NATIONAL CENTER Series 1 

For HEALTH STATISTICS INumber 7 

. 

VITAL and HEALTH STATISTICS 

PROGRAMS AND COLLECTION PROCEDURES 

Design and Methodology 

for a National Survey 

OfNursing Homes 

A description of the sample design and 

the National Center for Health Statistics 

about nursing homes in the United States, 

employees. 

Washington, D. C. 

U.S. DEPARTMENT OF


HEALTH, EDUCATION, AND WELFARE


Wilbur J. Cohen


Secretary 

survey procedure used by 

for obtaining statistics 

their patients, and their 

September 1968 

Public Health Service 

Wil Iiam H. Stewart 

Surgeon General 
Public Health Service Publication No. 1000-Series l-No. 7 

For sale by the Superintendent of Documents. U.S. Government Printing Office 

Washington, D. C., 20402. Price W cents 
NATIONAL CENTER FOR HEALTH STATISTICS 

THEODORE D. WOOLSEY, Director 

PHILIP S. LAWRENCE, SC. D., Associate Director 

OSWALD K. SAGEN, PH.D.,,Assistant Director for Health Statistics Development 

WALT R. SIMMONS, M. A., Assistant Director for Research and Scientific Development 

ALICE M. WATERHOUSE, M. D., Medical Consultant 

JAMES E. KELLY, D. D. S., Dental Advisor 

MARGERY R. CUNNINGHAM, Information Officer 

OFFICE OF STATISTICAL METHODS 

MONROE G. SIRKEN, Ph. D., Director 

E.EARL BRYANT, M.A. Deputy Director 

Public Health Service Publication No. 1000-Series 1-No. 7 

Library oi Congress Catalog Card Nwnber 68’62231 
PREFACE


A growing concern of public health administrators and others who 

have a responsibility for providing health facilities and services is the 

health and personal-care requirements of senior citizens. In response 

to this concern, the National Center for Health Statistics (NCHS) began 

a program in 1963 to collect statistics from long-stay hospitals and 

resident care institutions such as nursing and convalescent homes. 

The data from these surveys provide an objective basis for evaluating 

the health status of residents and patients and whether or not the 

available facilities and staff are sufficient to meet the patients’ 

needs. 

This report presents a detailed description of the design and 

methodology being used by the NCHS for a series of ad hoc surveys of 

nursing and personal care homes. It serves to provide technical 

support for the publications in Vital and Health Statistics, Series 12, 

which present the substantive findings of the surveys. However, an 

equally important objective of the report is to provide a tested and 

standard methodology that can be used by State and local agencies. 

The development of methodology and conduct of the survey was a 

group effort, involving the staff of the U.S. Bureau of the Census, the 

National Center for Health Statistics, and of the many nursing homes 

which cooperated in the survey. George F. Kearns and Edward F. 

Knowles had primary responsibility in the U.S. Bureau of the Census 

for preparing instruction and interviewer training manuals and for 

providing liaison with the field staff of the Bureau of the Census who 

conducted the survey. The sample was designed by Walt R. Simmons, 

who also served as consultant on all phases of the survey. The survey 

was developed and conducted under the supervision of Earl Bryant with 

the assistance of Carl Taube and Gooloo Wunderlich of the NCHS staff. 

Mr. Bryant also prepared this report. 

The success of the survey was made possible through the cooperation of many individuals, including Bureau of the Census interviewers 

and field supervisors and employees of nursing homes who completed 

questionnaires. Their assistance is gratefully acknowledged. 

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CONTENTS


Preface 

Introduction -----.--

Survey Metiodolo~---------------------------------------------------

Development of Questiomaires and Procedures 

Procedures Used in the National Survey 

Design and Selection of the Sample 

The Sampling Frame and Stratification Procedure 

Selection of Sample Establishments 

Selection of Sample Employees 

Selection of Sample Residents 

Evaluation of Measurement Errors 

Evaluation of Errors in Selecting Sample of Employees 

Nonresponse 

References 

Appendix I. Estimation and Sampling Variance Equations 

Estimator for Resident-T~e Statistics 

Estimator for Employee-Type Statistics------------------------------”


Estimator for Establishment Statistics


Procedure for Computing Sampling Errors


Appendix II. Definitions of Terms Used in the Survey 

Terms Used on the Establishment Questionnaire (HRS-3a)--------------

Terms Used onthe Staff Information and Control Record (HRS-3b) 

Terms Usedon the Staff Questionnaire (HRS-3d)-----------------------

Terms Used on the Resident Questionnaire (HRS-3C)-------------------

Appendix 111. Classification ofHomes by Type of Service 

Appendix IV. Forms and Questionnaires 

Page 

... 111


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THIS REPORT gives a detailed description of the survey design used in 

1964 by the National Centev fov Health Statistics (NCHS) for collecting 

statistics on the Nation’s nuvsing homes, their patients and employees. 

The repovt also pvovides information on the magnitude of certain types 

of measurement ewvors, including WYOVS in selecting the sample of 

employees, and of nonresponse. 

The sample design UMS a stratified, two-stage probability design. The 

fivst stage was a systematic sample of homes from a list j?ame (the 

Mastw Facility Inventory) within each of 12 bed-size, type-of-service 

strati. A sample of patients and a sample of employees was selected 

from each of the sample nursing homes. The second stuge sample was 

selected by the intwviewev at the time of hev visit to the home accovding to instructions pvovided by NCHS. 

The survey was complex since information was collected about three 

diffarent sampling units (homes, patients, and employees) and a number 

of diffevent respondents and data sources were used. 

The report gives a sequential account of how the survey was conducted 

in a home. 
DESIGN AND METHODOLOGY FOR A 

NATIONAL SURVEY OF NURSING HOMES


INTRODUCTION 

An integral part of the program of the National 

Center for Health Statistics (NCHS) is a series of 

ad hoc national surveys of the institutional population. These, combined with surveys of the noninstitutional population conducted by NCHS provide 

comprehensive statistical information about the 

health of the American people.1-3 

The universe for the institutional population 

surveys includes both long-term medical and 

resident care facilities. Resident care facilities 

are those in which unrelated individuals reside, 

usually for relatively long periods of time (30 days 

or more), and those which provide special care 

of or take into custody residents, patients, or inmates. They may be classified into two major 

groups: (1) nursing and personal care homes and 

(2) custodial care homes, resident schools and 

penal institutions. A long-term medical facility 

is defined as any hospital with an average patient 

stay of 30 days or more. 

The surveys are being conducted on an adhoc 

basis, primarily because of the great heterogeneity of the institutional population and associated problems of measurement. They are not 

necessarily conducted in a sequence to gradually 

cover all types of institutions, nor to cover all 

types of institutions in a single survey. Rather, the 

type of survey to be conducted depends on current 

needs for data on specific segments of the population. 

The first institutional population survey was 

of resident places providing nursing and personal 

care to the aged and chronically ill. Since this 

was the first national survey of its kind in the 

United States and because of the increased emphasis on the health and welfare of aged citizens, a 

large volume of data were needed—more than 

could be collected in a single survey. Consequently, it was decided to conduct the survey in 

two phases. 

The first phase of the survey, referred to as 

Resident Places Survey- 1 (RPS-1), was conducted in 1963 and was limited to the types of 

data that could be readily and reliably obtained 

by mail. This included information about the 

establishments (such as their admission policies 

and size) and certain personal and health characteristics of the residents or patients. Health 

characteristics that were easily discerned, such 

as patient’s degree of ambulation, continence, 

mental awareness of surroundings, or his ability 

to see and hear, were reported by a nurse or 

other employee respondent. In addition to nurs ­

ing and personal care homes, RPS- 1 included 

long-term chronic disease units of general hospitals, as well as geriatric, chronic disease, and 

mental hospitals. 

The second phase of the survey (RPS-2) was 

conducted in 1964 by personal visits to the establishments. Detailed information was collected on 

the characteristics of residents, including data 

on chronic conditions and impairments; on the 

characteristics of employees, such as their work 

experience, special training to care for the aged 

and chronically ill, and wages; and on certain 

characteristics of the establishments themselves. 

The scope of the survey was not as broad as 

RPS-1 in that it excluded all types of hospitals, 
except those specializing in the care of geriatric 

patients. A number of reports have been published 

on the findings of both phases of t“he survey .~-Is 

This report describes the design and methodology used for RPS-2. It illustrates the procedures 

to be used in similar future surveys and provides 

technical background information for the substantive reports published in Series 12 of Vital and 

Health Statistics. The methodology is presented 

in detail so that others in State or local governments who may be planning similar surveys can 

have the benefit of this experience. 

SURVEY METHODOLOGY 

Development of Questionnaires 

and Procedures 

The questiomaires ,and procedures were 

developed in a pilot study conducted in Washington, 

D.C., during the fall of 1963 and were refined in 

a pretest in Baltimore, Maryland, during the 

winter of 1964. In each instance, as well as in the 

national survey, the staff of the U.S. Bureau of 

the Census had the primary responsibility for 

training interviewers and collecting data. Content of the questionnaires and specifications 

and design of the survey were the responsibility 

of the National Center for Health Statistics. 

A pilot study was necessary to obtain insight 

into a number of problems. Information was 

needed on the availability of data, how to phrase 

and order questions, the availability of lists of 

residents and employees which could serve as 

sampling frames, the most efficient and effective 

procedure for conducting the survey, the best 

time to arrange for interviews, and how to obtain 

completed questionnaires for employees not present or available at the time of interview. 

Three interviewers were used in the pilot 

study. Two of them were regularly employed as 

interviewers for the Health Interview Survey, 

one of the major statistical activities’ of NCHS.2 

They were, therefore, familiar with much of the 

subject matter to be covered in RPS-2, especially 

about chronic conditions, impairments, use of 

special aids, and other data that they ordinarily 

collect in the household interviews. The other 

interviewer, regularly employed in another large 

survey—Current Population Survey (CPS}4—con-


ducted by the Bureau of the Census, had experi- .


ence in establishment surveys but lacked the


knowledge and experience of the other two in


health surveys. The pilot study, as well as the


pretest,provided an opportunity to determine


the feasibility of using CPS interviewers in the


national survey. If the CPS interviewers could .


be satisfactorily trained in the time allowed,


more flexibility in the field staff could be at­


tained.


At the close of a l-day training session held 

at the Bureau of the Census, each interviewer was 

given five assignments. Administrators of the 

selected nursing homes were contacted by telephone to make appointments for conducting the 

survey. To aid the interviewers and to help insure 

cooperation, NCHS mailed a letter to each admin- ‘ 

istrator. The letter told the purpose of the survey, 

solicited cooperation, and stated that a representative of the Bureau of the Census would call 

in a few days to determine a convenient time for 

visiting in the home. 

For each appointment, the interviewer was 

accompanied by a statistician who was familiar 

with survey objectives. The statistician’s primary 

role was to observe the interview and answer 

questions’ which might arise that the interviewer 

could not answer. Alternative approaches were 

tried during the series of interviews, and notes 

were made on problems that arose as well as on 

suggested solutions to the problems. 

After all interviews were completed, a meeting was held with all the people participating in 

the pilot study to discuss individual experiences 

and to decide on procedures and questionnaires 

that were most likely to be successful. Following 

this discussion, the questionnaires were revised 

and definite procedures were formulated for the 

national survey. 

A formal pretest was conducted during February 1964 in 19 nursing homes in Baltimore. The 

procedures developed in the pilot study seemed to 

function smoothly. Therefore, with minor adjustments, questionnaires and methodology were made 

ready for the national survey. The questionnaires, 

letters, and other forms developed and used in the 

national survey are reproduced in appendix IV. 

Definitions of terms are given in appendix II. 

2

, 

, 

Procedures Used in the National Survey 

Tvaining of field supervisors and interw’ewers. —For the national survey, training of 

personnel was conducted in two stages. First, 

the people who were to supervise the field operations in the various regions of the country were 

instructed in all phases of survey operations, 

including training of interviewers, obtaining establishment cooperation, interviewing procedures, nonresponse followup, editing, and quality 

control. This instruction was given through the 

use of study manuals, training guides, and so forth, 

and in a formal 1-day training session attended 

by all regional supervisors for the Health Interview Survey program. 

After the supervisors had become familiar 

with survey procedures and objectives, they were 

given the task of training interviewers in their 

respective regions. 

Interviewer training was divided into two 

parts: a home-training assignment and on-thejob training by the supervisor on first interview 

assignments. At least 1 week before an interviewer was to complete her first interview 

assignment, she was sent a package of training 

materials, supplies, and instructions for contacting and obtaining the cooperation of establishments. Home training consisted of studying 

the interviewer instruction manual, answering 

questions about the questionnaires and procedures, and working through a practice narrative, 

i.e., a mock interview. Questionnaires were 

completed with the answers provided in the narrative. The material was presented in the same 

sequence as the procedure to be followed in conducting the survey in an establishment. The interviewer was told to read, in order, the appropriate sections of the training guide and 

instruction manual and to answer the questions 

that appeared at the end of each section. She 

was to compare her answers with those on a key 

and to review the troublesome areas before 

proceeding to the next section of the training 

materials. The interviewer was to make notes 

on anything not understood and to get them clarified by her supervisor before her first interview. 

