Vitaland

HealthStatistics

Mental Illness in

Nursing Homes:

United States, 1985

Series 13:

Data From

No. 105

the National Health Survey

This report presents statistics on residents of nursing homes who had at least one

condition that can be classified as a mental illness, Data for this major subgroup of

nursing home residents are presented by length of stay since admission, source of

payment in the month before the survey, functional dependencies in the activities

of daily living, usual living arrangements prior to admission, and reasons for

admission, according to major demographic and facility characteristics. This report

also includes selected comparisons between residents with and without mental

disorders, Estimates are based on data collected in the 1985 National Nursing

Home Survey,

US. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control

National Center for Health Statistics

Hyattsville, Maryland

February 1991

DHHS Publication No, (PHS) 91-1766
Copyright information

All material appear!ng In this report IS In the publlc domain and rr’ay b,:

reproduced or copied without permlsslon, cltahon as 10 sour< e,

however, IS appreciated

Suggested citation

Strahan GW Mental Illness m Nursing Homes Un!ted States, 1985

National Center for Health Stat(sltcs Vital Health Stat 13( 105~ 1’391

—

Library of Congress Cataloging-i n-Publlcalion Data

Strahan, Geneweve W

Mental dlness m nursing homes Unlled States, 1985

P cm — (Vital and health statwtlcs Series 13, Data from the Fdalmrl. i

Health Survey , no 105) (DHHS publrcat!on no (PHS) 91–1766)

By Geneweve Strahan and Barbara J Burns

Based on data collected !n the 1985 National Nursing Home Surv+${

ISBN 0–8406–0438–6

1 Nursing home patients—Mental health-–Un!ted States—Statlstcs

2 Mental dlness-Un Ned States—Stat@cs 3 Umted States—Statst!cs,

Medical I Burns, Barbara J II National Center for Healfh Statlsl}cs (U S I

Ill National Nursing Home Survey (U S ) IV Title V Series Vl Series

DHHS pubhcahon , no (PHS) 91-1766

[DNLM 1 Mental Disorders—United States 2 Nursing Homes- Un Icd

States—statmtlcs W2 A N148vm no 105]

RA407 3 A349 no 105

[RC451 4 N87]

3621 ‘0973021 s—dc20

[362 2’0422]

DNLM/DLC

for Library of Congress 90 13202

CIP
National Center for Health Statistics

Manning Feinleib, M. D., Dr. P. H., Director

Robert A. Israel, Deputy Director

Jacob J. Feldman, Ph. D., Associate Dii-ectorfor Analysis and

Epidemiology

Gail F. Fisher, Ph. D., Associate Directorfor Planning and

Extramural Programs

Peter L. Hurley, Associate Director for Vital and Health

Statistics Systems

Stephen E. Nieberding, Associate Director for Management

Charles J. Rothwell, Associate Director for Data Processing

and Serl’ices

Monroe G. Sirken, Ph. D., Associate Director for Research

and Methodology

David L. Larson, Assistant Director, Atlanta

Division of Health Care Statistics

W. Edward Bacon, Ph. D., Director

Thomas McLemore, Deputy Director

Evelyn S. Mathis, Chief, Long-Term Care Statistics Branch

Manoochehr K. Nozary, Chief, Technical Services Branch
Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .“” ””-””

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

Mentaldisordersbytype . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dependencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lengthofstay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....”.”.

Primarysourceofpayment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Usuallivingarrangementsandreasonsforadmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Listofdetailedtables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...........

Appendixes

I. Tecbnicalnotesonmethods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11. Definitionofcertaintermsusedinthisreport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

III. Selectedswveyinstrumentsusedinthe 1985NationalNursingHomeSumey . . . . . . . . . . . . . . . . . . . . . . .

List of text figures

1.

2.

3.

4.

5.

6,

7.

8.

Percent distribution of nursing home residents, by mental condition: United States, 1985. . . . . . . . . . . . . . . . . .

Percent of mentally ill nursing home residents, by type of mental disordec United States, 1985 . . . . . . . . . . . . . .

Percentofnursinghomeresidentswith mental disorders,by selectedresident characteristics: UnitedStates,1985 . . . .

Percentofnursing homeresident.s with atleastone dependency intheactivitiesof dailyliving(ADL), byageandmental

condition: UnitedStates, 1985.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Average number of dependencies of nursing home residents, by age and mental condition: United States, 1985 . . . . . .

Percent distribution of nursing home residents by length of stay since admission, according to mental condition:

UnitedStates, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

Averagelengthofstaysinceadmission ofnursinghomeresidents,byageand mental condition: UnitedStates,1985 . .

Percent of nursing home residents with mental disorders, by selected facility characteristics: United States, 1985 . . . . .

List of text tables

A. Number and percent of residents with mental disorders and percent of total residents, by selected mental disorders:

UnitedStates, 1985 . . . . . . . . . . . . . . 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...

B. Number and percent distribution of nursing home residents by selected resident characteristics, according to mental

conditionUnitedStates,1985. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

C. Average number ofdependencies of nursing home residents, by mental condition, age, sex, and race: United States,

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

D. Percent of nursing home residents, by mental condition, age, and functional status: United States,

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...

1

2

3

5

7

9

11

13

14

16

17

37

43

46

2

3

5

8

8

9

10

15

4

6

7

8

.,,

Ill
E. Average length of stay since admission of nursing home residents, by mental condition and selected resident characteristics:

United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...10

F. Number and average length of stay since admission of nursing home residents, by mental condition and selected facility

characteristics: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . ...10

G. Number, percent distribution, and average total monthly charge of nursing home residents by primary source of payment,

according tomental condition: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

H. Average total monthly charge of nursing home residents, by mental condition and selected resident characteristics:

United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . ..I2

J. Average total monthly charge of nursing home residents, by mental condition and length of stay since admission:

United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...12

K. Percent distribution of nursing home residents by usual living quarters prior to admission, according to mental condition:

United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...13

Symbols

-- Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than 500

where numbers are rounded to thousands

*

Figure does not meet standard of

reliability or precision (more than 30-

percent relative standard error)

# Figure suppressed to comply with

confidentiality requirements

iv
Mental illness in nursing

homes

by Genevieve Strahan, Division of Health Care Statistics, and

Barbara J. Burns, Ph. D., Duke University Medical Center

Background

The data presented in this report on mental illness in

nursing homes are from the 1985 National Nursing Home

Survey (NNHS). The survey is a nationwide (excluding Alaska

and Hawaii) sample of nursing and related care homes, their

residents, discharges, and staff, conducted periodically by the

National Center for Health Statistics. The survey is based on a

probability sample of nursing homes with three beds or more,

set up and staffed to provide nursing and personal care services

to residents on a routine basis. The sample frame included all

types of nursing homes without regard to the level of care they

provided, whether they participated in the Medicare or Medicaid program, or whether they were licensed.

A facility could be freestanding or a nursing care unit of a

hospital. retirement center, or similar institution, provided it

maintained separate financial and employee records. The frame

did not include board and care homes. In addition, it excluded

facilities identified as providing residential care. A sample of

1,220 homes was selected from the frame of 20,479 facilities.

Estimates are based on data collected from 1,079 participating

facilities. The 1985 survey, conducted between August 1985

and January 1986, was the third in a series of surveys designed

to provide comprehensive information about people using this

segment of long-term care and about the facilities in which they

reside. The first survey was conducted between August 1973

and April 1974; the second survey was conducted from May

through December 1977. For convenience, this report will use

the terms “nursing and related care homes,” “nursing homes,”

and “facilities” interchangeably.

The sample frame for residents was the total number of

residents on the register of the facility on the evening prior to the

day of the survey. Residents who were physically absent from

the facility because of overnight leave or a hospital visit but who

had abed maintained for them at the facility were also included

in the sample frame. Five residents or fewer per facility were

selected for each of the sampled nursing homes. Data for a total

of 5,243 residents were collected by interviewing the staff

member most familiar with the care provided to the resident.

When responding, the staff member relied on the medical

records of each resident.

Additional followup information on the sample residents

was collected by telephone interview with each resident’s next

of kin. (A resident’s guardian or friends were contacted if there

was no next of kin.) Data collected from the next of kin focused

on the circumstances and reasons for the resident’s nursing

home admission. The primary focus of this report is to present

data obtained from nursing home staff respondents. However,

selected data from the resident’s next of kin also are presented.

Detailed information about the sampling frame, sample “

design, and survey procedures is presented in appendix I. In

addition, appendix I includes imputation procedures and estimation techniques. Because the data in this report are national

estimates based on a sample and are subject to sampling errors,

standard error charts and illustrations of their use also are

provided in appendix I.

Appendix II presents definitions of terms used in this report

and explanations of how the population of residents with mental

disorders was identified. Reference to appendix II is essential to

interpret the data in this report. A facsimile of the current

resident questionnaire used in the survey is shown in appendix

III.

Data based on the entire survey are available on computer

tape and in published reports. These reports include preliminary

statistics about facilities, residents, discharges, and registered

nurses (1-4). Final statistics on most of the topics covered by the

survey (5), on the effects of Medicare’s prospective payment

system on nursing homes (6), on utilization of nursing homes by

current residents (7), and on discharges from nursing homes (8)

also have been published.
Introduction

The 1985 National Nursing Home Survey reports that 65.3

percent of all current nursing home residents (or 974,300

persons) had at least one condition that can be classified as a

mental illness (figure 1). Because nursing homes have become

a major resource for residential care of the mentally ill, this

report will describe this major subgroup of nursing home

residents. “Mental illness” and “mental disorders” will be used

interchangeably to describe the conditions of patients who

currently have any of the following conditions: mental retardation, alcohol or drug abuse, organic brain syndromes (OBS)

(including Alzheimer’s disease), depressive disorders, schizophrenia and other psychoses, anxiety disorders, and other mental disorders (including personality disorders, physiological

malfunction arising from mental factors. special symptoms or

syndromes not elsewhere classified, and adjustment reaction).

It was easier to identify and count persons with mental

disorders in institutions when they were the long-term residents

of psychiatric hospitals. However, with the beginning of

deinstitutionalization of mental hospitals in the middle 1950’s,

these patients were discharged to community mental health

centers, family homes, nursing homes, intermediate care facilities, and other types of facilities. Survey results provided

information to identify the whole range of mental disorders, not

just the subset of persons with chronic mental illness. To

accomplish this, two approaches were used: 1) all conditions

listed in the ninth edition of the International Class~ication of

Diseases (ICD-9-CM) (including chapter V) were recorded;

and 2) boxes covering the whole range of mental conditions and

a box to check no mental disorder were also available to prompt

recording of mental conditions.

To assess the prevalence and to assure that the count was

inclusive of all persons with mental disorders, three questions

from the current resident questionnaire (see appendix III) were

used to capture this subgroup for this report:

●

●

Question 14 asked that the respondent list the current

primary and other diagnoses from the medical record of

each sampled resident. Up to a total of eight diagnoses

could be listed. Residents with any of the mental disorders

from chapter V and other related conditions based on the

ICD-9-CM became the base subgroup of nursing home

residents with mental disorders.

Question 15 asked that the respondent look at a specific list

of mental disorders and mark all that apply to each sampled

resident based on the resident’s medical record. If a resident was identified by the boxes in question 15 as having a

No mental disorders

At least one

mental disorder

65.3%

Figure 1. Percent distribution of nursing home residents, by mental

condition: United States, 19SS

mental disorder but did not have previous diagnoses of the

same conditions, then he or she was added to the base

subgroup with two exceptions (anxiety and depression).

. Question 35, which asked if the resident displayed anxiety

or depression nearly every day, was used to confirm these

conditions on the chance that the box may have been used

to record symptoms rather than conditions. Residents with

anxiety andlor depression were added to the subgroup of

nursing home residents with mental disorders if both questions 15 and 35 indicated these conditions.

This report will present data on the length of stay since

admission, source of payment in the month before the survey,

functional dependencies in activities of daily living, and other

characteristics of this large subgroup of current residents. These

residents with mental disorders will be described according to

demographic characteristics as well as by selected characteristics of the nursing homes.

Comparisons will be made between the total nursing home

population and those with mental disorders and between those

with mental disorders and those without mental disorders.

Because of differences in methods used to identify persons with

mental disorders (described above), data presented in this

report will differ from previously published data from the 1985

NNHS.
Mental disorders by type

Based on results from the 1985 NNHS, nearly two-thirds of Alzheimer’s disease made up about 65,000 of the total 696,800

all nursing home residents had at least one mental disorder. For residents with OBS. Nearly half (46.7 percent) of the total

this report these disorders have been grouped as follows: mental nursing home population was diagnosed with this type of

retardation, alcohol and drug abuse, organic brain syndromes disorder. Twenty percent of the nursing home residents with

(including Alzheimer’s disease), depressive disorders, schizo- mental disorders had diagnoses of schizophrenia and other

phrenia and other psychoses, anxiety disorders, and other men- psychoses. Anxiety and depressive disorders were found in 17

tal disorders. The most prevalent mental disorder was organic percent of all residents with mental disorders and 11 percent of

brain syndromes. More than 70 percent of all residents with at all residents in nursing homes (table A).

least one mental disorder had OBS (figure 2). Those with

Organicbrainsyndrome

(including Alzheimer’s disease)

71.5

Schizophrenia and other psychoses

Depressive disorders 17,1

&

~

0

.!!

u

~

c Anxiety dkorders 16.8

E

z

Mental retardation

Alcohol and drug abuse

Other mental disorders

I 1 I I 1 I I I I 1 I

o 10 20 30 40 50 60 70 80 90 100

Percent of mentally ill residents

NOTE:Subgroups add to more than 100.0 percent because res]dents wth mult!ple dsorders are counted in each group.

Figure 2. Percent of mentally ill nursing home residente, by type of mental disorder: United States, 1985
Table A. Number and percent of residents with mental disorders and

percent of total residents, by selected mental disorders: United States,

1985

Percent Percent

of residents of

with rr7enta/ total

Menta/ d/sorder Total ‘ disorders’ residents

Total . . . . . . . . . . . . . . . . . 974,300 100.0 65,3

Mental retardation . . . 83,200 8.5 5.6

Alcohol and drug abuse . . . . . . . . . . . . ... 58,700 6.0 3,9

Orgarvc brain syndromes

(including Alzheimer’s disease). 696,600 715 46.7

Depressive disorders 167,000 17.1 11.2

Schizophrenia and other psychoses 195,400 20.0 13.1

Anxiety disorders . . . . . . 163,700 16.8 11.0

Other mental illnesses. ., . . 17,700 1.8 1.2

1Subgroups add to morethan the total because resdents with mult(ple d(aorders are counted

only once m tha total

With the exception of mental retardation and alcohol and

drug abuse, male and female residents showed no significant

difference in the prevalence of the mental disorders identified.

Males were diagnosed twice as often as females for mental

retardation and four times as often as females for alcohol and

drug abuse.

The percent of residents with mental disorders decreased

with age for each of the selected disorders except OBS. About

20 percent of all residents under 65 years of age had a diagnosis

of OBS. The percent of residents with OBS increases with age

to 55.6 percent of the total for those 85 years of age and over,

The number of residents with each of the other mental disorders

all declined with age. The greatest decline was among those

residents with mental retardation and schizophrenia and other

psychoses (table 1).
Demographics

A report published by the National Center for Health

Statistics (7) shows that there are significantly more female

residents in nursing homes than males. Females make up about

72 percent of the total resident population, and males account

for the remaining 28 percent. This is true also for the ratio of

females to males with mental disorders in nursing homes.

Seventy-two percent of all persons with at least one mental

disorder are female, and 28 percent are male. Of the total males

and females in nursing homes, 65 percent of each suffer from

some form of mental illness (figure 3). This 65 percent of total

male residents with mental disorders was disproportional to the

male population in nursing homes.

disorders were 65 years of age and over. More than one-third of

all residents with mental illness were 85 years of age and over

(table B). The average age of all residents with mental disorders

was 79 years. The average age for females was 81 years and for

males, 73 years (tables 2 and 3). Although the total number of

residents in nursing homes is overwhelmingly white (92 percent), significant differences were not observed in the percent

of total residents with mental disorders by race or Hispanic

origin. This was probably due to the small sample sizes among

the minority groups. Tables 2 and 3 also show the number and

percent distribution of nursing home residents with mental

disorders by selected nursing home characteristics, according

Approximately 87 p;rcent of all residents with mental to age, sex, and race.

R: i 65.4

75.8

65.4

Male Female Under 65-74 75-84 85 years

65 years years years and over

Resident characteriatica

White Black and

other

Figure 3. Percent of nurelng home residents with mental dlsordere, by eelected reeldent characteristics: United States, 1985

5
Table B. Number and percent distribution of nursing home residents by selected resident characteristics, according to mental condition: United States, 1985

Mental condition

All Residents with Residents without

residents mental disordera mental disorders

Resident Percent Percent Percent Percent Percent

charactenst~c Number distribution Number distribution of total Number distribution of tots/

Total . . . . . . . . . . . . . . ,. ,., 1,491,400 100.0 974,300 100.0 65,3 517,200 100.0 34.7

Age

Under 65 years 173,100 11.6 131,200 13.5 75,8 41,900 6.1 24.2

65 years And over . . . . . . . . . . . .,, .,. ,. 1,316,300 88.4 843,000 86.5 64,0 475,300 91,9 36.1

65-74 years. ,,, .,, .,.,,.,. 212,100 14.2 143,800 14.8 67,8 68,300 13,2 32.2

75–84 years.,..,.,.,,. ., ., .,,...,, 509,000 34.1 322,700 33.1 63.4 186,300 36,0 36.6

85years andover. 597,300 40.0 376,500 38.6 63,0 220,800 42,7 37.0

Sex

Male, . . . . . . . . . . . . . . 423,800 28.4 276,200 28.3 65.2 147,500’ 28.5 34.8

Female, . . . . . . . . . . . . . . . . . . . ., .,,, 1,067,700 71,6 698,100 71.7 65.4 369,600 71.5 34.6

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,374,600 92.2 899,600 92.3 65.4 475,100 91.9 34.6

Black and other.,.....,..,,.. 116,800 7,8 74,700 7.7 64.0 42,100 8.1 36,0

Hispanic ongm

Htspanlc . . . . . . . . . . . . . . . . . . . . . 41,000 2,7 30,900 3.2 75.4 10,100 2.0 24.6

Non-Hwpanlc . . . . . . . . . . . . . . 1,450,400 97.3 943,300 96.8 65.0 507,100 98.0 35.0

NOTE, Figures may not add to totals because of mundmg
Dependencies

Many older people require assistance in performing those

daily activities consistent with normal human behavior. Data on

whether residents needed assistance in the basic activities of

daily living (ADL’s) were collected in the 1985 survey. The

ADL’s include bathing, dressing, eating, mobility, transferring

in and out of bed or chair, using the toilet room, and continence

(9).

Tables 4 and 5 show dependencies in ADL’s for each type

of mental disorder. Assistance in bathing and dressing would be

ranked first and second in a list of the most frequently listed

dependencies. Ninety percent of all residents with mental disorders required assistance in bathing; 79 percent required assistance in dressing. Residents with OBS were more dependent in

each of the ADL’s than were residents with the other mental

disorders.

Residents with mental disorders had an average of 4.0

dependencies in contrast to 3.3 dependencies for those without

mental disorders (table C). Table D shows a comparison of the

percent of residents with and without mental disorders in

relation to their need for assistance in the ADL’s. The 1985

survey indicates that 90.3 percent of the residents with mental

Table C. Average number of dependencies of nursing home residents, by

mental condition, age, aax, and race: United Statea, 1985

Mental condit;on

All With mental Without mental

Age, sex, and race residents disorders disorders

Average number of dependencies

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.8 4.0 3.3

Age

Under 65years . . . . . . . . . . . . . . . . . . . 2.8 2.4 3.8

65-74 years . . . . . . . . . . . . . . . . . . . . . . 3.4 3.5 3.2

7S64years . . . . . . . . . . . . . . . . . . . . . . 3.8 4.1 3.3

85years and over . . . . . . . . . . . . . . . . . 4.1 4.7 3.2

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3 3.5 3.1

Female . . . . . . . . . . . . . . . . . . . . . . . . . . 3.9 4.2 3.4

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.7 4.0 3.2

Black andother . . . . . . . . . . . . . . . . . . 3.9 4.0 3.9

disorders compared with 85.8 percent without mental disorders

required assistance with bathing. The comparison was 79.4

percent and 67.8 percent, respectively, for assistance with

dressing and 45.4 and 27.7 percent, respectively, for assistance

with eating. Residents with mental disorders required less help

with mobility but more help with using the toilet room. Difficulty controlling both bowel and bladder was a problem for

more residents with mental disorders than for those without.

Nearly 60 percent of the residents with mental disorders had this

dit%culty, compared with 37.3 percent without mental disorders. More than twice as many residents with mental disorders

(35.2 percent) than those withoutmentaldisorders (17.1 percent)

had dependencies in all six of the ADL’s.

Tables 6 and 7 show the number and percent of nursing

home residents with mental disorders by selected functional

status, age, sex, and race. The percent of residents with dependencies in each of the ADL’s increased with age. However, age

did not seem to have the same effect on the percent of residents

without mental disorders needing assistance with the ADL’s.

Figure 4 shows a comparison of the two groups. The percent of

residents without mental disorders needing assistance showed

no difference based on age.

The average number of dependencies for residents with and

without mental disorders by age, sex, and race is shown in table C and illustrated forage in figure 5. The average number of

dependencies increased with age for residents with mental

disorders. Residents without mental disorders had an average

number of dependencies that decreased with age. In general,

female residents with mental disorders were more dependent

than males were in the ADL’s. There was no difference in the

average for residents with no mental disorders or for either

group by race.

Other daily activities, such as care of personal possessions,

handling money, securing personal items, and using the telephone, are referred to as instrumental activities of daily living

(IADL’s). Results from the 1985 survey show more nursing

home residents with mental disorders needing help with each of

the IADL’s than those with no mental disorders. Overall, 90.0

percent of the residents with mental disorders received assistance with at least one of the IADL’s activities, compared

with 74.9 percent for residents without mental disorders (table D).

7
Table D. Percent of nursing home residents, by mental condition, age, and functional status: United States, 1985

Mental condition

With mental disorders Without mental disorders

Under 65 years Under 65 years

Functions/ Status A// residents 65 years and over All residents 65 years and over

Requires assistance bathing .,, ., 90.3

Requires assistance dressingi. . 79,4

Requires assistance eatingz .,.... ,., ,., ,., 45.4

Requires assistance wlthmoMity3 .,. 68.8

Requires assistance transferring4 61.6

Requires assistance using toilet room5 .,, ...,, ,. 65.3

Continence-difficulty with bowel and/or bladder control . . . . 59,7

Receives help in instrumental activmes of daily living ., ., ., 90.0

67.2

53.4

26.6

38,1

30,3

34.5

30.5

76.2

93.9

83.5

48.4

73.6

66.5

70.0

64.2

92.1

85.8

67.8

27.7

74.2

56.7

52.6

37.3

74,9

83.1

76.1

46.8

83,1

68,7

69.2

37.9

71.6

86.0

67.1

26.1

73.5

55.7

51,1

37.3

75.2

1 Includes those who do not dress,

2 Includes those who are lube or intravenously fed,

3 Includes those who are charfast or bedfast.

4Transferrlng refers to getting m or out of bed or ch.w,

5 Includes those who do not use toilet room.

Mental condition

❑ With mental disorders

❑ Without rnentaldisorciers

98,5

85.4

93.9

87.6

Under 65-74 75–84 85 years

65 years years years and over

Age

1.0

0.5

I

Mental condition

— With mental cfiaorders

--- Without mental diaordera

o ~~

Under 65 65-74 75-84 85 years

years years years and over

Age

Figure 5. Average number of dependencies of nursing home residents, by

age and mental condition: United Statea, 1985

Figure 4. Percent of nursing home residents with at Ieaat one dependency

in the activities of daily living (ADL), by age and mental condition:

United States, 1985
Length of stay

Slightly more than 30 percent of all residents with mental

disorders had lengths of stay from 1 year to less than 3 years.

