors. Nonsampling errors

include errors because of response bias, questionnaire

and item nonresponse, and processing errors. To the

extent possible, the latter types of errors were kept to

a minimum by methods built into survey procedures

such as standardized interviewer training, observation

of interviewers and field followups for missing and

inconsistent data, manual and computer editing, 100-

percent verification of all keypunching, and other

quality checks. Because survey results are subject to

both sampling and nonsampling errors, the total error

is larger than errors due to sampling variability alone.

Because statistics presented in this report are

based on a sample, they will differ somewhat from

figures that would have been obtained if a complete

census had been taken by using the same schedules,

instructions, and procedures.

The standard error is primarily a measure of the

variability that occurs by chance because only a sample, rather than the entire universe, is surveyed. The

standard error also reflects part of the measurement

error, but it does not measure any systematic biases

in the data. It is inversely proportional to the square

root of the number of observations in the sample.

Thus as the sample size increases, the standard error

generally decreases.

The chances are about 68 out of 100 that an estimate from the sample differs from the value that

would be obtained from a complete census by less

than the standard error. The chances are about 95

out of 100 that the difference is less than twice the

standard error and about 99 out of 100 that it is less

than 2% times as large.

The relative standard error of an estimate is the

standard error of the estimate divided by the estimate

itself and is expressed as a percent of the estimate.

Relative standard errors of estimated number of admissions; discharges; facilities; beds; residents; total

staff and nurse’s aides; administrative, medical, and

therapeutic staff, registered nurses, and licensed

practical nurses; and resident days of care are shown

in figures 1, II, and III. In this report, estimates that

have a relative standard error more than 30 percent

o+ the estimate itself are considered “unreliable.” For

example, curve D of figure I shows the relative standard errors of estimated number of residents. For a

relative standard error of 30 percent or less, the minimum number of residents is 3,500. Thus resident

estimates smaller than 3,500 are considered “unreliable” and are presented with an asterisk.

Because of the relationship between the relative

standard error and the estimate, the standard error

of an estimate can be obtained by multiplying the

estimate by its relative standard error. Thus for example, in curve B of figure I, an estimate of 5;000 discharges has a relative standard error of 30 percent. Its

standard error is 0.30 X 5,000= 1,500.

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-XIII show the standard errors for percent estimates used in this report

for facilities (table 111); residents (table IV); discharges (table V); total staff and nurse’s aides (table

VI); administrative, medical, and therapeutic staff,

registered nurses, and licensed practical nurses (table

VII); beds (table VIII); admissions (table IX); total

costs and revenues (table X); labor costs (table XI);

operating, fixed, and miscellaneous costs (table XII);

and resident days of care (table XIII). Tables XIVXVI show the standard errors for average total costs

and revenues; average labor costs; and average operating, fixed, and miscellaneous costs per resident day

estimates, respectively. Table XVII shows thle standard error for occupancy rate.

The illustrations that follow show how to use the

tables to find the standard error of an estimate.

Illustration of use of tables III-XIII to find

approximate standard errors of percentages of estimates. –Table I shows that 21.6 percent of the

1,303,100 residents in nursing homes reside in volun54
100

90 [

80 1 1

;:

50

40 \

.

30 \ \

20

1:

8

,

:

5

4

3

2

0.4

0.8

0,7

0.6

0.5

0.4

0,3

0.2

0.1

A 2

100

3 456789A 2 3 4 56789A

1,000 10,000

I I k I 1 1 1 1 111111 1 t ! 1 1 1

! I I I 1 I

+tFttHt

2 3 4 56789A 2 34

100,000

Size of estimate

100

%

70

60

50

40

30

W!! 1 1 I I I I I I I Id

I

, , , ,,

k. 1 , , ,

2

Ii 1 1 1 t I 1 I I 1111,

1

0.5

0.4

0,3

0.2

0,1

5 6789A 2 3 4 56789A

1,000,000 10,OOO,OOO

Ui

m Figure 1. Relative standard error curves Of estimated admissions, discharges, beds, residents, and facilities
100

%

!!?

80

70 70

60 60

50 50

40 40

30 30

20

10

:

7

t

20

10 , 1 1

9 ,

8

1

1 I I -1

7

1 !

w 1 1 1 I

6 6

1- N .1 II

5

I I %

5

4

h “

1 1

3

2

0.:

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

2

v

0.5

0.4

0.3

1

:::

0.7

3.6

0.2

0.1

A 23 456789 2 3 456789A 23 4 56789AA

1 100 1,000

Size of estimate (in thousands)

Figure II. Relative standard error curve of estimated resident days of care

values shown in table IV yields an approximate standard error of 0.65 percent for 21.6 percent with a base

of 1,303,100.

Illustration of use of tables XIV-XVII to find approximate standard errors of rates. –T’able 9 shows

that the total revenue per resident day for proprietary

facilities in 1976 was $22.73 with a base number of

315,225,700 resident days. Linear interpolation

between values shown in table XIV yields an approximate standard error of $0.56 for the estimate of

$22.73 with a baseof315 ,225,700 resident days.

tary nonprofit homes. Linear interpolation between Approximate standard errors of ratios such as

full-time equivalent employees per 100 beds can be

calculated as in the following sample. Suppose the

standard error (URr) for the ratio of total full-time

equivalent (FTE) “employees per 100 beds is desired

for skilled nursing facility (SNF) only nursing homes.

In table 7, the total FTE employees per 100 beds for

facilities with SNF only certification is 46.8, which

is equal to a total of 137,600 FTE employees divided

by 294,000 beds (table 1) times 100. The relative

standard error of 137,600 total FTE employees is

(from figure III, curve A) approximately 1.65 per56
,-

1:()

80

100

88

RI 70

50

60

40

50

40

30 30

20 20

10 10

:

9

8

:

5

i

4

5

4

3 3

2 2

0,3

0.8

:.9

0.7

;.;

0.6

0.5

0:6

0.4

0.5

0.4

0.3 0.3

0.2 0.2

0,1 0.1

A 2 3 456789A 2 3 456789A 2 3 4 56789A

100

2 3 456789A

1,000

2 3 4 56789A

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

Size of estimate

Figure I I 1. Relative standard error curves of estimated employees
Table I I 1. Standard errors of percentages for homes

Estimated nercent

Base of percent (number of homed 1 2 5 10 20 30 40

or 99 or 98 or 95 or 90 or 80 or 70

50

or 60

300 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.54

400 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.20

500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.97

600 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.80

700 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.67

800 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.56

900 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.47

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . ‘1.39

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.99

3,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.80

4,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.70

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.62

6,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.57

7,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.53

8,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.49

9,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.46

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.44

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.31

3.58

3.10

2.77

2.53

2.34

2.19

2.07

1.96

1.39

1.13

0.98

0.88

0.80

0.74

0.69

0.65

0.62

0.44

Standard error in percentage points

5.57 7.67 10.23 11.72

4.83 6.65 8.86 10.16

4.32 5.94 7.93 9.08

3.94 5.43 7.23 8.29

3.66 5.02 6.70 7.67

3.41 4.70 6.27 7.18

3.22 4.43 5.91 6.77

3.05 4.20 5.60 6.42

2.16 2.97 3.96 4.54

1.76 2.43 3.24 3.71

1.53 2.10 2.80 3.21

1.37 1.88 2.51 2.87

1.25 1.72 2.29 2.62

1.15 1.59 2.12 2.43

1.08 1.49 1.98 2.27

1.02 1.40 1.87 2.14

0.97 1.33 1.77 2.03

0.68 0.94 1.25 1.44

12.53 12.79

10.85 II1.08

9.71 9,91

8.86 9.04

8.20 8.37

7.67 7.83

7.23 7.38

6.66 7.00

4.85 4.95

3.96 4.04

3.43 3.50

3.07 3.13

2,80 2.86

2.59 2.65

2.43 2.48

2.29 2.33

2.17 2.22

1.53 1.57

Table IV. Standard arrors of percentages for residents

Estimated percent

Base of percent (number o f residents)

1 2 5 10 20 30 40

or 99 or 98 or 95 or 90

50

or 80 or 70 or 60

Standard error in percantaga points

3,500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.05 4.29 6.68 9.20 12.26 14.05

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.55 3.59 5.59 7.69 10.26 11.75

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.80 2.54 3.95 5.44 7.25 8.31

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.28 1.80 2.79 3.85 5.13 5.88

30,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.04 1.47 2.28 3.14 4.19 4.80

40,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.90 1.27 1.98 2.72 3.63 4.16

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.81 1.14 1.77 2.43 3.24 3.72

60,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.74 1.04 1.61 2.22 2.96 3.39

70,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.68 0.96 1.49 2.06 2.74 3.14

80,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.64 0.90 1.40 1.92 2.56 2.94

90,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.60 0.85 1.32 1.81 2.42 2.77

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.57 0.80 1.25 1.72 2.29 2.63

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.40 0.57 0.88 1.22 1.62 1.66

300,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.33 0.46 0.72 0.99 1.32 1.52

400,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.29 0.40 0.62 0.86 1.15 1.31

500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.26 0.36 0.56 0.77 1.03 1.18

600,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.23 0.33 0.51 0.70 0.94 1.07

700,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.22 0.30 0.47 0.65 0.87 0.99

800,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.20 0.28 0.44 0.61 0.81 0.93

900,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.19 0.27 0.42 0.57 0.76 0.88

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.18 0.25 0.40 0.54 0.73 0.83

1,300,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.16 0.22 0.35 0.48 0.64 0.73

15.02 15.33

12.56 12.82

8.88 9.07

6.28 6.41

5.13 5.23

4.44 4.53

3.97 4.05

3.63 3.70

3.36 3.43

3.14 3.21

2.96 3.02

2.81 2.87

1.99 2.03

1.62 1.66

1.40 1.43

1.26 1.28

1.15 1.17

1.06 1.08

0.99 1.01

0.94 0.96

0.89 0.91

0.78 0.80

58
Table V. Standard errors of percentages for discharges

Estimated parcant

Base of percent (number of discharges) 1 2 5 10 20 30 40

or 99 or 98 or 95 or 90 or 80

50

or 70 or 6U

Standard error in percentage points

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.07 4.32 6.73 9.26 12.35 14.15 15.12 15.44

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.17 3.06 4.76 6.55 8.73 10.00 10.69 10.91

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.64 2.16 3.36 4.63 6.17 7.07 7.66 7.72

30,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.25 1.76 2.75 3.78 5.04 5.78 6.17 6.30

40,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.09 1.53 2.38 3.27 4.37 5.00 5.35 5.46

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.97 1.37 2.13 2.93 3.91 4.47 4.78 4.88

60,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.89 1.25 1.94 2.67 3.56 4.08 4.37 4.46

70,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.82 1.16 1.80 2.46 3.30 3.78 4.04 4.13

80,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.77 1.08 1.68 2.32 3.08 3.64 3.78 3.86

90,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.72 1.02 1.59 2.18 2.91 3.33 3.56 3.64

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.69 0.97 1.50 2.07 2.76 3.16 3.38 3.45

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.49 0.68 1.06 1.46 1.95 2.24 2.39 2.44

300,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.40 0.56 0.87 1.20 1.59 1.83 1.95 1.99

400,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.34 0.48 0.75 1.04 1.38 1.58 1.69 1.73

500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.31 0.43 0.67 0.93 1.23 1.41 1.51 1.54

600,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.28 0.39 0.61 0.85 1.13 1.28 1.38 1.41

700,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.26 0.37 0.57 0.78 1.04 1.20 1.26 1.30

800,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.24 0.34 0.53 0.73 0.98 1.12 1.20 1.22

900,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.23 0.32 0.50 0.69 0.92 1.05 1.13 1.15

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.22 0.31 0.48 0.65 0.87 1.00 1.07 1.09

1,100,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.21 0.29 0.45 0.62 0.83 0.95 1.02 1.04

Table VI. Stan& rderrors of~rmntqes fortotal employees andnurw'sai&s

Estimatedparcen t

Base of percant (number of total staff)

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 percantege points

3,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.82 3.97 6.18 8.50 11.34 12.99

4,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.44 3.44 5.35 7.36 9.82 11.25

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.18 3.07 4.79 6.59 8.78 10.06

6,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.99 2.81 4.37 6.01 8.02 9.19

7,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.85 2.60 4.04 5.57 7.42 8.50

8,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.73 2.43 3.78 5.21 6.94 7.86

9,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.63 2.28 3.57 4.91 6.55 7.50

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.54 2.17 3.38 4.66 6.21 7.12

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.09 1.54 2.39 3.28 4.39 5.03

30,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.89 1.26 1.95 2.69 3.59 4.11

40,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.77 1.09 1.69 2.33 3.11 3.56

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.69 0.97 1.51 2.08 2.78 3.18

60,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.63 0.89 1.38 1.90 2.54 2.90

70,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.58 0.82 1.28 1.76 2.35 2.69

80,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.55 0.77 1.20 1.65 2.20 2.52

90,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.51 0.72 1.13 1.55 2.07 2.37

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.49 0.69 1.07 1.47 1.96 2.25

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.35 0.49 0.76 1.04 1.39 1.59

300,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.28 0.40 0.62 0.85 1.13 1.30

400,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.24 0.34 0.54 0.74 0.98 1.13

500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . ,0.22 0.31 0.48 0.66 0.88 1.01

600,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.20 0.28 0.44 0.60 0.80 0.92

778,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.18 0.25 0.38 0.53 0.70 0.81

13.89

12.03

10.76

9.82

9.09

8.60

8.02

7.61

5.38

4.39

3.80

3.40

3.11

2.87

2.69

2.54

2.41

1.70

1.39

1.26

1.08

0.98

0.86

14.17

12.27

10.98

10.02

9.28

8.68

8.18

7.76

5.49

4.48

3.88

3.47

3.17

2.93

2.74

2.59

2.45

1.74

1.42

1.23

1.10

1.00

0.88

59
Table V1l. Standard arrorsof percentages for professional employees

Estimated percent

Base of percent

(number of professional staff) 1 2 5 10 20 30 40

or 99 or 98 or 95 or 90 50

or 80 or 70 or 60

Standard error in percentage points

550 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.05 4.29 6.68 9.20 12.27 14.05

800 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.53 3.56 5.64 7.63 10.17 11.65

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.26 3.18 4.96 6.82 9.10 10.42

,2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.60 2,25 3.51 4.82 6.43 7.37

3,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.31 1.64 2.86 3.94 5.25 6.02

4,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.13 1.59 2.48 3.41 4.55 5.21

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.01 1.42 2.22 3.06 4.07 4.66

6,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.92 1.30 2.02 2.79 3.71 4.25

7,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.86 1.20 1.87 2.58 3.44 3.94

8,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.80 1.13 1,75 2.41 3.22 3.68

9,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.75 1.06 1.65 2.27 3.03 3.47

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.72 1.01 1.57 2.16 2.88 3.30

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.51 0.71 1.11 1.63 2.03 2.33

30,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.41 0.58 0.81 1.25 1.66 1.90

40,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.36 0.50 0.78 1.08 1.44 1.65

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.32 0.45 0.70 0.96 1.28 1.47

60,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.29 0.41 0.64 0.88 1.17 1.36

70,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.27 0.38 0.59 0.82 1.09 1.25

80,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.25 0.36 0.55 0.76 1.02 1.17

90,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.24 0.34 0.52 0.72 0.96 1.10

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.23 0.32 0.50 0.68 0.91 1.04

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.16 0.23 0.35 0.48 0.64 0.74

315,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.13 0.18 0.28 0.38 0.51 0.59

15.02 15.33

12.46 12.71

11.14 11.37

7.88 8,04

6.43 6.57

5.57 5.69

4.98 5.09

4.55 4.64

4.21 4.30

3.94 4.02

3.71 3.79

3.52 3.60

2.49 2.54

2.03 2.08

1.76 1.80

1.58 1.61

1.44 1.47

1.33 1.36

1.25 1.27

1.17 1.20

1.11 1.14

0.79 0.80

0.63 0.64

Table Vlll. Standard errors of percentages for beds

Estimated percent

8aseofpercent (number ofbeds)

1 2 5 10 20 30 40

or 99 or 98

50

or 95 or 90 or 80 or 70 or 60

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.94 4.13

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.08 2.92

30,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.69 2.38

404000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.47 2.07

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.31 1.85

60,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.20 1.69

70,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.11 1.56

80,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.04 1.46

90,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.98 ‘1.38

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.93 1.31

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.66 0.92

300,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.54 0.75

400,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.46 0.65

500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.42 0.58

600,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.38 0.53

700,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.35 0.49

800,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.33 0.46

900,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.31 0.44

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.29 0.41

1,400,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.25 0.35

Standard error in percentage points

6.43 8.85 11.80 13.52

4.55 6.26 8.35 9.56

3.71 5.11 6.81 7.81

3.22 4.43 5.90 6.76

2.88 3.96 ~ 5.28 6.05

2.63 3.61 4.82 5.52

2.43 3.35 4.46 5.11

2.27 3.13 4.17 4.78

2.14 2.95 3.93 4.51

2.03 2.80 3.73 4.28

1.44 1.98 2.64 3.02

1.17 1.62 2.15 2.47

1.02 1.40 1.87 2.14

0.91 1.25 1.67 1.91

0.83 1.14 1.52 1.75

0.77 1.06 1.41 1.62

0.72 0.99 1.32 1.51

0.68 0.93 1.24 1.43

0.64 0.89 1.18 1.35

0.54 0.75 1.00 1.14

14.45

10.22

8.35

7.23

6.46

5.90

5.46

5.11

4.82

4.57

3.23

2.64

2.29

2.04

1.87

1.73

1.62

1.52

1.45

1.22

14.75

10.43

8.52

7.38

6.60

6.02

5.58

5.22

4,92

4.67

3.30

2.69

2.33

2.09

1.90

1.76

1.65

1.56

1.48

1.25

60
Table IX. Standard errorsof percentages foradmissions

Base of percent (number of admissions)

Estimated percent

1 7 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

8,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.7% 3.91 6.08 8.38 11.17 12.80

9,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.62 3.69 5.74 7.90 10.53 12.07

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.49 3.50 5.45 7.50 9.99 11.45

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.76 2.47 3.85 5.30 7.07 8.10

30,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.44 2.02 3.14 4.33 5.77 6.61

40,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.24 1.75 2.72 3.75 5.00 5.72 .

