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Design and Methods of the 1996 

Medical Expenditure Panel Survey 

Nursing Home Component 

Methodolo Methodology 

U.S. Department of Health and Human Services

Public Health Service

Agency for Health Care Policy and Research

Agency for Health Care Policy and Research
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Abstract

The Medical Expenditure Panel Survey (MEPS) is

the third in a series of nationally representative surveys

of medical care use and expenditures sponsored by the

Agency for Health Care Policy and Research (AHCPR).

MEPS comprises four component surveys. The Nursing

Home Component (NHC) produces national estimates of

insurance coverage and the use of services, expenditures,

and sources of payment for persons residing in or

admitted to nursing homes. The NHC also gathers

information on nursing home characteristics–such as

facility type, ownership, chain affiliation, certification,

facility size, and location–for a nationally representative

sample of nursing homes. This report describes the

design of and methods used in the MEPS NHC.

Information is included on the NHC objectives, sample

design, instruments of data collection, and data

collection procedures.

Suggested citation

Potter DEB. Design and methods of the 1996 Medical Expenditure

Panel Survey Nursing Home Component. Rockville (MD):Agency

for Health Care Policy and Research; 1998. MEPS Methodology

Report No. 3. AHCPR Pub. No. 98-0041.

http://www http://www.ahcpr.gov/
Design and Methods of the 1996 

Medical Expenditure Panel Survey 

Nursing Home Component 

U.S. Department of Health and Human Services

Public Health Service

Agency for Health Care Policy and Research

   yyyyy zzzz {{{{{ |||| Report 3

Methodolo Methodology 

AHCPR Pub. No. 98-0041

September 1998
The Medical Expenditure Panel

Survey (MEPS)

Background

The Medical Expenditure Panel Survey (MEPS) is

conducted to provide nationally representative estimates

of health care use, expenditures, sources of payment,

and insurance coverage for the U.S. civilian

noninstitutionalized population. MEPS also includes a

nationally representative survey of nursing homes and

their residents. MEPS is cosponsored by the Agency for

Health Care Policy and Research (AHCPR) and the

National Center for Health Statistics (NCHS).

MEPS comprises four component surveys: the

Household Component (HC), the Medical Provider

Component (MPC), the Insurance Component (IC), and

the Nursing Home Component (NHC). The HC is the

core survey, and it forms the basis for the MPC sample

and part of the IC sample. The separate NHC sample

supplements the other MEPS components. Together

these surveys yield comprehensive data that provide

national estimates of the level and distribution of health

care use and expenditures, support health services

research, and can be used to assess health care policy

implications.

MEPS is the third in a series of national probability

surveys conducted by AHCPR on the financing and use

of medical care in the United States. The National

Medical Care Expenditure Survey (NMCES) was

conducted in 1977, the National Medical Expenditure

Survey (NMES) in 1987. Beginning in 1996, MEPS

continues this series with design enhancements and

efficiencies that provide a more current data resource to

capture the changing dynamics of the health care

delivery and insurance system.

The design efficiencies incorporated into MEPS are

in accordance with the Department of Health and

Human Services (DHHS) Survey Integration Plan of

June 1995, which focused on consolidating DHHS

surveys, achieving cost efficiencies, reducing respondent

burden, and enhancing analytical capacities. To

accommodate these goals, new MEPS design features

include linkage with the National Health Interview

Survey (NHIS), from which the sample for the MEPS

HC is drawn, and enhanced longitudinal data collection

for core survey components. The MEPS HC augments

NHIS by selecting a sample of NHIS respondents,

collecting additional data on their health care

expenditures, and linking these data with additional

information collected from the respondents’ medical

providers, employers, and insurance providers.

Household Component

The MEPS HC, a nationally representative survey

of the U.S. civilian noninstitutionalized population,

collects medical expenditure data at both the person and

household levels. The HC collects detailed data on

demographic characteristics, health conditions, health

status, use of medical care services, charges and

payments, access to care, satisfaction with care, health

insurance coverage, income, and employment.

The HC uses an overlapping panel design in which

data are collected through a preliminary contact

followed by a series of five rounds of interviews over a 

21⁄

2-year period. Using computer-assisted personal

interviewing (CAPI) technology, data on medical

expenditures and use for 2 calendar years are collected

from each household. This series of data collection

rounds is launched each subsequent year on a new

sample of households to provide overlapping panels of

survey data and, when combined with other ongoing

panels, will provide continuous and current estimates of

health care expenditures.

The sampling frame for the MEPS HC is drawn

from respondents to NHIS, conducted by NCHS. NHIS

provides a nationally representative sample of the U.S.

civilian noninstitutionalized population, with

oversampling of Hispanics and blacks.

Medical Provider Component

The MEPS MPC supplements and validates

information on medical care events reported in the

MEPS HC by contacting medical providers and

pharmacies identified by household respondents. The

MPC sample includes all hospitals, hospital physicians,

home health agencies, and pharmacies reported in the

ii
iii

HC. Also included in the MPC are all office-based

physicians: 

• Providing care for HC respondents receiving

Medicaid.

• Associated with a 75-percent sample of households

receiving care through an HMO (health maintenance

organization) or managed care plan.

• Associated with a 25-percent sample of the

remaining households.

Data are collected on medical and financial

characteristics of medical and pharmacy events reported

by HC respondents, including:

• Diagnoses coded according to ICD-9 (9th Revision,

International Classification of Diseases) and DSMIV (Fourth Edition, Diagnostic and Statistical

Manual of Mental Disorders).

• Physician procedure codes classified by CPT-4

(Current Procedural Terminology, Version 4).

• Inpatient stay codes classified by DRG (diagnosisrelated group).

• Prescriptions coded by national drug code (NDC),

medication names, strength, and quantity dispensed.

• Charges, payments, and the reasons for any

difference between charges and payments.

The MPC is conducted through telephone

interviews and mailed survey materials.

Insurance Component

The MEPS IC collects data on health insurance

plans obtained through employers, unions, and other

sources of private health insurance. Data obtained in the

IC include the number and types of private insurance

plans offered, benefits associated with these plans,

premiums, contributions by employers and employees,

and employer characteristics.

Establishments participating in the MEPS IC are

selected through four sampling frames:

• A list of employers or other insurance providers

identified by MEPS HC respondents who report

having private health insurance at the Round 1

interview.

• A Bureau of the Census list frame of private-sector

business establishments.

• The Census of Governments from the Bureau of the

Census.

• An Internal Revenue Service list of the selfemployed.

To provide an integrated picture of health insurance,

data collected from the first sampling frame (employers

and other insurance providers) are linked back to data

provided by the MEPS HC respondents. Data from the

other three sampling frames are collected to provide

annual national and State estimates of the supply of

private health insurance available to American workers

and to evaluate policy issues pertaining to health

insurance.

The MEPS IC is an annual panel survey. Data are

collected from the selected organizations through a

prescreening telephone interview, a mailed

questionnaire, and a telephone followup for

nonrespondents.

Nursing Home Component

The 1996 MEPS NHC was a survey of nursing

homes and persons residing in or admitted to nursing

homes at any time during calendar year 1996. The NHC

gathered information on the demographic

characteristics, residence history, health and functional

status, use of services, use of prescription medications,

and health care expenditures of nursing home residents.

Nursing home administrators and designated staff also

provided information on facility size, ownership,

certification status, services provided, revenues and

expenses, and other facility characteristics. Data on the

income, assets, family relationships, and caregiving

services for sampled nursing home residents were

obtained from next-of-kin or other knowledgeable

persons in the community.

The 1996 MEPS NHC sample was selected using a

two-stage stratified probability design. In the first stage,

facilities were selected; in the second stage, facility

residents were sampled, selecting both persons in

residence on January 1, 1996, and those admitted during

the period January 1 through December 31.

The sampling frame for facilities was derived from

the National Health Provider Inventory, which is

updated periodically by NCHS. The MEPS NHC data

were collected in person in three rounds of data

collection over a 11⁄

2-year period using the CAPI system.

Community data were collected by telephone using

computer-assisted telephone interviewing (CATI)

technology. At the end of three rounds of data collection,
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the sample consisted of 815 responding facilities, 3,209

residents in the facility on January 1, and 2,690 eligible

residents admitted during 1996.

Survey Management

MEPS data are collected under the authority of the

Public Health Service Act. They are edited and

published in accordance with the confidentiality

provisions of this act and the Privacy Act. NCHS

provides consultation and technical assistance.

