NATIONAL CENTER Series 1 

For HEALTH STATISTICS INumber s 

VITAL and HEALTH STATISTICS 

PROGRAMS AND COLLECTION PROCEDURES 

TheAgencyReportingSystem 

for Maintaining the National Inventory 

of Hospitals and Institutions 

A study of the development, 

and evaluation of the Agency 

tem was used to reconstruct 

Facility Inventory. 

Washington, D. C. 

U.S. DEPARTMENT OF 

HEALTH, EDUCATION, AND WELFARE 

John W. Gardner 

Secretary 

composition, implementation, 

Reporting System. This SYSand keep current the Master 

Apri I 1968 

Public Health Service 

Wil Iiam H. Stewart 

Surgeon General 
Public Ilealtb service Publication No. 1000-Series l-No. 6 

.— 

For sale by the $uperintentlcnt of Documents, {7. S, Government Printing Ollice, }Vmhington. I ).( ’., 2,MW - l’rim 25 rents 
NATIONAL CENTER FOR HEALTH STATISTICS 

THEODORE D.WOOLSEY, Director 

PHILIPS.LAWRENCE, SC.D., Associate Director 

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

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

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

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

LOUIS R. STOLCIS, M. A., Executive O/ficer 

DONALD GREEN, Information Officer 

DIVISION OF HEALTH RESOURCES STATISTICS 

SIEGFRIED A. HOERMANN, Director 

JOHN MONROE, M.S., A.ssistan t Director 

JACQUELINE GLEASON, M.A., Chief, Health Manpower Statistics Branch 

PETER L. HURLEY, (%ie/, Heaztb Facilities Statistics Branch 

JOHN MONROE, M.S., Acting Chief, Hospital Discharge Suruey Branch 

Public Health Service Publication No. 1000-Series l-No. 6 

Library of Congress Catalog Card Number 67-62376 
PREFACE


The National Center for Health Statistics 

(NCHS) collects and publishes data on health and 

health-related topics. Data are collected on both 

the institutional population and the noninstitutional 

population. Comprehensive statistics on the health 

of the institutional population are provided by 

utilizing probability sample surveys. These surveys are most efficient when the samples can be 

drawn from an up-to-date list of places in the 

universe, properly classified, and accompanied 

by such critical attributes as the numbers of 

employees and beds. The Master Facility Inventory (MFI) comprises this list. 

It is imperative that the MFI be kept as current as possible if it is to serve as an efficient 

sampling frame. To aid in accomplishing this 

purpose, extensive time and preparation have been 

devoted to the development of a system of agencies, 

known as the Agency Reporting System (ARS), 

which will provide information on new institutions 

at regular intervals to be incorporated into the 

MFI. The origin and development of this system 

were the result of the extensive collaboration of 

the Surveys and Research Corporation, the Bureau 

of the Census, and NCHS. 

The Surveys and Research Corporation canvassed prospective sources of facility listings, 

suggested agencies for inclusion in the ARS, and 

recommended steps to be taken in launching the 

ARS. The Bureau of the Census conducted visits 

to agencies maintaining the largest lists of facilities and/or agencies having a large turnover of 

facilities. Also most of the processing involved in 

assembling the updated MFI was handled by the 

Bureau of the Census. NCHS coordinated the projects undertaken by the Bureau of the Census and 

the Surveys and Research Corporation. In addition, 

NCHS conducted a survey by mail of all agencies 

included in the ARS that were not visited by the 

Bureau of the Census, and several members of 

the NCHS staff contributed in other ways to the 

research leading up to the establishment of the 

system. 

This report was prepared by Darrel Eklund. 

... 

Ill 
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CONTENTS 

Preface . . --.-”----

Introduction -,.”------ “--------- -

Background --------------------------------------------------------

Development of the First Master Facility Inventory --------------------

Evaluation of Coverage of the Master Facility Inventory 

Maintaining the Master Facility hventory 

Development of - the Agency Reporting System --,-- -. -.,--. -. --- . -- - . -- -

Survey Chronology and Procedures - -- -- - -- ---- -- -- . - -- . 

Composition of the Agency Reporting System -----------------------------

State Administrative Agencies ---------- ---.--- -----.--

State Re~latory Agencies -------------------------------------------

Secondary Sources ------------------------------------------------- , 

Implementation of the Agency Reporthg System 

Obtaining Agency Cooperation -. - - --- - -. ---, ---- -- -- -

Reconstructing the MFI- - -- --+- - - - . -. --

The Agency Reporting System hformation Files 

Basic Information Ffle ----------------------------------------------

Reporting Information File ------------------------------------------

Evaluation of the Agency Reporttig System ------------------------------

Investigation of Coverage Gaps --------------------------------------

Homes forthe Aged------------


Homes for Dependent Children --------- --., ------ -----.”--- -


Future Maintenance of the ARSand MFI------------------------------

Appendix I. Survey Letter Announcing Visits Conducted by the Bureauof 

the Census . --------

Appendix H. Annual Report Gard Used inthe Reporting Information File---

Page 

... 111


1 

1 

1 

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2 

3 

3 

5 

6 

7 

9 

10 

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11 

11 

12 

12 

13 

13 

13 

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CONTENTS—Con. 

Table 

1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

9* 

10. 

Number of survey schedules mailed and response, by type of schedule-­

Number of State administrative and regulatory agencies, by type -------

Number of State and Federal administrative and regulatory agencies in 

the survey, byt~e 

Number of State agencies administering facilities, by type---

Number of State agencies regulating facilities, by type ---------------

Percent distribution of facilities in files reported by regulatory agencies, 

by t~e-------------------------------------------------------

Percent distribution of 1964 additions to files of regulatory agencies, 

by type of establishment 

Percent distribution of 1964 additions to files of regulatory agencies, 

by type of agency 

State estimates of the number of facilities not included inthe Agency 

Reporting System andspecific area of undercoverage 

Percentage of facilities missed in the Master Facility Inventory at the 

national level according to State agency estimates 

Page 

4 

5 

5 

6 

8 

8 

9 

9 

15 

16 
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I Category not applicable . . . I 

I Quantity zero -

I 

Quantity more than Obut less than 0.05---- ().() 

Figure doesnot meet standards of 

* reliability or precision 
IN THIS REPORT the Agency Re~ovtingSystem (ARS) is described. The 

ARS was chiefly conceived of as a means of updating the Master Facility Inventory. This system of agencies was developed by canvassing 

State and Federal agencies, national organizations, and commercial 

publishers believed to maintain files containing the names and addresses 

of in-scope facilities, such as h.osfiitals and nursing homes. 

The implementation of the ARS MS initiated by visiting the agencies 

maintaining the largest lists offacilities an&or having the largest tuvnovev of facilities. The vemainingagencies in the ARS were contacted bj 

maiL In this initiai contact, the agenciesr coo@vation was enlisted in 

reporting new facilities at that time and at regular intevvals in the future. 

An evaluation was made of the Undercovwage in the Master Facility Inveniory to dt?temnine the adequacy of the ARS as a means of pvoviding 

a complete and cuwetit list of in-patient facilities. The evaluation ve ­

vealed that the wndercoverage in the Master Facility Inventory was quite 

small, 

viii 
THE AGENCY REPORTING SYSTEM


FOR MAINTAINING THE NATIONAL INVENTORY 

OF HOSPITAL S AND INSTITUTIONS 

INTRODUCTION 

Background 

The National Center for Health Statistics 

(NCHS) maintains a system for collecting data 

on health and health-related topics. In addition 

to compiling national figures from State and local 

registration of vital events such as births, deaths, 

marriages, and divorces, NCHS conducts a variety 

of continuing and ad hoc sample surveys to collect 

information on the general health of all persons 

living in the United States, 

The Health Interview Survey and the Health 

Examination Survey collect information on the 

noninstitutional population. The Institutional Population Survey provides health statistics on the 

institutional population and represents the most 

efficient medium for the collection of statistics 

on utilization of long-stay hospitals, resident 

institutions, and other types of health facilities. 