On-the-job training involved a meeting of the 

interviewer and supervisor immediately prior to 

the interviewer’s first assignment, allowing 1 to 

2 hours to discuss survey procedures and to 

answer any questions that the interviewer might 

have. Then the supervisor accompanied the interviewer on her first assignment to observe the 

interview. Afterwards they met again to discuss 

problems encountered in the interview. 

As a quality control measure, statisticians 

from the Bureau of the Census and NCHS made 

visits to a number of the regional offices almut 

2 to 3 weeks after the survey began to be sure 

that the supervisors understood and were properly carrying out survey specifications. They 

also made spot checks on interviewer performance by visiting several establishments with the 

interviewers. 

A total of 141 interviewers were employed 

in the survey, of which about half were regular 

interviewers for the Health Interview Survey. 

The remaining interviewers were employed in 

other continuing surveys conducted by the Bureau 

of the Census, most of whom were interviewers 

on the Current Population Survev. 

Obtaining establishment coopwation. — The 

initial contact with the sample establishments 

was made by mail (Form HRS-3f in appendix 

IV) about a week prior to the time of the interviewer’s visit to the establishment. The letter, 

signed by the Director of the Bureau of the Census, 

told the administrator about the survey, requested 

his cooperation, and indicated that a representative would call to make an appointment for conducting the survey. The interviewer’s telephone 

call followed within 3 to 4 days. In the conversation, she suggested a date that fitted into her 

overall interviewing schedule, but to the extent 

possible, the administrator was given a choice. 

The interviewer tried to schedule the interview 

for about 9:30 a.m. so as not to interfere with 

the early morning duties at the home. Beginning 

this early, many of the interviews could be 

completed before noon. Those that could not be 

completed before noon were discontinued about 

11:30 and resumed around 2:00 p.m. Since the 

length of an interview was uncertain, the interviewer was instructed not to make more than one 

appointment a day. 

Visit to the establishment to conduct the 

swvey. — After introducing herself to the admin3 
istrator, the interviewer began the interview by 

describing briefly the three elements of information covered by the survey (establishment, 

staff, and patient information) and by specifying 

the order in which the interview was to proceed. 

The following is an example of the recommended 

approach: 

“Mr. Green, this first form (referring to the 

Establishment Questionnaire) is for obtaining 

information about the number of beds, number 

of employees, number of patients discharged 

last year and so on. As you can see, this will 

probably take five or ten minutes. 

“Next I want to get a list of all your employees. For some of them, I want to ask a 

few questions and have those who are available complete a very brief questionnaire. 

“Finally, I need to get some information 

about some of the patients or residents. 

Since this pertains primarily to health, I 

would probably need to get this information 

from the person in the immediate charge of 

their care.” 

This example was modified as necessary to 

fit the situation. To illustrate, in some homes the 

design called for collecting information on all 

staff and patients rather than on a sample. The 

interviewer emphasized that the data would be 

held strictly confidential by the Bureau of the 

Census and the National Center for Health Statistics and would be used for statistical purposes 

only. Ordinarily, with this assurance, the administrator did not hesitate to cooperate fully 

in the survey. However, if he was reluctant to 

identify the names of individuals, they were 

identified on the questionnaire by numbers only. 

Thus, to obtain information about such persons, 

the interviewer would pose questions like, “Now 

I want to ask about the third patient in the file; 

the eighth patient in the file,” and so cm. 

Completion of the Establishment Questionnaire (HRS-3a).—The respondent, usually the 

administrator, was handed a copy of the form to 

make it easier for him to follow questions as they 

were asked by the interviewer. The respondent 

usually knew the answer to most of the questions. However, when he was not sure of the 

answers, he was requested to refer to records or 

possibly to another employee in the home. The 

procedure varied somewhat, depending on the situation, and it was left to the interviewer to choose 

the procedure that seemed most efficient and 

practicable. For example, she might point out to 

the administrator before the interview began that 

certain information would likely have to come 

from the records. The administrator could then 

assign another person to compile the necessary 

information while the interviewer proceeded with 

other parts of the survey. In general, records 

were used to obtain the number of residents in 

the home, number and types of discharges, and 

number of employees. The number of residents 

receiving nursing care during the week prior to 

the survey may have been based on the personal 

knowledge of the nurse providing care or on the 

records; the larger the home, the more likely 

that records would be available and used. In 

answering the ,question about residents receiving 

nursing care, the respondent had access to Card 

A, “List of Nursing Services” (appendix IV). 

Completion of the Stuff Information and Contvol Record (Fore HRS-3b). —After completing 

the Establishment Questionnaire, the name (including the title of h4r., Mrs., Miss, or Dr.) of 

each employee working in the establishment 

15 hours or more per week was listed on the 

Staff Information and Control Record, indicating 

in the appropriate column of the form the profession or type of work performed. As the 

respondent called out the name of each employee, 

he was asked, “What is his job here?” Reference 

was made to Card B, “List of Selected Job Categories ,“ to determine the code number to enter 

on the form. (Card B is reproduced in appendix 

IV.) If the employee’s job was in the group 

numbered 1-10 on Card B, he was considered 

“professional,” and the code for his job was 

written in column 1 of the form. For an ‘‘administrator, “ it was determined if he performed any 

of the other jobs shown on Card B. If so, the code 

number(s) for the other job was entered in parenthesis beside the code numbers designating “administrator.” If the employee’s job was classified 

as Code 11 (other nursing personnel), he was considered “semiprofessional” and an ‘‘11‘’ was 

written in column 2 of the form. Other employees 

4 
1 

1 

I (numbers 12-15 on Card B) were considered as 

“nonprofessional.” For each such person employed15 hours ormore per week ,theappropriate code was written in column 30f the form. If 

a person’s job title was not listed on Card B, the 

interviewer used her judgment as to which group 

it belonged. 

After the names of all employees were listed, 

the number listed was compared with the number 

recorded on the Establishment Questionnaire as 

usually working 15 hours or more per week in the 

establishment. If the numbers were different, they 

were reconciled and changes were made accordingly. 

Next, a systematic sample of the employees 

listed on the Staff Information and Control Record 

was selected. The interviewer had specific instructions about how to select the sample, which 

are discussed in the next section on Design and 

Selection of the Sample. The remainder of the 

form was then completed for each sample person 

in the order listed. 

In general, the question about the sample 

person’s sex was asked only if it was not obvious 

from the person’s name and title. The interviewer 

was instructed to make an entry for each item on 

the form for every sample person. If the information, which ordinarily came from payroll records, 

was not available, an entry of unknown was made. 

Comp&@on of the supplemental Staff Ques ­

tionnuive (HRS-3d) and selecting sample of residents. — Upon completion of the Staff Information 

and Control Record, the interviewer initiated a 

Staff Questionnaire for each “professional” and 

“semiprofessional” employee in the sample by 

entering an identification number, the employee’s 

name, and the type of job he had in the establishment. For those on duty at the time of interview, 

questionnaires were distributed to be completed, 

if possible, before the interviewer left the establishment. The administrator was requested to 

distribute questionnaires to the remaining sample 

employees as they came to work. These employees, as well as those on duty at the time of 

the interview who were unable to complete the 

questionnaire right away, were asked to complete 

the form and mail it to the Bureau of the Census. 

Precaution was taken to guard the confidentiality 

of information provided by the staff present at 

the time of the survey through the provision of 

envelopes in which a person could seal his completed form, if desired. 

Completed questionnaires were returned to 

the interviewer, who reviewed each form for completeness before she left the establishment. The 

interviewer also made an entry on the Staff Information and Control Record for each sample’ ‘professional” and “semiprofessional” employee as to 

whether the supplemental Staff Questionnaire was 

completed at the time of her visit or whether a 

form was left to be completed later. Collecting 

forms before leaving the home was an important 

part of the survey methodology in that it minimized 

the need for expensive followups in case of nonresponses or incomplete responses, and it maximized the quality of completed questionnaires 

since the interviewer had a chance to review them 

for completeness. 

Completion of the Resident Questionnaire 

(HRS-3C). —After completing the Staff Information and Control Record for each sample employee, 

the interviewer told the respondent that she needed 

to obtain certain information about a sample of 

the residents or patients in the home and asked 

if a list containing the names of all residents was 

available from which a sample could be selected. 

If not, a listing was made. In either case, however, 

the interviewer had to make sure that the list 

contained the names of all people who were on 

the register of the establishment, exclusive of 

discharges, and that the number registered was 

consistent with the number recorded on the Establishment Questionnaire. While the respondent was 

distributing the Staff Questionnaire to employees 

in the home, the interviewer selected a sample of 

residents and entered each of their names on the 

Resident Questionnaire. 

The respondent, who was often the administrator at this point in the survey, was shown a 

copy of the questionnaire to indicate the specific 

types of information needed about the residents. 

He was asked if part or all of the information 

could be provided from records or if it would be 

necessary to obtain part of it, especially that pertaining to health, from a person directly responsible for care of the patients. Usually another person 

such as the nurse in charge of nursing care was 

designated as the respondent. 

5 
Records were assembled for each sample 

person and then the interview began, completing 

the Resident Questionnaire shown in appendix IV 

for each resident. Maximum use was made of the 

records for each question. However, it is believed 

that the respondent’s personal knowledge was the 

primary source of veteran status, frequency of 

visits by relatives, limitation of mobility, use 

of special aids, use of dentures, and the primary 

type of care received by the resident at the time 

of his admission to the home. 

In answering questions 9 (use of special aids), 

13 (prevalence of chronic conditions), 14 (prevalence of impairments), and 17 (provision of nursing and personal care), special cards (Cards C-F) 

were used which listed possible answers (appendix 

Iv). 

Although the chronic conditions listed on Card 

D were in lay terms, an attempt was made to 

obtain the exact medical name of each condition 

reported. Thus, if the respondent said a patient’s 

“heart trouble” was a myocardial infarction, the 

latter term was recorded in table 1 of the Resident Questionnaire. 

Ordinarily, by the time the interview shut 

residents was over, the Staff Questionnaires had 

been returned to the interviewer. These were 

reviewed for omissions and completed as necessary before the interviewer left the home. 

The interviewer was also required to complete a special form called the’ ‘Interviewer Check 

List” (appendix IV) before leaving the establishment. This was instituted when the survey was 

about half finished to guard against the types of 

errors that seemed to be predominant, especially 

those relating. to sample selection. 

After completing the survey in an establishment, the questionnaires were mailed to a census 

regional office for certain processing before 

being sent to headquarters in Washington, D.C. 

Regional office p~ocessing and followup. —As 

the questionnaires were received in the census 

regional offices, they were reviewed for’completeness and for problem areas that may be apparent 

in the survey procedures. Editing consisted primarily of an inventory of forms to be sure that 

(1) a questionnaire was present for each sample 

person and each sample establishment, (2) each 

form was properly identified with a predetermined 

establishment number, (3) an entry appeared in 

certain crucial items of the questionnaires, (4)the 

sampling procedure was carried out properly, and 

(5) a control was kept on the receipt of Staff 

Questionnaires mailed in by respondents who did 

not complete questionnaires at the time of the 

interviewer’s visit in the establishment. Mail or 

telephone followups were made as necessary to 

complete questionnaires or correct errors. 

As Staff Questionnaires were received in the 

mail, they too were edited for completeness, and 

entries were made on the Staff Information and 

Control Record to show the date the form was 

received in the regional office. 

Nonresponse followup involved two stages of 

solicitation. The first was by mail 1 week after 

the interviewer’s visit in the home (Form HRS-3g, 

appendix IV), and the second was 2 weeks later 

by telephone. In both instances the sample employee was contacted. Results of the nonresponse 

followup are discussed in the section on Evaluation 

of Measurement Errors. 

When Staff Questionnaires had been received 

from all sample employees and when errors or 

omissions had been corrected, the questionnaires 

were forwarded to Washington for final processing. 

In Washington, spot checks were made of 

completed questionnaires throughout the survey 

to detect any errors consistently being made. As 

such errors were detected, they were brought 

to the attention of all regional office directors. 

In fact, these spot checks ultimately led to instituting a routine procedure (the Interview Check 

List shown in appendix IV) for the interviewers 

to use to minimize errors. 

DESIGN AND SELECTION 

OF THE SAMPLE 

The RPS-2 was based on a stratified, twostage probability design. The first stage was a 

systematic sample of establishments. With these 

establishments serving as primary sampling 

units, systematic samples of residents and employees were selected. 

The design was to be approximately optimum 

to produce statistics with a specified precision 

at a minimum cost. The ability to produce such 

6

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

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

a designwas conditioned
by the factthatno


singlefactorcoulddetermineuniquely
thedesign.