As soon as data collection and editing are

completed, the MEPS survey data are released to the

public in staged releases of summary reports and

microdata files. Summary reports are released as printed

documents and electronic files. Microdata files are

released on CD-ROM and/or as electronic files.

Printed documents and CD-ROMs are available

through the AHCPR Publications Clearinghouse. Write

or call:

AHCPR Publications Clearinghouse

Attn: (publication number)

P.O. Box 8547

Silver Spring, MD 20907

800/358-9295

410/381-3150 (callers outside the United States

only)

888/586-6340 (toll-free TDD service; hearing

impaired only)

Be sure to specify the AHCPR number of the

document or CD-ROM you are requesting. Selected

electronic files are available through the Internet on the

AHCPR Web site: 

http://www.ahcpr.gov/

On the AHCPR Web site, under Data and Surveys,

click the MEPS icon.

Additional information on MEPS is available from

the MEPS project manager or the MEPS public use data

manager at the Center for Cost and Financing Studies,

Agency for Health Care Policy and Research, 2101 East

Jefferson Street, Suite 500, Rockville, MD 20852

(301/594-1406).
v

Table of Contents

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

Objectives of the MEPS NHC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Sample Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Facility Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Sample Frame . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Sample Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

First-Phase Facility Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Second-Phase Facility Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Person-Level Sample Selection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Subsampling the Sample of Facilities and Persons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Instruments and Data Collection Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Overview of Data Collection Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Round 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Round 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Round 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Instruments and Data Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Facility-Level Data, Sampled Nursing Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Person-Level Data, Sampled Nursing Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Person-Level Data, Community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Data Collection in New Facilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Medicare Claims Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Appendix: List of Acronyms and Terms Used in This Report and in the

MEPS Nursing Home Component Questionnaires. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
vi

Tables

1. Number of nursing facilities and beds in sampling frame, by source from which 

facilities were added to frame . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

2. Number of nursing facilities selected during first- and second-phase sample of facilities, by cost stratum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

3. Projected sample yield of nursing homes and sampled persons: numbers 

sampled and responding, by round . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

4. Overview of data collection activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

5. Major sampled facility-level data items, by round of data collection . . . . . . . . . . . . . . . . . . . . . . . . . . 28

6. Major data items collected in facility Residence History section of person-level questionnaire . . . . . . 33

7. Overview of health status data items collected in nursing home, by sample type, time 

points of measurement, and whether question wording based on minimum data set . . . . . . . . . . . . . 35

8. Overview of demographic data items collected in nursing home and community 

questionnaires, by primary and secondary data source for item . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

9. Major data items collected in facility Prescribed Medicines section of the 

person-level questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

10. Major data items collected in the facility Expenditures section of the person-level questionnaire . . . . 43

11. Major data items collected in the facility Health Services Use section of the 

person-level questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

12. Overview of data items collected in the Community Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . 46

Figures

1. Example of computer-assisted personal interview (CAPI) person-level navigation 

screen used in sampled facilities during Round 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

2. Types of sampled persons referred to in the CAPI questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

3. Examples of residence history timelines and key date items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

4. Example of a CAPI screen and its associated online help screen, used to collect 

health status data typically obtained from minimum data set records . . . . . . . . . . . . . . . . . . . . . . . . 14

5. Example of a CAPI screen used to collect health status data not tied directly 

to a minimum data set item . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

6. Example of two CAPI screens used to collect prescribed medicine data (name, form, and strength) . . 17

7. Example of a CAPI screen used to begin expenditure data collection with information 

on eligible facility/unit(s) for the sampled person inserted into question text. . . . . . . . . . . . . . . . . . . 19

8 Example of a CAPI screen used to collect expenditure data with appropriate reference 

dates inserted into question text . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 
1

Introduction

The 1996 Nursing Home Component (NHC) of the

Medical Expenditure Panel Survey (MEPS) is a national,

year-long, panel survey of nursing homes and their

residents. MEPS is the third in a series of surveys

sponsored by the Agency for Health Care Policy and

Research (AHCPR) to collect information on the health

care utilization and expenditures of the American public.

The first survey was the 1977 National Medical Care

Expenditure Survey (NMCES); the second, the 1987

National Medical Expenditure Survey (NMES). NMES

was the first national expenditure survey to contain an

institutional component designed explicitly to collect

medical expenditure information on persons in longterm care facilities.

The 1996 MEPS NHC is cosponsored by AHCPR

and the National Center for Health Statistics (NCHS),

both agencies of the U.S. Public Health Service. Westat,

Inc., is the prime contractor for data collection and is

supported by MedStat, the National Opinion Research

Center, and CODA.

This report describes the design of and methods

used in the MEPS NHC. Information is included on the

NHC objectives, sample design, instruments of data

collection, and data collection procedures. The appendix

provides a glossary of terms and acronyms used in this

report and in the MEPS NHC questionnaires.

Objectives of the MEPS NHC

The primary objective of the NHC is to estimate use

and expenses for nursing home services and health care

for persons who were nursing home (NH) residents at

any time during 1996. Other major objectives are to

permit estimates of the following measures: 

For nursing home residents—

• Annual expenditures and sources of payment for

nursing home services.

• Annual use, expenditures, and sources of payment for

inpatient hospital services.

• Use, expenditures, and sources of payment for

physician services during periods of NH residence.

• Use of prescribed medications.

• Health status at selected points in time.

• Discharge status for residents discharged during 1996.

• Characteristics of NH residents prior to admission.

• Annual use, expenditures, and sources of payment

stratified by facility and resident characteristics.

For nursing home facilities—

• Facility structure, type of ownership, expenses, and

revenues.

• Services typically provided, staffing, and numbers of

beds and residents.

The MEPS NHC is also designed to permit national

estimates of—

• Number of persons who were NH residents as of

January 1, 1996.

• Number of persons admitted to an NH during 1996.

• Number of persons discharged from an NH during

1996.

• Total NH users for the year.

Design and Methods of the 1996 Medical Expenditure Panel Survey 

Nursing Home Component

by D.E.B. Potter, M.S.,

Agency for Health Care Policy and Research

Note: Earlier versions of this report were presented

at the 1996 Joint Statistical Meetings of the American

Statistical Association, Chicago, August 1996, and the

1996 annual meeting of the American Public Health

Association, New York, November 1996.
2

Sample Design

The MEPS NHC is a year-long panel survey for

calendar year 1996. The design is similar to that of the

1987 NMES Institutional Population Component survey

(Cohen, Potter, and Flyer, 1993) and is intended to equal

or exceed the precision of the 1987 survey. The final

sample design is based on results from the 1987 survey,

analyses conducted during the 1991 NMES Institutional

Feasibility Study (Bethel, 1993; Bethel, Flyer, and

Wolters, 1993; Bethel, Ward, and Kalton, 1993), and

work conducted during the pretest stage of the NHC. 

The NHC has a multistage stratified probability

design, with facilities selected in the first stage and

residents in the last stage. The reference population

(universe) is all persons who spent one or more nights in

1996 as a resident of a nursing home. To allow a chance

of selection for all persons in this universe, two samples

of residents were selected within sampled cooperating

facilities:

• A cross-sectional sample of January 1, 1996,

residents (referred to as January 1st residents or

current residents).

• A sample of persons admitted during 1996, with no

prior admissions during 1996 to a facility eligible for

the NHC (referred to as first admissions).

Thus, all persons who were residents of an NH any time

during 1996 were represented in the sample.

Facility Eligibility

The universe of institutions eligible for inclusion in

the MEPS NHC consisted solely of nursing homes,

whereas the 1987 institutional survey also included

personal care homes and facilities for persons with

mental retardation. For a discussion of why these

facility types were excluded from MEPS, see Sommers

(1995). 

To be included as a nursing home, a facility must

have met one of the following definitions:

• A facility or distinct portion of a facility certified as

a Medicare skilled nursing facility (SNF).

• A facility or distinct portion of a facility certified as

a Medicaid nursing facility (NF).

• A facility or distinct portion of a facility licensed as a

nursing home with three or more beds that provides

onsite supervision by a registered nurse (RN) or

licensed practical nurse (LPN) 24 hours a day, 7 days

a week.