This was about the same for residents without mental disorders,

as 30.5 percent of them had lengths of stay of 1year to less than

3 years. Differences in the distribution of these two groups,

however, are seen for the percent of those with less than 1 year

and those with 3 years or more. More residents (42.1 percent)

without mental disorders than those with mental disorders had

spent shorter periods of less than 1 year in nursing homes. The

opposite was true for the percents of those with lengths of stay

of 3 years or more: 34.4 percent for those with mental disorders

and 27.5 percent for those without mental disorders (figure 6).

The average length of stay since admission of residents

with mental disorders was 1,139 days, compared with 1,059

days for all residents and 907 days for residents with no mental

disorders. There was no difference in the length of stay by sex,

race, or Hispanic origin. However, other resident characteristics showed significant differences. Residents who were married had a much shorter length of stay than those who were not

married. Residents who were never married had the longest

lengths of stay. The average length of stay for residents with

mental disorders was shorter for those with living children than

for those with no living children (table 8).

The average length of stay for residents with and without

mental disorders, by age, race, current marital status, and other

characteristics of the residents in nursing homes, is shown in

table E. For each characteristic of residents, the average length

of stay was significantly longer for residents with mental

disorders than for residents with no mental disorders. Residents

under 65 years of age with mental disorders had an average

length of stay of 1,464 days, compared with 829 days for this

same group of residents with no mental disorders (figure 7).

Both white and black and other residents with mental disorders

stayed more than twice as long as did those with no mental

disorders. Residents with mental disorders who were married

had shorter stays in nursing homes (724 days) than did unmarried

residents with mental disorders. Residents with no mental

disorders (table E) had even shorter stays (293 days).

Several differences were observed in the lengths of stay of

the residents with mental disorders according to the characteristics of the nursing facility and where it is located. Although

not significant, government-owned nursing homes had slightly

longer lengths of stay than did other types of ownership.

Residents in skilled nursing facilities only and skilled and

intermediate care facilities, with average lengths of stay of 948

and 1,043 days, respectively, had shorter stays than residents in

intermediate care facilities only or not certified facilities.

Length of stay since admission

A = Less than 3 months

B = 3 months to less than 6 months

C = 6 months to less than 12 months

D = 1 year to less than 3 years

E = 3 years to less than 5 years

F = 5 years or more

With mental disorders

Without mental disorders

Figure 6. Percent distribution of nursing home residents by length of stay

since admission, according to mental condition: United States, 1985

9
Table E. Average length of stay since admission of nursing home

residents, by mental condition and selected resident characteristics:

United States, 1985

Mental condition

All With mental Without mental

Resident characferwtlc res!dents disorders disorders

Total.

Age

Under 65yaars ...,.... ...,.,,,

65 years Andover,.,..,..

65-74 years,.,.........,,.,,,,..

75-84 years, ...,,...

85 years and over, . . . . . . . . . . . . . ,,.

Race

White . . . . . . . . . . . . . . . . . .

Black and other, . . . . . . . . . . . . . . .

Current marital status

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

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

Divorced orseparated, . . . . . . . . . . . . .

Never married..,.,..,.,..

Has Iivmg children

Yes, .,....,...,,....,.,....,..

No or unknown..,,,,.,,...,,..

Length of stay m days

1,059 1,139 907

1,311 1,464 829

1,026 1,089 914

1,055 1,161 833

948 997 864

1,081 1,140 981

With the exception of homes with 200 beds or more,

residents stayed significantly longer in smaller nursing homes

(less than 50 beds) than in homes with more than 50 beds.

Homes in the West had residents with shorter lengths of stay

than the other three census regions (table 9). Residents without

mental disorders had the same basic patterns in lengths of stay,

according to facility characteristics, as did those with mental

disorders. The stays, however, for residents without mental

disorders were almost always significantly shorter (table F).

Table F. Number and average length of stay since admission of nursing

home residents, by mental condition and selected facility characteristics:

United States, 1985

1,061 1,140 515

1,037 1,136 451

With mental Without mental

disorders disorders

Length of Length of

Faci/ity characteristic Number stay in days Number stay/n days

675 724 293

990 1,032 545

997 1,114 350

1,582 1,721 629

933 989 479

1,244 1,343 541

1,500 -

1,400

1,300

%m

: 1,200

hm

z

z

~

~ 1,100

:

1,000

900

Mental condition

— With mental disorders

--- Without mental disorders

800~

Under 65-74 75–84 85 years

65 years years years and over

Age

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

Ownership

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

Voluntary nonprofit . . . .

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

Certification

Skilled nursing

facility only,....,....,..

Skilled nursing facility and

Intermediate care

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

Intermediate care

facility only. , . . . . . . . . . . .

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

Bed size

Lessthan50 beds . . . . . . .

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

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

200 beds ormore .,....,..

Census region

Northeast, . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . .

South . .,....:....,.,..

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

974,300

692,600

195,300

86,400

178,300

438,800

254,000

103,100

93,900

263,100

418,400

198,900

234,700

308,900

286,700

143,900

1,139

1,103

1,166

1,374

948

1,043

1,354

1,351

1,506

1,108

1,015

1,268

1,138

1,207

1,179

917

517,200

331,300

146,300

39,600

97,000

235,900

117,400

66,900

39,400

149,100

226,300

102,400

117,400

175,200

151,600

72,900

907

773

1,085

1,371

690

916

1,012

1,007

785

912

841

1,092

1,101

923

850

677

NOTE: F!gures may not addtototalsbecause of rounding

Figure 7. Average length of stay since admission of nursing home

residenta, by age and mental condition: United States, 1985

10
Primary source of payment

The average total monthly charge for the 974,300 residents

with mental disorders was $1,460. Residents without mental

disorders had an average total monthly charge of $1,448. A

comparison of the average total monthly charge for residents

with and without mental disorders, by primary source of payment, is shown in table G. There were minimal differences for

the two groups of residents by source of payment with the

exception of payments made by Medicare. Medicare payments

for residents with mental disorders were 37 percent less than

payments for residents without mental disorders.

The average total monthly charge for residents with mental

disorders from all sources of payment increased with age. Those

residents under 65 years of age had an average total monthly

charge of $1,275 from all sources, whereas the 85 years and

over age group had an average total monthly charge in excess of

$1,500 per month. There were no differences in the average

total monthly charges based on the sex, race, or Hispanic origin

of these residents (table 10).

Table H presents a comparison of the average total monthly

charge for nursing home residents with and without mental

disorders by selected characteristics of the residents. As shown

in table G, residents without mental disorders had an average

total monthly charge of $1,448, compared with a nonsignificant

difference of $1,460 for those with mental disorders. However,

younger residents (under 65 years of age) without mental

disorders averaged $1,704 per month, whereas residents with

mental disorders had an average total monthly charge of $1,275.

The average total monthly charge for residents with and

without mental disorders is shown by length of stay since

admission in table J. Residents with mental disorders had

average total monthly charges that decreased from $1,517 for

less than 3 months to $1,335 for residents in the nursing home

5 years or more. Those residents without mental disorders had

monthly charges that ranged from $1,703 down to $1,300 a

month.

Skilled nursing facilities, based on the fact that they are

required to provide a higher level of nursing care, had a higher

average total monthly charge for all sources of payment than did

the other certified facilities. The average total monthly charge

for all sources of payment for residents with mental disorders

increased with the bed size of the facility. This charge was

$1,077 for homes with less than 50 beds and increased to $1,792

for homes with 200 beds or more. States in the Northeast had a

higher average total monthly charge than did States in the other

regions. Residents with mental disorders in the Northeast averaged a high of $1,813 for all sources of payment, whereas

States in the South had a low of $1,246 per month (table 11).

Table G. Number, percent distribution, and average total monthly charge of nursing home residents by prima~ source of payment, according to mental

condition: United States, 1985

Mental condition

With menta/ disorders Without mental disorders

Percent Average Percent Average

Primary source of payment Number distribution monthly charge Number distribution monthly charge

Allsources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 974,300 100.0 $1,460 517,200 100.0 $1,448

Ownincome or family support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378,600 38.9 1,466 242,100 46.8 1,425

Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,100 0.9 1,770 11,900 2.3

Medicaid:

2,424

Skilled . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184,500 18.9 1,896 78,500 15.2 1,902

Intermediate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338,500 34.7 1,293 149,800 29.0 1,289

Other government assistance orwelfare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35,800 3.7 885 14,900 2.9 808

All other sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27,900 2.9 1,140 20,000 3.9 1,043

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

11
Table H. Average total monthly charge of nursing home residents, by Table J. Average totel monthly charge of nursing home residenta, by

mental condition and selected resident characteristics: United States, 1985 mental condition and length of stay since admission: United States, 1985

Mental condition Mental condition

All With mental Without menta/

Resident characteristic

All

residents disorders disorders

With menta/ Without rnenta/

Length of stay since admission residents disorders disorders

Age

Under 65 years . . . . . . . . . . . . . . . .

65 years Andover.. . .

65–74 years...,....,....,..

75-84 years. ,., ,..

85 years And over .,.... ,., ...

Sex

Male, . . . . . . . . . . . . . . . . . .

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

Race

White, .,,...,.,., . . . . . . . . . .

Black andother . . . . . . . . . . . . . .

Black ...,.,,. . . . . . . . . . . . . . . . .

Hispanic origin

Hispanic. . . . . . . . . . . . . . . . . . . . . . .

Non-Hispanici . . . . . . . . . . . . . . . . .

Current marital status

Married . ., . ., . .,, , . . . . . . . . . . . . .

Widowed’ .,. . . . . . . . . . . . . . . . . . . .

Divorced or separated

Never married . . . . . . . . . . . . . . . . . . .

Has hvmg children

Yes ..,....,,,..,.......,....,..

No orunknown .,.........,,,..

$1,379

1,466

1,372

1,468

1,497

1,438

1,463

1,454

1,481

1,451

,400

,457

,540

,472

,362

1,382

1,485

1,413

Charge m dollars Charge in dollars

$1,275

1,488

1,360

1,487

1,539

1,395

1,485

1,459

1,466

1,400

1,457

1,460

1,470

1,513

1,288

1,364

1,505

1,398

$1,704 Total . . . . . . . . . . . . . . . . $1,456

1,426

$1,460 $1,448

1,398 Less than 3 months . . . . . . . . . .. . . . 1,601 1,517 1,703

1,435 lyearto lessthan3 years . . . . . . . 1,441 1,469 1,385

1,427 3 years to less than 5 years 1,407 1,440 1,336

5years or more..,., ... 1,325 1,335 1,300

NOTE Figures may not add to totals because of rounding.

1,519

1,420

1,443

,506

,540

,225

,453

1,676

1,403

1,505

1,430

1,451

1,444

‘ Includes a small number of unknowns,

NOTE: F]gures may not add to totals because of rounding,

12
Usual living arrangements and

reasons for admission ‘

Additional information was collected in a followup survey

from the next of kin for 90 percent of the nursing home

residents. This information gave some insight into lifestyles of

these residents prior to their entry into the nursing home.

Information collected included: usual living quarters, usual

living arrangements, main medical and general reasons for

admission, and functional status of the resident at admission.

Data are presented in this section by age, sex, race, marital

status at admission, and primary source of payment at admission. Tables 12-16 present data for an estimated 956,600 residents with mental disorders based on the next-of-kin followup

survey. Tables 14 and 15 show comparisons of these residents

with next-of-kin data collected for residents without mental

disorders.

About 68 percent of the residents with mental disorders,

compared with 75 percent without mental disorders, lived in

private or semi-private residences prior to entering the nursing

home, with most (38 and 47 percent, respectively) living in their

own home or apartment. Most (27.5 percent) of the remaining

residents with mental disorders and 20 percent without mental

disorders came from another health facility. Of the 27.5 percent

with mental disorders admitted from another health facility,

18.5percent entered from another nursing home and 3.5 percent

came from a mental institution (table K). The 3.5 percent is

down from the 5.9 percent who entered from mental institutions

in 1977(10), indicating that deinstitutionalization is subsiding.

Table 12 shows the prior living arrangement of residents

with mental disorders by age, sex, and race, and table 13

presents these same data by marital status and primary source of

payment. A comparison of this followup information for residents with and without mental disorders shows significant

differences in the type of usual living arrangements. More

residents without mental disorders lived alone previously than

did those with mental disorders. Nearly 47 percent of those

without ,mental disorders lived in their own home or apartment,

compared with 38 percent of those with mental disorders (table 14).

Table 15presents the main medical and general reasons for

Table K. Percent distribution of nursing home residents by usual living

quarters prior to admission, according to mental condition: United States,

198s

Mental condition

kWth mental Without mental

Usual living quatiers 1 disorders disorders

Percent distribution

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

Private or semi-private residence . . . . . . . . . . . . . . . . .

Ownhome orapartment . . . . . . . . . . . . . . . . . . . . . .

Relative’s homeorepartment . . . . . . . . . . . . . . . . . .

Other private living arrangement . . . . . . . . . . . . . . . .

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

Another nursing home . . . . . . . . . . . . . . . . . . . . . . . .

Menta[ hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other typehospital . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other place orunknown . . . . . . . . . . . . . . . . . . . . . . . .

67.5

37.7

20.2

9.7

27.5

18.3

3.5

5.5

5.0

75.0

46.6

19.6

8.8

20.0

13.4

0.1

6.5

5.1

1Living quariers are as reported by nexi of kin.

NOTE: Percanis may not add to totals becauae of rounding.

admission and state of health before admission for residents

with mental disorders, by age, sex, and race. The main medical

reasons for admission centered around those conditions related

to mental illness—Alzheimer’s disease, senility, forgetfulness

and confusion, and other emotional, mental, or nervous conditions. Other most frequently reported medical reasons for

admission included stroke, hip fracture, heart and circulatory

conditions, and atherosclerosis. Allowing for more than one

general reason for admission, 79.1 percent required more care

than household members could give, 72.6 percent had problems

doing everyday activities, and 62.4 percent had no one at home

to provide care. These are about the same general reasons that

most residents without mental disorders have for entering

nursing homes (table 16). The states of health of more than half

of all residents with mental disorders were perceived by their

next of kin as gradually worsening before admission. Only 14.3

percent of those with mental disorders were suddenly ill or

injured, compared with 22.4 percent of those without mental

disorders who were suddenly ill or injured.

13
Conclusions

The results of the 1985 National Nursing Home Survey

showed that most residents of nursing homes have mental

disorders. The average number of dependencies increased

dramatically with age for residents with mental disorders, but

age had a very different effect on residents without mental

disorders (figure 5). Growth of the “very old” or “frail elderly”

age strata in the general population means that the magnitude of

both physical and mental health problems have increased significantly for this group as they reside in the community and for

the many that will be cared for in nursing homes.

Organic brain syndromes (including Alzheimer’s disease),

reported for 71.5 percent of the residents with at least one

mental disorder, was the leading diagnosis of the mental conditions. Historically, OBS patients would have been placed in

mental hospitals but are now being admitted directly to nursing

homes. A much smaller group—those with substance abuse,

depressive disorders, schizophrenia, and anxiety disorders—

would historically have been candidates for psychiatric hospitalization. However, given pressure for short stays in hospitals

(including psychiatric) and given the extensive functional and

instrumental disability of these persons, there appears to be a

need for the long-term care with nursing assistance provided

only in nursing homes. This form of care is clearly much less

expensive than in hospitals, and—in the absence of other

community facilities and one type of funding to cover these

OBS patients (that is, Medicaid)—nursing homes are the only

alternative when extensive supervision is required.

Federal policies may influence the prevalence of this

condition in these facilities. Organic mental disorders are not

counted when facilities are considered for classification as an

institution for mental disorders (IMD). Any facility with more

than 50 percent of its patients exhibiting mental diseases, other

than OBS, is classified as an IMD and loses Medicaid funding

for all patients. This leads to the view that many nursing homes

may have a tendency to overclassify people with mental disorders

as having Alzheimer’s disease not only to evade the 50 percent

rule, but to justify an assessment that there is little hope of

improvement (11 ). By contrast. the next most frequent mental

disorder diagnosis, schizophrenia and other psychoses. was

reported for only 20 percent of the residents.

A significantly higher percentage of those under 65 years

of age with mental disorders are in nursing homes. Nursing

homes are an obvious choice for residents under 65 years of age

with mental disorders because State mental hospitals receive

Medicaid reimbursements only for those residents over 65

years of age. By race, differences were not observed in the

percentage of residents with mental disorders. Figure 8 shows

variations in the percentage of residents with mental disorders

by selected facility characteristics. Voluntary nonprofit facilities had significantly fewer residents with mental disorders than

the national average, compared with proprietary and government

facilities. Homes that were not certified had a smalierpercentage

of residents with mental disorders than did certified homes.

Residents with mental disorders were concentrated in the smaller

homes (fewer than 200 beds) and were spread evenly among the

four regions.

Because the mentally ill make up such a large proportion of

the total nursing home population, a comparison of the distribution of these groups shows no significant difference by any of

the facility characteristics. Although the average length of stay

for most mentally ill residents was from 1 to less than 3 years,

about 20 percent of all residents with mental disorders had

nursing home stays of 5 years or more in contrast to 14.9 percent

without mental disorders. Those mentally ill residents with

living children had shorter average lengths of stay by about 1

year than those with no children. There exists a general feeling

that mentally ill residents are sent to nursing homes to be

maintained on a long-term basis. Because they tend to be

younger and physically healthier than other residents, their

longer lengths of stay are not unexpected.

However, the data showed that residents with mental disorders were more dependent than residents without mental

disorders in the ADL’s-especially dressing, eating, and controlling both bowel and bladder. Having to deal with these kinds

of dependencies was reported by the next of kin as one of the

main reasons for the residents’ admission to the nursing home.

Other main reasons for admission included not having anyone

at home to provide the care or having a requirement for more

care than the provider could give.

Although Federal policy has encouraged the expansion of

nursing homes to meet the needs of the increasing elderly

population, deinstitutionalization of the mentally ill from the

State hospitals to community care has also been encouraged by

Federal policy from another source—the National Institute of

Mental Health. However, community -based residential programs

have not been developed to meet the need. Therefore, availability

of the additional beds in nursing homes has provided an unintended source of community placement for the mentally ill.
100

80

60

g

p

E

40

20

0

67 G 68.6 -.. .

66.4 70.4

66.7 __ _ 65.4 66.4

Ownership Certification Bed size Census region

NOTE: SNF = Skilled nursing facility

[cF = Intermediatecare faCilitY

Figure 8. Percent of nursing home residents with mental disorders, by selected facility characteriatice: United States, 1985

15
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15. McCarthy PJ. Pseudoreplication: Further evaluation and application of the balanced half-sample technique. National Center

for Health Statistics. Vital Health Stat 2(3 1). 1969.

16. Hansen MH, Hurwitz WN, Madow WG. Sample survey methods

and theory, vol 1. New York: John Wiley and Sons. 1953.

17. Cochran WG. Sampling techniques. New York: John Wiley and

Sons. 1953.

18. Stone R. Aging in the eighties, age 65 years and over—use of

community services, preliminary data from the Supplement on

Aging to the National Heafth Interview Survey: United States,

January-June 1985. Advance data from vital and health statistics;

no 124. Hyattsville, Maryland: National Center for Health Statistics. 1986.

19. Public Health Service and Health Care Financing Administration.

International Classification of Diseases, 9th Revision, clinical

modification. Washington: Public Health Service. 1980.

Stat 13(43). “1979.

16
List of Detailed Tables

1. Number and percent of nursing home residents with mental

disorders, by selected patient characteristics: United States,

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. Average and median age and number of nursing home residents with mental disorders, by age, sex, race, and selected

nursing homecharacteristics: United States, 1985 . . . . . . . .

3. Average andmedian ageandpercent disRibution of nursing

home residents with mental disorders by selected nursing

home characteristics, according to age, sex, and race:

UnitedStates, 19S5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. Number ofnursing homeresidents withmental disorders, by

dependencies in activities of daily living and selected mental

disorders: UnitedStates, 1985 . . . . . . . . . . . . . . . . . . . . . . . .

5. Percent of nursing home residents with mental disorders,

by dependencies in activities of daily living and selected

mental disorders: United States, 1985 . . . . . . . . . . . . . . . . . .

6. Number ofnursing homeresidents \vithmentaI disorders, by

age, sex, race, and functional status: United States, 1985. . .

7. Percent distribution ofnursing home residents with menta1

disorders by selected functional status, according to age,

sex, andrace: United States, 1985 . . . . . . . . . . . . . . . . . . . .

8. Number ofnursing home residents with mental disorders,

percent distribution by length of stay since admission, and

average and median length of stay, accordirtg to selected

resident characteristics: United States, 1985 . . . . . . . . . . . . .

9. Number ofnursing home residents with mental disorders,

percent distribution by length of stay since admission, and

average and median length of stay, according to selected

nursin.ghome characteristics: United States, 1985 . . . . . . . .

18

19

20

21

21

22

24

26

27

10. Average total monthly charge andnumber ofnursing home

residents with mental disorders, by primmy source of payment in month before interview and selected resident

characteristics: United States, 1985 . . . . . . . . . . . . . . . . . . . 28

11. Average total monthly charge andnumber ofnursing home

residents with mental disorders, by primary source of payment in month before interview andselected nursing home

characteristics: UnitedStates,1985 . . . . . . . . . . . . . . . . . . . 30

12. Percent distribution ofnursing home residents with mental

disorders and next of kin by usual living arrangement prior to

admission, according to age, sex, and race: United States,

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

13. Percent distibution ofnursing home residents with mental

disorders and next of kin by usual living arrangement prior to

admission, according to marital status artd primary source of

payment atadmission: United States, 1985 . . . . . . . . . . . . . 32

14. Percentdistributionof nursinghomeresidents witinextofkin

by usual living arrangement prior to admission, according to

ageandmental condition: United States, 1985 . . . . . . . . . . . 33

15. Percent distribution ofnursing home residents with mental

disorders and next of kin by reason for admission and prior

state of health, according to age, sex, and race: United States,

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

16. Percentdistributionof nursinghomeresidents withnextofkin

by reason for admission and prior state of health, according to

ageandmental condition: United States, 1985 . . . . . . . . . . . 35

17
Tablel. Number andpercent ofnuraing home residents with mental disorders, byselected patient characteristics: United States, l985

A// residents Organic Schizophrenia Other

All with nrerrta/ Mental Alcohol and brain Depressive and other Anxiety mental

Patient characteristic residents disorders’ retardation drug abuse syndromes2 disorders psychoses disorders illnesses

Number of residents

58,700

37,700

21,000

18,200

40,500

16,100

16,900

7,500

51,800

8,900

6,200

‘2,100

56,500

696,800

170,800

526,000

33,800

663,000

81,000

249,800

332,200

642,200

54,500

50,300

23,900

672,900

167,000

40,700

126,200

24,900

142,000

26,900

64,500

46,600

155,600

11,300

8,500

“4,900

162,100

Total ,, .,,,,...,,.,.,,,.,,,,,,, 1,491,400 974,300

276,200

698,100

131,200

843,000

143,800

322,700

376,500

899,800

74,700

66,600

30,900

943,300

65.3

65.2

65.4

75.8

63.9

67.8

63.4

63.0

65.4

63.9

63.9

75.4

650

83,200 195,400

64,700

130,700

54,100

141,300

44,000

53,500

43,800

177,600

17,800

15,900

7,700

187,700

13.1

15.3

12.2

31.2

10.7

20.7

10.5

7.3

12.9

15.2

15.3

18.8

12.9

163,700

44,500

119,200

22,400

141,300

28,000

61,800

51,500

151,600

12,100

10,500

‘4,900

158,800

11.0

10.5

11.2

13.0

10.7

13.2

12.1

8.6

11.0

10.4

10.1

“12.0

10.9

17,700

8,400

9,300

“5,600

12,100

“3,900

‘3,400

“4,800

16,800

“900

’900

“800

18,600

1.2

2.0

0.9

‘3.2

0.9

‘1.8

‘0.7

‘0.8

1.2

“0.8

‘0.9

‘2.0

1.2

Sex

Male. . ,,

Female .,,.,.,,,,.,..,.,,.,,, ,., ,.,

423,800

1,067,700

37,700

45,500

Age

Under 65years . . . .

65years and over.

65-74 years . . . . . . . . . . . . . .,

75-84 years,.,,,,.,,.,.,,,. ,.,

85 years And over..... .,, ..,,.,

173,100

1,318,300

212,100

509,000

597,300

44,500

38,700

20,200

14,000

“4,600

Race

White . . . . . . . . . . . .,,.,,,,,,,,

Black and other...