In addition, NCHS collects information about 

persons discharged from short-term hospitals, 

This information is collected in the Hospital 

Discharge Survey. In the latter two surveys infor. 

mation is obtained from the facility providing 

service and a major part of the data collected is 

based on existing records, 

The universe or sampling frame for the 

Institutional Population Survey and the Hospital 

Discharge Survey is the Master Facility Inventory 

(MFI), This inventory includes all types of inpatient facilities, such as hospitals, nursing 

homes, homes for the mentally retarded, and 

homes for dependent children. The program of 

the MFI includes the development and maintenance 

of a list of names and addresses of all facilities 

or establishments within its scope and the collection of inf, mmation from these places which 

describe them with respect to their size, type, 

and current status of business. The information 

not only provides a basis for stratifying the MFI 

into homogeneous groups for the purpose of 

sampling, but also provides important national 

statistics about the availability of such facilities 

in the Nation. 1 

Development of the 

First Master Facility Inventory 

There were three basic operations in the 

development of the original MFI. First, an investigation was made to determine what files on 

facility names and addresses were available in the 

United States, and which of tie files should be 

merged to produce the most complete list of 

facilities. Second, the selected files were matched 

to eliminate duplicate names. And third, a questionnaire was mailed to each address on the list 

to determine if the place was still in operation 

and to collect information for classifying the 

facilities by type of business, ownership, and 

size. 

The mailing list was essentially the product 

of collating the files of four Federal agencies, 

lNatiohal Center for Health Statistics: Development and 

maintenance of a national inventory of hospitals and institutions. V2d and Hedt% Statistics. PHS Pub. No, 1000-Series 

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

Prin&g Office, Feb. 1965. 

1

each containing between 20,000 and 30,000 names 

and addresses of facilities. Additional facilities 

were added to the list by matching places named 

in directories maintained by national associations 

and organizations and by State licensure files 

for nursing homes and related facilities. 

The matching procedure was a simple one, 

primarily because little information was available on which to make comparisons. The principal 

factors were name and address, but, when available, the number of beds, type of ownership, and 

type of business were used to aid in the matching. 

The criteria for matching were not strict. If 

there was any doubt concerning the match, the 

case was considered a ‘‘nonmatch” and included 

in the mailing list. This procedure insured maximum coverage among establishments in the lists 

being collated, but it also resulted in duplication, 

an undesirable trait of a sampling frame. 

Evaluation of Coverage of the 

Master Facility Inventory 

The importance of knowing the completeness 

of the frame when conducting sample surveys 

cannot be overemphasized. Whether or not the 

survey results produce relatively precise national estimates is largely dependent upon the 

MFI’s including a2Z facilities in the Nation. There 

was some confidence that the newly developed 

MFI did indeed include all but a negligible number of hospitals and institutions in the United 

States. The confidence, however, reflected only 

subjective evaluations based primarily on the 

fact that the inventory was developed by merging 

several very large files and, consequently, was 

the most complete file of its kind. Such subjective 

evaluations unfortunately did not permit definitive 

statements about the MFI’s completeness. It was 

apparent that some objective method of evaluation 

was needed. 

The comprehensiveness and completeness 

of the MFI were evaluated with the aid of a multiframe method. The method involved the overlap 

between the MFI and a complete listing of inscope facilities in an area sample of the United 

States. Each facility in the area sample was 

matched against the facilities in the MFI. The 

measure of undercoverage in the MFI was based 

on the subsample of places which did not match. 

The results of the study, referred to as the 

Complement Survey, indicated that the first 

attempt at developing a national inventory of hospitals and institutions had been relatively successful. It was. found that at the time of its development, 

the MFI was about 90 percent complete in terms 

of facilities and about 95 percent complete in 

terms of number of beds. Although the sample 

was small, it provided some idea about coverage 

by type of establishment. The most complete 

coverage seemed to be for hospitals as all hospitals in the area sample were listed in the MFI. 

Nursing and personal-care-type homes were less 

complete (about 90 percent); for other types of 

institutions, the coverage was estimated to be 

about 80 percent complete. 2 

Maintaining the Master Facility Inventory 

The MFI is composed of many types of facilities that are in an almost continuous state of 

change. Many new facilities are being built and 

additions are being made to existing structures. 

Some facilities are going out of business permanently while others only change ownership or 

management. Since the MFI is to be the sampling 

frame for surveys of hospitals and institutions, it 

must be kept current. Maintaining the MFI involves 

adding new facilities which go into business each 

year, deleting those which go out of business, and 

obtaining certain information from those currently 

in business. It was planned to survey all new 

facilities each year to obtain the data needed for 

classification purposes and to survey the entire 

MFI every 2 years to bring it up to date. 1 

Before the plan for surveying the MFI was 

implemented, a decision was made to reconstruct 

the MFI. The decision was prompted largely because of the lack of adequate means for adding 

new facilities to the MFI. Supplementary deficiencies such as duplication of facilities and 

difficulty in identifying specific areas of undercoverage were also considered. Thus, in the reconstruction of the MFI a system of agencies 

2

Bryant, E. E., and DeLozier, J. E.: Methodology for Developing, Maintaining, and Evaluating a Sampling Frame of 

Hos~itals and Institutions. Paner Presented at the 94th Annual 

Meekgofthe American Publi; H;alth Association, San Francisco, Calif., Oct. 31-Nov. 4, 1966. 

2 
.1 

I 

I 

I 

was desired that would provide a reliable input 

system for the addition ofnewfacilities, minimize 

the amount of duplication in the MFI, and enable 

NCHS to identify and eliminate undercoverage in 

the MFI. There were a large number of possible 

sources of facility information, many of which 

overlap but none of which were sufficient alone. 

These sources included State licensure agencies, 

certain departments of the Federal Government, 

and private agencies and organizations which 

maintain or publish facility lists. The development 

and maintenance of this system of agencies, knowfi 

as the Agency Reporting System, are discussed in 

detail in this report. 

DEVELOPMENT OF THE 

AGENCY REPORTING SYSTEM 

The development of the Agency Reporting 

System (ARS) was initiated by the contract 

awarded to the Surveys and Research Corporation 

by NCHS on October 26, 1964. The objectives of 

the contract were to survey and identify agencies 

maintaining lists of hospitals and institutions 

providing long-term medical, nursing, personal, 

domiciliary, or custodial care; to obtain information on the scope and character of their name 

and address files; and to make recommendations 

to NCHS concerning the agencies to be included 

in the ARS. It was agreed that the goal would 

be pursued via the following steps: 

1,	 To canvass all State and Federal agencies, 

national organizations, and commercial 

publishers believed to maintain files because they 

a.	 License, approve, register, certify, 

supervise, or otherwise regulate hospitals or institutions, 

b.	 Operate one or more hospitals or institutions, 

c. Administer Federal grant programs 

affecting hospitals or institutions, 

d, Conduct programs whose administration yields as a byproduct listings of 

facilities which include hospitals or 

institutions. 

2,	 To solicit from them, via a mail schedule 

(or interview in the case of Federal agencies), information on the scope and character of their files, methods used to update the files, publication practices, and 

related information. 

3. To ascertain the extent to which these 

files account for all hospitals and institutions deemed to be within the scope of 

the MFI, particularly with respect to facility “births.” 

4. To make recommendations concerning 

the agencies and organizations which 

would be invited to participate in the ARS 

and the operational characteristics of the 

ARS. 

5.	 To prepare a report embodying survey 

findings and recommendations. 

Survey Chronology and Procedures 

The early months of the Surveys ancl Research Corporation’s work were devoted to the 

development of schedules and instructions in 

close collaboration with NCHS staff. Field visits 

to test the schedules were made in the District 

of Columbia and Pennsylvania in December 1964. 

Successive redrafts of the schedules led to a pretest conducted during March and April 1965 in 

California, Illinois, Louisiana, New York, and 

Wyoming. 

Two schedules and three procedures were 

used in the pretest. One schedule was addressed 

to State regulatory agencies, the second to all other 

types of respondents. The three procedures represented three different approaches to the problem 

of how to best identify and obtain the participation 

of all potential respondents in the States. 

