Vital and

~ Health Statistics

Nursing Home

Utilization by

Current Residents:

United States, 1985

Series 13:

Data From the National Health Survey

No, 102

This report presents utilization characteristics (rate of residency in nursing

homes, length of stay since admission, average total monthly charge, and

average number of dependencies in activities of daily living) according to

the major demographic characteristics of age, sex, race, and Hispanic

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

Home Survey, Selected trends in use of nursing homes are also examined.

US. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control

National Center for Health Statistics

Hyattsville, Md.

October 1989

DHHS Publication No. (PHS) 89-1763
Copyright information

All material appearing In this report IS In the publlc domain and may

be reproduced or copied without permission; citat[on as to source,

however, IS appreciated.

Suggested citation

Htng E. Nursing home uttllzatlon by current residents: United States,

1985. National Center for Health Statlstlcs Vital Health Stat 13(102)

1989.

Libra~ of Congress Cataloging-in-Publication Data

Htng, Esther.

Nursing home utilization by current residents, United States, 1985,

P. cm. — (Vital & health statistics. Series 13, Data from

the national health sunfey ; no. 102) (DHHS pubilcatlon no.

(PHS) 89-1 763)

Includes blbllograph~es.

ISBN 0–6406–041 8–1

1. Nursing homes—United States —Utilization —Stattstlcs.

1. Nattonal Center for Health Statisttcs(U.S,) tl. Title.

Ill. Series: Vnal and health statistics. Series 13, Data from the

national health survey ; no, 102. IV. Series: DHHS publication

no. (PHS) 89–1763.

[DNLM: 1. Nursing Homes—utilization— Untted States—statistics.

W2 AN148vm no, 102]

RA997. H563 1989

362.1 ‘6’0973021 —dc20

DNLM/DLC

for Library of Congress 69-600139

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 Director for Analysis

and Epidemiology

Gail F. Fisher, Ph. D., Associate Director for Planning and

Extramural Programs

Peter L. Huxley, Associate Director for Vital and Health

Statistics Systems

Stephen E. Nieberding, Associate Director for Management

Charles J. Rothwell, Associate Director for Data Processing

and Services

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

and Methodology

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
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Scope ofreport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I

Sources and qualifications ofdata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Trend comparison qualifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Utilization by demographic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Demographic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Length ofstay since admission.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Functional status in activities ofdaily living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Average monthly charge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Utilization by health status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Primary diagnosis attime ofsurvey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Ail-listed diagnoses at time ofsurvey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Mental status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Prior nursing home and hospital utilization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

~lvingarrangements prior to admission. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Prior nursing home use and hospitalizations while still a resident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Primary source ofpayment at admission and in month before interview.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Changes in payment source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Average monthly charge and average number ofactivities ofdaily living dependencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

List ofdetailed tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Appendixes

I. Technical notes on methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

11. Definitions ofcertain terms usedin thk repoti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

111. Selected survey instmments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

List of text figures

1. Medicare home health agency visits per 1,000 beneficiaries: United States, 1973-85 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

2. Average monthly charge for nursing home residents, by number ofdependencies in activities ofdaily living United

States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

3. Percent distribution of nursing home residents by number of diagnoses: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . 12

4. Prevalence rates per 1,000 nursing home residents for selected diagnoses at time of survey, by age and sex: United

States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

5. Average number of dependencies in activities of daily living for nursing home residents, by presence of disorientation or

memory impairment, behavioral problems, or disturbance ofmood United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . 17

6. Average number of dependencies in activities of daily living for nursing home residents, by living arrangement prior to

admission: United States, 1985. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

7. Number of residents hospitalized subsequent to admission to anursing home, by whether hospitalization wasaccompaniedby aformal discharge from the nursing home: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
List of text tables

A. Number and percent of persons 65 years and over, by whether nursing home resident or noninstitutionalized and Hispanic

origin: United States, 1977 and 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

B. Average length of stay since admission of nursing home residents, by selected characteristics: United States. 1977 and

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...’. . . . . . . . .

C. Average monthly charge and average number of dependencies in activities of daily living of nursing home residents, by

selected characteristics: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

D. Percent of nursing home residents, by selected characteristics and reason for admission as reported by next of kin: United

States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E. Average monthly charge, medical care price index, andaverage monthly charge in constant (1977) dollars: United States,

1977 and 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

F. Percent ofnursing home residents, by type ofdependency in activities ofdaily living, percent distribution bynumbcrof

dependencies, and average numberof dependencies: United States, 1977 and1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

G. Percent distribution of nursing home residents by primary diagnostic class at time of survey, according to selected characteristics: United States, 1985.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

H. Percent distribution of nursing home residents by primary diagnostic class: United States, 1969, 1973–74, 1977, and

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

J. Percent distribution of all-listed diagnoses at time of survey, according to selected characteristics of residents: United

States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

K. Prevalence rates per 100 nursing home residents for selected chronic conditions: United States, 1977 and 1985 . . . . .

L. Prevalence rates per 1,000 persons aged 65 years and over in nursing homes and in the community, for selected conditions: United States, 1983-85 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

M. Number ofnursing home residents and percent distribution by current mental disorders, accordingto presence ofbehaviorrd

problems, disorientation or memory impairment, or disturbanceof mood United States, 1985 . . . . . . . . . . . . . . . . . . . . .

N. Percent distribution ofnursing home residents and average length ofstay since admission by living arrangement priorto

admission: United States, 1977 and 1985, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

O. Average length of stay since admission of nursing home residents and percent distribution by whether admitted from a

short-stay hospital, according to prior nursing home and hospital utilization United States, 1985 . . . . . . . . . . . . . . . . . .

P. Number and percent distribution of nursing home residents by primary source of payment in month before interview,

according to primary sourceof payment at admission: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Q, Number of nursing home residents with non-Medicaid primary source of payment at admission and percent shifting to

Medicaid in month before interview, by length ofstaysince admission United States, 1985 . . . . . . . . . . . . . . . . . . . . . .

R. Average monthly charge of nursing home residents and average number of dependencies in activities of daily living, by

primary source ofpayment in month before interview: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Symbols

. . . Data not available

. . . Catego~ nonapplicable

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 roundedto

thousands

*

Figure does not meet standard of

reliability or precision (more than 30-

percent relative standard error)

4

5

6

6

7

8

10

11

13

14

14

16

18

20

22

23

23

# Figure suppressed to comply with

confidentiality requirements

Iv
Nursing home utilization by

current residents

by Esther Hing, Division of Health Care Statistics

Introduction

Scope of report

Inthis report, several measures of nursing home utilization

for current residenta will be examined by the major demographic

characteristics of age, sex, race, and Hispanic origin. The utilization measures examined are the rate of residency in nursing

homes as measured by the number of nursing home residents

per 1,000 population, length of stay since admission, average

total monthly charge, and average number of dependencies in

activities of daily living. These four utilization measures reflect

“snapshot” use of nursing homes by persons living in nursing

homes on any given day during the August 1985 through

January 1986 survey period. Other characteristics examined in

this report include marital status, living arrangements prior to

admission, prior nursing home use, hospitalizations while still

a resident, health status (primary and all-listed diagnoses at

time of survey and mental status), and primary source of payment at admission and in month before interview. Selected

trends in use of nursing homes by current residents are also

examined in thk report.

Sources and qualifications of data

The data presented in this report are from the 1985

National Nursing Home Survey (NNHS), a nationwide sample

survey of nursing homes, their residents, discharges, and staff

conducted by the National Center for Health Statistics. The

survey, which was conducted from August 1985 through

January 1986, was the third of a continuing series of nursing

home surveys. The frost survey was conducted from August

1973 through April 1974, and the second was conducted from

May through December 1977.

Facilities included in the 1985 NNHS were nursing and

related-care homes in the conterminous United States that had

three beds or more set up and staffed for use by residents and

that routinely provided nursing and personal care services. A

facility could be free standing or could be a nursing care unit of

a hospital, retirement center, or similar institution as long as

the unit maintained financial and employee records separate

from the parent institution. Places providing only room and

board were excluded, as were places serving only persons with

specific health problems (for example, mental retardation or

alcoholism). In addition, facilities identified as residential care

were also excluded.

The sampling iku-ne for the 1985 NNHS consisted of the

following components:

The 1982 National Master Facility Inventory (NMFI), a

census of nursing and related-care homes conducted by

the National Center for Health Statistics (1).

Homes identified in the 1982 Complement Survey of the

NMFI as “missing” from the 1982 NMFI.

Nursing homes opened for business from 1982 through

June 1, 1984.

Hospital-based nursing homes identified in the records of

the Health Care Financing Administration.

The resulting frame contained 20,479 nursing homes. In this

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

homes,” and “facilities” are used interchangeably.

Estimates in this report are based on a sample of 5,243

residents of the 1,079 nursing homes participating in the

survey. A sample of five residents or fewer per sample facility

was selected. Residents included in the sample were those on

the nursing home’s roster the night before data collection

began. Data were collected by interviewing knowledgeable

nursing home staff members, who referred to the residents’

medical records when necessary. Additional followup information on the sample residents was collected by telephone interview with the residents’ 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 bulk of

the data in this report were obtained from the nursing home

staff. Selected data reported by the residents’ next of kin,

however, also are presented.

A detailed description of the sampling frame, sample

design, and survey procedures is presented in appendix I.

Appendix I also 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,

a standard error chart and a description of its use are provided

in appendix I.

Appendix 11 presents deftitions of terms used in this

report. Reference to the deftitions in append~ II is essential

to interpret the data in this report. Facsimiles of selected questiomaires and forms used in the survey are shown in appendix III.
Preliminary statistics about facilities, residents, discharges, and registered nurses have been published (2–5).

Final statistics on a variety of topics (6) and on the effects of

Medicare’s prospective payment system on nursing homes (7)

also have been published.

Trend comparison qualifications

Although data on residents reported by the nursing home

staff were collected in a similar manner in earlier National

Nursing Home Surveys as in the 1985 survey, note should be

taken of some differences.

First, personal care without nursing and domiciliary care

homes were excluded from the scope of the 1973-74 NNHS

but included in the two later surveys. The effect of this difference is noteworthy because, according to the 1971 NMFI,

about 25 percent of all nursing homes in 1971 were personal

care without nursing or domiciliary care homes and they

housed about 7 percent of the residents (8). The 1971 NMFI,

updated for newly opened facilities, was basically the sampling

frame for the 1973–74 NNHS. Because no adjustments were

made when making trend comparisons between 1973-74 and

later NNHS data, the reader should be cognizant of the restricted scope of the 1973–74 survey. Overall, and in specific

cases, the 197 3–74 estimates will underestimate the total

number of nursing home residents.

Second, certain variables presented in this report were not

available from previous surveys. Data on some variables discussed in this report-prior use of nursing homes, hospitalizations while still a resident, ability to transfer in or out of

a bed or chair, and primary source of payment at admission—

were not collected in the earlier surveys.

Third, race and ethnicity were collected as a single item in

the 1973–74 and 1977 surveys but as separate items in 1985.

This difference should be considered when comparing data by

race from the 1985 NNHS and previous surveys.

In addition to the three NNHS’S, a series of surveys conducted from 1963 through 1969, called the Resident Places

Surveys, provides additional background information about

nursing home residents. Because the methodology and many of

the data items collected in the Resident Places Surveys and the

first two NNHS’S are comparable with those of the 1985

NNHS, selected trend data are presented in this report.
Utilization by demographic

characteristics

Demographic characteristics

In 1985, an estimated 1,491,400 residents lived in 19,100

nursing homes nationwide, representing a 14-percent increase

over the 1,303,100 residents reported in the 1977 NNHS. The

vast majority of nursing home residents were elderly (88 percent) and three-quarters were 75 years of age and over (table

1). Since 1977, the age structure of the resident population has

shifted to the oldest age group. In 1977, 14 percent of the

residents were under 65 years of age and 35 percent were 85

years of age and over. By 1985, 12 percent of the residents

were under 65 years and 40 percent were 85 years of age and

over. As a result of the shifting age distribution, the average

age of nursing home residents increased from 78 to 79 years

from 1977 to 1985. The median age was 81 years.

Not only were nursing home residents predominantly

elderly, they also tended to be female (72 percent). Females

outnumbered males in each age group over 64 years and

tended to be older (with an average ageof81 years) than male

residents were (74 years of age). The preponderance of females

in nursing homes is related to their longer life expectancy (78.2

years compared with 71.2 years for males in 1985) (9). It also

reflects a greater tendency among the elderly without spouses

or living alone to enter nursing homes (10,11). According to

data from the Longitudinal Study of Aging, for example, persons aged 70 years and over living alone in 1984 were more

likely than those living with others to be in a nursing home 2

years later. In 1985, 73 percent of female nursing home

residents were widowed, compared with only 33 percent of

male residents.

The overwhehning majority of nursing home residents also

were white (92 percent). Only 7 percent of the residents were

black, and less than 1 percent were other races (Asian or

Pacific Islander; American Indian or Alaskan Native). On the

average, white residents were older (80 years) than black

residents (75 years) and residents of other races (73 years). A

larger proportion of black residents (21 percent) than white

residents (11 percent) were under 65 years.

The rate of residency in nursing homes by the elderly population 65 years of age and over in 1985 was 46.2 per 1,000

population. The rate of residency in nursing homes increased

with age, from less than 1 out of every 1,000 persons under 65

years to 220 for every 1,000 persons aged 85 years and over.

In general, rates of residency were lower for males than

females, lower for persons who were black or other races than

for white persons. In 1985, the rate of residency for elderly

females (58 per 1,000 population) was twice that of elderly

males (29 per 1,000 population). Wnikuly, the rate of residency

for elderly white persons (48 per 1,000 population) was greater

than that for elderly black persons (35 per 1,000 population)

and elderly persons of other races (20 per 1,000 population)

(3). Table 2 shows that when age, sex, and race are jointly considered, elderly white females had the highest rates of residency

in nursing homes of the four age-sex-race groups. At 65 years

of age and over, 60 of every 1,000 white females resided in

nursing homes, compared with 39 of every 1,000 black females,

29 per 1,000 white males, and 29 per 1,000 black males of the

same age. At 85 years of age and over, the discrepancy in rates

of residency was even greateq 259 of every 1,000 white

females resided in nursing homes, compared with 163 of every

1,000 black females, 151 of every 1,000 white males, and 96

of every 1,000 black males of the same age.

Overall, the rate of residency for the elderly has not

changed since 1973–74. About 5 percent of the elderly resided

in nursing homes on any given day in 1973–74, 1977, and

1985, based on data from the three NNHS’S. The rate of

residency for persons 85 years of age and over, however,

declined from 257 per 1,000 persons in 1973-74 to 220 per

1,000 persons in 1985. The same trend applies to both males

and females aged 85 years and over and to white males and

white females of the same age. The reasons for the declining

use of nursing homes by those in the age group with the highest

nursing home utilization rates are unknown. Several factors,

however, may be related to this trend. A tight supply of nursing

home beds, for example, limits nursing home utilization. During

the 1970’s, many States established certificate-of-need laws to

control nursing home bed supply and expenditures (12,1 3).

The effectiveness of these laws is seen in the uniformly high

occupancy rates in nursing homes, which increased from 87

percent in 1972 to 92 percent in 1984 (2). As a result, the

nursing home bed supply grew more slowly (38 percent fi-om

1973 to 1985) than the population 85 years and over (69 percent during the same period), who are the heaviest users of

nursing homes among the elderly (2,14,15).

If nursing home beds are not available, alternative forms

of long-term care may be substituted (16,17). This may have

happened for many elderly aged 85 years and over because

incident use of home care services was 12 times higher among

those aged 85 years and over than among those aged 65–74

years (18). Figure 1 shows that from 1973 to 1985, the

number of Medicare home health agency visits per 1,000

beneficiaries increased dramatically, ftom 272 visits per 1,000

enrollees in 1973 to 1,360 visits per 1,000 enrollees in 1985.

In 1985, it was estimated that, nationwide, over 2.1 million

3
1,400

1,200

1,000

800

600

400

200 I I I I I I 1

1973 1975 1977 1979 1981 1983 1985

Year

SOURCE: Health Care Financing Admlnlatration, Bureau of Data

Management and Strategy: Unpublished data from the Medicare

Statistical System,

Figure 1. Medicare home health agency visits per 1,000

beneficiaries: United States, 1973–85

patients substituted home care for care in a hospital or nursing

home (19). According to data from the Supplement on Aging

to the 1984 National Health Interview Survey, 3 percent of the

noninstitutionalized elderly population received home health

care from a visiting nurse, 2 percent received care from home

health aides, 2 percent received home-delivered meals, and 1

percent received homemaker services (20). Use of these inhome services was found to be greater among the elderly with

moderate and severe limitations of activity (20). Moderate and

severe limitations were highest among those aged 85 years and

over (21).

Although declining rates of nursing home residency were

observed for white males and white females aged 85 years and

over since 1973–74, the same trend did not apply to black

males and black females of the same age. From 1973–74 to

1985, use of nursing homes by black males and black females

of this age group did not change, perhaps because of the small

number of black persons in the sample. The overall use of

nursing homes by black persons aged 65 years and over,

however, increased from 22 per 1,000 population in 1973-74

to 35 per 1,000 population in 1985.

It should be noted that the trends on rates of residency in

nursing homes since 1973–74 are affected by the more restricted scope of the 1973–74 NNHS. Overall, the total

number of nursing home residents may be underestimated by 7

percent. Other specific categories affected by the narrower

scope of the 1973–74 NNHS, however, are unknown because

of lack of information on residents in personal care homes

without nursing and domiciliary care homes in 1973-74.

Table 1 shows that, in 1985, there were 41,000 residents

of Hispanic origin in nursing homes nationwide, representing a

near tripling of the 14,400 Hispanic residents reported in the

1977 NNHS (22). The percent of elderly residents of Hispanic

origin also tripled (table A). Much of the increased representation of Hispanic people in nursing homes may result from

changes in survey methodology. In 1977, Hispanic origin and

race were collected as a single item. In 1985, race and Hispanic origin were collected as separate items. Estimates of

Hispanic persons are expected to be higher when collected

separately because race and Hispanic origin are not mutually

exclusive categories. In 1985, the proportion of elderly Hispanic residents in nursing homes (3 percent) was comparable

to that found in the elderly noninstitutionalized population

(table A). In contrast, the 1977 proportion of elderly Hispanic

residents in nursing homes ( 1 percent) was half that found

among the elderly noninstitutionalized population (2 percent).

Estimates from the 1976–77 and 1978 National Health Interview Surveys (NHIS’S) showed similar results. The estimate of

Hispanic persons from the 1978 NHIS, in which race and Hispanic origin were collected separately, was 10 percent higher

(13. 1 million persons) than the average annual estimate of

11.9 million Hispanic persons from the 1976–77 NHIS (in

Table A. Number and percent of persons 65 years and over, by whether nursing home resident or noninstitutionalized and Hispanic origin:

United States, 1977 and 1985

1977 1985

Nursing home Nonirrstitutiona Iized Nursing home Noninstitutiona lized

Hispanic origin residents population 1 residents populaiionz

Number

Allpersons 65yesrs Andover.. . . . . . 1,126,000 22,107,000 1,318,300 26,918,000

Hispanic persons 65 yesrs and over, . . . ., . 10,500 464,000 35,300 813,000

Percent

Hispanic persons 65 yesrs and over. 0.9 2.1 2.7 3.0

lData are from the U S Buresu of the Csnsus, Persons of Spamsh ortg!n In the United States. March 1977. Current Population Reports; aenes P–20, no 329.

Washington: U S, Department of Commerce, Sept 1 97S.

‘Data are from the US Bureau of the Census. The Hlepanlc population of the United States: March 1985. Current Population Reports; series P-20, no 422.

Washington U.S. Department of Commerce Mar 198S

4
which these items were collected jointly) (23 ). In 1985, the

average age of Hispanic residents (77 years) was not significantly different fi-om that of non-Hispanic residents (79 years).

Length of stay since admission

In 1985, as was found in previous nursing home surveys

(22,24-27), most nursing home residents were characterized

by long stays in the facility; 64 percent had been in the facility

1 year or more and 18 percent had been in the facility 5 years

or more (table 3). In contrast, 22 percent had been in the

facility less than 6 months and 13 percent had been in the

facility less than 3 months. The median length of stay in

nursing homes was 1.7 years. The median length of stay is the

point in the distribution where half of the residents have shorter

stays and half have longer stays. The average length of stay,

2.9 years, which is influenced by the range of cases, was

significantly longer than the median length of stay. The average

length of stay did not vary by sex, race, or Hispanic origin.

Residents under 65 years, however, tended to have longer stays

(3.6 years) than elderly residents (2.8 years). The average

length of stay for never married residents (4.3 years) was

longer than that for any other marital status group ( 1.8–2.7

years).

The median length of stay in 1985 was not statistically different from that in 1977. The average length of stay, however,

increased from 2.6 years in 1977 to 2.9 years in 1985 (table B).

Since 1977, increases in average length of stay occurred

among residents aged 65–74 years and aged 75 –84 years,

Table B. Average length of stay since admission of nursing home

residante, by selected characteristics: United States, 1977 and 1985

Characteristic 1977 1985

Average length

of stay in days

ToteI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 958 1,059

Age

Under 65 years . . . . . . . . . . . . . . . . . . . . . . . . 1,123 1,311

65yesrs and over . . . . . . . . . . . . . . . . . . . . . . 932 1,026

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . 883 1,055

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . 848 948

85 years and over . . . . . . . . . . . . . . . . . . . . 1,042 1,081

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 885 1,031

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 987 1,070

Race

White! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 957 1,061

Another . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 977 1,037

black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 977 1,041

Current marital status

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 581 675

WidowedZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . 921 990

Divorced or separated . . . . . . . . . . . . . . . . . . 889 997

Never married . . . . . . . . . . . . . . . . . . . . . . . 1,336 1,582

lData for 1977 Include Hispanic residents.

2Data Include a small number of unknowns.

among both sexes; among white residents; and among married,

widowed, and never married residents. The shift of the age distribution toward the oldest age group since 1977, noted earlier,

did not account for the overall longer stays of nursing home

residents in 1985. When the 1985 average length of stay was

age adjusted to the age distribution of the 1977 resident population in nursing homes, the age-adjusted average stay was

still 2.9 years.

The most obvious explanation for the longer average stays

for residents in 1985 is that there were more residents with

very long stays (5 years or more) in 1985 than in 1977; in

1985, 18 percent of the residents had been in the facility 5

years or more, compared with 16 percent in 1977 (22). Other

reasons for the increased length of stay for nursing home

residents will be examined in more detail in later sections of

this report.

Functional status in activities of

daily living

Because of the preponderance of very old residents in

nursing homes, many residents required assistance or did not

perform the basic activities of daily living (ADL’s) needed for

independent living. The ADL’s are bathing, dressing, using the

toilet room, transferring into or out of a bed or chair, continence, and eating. In 1985, 89 percent of nursing home

residents required assistance in bathing, 75 percent required

assistance in dressing, 61 percent required assistance using the

toilet room, 60 percent required assistance in transferring into

or out of a bed or chair, 52 percent were incontinent (bowels,

bladder, or both), and 39 percent required assistance in eating

(table 4).

In general, dependency in the ADL’s increased with age;

71 percent of younger residents (under 65 years) required

assistance in bathing, compared with 94 percent of residents

85 years of age and over. Similarly, 32 percent of younger

residents were incontinent, compared with 58 percent of residents 85 years of age and over. Because female residents were

older, on the average, than male residents, they tended to

require assistance more often than male residents in all six

ADL’S.

The ADL’s may be summarized by summing the number

of activities in which a resident required assistance (28). In

1985, 29 percent of residents required assistance in all six

activities, and only 10 percent were independent in all six

activities (tables 5–6). The average number of ADL dependencies was 3.8 overall and tended to increase with age. Residents

under 65 years had an average of 2.8 dependencies, compared

with 4.1 for residents aged 85 years and over. The average

number of ADL dependencies was greater for female residents

(3.9) than for male residents (3.3) because of their older ages.

The same trend, however, also applied to each of the major age

groups. The average number of ADL dependencies was also

greater for black residents (4.0) than white residents (3.7).

There was no statistically significant difference in the average

number of ADL dependencies by Hispanic origin (table C).

Elderly residents, who constitute 88 percent of all residents

in nursing homes, were more functionally dependent in the

ADL’s on any given day of the survey period than their non5
Table C. Average monthly charge and average number of dependencies in activities of daily living of nursing home residents, by selected

characteristics: United States, 1985

Average monthly Average number of

Characteristic charge dependencies

Sex and age

Both sexes, all ages

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

65 years And over . . . . . . . .

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

75–84 years . . . . . . . . . .

85 years and over. . . . .

Male, alleges . . . . . . . . . . .

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

65 years And over . . . . . . . .

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

75-64 years . . . . . . . . . .

85 years and over. . . .

Female, all ages . . . . .

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

65 years And over . . . . . . . .

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

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

85 years and over. . .

Race

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

Another., . . . . . . . . . . . . . .

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

Hispanic or!gin

Hispanic, . . . . . . . .

Non- Hispanicl

Current marital status

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

Wldowedl, . ., . ...,....,

Divorced or separated, . . .

Never marbled . . . . . . . . . . .

$1,456

1,379

1,466

1,372

1,468

1,497

1,438

1,391

1,451

1,349

1,455

1,519

1,463

1,367

1,471

1,386

1,473

1,492

3.8

2.8

3.9

3.4

3.8

4.1

3,3

2,5

3,6

3.1

3.6

3.9

3.9

3.0

4.0

3.6

3.9

4.2

1,454 3.7

1,481 3.9

1,451 4.0

1,400 4.1

1,457 3,8

1,540 4,3

1,472 4,0

1,362 2,9

1,382 3.1

‘Data tnclude a small number of unknowna

institutionalized counterparts (3). In addition, according to

followup information on the residents provided by telephone

interview with their next of kin, problems doing everyday

activities (such as bathing, dressing, eating, walking, getting

into or out of a chair or bed, and controlling urination and

bowel movements) were the second most frequent reason for

the resident’s admission to the nursing home (table D). Among

the 1,462,900 residents with next of kin, the most frequent

reason cited for nursing home admission was that the resident

required more care than household members could give (78

percent), followed by problems doing everyday activities (74

percent). The third most frequent reason given by next of kin

for admission was that there was no one at home to provide

care (64 percent), followed by not enough money to purchase

nursing care at home (41 percent), recuperation from “surgery

or illness (34 percent), and spouse entered nursing home (3

percent). (The percent of residents by reasons for admission

exceeds 100 percent because residents may have had more

than one reason for admission to the nursing home.) The fact

that nearly three-quarters of these residents had problems

doing ADL’s at admission tends to support the notion that

dependence in the ADL’s is a risk factor for nursing home

admission (10,29–3 1).

Table D also gives a partial explanation for the more dependent functional status of female residents, noted previously.

Next of kin reported problems doing ADL’s at time of admission more often for female residents (75 percent) than for male

residents (70 percent). Thus, female residents tended to be

more functionally dependent at the time of the survey because

they had entered the nursing home in a more functionally dependent state.

Not only are the ADL’s indicators of need for nursing

home care, but they have also been found to be good predictors

of resource use in long-term care settings (32) and cost of care

(33). This is illustrated in figure 2, which shows the average

total monthly charge for residents by number of ADL dependTable D. Percent of nursing home residents, by selected characteristics and reason for admission as reported by next of kin: United States,

1985

Age

65 years and over

All 85 Hispanic origin

residents years Sex Race

with next Under 65 65– 74 75-84 and tVonReason for admission of kin years Total years years over Male Female White Black Hispanic Hispanic~

Recuperation from surgery or

Percent

illness . . . . . . . . . . . . . . . . . . . 34.2 23.8 35.4 38.1 34.9 35.0 33.0 34.6 34.0 35.9 42.1 34.0

No one at home to provide

care . . . . . . . . . . . . . . . . . . . . . . 63.9 55.8 64.9 60.9 65.3 65.9 62.0 64.6 63.8 65.0 56.6 64,1

Not anough money to purchase

nursing care at home . . 40.6 45.6 39.9 46.0 41.4 36.7 41.3 40.3 39.5 55.2 36.5 40,7

Required more cara than household membars could give . . . 77.5 75.9 77.7 77.4 78.3 77.3 77.9 77.4 77.4 79.0 78.2 77,5

Problems in doing eve~day

activities . . . . . . . . . . . . . . . 73,9 65.4 74.9 74.8 75.0 74.9 69.9 75.4 73.5 76.9 76.2 73.8

Because spouse entered. . . . . . 2,9 “0.5 3,2 *2.2 2.9 3.7 3.9 2.5 3.0 “1.9 *4.7 2.8

1Data include a small number of unknowns.

NOTE, Res!dent may have had more than 1 reaaon for admlsslon to nurs(ng home.

6
c

.-

1,700

1,600

1,500

1,4’00

1,300

1,200

1,100

1,000

900

!

100

0

$1,241

$986

$1,352

$1,576

$1,449

$1,611

$1,562

0 1 2 3

Number of dependencies

4 5 6

Figure 2. Average monthly charge for nursing home residents, by number of dependencies in activities of daily living: United States, 1985

encies. This figure shows that residents with four to six ADL

dependencies had the highest average total monthly charge;

residents with no ADL dependencies had the lowest average

monthly charge. Overall, the average monthly charge in 1985

was $1,456, or roughly $17,500 a year.

Average monthly charge

Table C shows that the average monthly charge for nursing

home residents did not vary substantially by sex, race, or Hispanic origin. Residents under 75 years of age tended to have

lower average monthly charges ($1 ,375) than residents 75

years of age and over ($1,484). The same tendency also

applied to female residents. Married residents tended to have

higher average monthly charges than divorced or separated and

never-married residents. The difference in average monthly

charges for married and widowed residents, however, was not

statistically significant.

The average monthly charge for residents in 1985 was

more than double that paid in 1977 ($689). Table E, however,

Table E. Average monthly charge, medical care price index, and

average monthly charge in constant (1977) dollars: United States,

1977 and 1985

Average monthly

Average monthly Medical care charge in constant

Year charge price indexl ( 1977) dollars2

1977 . . . . $ 689 100.0 $689

1985 . . . . 1.456 201.6 722

lThe medical care price index was adjusted to make 1977 equal to 100.0 by

dividing the medical care component of the Consumer Price Index (CPI) for

each year by that for 1977. Data from the Bureau of Labor Statistics used in

this adjustment are presented below.

Medical care component

of CPI (1977 = 100) Date

204.9 August 1977

413.0 November 1985

2T0 convert average charges to constant [1 977) dollars, charges are divided by

the medical care price index and multiplied by 100.

7
Table F. Percent of nursing home residents, by type of dependency

in activities of daily living, percent distribution by number of dependencies, and average number of dependencies: United States, 1977

and 1985

Dependency status 1977 1985

Type of dependency

Requires assistance in bathing . . . . . . . . . . . .

Requires assistance in dress!ng. . . . . . .

Requires assistance In using toilet room . . . . .,

Requires assistance in mobllltyl ., . . . . . . . . . . . .

Has difficulty with bowel and/or bladder control. . .

Requires assistance in eating, . . . . . . . . . . . .

Average, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent

86.3 88.7

69.4 75.4

52.6 60.9

66,1 70,7

45.3 51.9

32.6 39.3

Percent

distribution

9.6 8.2

12.4 9,3

12,9 10,4

10,7 9.2

13.5 14.3

17.6 19.5

23.3 29.1

Number

3.5 3.9

shows that most of the increase in average charge resulted from

inflation. In constant (1977) dollars, the average monthly

charge in 1985 was only 5 percent higher than that for 1977.

The remaining difference in average charges for 1977 and

1985 may result from changes in the case mix of residents

served in nursing homes from 1977 to 1985. As table F shows,

nursing home residents in 1985 were more dependent in

bathing, dressing, using the toilet room, continence, and eating,

as well as in mobility, than their counterparts in 19’77. When

mobility is substituted for transferring into or out of a chair or

bed, residents in 1985 had a higher average number of ADL

dependencies (3.9) than residents in 1977 (3.5).

7Mobll Ky is used in place of transferring Into or out of s chair or bed, because

transferring wss not svallable [n the 1977 survey,
Utilization by health status

Primary diagnosis at time of survey

In 1985, the most frequent primary or first-listed diagnosis

found among nursing home residents was heart disease (16

percent), followed by cerebrovascular disease (10 percent),

organic brain syndrome (9 percent), psychoses other than

senile dementia (6 percent), and diabetes mellitus (4 percent)

(table 7). Table G shows significant differences in primary

diagnoses between elderly residents and residents under 65

years of age. The primruy diagnosis for elderly residents was

more likely to involve diseases of the circulatory system (35

percent) than was the case for younger residents (12 percent).