This was a multipurposesurvey;thereforethe


designhad to be balancedtosatisfya
number of


objectives.
 Alsothedesignwouldneedtobebased


on lessthanpreciseinformation
aboutpopulation


variancesandunitcosts,whichwere determined


from pretestdata and othernationalsurveys.


In planningthe RPS-2, some of theleading


considerations
 were as follows:


1. The surveyshouldprovideseparateesti-


mates for each of 12 bed-size,
type-of­


servicestrata.


2. Estimateswere requiredfor specified


characteristics of establishments,
 resi­


Table A. Number of establishments,
beds, and employees in the RPS-2 sampling frame, by


primary strata (type of service and size of establishment)


Type of service and size of establishment


Total---------------------------------


Nursing care


All sizes


Under 30 beds-------------------------------
 30-99 beds----------------------------------
 100-299 beds--------------------------------
 300 beds and over---------------------------


Personal care with nursing


All sizes-----------------------------


Under 30 beds-------------------------------
 30-99 beds----------------------------------
 100-299 beds--------------------------------
 300 beds and over---------------------------


Personal care


All sizes


Under 30 beds-------------------------------
 30-99 beds----------------------------------
 100-299 beds--------------------------------
 300 beds and over---------------------------


Number of


establishments	 Number Number of


of beds employees


Group I Group I


Group I Group 111


16,748 2,772 587,300 256,200


8,155 2,772 336,800 172,400 

4,400 79,000 42,500 

3,247 158,300 80,900 

448 66,000 32,500 

60 33,500 16,500 

4,972 189,400 66,600 

3,168 47,900 18,700 

1,423 71,800 26,200 

345 52,400 16,700 

36 17,300 5,000 

3,621 61,100 17,200 

3,187 37,200 10,500 

402 18,500 5,100 

29 4,300 1,300 

3 1,100 300 

lThe establishmentsin Group II are classified on the basis of old information ob­


tained from source lists used in assembling the MFI. ‘I’hey
 are shown under nursing care
 in this table for convenience.


7

3. 

4. 

5. 

6. 

dents, and employees. Certain parameters 

to be estimated may prevail in no more 

than 1 percent of the population. 

The estimated statistics should be within 

20 percent of its true value at least 95 

percent of the time. 

Estimates should be derived from a ratio 

estimation technique insofar as possible, 

utilizing census-type data collected in a 

previous survey. 

The type of detail needed from the survey 

demanded that the survey be conducted by 

personal visits to sample establishments. 

The sample size for residents or staff 

within an establishment should have an 

upper limit of 10 to 15 persons. This was 

necessary since one person often would 

respond for all sample persons. 

The Sampling Frame and 

Stratification Procedure 

Conceptually, the sampling frame for the 

survey was composed of all establishments in the 

United States that provided long-term nursing and 

personal care to the aged and chronically ill. 

This included such places as geriatric hospitals, 

nursing and convalescent homes, and homes for 

the aged. The principal frame was the Master 

Facility Inventory (MFI), which is a listing of the 

names, addresses, and descriptive data for the 

vast majority of institutions and hospitals in the 

United States. The MFI was supplemented by a 

probability sample of establishments not in the 

MFI list, which is commonly referred to as the 

Complement Survey. A detailed description of the 

MFI and the Complement Survey has been published.L5’16 

The establishments in the MFI were divided 

into two groups on the basis of whether or not 

current information was available about the establishment. Group I was composed of establishments which returned a questionnaire in a previous survey of the MFI. Group 11 contained 

places which were possibly within the scope of 

RPS-2 but were not confirmed in the MFI survey, 

i.e., nonresponse, questiomaires not delivered 

by the Post Office because of insufficient addresses, and newly listed establishments which 

had not been sent a questionnaire. Group I was 

sorted into 12 type-of-service, bed-size groups. 

Further stratification within each of these primary strata was accomplished by sorting on 

type of ownership and then on State and county , 

within each service-size-ownership group. Group 

II was considered a separate stratum and was 

substratified in a similar manner except that the : 

specific type of establishment was not known. 

Only information from source lists used in 

assembling the MFI was available for Group II 

piaces. The distribution of establishments, beds, 

and employees in the sampling frame by primary 

strata (type of service and size of establishment) 

is shown in table A. The procedure for classif ying 

establishments by type of service is shown in 

appendix III. 

Selection of Sample Establishments 

The sampling of establishments from the 

MFI was systematic after a random start within 

each of the primary strata. The first-stage sampling fractions varied depending on the size and 

type of e’stablishment, ranging from unity for 

establishments with 300 beds and over to 1 in 50 

for personal care homes with less than 30 beds. 

Table B shows for each stratum the sampling 

fractions used, number of establishments selected 

in the sample, and the number of establishments 

in scope and in business at the time of the survey. 

It should be noted that the majority of the 

establishments in Group H were either out of 

business or out of scope of the survey. Of the 73 

places selected in the original sample, only 19 

were found to be in business and within the scope 

of RPS-2. 

Selection of Sample Employees 

The sample of employees was selected by 

Bureau of the Census interviewers, using a Sys ­

tematic sampling technique after a random start 

within each of three job category strata. The 

random “start with” number and sampling inter -

8 

I 
--------------------------

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Table B. Sampling fractions for selecting establishments for RPS-2, and distribution


of the s&pl= by primary strata (type of service and size of establishment)


Number
 Total
 Sampling in in scope
 Type of service and size of establishment fraction and in
 sample
 .


Group I


Total -----------------------------------------------


Nursing care


All sizes ---b-.-----------


Under 30 beds


30-99 beds ----.--- -----..--


100-299 beds


300 beds and over
 -


Personal care with nursin~


All sizes


Under 30 beds


30-99 beds -.------


100-299 beds


300 beds and over


Personal care


All sizes


Under 30 beds


30-95 beds ---m---­


100-299 beds
 -


300 beds and over
 -


Group II


Total


Under 25 beds


25-99 beds


100-299 beds -----h--


300 beds and over


business


11,128 11,066


634 597 

1/25 179 158 

2/25 260 249 

3/10 135 132 

1/1 60 58 

381 369


1/25 128 118 

2/25 114 113 

;;$0 103 102 

36 36 

113 100 

64 53


32 32


14 12


3 3


73 19


1/50 52 15 

;;;5 15 3 

3 

1/1 3 i 

lThe sample includes 4 establishments from the Complement Survey; see text for ex-


planation.

val (’‘take every” number) were specified by the lishment in the sample. These figures were deterWashington office and were entered on the Staff mined by using the following tables: 

Information and Control Record for each estabFor Professional Staff 

Strata code 11 12 13 14 21 22 23 24 31 32 33 34 81 82 83 84 

Start with 1 1 4 + 1 1 2 $ 1 1 2 + 1 1 3 + 

Take every all all 4 9 all all 4 9 all all 4 9 all all 4 9 

$Denotes variable “start with” numbers ranging from 1-9 (see text). 

Semiprofessional Staff 

Strata code 11 12 13 14 21 22 23 24 31 32 

Start with 1 +4 5 17 1 44 6 12 1 w’ 

Take

@#Denotes 

every 

a variable 

all 

“start 

2 8 

with” 

18 

number 

all 2 

of 

8 

either 

18 3all

1 or 2. 

2 H3!f!

OthwStaff 

Strata code 11 12 13 14 21 22 23 24 31 32 33 34 81 82 83 84 

Start with 1 $$ 5 17 1 $+ 6 12 1 $+ 1 1 1 ++ 6 12 

Take every all 2 8 18 all 2 8 18 all 2 8 18 all 2 8 18 

#$Denotes a variable “start with” number of either 1 or 2. 

The establishment stratum code, which was 

determined from the name and address labelon 

the Resident Questionnaire foreachsampleestablishment, identified the appropriate “startwith” 

and ’’take every’ ‘ numbersfor eachofthejob categories. For example, ifthe stratum code for the 

establishment was33, the “startwith’’numberfor 

professional staff was 2andthe sampling interval was 4; for both semiprofessional and other 

staff the “start with” number was 1 and the sampling interval was 8. 

In certain instances, variable “start with” 

numbers were used. For professional staff employed in establishments with 300 beds and over 

(denoted by+in thetable forprofessional staff), 

a “start with” number of 1-9 was assigned in 

numerical order to the first nine establishments 

listed in each of strata 14, 24, 34, and 84. The 

process was repeated until the starting number 

had been assigned for each of the establishments 

in these strata. For semiprofessional and other 

staff employed in establishments with 30-99 beds 

(denoted by AJ in the above tables) a number “l” 

or “2” was assigned alternately to each establishment in the affected strata (strata 12, 22, 32, 

and 82). 

Part of the procedure that an interviewer 

followed in conducting the survey in an establishment was to make a list of all employees 

working in the establishment 15 hours or more 

per week and to select a sample of employees. 

The procedure used for establishing this sampling 

To

-----

------

-----

------

-----

------

-----

------

Table C. Number of employees in sample establishments, number of employees in the sample who responded,


and number of employees in the sample per sample establishment, by job category and primary strata


(type of service and size of establishment)


Number	 of employees in sample Number of employees in the !?umber of employees


sample who responded sample establishment 

Type of service 

and size of 

. establishment Pro - Semi - Pro - Semi - Pro - SemiTotal fessional 

professiona 1 

Other Total fessional 

pro -

fessional 

Other fesiional 

pro - Other fessiona 1 

establishments in the sample per


All types-- 49,993 9,341 17,841 22,811 11,832 3,710 4,277 3,845 3.4 3.9 3.5


GROUP I


Nursingcare


Under 30 beds-- 1,812 495 842 475 1,661 495 777 389 3.1 4.9


30-99beds 6,371 1,369 2,918 2,084 3,853 1,358 1,459 1,036 5.5


100-299beds--- 10,538 1,817 4,411 4,310 1,474 395 548 531 3.0 ::;
 300+ beds 16,441 3,309 5,141 7,991 1,047 368 266 413 6.3 4.6


Personal care


with nursing


Under 30 beds-- 765 207 334 224 765 207 334 224 2.8


30-99beds 2,211 375 903 933 1,286 371 455 460 ::! 3.9


100-299beds--- 5,128 769 1,463 2,896 

300+ beds 5,130 693 1,379 3,058 

Personal care 

Under 30 beds-- 202 

30-99beds 425 H 1;; 2?; 

100-299beds--- 510 65 100 345 

300+ beds 259 36 86 137 

GROUP 11 

Under 25 beds-- 143 32 48 

25-99beds 52 9 !3 13 

100-299beds---

300+ beds i ; ; i 

frame is described on page 4. The sample of 

employees was selectedby applyingthe “start 

with” and “takeevery’’numbers thatappeared in 

the heading of the Staffinformationand Control 

Record for an establishment.Table Cshowsby 

primary stratathe distributionoftotalemployees


in the sample establishments,employees inthe


sample who responded, and the number of em­


ployeesselectedinthe sample per sampleestab­


lishment.


There was no particular orderforlisting
em­


ployeesinthesampling frame. For themost part,


717 212 165 340 2.1 1.6


309 78 69 162 2.2 1.9


190 73 41 0.8 

250 87 61 J: ;:; 1.9 

85 20 17 48 1.7 1.4 

20 4 7 9 1.3 2.3 

143 32 63 48 2.1 4.2


31 9 15 7 3.0 5.0


i 1 1.0


payrollrecords were used to identifyemployees


for the listing.
Sometimes, especiallyfor small


places,the listwas made up on the basisof the


respondent’smemory. Theorderwas alphabetical


by employee name for some places,innumerical


order accordingto procedures used innumbering


records inotherplaces,and still
inotherplaces


the names were ordered according to the em­


ployee’stype of work. Consequently,thereisno


apparent reason to believethattheorder of the


listingresulted in an appreciable systematic


bias in the sample estimates.


11

-----------

-----------

Selection of Sample Residents 

In general, the procedure for selecting a 

sample of residents from an establishment was 

similar to that for sampling employees. A major 

difference was that residents were not stratified 

within a place while employees were. Thus, for 

residents, stratification was done only in the firststage sample of establishments. The overall 

sampling fraction was 1 in 50 for each stratum. 

That is, within each stratum, the product of the 

fraction for selecting establishments and the 

fraction for selecting residents was 1 in 50; 

therefore, the sample was theoretically selfweighting. 

A random “start with” number and “take 

every” number were entered on page 3 of the 

Resident Questionnaire for each sample establishment prior to interview assignment. The 

numbers were determined from the following 

table by knowing the establishment strata code 

which was part of the name and address label. 

For nursing care homes and personal-carewith-nursing homes with less than 30 beds (strata 

codes 11 and 21), “start with” numbers ‘‘1‘’ and 

“2” were assigned alternately to each establishment in the two strata. 

In addition to entering the “start with” and 

“take every” numbers on the Resident Questionnaire, the first three sample designation numbers 

were written on page 2 of the questionnaire (a 

listing sheet for sample designation numbers and 

for sample persons). This provided an example 

for the interviewer to follow in determining the 

remaining sample designation numbers for the 

establishment.. Specific instructions of how to 

determine the sample designation numbers and 

how to select a sample of residents were written 

on page 3 of the questionnaire. 