In the first procedure the director of the department was contacted and asked to distribute 

schedules to the persons named in his department. 

In the second procedure the schedules were mailed 

directly to the persons concerned along with a 

letter mailed to the director identifying persons 

contacted in his department. In the third procedure the director was requested to identify 

appropriate persons in his department who had 

lists of facilities. The persons identified were 

then sent schedules by the Surveys and Research 

Corporation. Field visits were subsequently made 

to all respondents, who were interviewed as a 

basis for assessing the relative merits of the 

procedures used. 

Pretest results indicated that a direct approach to the person who had the lists of facilities. 

3 
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Table 1. Number of survey schedules mailed and response, 

Schedule response 

Total schedules mailed 

Schedules returned --.-------.” .-

With sufficient information to be punched Insuffi.ci.ent information, not punched 

Schedules not returned 

RequesCed information supplied via letter or phone .......... 

by type of schedule 

< 

Type of schedule 

I‘“’a’11—1———— 

A B c 

Ww 267 

214 

P-lw 

334 135 113 

162 10 24 1% 

53 

HP--P 

43 4 2 37 . No response, information obtained from other sources 21 2 3 16 

usually proved productive. Thus the final procedures incorporated this feature of the second 

procedure along with some minor characteristics 

ofthe other two procedures. 

In November 1965 a second pretest, which 

was a trial run of the final schedules and procedures, was conducted inthe Statesof Michigan, 

New Jersey, and South Carolina. This proved 

sufficiently successful to encourage NCHS and 

the Surveys and Research Corporation to plan 

for a general mail-out in January 1966. The 

general mail-out (excluding the pretest States) 

took place, as scheduled, in January 1966. Itwas 

preceded by telephone calls to the principal 

respondents in all States (except Alaska and 

Hawaii) to verify the correctness andcompletenessofthe mailing list and to establish personal 

contacts useful in promoting survey cooperationq 

Themailing list required fewsubstantive changes 

as aresultofthe telephone calls. 

Three schedules were used in tie general 

mail-out: 

addressed to State regulatory agencies and 

designed to obtain information not only on the 

number and types of establishments in their 

files but also cm their regulatory coverage 

and practices and the availability of facility 

names and addresses in reproduced form; 

addressed to State agencies administering 

facilities within survey scope, requesting data 

on the number and types of such facilities, 

and a listing by name and address; 

c. addressed to other State agencies believed to 

have lists of facilities, to national voluntary 

agencies, and to commercial publishers; requesting data on the number and types of 

facilities in their files, and their practices 

with respect to listing requirements, information gathering methods, and publication, 

Altogether, 560 schedules were mailed (including the schedules used in the two pretests), 

of which 496, or 89 percent, were returned, The 

response rate was actually better than the percentage of returns would indicate, since 43 of the 

64 respondents with no schedules supplied the 

essential information requested, via correspondence or telephone, The effective response rate 

on the survey may therefore be put at 96 percent, 

Of the remaining 21 in the nonresponse group, 

only 2 were State regulatory agencies. Three were 

State administrative agencies, 3 were other State 

agencies, and the remaining 13 were national 

voluntary agencies. The basic information that 

was requested via schedule from the nonresponse 

regulatory and administrative agencies was obtained from other agencies in the State or from 

national directories. Table 1 summarizes theresponse obtained from the survey schedules which 

were mailed. Not all of the 496 returned schedules 
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[ 

Table 2, Number of State administrative 

and regulatory agencies, by type 

Type of agency INwnber


ToixIl~ unduplicated 323 

k


Administrative agencies 269


k


&lrniniatrativeonly-.--.--.--.--= 211 

Administrative and regulatory---- 58 

Regulatory agencies 112


k 

Regulatory only------------------ 54 

Regulatory and adrninistrative---- 58 

with sufficient informationto warranttransfer


to punchcards,One-thirdoftherespondents
had


checkedas a responsethestatement“Noestab­


lishmentfiles
maintained”orhad made awritten


declaration tothateffect. Falling
withinthescope


late facilities. The survey also identified
 49


agencies,includinga number with regulatory


responsibilities,
 whichhaveoccasiontomaintain


filesbased on neitheradministrative
 norregu­


latoryresponsibilities
 .Asurnmaryof numberand


typesof agenciesrespondingisgivenintable2.


COMPOSITION OF THE AGENCY 

REPORTING SYSTEM 

A totalof323 Stateagencieswere identified


as producersof primarydataon establishments


and thereforeas potential
 respondentsforthe


ARS. They are referredtohereas producersof


Table 3. Number of State and Federal


administrative and reswlatorv agencies


in the survey, by typ~ “


.—.


Type of agency


Tocal---------------------- 327


ofthesurveyand supplying sufficientinformation
 State agencies, unduplicated­


toreedited,coded,andpunchedwere 334sched­


ules,or 60 percentof thetotal
mailed,The334 Health department


scheduleswithinformation sufficient
 forcoding Mental health department


andpunchingcame from 234 agencies,
Instriving Welfare department


forcomprehensivecoverageasubstantial Health and welfare department---­
 number Education department


of Stateagencieswere identified,
 butwere not Corrections department


mailed schedules,
eitherbecausetheywere,one- Mental health and corrections


facility department
 agencies or for other validreasons. Department of institutions.....-.
 Between 500 and 600 Stateage~cieswere Youth authority


viewed as potential respondents
inthecourseof Tuberculosis board or commission­


State board of regents
 thesurvey.The surveyprocess(involvingsched- Board of State training schools-.


uleentries, correspondence, telephone calls,
and


fieldvisits) resultedin the identification
 of269


Stateagenciesswhich administerone or more


facilities falling
withinthe scope ofthesurvey,


and 112agencieswithstatutory
 authority[oregu-


3

Asthe term is used here, “State agepcy” refers h the 

most inclusive structure of State government responsible for 

the op~rationof the facility short of the Governor or the legislature. This is usually a department, but can be the board of 

hWHb3CH for a State school for the blind if the board is not 

undw nny dopwtment nnd reports directly to tbe GovernoT in 

1	 tha Nute legislature. A youth division of a corrections depurtrnont is not considered a State agency, but an independent 

youth division or youth authority is. 

State university or medical


college


Long-stay State hospital


facility


Short-stay State hospital


facility


State veterans’ home


State training school


State school for the deaf--------
 State school for the blind-------
 State school for g~e deaf and


the blind


All other------------------------


Federal agencies operating


civilian hospitals or insti­


tutions


5 
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--------------------------------------------- --------------------- ------------ ---------------------------------------- -------- ------------------------ ------------- -------------------------------- -------------- ------------------------------------------------------- ------------------------------------------------- --------------------------- ------------------------ -----------

primarydatabecausename andaddressinforma­


tionoriginates intheseagencies
byreasonoftheir


administrative or regulatory functions.
 Some are


responsible for listscontaining
 more than1,000


names. Others, by contrast,are one-facility


agenciesandcanreportonlyforthemselves.


To thoseStateagencieswhichproducedpri­


mary datashouldbe addedfourFederalagencies


operatingwithin-scope facilities
 (PublicHealth


Service’sDivisionof IndianHealth,theDepart­


ment of the Army, theVeteransAdministration,


and the Bureau of PrisonsintheDepartmentof


Justice).
 The listprovidedby theDepartmentof


the Army includesthefacilities
 of alltheuni­


formed services. The numberofState
andFederal


administrative and regulatory agencies
inthesur-


vey are givenby typeintable3.


State Administrative Agencies 

Statesadministera wide rangeofmedical­


care and resident-care facilities.
 They include


examples of everytypeofin-scopefacility,
 with


theexception
ofhomes forunwedmothers.Twen-


Table 4. Number of State agencies administering facilities, by type


Type of agency Number 

Total-------- 269 

Health departmnt


Menta1 health department


Public welfare department


Combined department of health and public welfare


Education department
 ”----


Corrections department -.-------


Combined department of mental health and corrections--.-----


Institutions department


Combined department of welfare and institutions


Rehabilitation department


Hospital department


Youth authority------.-


Tuberculosis board or commission


State board of regents


Board of trustees for State training schools


Department of veterans’ affairs


Board of trustees, State schools for deaf and blind ----,----


State juvenile court system
 ----”---


Crippled children’s board -b-------


State eleemosynary board


Military affairs department
 ----”


Board of control, State homes for the aged


State university (operating general hospital) .