In contrast, younger residents were more likely to be diagnosed

with mental disorders (45 percent) than elderly residents were

(19 percent). This pattern of diagnosis is also evident in

table 7. For residents under 65 years, the most frequent primary

diagnosis at the time of survey was psychoses other than

senile dementia (22 percent), followed by mental retardation

(13 percent), cerebrovascular disease (6 percent), other mental

disorders (5 percent), diabetes mellitus (5 percent), and organic

brain syndrome (4 percent). Among residents aged 65-74

years, cerebrovascular disease (12 percent) was the most frequent primary diagnosis, followed by psychoses other than

senile dementia (10 percent), heart disease (9 percent), organic

brain syndrome (7 percent), chronic obstructive pulmonary

disease (6 percent), and Alzheimer’s disease and other degeneration of the brain (5 percent). For the group 75 years of age

and over, heart disease, cerebrovascular disease, organic brain

syndrome, and chronic conditions (diabetes mellitus, arthritis

or rheumatism, and essential hypertension) were the leading

diagnoses, and mental disorders (excluding organic brain syndrome) fell in rankings. The rankings of primary diagnoses for

each sex tended to follow similar patterns by age. Table 8 presents the average length of stay and average monthly charge by

primary diagnosis at time of survey.

Information on the primary diagnosis for residents has

been collected in each of the NNHS’S and in ad hoc surveys of

nursing homes preceding the NNHS. Table H shows that the

distribution of primary diagnoses among nursing home residents

has remained stable for most of the major chapters of the International Classification of Diseases (ICD) since 1969. Exceptions to this rule occurred among the ICD chapters on mental

disorders; diseases of the circulatory system, and symptoms,

signs, and ill-defined conditions. The percent of residents with

a primary diagnosis involving mental disorders doubled from

1969 to 1985 (from 11 to 22 percent); the percent of residents

with a primary diagnosis involving symptoms, signs, and illdefmed conditions declined from 10 percent in 1969 to 4 percent in 1985. The percent of residents with a primary diagnosis

involving diseases of the circulatory system fluctuated during

this time, but was lower in 1985 (33 percent) than in 1969

(39 percent).

The change in distribution of mental disorders may reflect

a change in location of care for the chronically mentally ill

during this period-from mental hospitals to nursing homes.

From 1969 to 1973–74, the number of nursing home residents

65 years of age and over with a chronic mental disorder

increased by more than 100 percent, but the number of residents

65 years and over in mental hospitals decreased by 30–40 percent (34). As will be shown in a later section on mental status,

mental disorders were highly prevalent among nursing home

residents in 1985. The change in distribution of symptoms,

signs, and ill-defined conditions is probably a reflection of

changes in the coding system used for the 1985 data that

resulted from adoption of the lnternationaZ Classzj7cation of

Diseases, 9th Revision, clinical modz~cation (ICD-9-CM).

The ICD–9-CM included signs and symptoms generally considered to be applicable to a specific body system (for example,

the digestive system or the circulatory system) in those appropriate chapters rather than the more general chapter 16 (symptoms, signs, and ill-defined condhions).

All-listed diagnoses at time of survey

In the 1985 NNHS, up to eight diagnoses were obtained

fkom the residents’ medical records and coded according to the

ICD–9–CM. An estimated 4.9 million diagnoses were recorded for the 1,491,400 residents in nursing homes. Figure 3

shows that almost all nursing home residents (98 percent) had

one diagnosis or more at the time of survey. The average

number of diagnoses was 3.3. Table 9 presents the number of

all-listed diagnoses at time of survey for nursing home residents

by age and sex. Residents under 65 years of age had fewer

diagnoses on the average (2.8) than elderly residents (3.3–

3.5). Female residents had more diagnoses on the average

(3.4) than male residents (3.2). Table 10 shows that black

residents had more diagnoses on the average (3.6) than white

residents (3.3). There was no dfierence in the average number

of diagnoses for Hispanic (3.2) and non-Hispanic residents

(3.3).

Of the major ICD–9–CM diagnostic classes, diseases of

the circulato~ system ranked first, accounting for 31 percent

9
Table G. Percent distribution of nursing home residents by primary diagnostic claas at time of survey, according to selected characteristics:

United States, 1985

Age

65 years and over

Race

85 Hispanic origin

65– 75- years Sex All other

Primary diagnostic class Under 65 74 84 and Nonand ICD–9-CM code~ Total years Total years years over Male Female White Total Black Hispanic Hispanic2

All categories . . .

Chapter 1. Infectious and

parasitic

diseases . 001–1 39

Chapter 2. Neoplasms . . . 140–239

Chapter 3. Endocrine,

nutritional, and

metabolic diseases,

and immunity

disorders . . . 240–279

Chapter 4. D!seases of

the blood and bloodforming

organs 280–289

Chapter 5. Mental

disorders 290–31 9

Chapter 6. Diseases of

the nervous system

and sense

organs . 320–389

Chapter 7. Diseases of

the circulatory

system . . . . 390–459

Chapter 8. D(seases of

the respiratory

system 460-519

Chapter 9. Oiseases of

the digestwe

system . . . . . 520–579

Chapter 10. Diseases of

the genltourmary

system . . 580-629

Chapter 12. Diseases of

the skin and subcutaneous

tissue . . . . 680–709

Chapter 13. Diseases of

the musculoskeletal

system snd connectwe

tissue . . . 710–739

Chapter 14. Congenmal

snomalies. 740–759

Chapter 15. Certain

conditions originating

in the per!natal

period. . . . . 760-779

Chapter 16. Symptoms,

signs, snd ill-defined

conditions. 780–799

Chapter 17. Injury and

poisoning 800–999

Supplementary

classifications . . . VOI–V82

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

100.0

0.4

2.3

5.5

0.7

22.2

10.5

32.6

3.4

2.3

1.7

0.8

6.3

0.4

“0.0

4.0

3.5

1.1

2.1

I 00.0

“0.3

‘1.3

5.3

44.5

17.4

11.9

“1.7

“1.5

“1,1

“0,4

*1.2

*2.8

“0,2

3.9

3.8

“0.8

“1.8

100.0

0.4

2.5

5.5

0.8

19.2

9.6

35.3

3.7

2.4

1,8

0.8

7.0

“0.1

4.0

3.5

1,2

2,2

100.0

*0.2

*2.4

6.7

“0.3

25,3

14.5

25,5

6.8

*1.5

*1.7

“1.2

4,4

“0.5

4.6

*1.3

“0,9

*2.4

100.0

“0,8

3.2

6,9

“0.9

20.3

10.8

32.6

4.2

2.0

1,7

“0.5

6,2

3.8

2.7

1,2

2,2

100.0

Percent distribution

“0.1

1.9

3.9

“0.8

16.1

6.9

41,1

2.1

3.0

1.9

‘0.9

8.7

“0.1

4.0

4.9

1,2

2,1

i00.0

“0.3

3.3

5.0

‘0.7

24.8

13.2

27.3

5,1

2.0

2,6

‘0.7

4.3

“0.5

3.8

2.4

1.7

2.1

100.0

“0.4

2.0

5.7

0.7

21,1

9.5

34.7

2.8

2.4

1.4

0.8

7.2

0.4

“0.0

4.1

3.9

0.9

2.1

100.0

*0.3

2.3

5.2

0.7

22.3

10,8

32.3

3,5

2.4

1,8

0.8

6.4

0.4

“0.0

3,8

3.6

1.2

2.1

I 00.0

‘1.6

*2.9

8.4

“0,6

21.0

8.1

36.2

*2,1

“1.3

*1.5

0.5

5.3,

0.2

5.9

2.3

0.2

2.0

100,0

“1.8

“3.0

8.4

‘0.5

20.1

8.3

37.7

*2.2

*1.4

“1.1

“0.3

*4.9

“0.2

6.0

*2,1

“0.2

*1.8

100.0

“0.5

‘1.3

“5.0

31.5

*1 3.8

29,1

*3.8

*1.7

“2.4

“0.6

“4,1

“1.8

“1.6

*2.6

100,0

0.4

2.4

5.5

0.7

21.9

10.5

32.7

3.4

2.3

1.7

0.8

6.4

0.4

“0.0

4.1

3.6

1.2

2.1

lDlagnostlc groupings and code number lnclus]ons are based On the International Classification of D!seases, 9th Rewsion, cltnical modification

‘Data Include a small number of unknowns

10
Table H. Percent distribution of nursing home residents by primsry

diagnostic cless: United States, 1969, 1973–74, 7977, and I g85

Primary diagnostic class~ 19692 1973-743 1977 1985

Percent distribution

All categories. ., . . . . . . . . .

Infectious and parasitic

diseases . . . . . . . . . . . . . . .

Neoplaams . . . . . . . . . . . . . .

Endocrine, nutritional, and

metabolic diseases and

immunity disorders . . . . . .

Diseases of the blood and

blood-forming organs . . . .

Mental disorders. . . . . . . . .

Diseases of the nervous

system and sense

organs . . . . . . . . . . . . . . . .

Diseases of the circulatory

system . . . . . . . . . . . . . . . .

Diseases of the respiratory

system . . . . . . . . . . . . . . . .

Diseases of the digestive

system . .,, . . . . . . . . . . . .

Diseases of the

genitourinary system. . . . .

Diseases of the skin and

subcutaneous tissue . . . . .

Diseases of the musculoskeletal system and

connective tissue . , . . . . .

Congenital anomalies . . . . .

Certain conditions originating

in the perinatal period . . .

Symptoms, signs, and illdefined conditions , ., . . .

Injury and poisoning. . . . , .

Unknown or other

diagnoses . . . . . . . . . . . . . .

100.0

3,8

2.2

5,2

0.5

11.1

7.6

39.1

2.0

2.4

1.2

0.4

6.5

0.3

*

10.1

4.8

3.2

100.0

*

2.4

4.5

0.7

10.8

6.0

41.9

2.1

1.9

1.5

0.6

6.8

0.3

*

13.6

4.6

1.4

I 00.0

. . .

. . .

. . .

18:4

. . .

39.7

2.4

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

6.9

I00,0

0.4

2,3

5.5

0.7

22.2

10.5

32.6

3.4

2.3

1.7

0.8

6.3

0.4

*

4.0

3.5

3.3

‘Diagnostic groupings are based on the International Classification of

Disesses.

ZData are from van Nostrand JF, Sutton JF. Charges for care and sources of

payment for residenta in nursing homes United Statea, June-August 1969.

National Center for Health Statistics. Vital Health Stat 12(21 ). 1973.

3Data are from Ingram DK. Profile of chronic illness in nursing homes. National

Nursing Home Survey, United Statea, August 1973-April 1974. National

Center for Health Statistic. Vital Health Stat 13(29). 1973.

of all diagnoses. The next most fkequent chapter for residents’

diagnoses was mental disorders (14 percent), followed by diseases of the nervous system and sense organs (10 percent), diseases of the musculoskeletal system and connective tissue (9

percent), and endocrine, nutritional, and metabolic and immunity disorders (6 percent). Supplementary classifications of

the ICD–9–CM accounted for 8 percent of the residents’

diagnoses (table J).

Prevalence often refers to the number of existing cases of a

disease at a given point in time; this deftition of prevalence is

usually referred to as point prevalence. Point prevalence of

conditions refers to the number of residents with a specific condition rather than the number of these conditions (presented in

tables 9 and 10). Because only point prevalence of conditions

and impairments were available from previous NNHS’S, the

remainder of this section on all-listed diagnoses will present

point prevalence rates of specific diagnoses for comparability

purposes.

Table K presents prevalence rates of selected conditions

fkomthe 1977 and 1985 NNHS’S. Prevalence estimates horn

the 1985 NNHS differ from those obtained in the 1977 NNHS

for several reasons. In general, conditions have lower prevalence in the 1985 NNHS than in the 1977 NNHS because of

the different methodologies employed by the surveys. The

1985 estimates were based on information written in the

medical record, but the 1977 estimates were based on responses to a preceded checklist of conditions. Methodological

studies have found that inclusion of a checklist of descriptive

condition titles as part of the interview questiomaire increases

the probability that respondents will recognize the terms and

report those of which they are aware (35). Prevalence of most

conditions from 1977 is higher than prevalence from 1985

(table L). For example, the 1977 rates of diabetes, mental

retardation, and arthritis or rheumatism per 100 residents are

signitlcantly higher than the comparable rates in 1985. Differences also may have occurred because of respondent interpretation of terms shown in the 1977 checklist of conditions.

Heart trouble, for example, may not have been interpreted by

the 1977 respondents to include all the diagnoses coded under

heart disease (shown in table K rmd included in the 1985 data).

Respondent interpretation of the terms “hardening of the

arteries” and “stroke” may also have varied with data found in

the residents’ medical records, the source of the 1985 data on

diagnoses. Other differences may result from changes in coding.

The 1977 NNHS included preceded lists of conditions based

on the Eighth Revision Intemati.onal Classification of Diseases, adapted for use in the United States (36), but the 1985

NNHS data were coded according to the International Classl~cation of Diseases, 9th Revisionj clinical modz~cation (37).

A major difference between these two classification systems is

the expansion of categories in the ICD–9–CM, which resulted

in greater specificity and detail of disease. In the previous section on primary diagnoses, a decline from 1969 to 1985 was

noted in the percent of residents with a primary diagnosis

involving symptoms, signs, and ill-defined conditions; this may

have resulted from the change in coding systems used in those

data years. In addition to these methodological factors, differences in prevalence rates also may result from changes in

types of residents admitted to nursing homes since 1977. As

was noted earlier, residents were more fictionally dependent

in 1985 than in 1977. Thus, the prevalence of diagnoses for

these patients also may have chauged.

Table 11 presents 1985 point prevalence rates for selected

diagnoses according to age and sex. In 1985, the most prevalent diagnosis among nursing home residents was heart disease (37 percent), followed by senile dementia or organic brain

syndrome (23 percent), cerebrovascular disease (18 percent),

arthritis or rheumatism (18 percent), essential hypertension

(16 percent), diabetes mellitus (12 percent), and psychoses

other than senile dementia (11 percent). Overall, 60 percent of

all nursing home residents were diagnosed with some type of

disease of the circulatory system 41 percent of all residents

were diagnosed with some type of mental disorder.

Prevalence of senile dementia or organic brain syndrome,

‘heart disease, and arthritis or rheumatism each increased with

age. Rates of llacture of neck of femur (hip fracture) were

greater in the group 75 years and over. Excluding senile

dementia or organic brain syndrome, prevalence of mental dis11
25 —

20

15

10

5

0

None or 1 2 3 4 5 6 7 8

unknown

Number of diagnoses

orders tended to decrease with age. For example, 17 percent of

residents under 65 years were diagnosed with mental retardation, compared with less than 2 percent of residents aged 85

years and over.

Prevalence of certain diagnoses varied by sex. Diagnoses

more prevalent among male than female residents included

malignant neoplasms, mental retardation, and chronic obstructive pulmonary disease. Diagnoses more prevalent among

female than male residents included senile dementia or organic

brain syndrome, essential hypertension, heart disease, arthritis

or rheumatism, senility without psychosis, osteoporosis, and

hip and other fractures, Figure 4 shows prevalence rates for

selected diagnoses by age and sex.

Table 12 shows higher prevalence of essential hypertension, cerebrovascular disease, and diabetes mellitus among

black than white residents. The higher prevalence of essential

hypertension, cerebrovascular disease, and diabetes mellitus

among black nursing home residents is consistent with prevalence patterns of these diseases among the elderly noninstitutionalized population. In 198 2–84, the prevalence rates

of cerebrovascular disease and diabetes among elderly noninstitutionalized black males and females exceeded those found

among elderly white males and females (21 ). Although the

prevalence pattern for arthritis or rheumatism was higher

among elderly noninstitutionalized black than white persons in

1982–84 (21 ), the rate of arthritis or rheumatism was higher

among white nursing home residents (18 percent) than black

residents (12 percent). This discrepancy may be a result of

underrecording on the medical records. Because black residents

had more diagnoses (3.6, on the average) than white residents

(3.3) to record, it maybe that the medically ameliorable con12

Figure 3. Percent distribution of nursing home residents by number of diagnoses: United States, 1985

ditions were recorded and the less serious conditions were

either omitted or undiagnosed. This conjecture warrants further

research. Although there was an observable difference in prevalence of senile dementia or organic brain syndrome by Hispanic origin, the difference was not statistically significant

because of the small sample size of Hispanic residents.

Table L shows prevalence rates of selected diagnoses

among the elderly population in nursing homes and in the community. Prevalence estimates for the elderly noninstitutionalized

population are annual average estimates from the 1983–85

NHIS’S. Chronic conditions, as defined for NHIS, are conditions with a duration of 3 months or more (prior to the interview) or conditions considered chronic regardless of when they

began. Compared with the elderly noninstitutionalized population, elderly nursing home residents were more likely to have

ischemic heart disease, cerebrovascular disease, and anemias.

The disparity in prevalence of these conditions among the

elderly in nursing homes and in the community suggests that

the presence of these conditions may be associated with an

increased chance of institutionalization among the elderly. In

contrast, the elderly living in the community had higher prevalence of the less serious conditions of arthritis or rheumatism,

hypertension, and cataracts than their counterparts in nursing

homes had. It should be noted that the prevalence rates just

presented for the noninstitutionalized elderly differ in several

ways from those for nursing home residents. The prevalence

rates from the 1983 –85 NHI S represent the average prevalence of these conditions during a l-year period; those for

nursing homes represent prevalence of conditions among residents on any given day during the survey period. Desp,ite these

differences, the data show significant differences in the types of
Table J. Percent distribution of aI1-Iisted diagnoses at time of survey, according to selected characteristics of residents: United States, 1985

Age

65 years and over

Race

85 Hispanic origin

65– 75- years Sex

All-1isted diagnostic class

All other

Under 65 74 84 and Nonand ICD-9-CM codel Total years Total years years over Male Female White Total Black Hispanic Hispanic2

I 00.0

0.4

1.9

5.9

1.5

13.9

10.2

30.6

3.1

4.1

2.7

1.1

8.6

0.3

“0.0

5.4

2.0

7.6

100.0

0.7

1.5

6.4

*0.9

26.1

17.0

15.3

2.5

3.1

2.3

1.3

4.0

1.9

“0.1

7.5

2.3

6.7

100.0

0.4

2.0

5.8

1.6

12.6

9.5

32.2

3.2

4.1

2.7

1.1

9.1

0.2

5.2

2.0

7.7

100.0

0.7

2.1

7.7

1.4

16.2

11.9

26.6

4.2

3.2

2.8

1.4

6.6

“0.4

6.0

1.0

7.1

100.0

0.5

2.2

7.0

1.4

13.5

9.8

30.6

3.5

4.1

2.7

1.0

8.3

*0.1

5.2

1.7

7.8

Percent distribution

All categories . . . . . . . .

Chapter 1. Infectious and

parasitic

diseases. . ..001-139

Chapter 2. Neoplasms . . ...140-239

Chapter3. Endocrine,

nutritional, and

metabolic diseases,

and immunity

disorders . ..240-279

Chapter4. Diseases of

the blood and bloodforming

organs . . . . . 280-289

Chapter 5, Mental

disorders . ..290-319

Chapter 6. Diseases of

the nervous system

and sense

organs . . ...320-389

Chapter7. Diseases of

the circulator

system . . ...390-459

Chapter 8. Diseases of

the respiratory

system . . ...460-519

Chapter 9. Diseases of

the digestive

system . . ...520-579

Chapter 10. Diseases of

the genitourinary

system . . ...580-629

Chapter 12. Diseasas of

the skin and

subcutaneous

tissue . . . ...680-709

Chapter 13. Diseases of

the musculoskeletal

system and connective

tissue . . . ...710-739

Chapter 14. Congenital

anomalies. . .740-759

Chapter 15. Certain

conditions originating

in the parinatal

period. . . ...760-779

Chapter 16. Symptoms,

signs, and ill-defined

conditions. .. 780-799

Chapter 17. Injury and

poisoning. .. 800-999

Supplementary

classifications. . . . .VO1-V82

‘Diagnostic groupings and code number Inclusions are based on the International Classiflcat!on of Dmeases, 9th Rewsion, cl!nlcal modifwmon,

2Data include a small number of unknowns.

100.0

0.2

1.9

4.3

1.8

10.6

8.5

35.4

2.5

4.5

2.7

1.0

10.6

“0.1

4.8

2.6

7.8

100.0

0.4

2.5

5.6

1.6

15.3

12.1

27.5

4.6

4.2

3.4

1.3

5.7

“0.3

5.4

1.5

8.0

100.0

0.4

1.7

6.0

1.5

13.4

9.6

31.8

2.5

4.0

2.4

1.0

9.7

0.3

*0.O

5.4

2.2

7.4

100.0

0.4

1.9

5.6

1.5

13.9

10.3

30.4

3.1

4.2

2.7

1.1

8.8

0.3

‘0.0

5.3

2.1

7.6

100.0

0.9

2.1

8.7

1.5

13.6

9.8

32.9

2.7

2.7

2.4

“0.8

6.6

“0.2

6.2

“1.1

7.3

100.0

1.0

2.2

8.7

*1.3

13.6

10.0

33.9

2.4

2.5

2.0

“0.8

6.5

“0.2

6.5

*1.1

6.7

100.0

“0.2

1.2

6.2

“0.9

20.7

11.2

27.1

*3.8

*2.5

“3.7

“1.1

7.9

“0.2

5.3

*1.4

5.7

100.0

0.4

2.0

5.9

1.5

13.7

10.2

30.7

3.1

4.1

2.6

1.1

8.7

0.3

*0.O

5.4

2.0

7.6

13
Table K. Prevalence rates per 100 nursing home residents for

selected chronic conditions: United States, 1977 and 1985

Chronic condition andlCD-9–CMcodel 7977 1985

Rate per lOO

Diseases of the circulatory system residents

Hardening of the arteries ...,.., ,. .,..440 47.6 7,5

Heart trouble. 391–392.0, 393-398, 402,

404, 41 O–429 34,5 36,8

Hypertension . . . . . . . . . . . . . . . . ..4 Ol-4O5 20,9 17,0

Stroke . . . . . . . . . . . . . . . . . . . . . . . . 430–438 16,4 18,2

Mental disorders

Chronic brain syndrome . . . . . . . . . . ...310 24,9 18.4

Mental retardation . . . . . . ,. .,.., ,317-319 6.1 3.4

Other chronic cond!tlons

Anemias . . . . . . . . . . . . . . . . . . . .,,280–285 5.4 4.7

Arthritis or rheumatism. 710–716, 729.0 24.6 17.9

Bedsores . ., . . . . . . . . . . . . . . . . . . . ...707.7 2.7 1.0

Cancer . . . . . . 140-208, 230-234 4.9 4.9

Diabetes ., ., . .,, . . . . . . . . . . . . , ..,,,.250 14.5 12.4

Hip fracture . . . . . . . . . . . . . . . . . . .,, ,. .820 8.3 2.6

Other bone fracture ., 800–81 9, 821 –829 3.6 2.3

Parkinson’s disease.......,.. . .,,...332 4.5 4.7

lCode number inclusmns are based on the International Classification of

Diseases, 9th Rev!s! on, clinical modifi catjo”,

Table L. Prevalence rates per 1,000 persons aged 65 years and over

in nursing homes and in the community, for selected conditions:

United States, 1983-85

In nursing In the

homes, community, 1

Condition 1985 1983–85

Heart disease . . . . . . . . . . . . . . . . ,. .,...

Ischemic heart disease. . . . . . . . . . .

Arthritis or rheumatism. . . . . . . . . . . . . .

Cerebrovascular disease . . . . . . . . . . . .

Hypertension. . . . . . . . . . . . . . . . . . . .

Diabetes mellitus . . . . . . . . . . . . . . . ...,,

Hardening of the arteries . . . . . . . . .

Malignant neoplasms . . . . . . . . . . ... ,,.

Anemias, . . . . . . . . . . . . . . . . . . . ,., ,,. .

Cataract . . . . . . . . . . . . . . . . . . . . . .,, ,..

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . .

Deafness . . . . . . . . . . . . . . . . . . . .,, ,.. .

Ulcer of stomach, duodenum,

peptic ulcer, or unspecified site . . . .

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

Blandness . . . . . . . . . . . . . . . . . . . . . . . .

Rate per 1,000 persons

400,1 309.1

263,5 144.5

197,6 485.4

193.3 59.3

175.2 403.1

125.2 95.5

83.2 83.4

51.3 43.8

50.3 20.6

33.4 152.5

26.4 39,5

22.1 34,5

17.4 34,0

15.7 “1.0

13.8 8.1

lUnpubl ished average annual rates of selected chron)c conditions from the

1983-85 National Health Interview Suwey,

‘Includes International Classification of Dlaeases, 8th Rewslon, clinlcal

modlf!catlon codes 401–405,

conditions found among these two populations of elderly

persons.

Mental status

In addition to diagnostic information presented in the preceding sections, information about the prevalence of specific

14

mental disorders was also collected in the 1985 NNHS (table

13). Overall, 66 percent of all nursing home residents were

reported to have at least one of the following conditions:

mental retardation, alcohol abuse or dependence, dnug abuse

or dependence, senile dementia or chronic and organic brain

syndrome, depressive disorders, schizophrenia, other psychoses, anxiety disorders, personality or character disorders,

or other mental disorders. Thirty-four percent of the residents

were reported to have no mental disorders. The most frequently reported mental disorder among residents was senile

dementia or chronic and organic brain syndrome (43 percent),

followed by depressive disorders (14 percent) and personality

and character disorders (11 percent). Prevalence c,f senile

dementia or chronic and organic brain syndrome increased

with age, and these conditions were more prevalent among

female (46 percent) than male residents (37 percent). There

was no difference in the prevalence of senile dementia or

chronic and organic brain syndrome by race or Hispanic origin

because of the small sample sizes of these cells (table 14).

Prevalence of mental retardation, schizophrenia, personality or

character disorders, and alcohol abuse or dependence was

highest among residents under 65 years and among male

residents.

The data on prevalence of mental disorders presented previously differ from prevalence estimates of mental disorders

based on all-listed diagnoses coded from the residents’ medical

records (tables 11 – 12). For example, 23 percent of nursing

home residents were reported to have senile dementia or organic

brain syndrome (ICD–9–CM codes 290 or 3 10) based on alllisted diagnoses, but 43 percent of the residents were reported

to have the same diagnoses when information was obtained by

showing a flashcard of mental disorders to the nursing home

stti respondent. Similarly, prevalence of mental retardation

was higher when obtained using the checklist of mental disor~

ders (5 percent) than when based on all-listed diagnoses (3 percent). The difference in these estimates may result from personal knowledge of the staff respondent that is not recorded in

the medical record. For a number of reasons, not all diagnoses

for residents are recorded in their medical record. For example,

Medicaid regulations that restrict the mentally ill population in

nursing homes to 50 percent may discourage nursing homes

from identifying all patients with a diagnosis involving mental

disorders (38). Conditions that may be suspected but not clinically diagnosed may also be omitted from the medical records.

Prevalence estimates based on all-listed diagnoses are limited

to information written in the medical record.

Several measures related to mental status, including disorientation or memory impairment, behavioral problems, and

disturbance of mood, were also collected in the 1985 NNHS.

Disorientation or memory impairment was defiied as inability

to do at least one of the following activities: remember dates or

time, identify familiar locations or people, recall important

aspects of recent events, or make straightforward judgments. In

1985, 62 percent of nursing home residents were disoriented or

memory impaired to such a degree that performance of the

basic activities of daily living, mobility, and performance of

other tasks were impaired nearly every day, Disorientation or

memory impairment may result from a variety of causes, including medication side effects, stroke-related aphasia,, and
All ages

Under 65 years

65-74 years

75-84 years

85 years and over

All ages

Under 65 years

65-74 years

75-84 years

35 years and over

All ages

Under 65 years

65-74 years

75-84 years

35 years and over

170.2

125.6

3,6

183.4

69.7

nsion

267.5

I

Arthritis or rheumatism

105.6

I I “58.8

163,2

I I 72.7

128.7

1.8

t-’

Chronic obstructive pulmona~ disease

Male

Female

66.6

481.9

isease

248.0

I

I 193.5

T

272.6

262.3

I

I 273.1

Senile dementia or organic brain syndrome

o 100 200 300

Rate per 1,000 res(dents

o 100 200 300 400 500

Rate per 1,000 residents

Figure 4. Prevalence rates per 1,000 nursing home residents for salected diagnoses et time of survey, by age and sex United States, 1985

15
several other diagnoses. Disorientation or memory impairment

was highest among residents 85 years of age and over and was

more common among female residents (63 percent) than male

residents (59 percent). Table M shows that senile dementia or

chronic and organic brain syndrome (based on the checklist of

mental disorders) is highly associated with disorientation or

memory impairment; 61 percent of residents who were disoriented or memory impaired were also reported to have senile

dementia or chronic and organic brain syndrome. Other mental

disorders among disoriented or memory-impaired residents

ranged from 1 to 16 percent. Eighteen percent of disoriented or

memory-impaired residents were reported to have no mental

disorders.

Thirty-eight percent of the residents were reported to have

one or more of the folIowing behavioral problems: disrobing or

exposing oneself, screaming, being physically abusive to self or

others, stealing, getting lost or wandering into unacceptable

places, or inability to avoid simple dangers. The presence of

behavioral problems was also highly associated with senile dementia or chronic and organic brain syndrome. Sixty-five percent of residents with behavioral problems were also reported

to have senile dementia or chronic and organic brain syndrome, 20 percent were reported to have anxiety disorders, and

20 percent were reported to have personality or character disorders. Disturbance of mood (displays depression, anxiety,

fearfulness, or worry) was reported for 42 percent of nursing

home residents. Disturbance of mood was more common among

female (44 percent) than male residents (38 percent) and was

more common among Hisparsic (54 percent) than non-Hispanic

residents (42 percent). Senile dementia or chronic and organic

brain syndrome was reported to be present for half of the

residents with disturbance of mood. Depressive disorders and

anxiety disorders were reported for 26 and 27 percent, respectively, of the residents with disturbance of mood. Overall,

residents reported to have behavioral problems, disorientation

or memory impairment, or disturbance of mood at the time of

interview were highly likely (80–87 percent) to also have some

type of mental disorder, underscoring the increasing role of

nursing homes in caring for the chronically mentally ill (34).

Cognitive impairment and behavioral problems have been cited

as reasons for nursing home admission (10,30,39,40).

Cognitive impairment and behavioral patterns have also

been cited as indicators of service needs within nursing homes

(41 ). As figure 5 shows, residents with behavioral problems,

disorientation or memory impairment, and disturbance of mood

tend to have more dependencies in the ADL’s, on the average,

than residents without these conditions. As a rule, residents

reported to have at least one mental disorder (from the checklist of mental disorders) had more ADL dependencies, on the

average 4.0, than residents with no reported mental disorders,

3.3 (6).

Regardless of the measures used to identify the chronically

mentally ill in nursing homes, mental disorders and cognitive

impairments are highly prevalent among the nursing home resident population.

Table M. Number of nursing home residents and percent distribution by current mental disorders, according to presence of behavioral problems, disorientation or memory impairment, or disturbance of mood: United States, 1985

Disorientation or

Current mental disorders All residents Behavioral problems memory impairment Disturbance of mood

Number

Total ...,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,491,400 572,600 922,500 623,7CI0

Percent distribution

Total, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0

Hasnomental disorders l,..,.... ., .,,,.. . . . . . . . . . . . 34.2 13.0 18.4 20,0

Hasmental disorders2 . . . . . . . . . . . . . . . . . . 65.8 87.0 81.6

Mental retardation......,,.. ..,.,..,,

80.0

5.4 7.2 6.4 4.6

Alcohol abuse or dependence., . . . . . . . . . . . . . . . . . . . . . 2.8 3,3 2.6 3.1

Drug abuse or dependence . . . . . . . . . . . . . . . . . 0.9 “0.8 0.7 1.5

Senile dementta or chronic organic brain syndrome ., 43.4 65.0 61.3 50,2

Depressive disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.8 15.6 14.8

Schizophrenia . . . . .,, ...,,,,.,.,.,,,.. .,, ,., ...

26.4

5,7 7.6 6.7 7.5

Other psychoses . . . . . . . . . . . . . . . . . . 2,3 4,0 2.9 4,3

Anxiety disorders...,,,,..,,, . . . . . . . . . . . . . . . . . . . . . 13.5 20.1 15.8 26.8

Personality or character disorders 11,0 19.7 14.1 16.2

Other mental disorders ...,,.., . . . . . . . . . . . . . . . . . . . . 0.4 “0.2 *0.5 ‘0.3

lData (nclude a small number of unknowns.