The sampling frame of residents, i.e., a list 

of persons who were registered as patients or 

residents in the home at the time of the survey, 

was usually readily available in one form or 

another. If not, the interviewer created a list. 

The order of the lists varied for different establishments—some were in alphabetical order, 

some were in order by serial numbers, and others 

were in order according to date of admission. 

Possibly the most common sequence was alphabetical. 

In determining an appropriate sampling 

frame. the interviewer was instructed to make 

sure that the list did not contain the names of 

anyone who was no longer a resident. As a check 

on the accuracy of the sampling frame, the number 

of persons listed was compared with the number 

reported earlier in the interview by the respondent 

in answer to the question “How many residents 

(patients) are currentlyon your register as formal 

admissions who have not been discharged? Do not 

include employees or proprietors. ” (See Establishment Questionnaire in appendix IV.) When 

there was a difference in the two numbers, reconciliation and necessary corrections were made. 

Table D shows the distribution of the number of 

residents in the sample establishments and the 

number of residents selected in the sample by 

strata. 

EVALUATION OF 

MEASUREMENT ERRORS 

The data collected in RPS-2 are subject to 

two types of errors: errors of measurement and 

sampling errors. Measurement errors include 

response errors; nonresponse errors; and errors 

made in sample selection, data processing, or 

other deviations from the specified sample design. 

Straka code 11 12 13 14 21 22 23 24 31 32 33 34 81 82 83 84 

Start with W 1 9 46 W 2 3 57 4 16 20 

Take every 2 4 15 50 2 4 15 50 al; : 2; % al; 4 25 50 

#fiDenotes a variable “start with” number of e~ther 1 or 2. 

12 
-------

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

-------

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

-------

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

-------

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

Table D. Number of residents in sample I	 establishments and number of residents 

selected in the sample, by primary 

strata (tvDe of service and size of 

establis~e;t) 

I Total number of 

residents 

Type of service 

and size of 

establishments In sample In the establishments sample 

All typesi 

All sizes 100,129 10,342 

Under 30 beds 5,034 2,669 

30-99 beds 17,918 4,593 

100-299 beds 33,960 2,252 

300 beds and over 43,217 828 

Nursing care 

All sizes 61,171 6,106 

Under 30 beds 2,955 1,395 

30-99 beds 11,430 2,948 

100-299 beds 18,520 1,223 

300 beds and over 28,266 540 

Personal care with 

nursing 

All sizes 35,206 3,358 

Under 30 beds 1,565 760 

30-99 beds 5,352 1,358 

100-299 beds 13,827 960 

300 beds and over 14,462 280 

Personal care 

All sizes 3,752 878 

Under 30 beds 514 514 

30-99 beds 1,136 287 

100-299 beds 1,613 69 

300 beds and over 489 8 

lThese figures exclude residents of 

Group 11 sample establishments. # 

Sampling error, on the other hand, is primarily 

a measureof variabilityin estimates that occurs 

by chance because only assmpleof thepopulation 

is surveyed. The methodology for computing 

sampling errors, as well as formakingestimates 

based onRPS-2 data, is givenin appendix I. 

As calculated for RPS-2 data, the sampling 

error also reflects part of the variation which 

arises in the measurement process. However, 

systematic accumulative biases are not part of 

the sampling error. Objective evaluationof such 

biases usually require specialstudies, carriedout 

under a controlled procedure, which were not 

done for RPS-2. As pointed out in other parts of 

the report, however, an attempt was made to 

keep systematic bias to a minimum by certain 

built-in controls. 

Evaluation of Errors in Selecting 

Sample of Employee+ 

Since the names of every sample employee 

working 15 hours or more per week were listed 

on the Staff Information and Control Record, it 

was possible to detect deviations from the specified sampling procedure. The types of errors 

that could occur included (1) the number of 

employees listed in the sampling frame that 

did not agree with the number reported by the 

respondent to be working 15 hours or more per 

week (question 10on the EstablishmentQuestionnaire), (2) errors in the listingof employees who 

usually worked less than 15 hours per week, (3) 

entering a code for a job category in the wrong 

column of the Staff Information and Control Record and thus in the wrong strata, (4) failureto 

enter a job category code for a listed employee, 

and (5) misapplying the “start with” and “take 

every” numbers. In all 142 such errors were 

made—about one error per”interviewer for allof 

her assignments , which included, on the average, 

alxmt eight establishments. About half of the interviewers carried out the sampling procedures 

without a detected error. Also, the errors were 

concentrated in only a few of thehomes. Of the 

1,073 places for which Staff Questionnaires were 

completed, deviations from specified sampling 

procedures occurred in 123 (11 percent) of the 

homes. Thus, except for a few instances, there 

was only one error per home. As part of the 

field editing procedures, the interviewer’s work 

relating to sampling was reviewed. Any errors 

found were referred to the Washington Office for 

adecision as to whether the errors were serious 

enough to resample employees in an establishment. The errors discussed in this section were 

13 
-----------------------

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

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

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

--------

----------

---------

-----------

Table E. Number and percent distribution of the sample of Professional and semiprofessional employees by job category aid respohse status 

Response status 

Total employees r 1 

in sample II Questionnaire I Questionnaire Job category


Number


Total 7,994 

Administrators 969 

Registered nurses 1,207 

Licensed practical nurses 1,266 

Nurse’s aides 4,278 

Other professionals 274 

considered too minor to warrant the expenseof 

revisiting the establishments involved. 

Nonresponse 

Several types of nonresponse were possible, 

suchas (1) an establishmentrefusedtocooperate, 

(2) an establishment cooperated byproviding information on only certain parts of the survey, 

(3) Staff Questionnaires left at the establishment to be completed by the sample employee 

were not mailedto the census regional office, or 

(4) certain items on the questionnaire were not 

completed. The only types ofnonresponseof any 

consequence were types (3) and (4). Only 12 of 

the 1,085 sample places refused to cooperate. 

Seven of these were quite small, maintaining 

fewer than 30 beds; four had30-99 beds; andone 

had 100-299 beds. 

The overall nonresponse rate for professional and nonprofessional personnelwas 5.7percent. The rate ranged from alowof 2.2 percent 

for administrators to 6.8 percent for LPN’sas 

indicated in table E. The low nonresponse rate 

for administrators was because most of their 

responses (71 percent) wereobtainedbytheinterviewers. The major reason for nonresponse was 

the inability to contact the employee. Of the 5.7 

percent total nonresponse, 1 percentage point 

II returned I not returned 

Percent Number Percent Number Percent
 <F100.0
 7,537 94.3 457 5.7

100.0 948 97.8 21 

100.0 1,148 95.1 59 ;:; 

100.0 1,180 93.2 86 6.8 

100.0 3,999 93.5 279 

100.0 262 95.6 12 ::2 

1 I 

had changed their place of employment and their 

addresses or telephone numbers were not available and 2.5 percentage points couldnot be contacted for other reasons. Only 0.2 percentage 

points were attributed to refusals. 

Failure to obtain answers to items on the 

questionnaires was generally not a problem as 

indicated in tables F, G, and H. 

Table F shows the percent of items on the 

Establishment Questionnaire notcompleted. l%e 

Table F. Percent of items on the Estab­


lishment Questionnaire not completed,


by item


Item


Number of residents receiving 

nursing care 

t7ho is in charge of nursing 

care


Full time or part time


24-hour nursing care


Physician arrangement


Dentist arrangement


Deaths during 1963------------


Discharges other than deaths


during- 1963------------------


Percent


not


completed


0.9


::? 

4.6 

0.6 

0.6 

2.1 

6.4


14 
----------------

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

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

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

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

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

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

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

-----------

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

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

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

proportionwas lessthan5 percentforallitems


exceptlivedischarges.


The nonresponseratefor sampleresidents


rangedfrom almostzero forsextoa highof21


percentforveteran’s status(table
G).Duringthe


developmental
stageof thesurvey,therewas an


indication thatmany respondents (i.e.,
 adminis­


trators,
nurses,etc.)would notknow whethera


patientwas a veteran.
Therefore,inthenational


surveytheinterviewers were instructed
 toobtain


theinformation from thepatient
himselfifitwas


notavailable elsewhere.Apparently,
 thequestion


was confusingto some oftheinterviewers
 since


itwas notansweredforsucha highproportion
of


residents.


TableH showsthepercentofnonresponse
for


specified itemson theStaff Information
andCon­


trolRecordandtheStaff Questionnaire.
 Thenon-


responseratewas sohighforsome itemsthatthe


Table G. Percent of items on the Resident


Questionnairenot completed, by item


Percent


Item not


completed


Age:


Month and years-------------
 Month only------------------ 16’:: 

Sex---------------------------

Veteran status 2:::


Marital status 1.6


Date admitted:


Month and year-------------- 1.0 

Month only------------------ 1.5 

Residence prior to admission-- 3.0 

How often visited 2.1


Special aid------------------- 1.2


Date last saw doctor:


Month only------------------ 2.0 

Month and year-------------- 1.5 

Date last saw dentist: 

Lost all teeth 3.0 

Full dentures 0.3 

Initial care------------------ 0.9 

Charges 

Primary source ;:: 

Secondary source 6.4 

Nursing services received


Mobility status


lNot ascertained.


Table H. Percent of items on the Staff


Information and Control Record and the


Staff Questionnaire not completed, by


item


Item


Job category


Pay period, wages, and hours


worked per week:


Total sample


Administrators


Other professional


Semiprofessional


Nonprofessional


Sex---------------------------


Room and board----------------
 Month last started work in


this establishment


Year last started work in this


establishment


Age---------------------------


Work experience in this estab­


lishment


Educati.on:


Level and grade-------------
 Grade only------------------
 Special courses
 Degrees-----------------------


Percent


not


completed


0.4 

2::: 

4.2 

2.7 

5.3 

H 

7.7 

;:: 

6.1 

M 

1;:; 

estimateswere meaningless.Items of nonre­


sponseforeachjobcategoryincluded
payperiod,


wages,andhoursworkedper week—ofwhich28.6


percentoftheadministrators
 leftone ormore of


the itemsblank.The percentofnonresponsewas


reportedfor thethreeitems combinedforeach


job categorybecauseoftheway nonresponsefor


theseitemswere imputed.Ratherthanimputefor


each item separately,
 itwas consideredbestto


imputefor allthreeifany oneofthem was left


blank.When possible
 ,theprocedurewastoassign


the wages, hours worked,and pay periodof a


personinasimilarjobworkinginthe
 same estab-


Iishmentto thosepersonswho didnotrespond.


The nonresponseratewas alsohighforitem


4 on the Staff Questiomaire,
whichconcernsthe


degree,diploma,or license
thatanemployeemay


have had.Nevertheless, information
 from the86


percentwho answeredthequestion
was valuable


sincetheprimaryuseof thedatawasto evaluate


15

the validity of the person’s classification by job 

category. The question concerning special courses 

in the care of the aged and chronically ill was 

also often left blank. Of the total sample employees, information was obtained from only 85.7 

percent. The nonresponse rate of 14.3 percent 

included 5.8 percent of employees who did not 

send in a questionnaire plus 8.5 percent who did 

not answer the question. 

Although the nonresponse rate for the question on education was low, the data have serious 

limitations for another reason. College education 

was not adequately defined in the survey, especially as it pertained to nursing education. Some 

registered nurses, for example, indicated that 

they had 3 years of college as a result of their 

training to become a nurse, when the nursing 

school they attended was not affiliated with a 

college or universi~, others with the same training said they had only a high school education. 

REFERENCES 

lNational center for Health Sthtisti cs: Origin,Pwarnt 

and operation of the U.S. National Health Survey. VitaZ and 

Health Statistics. PHS Pub. No. 1000-Seriee l-No. 1. Public 

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

Aug. 1963. 

2

National Center for Health Statistics: Health survey 

procedure, concepts, questionnaire development, and definitions in the Health Interview Survey. Vitat and Hea.Zth Statietks. PHS Pub. No. 1000-Series l-No. 2. Public Health Service. \Vashington. U.S. Government Printing Office, May 1964. 

3

National Center for Health Statistic: Plan and initial 

program of the Health Examination Survey. Vitat and HeaZth 

Statistics. PHS Pub. No. 1000 -Seriee l-No. 4. Public Health 

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

1965. 

4

Bryant, l?. E., Nelson, A. B., and Taube, C. A.: Health 

characterietios of patients in nursing and personal care homes. 

Proosedings of the Social Statistics Section, 1965, American 

Statistical Association, Washington, D. C., 1965. pp. 168-176. 

5

National Center for Health Statistics: Institutions for 

the aged and chronically iII, United States, April-June 1963. 

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

1. Public Health Service, Washington. U.S. Government Printing Office, July 1965. 

6

National Center for Health Statistics: Characteristics 

of residents in institutions for the aged and chronically ill, 

United States, April-June 1963. vital and Health Statistic. 