Black.

1,374,600

116,800

104,400

77,000

6,200

‘4,700

Hispanic origin

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . ., .,,.,

Non-Hispanic . . . . . . . . . . . . . . . . . . . .

41,000

1,450,400

‘2,200

81,000

Percent of total residents

Total. . 100.0 3.9 46.7 11.2

Sex

Male, .,...........,,..,,....,., ,. .,,., 100.0

Female, . . . . . . . . . . . . . 100.0

Age

Under 65years . . . . . . . . . . . . . . . . . . . 100.0

65years and over . . . . . . . . . . . . . . . . 100.0

65-74 years.,.,....,....,.,,..,,. 100.0

75-84 yeare .,, . . . . . . . . . . . . . . . . . ,., ..,. 100.0

85 years andover .,.,....,.....,,. 100.0

Race

White. . 100.0

Black and other . . . . . . . . . . . . . . . 100.0

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0

Hispanic origin

Hispanic 100.0

Non-Hispanic. . . . . . . . . . ., 100.0

5.6

8.9

4.3

8.9 40.3 9.6

2.0 49.3 11.8

25.7

2.9

9.5

2.8

‘0.8

10.5 19.5 14.4

3.1 50.3 10.8

7.6 38.2 13.6

3.3 49.1 12.7

1.3 55.6 8.1

5.6

5.3

‘4.5

3.8 46.7 11.3

5.9 46.7 9.7

5.9 48.2 8.2

‘5.4

5.6

“5.2 58.3 ‘11.9

3.9 46.4 11.2

—

1 Subgroups add to more than the total because residents with multiple disorders are counted only onca m the total.

2 Includes Alzhe(mer’s disease.

18
Table 2. Average and median age and number of nursing home residents with mental disorders, by aga, sex, race, and selected nursing home characteristics:

United States, 1985

Age

65 years and over

Race

Sex

All residents with Under 65 65-74

Black and other

75-84 85 years

Facility characteristic mental disorders years Total vears vears and over Male Female White Total Black

Age in years

70

70

80

80

90

90

73 81 79

76 83 82

Average resident age . . . . . . . . .

Median resident age . . . . . . . . . . . . .

79

82

51 83

55 83

75 76

77 77

Number

Total, . . . . . . . . . . . . . . . . . . . . . . . . 974.300 131,200 843,000 143,600 322,700 376,500 276,200 698,100 899,600 74,700 66,600

Ownership

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

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

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

692,600

195,300

86,400

101,300 591,300

10,600 184,700

19,400 67,000

110,400

21,400

12,000

221,500

71,000

30,200

259,400

92,300

24,800

199,400 493,200 637,000

43,800 151,500 182,200

33,000 53,400 80,300

55,600 50,500

13,000 12,100

6,100 4,100

Certification

Skilled nursing facility only . . . . . . .

Skilled nursing facility and

intermediate care facility. . . . . . .

Intermediate care facility only. . . . . .

Notcerlified . . . . . . . . . . . . . . . . . . .

178,300 19,000 159,300 23,200

60,400

40,700

19,500

56,500

153,300

85,300

27,500

79,600 44,900 133,400 160,900

115,300 323,500 406,600

75,100 178,900 234,300

40,800 62,200 97,800

17,400 13,300

32,300 30,800

19,800 16,200

“5,300 “4,300

438,800

254,000

103,100

47,800 391,100

29,500 224,500

34,900 66,100

177,300

96,500

21,100

Bed size

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

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

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

200 beds ormore . . . . . . . . . . . . . . .

93,900

263,100

418,400

198,900

24,800 69,100

23,800 239,300

49,600 368,800

33,000 165,900

18,000

40,900

56,500

26,400

27,200

60,800

152,700

62,100

23,900

117,600

159,600

75,400

30,100 63,800 66,100

68,700 194,400 249,700

113,900 304,500 383,700

63,500 135,400 180,000

7,600 8,900

13,400 12,200

34,700 30,300

18,800 17,200

Census region

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

Midwest . . . . . . . . . . . . . . . . . . . . . .

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

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

234,700

308,900

286,700

143,900

31,100 203,600

42,400 266,500

32,900 253,800

24,800 119,100

38,300

42,000

42.800

75,000

104,000

103,500

40,300

90,300

120,600

107,600

58,000

64,200 170,600 221,100

92,400 216,500 291,300

74,000 212,700 254,800

45,700 98,200 132,400

13,600 13,400

17,700 16,500

32,000 30,100

11,500 6,600

Standard Federal

Administrative Region

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

Region 11. . . . . . . . . . . . . . . . . . . . . .

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

Region lV . . . . . . . . . . . . . . . . . . . . .

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

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

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

Region VH1 . . . . . . . . . . . . . . . . . . . .

Region lX . . . . . . . . . . . . . . . . . . . . .

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

63,300

122,400

81,700

138,800

217,300

117,500

77,100

34,400

80,300

41,400

6,300

18,700

7,900

17,900

32,400

13,200

8,300

4,600

12,100

9,700

56,900

103,700

73,800

120,900

184,900

104,400

68,600

29,800

68,200

31,700

10,000

19,200

12,800

22,500

30,800

17,200

9,500

“3,800

13,300

‘4,700

20,500

36,400

31,400

47,500

68,700

43,100

28,900

11,700

24,200

10,300

26,400

46,000

29,600

50,900

85,400

44,100

30,300

14,300

30,700

16,700

18,500

33,000

20,400

36,100

60,600

30,900

27,400

10,800

22,700

15,800

44,800

89,400

61,300

102,700

156,700

86,600

49,700

23,600

57,600

25,600

61,700

114,200

74,000

121,700

204,500

106,500

72,300

34,000

70,100

40,600

1,600 1,600

8,200 7,900

7,700 7,500

17,100 16,800

12,800 12,600

11,000 9,700

“4,600 “3,900

’500 ’500

10,200 5,700

“600 “500

Metropolitan statistical area (MSA)

MA. . . . . . . . . . . . . . . . . . . . . . . . .

Not MSA . . . . . . . . . . . . . . . . . . . . . .

659,700

314,600

88,700 571,000

42,600 272,000

90,700

53,100

216,400

106,300

263,900

112,600

181,000 478,700 601,700

95,200 219,400 297,900

56,000 50,600

16,700 16,000

Affiliation

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

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

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

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

471,100

409,600

66,400

7,100

53,000 418,100

57,900 351,700

19,400 67,000

‘1 ,000 6,200

72,000

59,200

12,000

157,100

131,900

30,200

‘3,600

169,000

160,700

24,800

‘2,000

129,000 342,000 438,200

111,100 298,500 374,300

33,000 53,400 80,300

“3,000 ‘4,1 00 6,700

32,900 30,600

35,300 31,700

6,100 ●4,1 00

’400 ’300

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

19
Table 3. Average and median age and percent distribution of nursing home residents with mental disorders by selected nursing home characteristics,

according to age, sex, and race: United Statea, 1985

,4ge

65 years and over

Race

Sex

All restdents wdh Under 65 65–74

Black and other

75–84 85 years

Faci//ty characteristic menta/ disorders years Total years years and over Male Female White Total Black

Average resident age

Median resident age . ., .,, .,.,...

Total . . . . . .

Ownership

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

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

Government. . . .

Certification

Skilled nursing facility only.

Skilled nursing facility and

intermediate care facility. .

Intermediate care facility only .,

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

Bed size

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

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

100–199 beds . . . . . . . . . . . . . . . . . .

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

Census region

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

Midwest, .,....,.,..,.,,...,.,

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

West, . . . . . .

Standard Federal

Administrative Region

Region, . . . . . . . . . . . . . . . . . . . . .

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

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

ReglonlV . . . . .

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

Region al, . ., . . . . . . . . . . . . . . . . .

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

Region Vlll. .

Region lX . . . . . . . . . . . . . . . . . . . . .

Region X . . . . . . . .

Metropolitan statistical area (MSA)

MA, ., . ., .,, . . . . . . . . . . . . . . . .

Not MSA, . . . . . . . . . . . . . . . . . . . . .

Affihation

Chai n. . . . . . . . . . . . . . . . . . . . . . .

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

Government.

Unknown, . . . . . . . . . . . . . . . . . . . . .

79

82

100.0

711

20.8

8,9

18.3

45.0

26.1

10.6

96

27,0

42.9

20.4

24.1

31.7

29.4

14.8

6.5

12.6

8.4

14.2

22.3

12.1

7.9

3.5

82

4.2

67.7

32.3

48.4

42.0

8.9

0.7

51

55

i 00,0

77.2

8.1

14.8

14.5

36.4

22.5

26.6

18.9

18,1

378

25.2

23,7

32,3

25,1

189

4,8

14,3

60

13.6

24.7

10.1

6.3

3,5

92

74

67,6

32,5

40,4

44,1

14,8

‘0.8

83

63

I 00.0

70.1

21.9

7.9

18.9

46.4

26.6

8,1

8.2

28.4

43.7

19.7

24.2

31,6

30.1

141

6,7

12,3

8.8

143

21.9

12.4

8.2

3.5

8,1

3.8

67.7

32.3

49.6

41.7

7,9

0.7

70

70

100.0

76.8

14.9

8.3

16.1

42.0

28.3

13.6

12.5

28.4

39.3

19.7

26.6

29.2

29.8

14.5

7.0

13.4

8.9

15.6

21.4

12.0

6,6

“2.6

9,2

“3.3

63.1

36.9

50.1

41.2

8.3

“0.4

Age in years

80 90 73

80 90 76

Percent distribution

100.0

68.6

22.0

9.4

17.5

47.5

26.4

8.5

8.4

25.0

47.3

19.2

23.2

32.2

32.1

12.5

6.4

11.3

9.7

14.7

21.3

13.4

9.0

3.8

7.5

3.2

67.1

32.9

48.7

40.9

9.4

“1.1

100.0

68.9

24.5

6.6

21.1

47.1

26.2

5.6

6.3

31.2

42.4

20.0

24.0

32.0

28.6

15.4

7.0

12.7

7.9

13.5

22.7

11.7

8.0

3.8

8.2

4.4

70.1

29.9

50.2

42.7

6.6

“0.5

100.0

72.2

15.9

11.9

16.3

41.7

27.2

14.8

10.9

24.9

41.2

23.0

23.2

33.5

26.8

16.5

6.7

11.9

7.4

13.1

21.9

11.2

9.9

3.9

8.2

5.7

65.5

34.5

46.7

40.2

11.9

“1.1

81

83

100.0

70.6

21.7

7.6

19.1

46.3

25.6

8.9

9,1

27,8

43.6

19.4

24.4

31.0

30.5

14.1

6.4

12.8

8.8

14.7

22.4

12.4

7,1

3.4

8.3

3.7

68.6

31.4

49.0

42.8

7.6

‘0.6

79

82

100.0

70,8

20,3

8,9

17,9

45,2

26.0

10.9

9.6

27.8

42.7

20.0

24.6

32.4

28,3

14.7

6,9

12.7

8.2

13.5

22.7

11,8

8.0

3.8

7,8

4.5

66.9

33.1

48.7

41.6

8.9

0.7

75

77

100.0

74.4

17,4

8,2

23.3

43.2

26.5

‘7,1

10.4

17.9

46.5

25.2

18.2

23.7

42.8

15.4

2.1

11.0

10,3

22,9

17,1

14..7

●6.4

‘CI.7

13,7

“1.1

77.6

22.4

44.0

47.3

8.2

“0.5

76

77

100.0

75.8

18.2

6.2

20.0

46.2

27.3

“6.5

10.4

18.3

45.5

25.8

20.1

24.8

45.2

9.9

2.4

11.9

11.3

25.2

18.9

14.6

‘5,9

*0.8

8.6

‘0.8

76.0

24.0

45.9

47.6

6.2

‘0.5

NOTE: Figures may not add to totals because of rounding

20
Table 4. Number of nursing home residents with mental disorders, by dependencies in activities of daily fiving and selected mental disorders:

United States, 1985

Dependency in activities of daily living

Continent*

Requires difficulty with

A// residents Requires Requires assistance Requires bowel arrtior Requires Average

with menta/ assistance assistance in using assistance in bladder assistance in

Mental disorder disorders

number of

in bathing in dressing toilet room transferring’ control eating dependencies

Number

Total residents . . . . . . . . . . . . . . . . . . . . 1,491,400 1,323,200 1,124,600 907,600 693,400 774,400 586,300 3.8

Total with mental disordars2 . . . . . . . . . . . . . 974,300 879,500 773,900 635,800 599,900 581,400 442,800 4.0

Mental retardation . . . . . . . . . . . . . . . . . . . . 83,200 71,100 60,100 40,300 34,900 39,600 29,100 3.3

Alcohol anddrug abuse . . . . . . . . . . . . . . . . 58,700 43,600 30,400 21,900 20,100 20,600 11,700 2.5

Organic brain syndromes (including

Alzheimer’s disease) . . . . . . . . . . . . . . . . . 696,800 667,700 606,500 516,900 485,400 460,300 373,300 4.5

Depressive disorders . . . . . . . . . . . . . . . . 167,000 144,500 126,200 104,700 104,900 67,600 67,200 3.8

Schizophrenia and other psychoses . . . . . 195,400 153,300 119,600 84,400 74,900

Anxiety disorders . . . . . . . . . . . . . . . . . . . . . .

80,300 56,500 2.9

163,700 147,100 127,700 101,700 99,900 67,500 70,600 3.9

Other mental illnesses . . . . . . . . . . . . . . . . . 17,700 12,900 10,800 7,100 8,000 6,500 6,000 2.9

1Transferring refersto gening in or out of a bsd or chair.

2Subgroups add to more than total because the total only equals the number of reslden!s with at least one mental disorder.

Table 5. Percant of nursing home residents with mental disordera, by dependencies in activities of daily living and selected mental disorders:

United States, 1965

Dependency in activities of daily living

ContinencaRequires difficulty with

Requires Requires assistance Requires bowel and/or Requires

assistance assistance in using assistance in bladder

Mental disorder

assistance in

in bathing in dressing toilet room transferring! control eating

Total residents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total with mental cfisordersz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Alcohol anddrug abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Organic brain syndromes (including

Alzheimer’s disease) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Depressive disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Schizophrenia and other psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anxie!y disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other mental illnesses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

88.7

90.3

85.5

74.3

95.8

86.6

78.5

89.9

73.1

75.4

79.4

72.2

51.8

87.3

75.6

61.3

78.0

61.0

Percent

60.9 59.9

65.3 81.6

48.4 41.9

37.4 34.3

74.2 69.7

62.7 62.8

43.2 38.3

62.1 61.1

40.4 45.2

51.9

59.7

47.5

35.1

68.9

52.5

41.1

53.4

36.8

39.3

45.4

34.9

19.9

53.6

40.3

28.9

43.1

34.1

~Trsnsfsrring rsfsrs to getting in or out of a bsd or chair.

Subgroups add to more than total because the total only equals the number of residentawith at least one mental disorder.

21
Table 6. Number of nursing home reaidenta with mental disorders, by age, sex, race, and functional status: United States, 1985

Age

65 vears and over

Race

Sex

All residents with Under 65 6.5=74

Black and other

75-84 85 years

Functional status mental d!sorders years Total years years and over Male Female White Total Black

Number

Total, .,,,.. ., .,,.,.,. 143,800 322,700 376,500

Aids usedl

Eyeglasses or contacts. .,

Hearing aid.,..,.,.,,.

Vlslon 2

Notlmpared. .,, .,,.,

Partially impaired3. .,......,..,.,

Severely Impaired. ., .,

Completely lost. ...

Unknown . . . . . . . ., .,,.,,,

Hearingz

Notlmpaired . . . . . . . . . . . ,., ,.

Partially impaired3. . . . . ., .,

Severely impaired . . . ., ..,..

Completely lost,.....,,,,,,.,,.,

Unknown, ., . . . . . . . . . . . . . . . . . . .

Bathing

lndependent4 . . . . . . . . . . . . . . . . . .

Requires assistance . . . . . . . . . . . . .

Dressing

lndependent4 . . . . . . . . . . . . . . . . . .

Requires assistance; includes those

whodo notdress . . . . . . . . . . . .

Eating

lndependent4 . . . . . . . . . . . . . . . . . .

Requires assistance; includes

those who are tube or

intravenously fed . . . . . . . . . . . . . . .

Mobility

Walks independently. . . . . . . .

Walks with assistance. . . . . . . . . . . .

Chairfaat . . . . . . . . . . . . . . . . . . . .

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

Transferring

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

Requires assistance . . . . . . . . . ,

Using toilet room

lndependent4 . . . . . . . . . . . . . . . . . .

Requires assistance . . . . . . . . . . . . .

Does not use toilet room. . . . . . . . . .

Continence

No difficulty controlling bowels

or bladder4 . . . . . . . . . . . . . ...

Difficulty controlling bowels. .,

Difficulty controlling bladder

Dlfhculty controlling both

bowels and bladder ., . . .

Ostomy in either

bowels or bladder .,..,.... . .

974,300

560,600

52,900

725,800

145,500

58,700

28,600

15,700

761,900

160,500

37,000

6,000

8,900

94,700

879,5I3O

200,300

773,900

531,500

442,800

303,600

206,300

393,500

70,800

374,400

599,900

338,500

504,500

131,300

392,900

16,800

103,800

387,900

72,800

131,200 843,000 276,200 698,100 899,600 74,700 66,600

46,300 514,300

‘1 ,500 51,400

70,400 192,600 251,300

‘2,600 14,000 34,800

129,200 431,500 537,400

13,800 39,100 52,000

23,200 20,500

’900 ’900

i 16,800 609,000

8,000 137,500

“1 ,800 56,900

“3,1OO 25,500

‘1 ,600 14,100

118,600 242,000 250,300

16,600 49,500 71,400

7,400 14,600 34,900

‘2,000 8,600 14,800

“1,1OO 8,000 “5,000

215,200 510,600 669,500

36,500 109,000 134,500

13,200 45,500 56,500

6,900 21,700 23,800

‘4,400 11,300 15,300

56,200 49,700

11,000 10,000

‘2,200 “2,000

‘4,800 ‘4,500

’400 ’400

126,300 635,600

“3,900 156,600

“200 36,800

“o 5,900

’800 8,100

127,800 264,900 242,800

11,600 47,900 97,000

‘2,300 6,100 28,400

“700 ‘2,100 ‘3,100

‘1 ,300 ‘1,700 “5,100

222,100 539,800 700,200

41,600 118,900 149,600

9,100 28,000 35,500

*1,400 ‘4,600 “5,500

“2,100 6,900 8,700

61,700 55,100

10,800 9,400

“1 ,500 ‘1,500

“400 “400

“300 ’300

43,000 51,700

88,200 791,300

20,000 22,900 8,900

123,800 299,900 367,600

48,800 45,900 87,500

227,400 652,200 812,100

7,300 6,100

67,500 60,600

61,200 139,100

70,000 703,900

42,200 60,700 36,200

i 01,600 262,000 340,300

82,800 117,500 166,800

193,400 580,600 712,800

13,600 11,600

61,100 55,000

96,400 435,100 91,500 172,600 171,000 173,600 357,900 489,900

102,600 340,100 409,600

41,600 35,900

34,900 407,900 52,300 150,100 205,500 33,100 30,800

81,200 222,400

15,400 191,000

28,400 365,100

6,300 64,500

62,300 102,900 57,300

27,500 88,400 95,100

44,400 128,000 192,700

9,700 23,500 31,400

114,300 189,300 280,900

55,700 150,700 189,600

93,700 299,600 362,100

12,500 58,300 66,900

22,700 19,300

16,700 15,700

31,400 28,200

“3,900 “3,500

91,500 282,900

39,700 560,200

71,400 124,600 86,900

72,400 198,20Q 289,600

134,800 239,600 344,900

141,400 458,500 554,700

29,500 25,100

45,200 41,600

86,000 252,500

33,200 471,300

12,100 119,200

62,600 109,700 80,300

66,400 167,800 237,100

14,800 45,300 59,100

124,800 213,700 311,300

123,400 381,100 469,000

28,000 103,300 119,300

27,100 23,600

35,500 32,700

12,100 10,300

91,200 301,700

‘2,700 14,200

6,400 95,400

75,900 115,700 110,100

“2,600 *4,000 7,600

10,500 39,000 45,900

47,500 139,400 179,400

7,400 24,700 33,500

127,400 265,500 359,700

6,000 10,800 15,700

27,600 76,100 98,000

33,200 28,300

‘1,100 ‘1,100

5,800 ‘4,900

21,700 366,300 95,300 292,700 359,100 28,900 26,700

7,300 65,500 19,900 52,900 67,100 5,800 ‘5,600

See footnotes at end of table

22
Table 6. Number of nursing home residents with mental disorders, by sge, sex, rsca, and functional status: United States, 1985-Con.

Age

65 years and over

Race

All residents with Under 65

Sex Black and other

65-74 75=84 85 yeare

Functional status mental disorders years Total years years and over Male Female White Total Black

Number of dependencies

in activities of daily livings

None . . . . . . . . . . . . . . . . . . . . . . . . .

l . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Instrumental activities

of daily living

Does not receive help4 . . . . . . . . . . .

Receives help . . . . . . . . . . . . . . . . . .

Care of personal possessions . . . .

Handling money . . . . . . . . . . . . . . .

Securing personal items such as

newspapers, toilet articles,

snack food . . . . . . . . . . . . . . . . . .

Using the telephona. . . . . . . . . .

82,700

89,800

94,300

68,100

109,700

186,300

343,400

97,700

876,600

786,500

807,000

803,800

677,200

39,700 43,100 17,800 19,700 ‘5,600

17,300 72,400 20,100 31,200 21,100

20,100 74,200 16,300 30,700 27,200

10,500 57,600 11,600 23,900 22,100

10,100 99,600 17,700 38,000 45,900

12,700173,700 20,900 65,300 87,500

20,900 322,400 39,400 115,900167,100

31,300 66,400 20,100 29,700 16,600

100,000 776,600 123,700 293,100 359,800

76,600 707,900 110,200 267,400 330,300

91,900 715,000 111,700 288,400 335,000

61,500 722,200 110,100 269,600 342,500

62,300 614,900 92,700 232,900 289,300

43,600

31,900

27,100

20,100

26,800

48,700

76,000

42,300

233,900

201,200

213,400

209,800

172,800

39,100 76,400

57,600 64,500

67,100 66,700

48,000 59,800

82,900 99,aoo

137,700 174,300

265,400 316,400

55,400 89,200

642,600 610,400

585,300 723,400

593.600 747,400

594,000 743,200

504,400 623,600

6,300 ‘5,1OO

‘5,300 ‘4,800

7,600 6,600

8,600 7,700

9,900 7,600

12,100 11,400

25,000 23,500

8,500 7,300

66,200 59,300

63,000 56,700

59,600 52,700

60,600 54,900

53,600 49,300

1 Figures do not add to totals besause resident may not have used glasses, contacts, or hearing aid.

‘Status at best correction, that is, with corrective lenses or hearing aid, K applicable.

3 Includes a small number of residents who were impaired but whose level of impamnefit is unknown.

4 Includes a small number of unknpwna

5Transferring raffxe to gening in or out of a bed or chair.

6Activities of daily living include bathing, dressing, eating, transferring, using toilet room, and continence. Unknowna Wera considered not dependent.

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

23
Table 7. Percent distribution of nursing home residents with mental disorders by selected functional status, according to age, sex, and race:

United States, 1985

Funcr/ona/ status

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

Aids used’

Eyeglasses or contacts.

Hearing aid, ., ,, ..,,,,. ,.

Vlslon 2

Not impaired,. ,,. ,,.

Parbally impaired3 .:. ., ., .,

Severely impaired . . . . .

Completely lost,..

Unknown ...,.,.. ., .,,,..,.

Heanngz

Notimpaired . ., . . . . . . . . . . . . . . . .

Partially !mpaired3. .,

Severely impaired ., ., .,

Completely lost

Unknown ., ...,,....

Bathing

lndependent4 ... .,.,,.,,..

Requires assistance

Dressing

lndependent4, . . . . . . ,., ..,,,

Requirea assistance, includes

those who do not dress

Eating

lndependent4 .,.......