One-facility independent agency:


“-------


State home for veterans .-----”-

Long-stay hospital facility --”----- -

State school for deaf--------

State school for deaf and blind 

State facility for mentally retarded .---”--

State training school


State penal facility
 -“------


State home for the aged-------- ----.-”­


State school for blind
 -------”


State general hospital


Short-stay hospital facility


State facility for alcoholics .......-------------


State home for dependent children ---.”---


State facility for crippled children--------------------------"-------------­


22


23


18 

22


32


1: 

1 

1 

1 

7 

3


1 

1 

3i 

13 

1; 

8 

6


4


3 

2 

2 

2


2


1


1 

1 

6

ty-two health departments, 23 mental health departments, 18 welfare departments, and 32 corrections departments are numbered among the 

269 agencies reporting the operation of one or 

more facilities. Fully one-third of the agencies 

are one-facility organizations. For example, 30 

State universities operate general hospitals in 

connection with the medical school; the hospitals 

are independent of operating controls other than 

! those imposed by the university. The complete 

list of State agencies administering facilities is 

i given in table 4. 

All 50 States and the District of Columbia 

are represented among the 269 agencies. The 

range in number of agencies by State is from 2 in 

such States as Alaska, Iowa, Maine, and Montana 

to 13 in Connecticut. For the country as a whole, 

the average of administrative agencies is five per 

State. 

The survey identified, in all, 1,244 State facilities in operation in the spring of 1966. The largest 

group was composed of 284 penal and correctional 

facilities for adults. State hospitals for the mentally ill constituted the second largest group, and 

training schools for juvenile offenders the third. 

Substantial numbers were also contributed by 

homes for the mentally retarded and long-stay 

hospitals other than for psychiatric care. 

Differences in the number of facilities by 

type reflect in large measure the traditional 

responsibility of State governments for the care 

of major offenders, the mentally ill, the mentally 

retarded, and selected types of chronic illness. 

The lesser importance in the State institutional 

pattern of short-stay hospitals, childrens’ homes, 

and nursing and personal care homes for the aged, 

infirm, and chronically ill persons may be 

attributed to the major role of voluntary agencies, 

local governments, and commercial enterprises 

in the development of facilities in these areas. 

The range in the number of facilities by State 

was from 5 in Nevada to 85 in New York. Differences in this respect among States correspond 

roughly to differences in population. 

Departments of correction accounted for the 

largest numbers of facilities (213) administered 

by the States. This represents abut one-sixth 

of the total. The second largest group was made 

I up of departments of mental health, and the third 

largest by welfare departments. A substantial 

number was also accounted for by the “departments of institutions” which exist in 12 States. 

Health, education, and youth authority agencies 

contributed smaller numbers. These differences 

among departments reflect in part the major 

responsibility, historically assumed by State 

governments, for providing care for selected types 

of patients, prisoners, and handicapped individuals, and the tendency of States to concentrate such 

facilities in a few departments, i.e., corrections, 

mental health, and welfare. 

One of the questions asked in the survey concerned facilities added in 1964. The extent of the 

facility turnover in the Nation was of course a key 

consideration in the design of the survey because 

of its obvious implications for the maintenance by 

NCHS of an up-to-date inventory of institutions. 

But it was not expected that State-operated 

facilities would show a high turnover rate. The 

relative stability of the patient and resident population was verified by survey results which indicated that the amual changes in the number and 

composition of State-operated facilities were quite 

small. Among 112 agencies responding to this 

question, only 15, or 1 in 8, reported any facilities 

added in 1964. One agency listed four facilities 

opened, a second agency opened two facilities, and 

the remaining 13 opened one each. The 19 

facilities added comprised 2 percent of the total 

number reported by the 112 agencies in operation 

at the time of the survey. 

State Regulatory Agencies 

The survey identified 112 State agencies with 

regulatory responsibilities for one or more types 

of facilities within the scope of the survey. These 

responsibilities assume different forms in different States and include such functions as approval, 

inspection, licensing, and certification. Licensing 

is the most common form of regulation. A byproduct of regulation in all States is the accumulation 

of names and addresses of facilities. These generally appear in the form of annual lists or 

directories and sometimes contain supplementary 

information such as bed capacity, types of care 

offered, type of control, and license number. 

Health departments and welfare departments 

accounted for 75 percent of the 112 agencies reporting regulatory functions. A summary of State 

7 
----------------------

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

---------

--------

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

---------

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

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

Table 5. Number of State agencies regulating facilities, by type 

Type of agency Number 

Total 112 

Health department 43


Mental health department


Public welfare department i:


Department

welfare 5 

Education department 3 

Department of institutions 2 

Department of mental health and 

of health and public


corrections 1 

Department of welfare and institutions 

Hospital department ; 

State medical care commission---- 1 

Cormni.ssion on hospital care 

Commission for the blind : 

Youth authority 1 

Department of Licenses and 

inspections ...... 1


agencies which regulate facilities is given in 

table 5. 

The number ofregulatory agencies variesby 

State from one to four. In Alaska, Kansas, Maine, 

Missouri, Nevada, New Hampshire, New Mexico, 

New Jersey, Pennsylvania, andUtahallregulatory 

functions for facilities are located inone department. At the other extreme are States such as 

California, Massachusetts, Michigan, New York, 

and North Carolina, each with four regulatory 

agencies —health, mental health, public welfare, 

and one other, which varies amongthefiveStates. 

The most common pattern is represented bythe 

State with two regulatory agencies—health and 

public welfare. 

Regulatory agencies participatingin thesurvey reported approximately 30,000 facilities in 

their files, This figure doesnotrepresentthetrue 

number of facilities regulatedinthe country,since 

this number may actually be larger or smaller. 

Some agencies failed to report alltheir facilities. 

Others, on the contrary, included in the number 

they reported facilities which are notregulated 

by the respondent or are regulated by another 

agency. Respondents were asked to report the 

number of establishments in their files. They 

were not asked to report the number regulated. 

While the files are largely limited to regulated 

facilities, some contain, in addition, the names 

and addresses of facilities of the same type 

operated by the State or Federal Government 

that are not subject to regulation and some that 

are regulated by another agency. The extent of 

duplication in the regulated group and the size 

of the group not regulated but listed in the files 

are not known and could be determined only, per- , 

haps, on the basis of anameand address match. 

The number of facilities reported by State , 

varied from fewer than 100 in Alaska, Delaware, 

Nevada, and Wyoming to close to2,500in California. Eight States reported more thanl,OOO. 

Nursing and convalescent homes comprised 

about one-half of the establishments reported, 

short-stay hospitals almost one-fourth, andhomes 

for the aged other than nursing homes, one-sixth, 

These were the three biggest blocks and accounted 

for 86percent of teetotal. Another 5percent was 

Table 6. Percent distribution of facilities in files reported by.- regulatory 

agencies, by type -

Percent 

Type of agency distribution 

Total 

Short-stay hospitals 

Psychiatric hospitals 

Other long-stay hospitals 

Diagnostic and treatment 

centers 

Faci.liti.es for the mentally retarded 

Other facilities, mental 

illness 

Other medical facilities 

Nursing and convalescent homes-­

Other homes for the aged 

Homes for crippled children 

Other personal care homes ------- Homes for the blind 

Homas for the deaf 

Homes for dependent children----

Homes for unwed mothers 

Training schools for juvenile 

delinquents

Detention homes ----------------- Other establishments 

100*O 

2;.: 

1:4 

1.2 

1.4 

0.7 

4%; 

17.3 

0,1 

%: 

0.1 

4.5 

0.6 

0.4 

0.5 

0.3 

8 
---------------------

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

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

Table 7. Percent distribution of 1964 

additions to files of regulatory agenci,es, by type of establishment 

Total 

b 

Nursing homes------------------- 61.7 

Other homes for the aged 23.7 

Short-stay hospitals 7.0 

All others 7.6 

contributed by homes for dependent andneglected 

children. All other types of facilities aggregated 

less than 10 percent of the total. The distribution 

of facilities by typeis shown intable 6. 