PHS Pub. No. 1000-Series 12-No. 2. Public Health Service. 

Washington. U.S. Government Printing Office, Sept. 1965. 

7

National Center for Health Statistics: Characteristics of 

patients in mental hospitals, United States, April-June 1963. 

Vital and Health Statistics. PHS Pub. No. 1000-Series 19-No. 

3. Public Health Service. Washington. U.S. Government Print- ‘ 

ing Office, Dec. 1965. I 

8

National Center for Health Statistics: Utilization of institutions for the aged and chronically ill, United States, AprilJune 1963. Vital and HeaZtL Statistics. PHS Pub. No. 1000-

Series 12-No. 4. Public Health Service. Washington. U.S. 

Government Printing Office, Feb. 1966. 

9

National Center for Health Statistics: Employees in 

nursing and personal care homes, United States, Mw-Jun~ 

1964. Vital and HeaZth Statistics. PHS Pub. No. 1000-Series 

12-No. 5. Public Health Service. Washington. U.S. Government 

Printing Office, Sept. 1966. 

10National Center for Health Statistics: Employees in 

nursing and personal care homes: number, work experience, 

special training, and wages, United States, May-June 1964. 

Vital and Heatth Statistics. PHS Pub. No. 1000-Series 12-

No. 6. Public Health Service. Washington. U.S. Government 

Printing Office, Jan. 1967. 

11National Center for Health Statistics: Chronic illnese 

among residents of nursing and personal care homes, United 

States, May-June 1964. Vital and HeaZth Statis tics. PHS Pub. 

No. 1000-Series 12-No. ‘i. Public Health Service. Washington. 

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

l?National Center for Health Statistics: Prevalence of 

chronic conditions and impairments among residents of nursing and personal care homes, United States, May-June 1964. 

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

8. Public Health Service. Washington. U.S. Government Printing Office, July 1967. 

13National Center for Health Statistics: Charges for care 

in institutions for the aged and chronically ill, United States, 

May-June 1964. Vital and Health Statistics. PHS Pub. No. 

1000-Series 12-No. 9. Public Health Service. Washingtcm. 

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

14 U.S. Bureau of the Census: The Current Population Slvwey-A Report on ,Methodologry. Technical Paper No. 7. Washington. L’.S. Government Printing Office, 1963. 

l%ational Center for Health Statistics: Development and 

maintenance of a national inventory of hospitals and institw 

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

l-No. 3. Public Health Service. Washington. U.S. Government 

Printing Office, Feb. 1965. 

16Bryant, E. E., and DeLozier, J. E.: Developing, maintaining, and evaluating a sampling frame of institutions. Pub. 

HeaZth Rep. 83(2):161-166, Feb. 1968. 

000 

16 
APPENDIX I 

AND SAMPLING VARIANCE EQUATIONS 

Three basic types of statistics were collected in 

RPS-2: X-characteristics of residents, Y-characteristics of employees, and Z-characteristics of establishments. The principal type of estimate derived from 

these data was a total such as the number of residents 

uged 65-74 with arthritis, the number of RN’s with 5 

yttms or more of experience, or the number of beds 

in nursing care homes. The formulas for obtaining 

estimates relating to residents, employees, and establishments are shown below. 

Estimator for Resident-Type Statistics 

The estimated total number of residents with an 

X-characteristic is denoted by ~ where 

$3=	 weighted sum of residents with the X-characteristic selected from the Complement Universe, i.e., from places not listed in the MFI. 

The terms involved in the equations are defined 

as follows: 

Xl jk = X-characteristic of ktb resident in the jth 

establishment in the ith service-size 

stratum. 

BI = total number of beds maintained by establishments in the itb service-size stratum of 

the MFI, based on data collected in the MFI 

survey and adjusted to exclude beds in establishments no longer in business or out of 

scope of RPS-2. .-

#1 = ~ ~ Bl, = estimated number of beds main­

~1 1=1 tained by responding in-scope establishments in the i th servicesize stratum of the MFI based on 

data collected in the MFI survey. 

Ml =	 total establishments in the ith stratum of the 

universe. 

mi =	 number of sample establishments selected 

from the i th stratum. 

m I=	 number of responding in-scope sample establishments in the i th stratum. 

Nil =	 total number of residents on the register of 

the j th sample establishment in the ith stratum. 

Aii =	 number of sample residents in the ,“th establishment in the ith stratum for whom 

questionnaires were completed. 

LI = number of primary strata from which establishments were selected with probability less 

than 1. 

Lz = number of primary strata from which establishments were selected with probability of 

unity, plus the Group H stratum. 

The estimator for Al includes correction for nonresponse of Imth establishments and residents ~in that 

Ai~ refers only to responding residents and B, is an 

estimate based only on responding establishments. Bi 

is the actual number of beds in the ith stratum of the 

MFI, including beds maintained by esta~lishments not 

responding in RPS-2. The estimator for X2 differs from 

that for ~1 primarily because it does not contain the 

ratio adjustmen~ it is an estimate of an X-characteristic among residents in establishments with 300 beds 

or more and in establishments in Group II of the sampling frame. 

Estimator for Emplayee-Type Statistics 

This estimator is similar to that for residents, 

except that it takes into consideration the stratification 

of employees within establishments and contains a ratio 

adjustment by strata to correct for underrepresentation 

17

or overrepresentation of specific job categories in the 

particular samples selected within the establishments. 

The estimate ; of an employee statistic Y is given by 

the equation: 

The subscripts refer to the same subgroups as explained above for residents. 

;2 is represented by a similar expression, except that 

it does not include the first-stage ratio adjustment 

Bi/~i, but has instead a nonresponse adjustment factor 

m,/*i.

Y3 is the weighted sum of employees with a Ycharacteristic who were selected from establishments 

in the Complement Survey universe. 

The terms used in the equations are defined as 

follows : 

Tijr =	 total employees in the rth employee stratum in the jth establishment in the ith 

service- size stratum. 

~ij,= total responding sample employees in the 

r th employee stratum in the ~“th establishment in the ith service-size stratum. 

TI.rs =	 total employees in the Sth job category 

in the rth employee stratum in the ith 

service-size stratum. 

rili 

T,jr $i, r. = z i Ijrs where 

J.1 r Ijr 

t,j,. =	 total responding sample employees in the 

Sth job category in the rth employee 

stratum in the j th establishment in the 

ith service-size stratum. 

Other terms in the formula are defined as part of 

the X-statistic estimator. 

Estimator for Establishment Statistics 

The estimator for statistics such as number of 

establishments, number of beds, or other statistics 

which may be considered as characteristics of establishments is represented by the following equation: 

23 is a weighted sum of Z-characteristics among 

establishments in the Complement Survey. 

Each term of the equations has been defined 

previously in the report. 

Procedure for Computing Sampling Errors 

The formulation of sampling variance is different, 

depending on the estimation technique employed in a 

strata—whether a ratio estimate or a simple inflation 

estimate is used and whether the estimate involves 

single-stage or two-stage sampling. For simple inflation estimates involving two-stage sampling, the following formula was usedAto obtain the sampling variance 

of an estimated total, Xi, for the ith stratum. 

where {:x and ~ 2 are estimators of .+x, and .52X,1, 

1 q 1 

respectively, and are represented by the formulas: 

s 

A2 ‘ii (Xijk – :,,
)2 =x 2x..[l k=l riij — 1 

For estimates based on the first stage of sampling 

(e.g., an establishment-type statistic such as the number of beds), the last term of the variance formula 

vanishes. In strata where ratio estimates were used, 

the variance formulation is more complex and may be 

represented by the general variance equation 

2= M:(Mi - m,) 

[ 

4Z 

lx, + iiz tfB 

1 

-2A4 ‘A 

‘1 Mi hi 

i 1X,13,1

M2 I ~ N,; (Nij - ziij) $2, +	 A= 

rni [ mi j=l Nij n..El 2Y’IJ 1 

18


2 
I In the above formulas, the following terms need 

defining: 

I 52lx, and similar terms represent the variation between 

I establishments in the ith stratum; S22x,, is a measure of 

I 

vari:~tion within thejth establishment in the ith stra1 turn. 

( 

I ~lJ- estimated total number of units in the jth 

establishment in the ith stratum with the 

X -characteristic. 

average estimated total number of units per 

establishment in the ith stratum with the 

I X -characteristic. 

estimated average number of persons in the 

j th establishments in the ith stratum with 

the X-characteristic. 

000 

In RPS-2 a variety of estimates were made, such 

as the number of residents by sex, age, health condition, 

service received, and so forth. Each of those estimates 

has a sampling variance, and, in general, the variance 

of one statistic is different from that of another. Since 

it was not feasible to compute variances for all of the 

statistics derived from the survey, an approximate 

method was used which in essence involved fitting a 

curve to a number of point estimates, computed by 

the exact formulas shown above. The curve-fitting 

operation is an iterative process on a computer, using 

the general equation ~i = a,+ ~ Xj . Yij is the relvariante of the j th statistic (Xj) from the ith curve. The 

constants “a” and “b” are functions of the estimates 

and the computed point estimates of relvariances. 

(’The relvariance is the ratio of the variance to the 

square of the estimate. For example, the relvariance 

of Xi is u;, /(xj)’ .) 1 

19 
APPENDIX II 

DEFINITIONS OF TERMS USED IN THE SURVEY 

Four numbered forms were used in the survey 

and are reproduced in Appendix IV. Form HRS-3a, the 

Establishment Questionnaire, and Form HRS-3b, the 

Staff Information and Control Record, were combined 

into a booklet of forms, one of which was used for each 

establishment in the sample. Form HRS-3C, the Resident Questionnaire, was also in booklet form, containing a listing sheet on which the name of each sample resident was recorded, instructions for selecting 

a . sample of residents, and 14 individual resident 

questionnaires. Ordinarily, only about 10 residents 

in a home were in the sample; therefore, except in 

rare instances, one booklet was sufficient for a home. 

Form HRS-3d was a loose-leaf, single-page questionnaire for collecting supplemental information almut the 

professional and semiprofessional employees in the 

sample. It was the only questionnaire of the four to be 

completed by the sample person himself. 

Terms Used on the Establishment Questionnaire 

[H RS-3a’J 

Beds: 

A bed is one set up and regularly maintained for 

use by a resident or patient, whether or not it 

is in use. at the present time. This excludes beds 

used by the staff and those used exclusively for 

emergency services. 

Resident OYpatient: 

The terms “resident” and “patient” are used 

synonymously. A resident is any person who has 

been formally admitted to a home but not discharged. This includes a resident who is temporarily away in a hospital, visiting with friends or 

relatives, on vacation, or some other place, but 

whose bed is maintained for him in the home. 

Nursing caye: 

Nursing care is defined as provision of any one 

of the services listed on Card A, List of Nursing Services, shown in Appendix IV. For the purposes of RPS-2, a person was receiving nursing 

care if he received at least one of the listed services during the 7 days prior to the interview in the 

home. 

Sufx3-visoYy nurse: 

The person who supervises nursing care is the 

person in charge of the daily nursing activities 

provided in the home, such as the head nurse. This 

is not the person who employs the nursing staff 

(i.e., the owner or adminiatrator), unless he also 

supervises the daily nursing activities of the 

nurses. 

On duty 24 hours a &y: 

This means that nursing service is routinely provided at aIl hours of the day or night by either a 

nurse or nurse’s aide. A person is not “on duty” 

if she is available to provide care only upon call 

or in emergencies. For exampIe, a nurse who resides in a nursing home is not on duty while asleep 

even though she is available to provide nursing 

care. 

Full-time staff physician: 

This is defined as a physician (i.e., a doctor of 

medicine or a doctc,r of osteopathy) who is employed by the home for the care of the residents 

and who works in the establishment at least 40 

hours per week. 

A dentist on the premises full time: 

This is defined as a dentist who is employed by the 

establishment and who works in the establishment 

at least 40 hours a week or more. 

Awangement with a physician (or dentist): 

This refers to an agreement, either written or 

oral, between the home and a doctor relating to the 

care of residents of the home. This excludes any 

arrangements that a resident might have with his 

private physician or dentist. 

Regular intends: 

This is defined as “once a week,” “once a month,” 

“every Friday for half a day,” or any other 

specified periodic interval of time. 

Discharge: 

This term is defined as formal removal of a resident’s name from the register of an establishment. 

A discharged person no longer occupies a bed in 

20 
the establishment, and a bed is not held for his 

possible return to the establishment. 

Employee: 

This refers to any person who works in the establishment, other than voluntary workers. Although 

employees are. usually paid, “unpaid workers” 

(such as nuns) in certain types of establishments 

are considered employees. 

Fifteen I1OUVSOYmore pev week: 

This refers to the number of hours that a person 

usually works in an establishment. New employees 

were included even though they had not worked 

as many as 15 hours in the establishment at the 

tim”e of the interview, provided they were expected 

to work at least 15 hours per week. Employees on 

vacation, sick leave, or temporarily away for 

other reasons, were also included if they usually 

worked 15 hours or more per week. 