2Resident may have had more than 1 mental dmorder

16
.

4.4

2.7

4.4

3.3

4.?

3.5

Yes No Yes No Yes No

Disorientation or Behavioral problems Disturbance of

memory impairment mood

Figure 5. Average number of dependencies in activities of daily living for nursing home residents, by presence of disorientation or memory

impairment, behavioral problems, or disturbance of mood: United States, 1985

17
Prior nursing home and

hospital utilization

Living arrangements prior to admission

Table N shows that, in 1985, the most frequent location

from which residents were admitted was a general or short-stay

hospital (37 percent), followed by a private residence (35 percent), another nursing home (12 percent), and another health

facility other than a hospital, nursing home, or mental hospital

(7 percent). The percent of residents transferred from a shortstay hospital in 1985 is higher than the comparable percent in

1977 (32 percent). There was also an increase in the percent of

residents admitted from another health facility, from 4 percent

in 1977 to 7 percent in 1985. This latter finding, however, may

be related to changes in question alternatives in the latter

survey. In 1985, there were more question alternatives relating

to mental health facilities, including facilities for the mentally

retarded, general or short-stay psychiatric units, and mental

health centers in addition to mental hospitals. Overall, 5 percent of the residents were admitted from some type of mental

facility in 1985 (table 15); this figure was not statistically different from the proportion of residents admitted from a mental

hospital in 1977 (6 percent).

Although there was an increase in the percent of residents

transferred from a short-stay hospital or other health facility,

there was a decline in the percent of residents admitted from a

private residence and from mental hospitals since 1977. In

1985, 35 percent of residents were admitted from a private

residence, compared with 37 percent in 1977. There was no

difference IYom 1977 to 1985 in the percent of residents admitted

Table N, Percent distribution of nursing home residents and average

length of stay since admission by living arrangement prior to admission: United States, 1977 and 1985

Living arrangement

prior to admission 7977 1985 1977 1985

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

Prwate residence . . . . . . .

Semiprivate res[dence . . .

Another nursing home . . . . .

General or short-stay

hospital . . . . . . . . . . . . . . . . . .

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

Other health faclllty . . . .

Unknown or other

arrange merit..... . . . .

Percent

distribution

Average length

of stay In days

100,0 100,0

37.2 34.5

3.1 3.5

12.5 12,2

32.3 37.4

5.9 2.5

3.5 6.7

55 3.2

958 1,059

1,075 1,158

907 1,036

815 1,044

664 778

1,650 2,660

1,123 1,255

1,399 1,688

1Psychiatric units are excluded

18

from a semiprivate residence (boarding home, rented room, or

retirement center) or a nursing home.

The shift in admitting location for nursing home residents

toward short-stay hospitals in 1985 maybe related to the introduction of Medicare’s prospective payment system in 1983-

84. Under this payment system, hospitals are reimbursed a

preestablished amount based on the Medicare patient’s condition as classified by the diagnosis-related group. Because the

prospective payment system gives hospitals strong incentives

to limit costs incurred by Medicare patients, hospitals are discharging patients after shorter hospital stays. From 1982 to

1985, the percent of elderly persons discharged from short-stay

hospitals to long-term care institutions increased from 8 to 11

percen~ the average hospital stay for these patients decreased

from 15.8 days in 1982 to 12.9 days in 1985 (7). Table N

shows that the average nursing home stay for residents admitted

from short-stay hospitals increased from 1.8 years in 11977 to

2.1 years in 1985. It has also been found that elderly residents

transferred from short-stay hospitals in 1985 were more functionally dependent in the ADL’s than a comparable population

of nursing home residents in 1977 (7).

The longer stays of residents transferred from shofi-stay

hospitals to nursing homes contributed to the overall longer

stays in nursing homes in 1985, but residents admitted from

mental hospitals and other nursing homes had even greater

impact on the average nursing home stay. Table N shows that,

from 1977 to 1985, the average nursing home stay increased

61 percent (from 4.5 to 7.3 years) for residents admitted from

mental hospitals, and increased 28 percent (from 2.2 to 2.9

years) for residents transferred from another nursing home. In

contrast, the average stay for residents transferred from shortstay hospitals increased only 17 percent.

The average stay for residents admitted from any mental

facility in 1985 was longer (6.1 years on the average) than that

for residents admitted from a mental hospi’tal (4.5 years) in

1977 (6). For residents with the remaining living arrangements

prior to admission, there was no change in the average length of

nursing home stay.

In 1985, elderly residents were more likely to be admitted

fkom short-stay hospitals (39 percent) than residents under 65

years were (27 percent). Overall, female residents were more

likely to be admitted from a short-stay hospital tha.rn male

residents (39 compared with 33 percent). Female residents

also were more likely to be admitted from a shofi-stay hospital

in all age groups 65 years and over (table 15). Black residents

were more likely than white residents to be admitted from a
short-stay hospital (48 percent, compared with 37 percent of

white residents). The higher percent of female and black residents admitted from hospitals is consistent with their generally

more dependent functional status, described earlier. Figure 6

shows that residents admitted from short-stay hospitals were

more functionally dependent in the ADL’s than residents admitted fkom other locations. It was shown in a previous report

that the average monthly charge was higher for residents admitted

from short-stay hospitals ($1,627) than for residents admitted

from other locations ($1,1 94–1 ,376) (6). There was no difference in the percent of residents admitted from short-stay

hospitals by Hispanic origin (table 16).

Younger residents were more likely to be admitted horn

some type of mental facility (20 percent) than were elderly

residents (3 percent). Male residents were more likely to be

admitted from a mental facility (8 percent) than were female

residents (4 percent). Divorced or separated (10 percent) and

never married residents (14 percent) also were more likely to

be admitted from a mental facility than married (3 percent) and

widowed residents (2 percent).

Thirty-eight percent of residents were admitted from a

private or semiprivate residence; 14 percent had lived alone

prior to admission, 19 percent had lived with family members,

and 3 percent had lived with persons who were not family

members. The percent of residents living alone prior to admission increased with age. Female residents were more likely to

have lived alone (15 percent) than male residents (10 percent).

White residents were more likely to have lived alone (14 percent) than black residents (6 percent). There was no difference

in the percent of residents living alone prior to admission by

Hispanic origin. Of all marital statuses, widowed residents

were most likely to have lived alone ( 17 percent compared with

2– 10 percent for residents in the remaining marital statuses).

On the other hand, residents who were married were more

likely to have lived with family members (34 percent) than any

of the remaining marital statuses (11–17 percent).

Prior nursing home use and

hospitalizations while still a resident

In the 1985 NNHS, information about the residents’ prior

use of nursing homes (excluding the current admission) was

collected for the first time. In 1985, 38 percent of nursing home

residents had previous nursing home stays in either the sample

facility or some other nursing home. This estimate is comparable with the percent of nursing home residents with prior

institutionalizations (37 percent) reported by next of kin in the

1976 Survey of Institutionalized Persons (42). In 1985, 22

percent had previous admissions in the sample facility and 19

percent had previous stays in some other nursing home (table

17). The sum of the percents of residents with previous stays in

the sample facility and in other nursing homes exceeds the per5

4

3

2

1

0

Private Another Short-stay Mental Veterans Other Unknown

or semiprivate nursing hospital facility hospital health or other

residence home facility arrangement

Living arrangement prior to admission

Figure 6. Average number of dependencies in activities of deily living for nursing home residents, by living arrangement prior to admission:

United States, 1985

19
cent of residents with any previous nursing home stay because

some residents may have had previous nursing home stays at

both locations. The percent of residents with any previous

nursing home stays did not vary by age, sex, or race.

It should be pointed out that although the overall percent

of nursing home residents in 1985 with prior institutionalizations in any nursing home is similar to that reported in 1976,

there was an increme in the percent of residents with previous

admissions in the sample facility. As reported by nursing home

staff in the 1976 Survey of Institutionalized Persons, 13 percent of nursing home residents had previous admissions to the

sample facility compared with 22 percent reported in 1985.

In the last several years, increasing attention has been

focused on the role that hospitals share with nursing homes in

the care of the elderly. Shapiro and Tate, for example, found

increased chances of nursing home placement after a hospital

stay during 2% and 7-year study periods (30). Medicare policies

have largely influenced hospitals’ becoming a major gateway to

nursing homes (43). In 1964, the year before Medicare began,

only 12 percent of nursing home residents were admitted from

short-stay hospitals. By 1973–74, 35 percent of nursing home

residents were admitted from short-stay hospitals (27). In

1985, hospitals were the admitting location for 37 percent of

all nursing home residents. This shift in admission location for

nursing home residents occurred because Medicare pays for

care in facilities certified as skilled nursing facilities only if a

patient has been recently discharged from a hospital (within 30

days) after a stay of 3 days or more. (Medicare requirements

for coverage will be discussed in more detail in the section on

“Primary source of payment at admission and in month before

interview”).

Once in a nursing home, some residents are frequently

“shuttled” to hospitals for acute care services and then returned

to the nursing home. Several studies have found that prior

nursing home residence for hospital patients was associated

with a very high probability of continued institutionalization

(39,44). Lewis, Cretin, and Kane also found that transfers between hospitals and nursing homes (in both directions) occurred

in 54 percent of first-time admissions to nursing homes in the

2-year period following admission (43). At the national level,

table O confirms this pattern of hospitalizations during the

course of a nursing stay. Of the 558,900 residents with previous stays in nursing homes, 253,900, or 45 percent, were

hospitalized (admitted from a short-stay hospital) and then

entered a nursing home again (either readmission to the same

facility or admission to another facility). This pattern of a hospital admission and subsequent nursing home readmission was

more common among residents with previous stays in the

sample facility (68 percent) than among residents with previous stays in another nursing home (23 percent). This finding,

however, may reflect lack of information rather than differences in transfer patterns.

Nursing homes vary in their discharge policies when a

nursing home resident requires hospitalization. Some nursing

homes discharge a resident to the hospital. After the hospital

stay, the patient may be readmitted to the same nursing home

or admitted to another. Other nursing homes hold a bed for

the resident during the hospital stay. Information about hospitalizations that occurred while the patient still was a resident

(that is, hospitalizations without a formal discharge from the

nursing home) was also collected in the 1985 NNHS. Overall,

319,800, or 21 percent, of all nursing home residents were hospitalized since their current admission. These residents differ

from the 253,900 residents who were transferred to a hospital

from a nursing home and then readmitted only in that a bed

was held for them while hospitalized. These two groups of

nursing home residents with hospitalizations during their nursing home stays are basically distinct groups. Figure 7 shows

Table 0, Average length of stay since admission of nursing home residents and percent distribution by whether admitted from a short-stay hospital, according to prior nursing home and hospital utilization: United States, 1985

Admitted from short- Not admitted from

Prior nursing home and hosp~tal utilization All residents stay hospital short-stay hospital Average length of stay

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

Other stays in any nursing home

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

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

Previous stays at sample facility

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

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

Stays at other nursing homes

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

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

Hospital stays while a resident In sample facility

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

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

Percent distribution Stay in days

100.0 37.4 62.6

100,0 45.3 54.7

100.0 32,6 67.4

100.0 67.5 32.5

100.0 28.9 71.1

100.0 22,7 77.3

100.0 40.8 59.2

100,0 24.8 75,2

100.0 40.8 59.2

1,059

817

1,204

616

1,183

1,003

1,072

1,603

910

NOTE: Figures may not add to totals because of rounding

20
. .. .. . ... .

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

. .. .. . ... . . .. / ,;, ,,. :, :. , \

:, :,. , :,, ,: .: .,, ,,, :,,:

:,. ,:::: :,,

:’

\

,,:,,

.:,

:::

:, ,,:

,, :,, \

.,

,, ,:

/

.:.:.:.::::::::::::::

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

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

I ~~

Not discharged ‘

““” 1

,:.

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

:.:.:.:. ::::::.:::::: from nursing home ~

,,,

,.,..... ......f......

,.,

319,800

,.. :,,,/,

,,

,,

,,

., ,,/,’ ,., .’.

19.600

/

NOTE Overlap occurs when a resident is formslly discharged from a nursing home on 1 occasion of hospital admission but is not discharged on another.

Figure 7. Number of residents hospitalized subsequent to admission to a nursing home, by whether hospitalization was accompanied by a

formal discharge from the nursing home: United States, 1985

that the overlap in number of residents who could be classified

in both groups was only 3 percent. If the unduplicated numbers

of residents in these two groups of hospitalized patients are

combined, it can be seen that 553,300, or 37 percent, of all

residents had at least one hospital stay since first entering a

nursing home.

Unlike the pattern for residents with previous nursing

home stays who were hospitalized and subsequently readmitted, there were differences in patterns of hospitalizations

during the current stay by age and race. Elderly residents were

more likely to be hospitalized whale still a resident (22 percent)

than younger residents (15 percent), White residents were

more likely to be hospitalized during their nursing home stay

(22 percent) than black residents (15 percent).

The average length of stay presented in this report is the

number of days in the facility since admission up to the day of

the survey. For residents with previous stays in any nursing

home, the average length of stay reported is an underestimate

of the total time that the resident has spent in any nursing home

because information about length of stay during previous nursing

home stays is not included. This may explain, in part, the

significantly shorter average nursing home stays of residents

with any previous nursing home stay (2.2 yearn) compared

with residents without any previous nursing home stay (3.3

years). The average length of stay since admission for residents

hospitalized since their current admission was significantly

longer (4.4 years) than that of residents with previous nursing

home stays (2.2 years).

21
Primary source of payment

at admission and in month

before interview

Changes in payment source

At the time of admission, most nursing home residents

relied primarily on their own income or family support to pay

for care (48 percent). The second most common primary source

of payment at admission was Medicaid (41 percent). Seven

percent of the residents relied on other government assistance

or welfare, religious organizations, volunteer agencies, Veterans

Administration contracts, initial payment— life care funds, or

no-charge arrangements to pay for care. Only 5 percent relied

on Medicare as their primary source of payment at admission.

By the month before the survey, Medicaid was the most

frequent primary source of payment used by residents (50 percent); 42 percent relied on their own income or family support

for primary payment and 1 percent relied on Medicare for

primary payment (table P).

The greatest proportionate shifting of the primary source

of payment toward Medicaid occurred among residents who

used Medicare as their primary source of payment at admission, By the month before the survey, 43 percent of residents

relying on Medicare for primary payment at admission had

shifted to Medicaid as their primary source of payment. In contrast, only 19 percent of residents who originally relied on their

own income or family support and 15 percent of residents

relying on all other sources for payment had shifted to Medicaid

as their primary source of payment by the month before the

survey.

The shifting of Medicare to Medicaid as the primary

source of payment is a necessity for many nursing home residents

because of the limitations of benefits and stringent requirements

for coverage under the Medicare skilled nursing care program

in 1985. Medicare covered the first 100 days in a facility certified as a skilled nursing facility ( SNF) for Medicare beneficiaries hospitalized before admission. To quali~ for Medicare’s

SNF benefit, the patient needs to be certified by a physician as

needing daily skilled nursing care or related rehabilitative

services that, as a practical matter, can be provided only on an

inpatient basis in an SNF, In addition, the patient must be

admitted for further treatment of a condition for which he or

she was hospitalized, with a stay of at least 3 days. Admission

to the SNF must occur within 30 days of discharge from the

hospital. In addition to those level-of-care requirements, coverage of SNF benefits applies only as long as all level-of-care

requirements are met. Thus, many patients admitted under the

Medicare SNF benefit may have to switch to other payment

sources during their stay in a nursing home because Medicare

coverage terminates after these requirements are not met. In

1980, the average number of days covered by Medicare in an

SNF was only 30 days (45). In contrast, the average stay for

all nursing home residents in 1985 was 2.9 years. Because of

the limited coverage of SNF Medicare benefits and the stringent

level-of-care requirements necessary to qualify for coverage,

utilization of Medicare in nursing homes in 1985 was low.

Table 18 shows that residents relying on Medic,are for

primary payment in the month before the survey tended to be

recently admitted to the facility. Eighty percent of residents

relying on Medicare were admitted from a short-stay hospital

and 76 percent had been a resident in the facility for less than 3

Table P. Number and percent distribution of nursing home residents by primary source of payment in month before interview, according to

primary source of payment at admission: United States, 1985

Primary source of payment in month before interview

Own Own

income income

or or

Primary source of All fam)ly All other All family All other

payment at admission sources support Medicare Medicaid sources 1 sources support Medicare Medicaid sources ~

Number Percent distribution

All sources,..,.,,,..,.,,,,,, 1,491,400 620,800 20,900 751,300 98,500 100,0 41.6 1,4 50.4 6.6

Own income or family support. 712,500 557,400 “3(000 134,600 17,600 100.0 78.2 *0.4 i 8.9 2.5

Medicare . . . . . . . . . . . . . . . . . 71,500 22,800 16,700

Medicate . . . . . . . . . . . . . . . . . . .

31,000 “900 100.0 31.9 23.4 43.4 “1,3

605,800 29,000 “1 ,200 570,000 “5,600 100.0 4.8 “0.2 94.1 “0.9

Another sourcesl . . . . . . . . . . . . 101,700 11,600 15,600 74,400 100,0 11.4 15,4 73,2

71ncludes other government asswtance or welfare; rellglous orgamzatlons; foundations, volunteer aganc!es; Veterans Admlnistratlon contract; inmal payment—ltfe

care funds; and other sources or no charge.

NOTE: Numbers may not edd to totals due to rounding,

22
Table Q. Number of nursing home residents with non-Medicaid primary source of payment at admission and percent shifdng to Medicaid in

month before interview, by length of stay since admission: United States, 1985

Residents shifting to Medicaid

Residents with non-Medicaid in month before interview

primary source of payment

Length of stay since admission at admission Total Skilled care Intermediate care

Number Percent

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 885,700 20.5 7.3 13.2

Less than 3 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131,400

3months tolessthan6 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90,300

6months tolessthan12 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131,000

lyearto less than 3 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273,200

3yearsto less than 5 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118,400

5years or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141,400

“3.2 “0.6 *2.6

13.1 7.3 5.8

18.0 7.6 10.4

23.9 8.7 15.2

27.0 7.2 19.8

31.5 10.7 20.9

months. In contrast to Medicare coverage in skilled nursing

homes, the Medicaid skilled nursing and intermediate care programs have no limitations on length of stay for coverage. Only

24 percent of Medicaid residents had been in the facility for

less than 3 months, and the average length of stay for these

residents was 3.4 years. The average length of stay for Medicare

residents in the month before the survey was 0.5 year. (This

figure exceeds 100 days because it includes residents who may

have switched to Medicare from an admission payment source

other than Medicare by the time of the survey. )

In 1985, there were 885,700 residents relying on payment

sources other than Medicaid for primary payment at admission

(table Q). By the month before the survey, 21 percent had

shifted to Medicaid as primary source of payment 7 percent

received SNF services and 13 percent received intermediate

care facility services primarily funded by Medicaid. The percent of non-Medicaid residents at adraksion who shifted to

Medicaid for primary payment by the month before the interview increased with increasing lengths of stay. The percent of

non-Medicaid residents shifting to Medicaid was 13 percent

among residents in the facility 3 months to less than 6 months,

compared with 32 percent among residents in the facility 5

years or more.

Average monthly charge and average

number of activities of daily living

dependencies

Table R presents the average monthly charge for care by

primary source of payment in the month before interview.

Residents relying on Medicare for primary payment had the

highest average monthly charge ($2, 141), followed by that for

Medicaid residents receiving skilled nursing care ($1 ,898),

residents relying on their own income or family support ($ 1,450),

Table R. Average monthly charge of nursing home residents and

average number of dependencies in activities of daily living. by prima~

source of payment in month before interview United States, 1985

Primaiy source of Average monthly Average number of

payment charge dependencies

All sources . . . . . . . . . . . . . $1,456 3.8

Own income or family

support . . . . . . . . . . . . . . . 1,450

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

3.7

2,141 4.5

Medicaid . . . . . . . . . . . . . . . 1,504 4.0

Skilled care . . . . . . . . . . 1,898 4.6

Intermediate care. . . . . . 1,292 3.8

Other government

assistance or

welfare . . . . . . . . . . . . . . . 863 1.9

All other sources . . . . . . . . 1,099 2.3

and Medicaid residents receiving intermediate care ($1,292).

Residents relying on other government. assistance or welfare

($863) and all other payment sources ($1 ,099) had lower

average monthly charges. The average monthly charge for all

Medicaid residents ($1,504) was not statistically different from

that for residents relying on their own income or family support

($1 ,450). The higher charge for Medicare residents was associated with greater care needs, as indicated by the average

number of ADL dependencies. The average number of ADL

dependencies was greater for Medicze and Medicaid residents

(on the average, 4.5 and 4.0 ADL dependencies, respectively,

compared with 2.3–3.7 ADL dependencies for residents with

the remaining payment sources). The average number of ADL

dependencies for Medicaid residents overall (4.0 dependencies) was significantly greater than the average for residents

relying on their own income or family support (3.7 dependencies).

23
Conclusions

Several utilization measures for nursing home residents in

1985 are examined in this report by the major demographic

characteristics of age, sex, race, and Hispanic origin. Trends in

nursing home use are also examined. As measured by the

number of residents per 1,000 population, the rate of residency

in nursing homes increased with age and, in general, was lower

for males than females and lower for persons of black or other

races than for white persons. When age, sex, and race were

considered jointly, elderly white females had the highest rates

of residency of the four age-sex groups. At 85 years of age and

over, 259 of every 1,000 white females resided in nursing

homes, compared with 163 of every 1,000 black females, 151

of every 1,000 white males, and 96 of every 1,000 black males

of the same age. In 1985 the percent of elderly residents of

Hispanic origin in nursing homes (3 percent) was comparable

with that found in the elderly noninstitutionalized population,

The average number of dependencies in the activities of

daily living (ADL), used as a measure of case mix, was found

to increase with age and was greater for female than male

residents. The average number of ADL dependencies was also

greater for black than white residents but did not vary by Hispanic origin. The average number of ADL dependencies was

also greater for residents admitted from short-stay hospitals

and for residents relying on Medicare or Medicaid for primary

payment in the month before the survey. The poor functional

status of nursing home residents at the time of admission was a

reason for admission for 74 percent of the residents, according

to their next of kin.

The average length of stay in the nursing home tended to

be longer for residents under 65 years than for elderly residents.

The average nursing home stay was also longer for never

married residents and for residents admitted from mental facilities. Average length of stay did not vary, however, by sex,

race, or Hispanic origin.

There were no statistically significant differences in the

average monthly charge by sex, race, or Hispanic origin. Residents under 75 years had lower average monthly charges than

residents aged 75 years and over. The average total monthly

charge varied by the residents’ functional status. Residents

with 4 to 6 ADL dependencies had significantly higher average

monthly charges than residents with fewer ADL dependencies.

Residents relying on Medicare as their primary source of payment in the month before the survey also had higher charges

than residents relying on payment sources other than Medicare.

The average charge for residents relying on Medicaid for primary

payment in the month before the survey was not statistically

different from that for residents relying on their own income or

family support, even though they were more dependent in

ADL activities (on the average, 4.0 dependencies compared

with 3.7 dependencies for residents relying on their own income

or family support).

In addition to the utilization patterns of residents in 1985,

several trends in nursing home use since 1973 are also examined.

First, from 1973 to 1985, a decline in the rate of nursing home

residency was noted for the population aged 85 years and over,

but the rate of residency remained stable at about 5 percent for

the population aged 65 years and over. The decline in nursing

home use by those 85 years and over, the age group among the

elderly that has the heaviest use of nursing homes, may be

related to the tight supply of nursing home beds and increasing

use of home care services during this time. From 1973 to

1985, the supply of nursing home beds increased 38 percent,

while the population 85 years and over increased 69 percent.

According to a prospective study of incident home care use in

Massachusetts, use of home care services was 12 times higher

among those aged 85 years and over than those aged 65–74

years (18). Further research is needed to investigate this trend.

A second trend noted in this report was the increasing

prevalence of mental disorders among the nursing home resident population. In 1969, 11 percent of the residents had a

primary diagnosis involving mental disorders; in 1985, the

comparable proportion was 22 percent. In 1985, 66 percent of

the residents were reported to have one mental disorder or

more, and 62 percent were reported to be disoriented or memory impaired.

Finally, it was found that the nursing home resident population was more dependent in ADL’s in 1985 than in 1977.

The average number of ADL dependencies for residents in

1985 was 3.9, compared with 3.5 in 1977. At least part of this

change may result from a nationwide trend toward earlier hospital discharge subsequent to the introduction of Medicare’s

prospective payment system in 1983–84 (7). Other factors,

however, may also account for this change, such as increased

use of alternative services or improved medical management of

chronic conditions that prolong the life expectancy for the

chronically ill. The reasons for this change also require further

research.
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26
List of detailed tables

1. Number and percent distribution of nursing home residents

by marital status, race, and Hispanic origin, according to

sexandage United States, 1985 . . . . . . . . . . . . . . . . . . . . .

2. Number and rate per 1,000 population of nursing home

residents, by race, sex, and age United States, 1973–74,

1977, and 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. Number of nursing home residents, percent distribution by

length of stay since adrnksion, and average and median

lengths of stay, according to selected characteristics: United

States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. Number and percent of nursing home residents by dependency in activities of daily living, sex, and age United States,

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

5. Number and percent distribution of nursing home residents

by number of dependencies in activities of daily living,

according to sex and age United States, 1985 . . . . . . . . . .

6. Number and percent distribution of nursing home residents

by type of dependency in activities of daily living and

number of dependencies, according to race and Hispanic

origin: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . .

7. Number and percent of nursing home residents by selected

most frequent primary diagnoses at time of survey, accordingto sex and age: United States, 1985 . . . . . . . . . . . . . . .

8. Average length of stay since admksion of nursing home

residents, average monthly charge, and average number of

dependencies in activities of daily living, by primary diagnosis at time of survey: United States, 1985 . . . . . . . . . . . .

9. Number of all-listed diagnoses of nursing home residents at

time of survey by age and sex: United States, 1985 . . . . . .

10. Number of all-listed diagnoses of nursing home residents at

time of survey by race and Hispanic origim United States,

28 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

11. Prevalence rate of selected diagnoses at time of survey per

1,000 nursing home residents, by age and sex: United

30 States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

12. Prevalence rate of selected diagnoses at time of survey per

1,000 nursing home residents by race and Hispanic origk

United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

32 13. Number and percent distribution of nursing home residents

by mental status, according to age and sex: United States,

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

33 14. Number and percent distribution of nursing home residents

by mentrd status, according to race and Hispanic origim

United States. 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

34 15. Number snd percent distribution of nursing home residents,

by living arrangement prior to admksion United States,

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

16. Number and percent distribution of nursing home residents

35 by living arrangement prior to admission, according to

marital status, race, and Hispanic origkx United States,

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

36 17. Number and percent distribution of nursing home residents

by prior nursing home and hospital utilization, according to

age, sex, and race: United States, 1985 . . . . . . . . . . . . . . . . 54

18. Percent distribution of nursing home residents by selected

39 characteristics and average length of stay since admission,

according to primary source of payment in month before

40 interview: United States, 1985... . . . . . . . . . . . . . . . . . . . . . 56

27
w

02 Table 1. Number and percent distribution of nursing home residents by msrital status, race. and Hispanic 0ri9in, according to sex and e9e: United States, 1985

Marital status

Race Hispanic orwin

Divorced

or Never All NonSex and age Total Married Widowedl separated marr)ed White other Black Hispanic H/spanic’

.—

188,200

19,800

168,400

42,500

78,700

47,200

103,800

9,600

94,100

21,100

41,800

31,300

84,500

10,200

74,200

21,500

36,900

15,900

12.6

11.5

12.8

20.1

15.5

7.9

24.5

10.8

28.1

26.1

29.6

27.8

914,800

20,900

894,000

81,700

327,700

484,600

141,100

* 5,400

135,700

14,100

56,100

65,500

773,800

15,500

758,300

67,600

271,600

419,100

61.3

12.1

67.8

38.5

64.4

81.1

33.3

6.0

40.6

17.5

39.7

58.2

Both sexes

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

65 years And over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

75–84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Male

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

75–84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Female

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

75–84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Both sexes

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

65ysars and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

75–84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Male

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

65 years And over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

See footnote and note at end of table.

Number

116,800

25,900

91,000

24,300

35,400

31,300

1,491,400

173,100

1,318,300

212,100

509,000

597,300

423,800

89,300

334.400

80,600

141,300

112,600

1,067,700

83,800

983,900

131,500

367,700

484,700

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

117,000

38,800

78,200

30,600

34,500

13,200

271,400

93,600

177,800

57,300

68,200

52,300

1,374,600

147,200

1,227,400

187,800

473,600

566,000

377,100

73,900

303,200

70,600

127,900

104,800

997,500

73,400

924,100

117,200

345,700

461,200

104,400

22,300

82,000

22,500

30,600

29,000

41,000

“5,700

35,300

6,800

12,600

13,900

1,450,400

167,400

1,283,000

203,200

496,400

583,400

406,600

85,200

321,400

76,800

136,700

107,800

1,043,900

82,200

961,700

126,400

359,700

475,600

97,3

96.7

97.3

95.8

97.5

97.7

95.9

95.4

96.1

95.4

96.7

95.8

17,200

*4,1 00

13,100

“3,700

“4,600

*4,800

57,200

21,500

35,700

17,600

13,900

“4,200

121,700

52,800

68,900

27,900

29,500

11,500

46,700

15,400

31,200

10,000

13,400

7,800

40,600

13,800

26,800

8,900

11,700

6,200

59,700

17,300

42,400

13,000

20,500

8,900

149,700

40,800

108,900

29,400

38,800

40,700

70,200

10,400

59,700

14,300

22,000

23,500

63,800

8,500

55,200

13,500

18,900

22,800

23,800

*1 ,600

22,200

*5,1OO

8,000

9,100

Percent distribution

18.2 92.2

54.1 85.1

13.5 93.1

27.0 88.5

13.4 93.0

8.8 94.8

7.8

22.4

5.9

14.4

6.8

2.2

7.8

14.9

6.9

11.5

7.0

5.2

7.0

12.9

6.2

10.6

6.0

4.9

2.7

*3.3

2.7

4.2

2.5

2.3

13.5

24.1

10.7

21.8

9.9

*3.8

28.7 89.0

59.2 82.7

20.6 90.7

34.6 87.6

20.9 90.5

10,2 93.1

11.0

17.3

9.3

12.4

9.5

6.9

9.6

15.4

8.0

11.1

8.3

5.5

4.1

*4.6

3.9

*4.6

*3.3

*4.2
Table 1, Number and percent distribution of nursing home residents by maritel status, race, and Hispanic origin, eccording to sex and age: United States, 1985—Con.

Marital status

Race Hispanic origin

Divorced

or Never All NonSex and age Total Married Widowedl separated married White other Black Hispanic Hispanicl

Female Percent distribution

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 7.9 72.5 5.6 14.0 93.4 6.6 6.0 2,2 97.8

Under 65 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 12,2 18.5 20.6 48.7 87.6 12.4 10.2 *1.9

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

98.1

100.0 7.5 77.1 4.3 11.1 93.9 6.1 5.6 2.3 97.7

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 16,3 51,4 9.9 22.4 89.1 10.9 10.3 *3.9 96.1

75–84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 10.0 73.9 5.6 10.5 94.0 5.1 2.2 97.8

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 3.3 86.5 1.8 8.4 95.2 ::: 4.7 1.9 98.1

‘ Data include a small number of unknowns.

NOTE Figures may not add to totals because of rounding.

N

co
Table 2. Number and rate per 1,000 population of nursing home residents, by race, sex, and age: United States, 1973-74, 1977, and 1985

Residents

Race, sex, and age 1973-74J 1977 1985 7973–74~2 79772 19852

All races3

Both sexes:

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

65 years And over . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Male:

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

65 years And over, ,, . . . . . . . . .

65–74 years.....,.....,.,.. . .

75–84 years . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Female:

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

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

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

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

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

White

8oth sexes:

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

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

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

75–84 years . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Male

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

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

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

75–84 years, . . . . . . . . . . . . . . . . . . . . . . . . .

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

Female:

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

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

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

75–84 yeara . . . . . . . . . . . . . . . . . . . . . . . . .

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

All other

Both sexes:

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

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

65-74 yeara. . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Male:

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

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

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

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

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

Female:

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

65yeara and over . . . . . . . . . . . . . . . . . . . . . .

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

75–84 yeara. .,, . . . . . . . . . . . . . . . . . . . . . .

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

Black

Both sexes:

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

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

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

75-84 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

See footnotes and note at end of table.