‘l%e paramount role oftheStatehealth department in the field of regulation clearly emerges 

when facilities are grouped by type of regulatory 

agency. Health departments accounted for70percent of the facilities reported in the filesofregulatory agencies. Welfare departments supplied 

17 percent and combined health and welfare 

another 5 percent. This concentrations consistent with the dominance of hospitals, nursing 

homes, and homes for the aged among the facilities reported, and with the usual role of the 

health department in the regulation ofsuchfacilities. 

With 112 regulatory agencies reporting some 

30,000 names and addresses in their files, the 

average number per file was about 268establishments. By and large, however, files onparticular 

types of facilities tended to contain fewer than 100 

names. This was true of all psychiatric and other 

long-stay hospital files, of files on facilities for 

dependent children (with two exceptions), and on 

facilities for unwed mothers. 

Respondents were requested to report the 

number of facilities added to their files in 1964, 

but about 40 percent left the item blank. Some 

undoubtedly meant this as a zero entry; others 

either overlooked the item or did not attempt 

an answer. From the 60 percent with an entry, 

a total of a little more than 1,200 facilities was 

added to the files in 1964; or about 4 percent of 

the 30,000 names and addresses in the files of all 

112 agencies. It is reasonable to assume that, with 

more agencies reporting, the number of facilities 

added in 1964 could have been as high as 5 or 6 

percent of the total in the files. In general, the 

larger the file, the larger the number added. 

California, Illinois, and Texas each added more 

than 100, In some of the smaller States, facilities 

added in 1964 numbered fewer than 10. For the 

same reason, the additions were concentrated in 

the nursing home files and, among agencies, in the 

health department as illustrated in tables 7 and 8. 

Related to the question of currency of the name 

and address of the facility regulated is agent y 

practice with respect to frequency of contact. 

Ninety-three percent reported that facilities are 

required to renew their license or permit annually 

or to be inspected or approved annually. 

Nearly all regulatory agencies issue a printed 

or mimeographed list of the facilities they regulate. Publication is usually annual, but about one 

agency in five issues lists on a quarterly or semiannual basis, and about 3 percent on a biennial 

basis, another 28 percent use an entirely different 

approach such as issuing revised sheets as needed 

containing new names or changes in address or 

owner6hip. 

Secondary Sources 

The 323 State agencies and 4 Federal agencies 

compose both the vast majority and the most 

important respondents in the ARS. State agencies 

which neither administer nor regulate facilities 

are being evaluated and may be included in the 

Table 8. Percent distribution of 1964 

additions to files of regulatory agencies, by type of agency 

I 

Percent 

Type of agency distribut ion 

Total 100.0 

l-==== 

9 
ARS if additional facilities can be picked up from 

them. 

National voluntary agencies, mostly under 

denominational auspices, which issue lists or 

directories of hospitals and institutions operated 

by member organizations may also be considered, 

in a sense, primary data producers. Since all or 

nearly all of their establishments are included in 

the lists put out by State regulatory agencies, and 

since the latter agencies possess legal authority 

to collect the information thus endowing the State 

lists with an “official” status, it is best perhaps 

to restrict the term “primary data producers” 

to State and Federal agencies. There were 34 such 

national organizations to be included in the ARS 

that were identified in the survey, all of which 

furnished lists for examination and analysis. 

With the inclusion of four commercial directories of hospitals and/or other facilities, 365 

agencies and organizations have been identified 

which produce lists of in-patient facilities. These 

365 agencies and organizations compose the ARS.4 

IMPLEMENTATION OF THE 

AGENCY REPORTING SYSTEM 

Obtaining Agency Cooperation 

The Surveys and Research Corporation (SRC) 

submitted the final report and recommendations 

for launching the ARS on October 31, 1966. It was 

decided that NCHS would initiate correspondence 

during January and February 1967 with all agencies that were recommended for inclusion in the 

ARS. An extensive review of the agencies recommended for inclusion in the ARS was made. Personal visits were recommended for all agencies 

maintaining a large number of facilities in their 

files and having a relatively high turnover of 

facilities. The remaining agencies were to be 

canvassed by a mail survey. There were approximately 80 State agencies located in 50 departments 

that were selected to be visited. These agencies 

were located in 40 States scattered throughout 

the country. 

An agreement was made with the Bureau of 

the Census to conduct the visits to the State 

4

Surveys and Research Corporation: Updating the NationaJ 

hvento?y of Hospitals and institutions, Vol. 1. Washington, 

D.”C. Oct. 1966. 

agencies. The agencies were to be visited for the 

dual purpose of securing their cooperation in the 

ARS and to plan acceptable arrangements for 

submitting lists of all new facilities to the Center. 

There were two arrangements that needed to be 

worked out with each agency contacted. One was 

to update the list sent by the agency to SRC, that 

is, to arrange for the agency to submit the names 

and addresses of all the new facilities 5 starting 

business between the publication date of the list 

received by SRC and December 31, 1966. The 

other was to arrange a continuing reporting 

system on either an annual basis or a more frequent interval, starting on January 1, 1967. 

In preparation for these visits a pretest was 

held in November 1966 in the District of Columbia, 

Maryland, New Jersey, and Virginia. The pretest 

visits were conducted jointly by personnel from 

the Bureau of the Census and NCHS. Each visit 

was preceded by a letter explaining the ARS to 

the agency and announcing the forthcoming visit, 

the date and time of which would be arranged by 

telephone. The pretest showed that the agencies 

were quite willing to join the ARS on a continuing 

and regular reporting basis. If they did not 

periodically publish lists of new facilities as part 

of their regular duties, the agencies were somewhat reluctant to take the time to identify them 

in their files. Some agencies had no system of 

keeping track of new facilities and consequently 

were unable to identify them, Thus, arrangements 

were made for several agencies to send only a 

current list of facilities. The new lists sent by 

the State agencies have to be matched each time 

against the most current lists on file in NCHS to 

identify new facilities. 

Personal visits were begun on a full-scale 

basis in the latter part of January 1967 and were 

completed in the latter part of February 1967. 

For a few of the visits, the Bureau of the Census 

interviewers were accompanied by members of the 

NCHS staff, so that a first-hand report might be 

5 

New facilities include: (I) additions to buildings, if this 

new component has a function different from the function of 

the original building (nursing home added to a general hospital); (2) facilities that change their function fmm a nonhealth or custodial care facility into a health-oriented facility 

(hotels converting into homes for the aged); (3) facilities added 

due to a change in agency requirements; and (4) newly constructed facilities. 

10 

— 
obtained concerning agencies maintaining some of 

the largest files. These visits were to agencies 

located in California, Illinois, New York, and Ohio. 

The visits were usually the first ones scheduled 

in their region and served to aid the interviewers 

in understanding the more intricate mechanisms 

of the ARS. Each visit was again preceded by a 

letter explaining the ARS to the agency and announcing the future visit, for which the date and 

time would be arranged by telephone. The letter 

is reproduced in Appendix I of this report. The 

results of the visits indicate that all agencies 

were willing to provide lists of facilities which 

they have available in their files, Many agencies 

publish monthly or quarterly lists of new facilities and were willing to furnish these. There 

were a number of agencies that do not identify 

new facilities and would agree only to provide a 

current list of facilities on a regular basis. Thus, 

as described above, the new lists sent by the State 

agencies have to be matched each time against 

the most current lists on file in NCHS to identify 

new facilities, 

The agencies that were not visited maintained 

small files of in-scope facilities or had relatively 

little turnover of facilities. In early February 

1967 a letter was sent to each of these agencies, 

explaining the ARS to the agency and asking it 

to cooperate with the Center. Each agency was 

asked to update the list sent by the agency to SRC 

and to participate in a continuing reporting system 

on an annual basis. Almost 70 percent of the 

agencies had responded by the middle of March. 