Terms Used on the Staff Information and 

Control Record [H RS-3b] 

Terms identifying the three job categories and 

other terms used on the Staff Information and Control 

Record are given below. 

Professional: 

This category includes administrators, physicians 

dentists, occupational and physical therapists, 

dietitians or nutritionists, social workers, registered professional or graduate nurses and licensed practical nurses. 

Semiprofessional: 

In this category are other nursing personnel such 

as nurse’s aides, practical nurses, student nurses, 

and other supporting nursing staff. 

Nonprofessional: 

This refers to clerical and other office staff and 

food service personnel such aa cooks and housekeeping personneL 

No attempt was made to define specific job categories, e.g., a “registered professional nurse” or a 

“dietitian.” Instead, an item was added to the Staff 

Questionnaire (item 4 on HRS-3d) for the purpose of 

screening certain job categories that might tend to be 

ill-defined. For example, an entry in the box ‘‘Member-American Dietetic Association” provides a means 

of evaluating the level of skill posaeased by a person 

employed as a dietitian. 

Hours usually worked per week in this establishment was defined by giving examples: (1) If the 

employee’s standard work week is 60 hours and he 

usually works 60 hours per week, enter 60 hours.’ 

(2) If the employee worked 60 hours last week but 

he usually works 50 hours per week, enter 50 

hours. (3) If the employee’s standard work week is 

40 hours, but he usually works 20 hours overtime, 

enter 60 hours. 

Cash wages refers to a person’s gross wages or 

salary, i.e., before any deductions are made for 

income tax, bonds, health insurance, social security, and so forth. For owners or proprietors, 

cash wages refers to adjusted gross income—i.e., 

after operating expenses have been deducted but 

before any deductions for taxea, lmnds, and so 

forth. 

Terms Used on the Staff Questionnaire [H RS-3,d] 

This questionnaire was designed to be aa selfexplanatory as possible since generally it was to be 

completed by the respondent without assistance from 

an interviewer. The job that the sample staff member 

held in the establishment was written on the form by 

the interviewer in the space provided for question 2, 

“How many years have you worked as a ,, 

(i.e., registered professional nurse, nurse’s aide, etc.). 

Thus, the length of time employed does not necessarily 

refer to the person’s total work experience in nursing 

homes and hospitals but to her experience in the type 

of work she was doing at the time of the survey. 

Terms Used on the Resident Questionnaire 

CHRS-3CJ


Date of admission: 

This refers to the date tbe resident was last admitted to the home. If he had more than one episode of stay in the home, the reference ia to the 

date of his most recent admission. 

In bed all OY most of the day: 

This means that the person stays in bed most 

of the time because he is unable to get up (health 

reasons) or because he prefers to stay in bed even 

though he is physically able to getup (psychological 

reasons). A resident who is unable to getup by himself but who ia routinely put in a wheelchair and is 

up and almut most of the day is not considered as 

“in bed all or most of the day.” If a person is confined to bed with an acute condition, such aa a severe cold, but will be up and abut in a few days, he 

was not considered as “in bed all or most of the 

day.” However, a person recently confined to bed 

with a chronic condition who is likely to continue 

to be confined to bed for a long period of time is 

considered “in bed all or most of the day.” 

In own Yoom all or most of the day: 

This means that a person is restricted to his room 

for health reasons or because he prefers to stay 

21

in his room even though he is able to move about 

(psychological reasons). 

Going off the premises: 

This means leaving the home either alone, with 

relatives or friends, or with a staff member to go 

shopping, walking, visiting with friends or relatives, and so forth. This excludes going off the 

premises to see a doctor or dentist. 

Spectil aids: 

Reference is made to those listed on Card C shown 

in Appendix IV. For a special aid to be counted in 

the survey, it was necessary for the sample resident to be actually using the aid. 

Last time resident saw doctov: 

This refers to the patient’s present stay in the 

home for treatment, medication, or examination by 

a medical doctor. Seeing a doctor involves either 

a visit by the doctor to the home or a visit by the 

resident to the doctor’s office for medical advice, 

treatment, medication, or an examination. The 

visit by the doctor to the establishment need not 

be a special visit to see the patient, but to be 

counted, the doctor must provide either treatment, 

medication, or examination. A doctor merely going 

over the charts or making rounds and saying,’ ‘How 

are you, Mrs. Jones?” does not constitute a visit. 

Medication: 

This includes any medicine prescribed by the 

doctor even though it may be a nonprescription 

medicine such as aapirin. 

Seen by the dentist: 

This refers to a visit by the dentist to the establishment to provide dental care to the patient, or 

a visit by the patient to the dentist’s office to 

receive dental care, including routine dental examinations. Also included is dental care provided by 

a dentist employee of the establishment. 

Chronic condition: 

A condition is considered to be chronic if (1) it is 

described by the respondent as one of those listed 

on Card D, “List of Chronic Conditions, ” or Card 

E, “List of Selected Conditions ,“ or (2) it is not 

000 

on Card D or Care E but is recorded in the 

patient’s medical record and reported as chronic 

by the respondent. (Cards D and E are reproduced 

in Appendix IV.) 

Pvimarily nursing care: 

This term is used in the survey in two ways. One 

relates to the primary type of service provided 

by an establishment to the majority of its residents. The classification criteria are given in 

Appendix III. “Primarily nursing care,” as used 

on the Resident Questionnaire refers to primary 

type of care actually provided to the sample person when admitted tc, the establishment. “Nursing 

care” is defined as any one of the items 7-19 on 

Card F, “List of Services.” (Card F is reproduced 

in Appendix IV.) 

Primarily personal care: 

This term is also used in two ways, similar to 

those for “primarily nursing care. ” “Personal 

care,” when referring to individual patients, is the 

provision of any one of items 1-5 on Card F. 

“Primarily personal care” means that personal 

care was the predominant type of service provided, although minimal nursing care may also have 

been provided. 

Room and board only: 

This means that neither nursing nor personal care 

was provided to the resident when he was first 

admitted to the establishment. 

Total chavge for residents care: 

This term refers to the charge made “last month” 

by the establishment for the services that are provided to a resident. Tiiese services usually include 

lodging, meala, nursing care, and personal care. 

The charge made by the establishment includes 

charges for special services if such services are 

provided by establishment employees or by outside 

employees if their services are contracted for by 

the establishment. Excluded are charges for services that are not part of the establishment’s bill, 

such as those provided by a patient’s private 

physician. 

22 
APPENDIX Ill 

CLASSIFICATION OF HOMES BY TYPE OF SERVICE 

For purposes of stratification of the universe prior nursing care (see definition, Appendix II) durto selection of the sample, the homes on the MFI were ing the week prior to the survey in the home, 

classified as nursing care, personal-care-with-nursing, with an RN or LPN employed 15 hours or more 

personal care, or domiciliary care homes. The latter per week. In this report geriatric hospitals are 

two classes were combined to produce the three types included with nursing care homes. 

of service classes shown in table A. Details of the 

classification procedure in the MFI have been pub- 2. A pevsonal-care-with-nursz%g home is defined 

lished.lfi as one in which either (a) over 50 percent of 

the residents received nursing care during the Due to the 2-year interval between the MFI survey week prior to the survey, but there were no and the RPS-2 survey, it was felt that, for producing RN’s or LPN’s on the staff; or (b) some, but
 statistics by type of service from the RPS-2 survey,


the homes should be reclassified on the basis of the less than 50 percent, of the residents received


nursing care during the week prior to the sur­ current data collected in the survey. This classificavey regardless of the presence of RN’s or tion procedure is essentially the same as the MFI LPN’s on the staff. 

scheme. The three types of service classes delineated 

for RPS-2 are defined as follows: 3. A pevsonal ca~e home is defined as one in which 

residents routinely received personal care, but 

1.	 A nuvsing care home is defined as one in which no residents received nursing care during the 

50 percent or more of the residents received week prior to the survey. 

000 

23 
APPENDIX IV 

FORMS AND QUESTIONNAIRES 

U.S. DEPARTMENT OF COMMERCE 

BURSAU OF THE CENSUS 

WASHINGTON, D.C. 20233 

r 1 

L J 

Dear Administrator:


The Bureau of the Census, acting as the collecting agent for the


United States Public Health Service, is conducting a nationwide survey


of nursing homes, homes for the aged, and other establishments providing


nursing, personal, and domiciliary care to the aged and infirm. The


purpose of this survey is to collect much needed statistical information


on the health of residents and on the types of employees in these homes.


This survey is part of the National Health Survey program authorized by


Congress because of the urgent need for up-to-date statistics on the


health of our people.


The purpose of this letter is to request your cooperation and to inform


you that a representative of the Bureau of the Census will visit your


establishment within the next week or so, to conduct the survey. Prior


to his visit, the Census representative will call you to arrange for a


convenient appointment time.


All the information given to the Census representative will be.kept


strictly confidential by the Public Health Service and the Bureau of


ths Census, and will be used for statistical purposes only.


Your cooperation in this important survey will be very much appreciated.


Sincerely yours,


GG


Richard M. Scammon


Director


Bureau of the Census


24

OFFICE OF 

THE DIRECTOR 

U.S. DEPARTMENT OF COMMERCE 

BUREAU OF THE CENSUS’ 

Dear


About a week ago the Bureau of the Census conducted a survey in the


establishment in which you are employed to obtain information on the work


experience and education of certain professional and semi-professional


employees of the home. At that time we left a questionnaire for you to


complete and return to us. According to our records, the questionnaire


has not been received.


Another copy of the questionnaire is enclosed for your use if the other


copy has been lost or misplaced. Please complete the questionnaire and


mail it to the Bureau of the Census within 5 days. For your convenience,


a self-addressed envelope which requires no postage is enclosed.


If you have already returned the original questionnaire, please disregard


this reminder.


Thank you for your cooperation.


%L


Enclosures


Please send completed


form to:


FOF?M HRS.3S (4.2.64) 

Sincerely yours,


Richard M. Scammon


Director


Bureau of the Census


USCC.M!.!. DC 2.’., p.64 

25

Budget Bureau No. 6S-R620.RZ Approval Expires December31, 1964 

CONFIDENTIAL - This in formation iscollected for the U.S. Public Health Service under auzhoricy of Public Law6520f the 84th Conwess 

70 Stat. 48% 42 U.S. C. 305). M information which would pennitidcntification of the individual will beheld strictly confiden!id, will be 

sed only by persons engaged i“ a“d for the purposes of rhe snrvey, and will not be disclos.edcu c.+ased to others for any other puqoses 

7?FR .. -. .-.1687). ....


,ORM HR5-30 (Verify name and address and make my .. CO.S.V c.rr.ctime)€

t. 1-64) 

U.S. DEPARTMENT OF COMMERCE 

BUREAU OF THE CENSUS 

ACTING AS COLLECTING AGENT FOR THE 

U.S. NATIONAL HEALTH SURVEY 

ESTABLISHMENT QUESTIONNAIRE 

Number 

How many beds are regularly maintained for residents (patients)? 

“	 (include anyheds setup forusewhecher ornotthey areinuse atthepresentcime. 

Exclude beds used by staff oranybeds used exclusively for emergency services) 1 

[ Number 

!.	 How man residents (patients) arecurrentlyc.n y.aur register as 

formal aJ“misstons whohave not been discharged? 

(Do not include employees or proprietors) 

Number 

1.	 During the post 7 days how man of these - - residents ~ ORm FSone (patients) received nursing care? By wrsi.g core we mea” (Go fO q. 7; any of the services Iistedcm this card. (Show card A) I 

Registered Licensed L Someone Is the person who supervises NURSING CARE I 0 professional 2 n practical 3 G =1~= a registered pr.afessio”nl nurse, a li:-,lsed nurse nurse practicol nurse, or someone else? 

i.	 Does she work full-time or part-time? I u Full-time 2 n Part-time 

.By full-time we mean 40 or more hours a week. 

1 0 Yes L Is there o nurse or nurse’s aide ON DUTY 24 hours o day? 

~o, Does this home employ a full.time staff physician 1 I-J Yes 21_JN0 

for the care of the residents (patients)? (Go to question 8) 

b.	 Does this home hove an derangement with a physician 1 a Yes 2uN0 

to comcto the home at re ular intervals for the care (Go {o question 8) of the residents (patients ?? 

1 Ig Yes am No c.	 Does this home hav= an arrangement with a physician to come (Go to question 8) to the home whea needed, but not at regular intervals? 

d.	 Does this home have anarran etnent witha hysician to give 1 n Yes 20N0 

medical care to the residents !$patients) IN IS OFFICE? 

1 a Yes 21q No 

10.	 Does this home employ a dentist on the premises full (Go to question 9) time to give dental care to the residents (potients)? 

b. Doesthis home have an derangement with a dentist t a Yes 21_JN0 to	 come to the home at regular intervals to give (Go to question 9) dental care to the residents (patients)? 

1 I-J Yes 2U No c.	 Ooes this home have an arrangement with a dentist to come (Go to question 9) to the home when needed but not at regular intervals? 