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.11 1.56 2.44 3.35 4.47 5.12

60,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.01 1.43 2.22 3.06 4.08 4.67

70,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.94 1.32 2.06 2.83 3.78 4.33

80,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.88 1.24 1.93 2.65 3.53 4.05

90,000 . . . . . . . . . . . . 0.83 1.17 1.82 2.50 3.33 3.82

100,000...........:;:::: ::::::::: 0.79 1.11 1.72 2.37 3.16 3.62

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.56 0.78 1.22 1.68 2.23 2.56

300,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.45 0.64 0.99 1.37 1.82 2.09

400,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.39 0.55 0.86 1.19 1.58 1.81

500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.35 0.49 0.77 1.06 “i.41 1.62

600,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.32 0.45 0.70 0.97 1.29 1.48

700,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.30 0.42 0.65 0.90 1.19 1.37

800,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.28 0.39 0.61 0.64 1.12 1.28

900,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.26 0.37 0.57 0.79 1.05 1.21

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.2!5 0.35 0.54 0.75 1.00 1.14

1,100,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.24 0.33 0.52 0.71 0.95 1.09

13.69 13.97

12.90 13.17

12.24 12.49

8.66 8.83

7.07 7.21

6.12 6.25

5.47 5.59

5.00 5.10

4.63 4.72

4.33 4.42

4.08 4.16

3.87 3.95

2.74 2.79

2.23 2.28

1.94 1.98

1.73 1.77

1.58 1.61

1.46 1.49

1.37 1.40

1.29 1.32

1.22 1.25

1.17 1.19

Table X. Standard errors of percentages fortotal costs andtotaI revenues

Estimated percent

Base of percent (total cost

1 2

andrevenuein thousands) 5 10 20 30 40

or 99 or 98 or 95 or 90 or 80 50

or 70 or 60

85,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.07

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 2.83

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 2.00

300,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 1.63

400,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 1.41

500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 1.26

600,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 1.15

700,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 1.07

800,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00

900,000 . . . . . . . . . . . . . . . . . . . . ...”... 0.94

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.89

2,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.63

3,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.52

4,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.45

5,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.40

6,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.36

7,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.34

8,0008000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.32

9,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.30

10,000,000 . . . . . . . . . . . . . . . . . . . . . . . . 0.26

4.31

3.98

2.81

2.30

1.99

1.78

1.62

1.50

1.41

1.33

1.26

0.89

0.73

0.63

0.56

0.51

0.48

0.44

0.42

0.40

Standard error in percentage points

6.72 9.24 12.33 14.12

6.19 8.52 11.36 13.02

4.38 6.03 8.04 9.21

3.57 4.92 6.56 7.52

3.10 4.26 5.68 6.51

2.77 3.81 5.08 5.82

2.53 3.48 4.84 5.32

2.34 3.22 4.30 4.92

2.19 3.01 4.02 4.60

2.06 2.84 3.79 4.34

1.96 2.70 3.59 4.12

1.38 1.91 2.54 2.91

1.13 1.56 2.07 2.38

0.98 1.35 1.80 2.06

0.88 1.21 1.61 1.64

0.80 1.10 1.47 1.68

0.74 1.02 1.36 1.56

0.69 0.95 1.27 1.48

0.65 0.90 1.20 1.37

0.62 0.85 1.14 1.30

15.10

13.92

9.64

8.04

6.96

6.22

5.68

5.26

4.92

4.64

4.40

3.11

2.54

2.20

1.97

1.80

1.66

1.56

1.47

1.39

15.41

14.21

10.04

8.20

7.10

6.35

5.80

5.37

5.02

4.74

4.49

3.18

2.59

2.25

2.01

1.83

1.70

1.59

1.50

1.42

61
Table Xl. Standard errorsof percentages for labor coats

Estimated percent

Base of percent (labor cost in thousands)

1 2 5 10 20 30 40

or 99 or 98 or 95 or 90

50

or 80 or 70 or 60

25,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.98 4.20

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.11 2.97

70,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.78 2.51

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 1.49 2.10

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 1.06 1,48

300,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.86 1.21

400,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.75 1.05

500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.67 0.94

600,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.61 0.86

700,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.56 0.79

800,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.53 0.74

900,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.50 0.70

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.47 0.66

2,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.33 0.47

3,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.27 0.38

4,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.24 0.33

5,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.21 0.30

6,400,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.19 0.26

Standard error in percentage points

6.54 9.00 12.00 13.7!5

4.62 6.36 8.48 9.72

3.91 5.38 7.17 8.21

3.27 4.50 6.00 6.87

2.31 3,18 4.24 4.86

1.89 2,60 3.46 3.97

1.63 2.25 3.00 3.44

1.46 2.01 2.68 3.07

1,33 1.84 2.45 2.81

1.24 1,70 2.27 2.60

1.16 1,59 2.12 2.43

1.09 1.50 2.00 2.29

1.03 1.42 1.90 2.17

0.73 1,01 1.34 1.54

0.60 0.82 1.10 1.25

0.52 0.71 0.95 1.09

0.46 0.64 0.85 0.97

0.41 0.56 0.75 0.86

14.69 15.00

10.39 10.60

8.78 8.96

7.35 7.50

5.20 5.30

4.24 4.33

3.67 3.75

3.29 3.35

3.00 3.06

2.78 2.83

2.60 2.65

2.45 2.50

2.32 2.37

1.64 1.68

1.34 1.37

1.16 1.19

1.04 1.06

0.92 0.94

Table X1l. Standard errors of percentages forother (o~rating, fixed, and miscellaneous) costs

Estimated percent

Base of percent (other cost in thousands)

1 2 5 10 20 30 40

or 99 or 98 or 95

50

or 90 or BO or 70 or 60

Standard error in percentage points

400 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.41 13.24 20.61 28.37 37.83 43.34 46.33 47.29

600 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.68 10.81 16.83 23.17 30.89 35.39 37.83 38.61

800 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.65 9.36 14.58 20.06 26.75 30.65 32.76 33.44

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.95 8.37 13.04 17.95 23.93 27.41 29.30 29.91

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.21 5.92 9.22 12.69 16.92 19.38 20.72 21.15

4,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.98 4.19 6.52 8.97 11.96 13.71 14.65 14.95

6,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.43 3.42 5.32 7.33 9.77 11.19 11.96 12.21

8,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.10 2.96 4.61 6.34 8.46 9.69 10.36 10.57

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 1.88 2.65 4.12 5.67 7.57 8.67 9.27 9.46

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 1.33 1.87 2.92 4.01 5.35 6.13 6.55 6.69

40,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.94 1.32 2.06 2.84 3.78 4.33 4.63 4.73

60,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.77 1.08 1.68 2.32 3.09 3.54 3.78 3.86

80,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.67 0.94 1.46 2.01 2.68 3.06 3.28 3.34

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.60 0.s4 1.30 1.79 2.39 2.74 2.93 2.99

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.42 0.59 0.92 1.27 1.69 1.94 2.07 2.11

400,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.30 0.42 0.65 0.90 1.20 1.37 1.47 1.50

600,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.24 0.34 0.53 0.73 0.98 1.12 1.20 1.22

800,000 . . . . . . . . . . . . . . . . . . . . . . . . . 0.21 0.30 0.46 0.63 0.85 0.97 1.04 1,06

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . 0.19 0.26 0.41 0.57 0.76 0.87 0.93 0.95

2,300,000 . . . . . . . . . . . . . . . . . . . . . . . . 0.12 0.17 0.27 0.37 0.50 0.57 0.61 0.62

62
Table Xl Il. Standard errors ofpercentages for resident days

Estimated percent

Basa of persent (resident days in thousands) 1 2 5 10 20 30 40

or 99 or 98 or 95 or 90

50

or 80 or 70 or 60

Standard error in percentage points

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.01 4.24 6.60 9.08 12.11 13.88

3,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.46 3.46 5.39 7.42 9.89 11.33

4,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.13 3.00 4.67 6.42 8.56 9.81

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.91 2.68 4.17 5.75 7.66 8.78

6,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.74 2.45 3.81 5.24 6.99 8.01

7,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.61 2.27 3.53 4.86 6.47 7.42

8,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.51 2.12 3,30 4.54 6.06 6.94

9,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.42 2.00 3.11 4.28 5.71 6.54

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.35 1.90 2.95 4.06 5.42 6.21

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.95 1.34 2.09 2.87 3.83 4.39

30,0CS0 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.78 1.09 1.70 2.35 “ 3.13 3.58

40.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.67 0.95 1.4s 2.03 2.71 3.10

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.60 0.85 1.32 1.82 2.42 2.78

60,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.55 0.77 1.20 1.66 2.21 2.53

70,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.51 0.72 1.12 1.54 2.05 2.35

80,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.48 0.67 1.04 1.44 1.92 2.19

90,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.45 0.63 0.98 1.35 1.81 2.07

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.43 0.60 0.93 1.28 1.71 1.96

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.30 0.42 0.66 0.91 1.21 1.39

300,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.25 0.35 0.54 0.74 0.99 1.13

450,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 0.20 0.28 0.44 0.61 0.81 0.93

14.83

12.11

10.49

9.38

8.56

7.93

7.42

6.99

6.63

4.69

3.83

.3.32

2.97

2.71

2.51

2.35

2.21

2.10

1.48

1.21

0.99

15.14

12.36

10.71

9.58

8.74

8.09

7.57

7.14

6.77

4.79

3.91

3.39

3.03

2.76

2.56

2.39

2.26

2.14

1.51

1.24

1.01

Table XIV. Standard errors foraverage total cotiprresident dayandwerage revanua ~rresident day

Basa of ratio Averegetotalcost orrevenueperresitiwt daY

inthouwnds) $16.00 $18.00 $20.00 $22.00 $24.00 $26.00 $28.00 $30.00 $32.CX7 $34.00 $36.00 $38.00 $40.00

3,000 . . . . . . . . . *5.71

4,000 . . . . . . . . . ●4.95

5,000 . . . . . . . . . 4.42

6,000 . . . . . . . . . 4.04

7,000 . . . . . . . . . 3.73

8,000 . . . . . . . . . 3.49

9,000 . . . . . . . . . 3.29

10,000 . . . . . . . . 3.12

20,000 . . . . . . . . 2.20

30,000 . . . . . . . . 1.78

40,000 . . . . . . . . 1.54

50,000 . . . . . . . . 1.37

60,000 . . . . . . . 1.24

70,000 . . . . . . . . 1.15

80,000 . . . . . . . . 1.07

90,000 . . . . . . . . 1.00

100,000 . . . . . . . 0.94

200,000 . . . . . . . 0.63

300,000 . . . . . . . 0.49

450,000 . . . . . . . 0.36

●6.1 O ●6.47

5.28 5.60

4.72 5.01

4.30 4.57

3.98 4.23

3.72 3.95

3.51 3.72

3.33 3.53

2.34 2.48

1.90 2.01

1.84 1.73

1.46 1.64

1.32 1.40

1.22 1.29

1.13 1.20

1.06 1.12

1.00 1.06

0.67 0.70

0.51 0.53

0.37 0.37

‘6.S4 “7.20

5.92 6.23

5.29 5.57

4.83 5.0S

4.47 4.70

4.17 4.40

3.93 4.14

3.73 3.93

2.62 2.76

2.13 2.24

1.83 1.93

1.63 1.71

1.48, 1.55

1.36 1.43

1.26 1.32

1.18 1.24

1.11 1.17

0.73 0.76

0.55 0.57

0.38 0.38

Standard error in dollars

7.57 7.93 8.28 8.56 9.02 9.38 9.75 10.11

6.55 6.S6 7.18 7.49 7.80 8.12 8.44 8.75

5.85 6.13 6.41 6.69 6.98 7.28 7.64 7.82

5.34 5.60 5.85 6.11 6.36 6.62 6.88 7.13

4.94 5.18 5.41 5.65 5.S8 6.12 6.36 6.60

4.62 4.S4 5.06 5.28 5.50 5.72 5.94 6.17

4.35 4.58 4.77 4.97 5.18 5.39 5.60 5.81

4.13 4.32 4.52 4.72 4.91 5.11 5.31 5.51

2.90 3.03 3.17 3.31 3.45 3.58

2.35 2.46

3.72 3.66

2.57 2.68 2.79 2.90 3.01 3.12

2.02 2.11 2.21 2.30 2.40 2.49 2.59 2.68

1.79 7.s8 1.96 2.04 2.12 2.21 2.29 2.38

1.63 1.70 1.77 1.85 1.92 2.00 2.07 2.15

1.49 1.56 1.63 1.70 1.76 1.83 1.90 1.97

1.39 1.45 1.51 1.57 1.84 1.70 1.76 1.83

1.30 1.35 1.41 1.47 1.53 1.59 1.65 1.70

1.22 1.27 1.33 1.38 1.44 1.49 1.55 1.60

0.79 0.82 0.85 0.89 0.92 0.95 0.98 1.02

0.58 0.60 0.62 0.84 0.66 0.68 0.77 ---

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

63
Table XV. Standard errors foraverage labor costs plus labor components perresident day

Base of ratio Average labor cost per resident day

(resident days

in thousands) $0.50 $1.00 $2.00 $4.00 $6.00 $8.00 $10.00 $72.00 $74.00 $16.00 $18.00 $20.00 $25.00

Standard error in dollars

2,000 . . . . . . . . . “0.69 “0.95 ●1.31 * 1.85 *2.31 *2.76 ●3.21 *3.66 4.12 4.58 5.05 5.53 6.74

3,000 . . . . . . . . . ‘0.56 ‘0.77 ●1.07 *I .51 “1 .89 2.26 2.62 2.99 3.37 3.74 4.13 4.52 5.50

4,000 . . . . . . . . . *0.49 “0.67 “0.93 *1 .31 1.64 1.96 2.27 2.59 2.92 3.25 3.58 3.91 4.77

5,000 . . . . . . . . . ‘0.43 ●0.60 ‘0.83 1.17 1.47 1.75 2.04 2.32 2.61 2.91 3.20 3.50 4.27

6,000 . . . . . . . . . “0.40 “0.55 ‘0.76 1.07 1.34 1.60 1.86 2.12 2.39 2.65 2.93 3.20 3.90

7,000 . . . . . . . . . ‘0.37 *0.51 “0.70 0.99 1.24 1.48 1.72 1.97 2.21 2.46 2.71 2.96 3.61

8,000 . . . . . . . . . “0.34 ‘0.47 ‘0.66 0.93 1,16 1.39 1.61 1.S4 2.07 2.30 2.54 2,78 3.38

9,000 .,....... ‘0.32 ‘0.45 “0.62 0.87 1.10 1.31 1.52 1.74 1.95 2.17 2.39 2,62 3.19

10,000 .,....., ‘0.31 “0.42 0.59 0.83 1.04 1.25 1.45 1.65 1.86 2.06 2.27 2.49 3.03

20,000 . . . . . . . . ‘0.22 ‘0.30 0.42 0.59 0.74 0.89 1.03 1.18 1.33 1.47 1.62 1.77 2.15

30,000 . . . . . . . . ●0.18 0.25 0.34 0.49 0.61 0.73 0.85 0.97 1.09 1.22 1.34 1.46 1.77

40,000 ,. .,,... *0.I 5 0.21 0.30 0.42 0.54 0.64 0.75 0.85 0.96 1.06 1.17 1.28 1.55

50,000 . . . . . . . . 0.14 0.19 0,27 0.38 0.48 0.58 0.68 0.77 0.87 0.96 1.06 1.15 1.40

60,000 . . . . . . . . 0.13 0.18 0.25 0.35 0.45 0,53 0.62 0<71 0.80 0.89 0.98 1.06 1.29

70,000 . . . . . . . . 0.12 0.16 0.23 0.33 0.42 0.50 0.58 0.67 0.75 0.83 0.91 1.00 1.20

80,000 . . . . . . . . 0.11 0.15 0.21 0.31 0.39 0.47 0.55 0.63 0.71 0.79 0.86 0.94 1.14

90,000 . . . . . . . . 0.10 0.14 0.20 0.29 0.37 0.45 0.52 0.60 0.67 0.75 0.82 0.90 1.09

100,000 . . . . . . . . 0.10 0.14 0.19 0.28 0.36 0.43 0.50 0.58 0.65 0.72 0.79 0.86 1.04

200,000 . . . . . . . . 0.07 0.10 0.14 0.21 0.27 0.34 0.39 0.45 0.51 0.57 0.63 0.69 0.83

300,000 . . . . . . . . 0.06 0.08 0.12 0.18 0.24 0,30 0.35 0.41 0.46 0.52 0.57 0.63 ---

450,000 . . . . . . . . 0.05 0,07 0.11 0.17 0,22 0.28 0.33 0.38 0.44 --- --- --- ---

TableXVI. Standard errors foravar~e operating, fixed, andmiscallanaous cos@perrasident day

Bese of ratio Average cost per resident day

(resident deys

in thousends) $0.50 $7.00 $2.00 $3.00 $4.00 $500 $6.00 $7.00 $8.00 $9.00

2,000 . . . . . . . . . .