Requires assistance; includes

those who are tube or

intravenously fed.

Mobility

Walks mdependently4, ., .,

Walks with asewtance,

Chairfast .,....

Bedfast .,,.,..,.,,,.,

Transferrmg5

lndependent4 .,,.,,...,....,.,

Requires assistance

Using toilet room

lndependent4, . . . . . . . . . . . . .

Requires assistance ., .,

Does not use toilet room.

No difficulty controlling bowels

or bladder4 .,..,.,......,.. . .

Difficulty controlling bowels. ., .,

Dificulty controlling bladder .,

Diticulty controlling both

bowels and bladder, . . . .

Ostomy in either

bowels or bladder . . . . . . ,., .,

Age

65 years and over

Race

Sex

Allresfdentswjth Under65 65-74 75=84 85 years

Black and other

n?enta/ djsorders yaars Total years years and over Male Female White Total Black

Percent distribution

100.0

575

5,4

74,5

14.9

6.0

2.9

1,6

78.2

16.5

3.8

0.6

0.9

9.7

90.3

20,6

79,4

54.6

45.4

31.2

21.2

40.4

7.3

38.4

61,6

34.7

51.8

13.5

40,3

1,7

10,7

39.8

7.5

1000

353

‘1.1

89.0

6,1

‘1,4

‘2,4

“1.2

96.3

‘3.0

‘0.2

‘0.0

‘O 6

32.8

67.2

46.6

53.4

73.5

26.6

61.9

11.7

21.6

4.8

69.7

30.3

65.5

25.3

9.2

69.5

“2.1

6,4

16,5

5.6

100.0

61.0

6,1

72.2

16,3

67

3,0

1.7

75.4

18.6

4,4

07

1.0

6.1

93.9

16.5

83.5

51.6

48.4

26.4

22.7

43.3

7.7

33.6

66.5

30.0

55.9

!4.1

35.8

1.7

11.3

43.5

7.8

100.0

49.0

“1,8

81 1

115

5.1

‘1.4

‘0.8

86.9

8.1

‘1.6

“0.5

‘0.9

13.9

86.1

29.3

70.7

63.6

36,4

43.3

19.1

30.9

6.7

49.7

50.3

43.5

46.2

10.3

52.8

‘1.8

7.3

33.0

5.1

100.0

59.7

4.3

75.0

15.3

4,5

2,7

2,5

82.1

14.8

1.9

0.7

0.5

7.1

92.9

18.8

81.2

53.5

46.5

31,9

21,2

39,7

7.3

38.6

61.4

34.0

52.0

14.0

35.9

“1.2

12.1

43.2

7.7

I00.0

66.7

9.2

66.5

19.0

9.3

3.9

‘1.3

64.5

25.8

7.5

“0.8

‘1.4

2.4

97.6

9.6

90.4

45.4

54.6

15,2

25,3

51,2

8.3

23.1

76.9

21.3

63.0

15.7

29.2

2.0

12.2

47.6

8.9

100.0

46.8

5.0

77.9

13,2

4.8

2.5

‘1.6

80.4

15.1

3.3

“0.5

“0.8

17.7

82.3

30.0

70.0

62.9

37.1

41.4

20,2

33.9

4.5

46.8

51.2

45.2

44.7

10.1

46.1

2.2

10.0

34.5

7.2

100.0

61.8

5,6

73.1

15,6

6.5

3.1

1.6

77.3

17.0

4.0

‘0.7

1.0

6.6

93.4

16.8

83.2

51.3

48.7

27,1

21,6

42,9

8.4

34.3

65.7

30.6

54.6

14.8

38.0

1.5

10.9

41.9

7.6

100,0

59,7

5.8

74.4

15.0

8.3

2.6

1.7

77.8

16.6

3.9

‘0.6

1.0

9.7

90.3

20.8

79.2

54.5

45,5

31,2

21,1

40.3

7.4

38.3

61.7

34.6

52.1

13.3

40.0

1.7

10.9

39.9

7.5

I00,0

31,1

‘1,2

75.2

14.7

“2.9

‘6.4

‘0.5

82.6

14.5

‘2.0

‘0.5

“0.4

9.8

90.4

18.2

81,8

55.7

44,3

30.4

22.4

42.0

●5.2

39.5

60.5

36.3

47.5

16.2

44.4

*1.5

7.8

36.7

7.8

I00,0

30,8

‘1.4

74,6

15,0

‘3.0

‘6.8

‘0.6

82.7

14.1

‘2.3

‘0.6

“0.5

9.2

91.0

17.4

82.6

53.9

46.2

29.0

23,6

42.3

*5,3

37.7

62.5

35.4

49.1

15.5

42.5

●I.7

7.4

40.1

8.4

See footnotes al end of table

24
Table 7. Percent distribution of nursing home residents with mental disorders by selected functional status, according to age, sex, and race:

United States, 1985-Con.

Age Race

65 yeacs and over

Sex

All residents with Under 65 65-74

Hack and other

75-64 85 years

Functional status mental disorders years Total years years and over Male Female White Total Black

Number of dependencies

in activities of daily fivings

Instrumental activities

of daily living

Does not receive help4 . . . . . . . . . . .

Receives help . . . . . . . . . . . . . . . . . .

Care of personal possessions . . . .

Handling money . . . . . . . . . . . . . . .

Securing personal items such as

newspapers, toilet articles,

snack food . . . . . . . . . . . . . . . . . .

Using the telephone . . . . . . . . . . . .

8.5

9.2

9.7

7.0

11.3

19.1

35.2

10.0

90.0

80.7

82.8

82.5

69.5

30.3

13.2

15.3

8.0

7.7

9.7

15.9

23.9

76.2

59.9

70.0

62.1

47.5

5.1 12.4 6.1 ‘1.5 15.8

8.6 14.0 9.7 5.6 . 11.5

8.8 11.3 9.5 7.2 9.8

6.8 8.1 7.4 5.9 7.3

11.8 12.3 11.2 12.2 9.7

20.6 14.5 20.2 23.2 17.6

38.2 27.4 35.9 44.4 28.2

7.9 14.0 9.2 4.4 15.3

92.1 86.0 90.8 95.6 84.7

84.0 76.6 82.9 87.7 72.8

84.8 77.7 63.2 89.0 77.3

85.7 76.6 83.5 91.0 76.0

72.9 64.5 72.2 76.6 62.6

5.6

8.3

9.6

6.9

11.9

19.7

38.0

7.9

92.0

83.8

85.0

85.i

72.3

8.5 8.4

9.4 ‘7.1

9.6 10.2

6.6 11.5

11.1 13.3

19.4 16.2

35.4 33.5

9.9 11.4

90.1 88.6

80.4 84.3

83.1 79.8

82.6 81.1

69.3 71.8

“7.7

“7.2

9.9

11.6

11.4

17.1

35.3

11.0

89.0

85.1

79.1

82.4

74.0

1Figuresdo not add to totals bacause rssident may not have used gkissas, rnntacts, or hearing aid.

‘Status at best correction, that is, whh correcliva Ianses or hearing aid, if applicable.

3 Includes a small number of residents who were impairad but whose level of impairment IS unknown.

4 Includes a small number of unknowns.

‘Transferring refers to gening in or out of a bed or chair.

6Actwhies of daily Wing includa bathing, dressing, sating, transferring, using toilet room, and ~nllnence. Unknowns were Wnsidered not depandent.

NOTE Figures may not add to totals because of rounding.

25
Table 8. Number of nursing home residenta with mental disorders, percent distribution by length of stay since admission, and average and median length of

stay, according to selected resident characteristics: United States, 1985

Length of stay since admission

3 months 6 months Average Median

A// residents to less to less 1year to 3 years to /ength of /ength of

with menta/ Less than than 6 than 12 less than less than 5 years stay since

Resident characterkt)c disorders Total

stay since

3 months months months 3 years 5 yeara or more admission admission

Sex and age

Both sexes, all ages,,.,,....,.,.. ,.,

Under 65years ,.

65years Andover.. . . . . . . . . . . . . . . .

65–74 years . . . . . . ,.,

75–64 years . . . . . . . . .

65years Andover.. . . . . . . .

Male, all ages..,..,.,,...,,..,,. . . .

Under 65 years, .,.... ,, ..,,.

65yaars And over,.... . . . . . . . .

65–74 years . . . . . . . . . . . . . . . . . . . .

75-84 years . . . . . . . . . . . . . .

85years and over......,......,..

Female, alleges . . . . . . . . . . . . . . . . . . . .

Under 65years . . . . . . . . . . . . . . . . . . ,.

65 years and over . . . . . . . . . . . . . . . . .

65-74 years..,.,.. . . . . . . . . . .

75-84 years . .

85years and over . . . . . . . . . . . . . . .

Race

White, . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black and other, . . . . . . . . . . . . . . .

Black, ,, . . . . . . . . . . .

Hispanic origin

Hispanic ., . ., . . . . . . . . . . . . . . . . . . .

Non-Hispanic’ . . . . . . . . . . . . . . . . . ,. ...

Current marital status

Marrie d. . . . . . . . . . . . . . . . . . . . . . . . . . .

Widowed’ . . . . . . . . . . . . . . . . . . . . . . . ,.

Divorced orseparated . . . . . . . . . . . . .,, .

Never married.....,..,......,..

Has living children

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No or unknown ., ., . ., ., ..,.,... . . . . .

Living arrangement prior to admiasion

Private or semi-private residence. ., . .

Alone . . . . . . . . . . . . . . . . . . . . . . . .

Wlthfamily members. , ., . . . . . . . . . . .,

With nonfamily members . . .

Unknown ifwith others . . . . . . . . . . . . . .

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

Another nursing home . . . . . . . . . . . . . .

General or short-stay hospita12 . . . .

Mental facility s . . . . . . . . . . . . . . . . . . ,.

Veterans hospital . . . . . . . . . . . . . . . . ,.

Other health facility or unknown . . . .

Unknown or other arrangement . . . .

974,300

131,200

843,000

143,800

322,700

376,500

276,200

68,200

208,000

56,100

85,500

66,400

698,100

63,000

635,000

87,700

237,300

310,100

899,600

74,700

66,600

30,900

943,300

124,000

575,100

77,200

198,000

560,500

413,800

356,200

113,500

186,000

31,700

25,000

586,200

126,800

339,600

71,900

22,800

25,100

31,900

Percent distribution

100.0

100.0

100.0

100,0

100,0

100,0

100,0

100,0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100,0

100.0

100,0

100,0

100,0

100.0

100.0

100.0

100.0

100.0

100.0

100,0

100,0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100,0

100,0

10.8

12.2

10.6

12.9

10,3

9.9

13,4

i 4,3

13.0

13.0

12.1

14.2

9.8

9.9

9.7

12.9

9.6

9.0

10,7

11,4

10,9

13,5

10.7

18.4

9.6

13.9

8.1

11.3

10,0

10.4

10.9

11.6

6.3

1.0

11.4

6.7

13.5

6.6

13.6

7,0

5,0

9.3

12,3

8.8

10,2

8,4

8,7

10,2

13,6

9,1

8.8

8.8

9.7

9.0

11.0

8.8

11.1

8.2

8.5

9.3

9.9

10,0

8.5

9.3

12.6

6.5

11.7

6.6

9.5

9,0

7.0

5.0

7.9

14.1

. . .

10.9

6.6

11.6

8.4

18.6

8.3

6.6

13.4

10.7

13,8

13.9

15.6

12.3

12,6

11,8

12.9

13.2

14.0

11.3

13.7

9.5

14.1

14.4

16.1

12.6

13,6

11,4

10,6

13.4

13.4

16.2

14,3

11.9

9.6

14.8

11,6

12,4

13.5

13.1

6.4

9.4

14.2

16.8

14.9

7.2

19.2

7.7

10,6

32.1

24.8

33.2

28.9

35.8

32.6

31.7

27,2

33,1

28.3

35.9

33.8

32.2

22.1

33.2

29.3

35.8

32.4

31.8

35.6

36.9

34.2

32.0

30.3

34.0

29.2

28.7

32.7

31.2

32,9

34.5

30.4

40.3

35.3

32.1

37.7

34.9

19.8

30.3

32.4

23.0

14.6

12.2

14.9

14.6

14.3

15.6

12.6

8.7

13,9

15,8

12.5

14.3

15.4

16.1

15.3

13.9

15.0

15.9

14.8

12,5

12,2

18.1

14.5

12.9

15.8

14.3

12.1

15.0

14.1

14,3

13,2

15.8

9.6

14.4

14.2

15.4

13.9

15.5

6.7

16.7

23.5

19.8

27.7

18.6

19,4

15.7

20.8

19.5

24.4

17.9

21,0

16.7

16.7

20.0

31.4

16.9

18.4

15.3

21.7

19.9

19.2

19.1

12.3

20.1

9.7

17.6

19.0

32.9

16.7

24.1

23,1

22,8

21.2

21.4

39.8

17.3

18.5

11.0

42.5

11.6

27.9

31.3

Stay in days

1,139

1,464

1,089

1,161

997

1,140

1,141

1,322

1,082

1,281

1,006

1,011

1,139

1,619

1,091

1,084

993

1,168

1,140

1,136

1,141

989

1,144

724

1,032

1,114

1,721

989

1,343

1,198

1,194

1,174

1,051

1,586

1,073

1,095

811

2,242

779

1,420

1,701

674

740

663

591

624

742

624

588

629

684

617

625

700

994

663

517

630

774

674

663

666

643

676

419

677

609

935

636

721

769

848

708

686

1,164

610

676

538

1,437

328

972

1,353

1Includesa small number of unknowns

2Psychiatricumtsare excluded,

3Mental hospltala,fac]ht[esfor the mentally retarded, general or ahorr.stayhospital psychiatricunits, and marital health centars are included

NOTE Figures may not add to totala becauaeOfrounding,

26
Table 9. Number of nursing,home residents with mental disorders, percent distribution by length of stay since admission, and sverage snd median length of

stay, according to selected nursing home characteristics: United Ststes, 1985

Length of stay since admission

3 months 6 months Average Median

All residents to less to less 7 year to 3 yeara to /engtb of /ength of

with mental Less than than 6 than 12 less than less than 5 yaars stay since stay since

Faci/ity characteristic disorders Total 3 months months months 3 years 5 years or more admission admission

Number Percent distribution Stav in davs

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

Ownership

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

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

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

Certification

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

Skilled nursing facility and

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

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

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

Bed size

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

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

100-t 99 beds . . . . . . . . . . . . . . . . . . . . . .

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

Census region

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

Midwest . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Standard Federal Administrative Region

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

Region II . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

Region VII . . . . . . . . . . . . . . . . . . . . . . . . .

Region WI . . . . . . . . . . . . . . . . . . . . . . . . .

Region lX . . . . . . . . . . . . . . . . . . . . . . . . . .

Region X . . . . . . . . . . . . . . . . . . . . . . . . ,.

Metropolitan statistical area (MSA)

MA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Not MSA . . . . . . . . . . . . . . . . . . . . . . . . . .

Affiliation

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

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

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

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

974,300

692,600

195,300

86,400

178,300

438,600

254,000

103,100

93,900

263,100

418,400

198,900

234,700

308,900

286,700

143,900

63,300

122,400

81,700

138,800

217,300

117,500

77,100

34,400

80,300

41,400

659,700

314,600

471,100

409,600

86,400

7,100

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100,0

100,0

100.0

100.0

t 00.0

100.0

t 00.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

10.8

11.1

9.0

12.2

14.0

10.9

7.6

12,6

9.4

11.2

11,0

10.5

7.6

10.2

12.8

13.t

6.2

7.6

8.8

13.8

t 0.6

12.7

9.2

12.0

13.7

12.8

10.8

10.8

12.2

8.9

12.2

9.4

9.3

10.3

7.6

4.8

11.7

9.0

8.1

9.6

9.7

9.4

9.6

8.5

10.3

7.8

8.3

13.1

12.1

11.7

6.1

8.9

9.1

7.5

5.1

5.9

14.3

12.7

10.2

7.3

t 0.0

9.6

4.8

6.6

13.4

13,4

13.1

14.5

12.9

15.3

12.0

9.8

10.7

14.4

13.4

13.4

12.6

14.7

11.8

15.2

14.1

10.6

13.7

13.0

14.4

11.0

15.4

11.6

15.6

16.8

13.8

12.6

14.4

11.9

14.5

23.1

32.1

31.6

33.6

32.3

33.3

34.0

29.7

27.6

28.8

30.9

34.0

31.1

36.7

32.0

29.2

30.3

35.6

37.6

36.6

31.0

32.3

25.0

31.2

31.5

30.1

29.9

32.3

31.5

30.1

34.5

32.3

25.9

14.6

14.4

15.9

13.2

14.0

14.0

15.9

14.7

14.2

13.8

15.3

14.3

14.3

15.0

15.3

12.9

11.2

16.3

12.4

15.5

14.7

16.1

15,4

15.9

11.3

14.9

14.3

15.1

15.6

13.6

13.2

18.9’

19.8

19.2

20.8

23.0

14.2

16.8

26.6

25.7

27.3

20.3

16.7

22.3

18.5

20.4

22.6

15.4

20.7

16.3

22.4

17.8

18.9

27.7

23.7

23.0

15.1

13.0

18.5

22.6

17.8

21.6

23.0

16.0

1,139

1,103

1,166

1,374

946

1,043

1,354

1,351

1,506

1,108

1,015

1,268

1,138

1,207

1,179

917

1,199

1,063

1,232

1,014

1,178

1,356

1,265

1,217

864

890

1,091

1,241

1,047

1,200

1,374

910

674

657

742

689

590

629

855

814

834

664

653

685

686

700

723

542

692

700

651

652

696

913

734

641

497

533

652

742

629

715

689

521

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

27
m

m Table 10. Average total monthly cherge and number of nursing home residents with mental disorders, by primary eource of payment in month before interview and selected resident characteristics:

United Statea, 1985

Primary source of payment

Other

Own income or

Medicaid government

assistance or All other

All sources family supporl Medicare Skilled Intermediate we/fare sources 1

Average Average Average Average Average Average Average

monthly Numberof monthly Numberof monthly Numberof monthly Numberof monthly Numberof monthly Numberof

Resident characteristic charge

monthly Number of

residents charge residents charge residents charge residents charge residents charge residents charge residents

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

Age

Under 65years . . . . . . . . . . . . . . . . . . . . . .

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

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

5W34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65years andover . . . . . . . . . . . . . . . . .

6S89years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7C-74 years . . . . . . . . . . . . . . . . . . . . .

7%79 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

8%89 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

95years andover . . . . . . . . . . . . . . . .

Sex

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

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

Race

Hiepanic origin

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . .

Non-Hlspanic2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Current marital status

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

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

Divorced orseparated . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Never married . . . . . . . . . . . . . . . . . . . . . . . . .

Has living children

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Noorunknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$1,460

1,275

1,287

1,233

1,287

1,488

1,311

1,395

1,493

1,483

1,522

1,568

1,530

1,395

1,485

1,459

1,466

1,400

1,457

1,460

1,470

1,513

1,288

1,364

1,505

1,398

974,300

131,200

35,300

27,900

88,100

843,000

60,700

83,100

134,100

188,700

187,100

127,200

62,100

276,200

698,100

899,600

74,700

66,600

30,900

943,300

124,000

575,100

77,200

198,000

560,500

413,800

$1,466

1,007

’819

976

1,064

1,511

1,345

1,483

1,453

1,490

1,486

1,646

1,626

1,417

1,486

1,477

1,146

1.195

1,267

1.470

1,503

1,514

1,267

1,284

1,518

1,387

378,600

33,700

‘5,300

7,100

21,300

344,900

13,600

31,100

57,100

81,500

83,400

56,900

21,400

109,800

268,900

366,200

12,400

9,600

8,000

370,700

57,900

245,400

19,600

228,900

149,700

$1,770

’902

. . .

’902

1,785

‘1,150

“1,415

‘1 ,966

‘1,708

‘2,424

“751

“2,210

‘1 ,631

1,817

1,773

●1,611

‘1 ,611

‘1 ,423

1,802

‘1 ,251

1,823

‘1 ,980

‘2,572

‘1 ,726

‘1 ,839

9,100

200

. . .

200

8,900

“400

“1,000

“3,200

‘2,200

‘1 ,000

’700

“500

“2,300

6,600

8,900

’200

“200

’800

8,300

‘1 ,700

6,200

’700

’500

“5,600

‘3,500

$1,896

1,932

1,747

2,259

2,010

1,890

2,002

1,792

1,976

1,865

1,865

1,977

1,705

1,881

1,901

1,878

2,043

1,817

1,933

1,895

1,744

1,925

1,770

1,956

1,902

1,889

184,500

28,000

11,700

3,600

12,700

156,400

11,400

10,700

23,600

33,900

37,800

24,600

14,200

43,600

140,900

163,900

20,600

16,800

8,000

176,400

24,200

107,800

13,600

38,800

109,100

75,300

$1,293

1,303

1,489

1,259

1,244

4,292

1,178

1,252

1,298

1,309

1,320

1,275

1,372

1,285

1,296

1,292

1,304

1,305

1,227

1,296

1,278

1,302

1,233

1,302

1,292

1,295

338,500

46,500

10,500

12,100

23,900

292,000

25,600

34,000

42,600

64,100

59,400

43,400

23,000

86,400

252,000

301,700

36,800

35,400

13,000

325,400

30,200

197,900

33,300

77,000

196,500

141,900

$885

691

’656

’688

724

999

714

“860

“855

‘1,085

‘2,151

’811

1,373

815

940

872

996

996

270

889

’837

1,323

’735

712

1,216

768

35,800

13,200

‘5,100

‘2,300

5,800

22,600

7,200

‘2,900

‘4,900

‘3,300

‘2,400

‘1,100

900

15,700

20,100

31,800

4,000

4,000

200

35,600

‘5,200

8,900

‘4,000

17,600

9,400

26,400

$1,140

979

’599

’894

‘1 ,267

1,226

‘1 ,076

‘1,214

‘1 ,753

‘1 ,032

“1,372

’755

’986

1,096

1,226

1,135

‘1 ,322

‘1 ,322

‘2,502

1,094

1,655

1,170

840

1,022

1,231

1,081

27,900

9,700

2,600

2,800

4,300

18,100

‘2.600

‘3;400

‘2,700

‘3,600

‘3,200

’600

‘2,000

18,400

9,400

27,100

’700

’700

’900

26,900

4,800

8,800

5,900

8,400

10,900

17,000

Seefootnotesat end of table.
Table lO. Average total monthly charge andnumber ofnurslng home residentawith mental disorders, byprima~aource ofpayment inmonth before intewiew andselected resident characteristics:

Unitad States, 1985-Con.

Primary source of payment

All sources

Average

monthly Numberof

Resident characteristic charge residents

Living arrangement prior to admission

Private or semi-private residence . . . . . . . . . . . . . . . . . . . .

Alone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

With family members . . . . . . . . . . . . . . . . . . . . . . . . . . . .

With nonfamily members . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown ifwith others . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Another nursing home . . . . . . . . . . . . . . . . . . . . . .

GeneraI orshort-stay hospita13 . . . . . . . . . , . . . . . . . . . .

Mentaifacility4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Veterans hospital . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other health facility orunknown . . . . . . . . . . . . . . . . . . .

Unknown orother arrangement . . . . . . . . . . . . . . . . . . . . .

Length of stay since admission

Lessthan 3 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3months tolessthan 6monihs . . . . . . . . . . . . . . . . . . . . .

6months tolessthan 12months . . . . . . . . . . . . . . . . . . . .

lyearto [essthan 3years . . . . . . . . . . . . . . . . . . . . . . . . .

3yearsto lessthan 5years . . . . . . . . . . . . . . . . . . . . . . . .