Number Rate oer 1,000 population

114,300

961,500

163,100

384,900

413,600

52,400

265,700

65,100

102,300

98,300

61,900

695,800

98,000

282,600

315,300

101,700

177,100

,126,000

211,400

464,700

449,900

173,100

1,318,300

212,100

509,000

597,300

89,300

334,400

80,600

141,300

112.600

0.6

44.7

12.3

57.7

257.3

0.6

30.0

11.3

39.9

182.7

0.6

54.9

13.1

68.9

294.9

0.6

46.9

12.5

60.3

270.8

0.6

31.2

11.3

41.6

192.3

0.7

57.8

13.4

71.9

310.0

0.9

47,1

14.4

64.0

22$.9

0.8

30.3

12.6

44.9

146.3

1.0

58.6

15.8

75.4

262.4

0.9

48.9

14.2

67.0

234.2

0.8

31.1

12.1

47.1

152.9

1.0

60.9

15.7

78.7

271.1

0.8

46.2

12.5

57.7

220,3

0.9

29.0

10.8

43.0

145.7

0.8

57.9

13.8

66.4

250.1

0.8

47.7

12.3

59.1

228.7

0.8

29.2

10.5

43.0

150.8

0.8

60.2

13.7

68.5

259.2

81,300

294,000

B0,200

122,100

91,700

95,800

832,000

131,200

342,600

358,200

83,800

983,900

131,500

367,700

484,700

155,400 147,200

920,600

150,100

369,700

400,800

1,059,900

187,500

443,200

429,100

1,227,400

187,800

473,600

566,000

73,900

303,200

70,600

127,900

104,800

73,400

924,100

117,200

345,700

461,200

46,000

250,800

59,100

97,500

94,200

70,100

272,600

69,400

115,800

87,300

55,800

669,800

91,000

272,200

306,600

85,300

787,300

118,100

327,400

341,800

21,700

66,100

23,800

21,500

20,800

11,200

21,400

10,700

6,300

4,400

10,500

44,700

13,100

15,300

16,400

25,900

91,000

24,300

35,400

31,300

15,400

31,200

10,000

13,400

7,800

0.5

21.6

10.6

28.0

100.5

0.8

30.0

17.0

33.5

130.0

0.8

32.6

13.9

44.0

131.9

12,600

40,900

13,000

15,200

2,800

6,400

4,900

6,000

4,800

4,100

6,200

0.5

18.2

11.1

21.4

84.8

0.9

22,9

17,4

24.0

78.8

1.0

27.4

13.4

42.7

99.9

10,400

59,700

14,300

22,000

23,500

0.5

24.2

10.2

32.7

110.1

0.7

35.2

16.7

39.8

157.5

0.6

36.2

14.3

44.7

147.6

26,000

6,900

10,400

8,700

20,600

60,800

22,000

19,700

19,100

22,300 0.5

82,000 22.0

22,500 11.1

30,600 26.7

29,000 105.7

0.9

30.7

17.6

33.4

133.6

0.8

35.0

15.4

45.3

141.5

11,600

37,700

12,200

13,400

12,100

30
Tabla 2. Number and rata par 1,000 population of nursing home residents, by race, sex, and age: Unitad States, 1973-74, 1977, and

1985—Con.

Residents

Race, sex, and age 1973-747 1977 1985 1973-74~2 19772 19852

Black—Con. Number Rate per 1,000 population

Male:

Under 65 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,000 10,600 13,800 0.6 0.9

65 years And over . . . . . . . . . . . . . . . . . . . . . . . . . .

1.1

13,100 18,800 26,800 18.1 23.0 28.5

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,400 9,200 8,900 11.2 17.2 14.5

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,000 5,400 11,700 19.4 22.9 45.6

85 years and over . . . . . . . . . . . . . . . . . . . . . . . 3,800

Female:

4,200 6,200 92.0 86.7 95.6

Under 65 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,700 10,000 8,500 0.5 0.8 0.6

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . 24,600 42,000 55,200 24.8 36.1 39.4

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,900 12,800 13,500 11.0 17.9 16.0

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,400 14,400 18,900 31.8 40.5 45.1

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . 8,300 14,900 22,800 113,5 158.1 162.7

1Excludes residents in personal care or domiciliary care homes,

‘Population data used to compute ratea for 1973-74 and 1977 are from U.S. Bureau of the Census. Preliminary estimates of the population of the United States, by

age, sex, and race, 1970 to 1981. Current Population Reporta; serlea P-25, no 917. Washington: U.S. Department of Commerce, July 1982. Population data used to

compute rataa for 1985 are from U.S. Bureau of the Census. Estimatea of the population of the United States, by aga, sex, and race, 1980 to 1985. Current

Population Reporw series P-25, no 985. Department of Commerca, Apr. 19S6.

3For data years 1973-74 and 1977 all Hispanic persona ware included In the “white” categoty.

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

31
Table 3. Number of nursing home residents, percent distribution by length of stay since admission, and average and median lengths (of stay,

according to selected characteristics: United States, 1985

Length of stay since admission

3 months 6 months 1 year 3 years Average Median

to less to less to lass to less length of length of

Less than than 6 than 12 than 3 than 5 5 years stay since stay since

Characteristic Residents Total 3 months months months years years or more admission admission

Sex and age

Both sexes, all ages .

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

65 years and over. . . . .

65-i’4 years . . . . . . . . . .

75–84 years . . . . . . .

85 years And over,,...

Male, alleges. . . . . . . . . . .

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

65 years and over. . . . . .

65–74 years, . . . . . . . . .

75–84 years.......,..

85 years and over .,...

Female, all ages. .,......

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

65 years and over. . . . . .

65–74 years . .,,....,,

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

85vears and over . . . . .

Race

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

Another . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . .

Hispanic origin

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

Non- Hlspanlc’ . . . . . . . .

Current marital status

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

widowed’, . . . . . . . . . . . . .

Divorced or separated, . . .

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

Number Percent distribution Number of clavs

1,491,400

173,100

1,318,300

212,100

509,000

597,300

423,800

89,300

334,400

80,600

141,300

112,600

1,067,700

83,800

983,900

131,500

367,700

484.700

1,374,600

116,800

104,400

41,000

1,450,400

188,200

914,800

117,000

271,400

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

12.9

14.2

12,7

15.1

12.7

11.9

15.5

16.5

15.3

16.1

15.3

14.8

11.8

11.8

11.8

14.5

11.7

11.2

13,0

11.6

11.3

14,2

12.9

20.9

11.7

15,8

10.2

9.5 14.1

12.7 12.1

9.0 14.3

10.0 14.3

9.6 15.8

8.2 13.1

9.8 13.8

14,2 11.7

8,6 14.4

7.5 13.1

9.2 16.2

8.5 13.2

9.4 14.2

11.0 12.7

9.2 14.3

11.5 15.1

9.8 15.6

8,1 13.1

9.4 14,1

10.7 14.0

10.6 13.2

*9.1 “12.8

9.5 14,1

12.8 16.5

8.9 14.5

11.0 15.0

8.4 10,5

31.5

24,0

32,5

31.1

33.2

32.4

31.7

24.7

33.6

32.6

33.9

33.9

31.5

23.1

32.2

30.2

33.0

32.1

31,3

34.4

35.8

37.6

31,4

30.1

33.0

29.6

28.3

13.9

13.0

14,0

12.3

13.6

15.0

12,2

11.3

12.5

11.7

11.6

14.1

14.6

14.8

14.5

12.7

14.4

15.2

14.0

13.1

12.8

15.0

13.9

10.6

15.0

13.5

12.6

18.1

24.0

17.3

17.1

15.0

19.4

16.9

21.6

15.7

19.0

13.9

15.5

18.6

26.6

17.9

15.9

15.5

20.3

18.3

16.2

16.4

“11.2

18.3

9.1

16.9

15.1

29.9

1,059

1,311

1,026

1,055

948

1,081

1,031

1,192

987

1,150

912

966

1,070

1,437

1,039

997

962

1,108

1,061

1,037

1,041

928

1,063

675

990

997

1,582

614

654

611

528

554

677

575

563

581

622

522

617

630

838

624

477

560

708

614

599

621

512

614

357

629

538

865

‘Data Include a small number of unknowns

NOTE: Figures may not add to totals because of rounding

32
Tabla 4. Number and percent of nursing home residents by dependency in activities of daily living. sex, and age: United States, 1985

Dependency in activities of daily living

Requires Has difficulty

Requires Requires assistance Requires with bowel Requires

assistance assistance in using assistance in and/or bla alder assistance

Sex and age Total in bathin.q in dressing toilet room transferring control in eatin.q

Both sexes

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

Male

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

85years andcwer . . . . . . . . . . . . . . . . . . .

Female

Al[ ages . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

Both sexes

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

Mala

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

65-74 yeara . . . . . . . . . . . . . . . . . . . . . . .

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

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

Female

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Undar65 yeara . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

1,491,400

173,100

1,318,300

212,100

509,000

597,300

423,800

89,300

334,400

80,600

141,300

112,600

1,067,700

83,800

983,900

131,500

367,700

484,700

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

1,323,200

123,000

1,200,200

179,700

459,800

560,700

349,000

58,600

290,400

61,900

125,000

103,400

974,300

64,500

909,800

117,800

334,800

457,200

88.7

71.1

91.0

84.8

90.3

93.9

82.4

65.6

86.8

76.9

88.5

91.9

91.2

76.9

92.5

89.6

91.0

94.3

1,124,600

101,900

1,022,700

148,800

386,200

487,700

287,300

48,200

239,100

51,700

100,300

87,100

837,200

53,700

783,500

97,100

285,800

400,700

75.4

58.9

77.6

70.2

75.9

81.7

67.8

54.0

71.5

64.2

71.0

77.3

78.4

64.1

79.6

73.8

77.7

82.7

Number

907,600

74,300

833,300

120,000

307,200

406,100

221,400

33,700

187,700

393700

77.900

70,100

686,200

40,600

645,600

80,300

229,300

336,100

Percent

60.9

42.9

63.2

56.6

60.3

68.0

52.2

37.7

56.1

49.3

55.1

62.2

64.3

48.4

65.6

61.0

62.4

69.3

893,400

68,500

824.900

110.400

304,100

410,400

217,800

33,100

184,800

37,500

76,500

70,700

675,600

35,500

640,100

72,900

227,600

339,700

59.9

39.6

62.6

52.1

59.7

68.7

51.4

37.0

55.2

46.6

54.1

62.8

63.3

42.3

65.1

55.4

61.9

70.1

774,400

55,900

718,500

91,000

280,200

347.300

199,700

26,200

173,500

31,300

76,500

65,600

574,700

29,700

545,000

59,700

203,700

281,600

51.9

32.3

54.5

42.9

55.0

58.1

47.1

29.4

51.9

38.9

54.1

58.3

53.8

35.4

55.4

45.4

55.4

58.1

586,300

54,500

531,800

70,900

199,000

261,900

142,000

25,900

116,100

26,500

45,600

44,000

444,300

28,600

415,700

44,400

153,400

217,900

39.3

31.5

40.3

33.4

39.1

43.9

33.5

29.0

34.7

32.9

32.3

39.1

41.6

34.1

42.3

33.8

41.7

45.0

NOTE Figures may not add to totals because of rounding.

33
Table 5. Number and percent distribution of nursing home residents by number of dependencies in activities of daily living, according to sex

and age: United States, 1985

Dependencies in acriwties of daily living

Sex and age Total None 7 2 3 4 5 6

Both sexes

Alleges .,, , . . . . . . . . . . . . . . . . . . .

Under 65 yeara .,...... . . . . . . . .

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

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

75–84 years . . . . . . . . . . . . . . . . . . . . . . . .

B5 years and over . . . . . . . . . . . . . . . . . . .

Male

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

Female

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

75–84 years......,,.....,,.. . . . . . . . . .

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

Both sexes

Alleges, , . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

65years end over . . . . . . . . . . . . . . . . . . . . . . . . . .

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

75–84 years . . . . . . . . . . . . . . . . . . . . . . . . .

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

Male

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

Female

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

75–84 years . . . . . . . . . . . . . . . . . . . . . . . . . .

85yeare and over . . . . . . . . . . . . . . . . . . . . . .

Number

1,491,400

173,100

1,318,300

212,100

509,000

597,300

423,800

89,300

334,400

80,600

141,300

112,600

1,067,700

83,800

983,900

131,500

367,700

484,700

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

146,200

45,800

I 00,400

28,000

43,800

28,500

67,800

28,100

39,700

16,900

15,100

7,700

78,300

17,700

60,600

11,100

28,700

20,800

9.8

26.5

7.6

13,2

8.6

4,8

16.0

31.5

11.9

21.0

10.7

6.8

7.3

21.1

6.2

8,5

7,8

4.3

166,700

20,300

146,500

29,700

59,300

57,500

151,800

21,700

130,100

23,700

49,000

57,500

115,300

12,500

102,800

15,400

44,400

43,100

35,100

6,300

28,800

“4,700

13,300

10,700

B0,200

6,200

74,000

10,600

31,100

32,300

195,600

18,300

177,300

29,300

65,200

82,800

2B4,200

23,600

260,600

35,200

99,000

126,400

431,700

31,000

400,700

50,700

148,400

201,500

52,000

10,100

41,900

10,900

19,600

11,400

44,300

10,800

33,500

8,100

13,500

11,900

51,400

9,300

42,100

10,400

17,900

13,800

72,700

10,300

62,400

11,100

27,400

23,900

100,300

14,400

85,900

18,300

34,500

33,100

114,700

10,200

104,500

18,800

39,600

46,100

107,500

10,900

96,600

15,600

35,500

45,500

144,200

9,000

135,200

18,900

47,300

69,000

211,500

13,300

198,200

24,000

71,600

102,500

331,300

16,600

314,700

32,400

1 ‘14,000

168,400

Percent distribution

10.2 7.7

12,5 7.2

9.9 7.B

11.2 7.3

9.6 8.7

9.6 7.2

11.2

11.7

11,1

14.0

11.6

9.6

13.1

10.6

13.5

13.B

12.8

13,9

19.1

13.6

19.B

16.6

19.4

21.2

28.9

17.9

30.4

23.9

29.2

33.7

12.3

11.3

12.5

13,5

13.9

10.1

10.5 8.3

12.1 7.1

10.0 8.6

10.1 *5.9

9.5 9.4

10.6 9.5

12.1

10.4

12.6

13.0

12.7

12.3

17.2

11,5

18.7

13.8

19.4

21,2

23.7

16.1

25.7

22.7

24,4

29.4

10.7

12.2

10.6

14.3

10.8

9.5

10.1 7.5

13.0 7,4

9.8 7.5

11.8 8.1

9.6 8.4

9.4 6.7

13.5

10.7

13.7

14.4

12.9

14.2

19.8

15.9

20.1

18.3

19.5

21.2

31.0

19,8

32.0

24.6

31.0

34.7

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

34
Table 6. Number and percent distribution of nursing home residents by type of dependency in activities of daily living and number of

dependencies, according to rata and Hispanic origin: United States, 1985

Race Hispanic origin

All NonDependency status Total White other Black Hispanic Hispanicl

Number

All residents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,491,400 1,374.600 116,800 104,400 41,000 1,450,400

1,286,800

1,091,500

881,000

868,000

749,600

566,200

142,700

162,800

148,400

112,000

191,800

276,300

416,400

100.0

88.7

75.3

60.7

59.8

51.7

39.0

9.8

11.2

10.2

7.7

13.2

19.1

28.7

Type of dependency

Requires assistance in bathing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Requires assistance undressing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Requires assistance in using toilet room . . . . . . . . . . . . . . . . . . . . . .

Requires assistance in transferring . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Has difficulty with bowel and/or bladder control. . . . . . . . . . . . . . . . . .

Requires assistance id eating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

105,900 95,300

93,400 84,400

73,800 67,200

74,600 68,300

61,500 56,700

50,700 47,000

36,400

33,100

26,600

25,500

24,800

20.100

1,323.200

1,124,600

907,600

893,400

774,400

586.300

,217.300

,031,200

833,800

818,900

712,900

-S35.600

Number of dependencies

46,200

66,700

51,800

15,300

95,600

136,400

157,700

141,000

102,600

178,200

262,700

396,000

9,800 7,900

9,000 7,600

10,800 9,500

12,700 11,300

17,400 15,000

21,500 19,600

35,700 33,400

Percent distribution

100.0 100.0

‘3,500

*3,900

“3,400

*3,300

“3,800

7,900

15,200

284,200

431,700

All residents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0

Type of dependency

Requires assistance in bathing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Requires assistance indresaing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Requires assistance in using toilet room . . . . . . . . . . . . . . . . . . . . . .

Requires assistance in transferring . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Haa difficulty with bowel and/or bladder control. . . . . . . . . . . . . . . . . .

Requires assistance id eating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

88.7

75.4

60.9

59.9

51.9

39.3

88.6

75.0

60.7

59.6

51.9

39.0

90.7 91.3

80.0 80.9

63.2 64.4

63.8 65.5

52.7 54.3

43.4 45.0

88.9

80.7

65.0

62.2

60.4

49.1

Number of dependencies

9.8

11.2

9.9

11.5

10.3

7.5

13.0

19.1

28.8

8.4 7.6

7.7 7.3

9.2 9.1

10.8 10.8

14.9 14.4

18.4 18.8

30.6 32.0

*8.6

*9.5

*8.3

‘8.0

*9.3

19.1

37.2

10.2

7.7

13.1

19.1

28.9

I Data include a small number of unknowns.

NOTC Figures may not add to totals because of rounding.

35
Table 7. Number and percent of nursing home residents by selected most frequent primary diagnoses at time of survey, according to sex

and age: United States, 1985

Sex, age, primary diagnosis, and Nurs/rrg home

ICD–9–CM codel residents

Both sexes, all ages

Hesrt disease. . . . . 391-392.0, 393–398, 402,

404, 41 O–429

Ischemic heart disease. . . . . . . 410–414

Congestive haart failure . . . . . . . . . . . ...428.0

Other heart disease . . ...391-398. 402, 404,

415, 420–427, 428,1 –429,9

Cerebrovascular disease. . . . . . . . . . ...430-436

Organ lcbram syndrome. ,, ...,. . . . . . . . ...310

Psychoses other than senile

dementia, . . . . . . . . . . . . . . . . . . . . . . .291–299

Diabetes mellitus . . . . . . . . . . . . . . . . . . . ...250

Arthritis or rheumatism, . . ..71 0–71 6, 729.0

Essential hypertension, . . . . . . . ..401 . . . . ..4Ol

Senile dementia . .,, , . . . . . . . . . . . . . .,..,,290

Chronic obstructive pulmonary d!sease and

allied conditions . . . . . . . . .490-496

Alzhelmar’s disease and other spec!fred

and unspecified degeneration of the

brain . . . . . . . . . . . . . . . . . ..33l.O. 331.2, 331,9

Mental retardation, ... , . . . . ..317 . . ..3l7–3l9

Atherosclerosis . . . . . . . . . . . . . . . . . ,,, ..,..440

Parkinson’s disease . . . . . . . . . . . . . ,, . . . ...332

Malignant neoplasms . . . . . 140–208

Other mental disorders. . .300-309, 31 1–31 6

Fracture ofneck of femur....,,,. , . . . . ...820

Other fractures. . . . . . . . . .800 -819, 821–829

Both sexes, under 65 years

Psychoses other than senile

dementia . . . . . . . . . . . . . . . . . . . . . .,.291 –299

Mental retardation,,..,....,,. ., . ...317-319

Cerebrovascular disease . . . . . . . . 430–436

Other mental d[sorders, . ..300-309. 311-316

Diabates mellitus .,, . . . . . . . . . . . . . . . . . ...250

Organ lc brain syndrome. .,,,..... . ...,,..310

Both sexes, 65 years and over

Heart disease . . . 391–392.0, 393–398, 402,

404, 41 O–429

Ischemlc heart disease. . . . . . . . 410-414

Congestive heart failure . . . . . . ...428.0

Other heart disease 391–398, 402, 404,

415, 420–427, 428.1 –429.9

Cerebrovascular disease . . . . . . 430–436

Organ ic brain syndrome. .,,...... .,, ,. ...310

Arthritis or rheumatism. ., . . . . . 710–716, 729.0

Diabetes mallitus . . . . . . . . . . . . . . .,,,.....250

Psychoses other than senile

damentta, ..,..,,....,.....,.. . ..291-299

Essential hypertension ., . . . . . ..401 . . . . . ..4Ol

Alzheimer’s disease and other specified and

unspecified degeneration of the

brain .,, ... . . . . . . . . . . . ..33l.O.33l .2,331.9

Senile dementia . . . . . . . . . . . . . . . . . . . . . ...290

Chronic obstructwe pulmonary disease and

allied conditions ., . . . . . . . . 490–496

Atherosclerosis .,, ., . ...,...,. . ...,.....440

Parkinson’s disease . . . . . . . . . . . . . . ,, . . ...332

Malignant neoplasms . . . 140-208

Fracture ofneck of femur, . . . . . .,, . . . . ...820

Other mental disorders. . . 300–309, 31 1–31 6

Other fractures. . . . 800–819, 821–829

Mental retardation, , . . . . . . . . . . . ... ,317–319

Number Percent

234,100

116,900

46,900

70,300

153,700

133,400

86,700

66,000

61,900

49,900

44,000

39,600

45,800

34,900

33,700

33,200

31,900

31,600

26,600

15,900

37,700

23,100

11,000

8,900

8,500

6,700

230,000

114,800

46,200

69,000

142,700

126,800

60,700

57,500

49,100

44,900

43,600

43,200

38,000

33,400

30,600

29,900

25,000

22,800

14,900

11,800

15.7

7.8

3.1

4.7

10.3

8.9

5.8

4.4

4.1

3.3

2.9

2.7

3.1

2.3

2,3

2.2

2,1

2.1

1.8

1,1

21,8

13,3

6.3

5.1

4,9

3.9

17,4

8,7

3.5

5.2

10.8

9.6

4.6

4.4

3,7

3,4

3.3

3.3

2.9

2.5

2.3

2,3

1,9

1.7

1.1

0.9

Sax, aga, primary diagnosis, and Nursing home

ICD–9-CA4 code~ residents

8oth sexes, 65-74 years

Cerebrovascular diaeaae . . . . . . . . . . . ..430-436

Psychoses othar than senile

dementia . . . . . . . . . . . . . . . . . . . . . ...291-299

Heart disease . . . . . . . . . . 391 -392.0. 393–398,

402, 404, 410-429

Ischemlc heart disease, . . . . . . ...410-414

Other heart disease. . . . . . . . 391–398, 402,

404, 415, 420–427, 428.1 -429.9

Organic brain syndrome. . . . . . . . . . . . . . . ...310

Chronic obstructive pulmonary disease and

allledcondmons . . . . . . . . . . . . . . . . . . . 490–496

Alzhelmer’s disease and other specified and

unspecified degeneration of the

brain . . . . . . . . . . . . . . . . . ..33l.O. 331 .2,331.9

Diabetes mellltus . . . . . . . . . . . . . . . . . . . . ...250

Mental retardation . . . . . . . . . . . . . . . . ..317–319

Other mental disorders. . . 300–309, 311-316

Both sexes, 75-84 years

Heart diseasa . . . . . 391-392.0, 393-398, 402,

404, 410-429

Ischemic heart disaase. . . . . . . . . ...410-414

Congestive heart failure . . . . . . . . . . . ...428.0

Other heart disease . . ...391-398. 402, 404,

415, 420-427, 428.1 -429.9

Cerebrovaacular disaase. . . . . . . . . . ...430-436

Organ lcbrain ayndroma . . . . . . . . . . , . . . . ...310

Diabetes mellitus .,.......,,. . . . . . . . . ...250

Arthritis or rheumatism. . . . . . 710–716, 729.0

Alzhelmer’s disease and other specified and

unspecified degeneration of the

brain . . . ..331 . . . . . . . . . ..33l.O. 331.2, 331.9

Senile dementia . . . . . . . . . . . . . . . .,.......290

Chronic obstructive pulmonary disease and

allledcondltlo no . . . . . . . . . . . . . . . . 490–496

Essential hypartansion . . . . . . . . . . . . . . . . ...401

Psychoses other than senile

dementia . . . . . . . . . . . . . . . . . . . . . ...291-299

Mallgnant neoplasms . . . . . . . . . . . . ...140-208

Parkinson’a disease . . . . . . . . . . . . . . . . . . ...332

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . ...440

Fracture ofneck of femur . . . . . . . . . . . . . ...820

Both sexes, 85 years and over

Heart disease . . . . . . . . . . 391–392.0, 393-398,

402, 404, 410-429

Ischemic heart disease. . . . . . . . .410–414

Congestive heart failure . . . . . . . . . . . ...428.0

Other heart disease . . . 391–398, 402, 404,

415, 420-427, 428.1 –429.9

Organic brain syndrome . . . . . . . . . . . . . . . ...310

Cerebrovascular diseasa. . . . . . . . . . ...430-436

Arthritis or rheumatism. . . . . . . 710–716, 729.0

Essential hypertension . . . . . . . . . . . . . . . . ...401

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . ...440

Senile damentia . . . . . . . . . . . . . , . . . . . . . ...290

liabetes mellitus . . . . . . . . . . . . . . . . . . . . ...250

‘racture ofneck of femur. ,, . . . . . . . . . . ...820

~lzheimer’s disease and other specified and

unspecified degeneration of the

brain . . . . . . . . . . . . . . . . . ..33l.O. 331.2, 331.9

%ychoses other than senile

dementia . . . . . . . . . . . . . . . . . . . . . . ..291 –299

)ther fractures. . . . . . . . . ...800-819. 821–829

Number

25,900

21,900

19,900

10,700

6,900

4,100

2,500

1,500

1,200

6,800

6,300

Percent

12.2

10.3

9.4

5.1

3.2

6.7

5.9

5.4

5.3

3.2

3.0

72,600

34,100

16,400

22,100

61,700

53,300

28,800

21,400

19,700

18,600

17,000

16,500

16,000

15,700

15,000

9,500

7,300

137,500

69,900

27,600

40,000

59,300

55,100

34,900

22,800

22,600

20,000

17,500

16,000

2,400

1,200

0,500

14.3

6.7

3.2

4.3

12.1

10.5

5.7

4.2

3.9

3.7

3.3

3,2

3.1

3.1

2.9

1.9

1.4

23.0

11.7

4.6

6.7

9.9

9.2

5.8

3.8

3.8

3.4

2.9

2.7

2.1

1.9

1.8

lDlagnost!c groupings and code number !ncluslons ara based on the International Class! flcatlon of Dlseaaes, 9th Rewsion, cllnical modification.

36
Table 7. Number and percent of nursing home residents by selected most frequent primary diagnoses at time of survey, according to sex

and age: United States, 1985—Con,

Sex, age, primary diagnosis. and Nursing home

ICD-9-CM code~ residents

Both sexes, 85 years and over—Con.

Malignant neoplasms . . . . . . . . . . . . ...140-208

Chronic obstructive pulmona~ disease and

allied conditions . . . . . . . . . . . . . .490-496

Male, all ages

Heart disease . . . . . . 391-392.0, 393-398, 402,

404, 41 O–429

Ischemic heart disease . . . . . . . . . . ..41 O-4l4

Congestive heart failure . . . . . . . . . . . . ..428.O

Other heart disease . . ...391-398. 402, 404,

415, 420-427, 428.1 -429.9

Cerebrovascular disease. . . . . . . . . . ...430-436

Psychoses other than senile

dementia . . . . . . . . . . . . . . . . . . . . . ...291-299

Organic brain syndrome . . . . . . . . . . . . . . . ...310

Chronic obstructive pulmonary disease and

allied conditions . . , . . . . . . . . . . . . . . .490-496

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . ...250

Mental retardation . . . . . . . . . . . . . . .,..317-319

Alzheimer’s diseaae and other specified

and unspecified degeneration of the

brain. . . . . . . . . . . . . . . . . . . 331.0, 331.2, 331.9

Other mental disorders . . . ..309 .3O9. 311-316

Malignant neoplasms . . . . . . . . . . . . ...140-208

Parkinson’s disease . . . . . . . . . . . . . . . . . . ...332

Senile dementia . . . . . . . . . . . . . . . . . . . . . ...290

Essential hypertension . . . . . . . . . . . . . . . . . ..4Ol

Arthritis or rheumatism. . . . . ...710-716. 729.0

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . ...440

Male, under 65 years

Psychoses other than senile

dementia . . . . . . . . . . . . . . . . . . . . . . ..291-299

Mental retardation . . . . . . . . . . . . . . . ...317-319

Other mental disorders. . ...300-309. 31 1–316

Cerebrovascular disease. . . . . . . . . . ...430-436

Male, 65 years and over

Heart disease. . . . . . 391-392.0, 393-398, 402,

404, 410-429

Ischemic heart disease. . . . . . . . . ...410-414

Congestive heart failure . . . . . . . . . . . ...428.0

Other heart disease . . ...391-398. 402, 404,

415, 420-427, 428.1 -429.9

Cerebrovascular disease. . . . . . . . . . ...430-436

Organic brain syndrome . . . . . . . . . . . . . . . . ..31 O

Chronic obstructive pulmonary disease and

allied conditions . . . . . . . . . . . . . . . ...490-496

Psychoses other than senile

dementia . . . . . . . . . . . . . . . . . . . . . . ..291-299

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . ...250

Malignant neoplasms . . . . . . . . . . . . ...140-208

Alzheimer’s disease and other specified and

unspecified degeneration of the

brain . . . . . . . . . . . . . . . . . ..33l.O. 331.2, 331.9

Parkinson’s disease . . . . . . . . . . . . . . . . . . ...332

Senile dementia . . . . . . . . . . . . . . . . . . . . . ...290

Arthritis or rheumatism. . . . . ...710-716. 729.0

Other mental disorders. . ...300-309. 311-316

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . ...440

Essential hypertension . . . . . . . . . . . . . . . . ...401

Number Percent

10,100

8,500

52,300

26,100

8,800

17,400

43,500

33,600

31,500

178500

17,300

17,000

13,900

13,600

13,500

11,600

9,300

9,100

7,700

7,200

19,000

12,600

6,000

5,900

50,100

24,800

8,800

16,600

37,500

27,100

17,500

14,600

13,800

12,500

12,500

10,700

9,000

7,700

7,500

7,200

6,800

1.7

1.4

12.3

6.2

2.1

4.1

10.3

7.9

7.4

4.1

4.1

4.0

3.3

3.2

3.2

2.7

2.2

2.1

1.8

1.7

21.3

14.1

6.7

6.7

15.0

7.4

2.6

5.0

11.2

8.1

5.2

4.4

4.1

3.7

3.7

3.2

2.7

2.3

2.3

2.1

2.0

Sex, age, primary diagnosis, and Nursing home

ICD-9-CM codel residents

Male, 65-74 years

Cerebrovascular disease . . . . . . . . . . ...430-436

Psychoses other than senile

dementia . . . . . . . . . . . . . . . . . . . . . ...291-299

Heart disease. . . . . . 391-392.0, 393-398, 402,

404, 410-429

Chronic obstructive pulmonary disease and

allied conditions. . . . . . . . . . . . . ...490-496

Male, 75-84 years

Heart disease. . . . . . 391-392.0, 393-398, 402,

404, 410-429

Ischemic heart diseasa. . . . . . . . . ...410-414

Other heart disease . . ...391-398. 402, 404,

415, 420-427, 428.1 –429.9

Cerebrovascular disease . . . . . . . . . . ...430-436

Organic brain syndrome . . . . . . . . . . . . . . . ...310

Malignant neoplasms . . . . . . . . . . . . ...140-208

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . ...250

Chronic obstructive pulmonary disease and

allied conditions . . . . . . . . . . . . . . ...490-496

Male, 85 years and over

Heart disease . . . . . . 391-392.0, 393–398, 402,

404, 410-429

Ischemic heart disease. . . . . . . . . ...410-414

Other heat-i disease . . ...391-398. 402, 404,

415, 420-427, 428.1 -429.9

Organic brain syndrome . . . . . . . . . . . . . . . ...310

Cerebrovascular disease. . . . . . . . . . ...430-436

Female, all ages

Heart disease . . . . . . 391-392.0, 393-39B, 402,

404, 410-429

Ischemic heart disease, . . . . . . . . ...410-414

Congestive heart failure . . . . . . . . . . . ...428.0

Other heart disease . . ...391-398. 402, 404,

415, 420-427, 428.1 -429.9

:erebrovascular disease. . . . . . . . . . ...430-436

3rganic brain syndrome . . . . . . . . . . . . . . . ...310

!rthritis or rheumatism. . . . . ...710-716. 729.0

%.ychoses other than senile

dementia . . . . . . . . . . . . . . . . . . . . . ...291-299

)iabetes mellitus . . . . . . . . . . . . . . . . . . . . ...250

%sential hypertension . . . . . . . . . . . . . . . . . ..4Ol

:enile dementia . . . . . . . . . . . . . . . . . . . . . ...290

Nzheimer’s disease and other specified and

unspecified degeneration of the

brain . . . . . . . . . . . . . . . . . ..33l .0,331 .2,331.9

atherosclerosis . . . . . . . . . . . . . . . . . . . . . . ...440

:hronic obstructive pulmonary disease and

allied conditions . . . . . . . . . . . . . . . . ..490-496

‘racture ofneck of femur.. . . . . . . . . . . . ...820

‘arkinson’s disease . . . . . . . . . . . . . . . . . . ...332

Malignant neoplasms . . . . . . . . . . . . ...140-208

)ther mental disorders . . ...300-309. 311-316

ulental retardation . . . . . . . . . . . . . . . ...317-319

)ther fractures. . . . . . . . . ...800-819. 821-829

Female, under 65 years

%+ychoses other than senile

dementia . . . . . . . . . . . . . . . . . . . . . ...291-299

vlental retardation . . . . . . . . . . . . . . . ...317-319

Percent

9,600

7,900

7,200

6,300

19,700

7,900

6,900

17,600

12,500

8,000

7,500

6,500

23,300

13,900

6,800

11,000

10,400

181,800

90,700

38,200

52,900

110,200

101,900

54,100

53,100

48.700

40<900

34,700

31,900

26,500

22,100

21,900

21,700

18,400

18,100

17,800

14,400

18,600

10,500

11.9

9.9

8.9

7.8

13.9

5.6

4.9

12.5

8.8

5.7

5.3

4.6

20.7

12.3

6.0

9.8

9.2

17.0

8.5

3.6

5.0

10.3

9.5

5.1

5.0

4.6

3.8

3.3

3.0

2.5

2.1

2.0

2.0

1.7

1.7

1.7

1.4

22.2

12.5

1Diagnostic groupings and code number inclusions are baaed on the International Claaaification of Diseasea, 9th Revision, clinical modification.