By these definitions, all SNF- or NF-certified units

of licensed hospitals were eligible for the sample, as

were all Department of Veterans Affairs (VA) long-term

care nursing units. In such cases, and in the case of

retirement communities with nursing facilities, only the

long-term care nursing unit(s) of the facility were

eligible for inclusion in the sample. If a facility also

contained a long-term care unit that provided assistance

only with activities of daily living (e.g., a personal care

unit) or provided nursing care at a level below that

required to be classified as a nursing facility, that unit

was excluded from the sample. (For operational details

on how this was accomplished, see information in this

report on the Round 1 Facility-Level Data.)

Sample Frame

The cleaned (unduplicated) list of eligible facilities

from the 1991 National Health Provider Inventory

(NHPI) served as the starting point for frame

construction (Sirrocco, 1994). NCHS updated the NHPI

with lists of facilities that were licensed by the States or

certified by the Health Care Financing Administration

(HCFA). New facilities (births to the frame) were

determined by NCHS and AHCPR staff, who compared

the updated list with the 1991 NHPI. To ensure that the

updated list had no duplicate listings, comparisons were

made of facility name, address, phone number, and size

(Sommers, 1995).

Additionally, efforts were made to add hospitalbased long-term care (LTC) units to the frame. LTC

units have grown considerably in the last few years

(Prospective Payment Assessment Commission, 1996).

The American Hospital Association’s listing of hospitals

was carefully reviewed. Any hospital-based LTC units

not on the updated NHPI, including VA nursing homes,

were added. As a result, 275 facilities were added,

representing 13 percent of the hospital-based NHs in the

frame. The updated list consisted of 17,572 nursing

facilities containing 1,789,772 beds, an increase of 2,641

facilities and 174,086 beds over the 1991 NHPI (Table 1).
3

Key information required for sampling, such as

number of nursing home beds, was available for 15,581

of the 17,572 facilities in the final NHC frame. By

searching directories and lists of NHs, NCHS and

AHCPR staff found missing bed-size information for all

but 100 facilities. Bed size was imputed for these

facilities. A somewhat larger number of facilities had

missing information on other variables needed for

sampling, such as ownership. However, it was felt that

this amount of missing information was insignificant

(Sommers, 1995). Thus, to save resources, AHCPR did

not update frame information any further. 

The final numbers of NHs and NH beds in the NHC

frame were compared with an independent source

(Harrington, Preston, Grant, et al., 1990) and found to be

well within range (Sommers, 1995). Additional

information is available on the use of the 1991 NHPI as

a sampling frame (Sommers, 1993) and frame

construction for the MEPS NHC (Sommers, 1995).

Sample Selection

A stratified two-stage systematic sample was

adopted, where stage 1 reflected the selection of facilities

(in two phases) and stage 2 reflected the selection of

persons in these facilities. For complete technical

details, see Bethel, Broene, and Sommers (1998),

Sommers (1995), and Sommers, Bethel, and Broene

(forthcoming). 

First-Phase Facility Selection 

Facilities were selected in the first phase with

selection probabilities proportional to the number of

nursing home beds in the facility. Allocation was

proportional to the total number of beds in the stratum.

The primary stratification was by method of Medicaid

reimbursement and type of nursing facility. Within the

primary strata, location variables of the NH and type of

ownership were used for implicit stratification. 

As part of this phase, a Keyfitz procedure was used

to adjust the probabilities of selection to eliminate any

overlap between the 1996 MEPS NHC facility sample

and the sample for the 1995 NCHS National Nursing

Home Survey. This adjustment was made to reduce the

burden on nursing home respondents (Sommers, 1995).

By this methodology, 1,651 facilities were selected in the

first phase of facility selection.

Second-Phase Facility Selection

The initial sample of facilities was selected in order

to achieve a second-phase sample of 1,150 facilities.

Results from the 1987 survey (Cohen, Potter, and Flyer,

1993) and the 1991 feasibility study (Bethel, Ward, and

Kalton, 1993) indicated that survey data collection costs

could be reduced, while minimizing the effect on

variance, by subsampling facilities in the higher cost

strata at rates of selection lower than the rates for those

in the less expensive strata.

To subsample the facilities, those sampled in the

first phase were assigned to cost strata based on

interviewer travel and workload costs using

computerized mapping software. Table 2 shows the cost

strata. Once the facilities were assigned, each cost

stratum was subsampled using Cochran’s (1977) optimal

allocation technique. 

Table 2 shows the distribution of the first-phase

sample of facilities by cost strata. It also shows the

results for the second phase of facility subsampling by

cost strata, resulting in the final facility sample of 1,150. 

Person-Level Sample Selection

To assure representation of all persons who resided

in the nursing home during the study period, two types

of person samples were selected in the sampled

cooperating facilities: 

• Current residents—Persons admitted to a sampled

facility before January 1, 1996, who were not

discharged as of January 1, 1996 (i.e., the crosssectional sample of January 1st residents). 

• First admissions—Persons admitted to the sampled

facility on January 1 or later during 1996 who had no

earlier 1996 admission to any eligible facility.

Sample of Residents. A fixed sample of four

January 1st residents was selected in each cooperating

sampled facility during Round 1. The January 1st

sample of residents was selected by interviewers from a

frame constructed by the interviewer or from a frame

provided by the facility. Interviewers cleaned and

numbered the list of residents and then selected a

random sample of four residents by entering the number

of eligible residents in the facility into the interviewer’s

laptop computer. (Residents were eligible if they resided
4

in an eligible long-term care unit of the sampled facility

as of midnight December 31, 1995.) The computer then

listed the line numbers for the random sample selected.

The cross-sectional sample of all January 1st residents is

expected to yield 3,344 residents at the end of Round 1

and 3,144 with expenditure data at the end of Round 3

(Table 3). 

Sample of Admissions. To obtain a sample of

eligible first admissions, a sample of two persons was

selected from a list of first admissions at each of the

sampled cooperating facilities in Rounds 2 and 3. In a

few facilities with large admissions populations, the

sample could be three persons per round, for a maximum

of six 1996 admissions sampled per facility. 

The Round 2 frame consisted of all persons whose

first stay in the facility during 1996 resulted from an

admission during the period January 1, 1996, through

June 30, 1996. The Round 3 frame consisted of persons

admitted to the sampled facility during the July 1-

December 31, 1996, period who had no prior admissions

to the sampled facility during 1996. The interviewer’s

procedures for selecting the admissions sample are

analogous to those used for the January 1st sample.

To ensure that each person sampled as an admission

had a single chance of selection, information about

where the person resided between January 1, 1996, and

the date of admission to the sampled facility was

collected from facility and community respondents. All

places identified by respondents as a long-term care

place were searched on the sampling frame directory for

determination as an eligible NH. Persons sampled as an

admission who had a January 1, 1996, stay or 1996

admission to an eligible NH prior to their admission to

the sampled NH were not eligible for the MEPS NHC,

as they had a prior chance of selection. These

procedures were first tested in the 1991 feasibility study

(Bethel, Flyer, and Wolters, 1993). Subsequent data

collection on these ineligible persons was terminated.

This exclusion of ineligible admissions is expected to

result in a final admissions sample of 2,344 persons with

expenditure data at the end of Round 3. 

Subsampling the Sample of Facilities and

Persons

The response rate assumptions used to develop the

projected sample sizes presented in Table 3 were designed

to result in a final facility sample size of 787 cooperating

facilities at the end of 3 rounds of data collection. At the

end of Round 1 data collection, 1,127 of the 1,150

sampled facilities were determined to be eligible; 952 of

these were eligible and responding (85 percent). To bring

the sample size in line with the original design, the facility

sample was subsampled at the end of Round 1. A total of

127 facilities (and all sampled persons in those facilities)

were randomly deselected. Of these facilities, 108

cooperated in Round 1.

Instruments and Data Collection

Procedures 

The data collection methods of the MEPS NHC are

products of those used for the 1987 NMES institutional

expenditure survey (Edwards and Edwards, 1989), the

1991 institutional feasibility study (e.g., Anderson,

Harper, Tourangeau, et al., 1993), and NHC pretest

work. While the 1996 methods are similar to those used

in 1987, several enhancements have been introduced for

three principal reasons: 

• The analytic desirability of quantifying recent

changes in the NH industry—most importantly, the

diversification of services provided and the

debundling of payments for NH services. 

• The change in mode of data collection from a paperand-pencil mode to computer-assisted personal

interviewing (CAPI).

•Improvement in data quality and/or reduction in data

collection costs. (For example, see Anderson, Bethel,

Tourangeau, et al., 1994; Potter, 1988; Potter and

Braden, 1993.) 