5yeara ormore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,412

1,423

1,411

1,388

1,399

1,504

1,365

1,636

1,248

1,278

1,358

1,172

1,517

1,607

i ,495

1,469

1,440

1,335

356,200

1i 3,500

186,000

31,700

25,000

586,200

126,800

339,600

71,900

22,800

25,100

31,900

105,000

90,700

130,700

312,500

142,100

193,300

Own income or

Other

Medicaid

government

assistance or Al/other

family support Medicare Skilled Intermediate welfare sources’

Average Average Average Average Average Average

monthly Numberof monthly Numberof monthly Numberof monthlv Numberof monthlv Numberof monthlv Numberof

charge residents charge residents charg; residents charge residents charge residents charge residents

1,445

1,445

1,435

1,362

1,652

1,503

1,377

1,639

1,177

1,147

1,373

1,154

1,498

1,620

1,605

1,420

1,435

1,269

166,400

63,800

79,700

13,300

9,600

199,300

49,900

116,500

14,600

10,500

7,800

12,900

50,400

43,400

61,600

120,700

53,300

49,200

‘2,350 “800

---

‘2,350

---

---

t ,71 t

---

1,725

. . .

---

●I ,322

---

1,840

‘2,337

*1 ,301

“735

‘1 ,700

‘2,009

-..

’800

.-.

---

8,200

---

8,000

. . .

---

“300

. . .

5,300

‘1,100

’900

’600

’600

’500

1,836

1,832

1,909

‘1 ,676

‘1 ,529

1,930

1,725

1,961

1,923

‘1 ,880

‘2,21 o

‘1 ,469

1,946

1,913

1,715

1,919

2,017

1,847

45,300

11,300

25,500

‘5,300

‘3,100

135,000

19,800

97,200

12,900

‘1,100

‘4,1OO

“4,200

15,200

19,400

21,500

64,400

26,500

37,300

1,258

1,274

1,239

1,380

1,216

1,314

1,256

1,365

1,207

‘1 ,459

1,337

1,305

t ,288

1,405

1,309

1,332

1,256

1,236

125,600

30)500

73,700

11,000

10,300

202,200

48,600

111,400

31,100

‘2,700

8,300

10,700

24,800

20,100

40,000

110,500

53,500

89,600

1,073

‘1 ,462

’809

’745

’917

811

878

‘1 ,042

744

. . .

’641

’771

‘1 ,671

’851

‘1,011

853

’672

791

10,300

‘4, 100

‘3,600

‘1 ,200

‘1 ,400

24,500

5,700

‘4,400

10,300

. . .

“4,1OO

‘1 ,000

‘2,600

‘2,300

‘3,000

12,600

‘4,000

11,300

1,049 7,800

’986 ‘3,900

‘1,167 ‘2,600

“1,014 ’600

“879 “500

1,295 17,000

‘1 ,501 ‘2,800

●1,765 ‘2,200

’851 ‘3,000

1,305 8,500

’463 ’600

’507 ‘3,000

1,209 6,600

‘1 ,259 ‘4,300

’835 ‘3,600

‘1 ,538 ‘3,700

’897 ‘4,300

‘1 ,089 ‘5,400

1Includesreligious organizations,foundations, voluntsar agencies, VelersnsAdministration contract,initial payment hfe.carefunds, and other sources or no charge.

2 Includssa small numbsr of unknowns

3Psychiatricunits are excluded.

dMentalhospitals,facilitiesforthe mentally retarded,generai or short-stayhospital psychis!ric units,end mental health centers are included.

NOTE:Figuresmay not add to totals because of rounding,

N

w
CJ

0 Table Il. Average total monthly charge andnumber ofnuraing home residents with menta[disorders, byprimay source ofpayment inmonth before interview andaelected nursing homacharactaristics:

United States, 1985

r%rrfafy source ofpaymerrt

Own income or

All sources tami/y supporl

Average Average

monthly Number of monthly Number of

Faci//fy charactenst~c charge residents charge residents

Total

Ownership

Proprietary . . .

Voluntary nonprofi . . . . . . . . . . . . .

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

Cerflflcatlon

Skilled nursing facility only ., .,

Skdled nursing facility and intermediate care facdlty

Intermediate care facillfy only

Notcertif/ed.

Bed s!ze

Lessthan 50 beds, ,. ..,.

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

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

200 beds ormore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Census region

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

Midwest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

$1,460

1,369

1,679

1,690

1,916

1,576

1,177

862

1,077

1,333

1,467

1,792

1,813

1,402

1,246

1,433

974,300

692,600

195,300

66,400

178,300

438,800

254,000

103,100

93,900

263,100

418,400

198,900

234,700

308,900

286,700

143,900

$1,466 378,600

1,439 259,600

1,568 95.800

1,348 23,200

1,856 64,100

1,672 152,800

1,221 97,000

960 64,800

869 44,800

1,406 122,200

1,577 154,800

1,762 56,800

1,685 74,800

1,436 137,700

1,349 108,600

1,474 57,500

Medicare

Average

monthly Number of

charge residents

$1,770

1,753

‘2,006

‘1 ,527

‘1 ,831

●1,961

. . .

‘1 ,266

‘1 ,508

‘1,913

‘2,196

‘1 ,829

‘1 ,955

‘1 ,930

‘1 ,471

9,100

7,600

‘1 ,000

’500

‘3,500

‘4,600

’300

“1,400

‘2,300

‘3,700

‘1 ,800

‘3,800

‘1 ,200

‘1 ,600

‘2,400

Medicaid

Skilled Intermediate

Average Average

monthlv Number of monthlv Number of

charge residents

$1,896

1,652

2,357

2,532

2,125

1,724

‘1 ,320

1,811

1,557

1,711

2,380

2,520

1,639

1,578

1,527

184,500

125,200

40,600

18,600

81,300

99,400

‘1 ,800

7,300

37,400

81,100

58,600

62,200

46,900

22,200

53,200

charge residents

$1,293 338,500

1,230

1,411

1,594

1,481

1,404

1,150

. . .

1,282

1,196

1,264

1,501

1,606

1,265

1,151

1,305

254,800

49,800

33,900

20,500

167,100

147,500

28,100

85,300

161,700

63,400

71,200

107,700

137,200

22,400

Other

government

assistance or A// other

we/fare 1

sources

Average Average

monthly Numberof monthly Number of

charge residents charge residents

$885

755

‘1 ,021

‘1 ,755

‘1 ,482

1,211

●884

650

900

779

808

1,129

729

1,258

722

‘1,128

35,800

29,200

‘2,500

‘4,000

‘4,800

6,000

‘4,400

20,500

12,100

9,700

7,900

6,000

14,800

9,900

10,100

‘1 ,000

$1,140

1.169

‘1 ,289

932

‘1 ,484

1,642

‘1 ,470

548

‘1,41O

1,223

1,403

892

1,326

‘1 ,371

1,038

860

27,900

16,200

‘5,400

6,200

“4,100

8,900

“3,100

11,700

’300

6,200

9,200

12,200

8,000

‘5,600

7,000

7,300

1 Includes refiglous orgamzatmns, foundations, volunteer agencies, Veterans Admmlstration contract, initial payment fife-care funds, and other sources or no charge.

NOTE: F!gures may not add to totals because of rounding; in the case of source of payment, figures may not add to totals for certification because of recent changes in ownerahlp, lmputational arrors, and other speaaf cwwmstances
Table 12. Percent distribution of nursing home reaidenta with mental disorders and next of kin by usual living arrangement prior to admission, according to

age, sex, and race: United States, 1985

Age

65 years and over Race

All residents with Sex

Usual living arrangement

Black and other

mental disorders Under 65 6574 75-84 85 years

prior to-admis;iorrl and next of kin years Total years years and- over Male Female White Total Black

Percent distribution

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

Usual living quarters

Private or sami-private residence. . . .

Own home or apartment . . . .

Relative’s home or apartment .

Other private homa or

apartment . . . . . . . . . . . . . . . . . . .

Retirement home . . . . . . . . . . . . . .

Boarding house, rooming house,

or ranted room . . . . . . . . . . . . . . .

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

Another nursing home . . .

General or short-term hospital. . . .

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

Chronic disease or other

long-term care hospital ., . . .

Other place or unknown . . . . . . . . .

Type of usual living arrangement

Lived alone . . . . . . . . . . . . . . . . . . . .

Lived with spouse only . . . . . . . . . .

Lived with spouse and

other relatives . . . . . . . . . . . . . . . .

Lived with son or daughter . . . . . . . .

Lived with other relatives . . . . . . . . .

Livad with unrelated persons . . . . .

Group quartersz . . . . . . . . . . . . . . . .

Another health facility, other place,

or unknown s . . . . . . . . . . . . . . . . . .

Who lived with resident 4

Spouse . . . . . . . . . . . . . . . . . . . . . . .

Children . . . . . . . . . . . . . . . . . . . . . .

Parents . . . . . . . . . . . . . . . . . . . . . . .

Siblings . . . . . . . . . . . . . . . . . . . . . . .

Grandchildren . . . . . . . . . . . . . . . . . .

Other relatives . . . . . . . . . . . . . . . . .

Nonrelative . . . . . . . . . . . . . . . . . . .

100.0

67.5

37.7

20.2

3.6

4.4

1.7

27.5

18.3

4.5

3.5

1.0

5.0

22.7

10.9

1.7

13.6

8.7

3.6

6.1

32.9

13.0

14.8

2.3

4.2

5.9

t2.2

6.5

100.0

47,4

19,4

18,9

6.2

1.0

2.2

42.0

14.4

9.0

14.7

4.2

10.6

8.1

2.3

2.5

3.7

21.0

5.1

2.8

54.8

4.8

5.6

14.3

6.3

2.7

9.3

7.3

100.0

70.4

40.3

20.3

3.2

4.9

1.6

25.4

18.9

3.9

1.9

0.6

4.2

24.8

12.1

1.6

15.0

7.0

3.3

6.5

29.7

14.1

16.2

0.6

3.9

6.3

12.6

6.4

100.0

56.6

33.0

15.1

5.1

1.6

i .5

37.6

23.7

7.3

6.0

1.0

5.5

17.8

13.5

2.2

6.0

10.9

3.0

3.2

43.7

15.9

7.9

3.3

7.0

5.5

6.7

6.1

100.0

70.5

41.3

18.4

3.3

6.2

1.2

25.3

18.5

4.0

1.7

1.2

4.3

24.3

14.3

1.2

14.0

6.4

2.6

7.4

29.7

15.8

14.9

0.3

4.0

5.9

12.1

5.2

100.0

75.3

42.1

23.8

2.5

5.0

1.9

21.0

17.5

2.7

0.7

---

3.6

27.6

9.7

1.8

19.0

6.1

4.2

6.9

24.8

12.1

20.3

. . .

2.7

6.9

15.1

7.5

100.0

59.6

37.2

13.4

4.7

3.2

1.3

33.3

17.2

7.1

6.6

2.5

6.9

14.0

17.7

3.6

6.7

10.0

2.7

4.5

40.9

22.2

8.9

3.7

4.6

4.5

8.8

4.7

100.0

70.4

37.9

22.6

3.2

4,8

1.8

25.3

18.8

3.6

2.4

0.5

4.3

25.6

8.4

1.1

16.1

8.2

3.9

6.6

29.9

9.6

17.0

1.8

4.1

6.4

13.4

7.1

100.0

67.6

38.5

19.6

3.2

4.5

1.7

27.3

18.3

4.5

3.4

1.1

5.1

23.1

11.3

1.8

13.3

8.0

3.5

6.3

32.7

13.5

14.6

2.5

4.1

5.6

11.5

6.6

100.0

67.2

28.3

27.5

8.0

2.6

0.7

29.2

18.7

5.2

5.1

0.4

3.5

17.4

5.5

1.1

16.6

17.5

3.8

3.5

34.5

6.6

17.4

0.7

6.6

9.0

21.3

5.6

100.0

67.1

29.1

26.1

8.9

2.7

0.5

29.3

19.9

4.9

4.1

0.5

3.6

18.3

5.0

1.3

15.5

17.7

4.2

3.1

34.6

6.4

16.0

0.5

7.4

7.4

19.3

6.4

1Living arrangements areas reported by next of kin.

2 Includes retirement home, boarding house, rooming house, and rented room.

3 ln~l~desa small number Of residents with usual living quarters in a private or semi-private residence but whose usual hvmg arrangements are unknown.

4 Includes persons who usually lived wdh the resident in a private or semi-pnvale residence prior to admission.

31
Table 13. Percent distribution of nursing home residents with mental disorders and next of kin by usual living arrangement prior to admission, according to

marital status and primary source of payment at admission: United States, 1985

Primary source of payment af admission

,4// residents

&far(/a/ status at admisshr

own

wth mer7ta/ Divorced income or

Usua/ /ivirrg arrangement disorders and or Never family

Medicaid A// other

prior to admission 1 next of kin Married Widowed separated married support Medicare Skilled Intermediate sources 2

Percent distribution

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

Usual living quarters

Private or semi-private residence. . . . . . . .

c)wnhom eorapq’tm~ nt, . . . . . . . . . .

Relative’s home or apartment ., ., . . . .

Otharprivate homeor apartment .,, . . .

Retirement home . . . . . . . . . . . . . . . . . .

Boarding house, rooming housa,

or rented room....,,...,,.,,.. . . .

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

Another nursing home . . . . . . . . . . . . . .

General orshort-term hospital ., ..,...

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

Chronic disease or other

Iong-term care hospital , . .,, ,, .,...

Other place orunknown . . . . . . . . . . . . . . .

Type of usual living arrangement

Lived alone. . . . . . . . . . . . . . . . . . . . ,.. ,

Lived with spouse only . . . . . . . . . . . . . . . .

Lived with spouse and

other relative$ . . . . . . . . . . . . . . . ...,..

Lived with son or daughter. . . . . . .

Lived with other relatives ., ., . . . . .

Lived with unrelated persons . . . ., .,

Group quarters3, ., . ., . . . . . . . . . . . . .

Another health facility, other place,

orunknown4 . . . . . . . . . . . . . . . . . . ...

Who lived with residants

Spouse ..,,,...,,.,..,...,..,.. . . .

Children . . . . . . . . . . . . . . . . . . . . . . . . . .

Parents ..,.... . . . . . . . . . . . . . . . . . . . .

Siblings . . . . . . . . . . . . . . . . . . . . . . . . . .

Grandchildren ..,....,....,..,.. . . . .

Other relatwes, .,,.,.,..,.,,.,., ... .

Nonrelative. , ..,.,....,..,...,,., .,

190.0

67.5

37.7

20.2

3.6

4.4

1.7

27.5

18.3

4.5

3.5

1,0

5.0

22,7

10.9

1.7

13.6

8.7

3.6

6.1

32.9

13,0

14,8

2,3

4,2

5.9

12.2

6.5

100,0

73.9

61.5

6.7

2.2

2.7

0.6

22.6

13.6

5.2

3.0

0,8

3.5

4.2

54.6

7.5

2,2

0,9

07

3.5

26.2

64.4

7.7

0.3

0.2

3.2

4.4

t .8

100,0

71.6

36.5

24,8

2.9

5.8

1.6

24.2

18.8

3.9

1.1

0.4

4.2

29.3

2.7

0.6

21.6

5.9

3.8

7,4

26.8

3.3

22.1

0.2

2.9

8.4

15.8

7.2

~Llwng arrangements are aa reportad by next of kin

100.0

57.5

32.4

14.9

6.9

1.7

1.6

36.3

18.2

8,5

7.4

2,3

6.2

28.8

2.9

2.3

9.4

7.2

3.5

33

42.5

5.2

10.3

2.3

2.6

6.2

9,6

5.6

100.0

53.3

22.6

19.8

5.6

2.7

2.7

38.2

21.1

4.3

10.0

2,8

8,5

16.4

0.2

—

0.7

24.4

5.5

5.3

47.5

0.2

0.7

10.6

12.4

0.3

9.0

8.7

100.0

75.1

47.1

18.0

2.9

5.6

1.4

21.2

15.3

3.7

1.6

0.6

3.7

26.9

14.1

2,0

12,5

7,5

4.6

7.0

25.2

16.9

14.2

1.5

4.2

4.8

10.7

7,2

100,0

74.2

43.8

19.7

5.7

4.3

0.7

23.9

18.5

3.8

0.7

0.7

1.9

30.3

12.8

2.8

14.7

5.5

2.8

5.2

25.6

15.6

17.1

—

2.6

6.2

11.8

4.5

100.0

57.8

26.5

21.6

3.1

4.5

2.3

35.0

23.1

6.9

3.9

1.0

7.2

13.6

9.2

1.0

14.5

9.5

3.2

6.7

42.4

10,2

14,8

4.6

3.4

8.2

11.4

6.3

100.0

64.1

31.3

24.3

3.9

2.4

2.1

31.0

21.5

3.2

5.1

1.2

4.9

21.2

7.7

1.5

17.0

10.0

1.7

4.5

36.3

9.3

17.9

2.5

4,8

7,5

16,4

5.2

100.0

44.7

18.2

15.0

7.0

3.8

0.7

43,0

15.8

11.3

11.8

4.2

12.5

13.8

2.8

1.0

3.5

lt.8

5.0

4,5

57.5

4.3

4.7

4.3

5.3

1.3

7.7

8.7

‘Includea other government asaiatance or welfare, religious orgamzations,f oundatlons, volunteer agencies, Veterans Administration contract, initial payment llfe.care funds, andothersourwa or no

charge,

31ncludes retirement home, boardmghoy se, roommo house, and ranted room,

4 Includes a small number of residents with usual Ilvmg quarters m a private or semi-private residence but whose usual living arrangements are unknown,

‘Includes persons who usually lwed w(ththeresldant !naprivate orsemi-privete realdenca prlortoadmlssion,

32
Table 14. Percent distribution ofnursing home residents with next of Knbyusual living arrangement prior tosdmission, sccortingto sgeand mental

condition: United States, 1985

Mental condition

With mental disorders Without mental disorders

A// residents Under 65 years All residents Under 65 years

Usual living arrangement prior to admission’ with next of kin 65 years and over with next of kin 65 years and over

Percent distribution

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

Usual living quarters

Private orsemi-private residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ownhome orapartment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Relative’s homeor apartment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other private home orapartment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Retirement home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Boarding house, rooming house, or rented room. . . . . . . . . . . . . . . . . . .

Another heaith facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Another nursing home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

General orshort-term hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Chronic disease or other long-term care hospital . . . . . . . . . . . . . . . . . . . . . .

Other place orunknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Type of usual living arrangement

Lived alone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lived with spouse only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lived with spouse and other relatives.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lived withson ordaughter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lived with other relatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lived with unrelated persons . . . . . . . . . . . . . . . . . . . . . ,, . . . . . .

Group quartersz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Another health facility, other place, orunknown3 . . . . . . . . . . . . . . . ..”......

Who lived with resident4

100.0

67.5

37.7

20.2

3.6

4.4

1.7

27.5

18.3

4.5

3.5

1.0

5.0

22.7

10.9

1.7

13.6

8.7

3.6

6.1

32.9

13.0

14.8

2.3

4.2

5.9

12.2

6.5

100.0

47.4

19.4

18.9

6.2

0.8

2.2

42.0

14.3

8.8

14.7

4.2

10.6

8.1

2.3

2.5

3.7

20.5

5.1

2.8

54.9

4.8

5.6

14.3

6.3

2.8

9.3

7.3

100.0

70.4

40.3

20.3

3.2

4.9

1.6

25.4

18.9

3.9

1.9

0.6

4.2

24.8

12.1

1.6

15.0

7.0

3.3

6.5

29.7

14.1

16.2

0.6

3.9

6.3

12.6

6.4

100.0

75.0

46.6

19.6

3.5

3.6

1.7

20.0

13.4

5.7

0.1

0.8

5.1

34.0

9.5

1.9

13.8

8.0

2.2

5.3

25.3

11.5

15.2

1,4

4.2

6.7

12.5

5.2

100.0

57.2

31.5

19.6

1.9

---

4.1

36.7

23.8

11.3

---

1.7

6.1

7.7

10.2

5.8

7.2

20.7

1.4

4.1

43.1

16.0

12.2

14.9

8.6

3.9

13.0

2.2

100.0

76.3

47.8

19,6

3.6

3.9

1.5

18.7

12.6

5.3

0.1

0.8

5.0

36.0

9.5

1.6

14.4

7.0

2.3

5.4

23.9

11.2

15.4

0.4

3.9

6.9

12.4

5.4

1Lnqng arrangements sre as reported by next of kin.

2 Includes retirement home, boarding house, rooming house, and rented room.

3 Includes a small number of residents wth usual Ihving quarters in a private or semi-prwate res!dence but whose usual fiiiflg arrangements are unknown.

4 [ncludes persons who usually lived with the resident in a private or semi-private residence prior to admission.

33
Table 15. Percent distribution ofnursing home residents with mental disorders andnext ofkinby reason foradmission andprior atateof health) according to

age, sex, and race: United States, 1985

Age

A// residents kwth

65 years and over Race

Reason for admission and

Sex

men/a/disorders Under65 65–74 7544 85 years B/ack and

prior state of heakh 1 and next of km years Total years years and over Male Female White other

Percent distribution

Total, ,,. ,

Main medical reason for admission

Hip fracture,,,,,,, ,. ,. .,., .,

Other fracture

Arthr@.. ., .,, ,,.

Other condition of bones, muscles,

or joints . . . . ,,.

Stroke ,.. ,,.

Atherosclerosis

Other heart orcirculatory condmon

Cancer, alltypes . . . . . . . . . . . . . . . . . .

Alzheimer’s d[sease .,,.,.,,.,., ,., ,,,

Confused or forgetful . . . . . . . . . . . . . . . . .

Senihty . . . . . . . . . . . . . . . . . . . . . .

Other emotional, mental, or nervous

condition. ,, ..,,...,,.,..,.,.,

Parkinson’s disease.,,.,.,,.,.,,. ,., ,.

Central nervous system diseases

orlnjurles, . . . . . . . . . . . . . . . .

Dizziness, fainting, or falls ., ., .,

Loss ofvision or hearing ., .,,.,..,.,

Respwatory condlt[on

Diseases of the digestive or

endocrine systems.,....,..,., ... .,..

Genitourinary diseases ., ., .,

No main medical reason

Old age or general debilitation

Other medical reason or unknown ., .,

General reason for admission

Recuperation from surgery or illness .,

No one at home to provide care

Not enough money to purchase

nursing care at home .,, ,,, ,., ,,

Required more care than household

members could give.. ,, .,,,,,

Problems in doing everyday activities, .,

Because spouse entered,. ,..

State of health before admission

Suddenly dl orinjured, . . . . . . . . . .

Gradually worsening . . . . . . . . . . . . . . .,,

In poor condition most of year.

Other health status.

Unknown

100.0

53

1.2

1.4

2.2

9.7

4.2

44

1.3

9.6

4.9

5.7

14.0

1.7

25

11

2.0

1.6

2.6

0.8

27

27

18.4

29.6

62.4

41.0

79.1

72.6

26

143

516

157

15.1

32

100,0

11

0.3

. . .

1.1

4.8

. . .