1 0 Yes 20 No d.	 Does this home have an arrangement with o dentist fO $ve 

dental care to the residents (patients) IN HIS OF FfCE. 

Page 1 US COMM-DC 244 S7-P64 

26 
9.	 W@ want to know the totol number of resident. (patients) who were discharged during 1963 -- both those who were discharged 

to thair home or same other placo and those who died. First, I want to ask about those who died, 

Number a. How ~my persons died durin 1963 while residents (patients) in your establishment? Include 

thosa who died v,+ile ON YOI!R REGISTER eve” though they were temporarily away in a hospital 

or some other place. 

I 

b. Excluding deaths, how many other dischorg.s did you hove in 1963? . . . . . . . . . . . . . . 

o-u 

Of thase - (q. 9b) - discharges, other than deaths, how many were discharged to the following places: 

(1) Resident’s (patient’s) home w family? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 

(2) Another nursing home, home for the aged, or similar establishment? . . . . . . . . ., , , . . . . . . . . . . 

(3) Mental hospitol? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

‘o~ 

(4) Nonmental hospital?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

(5) Other places? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

(6) Place unknown? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I I 

lo,	 How many persons work i“ this e.st.ablishmem? (Ineluda ovmers who work in the establisbmem 

as well as all Daid emDloyees and members of relieious orders) Fb.	 HOW many of these - (q. 10a) - p+rsons usuolly work LESS than 15 hours a week in 

this establishment? 

(Subtract the answer to question 10b fmm the answer to question 10a 

and insert the difference in item 10c below) 

I 

I€ c.	 NOW I need to list thenomes of the employees who usually work 15 hours or more per week in this 

establishment. 

qame of respondent(s) Telephone number and ext. 

Citle or positicm Date completed 

I 

I hsus Interviewer’s name i Code 

I 

I I 

Zomments i 

:ORM HRS.3. (4-1.641 Page 2 US COMM. DC z44ss. Pe4 

27€
---

---

------

------

------

------

--------

-------- --

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

------

------

----- -- ---

!2?


ORM HRS-3b uS. DEPARTMENT OF COMMERCE 1-1.641 STAFF INFORMATION AND CONTROL RECORD BUREAU OF THE CENSUS 

— What is his iob here? (Enter 

number from Card B) I 

,!prof=~. “Semi- ( ‘Non. sex 

Employees who work 15 sional” p~Ofcs- p:ofe s;, ~Enter 

?r more hours a week ,, 

In thk establishment \Nuu&s ;;”::er ~{+;y fo: 

11) male (Enter Mr., Mr:. ! MISS, sw_ sw_ sw_ and or Dr., first inltlal


and last name) TE — TE_ TE _ fo:


(Circle G-:: (Circle female) 

sample sample persons) persons) persons) 

— (a) (b) (c) (d) (e)

When 

did he Ow (last) my Start DUTS working oes he in this SUAL. establish. Y ment? ork IA 

eek in (Enter lis es. month zblish- and ,ent? year) 

J/L (i) 

Month T Year 

—--

Month 

—-. 

Year 

Month 

Year 

Month 

Year 

Month 

Year 

Month 

Year 

Month 

----— 

Year 

Page 3 

kztablishment number 

INTERVIEWER 

Fill buff, Staff Qu=tiOnn~~fe form (Form HRS-3d.) for each 

sample employee in columns 

(b) and (c) only 

(Check one box for each 

sample employee eligible 

for staff form) 

m CompIeted at time of visit 

D Form left to be mailed in 

Date recelve~~n%~o~ ‘-—-

O Completed at time of visit 

m Form left to be mailed in ~-------

Date recelvc~ m R. O. 

m CompIet cd at time of visit 

n Form left to be mailed in - Date receIve~ ~n~. O. 

m Completed at time of visit 

n Form left to be mailed in . ----.- 15ate receIvelTRT. O. 

n Completed at time of visit 

a Form left to be mailed in 

‘-D~t~r~C~I~e2 %n. 0. 

n Completed at time of visit 

m Form left to be mailed in -— =----

Date receavcd m R. O. 

—— 
I 

RESIDENTS


Sample 

designation Name of sample resident 

(0) (b) 

FORM HRS-9C (3-2 S-64) 

OR PATIENTS IN SAMPLE I 

Line 

No. 

1


2


3


4


5


6


7


8


9


10


11


12


13


14


15


16


18


19


20


Y 

sample Name of sample resident Line 

designation , No. 

(.) (b) 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

% 

37


38


39


40 

2 
Establishment number 

SAMPLING INSTRUCTIONS FOR RESIDENTS (PATIENTS) I 

The sampling instructions for the residents (patients) of this establishment are: 

Starr with 

Take every 

The first three sample designation numbers have been entered in column(a) of the


worksheet on page 2. Continue to add the ‘<Take every” number for each


succeeding line until the sum exceeds the total number of patients now on the I


register as shown by the entry in question 2 of the Establishment Questionnaire,


Form HRS-’3a.


Enter the name of the sample resident (patient) in column (b) on the line opposite


the sample designation number which matches the resident’s position on the


register.


Example: The “Start with” is 1 and the *’Take every” is 2. 

The numbers in column(a) on the worksheet are 1, 3, 5, 7, 9, etc. 

When sampling the register, you take the first patient, the third 

patient, the fifth patient, etc., and enter their names in column 

(b) on the appropriate line. 

For each sample resident (patient) listed in column (b), complete a Resident 

(Patient) Questionnaire, Form HRS~3c, contained in booklet form: 

Page 3 (J5c OMM. DC 2449 S-P04 

30 
1 

Budget Bureau No. 66- R620.R2; Approval Expires December 31, 1964 

Establishment number Resident’s (patient’s ) Iine No. 

Month ~Year 

1. What is the month and year of this resident’s (patient’s) birth? I 

2, sex 1 D Male (Ask question 3) 2 n Female [Go to qIIes.ti.n 4) 

30. Has he served in 3.. h O TE ‘TO INTERVIEWER: 

the Armed Forces of Source of veteran status 

the United States? 1 n Yes {Ask Q. 3b) 2 n No (Go (O Q. 4) “3 m Urikmr+m in forma ti cm 

b.	 Did he serve in I U RecOrd 2Q Sample perso 

World War 1? 1 n Ycs 20N0 3 m Unknown 30 Respondent 

4.	 IS this resident (patient) married, 1 n Married 3 D Divorced 5 m Never married widowed, divorced, separated, or 

never morricd? 2 n Widowed 4 n Separated 

I Month	 1 Year 

1 5. In w%.t month and year was he (last) admitted to this horn=? f 

6.	 With whom dfd he live at I a Spouse only 70 In another nursing home or the”time of his admission? 2 D Children only related factllty 

(Check the FIRST 3 m Spouse a“d children 8 m In mental hospital 

box that applies) 

4 Q	 Re!atives ocher than spouse m 9 n In a 10ng-term specialty hospital 

children (except mental) 

5 n Lived in a,partmenr or own home _ 10 U I“ a general or short-stay hospital 

alone or w,cb umelated perscms t I n Other place (Specify) 

6 n In boarding borne 

7. 

relatives visit isfm? 

(Check the FIRST 2 = LeSS often than once a week but at 4 m Never 

box that applies) least once a nmmh 

Bo. Does he stay in bed all or most of the day? I = Yes (Go to question 9) 2 n No (Ask -.-stion 8b) 

How often do friends or I m AC least once a week 3 a Less than once a mo”tb 

b, Does he stay in his own room all or most of the day? I = Yes z U NO fAsk questiOn 8c) 

c.	 Does he go off the premises iust to walk, shop, or 

visit with friends or relatives and so forth? 1 n Yes ZONO 

). Which of these special aids 

does this resident (patient) 

(Check all that apply) 

use? (Show card C) I n Hearing aid 4 u Braces 7 U EYe glasses 

2 Cl Walker 5 a Wheel chair OR 

3 n Crutches 6 m Artificial limb(s) S n Noneof these aids used 

10.	 During his stay here when did he last see a hfonch I ye=, 

doctor for treatment, medication, or for an m ~fi: ;:l: doctor 

examination by the doctor? 

10.	 During his stay here, 

has he seen o dentist? I m Yes (Ask question Ilb) 2 D No (Go to question 12) 

hionth jYear 

b. When was the last time he saw a dentist? 1 

20. Has he lost ALL of his teeth? I = Yes (Ask question 12b) 2 = No (Go to qwestion 13) 

b. Does he wear full upper and lower dentures? 3 I-J Yes 4DN0 

3.	 Does this resident (patient) have any of these conditions? 

(Show, card D. Record in Table 1 each condition wbi cb the patient has) 1 n Yes 20N0 

4.	 Ooes he have any of these conditions? 

(Show card E Record i“ Table 1 each condition which the pati erd has) I I_J Yes 20N0 

;50. Does he have any other CHRONIC conditions listed in his record that you have not told me about? 1 D Yes 21_JN0 

If “Yes,?’ ask: 

b.	 What are they? 

(Reco KI in Table 1 each chronic condition men titm ed) 

:ORM HRS.3C [3.23.64] 

31


I 
Enter conditions from questions 13, 14 or 1S 

Enter the words used by the respondent to 

describe the condition. 

1. 

2. 

4. 

5. 

6. 

1. 

8. 

For the following conditions ask these questions 

ILL EFFEcTs oF STROKE... . . Whattwe the present ill effects? 

SPEECH DEFECT . . . . . . . . . . . What caused the speech defect? Do 

PARALYSIS, PERMANENT not 

STIFFNESS . . . . . . . . . . . . . . . What part of the body Is affectedi write 

TUMOR, CYST, OR GROWTH. . . .	 What p.a,t of the body is affected? In 

Is it malignant or benign? this 

DEAFNESS, HEAFJNG TROUBLE, column


OR ANY EYE CONDITION. . . . . . Isoneor both ears (eyes)


(Include glaucoma end cataracts) affected?


a 

O No eye condition reported (Go to question 17) 

with glosses? t a Yes 20N0 

8 n Temper? ture-pulse- 17= Intravenous injection 

9D Full-bed bath 19 a Nasal feeding 

Ion Enema 

respiratlO” 18 a Intramuscular injection 

II m Catheterization OR 

12 m Bowel and bladder 

retraining 20m N0ne of the above 130 BIood pressure services received 

140 Irrigation 

Isa Oxygen therapy 

160 Hypodermic injection 

1 mPrimarily 2 ~ Primarily 3m.Room and 

nursing personal - srd only 

care care 

I Amount 

care last month? I* 

6. If any eye conditions have been recorded in T Ie 1, ask: 

Yout;ldme about this residentcs (patient”s) eye condition. 

Con he see well enough to read ordinary newspaper print 

7.	 During the past 

7 days which of 

these services 

did this resident 

(patient) receive? 

(Show card F and 

check each one 

mentioned) 

1 nHelp with dr~ssing, shaving, 

or care of hair 

2n Help with tub bath 

or shower 

30	 HeIp.with earing 

(feed,ng the resident (patient)) 

.ID Rub and massage 

SD Administration of 

. medications or treatment 

6D Special diet 

7 U	 Appli$atiOn Of sterile dressings or bandages 

B. Atthe time this resldent(potient) was admitted to 

this home, what kind of care did he receive-primarily 

nursing care, prima,ily personal care, or room and 

board only? (Check one box only) 

?. What was the TOTAL charge for this reside”t”s (patient”s) 

h.	 What is the PRIMARY source of payment for his care? 

(Check ONE box only) 

1 U	 Ow~ income or family support (Incfude private plzns, 

retirement funds, social security, etc.> 

20 Church support 

3U Veterans benefits 

40 Public assistance or welfare 

5 U Initial payment - life care 

6 m Other (Please describe) 

32 

I 20b. 

I 

I 

I 

/ 

I 

I 

I 

I 

I 

I 

I 

I 

I 

I 

Areth=re any additional sources of payment? 

(Check ALL boxes that apply) 

t a	 Own income or family support (Incfude private pks, 

retirement funds, social security, etc.) 

20 Church support 

3D Veterans benefits 

40 Public assistance or welfare 

so Initial payment -life .Care 

6 D Other (Please describe) 

70N0 additional sources 

“scoMM.DC 2449 S--34 
R,, A.., R,,,..,, N. 6R.RK ,17 l?,. A..,fi...l-...=..; . . . ______-—--- .... -. .......... ..XX. .= m-. --l.-. ,, ,0.. say.. “.....”.– . ,., .,”., 

,ORM HRS-3d CONFIDENTIAL -This information iscollected forrbe U.S. Public Healch Semice under 3.91.04) authoriwof Public L.vr6520f the 84zh COngCess (70 Stat. 4S9; 42 U.S.C. 305). AH inforU.S. DEPARTMENT OF COMMERCE macion which would permit identification of the individual will be held strictly con fiden - B1.lRE&LI OF THE CENSUS 

ACTING As COLLECTING AGENT FOR THE cial, will be used only by persons mgagedih md for the purposes of che snrvey, and will 

nocbe disclosed or released to others forany ocber purposes (22 FR 1687). 

o. Establishment number U.S.	 NATIONAL HEALTH SURVEY 

STAFF QUESTIONNAIRE c. Name of person who should fill 

b. Line “wnber 

this form 

only a few minutes to complete the queswould very much ap reciate it if you will 

mail the fottn within $e next 5 cloys. 

will be given confidential treatment by the 

Health Survey end the Bureau of the Census. 

will be used for statistical purposes only, 

I%e U. S.. National Health Survey of the Public Health 

jervice is conducting a nationwide survey in nursing 

lomes, homes for the aged, snd other related types of 

establishments. The purpose of the survey is to obtain 

:ertain information about the staff employed in these 

:stabliahmencs as well as about the health of patients or 

:esidents in the establishments. 