At this time a followup letter was sent to the 

agencies which had not responded. Within the 

next month the response climbed to 85 percent 

and in mid-April the remaining agencies were 

contacted by means of a telephone followup. 

By July 1967 participation was virtually 100 percent with only one list not received. 

Reconstructing the MFI 

The new MFI was assembled in three basic 

stages. In the spring of 1966, SRC supplied to the 

Center the State lists that were collected in its 

survey of State agencies. These lists were duplicated to maintain a file at NCHS and out-of-scope 

places were deleted from the lists. The lists, 

from State agencies that were slated to participate 

in the ARS, were then sent to the Bureau of the 

Census. The Bureau of the Census standardized 

the names and addresses of the facilities; eliminated duplicates by matching; punched names, 

addresses, and some supplementary information 

such as number of beds and telephone numbers 

on cards; put the information on tape; and printed 

comprehensive lists containing all the in-scope 

facilities that were found in the lists obtained by 

SRC. Thus, the first stage of the updated MFI was 

completed. 

The second stage involved lists supplied by 

national voluntary organizations, Federal agencies, State agencies that were not scheduled to 

participate in the ARS, and the list of facilities in 

the old MFI. Facilities appearing in these lists 

were matched against each other and matched 

against the listing obtained in the first-stage 

compilation of the updated MFI. All names and 

addresses of facilities that were on these lists 

and not on the “stage one” list were standardized, 

punched on cards, and added to the “stage one” 

listing of facilities along with additional information such as telephone number, number of beds, 

etc. 

The third and final stage dealt primarily with 

adding to the list new facilities reported by the 

AIM and a separate group of homes for the aged 

in California. Homes for the aged maintaining 

fewer than 16 beds were not included in the report 

from California because they are county regulated. Since there were a large number of these 

facilities (over 3,000), each county was asked to 

send lists of these facilities to NCHS. The same 

procedure was then followed in this stage as in 

“stage two. ” The completion of this stage resulted in the printing of the updated MFI. 

The Agency Reporting 

System Information Files 

The Agency Reporting System is subdivided 

into two information files. A Basic Information 

File is maintained to record information about 

each type of facility within each State and a Reporting Information File is maintained to assist 

in mailing letters and recording responses from 

each of the agencies in the Agency Reporting 

System. 

11

Basic Information File 

The Basic Information File provides information from each State and the District of 

Columbia concerning each type of facility listed 

in the Master Facility Inventory and also about 

the lists from which each type of facility is enumerated. The information recorded for each type 

of facility includes control (State, local, voluntary, 

or proprietary), type of regulation (licensure, 

administrative, etc.), and coverage by number of 

beds, The information recorded concerning the 

list for each type of facility includes source of 

list (name and address), title, and/or description 

of the list; date of the list; frequency of publication; number of facilities on the list; and number 

of facilities added in 1964. The file may be used 

to determine if a list of facilities from a source 

not in the Agency Reporting System is superior 

to the list which is beti,g used, provided that 

sufficient information can be obtained about the 

new proposed list. 

The Basic Information File is set up in the 

following manner: The States are listed alphabetically; then the types of facilities within each 

State are listed in order on separate index cards 

containing the desired information about each type 

of facility and its list or lists. The system described above is available for a quick reference 

in contrast to the situation which might exist if 

the information were stored on computer tape. 

llms if new information is found for some type 

of facility the appropriate card may be pulled 

from the file and changed. 

Reporting Information File 

A Reporting Information File is needed to 

insure that NCHS can promptly and efficiently 

contact and record the responses of all agencies 

or organizations participating in the Agency Reporting System. 

The information needed about each agency is 

recorded on individual index cards. Three operational systems are used. All three systems record 

the State and department in which the agency is 

located, the name of the list, the source code (a 

3-digit code that identifies a specific list), and 

the name and address of the contact person in the 

agent y. 

The first system is used for recording information about agencies that have chosen to report 

annually. Two types of information are collected 

(1) information necessary to provide a record of 

agency contacts, such as the date of the mail request for listings, the first mail followup, the 

second mail followup, the telephone followup, and 

the date of response from the agency (recorded 

each year); (2) information concerning the list 

which the agency returns, such as publication date 

of the returned list and number of new facilities 

added since the last report. This card is reproduced in Appendix II. 

The second system is used for recording 

information about agencies that have chosen toreport quarterly or semiannually. It differs from 

the first system in having only one mail followup and having a check list on the back of the cards 

for recording the number of new facilities, the 

date the list is received, and the reporting interval 

of the agency, 

The third system is used for recording information akout agencies that have chosen to report 

every month. The information collected with this 

system is the number of new facilities added during the year. Also on the back of the cards in this 

system is a check list for recording the number 

of new facilities, the date the list is received, 

and the reporting interval of the agency. 

The first card in this file contains the suggested dates for requesting annual listings and 

suggested dates for all followup correspondence, 

The date that the mail request for listings is sent 

and the dates of any followup correspondence 

deemed necessary will be recorded as well as the 

individual agency’s date of response. These cards 

are placed in alphabetical order by State and by 

department within State, 

For those agencies reporting annually the 

date of response will be recorded and the corresponding card will be pulled and placed in the 

back of the file. Before each followup corresponcK 

ence it is necessary to look at the front of the 

file to see which agencies have not responded and 

hence must be sent a followup. Thus the cards 

will be alternated from front to back on a yearto-year basis, so that agencies which have not 

responded may be readily identified. 

All agencies that choose to report more than 

once during the year will have a card made out 

12 
and placed in alphabetical order by State and by 

department within the State. Onthe back of each 

card is a check list to record the date of response 

and the number of new facilities. After each agent y 

responds, the information requested on the check 

list is transcribed and once a year (preferably 

during January or February) the number of new 

facilities added during the previous year is totaled 

on the check list and transcribed on the front of 

the card. Periodic review of the check lists will 

indicate if the agencies are responding as expected. If they are not, followup correspondence 

will be initiated if necessary, 

After the appropriate information has been 

recorded on the cards, all lists of new facilities 

are placed in envelopes labeled by State to await 

their addition to the Master Facility Inventory. 

EVALUATION OF THE 

AGENCY REPORTING SYSTEM 

Investigation of Coverage Gaps 

The success of the ARS depends largely on 

the extent to which a coverage gap of facilities 

can be minimized, both now and in the future. 

The question arises, how complete is the coverage of institutions throughout the Nation in the 

updated MFI? 

To evaluate the coverage, the questionnaires 

collected in the ARS survey of State agencies and 

the report submitted by the Surveys and Research 

Corporation were reviewed. The coverage was 

analyzed along two problem dimensions: (1) inadequate coverage due to larger bed-size minimums established by the various State licensing 

agencies than specified by the MFI, and (2) insufficient information because of no regulation of the 

type of facility in question. 

Coverage gaps with regard to bed-size minimums were established using the requirements 

for inclusion in the MFI —that is, one or more 

beds for all hospitals and three or more beds for 

nursing homes and other institutions included in 

the MFI. The problem arising from the minimum 

requirements for licensure based on the number of 

beds was approached through a one-to-one match 

of the national lists with the lists of existing facilities supplied by the individual States. 

In the questionnaire used by SRC, the State 

agencies were asked to report the number of those 

facilities in the State which were not regulated 

by the Department and not included in their files. 

Not all State agencies responded but for those 

that did, the estimate was used as a baseline in 

estimating the total number of facilities contributing to the coverage gap due to lack of regulation. 

Once the possible problem areas were identified it was necessary to determine if the type 

of facility was, in fact, a coverage gap and if so, 

approximately how many facilities were missed 

in compiling the MFI. The initial screening was 

intended to identify all possible problem areas. 

Many of the areas first identified as having 

coverage gaps later proved to have complete, or 

nearly complete, coverage. 

The result of the investigation was the indication that only two types of facilities contribute 

sufficient undercoverage to warrant examination 

in this report. These types are homes for the 

aged and homes for dependent children, which will 

be discussed next. 