The MEPS NHC questionnaires are available on the

MEPS home page at the AHCPR Web site

<http://www.meps.ahcpr.gov/> or through the AHCPR

Clearinghouse (call 301-594-1406 for ordering

information).
5

Overview of Data Collection

Methods

Table 4 presents an overview of the data collection

plan for the MEPS NHC. The plan calls for a

Screener/Recruitment Round and three rounds of data

collection. The Screener/Recruitment Round is

conducted by telephone to recruit the facility’s

participation in the study. Rounds 1-3 are conducted in

the nursing home using CAPI technology. There is also

a single telephone interview with a community

respondent knowledgeable about the sampled person’s

situation prior to admission to the NH; this interview is

conducted in Round 2 (or Round 3 if sampled in Round

3). 

Round 1

Round 1 consists of a visit by an interviewer to the

sampled nursing facility to collect facility and sampled

person data. The interviewer administers the Facility

Questionnaire, which collects information on the

characteristics and structure of the facility, and

determines the facility’s final eligibility for the NHC.

Once the Facility Questionnaire is completed and the

facility (or any part of the facility) is determined to be

eligible, the interviewer constructs a sampling list of

January 1, 1996, residents in eligible parts of the facility,

selects a random sample of four, and begins person-level

data collection. 

Round 1 data collection for the January 1st resident

sample consists of residence history information

(including hospital stays) from the date of last residence

in the community until the date of the Round 1

interview; health status; demographics and background;

insurance information; and prescription medicine use.

Round 2

In Round 2, interviewers return to the sampled

facility and continue data collection on the facility by

updating facility certification information and

enumerating the services routinely provided by the

facility. Interviewers also continue data collection on the

January 1st sample of residents by updating their

residence history and collecting information on health

service use, prescribed medicine use, NH expenditures,

and incident health conditions (e.g., acute conditions

occurring during NH stays). This information is

collected for periods of NH residence during the period

from January 1st to the date of interview. Interviewers

also identified potential respondents for community data

collection. 

In Round 2, interviewers select a sample of residents

who were admitted to the sampled nursing home

between January 1 and June 30, 1996 (the first of two

samples of admissions). Data collected include

residence history information from January 1 (or date of

last community residence if prior to January 1) until the

date of the Round 2 interview; health status information,

demographic background, and insurance coverage at the

time of admission to the nursing home; and health

service use, prescribed medicine use, and NH

expenditures during periods of institutionalization.

Potential community respondents are also identified.

Community data collection for persons sampled as

January 1st residents and for the Round 2 sample of

admissions is begun in Round 2. The same interviewers

who conducted the facility interview generally conduct

the community interview about each sampled person by

telephone from the interviewer’s home using computerassisted interviewing (CAI) technology. The Community

Questionnaire collects information for which the nursing

home is not a good source of information, such as family

relationships (Tourangeau and Blair, 1993). It also

collects key information asked during the facility

interview but not available from that source, as well as

income, assets, and caregiving data.

New facility data collection is also initiated in

Round 2. The design of the NHC is such that sampled

persons are followed as they move from one eligible

facility to another eligible facility. This provides a

picture of an entire year’s worth of use and expenditures

in all nursing homes in which the person was a resident

during 1996. For all persons discharged from the

originally sampled nursing home during the Round 1

reference period and admitted to another potentially

eligible nursing home, Round 2 data collection in the

new (transfer) facility is initiated.

Data collection begins at the new facility with

administration of the New Facility Questionnaire, which

determines the facility’s eligibility and mirrors the

Round 1 sampled Facility Questionnaire. Person-level
data collection in a new facility is similar to Round 2

data collection in a sampled facility.

Round 3

Round 3 continues data collection on the sampled

facility by gathering information on patient revenues and

expenses in the facility and updating facility staffing

information that was originally collected in Round 1.

Resident information about residence history, health

status, health services use, expenditures, and prescribed

medicine use is updated. Health status information as of

December 31 is collected for the January 1st sample still

in a nursing home. 

During Round 3, interviewers select a sample of

admissions from residents who were admitted to the

sampled facility between July 1 and December 31, 1996,

and who were not admitted to the NH previously during

1996. The same data are collected on this sample as for

the Round 2 sample of admissions. 

New facility data collection continues in Round 3.

Instruments and Data Items

Data collection for the MEPS NHC was preceded by

almost 2 years of instrument design work, including

feasibility testing and usability testing. This work, in

conjunction with previous research (e.g., Anderson,

Bethel, Tourangeau, et al., 1994; Anderson, Harper,

Tourangeau, et al., 1993; Northrup and Ward, 1993;

Potter and Cunningham, 1994; Tourangeau and Johnson,

1993; Tourangeau, Vincent, Anderson, et al., 1993), led

to an instrument that uses CAPI technology almost

exclusively.

Aside from the intent of improving data quality, the

NHC CAPI instrument was designed to take advantage

of the CAPI computer environment in several ways,

including: 

• Determining the “best respondent” for the interviewer

at the item level rather than at the questionnaire level

or respondent level.

• Prompting the interviewer to retrieve missing data

items from alternative respondents before leaving the

NH.

• Prompting the interviewer to reconcile inconsistent

data (as determined by mathematical formulas) with

the respondent at the time of data collection.

• Providing the interviewer with preloaded directories

of information (e.g., prescribed medicine data) to be

used during data collection. 

• Reducing respondent burden in the NH by organizing

data collection around the respondent. 

Conducting the NHC in CAPI can have other

advantages as well, including shorter post-production

processing time and subsequent data release to the

public. However, using CAPI in a survey such as the

NHC can have a downside in that the resulting

instruments, with their numerous flow boxes,

programmer specifications, and question word fills, can

be difficult to comprehend. The purpose of this section

of the report is to overcome the natural limitations of

reading a complicated CAPI questionnaire by providing

the reader with the analytic intent of each of the

questionnaire sections. Also presented is an overview of

key data collection methods. The section is in four parts:

• Facility-level data collection in the sampled NH.

• Person-level data collection in the sampled NH.

• Person-level data collection in the community.

• Data collection in the transfer (new) facilities.

Facility-Level Data, Sampled NH

Screener/Recruitment Materials. The telephone

screener/recruitment round is conducted using scripted

materials. The purpose is to verify the facility’s name

and address, screen out facilities that are clearly

ineligible (e.g., facilities with no nursing staff), recruit

the facility to participate in the survey, and make an

appointment for the Round 1 interview. 

Round 1 Facility-Level Data. The Round 1 facilitylevel data collection consists of administering the Round

1 Facility Questionnaire (FQ), distributing and collecting

the Round 1 Self-Administered Questionnaire (SAQ),

and collecting the facility’s printed rate schedule. The

Round 1 FQ is a CAPI instrument that is administered in

person to the facility administrator (or designee). It must

be administered before any person-level data collection

can begin. The FQ is divided into five parts, each

6
7

uniquely identified in CAPI by letter identifiers. The

letter identifiers and their descriptions are as follows:

FA Facility structure and characteristics: This section

maps how the sampled facility is structured

(explained below), determines the facility’s final

eligibility for the survey, and collects data on

facility characteristics. A mechanism for

collecting the Round 1 SAQ is included at the

end.

FR This section is a mechanism for collecting a copy

of the facility’s printed rate schedule. 

FG Facility records organization grid: This section

includes prompts to identify the various records

containing resident data that the facility maintains,

and to obtain access to the records and to the

facility staff members in charge of the records. 

SS Sampling section: This section is used for

selecting a sample of four January 1st residents.

The “Call Home Office” function, related to this

section, is a mechanism for interviewers to alert

NHC statisticians, in real time, to problems with

the measure of size and dual probabilities of

facility selection, among other functions. Once

the sample of residents is selected, the sampling

section collects person-level information—name,

age, sex, date of admission, and date of death (if

applicable)–necessary to set up the question word

fills in the subsequent person-level instruments.

MD Missing data module: If certain critical facility

items are missing (e.g., information needed to

determine the facility’s eligibility), this module

presents the items for another respondent (in the

same NH) to answer.

See Table 5 for a listing of the major data items in the

Round 1 FQ.

The Round 1 Self-Administered Questionnaire is

distributed to the facility administrator (or designee)

during the administration of the Round 1 FQ. The SAQ

collects information that the pretest showed could not be

easily collected by in-person interviewing (mostly

staffing information). See Table 5 for a description of

the data items.