2.3

3.1

3.3

0.5

07

47.9

1.4

9.3

0.8

0.8

0.5

2.3

0.3

08

07

18.3

19.5

54.9

45.0

74.1

626

03

89

283

23.6

309

8.3

100.0

59

1.3

1,6

2.4

10.4

4.8

4.7

1.1

10.5

5.5

6.4

9.1

1.7

15

1.2

2.1

1.7

2.7

0.8

3.0

3.0

18.4

31.0

63.4

404

79.8

740

2.9

15,1

54.9

14.6

128

2.5

100.0

2.5

0.5

1.3

0.9

13.5

1.3

3.8

1.0

14.9

1.1

30

21.5

1.1

3.9

0.1

2.5

2.7

4.3

0.2

2.0

0.9

17.0

34.2

58.8

46.3

79.1

71.4

1.9

12.1

46,5

20.4

175

3.6

I00.0

3.4

1.0

1.6

2.3

11.2

5,9

5.2

1.3

13.9

4.7

8.5

8.8

2.9

1.4

0.7

2.0

1.9

2.1

1.0

2.9

2.6

16,8

30.3

64.0

42.2

79.9

73.4

2.3

12,5

59.3

14.8

10.2

3.3

100.0

9.3

1.8

1.8

3.1

8.6

5.1

4.5

0.9

8.0

7.7

7.6

5.1

0.9

0.8

1.9

2.1

1.3

2.6

0.9

3.5

4.2

20.3

30.5

64.6

369

79.9

75.4

3.9

18.4

54.3

12.5

13.5

1.3

100.0

2.3

0.3

0.8

1.7

10.3

3.0

3.9

2.7

9.3

3.2

2.8

21.1

2.7

4.4

0.5

1.9

1.4

2.9

0.8

1.9

2.4

19.7

28.1

59.6

40.6

79.4

67.7

3.4

13.2

46.0

19.7

16.7

4.4

100.0

6.4

15

1.7

2.4

9.5

4.6

4.6

0.8

9.6

5.5

6.8

11.4

1.3

1.8

1.4

2.0

1.7

2.5

0.8

3.1

2,8

17.9

30.1

63.4

41.2

78.9

74.4

2.4

14.8

53.7

14.3

14.5

2.7

I 00.0

5.7

1.2

1.5

2.4

9.4

4.4

4.3

1.4

9.9

4.7

5.7

13.5

1.8

2.6

1.2

1.8

1.7

2.4

0.8

2.7

2.8

18.3

29.5

62.1

40.0

79.1

72.3

2.7

14.4

51,6

15.6

15.2

3.2

100.0

0.8

0.3

1.1

0.4

13.8

1.4

4.6

0.4

4.9

7.4

6.3

20.6

0.4

1.7

0.4

3.2

0,4

5.5

0,8

3.6

1.7

20.1

30.9

65.2

53.9

79.0

75.2

2.0

13.9

52.2

17.3

13.6

3.2

1Reasons for admtsslon and prior stales of health are as reported by next of kln

2F(gures may not add to totals because resident may have had more than one reason for admlss!on to nursing home

34
Table 16. Percent distribution of nursing home residents with next of kin by reason for admission and prior state of heatlh, according to age and mental

condition: United States, 1985

Mental condition

With mental disorders Without mental disorders

A// residents Under 65 years All residents Under 65 years

Reason for admission and prior state of health with next of kin 65 years and over with next of kin 65 years and over

Percent distribution

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

Main medical reason for admission

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

Other fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other condition of bones, muscles, or joints . . . . . . . . . . . . . . . . . . . . . . . .

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

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other heart orcirculatory condition.. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cancer, alltypes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Alzheimets disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Confused or forgetful . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Other emotional, mental, or nervous condition . . . . . . . . . . . . . . . . . . . . . . . . .

Parkinson’a disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Central nervous system diseases orinjuries. . . . . . . . . . . . . . . . . . . . . . . . . . .

Dizziness, fainting, or falls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lossofvision orhearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Respiratory condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseasas of the digestive or endocrine systems , . . . . . . . . . . . . . . . . .

Genitourinary diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nomain medical reason . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Oldageor general debilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other medical reason orunknown. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

General reason for admissionl

Recuperation fromaurgery orillnesa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nooneat hometo provide care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Not enough money to purchase nursing care at home . . . . . . . . . . . . . . . . . . .

Required more care than household members could give . . . . . . . . . . . . . . .

Problems indoing everyday activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Because spouse entered . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

State of health before admission

Suddenly illor injured . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Gradually worsening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

lnpoorcondition mostof year. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other health atatus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

100.0

5.3

1.2

1.4

2.2

9.7

4.2

4.4

1.3

9.6

4.9

5.7

t 4.0

t .7

2.5

1.1

2.0

1.6

2.6

0.8

2.7

2.7

18.4

29.6

62.4

41.0

79.1

72.6

2.6

14.3

51.6

15.7

15.1

3.2

100.0

1.1

0.3

..-

1.1

4.8

. . .

2.3

3.1

3.3

0.5

0.7

47.9

1.4

9.3

0.8

0.8

0.5

2.3

0.3

0.8

0.7

18.3

19.5

54.9

45.0

74.1

62.6

0.3

8.9

28.3

23.6

30.9

8.3

100.0

5.9

1.3

1.6

2.4

10.4

4.8

4.7

1.1

10.5

5.5

6.4

9.1

1.7

1.5

1.2

2.1

1.7

2.7

0.8

3.0

3.0

18.4

31.0

63.4

40.4

79.8

74.0

2.9

15.1

54.9

14.6

12.8

2.5

100.0

6.8

2.1

4.3

3.9

19.4

1.6

6.5

3.0

0.4

2.2

1.4

2.4

2.1

4.5

1.3

2.8

2.4

3.9

1.2

4.8

2.7

19.9

42.9

66.8

39.7

74.6

76.4

3.4

22.4

45.4

16.8

13.8

1.6

100.0

0.8

-..

0.8

1.9

22.7

1.9

4.1

1.9

.-.

---

---

5.0

3.3

30.7

---

1.7

0.8

2.8

---

0.8

---

21.0

38.1

59.1

47.8

82.0

74.9

0.8

24.9

28.5

22.7

21.3

3.0

100.0

7.3

2.2

4.6

4.1

19.2

1.6

6.7

3.1

0.5

2.3

1.5

2.2

2.0

2.5

1.4

2.9

2.6

4.0

1.3

5.1

2.9

19.9

43.3

67.4

39.1

74.0

76.6

3.6

22.3

46.7

16.3

13.2

1.5

i Figurss may not add to totals because resident may have had more than one reason tor admission to nursing home.

35
Appendixes

Contents

I. Technical notes on methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...37

Surveydesign. . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . , . , . . . . . . , ,, . . . . 37

Generalqualifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,,....39

Reliabilityofestimates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...40

Hypothesistesting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,. . . . . . . . . 41

II. Definitionsofcertaintermsusedinthis report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 43

III. Selected instruments used inthe 1985 National Nursing Home Survey . . . . . . . . . . . . . . . , . . . . , . . . . 46

Appendix figure

I. Relative standmd emorsfor estimated numbers ofcument nursing homeresidents: United States, l985 . . . . . . . . , 42

List of appendix tables

I. Comparison between the 1985 NNHS (estimates) and 1986 ILTCP showing number of homes and beds by type of

home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37

II. Number of facilities in the 1985 National Nursing Home Survey universe and sample, by disposition and sampling strata:

Conterminous United States, 1985.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

111. Summary ofdatacollection procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

IV. ICD–9–CM and checklist codes for items in the Current Resident Questionnaire used to identify the mentally ill in nursing

homes byresident mental condition: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . , . . . , , . . 44

36
Appendix I

Technical notes on methods

Survey design

From August 1985 through January 1986, the Division of

Health Care Statistics (DHCS) conducted the 1985 National

Nursing Home Survey (NNHS)—a sample survey of nursing

homes, their residents, discharges, and staff in the conterrninous

United States. The survey was designed and developed by

NCHS, with input from several other Federal agencies. The

1985 survey was the third of a series of surveys designed to

satisfy the diverse data needs of those who establish standards

for, provide, and assess long-term ‘care services. The first

survey was conducted from August 1973 through April 1974,

and the second survey was conducted from May through December 1977.

Sampling frame

The 1985 NNHS included all types of nursing and related

care homes with three or more beds setup and staffed for use by

residents and routinely providing nursing and personal care

services. Facilities were either freestanding establishments or

nursing care units of hospitals, retirement centers, or similar

institutions maintaining financial and employee records separate from those of the larger institutions. Residential care

facilities were excluded. These included community care facilities in California, adult congregate Iivingfacilities inFlorida,

family care homes in Kentucky, and adult foster care homes in

Michigan (12).

The universe for the 1985 NNHS consisted of four components: (a) the base,the 1982National Master Facility Inventory

(NMFI), which is a census of nursing and related care homes;

(b) data on homes identified in the 1982 Complement Survey of

the NMFI as “missing” from the 1982 NMFI; (c) data on

hospital-based nursing homes obtained from the Health Care

Financing Administration; and (d) data on nursing homes

opened for business between 1982 and June 1, 1984. The

resulting frame contained information on 20,479 nursing and

related care facilities. Detailed descriptions of the 1982 NMFI

survey design and procedures have been published (12).

Because not all residential care facilities could be identified, an unknown number of them were present in the sampling

frame. It was not until after the 1986 Inventory of Long-Term

Care Places (ILTCP) had been conducted that such facilities

could be classified as residential facilities and that an estimate

could be obtained for the number of these facilities that were

included in the 1985 NNHS.

Using the 1986 ILTCPto identify homes in the 1985 NNHS

sample that were classified as residential in 1986, 32 such

homes were found. The weights for these homes produced an

estimate of 2,200 residential facilities and7 1,000beds for 1985.

Table I gives a comparison of the two surveys reflecting this

adjustment in residential facilities.

Table L Comparison between the 1985 NNHS (estimates) and 1986 ILTCP

showing number of homes and beds by type of home

1985 NNHS 1986 ILTCP

Type of home Homes Beds Homes Beds

Total . . . . . . . . . . . . . . . . . . . . . . 19,100 1,624,200 26,400 1,767,500

Certified . . . . . . . . . . . . . . . . . 14,400 1,441,300 14,100 1,451,200

Uncertified . . . . . . . . . . . . . 2,500 111,900 3,000 114,500

Residential . . . . . . . . . . . . . . . . . 2,200 71,000 9,300 201,800

NOTE: NNHS is National Nuramg Home Suwey; ILTCP is Inventory of LongTerm Care

Places,

Estimates for the 1985 NNHS will not correspond precisely

to figures from either the 1982 NMFI census or the 1986 ILTCP

survey for several other reasons. Among the reasons for differences are that the three surveys differed in time of data

collection and in data collection procedures and that the 1982

NMFI was a combination of data collectedly 35States and data

collected by the NCHS via mail survey in the remaining States

and in the 35 States where certain types of nursing and related

care homes were not surveyed by these States. In contrast, the

NNHS is conducted by personal interview. Thus the NNHSmethodology permitted more scrutiny in the identification and

exclusion of facilities that were out of scope. Finally, because

the NNHS is a sample survey, its data are subject to sampling

variability; because the NMFI and ILTCP surveys area census,

their data are not.

Sampling design

The sampling was basically a stratified two-stage probability design. The first stage was the selection of facilities, and the

second stage was the selection of residents, discharges, and

R.N.’s from the sample facilities. In preparation for the firststage sample selection, facilities listed in the universe were

sorted into the following types of strata, based on Medicare and

Medicaid certification: (a) certified by either Medicare or

Medicaid or (b) not certified by either Medicare or Medicaid.

Facilities in each of these two strata were sorted by frame

source: (a) 1982 Complement Survey and (b) all other sources

(that is, 1982 NMFI, HCFA hospital-based nursing homes, and

nursing homes opened between 1982 and 1984). Facilities in the

37
Non-Complement Survey strata were further sorted by bed size.

producing the 20primary strata as shown in table II. The nursing

homes in the universe were ordered by ownership, geographic

region, metropolitan status, State, county and MSA (metropolitan statistical area), and ZIP Code. The sample was then

selected systematically after a random start within each primary

stratum. Table 11 shows the distribution of facilities in the

sampling frame and the final disposition of the sample with

regard to response and scope status.

The number of nursing homes estimated in the survey is

less than the universe figure (20,479) for several reasons. Some

facilities went out of business or became ineligible for the scope

of the survey between the time the universe was frozen and the

study was conducted. A facility was considered out of scope if

it did not provide nursing, personal, or domiciliary care services

(for example, a facility providing only room and board) or if it

was a nursing care unit or wing of a hospital, retirement center,

or similar institution without separate financial and employee

records for that unit.

The second-stage sampling of residents, discharges, and

registered nurses was carried out by the interviewers at the time

of their visits to the facilities in accordance with specific

instructions to assure a probability sample. The sample frame

for residents was the total number of residents on the register of

the facility on the evening prior to the day of the survey.

Residents who were physically absent from the facility due to

overnight leave or a hospital visit but who had a bed maintained

for them at the facility were included in the sample frame. A

sample of five or fewer residents per facility was selected.

The sampling frame for discharges was the total number of

persons discharged alive or dead during the 12 months prior to

the survey date. Persons who were discharged more than once

during this 12-month period in the same nursing home were

listed for each discharge. Current residents discharged during

the 12 months prior to the survey and then readmitted to the

sample nursing home were also eligible to be included in the

discharge sampling frame. Forty-five of the sampled discharges

were also included in the current resident sample. A sample of

six or fewer discharges per facility was selected.

The sampling frame for nursing staff included all R.N.’s

who were employed by the facility on the day of the survey.

Registered nurses working under a special contractual arrangement or through a temporary service were included if they were

scheduled to work during the 24 hours constituting the survey

day. A sample of four or fewer R.N.’s per facility was selected.

Data collection procedures for the 1985 NNHS

The 1985 NNHS utilized nine questionnaires (see appendix III for facsimiles of selected questionnaires):

● Facility Questionnaire

. Expense Questionnaire and Definition Booklet

. Nursing Staff Sampling List

. Nursing Staff Questionnaire

. Current Resident Sampling List

. Current Resident Questionnaire

. Discharged Resident Sampling List

Table Il. Number of facilities in the 1965 National Nursing Home Survey universe and sample, by disposition and sampling strata: Conterminous

United Statea, 1985

Sample

Universe Out of scope or

In scope and in businese

Samphg strata (sarnphrg frame)’ A// facilities out of business Nonrespondhg ‘“Responding

Alltypes of certification, ,, . ...,..... ., .,

Certified

Complement survey homes . . . . . . . . . . . . . . .

3–14beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15–24 beds . . . . . . . . . . . . . . . . . . . . . . .

25-49 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

50–99 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

200-399 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

400-599 beds...,....,..,..,.. . . . . . . . . . . . . . . . . . .

600 beds or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown bed size..,........,.. . . . . . . . . . . . . . . . . . .

Not certified

Complement survey homes .,... .,,.,.,,,,,,,.,,.,,,,.

3–14 beds...,,....,........,,,.. ,,, ,,, ,,, .,

15-24 beds...

25-49 beds .,.,..,. .

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

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

200-399 beds.,:,,:,.,.. ., ..,.,,.,:,,::,::::

400-599 beds. ,.

600 beds or more. . .,, ,. .,,...

Unknown bedsize. .,,.,.,,.,.,

20,479

24

112

384

1,876

5,000

4,604

861

77

26

20

336

2,346

1,087

1,185

1,029

727

132

19

7

627

1,220

19

5

9

43

269

478

196

17

10

10

14

8

10

15

35

39

14

5

4

20

57

2

1

4

9

9

1

1

3

3

3

2

1

2

84

2

0

0

3

21

28

13

3

0

3

0

3

3

0

0

10

1,079

16

3

8

36

239

441

182

13

9

6

11

4

6

12

31

34

12

4

3

9

lThe urwerse conwted of nursing homes m the t9S2 Nat[onal Master Fac!llly Inventory (NMFI), nursing homes In the 1982 Complement Survey of the NMFI, hospital-based nursing homes from the

Health Care Financing Admmlstratlon file, and nursing homes opened for business from 19S2 to 19S4

38
.

.

1.

2.

3.

Discharged Resident Questionnaire

Next-of-Kin Questionnaire.

Data were collected according to the following procedures:

A letter was sent to the administrator of the sample facility

informing him or her of the survey and of the fact that an

interviewer would contact him or her for an appointment.

Included with this introductory letter were letters of endorsement from the American Association of Homes for

the Aging, the American College of Health Care Administrators, and the American Health Care Association urging

the administrator to participate in the survey. A sample

report from the 1977 survey was also enclosed to illustrate

how the data would be published.

At least 1 week after the letters had been mailed, the

interviewer telephoned the sample facility and made an

appointment with the administrator.

During the appointment, the Facility Questionnaire was

completed by the interviewer of the administrator (or

designee) of the nursing home. After completing this form,

the interviewer secured the administrator’s authorization

for completion of the Expense Questionnaire (EQ). Possible

respondents to the EQ included accountants, administrators,

and other knowledgeable staff members. Results from the

survey indicate that the respondents were evenly divided

into two groups: accountants located outside the facility

and administrators and other staff members, such as

bookkeepers, based in the facility. When apreparedfinancial

statement was available, it was accepted in lieu of an EQ.

This occurred in one-half of the cases. The interviewer

completed the Nursing Staff Sampling List, selected the

sample of R.N.’s from it, and prepared Nursing Staff

Questionnaires. These were left for each sample nurse to

complete, seal in an addressed envelope, and return either

to the interviewer by hand or to the data processing headquarters by mail. The interviewer completed the Current

Resident Sampling List (a list of all residents in the facility

on the night before the day of the survey), selected the

sample of residents from it, and completed a Current

Resident Questionnaire for each sample resident by interviewing the member of the nursing staff most familiar with

care provided to that resident. The nurse referred to the

resident’s medical record when responding. No resident

was interviewed directly.

The interviewer then completed the Discharged Resident Sampling List (a list of all persons discharged alive or

Table Ill. Summary of data collection procedures

dead during the 12 months preceding the survey date),

selected a sample of discharges from it, and completed for

that stay a Discharged Resident Questionnaire for each

sample discharge by interviewing a member of the nursing

staff, who referred to medical records. In larger facilities,

a team of two or three interviewers conducted the survey to

reduce the time spent in the facility.

Followup information on the two patient samples was

collected via a computer-assisted telephone interview with

a next of kin of the current or discharged resident, using the

Next-of-Kin (NOK) Questionnaire.

The next of kin interviewed was identified in the

Current Resident and Discharged Resident Questionnaires

and included relatives, guardians, and anyone familiar with

the sampled resident. A discharged resident could also be

contacted if discharged to a place of residence and residing

there at the time of the survey. An attempt was made to

identify the “best respondent” while obtaining next-of-kin

information from the nursing home. The best respondent

was mailed a letter of information about the survey, contacted by telephone, and administered the NOK Questionnaire. Table III presents a summary of the data collection

procedures.

General qualifications

Nonresponse and imputation of missing data

For nursing homes that agreed to participate, response rates

differed for each type of questionnaire:

Response rate

Questionnaire (percent)

Facility . . . . . . . . . . . . . . . . . . . . 100

Expense . . . . . . . . . . . . . . . . . . 68

Current Resident. . . . . . . 97

Discharged Resident . . . . . . . . 95

Nursing Staff . . . . . . . . . . . . . . . 80

Next-of-Kin . . . . . . . . . . . . . . . . 90

Number

1,079

732

5,243

6,023

2,763

9,134

Generally, response rates were higher for questionnaires

administered in a personal interview situation (Facility, Current

Resident, Discharged Resident, and NOK) than for those that

were self-enumerated (Expense and Staff). Statistics presented

in this report were adjusted for failure of a facility to respond

(that is, to participate in the survey) and for failure to complete

any of the other questionnaires (Expense, Current Resident,

Discharged Resident, Nursing Staff, or NOK). Those items left

Questionnaire Respondent hrterview situation

Facilily Questionnaire Administrator Interview

Expense Questionnaire Administrator, owner, accountant, or bookkeeper Self-enumerated

Nursing Staff Sampling List Staff members Informal interview or copied from records

Nursing Staff Questionnaire Sampled registered nurses Self-enumerated

Current Resident Sampling List Staff member who refers to current resident census

Current Resident Questionnaire

Informal interview or copied from remrds

Nurse who refers to medical record Interview

Discharged Resident Sampling List Staff member who refers to discharge records Informal interview or copied from remrds

Discharged Resident Questionnaire Nurse who refers to medical recmd Interview

Next-of-Kin Questionnaire Relatives, guardians, or anyone familiar with the sampled person Telephone interview

39
unanswered on a partially completed questionnaire were gener- residents (discharges or R. N.’s) upon which the selection is

ally imputed by assigning a value from a responding unit with based; the second is the ratio of the number of sample residents

major characteristics identical to those of the nonresponding (discharges or R.N. ‘s) in the facility to the number of residents

unit. (discharges or R.N. ‘s) for whom questionnaires were compounding of numbers

pleted within the facility (13).

Estimates of residents have been rounded to the nearest

hundred. For this reason, detailed figures within tables do not

always add to totals. Percents were calculated on the original,

unrounded figures and will not necessarily agree precisely with

percents that might be calculated from rounded data.

Data processing

Extensive editing was conducted by computer to assure

that all responses were accurate, consistent, logical, and complete. Once the data base was edited, the computer was used to

calculate and assign weights, ratio adjustments, recodes, and

other related procedures necessary to produce national estimates from the sample data.

After the publication of The National Nursing Home Survey: 1985 Summary for the United States, Series 13, No. 97(5 ),

a data processing error concerning the number of all-listed

diagnoses at the time of survey for current residents was

discovered. It was found that the special tape created to present

these estimates contained a serious undercount of the number of

cases in most categories. After correction, the increase in

estimated number of diagnoses by specific categories ranged

from 0.1 to 50.6 percent. The following categories were found

to decrease after correction: Infectious and parasitic diseases;

Pneumonia, all forms; Injury and poisoning; Fracture of neck of

femur; and Other fractures. The decrease in the estimated

number of diagnoses for these categories ranged from 4 to 42

percent. The corresponding rates of all-listed diagnoses per 100

residents generally increased as a result of this correction.

Estimation procedures

Statistics reported in this publication are derived by a ratio

estimating procedure. The purpose of ratio estimation is to take

into account all relevant information in the estimation process,

thereby reducing the variability of the estimate. The estimates

of number of facilities and facility data not related to size are

inflated by the reciprocal of the probability of selecting the

sample facility and adjusted for the nonresponding facilities

within primary strata. Two ratio adjustments, one at each stage

of sample selection, were also used in the estimation process.

The first-stage ratio adjustment (along with the preceding

inflation factors) was included in the estimation of facility data

related to size and of all resident, discharge, and nursing staff

data for all primary types of strata. The numerator was the total

number of beds according to the universe data for all facilities

in the stratum. The denominator was the estimate of the total

number of beds obtained through a simple inflation of the

universe data for the sample facilities in the stratum. The effect

of the first-stage ratio adjustment was to bring the sample in

closer agreement with the known universe of beds. The secondstage ratio adjustment was included in the estimation of all

resident, discharge, and R.N. data. It is the product of two

fractions: The first is the inverse of the sampling fraction for

Reliability of estimates

As in any sample survey, the results are subjecl to both

sampling and nonsampling errors. Nonsampling errors include

errors due to response bias, questionnaire and item nonresponse,

recording, and processing errors. To the extent possible, the

latter type of errors were kept to a minimum by methods built

into survey procedures, such as standardized interviewer training, observation of interviewers, manual and computer editing,

verification of keypunching, and other quality checks. Because

survey results are subject to both sampling and nonsampling

errors, the total error is larger than errors due to sampling

variability alone.

Because the statistics presented in this report are based on

a sample, they will differ somewhat from figures that would

have been obtained had a complete census been taken using the

same schedules, instructions, and procedures.

The standard error is primarily a measure of the variability

that occurs by chance because only a sample, rather than the

entire universe, is surveyed. The standard error also reflects part

of the measurement error, but it does not measure any systematic biases in the data. It is inversely proportional to the square

root of the number of observations in the sample. Thus as the

sample size increases, the standard error generally decreases.

The chances are about 68 in 100 that an estimate from the

sample differs by less than the standard error from the value that

would be obtained from a complete census. The chances are

about 95 in 100 that the difference is less than twice the standard

error and about 99 in 100 that it is less than 2 1/2 times as large.

The standard errors used for this survey were approximated

using the balanced repeated-replication procedure. This method

yields overall variability through observation of variability

among random subsamples of the total sample. A description of

the development and evaluation of the replication technique for

error estimation has been published (14, 15).

To derive error estimates that would be applicable to a wide

variety of statistics and could be prepared at moderate cost,

several approximations were required.

Rather than calculate standard errors for particular estimates Sx,the calculated variances for a wide variety of estimates

presented in this document were fitted into curves using the

empirically determined relationship between the size of an

estimate X and its relative variance (rel var X). This relationship

is expressed as:

s:

rel var X = ~

b

=a+—

x

where a and b are regression estimates determined by an iterative procedure.

40
The relative standard error is then derived by taking the

squzueroot of the relative variance curve. The relative standard

error estimates for estimated number of residents (with or

without next of kin) are shown in figure I.

The relative standard error (RSE(X)) of an estimate X may

be read directly from the curve in figure I or alternatively may

be calculated by the formula

RSE(X) =

d

530.2361

–0.000177 + x

where X is the number of residents of interest.

In this report, estimates that have a relative standard error

of 30 percent or more are considered unreliable and are indicated with an asterisk beside the estimate. Figures marked with

an asterisk are given primarily to allow the reader to combine

them with related estimates, thereby possibly producing a more

reliable overall estimate for a broader category.