3,000 . . . . . . . . . .

4,000 . . . . . . . . . .

5,000 . . . . . . . . . .

6,000 . . . . . . . . . .

7,000 . . . . . . . . . .

8,000 . . . . . . . . . .

9,000 . . . . . . . . . .

10,000 . . . . . . . . .

20,000 . . . . . . . . .

30,000 . . . . . . . . .

40,000 ..,...<..

50,000 . . . . . . . . .

60,000 . . . . . . . . .

70,000 . . . . . . . . .

80,000 . . . . . . . . .

90,000 . . . . . . . . .

100,000 . . . . . . . .

200,000 . . . . . . . .

300,000 . . . . . . . .

450,000 . . . . . . . .

‘0.26

“0.21

“0.1 8

*0.1 7

*0.15

0.14

0.13

0.12

0.12

0.08

0.07

0.06

0.06

0.05

0.05

0.05

0.04

0.04

0.03

0.03

0.03

*0.38

*0.31

0.27

0.24

0.22

0.21

0.19

0.18

0.17

0.13

0.11

0.09

0.09

0.08

0.08

0.07

0.07

0.07

0.06

0.05

0.05

Standard error in dollars

●0.61 0.s4 1.08 1.33

0.50 0.69 0.88 1.09

0.43 0.60 0.77 0.94

0.39 0.54 0.69 0.84

0.35 0.49 0.63 0,77

0.33 0.46 0.58 0.72

0.31 0.43 0.55 0.67

0.29 0.40 0.52 0.63

0.28 0.38 0.49 0.60

0.20 0.28 0.36 0.44

0.17 0.24 0.30 0.37

0.15 0.21 0.27 0.33

0.14 0.20 0.25 0.30

0.13 0.18 0.24 0.29

0.13 0.18 0.23 0.28

0.12 0.17 0.22 0.27

0.12 0.16 0.21 0.26

0.11 0.16 0.21 0.25

0.10 0.14 0.19 0.23

0.10 0.14 0.18 0.23

0.10 0<14 0.19 0.23

1.58 1.64 2.10 2.36

1.29 1.50 1.71 1.92

1.12 1.30 1.48 1.67

1.00 1.16 1.33 1.49

0.92 1.06 1.21 1.36

0.85 0.99 1.12 1,26

0.80 0.92 1.05 1.18

0.75 0.87 0.99 1.11

0.72 0.83 0.94 1.06

0.52 0.60 0.68 0.76

0.43 0.50 0.57 0.64

0.39 0.45 0.51 0.57

0.36 0.41 0.47 0.52

0.34 0.39 0.44 0.49

0.32 0.37 0.42 0.47

0.31 0.36 0.41 0.46

0.31 0.35 0.40 0.45

0.30 0.35 0.39 0.44

0.28 0.32 0.36 0.41

0.27 0.32 0.36 0.40

0.27 0.32 0.36 0.41

cent, and the relative standard error of 294,000 beds error of the ratio. If VxJis the relative standard error

(from figure I, curve C) is approximately 5.0 percent. of the number of total FTE employees, IVY~the relaThe square root of the sum of the squares of these tive standard error of number of beds, r the sample

two relative standard errors minus their covariance correlation coefficient between total FTE employees

provides an approximation for the relative standard and beds (conservatively estimated to be 0.5), and

64
Table XVI I. Standard errors f or occupancy rate

Occupancy rate

Base of ratio (number of beds)

30 40 50 60 70 80 90 100

Standard error in percentage points

10,000........................ *10.95 ●13.12 15.29 17.49 19.71 21.98 24.27 26.59

20,000........................ 7.73 9.26 10.79 12.34 13.91 15.50 17.11 18.75

30,000........................ 6.31 7.55 8.79 10.05 11.33 12.62 13.94 15.27

40,000........................ 5.46 6.53 7.60 8.69 9.79 10.90 12.04 13.18

50,000........................ 4.88 5.83 6.79 7.75 8.73 9.73 10.74 11.76

60,000........................ 4.45 5.32 6.18 7.06 7.95 8.66 9.77 10.70

70,000........................ 4.11 4.91 5.71 6.52 7.34 8.18 9.02 9.88

80,000........................ 3.84 4.59 5.33 6.09 6.85 7.63 8.42 9.22

80,000........................ 3.62 4.32 5.02 5.73 6.45 7.17 7.91 8.66

100,000....................... 3.43 4.09 4.75 5.42 6.10 6.79 7.49 8.19

200,000....................... 2.40 2.85 3.30 3.75 4.21 4.67 5.14 5.62

300,000....................... 1.94 2.29 2.84 2.99 3.34 3.70 4.07 4.44

400,000....................... 1.66 1.95 2.24 2.53 2.82 3.11 3.41 3.72

500,000....................... 1.47 1.72 1.96 2.20 2.45 2.70 2.95 3.21

600,000....................... 1.33 1.55 1.75 1.96 2.17 2.38 2.59 2.81

700,000....................... 1.22 1.41 1.59 1.77 1.95 2.13 2.31 2.50

800,000....................... 1.13 1.30 1.46 1.61 1.76 1.91 2.07 2.23

900,000....................... 1.06 1.21 1.34 1.47 1.60 1.73 1.87 2.00

1,000,000...................... 1.00 1.13 1.25 1.36 1.47 1.5s 1.69 1.80

1,400,000...................... 0.s4 0.93 1.00 1.05 1.08 1.11 1.14 1.15

VR#the relativestandarderroroftheratiol?‘=X’/Y’:

then

vR,2=vx#2+vyt2 -2rvxtvyt

= (0.0165)2+ (0.0500)2 -1.00 (0.0165X 0.0500)

=0.00027+0.00250 -0.00083=0.00194

VR1= 4 0.00194=0.04405

The approxknate standard error of the ratio of

total FTE employees per 100 beds maynowbeobtained by multiplying the relative standard error by

theratio

o~t=R’XV~,

=46.8X0.04405

= 2.14

The sample correlation coefficient (r) for calculating the standard error estimates of theratiospresentedin this report is assumed to be zero exceptin

the case ofFTE employees per 100 beds,occupancy

rate, and cost per resident day ratio estimates where

the correlation coefficient used was 0.5.

65
Hypothesis testing

z-Test. —To test the difference between two statistics (mean, percent, etc.), the standard normal test

should be performed to determine whether or——not to

reject the null hypothesis (for the two means Xl , X2,

the n).11hyp~thesis is Ho :~1 = ~z with the alternative

HA :Xl # Xz ). The standard error of the difference

of the two estimates is approximately the square root

of the sum of the squares of the standard error of

each of t~e esttiates~Thus if SE(~l ) is the stand~d

error of Xl and SE(X2 ) is the stand~d e~or of X2,

the standard error of the difference (Xl - Xz ) 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 ~1 and X2 are different)

if the probability of a type I error is less than 5 percent; that is, if

Z=F,-X2

--, >1.96

/SE2(~1 ) + SE2 (X2)

Weighted leastsquares as a test for trend.–If there

exists a strong relationship between two variables

(e;g., total cost per resident day and FTE nursing staff

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 signtilcantly greater than zero. That is,

a regression line of the form Y = a + ~jXi + ei is to be

fit to the data where in this case Y = FTE nursing

staff per 100 beds; X = total cost per resident day;

o!= “Y-interceptJ’ that is, value of FTE nursing staff

per 100 beds if total cost per resident day equaled

zero; @= slope of Y on X, that is, the rate of change

in FTE nursing staff per 100 beds per unit change in

total cost per resident day; and finally, e = unexplained error.

The data available from the NNHS present certain very basic problems that discourage the use of

classical regression procedures. Among these problems are violation of the assumptions of in~dependence 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 devised 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 arid

their standard errors are obtained from complex

surveys.”b The proposed model is as follows:

1.

2.

3.

4.

5,

Let ~i be the estimated mean and S7 be its estimated standard error for the ith group.

Let Xi be the midpoint of the independent variable for the group.

Assume SVris based on a large enough number of

observations that it can be assumed it is equal to

UT,and thus has no sarnpIing error.

Further assume that

V@j) =S;, fori=l, 2, ..., K,

where K is the number of groups.

Finally, it is assumed that the ,j7i’s are normally

distributed and are statistically independent of

each other.

bFrom an unpublished memorandum by Dr. Levy.

66
The weighting procedure proposed weights all

observations by the reciprocal of the variance. That is

and the mean

and the mean

. ~ WiYi

Y= E Wi “

The slope is computed in a manner similar to the

classical least squares regression, by the following

formula:

~ ~wi(xi - Myi

—.

=

~ Wi(xi-x)’

This is easily computed by

The variance of the slope is

Now, because

1

Wi‘—

05 ‘

Y1

this formula can be simplified to

and computationally

An approximate normal deviate test can now be

performed by

b

‘“g”

This equation would test the hypothesis that ~ = Oor,

alternatively, compute confidence intervals for ~. -

As an example, FTE nursing staff per 100 beds by

total cost per resident day is recorded as shown in

table XVIII. Applying this described method to the

data shown, we have

~wixi~i = 896.36004

~wi = 1.20304

~wiXi = 20.5955

~wi~i = 47.12855

~wix~ = 414.5045

~= 17.11956

7= 39.17455

b = 1.44610

Sb = 0.12708

=2= 11.37945

z Sb

Table XVI 11. Worksheet for weighted least squares regression of full-time equivalent (FTE) nursing staff per 100 beds,

by total cost per resident day: United States, 1977

Midpoint of totei FTE nursing Standard error

Total cost per resident day cost per resident staff per of FTE nursing s+ wi=—

day interval 100 beds staff per 100 beds i :;,

—.

Lessthan $15.00 . . . . . . . . . . . . . . . . . . . . . . . . 7.5 24.9 1.6

$15.00-$19.99 . . . . . . . . . . . . . . . . . . . . . . . . . .

2.56 0.39063

17.5 40.5 1.9

$20.00-$2499 . . . . . . . . . . . . . . . . . . . . . . . . . .

3.61 0.27701 *

22.5 48.5

$25.00 ormore . . . . . . . . . . . . . . . . . . . . . . . . .

2.1 4.41 0.22676

25.0 49.2 1.8 3.24 0.30864

67
Thus because the z-value is quite large, a positive pie, the number of FTE nursing staff per 100 beds

association is demonstrated between FTE nursing in the cost interval $20.00-$24.99 (48.5)-is not sigstaff per 100 beds and total cost per resident day. nificantly different (using the z-test) from the numA significant positive or negative association can ber in the interval $25.00 or more (49.2) despite an

be present despite some intervals that do not show a overall significantly positive relationship between adsignificant difference when compared with adjacent missions per 100 beds and total cost per resident day.

intervals in the characteristic of interest. For exam68
Appendix Il. Definitions of

certainterms used in

this report

Terms relating to facilities

.

Facility. -Nursing homes included in the 1977

NNHS were those classified by the 1973 MFI as nursing care homes, personal care homes with nursing,

personal care homes, and domiciliary homes. Also included are nursing homes that opened for business

between the initiation of the 1973 MFI and December 1976. A nursing home must have three beds or

more and may be either freestanding or a distinct unit

of a larger facility. (See appendix IV for details.)

Bed. –A bed is one that is set up and staffed for

use whether or not it was in use by a resident at

the time of the survey. Not included are beds

used by staff or owners, or beds used exclusively

for emergency purposes, or solely day or night

care.

Certified bed. –A certified bed is one that is

certilled: (a) as skilled under the Medicare or

the Medicaid program, or both or (b) as intermediate under the Medicaid program. (See

defiition under “Certification” for details.)

Certification. –Certification refers to the facility

certification by the Medicare or Medicaid program(s) or both.

Medicare. –Medicare refers to the medical

assistance provided in Title XVIII of the

Social Security Act. Medicare is a health insurance program administered by the Social

Security Administration to persons aged 65

years and over and to disabled persons who

are eligible for benefits.

Medicaid. –Medicaid refers to the medical

assistance provided in Title XIX of the Social -

Security Act. Medicaid is a State-administered

program for the medically indigent.

Skilled nursing facility. –Skilled nursing facilit y refers to certification as a skilled nursing

facility under the Medicare or Medicaid program or both.

Intermediate care facility. –Intermediate care

facility refers to certii3cation as an intermediate care facility under Medicaid.

iVot certified. –Not certit3ed refers to facilities

that are not certit3ed as providers of care

either by Medicare or Medicaid.

Financial variables. –See Expense Questionnaire

Deftition Booklet in appendix III for details concerning terms in this section.

Cost, total. –Total cost is the total cost of

providing care for residents for the facility’s

most recently completed fiscal year. Cost data

from 1975, 1976, or 1977 were acceptable.

For about half the facilities, this corresponded

to calendar year 1976. Eighty percent of the

facilities reported data covering at least six

months of 1976 with the remaining months

fairly evenly divided between 1975 and 1977.

For those not reporting for the calendar year,

July and October were the most prevalent

starting dates. Excluded from total costs are

any losses sustained in the sale or disposition

of fixed assets and other extraordinary losses’

not related to the current cost of providing

care.

Labor costs. –Labor costs consist of wages

and salaries, payroll taxes, and fringe

benefits.

Operating costs. –Operating costs consist

of expenses for food and other dietary

items; drugs; supplies and equipment; purchased maintenance of buildings, grounds,

and equipment; laundry and linen; health

care and other services purchased from

outside sources; and utilities.

Fixed costs. –Fixed costs consist of equipment rental, insurance, taxes and licenses,

interest and finance charges, rent on

building and land, and amortization of

leasehold improvement.

69
Miscellaneous costs. –Miscellaneous costs

are for dues, subscriptions, travel, automobile, advertising, other services not included elsewhere, medical and nonmedical

fees, and unclassified expenses.

Revenues

Patient care.–Patient, care revenues include payments from Medicare, Medicaid,

other public assistance or welfare programs, and private sources, as well as

other patient revenues for routine or

ancillary health care services.

Nonpatient. –Nonpatient revenues include

financial contributions, grants and subsidies received from churches, foundations,

voluntary agencies, government agencies,

and similar groups for general operating

purposes. They also include all other

sources of revenue not directly related to

patient health care (such as beauty-barber

services and vending machines) as well as

any revenues received in the form of

interest, dividend, and capital gains.

iVet income. –Net income (paper profit or

loss) refers to revenues minus costs.

Cash flow. –Cash flow (actual profit or loss)

refers to the net income (i.e., revenues minus

costs) plus depreciation.

Loss. –Loss refers to the amount that

costs exceed revenues.

Prof2. –Profit refers to the amount that

revenue exceeds costs.