Homes for the Aged 

The major problem in the ARS lies in the 

area of homes for the aged providing personal 

care. This area is difficult to evaluate since the 

State licensure requirements vary considerably 

when differentiating between homes providing 

some kind of nursing skill and other facilities 

considered to be “boarding homes. ” The definition 

of an institution as used in the MFI requires that 

the facility provide something more than just room 

and board. This discrepancy between the national 

and State definitions leaves several facilities in a 

borderline area. To insure that the coverage of 

the MFI is complete, these borderline cases have 

been included, at least until they are proved to be 

out of scope through the MFI questionnaire. 

Idaho, South Carolina, and West Virginia do 

not license personal care homes and have no 

regulatory program for those facilities defined 

as less than “skilled” nursing homes. With the 

exception of Idaho which lists seven so-called 

boarding homes in their files, these States exclude those facilities which provide personal 

and/or custodial care from their lists. The cover13 
age gap in this type of facility is estimated as 

quite large, West Virginia estimates the number 

of such facilities in the State at approximately 

500 to 600. This estimate may be too large, however, since it may include boarding homes providing nothing more than room and hard. South 

Carolina and Idaho (with the exception of the seven 

facilities listed on their schedules) did not provide 

estimates of the number of facilities which maybe 

in the State. 

The literature of the national voluntary organizations in the area of homes for the aged is 

limited in that most of the lists are published by 

various denominations and include only facilities 

which are under those particular religious auspices. If the required information akout homes 

for the aged in these three problem States is to 

be obtained from these sources, a time-consuming 

search of these numerous publications would be 

involved. Even if this were done, the list would 

not be complete because many proprietary facilities would be missed since facilities under 

religious auspices are usually nonprofit. 

The national listing used to evaluate the 

undercoverage of homes for the aged was the’ ‘Directory of Nonprofit Homes for the Aged, 1962. ” 

This source is not complete in listing facilities 

of this type. An example of the undercoverage can 

be seen in West Virginia. The schedule received 

from this State reports an estimate of 500 to 600 

personal care homes. Excluding those facilities 

classified as nursing homes, the directory reports only two nonprofit homes for the aged in 

West Virginia. This discrepancy between the 

State estimate and the directory is large enough 

to throw doubt on both the estimate and the 

completeness of the directory. Likewise, the directory reports three establishments each for 

Idaho and South Carolina. It seems unreasonable 

that States of this size could have as few as three 

facilities providing personal care for the aged, 

even considering that the directory lists only nonprofit homes. 

Included in the report submitted by SRC is the 

recommendation that a one-time census in these 

States be made to identify the personal care homes. 

Because of the large cost of such an undertaking, 

it could be justified only if there were a large 

number of facilities in these States. However, 

West Virginia is the only State providing an estimate of facilities. Since there is no complete 

national listing it is impossible to give a meaningful estimate of the number of facilities in Idaho 

and South Carolina. Therefore action on this 

recommendation has been deferred until more 

information is available. 

California posed a unique problem with regard to homes for the aged. The licensure program at the State level includes only those facilities of 16 beds or more. The control of all 

smaller facilities is relegated to the counties. 

A special survey letter was sent to each county 

requesting a listing of homes for the aged with 

fewer than 16 beds. The survey resulted in the 

addition of more than 3,000 facilities to the MFI 

and the elimination of this particular coverage gap 

in California. 

Three additional States posed problems of a 

lesser nature. Kansas does not license either 

church-owned nursing homes or personal care 

homes. The State estimates that approximately 

17 facilities of this type exist in the State. When 

the “Directory of Nonprofit Homes for the Aged” 

was checked, no facilities falling into this category 

were identified. To discover these 17 facilities it 

may be necessary to check the many listings of 

religious organizations. However, these facilities 

might also be found in the State Board of Health 

files and a followup inquiry to the State could be 

fruitful. 

Nebraska reported that its licensing program 

excludes fraternal homes and estimates that two 

facilities fall into this gap. Connecticut does not 

license municipal homes for the aged. Neither 

the two facilities estimated by Nebraska nor the 

three municipal facilities estimated by Connecticut were identified in the directory. For total 

estimations in this area it will be necessary to 

accept those made by the States. 

Homes for Dependent children 

At first glance this segment of the MFI 

seemed to be the greatest problem area, since 

14 States were found to have either large bed-size 

minimums or no licensure requirements of such 

facilities. However, the number of facilities resulting in this coverage gap proved to be less than 

the homes for the aged, 

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

---------

-----------

-----

-----

-----------

--------

------

-------

--------

----------

------

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

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

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

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

-----

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

Table 9. State estimates of the number of facilities not included in the Agency Reporting System and


specific area of undercoverage


Type of facility State Specific area of undercoverage Estimate


Total---------------------------- ------------I 

Psychiatric hospital Massachusetts---


Homes for mentally retarde&-- Alabama---------


Connecticut


Homes Y70rthe aged	 Connecticut


Idsho


Kansas----------


Nebraska


South Carolina--


West Virginia---


Homes for dependent children- California 

Louisiana 

Missouri 

Nevada 

New Jersey 

South Carolina-­

utah-----------­

l~e state made no estimate. 

With regard tothe minimum bed-size standPrivate hospitals, voluntary admission----


Voluntary and proprietaq


Private homes-----------------------------


Municipal homes---------------------------


All personal care homes-------------------


Church-owned homes------------------------


Fraternal homes


All homes for aged------------------------


All personal care homes-------------------


Facilities under 16 beds------------------


Facilities under 10 beds------------------


Religious facilities


Proprietary facilities


Facilities not receiving public funds


No specific aria--------------------------


No tifomation


610


4


2


2


(l?


17


(l;


500 

(1) 

(1)

40 

8 

27 

p; 

ards, there are only two States which remain as 

problems. California licenses only those facilities 

with 16 beds or more. There is no recordof 

smaller facilities, except perhaps at the local 

level. 

Louisiana is the second State where bed-size 

requirements for licensure may omit several 

facilities. In Louisiana, only facilities with lOor 

more beds are regulated. The only national listings availablein this area are inadequate intheir 

coverage. The “Directory of Member Agencies” 

of the Child Welfare League listsgoverningagencies rather than individual facilities. “Child Welfare Statistics,19 65,’’ publishedby theChildren’s 

Bureau of the U.S. Welfare Administration, reports fewer facilities for all Statesthan liavebeen 

reported by the States themselves. Becausesome 

States failed to report all facilities to the Children’s Bureau this source is not adequate for use 

ina match of State andnational lists.This source, 

in addition, includes someofthe special children’s 

units of mental hospitals and hence the figures 

are incorrect for the area of homes fordependent 

children because these larger hospitals aretabulated separately in the MFI. Louisiana also has 

no regulation for those homesnot receivingpublic 

funds. However, there are only three such facilities in Louisiana and these are known to the 

State. 

The problems resulting from no licensure 

of facilities are unresolved since there is no 

adequate national list against which acheck can 

be made. Problems of this nature exist in Missouri, New Jersey, South Carolina, andUtah. 

A complete listing of undercoverage bytype 

of facility and by State is given in table 9. Table 

10 shows the estimated amountof undercoverage 

for all thetypes of facilities included inthe MFI 

on the national level. Boththeoverallundercoverage and the undercoverage by type offacility are 

given. These estimates have been determined 

through one-to-one matches of State lists with 

available national listsofthefacilities inquestion. 

When anonmatch occurred, the facility wasadded 

as an estimate of the amount ofundercoverage. 

When no national lists were available for a 

particular type of facility, the numberoffacilities 

15 
-------

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

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

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

-------

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

-----------

---------

Table 10. Percentage of faci.liti.es
 missed in the Master Facility Inventory at the na­
 tional level according to State agency estimates


l?er­


cent. Overage of all
 Estim- Number each per-
 Type of facility Eotal ARS Federal ated


t~tal missed type of cent­


facil- age


ity missed


missed


Total---------------- 35,179 34,654 525 35,789 610 � *. 1.7 

Short-stayhospitals 7,418 7,030 1388 7,418 

Long-stay hospitals 559 538 221 .559 . 

Dia~ostic-treatment 

center 44 44 44 . 