37
Table 7. Number and percent of nursing home residents by selected most frequent primary diagnoses at time of survey, according to sex

and age: United Ststes, 1985— Con.

Sex, age, primary diagnosis, and Nursing home

ICD-9–CM code 1 residents

Female, 65 years and over

Heart disease . . . . . . 391-392.0, 393–398, 402,

404, 410-429

Ischemic heart disease. . . . . 410–414

Congestwe haartfallure . . . . ..428 . . . ..428.O

Other hesrtdisease . . ...3398.98, 402,404,

415, 420–427, 428,1 –429.9

Carebrovascular disease . . . . . . . . . . ...430-436

Organic brain syndrome . . . . . . . . .,, . . . . ...310

Arthrmso rrheumatlsm . . . . . . ..71 O-7l6. 729.0

Diabetes mallitus . . . . . . . . . . . . . , . . . . . . ...250

Essential hypertension . . . . . . . . . . . . . . . . . ..4Ol

Psychoses other thsn senile

dementia . . . . . . . . . . . . . . . . . . . . . . ..291 –299

Saniledementla . . . . . . . . . . . . . . . . . . . . . ...290

Alzheimer’s disease and otharspeclfied and

unspecified degeneration of the

brain . . . . . . . . . . . . . . . . . ..33l .0,331 .2,331.9

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . ...440

Fracture ofneck of femur . . . . . . . . . . . . . ...820

Chronic obstructive pulmonary disease and

allied conditions . . . . . . .490–496

Parkinson’s disease . . . . . . . . . . . . . . . . . . ...332

Malignant neoplasms, ,,, ... . ..140 ..l4O-2O8

Other mental disorders. . ...300-309. 311-316

Other fractures. ., . . . . . . 800–81 9, 821-829

Mental retardation . . . . . . . . . . . . . . . . ..317–319

Female, 65-74 years

Cerebrovascular disease. . . . . . . . . . ...430-436

Psychoses other than senile

dementia, . . . . . . . . . . . . . . . . . . , . ...291-299

Heart disease . . . 391-392.0, 393-398, 402,

404, 41 O–429

Ischemic heart disease. . . . . . ..410-414

Organ icbraln syndrome . . . . . . . . . . . . . . . ...310

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . ...250

Alzheimer’s disease and other spacifled and

unspecified degeneration of the

brain . . . . . . . . . . . . . . . . . ..33l .0,331 .2,331.9

Chronic obstructive pulmonary disease and

allied conditions . . . . .490-496

Female, 75-84 years

Heart disease . . ...391 –392.0, 393-398, 402,

404, 410-429

Ischemic haart. . . . . . . . . . . . . . . . ...410-414

Congestive haart failure . . . . . . . . . . . ...428.0

Other haart disease . . ...391-398. 402, 404,

415, 420-427, 428.1 –429,9

Number

179,900

90,000

37!500

52,500

105,200

99,600

52,900

43,700

38,100

34,500

34,200

31,100

26,200

21,400

20,400

19,800

17,400

15,200

13,900

7,300

16,400

13,900

12,700

7)700

10,500

9,400

7,000

6,200

52>900

26,200

11,500

15,200

Percent

18,3

9.1

3.8

5.3

10.7

10.1

5,4

4,4

3.9

3.5

3.5

3,2

2,7

2.2

2.1

2.0

1.8

1.5

1,4

0.7

12.4

10.6

9.7

5.8

8.0

7.1

5,3

4.7

14.4

7,1

3,1

4.1

Sex, age, prima~ diagnosis, and Nursing home

ICD–9-CIVI codel residents

Female, 75-84 years—Con,

Cerebrovascular disease. . . . . . . . . ...430-436

Organic brain syndrome . . . . . . . . , . . . . . . ...310

Diabetes mellitus, . . . . . . . . . . . . . . . . . . . ...250

Arthritis or rheumatism. ., . ...710-716. 729.0

Alzheimer’s disease and other specified and

unspecified degeneration of the

brain . . . . . . . . . . . . . . . . . ..33l.O. 331 ,2,331,9

Senile dementia ., . . . . . . . . . . . . . . . . . . . ...290

Essential hypertension . . . . . . . . . . . . . . . . . ..4o1

Psychoses other than senile

dementia . . . . . . . . . . . . . . . . . . . . . ...291-299

Chronic obstructive pulmonary disease and

allied conditions . . . . . . . . . . .490–496

Parkinson’s disease . . . . . . . . . . . . . . . . . . ...332

Other mental disorders. ., ., 300-309, 311-316

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . ...440

Fracture ofneck of femur . . . . . . .,......,,820

Female, 85 yaars and over

Heart diseasa . . . . 391-392.0, 393-398, 402,

404, 410-429

Ischemic heart disease. . . . . . . . . .. 410-414

Congestive heart failure . . . . . . . . . . . . .428.0

Other heart disease . . ...391-398. 402, 404,

415, 420-427, 428.1 -429,9

Organic brain syndrome . . . . . . . . . . . . . . . ...310

Cerebrovascular disease. . . . . . . . . . ...430-436

Arthritis or rheumatism. . . . . ...710-716. 729.0

Essential hypertension . . . . . . . . . . . . . . . . . ..4Ol

Atherosclerosla . . . . . . . . . . . . . . . . . . . . . . ...440

Senile dementia . . . . . . . . . . . . . . . . ., . . . ...290

Fracture of neck of femur . . . . . . . . . . ..’ . . ..82O

Diabetes mellitus . . . . . . . . . . . . . , . . . . . . ...250

Other fractures. . . . . . . . . . . . 800–819, 821-829

Alzheimar’s disease and other specified and

unspecified degeneration of the

brsin . . . . ..331 . . . . . . . ..331.0.331 .2. 331.9

Psychoses other than senile

dementia . . . . . . . . . . . . . . . . . . . . . ...291-299

Malignant neoplasms . . . . . . . . . . . . ...140-208

Parkinson’s disease, . . . . . . . . . . . . . . . . . ...332

Number Percent

44,100

40,900

21,300

178900

15,300

14;800

13,600

12,200

10,500

9,700

8,500

7,800

6,100

114,200

56,100

24,900

33,300

48,300

44,700

31,400

20,300

17,900

16,500

14,100

13,100

9,800

8,800

8,300

7,200

6,700

12.0

11.1

5.8

4.9

4.2

4.0

3.7

3.3

2.9

2.6

2.3

2,1

1,6

23.6

11.6

5.1

6.9

10,0

9.2

6.5

4.2

3.7

3.4

2.9

2.7

2.0

1.8

1.7

1.5

1.4

lDlagnost)c groupings snd code number lncluamns are bssed on the International Class! ficatlon of Drsaases, 9th Ravisi on, clinrcal modification,

38
Table 8. Average length of stay since admission of nursing home residents, average monthly charge, and average number of dependencies in

activities of daily living, by primary diagnosis at time of survey: United States, 1985

Average length of

stay since admission Average monthly Average number of

Primary diagnosis and lCD-9-CM code~ in days charge dependencies

Allcategorles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chapter 2. Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 140-239

Malignant neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-208

Chapter 3. Endocrine, nutritional, and metabolic diseases and immunity

disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..240-279

Diabetes mellitus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250

Chapter 5. Mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-319

Senile demantia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290

Other psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291-299

Specific non psychotic mental disorders due to organic brain damage . ...310

Mental retardation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 317-319

Other mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . ...300-309. 311-316

Chapter 6. Diseases of the nervous system and sense organs. . . . . ...320-389

Alzheimer’s disease and other specified and unspecified degeneration

of the brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331 .0,331.2,331.9

Parkinson’s disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...332

Chapter 7. Diseases of the circulatory system . . . . . . . . . . . . . . . . . . . . .390-459

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...401

Heart disease . . . . . . . . . . . . . . . . . 391-392.0, 393-398,402,404,410-429

Ischemic heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 410-414

Congestive haart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...428.0

Other hearl disease . . . . . . . . . . . . . ...391-398. 402, 404, 415, 420-427,

428.1 -429.9

Cerebrovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 430-436

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...440

Chapter8. Diseases of the respiratory system . . . . . . . . . . . . . . . . . . ...460-519

Chronic obstructive pulmonary disease and allied conditions . . . . . ..49 O-496

Chapter9. Diseases of the digestive system . . . . . . . . . . . . . . . . . . . ...520-579

Chapter IO. Diseases of the genitourinary system . . . . . . . . . . . . . . . ...580-629

Chapter 12. Disaases of the skin and subcutaneous tissue . . . . . . . ...680-709

Chapter 13. Diseases of the musculoskeletal system and connective

tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...710-739

Arthritis or rheumatism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...710-71 6,729.0

Chapter 16. Symptoms, signs, and ill-defined conditions . . . . . . . . . . ..78 O-799

Chapter 17. injury and poisoning.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-999

Fracture ofneck of femur . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...820

Other fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...800-81 9,821-829

All other diagnoses . . . . . . . . . . . . . . . . 001-139, 280-289, 740-759, VOI -V82

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

1,059

746

779

998

1,088

1,361

1,148

1,299

1,165

2,707

1,170

1,098

620

951

994

961

1,031

1,108

927

974

850

1,359

708

747

847

733

1,120

1,113

1,126

1,071

566

694

511

1,017

932

$1,456

1,421

1,420

1,448

1,436

1,379

1,599

1,259

1,506

1,089

1,188

1,568

1,615

1,498

1,461

1,255

1,471

1,550

1.401

1,385

1,564

1,216

1,558

1,548

1,447

1,616

1,423

1,471

1,380

1,416

1,683

1,608

1,563

1,510

1,166

3.8

4.0

3.9

3.8

3.7

3.4

4.5

2.1

4.4

2.6

2.0

4.5

4.9

4.6

3.9

3.3

3.7

3.7

3.5

3.6

4.5

3.6

3.2

3.0

3.6

4.4

4.1

3.6

3.4

3.8

4.1

4.5

4.0

3.6

2.1

IDmgnost!c group!ngs and code number inclusions ara based on the International Classlfwat!on of Dw+eases, 9th Rawsion, clin!cal modlfmation.

39
Table9. Number of all-listed diagnoses of nursing home residents at time of survey by age and sex: United States, 1985

Age

65 years and over

Under 65 85 years

Sex, all-listed diagnoses, andlCD-9–CM codel Total years Total 65–74 years 75-84 years ar over

Both sexes

Alldlagnoses . . . . . . . . . . . . . . . . . . . . .

Chapter 2. Neoplasms .,,,......,,. . . . . . . . ...140-239

Malignant neoplasm s, . . . . . . . . . . . . . . ..140–208

Chapter3. Endocrine, nutrltlonal, and metabolic diseases

and Immunity dmorders .240-279

Dlabetesmell!tus. . . . . . . . . . . . . . ...250

Chapter4. Dlseasesof the blood and blood-forming

organ s,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...280-289

Anemias. . . . . . . . .,, . . . ...280-285

Chapter5. Mental disorders . . . . . . . . . . . . . . . . . 290-319

Senile dementia ororganlc brain syndrome . ..290. 310

Psychoses other than senile dementia. .291 -299

Neurotic and perso,~allty disorders. . . . . . ...300-301

Mental retardation 317-319

Other mental disorders . . . . . 302’:309:311-316

Chapter6. Diseases of the nervous system and sense

organs ...,,,.....,,,.. . .,........,....,,320-389

Alzheimer’s disease and other specified and unspecified

degeneration of the brain.....,..33l.O, 331.2, 331.9

Parkinson’s disease.,,,,.. . . . . . . .,,,,.....332

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...365

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...366

Chapter7. Diseases of theclrculatory system . ..390-459

Essential hypertension . . . . . . . , . . . . . . . . . . . . . . ...401

Heart disease . . . 391-392.0, 393–398, 402, 404,

410-429

Ischemic heart disease ,, ...,..,,,.....,.410-414

Congestive heart failure . . . . . . . . . . . . . . . . . . ...428.0

Other heart disease . . . 391–398, 402, 404, 415,

420–427, 428.1 –429.9

Cerebrovascular disease, . . . . . . . . . . . . . 430-436

Atherosclerosis, . . . . . . . . . . . . . . . . . . . ..440

Chapter8. Diseases of the respiratory system . ..46519l9

Chrormc obstructive pulmonary disease and allled

conditions . . . . . . . . . . . . . . .,, . . . . . . . . . . ...490-496

Chapter9. Dtseases of thedlgestive system . ...520-579

Ulcer of stomach, duodenum, peptic ulcer, orunspeclfled

site . . . . . . . . . . . . . . .,, . . . . . . . . . . . . ...531-534

Chapter IO. Diseases of the genitourlnary

system . . . . . . . . . . . . . ., . . ...580-629

Urinary tract infection . . . . . . . . , . . . . . . . . . . . . ...599.0

Chapter 12. Diseases of the skin and subcutaneous

tissue . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . ...680-709

Chapter 13. Dleeases of the musculoskeletal system and

connective tissue...,,, . . . . . . . . . . . . . . . . . ...71 O-739

Arthritis orrheumatlsm . . . . . . . ..710 –713. 716, 729.0

Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . . . . . ..733.0

Chapter 16. Symptoms, s!gns, and ill-defined

condition s .,, , . . . . . . . . . . . . . . . . . . . . . . . . . ...780-799

Senility wrthout psychoses. . .,,,...............797

Chapter 17. Injury and poison ing . . . . . . . . . . . ...800-999

Fracture ofneck of femur . . . . . ., . . . . . . . . . . . . . ...820

Other fracturea 800–819,821-829

Supplementary class jflcations. . . . . . . . . .. VO1-V82

Persons with potential health hazards related to petsonal

and famllyh[story . . . . . . . . . . . . . . . . . . . . . .. V1 O-VI 9

Persons with a condltlon Influencing their health

status, . . . . . . . V40-V49

Number

4,495,500 703,300

14,500

12,900

54,000

35,100

10,100

8,700

114,200

4,977,700

96,900

82,600

293,300

186,200

75,300

70,600

690,100

357,900

770,400

36,100

50,600

75,200

509,400

73,900

70,900

35,800

45,900

1,520,800

233,600

814,400

395,600

159,400

259,400

291,800

111,400

153,400

111,100

201,400

24,300

133,000

58,000

53,700

429,300

271,500

49,100

267,500

57,400

100,700

39,100

35,600

377,500

230,800

132,600

1,368,300

34,800

31,900

476,300

7,100

5,900

30,300

20,500

“4,200

‘4,200

124,300

16,800

51,500

10,700

29,900

15,400

80,700

“3,200

“4,200

‘1,100

*1 ,800

72,800

21,500

29,000

14,200

*5,1OO

9,700

17,800

*1 ,800

11,700

1,696,300

36,600

31,400

119,300

74,600

23,200

21,400

228,400

135,500

44,800

11,800

7,200

29,100

165,600

32,000

32,600

10,200

12,100

519,000

85,400

267,300

130,200

55,800

81,300

111,200

32,500

59$700

43,900

69,300

9,100

46,400

22,200

17,500

141,500

88,000

16,400

88,400

16,200

28,300

11,100

9,900

131,900

81,800

44,700

464,900

17!900

16,600

2,C)95,900

38,800

32,300

89,700

56,000

37,800

36,400

223,200

165,700

34,900

8,100

*1,100

13,300

179,100

22,700

22,100

20,300

28,000

741,700

95,400

434,000

207,100

84,000

142,900

115,200

64,200

52,600

34,800

94,700

10,800

55,700

25,500

19,900

222,400

151,300

28,500

101,400

35,700

54,400

24,400

20,400

164,200

103,900

54,5(30

3!35,500

8,500

7,400

89,800

76,700

263,000

165,700

71,200

66,400

565,700

341,100

118,800

25,300

20,700

59,800

39,900

39,200

“5,400

12,300

17!400

428,600 83,900

70,700

66,800

34,700

44,100

1,448,000

212,000

785,400

381,400

154<300

16,000

12,100

“4,200

“4,000

187,300

31,100

84,100

44,100

14,500

249,700

274,000

109,600

141,700

25,600

47,700

13,000

29,400

8,000

5,000

1,500

1,000

3,300

6,100

103,100

186,500

24,400

22,400

22.900 “3,000

122,000

54,600

19,900

6,900

47,600

410,300

265,000

48,000

10,100

19,000

6,500

“1 ,000

46,400

25,700

“3,200

41,900

“3,800

7,100

*2,000

“3,100

49,700

35,800

“1,700

10,900

*1 ,600

‘2,1 00

31,700

231,700

55,700

89,800

37,500

33,500

345,800

17,100 213,800

119,200

28,100

13,400 20,100

Male

Alldlagnoses . . . . . . . . . . . . . . . .

Chapter 2. Neoplasms. . . . . . . . 140-239

Mallgnantneoplasms ,, . . . . . . . . ...140-208

237,500 1,130,800

“3,700 31,100

“3,500 28,500

270,300

“4,700

“4,400

See footnote and notes at end of table

40
Table 9, Number of all-listad diagnoaes of nursing home residents at time of survey by age and sex: United States, 1985—Con.

Age

65 years and over

Under 65 85 years

Sex, all-listed diagnoses, and ICD-9–CM codex Total years Total 65-74 years 75–84 years or over

Male—Con.

Chapter 3. Endocrine, nutritional, and metabolic diseases

and immunity disorders . . . . . . . . . . . . . . . . . . ...240-279

Diabetes mellitua . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..25(I

Chapter 4. Disaases of the blood and blood-forming

0r9ans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...280-289

Anemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...280-285

Chapter 5. Marital disorders . . . . . . . . . . . . . . . ...290-319

Senile dementia or organic brain syndrome . ..290. 310

Psychoses other than senile dementia. . . . . ...291-299

Neurotic and personality disorders. . . . . . . . ...300-301

Mental retardation . . . . . . . . . . . . . . . . . . . . . ...317-319

Other mental disordera . . . . . . . . ...302-309. 311-316

Chapter 6. Diseases of the nervous system and sense

organs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...320-389

Alzheimer’s disease and other specified and unspecified

degeneration of the brain . . . . . ...331.0. 331.2, 331.9

Parkinson’s disease . . . . . . . . . . . . . . . . . . . . . . . . . ...332

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...365

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...366

Chapter 7. Diseases of the circulatory system. . ..390-459

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . ...401

Heart disease . . . . . . . . 391-392.0, 393-398, 402, 404,

410-429

lschemic heart disease . . . . . . . . . . . . . . . ...410-414

Congestive heart failure . . . . . . . . . . . . . . . . . . . ..428.O

Other heart disease . . . . ...391-398. 402, 404, 415,

420-427, 428.1 -429.9

Carebrovascular disease. . . . . . . . . . . . . . . . . ...430-436

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...440

Chaptar 8. Diseases of the respiratory system . ..460-519

Chronic obstructive pulmonary disease and allied

conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . ...490-496

Chapter 9. Diseases of the digestive system . ...520-579

Ulcer of stomach, duodenum, peptic ulcer, or unspecified

site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...531-534

Chapter 10. Diseases of the genitourinary

syatam, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...580-629

Urinary tract infection . . . . . . . . . . . . . . . . . . . . . ...599.0

Chapter 12. Diseases of the skin and subcutaneous

tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...680-709

Chapter 13. Diseases of the musculoskeletal system and

connective tissue......,.. . . . . . . . . . . . . . . ...710-739

Arthritis or rheumatism. . . . . . . ...710-713. 716, 729.0

Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...733.0

Chapter 16. Symptoms, signs, and ill-defined

conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...780-799

Senility without psychoses . . . . . . . . . . . . . . . . . . . ...797

Chapter 17. Injury and poisoning. . . . . . . . . . . ...800-999

Fracture ofneckof femur . . . . . . . . . . . . . . . . . . . . ...820

Other fractures . . . . . . . . . . . . . . . ...800-819. 821-829

Supplementary classifications , . . . . . . . . . . . . . . . .VO1-V82

Persons with potential health hazards ralated to

personal and family history . . . . . . . . . . . . . . . .VIO-V19

Persons with a condition influencing their health

status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. V40—V49

Female

All diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chapter 2. Neoplaams . . . . . . . . . . . . . . . . . . . . ...140-239

Malignant neoplasms . . . . . . . . . . . . . . . . . . . ...140-208

Chapter 3. Endocrine, nutritional, and metabolic diseases

and immunity disorders . . . . . . . . . . . . . . . . . . ...240-279

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..25o

See footnote and notes at end of table.

76,500

50,600

21,400

20,200

209,000

85,500

57,900

12,500

22,600

30,600

165,000

20,300

24,400

7,400

13,100

375,700

51,600

197,500

97,100

29,900

70,400

79,900

26,500

63,300

47,700

57,600

7.600

46,000

14,000

18,000

78,300

40,400

‘3,700

73,200

6,400

20,700

5,900

4,200

110,200

59,000

45,100

3,603,500

62,100

50,600

216,800

135,600

12,700

8,800

“2,600

“2.600

64,800

9,200

25,900

5,800

14,500

9,500

41,100

“2,200

“1 ,600

“500

’700

34,700

11,000

12,800

8,200

“700

“3,900

9,900

. . .

‘3,600

“2,000

9,700

*1 ,200

4,600

“900

“3,700

6,900

*1 ,400

“300

18,100

. . .

8,500

*1 ,200

*1 ,300

16,100

8,400

6,800

238,800

“3.300

“2.400

17,500

11,700

63,800

41,700

18,700

17,500

144,200

76,300

32,000

6,700

8,100

21,100

123,900

18,100

22,900

6,900

12,400

341,000

40,600

184,600

88,900

29,200

66,500

70,000

26,500

59,600

45,800

47,800

6,400

41,400

13,100

14,300

71,300

39,000

“3,500

55,100

6,400

12,200

“4,700

‘2,900

94,100

50,600

38,200

3,364,700

58,700

48,200

199,200

123,900

Number

15,100

10,000

“5,100

“4,400

46,100

13,200

15,200

“3,400

“4,800

9,500

348000

“5,700

“4,900

“1,600

“2,400

65,900

9,400

29,600

11,800

“4,700

13,100

17,000

6,100

16,600

13,700

9,900

*1 ,400

8,700

*2,600

6,600

14,800

6,700

“300

16,400

“600

*1 ,900

“700

“900

19,800

10,500

9,300

433,000

9,800

8,500

38,900

25,000

32,300

19,200

7,500

7,200

58,100

32,800

11,000

*2,100

‘2,700

9,400

49,600

6,500

11,600

“2,800

84,100

141,100

18,000

75,300

37,900

13,200

24,200

31,400

6,800

26,900

20,200

18,200

“2,500

15,500

5,700

‘3,600

26,200

12,500

“800

19,900

“800

“5,500

*1 ,800

“700

37,800

19,000

16>000

1,231,300

18.600

14,800

86,900

55,400

16,300

12,500

6,200

5,900

40,000

30,400

5,800

*1,100

“600

*2,1 00

40,300

5,900

6,300

“2,500

6,000

134,000

13,200

79,700

39,200

11,300

29,300

21,600

13,500

16,100

11,900

19,700

“2,600

17,200

*4,900

“4,1 00

30,400

19,800

“2,400

18,800

“4,900

“4,800

“2,200

*1 ,300

36,500

21,100

13,000

1,700,400

30,300

24,900

73,400

43,500

41
Table 9. Number of all-listed diagnoses of nursing home residents at time of survey by age and sex: United States, 1985— Con.

Age

65 years and over

Under 65 85 years

Sex, all-listed diagnoses, and ICD-9-CM code~ Total years Total 65-74 years 75-84 years or over

Female—Con.

Chapter 4. Dweases of the blood and blood-forming

organ s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...280-289

Anemias . . . . . . . . . . . . . . . . . . . . . . . . . .,....,.280-285

Chapter 5. Mental disordars. . . . . . . . . . . . . . . ...290-319

Senile dementia or organic brain syndrome . ..290. 310

Psychoses other than senile dementia. . . .291 -299

Neurotic and personality disorders. . . ...300-301

Mental retardation . . . . . . . . . . . . . . ,,. . .. 317-319

Other mental disorders. . . . . . . . . . . 302–309,

311-316

Chapter 6. Dweases of the nervous system and sense

organs . . . . . . . . . . . . . . . . . . . . . . . . ...320-389

Alzhetmer’s disease and other specified and unspecified

degeneration of tha brain . . . . . ...331.0. 331.2, 331.9

Parkinson’s disease.,,,....,.. . . . . . . . . ...332

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...365

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...366

Chapter 7. Diseases of the circulatory system . ..390-459

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . ...401

Heart disease . . . 391-392 .0. 393-398, 402, 404, 41 O–

429

Ischemic heart dwease . . . . . . . . . . . . . . . ...410-414

Congeatwe heart failure . . . . . . . . . . . . . . . . . . ...428.0

Other heart disease . . . . . .391 -398, 402, 404, 415,

420-427, 428.1 -429.9

Cerebrovascular dw.ease. . . . . . . . . . . . . 430–436

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...440

Chapter 8. Diseases of the respiratory system. .460–51 9

Chronic obstructive pulmonary disease and allied

conditions, . . . . . . . . . . . . . . . . . . . ..490–496

Chapter 9. Diseases of the digestive system . . . 520–579

Ulcer of stomach, duodenum, peptic ulcer, or

unspecified sate, . . . . . . . . . . . . . . . . . . . . . . . ..531 –534

Chapter 10. Diseases of the genltourinary system. .580-629

Urinary tract infection . . . . . . . . . . . . . . . . . . . . . ...599.0

Chapter 12. Dlaeases of the skin and subcutaneous

tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..680–709

Chapter 13. Diseases of the musculoskeletal system and

connective tissue . . . . . . . . . . . . . . . . . . . . . . . . ..710–739

Arthritis or rheumatism. . . . . . .710 -713, 716, 729.0

Oateoporosm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...733.0

Chapter 16. Symptoms, signs, and Ill-defined

conditions . . . . . . . . . . . . . . . . . . . .,,,........,780-799

Senillty without psychoses . . . . . . . . . . . . . . . . . . . ...797

Chapter 17. Injury and poisoning. . . . . . . . 800–999

Fracture ofneck of femur ...,..., , . . . . . . . . . . . ...820

Other fracturea . . . . . . . . . . . . . . . ...800-819. 821–829

Supplementary classifications. . . . . . . . . . VOI–V82

Persona with potential health hazards related to

personal and family history. VI O–V19

Persons with a condltlon Influencing their health

status, . . . . . . . . . . . . . . . . . . . . . .,, ,, . . . . . .. V49–V49

54,000

50,400

481,100

272,400

112,500

23,600

27,900

44,600

344,400

53,600

46,500

28,500

32,800

1,145,000

182,000

616,900

298,500

129,400

189,000

211,900

84,900

90,200

63,400

143,900

16,800

87,000

44,000

35,700

351,000

231,100

45,300

194,200

51,000

80,000

33,200

31,300

267,400

171,800

87,500

*1 ,600

‘1,600

59,500

7,600

25,600

“4,900

15,400

5!900

39,600

“1,000

“2,600

* 600

*1,1OO

38,000

10,500

16,100

6,000

“4,300

5,800

7,900

“1,800

8,100

6,000

“5,200

*300

6,400

“2,500

“2,300

12,100

“5,1 00

“800

17,700

*1 ,700

“2,400

“400

“800

15,600

8,600

6,500

52,400

48,800

421,500

264,800

86,900

18,600

12,500

38,700

304,800

52,500

43,900

27,900

31,700

1,107,000

171,500

600,800

292,500

125,100

183,200

204,000

83,100

82,100

57,400

138,600

16,500

80,600

41,500

33,300

338,900

226,000

44,600

176,600

49,300

77,600

32,800

30,500

251 /700

163,200

81,000

Number

“5,000

“4,200

68,100

26,800

24,000

“2,000

7,500

7,800

49,900

10,300

7,200

*2,600

*1,600

121,500

21,700

54,600

32,300

9,700

12,500

30,700

6,900

12,800

10,700

12,500

*1 ,600

11,300

“4,300

“3,500

31,600

19,100

*2,900

25,500

“3,1 00

*5,200

*1 ,300

“2,200

29,900

17,600

10,800

15,700

14,100

170,400

02,700

33,800

9,700

4,500

19,700

16,100

25,400

21,000

7,400

8,000

31,700

30,500

‘I83,1OO

135,300

29,100

6,900

“600

11,200

138,800

16,800

15,800

17,800

22,000

377,900

67,400

191,900

92,200

42,600

57,100

79,800

25,600

32,700

23,800

51,200

6>600

30,900

16,600

13,900

115,300

75,500

15,600

68,500

15,400

22,800

9,300

9,200

94,200

62,800

28,700

607,600

82,300

354,200

167,900

72,700

113,600

93,500

50,700

36,500

22,900

75,000

8,200

38,500

20,600

15.900

192,000

131,500

26,100

i32,600

30,800

49,600

22,200

19,100

127,600

82,800

41,500

lDlagnostlc gmuplngs and code number Inclusions are based on the International Classiicatlon of Diseases, 9th Revision, cllnical modification.

NOTES: Because of a data processing error, estimates for all-l!sted d!agnoses at time of survey differ from estimates presented in H)ng E, Sekscenskl E, Strahan G

The National Nurstng Home Survey, 1985 summary for the United States, Nat!onal Center for Health Statistics, Vital Health Stat 13(97), 1989. See “Data processing”

(n appendix I for data!ls. Figures may not add to totals because of rounding.