Location

Geographic region. –Facilities are classified by

geographic area by grouping the conterrninous

States into regions. These regions correspond

to those used by the U.S. Bureau of the

Census:

Reg!on States included

Northeast. . . . .

North Central. .

South . . . . . . . .

West . . . . . . . . .

Standard Federal Administrative Regions. –

Facilities are classified by Standard Federal

Administrative Regions by grouping tlhe conterminous States into 10 regions. These

regions correspond to those used throughout

the Federal Government:

Region States included

Region I.....

Region Il. . . . .

Region ill....

Region IV. . . .

Region V . . . .

Region VI. . . .

Region Vll . . .

Region Vlll. . .

Region IX....

Region X . . . .

Connecticut, Maina, Massachusetts, New

Hampshira, Rhode Island, Vermont

New York, Naw Jarsey. (Puerto Rico and

Virgin Islands ara excluded,)

Dalawara, Maryland, Pennsylvaniar Virginia,

West Virginia, District of Columbia

Alabama, Florida, Georgia, Kantucky, Mississippi, North Carolina, South Carcllina,

Tannessea

Illinois, Indiana, Michigan, Minnesota, ohio,

Wisconsin

Arkansas, Louisiana, New Mexico, Oklahoma, Texas

Iowa, Kansas, Missouri, Nebraska

Colorado, Montana, North Dakota, South

Dakota, Utah, Wyoming

Arizona, California, Nevada. (Hawaii, Guam,

Trust Territory of Pecif ic Islands, and

American Samoa are excludad.)

Idaho, Oregon, Washington. (Alaska is

axcluded.)

Ownership. –Type of ownership refers to the type

of organization that controls and operates the

nursing home.

Proprietary facility. –A proprietary fi~cility is

operated under private commercial ownership .

Nonprofit facility. –A nonprofit facility is

operated under voIuntary or nonprofit

auspices, including both church- and

nonchurch-related facilities.

Government facility. –A government facility

is operated under Federal, State, or local government auspices.

Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, Naw

York, Naw Jersey, Pennsylvania

Michiganr Ohio, Indiana, Illinois, Wisconsin,

Minnasota, Iowa, Missouri, North Dakota,

South Dakota, Kansas, Nebraska

Delaware, Maryland, District of Columbia,

Virginia, West Virginia. North Carolina,

South Carolina, Georgia, Florida, Kantucky,

Texas, Tennasaee, Alabama, Mississippi,

Arkansas, Louisiana, Oklahoma

Montana, Idaho, Wyoming, Colorado, New

Mexico, Arizona, Utah, Nevada, Washington, Oragon, California. (Alaska and Hawaii

are axcluded).

Terms relating to staff

Employee.–An employee is an individual providing direct or health-related services to the residents of

the nursing home. Full-time employees, part-time

employees, personneI employed under contract who

worked in the facility in the month preceding the

survey, and members of religious orders who donated

their services are included under this definition. Volunteers who provided enrichment or extra services,

contract personnel who did not work in the facility in

the last month, and attending physicians who have

only private patients in the faciJ.ity are excluded.

I

70
Staff in certain facilities that were units of larger

institutions when staff could not specifically be designated as working in the unit are also excluded.

Employment Status

Full-time. –A full-time employee worked 35

hours or more in the week prior to the survey.

Part-time. –A part-time employee worked less

than 35 hours in the week prior to the survey.

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

of part-time employees’ work per week is considered equivalent to that of one full-time

employee.

Occupational Categories

Administrative and medical staff –The administrative and medical staff are those staff

members who are administrators, assistant

administrators, physicians (M.D. and D.O.),

dentists, pharmacists, dietitians or nutritionists, registered medical records administrators, other medical record administrators and

technicians, and members of other professional occupations.

Medical director. –The medical director is the

professional person or group who coordinates

the medical activities of the facility, both

internally and regarding Federal and State

rules and regulations.

Other professional occupations. –Other professional occupations include the categories of

psychologist, X-ray technician, and those professional occupations not included in the

administrative and medical staff category.

Z7zerapeutic staff –The therapeutic staff are

those staff members who are registered occupational therapists, registered physical therapists, activities directors, social workers,

speech pathologists or audiologists, occupational therapist assistants, physical therapist

assistants, or social worker technicians and

assistants.

Vacant staff positions. –Vacant staff positions

are unfilled staff positions in the budget of

the nursing home.

Terms relating to residents

Resident. –A resident is a person on the roster of

the nursing home on the night before the survey. AU

residents for whom beds are maintained although

they may be temporarily away on overnight leave or

in a hospital are included.

Health Status

Activities of daily living. –The ac~ivities of

daily living are six everyday activities (bathing, continence, dressing, eating, mobility,

and using toilet room) for which the nursing

staff respondent reported the resident’s current performance in terms of his need for the

help of special equipment or a.bother person.

Bathing

Independent. –The resident does not

currently require any assistance in

bathing. This category also includes

those cases in which the information

is unknown.

Requires assistance. —The resident

bathes with the help of special equipment or another person or both.

Continence

No difficulty controlling bowels or

bladder. –The resident does not currentiy have any difficulty in controlling either bowels or bladder.

Difficulty controlling bowels. –The

resident currently has difficulty in

controlling his bowels.

Difficulty controlling bladder. –The

resident currently has difficulty in

controlling his bladder.

Ostomy in either bowek or bladder. –

The resident has undergone a surgical procedure that results in the

creation of an a.rtitlcial opening for

the elimination of waste.

Dressing

Independent. –The resident does not

currently require any assistance in

dressing. This category also includes

those cases in which the information

is unknown.

Requires assistance, includes those

who do not dress.—The resident currently dresses with the help of special

equipment or another person or both.

This category also includes those cases

in which the resident remains partially

or totally undressed.

Eating

Independent. –The resident does not

currently require any assistance in eating. This category also includes those

cases in which the information is

unknown.

Requires assistance, includes those

who are tube or intravenously fed. –

The resident currently eats with the

help of special equipment or another

71
person or both. This includes those

residents requiring assistance with the

cutting of meat and buttering of

bread, as well as those who require

tube or intravenous feeding.

Mobility

Walks independeritly. -The resident

does not currently require any assistance in walking. This category also

includes those cases in which the

information is unknown.

Walks with assistaizce.-The resident

currently walks with the help of

special equipment or another person

or both.

Chair~ast. –The resident is currently

confined to a chair.

Bedj%st.-The resident is currently

confined to a bed.

Using toilet room

Independent. –The resident does not

currently require any assistance in

using the toilet room. This category

also includes those cases in which the

information is unknown.

Requires assistance. –The resident currently uses the toilet room with

the help of special equipment or

another person or both.

Does not use toilet room. –The resident does not currently use the toilet room because of an ostomy, being

chairfast, or similar reason.

Index of dependency in activities of daily living. –The index of dependency in activities

of daily living, based on the work of Dr. Sidney Katz,T~8 is a measure that permits the

overall classification of individuals according

to a “hierarchy” based on dependency in performing the six activities of daily living just

NOTE: A list of references follows the text.

described. The index has seven levels of dependence with each successive level indicating

greater dependency. The index category,

“other,” includes residents who were dependent in at least two functions but not classifiable into any of the categories of the “hierarchy.” The following list of activities is

ordered in “hierarchy” sequence and presents

the criterion for classifying a resident as

dependent:

Bat/zing. -This category refers to those

residents who require assistance.

Dressing. –This category refers to those

residents who require assistance, including

those who do not dress.

Using toilet room. –This category refers to

those residents who require assistance or

do not use toilet room.

Mobility. –This category refers to those

residents who walk with assistance, are

chairfast, or are bedfast.

Continence. –This category refers 10 those

residents who have difficulty controlling

bowels or bladder, or both; or lhave an

ostomy.

Eating. -This category refers tc) those

residents who require assistance, including those who ar=

fed.

Terms relating to discharges

Discharge. –A discharge is

tube or intravenously

a person who was formally discharged from a ‘nursing home during 1976.

Both live and dead discharges are included. Theoretically, the same person can be counted more than

once if he was discharged more than once from a

nursing home during 1976.

Discharge status. –The discharge status refers to

whether the person was discharged from the nursing home alive or dead.

Duration of stay. –The duration of stay is the

period of time between the date of admission and

the date of discharge.

72
Appendix Ill. Selected survey

instruments used in the 1977

National Nursing Home

Survey

Letter to administrator

@

\IH. E40C

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*

2 ?

.

2

~~ DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ‘&A

‘%*e @ “*+. PUBLIC HEALTH SERVICE

Usb

HEALTH RESOURCES A,DM IN lSTRATION

ROCKV1 LLE, MARYLAND 20857

NATIONAL CENTER FOR

HEALTH STATISTICS

Dear Administrator:

As part of its continuing program to provide information on

the health of the Nation and the utilization of its health resources, the

National. Center for Health Stdtis tics (part of the U.S. Public Health

Service ) is conducting a nationwide survey of nursing homes and

similar facilities. The survey, the second in a series, is authorized

under Section 306 (42 USC 242K) of the Public Health Service Act.

The purpose of this survey is to collect baseline and trend information about nursing facilities, their services, residents, staff and

financial characteristics. The resulting published statistics will

describe the Nation’s nursing facilities and the health status of their

residents. These data are used for studying the utilization of nursing

facilities, for developing policies which promote efficient allocation

of health care resources, and for supporting research directed at

finding effective means for treatment of long-term health problems.

Thus, the individual resident is the ultimate beneficiary.

73
Enclosed is a summary report from the previous survey,

which is illustrative of the kinds of data to be obtained from this su:r -

vey. Because the National Center for Health Statistics is committed

to providing a factual basis for the planning of programs for improving the health of the American people, basic information about

your facility (name, address, size, type of ownership, admission

policies, certification, and statistics on admissions and discharges)

will be made available upon request. In addition, some of this inf or -

mation is published in a national directory of nursing home facilities.

I want to emphasize that, except for the information specifically mentioned in the above paragraph, the information you supply

will be used solely for statistical research and reporting purposes.

No information collected under the authority of Section 306 (42 USC

242K) of the Public Health Service Act may be used for any purpose

other than the purpose for which it was supplied, and such information may not be published or released in other form if the individual

or establishment is identifiable unless the individual or establishment has consented to such release.

This survey includes a small, randomly selected, nationwide sample of nursing facilities, each of which represents a number

of similar facilities. Although your participation is voluntary and

there are no penalties for refusing to answer any question, it is

ess ential that we obtain data from all sample homes in order to

achieve accurate and complete statistics.

The survey will require about 30 minutes of your time to

conduct an interview about the facility. Some additional time involving

some of your staff will be required to complete documents for a small

sample of your employees and current and discharged residents. No

resident will be contacted or interviewed at ~ time.

.—

Within the next few weeks, an interviewer will contact you

for an appointment. This pers on will be with Informatics, Inc. , thle

firm under Federal contract to conduct this survey. I greatly appreciate your c operation in this survey.

Sincerely yours,

AjL-...icf4$L.

Director #

Enclosures

74
Letters of endorsement

TIO?’MLCOUnCIL OF t+eaLTH CaRe SeRVIC@S

March 29, 1977

Dear Administrator:

I am writing to urge your participation in the 1977 National Nursing Home SUI’Veyto

be conducted this summer by the National Center for Health Statistics. The survey,

the second in a series, 1s designed to collect baseline and trend information about

nursing facilities, their services, residents, staff and some basic financial

characteristics.

The support of our association and of all nursing home administrators is indispensable to the successful inauguration of this research. It has in the past provided

invaluable data for the industry, as well as for those drafting health legislation,

and setting national policies and priorities.

I believe you will find the survey to be extremely comprehensive, while designed to

maximize the utility of the data collected. In addition, strict confidentiality

provisions are to be maintained, with only summary data being published and made

available to health planners, researchers, health professionals, and the public.

I am confident that the information derived will be worth the investment of your

time and effort, as it will ultimately be used in an effort to improve long term care.

Furthermore, it is only through your cooperation that we can be sure the information

on which public policy will be based has the benefit of our input.

I, therefore, again urge your cooperation with this survey.

~au

/$ack ~“ cDonald{

Executive Vice President

%te402 ■ 1200FifteenthSt~eettN.W.. W=shington,D.C.20005 ●Tei. [20217B5-4754

75
flMERl(llN COLE8[OFNURSIKHOME IIDMINISTRII1OR ~

UW~~~~N16NWAY

wAnHlmToN,O.c.zao14

e

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(301)862430s %, ,,,.

~m”$CP$

j ALBIN YOKIE

Executiw Vke Prevalent

Dear Administrator:

I wish to encourage you to participate in the 1977 National

Nursing Home Survey conducted by the National Center for

Health Statistics of DHEW. The survey, the second in a

series, is designed to collect baseline and trend information

about long-term care facilities, their services, residents,’

staff and some basic financial characteristics.

The support of the professional administrator is indispensable

to th: success of this research which will provide invaluable

data for planning and organizitighealth care$of the aged, drafting health legislation, and setting national policies and

priorities.

The survey design maximizes the utility of the data collected

while it attempts to minimize the amount of staff involvement.

Strict confidentialitywill be maintained and only summary

data will be published and made available to health planners,

researchers, health professionals, and the public.

The value of the information derived is well worth the

investment of your time and effort. It is only through such

cooperation that the information, upon which public policy

will be based, has the benefit of your input.

I urge your cooperation in this survey.

Sincerely,

V*P

J, Albin Yokie

Executive Vice-Freeident
Suite 770

1050 l?th Street, N.W.

Washington, D.C. 20036

(202) 296-5960

Monsignor CharlesJ. Fahey

Fw xlent

David C. Crowley

Execuhve We Pres]deni

Dear

I am

Administrator:

writing to urge your participation in the 1977 National Nursing Home

Survey to be conducted this summer b.vthe National Center for Health Statistics.

The survey, the second in a series, ~s designed to collect baseline and trend

information about nursing facilities, their services, residents, staff and

some basic financial characteristics.

The support of our association members and of all facilities selected to be

included in this sample is indispensable to the successful development of

invaluable data for planning and organizing health care of the aged, drafting

health legislation, and setting national policies and priorities to obtain

quality care for al1 nursing home residents.

I believe you will find the survey design maximizes the utility of the data

collected while it attempts to minimize the amount of staff involvement. In

addition, strict confidentiality provisions are to be maintained. Only summary

data will be published and made available to health planners, researchers, health

professionals, and the public.

I am confident that the information derived will be worth the investment of your

time and effort as itwill ultimately be used in an effort to improve long term

care. Furthermore, it is only thr~ugh your cooperation that we can be sure the

information on which public policy will be based has the benefit of our input.

I, therefore, again urge your cooperation with this survey.

.

SL cDavidC. Crowley

Executive Vice President

77
di!ixi

Dear Administrator:

I am writing to urge your participation in the 1977 National

Nursing Home Survey to be conducted this summer by the National

Center for Health Statistics. The survey, the second in a

series, is designed to collect baseline and trend information

about nursing facilities, their services, residents, staff and

some basic financial characteristics.

The support of our association and of all nursing home administrators is indispensable to the successful inauguration of

this research which will provide invaluable data for planning

and organizing health care of the aged, drafting health legislation, and setting national policies and priorities to obtain

quality care for all nursing home residents.

I be2ieve you will find the survey design maximizes the utility

of the data collected while it attempts to minimize the amount

of staff involvement. In addition, strict confidentiality

provisions are to be maintained. Only summary data will be

published and made available to health planners, researchers,

health professionals, and the public.

I am confident that the information derived will be worth the

investment of your time and effort as it will ultimately be

used in an effort to improve long term care. Furthermore,

it is only through your cooperation that we can be sure the

information on which public policy will be based has the

benefit of our input.

I, therefore, again urge your cooperation with this survey.

Theodore Carcich, Jr. ~’

President

A non-profit organization of proprietary and non-proprietary long term health care facilities dedicated to improving health care of

the convalescent and chronically illof all ages. An equal opportunity employer.

78
Facility Questionnaire

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE

OMB fl 68-S75025 APPROVAL EXPIRES 12.31.77

Health ResourcesAdministration FACILITY (lUESTIONNAIRE

National Center for Health Statistics ,

1977 National Nursing Home Survey

A. Telephone Number m-~ B. Interviewer Nama

Area Code Number

C. Date of Interviaw mmm D. Start Tima

lClam

Mo. Day Year 2Upm

INTER VIEWER NOTE: Pleaae read the Facility Questionnaire Prompt Cerd BEFORE you begin the interview.

1. ACCORDING TO OUR RECORDS, THE NAME OF THIS FACILITY IS (Reed name of facility on label.)

a. IS THERE AN ERROR IN THIS NAME?

I •l Yes 2 ❑ No (Skip to Q.2)

b. WHAT IS THE CORRECT NAME OF THIS FACILITY?