Homes for mentally 

Psychiatric hospitals 580 536 144 584 0.; 0.6 

retarded 608 608 612 0.7 0.0 

Other facilities for 

mentally ill---------=---- 119 119 1,19 

Other medical facilities--- . . 

Nursing homes-------------- Homes for the aged--------- 14,OH 

8,765 

14,0;!! 

8,738 22; 14,0:! 

9,287 45.; ‘%oi 

Homes for crippled

children -F--------- . . Other resident facilities-- 1;; 1:: . lx . . Homes for blind------------ 55 55 55 

Homes for deaf------------- 65 65 65 “ 

Homes for’dependent 

children 1,397 1,397 1,477 55.4 50,2 

Homes for unwed mothers---- 223 223 223 . . 

Training schools 281 281 281 

Detenti.onhomes------------ Penal institutions 

320 

350 

320 

305 34; 

320 

350 . 

Other---------------------- 174 174 174 . 

lAmericanHospital Association: Hospitals. Guide Issue. 

2Master Facility Inventory.


31960 U.S, Census,


4N0 estimates for South Carolina and Idaho. Percentage missed will be greaeer than


reported.


bNo estimates for California,Loui,siana,and Utah. Percentage missed will be greater


than reported.


reportedbythe Stateasfalling
 outsidethescope


of theirlicensure
lawswas theestimateused.In


some Statestherewas no way to estimatethe


number of facilities affected
andthesearenoted


in table10.The totalamount of undercoverage


for the new MF1 as found from the tablesis


approximately percent.


Althoughthetables donotindicateother
 prob­


lemareas,itshouldbenotedthattwootherareas


, 

might resultinundercoverageintheARS, These


arehomesfor unwedmothersanddetention
 homes.


Althoughinformationis available
on thesetwo


types of facilities, itis obtained,
forthemost


part,from listssupplied by thenational
 voluntary


organizations
ratherthanfrom the filesof the


Stateagencies.The accuracyofthelists,
 there­


fore,is dependenton the completenessofthese


organizational
 listings,


16

A discrepancy in the number of reported 

State penal instittwions should also be noted. The 

number of prisons reported by the States under 

the ARS totals a little over 300. However, in 

1960, the Bureau of the Census enumerated 1,027 

State prisons, The reason for this discrepancy 

cannot be readily seen. All States report at least 

one State prison on their lists. It might be 

necessary to check closely the reported penal 

institutions for each State and prove worthwhile 

to use the Census data to identify missing facilities, 

Future Maintenance of the ARS and MFI 

The ARS consists primarily of State agencies, 

Federal agencies, and national voluntary organizations, During the three stages of compilation 

of the updated MFI a detailed count was made of 

the contribution which each individual list made 

to the updated MFI. From this information future 

composition of the ARS may be determined. For 

instance, suppose a list from a State agency that 

is not slated to participate in the ARS is examined. 

If this list makes a meaningful contribution, then 

the agency submitting the list will be included in 

the ARS for future reporting. 

The MFI is now being updated, with three 

major goals, First, to identify in-scope facilities, 

000 

second, to classify the facilities by type, and, 

finally, to weed out facilities that have gone out of 

business. A number of facilities were listed on the 

old MFI that were not on any of the lists supplied 

from the ARS. It is thought that these facilities 

will be found to be out of business when the survey 

of the updated MFI is completed. If these facilities 

are still functioning, steps will have to be taken to 

seek sources for the names of the missing facilities. These sources, of course, would then be 

included in the ARS for future reporting. 

Other methods of evaluating coverage in the 

MFI will be used. The Complement Survey, discussed earlier, will be conducted each time the 

entire MFI is surveyed. However, if it turns out 

that the ARS provides adequate coverage, the 

Complement Survey can be conducted at less frequent intervals .Tentative plans also call for using 

professional journals and lists for spot checking 

to see if all new facilities are being picked up 

by the ARS. 

After the ARS is established, it is planned 

to survey the entire MFI biemially. The biennial 

surveys will provide not only current information 

needed for sample design and estimation purposes, 

but also national statistics on the number and 

types of hospitals and institutions in the country 

and changes that occur between survey dates, 

17 
APPENDIX 1 

SURVEY LETTER ANNOUNCING VISITS CONDUCTED BY THE 

BUREAU OF THE CENSUS 

.0$’” ‘“%* 

.4 % 

:’ ** DEPARTMENT oF HEALTH. EDUCATION, AND WELFARE 

“.. % ,+” PUBLICHEALTH sERvIcE @ WASHINGTON, D.C. 20201 

NATIONAL CENTER FOR 

HEALTH STATISTICS REFER TO: 

Dear Sir:


The National Center for Health Statistics (NCHS) of the U.S. P~bllc


Health Service coaducted a survey several months ago in which information


was obtained from all State agencies which have files or lists of hospitals


and institutions. The Public Health Service wishes to thank you and your


Department for its cooperation during that survey.


As you may recall, the purpose of the survey was to gather information


needed to arrange a system for keeping up-to-date a national inventory


of hospitals and institutions. Through the survey, a minimum set of


State agencies was identified which, when taken together, can provide


the nemes of nearly all new hospitals and.”institutions in the country,


thus enabling NCHS to keep the Master Facility Inventory current.


This national inventory is needed as a sampling frsme to be used by the


Center in carrying out its mandate from Congress to collect, on a con­


tinuing basis, information about the health conditions of persons in the


United States.


Your office is among those included in the minimum set of agencies needed


for a successful updating system. Tne NCHS would like to make arrangements


with your office to provide, on a periodic basis, the nsmes and addresses


of all new hospitals and institutions added to your files.


In the near future, an employee of the Bureau of the Census, representing


the National Center for Health Statistics, will be contacting you to make


arrangements to meet with you. Tne purpose of his visit will be tc!arrange


for the reporting of new facilities in such a way as to place a minimum of


burden on your staff. In the meantime, should you have any questicns or


desire any additional information, please place a collect telephone call


to Mr. Peter Hurley who has principal responsibility for this project.


His telephone number is Area Cede 202, 962-1915.


Your continued cooperation in this important program is greatly appreciated.


Sincerely yours,


. 

Theodore D. Woolsey 

Acting Director 

18 000 
APPENDIX II 

ANNUAL REPORT CARD USED IN THE REPORTING INFORMATION FILE 

Annual Report Card 

State I Name of Cantrsct Fersan 

Department Address of Contact Person 

Name of list 

Saurce cade 

Mail request for listing 1966 1967 1968 1969 1970 

First mail follow-up 

Second mail follow-up 

Telephone fallow-up 

Date af response 

Pub. date of returned list 

Na. af new facilities 

added since last year 

000 
OUTLINE OF REPORT SERIES FOR VITAL AND HEALTH STATISTICS 

Public Health Service Publication No. 1000 

series 1.	 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. 

Series 2.	 Data evaluation and methods research. —-Studies of new statistical methodology including: experimental tests of new survey methods, studies of vital statistics collection methods, new analytical 

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

Series 3.	 Analytical studies. — Reports presenting analytical or interpretive studies based on vital and health 

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

Series 4. Documents and committee repovts. — Final reports of major committees concerned with vital and 

health statistics, and documents such as recommended model vital registration laws and revised birth 

and death certificates. 

Series 10.	 Data from the Health Interview Survey. —Statistics on illness, accidental injuries, disability, use of 

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

in a continuing national household interview survey. 

Series 11.	 Data from the Health Examiruztion Survey. — Data from direct examination, testing, and measurement of national samples of the population provide the basis ior two types of reports: (1) estimates 

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

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

analysis of relationships among the various measurements without reference to an explicit finite 

universe of persons. 

Series 12. Data from the Institutional Population Surveys.— 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. 

Series 13.	 Data from the Hospital Discharge Survey.— Statistics relating to discharged patients in short-stay 

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

Series LW.€ Data on mo~tality.— 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. 

Sevies 21.	 Data on natality, marriage, and divorce. —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. 

Series 22. Data from the National NataLity and Mortality Surveys. —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: Office of Information 

National Center for Health Statistics 

U.S. Public Health Service 

Washington, D.C. 20201