42
Table 10. Number of all-listad diagnoses of nursing home residents at time of survey by race and Hispanic origin: United States, 1985

Hispanic origin

Race

NonAll-listed diagnoses and ICD-9–CM code~ Total White All other Black Hispanic Hispanic2

All diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chapter 2. Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

Malignant neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-208

Chaptar 3. Endocrine, nutritional, and matabolic diseases and

immunity disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .240-279

Diabetea mellitus, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Chapter 4. Disaasea of the blood and blood-forming

organs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...280-289

Anemias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...280-285

Chapter 5. Mental disorders ..,.... . . . . . . . . . . . . . . . . . ...290-319

Senile dementia or organic brain syndrome. . . . . . . . . ...290. 310

Psychoses other than senile dementia . . . . . . . . . . . . . ...291-299

Neurotic and personality disorders . . . . . . . . . . . . . . . . ...300-301

Mental retardation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...317-319

Other mental disorders. . . . . . . . . . . . . . . . . . . . 302–309, 311-316

Chspter 6. Diseases of the nervous system and sense

organs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .320-389

Alzheimer’a disease and other specified and unspecified

degeneration of the brain. . . . . . . . . . . . . . ...331.0. 331.2, 331.9

Parkinson’s disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...332

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...365

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...366

Chapter 7. Diseasea of the circulatory system . . . . . . . . . ...390-459

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...401

Heart diseaae . . . . . . . . 391-392.0, 393-398, 402, 404, 410-429

Iachemic heart disease . . . . . . . . . . . . . . . . . . . . . . . . ...410-414

Congestive heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . ...428.0

Other heart disease . . . . . . . 391-398, 402, 404.415, 420-427,

428.1 -429.9

Cerebrovascular diaaase . . . . . . . . . . . . . . . . . . . . . . . . . ...430-436

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...440

Chapter8. Diseasea of the respiratory system . . . . . . . . . . ..46 O-5l9

Chronic obstructive pulmonary disease and allied

conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 490-486

Chapter9. Diseasea of thedigestive system . . . . . . . . . . ...520-579

Ulcer ofatomach, duodanum, peptic ulcer, orunapecified

site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 531-534

Chapter lO. Diaeases of thegenitourinary aystem . . . . . . ...580-629

Urinary tract infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...599.0

Chapter 12. Diseasea of the skin and subcutaneous

tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 680-709

Chapter 13. Diseasea of the musculoskeletal system and connective

tiaaua . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...710-739

Arthritis orrheumatiam . . . . . . . . . . . . . . . ...710-713. 716, 729.0

Osteoporosis, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...733.0

Chapter 16. Symptoms, aigns, and ill-defined

conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...780-799

Senility without psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . ...797

Chapter 17.1njury and poisoning . . . . . . . . . . . . . . . . . . . ...800-999

Fractura ofneckof femur . . . . . . ., . . . . . . . . . . . . . . . . . . . . ...820

Other fractures . . . . . . . . . . . . . . . . . . . . . . . . ...800-819.821-829

Supplementary classifications . . . . . . . . . . . . . . . . . . . . . . . .. VO1-V82

Persons with potential health hazarda related to personal and

family history . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. V1O–VI9

Peraons with a condition influencing their health

status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. V40-V49

4,97’I ,700

96,900

82,600

293,300

186,200

75,300

70,600

690,100

357,900

170,400

36,100

50,600

75,200

509,400

73,900

70,900

35,800

45,900

1,520,800

233.600

814,400

395,600

159,400

259,400

291,800

111,400

153,400

111,100

201,400

24,300

133,000

58,000

53,700

429,300

271,500

49,100

267,500

57,400

100,700

39,100

35,600

377,500

230,800

132,600

4,553,000

88,000

75,400

256,800

157,900

69,200

64,400

633,200

327,500

153,800

34,700

47,700

70,100

468,500

70,900

68,400

32,300

41,900

1,383,000

208,600

745,600

365,800

145,100

234,700

258,500

104,600

142,000

102,600

190,000

22,600

123,100

54,000

50.200

401,700

256,900

48,100

241,400

52,600

96,200

36,900

34,600

347,000

213,600

124,000

Number

418,700

8,900

7,200

36,400

28,300

6,200

6,200

56,800

30,400

16,600

“2,000

“2,800

*5,1 00

40,900

“3,000

*2,500

“3,500

“4,000

137,800

24.900

68,700

29,800

14,200

24,700

33,300

6,800

11,400

8,600

11,500

*1 ,700

9,900

“4,000

“3,500

27,600

14,700

*1 ,000

26,100

“4,800

“4,500

‘2,200

“1 .000

30.500

17.200

8,600

376,000

8,300

6,900

32,600

25,100

“4,900

“4,900

51,200

28,100

14,700

“2,000

*2,1 00

“4,400

37,700

‘2,700

“2,200

‘3,500

“3,300

127,400

22,500

64,100

28,400

13,300

22,300

31,100

6,000

9,1 @o

6,700

9,500

*I,1OO

7)700

“3,600

“3,200

24,500

12,900

*1 ,000

24,400

“4,500

“4,000

*1 ,700

*1 ,000

25,200

13,500

7,000

132,900

“1 ,600

*1 .600

8,200

*5,600

*1 .200

*1 ,200

27,500

14,900

6,700

*1 ,500

*1 ,200

“3,200

14,900

“1 ,900

“2,500

’800

“800

36,000

6,000

18,900

9,900

‘3,400

*5,500

8,800

*1,100

*5,000

“3,800

“3,300

“300

“5,000

*1 ,800

*1 ,500

10,500

6,000

*I,1OO

7,100

“1 ,200

*1 ,900

“300

*900

7,600

“5,200

“2,400

4,838,900

95,300

81,000

285,000

180,700

74,200

69,400

662,500

343,000

163,600

34,600

49,300

72,000

494,500

72,000

68,500

35,100

45,100

‘1,484,700

227,600

795,500

385,700

155,900

253,900

283,000

1 ‘10,300

148,400

107,300

198,100

24,100

128,000

56,200

52,200

418,800

265,500

48,000

260,400

56,200

98,800

38,900

34,700

369,900

225,600

130,200

1Diagnostic groupings and code number Inclusions are based cm the Internatmnal Classification of Diseases, 9th Revision, clinical modification.

‘Data include a small number of unknowns.

NOTES: Because of a data processing error, estimates for all-listed diagnoses at time of survey differ from astimates presented in Hing E, Sekscenski E, Strahan G. The

National Nursing Home Survey, 1985 summary for the Unned States. National Center for Health Statistics. Vital Health Stat 13(97). 1989. See “Data processing” in

appendix I for details. Figures may not add to totals becauae of rounding,

43
Table 11. Prevalence rate ofselected diagnoses at time of survey par l, OOOnursing home residents, byage and sex: United States, 1985

Age

65 years and over

Under

65 65-74 75-84 85 years

Ail-listed diagnoses andlCD–9-CMcodel Total years Total years years and over

Both sexes

Chapter 2. Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 140-239

Malignant neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-208

Chapter3. Endocrine, nutritional, and metabolic diseases and immunity

disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..240–279

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Chapter4. Diseases of the bloodandblood-forming organs . . . . . . . . . . . . ..28 O-289

Anemias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...280-285

Chapter 5. Mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..290–319

Senile dementia or organic brain syndrome . . . . . . . . . . . . . . . . . . . . . . . ...290. 310

Psychoses other than sanile dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 291-299

Neurotic and person ality disorders . . . . . . . . . . . . . . . . . . . . . . . . ..300–301

Mental retardation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,, ...,..317-319

Other mental dmorders, . . . . . . . . .,.......................302-309, 311–316

Chapter6. Diseases of the nervous system and sense organs . . . . , . . . . . . ..320–389

Alzhelmer’s disease and other specified and unspecified degeneration of the

brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...331.0. 331 .2,331.9

Parkinson’s disease.....,,,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . ,, . . . . . . . ...332

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . ...365

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...366

Chapter7. Diseases of the clrculato~ syatem, . . . . . . . . . . . . . . . . . . . . . . . ..39 O-459

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...401

Heart disease.,..........,.. . . . . . 391 –392.0, 393–398, 402, 404, 41 O–429

Ischemic heart disease ...,,.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...410-414

Congestive heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...428.0

Other heart disease. . . . . . . . 391–398, 402, 404, 415, 420-427, 428.1 -429.9

Cerebrovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..430–436

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,, . . . . . . . . ...440

Chapter 8. Diseases of the respiratory system. . . . . . . . . . . . . . . . . . . . . . . ...460-519

Chronic obstructive pulmonary disease and allied conditions . . . . . . . . 490–496

Chapter 9. Diseases of the digestive system . . . . . . . . . . . . . . . . . . . . ...520-579

Ulcer of stomach, duodenum, peptic ulcer, or unspecified site . . . . . . ..531-534

Chapter 10. Diseases of the genitourvnary system. . . . . . . . . . . . . . . . . . . . . . . 580–629

Urvnary tract infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...599.0

Chapter 12. Diseases of the skin and subcutaneous ttssue . . . . . . . . . . . . ...680-709

Chapter 13. Diseases of the musculoskeletal system and connective

tissue, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..710–739

Arthritis or rheumatism....,,. . . . . . . . . . . . . . . . . . . . . . . ...71 0-713, 716,729.0

Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...733.0

Chapter 16. Symptoms, stgns, and ill-defined conditions. . . . . . . . . . . . . . 780–799

Senility without psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...797

Chapter 17. lnjuryandpolsoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...800-999

Fracture ofneck of femur . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...820

Other fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...800-81 9,821–829

Supplementary classifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. VOI–V82

Persons with potential health hazards related to personal and family

history, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. V1O-V19

Persons with a condition influencing their health status . . . . . . . . . . . . . . . V40–V49

Male

Chapter 2. Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..140–239

Malignant neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-208

Chapter 3. Endocrine, nutrmonal, and metabollc diseases and Immunity

disorders, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..240–279

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Chapter 4. Diseases of the blood and blood-formtng organs. . . . . . . . . . 280–289

Anemias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...280-285

Chapter 5. Menta I disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-319

Senile dementia ororganlc brain syndrome . . . . . . . . . . . . . . . . . . . . . . . ...290. 310

Psychoses other than senile dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . ., ,291-299

Neurotic and personal ity disorders . . . . . . . . . . . . . . . . . . . . . . . . ..300–301

Mental retardatio n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..317–319

Other mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...302-309. 311-316

See footnote and note at end of table.

57.1

48.1

180.4

124.2

49.5

47.0

405.8

233.7

110,6

23,4

33.9

47.9

285.6

49.2

47.4

24.0

30,8

602,4

156.4

368.4

241.5

106.8

152.3

182.1

74.7

90.9

68.4

111,4

16,3

82.8

38.9

35.0

252.3

179.1

32.9

161.3

38.5

63,0

26.1

22.8

207.8

133.7

84.8

70.9

64.5

169,5

118.8

49.9

47.6

417.8

197.5

132.5

29.4

53.4

65.0

*29.4

*24.2

161.7

116.9

*24.2

*24.2

589.1

92.3

288.4

60.0

172.7

87.4

379.4

*I 8.5

“24,0

*6.4

“10,5

286.4

124.4

127.0

74.5

*29.2

51,2

96.5

“10.1

54.3

39.7

77.3

*8.4

55,5

*1 9.3

34.3

97.9

37.8

“6.0

184.0

*9.9

57.7

*9.3

*1O.8

151.1

85.1

75.7

*32.9

*29,9

134.6

99.1

*29.5

*29.5

598.3

102.8

282.7

*64.9

162.2

102.9

Rate per 1,000 residents

60.7

51.3

182.8

125.2

52,9

50,0

381.7

252.2

87.3

18.6

15.7

42.8

273.3

53.2

50.4

26.4

33.4

643.9

160.6

400.1

263.5

117.0

165.5

193.3

83.2

95.7

72.2

116.6

17.4

86.4

41.4

35.1

272.6

197.6

36.4

158.3

42.2

63.7

28.2

24.3

215.3

140.1

86.0

81.1

73.7

178.8

124.1

55.3

52.4

369.6

222.8

92.4

19.9

24.3

54.9

58.3

51.0

224.2

164.0

45.5

40.8

447.3

182,1

175.4

*25.5

58.0

74.9

335.3

75.4

55,7

*1 9.7

“18.7

546.8

145.7

266.3

774.9

68.2

104.7

219.9

61,4

124.7

107.1

95.2

“14,2

82.0

32.4

47.9

189.7

118,9

*1 5.0

171,6

*1 7.7

32.1

*9.4

*13.7

197.3

114.6

90.0

*48.3

*45.2

175.6

124.4

“60.7

54.9

461.3

163.5

181.5

‘42.0

*59.9

100,1

62,9

53.0

215.1

146.3

44.1

41.4

391.6

259.4

85.9

21.7

14,2

53.3

279.1

61.8

64.0

20.1

23.8

616.2

167.9

363.3

234.5

109.7

143.7

202.2

63.8

101.B

78.9

112.9

17.8

87.6

43.7

33.4

244.9

169.3

32.2

157.3

31.9

52.7

21.8

18.5

206.9

132.2

82.4

108.2

99.7

211.1

135.8

52.7

51.3

346.6

225.1

74.3

“15.0

*’1 9.4

57.8

59,7

49,9

140,7

93.4

63,0

60.5

349.9

271,0

57.1

13.6

“1.9

22.3

2.46.3

38.0

37.1

34.0

46.9

702.0

“159.8

479.0

319.6

140.7

205.8

176.3

107.4

80.2

54.2

127.4

18.1

86.9

42.7

32,0

325,7

249.7

47.7

154.5

59.7

84.4

40.5

33.1

228.9

155,9

87.7

70.5

61.5

140.5

109.2

54.8

52.0

332.9

262.3

“51.5

“10.2

“5.0

“1 9.0

44
Table 11. Prevalence rate of selected diagnoaes at time of survey per 1,000 nursing home residents, by age and sex: United States,

1985—Con.

Age

65 years and over

Under

65 65–74 75-84 85 years

All-1isted diagnoses and ICD-9-CM code’ Total years Total years years and over

Male—Con.

Chapter 6. Diseases of the nervous system and sense organs. . . . . . . . . . . .. 320-389

Alzheimer’s disease and other specified and unspecified degeneration of tha

brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...331 .0,331 .2,331.9

Parkinson’s disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...332

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...365

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...366

Chapter 7. Diseases of the circulatory system . . . . . . . . . . . . . . . . . . . . . . . ...390-459

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...401

Heart disease . . . . . . . . . . . . . . . . . . . . . . 391 –392,0, 393-398, 402, 404, 41 O–429

Ischemic heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...410-414

Congestive heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...428.0

Other heart disease. . . . . . . . . 391–398, 402, 404, 415, 420-427, 428.1 -429.9

Cerebrovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..430–436

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...440

Chapter8. Diseases of the respirato~ system . . . . . . . . . . . . . . . . . . . . . . . . ..46 O-5l9

Chronic obstructive pulmonary disease and allied conditions . .,........490-496

Chapter9. Diseases of thedigestive system . . . . . . . . . . . . . . . . . . . . . . . . . ..52 O.579

Ulcer of stomach, duodenum, peptic ulcer, or unspecified site . . . . . . . . ..531 -534

Chapter lO. Diseases of thegenitourinaw system . . . . . . . . . . . . . . . . . . . . . ..58 O-629

Urinary tract infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...599.0

Chapter 12. Diseases of theskin andsubcutsneous tissue . . . . . . . . . . . . . ..68 O-7O9

Chapter 13. Diseases of the musculoskeletal system and connective

tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...710-739

Arthritis or rheumatism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..710–713. 716, 729.0

Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...733.0

Chapter 16. Symptoms, signs, and ill-defined conditions . . . . . . . . . . . . . . . ..78O-799

Senility without psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...797

Chapter 17. injury and poisoning.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..800-999

Fracture ofneck of femur . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...820

Other fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-819,821-829

Supplementary classifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. VOI-V82

Persons with potential health hazards related to personal and family

history . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. VI O-V19

Persons witha condition influencing their health status . . . . . . . . . . . . . .. V40-V49

Female

Chapter 2. Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

Malignant neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-208

Chapter3. Endocrine, nutritional, and metabolic diseases and immunity

disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240-279

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Chapter4. Diseases of the blood and blood-forming organs . . . . . . . . . . . . ..28 O-289

Anemias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...280-285

Chapter 5. Mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-319

Senile dementia or organic brain syndrome . . . . . . . . . . . . . . . . . . . . . . . ...290.310

Psychoses other than senile dementia . . . . . . . . . . . . . . . . . . . . . . . . .. 291-299

Neurotic and personality disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..300-301

Mental retardation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...317-319

Other mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...302-309. 311-316

Chapter6. Diseases of the nervous system and sense organs . . . . . . . . . . . ..320–389

Alzheimer’s disease and other specified and unspecified degeneration of the

brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...331.0. 331 .2,331.9

parkinson’s disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , ..,.........332

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...365

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,, . . . . . ...366

Chapter7. Diseases of the circulator system . . . . . . . . . . . . . . . . . . . . . . . . ..39 O-459

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...401

Heart disease . . . . . . . . . . . . . . . . . . . . . 391 –392.0, 393-398, 402, 404, 410-429

Iachemic heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . ...410-414

Congestive heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...428.0

Other heart disease. . . . . . . . . 391-398, 402, 404, 415, 420-427, 428.1 -429.9

Cerebrovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...430-436

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...440

327.1

47.9

57.0

17.5

31.0

531.7

121.7

316.3

207.5

70.7

143.5

175.5

62.5

131.9

105.6

112.7

17.9

101.2

33.0

41.5

167.3

94.6

*8.8

148.7

15.0

44.8

13.9

*9.4

221.7

123.9

102.3

51.6

41.7

184.7

126.3

49.4

46.7

401.0

248.0

101.9

21.0

26.2

41.2

269.1

49.7

43.6

26.6

30.7

630.5

170.2

389.1

255.1

121.2

155.8

184.6

79.5

372.3

*24.3

“1 7.5

*5.6

*8.1

270.6

123.4

111.6

76.9

*7.9

*43.6

101.7

33.0

*2 I .9

86.2

“13.0

*46.5

*9.7

‘40.3

68.9

15.9

*3.1

177.3

84.7

*1 3.2

“11.9

153.3

81.1

76.5

*25.7

“18.1

190.5

136.8

*1 8.5

*1 8.5

579.3

81.2

294.5

*54.7

183.8

70.9

386.9

*1 2.3

“30.9

“7.2

*1 3.0

303.2

125.6

143.3

71.9

*5 I .8

*59.2

91.0

*2 I .0

Rate per 1,000 residents

315.1

54.2

67.5

20.6

37.1

601.4

121.3

370.9

242.3

87.4

170.2

195.3

79.2

158.3

128.0

119.8

19.2

115.8

39.2

41.8

193.6

115.6

“1 0.4

141.1

19.0

34.1

*14.1

*8.8

239.9

135.3

109.2

53.8

43.7

184.2

125.5

52.0

49.2

385.8

262.3

85.5

18.2

12.7

38.6

259.0

52.9

44.6

28.3

32.2

658.4

174.0

410.0

270.7

127.1

164.0

192.6

84.5

352.6

“70.6

*57.7

‘19.5

*29.4

502.8

116.6

236.3

126.0

*58.9

126.7

210.6

76.2

189.3

163.2

111.2

*1 7.0

99.9

*31 .9

82.3

171.5

83.0

*4.1

173.5

“8.0

*23.4

*8.3

“11.7

211.6

118.3

105.8

64.5

54.5

253.9

188.3

*36.1

*32.2

438,7

193.5

171.7

*15.3

56.9

59.5

324.7

78.4

54.5

*1 9.8

*1 2.2

573.7

163.6

284.6

204.8

73.9

91.2

225.5

52.3

307.8

46,3

82.1

*1 9.9

*28.8

595.3

127.3

371.5

239.7

93.5

158.4

205.5

48.5

161.2

128.7

108.4

*1 7.7

104.2

“40.0

*25.3

170.7

88.3

*5.4

117.1

*5.9

“36.7

*1 2.8

“5.1

224.2

115.7

109.7

45.5

35.1

216.6

150.3

40.7

37.7

408.9

272.6

90.3

24.3

“1 2.2

51.6

268.1

67.7

57.0

20.2

21.8

624.3

183.4

360.1

232.5

115.9

138.0

200.9

69.7

297.4

52.4

56.3

*22.3

53.0

679.8

117.2

466.6

328.9

100.2

216.1

171.3

119.9

132.4

101.8

140.1

“22.8

141.8

*43.4

“33.7

238.2

173.3

“21.1

148.1

*43.5

*38.5

“1 9.9

“11.3

279.9

172.0

110.9

57.1

47.2

140.8

89.7

64.9

62.5

353.9

273.1

58.5

14.3

*1.2

23.1

234.4

34.7

32.6

36.8

45.5

707.2

169.7

481.9

317.5

150.0

203.4

177.4

104.5

See footnote and note atend of table.

45
Table 11. Prevalence rate of selected diagnoses at time of survey per 1,000 nursing home residents, by age and sex: United States,

1985—Con.

Age

65 years and over

Under

65 65-74 75-84 85 years

All-listed diagnoses and ICD–9– CM code’ Total years Total years years and over

Female—Con.

Chapter 8. Diseases of the respiratory system, . . . . . . . . . . . . . . ., .. 460-519

Chronic obstructwe pulmonary disease and allted conditions . . . . . . . . ...490-496

Chapter 9. Diseases of the digestive system . . . . . . . . . . . . . . . ..520-579

Ulcer of stomach, duodenum, peptic ulcer, or unspecified site ., . . . . . .531 -534

Chapter 10. Diseases of the genitourinary system. . . . . . . . . . . . . . . . .. 580-629

Urinary tract infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...599.0

Chapter 12. Diseases of the skin and subcutaneous tissue . . . . . . . . . 680–709

Chapter 13. Diseases of the musculoskeletal system and connective

tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...710-739

Arthritis or rheumatism . . . . . . . .,, , . . . . . . . . . . . . . . . . . . ...71 0-713, 716,729.0

Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..733.0

Chapter 16. Symptoms, signs, and ill-defined conditions. . . . . . . . . . . . . . ...780-799

Senility without psychoses..,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...797

Chapter 17. injury and poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . ..800–999

Fracture ofneck of femur.,,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...820

Other fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..800–81 9,821-829

Supplementary classifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . .. V82–V82

Persons with potential health hazarda related to personal and family

history, ,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,, .. VI O-VI9

Persons with a condlt!on Influencing their health status . . . . . . . . . . . V40–V49

74.7

53.7

110,8

15.7

75.5

41.2

32.4

286.1

212.6

42.5

166.3

47.8

70.3

30.9

28.1

202.4

137.6

77.9

77.0

*58.8

55.3

*3.5

*65.1

*29.7

“27.9

128.8

61.1

*9.2

191.1

“20.4

*29.O

*5.3

*9.6

148.7

89.4

74.7

Rate per 1,000 residents

74.5

53.3

115.6

16.7

76,4

42.2

32.8

299.5

225.5

45.3

164.2

50.1

73.8

33.1

29.6

206.9

141.7

78,2

85,1

72,7

85.4

*12,5

71.1

*32.8

*26.8

200.7

140.8

*21 .7

170.5

*23.7

*37.4

*1 0.0

‘14.9

188.5

112.3

80.3

79.0

59.7

114.7

17.9

81.2

45.1

36.5

273.5

200.5

42.5

172.7

41.9

58.8

25.2

23.6

200.3

138.5

71.9

68.1

43.1

124.5

17.0

74.2

42.6

31.6

346.0

267.5

53.9

156.0

63.5

95.1

45.2

38.2

217.0

152.1

82.4

1Diagnostic groupings and code number !ncluslons are baaed on the International Classlf!catlon of Dlaeasea, 9th Rewsion, clinical modification.

NOTE: Resident may have had more than 1 dlagnoals.

46
Table 12. Prevalence rate of selected diagnoses at time of survey per 1,000 nursing home residents by race and Hispanic origin: United

States, 1985

Rate

per

Race, Hispanic origin, all-listed diagnoses, 7,000

and ICD-9-CM codel residents

White

Hearl disease. . . . . . . . . . . . . . . 391-392 .0. 393-398, 402,

404, 410-429

Ischemic heart disease . . . . . . . . . . . . . . . . . . ..410–414

Congestive heart failure . . . . . . . . . . . . . . . . . . . . ...428.0

Other heart disease . . . . . . ...391 –398, 402, 404, 405,

420-427, 428.1 –429.9

Senile dementia or organic brain syndrome . . ...290. 310

Arthritis orrheumatism . . . . . . . . . . ..71 O-7l3. 716-729.0

Cerebrovascular disease. . . . . . . . . . . . . . . . . . . . . . 430–436

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . ...401

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Psychoses other than senile dementia . . . . . . . , ..291-299

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...440

Chronic obstructive pulmona~ disease and allied

conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...490-496

Alzheimer’s disease and other specified and unspecified

degeneration of the brain . . . . . . . . ..33l.O. 331.2, 331.9

Parkinson’s disease . . . . . . . . . . . . . . . . . . . . . . . . . . . ...332

Other mental disorders . . . . . . . . . . ...302-309. 311–316

Malignant neoplasms . . . . . . . . . . . . . . . . . . . . . . ..140–208

Anemias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..280–285

Urinary tract infection . . . . . . . . . . . . . . . . . . . . . . . ...599.0

Senility without psychoses . . . . . . . . . . . . . . . . . . . . . ...797

Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...733.0

Mental retardation . . . . . . . . . . . . . . . . . . . . . . . ...317-319

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...366

Fracture ofneck of femur . . . . . . . . . . . . . . . . . . . . . . ...820

Neurotic and personality disorders . . . . . . . . . . ...300-301

Other fractures . . . . . . . . . . . . . . . . . . ..800-819 .821 –829

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...365

Black

Hesrt disease . . . . . . . . . . . . . . . 391-392.0, 393-398, 402,

404, 410-429

Ischemic heart disease . . . . . . . . . . . . . . . . . ...410-414

Congestive heart failure . . . . . . . . . . . . . . . . . . . . ...428.0

Other heart disease . . . . . . ...391-398. 402, 404, 405,

420-427, 428.1 -429.9

Cerebrovascular disease. . . . . . . . . . . . . . . . . . . . . . 430–436

Senile dementia or organic brain syndrome . . ...290. 310

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..z5o

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . ...401

Psychoses other than senile dementia. . . . . . . ...291-299

Arthritis or rheumatism. . . . . . . . . ...710-713. 716, 729.0

369.3

242.3

105.6

150.2

232.2

183.6

174.6

151.6

114.2

108.3

76.1

68.0

51.2

49.6

48.3

48.2

46.5

39.3

38.2

35.0

34.7

30.5

26.6

24.2

24.0

23.5

366.6

249.7

127.9

174.1

280.9

260.5

240.2

215.3

136.1

123.9

Rate

per

Race, Hispanic origin, all-listed diagnoses, 1,000

and ICD-9-CM code~ residents

Black—Con.

Chronic obstructive pulmonary disease and allied

conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...490-496

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...440

Hispanic origin

Senile dementia or organic brain syndrome . . ...290. 310

Heart disease . . . . . . . . . . . . . . . 391 –392.0, 393-398, 402,

404, 410-429

Lschemic heart disease . . . . . . . . . . . . . . . . . ...410-414

Cerebrovascular disease. . . . . . . . . . . . . . . . . . . . . .430-436

Psychoses other than senile demantia. . . . . . . ...291-299

Arthritis or rheumatism. . . . . . . . . ...710-713. 716, 729.0

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . ...401

Non-Hispanic originz

Heart disease . . . . . . . . . . . . . . . 391-392.0, 393-398, 402,

404, 410-429

Ischemic heart disease . . . . . . . . . . . . . . . . . ...410-414

Congestive heart failure . . . . . . . . . . . . . . . . . . . . ...428.0

Other hearl disease . . . . . . ...391-398. 402, 404, 405,

420-427, 428.1 -429.9

Senile dementia or organic brain syndrome . . ...290. 310

Cerebrovascular disease. . . . . . . . . . . . . . . . . . . . . .430-436

Arthritis or rheumatism. . . . . . . . . ...710-713. 716, 729.0

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . ...401

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..z5o

Psychoses other than senile dementia. . . . . . . ...291-299

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . ...440

Chronic obstructive pulmonary disease and allied

conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...490-496

Alzheimer’s disease and other specified and unspecified

degeneration of the brain . . . . . . . ...331.0. 331.2, 331.9

Malignant neoplasms . . . . . . . . . . . . . . . . . . . . . ...140-208

Anemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...280-285

Other mental disorders . . . . . . . . . . ...302-309. 311-316

Parkinson’s disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332

Urinary tract infection . . . . . . . . . . . . . . . . . . . . . . . ...599.0

Senility without psychoses . . . . . . . . . . . . . . . . . . . . . ...797

Mental retardation . . . . . . . . . . . . . . . . . . . . . . . ...317-319

Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...733.0

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...366

Fracture ofneck of femur . . . . . . . . . . . . . . . . . . . . . . ...820

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...365

Neurotic and personality disordera. . . . . . . . . . ...300-301

Other fractures . . . . . . . . . . . . . . . . . . ..800 -B19. 821-829

64.5

57.5

341.2

339.8

234.0

206.9

146.9

146.9

146.2

369.2

241.7

107.5

152.9

230.6

181.4

180.0

156.7

123.9

109.6

76.0

67.9

49.3

48.4

47.5

47.1

47.0

38.7

38.7

34.0

33.1

31.1

26.6

24.2

23.1

22.8

1Diagnostic groupings and code number inclusions are baaed on the Internatmnal Classification of Dmeases, 9th Revision, cllnical modification.

21ncludes a small number of unknowns.

NOTE: Resident may have had more than 1 diagnoals.

47
Table 13. Number and percent distribution of nursing home residents by mental status, sccording to age and sex: United States, 1985

Age

65 years and over

All Under 65– 74 75-84 85 years

Sex and mental status residents 65 years Total years years and over

Both sexes, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Current mental disorders

Nomental disordersl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ,,.

Hasmental disordersz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental retardation . ...,..... . . . . . . . . . . . . . . . . . . . . . . . . . .

Alwhola buseordependence.. . . . . . . . . . . . . . . . . . . . . . . . .

Drug abuse or dependence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Senile dementia or chronic organic brain syndrome. . . . . . . . . . . . .

Depresswe disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Schizophrenia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other psychoses, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Personal ityorcharacter disorders. . . . . . . . . . . . . . . . . . . . . .

Other mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Behavioral problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Disorientation ormemoryimpalrment . . . . . . . . . . . . . . . . . . . . . . .

Disturbance of mood, ,,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Current mental disorders

Nomental dlsordersl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...,,

Hasmental dlsordersz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,, .

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

Alcohol abuse or dependence . . . . . . . . . . . . . . . . . . . . . . . . .

Drug abuse or dependence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Senile dementia or chronic organic brain syndrome. . . . . . . . . . . . .

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

Schizophrenia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Persona lityorcharacter disorders. . . . . . . . . . . . . . . . . . . . . . . . . .

Other mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Behaworalp roblems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,. .

Disorientation ormemorylmpairment . . . . . . . . . . . . . . . . . . . . .

Disturbance of mood ...,,... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Current mental dleorders

Nomental disordersl, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hasmental disorders2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental retardation, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,., .

Alcohol abuse or dependence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drug abuse ordapendence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Senile dementia or chronic organic brain syndrome. . . . . . . . . . . . . . .

Depress we disorders ...,.,.., . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Schizophrenia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,

Other psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Persona lityorcharacter disorders. . . . . . . . . . . . . . . . . . . .

Other mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Behavioral problems ..,...... . . . . . . . . . . . . . . . . . . . . . . .

Dlsorlentation ormemo~[mpairment . . . . . . . . . . . . . . . . . . . . . . . . . . .

Disturbance of mood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,.

See footnotas at and of table.

1,491,400

510,000

981,500

81,100

41,800

13,900

646,700

205,300

85,200

34,900

200,700

164,700

6,300

572,600

922,500

623,700

423,800

145,500

278,300

36,000

31,200

‘4,800

155,500

53,100

35,000

12,300

52,100

56,800

“1 ,300

163,900

248,300

158,900

1,067,700

364,500

703,200

45,100

10,600

9,200

491,200

152,300

50,100

22,600

148,600

105,900

‘5,000

408,700

674,300

464,800

173,100

37,600

135,500

44,500

14,100

“4,1 00

28,000

28,000

41,700

6,000

28,100

31 ,BOO

’500

68,700

96,700

70,400

89,300

18,400

70,900

22,200

12,100

“2,400

14,900

14,000

20,400

“2,600

13,400

16,400

’300

34,100

51,700

36,300

83,800

19,200

64,600

22,300

*2,100

*1 ,600

13,100

14,000

21,300

“3,400

14,700

15,400

“200

34,600

44,900

34,100

Number

1,318,300

472,300

846,000

36,600

27,700

9,900

618,800

1778300

43,400

29,000

172,600

132,900

5,800

503,900

825,900

553,300

334,400

127,000

207,400

13,800

19,100

“2,300

140,600

39,100

14,600

9,700

38,600

42,400

*1 ,000

129,800

196,500

122,500

983,900

345,300

638,600

22,800

8,500

7,500

478,100

138,200

28,800

19,300

134,000

90,400

*4,800

374,100

629,300

430,800

212,100

69,100

142,900

19,300

12,400

“2,1 00

72,200

38,400

23,100

8,300

31,700

31,100

“600

75,300

118,000

97)900

80,600

24,900

55,700

8,300

8,400

“800

24,200

14,300

9,600

“4,500

12,600

14,000

27,400

41,600

33,400

131,500

44,300

87,200

11,000

“3,900

*1 ,200

47,900

24,100

13,500

3,800

19,100

17,100

“600

47,900

76,500

64,500

509,000

182,500

326,500

13)400

11,800

“4,700

231,100

77,800

13,500

11,800

73,700

56,700

“2,400

202,100

309,400

211.000

141,300

55,700

85,600

“5,300

9,100

*1 ,300

59,500

14,600

“4,200

“4,500

19,300

20,300

“300

57,600

82,900

50,900

367,700

126,800

240,900

8,100

“2,600

*3,400

177,700

63,200

9,300

7,200

54,500

36,300

“2,100

144,600

226,500

160,100

597,300

220,700

376,600

‘4,000

“3,600

“3,100

315,500

61,100

6,900

8,900

67,200

45,100

“2,900

226,500

398,500

244,300

112,600

46,500

66,100

“300

*1 ,600

“300

56,900

10,200

* 900

* 600

6,800

8,100

“800

44,900

72,100

38,200

484,700

‘174,200

310,500

“3,700

“2,000

“2,900

258,500

50,800

6,000

8,300

60,400

37,000

“2,200

181,600

326,400

206,100

48
Table 13. Number and percant distribution of nursing home raaidents by mental status, according to age and sex: Unitad States,

1985—Con.