I 1

2. ACCOROING TO OUR RECORDS, THE MAILING ADDRESS OF THIS FACILITY IS: (Readeddresson label.)

a. ISTHERE AN ERROR IN THIS ADDRESS?

I •l Yes 2 ❑ No (Skip to 0.3)

h WHAT IS THE CORRECT MAILING ADDRESS OF THIS FACILITY?

r

Number Street P.O. Box, Route, etc.

City or Town County

State Zip Code

HRA-190-1 (3-77)

3. HAS THIS NURSING HOME BEEN IN BUSINESS AT THIS ADDRESS FOR TWO YEARS OR LONGER? COUNT FROM THE

TIME IT FIRST OPENEO AT THIS AODRESS AS A NURSING HOME, EVEN THOUGH THE OWNERSHIP OR THE SERVICES

OFFERED MAY HAVE CHANGED.

1 ❑ Yes 2UN0

79
4. ARE ANY OF THE FOLLOWING SERVICES ROUTINELY PROVIDED TO RESIDENTS IN ADDITION TO ROOM AND —

BOARD:

a. SUPERVISION OVER MEDICATIONS WHICH MAY BE SELF-ADMINISTERED? . . . . . , . 1 ❑ yes 2 lg No

b. MEDICATIONS ANO TREATMENTS ADMINISTERED IN ACCORDANCE WITH

PHYSICIAN’S ORDERS? . . . . . . . . . . . . . . . . . ...”..... ..l~yes 2DN0

c. RUB AND MASSAGE? . . . . . . . . . . . . . . . . . . . . . . . . . ..l Clyes 2DN0

d. HELP WITH TUB BATH OR SHOWER?. . . . . . . . . . . . . . . . . . . . . . l~yes 2 @No

e. HELP WITH DRESSING? . . . . . . . . . . . . . . . . . . . . . . . . . ..l ayes 20No

f, HELP WITH CORRESPONDENCE OR SHOPPING? . . . . . . . . . . . . . . . . . . 1 oYes 20No

g. HELP WITH WALKING OR GETTING ABOUT? . . . . . . . , . . . . . . . . . , . 1 ❑ Yes 20No

h. HELP WITH EATING? .,..... . . . . . . . . . . . . . . . . . . . ..lnyes 20No

OR

i. NONE OF ABOVE SERVICES ROUTINELY PROVIOED, ONLY ROOM ANO BOARD PROVIDED? . 1 ❑ Yes

I

INTER VIEWER: This facility is out-of-scope of the survey. Please termirqte interview.~

.

5a, IS THIS FACILITY A DISTINCT NURSING HOME UNIT OF A HOSPITAL, ANOTHER HEALTH INSTITUTION, OR A

RETIREMENT CENTER?

I •l Yes 2 ❑ No (Skip to Q.6eJ

b. HOW MANY BEDS ARE IN THE ENTIRE FACILITY INCLUDING THE NURSING HOME UNIT?

11111

READ: FOR THE REMAINDER OF THE INTERVIEW, THE QUESTIONS REFER ONLY TO THE NURSING HOME UNIT,

80
6a. ~Show Flaticard #’l WHAT IS THE TYPE OF OWNERSHIP WHICH OPERATES THIS FACILITY?

01 ❑ Individual

1 1

02 •l Partnership

J

For profit

03 ❑ Corporation I

b. IS THIS FACILITY A MEMBER OF A GROUP OF FACILITIES OPERATING

04 ❑ Church related UNDER ONE GENERAL AUTHORITY OR GENERAL OWNERSHIP?

05 ❑ Nonprofit corporation I El Yes 20No

06 ❑ Other nonprofit ownership J

07 •l State

08 •1 County

09 ❑ City

I o •l City-County

II ❑ Hospital District

12 ❑ U.S. Public Health service

13 ❑ Armed Forces

14 ❑ Veterans Administration

15 ❑ Other Federal Agency, Specify

7a. DOES YOUR FACILITY ACCEPT BOTH MALES AND FEMALES?

1 ❑ Yes (Skip to Q.8a) 20No

b. DOES IT ACCEPT ONLY MALES OR ONLY FEMALES?

I •l Only males

2 El Only females

Sam HAS YOUR FACILITY SET A MINIMUM AGE BELOW WHICH NO ONE IS ACCEPTED?

1 ❑ Yes 2 ❑ No (Skip to Q.8c)

b. WHAT IS THAT MINIMUM AGE?

W Years

c. HAS YOUR FACILITY SET A MAXIMUM AGE ABOVE WHICH NO ONE IS ACCEPTED?

1 •l Yes 2 n No (Skip to Q.9)

d. WHAT IS THAT MAXIMUM AGE?

L1-.l Years

81
9. DOES YOUR FACILITY ACCEPT PERSONS WHO ARE PRIMARILY DIAGNOSED AS:

a. MENTALLY ILL OR EMOTIONALLY DISTURBED? . . . . . . . . . . . . . . . . . I ❑ yes 20No

b. MENTALLY RETARDED? . . . . . . . . . . . . . . . . . . . . . . . . ..lnyes 20No

c. ALCOHOLICS? . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..l ayes 20No

d. DRUG ADDICTS? .,....... . . . . . . . . . . . . . . . . . ...lnyes 20No

e. SENILE? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..lnyes 20No

10. WHAT IS THE TOTAL NUMBER OF BEDS REGULARLY MAINTAINED FOR RESIDENTS?

INCLUDE ALL BEDS SET UP AND STAFFED FOR USE WHETHER OR NOT THEY ARE IN USE BY RESIDENTSAT THE

PRESENT TIME. DO NOT INCLUDE BEDS USED BY STAFF OR OWNERS OR BEDS USED EXCLUSIVELY FOR EMERGENCY PURPOSES, StiELY DAY CARE, OR SOLELY NIGHT CARE.

Total beds 11111

11. WHAT IS THE NUMBER OF BEDS IN THIS FACILITY THAT ARE LICENSED BY THE HEALTH DEPARTMENT OR OTHER

RESPONSIBLE AGENCY?

Total licensed beds I I I I

12a. WAS THERE A CHANGE IN THE TOTAL NUMBER OF BEDS REGULARLY MAINTAINED DURING 1976?

1 ❑ Yes 2 ❑ No (Skip to Q. 13)

b. IN WHICH MONTHS WAS THE NUMBER OF BEDS CHANGED?

C. (Ask for each change:) IN (month), WAS THAT AN INCREASE OR DECREASE?

d, (Ask for each change:) HOW MANY BEDS?

Month Increase (Number added) Decrease (Number eliminated)

3

w

w

w

Id

1111

1111

I I

1111

1111

13. IS THIS FACILITY CERTIFIEO BY BOTH MEDICARE AND MEDICAID, MEOICARE ONLY, MEDICAIO ONLY, OR

.. NEITHER?

I ‘n Both Medicare and Medicaid

2 ❑ Medicare only

3 ❑ Medicaid only (Skip to Q. 16)

4 ❑ Neither (Skip to Q.24)

82
14s. HOW MANY BEDS ARE CERTIFIED UNDER MEDICARE? - beds

b. ARE THESE BEDS A PHYSICALLY DISTINCT UNIT FROM THE REST OF THE FACILITY? I •l Yes 2DN0

15. Show Flashcard #2 WHICH OF THE REIMBURSEMENT METHODS AUTHORIZED BY MEDICARE IS USED BY THIS

FACILITY?

1!2

2U

30

90

RCCAC Method (Departmental-Relationship of Charges to Charges Applied to Cost Method; i.e., costs are apportioned by

applying a percentage representing the beneficiaries’ share of total charges, on departmental basis, to total costs for the

respective departments.)

Combination Method (For routine services such as room, board, and nursing services the providers total allowable costs are

apportioned on the basis of the relative number of patient days for beneficiaries and for other patients. For non-routine or

ancillary services, the providers allowable costs are apportioned on the basis of a percentage representing the beneficiaries’

share of the total charges to all patients for these services.)

Other, Specify

Don’t Know

INTER VIEWER NOTE: Skip to Q.23a if “Medicare only” in Q. 73.

16. IS THIS FACILITY CERTIFIED AS AN SNF, THAT IS A SKILLED NURSING FACILITY, BY THE MEDICAID PROGRAM?

I •l Yes 2 ❑ No (Skip to Q. 79)

17a. HOW MANY BEDS ARE CERTIFIED UNDER MEDICAID AS SNF BEDS? ~ beds

b. ARE THESE BEDS A PHYSICALLY DISTINCT UNIT FROM THE REST OF THE FACILITY?

I •l Yes 20No

18a. Show Flashcard #3 WHICH OF THE FOLLOWING REIMBURSEMENT METHODS FOR SNF-MEDICAID PATIENTS IS

USED BY THE FACILITY?

I ❑ Flat Rate Only ~b. WHAT IS THE FLAT RATE? $ ~c. Per ~aday

per 2 ~ week

per 3~ month

per 40 other, specify

2 ❑ Fiat Rate Plus Point System for Ancillary Services ~d. WHAT IS THE FLAT RATE PORTION?

3 ❑ Cost Plus Allowable Profit $ ~e. per ~nday

4 ❑ Other, Specify

9 ❑ Don’t Know

per 2 n week

per 3n month

per 4U other, specify

83
19. IS THIS FACILITY CERTIFIED AS AN ICF, THAT IS AN INTERMEDIATE CARE FACILITY, BY THE MEDICAID

PROGRAM?

1 •l Yes 2 ❑ No (Skip to Note above Q.22)

20a. HOW MANY BEDS ARE CERTIFIED UNDER MEDICAID AS ICF BEDS? ~ beds

b. ARE THESE BEDS A PHYSICALLY DISTINCT UNIT FROM THE REST OF THE FACILITY? I ❑ yes 20No

21a. ] Show Flashcard #3 [ WHICH OF THE FOLLOWING REIMBURSEMENT METHODS FOR ICF-MEDICAID PATIENTS .

IS USED BY THE FACILITY?

I ❑ Flat Rate Only~ b. WHAT IS THE FLAT RATE? $ ~c. per I ❑ dav

per z ❑ week

per a ❑ month

per 4 ❑ other, specify_

2 ❑ Flat Rate Plus Point System for Ancillary Services ~ d.WHAT IS THE FLAT RATE PORTION?

3 ❑ Cost Plus Allowable Profit $ ~r?. per ~nday

per 2 a week

4 ❑ Other, Specify

per 3 ❑ month

9 ❑ Don’t Know per 4 n other, specify_

INTER VIEWER NOTE: Skip to Q.23a if the facility is certified by only one program and at only one level of care.

22. SOMETIMES THE SAME BED IS CERTIFIED BY MORE THAN ONE PROGRAM. WITH REGARD TO THESE SO CALLED

“SWING BEDS”, HOW MANY BEDS IN YOUR FACILITY ARE CERTIFIED:

a. ASSNF BEDS UNDER BOTH MEDICARE AND MEDICAID? lJ_uJ

b. AS BOTH ICF AND SNF BEDS UNDER MEDICAID? LLJ-1-l

c. AS MEDICAID-ICF AND MEDICARE-SNF BEDS? I_J_u_l

d. UNDER ALL THREE PROGRAMS THAT IS, MEDICARE-SNF, MEDICAID-SNF, AND MEDICAID-ICF? !__u_J~

23a.

b.

DO YOU HAVE ANY BEDS NOT CERTIFIED BY EITHER MEDICAID OR MEDICARE?

I •l Yes 2 ❑ No (Skip to Q.24)

HOW MANY OF THESE BEDS DOES YOUR FACILITY HAVE?

~ Beds

24. HOW MANY PERSONS WERE ADMITTED TO THIS FACILITY DURING 1976?

~ adrrri.ions none ❑

84
25a. DOES THISFACILITY ACCE~TEMPORARY ADMISSIONS OF PERSONSWHOSE USUAL CARETAKERS AREILL, ON

VACATION, OR OTHERWISE UNAVAILABLE?

I ❑ Yes 2 ❑ No W@ to Q.26)

b. HOW MANY TEMPORARY RESIDENTS WERE ADMITTEO TO THIS FACILITY DURING 1976?

l_l_l-d temporary admissions none ❑

26a.

b.

WE WOULD LIKE TO OBTAIN INFORMATION ON DAYS OF CARE PROVIDED BY THE FACILITY FOR YOUR MOST

RECENTLY COMPLETED FISCAL YEAR, THAT IS, THE TWELVE MONTH PERIOD ON WHICH YOU COMPUTE THE

FACILITY’S EXPENSES. IS THIS INFORMATION AVAILABLE FOR A FISCAL YEAR?

I •l Yes 2 ❑ No (Skip to Q.26c)

WHAT WAS THIS TIME PERIOD?

Mo. Year Mo. Year

from W l-d through W W

(If this is less than a twelve month period, please record the number of months in this box.) LL-1

c.

‘“d.

FOR WHAT TIME PERIOD IS THIS INFORMATION AVAILABLE?

Mo. Year Mo. Year

from ~ ~ through W W

(If this is less than a twelve month period, please record the number of months in this box.)

FOR THIS PERIOD, WHAT WERE THE TOTAL INPATIENT DAYS OF CARE PROVIDED, THAT IS THE SUM OF THE

DAILY PATlENT CENSUS COUNT BY TYPE OF CERTIFICATION? DO NOT INCLUDE CASES THAT ARE DAY CARE

ONLY.

(1) Total Days: ~ days

(2) SNF-Medicare ~ days

(3) SNF-Medicaid ~ days

(4) lCF-Medicaid ~ days

(5) All Other Days ~ days

❑ Mark (X) if estimated

O Mark (X) if estimated a not applicable

❑ Mark (X) if estimated ~ not applicable

a Mark (X) if estimated O not applicable

❑ Mark (X) if estimated ❑ not applicable

85
I

Cotildential Information

hrterview%, Read: Information contained on this form which would permit identification of any individual or establishment has

been collected with a guarantee that it will be held in strict confidence, will be used only for purposes stated for this study, and

will not be disclosed or released to others without the consent of the individual or the establishment in accordance with Section

308(d) of tha Public Health Service Act (42 USC 242m).

27a. COUNTING FROM THE TIME IT WAS ORIGINALLY CONSTRUCTED, HOW OLO IS THIS BUILDING? (/interviewer: Round

fractions to nearest whole year. If intewal is given, record mid-point and mark “if estimatefl box.)

W Years (Mark (X) box ~ if estimated) ❑ Don’t Know

b. WAS THIS BUILDING ORIGINALLY CONSTRUCTED SPECIFICALLY FOR USE AS A NURSING HOME? (/nterviewor: Other

terms for nursing homes are rest home, home for the aged, mentally ill, or mentally retarded.)

I ❑ Yes (Skip to Q.27d) 20No 9 ❑ Don’t know (Skip to Q.27d)

c. WHAT WAS THE ORIGINAL PURPOSE OR USE OF THIS BUILDING?

I ❑ Private home, apartment, hotel/motel

2 ❑ Hospital, sanitarium, or other health related building

3 ❑ Other, Specify

d. NOT COUNTING PAINTING OR PAPERING, HAS THE STRUCTURE OF THIS BUILDING EVER BEEN RENOVATED OR

REMODELEO?

I El Yes 2 ❑ No (Skip to Q.28) 9 ❑ Don’t know (Skip to Q.28)

e. Show Flashcard #4 WHICH OF THE FOLLOWING CHANGES f. IN WHAT YEAR WAS THE MOST RECENT

WERE MADE? (Mark (X) all that apply; then ask 27f for each change.) (change)?

Year In Process Don’t Know

(1) Addition to the building constructed . . . . . . . . ❑ Wn •1

(2) Fire safety equipment/construction added or changed . . ❑ Wcl n

(3) Interior remodeling . . . . . . . . . . . . . . ❑ Wn ❑

(4) Other, Specify •1 Wa •1

28. HOW MANY ROOMS FOR RESIDENTS DOES THIS FACILITY HAVE THAT CONTAIN:

a. 1 BEO ONLY? ~ rooms None ❑

b. 2 BEDS? ~ rooms None ❑

c. 3 BEDS? ~ rooms None ❑

d. 40R MORE BEDS? ~ rooms None ❑

86
29a. FOR THE OAY SHIFT YESTERDAY, WAS THE PERSON IN CHARGE OF NURSING CARE FOR THE ENTIRE FACILITY

ON CALL OR ON DUTY, THAT IS AWAKE, DRESSED, AND SERVING THE RESIDENTS?

I ❑ On Call (Skip to Q.30a)

2 ❑ On Duty

b. WHAT IS THE LEVEL OF SKILL OF THIS PERSON?