Facility Structure and Place Type. The structure of

some institutions that provide residental treatment

continues to become increasingly complex. The Round

1 Facility Questionnaire was designed to elicit this

complexity. Some nursing homes exist within a larger

establishment (e.g., a retirement center or hospital). In

such cases, the entity that appeared on our sampling

frame might be the larger facility, the nursing home

within a larger facility, or only one of several units

within the larger facility. Therefore, the Round 1 FQ

was designed to identify all parts of the larger facility,

the nursing home within the larger establishment, and all

units within the nursing home (including special care

units such as Alzheimer’s units), as well as enumerating

all other nonhospital residential parts such as assisted

living complexes, personal care units, and independent

living facilities. All places where persons sleep

overnight (and on the same campus as the NH) were

enumerated by name, type, bed size, and survey

eligibility. To make this workable within an interviewing

environment, the CAPI application used specific name

fills. For example, when a question referred to the larger

entity, the question shown on the interviewer’s laptop

computer displayed the appropriate name of the larger

establishment. When a question referred to only the

eligible nursing home/unit within the larger

configuration, then the name of each eligible nursing

home/unit was displayed. Based on the enumerated

information, the Round 1 CAPI application assigned a

“place type” taxonomy to each and every part of the

facility. Possible place types are:

• Eligible long-term care (e.g., nursing home).

• Ineligible long-term care (e.g., personal care unit).

• Hospital.

• Community.

An eligible long-term care place is defined as a

facility or distinct part of a facility certified by Medicare

or Medicaid or licensed as a nursing home with three or

more beds that provides onsite supervision by an RN or

LPN, 7 days a week, 24 hours a day. An ineligible longterm care place is a facility or distinct part of a facility

that is not certified or licensed as an eligible nursing

home but provides services for personal care assistance

with bathing or dressing. These include residential care
8

places, board and care homes, personal care homes,

assisted living facilities, and similar units of retirement

centers or nursing homes. Hospitals could be acute or

long-term care (LTC) hospitals. In the case of a hospital

with a skilled nursing (SNF) unit or an eligible LTC unit,

the SNF/LTC unit was classified as an eligible LTC

place and the remaining hospital units classified as

appropriate (e.g., hospital). Community places include

all independent living units of retirement centers, as well

as private homes or apartments.

The NH structure/place type information—known

collectively as the Place Roster—is important for two

reasons. First, analytically, it is the mechnism by which

basic characteristics of the NH are enumerated. Second,

operationally, it is used by the CAPI software to drive

subsequent skip patterns and word fills in the Round 1

Facility Questionnaire and in all person-level

instruments. (See section on person-level data below.) A

fictitious example of how a Place Roster might look on

the interviewer’s laptop at the end of the Round 1

Facility Questionnaire is shown below.

In this case, the larger facility is the Jordan Senior

Living Center, which has three parts: an independent

living building (Horizon House), an assisted living

building (Naomi House), and a nursing home (Johnson

Health Center). The nursing home (eligible LTC)

contains three parts: an Alzheimer’s unit and two general

population nursing wings (the East and West Wings). In

this example, NH expenditure data would be collected

for sampled person stays in any part of the Johnson

Health Center but would not be collected for sampled

person stays that occurred in the Horizon House or

Naomi House.

Round 2 Facility-Level Data. The Round 2

instruments on the sampled facility level consist of:

• Round 2 Facility Questionnaire.

• Round 2 Sampling Instrument.

• Facility Rate Schedule Form.

In addition, any Round 1 SAQs not collected previously

are collected in Round 2. 

The Round 2 FQ is a CAPI instrument administered

to the facility administrator. The majority of the data

items are on services routinely offered by the facility to

residents and nonresidents (Table 5). The instrument

PLACE NAME PLACE TYPE

Jordan Senior Living Center INEL LTC

Horizon House COMMUNITY

Naomi House INEL LTC

* Johnson Health Center ELIG LTC

* Alzheimer’s Unit ELIG LTC

* East Wing ELIG LTC

* West Wing ELIG LTC

{* consider this place as part of the eligible case}
9

also collects information about physicians with NH staff

privileges. This information has both analytic and

operational relevance. Operationally, this information is

used to differentiate physicians whose services are

billed for through the NH, as part of the NH’s basic

room and board rate, from those physicians who bill the

NH separately for their services (i.e., services that

might subsequently result in Medicare Part B claims).

Unlike the Round 1 FQ, the Round 2 FQ does not have

to be administered prior to Round 2 person data

collection.

The Round 2 Sampling Instrument is used to select

the first sample of admissions (two persons on average,

with a maximum of three). To eliminate persons with a

dual probability of selection, persons residing in the NH

on January 1st are not eligible for Round 2 admissions

sampling. Otherwise, the instrument is similar to the

Round 1 sampling instrument. 

The Facility Rate Schedule Form is a paper

instrument uniquely generated by the data collection

contractor for each facility. It retrieves missing rate

schedule information not collected in Round 1, as well

as collecting billing rates for basic care provided in each

special care unit within the facility and for HMO (health

maintenance organization) contract care. 

Round 3 Facility-Level Data. The Round 3 facilitylevel instruments consist of:

• Round 3 Facility Questionnaire.

• Round 3 Sampling Instrument.

• Round 3 Self-Administered Questionnaire.

The Round 3 FQ is a CAPI and/or paper

instrument, depending on the availability of the

respondent and applicable records. Known as the Costof-Patient-Care Questionnaire (CPCQ), its main

purpose is to collect patient revenue and expense data

on the NH. ( See Table 5 for details.) NH

administrators are the most likely respondents. They are

urged to consult the facility’s Medicaid Cost Reports

and/or annual report when answering the questions. 

The Round 3 Sampling Instrument is similar to the

one used in Round 2 (two admissions sampled on

average), except that the sampling frame is constructed

from a list of persons admitted to the NH from July 1 to

December 31, 1996. Persons residing in the sampled

NH on January 1 or admitted to the facility between

January 1 and June 30, 1996, are not eligible for Round

3 admissions sampling, as they had a prior chance of

selection.

The Round 3 SAQ is also known as the Round 3

NH Staffing Questionnaire. It is similar in design to the

Round 1 SAQ, except that data are collected as of the

end of the year and items on NH staff turnover and

physicians’ privileges in the NH have been added (Table

5).

Person-Level Data, Sampled NH

Previous research showed that multiple respondents

within a single NH would be needed for sampled person

data collection (Anderson, Bethel, Tourangeau, et al.,

1994). This need arose partly because of the wide

variety of organizational structures and medical record

storage locations among NHs and partly because of the

demanding schedules of nursing home staff. Therefore,

the NH CAPI application was designed with seven

topical modules to accommodate multiple respondents,

NH staff, and records availability. These topical

sections are: 

• Residence History.

• Health Status.

• Background.

• Insurance.

• Prescribed Medicines.

• NH Expenditures.

• Health Services Use.

At the time of data collection, the interviewer

determines the order in which the topical sections are

administered, based on availability of staff and medical

records. The one exception is the Residence History

section, which sets up a person’s reference dates; it must

be administered prior to other sections for each person. 

Interviewers select a sampled person and associated

topical section with the use of a specially designed

CAPI person-level screen used for navigation, which

displays a grid with the names of the sampled persons
10

for a particular NH down the left side, defining rows,

and displays abbreviated topical section names across the

top, as column heads (Figure 1). When using the

navigation screen, interviewers use the arrow keys of the

laptop to move the cursor around the cells of the grid,

pressing the enter key to bring up a program section for

a sampled person. (For more details, see Sperry,

Edwards, Dulaney, et al., forthcoming.) Whether a

topical section needs to be administered during a round

is determined by numerous MEPS NHC design criteria,

including when the sampled person was sampled, the

round of data collection, where the sampled person

moved to during the round (and in some cases the

previous round), the sampled person’s vital status and

date of death, and, in some instances, the availability of

key data items. These specifications are programmed as

part of the CAPI application. (See MEPS NHC

Navigation Specifications for details. The Navigation

Specifications are part of the MEPS NHC questionnaires

and are available on the MEPS home page at the

AHCPR Web site, <http://www.meps.ahcpr.gov/>.) An

overview of the design by topical section and round is

shown in Table 4.

The NHC CAPI questionnaire makes numerous

references to four types of sampled persons. These

person types (Figure 2) are defined each round, using

information collected with the Residence History

questionnaire section. They are used to define question

skip patterns in the subsequent person-level

questionnaire sections.