Age

65 years and over

All Under 65–74 75-84 85 years

Sex and mental status residents 65 years Total years years and over

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Current mental disorders

Nomental disordersl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hasmental disordersz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Alcohol sbuse or dependence.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drug abuse or dependence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Senile dementia or chronic organic brain syndrome . . . . . . . . . . . . . . .

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

Schizophrenia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anxiety disorders, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Personality orchsracter disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Behavioral problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Disorientation or memory impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Disturbance of mood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Current mental disorders

Nomental disordersl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hasmental disordersz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Alcohol abuse or dependence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drug abuse or dependence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Senile dementia or chronic organic brain syndrome. . . . . . . . . . . . . . .

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

Schizophrenia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Personality or character disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Behavioral problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Disorientation ormemoty impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Disturbance of mood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Current mental disorders

Nomental disordersl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hasmental disordersz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Alcohol abuse ordependance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drug abuse ordepandence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Senile dementia or chronic organic brain syndrome. . . . . . . . . . . . . . .

Depress ive disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Schizophrenia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Personality orcharactar disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Behavioral problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Disorientation or memory impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Disturbance of mood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

100.0

34.2

65.8

5.4

2.8

0.9

43.4

13.8

5.7

2.3

13.5

11.0

0.4

38.4

61.9

41.8

100.0

34.3

65.7

8.5

7.4

“1.1

36.7

12.5

8.3

2.9

12.3

13.9

“0.3

38.7

58.6

37.5

I 00.0

34.1

65.9

4.2

1.0

0.9

46.0

14.3

4.7

2.1

13.9

9.9

“0.5

38.3

63.2

43.5

100.0

21.7

78.3

25.7

8.2

*2.4

16.1

16.2

24.1

3.4

16.2

18.4

“0.3

39.7

55.B

40.7

100.0

20.6

79.4

24.9

13.5

*2.7

16.6

15.7

22.9

*2.9

15.0

18,4

“0.3

38.2

57.9

40.7

100.0

22.9

77.1

26.6

*2.5

‘2.0

15.6

16.8

25.4

4.0

17.5

18.4

“0.3

41.3

53.6

40.7

Percent distribution

100.0

35.8

64.2

2.8

2.1

0.7

46.9

13.4

3.3

2.2

13.1

10.1

0.4

38.2

62.6

42.0

100.0

38.0

62.0

4.1

5.7

‘0.7

42.1

11.7

4.4

2.9

11.6

12.7

‘0.3

38.8

58.8

36.6

100.0

35. t

64.9

2.3

0.9

0.8

48.6

14.0

2.9

2.0

13.6

9.2

“0.5

38.0

64.0

43.8

100.0

32.6

67.4

9.1

5.8

‘1.0

34.0

18.1

10.9

3.9

14.9

14.7

“0.3

35.5

55.7

46.2

100.0

30.9

69.1

10.2

10.5

*1.O

30.1

17.7

11.9

*5.6

15.6

17.4

34.0

51.6

41.5

100.0

33.7

66.3

8.4

“3.0

“0.9

36.4

18.4

10.3

2.9

14.5

13.0

“0.4

36.4

58.1

49.0

100.0

35.9

64.1

2.6

2.3

‘0.9

45.4

15.3

2.6

2.3

14.5

11.1

‘0.5

39.7

60.8

41.5

100.0

39.4

60.6

“3.7

6.5

“0.9

42.1

10.3

*2.9

*3.2

13.6

14.4

“0.2

40.7

58.7

36.0

100.0

34.5

65.5

2.2

“0.7

“0.9

46.7

17.2

2.5

2.0

14.8

9.9

“0.6

39.3

61.6

43.6

100.0

36.9

63.1

“0.7

‘0.6

“0.5

52.8

10,2

1.1

1.5

11.3

7.5

“0.5

37.9

66.7

40.9

100.0

41.3

58.7

“0.2

“1.4

“0.2

50.6

9.1

*0.8

*0.6

6.0

7.2

*0.7

39.9

64.0

33.9

I 00.0

35.9

64.1

“0.8

“0.4

‘0.6

53.3

10.5

1.2

1.7

12,5

7.6

“0,4

37.5

67.3

42.5

lData include a small number of unknowns.

‘Resident may have had more than 1 mental dlaorder.

49
Table 14. Number and percent distribution of nursing home residenta by mental status, according to race and Hispanic origin:

United States, 1985

Race

Hispanic origin

All other

All

Mental status

Nonresidents White Total Black Hispanic hfispanic~

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

Current mental disorders

Nomental disordersl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hasmental disordersz .,, ,, ...,.., . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental retardation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,,

Alcohol abuae or dependence. . . . . . . . . . . . . .

Drug abuse or depend ence ...,. . . . . . . . . . . . . . . . . . . . . . . .

Senile dementia or chronrc organic brain syndrome. . . . .

Depressive disorders,,......,,. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Schizophrenia ...,,......,,,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anxiety disorders, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Persona lttyor character disorders ... . . . . . . . . . . . . . . . . . . . . . .

Other mental disorders . .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Behavioral problems.......,., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dworientation ormemory impairment, . . . . . . . . . . . . . . . . . . . . . . . . . .

Disturbance of mood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Current mental disorders

Nomental disorders7, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,

Hasmental disorderaz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental retardation, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Alcohol abuse or dependence . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drug abuse or dependence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Senile dementia or chronic organic brain syndrome . . . . . . . .

Depress ive disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Schizophrenia, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other psychoses ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Personal ityor character disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other mental disorders, ,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Behavioral problems . .,,,..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Disorientation ormemo~impalrment. . . . . . . . . . . . . . . . . . . . . . . . . . .

Disturbance of mood. ,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,,

1,491,400

510,000

981,500

81,100

41,800

13,900

646,700

205,300

85,200

34,900

200,700

164,700

6,300

572,600

922,500

623,700

100.0

34.2

65.8

5.4

2.8

0.9

43.4

13.8

5.7

2.3

13.5

11.0

0.4

38,4

61.9

41.8

1,374,600

468,400

906,200

75,000

35,400

13,700

597,400

192,300

77,000

32,100

185,400

149,400

5,800

525,200

847,100

580,300

100.0

34.1

65.9

5.5

2,6

1,0

43,5

14.0

5.6

2.3

13.5

10.9

0.4

38.2

61.6

42.2

116,800

41,600

75,300

6,200

6,400

*300

49,400

13,000

8,200

“2,800

15,300

15,300

“500

47,400

75,400

43,400

I 04,400

37,200

67,200

“4,700

‘5,700

“300

45,600

10,500

6,600

“2,500

12,800

14,700

“500

43,600

68,600

38,700

Percent distribution

100,0 100.0

35.6 35.6

64.4 64.4

5.3 *4.5

5.5 *5.4

“0.2 ‘0.3

42.3 43.7

11.1 10.0

7.0 6.3

*2.4 *2.4

13.1 12.3

13.1 14.1

*0.4 ‘0.5

40.6 41.8

64.6 65.7

37,2 37.1

41,000

10,300

30,700

‘2,200

*2,1OO

22,000

6,400

*3,100

*1 ,900

5,800

5,800

18,700

28,700

22,300

100.0

25,2

74.8

*5.4

*5.2

53.7

15.7

“7.5

*4.7

14.3

14.1

45.7

70,0

54,4

1,450,400

499,600

950,800

78,900

39,700

13,900

624,700

198,900

82,100

33,000

194,900

158,900

6,300

553,900

893,800

601,400

100.0

34.4

65.6

5.4

2.7

1.0

43.1

13.7

5.7

2.3

13.4

11,0

0.4

38.2

61.6

41.5

lData lncluda a small number of unknowns.

2Rasldent may have more than 1 mental d]sorder,

50
Table 15. Number and percent distribution of nursing home residents, by living arrangement prior to admission: United States, 1985

Age

65 years and over

Under 65–74 75–84 85 years

Sexandlivirwa rrangementw iorto admission Total 65 years Total years years and over

Both sexes

All residents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Private or semiprivate residence.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

With family membara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Unknown if with others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

General orshort-stay hospitsll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental fscilityz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Unknown or other arrangement.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male

All males . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Private orsemiprivate residence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Unknown if with others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

General orshott-stay hospitall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental facilityz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Unknown or other arrangement.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female

All females . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Private orsemiprivate residence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Unknown if with others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

General orshort-stay hospital’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental facility2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Other health facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -.

Unknown or other arrangement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Both sexes

Allresidants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Private or semiprivate residence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Unknown if with others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anothar health facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

General orshort-stay hospital’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mentelfacilityz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Other haalth facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown or other arrangement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

See footnotea and note at end of table.

1,491,400

566,800

201,000

275,200

48,100

42,500

862,700

181,900

557,400

73,100

29,700

34,800

47,900

423,800

140,000

41,900

75.800

13,100

9,200

263,800

54,500

140,600

32,800

29,300

11,100

15,500

‘1,067,700

426.800

159,100

199,400

34,900

33,400

598,900

127,400

416,800

40,300

“400

23,700

32,400

100.0

38.0

13.5

18.5

3.2

2.9

57.8

12.2

37.4

4.5

2.0

2.3

3.2

173,100

40,BO0

7,500

26,300

“3,800

‘3,200

121,100

22,000

46,800

34,200

11,200

10,000

8,100

69,300

18,500

“2,900

11,400

“2,300

*1 ,900

64,300

10,800

22,900

16,200

11,200

“4,900

“4,700

83,800

22,300

“4,600

14,900

*1,500

“1 ,300

56,800

11,100

23,900

18,000

*5,1 00

‘3,400

100.0

23.6

4.3

15.2

*2.2

*1.8

70.0

12.7

27.1

17.6

6.4

5.8

4.7

Number

1,318,300

526,000

193,400

248,900

44,300

39,300

741,600

159,900

510,500

38,900

18,500

24,700

39,800

334,400

121,500

39,000

64,400

10,800

7,200

199,500

43,700

117,700

16,500

18,200

6,200

10,700

983,900

404,500

754,400

184,500

33,500

32,100

542,100

116,200

392,BO0

22,300

“400

18,600

29,000

212,100

61,900

17,400

34,000

6,600

“3,900

141,600

27,400

83,900

16,100

9,700

6,900

6,200

B0,600

18,700

5,000

9,600

2,800

*1 ,300

58,300

11,100

28,500

7,700

9,400

“2,600

*2,600

131,500

43,200

12,400

24,400

“3,800

“2,600

B3,300

16,300

55,400

8,400

“400

“4,300

“3,700

Percent distribution

100.0 100.0

39.9 29.2

14.7 8.2

18.9 16.0

3.4 3.1

3.0 “1.8

56.3 66.8

12.1 12.9

38.7 39.5

2.8 7.0

1.4 4.6

1.9 3.3

3.0 2.9

509,000

206,300

74,900

101,000

16,900

13,500

284,500

64,100

194,500

16,100

“4,600

9,400

14,100

141,300

52,600

17,200

26,800

*5,1OO

“3,500

82,700

18,600

51,500

6,500

‘4,600

“2,500

“5,100

367,700

153,800

57,700

74,200

11,800

10,000

201,800

45,500

143,000

9,600

6,900

8,900

100.0

40.5

14.7

19.8

3.3

2.7

55.9

12.6

38.2

2.9

‘0.9

1.8

2.8

597,300

257,800

101,100

114,000

20,800

21,900

315,500

68,400

232,100

6,700

“4,200

8,500

19,500

112,600

50,200

16,800

28,000

“3,000

‘2,400

58,500

14,000

37,700

“2,300

“4,200

*1,100

*3,1 00

484,700

207,600

84,300

86,000

17,800

19,500

257,000

54,400

194,500

“4,400

78400

16,500

100.0

43.2

16.9

19.1

3.5

3.7

52.8

11.5

38.9

1.1

“0.7

1.4

3.3

51
Table 15. Number and percent distribution of nursing home residents, by living arrangement prior to admission: United States, 1985—Con.

Age

65 years and over

Under 65-74 75-84 85 years

Sexandliving arrangement prior to admission Total 65 years Total years years and over

Male

All males . .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Private orsemiprwate residence. . . . . . . . . . . . . . . . . . . . .

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

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

Wmhnonfamlly members . . . . . . . . . . . . . . . . . .

Unknown if with others....,,,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,

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

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

General orshort-stay hospitall, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,

Mental facilityz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Other health facillty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,

Unknown or other arrangement . . . . . . . . . . . . . . . . . . . . . . . . . . . ,. ..,,

Female

All females . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prwateor semlpnvate residence. . . . . . . . . . . . . . . . . . . . . . . . . . . . ,. .,,

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

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

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

Unknown lf with others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

General orshort-stay hospitall, , . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,

Mental fscllityz .,, , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,

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

Other health facility, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,,

Unknown or other arrangement . . . . . . . . . . . . . . . . . . . . ... ,,,

100,0

33,0

9.9

17.9

3.1

2.2

62.3

12.9

33.2

6.9

6.9

2.6

3.6

100.0

40.0

14.9

18.7

3.3

3.1

56.1

11.9

39.0

3.5

“0.0

2.2

3.0

100.0

20.8

*3.2

12.8

*2.6

*2.2

72.0

12.1

25.7

15.5

12.5

*5.5

*5.3

100.0

26.6

*5.5

17.8

*1.8

“1.5

67.8

13.3

28.6

19.9

“6.1

“4.1

Percant distribution

100.0

36.3

11.7

19,3

3.2

2,2

59,6

13.1

35,2

4.7

5.4

1,9

3.2

100.0

41.1

15.7

18.8

3.4

3.3

55.1

11.8

39.9

2.1

“0.0

1.9

3.0

100,0

23.2

6.2

12.0

3.4

*1.6

72.4

13.8

35.4

9.2

11.6

*3.3

*3.2

100.0

32.8

9.4

18.5

“2.9

“2.0

63.3

12.4

42.1

5.6

“0.3

*3.2

*2.8

100.0

37.2

12.2

18.9

*3.6

*2.5

58.5

13.1

36.5

4.1

*3.2

*1.7

*3.6

100.0

41.8

15.7

20.2

3.2

2,7

54.9

12.4

38.9

2.5

1,9

2.4

100.0

44.6

14.9

24.9

*2.6

*2.2

52.0

12.4

33.5

*2,1

*3.8

“1.0

*2.7

100,0

42.8

17.4

17.7

3.7

4.0

53.0

11.2

40.1

“0.9

1.5

3.4

lPsych!atric units are excluded,

2Mental hospitals, fac!lmes for the mentally retarded, general or short-stay hospital psychiatric un!ts, and mental health centers are included,

NOTE: F!gures may not add to totals because of rounding.

52
Table 16. Number andpercent distribution Ofnursing home residents byliving arrangement prior to admission, according to marital status, race, and Hispanic origin: United States, 1985

Marital status

Hispanic origin

Divorced Race

or Never

Living arrangement prior to admission Total

NonMarried Widowed) separated married White All other Black Hispanic Hispanicl

All residents,,,..........,.,,. . . . . . . . . . . . . . . . . . . . . . . . . . .

Privste or semiprivate residence.. . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Unknown if with others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

General orshort-stay hospita12 . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental facility3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Unknown orother srrsngement. . . . . . . . . . . . . . . . . . . . . . . . . . . .

All residents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Private or semiprivate residence. . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Unknown if with others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

General orshort-stay hospitalz . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mentslfacility3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Other health facility, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown or other arrangement . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,491,400

566,800

201,000

275,200

48,100

42,500

862,700

181,900

557,400

73,100

29,700

34,800

47,900

100.0

38.0

13.5

18.5

3.2

2,9

57.8

12.2

37.4

4.9

2.0

2.3

3.2

188,200

69,600

*3,400

63,000

*1 ,700

*1 ,500

116,400

25,100

77,600

6,000

6,100

*2,1OO

*1 ,600

100.0

37.0

“1.8

33.5

“0.9

*0.8

61.9

13.3

41,2

3.2

3,2

“1.1

*0.9

914,800

380,500

158,100

159,500

30,800

32,100

494,500

108,200

356,400

16,000

6,200

15,700

31,800

100.0

41.6

17.3

17.4

3.4

3.5

54.1

11.8

39.0

1.8

0.7

1.7

3,5

117,000

31,700

11,100

13,300

‘4,300

‘3,000

80,100

15,700

38,800

12,200

8,600

‘5,400

“4,600

100.0

27,1

9.5

11.4

*3.7

*2.5

68.4

13.4

33.1

10.4

7.4

*4.6

*3,9

Number

271,400 1,374,600

84,900 532,900

28,300 193,400

39,400 255,900

11,300 43,900

5,900 39,700

171,800 785,200

32,800 170,500

84,600 503,000

38,800 66,100

8,700 27,700

11,500 31,100

10,000 43,300

Percent distribution

100.0 100.0

31.3 38.8

10.4 14.1

14.5 18.6

4.2 3.2

2.2 2.9

63.3 57.1

12.1 12.4

31.2 36.6

14.3 4.8

3.2 2.0

4.2 2.3

3.7 3.1

116,800

33,900

7,600

19,300

‘4,200

“2,800

77,500

11,300

54,400

6,900

‘2,000

“3,700

“4,600

100.0

29.1

6.5

16.6

*3.6

*2.4

66.3

9.7

46.5

5.9

*1.7

“3.1

“4.0

104,400

30,100

6,200

17,700

“3,700

“2,600

70,000

10,500

49,700

‘5,000

“2,000

‘3,700

‘3,400

100.0

28.9

5.9

16.9

*3.5

*2.5

67.1

10.0

47.6

“4.8

“1.9

*3.5

*3.3

41,000

12,500

‘3,500

8,400

’600

27,100

“4,600

17,300

‘3,1 00

*1 ,600

’500

*1 ,300

100.0

30.5

*8.5

20.5

*1.5

66.2

*11.1

42.2

“7.7

*3.9

*1.3

*3.3

1,450,400

554,300

197,500

266,800

47,500

42,500

835,600

177,300

540,000

69,900

28,100

34,300

46,600

100.0

38.2

13.8

18.4

3.3

2.9

57.6

12.2

37.2

4,8

1.9

2.4

3.2

I Data include a small number of unknowns,

2Psychiatric units are excluded.

3Mental hospitals, facilities for the mentally ratarded, general or short-stsy hospital psychiatric units, and mental health centers are included,

NOTE Figures may not add to totals because of rounding,

m

C..)
: Table 17. Number and percent distribution of nursing home residents by prior nursing home and hospital utilization, according to age, aax, and race: United States, 1985

All

Prior nursing home and hospital utilization residents

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

Other staya in any nursing home

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

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

Prewous stays at sample facility

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

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

Number of previous stays at sample facility

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

I stay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Zstays or more . . . . . . . . . . . . . . . .

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

Stays at other nursing homes

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

No . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Number of other nureing homes used

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

l home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Zhomes or more . . . . . . . . . . . . . .

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

Hospital stays while a resident In sample facility

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

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of hospital stays while a nursing home

resident

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

I stay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2stays or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

See note at end .of table.

Age

Race

65 years and over

Under Sex

65

All other

65-74 75–84 85 years

years Total years years and over Male Female White Totai Black

1,491,400

558,900

932,600

326,100

1,165,300

1,165,300

190,900

106,500

28,700

283,600

1,035,700

173,100

71,800

101,300

41,100

132,000

132,000

23,800

12,200

●5,1OO

39,600

108,400

172,100 25,100

1,207,900 133,500

213,800 26,300

21,200 “3,500

48,500 9,800

319.800 25,100

1,171,600 148,000

1,318,300

487,000

831,300

285,000

1,033,300

1,033,300

167,200

94,300

23,500

244,000

927,400

147,000

,074,400

187,600

17,700

38,700

294,700

,023,600

212,100

83,100

129,000

44,700

167,400

167,400

26,100

15,400

*3,300

46,700

140,400

25,000

165,400

32,700

“4,800

9,200

42,500

169,600

1,171,600 148,000 1,023,600 169,600

190,600 16,200 174,500 24,700

129,200 8,900 120,300 17,800

509,000

180,300

328,700

100,000

409,000

409,000

63,100

30,000

6,900

93,800

355,900

59,300

415,200

75.100

6,700

12,000

114,600

394,400

394,400

67,800

46,800

Number

597,300

223,600

373,600

140,300

456,900

456,900

78,000

48,900

13,400

103,500

431,100

62,700

493,800

79,800

6,200

17,500

137,700

459,600

459,600

82,000

55,700

423,600

157,500

266,300

87,600

336,200

336,200

50,600

30,300

6,700

83,500

290,100

50,100

340,300

63,800

7,200

12,500

84,700

339,000

339,000

49,000

35,700

1,067,700

401,400

666,300

238,500

829,200

829,200

140,300

76,200

21,900

200,100

745,600

122,000

867,600

150,000

14,000

36,000

235,100

832,600

832,600

141,700

93,500

1,374,600

519,100

855,500

301,600

1,073,000

1,073,000

172,400

102,500

26,700

264,100

954,000

156,600

1.110,600

199,600

19,800

44,700

301,700

1)072,900

1,072,900

179,600

122,100

116,800

39,800

77,100

24,500

92,300

92,300

18,600

“4,000

‘2,000

19,500

81,800

15,500

97,300

14,300

*1 ,400

‘3.800

18,100

98,700

98,700

11,000

7,100

I 04,400

34,900

69,500

22,400

81,900

81,900

16,700

“4,000

*1 ,700

16,400

74,200

13,700

87,900

11,700

‘ 1,400

“3,400

15,400

89,000

89,000

9,000

6,400
Table 17. Numbar and percent distribution of nursing home residents by prior nursing home and hospital utilization, according to age, sex, and race: Unitad States, 1985—Con.

Age

Race

65 years and over

Under Sex All other

All 65 65–74 75-84 85 years

Prior nursing home and hospital utilization residents years Total years years and over Male Female White Total Black

Percent distribution

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

35.4

64.6

19.6

80.4

80.4

12.4

5.9

1.4

18.4

69.9

11.7

81.6

14.8

1.3

2.4

22.5

77.5

77.5

13.3

9.2

100.0

37.4

62.6

23.5

76.5

76.5

13.1

8.2

2.2

17.3

72.2

10.5

82.7

13.4

1.0

2.9

23.0

77.0

77.0

13.7

9.3

I 00.0 100.0 100.0

37.8

62.2

21.9

78.1

78.1

12.5

7.5

1.9

19.2

69.4

11.4

80.8

14.5

1,4

3.3

21.9

78.1

78.1

13,1

8.9

100.0

34.0

66.0

21.0

79.0

79.0

15.9

*3.4

“1.7

16.7

70.0

13.3

83.3

12.2

‘1.2

*3.3

15.5

84.5

84.5

9.4

6.1

100.0

33.4

66.6

21.5

78.5

78.5

16.0

*3.8

*1.7

15.8

71.1

13.1

64.2

11.2

“1.3

*3.2

14.7

85.3

85.3

8.6

6.1

100.0 100.0

36.9

63.1

21.6

78.4

78.4

12,7

7.2

1.8

18.5

70,3

11.2

81.5

14.2

1.3

2.9

22.4

77.6

77.6

13.2

9.1

100.0

39.2

60.8

21.1

78.9

78.9

12.3

7.2

*1.5

22.0

66.2

11.8

78.0

15.4

*2.3

4.3

20.0

80.0

80.0

11.6

8.4

Other stays in any nursing home

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

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

37.5

62.5

41.5

58.5

37.2

62.8

37.6

62.4

Pravious stays at sample facility

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

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

21.9

78.1

23.8

76.2

20.7

79.3

22.3

77.7

Number of previous stays at sample facility

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

I stay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2stays or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

78.1

12.8

7.1

1.9

76,2

13.7

7,1

*3.O

79.3

11.9

7.1

1.6

77.7

13.1

7.1

2.1

Stays at other nursing homes

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

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . , .,, ,,, . . . . . . . .

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

19.0

69.4

11.5

22.9

62.6

14.5

19.7

68.5

11.8

16.7

69.8

11.4

Numbar of other nursing homes usad

81.3

14.1

1.3

3.4

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

l home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2homes or more. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

81.0

14.3

1.4

3.3

77.1

15.2

“2.0

5.7

80.3

15.1

1.7

3.0

Hospital stays while a resident in sample facility

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

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

21.4

78.6

14.5

85.5

20.0

80.0

22.0

78.0

Number of hospital stays while a nursing homa

resident

80.0

11.6

8.4

78.0

13.3

8.8

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

I stay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2atays or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

78,6

12.8

8.7

85.5

9.3

5.2

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

m

m
Table 18. Percent distribution of nursing home residents by selected characteristics and average length of stay since admission, according

to primary source of payment in month before interview: United States, 1985

Primary source of payment in month before interview

Medicaid

Own Other

income Skilled lnter- government All

All or family nursing mediate assistance other

Characteristic sources Suppoti Medicare Total care cara or welfare sources

Sex and age

Both sexes, alleges, . . . . . . . . . . . . . . . . . . . . . .

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

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

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

75–84 years .,, ., . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

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

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

Female, all ages, . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

75–84 years.....,,,.....,.. . . . . . . . . .

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

Race

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

Another., ,, ., . . . . . . . . . . . . . . . . . . . . . . . . .

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

Hispanic orlgln

Hmpanic. .,.,..,,,,.....,,,.. . . . . . . . . . . .

Non- Hispanicl .,,,,....,,,,.. . . . . . . . . . . .

Current marital status

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

Widowed, .,,,...,..,,,..,., . . . . . . . . . .

Divorced or separated, ,,, . . . . . . .,,.,..,..,,,,.

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

Llvlng arrangement prior to admlsslon

Private or semiprivate residence.

Alone . . . . . . . . . . . . . . . . . . . . . . . ,, ...,.,,,,,..

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

Wlthnonfamrly members . . . . . . ,..

Unknown lf with others ...,.., . . . . . . . . . .

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

Another nursing home . . . . . . . .

General or short-stay hospltalz . . . . . .

Mental facillty3 .,,........,,,. . . . . . . .

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

Other health faclltty or unknown. . .

Unknown or other arrangement . . . .

See footnotes at end of table.

100.0

11.6

88.4

15,3

34.1

40,0

28,4

6,0

22,4

5,8

9.5

7.5

71.6

5.6

66.0

9.5

24.7

32.5

92.2

7.8

7.0

2,7

97,3

12.6

61.3

7.8

18.2

38.0

13.5

18.5

3.2

2.9

57.8

12.2

37.4

4.9

2.0

2.3

3,2

100,0

7,3

92.7

12,4

37.2

43.7

29.0

4.3

24.7

4.9

10,1

10.0

71.0

3.0

68.0

7.5

27.1

33.7

97.2

2,6

2,2

2.1

97.9

14.8

66.1

4.7

14.4

44.9

18.7

19.8

3.5

2.9

50.7

12.2

33,1

2,4

2,2

1,8

3.4

100,0

“3.0

97.0

*25.3

47.5

*24.2

33.3

“3,0

30.3

“11,7

*14,3

4.2

66.7

66.7

*1 3.6

33.2

*1 9.9

94,9

*5.1

*3.8

“5.1

94.9

“20.8

64.6

*6.7

“7.9

*1 5.9

*8.4

*4.9

*2.6

82,8

*2.3

80.4

*1.4

Percent distribution

100.0

13.2

86.8

16.1

32.5

39.7

25.1

5.7

19,5

5.5

8,8

5,7

74.9

7.5

67.3

10.6

23.7

34.0

88.1

11.9

10.8

3,4

96.6

10.5

60.5

9.1

19.9

33.2

9.2

18.4

2.8

2.8

63.2

12.5

42.8

6.0

“0.6

2.2

2.7

100.0

14.9

85.1

13.4

32.1

41.3

24,8

6.2

18.6

3.9

8.6

6.4

75.2

8.6

66.5

9.5

23.5

34.9

87.7

12,3

10.2

4.0

96.0

12.4

60.4

8.4

18.8

24.3

6.1

13.9

2.4

*1.9

72.9

10.7

55.4

5.0

‘0.7

“1.7

“2.1

100.0

12.3

87.7

17.6

32.8

38.9

25.3

5.4

19.9

6.3

8.9

5.4

74.7

6.9

67,8

11,3

23.9

33.5

88.4

11.6

11.1

3.1

96.9

9.4

60.6

9.5

20,4

38.0

10.9

20.9

3,0

3,3

57.9

13,5

35.9

6.5

0.6

2.4

3.0

100.0

29.0

71.0

28.0

23.2

20.7

38.6

15.6

23.0

*8.9

*1 0.2

“4.0

61.4

13,3

48.0

19,2

13.1

16.7

86.5

13.5

13.1

“0.4

99.6

12.7

35.6

12.5

39.2

34.2

11,9

16,7

*2.5

*3.2

61,6

13,6

17.6

20.4

“10,5

“3.7

100.0

28.4

71.6

22.0

25.0

24.6

59.9

24.4

35.5

16.7

*9,8

“9.0

40.1

“4.0

36,1

*5.3

15,2

15.6

94.8

*5.2

*5,2

*2,9

97.1

14.3

37.9

23.8

24.1

36,9

16,6

“9.5

*7.5

*3.3

51.7

*1O,5

*1 0.0

“6.2

23.9

“3,0

*9,6

56
Table 18. Percent distribution of nursing home residents by selected characteristics and average length of stay since admission, according

to primary sourca of payment in month before interview United Statas, 1985—Con.

Primary source of payment in month before interview

Medicaid

Own Other

income Skilled lnter- government All

All or family nursing mediate assistance other

Characteristic sources Suppofl Medicare Total care care or welfare sources

Length of stay since admission Percent distribution

Less than 3 months . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.9 16.2 76.0 8.2 9.3 7.6 *7.5 21.7

3months tolessthan6 months. . . . . . . . . . . . . . . . 9.5 11.3 *6.6 7.9 10.1 6.7 “5.8 15.6

6months tolessthan 12 months. . . . . . . . . . . . . . . 14.1 16.1 *5.6 13.1 14.7 12.3 *7.9 13.7

lyearto leas than 3 years . . . . . . . . . . . . . . . . . . . . . 31.5 31.4 *5.3 33.3 32.7 33.6 33.4 15.7

3yearsto less than 5 years.... . . . . . . . . . . . . . . . . 13.9 12.5 “4.0 15.3 14.6 15.7 16.2 *1 2.0

5years or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18.1 12.5 *2.5 22.2 18.7 24.1 29.2 21.2

Length of stay in days

Average length of stay since admission. . . . . . . . . . . 1,059 811 187 1,253 1,122 1,324 1,619 1,016

1Data include a small number of unknowns.

2Psychiatrlc units are excluded.

3Mental hospitals, facilities for the mentally retarded, general or short-stay hospital psychiatric units, and mental health centers are included.

57
Appendixes

Contents

I. Technical notes on methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Survey design...........,.,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

General qualifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reliability ofestimates ...,... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hypothesis testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

II. Definitions of certain terms used in this report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

111. Selected survey instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Appendix figure

I. Relative standard emors for estimated numbers occurrent nursing home residents: United States, 1985 . . . . . . . . . . . . .

Lkt of appendix tables

I. Comparison between the 1985 NNHS(estimates) and 1986 ILTCPshowing number ofhomes and beds bytypec~f

home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

II. Number offacilities inthe1985 National Nursing Home Surveyuniverse and sample, by disposition andsampling stratx

Conterminous United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

111. Summary ofdata collection procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

59

59

61

62

63

65

67

64

59

60

61

58
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, dkcharges, and staff in the conterminous 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

satis~ 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 frama

The 1985 NNHS included all types of nursing and related

care homes with three or more beds set up and stafled 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 living facilities in Florida, family

care homes in Kentucky, and adult foster care homes in Michigan (l).

The universe for the 1985 NNHS consisted of four components: (a) the base, the 1982 National 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 (1).

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 LongTerm 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 ILTCP to identifj 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 and 71,000 beds for

1985. Table I gives a comparison of the two surveys reflecting

this adjustment in residential facilities.

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 collected by

35 States 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 NNHS methodology 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 are a 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

RN.’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 cert~lcation: (a) certified by either Medicare or

Medicaid or (b) not certitled by either Medicare or Medicaid.