I ❑ Registered Nurse

2 ❑ Licensed Practical Nurse

3 ❑ Nurse’s Aide or Orderly

4 ❑ Other (Specify Occupation)

c. WHAT HOURS DID T~PERSON ACTUALLY WORK YESTERDAY? (Mark (X) am orpm)

from~:~ ::;tom:m;:;

30a. FOR THE EVENING SHIFT YESTERDAY, WAS THE PERSON IN CHARGE OF NURSING CARE FOR THE ENTIRE

FACILITY ON CALL OR ON DUTY?

I ❑ On Call (Skip to Q.37a)

2.0 On Duty

3 ❑ No Such Shift (Skip to Q.37a)

b. WHAT IS THE LEVEL OF SKILL OF THIS PERSON?

I ❑ Registered Nurse

2 ❑ Licensed Practical Nurse

3 ❑ Nurse’s Aide or Orderly

4 ❑ Other (Specify Occupation)

C. WHAT HOURS DID THIS PERSON ACTUALLY WORK YESTERDAY? (Mark (XJ am orpm)

from Cl:Q :~:to~:Cl:~:

87
31a. FOR THE NIGHT SHIFT YESTERDAY, WAS THE PERSON IN CHARGE OF NURSING CARE FOR THE ENTIRE FACILITY

ON CALL OR ON DUTY?

I ❑ On Call (Skip to (2.32)

2 ❑ On Duty

3 ❑ No Such Shift (Skip to Q.32)

b. WHAT IS THE LEVEL OF SKILL OF THIS PERSON?

1 ❑ Registered Nurse

2 ❑ Licensed Practical Nurse

3 ❑ Nurse’s Aide or Orderly

4 n Other (Specify Occupation)

C. WHAT HOURS OID T~S PERSON ACTUALLY WORK YESTEROAY? (Mark (X) am orpm)

from Cil:G3 j~~toGJ:lIl~~~

32. HOW MANY DIFFERENT PHYSICIANS CURRENTLY ATTENO THEIR OWN PRIVATE PATIENTS IN THIS FACILITY?

(Do not count physicians who are on the staff of the facility or are employad under contract.)

~ Physicians or ❑ none

33a. DOES THE FACILITY HAVE A MEDICAL DIRECTOR?

1 ❑ Yes 2 ❑ No (Skip to Q.34

b. I Show Flashcard #5 I

UNOER WHICH OF THESE TYPES OF ARRANGEMENTS IS THE MEDICAL OIRECTIION OF THIS

FACILITY PROVIDED?

1 ❑ An individual physician

2 ❑ A physician partnership or group practice

3 ❑ Several individual physicians

4 ❑ An H. M. O., medical school, or medical society

5 ❑ Hospital Staff

6 ❑ Other, Specify

34.

a.

b.

c.

d.

e.

f.

9.

DOES THIS FACILITY ROUTINELY PROVIDE ON THE PREMISES ANY OF THE FOLLOWING THERAPIES BY A

LICENSED, REGISTERED, OR PROFESSIONALLY TRAINEO THERAPIST:

PHYSICAL THERAPY? . . . . . . . . . . . . . . . . . . . . . . . . . ..l aYes 20No

OCCUPATIONAL THERAPY? . . . . . . . . . . . . . . . . . . . . . . . . .lUYes 20No

RECREATIONAL THERAPY? . . . . . . . . . . . . . . . . . . . . . . . ..ln Yesi 20No

SPEECH AND HEARING THERAPY? . . . . . . . . . . . . . . . . . . . . . . lUYes 20No

COUNSELING/THERAPY BY PSYCHIATRIST, PSYCHOLOGIST, OR MENTAL HEALTH WORKER? 1 ❑ Yes 20No

COUNSELING BY SOCIAL WORKER? . . . . . . . . . . . . . . . . . . . . . . lnyes 20No

OTHER REHABILITATION THERAPIES? Specify 1 •l Yes 20No

88
35a. DOES THIS FACILITY KEEP A WAITING LWT OF PERSONS TO BE ADMITTED WHEN A BED BECOMES AVAILABLE?

I •l Yes 2 ❑ No (Skip to Q.36a)

b. HOW MANY PEOPLE ARE PRESENTLY ON THIS WAITING LIST?

~ people or ❑ None

36a, DOES THIS FACILITY PROVIDE ANY SERVICES TO PERSONS WHO ARE ~T RESIDENTS OF THE FACILITY?

I ❑ Yes 2 ❑ No (Skip to Q.38)

b. FOR WHICH OF THE FOLLOWING CATEGORIES OF NON-RESIDENTS DO YOU PROVIDE SERVICES:

(1) (/appropriate) PERSONS ON THE WAITING LIST? . . . . . . . . . . . . . . . I ❑ Yes 20No

(Z) DISCHARGED RESIDENTS? . . . . . . . . , . . . . . . . . . . . . . . loyes 20No

(3) ANY PERSON WHO APPLIES?. . . . . . . . . . . . . . . . . . . . . . . lClyes 20No

(4) ANY OTHER TYPE OF NON-RESIDENT? Specify I •l Yes 20No

37. ~Show F/ashcard #6 [ WHICH OF THE FOLLOWING SERVICES DO YOU PROVIDE TO NON-RESIDENTS? (Mark (X) all

that apply.)

a. ❑ Day care (services provided during the day to parsons who do not sleep in the facility overnight.)

b. ❑ Physical therapy

c. ❑ Occupational, recreational, or speech and hearing therapy

.

d. ❑ Psychiatric care

e. ❑ Home health care services

f. ❑ Meals either home delivered or in a group setting

g. ❑ Transportation and/or escort services

h. ❑ Homemaker or chore services

i. ❑ Information and/or referral for health needs

j. ❑ Friendly visiting

k. ❑ Daily telephone checking service

1. ❑ Arrangement or provision of recreational activities

m. ❑ Laundry service

n. ❑ Other, Specify

38. DOES THIS FACILITY HAVE ANY VACANT STAFF POSITIONS IN ITS BUDGET THAT IT IS CURRENTLY TRYING TO

FILL?

I n Yes 2 n No (Skip to Note below (2.39)

89
39. Show Flashcard #’7 HOW MANY VACANT FULL TIME ANO PART TIME STAFF POSITIONS ARE IN THE BUOGET FOR

THE FOLLOWING OCCUPATIONS? FULL TIME IS OEFINEO AS35 HOURS OR MORE PER WEEK.

a.

b.

c.

d.

e.

f.

9.

h.

i.

j.

k.

1.

m.

Administrator/Asst. Administrator . . . . . . . .

Physician (M.D. or D.O.), Residents and Interns . . .

Dentists . . . . . . . . . . . . . . . . .

Pharmacists . . . . . . . . . . . . . . .

Registered Occupational Therapists . . . . . . . .

Registered Physical Therapists . . . . . , . . .

Speech Pathologist and/or Audiologists . . . . . .

Activities Directors . . . . . . . . . . . . .

Dietitians or Nutritionists . . . . . . . . . . .

Registered Medical Records Administrators . . . . .

Social Workers . . . . . . . . . . . . . .

Other Professional Occupations . . . . . . . . .

Registered Nurses (R. N.) . . . . . . . . . . .

n. Licensed Practical Nurses (L. P. N.) or Licensed Vocational

Nurses (L. VAN.) . . . . . . . . . . . . . .

0. Nurses Aides/Orderlies . . . . . . . . . . . .

p. Office Staff . . . . . . . . . . . . . . .

q. Food Service Personnel . . . . . . . . . . . .

r. Housekeeping/Maintenance Personnel . . . . . . .

s. Other, Specify

Full Time

w

IJ_-1

w

w

l-d

w

w

w

w

w

w

w

Part Time

w

L-l

w

w

w

w

❑ None

❑ None

❑ None

❑ None

❑ None

❑ None

❑ None

❑ None

❑ None

a None

❑ None

❑ None

❑ None

❑ None

❑ None

❑ None

❑ None

❑ None

❑ None

Name of the Respondent Title

lClam

E. End Time F. Time Elapsed ~ Minutes

2Clpm

THANK YOU FOR YOUR TIME AND COOPERATION

INTER VIEWER NOTE: After completing the above items and thanking the respondent, continue the interviewing process with Prompt

Card 7Y3.

z?-?U.S. GOVERNMENT PRtNTJNG OFFICE: 1977–724-674/669 9.1

90
Letterto accountant

@

>Xn. .eo~

*. %%

$

@

%

2 z❑

2 ** DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

%.

%0 @*+ PUBLIC HEALTH SERVICE

U.S*

HEALTH RESOURCES ADMINISTRATION

ROCKVILLE, MARYLAND 20857

NATIONAL CENTER FOR

HEALTH STATISTICS

Dear Accountant:

As part of its continuing program to provide information on

the health of the Nation and the utilization of its health resources, the

National Center for Health Statistics (part of the U.S. Public Health

Service) is conducting a nationwide survey of nursing homes and similar facilities. The survey is authorized under Section 306 (42 USC

242K) of the Public Health Service Act. One of the purposes is to

obtain financial information about nursing facilities in order to learn

more about the amount and type of resources being devoted to this

rapidly expanding segment of the health care delivery system. From

this information, statistical reports will present the financial and

operating characters tics of the Nation’s nursing facilities. These

reports will be useful in promoting effective long-term health care

planning and efficient use of the Nation’s health resources.

The information you supply will be used solely for statistical

research and reporting purposes. No information collected under the

authority of Section 306 (42 USC 242K) of the Public Health Service

Act may be used for any purpose other than the purpose for which it

was supplied, and such information may not be published or released

in other form if the individual or establishment is identifiable

unless the individual or establishment has consented to such re lease.

This survey includes a small, randomly selected, nationwide

sample of nursing facilities, each of which represents a number of

similar facilities. Although your participation is voluntary and there

are no penalties for refusing to answer any question, it is essential

that we obtain data from all sample homes in order to achieve accurate and complete statistics.

91
Pleas e note that on Page I of the questionnaire, authorization

is given for you to release the requested information. Please read

the instructions on Page 1 and complete the Expense Questionnaire by

using the enclosed definition booklet, which provides account descriptions of the categories in the questionnaire. There is an accountant

whose services are available free of charge (telephone 301 /770-2048

collect and ask for the National Nursing Home Survey accountant) to

answer those questions which are not answered by the instructions or

the definition booklet.

Please complete this questionnaire and return within five

working days in the enclosed postage-paid envelope. I greatly appreciate your cooperation in this survey.

Sincerely yours,

Enclosures

92
Expense Questionnaire

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE r ,

PUBLIC HEALTH SERVICE

Health Resources Administration

National Center for Health Statistics

1977 National Nursing Home Survey

EXPENSE QUESTIONNAIRE

I

OMB # 68-S75025

APPROVAL EXPIRES 12-31-77 I

CONTROL NO. I I I I I I

Confidential Information

Information mntainad on this form which would permit identification of any individual or establishmenthasbeencollectedwith a guaranteethat it will ba held in strictconfidence,will be usadonly for purposesstatadfor this study, and will not be disclosedor releasedto

otherswithout the consentof the individual or the establishmentin accordancewith Section 308(d) of the Public Health ServiceAct

(42 USC 242m).

I hereby authorize of

(Accountant’s Name) (Accountant’s Address)

(Accountant’s Telephone)

to list for the most recently completed fiscal year the following financial data for the facility:

Date

(Signature) (Title)

PLEASE READ THESE INSTRUCTIONS CAREFULLY BEFORE YOU BEGIN TO ANSWER THE EXPENSE QUESTIONNAIRE.

The definition booklet highlights the substance of each cost grouping, as well as related groupings of expanses to be excluded from

specific cost definitions. Since the intent of this questionnaire is to obtain information that is comparable among facilities, it is important

that you read each of the definitions before answering the questions to which they apply.

The cost categories in the questionnaire are aimed at the total cost of care for patients. To capture all costs incident to providing

health care in a home, those services and supplies specifically purchased for sale to patients should also be included in the relevant cost

categories.

Sincethe financial data requested in this questionnaire are to be used with other survey information, it is necessary to provide data

which have comparable time periods. Therefore, please give the financial data for the most recently completed fiscal year (calendar year

or other 12 month period) and specify that time period in Box A on page 2 of this questionnaire. If for some reason, the twelve months

of data are not available, specify in Box A the time period to which the data apply. The data may be reported on either a cash or accrual

basis as long as there is consistency in the system applied throughout the entire period under repot%

In general, it is essential that all recorded expenses incurred by the facility be included in the expense categories. Excluded from

costs, however, are any lossessu~ained in the sale or disposition of fixed assets and other extraordinary losses not related to the current

cost of providing health care.

USE OF FINANCIAL STATEMENTS: If the financial data requested in this questionnaire are available in a Statement of Income and

Expenses from the financial report of the home, you may elect to submit such a statement rather than complete this questionnaire. However, to facilitate the follow-up of any questionable items, please indicate your name, telephone number, and title in the spaces provided

at the end of the questionnaire. Forward the blank questionnaire and the Statement of Income and Expenses to the National Nursing

Home Survey, Informatics, Inc., 6000 Executive Blvd., Rockville, Maryland 20852, in the postage paid envelope provided.

AFFILIATED FACI LITI ES: If a home is an affiliate of another facility, such as a hospital, the remrds of ON the nursing home unit

should be used in this survey. Where the records of a home are 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.

HRA-1 90-2 (3-77)

93
A. PLEASE LIST THE DJATES OF THE FACILITY’S MOST RECENTLY COMPLETED FISCAL YEAR IN THE BOXES PROVIDED AND SUPPLY THE FfEQIJ&jTED FINANCIAL DATAJ FOR THAT TIME PERIOD BELOW.

~ WTOUIW

Mo. Year Mo. Year

B. IF YOUR ACCOUNTING SYSTEM DOES NOT GENERATE COST ITEMS AS CATEGORIZED BELOW, PLEASE USE YOUR

BEST ESTIMATE OF ALLOCATIONS AMONG THE LINE ITEMS. IF FURTHER CLARIFICATION IS NEEDED ON ANY

POINT, PLEASE CALL CCILLECT INFORMATICS, INC. AT 301–770-2048 AND ASK FOR THE NATIONAL NURSING

HOME SURVEY ACCOUNTANT. ROUND AMOUNTS TO THE NEAREST WHOLE DOLLAR.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

EXPENSES

(Please refer to Definition Booklet)

Payroll Expense (Do not include contract services);

a. Wages and Salaries (gross amount including employees’ vacation and sick pay, taxes, etc.):

(1) Nursing staff payroll expense (include RN’s, LPN’s, practical nurses, aides, orderlies,

student nurses, and other nursing staff)

(2) Physicians, other professionals and semi-professionals payroll expense (include only

those employees who provide health care services)

(3) All other staff payroll expense (All employees not listed in (1) and (2), i.e., those —not

providing health care services)

(4) Subtotal of wages and salaries (add lines a(l), a(2), and a(3))

b. Payroll Taxes and Fringe Benefits (employer share of payroll taxes, state unemployment,

group health and life insurance and all other payroll and non-payroll benefits paid by

employer)

c. Total Payroll Expense (add line la(4) and 1b)

Health Care Services purchased from outside sources:

a. Nursing Services

b. Other Health Care Services (Physicians, Therapists, Laboratory services, and other

services that provide health care)

c. Total expense of Health Care Services purchased from Outside Sources (add lines 2a

and 2b)

Equipment Rent

Insurance (include professional public liability and other insurance)

Taxes and licenses (include franchise tax)

Interest and Financing Charges

Rent on Building and Land

Amortization of Leasehold Improvements

Depreciation Charges (Buildings and Equipment)

Food and other dietary items (include cost of services purchased from outside sources)

DOLLAR AMOUNTS

(If none, Please enter “O”.)

$

$—

$—

$

$

$

$

$

$—

(CONTINUE)

94
11.

12.

13.

14.

15.

16.

17.

.

Drug Expenses (include cost of drugs purchased for patients and sold directly to them) $

Supplies and Equipment (include cost of supplies and equipment purchased for patients and

sold directly to them) $

Purchased Maintenance of buildings, grounds and equipment $

Purchased Laundry and Linen services $

Utilities (telephone, gas, water and electricity) $

Other and Miscellaneous Expense (include dues, subscriptions, travel, automobile,

advertising, other services not included elsewhere, medical and non-medical fees,

unclassified). See Note 1 below. $

TOTAL EXPENSES (add expense category line items 1 through 16) $

—.

REVENUES DOLLAR AMOUNTS

(Please refer to Definition Booklet.) (If none, Please enter “O”.)

18. Total Revenue:

a.

b.

c.

$

Patient Care Revenues (include all public and private payments for routine and

ancillary health care services.)