The following sections detail the data collection

methodology and the major data elements contained in

Figure 1. Example of CAPI person-level navigation screen used in sampled

facilities during Round 1: 1996 Medical Expenditure Panel Survey Nursing Home

Component

NAVIGATE 90401 Mountainside Nursing Home

SELECT THE SP AND SECTION YOU WOULD LIKE TO DO NEXT.

TYPE NAME RH HS PM BQ IN

CR ELAINE BRAZIL C RDY C RDY RDY

CR JACKIE CALDRON C RDY C RDY RDY

CR DONALD FREUD C RDY C RDY RDY

CR PEGGY LACEY C RDY C RDY RDY

SAMPLED ADMISSION DATE: 09/11/93 AVAILABLE RESULT CODES:

1. CONSENT REQUIRED

4. INITIAL REFUSAL

VITAL STATUS: DECEASED ON 03/03/96

BACKGROUND STATUS: READY TO INTRVW

USE ARROW KEYS. TO SELECT, PRESS ENTER. TO EXIT, PRESS ESC.

Note: The names of the persons and facility shown are fictitious. CAPI is computer-assisted personal interview.

Source: Agency for Health Care Policy and Research, Medical Expenditure Panel Survey Nursing Home Component, 1996.
11

the seven person-level topical sections of the NH CAPI

application. 

Residence History. The Residence History (RH)

section is administered in the sampled facility during

the round in which the sampled person was first

sampled and in every round thereafter. Data are

typically collected from respondents using medical

records and admissions and discharge documents. The

RH section has three major purposes:

• To determine the whereabouts of the sampled person

each day of the 1996 reference period. This includes

identifying such things as NH admission/discharge

dates, place of residence prior to NH admission (or

after discharge), date of last community residence,

and date of death.

• To drive data collection for all the other person-level

sections. For example, NH admission and discharge

dates (during 1996) determine the reference periods

for prescribed medicine use data collection.

• To determine the survey eligibility of persons

sampled for inclusion in the survey. (For example,

persons with a prior probability of selection are

ineligible.) 

As noted previously, the RH instrument must be

administered before any other person-level

questionnaire section in order to establish each person’s

reference dates. The section collects information about

all stays of one or more nights. These include, for

example, inpatient hospital stays; stays in the

community, in the sampled person’s own residence,

personal care places, or in other nursing homes; and

stays in the sampled NH. Other RH data items include

dates of the stay and stay type. Also identified is the

specific unit in which the NH stay occurred, in

situations where the NH (or the larger configuration of

the NH) has multiple units. Table 6 provides an

overview of the RH data items.

All stays identified as part of RH data collection are

classified into one of four stay types. The criteria for

stay type determination are programmed into the CAPI

RH application and are used to define stays in eligible

nursing units. Since a place can have multiple units with

distinctly different place types, the RH questionnaire

classifies both places and stays, as follows:

Figure 2. Types of sampled persons referred to in the CAPI questionnaire:

1996 Medical Expenditure Panel Survey Nursing Home Component

1. “SP sampled in this facility (NH) this round.” This can refer to persons sampled as January 1st 

residents or sampled as an admission in the second round (F2) or the third round (F3). 

2. “Continuing resident still in the facility (NH) at the end of the previous round reference period.” This 

can refer to persons sampled as January 1st residents or sampled as an admission in the second 

round (F2) and still in the facility at the end of the previous round, or to a transfer SP in either a 

sampled or new facility at the end of the previous round.

3. “Continuing resident discharged alive from the facility (NH) at the end of the previous round reference 

period.” This can refer to a January 1st resident, to an admission sampled in the second round of data 

collection in the current facility, or to a transfer SP who was in the current facility last round.

4. “First residence history for this SP in this facility, and SP was not sampled in this facility.” 

This would also apply to transfer sampled persons. 

Note: CAPI is computer-assisted personal interview. NH is nursing home. SP is sampled person.

Source: Agency for Health Care Policy and Research, Medical Expenditure Panel Survey Nursing Home Component, 1996.
12

• Eligible long-term care. 

• Ineligible long-term care. 

• Hospital. 

• Community. 

The definitions of these place/stay types match

those described earlier. (See Facility Structure and Place

Type.) Depending on the place type, additional

information about the stay and the place where the stay

occurred can be collected. For example, for stays in the

community, information is collected about the person(s)

with whom the sampled person lived (Table 6). 

Several key dates are determined by the RH CAPI

application and then used to steer person-level data

collection within a round and across rounds. In addition

to such information as NH admission and discharge

dates and date of death, these key analytic dates include: 

• Sampled Admission Date (SAD)—For January 1st

residents (current residents), the date of the most

recent admission to the sampled facility prior to

January 1, 1996. For persons sampled as first

admissions, the date of the first admission to the

sampled facility during the reference year (January

1-December 31, 1996).

• Key Admission Date (KAD)—The beginning of the

episode of sampled nursing home care. The date of

the first admission to the sampled facility, excluding

readmissions following an acute care hospital stay.

• Inscope Admission Date (IAD)–The beginning of the

episode of eligible nursing home care. The date of

the first admission to an eligible nursing facility,

excluding readmissions following an acute care

hospital stay.

• Transfer Admission Date (TAD)—The date of

admission to an eligible facility, either sampled or

new, by a sampled person who transfers out of the

originally sampled NH to another NH during the

reference year, as reported by the transfer facility.

• End Date for Earliest Community Stay (CED)—The

date of the beginning of the episode of

institutionalization (regardless of whether the stay

was in an eligible nursing home or an ineligible

long-term care place), excluding readmissions

following an acute care hospital stay. The end date

of the most recent time the sampled person lived in

the community. 

One other key date is used for person-level data

collection. This date is not established in the RH but in

the Background Questionnaire section. It is defined

here for completeness:

• First Long-Term Care Use (FLU)—The date of first

ever long-term care use in a person’s lifetime.

Examples of these key dates for a few fictitious sampled

persons are illustrated in Figure 3. It is possible for all

these dates to be the same for a person, for all the dates

to be different, or something in between. 

The RH section is also used to determine personlevel eligibility. Persons sampled as an admission who

have a prior 1996 admission to an eligible NH, or who

were resident in an NH on January 1, 1996, are

ineligible for the survey. Determination of eligibility is

made by CAPI using RH data and a preloaded directory

of the sampling frame. This methodology was first

tested in the 1991 feasibility study (Anderson, Bethel,

Tourangeau, et al., 1994; Bethel, Flyer, and Wolters,

1993). Persons classified as an ineligible first

admission are ineligible for subsequent data collection.

Sampled admissions can also be classified as ineligible

using residence history data collected from community

respondents. (See Person-Level Data, Community.)

Health Status. Health status data collected in the

facility are measured at multiple time points, depending

on the data item and whether the person was sampled as

a January 1st resident or as an admission. The

following time points are possible:

• January 1, 1996—Used to collect baseline health

status information for persons sampled as January

1st residents. These data are collected during 

Round 1.

• December 31, 1996—Used to collect end-of-year

health status information for persons sampled as

January 1st residents and still in an eligible nursing

facility on December 31. These data are collected

during Round 3. 

• Key Admission Date (KAD)—Used to collect

baseline health status information for persons
13

Figure 3. Examples of residence history timelines and key date items: 1996 Medical

Expenditure Panel Survey Nursing Home Component

Possible Timelines for January 1st Residents

Person 1 Community Sampled NH

▲ ▲

SAD, KAD, Jan. 1

IAD, CED

Person 2 Community Sampled NH Hospital Sampled NH

▲ ▲ ▲

KAD, IAD, SAD Jan. 1

CED

Person 3 Community Other NH Sampled NH

▲ ▲ ▲

IAD, CED SAD, KAD Jan. 1

Person 4 Community Board & Care Other NH Sampled NH

▲ ▲ ▲ ▲

CED IAD SAD, KAD Jan. 1

Person 5 Community Sampled NH Community Sampled NH

▲ ▲ ▲

First LTC Use SAD, KAD, Jan. 1

IAD, CED

Person 6 Community Other NH Community Board & Care Other NH Sampled NH Hospital Sampled NH

▲ ▲ ▲ ▲ ▲ ▲

First LTC Use CED IAD KAD SAD Jan. 1

Possible Timelines for First Admissions

Person 7 Community Sampled NH Hospital Sampled NH

▲ ▲

Jan. 1 SAD, KAD

IAD, CED

Person 8 Community Sampled NH Hospital Sampled NH

▲ ▲ ▲

KAD, IAD, CED Jan. 1 SAD

Note: LTC is long-term care. NH is nursing home. Key dates are as follows—CED is End Date for Earliest Community Stay. IAD is

Inscope Admission Date. KAD is Key Admission Date. SAD is Sampled Admission Date.