?Iease enswer the questions on this questionnaire. When 

,OU have completed it, mail it to the Bureau of the Census 

n the postage-free, self-addressed envelope provided. 

.Howold w@reyou onyour Iast birthday?. . . . . . . . . . . 

Since it takes 

tionnaire, we 

complete and 

Your answers 

U.S. National 

The information 

and will be presented in such 

person or eatablisbment can be 

Thank you for your cooperation. 

a reamer rhar no individual 

iderrtified. 

Age 

. . . . . . . . . . 

Number of – 

Yeare and ~ 

Y. ara and month. 

year. and month. 

Doctor of Dents! Surgery or Dental Medicine 

(D.D.S. or D.M.D.) 

physician (M.D. or D. O.) 

Master of Social Welfare (M. S. W.) 

Other (P I.... .pecffr) 

None of the above 

US COMM-DC Z4S10-P64 

33 

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

!. How many years have you worked as a -. 

a--in this establishment? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

b .- in other nursing homes, homes for the aged, or related facilities? 

c-- in hospital s? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

(If yotu present jobisinahospitaI, do not include the experience shown in question 2a. ) 

NOTE TO NVRSES: Donottnclude special duty Or/private duty nursing. 

Whatis the highest grada you 

. COMPLETED in schaol? I Elementary school . . 

(Grade school) 

(Circle the highest grade completed) 2 High school . . . . . . . 

aCOllege . . . . . . . ...1 

. 1 2345678 

. 1	 234 

2345+ 

7 u 

e n 

9 n


10 n 

OR 

I I = 

1. Which, if any, af the fallawing I n degrees, diplamos, ar licenses 

do you hav~? 

2 n (Check .11 boxes that apply) 

3 m 

4 D


5 U 

e n 

Registered professional 

nurse (R. N.) 

Licensed practical 

narse (L. P.N. ) 

Degree in home 

economics 

M~mb e; — American 

Dietetic Association 

Registered occupational therapist 

Registered physical 

therapist 

Continue on reverse side 
i. Have you taken any of the courses Ii st.d blow? 

TJ-Yes m No 

+ 

For each course that you have taken, please ideate by checking the appropriate column, 

whether the course was *’accre&:ed ynder college or up,iversity sponsorship” or 

whether it was a “short course, mstmme, or workshop.l] 

Accredited course Short course, 

.ine Types of courses under college or institute or 

No. university sponsorship workshop 

(a) (b) (c) 

1 Notsing home adminisrtarion I 

[ I 

2 Nursing care of the aged or chronically ill 

3 Medical or dental care of the aged or chronically ill 

4 Mental or social problems of the aged or chronically ill 

5 Physical therapy or rehabilitation 

I I I 

6 Occupational therapy 

I I I 

7 Nutrition or food services I I Zomments 

FORM HRS-3d [3-31-64) u5c0MM-mc 2451 O-P6 
I 

I 

I 

1 

I 

I 

I 

I 

, 

[ 

I 

Card h 

LIST OF NURSING SERVICES


1. Temperature—pulse—respiration


2. Full bed bath


3. Application of sterile dressings or


bandages


4. Catheterization


5. Bowel and bladder retraining 

6. Blood pressure


7. Hypodermic injection


8. Intravenous injection


9. Intramuscular injection


,0.Nasal feeding


1. Irrigation


2. Oxygen therapy


3. Enema


Card B 

LIST OF SELECTED JOB CATEGORIES 

JHICH OF THE FOLLOWING JOB CATEGORIES BEST


?ITS THE JOB WHICH THIS EMPLOYEE DOES IN THIS


ESTABLISHMENT?


1. 

2.


3.


4.


5.


6.


7.


8.


9.


LO.


L1.


12.


13.


14.


15.


16.


Administrator


Physician (M.D. or D.O.)


Dentist


Occupational Therapist


Physical Therapist


Dietitian or Nutritionist


Social Worker


Registered Professional Nurse


Graduate Nurse, but not registered


Licensed Practical Nurse


Other nursing personnel (include,


(a) practical nurse, (b) nurse’s aide,


(c) student nurse, and (d) other sup-


porting nursing staff)


Orderly


Clerical, bookkeeping, or other office


staff


Food service personnel (cook, kitchen


help, etc.)


Housekeeping personnel (maid, mainte­


nance man, etc.)


Job other than those listed above


(Please describe employee’s duties)


Card C 

SPECIAL AIDS 

1. Hearing aid


2. Walker


3. Crutches


4. Braces 

5. Wheel chair


6. Artificial limb


7. Eyeglasses


35

Card D 

LIST OF CHRONIC CONDITIONS


Does thisresidenthave any oftheseconditions?


1. Asthma


2. CHRONIC bronchitis


3. REPEATED attacks of sinus trouble


4. Hardening of the arteries 

5. High blood pressure


6. Heart trouble


7. 111 effects of a stroke


8. TROUBLE with varicose veina


9. Hemorrhoids or piles


10. Tumor, cyst or growth


11. CHRONIC gall bladder or liver trouble


12. Stomach ulcer


13. Any other CHRONIC stomach trouble


14. Bowel or lower intestinal disordera


15. Kidney stones or CHRONIC kidney trouble


16. Mental illness


17. CHRONIC nervous trouble


18. Mental retardation


19. Arthritis or rheumatism


20. Diabetes


21. Thyroid trouble or goiter


22. Epilepsy


23. Hernia or rupture


24. Prostate trouble


25. ADVANCED senility


Card E 

LISTOFSELECTED CONDITIONS 

Does thisresidenthave any oftheseconditions?


1.


2.


::


2:


;:


1. 

2.


3.


4.


5.


6.


7.


8.


9.


I.O
.

L1.


12.


L3.


L4.


15.


Deafness or SERIOUS trouble hearing


with one or both ears
 SERIOUS trouble seeing with one or


both eyes even when wearing glasses


Any speech defect


Missing fingers, hand, or arm--toea,


foot, or leg


Palsy


Paralysis of any kind


Any CHRONIC trouble with back or spine


PERMANENT stiffness or any deformity


of the foot,leg, fingers, arm, or back


Card f 

LIST OF SERVICES 

Help with dressing, ahaving, or care of


hair


Help with tub bath or shower


Help with eating (feeding the patient)


Rub and massage


Administration of medications or treatmel


Special diet


Application of aterile dressings or


bandages


Temperature—pulse—reapiration


Full bed bath


Enema


Catheterization


Bowel and bladder retraining


Blood pressure


Irrigation


Oxygen therapy


16. Hypodermic injection


17. Intravenous injection


18. Intramuscular injection


19. Nasal feeding


000 

36
 I 
RESIDENT PLACES SURVEY -2 

iNTERVIEWER CHECK LIST 

hfuke the following checks on the appropriate RPS-2questionnaires for each establishment before you leave the establishment. Place a check 

mmrk � in the box tm the right of each check item after making the specified check mrddeterminingt hat the item is correct. 

Iftheitem isrrot correct, make anynecessary corrections bytalkingb the administrator, resnmpling, oranyotberpmcedure which the item 

roquiros. After ~OrrectinE the item, make a check mark in the box after the item. 

A completed check fist is required for each establishment. 

Form HRS-3a ~ 

1.	 Question 9-The sum of the entries 

in queetions 9b (1)-9b(6) is equal tn 

tbe entry in question 9b. 

Z	 Question 10-The entry inquesticm 

10cis thedifferenoe between the 

numherin question 10b subtracted 

frornthe number in question 10a. 

(The number in question 10c cannot 

belarger thmrthe entry in 10a.) 

Ihmor HRS.31r 

,, ‘1

4. 

K 

G. 

7. 

Tbe number of employees listed on 

Form HRS-3b is the same as tbe 

number entered in question 10c of 

Form HRS-3a. 

Columns (b), (c), and (d)-A job 

cntegory number is entered in one of 

columns (b), (c), or (d) for each 

employee listed. 

Column (c)-Each employee with an 

entry of “11” in column (c) has a 

Iettw suffix, e.g. (11A). If the 

entry is IID, the job description is 

given in a footnote. 

The sample selection in columns (b), 

(c), and (d) is correct. (Look at the 

[{start ,vith~$ and “Take every” numbers 

on page 3 for each column and review 

your selection.) 

Columns (e) through (j) are completed for 

onch sample employee in columns (b) - (d). 

•1 

•1 

•1 

•1 

•1 

•1 

•1 

8.	 Column (k)-A Staff Questionnaire has 

been “completed at the time of visit” 

or “left to be mailed in” for each 

sample employee in columns (b) and (c) only. •1 

Form HRS-3C 

9.	 The number of sample residents (patients) 

is correct using this procedure: 

a.	 Enter the number of residents - (patients) shown in question 2 

of the HRS-3a. 202 

b.	 Subtract the “Start with” 

number g 

c. Divide the difference by the 

“Take every” nrrmher (whole 

numbers only) 15-j% 

d.	 Add” 1“ to the quotient 12+1=13 

obtained above. This is the 

number of sample patients which 13 sample 

should be entered in page 2. residents 

Example: In the example above (patients) 

the number of residents (patients) should be 

in q. 2 nf the HRS-3ais 202. The listed. 

“Start with” is 9 and tbe “Take 

every” is 15. •1 

Form HRS-3d 

10. Each Staff Questionnaire “completed at 

the time of visit” has been reviewed fnr


omissions (age, job experience, etc. and


the back of the questionnaire). �
 11.	 Each Staff Questionnaire has only one job 

category description in question 2. •1 

fi U. S. GoVERNMENT PRINTING OFFICE 1968 —S42041/6 

37 
OUTLINE OF REPORT SERIES FOR VITAL AND HEALTH STATISTICS 

Public Health Service Publication No. 1000 

Series 1, 

Series 2. 

Series 3. 

Series 4. 

Series 10. 

Series 11. 

Series 12. 

Series 13. 

Series 20. 

Series 21. 

“ Series 22. 

Programs and collection procedures.— Reports which describe the general programs of the National 

Center for Health Statistics and its offices and divisions, data collection methods used, definitions, 

and other material necessary for understanding the data. 

Data evaluation and methods research. —Studies of new statistical methodology including: experimental tests of new survey methods, studies of vital statistics collection methods, new analytical 

techniques, objective evaluations of reliability of collected data, contributions to statistical theory. 

Analytical studies. —Reports presenting analytical or interpretive studies based on vital and health 

statistics, carrying the analysis further than the expository types of reports in the other series. 

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 Health Interview Sumey. —Statistics on ilhtess, accidental injuries, disability, use of 

hospital, medical, dental, and other services, and other health-related topics, based on data collected 

in a continuing national household interview survey. 

Data from the Health Examination Sut’vey. — Data from direct examination, testing, and measurement of national samples of the ~pulation provide the basis for two types of reports: (1) estimates 

of the medically defined prevalence of specific diseases in the United States and the distributions of 

the population with respect to physical, physiological, and psychological characteristics; and (2) 

anal ys is of relationships among the various measurements without reference to an explicit finite 

universe of persons. 

Data from the Institutional Population Suvveys.— Statistics relating to the health characteristics of 

persons in institutions, and on medical, nursing, and personal care received, based on national 

samples of establishments providing these services and samples of the residents or patients. 

Data from the Hospital DischaYge SuYvey. —Statistics relating to discharged patients in short-stay 

hospitals, based on a sample of patient records in a national sample of hospitals. 

Data on mortality. —Various statistics on mortality other than as included in annual or monthly 

reports— special analyses by cause of death, age, and other demographic variables, also geographic 

and time series analyses. 

Data on natality, maryiage, and divoyce. —Various statistics on natality, marriage, and divorce other 

than as included in annual or monthly reports— special analyses by demographic variables, also 

geographic and time series analyses, studies of fertility. 

Data from the NationaL Natality and Mo?’tality Swweys. —Statistics on characteristics of births and 

deaths not available from the vital records, based on sample surveys stemming from these records, 

including such topics as mortality by socioeconomic class, medical experience in the last year of 

life, characteristics of pregnancy, etc. 

For a list of titles of reports published in these series, write to: mice of Information 

National Center for Health Statistics 

U.S. Public Health Service 

Washington, D.C. 20201