Non-Patient Revenues (include all sources of non-patient revenues such as contributions

for general operating purposes, payment for services not directly related to patient

care, interest, dividends and capital gains.) $

TOTAL REVENUES (add subtotal 18a and subtotal 18b) $

I

NOTE 1: If Other and Miscellaneous Expense (item 16) comprise 10 percent or more of the total expenses (item 17), please give

details below of major amounts which constitute 20 percent or more of item 16.

Description Amount

$

I

$

PLEASE CHECK THE ADDITION OF SUBTOTALS AND TOTALS.

FOR THE PURPOSES OF FOLLOWING UPON ANY DIFFICULTIES ENCOUNTERED IN THE ANALYSIS OF THIS iNFORMATION, PLEASE INDICATE YOUR NAME, PHONE NUMBER, YOUR TITLE (ACCOUNTANT, ADMINISTRATOR; ETC.), AND

THE DATE YOU COMPLETED THIS QUESTIONNAIRE.

NAM E

●

PHONE NO. (—)–( )

TITLE COMPLETION DATE

THANK YOU FOR YOUR TIME AND COOPERATION IN FILLING OUT THIS QUESTIONNAIRE. PLEASE FOLD AND SEAL IT

IN THE ENCLOSED POSTAGE PAID ENVELOPE AND MAIL IT TO:

NATIONAL NURSING HOME SURVEY

INFORMATICS, INC.

6000 EXECUTIVE BLVD.

ROCKVILLE, MARYLAND 20852

95
Defiition Booklet for Completing the Expense

Questionnaire

‘DEPARTMENT oF HEALTH, EDuCATlON, AND wizLFAf3E

PUBLIC HEALTH SERVICE

Health ResourcesAdministration

OMB # 68-S75025

DEFINITION BOOKLET FOR COMPLETING APPROVAL EXPIRES 12-31-77

National Centerfor Health &atistic5 THE EXPENSE QUESTIONNAIRE

1977National NursingHome Survey

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 the amount earned and reported to the Internal Revenue Service on his or her W-2 statement.

Self-employed proprietors, while not salaried as employees, are to be included in this definition in the amount reported

on the tax return as self-employed salary.

Employee salaries and wages, by the above definition, exclude payments for professional or non-professional

services obtained under contract, or fees paid doctors on a fee-for-service basis. Also excluded from Wages and Salaries

are Fringe Benefits as defined in 1b (Payroll Expense - Fringe Benefits) on the next page.

Non-funded employee benefits such as meals and living quarters, if provided an employee, and considered a lPart.

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 emplo,yee’s contribution to FICA,

Federal and State taxes, and other deductions from an employee’s gross wages and salaries.

Any employee who spends 75 percent or more of his time in any one of the three areas mentioned below should

have all of the wage and salary compensations charged to that expense category. Further allocation is acceptable if it

is a feature of your accounting system.

a(1) Nursing 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, qurses’ aides, orderlies,

and student nurses.

a(2) Physicians, Other Professionals, and Semi-Professionals Payroll Expense

Physicians, other professionals, and semi-professional payroll expense is defined as wage and salary compensation given those professional and semi-professional employees who provide health care services to patients.

This category includes physicians, psychiatrists, dentists, pharmacists, optometrists, therapists, dietitians,

psychologists, podiatrists, audiologists, medical social workers, medical record administrators, medical and dental

technicians, X-ray and laboratory assistants, and all others providing health care services to p?tients.

a(3) All Other Staff Payroll Expense

All other staff payroll expense is defined as wage and salary compensation given all employees not specificallyy categorized .in (1), or (2) above, (i.e., those not involved in providing health care services to patientsJ

This category includes the administrator and assistant administrators as well as clerical, bookkeeping, and

other office staff; food service, housekeeping, and maintenance personnel.

HRA-190-2A (3-77)

96
b. Payroll Taxes and Fringe Benefits

Payroll taxes and fringe benefits are expenses incurred by the facility for the current and future benefit of

facility employees. These expenses, not added to the wages and salaries of the employees, include such items as group

health insurance, hospitalization, employer’s portion of FICA, Federal and State Unemployment Insurance, and life

insurance premiums (exclusive of premiums paid (a) where the facility is the beneficiary or (b) on the life insurance

of the proprietor owner).

Excluded from this cos at~ ,Y are payments for vacation, maternity and sick pay, terminal payments,

employee’s share of FICA, and Iivi Facilities provided employees where such facilities are established for the benefit of the home.

2. HEALTH CARE SERVICES PURCHASED FROM OUTSIDE SOURCES

a. Nursing Services

This category includes the cost of those services provided by RN’s, LPN’s, practical nurses, aides, orderlies,

student nurses, and other nursing personnel which were purchased by the facility from outside sources by contractor

other arrangements,

Exclude those nursing sewices purchased directly by the resident from outside sources.

b. Other Health Care Services

This category includes the cost of those services provided by medical professionals and semi-professionals

(definition 1a.(2)) purchased by the facility from outside sources by contract or other arrangements.

Exclude the cost of those,professional and semi-professional health care services purchased directly by the

resident from outside sources.

3. EQUIPMENT RENT

Charges to this category include the rental or leasing of furniture, typewriters, computers, X-ray machines or

other forms of equipment. Exclude from this category ail lease-purchase agreements and deferred payment plans on

the purchase of equipment. These latter type purchases will be treated through the Depreciation Cost Category (expense category 9).

4. 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. See definition of expense category 1(b’) for distribution of employee benefit insurance paid.

If the home’s accounting system is on the accrual basis, exclude any prepaid costs and include only the premiums on

the current year’s portion.

5. TAXES AND IJCENSES

This category includes licensesobtained for the right to do businessand taxes on real estate, personal property,

excise and businessfranchise taxes.

All federal and state taxes on the income of the facility are to be included as tax and license expenses. Amounts

remitted to Federal, state, county, and local governments for income taxes withheld from wages and salaries must be

excluded.

97
6. INTEREST AND FINANCING CHARGES

These charges include amounts of interest on notes payable, mortgages payable, long-term purchase agreements,

or other forms of indebtedness. 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 be excluded from this expense

category are placement fees on loans and costs related to penalty clauseson 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.

7. RENT ON BUILDING AND LAND

Rent on building and land is defined as all costs incurred for space occupied pursuant to leasesor rental

agreements.

Included in this category is the cost of all buildings or real estate rented or leased by the home.

Charges to this category should exclude lease-purchaseagreements and payments made on a mortgage covering

the building or land.

8. AMORTIZATION OF LEASEHOLD IMPROVEMENTS

Amortization of leasehold improvements is defined as the writeoff of improvements to leased premises cwerthe

remaining life of the leaseor the useful life of the improvement, whichever is shorter.

1mprovements to leased premises which have a remaining leaseor useful life of one year or lessshould 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.

9. 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.

Tangible capital assets,currently being purchased under a lease-purchase agreement, are to be depreciated rather

than treated as a rental payment. Exclude from this category any equipment of a nominal amount expensed in Equipment (Cost category 12.).

10. FOOD AND OTHER DIETARY ITEMS

This account includes food and other dietary items purchased for preparation on the home’s premises as well as

the cost of meals purchased from hospitals or other outside serviceswhether or not under contract.

Where food inventories are maintained, the cost of food consumed will be the basisfor the recording of cost

(inventory at beginning of year Plus purchases, lessending inventory Freight and salestaxes, 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” (salestax) or “Other and Miscellaneous Expense” (freight).

This cost category excludes costs related to the serving of meals, such as food and menu preparation (wages) and

kitchenware and dishes (supplies). It also excludes the cost of meals which are non-funded employee benefits and

were included as part of the grosssalaries in Item 1.

98
11. DRUG EXPENSES

Drug expenses represent the cost of drugs consumed out of inventory or purchased for patients and resold

them. Drugs not under inventory control will be considered expensed when purchased.

For mrmoses of this definition. druas include both ~rescrimion tv~e medicines as well as non-m_escriRtion

to

.- -. items

such as as~pirin,laxatives, and vitamins. Excluded from this definition are such non-medicine items as cotton, bandages,

syringes, and other items which do not meet the common definition of drugs, and are categorized under supplies, item

12, below.

Recognizing that medical supplies may be co-mingled in the cost account with d~ug items, an allocation tecimique

may be adopted for the purposes of determining the separate cost of drug expenses.

The cost of drugs includes freight costs as well as salestaxes 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 their use.

12. SUPPLIES AND EQUIPMENT

a. Supplies

Includes the purchase of all supplies exclusive of drug supplies (see 11.) and food and other dietary items

(see 10.).

Supplies include, but are not limited to, supplies used in food preparation and serving (dishes, kitchen ware,

paper supplies, etc.), office supplies, medical supplies such as bandages, 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.).

Usually, supplies 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 home will dictate whether these costs will be developed on a “delivery basis” or on an “issued” basis. Either

method is acceptable.

b. Equipment

Includes the purchase 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 not limited to medical equipment, furniture and fixtures of a

nominal value not maintained under asset control, repair and maintenance equipment, kitchen equipment, and administrative equipment,

All equipment purchased specifical Iy for sale to a patient, regardlessof the cost or nature of the purchase,

is to be included in this 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 9.

13. PURCHASED MAINTENANCE OF BUILDING, GROUNDS, AND EQUIPMENT

This cost grouping includes the costs of purchasing from outside sources; elevator maintenance, equipment or

appliance maintenance, ground maintenance, plumbing maintenance, electrical systems maintenance, and similar

type services. Also included are the costs of trash removal, exterminator services, cleaning services, and other housekeeping serviceswhen purchased from outside sources.

Purchased maintenance of building, grounds, and equipment, as classified in this cost category, excludes services

for this function provided by the home’s staff. The home’s personnel costs for these services are to be charged to

1a.(3),Wages and Salaries - All Other Staff Payroll Expense.

99
14. PURCHASED LAUNDRY AND LINEN SERVICES

This account relates to the cost of outside service only, rather than the cost of purchasing linens, towels, blankets,

uniforms, etc. This cost may or may not be under a 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 servicesfor this function provided by

nursing home staff. Personnel costs for this service are to be charged to 1a.(3), Wages and Salaries — All Other Staff

Payroll Expense.

Charges for laundry or linen lost or damaged by the nursing home under a service-rental agreement are to be reflected in this grouping.

15. UTILITIES

Utilities are defined as charges for telephone and telegraph, gas, fuel, oil, water, and electricity.

Chargesto this category should exclude any utility charges, such as telephone, that are paid directly by patients

or employees or charges that are paid by the lessor under the lease agreement.

16. OTHER AND MISCELLANEOUS EXPENSES

This expense category is a catchall to record all costs not classified in 1 through 15 above. Costs inclucied in

this grouping are dues and subscriptions, printing costs, advertisements, travel costs; automobile expenses, nonclassified medical and non-medical fees (example - audit and legal fees), postage and casual labor not charged to other

expense categories.

17. TOTAL EXPENSES

This is the total of alI expense categories 1 through 16.

18. TOTAL REVENUES

a. Total Patient Care Revenues

This group includes payments from Medicare, Medicaid, other public assistance or welfare programs and

private sources, as well as other patient revenues for routine or ancillary health care services.

b. Total Nonpatient Revenues

This group includes financial contributions, grants and subsidies received from churches, foundations,

voluntary agencies, government agencies, and similar groups for general operating purposes. It also includes all other

sources of revenue not directly related to patient health care such as beautician/barber services, vending macahine

concessions, charges for servicesrendered to guests (e.g., room and board), luncheonettes, etc., as well as any revenues

received in the form of interest, dividends and capital gains.

& U.S. GOVERNMENT PRINTING OFFICE 197,7–724.705 3.1

100
Staff Classification Card

WHICH OF THE FOLLOWING JOB CATEGORIES BEST FITS THE JOB WHICH THIS EMPLOYEE DOES

FACILITY? (If the employee performs more than one job, seleat the job for which the employtw spends the most time.)

01.

02.

03.

04.

05.

06.

07.

09.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

Administrator, Assistant Administrator

Physician (M.D. or D. O.)

Residents and Interns

Dentist

Pharmacist

Registered Occupational Therapist

Other Occupational Therapist or Assistant

Registered Physical Therapist

Other Physical Therapist or Assistant

Activities Director (Recreational Therapist)

Dietitian or Nutritionist

Social Workar

Social Work Technician/Assistant

Speach Pathologist and/or Audiologist

Registered Medical Reoords Administrator

Other Medical Records Administrator or Technician

Registered Nurse (R. N.)

Licensed Practical Nurse (L. P.N.) or Licensad Vocational Nurse (L.V.N.)

Nurse’s Aide/Orderly

Other Professional Ooaupations (Including psychologist, X-Ray Technicians, etc.)

IN THIS

101
Letter to staff member

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE

HEALTH RESOURCES ADMINISTRATION

ROCKVILLE, MARYLAND 20S57

NATIONAL CENTER FOR

HEALTH STATISTICS

Dear Staff Member:

As part of its continuing program to provide information on the

health of the Nation and the utilization of its health resources, the

National Center for Health Statistics (part of the U.S. Public Health

Service) is conducting a nationwide survey of nursing homes and similar facilities. The survey, the second in a series, is authorized under

Section 306 (42 USC 242K) of the Public Health Service Act. One of its

purposes is to obtain basic information about the staff employed in

nursing homes. The published statistics based on this survey will describe the services performed by nursing home staff, their education,

special training, work experience, workload, and salary. This information will be useful in developing specialized education and training

programs for health manpower.

The information you supply will be used solely for statistical

research and reporting purposes. No information collected under the

authority of Section 306 (42 USC 242K) of the Public Health Service

Act may be used for any purpose other than the purpose for which it

was supplied, and such information may not be published or released

in other form if the individual or establishment is identifiable unless

the individual or establishment has consented to such release.

As a sampled staff member, you were randomly selected to

represent others in your particular occupational group. Although

your participation is voluntary and there are no penalties for refusing

to answer any question, it is essential that all sampled staff members

respond s o that information about each occupational group is accurate

and complete. The questionnaire will require only a few minutes of

your time. Please seal your completed questionnaire in the postagepaid envelope provided and either return it to the interviewer or drop

it in the mail. If you have any questions about the survey or the

questionnaire, you may ask the interviewer or call the national sur -

vey collect at the following number: 301 /770-2048.

I greatly appreciate your cooperation in this survey.

Sincerely yours,

A/-wz/LL

t

Dorothy P. Ri e

, Director

Enclosure

102
Staff Questionnaire

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE OMB # 68-S75025

Health Resources Administration STAFF QUESTIONNAIRE

APPROVAL EXPIRES 12-31-77

National Center for Health Statistics

1977 National Nursing Home Survey CONTROL NO. ~

A. LINE NO. ~ B. OCCUPATION CODE ~ c.

(Occupational Title) I

I Confidential Information I

Information contained on this form which would permit identification of any individual or establishmenthesbeen colleotedwith a guaranteethat it will be held in strictconfidence, will be usedonly for purposesstatedfor this study, and will not be disclosedor releasedto

others without the consentof the individual or the establishmentin accordancewith 8ection 308(d) of the Public Health serviceAct

(42 USC 242m).

PLEASE READ THESE INSTRUCTIONS BEFORE YOU BEGIN TO ANSWER THE STAFF CZUESTIONNAIRE,

The letter accompanying this questionnaire explains the purposes of the survey, the usesof the information, and

the confidentiality of the data. Please read this letter carefully before completing the questionnaire.

The occupation for which you were sampled is cited in Item C above. All questions about your work refer to that

occupation and you should keep that in mind as you complete this instrument.

Most of the questions have detailed instructions printed in italics after them. The instructions were put thereto help

you to give the most accurate answer possible to the questions. If you have any questions regarding items on the questionnaire or how you should complete it, please call COLLECT 301-770-2048 and a National Nursing Home Survey

employee will be available to help you.

Your cooperation in carefully completing the questionnaire is greatly appreciated. It should take only a few minutes of your time and the information that you provide is very important. As stressed in the letter, these data are held

in strictest confidence. When you have completed the questionnaire, please seal it in the postage-paid envelope provided, You may return it to the interviewer if he is still in the facility or drop it in the mail to the address cited on the

bottom of page 4.

HRA-190-4 (3.77)

103
1.

a.

b,

HOW LONG HAVE YOU WORKED IN THE OCCUPATION SPECIFIEO IN ITEM C ON THE FRONT OF THIS

QUESTIONNAIRE:

(Please be sure that both years and months are filled in. If less than one year, enter ‘lOO” in Yrs. box; if less than one month, enter

“’00” in Mos. box.)

IN THIS FACILITY? Ww

Yrs. Mos.