Source: Agency for Health Care Policy and Research, Medical Expenditure Panel Survey Nursing Home Component, 1996.
14

sampled as an admission. For most admissions, the

KAD is the first admission in 1996 to the sampled

NH. (However, if a person were admitted to the

sampled NH from the hospital following a stay that

began before 1996 and had been a resident of the

sampled NH immediately prior to the hospital stay,

the KAD would be the date the person was first

admitted to the sampled NH, which would be prior

to 1996.) For the Round 2 sample of admissions,

these health status data are collected during Round

2; for the Round 3 sample of admissions, these data

are collected during Round 3.

• KAD plus 90 days—Used to collect health status

data a second time for persons sampled as an

admission (provided that the person is still in an

eligible nursing home). These data can be collected

in either Round 2 or 3, depending on when the 90-

day point occurs. When the 90-day point occurs

during 1997, data collection is still attempted,

provided the person is in an eligible NH unit.

• All of 1996—Used to ascertain incident infections

during periods of NH residence. These data are

collected each round that a sampled person resided

in an eligible NH unit.

The facility Health Status section is designed to

accommodate all of these time points. (See Table 7.) 

Most of the health status items collected in the NH

are based on the Resident Assessment Form of the

Health Care Financing Administration (HCFA), known

as the minimum data set (MDS). (The address of the

MDS 2.0 information site on the World Wide Web is

<http://www.hcfa.gov/Medicare/MdS204/default.ntm>.)

The CAPI application collects the MDS information in

Figure 4. Example of a CAPI screen and its associated online help screen, used to

collect health status data typically obtained from MDS records: 1996 Medical

Expenditure Panel Survey Nursing Home Component

125.16 HA16 03/12/96 ELAINE BRAZIL

Hearing/Communication Mountainside Nursing Home

M SEC. C

What was the condition of ELAINE BRAZIL’s hearing, with a hearing 

appliance, if used, on or around January 1, 1996? Did she hear adequately,

did she have minimal difficulty, did she hear only in special situations, or was her 

hearing highly impaired?

(1)

0. HEARS ADEQUATELY

1. HEARS WITH MINIMAL DIFFICULTY

2. HEARS IN SPECIAL SITUATIONS ONLY

3. HEARING HIGHLY IMPAIRED

PRESS F1 KEY FOR COMPLETE DEFINITIONS

HA16

O HEARS ADEQUATELY - normal conversational speech, including telephone or watching TV

1 MINIMAL DIFFICULTY - when not in a quiet setting

2 HEARS IN SPECIAL SITUATIONS ONLY - speaker has to adjust tonal quality and speak distinctly

3 HIGHLY IMPAIRED - absence of useful hearing

Note: The names of the person and facility shown are fictitious. CAPI is computer-assisted personal interview. MDS is minimum data set.

Source: Agency for Health Care Policy and Research, Medical Expenditure Panel Survey Nursing Home Component, 1996.
15

a question format (Figure 4, top screen), with question

wording, response categories, and definitions of

concepts derived directly from the MDS. This design

permits the interviewer to abstract health status data

directly from MDS forms, and also provides a

questionnaire mechnism to collect data for persons with

no MDS forms. Definitions of the possible response

categories (e.g., what does “occasionally incontinent”

mean?) were derived from the MDS and were provided

to interviewers as part of the CAPI online help system,

which the interviewer could access with a laptop

function key (Figure 4, bottom screen).

There are multiple versions of the MDS. MEPS

health status questions (to be obtained in the NH) were

based on question wording in Version 2 of the MDS.

Version 2 has more detail than Version 1 and was the

HCFA standard for 1996.

There are also multiple reasons for an MDS

assessment (e.g., annual review, quarterly review), and

different MDS forms are used for different assessment

reasons. MDS forms can also vary by State (e.g.,

because of waivers). As a result, not all MDS health

status items are located on all MDS forms. In order to

accommodate this variation in the MDS, Westat, the

data collection contractor, surveyed all States as to their

use of MDS forms (Hallman, 1995). Copies of all the

State forms were collected and reviewed, and this

variation was built into the health status CAPI

programming. CAPI determines for the interviewer

which MDS forms (e.g., annual, quarterly) and which

section of the MDS the respondent (and interviewer)

should be using to obtain the correct information

(Figure 4). Health status items not based on the MDS

are labeled as such so that interviewers can cue the

respondent to check medical records to obtain the

information (Figure 5). Table 7 indicates the NHC

health status items and whether the MDS question

wording is the basis of the item. 

Health status data are collected each round. These

data are abstracted from NH medical records and MDS

forms, or collected by interviewing respondents

(typically nursing staff), who refer to records during the

interview.

Background and Insurance. The design of the

1987 institutional survey was such that many of the

demographic data items for sampled persons were

collected from both next-of-kin residing in the

community and from NH respondents. This resulted in

some redundancy and inconsistency in the data and

increased the data collection costs. Because of these

problems, as well as the questionnaire and item

nonresponse associated with community data collection

in 1987, AHCPR undertook a series of analyses to

investigate alternative data collection methodologies for

background data items (Anderson, Bethel, Tourangeau,

et al., 1994; Tourangeau and Blair, 1993; Tourangeau

and Johnson, 1993). The design for the MEPS NHC

Background and Insurance sections is a direct

Figure 5. Example of a CAPI screen used to collect health status data not tied

directly to an MDS item: 1996 Medical Expenditure Panel Survey Nursing Home

Component 

125.17 HA17 03/12/96 ELAINE BRAZIL

HEARING/COMMUNICATION Mountainside Nursing Home

NOT ON MDS 

Did she have a hearing aid?

(0)

1. YES

2. NO

Note: The names of the person and facility shown are fictitious. CAPI is computer-assisted personal interview. MDS is minimum data set.

Source: Agency for Health Care Policy and Research, Medical Expenditure Panel Survey Nursing Home Component, 1996.
outgrowth of those analyses. The analyses indicated, in

part, that:

• Some demographic data items could be collected

from either facility respondents or community

respondents with no loss in the reliability of the data.

• Some data items were best collected from

community respondents.

• Background item nonresponse could be reduced,

with no sacrifice in reliability, by collecting some

items from the facility rather than from the

community.

This led to an NHC design based on the premise

that a “best” respondent could be identified for a data

item, considering simultaneously data quality issues,

respondent burden, and data collection costs. Thus,

each demographic item is collected by one of the

following five methodologies: 

• Facility is the only data source for the item.

• Facility is considered the primary data source for the

item. If the facility is unable to provide the

information for a person, it is subsequently collected

from the person’s next-of-kin residing in the

community.

• Community is the only data source for the item.

• Community is considered the primary data source

for the item. For operational reasons, the data are

collected from both the community and facility.

• Item is collected from both community and facility.

The NHC design assumes no primary data source

for the item.

Since the methodology is driven, in part, by the

completeness of the data provided, it may vary across

persons. Table 8 shows the data items by the

methodology used. Excluded from this table are

community-respondent-reported items on potential

caregiver network, caregiver services, and health status

data for the period prior to admission; these data are

collected only from community respondents. See

Person-Level Data, Community, for additional

information on these items.

The facility Background (BQ) and facility

Insurance (IN) sections are used to collect demographic

items from respondents and records within the sampled

NH. The Background section collects demographic

information, typically from nursing staff who use

medical records. The Insurance section collects data on

a person’s insurance coverage at baseline. For January

1st residents, this is January 1, 1996. For persons

sampled as admissions, this is the time of admission to

the sampled NH (KAD). For January 1st residents, a

few items on insurance coverage are also collected for

the time of first admission to the NH (KAD). These

data may be collected from respondents who use

medical records (including MDS forms) but may also

be collected from sources in the NH’s billing office.

The Background and Insurance sections are

administered just once per person during the round in

which the person is sampled and always prior to any

community data collection. At the interviewer’s

discretion or the NH’s direction, the interviewer might

abstract these data from NH records or collect them

from an NH respondent.