Because of the relationship between the relative standard

error and the estimate, the standard error of an estimate qan be

obtained by multiplying the estimate by its relative standard

error. Thus, for example, in figure I, an estimate of 5,800

residents has a relative standard error of 30 percent; therefore,

the standard error is 0.30x 5,800= 1,740.

Toapproximatetherelative standard error (RSE(p)) and the

standard error (SE(p)) of a percent p, the following equations

are used:

RSE(p) =

d

530.2361. (100 –p)

p.Y

SE(p) =p . RSE(p)

where x = the numerator of the estimated percent

y = the denominator

P=loo.:

Y

The approximation of the relative standard error or the

standard error of a percent is valid when only one of the

following conditions is satisfied: the relative standard error of

the denominator is 5 percent or less (16) or the relative standard

errors of the numerator and the denominators are both 10

percent or less (17).

Hypothesis testing

To test the difference between two statistics (mean, percent, and so forth), the two-tailed t-te~ with 20 degrees of

freedom was performed to determine whether to reject the null

hypothesis (for the two means ~lL~z, the null hypothesis is

HO:~l= ~q with the alternative H~:Xl# ~J. At the 0.05 (5 percent) level, the critical value for the t-test is 2.09. Terms such as

“higher” and “less” indicate that differences are statistically

significant. Terms such as “similar” or “no difference” mean

that no statistically significant difference exists between the

estimates being compared. A lack of comment on the difference

between any two estimates does not mean that the difference

was tested and found not to be significant.

The standard error of the difference of the two estimates is

approximately the square root of the sum of the squares of the

standard error of each of the estimates. Thus, if SE(~,)js the

standard error of xl, and SE(%Z)is the standard error of Xz,the

standard error of the difference (xl –~J is

SE(Z –%2) = SE2(~l) + SEZ(X)

(This formula will represent the actual standard error for the

difference between separate and uncorrelated characteristics,

although it is only a rough approximation in most other cases.

The number of replicates (18) used in the balanced repeatedreplication technique can be used to approximate the number of

degrees of freedom when testing hypotheses about differences

between estimated statistics. )_The null hypothesis is rejected

(that is, the two means xl andX, are different) if the probability

of a type I error is less than 5 percent; that is, if

>2.09

NOTE A list of references follows the text.

41
60

50

40

30

20

lCJ

8

7

6

5

4

3

2

0.;

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

-1

u

I 1=

I I I

Ill I 1 I I I I I I 11111[1 I

I I I I I I I

II

I I I I ( I I I I 1 1111(111 \

1 [ 1 1 1 1 1 I 1 I 1

I I I I I 1 I lllllq+!H!

t

I 1 1 1 1 I [ I 1 111111111

1 [ 1 # 1 1 I ,

I I I I 11111111111111 I I I I 11! 11111

EHB

El= I

I , !

I 1 I I I 1111 [1111 I I I I I ~ I 1111~

,

, ,

1 1 1 I 1 1 I 1 I 1 1 WtttH 1 I 1 1 1 1 1 ! 1 11111111 I I I

2 3 456789A 2 3 456789A 2 3 456789A 2 3 456789A

1,000 10,000 100,000 1,000,000 10,000,000

Size of estimete

60

50

40

30

20

10

9

8

7

6

5

4

3

2

;.9

0.8

:::

0.5

0.4

0.3

0.2

0.1

Figure 1. Reletive standard arrors for astimated numbers of current nursing home residents: United States, 1985
Appendix II

Definitions of certain terms

used in this report

Terms relating to residents

Resident—A person on the roster of the nursing home as of

the night before the survey. Included are all residents for whom

beds are maintained, even though they may be away on overnight leave or in a hospital.

Charges and primary sources of payment

Charge—The total amount charged to the resident by

the facility in the last completed calendar month prior to the

survey.

Primary source of payment at admission—The one

payment source that paid the greatest amount of the

resident’s charge in the calendar month of admission.

Own income orfamily support—Includes health

insurance, retirement funds, and social security.

Medicare—Money received under the Medicare

program.

Medicaid-skilled—Money received under the

Medicaid program for skilled nursing care.

Medicaid-intermediate—Money received under

the Medicaid program for intermediate nursing care.

Other government assistance or welfareSources of government aid (Federal, State, or locai)

other than Medicare or Medicaid.

All other sources—Includes religious organizations, foundations, volunteer agencies, Veterans Administration contracts, initial payment arrangements,

life care arrangements, miscellaneous sources, and nocharge arrangements.

Current primary source of payment—The one payment source that paid the greatest amount of the resident’s

charge in the last completed calendar month prior to the

survey. (See Primary source ofpaynent at admission for

definitions of payment sources.)

Length ofstay since current admission—The period of stay

from the date of the resident’s most recent admission to the

facility to the date of the survey interview.

Demographic items

Age—The age of the resident on the day the survey was

conducted, calculated from date of birth.

Race—The racial background of the resident as reported by the nursing home staff respondent.

Hispanic origin—Hispanic refers to a person of Mexican. Puerto Rican, Cuban, Central or South American, or

other Spanish culture or origin, regardless of race. as

reported by the nursing home staff respondent.

Current marital status—Marital status of the resident at the

time of the survey.

Health status

Activities of daily li]’ing—The six everyday activities

(bathing, continence, dressing, eating, transferring, and

using toilet room) for which the nursing home staff respondent reported the resident’s current performance in terms

of need for the help of special equipment or another person.

Number of dependencies in activities of daily living-The

number of dependencies in activities of daily living, based on

the work of Dr. Sidney Katz (28,51), is a measure that summarizes the level of dependency in performing the six activities of

daily living.

The following criteria are used in classifying a resident as

dependent:

Bathing—Requires assistance.

Dressing—Requires assistance or does not dress.

Using toilet room—Requires assistance or does not

use toilet room.

Transferring—Requires assistance in getting into or

out of a chair or bed.

Continence—Has difficulty controlling bowels,

bladder, or both or has an ostomy.

Eating—Requires assistance; includes tube or intravenous feeding.

Diagnoses—One or more diseases or injuries (or some

factor that influences health status and contact with health

services that is not itself a current illness or injury) listed by the

attending physician on the medical record of patients. Diagnoses were recorded for two time periods: at admission and at

time of survey. All diagnoses for sample residents were transcribed in the order listed. Each sample resident was assigned

a maximum of eight 5-digit codes according to thelnternational

Classification of Diseases, 9th Re>*ision,Clinical Modification

(ICD-9-CM) (19).

A diagnostic chapter within ICD-9-CM is primarily an 6

arrangement of diseases according to their principal anatomic

site, with special chapters for infectious and parasitic diseases;

neoplasms; endocrine, nutritional, and metabolic diseases;

mental disorders; complications of pregnancy and childbirth;

certain diseases peculiar to the perinatal period; and ill-defined

conditions. In addition, two supplemental classifications are

provided: (a) factors influencing health status and contact with

health services and (b) external causes of injury and poisoning.

All-1isted diagnoses—All-listed diagnoses are all diagnoses, up to a maximum of eight, listed from the medical

43
record of each sample resident (see item 14 of the Current

Resident Questionnaire).

Current mental disorders—Current mental disorders

include mental problems of the resident selected by the

nursing home staff respondent from a list of 10 mental

conditions or disorders (see item 15 of the Current Resident

Questionnaire). The respondent based the selection upon

knowledge of the resident’s mental health and a check of

the resident’s medical record. More than one mental condition or disorder could have been reported.

Disturbance of mood—Depression, anxiety. fearfulness, or worry of such degree that the resident is distressed

or restricted in functioning nearly every day (see item 35 of

the Current Resident Questionnaire).

All-listed diagnoses, current mental disorders, and disturbance

of mood were used in combination to identify residents with

mental disorders (table IV).

Table IV. ICD-9-CM and checklist codes for items in the Current Resident

Questionnaire used to identify the mentally ill in nursing homes by resident

mental condition: United States, 1985

Question 74 Question 15 Question 35

Condition ICO-9-CM code Check/ist code

Mental retardation. 317–319 or 01

Alcohol or drug abuse. 219-292, or 02,

303–305 03

Organic brain syndrome 290,310, 04

331.0,797

Depressive disorders 304,311, or 05

300.4

Schizophrenic and

other psychosis. 293–299, or 06,07

Anxiety disorders . . . . . . 300.7,300.9,

300.00

30010 or 06

300.11 .,

300,20

300.81

Other mental disorders 301 ,306–309,

312–315,780.52

Total . . . . . . . . . . . . . . . . . . . Ifanyof theabove

.,.

and 01

,..

,..

and 02

NOTE ICD-9-CM Is the Jntemat/onal C/assMcat)on of Dwaases, 9th Revmon, C/mma/

Modification,Third Edition

Terms relating to residents with next of kin

Next o~kin—Relatives, guardians, or anyone familiar with

the sample resident and identified by the nursing home staff as

the best potential respondent from the resident’s medical records.

Usual living quarters—The place where the resident or

discharge lived most of the time during the 3 months prior to

admission to the sample nursing home. This information was

reported by the next of kin.

Another nursing home—Includes domiciliary or personal care facilities, intermediate care facilities, and skilled

nursing facilities.

Other healthfacility—Includes chronic disease, rehabilitation, geriatric and other long-term care hospitals, and

facilities for the mentally retarded.

Private or semiprivate residence—Includes houses or

apartments, rented rooms, boarding houses, and retirement

homes.

Usual living arrangements—Refers to both the number of

persons who usually resided with the sample resident or discharge and their relationship during the 3 months prior to

nursing home admission. This information applies only to

residents and discharges who usually lived in private or semip~ivate residences before admission. Persons living in group

quarters (retirement home, boarding house, rooming house, or

rented room) are separately identified, as well as persons living

in institutional quarters.

Main medical reason for admission—The one medical

condition or disease reported by the next of kin as causing the

resident or discharge to be admitted to the sample facility.

General reasons for admission—Includes six circumstances that the next of kin could have reported as influencing

the resident’s or discharge’s nursing home admission. More

than one reason could have been reported. The six reasons are

as follows: recuperation from surgery or”illness, no one at home

to provide care, not enough money to purchase nursing care at

home, requiring more care than household members can give,

problems in doing everyday activities (such as bathing, dressing, eating, walking, getting in and out of a chair or bed, or

controlling urination or bowel movements), or a spouse’s having entered a nursing home.

Terms relating to facilities

Nursing homes—Facilities with three or more beds that

provide to adults who require it either nursing care or personal

care (such as help with bathing, correspondence, walking,

eating, using the toilet, or dressing) and/or supervision over

such activities as money management, ambulation, and shopping. Facilities providing care solely to the mentally retarded

and mentally ill are excluded. A nursing home may be either

free standing or a distinct unit of a larger facility.

Bed—One that is setup and staffed for use, whether or not

it was in use by a resident at the time of the survey. Not included

are beds used by staff or owners or beds used exclusively for

emergency purposes, for day care only, or for night care only.

Licensed bed—One that is licensed by the health department or other responsible agency.

Certified bed—One that is certified as “skilled” under

the Medicare program, the Medicaid program, or both or as

“intermediate” under the Medicaid program. (See definition under Certification for details.)

Certification-Facility certification by Medicare andlor

Medicaid.

Medicare—The medical assistance provided in title

XVIII of the Social Security Act. Medicare is a health

insurance program administered by the Social Security

Administration for persons aged 65 years and over and for

disabled persons who are eligible for benefits.

Medicaid—The medical assistance provided in title

XIX of the Social Security Act. Medicaid is a Stateadministered program for the medically indigent.

44
Skilled nursing facility-One certified as a skilled

nursing facility under Medicare, under Medicaid, or under

both programs.

Intermediate care facility-One certified as an intermediate care facility under Medicaid.

Not cert~ied—Not certified as a provider of care by

either Medicare or Medicaid.

Ownership—The type of organization that controls and

operates the nursing home.

Proprietary facility-One operated under private

commercial ownership.

Voluntary nonprofit facility-One operated under

voluntary or nonprofit auspices, including church-related

facilities.

Government facility-One operated under Federal,

State, or local government auspices.

Location

Geographic region—Facilities are classified by geographic area by grouping the conterrninous States into

regions. These regions correspond to those used by the U.S.

Bureau of the Census.

Region

Northeast . . . . . . . .

Midwest . . . . . . . . .

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

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

States included

Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York,

New Jersey, Pennsylvania

Michigan, Ohio, Indiana, Illinois, Wisconsin,

Minnesota, lowa, Missouri, North Dakota, South

Dakota, Kansas, Nebraska

Delaware, Maryland, District of Columbia, Virginia, West Virginia, North Carolina, South

Carolina, Georgia, Florida, Kentucky, Texas,

Tennessee, Alabama, Mississippi, Arkansas,

Louisiana, Oklahoma

Montana, Idaho, Wyoming, Colorado, New

Mexico, Arizona, Utah, Nevada, Washington,

Oregon, California (Alaska and Hawaii are excluded)

Standard Federal Administratit’e Re,qiuti—Facilities are classified by Standard Federal Administrative Region by grouping the conterrninous States into

10 regions. These regions correspond to those used

throughout the Federal Government:

Region] . . . . . . . .

Region al . . . . . . . . .

Region Ill . . . . . . .

Region IV . . . . . . . .

Region V . . . . . . . . .

Region VI . . . . . . . .

Region V1l . . . . . . . .

Region Vlll . . . . . . .

Region IX . . . . . . . .

Region X . . . . . . . . .

States included

Connecticut, Maine, Massachusetts, New

Hampshire, Rhode Island, Vermont

New York, New Jersey (Puerto Rico and Virgin

Ielands are excluded.)

Delaware, Maryland, Pennsylvania, Virginia,

West Virginia, District of Columbia

Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee

Illinois, Indiana, Michigan, Minnesota, Ohio,

Wisconsin

Arkansas, Louisiana, New Mexico, Oklahoma,

Texas

lowa, Kansas, Missouri, Nebraska

Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming

Arizona, California, Nevada (Hawaii, Guam, Trust

Territory of Pacific Islands, and American Samoa are excluded.)

Idaho, Oregon, Washington (Alaskeisexcluded)

45
Appendix Ill

Selected instruments used in the 1985

National Nursing Home Survey

PAmuEw*wTHAwt+lMAN~

JBIEtuEuTnaEavscE sh6a _ Of_aslssE OMB No. 0S37-0115

tititinsdm~

APPROVAL EXPIRES 12/31/B6

msN6uod*mms9uwv

CURRENT RESIDENT SAMPLING LIST - ~.——

Confidential Issformation

Information containedon this form which would permit identifmtion of any individual or establishment has been collected with

a guarantes that it witl be held in swictConf-, will Lx used only for pwposes stated for this study, and will not be disclosed

or rekased to others without the consent of the individualor the establishmentitsaoxsrdastcewith Section 366(d)of the Public Health

ServiceAct (42 USC M2m).

A. Type of identifm used I ❑ Name 2 a other, specify

B. Current Residents: Facility Total C. Total in sample

D. interviewer Name E. Interviewer ID

Lst the residents consecutivelyin the order in which they are given to you. Enter the total listed in Item B above. Compare the

total with Tabk 2 to determine the sampk. Ctrck the line numbers of allsampledresidents.Count the number circledand enter

it in Item C above.

MWDENTS M NURSINGHOME RESIDENTSIN NURSING HOME —

NE LINE

10. RaaidantIdantwr No. Ra@tknt ldantifi6r

)1 26

)2 27

)3 28

)4 29

)5 30

)6 31

)7 32

)8 33

>9 34

10 35

11 36

12 37

13 38

14 39

15 40

16 41

17 42

18 43

19 44

20 45

21

—.

46

22

——

47

23 48

24 49

25 50

1S6271 tfmom Sns8MSnsodd CONTWWEONT14EBACS

01KS

46
I CURRENT RESIDENT SAMPLING LIST-CONTINUED

RESIDENTS IN NURSING HOME

LINE ~

NO. \

Remidant Idetimr

51

52

53 I

54

55

56

63 I I

e4

ti5

?6

67

68

69

70

71 I

72

75

I

RESIDENTS IN NURSING HOME

Resident Identii

80 I

81 —

1871

88

89

80

Q1

94

95

96

97

98

Ifmkranfndodueamw - & Mnumlmrdm khlabqbming

wlml#lol. ~Mlam~ m, 201, 301, m.

47
DEPARTMENT OF HEALTH AND HUMAN SERVICES

PUBLtC HEALTH SERVICE

National Center for Heatth Statistics

1985 National Nursing Home Survey k

CONTROL NO.

CURRENT RESIDENT QUESTIONNAIRE

CONFIDENTIAL INFORMATION

Information contained on this form which would permit identificationof any indiwduat or estabttshment has been collected with

a guarantee that it will be held in strict confidence, will be used only for purposes stated for this study, and will not be disclosed

or released to others without the consent of the individual or the establishment in accordance with Section 308(d) of the Public

Health Service Act (42 USC 242m).

A. Interviewer Name B. Interviewer I.D. C. Date of Interview

/ /

ENTER HERE /&D ON F%LDOU;*SHEE1

D. Resident Line No. E. Respondent Thle

F, Name of Resident

Fusl Initial Last

1. What is the sex of this resident?

01 ❑ Male 02 ❑ Female

2. What is ‘s date of birth?

/ / or

Mo. t3ay Year Age

f 1

] SHOW FLASHCARD # 1 I

3a. What is the racial background that best describes ?

01 ❑ White

02 I_J Black

03 ❑ American Indian or Alaska Native

04 ❑ Asian or Pacific Islander

94 ❑ Don’t know

48
3b. [S Hispanic or not?

01 ~ Hispanic

02 ❑ Not Hispanic

94 H Don’t hnow

4a. What was _’s marital status at admission?

01 ❑ Married 04 ❑ Separated

02 ❑ Widowed 05 ❑ Never Married

03 •l Divorced 94 ❑ Don’t know

b. What is ‘s marital status now?

01 D Married 04 ❑ Separated

02 m Widowed 05 ❑ Never Married

03 ❑ Divorced 94 ❑ Don’t know

INTERVIEWER: READ INTRODUCTORY PARAGRAPH FOR THE SOCIAL SECURITY NUMBER

ONLY ONCE FOR EACH NEW RESPONDENT.

5. As part of this survey, we would like to have ‘s Social Security Number. Pro\ ision

of this number is voluntary and not providing the number will have no effect in any way on

‘s benefits. This number will be useful in conducting future follow-up studies. It

will be used to match against the vital statistics records maintained by the National Center for Health

Statistics. This information is collected under the authority of Section 306 of the Public Health Service

Act.

What is ‘s Social Security Number?

Social Security #

6. Does have any living children?

01 •1 Yes 02 ❑ No 94 ❑ Don’t know

. .

7. What was the date of ‘s current admission to this facility?

/ /

Mo. Oay Year

INTERVIEWER: ENTER ADMISSION DATE ON FOLDOUT SHEET THEN ASK Q. 8.

SHOW FLASHCARD # 2

1

8a. Where was staying immediately before entering this facility?

01 ❑ Private residence (house or apartment)

02 ❑ Rented room, boarding house

03 ❑ Retirement home

04 ❑ Another health (including mental health) facility (SKIP TO Q. 8c)

05 ❑ Other arrangement, (SPECIFY) (SKIP TO Q. 10)

94 ❑ Don’t know (SKIP TO Q. 10)

49
8b. At that time, was living with family members, non-family members, or alone?

01 ❑ With family members

02 ❑ With non-family members —

03 U Alone

94 ❑ Don’t know

~

8c. What type of facility was it?

I SKIP TO Q. 10 I

01

02

03

04

05

06

07

08

09

10

11

12

13

94

•1

❑

•1

•1

•1

❑

•1

•1

•1

•1

•1

•1

•1

•1

Domiciliary or personal care facility

Intermediate Care Facility (ICF)

Skilled Nursing Facility (SNF)

Facility for mentally retarded

General or short term hospital, except psychiatric unit

General or short-term hospital psychiatric unit

Veteran’s hospital

Mental health Center

Residential facility (group home, cooperative apartment, family/foster care home)

State mental hospital

Private mental hospital

Chronic disease, rehabilitation, geriatric or other long-term care hospital

Other, (SPECIFY)

Don’t know

I

SHOW FLASHCARD # 4

I

8d. Where was staying immediately before entering that facility?

01

02

03

04

05

06

07

94

❑

•1

•1

•1

•1

•1

•1

•1

Private residence (house or apartment)

Rented room, boarding house

Retirement home

This facility (SKIP TO INTERVIEWER NOTE ABOVE Q. 9)

Another nursing home (SKIP TO INTERVIEWER NOTE ABOVE Q. 9)

Another health (including mental health) facility (SKIP TO INTERVIEWER NOTE ABOVE

Q. 9)

Other arrangement, (SPECIFY) (SKIP TO INTERVIEWER

NOTE ABOVE Q. 9)

Don’t know

(SKIP TO INTERVIEWER NOTE ABOVE Q. 9)

50
8e. At that time was he/she living with family members, non-family members, or alone?

01 ❑ With family members

02 ❑ Whh non-family members

03 •l Alone

94 ❑ Don’t know

INTERVIEWER NOTE: BEFORE PROCEEDING, REFER TO Q. &. IS CATEGORY 05 CHECKED?

❑ YES (CONTINUE WITH Q. 9) NO (SKIP TO Q. 10)

You reported that was staying in a hospital before entering this facility.

9a. Do you know what ‘s hospital diagnosis related group (DRG) category was

while was in the hospital?

01 •l Yes 02 ❑ No (SKIP TO Q. 9c)

9b. What was ‘s DRG category?

DRG CATEGORY

DRG Number OIlty

SKIP TO Q. 9h I

9c. What condition, or diagnosis was chiefly responsible for ‘s admission to the

hospital for care? FOR OFFICE USE ONLY

Principal diagnosis DIAGNOSIS CODE

9d. Were there any other conditions that existed at the time of ‘s admission to

the hospital or that developed during the stay which affected the treatment received?

01 ❑ Yes 02 ❑ NO (SKIP TO Q. 9~ 94 ❑ Don’t know (SKIP TO Q. 9f)

9e. What were those conditions?

FOR OFFICE USE ONLY

CONDITION

1.

2.

3.

9f. Were any diagnostic or surgical procedures performed at the hospital?

01 ❑ YEs 02 ❑ NO (SKIP TO Q. 9h) 94 ❑ Don’t know (SKIP TO Q. 9h)

FOR OFFICE USE ONLY

9g. What were the procedures? PROCEDURE

1.

2.

3.

9h. How many nights did spend in the hospital during that stay?

Number of nights 94 ❑ Don’t know

51
10a. Has been admitted to a short-stay hospital while a resident in this facility?

That is. since (DATE OF ADMISSION) and without being

formally disch~ged from thisfacility.

01 ❑ Yes

02 ❑ No (SKIP TO Q. 11)

94 ❑ Don’t know (SKIP TO Q. 11)

10b.

10C.

led.

lee.

IOf.

log.

IOh.

10i.

10j.

How many stays did have in short-stay hospitals since (DATE OF

ADMISSION) and without being formally discharged from this facility?

Number of stays

DO you know what ‘s hospital diagnosis related group (DRG) category was

while in the hospital for the most recent stay?

01 ❑ Yes 02 ❑ NO (SKIP TO Q. lee)

What was ‘s DRG catego~ for that stay?

DRG category

DRG Number Only

SKIP TO Q. IOj

What condition or diagnosis was chiefly responsible for ‘s admission to the

hospital for care for the most recent stay? FOR OFFICE USE ONLY

Principal diagnosis DIAGNOSIS CODE

Were there any other conditions that existed at the time of ‘s admission to

the hospital or that developed during the stay which affected the treatment received?

01 I--J Yes 02 ❑ No (SKIP TO Q. 10h) 94 ❑ Don’t know (SKIP TO Q. IfOh)

What were those conditions? FOR OFFICE USE ONJLY

CONDITION —

2.

3.

Were any diagnostic or surgical procedures performed at the hospital?

01 ❑ Yes 02 ❑ No (SKIP TO Q. 10j) 94 ❑ Don’t know (SKIP TO Q. IOj)

What were the procedures? FOR OFFICE USE ONLY

PROCEDURE

1.

2.

3.

How many nights did spend in the hospital during that stay?

Number of nights 94 ❑ Don’t know

52
la. Has previously been a resident in this facility?