Table 1. Comparison between the 1985 NNHS (estimates) and 1986

ILTCP showing number of homes and bads by type of home

1985 NNHS 1986 IL TCP

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 A list of references follows tbe text.

NOTE NNHS = National Nursing Home Surve~ ILTCP = Inventory of Long-Term

Care Places.

59
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 Non-Complement Survey strata were further sorted by

bed size, producing the 20 primary 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 II 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 survey 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 RN.’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

Table 11. Number of facilities in the 1985 National Nursing Home Survey universe and sample, by disposition and sampling strata: Conterminous

United States, 1985

Sample

In scope and in business

Universe Out of scope or

Sampling strata (sampling frame]’ All facilities out of business Nonresponding Responding

Alltypes ofcert[flcatlon, . . . . . . . . . . . . . . . . . .

Certlfled

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 bedslze. , . . . . . . . . . . . . ., ..,,,,.,...,.,,.

Not cert!fied

Complement surwey 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 bed size, .,, .,,,,..,..,,,,.

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

.

62$

1,220

19

5

9

43

269

478

196

17

10

10

14

8

10

15

35

39

14

5

4

20

57

1

2

1

4

9

9

1

1

1

1

3

3

3

2

1

2

1

1

1

10

84

2

0

0

3

21

28

13

3

0

3

0

1

1

1

3

3

1

0

0

1

1,079

16

3

8

36

239

441

182

13

9

6

11

4

6

12

31

34

12

4

3

9

lThe unwer?.e consisted of nursing homes In the 19S2 National Master Fac(hty Inventory (N MFI), nursing homes in the 1982 Complement Survey of the NMFI, hospnal -

based nursing homes from the Health Care Flnanclng Admlnlstrat!on file, and nurs[ng homes opened for buslnesa from 1982 to 1984,

60

i
. Nursing StatT Sampling List

. Nursing Staff Questiomaire

. Current Resident Sampliig List

. Current Resident Questionnaire

. Discharged Resident Sampling List

c Discharged Resident Questionnaire

. Next-of-Kin Questionnaire.

Data were collected according to the following procedures:

1.

2.

3.

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 a prepared

financial statement was available, it was accepted in lieu

of an EQ. Thk occurred in one-half of the cases. The

interviewer completed the Nursing Staff Sampling List,

selected the sample of RN.’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 Questiomaire for each sample resident

Table I I [. Summary of data collection procedures

by interviewing the member of the nursing stti most

familiar with care provided to that resident. The nurse

referred to the resident’s medical record when responding.

No resident was interviewed directly.

The interviewer then completed the Discharged Resident Sampling List (a list of all persons discharged alive or

dead during the 12 months preceding the survey date),

selected a sample of discharges from it, and completed for

that stay a Discharged Resident Questiomaire for each

sample discharge by interviewing a member of the nursing

staff, who refereed to medical records. In larger facilities, a

team of two or three interviewers conducted the survey to

reduce the time spent in the facility.

Follow-up 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 identfi 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

Questiomaire. 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 Number

Questionnaire (percent) responding

Facility . . . . . . . . . . . . . . . . . 100 1,079

Expense . . . . . . . . . . . . . . . . 68 732

Current Resident. . . . . . . . . 97 5,243

Discharged Resident. . . . . . 95 6,023

Nursing Staff . . . . . . . . . . . . 80 2,763

Next-of- Kin . . . . . . . . . . . . . 90 9,134

Generally, response rates were higher for questionnaires

adrninktered in a personal interview situation (Facilhy, Current

Resident, Discharged Resident, and NOK) than for those that

Questionnaire Respondent Interview situation

Facility Questionnaire

Expense Questionnaire

Nursing Staff Sampling List

Nursing Staff Questionnaire

Current Resident Sampling List

Current Resident Questionnaire

Discharged Resident Sampling List

Discharged Resident Questionnaire

Next-of-Kin Questionnaire

Administrator

Administrator, owner, accountant, or bookkeeper

Staff members

Sampled registered nurses

Staff member who refera to current resident census

Nurse who refers to medicsl record

Staff member who refers to discharge records

Nurse who refera to medical record

Relatives, guardisns, or anyone familiar with the sampled person

Interview

Self-enumerated

Informal intetview or copied from records

Self-enumerated

Informal interview or Copied from records

Interview

Informal inter-view or copied from records

Intewiew

Telephone interview

61
were self-enumerated (Expense and StafT). 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 unanswered on a partially completed questionnaire were

generally imputed by assigning a value from a responding unit

with major characteristics identical to those of the nonresponding unit.

Rounding of numbers

Estimates of 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 (6), a data processing error concerning the number of alllisted 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. Ailer correction, the increase in estimated number of diagnoses by specific categories

ranged from 0.1 –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 femuq 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 M 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

NOTE: A list of references follows the text,

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

second-stage 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

residents (discharges or R.N. ‘s) upon which the selection is

based; the second is the ratio of the number of sample residents

(discharges or RN.’s) in the facility to the number of residents

(discharges or R. N.’s) for whom questionnaires were completed within the facility (46).

Reliability of estimates

As in any sample survey, the results are subject 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 types 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]%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 (47–48).

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

62
estimate X and its relative variance (rel var X). This relationship

is expressed as:

s;.

relvar X=—

X2

b =~+—

x

where a and b are regression estimates determined by an iterative procedure.

The relative standard error is then derived by taking the

sqwu-e root 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(~) 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

–0.000177 +

530.2361

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 can 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 percenu therefore,

the standard error is 0.30 X 5,800 = 1,740.

To approximate the relative standard error (RSE(p)) and

the standard error (SE(p)) of a percent p, the following equations

are used

SE(p) ‘p ● RSE (p)

where x = the numerator of the estimated percent

y = the denominator

~=loo.z

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 (49) or the relative standard errors of the numerator and the denominators are both 10

percent or less (50).

Hypothesis testing

To test the difference between two statistics (mean, percent, and so forth), the two-tailed t-test with 20 degrees of

freedom should be performed to determine whether to reject

the null hypothesis (for the two means ~1, XzLthe n~ll hypothesis is HO:Zl = 2Z with the alternative HA:X1 # -V At the

0.05 (5 percent) level, the critical value for the t-testis 2.09.

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(X1 ) is the

standard error of xl and SE(XJ is_the s@dard error of ~z, the

standard error of the difference (Xl —X2) is

(This formula will represent the actual standard error for the

difference between separate and uncorrelated characteristics,

although it is only a rough approximation in most other cases.

The number of replicates (20) used in the balanced repeated

replication 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 and Z2 are different) if the

probability of a type I error is less than 5 percenq that is, .if

NOTE A list of references follows the text.

>2.09

63
cm

.P

100

90

80

70

60

50

100

90

80

70

60

50

40

30

20

1:

8

7

6

5

4

3

2

0.;

0.8

0.7

0.6

05

0.4

0.3

0.2

0.1

40

20

10

9

8

7

6

5

4

3

2

I!I.9

0.8

:,;

0.5

0.4

0.3

0.2

nl

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 estimate

Figure 1. Relative standard errors for estimated 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 source ofpayinent

Charge—The total amount charged to the resident by

the facility in the last completed calendar month prior to

the survey.

Prima~ source ofpayment 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 fimds, 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 welfare- Sources

of government aid (Federal, State, or local) 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

no-charge 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 ofpayment at admission for

defiitions of payment sources.)

Length of stay 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 or&in—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 man.tal status—Marital status of the resident at

the time of the survey.

Health status

Activities of daily living—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 toi[et room—Requires assistance or does not

use toilet room.

Transferring—Requires assistance in getting into or

out of a chair or bed.

Continence-Has ditliculty 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 medicaI record of patients. Diagnoses

were recorded for two time period~ 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 the International

Classz~cation of Diseases, 9th Revision, clinical modl~cation

(ICD-9-CM) (37).

A diagnostic chapter within ICD–9–CM is primarily an

arrangement of diseases according to their principal anatomic

site, with special chapters for infectious and p~asitic diseases;

neoplasm~ endocrine, nutritional, and metabolic diseases; menNOTE: A list of references follows the text.

65
tal 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 aud (b) external causes of injury and poisoning.

Primaiy diagnosis—The diagnosis listed first on the

medical record.

All-listed diagnoses—All diagnoses, up to a maximum of eight, listed on the medical record of each sample resident.

Current mental disorders—Mental problems of the residents, 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 bases the selection

on 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.

Behavioral prohlems—Display by the resident of any of

the six selected types of behavior that are generally considered

dependent or disruptive disrobing or exposing oneself, screarnin~

being physically abusive to oneself or others, stealing, getting

lost or wandering into unacceptable places, and inability to

avoid simple dangers.

Disorientation or memory impairment—inability to remember dates or time, identify familiar locations or people,

recall important aspects of recent events, or make straightforward judgments, of such degree that the resident is impaired

nearly every day in performance of basic activities of daily

living, mobility, and other activities.

Disturbance of mood—Depression, anxiety, fearfulness,

or worry of such degree that the resident is distressed or restricted in functioning nearly every day.

Terms relating to residents with next of kin

Next of kin—Relatives, guardians, or anyone familiar with

the sample resident and identified by the nursing home staff as

the best potential respondent ffom the resident’s medical records.

General reasons for admission—Includes six circumstances that the next of kin could have reported as influencing the resident’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.
Appendix II1

Selected survey instruments

-AMWENT OF MEALTH ANDHtMAN S~

PuBw HttALIHsERvcs Slwm — ot_stmts OMB No. 0937-0115

Naiorml cumrforwsmusua

APPROVAL EXPIRES 12/31/S6

lsa51wrmsi NumhrgnornsswwY

CURRENT RESIDENT SAMPLING LIST - w

Conildential Information

Information contained on thii form which would permit identification of any individual or establishment has been collected WM

a guarantee that it will be held in strict confidct=, will be used only for purposesstatedfor this study, and will not be disclosed

or released to others without the consent of the individual or the establishment in accordance with section 3(?&d)of the Public Health

ServiceAct (42 USC 242M).

A. Type of identifier used: 1 ❑ Name 2 ❑ Other, Specify

B. Current Residerm Facility Total C. Total in sample

D. Interviewer Name I

E. Interviewer ID

List the rmidcrstsconsecutively in the order in which they arc given to you. Enter the total listed in hens B above. Compare the

total with Tabk 2 to determine the samDlc. Circle the limenumbers of all sarnDkd residents. Count the number circled and enter

it in hem C above.

01

02

03

04

05

06

07

08

09

10

11 I

12 I I

13

14

15

16 t

17

I RESIDENTS IN NURSING HOME

UNE

ND. IWident IduMmr

26

27

28

29

30

1371

38 I

1391 I

40

1411

43

44

45

46 —

47

14ftl

I

.- )

49

25 I I

, I

50 I

HS4271

11s6

lSma, Snnnnndul CON7iNUEON THE BACK

f

67

\
CURRENT RESIDENT SAMPUNG LIST-CONTINUED

RESIDENTS IN NURSING HOME

,INE I

Uo. I

Resident klentifiir

.-

61

62

63

64

65

X6

67

68

69 I I

71 I

72

73 I

74

75 I

I RESIDENTS IN NURSING HOME

LINE

NO.

Resident klentifiir

t“---I

76 i

-.

80 I

81 ——

82

83

t

84

85

86

87

88 ——

89

90

91-.

92

93 —.-

94

95

96

97

98

99

100

Ifrnmhrms mnnrl,dunamwdtsor d mrunrbu lhOlinab@rnily

with #lol. ~kma on 8dumd8trata, 201, 201, *.
DEPARTMENT OF HEALTH AND HUMAN SERVICES OMB r0937 0115

PUBLIC HEALTH SERVICE AppROVAL EXPIRES 1231 86

National Cantar for Health Statistics

1985 National Nursing Home Survey

CONTROL NO.

CURRENT RESIDENT QUESTIONNAIRE

CONFIDENTIAL INFORMATION

Information contained on this form which would permit identification of any individual or estabhshment 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 estabtkhment in accordance with Section 308(d) of the Pubtic

Health Service Act (42 USC 242m).

A. Interviewer Name B. Interviewer I.D. C. Date of Interview

/ /

ENTER HERE %D ON F%LDOU;WSHEET

D. Resident Line No. E. Respondent Title

F. Name of Resident

Fust Initial Las[

1. What is the sex of this resident?

01 ❑ Male 02 ❑ Female

2. What is ‘s date of birth?

1~ or

Mo. Oay Year Age

SHOW FLASHCARD # 1

3a. What is the racial background that best describes ?

01 •l White

02 ❑ Black

03 ❑ American Indian or Alaska Native

04 ❑ Asian or Pacific Islander

94 ❑ Don’t know

69
3b. [S Hispanic or not?

01 ~ Hispanic

02 ❑ Not HispiUliC

94 ❑ Don’t know

4a. What was ‘s marital status at admission?

01 ❑ Married 04 ❑ Separated

02 ❑ Widowed 05 ❑ Never Married

03 ❑ Divorced 94 ❑ Don’t know

b. What is ‘s marital status now?

01 ❑ Married 04 ❑ Separated

02 n 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. Provision

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 tiving children?

01 •l Yes 02 ❑ No 94 ❑ Don’t know

-.

7. What was the date of ‘s current admission to this facility?

/ /

Mo. Day Year

I INTERVIEWER: ENTER ADMISSION DATE ON FOLDOUT SHEET THEN ASK Q. 8. ]

1SHOW FLASHCARD # 2

I

8a. Where was staying immediately before entering this facility?

01 ❑ Private residence (house or apartment)

02 •l 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)

70
8b. At that time, was 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

I SKIP TO Q. 10 I

I

SHOW FLASHCARD # 3

I

8c. What type of facility was it?

01 •1

02 •1

03 ❑

040

05 •1

060

07 •1

08 ❑

090

10 •1

11 •1

12 ❑

13 ❑

94 ❑

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 Iong-term care hospital

Other, (SPECIFY)

Don’t know

[

SHOW FLASHCARD # 4

8d. Where was staying immediately before entering that facility?

01

02

03

04

05

06

07

94

•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)
le. At that time was he/she living with family members, non-family members, or alone?

01 ❑ With family members

02 ❑ With non-family members

03 •l Alone

94 ❑ Don’t know

[INTERVIEWER NOTE: BEFORE PROCEEDING, REFER TO Q. &k.IS CATEGORY 05 CHECKED?

❑ ms (CONT~UE WITH Q. 9) NO (SKIP TO Q. 10)

YOUreported 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 my

I

SKIP TO Q. 9h J

9c. What condition, or diagnosis was chiefly responsible for ‘s admission to the

hospital for care? FOR OFFICE USE ONL1t

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. 9f) 94 ❑ Don’t know (SKIP TO Q. 9f)

9e. What were those conditions?

FOR OFFICE USE 0NL%

CONDITION -

1.

2. —

3. —

9f. Were any diagnostic or surgical procedures Wrforrned 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

I 72
10a.

10b.

10C.

led.

lee.

lof.

log.

10h.

IOi.

10j.

Has been admitted to a short-stay hospital while a resident in this facilit) ?

That is, since (DATE OF ADMISSION) and without being

formally dischruged from this facility.

01 ❑ Yes

02 ❑ No (SKIP TO Q. 11)

94 ❑ Don’t know (SKIP TO Q. 11)

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. Ioe)

What was ‘s DRG category for that stay?

DRG category

DRG Number Only

SKIP TO Q. 10j

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 n Yes 02 ❑ No (SKIP TO Q. 10h) 94 ❑ Don’t know (SKIP TO Q. 10h)

What were those conditions? FOR OFFICE USE ONLY

CONDITION

1.

L.

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. 10j)

What were the procedures? FOR OFFICE USE ONLY

PROCEDURE

1.

2.

5.

How many nights did spend in the hospital during that stay?

Number of nights 94 ❑ Don’t know

73 I
ha. Has previously been a resident in this facility?

01 ❑ Yes 02 ❑ No (SKIP TO Q. 1Id) 94 ❑ Don’t know (SKIP TO Q. 1Id)

I lb. How many times has been a resident in this facility, not counting the (DATE

OF ADMISSION) admission?

Times 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?

Admitted Discharged

mo./day/yr. mo./day/yr. Yes No Don’t know

1. / /— ~— / /_. 01 ❑ 02 ❑ 94 ❑

2. / — / — — / — / — 01 •1 02 ❑ 94U

3. / /_ /~._ 01 ❑ 02 •1 94 ❑

4. / / ___ / / 01 ❑ 02 •1 94 rJ

5. / /_ __/~_ 01 •1 02 •1 940

6. / / / / 01 ❑ 02 •1 94 n

7. / /_ __ / / 01 •1 02 •1 94 ❑

8. / /_ _ / /_ 01 ❑ 02 ❑ 94 ❑

lld. Was ever in any other nursing homes beside this one?

01 ❑ Yes 02 ❑ No (SKIP TO Q. 12) 94 ❑ Don’t know (SKIP TO Q. 12)

he. Not counting this facility, in how many different nursing homes has resided?

Number of different homes 94 ❑ Don’t know

Ilf. 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)

llh. How many times was a resident in (NAME OF FACILITY IN Q. 1lg( 1))?

Times in facility

1

74
hi.

1

1

j.

k.

111.

llm,

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 in (NAME OF FACI

Times in facility

ITY IN Q. 1 g(2))!

On what dates was admitted and discharged from (NAME OF FACILITY IN Q. 1lg(2))?

1.

2.

3.

Admitted Discharged

Month Year Month Year

/ /

/ /

/ /

How many times was a resident in (NAME OF FACILITY IN Q. 1lg(3))’?

Times in facility

On what dates was admitted and discharged from (NAME OF FACILITY IN Q. 11g(3))?

1.

2.

3.

Admitted Discharged

Month Year Month Year

/ /

/ /

/ /

12. In order to follow-up on ‘s complete history of nursing home utilization, we would

like to have any information you have that wilI 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:

❑ NOnext of kin on record

Name (First, Initial, Last)

Street

City and State

Zip Code

Telephone number ( ) —

Relationship to resident

75
12b.

12C.

12d.

12e,

12f.

Kin/Friend/Other:

Name (First, Initial, Last)

Street

City and State

Zip Code

Telephone number()—

Relationship to resident

—

Kin/Friend/Other:

Name (First, Initial, Last)

—

Street

—

City and State

.

Zip Code

Telephone number()—

Relationship to resident

Kin/Friend/Other:

Name (First, Initial, Last)

Street—

City and State .—

Zip Code

Telephone number()—

Relationship to resident

Kin/Friend/Other:

Name (l%st, Initial, Last)

Street

City and State

Zip Code

Telephone number()—

Relationship to resident.

Kin/Friend/Other:

Name (13rst, Initial, Last)

Street

City and State

Zip Code

Telephone number()—

Relationship to resident
13. According to ‘s medical record, what were the primary and other diagnoses at the

time of admission, that is, on (DATE OF ADMISSION)? (SPECIFY).

FOR OFFICE USE ONLY

ICD9 E or V CODE

Primary: 1.

Other: 2.

3.

4.

5.

6.

7.

8.

14. According to ‘s medical record, what are ‘s current

primary and other diagnoses? (SPECIIW)

FOR OFFICE USE ONLY

ICD9 E or V CODE

Primary: 1.

Other: 2.

3.

4.

5.

6.

7.

8.

I

SHOW FLASHCARD # 5

I 15. According to ‘s medical record does he/she currently have any of the following

conditions? (MARK (X) ALL THAT APPLY)

01 ❑ Mental retardation

02 ❑ AIcohol abuse/dependence

03 ❑ Drug abuse/dependence

04 ❑ Senile dementia/chronic and organic brain syndrome

05 H Depressive disorders

06 •l Schizophrenia

07 ❑ Other psychoses

08 ❑ Anxiety disorders

09 ❑ Personality/character disorders

10 ❑ Other mental disorders (SPECIFY)

11 ❑ No mental disorder

77
16a. During (LAST MONTH), did receive arty 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

16b. 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 ❑ Evaluation or mental health treatment by a psychologist

08 ❑ Evaluation or mental health treatment by a psychiatric/clinical social worker

09, ❑ Evaluation or mental health treatment by a psychiatric nurse

10 ❑ Social services by a social worker

11 ❑ Other therapy services (SPECIFY) —

17a. Does wear eyeglasses or contacts? 010 Yes 02 ❑ No

17b. 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

17C. 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 ❑ Completely lost-blind

94 ❑ Don’t know

18a. Does wear a hearing aid? 01 •l Yes 02 ❑ No

18b. Does have any difficulty in hearing (when wearing a hearing aid)?

01 •l Yes 02 ❑ No (SKIP TO Q. 19) 94 ❑ Don’t know (SKIP TO Q. 19)

78
SHOW FLASHCARD # 8

18c. h ‘s hearing (with hearing aid) partially, severely, or completely impaired as defined on this card?

01 ❑ Partially impaired-can hear most of the things a person says

02 ❑ Severely impaired-can hear only a few words a person says or loud noises

03 ❑ Completely lost-deaf

94 ❑ Don’t know

19a. Does currently require any assistance in bathing or showering?

01 •l Yes 02 H No (SKIP TO Q. 20) — 94 ❑ Don’t know (SKIP TO Q. 20)

19b. Does bath or shower with the hehJ of:

(1) Special equipment? 01 •l Yes 02 ❑ No

(2) Another person? 01 •l 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) bother person? 01 •l 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 ofi

(1) Special equipment? 01 •l Yes 02 ❑ No

(2) Another person? 01 •l 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
23a. Does 1

currently require any — assistance transferring 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 •l Yes 02 ❑ No

(2) Another person? 01 El Yes 02 ❑ No

IF YES TO EITHER Q. 23M1) OR 23b(2), SKIP TO Q. 25

24a. Does currently require any assistance in walking?

01 •l Yes 02 ❑ No (SKIP TO Q. 25) ‘~ ❑ Don’t know (SKIP TO Q. 25)

24b. Does walk with the help OE

(1) Special equipment? 01 •l Yes 02 ❑ No

(2) Another person? 01 •l Yes 02 ❑ No

~5a. Does go outside the grounds of this facility?

01 •l Yes 02 ❑ NO (SKIP TO Q. 26) 94 ❑ Don’t know (SKIP TO Q. 26)

~5b. When goes outside the grounds, does require the help ofi

(1) Special equipment 01 •l Yes 02 ❑ No

(2) Another person? 01 •l Yes 02 ❑ No

!6a.

~(jb.

~(jc.

26d.

Does have an ostomy, an indwelling catheter or similar device?

01 •l Yes 02 ❑ No (SKIP TO Q. 26c)

Does require any — assistance from another person in caring for this device?

01 •l Yes 02 ❑ No

Does currently require any — assistance using the toilet room?

01 El Yes

02 ❑ No (SKIP TO Q. 27)

03 @ Does not use toilet room (ostomy patient, chairfast, etc.) (SKIP TO Q. 27)

94 ❑ Don’t know (SKIP TO Q. 27)

D(XS require the help ofi

(1) Special equipment? 01 ❑ Yes 02 H No

(2) Another prson? 01 ❑ Yes 02 ❑ No

I

80
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)

27b. 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

28a. Does currently have any difficulty in controlling bladder?

01 ❑ Yes

02 D 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 ❑ Yes 02 ❑ No 94 ❑ Don’t know

29. Does receive ~rsonal help or supervision in any of the following activities:

Yes No Don’t know

a. Care of personal possessions? 01 •1 02 n 940

b. Handling money? 01 ❑ 02 •1 940

c. Securing personal items such as newspapers,

toilet articles, snack foods? 01 ❑ 02 c1 940

d. Using the telephone? (dialing or receiving calls) 01 ❑ 02 •1 940

81 I
10. How long have you provided care for ?

01 ❑ less than 1 month

02 •l 1-3 months

03 ❑ 4-6 months

04 ❑ 7-11 months

05 ❑ 12 months or more

06 ❑ Respondent does not provide care

J1. How would you rate ‘s physical health at the present time?

01 ❑ Excellent

02 ❑ Good

03 ❑ Fair

04 ❑ Poor

94 ❑ Don’t know

32. How would you rate ‘s mental health at the present time?

01 ❑ Excellent

02 ❑ Good

03 ❑ Fair

04 IJ 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 places

06 ❑ Inability to avoid simple dangers

07 ❑ None of the above

SHOW FLASHCARD # 10

34. Is disoriented or memory impaired irtthe following activities to such a degree that

is impaired nearly every day in performing the basic activities of daily living, mobility, 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 A

I 82
SHOW FLASHCARD # 11

1

35. Does display depression, anxiety, fearfulness or worry tosucha degree that

is distressed or restricted in functioning nearly every day? (MARK (X) ALL THAT

APPLY)

01 ❑ Displays depression

02 ❑ Displays anxiety

03 ❑ Displays fearfulness or worry

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 ❑ No (DETERMINE WHO HAS INFORMATION AND WHEN

YOU HAVE COMPLETED ~ THE RESIDENT QUESTIONNAIRES, INTERVIEW THAT 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, health insurance, retirement funds, Social Security, etc.

02 ❑ Medicare

03 ❑ Medicaid — skilled nursing

04 ❑ Medicaid — intermediate care

05 ❑ State funded indigent care (excluding Medicaid)

06 ❑ Other government assistance or welfare

07 ❑ Religious organizations, foundations, volunteer agencies

08 ❑ VA contract

09 ❑ Initial payment-life care funds

10 ❑ No charge made for care (facility assumes cost)

11 ❑ Payment source not yet determined

12 ❑ Other, (SPECIFY)

83
SHOW FLASHCARD # 12

37. What was the primary source of payment for ‘s care for the month of (MONTH

AND YEAR mMISSION)?

01 ❑ Own income, family support, health insurance, retirement funds, Social Security, etc.

02 ❑ Medicare

03 ❑ Medicaid — skilled nursing

04 ❑ Medicaid — intermediate care

05 ❑ State funded indigent care (excluding Medicaid)

06 ❑ Other government assistance or welfare

07 ❑ Religious organizations, foundations, volunteer agencies

08 ❑ VA contract

09 ❑ Initial payment-life care funds

10 ❑ No charge made for care (facility assumes cost)

11 ❑ Payment source not yet determined

12 •l Other, (SPECIFY)

38. Last month, what was the total charge billed for ‘s care, including all charges for

private duty nursing, drugs, and special medical supplies?

$ .— per month 01 ❑ No charge was made for care

[

SKIP TO INTERVIEWER NOTE ABOVE Q. 40

39. From (DATE OF ADMISSION) through yesterday, what was the total charge billed for

cue, including all charges for private duty nursing, drugs, and special medical supplies?

01 ❑ Since date of admission

02 ❑ Day

$ ._ per 03 ❑ Week

04 ❑ Month

05 ❑ Other period, (SPECIFY)

06 ❑ No charge was made for care

94 ❑ Don’t know (not billed yet, etc.)

84
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 BJJthe sources of payment for b. ASK FOR EACH SOURCE MARKED:

‘s care (LAST What was the amount paid by _

MONTH/DURING THIS TIME)? U MONTH~URING THIS TIME)?

(MARK (X) ALL THAT APPLY) (ENTER AMOUNT OR MARK “Don’t

know” )

Don’t

know

01 •l Own income, family support,

health insurance, retirement funds, Social

Security, etc. $ . 94 ❑

02 ❑ Medicare $ . 94 ❑

03 ❑ Medicaid — skilled c~e s . 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, foundations, 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 determined

12 ❑ Other, (SPECI~

$ . 94 ❑

INTERVIEWER: CONTINUE TO NEXT CURRENT RESIDENT QUESTIONNAIRE
SUMMARY OF DATES

Date of Interview: ~ -/

Mo. Day Year

Date of Admission: ~~

Mo. Day Year

OVERLAP CASES

DRQ

None ❑

I

I 86
Vital and Health 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—Reports describing

the general programs of the National Center for Health

Statistics and its offices and dwmons and the data colIect!on methods used. They also Include deflnltlons and

other material necessary for understanding the data.

Data Evaluation and Methods Research—Studies of nevj

statmtlcal methodology Including e,.:pertmental tests of

nmv survey methods, studies of vital statmtlcs collection

methods, new analytical techniques, oblecto. ~eeva!uat!ons

of rellablllty of collected data, and contrlbut!ons to

statistical theory. Studies also Include comparison of

U.S. methodology with those of other countries

Analytical and Epidemiological Studies— Reports prew!ntmg analytical or mterpretwe studies bas~d on vital

and health stat! stlcs, carry[ng the analysis further than

the expository types of reports m the other series,

Documents and Committee Reports-Final reports of

major committees concerned with vital and health statistics and documents such as recommended model vital

regtstrat!on laws and rewsed birth and death certlflcates,

Comparative International Vital and Health Statistics

Reports-Analytical and descnptwe reports comparing

U.S. vital and health statmt!cs k-<lththose of other ccruntnes,

Cognition and Survey Measurement—Reports from the

National Laboratory for Collabomtwe Research in Cogn!-

t[on and Survey Measurement using methods of cognmve

science to design, evaluate, and test survey instruments,

Data From the National Heakh Interview Survey-Stst{stlcs on illness, accidental Injuries, dwabtllty, use of hosp!tal, med~cal, dental. and other services, and other

health-related topics, all based on data collected m the

continuing national household mterwew survey.

Data From the National Health Examination Survey and

the National Health and Nutrition Examination Survey—

Data from direct exammatlon, testing, and measurement

of national samples of the cwlltan nonlnstltutlonal! zed

population provide the basts for (1) estimates of the

medically defined prevalence of speclflc dmeases m the

United States and the dwtnbuttons of the population

with respect to physical, physiological, and psychological characteristics and (2) analysts of relationships

among the various measurements without reference to

an expllcit finite unwerse of persons.

Data From the Institutionalized Population Surveys- Dwcontinued m 1975. Raports from these surveys are tncluded in Series 13.

Data on Health Resources Utilization—Statwt!cs on the

utihzation of health manpower and faclllt!es prov!dlng

long-term care, ambulato~ care, hospital care, and family

planning services.

Data on Health Resources: Manpower and Facilities—

Statistics on the numbers, geographic dlstrlbutlon, and

characteristics of health resources Including physlclans,

dentists, nurses, other health occupations, hospitals,

nursing homes, and outpatient facilities.

SERIES 15,

SERIES 16.

SE RIES20.

SERIES 21

SERIES 22.

SERIES 23.

SERIES 24.

Data From Special Surveys-Statmtics on health and

health-related top!cs collected In special sutveys that

are not a part of the contmumg data systems of the

Nat!onal Center for Health Stattst!cs.

Compilations of Advance Data From Vital and Health

Statistics—These reports provide early release of data

from the National Center for Health Stattstlcs” health and

demographic surve~s. hlan~ of these releases are followed

b,; deta[led reports in the Vital and Health Stat[sttcs

Sertes.

Data on Mortalit-y-var,ous stat[stlcs on mortal[ty other

than as Included in regular annual or monthly reports.

Specla! analyses b$; cause of death, age, and other demographic variables: geographic and time series analyses;

and statlsttcs on characteristics of deaths not available

from the vital records based on sample surveys of those

records.

Data on Natality, Marriage, and Divorce—Var]ous stat[strcs on nataliF:, marriage, and divorce other than as

included In regular annual or monthly reports. Special

analyses b,{ demographic variables; geographic and ttme

series analyses; studies of fertlllty; and statw.tics on

characteristics of lxrths not available from the vttal

records based on sample surveys of those records,.

Data From the National Mortality and Natality Surveys—

Dlscontlnued m 1975. Reports from these sample surveys

based on vltai records are included m Series 20 and 21,

respectwely.

Data From the National Survey of Family Grovvth—

Statwttcs on fert[lmy, family formation and dlsso[ut[on,

fam!ly plannlng, and related maternal and infant health

topics derived from a periodic survey of a natmnwde

probability sample of tvomen 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 Statistics

System and are publlshed annually as supplements to the

F.lonthly Vital Statistics Report (MVSR). These reports are

followed by the publication of detailed data in Vital Statistics of the United States annual volumes. Other reports

mckrdmg reduced terminations of pregnancy issued periodically as supplements to the MVSR provide selected findings based on data from the National Vital Statistics

System and may be followed by detailed reports in Vital

and Health Statlstlcs Series.

For answers to quest!ons about thm report or for a Iwt of titles of

reports published In these series, contacti

Scientific and Technical Information Branch

National Center for Health Statistics

Centers for Disease Control

Public Health Service

Hyattswlle, Md. 20782

301-436-8500
U.S DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Public Health Service

Centers for Disease Control

National Center for Health Stat[stlcs

3700 East-West Highway

Hyattsville, Maryland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

DHHS Publication No. (PHS) B9–1 763, Series 13, No 102

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POSTAGE & FEES PAID

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