IN OTHER NURSING HOMES, HOMES FOR

THE AGED, HOSPITALS, OR SIMILAR

FACILITIES? (Only count work experience

—

before your employment in this facility.) ~ !-# OR Mark this box if you have never worked in

any other nursing or hospital facility. •1

2. ARE YOU A MEMBER OF THE STAFF OF THIS FACILITY OR EMPLOYED UNDER CONTRACT?

(Mark only one box)

I ❑ Staff member (Part Time or Full Time) 2 ❑ Under contract (Part Time or Full Time)

3 ❑ Other arrangement, Specify

3. DO YOU USUALLY PERFORM ANY OF -

(Mark the Yes or No box for ~h line)

a. Administration of the facility . . .

b. Screening persons for admission . . .

c. Nursing care . . . . . . . . .

d. Medical and dental care . . . . .

e. Physical therapy . . . . . . . .

f. Occupational therapy . . . . . .

g. Recreational therapy . . . . . .

h. Speech and hearing therapy . . . .

i. Social work, counseling (religious, etc.)

j. Training of staff . . . . . . . .

k. Supervision of staff . . . . . . .

HE FOLLOWING SERVICES IN

1. Clerical work, medical and social record keeping

m. Kitchen/dietary work, grocery shopping . . .

. .

. .

. .

. .

. .

. .

. ..

. .

. .

. .

. .

. .

. .

n. Housekeeping services, maintenance, care of grounds . .

0. Other, Specify

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

HIS FACIL

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

1 0 Yes 20No

I 0 Yes 20No

I 13 Yes 2DN0

I ❑ Yes 2i3No

I •l Yes 20No

1 ❑ Yes 2DN0

1 •l Yes 20No

I D Yes 20No

I •l Yes 20No

1 ❑ Yes 20No

I ❑ Yes 2DN0

I ❑ Yes 20No

I ❑ Yes 20No

I •l Yes 20No

1 ❑ Yes 20No

4. HOW MANY HOURS PER WEEK DO YOU USUALLY WORK ——IN THIS FACILITY?

W hours per I ❑ week

2 ❑ other time period, Specify

5a. DO YOU USUALLY WORK ANY ADDITIONAL HOURS IN YOUR PROFESSION BESIDES THE HOURS WORKED IN THIS

FACILITY?

2 ❑ No (Skip to Question 6.)

I •l Yes ~b. HOW MANY? ~ hours per I ❑ week

2 ❑ other time period, Specify

104
6a. WHAT IS THE HIGHEST YEAR OF EDUCATION YOU HAVE COMPLETED?

(Please circle only the highest completed year; include whatever professional training you have had.)

~ ‘3 ~~.~~

17 18+

L

Y

J

Elementary High School College and/or More Than Four Years of

Other Training College and/or Other Training

If your highest year of completed education is —less than 14 years, skip to Question 7.

J

b. DO YOU HAVE AN ASSOCIATE, BACHELOR’S, MASTER’S, OR DOCTORATE DEGREE?

1 •l Yes 2 ❑ No (Skip to Question 7)

c. WHICH OF THE FOLLOWING d. SPECIFY MAJOR FIELD OF STUDY FOR

DO YOU HOLD?

e. SPECIFY YEAR

EACH DEGREE. COMPLETED

(1) Associate ❑ (1) 19—

(2) Bachelor’s •1 (2) 19—

(3) Master’s •1 (3) 19_

(4) Doctorate ❑ (4) 19_

7. DURING THE LAST TWELVE MONTHS, HAVE YOU TAKEN A NON-DEGREE TRAINING COURSE IN ANY OF THE FOLLOWING AREAS?

(Training courses include class sessions and seminars. Do not inciude any courses you have taken for a degree. Mark the Yes or

No box for ~h line.)

a.

b.

c.

d.

e.

f.

9.

h.

i.

j.

k.

L

m.

Nursing care of the aged or chronically ill . . . . . 2 ❑ No

Medical or dental care of the aged or chronically ill . 2 ❑ No

Mental or social problems of the aged or chronically ill 2 ❑ No

Physical therapy or rehabilitation . . . . . . . 2 ❑ No

Occupational therapy . . . . . . . . . . . 2 ❑ No

Nutrition or food services . . . . . . . . . . 20No

Nursing home administration or management . . . 2 ❑ No

Inservice education , . . . . . . . . . . . 20No

Medical records . . . . . . . . . . . . . 20No

Activity programs for the aged or chronically ill . . 2 ❑ No

Social services for the aged or chronically ill . . . . 2 ❑ No

Pharmacology and care of drugs . . . . . . . . 2 ❑ No

Other courses related to vour work,

I ❑ Yes —E How many courses?

I ❑ Yes ~How many courses?_

I •l Yes ~How many courses?

I •l Yes ~How - courses?

I ❑ Yes ~How m courses?

I •l Yes ~How = courses?

I •l Yes ~How m courses?

I •l Yes ~How many courses?

I ❑ Yes ~How many courses?

I •l Yes ~How g courses?

1 •l Yes ~How many courses?

I •l Yes ~How —,

many courses?

Specify 20No I •l Yes ~How many courses?

8. ARE YOU 2 ❑ Female? OR I ❑ Male?

9. WHAT IS YOUR DATE OF BIRTH? LL-lww

Mo. Day Yr.

10. WHICH ONE OF THESE GROUPS= DESCRIBES YOUR ETHNIC ORIGIN OR ANCESTRY?

I ❑ White (Not of Hispanic Origin) 4 ❑ Asian or Pacific islander

2 ❑ Black (Not of Hispanic Origin) 5 H Hispanic

3 ❑ American Indian or Alaska Native

105
11. BEFORE DEDUCTIONS WHAT IS YOUR SALARY FOR THE WORK YOU PERFORM IN THIS FACILITY ONLY? —.

(Mark only one box)

[

I ❑ hour

2 ❑ day

Dollars Cents 3 ❑ week

m ● n per :::::

OR 6 •l year

7 ❑ other time period, specify

❑ I donate my services (Sk@ to Question 13)

12. IN ADDITION TO THIS SALARY, DO YOU RECEIVE:

(Mark the Yes or No box for& line)

a.

b.

cm

d.

e.

f.

9.

h.

i.

j.

Paid vacation, and/or paid holidays, and/or paid sick leave? . . . . . . . . . . . . . . . 1 a Yes 20No

Pension plan in addition to Social Security? . . . . . . . . . . . . . . . . . . . . 1 ❑ Yes 20No

Health insurance? . . . . . . . . . . . . . . . . . . . . . . . . . . . . I ❑ Yes 20No

Life insurance? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I ❑ Yes 20No

Direct medical benefits? . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ❑ Yes 20No

Release time for attending training institutes? . . . . . . . . . . .. . . . . . . . . 1 ❑ Yes 20No

Civic or personal leave (such as leave for jury duty, military reserves, voting, funerals)? . . . . . . I ❑ Yes 20No

Room? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I •l Yes 20No

Meals? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . z ❑ Yes 20No

Other? Specify I •l Yes 20No

13. ARE YOU A PHYSICIAN? 2 ❑ No (Skip to the message after Question. 20.)

I D Yes (Go to Question 14. Questions 14 through 20 apply o@ to ph ysicians.)

14a. DO YOU ATTEND YOUR OWN PRIVATE PATIENTS IN THIS HOME? 1 ❑ Yes 2 ❑ No (Skip to Question 15)

b. HOW MANY OF YOUR OWN PRIVATE PATIENTS DO YOU CURRENTLY ATTEND IN THIS FACILITY? l_I_L_d patients

15. ARE YOU TEMPORARILY ATTENDING PATIENTS IN THIS FACILITY TO COVER FOR THE PATlENT’S OWN PHYSICIAN?

1 •l Yes 20No

16. DO YOU TAKE EMERGENCY CALLS FOR MPATIENTS IN THIS HOME? 1 ❑ Yes 2DN0

17. DO YOU PROVIDE OTHER DIRECT PATlENT SERVICE IN BEHALF OF THE FACILITY’S RESPONSIBILITY FOR SECURING SUCH COVE RAG ES (e.g., Admission exams, pronouncing deaths, securing medication and diet orders, etc.)?

1 •l Yes 20No

18. DO YOU PROVIDE FORMAL INSERVICE TRAINING TO THE FACILITY’S PERSONNEL? I ❑ Yes 2 ❑ No

19. ARE YOU THE MEDICAL DIRECTOR FOR THIS FACILITY? 1 •l Yes 20No

20. FOR HOW MANY RESIDENTS IN THIS HOME DO YOU PROVIDE MEDICAL CARE? l_l_l_d residents

THANK YOU FOR YOUR COOPERATION, PLEASE RETURN THE QUESTIONNAIRE TO THE INTERVIEWER IN THE POSTAGE

PAID ENVELOPE PROVIDED OR DROP IT IN THE MAIL TO:

NATIONAL NURSING HOME SURVEY

INFORMATICS, INC.

6000 EXECUTIVE BLVD.

ROCKVILLE, MD. 20852

GPo 914-S78

106
Appendix IV. Criteriafor

classifyingnursing homes

accordingto level of

nursing care

The criteria for classifying facilities are based on

several factors: (1) the number of persons receiving

nursing care during the week prior to the day of the

survey; (2) administration of medications and treatments according to physician’s orders; (3) supervision

over medications that may be self-administered; (4)

the routine provision of the following criterion personal services: rub and massage, help with tub bath or

shower, help with dressing, correspondence, shopping,

walking or getting about, and help with eating; and

(5) the employment of registered professional or

licensed practical nurses. On the basis of these factors,

four types of facilities were distinguished and are defined as follows.

Nursing care home. –A facility is a nursing care

home if nursing care is its primary and predominant

function. Those meeting the following criteria are

classified as nursing care homes in this report.

1. One or more registered nurses or licensed practical nurses were employed.

2. 50 percent or more of the residents received nursing care during the week prior to the survey.

(Nursing care is defined as the provision of one or

more of the following services: nasal feeding,

catheterization, irrigation, oxygen therapy, full

bed bath, enema, hypodermic injection, intravenous injection, temperature-pulse-respiration

check, blood pressure reading, application of

dressings or bandages, and bowel and bladder

retraining.)

Personal care home with nursing. –A facility is a

personal care home with nursing if personal care is its

primary and predominant function, but some nursing

care is also provided. If a facility met either of the

following criteria, it was classified as a personal care

home with nursing.

1. Some but less than 50 percent of the residents received nursing care during the week prior to the

survey, and one registered professional or licensed

practical nurse or more was on the staff.

2. Some of the residents received nursing care during

the week prior to the survey, no registered nurses

or licensed practical nurses were cm the staff, but

one or more of the following conditions were

met.

a.

b.

c.

Medications and treatments were administered

according to physician’s orders.

Supervision over self-administered medications was provided.

Three or more personal services were routinely provided.

Personal care home. –A facility is a personal care

home if its primary and predominant fimction is personal care and no residents received nursing care during the week prior to the survey. Places in which one

or both of the following criteria were met are classified as personal care homes in this report whether or

not they employed registered nurses or licensed

practical nurses.

1.

2.

Medications and treatments were administered in

accordance with physician’s orders, or supervision

over medications that may be self-administered

was provided.

Three or more of the criterion personal services

were routinely provided.

Domiciliary care home. –A facility is a domiciliary care home if its primary and predominant

function is domiciliary care but the facility has a

responsibdity for providing some personal care. If

the criteria for a nursing care home or personal care

home are not met but one or two of the criterion personal services are routinely provided, the faciIity is

classii3ed in this report as a~’’domiciliary care home.”

In the classii3cation process, a criterion was considered as not having been met if the necessary information for that criterion was unknown. For instance,

if the type of nursing staff was unknown for a particular place, it was considered as not having met the

criterion of having one or more registered nurses or

licensed practical nurses on the staff. Establishments

107
indicating that some nursing care was provided but nursing care to some but less than 50 percent of their

not giving the number of ptksons to whom this care patients or residents. Table XIX shows in detail the

was provided were considered as facilities providing classification of the facilities.

Table XIX. Classification of facilities by type of sewice

Classification variable Classification criteria

Percent of total residents who received nursing care dur- 50 percent or more

ing the week prior to tha day of survey . . . . . . . . . .

Number of registered or licensed practical nurses. . . . . . 1+

Does the facility provide:

(a) Administration of medicine or treatments accordingtodoctor’s orders . . . . . . . . . . . . . . . . . ..4

or

(b) Supervision over self-administered medicine?. . . .

Does the facility offer assistance with three activities or

more for daily living? . . . . . . . . . . . . . . . . . . . . . ““”

Does the facility offer assistance with one or two activitiesfor daily living?..,,. . . . . . . . . . . . . . ...” ““

Does the facility offer room and/or board as its on Iy

service?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ‘--

Facility l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NC

None

Yes No

. . . Yes No

. . . . . . Yes

. . . . . . . . .

Pcn Pcn Pc

1+

. . .

. . .

. . .

. . .

Pcn

Some but less than

50 percent

Yes

. . .

. . .

. . .

Pcn

None

Yes

. . .

.,.

Pcn

No

No

Yes No

. . . Yes

Pc D

Ncme

Ncme

Yes

. . . Yes

. . . . . .

. . . . . .

Pc Pc

No

No

Yes No

. . . Yes

DB

I NC = Nursing care home.

Pcn =’Personal cere with nursing home.

Pc = Personal care home.

D = Domiciliary care home.

B = Boarding or rooming house (out of scope).

108
Vital and Health Statistics series descriptions

SERIES 1.

SERIES 2.

SERIES 3.

SERIES 4.

SERIES 10.

SERIES 11.

SERIES 12.

SERIES 13.

Programs and Collection Procedures. -Reports describing

the general programs of the National Center for Health

Statistics and its offices and divisions and the data collection methods used. They also include definitions and

other material necessary for understanding the data.

Date Evaluation and Methods Research .-Studies of new

statistical methodology including experimental tests of

new survey methods, studies of vital statistics collection

methods, new analytical techniques, objective evaluations

of reliability of collected data, and contributions to statistical theory.

Analytical and Epidemiological Studies. –Reports presenting analytical or interpretive studies based on vital

and health statistics, carrying the analysis further than

the expository types of reports in the other series.

Documents and Committee Reports. -Final reports of

major committees concerned with vital and health statistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

Data From the National Health interview Survay.–Statlstics on ]ilness, accidental injuries, disability, use of hospital, medical, dental, and other services, and other

health-related topics, all based on data collected In the

continuing national household interview survey.

Data From the National Health Examination Survey and

the National Health and Nutrition Examination Survey.–

Data from direct examination, testing, and measurement

of national samples of the civilian noninstitutlona lized

population provide the basis for (1) estimates of the

medically defined prevalence of specific diseases m the

United States and the distributions of the population

wtth respect to physical, iiwolo@d, and twchoIog!cal characteristics and (2) analysis of relationships

among the various measurements without reference to

an explicit finite universe of persons.

Data From the Institutionalized Population Surveys. -Discontinued in 1975. Reports from these surveys are included in Series 13.

Data on Health Resources Utilization. -Statistics on the

utilization of health manpower and facilities providing

long-term care, ambulatory care, hospital care, and family

planning services.

SERIES 14. Data on Health Resources: Manpower and FaciIities.–

Statistics on the numbers, geographic distribution, and

characteristics of health rasources includlng physicmns,

drmtistz, nurses, other health occupations, hospitals,

nursing homes, and outpatient facilities.

SERIES 15. Data From Special Survey s.-Statistics on health and

health-related topics collected in special surveys that

are not a part of the continuing data systems of the

National Center for Health Statistics.

SERIES 20. Data on Mortality. -Various statistics on mortality other

than as included in regular annual or monthly reports.

Special analyses by cause of death, age, and other demographic variables; geographic and time series analyses;

and statistics on characteristics of deaths not available

from the vital records based on sample surveys of those

records.

SERIES 21. Data on Natality, Marriage, and Divorce. –Various statistics on natality, marriage, and divorce other than as

included in regular annual or monthly reports. Special

analyses by demographic variables; geographic and time

series analyses; studies of fertility; and statistics on

characteristics of births not available from the vital

records based on sample surveys of those records.

SERIES 22. Data From the National Mortality and Natality Surveys.–

Discontinued in 1975. Reports from these sample surveys

based on wtal records are included in Series 20 and 21,

respect we] y.

SERIES 23. Data From the National Survey of Family Growth.–

Statistics on fertility, family formation and dissolution,

famdy planning, and related maternal and infant health

topics derived from a periodic 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

Nazional Center for Health Statistics

Public Health Service

Hyattsville, Md. 20782
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Serwce

Office of Health Research, Statistics, and Technology

National Center for Health Statistics

3700 East-West Highway

Hyattsville, Maryland 20782

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for a listing of publications in the VITAL AND HEALTH STATISTICS SER IES call 301-436-NCHS