01 •l Yes 02 ❑ No (SKIP TO Q. 1ld) 94 ❑ Don’t know (SKIP TO Q. 1ld)

lb. How many times has been a resident in this facility, not counting the (DATE

OF ADMISSION) admission?

Trees in facility

11C(1). On what dates was 11c(2). Was this discharge to a short-stay or

admitted to and discharged from this facility? general hospital?

1.

2.

3.

4.

5.

6.

7.

8.

lld. Was

Admitted

mo./day/yr.

Discharged

mo./day/yr.

~_/— 01

Yes

•1

•1

❑

•1

•1

•1

•1

•1

No

02 •1

02 •1

02 •1

02 •1

02 ❑

02 ❑

02 •1

02 ❑

ever in anv other nursiruz homes beside this one?

Don’t know

94U

940

940

940

940

94n

940

940

——- -———.—.

01 •l Yes 02 ❑ No (SKIP TO Q. 12) 94 ❑ Don’t know (SKIP TO Q. 12)

Ile. Not counting this facility, in how many different n~sing homes h= resided?

Number of different homes 94 ❑ Don’t know

I If. Altogether, what was the total length of time that spent in all those other nursing homes?

Do not include time spent in this facility.

—

94 ❑ Don’t know

Years Months

11 g. What is the name of each of the other nursing homes at which was a resident

or patient?

Facility

(1)

(2)

(3)

1lh. How many times was a resident in (NAME OF FACILITY IN Q. 1lg(l))?

Times in facility

53
hi.

1lj.

Ilk.

111.

Ilm.

On what dates was admitted and discharged from (NAME OF FACILITY IN Q. 1lg(l))?

Admitted Discharged

Month Year Month Year

1. / / —.

2. / /

3. ~ /

How many times was a resident

Times in facility

in (NAME OF FACILITY IN Q.

On what dates was admitted and discharged from (NAME OF FACILITY IN Q.

Admitted Discharged

Month Year Month Year

1. / /

2. / /

3. / /

11.g(2))?

lg(2))?

How many times was a resident in (NAME OF FACILITY IN Q. I lg(3))?

Times in facility

On what dates was admitted and discharged from (NAME OF FACILITY IN Q. 1lg(3))?

Admitted Discharged

Month Year Month Year

1. /

2. / /

3. / /

12. In order to follow-up on ‘s complete history of nursing home utilization,wewould

like to have any information you have that will allow us to locate ‘s next of kin.

Please give me the names, addresses and telephone numbers of ‘s next of kin as

well as any other relatives, friends or anyone else who might know about

INTERVIEWER: FILL IN AS MANY NAMES AND ADDRESSES AS AVAILABLE. PRINT ALL ENTRIES. ASK RESPONDENT TO INDICATE WHICH CONTACT IS THE “BEST CONTACT” AND

PLACE AN ASTERISK ON THE LINE NEXT TO THAT NAME.

12a. Next of kin:

❑ NO next of kin on record

Name (13rst, Initial, Last)

Street

City and State

Zip Code

Telephone number ( ) —

Relationship to resident

54
12b. Kin/Friend/Other:

Name (First, Initial, Last)

Street

City and State

Zip Code

Telephone number()—

Relationship to resident

12c. Kin/Friend/Other:

Name (First, Initial, Last)

Street

City and State

Zip Code

Telephone number()—

Relationship to resident

12d. Kin/Friend/Other:

Name (Fhst, Initial, Last)

Street

City and State

—

Zip Code

Telephone number()—

Relationship to resident

12e. Kin/Friend/other:

Name (First, Initial, Last)

Street

City and State

Zip Code

Telephone numtxr()—

Relationship to resident

12f. Kin/Friend/Other:

Name (First, Initial, Last)

Street

City and State

Zip Code

Telephone number()—

Relationship to resident

55
13. According to ‘s medical record, what were the primary and other diagnoses at the

time of admission, that is, on (DATE OF ADMISSION)? (SPECHW).

FOR OFFICE USE ONLY

ICD9 E or V CODE

Primary: 1.

Other: 2.

3.

4. 1

5.

6.

14. According to ‘s medical record, what are ‘s current

primary and other diagnoses? (SPECIFY)

FOR OFFICE USE ONLY

ICD9 E or V CODE

Primary: 1.

Other: 2.

3.

4.

5.

6.

. I

1. I

8.

I SHOW FLASHCARD # 5 ]

1 !

15. According to ‘s medical record does he/she currently have any of the following

conditions? (MARK (X) ALL THAT APPLY)

01

02

03

04

05

06

07

08

09

10

11

•1

•1

❑

•1

❑

•1

•1

•1

•1

•1

•1

Mental retardation

Alcohol abuse/dependence

Drug abuse/dependence

Senile dementitichronic and organic brain

Depressive disorders

Schizophrenia

Other psychoses

Anxiety disorders

PersonaMy/character d~orders

Other mental disorders (SPECIIW) _

No mental disorder

syndrome
5a. During (LAST MONTH), did receive any therapy services either inside or outside

this facility from a licensed, registered, or professionally trained therapist?

01 •l Yes 2 ❑ No (SKIP TO Q. 17) 94 ❑ Don’t know (SKIP TO Q. 17)

SHOW FLASHCARD # 6

5b. Which types of therapy did receive during (LAST MONTH)? (MARK (X) ALL THAT APPLY]

01 ❑ Physical therapy

02 ❑ Occupational therapy

03 ❑ Recreational therapy

04 ❑ Speech and hearing therapy

05 ❑ Evaluation or mental health treatment by a physician other than a psychiatrist

06 ❑ Evaluation or mental health treatment by a psychiatrist

07 ❑ Evrduation or mental health treatment by a psychologist

08 ❑ Evaluation or mental health treatment by a psychiatriciclinical social worker

09 ❑ Evaluation or mental health treatment by a psychiatric nurse

10 ❑ Social servicesby a swial worker

-11 ❑ Other therapy services(SPECIFY)

7a. Does wear eyeglassesor contacts? 01❑ Yes 02 ❑ No

lb. Does have any difficulty in seeing (when wearing glasses or contacts)?

01 •l Yes 02 ❑ No (SKIP TO Q. 18) 94 ❑ Don’t know (SKIP TO Q. 18)

SHOW FLASHCARD # 7

7C. Is ‘s sight (with glasses or contacts) partially, severely, or completely impaired, as

defined on this card?

01 ❑ Partially impaired-cannot read newspaper print but can watch television 8 to 12 feet away

02 ❑ severely impaired-cannot watch TV 8 to 12 feet away, but can recognize features of familiar persons

if they are within 2-3 feet

03 0 Completely lost-blind

94 ❑ Don’t know

8a. Does wear a hearing aid? 01 •l Yes 02 ❑ No

8b. DLXS have any difficulty in hetig (when wearing a hearing aid)?

01 •l Yes 02 ❑ No (SKIP TO Q. 19) 94 ❑ Don’t know (SKIP TO Q. 19)

57
SHOW FLASHCARD # 8

18c. h ‘s hearing (with hearing aid) partially, severely, or completely impaired as defined on this card?

01 •1

02 •1

03 •1

94 •1

Partially impaired-can hear most of the things a person says

Severely impaired-can hear only a few words a person says or loud noises

Completely lostdeaf

Don’t know

19a. Does currently require any assistance in bathing or showering?

01 •l Yes 02 ❑ No (SKIP TO Q. 20) 94 ❑ Don’t know (SKIP TO Q. 20)

19b, Does bath or shower with the hehI OE

(1) Special equipment? 01 •l Yes 02 ❑ No

(2) Another person? 01 IJ Yes 02 ❑ No

20a. Does currently require any assistance in dressing?

01 •l Yes

02 ❑ No (SKIP TO Q. 21)

03 ❑ Remains partially or completely undressed or is dressed by another and does not participate (SKIP TO

Q. 21)

94 ❑ Don’t know (SKIP TO Q. 21)

20b. Does dress with the help ofi

(1) Special equipment? 01 •l Yes 02 ❑ No

(2) Another person? 01 •1 Yes 02 ❑ No

21a. Does currently require any assistance in eating?

01 •l Yes

02 ❑ No (SKIP TO Q. 22)

03 @ Requires tube or intravenous feeding (SKIP TO Q. 22)

94 ❑ Don’t know (SKIP TO Q. 22).

21b. DOeS eat with the help of

(1) Special equipment? 01 •l Yes 02 ❑ No

(2) Another person? 01 •1 Yes 02 ❑ No

21C. Is fed totally by another person? 01 •l Yes 02 ❑ No

22a. Is bedfast?

01 ❑ Yes (SKIP TO Q. 23) 02 ❑ No

22b. k chairfast?

01 •l Yes 02 ❑ No

58
23a. Does currently require any — assistance transfen-ing in and out of bed or chairs?

01 El Yes

02 ❑ No (SKIP TO Q. 24)

94 ❑ Don’t know (SKIP TO Q. 24)

23b. Does require the help ofi

(1) Special equipment? 01 •1 Yes 02 a No

(2) Another person? 01 •1 Yes 02 ❑ No

IF YES TO EITHER Q. 23b(l) OR 23Q2), SKIP TO Q. 25

24a. Does currently require any assistance in walking?

01 •1 Yes 02 ❑ No (SKIP TO Q. 25) ‘% ❑ Don’t know (SKIP TO Q. 25)

24b. Does walk with the help OR

(1) Special equipment? 01 •1 Yes 02 ❑ No

(2) Another person? 01 El Yes 02 ❑ No

25a. Does go outside the grounds of this facility?

01 •1 Yes 02 ❑ No (SKIP TO Q. 26) 94 ❑ Don’t know (SKIP TO Q. 26)

25b. When goes outside the grounds, does require the help ofi

(1) Special equipment 01 ❑ Yes 02 ❑ No

(2) Another person? 01 •1 Yes 02 ❑ No

26a.

26b,

26c.

26d.

Does have an ostomy, an indwelling catheter or similar device?

01 El Yes 02 ❑ No (SKIP TO Q. 26c)

require any — assistance from another person in caring for this device?

01 ❑ Yes 02 ❑ No

Does currently require any assistance using the toilet room? — —

01 L1

02 ❑

03 cl

940

Does _

Yes

No (SKIP TO Q. 27)

Does not use toilet room (ostomy patient, chairfast, etc.) (SKIP TO Q. 27)

Don’t know (SKIP TO Q. 27)

require the help ofi

(1) Special equipment? 01 •1 Yes 02 ❑ No

(2) Another person? 01 •l Yes 02 ❑ No

59
27a. Does currently have any difficulty in controlling bowels?

01 •l Yes

02 ❑ No (SKIP TO Q. 28)

03 ❑ Not applicable, has had an ostomy (SKIP TP Q. 28)

94 ❑ Don’t know (SKIP TO Q. 28)

!7b. How frequently does have this difficulty?

01 ❑ Daily

02 ❑ Several times a week

03 ~❑ Once a week

04 ❑ Less than once a week

w El Don’t know

28a. Does currently have any difficulty in controlling bladder?

01 •l Yes

02 ❑ No (SKIP TO Q. 29)

03 ❑ Not applicable has indwelling catheter, ostomy, or external device (SKIP TO Q, 29)

94 ❑ Don’t know (SKIP TO Q. 29)

28b. How frequently does have this difficulty?

01 ❑ Daily

02 ❑ Several times a week

03 ❑ Once a week

04 ❑ Less than once a week

94 ❑ Don’t know

28c. Does this occur only at night?

01 •l Yes 02 ❑ No 94 ❑ Don’t know

29. Does receive personal help or supervision in any of the following activities:

Yes No Don’t know

a. Care of personaI possessions? 01 •1 02 ❑ 940

b. Handling money? 01 •1 02 •1 940

c. Securing personal items such as newspapers,

toilet articles, snack foods? 01 •1 02 •1 940

d, Using the telephone? (dialing or receiving calls) 01 •1 02 IJ 94 ❑
30. How long have you provided care for ?

01 ❑ less than 1 month

02 ❑ 1-3 months

03 ❑ 4% months

04 ❑ 7-11 months

05 ❑ 12 months or more

(M ❑ Respondent does not provide care

31. How would you rate ‘s physical health at the present time?

01 ❑ Excellent

02 ❑ Good

03 ❑ Fair

04 •l Poor

94 ❑ Don’t know

32. How would you rate ‘s mental health at the present time?

01 •l Excellent

02 ❑ Good

03 ❑ Fair

04 ❑ Poor

94 ❑ Don’t know

[

SHOW FLASHCARD # 9

33. The types of behaviors on this card are generally considered dependent or disruptive. Does

display any of these types of behavior problems? Assess ‘s behavior with

medications if customarily taken. (MARK (X) ALL THAT APPLY).

01 ❑ Disrobing/exposing oneself

02 •l Screaming

03 ❑ Being physically abusive to self or others

04 •l Stealing

05 ❑ Getting lost or wandering into unacceptable piaces

06 H Inability to avoid simple dangers

07 ❑ None of the above

SHOW FLASHCARD #10

34. Is disorientedor memory impaired in the followingactivitiesto such a degreethat

isimpairednearlyevery&yin performingthe basicactivitiesof dailyliving,mobtity, and adaptive tasks? (MARK (X) ALL THAT APPLY)

01 ❑ Unable to remember dates or time

02 ❑ Unable to identify familiar locations or people

03 ❑ Unable to recall important aspects of recent events

04 ❑ Unable to make straight forward judgments

05 ❑ None of the above

61
SHOW FLASHCARD # 11

35. Does display depression, anxiety, fearfulness or worry tosuch a degree that

is distressed or restricted in functiotig nearly every day? (MARK (X) ALL THAT

APPLY)

01 ❑ Displays depression

02 ❑ Displays amiety

03 ❑ Displays fearfulness or worw

04 ❑ None of the above

INTERVIEWER, READ: The remaining few questions deal with charges and payment sources. Do

you have this information?

01 •l Yes 02 •1 F-do (DETERMINE WHO HAS INFORMATION AND WHEN

YOU HAVE COMPLETED ALL THE RESIDENT QUESTIONNAIRES, INTERVIEW TH~PERSON FOR THE INFORMATION, USING PROMPT CARD # 11.)

INTERVIEWER NOTE: BEFORE PROCEEDING, REFER TO THE ADMISSION DATE ON THE

FOLDOUT SHEET. WAS THE RESIDENT ADMITTED AFTER THE FIRST DAY OF LAST MONTH?

01 ❑ YES (SKIP TO Q. 39) 02 ❑ NO (CONTINUE WITH Q. 36)

SHOW FLASHCARD # 12

36. What were ~ the sources of payment for ‘s care for the month of (MONTH AND

YEAR OF ADMISSION)? That is, for the month when was admitted to this

facility. (MARK (X) ALL THAT APPLY)

01 ❑ Own income, family support, heakh insurance, retirement funds, Social Security, etc.

02 ❑ Medicare

03 ❑ Medicaid — skilled nursing

04 ❑ Medicaid — intermediate care

05 ❑ State funded indigent rzwe (e:fch.ding Medicaid)

06 •l Other government asssistrmcem welfare

07 •l Religious organizations, fm.mc!ations, volunteer agencies

08 ❑ VA contract

09 ❑ Initial payment-life cme funds

10 ❑ No charge made for care (facility assumes cost)

11 ❑ Payment source not yet determined

12 ❑ CXher, (SPECIFY)

62
] SHOW FLASHCARD # 12 I

37. What was the primary source of payment for ‘s care for the month of (MONTH

AND YEAR -MISSION)?

01

02

03

04

05

06

07

08

09

10

11

12

•1

•1

•1

•1

•1

•1

•1

❑

•1

•1

•1

•1

Own income, family support, health insurance, retirement funds, Social Security, etc.

Medicare

Medicaid — skilled nursing

Medicaid — intermediate care

State funded indigent care (excluding Medicaid)

Other government assistance or welfare

Religious organizations, foundations, volunteer agencies

VA contract

Initial payment-tife care funds

No charge made for care (facility assumes cost)

Payment source not yet determined

Other, (SPECIFY)

38. Last month, what was the total charge balledfor ‘s care, including all charges for

private duty nursing, drugs, and special medical supplies? L

$ .— per month 01 ❑ No charge was made for care

I

SKIP TO INTERVIEWER NOTE ABOVE Q. 40 I

39. From (DATE OF ADMISSION)through yesterday,what wasthe total chargebilledfor

care, including all charges for private duty nursing, drugs, and special mediczdsupplies?

01 •1

02 •1

$ ._ per 03 •1

040

05 •1

m-cl

940

Since date of admission

Day

Week

Month

Other period, (SPECIFY)

No charge was made for care

Don’t know (not billed yet, etc.)

63
INTERVIEWER NOTE: IF Q. 38 WAS ASKED (RESIDENT IN HOME ONE FULL CALENDAR

MONTH OR MORE), USE THE PHRASE “LAST MONTH” IN Q. 40. IF Q. 39 WAS ASKED,

USE THE PHRASE “DURING THIS TIME” IN Q. 40.

SHOW FLASHCARD # 12

40a. What are —all the sources of payment for b. ASK FOR EACH SOURCE NL4RKED:

‘s care (LAST What was the amount paid by _

MONTH/DURING THIS TIME)? (LAST MONTWIXJRING THIS TIME)?

(MARK (X) ALL THAT APPLY) (ENTER AMOUNT OR MARK “Don’t

know” )

Don?

know

01 •l Own income, family support,

health insurance, retirement funds, Social

Security, etc. $ . 94 l-J

02 ❑ Medicare $ . 94 (-J

03 ❑ Medicaid — skilled care $ . 94 ❑

04 ❑ Medicaid — intermediate care $ 94 ❑

05 ❑ State funded indigent care

(excluding Medicaid) s . 94 ❑

06 ❑ Other government assistance

or welfare $ . 94 ❑

07 ❑ Religious organizations, foun&-

tions, volunteer agencies $ . 94 ❑

08 ❑ VA contract $ . 94 ❑

09 ❑ Initial payment-life care funds $ . 94 ❑

10 ❑ No charge made for care (facility

assumes cost) $ . 94 ❑

11 ❑ Payment source not yet dettied

12 ❑ Other, (SPECIFY)

$ . 94 ❑

INTERVIEWER: CONTINUE TO NEXT CURRENT RESIDENT QUESTIONNAIRE

64
SUMMARY OF DATES

Date of Interview: _/ J

Mo. Day Year

Date of Admission: /~

Mo. Day Year

OVERLAP CASES

DRQ

None •1

‘~- Us. GOVERNMENT PRINTING OFFICE: 1991— 2 8 I – 7 9 8 / 2 0 0 1 -

65
Vital and Hea!th Statistics

series descriptions

SERIES 1.

SERIES 2.

SERIES 3.

SERIES 4.

SERIES 5.

SERIES 6.

SERIES 10,

SERIES 11.

SERIES 12.

SERIES 13.

SERIES 14,

Programs and Collection Procedures— Repotis descnblng

the general programs of the I’4atlonal Center for Health

Statlstlcs and ds offices and dlwsrons and the ,data col -

Iectlon methods used They also Include def(ntt[ons and

other material necessarv for understanding the date

Data Evaluation and Methods Ft&ssmrch-Studies of new

statmtlcal methodology Including e.perlmental tests of

new survey methods, studies of vital statistics ,:ollect ion

methods, new analytical techniques, ablective evaluations

of rellablllty of collected data and contr!but]ons to

statistical theory Studies also include comparison of

U.S. methodology w,lth those of other countries

Analytical and Epidemiological Studies—Reports presenting analytical or Interpretive studies based on v!tal

and health statlstlcs, carrying the analysis further than

the exposlto~, types of reports In the other series

Documcmts and Committee Reports-Final repons of

major committees concerned with vital and health statwtlcs and documents such as recommended model vital

reglstrat!on laws and revised birth and death certificates

Comparative International Vital and Health Statistics

l?eportc-Analytical and descnptwe reports comparing

U.S. vital and health statmtlcs vwth those of o!her countries

Cognition and Suwoy Mmmmromsmt- Reports from the

National Laboratory for Collaboratt,ve Research In Cognition and Survey Measurement using methods of cognttlve

science to design, evaluate, and test EUWI?Y Instruments

Data From th~ National Health Intwview Survoy— Statlst!cs on !Ilness, accidental tnjunes, dlsablllty use of hospital, medical, dental, and other serv!ces, and other

health-related topics, all based on data collected in the

continuing national household !ntervlev; sun, ev

Data From the National Health Examination Survey and

the National Health and Nutrition Examination Su~O\i—

Data from direct examtnatlon, testing, and measurement

of nat!onal samples of the cwlllan nonlnstltutl onallzed

population provide the bas!s for (1 ) est!mates of the

medically defined prevalence of speclflc diseases in the

United States and the dlstrlbut!ons of Ihe population

with respect to physical, physlolog[cal and ps+, choIogtcal characteristics and (2) analysts of relationships

among the various measurements w!th~ut reference to

an expllcn flnlte unwerse of persons.

Data From the Institutionalized Population Sutveys-Dlscontlnued In 1975. Reports from these surveys are included In Series 13.

Data on Health Rsmources Utilization—Statistics on the

utlllzatlon of health manpower and fac!lttles prov]d!ng

long-term care, ambulatory care, hospital care, and family

plannlng services,

Data on Health Resources: Manpower and Facilities—

Statmtlcs on the numbers, geographic d!str!butlon, and

characteristics of health resources Includ]ng physicians.

dentists, nurses, other health occupations, hospitals,

nursing homes, and outpatient faclllttes

SERIES 15

SERIES 16

SERIES 20

SERIES 21

SERIES 22

SERIES 23

SERIES 24

Data From Spatial Survey s-Statwtlcs on health and

health-related top[cs collected In special surveys that

are not a part of the cont(nulng data systems of the

National Center for Health StatlSt!CS.

Compilations of Advance Data From Vital and Health

Statistics—These reports provide early releaae of data

from the National Center for Health Statwtlcs’ health and

demographic surveys, Many of these releases are followed

by detailed reports tn the Vital and Health Statlst!cs

Series

Data on Mortali P:—Various statistics on mortallty other

than as Included in regular annual or monthly reports.

Spec!al anal,fses by cause of death, age, and other demographic variables, geographic and time series analyses;

and statlst!cs on characteristics of deaths not available

from the vital records based on sample surveys of those

records

Data on Natality, Marriage, and Divorce—Various statistics on natal lty, marr]age, and dworce other than as

Included In regular annual or monthly reports, Special

analyses by demographic variables; geographic and time

series analyses; studies of fertlilty; and statistics on

characteristics of births not available from the vital

records based on sample surveys of those records.

Data From the National Mortality and Natality Surveys—

Dtsconttnued In 1975, Reporfs from these sample surveys

based on v!tal records are Included In Ser!es 20 and 21,

respectively,

Data From the National Survey of Family Growth—

Stattstlcs on ferttl!ty. family formation and dissolution,

famll,; planning and related maternal and Infant health

topics derived from a perlod!c survey of a natlorwwde

probability sample of v~ornen 15-44 years of age,

Compilations of Data on Natality, Mortality, Marriage,

Divorce, and Induced Terminations of Pregnancy—

Advance reports of births, deaths, marriages, and divorces

are based on final data from the National Vital Statlstlcs

System and are publlshed annually as supplements to the

Monthly Vital Stat[strcs Repoti (MVSR). These reports are

followed by the publication of deta]led data tn Vital Statlstlcs of the Un]ted States annual volumes. Other reports

tncludlng Induced termlnattons of pregnancy Issued periodically as supplements to the MVSR prov]de selected

flndlngs based on data from the National Vital Statistics

System and may be followed by detailed reports In Vital

and Health Statlstlcs Series,

For anawers to questions about tfws reporl or for a list of titles of reports

published m these series, contact,

Scientific and Technical Information Branch

National Center for Health Statlstlcs

Centers for Disease Control

Publ[c Health Serv]ce

6525 Belcrest Road, Room 1064

Hyattsw[le, Md. 20782

301-436-8500
DEPARTMENT OF

HEALTH & HUMAN SERVICES

Publlc Health Service

Centers for Disease Control

National Center for Health Statistics

6525 Belcrest Road

Hyattswlle, Maryland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

I I

BULK RATE

POSTAGE & FEES PAID

PHS/NCHS

PERMIT NO. G-281

DHHS Publication No, (PHS) 91-1768, Series 13, No. 105