Prescribed Medicines. The Prescribed Medicines

(PM) section of the facility CAPI collects data on a

person’s use of prescribed medicines while a resident of

an NH for calendar year 1996. The data collected

include the name of the medicine; the form, strength,

and dosage in which it was prescribed; and the number

of times it was prescribed each month (Table 9).

Information on medicines that were given only as

needed (PRN) is also captured.

The feasibility of collecting prescribed medicine

data was first evaluated in the 1991 feasibility study

(Tourangeau and Kuby, 1993). The feasibility study

showed that: 

• PM data can be collected with sufficient detail to

code the data and subsequently link it to general

drug information, such as wholesale cost.

• Abstracting the data was “relatively easy” and

“substantially reduced” the burden on the facility to

provide these data (Anderson, Bethel, Tourangeau, et

al., 1994).

The design of the MEPS PM section built on that

experience. Since results showed that data could be

abstracted, the PM section was designed so that

interviewers can either input data abstracted from the

forms used in NHs to track the administration of

medicines or administer the PM questions to

respondents (typically nursing staff) while they review

16
17

the standardized administration forms. PM data are

collected in each round in which the person was in an

eligible NH.

To improve the quality of the data, and to reduce the

burden of data collection and coding, a directory of over

2,000 prescribed medicines known to be frequently used

by the elderly was built into the application. The source

of information for the directory was the 1995 Red Book

file (Medical Economics Company, Inc., 1995), which

contains detailed information on all prescribed

medicines sold in the United States. As a result,

interviewers do not have to key the name, form, and

strength of drugs on the preloaded list. Examples of

CAPI screens containing the preloaded Red Book

Figure 6. Example of two CAPI screens used to collect prescribed medicine data

(name, form, and strength): 1996 Medical Expenditure Panel Survey Nursing Home

Component

123.002 PM2 03/13/96 ROXANNE BACHUS

SISTERS OF CHARITY

IN JANUARY 1996:

What was the name of the prescribed medicine administered to

ROXANNE BACHUS?

ACETAZOLAMIDE

ADALAT

ADVIL

ALBUTEROL

ALBUTEROL SULFATE

ALDACTONE

ALLBEE C-800

✓ ALLOPURINOL

ALPRAZOLAM

More Above/Below

PRESS F1 FOR EXPLANATION OF ADMINISTERED.

TO SELECT/DESELECT, PRESS ENTER. IF MEDICINE NOT ON LIST OR TO EXIT, PRESS ESC.

123.0022 PM2B 03/13/96 ROXANNE BACHUS

SISTERS OF CHARITY

In what form and strength was ALLOPURINOL?

✓ Tablet 100 MG

Tablet 300 MG

ADD FORM AND STRENGTH

USE ARROW KEYS. TO SELECT/DESELECT PRESS ENTER. TO EXIT PRESS ESC.

Note: The names of the person and facility shown are fictitious. CAPI is computer-assisted personal interview. 

Source: Agency for Health Care Policy and Research, Medical Expenditure Panel Survey Nursing Home Component, 1996.
18

information are shown in Figure 6. As an illustration, to

enter information on “allopurinol,” the interviewer

would proceed as follows:

In response to the question “What was the name of

the prescribed medicine...?” the interviewer simply

types “all,” the first three letters of allopurinol. This

searches the directory and moves the on-screen

cursor to within one entry of the desired medication.

The interviewer then moves the cursor down one

entry and hits the Enter key for the desired

medication. For the next question—”In what form

and strength was ALLOPURINOL?”—the directory

shows all the known forms and strengths in which

allopurinol is available. The interviewer again

moves the cursor to the desired location and hits the

Enter key to select, for example, “Tablet 100 MG.”

Eventually, the interviewer is prompted to collect the

monthly frequency of administration information.

In situations where the form and strength of the

administered medication are not contained on the list,

the interviewer must key in the information in response

to various questions posed by CAPI on the form and

strength of the drug. The PM section also collects

information on medications not contained in the

directory. For these medications, the interviewer must

also key in the name of the drug.

Expenditures. The Expenditures section of the

person-level facility questionnaire collects data on the

costs of health care services provided by nursing homes

during 1996. The data collected include information

about the facility’s billing practices such as the length of

the billing period, start and end date of each billing

period, number of days billed for in each period, and the

rate or rates billed for a person’s room, board, and basic

care in each billing period, as well as charges for

ancillary care. The section also includes information on

all payments received by the facility (for both basic and

ancillary services), the sources of payments for those

services, and the amounts paid by each source, by

billing period. Table 10 lists possible sources of

payments, as well as all the major expenditure data

items.

In situations where the nursing home/eligible unit is

part of a larger facility (e.g., retirement complex),

billing and payment data are collected only for the

services provided in the eligible part of the facility. For

example, if a person was in a board and care unit of a

retirement center early in the year and then transferred

to a nursing unit midway through the year, billing and

payment data are collected only for the care provided in

the nursing unit of the facility.

This is operationalized with the use of CAPI

technology. Figure 7 shows an example of the

introductory screen for an interviewer to read to the

expenditure respondent. When reading, the interviewer

replaces the capitalized text shown within the brackets

with the name(s) of the eligible NH unit(s) in which the

sampled person resided during the reference period. The

names of the eligible unit(s) are provided to the

interviewer in the upper righthand corner of the same

screen–in this example, the New Wing and the

Alzheimer’s unit. If a person had resided in a personal

care unit for part of the year, the name of the personal

care unit would not be displayed on screen. This word

fill information is specific to a sampled person and is

initially collected as part of the Residence History data.

Figure 8 shows an example of the subsequent

expenditure screen. The CAPI program inserts the

sampled person’s reference dates into the expenditure

questions, bounding the periods of expenditure data

collection to periods of residence in an eligible NH unit.

Analysis of data from the 1987 NH expenditure

study revealed that data inconsistencies and anomalies

occurred during data collection (Northrup and

Anderson, 1993). While these anomalies did not

compromise the quality of the data, they added

considerably to the cost and time of the post-data

collection efforts, delaying the availability of

expenditure estimates. To this end, the Expenditures

section was redesigned during the feasibility study and

field tested (Anderson, Bethel, Tourangeau, et al., 1994;

Northrup and Ward, 1993). Results from those efforts

showed that edits could be built into the questionnaire to

greatly reduce the number of data anomalies. The NHC

Expenditures section incorporates several data edits into

the programming logic of the CAPI. They range from

simple numeric comparisons (e.g., “Why does the total

amount billed not equal the sum of the sources of

payments?”) to complex logical edits across several

questionnaire sections (e.g., “Why was Medicare Part A

a source of payment when the NH stay was not

preceded by a hospital stay?”). See Table 10 for an

overview of the major edits used.
19

Figure 7. Example of a CAPI screen used to begin expenditure data collection with

information on eligible facility/unit(s) for the sampled person inserted into question

text: 1996 Medical Expenditure Panel Survey Nursing Home Component

129.01 EX1PRE 07/25/96 MAUDE WICKLEFFE

NEW WING

ALZHEIMER’S

This series of questions asks about MAUDE WICKLEFFE’S

expenditures for room and board and ancillary charges while a

resident of [READ FACILITY/UNITS ABOVE] this year, 1996.

PRESS ENTER TO CONTINUE

Note: The names of the persons and facility shown are fictitious. CAPI is computer-assisted personal interview.

Source: Agency for Health Care Policy and Research, Medical Expenditure Panel Survey Nursing Home Component, 1996.

Figure 8. Example of a CAPI screen used to collect expenditure data with

appropriate reference dates inserted into question text: 1996 Medical Expenditure

Panel Survey Nursing Home Component

129.02 EX2 07/25/96 MAUDE WICKLEFFE

NEW WING

ALZHEIMER’S

(The following questions are about MAUDE WICKLEFFE’s basic

care between January 5, 1996 and July 25, 1996.) Was there 

a charge for her room and board and basic care between

January 5, 1996 and July 25, 1996? Please include any charges

to MAUDE WICKLEFFE, her family, or a third party, such

as Medicaid, Medicare, or a legal guardian.

(1)

1. YES

0. NO

Note: The names of the persons and facility shown are fictitious. CAPI is computer-assisted personal interview.

Source: Agency for Health Care Policy and Research, Medical Expenditure Panel Survey Nursing Home Component, 1996.
Expenditure data are first collected in eligible NHs

during Round 2. (However, the reference period begins

on January 1, 1996, for January 1st residents and on the

date of admission (SAD) for the admissions sample.)

These data are collected again during Round 3. Typical

respondents are facility billing office personnel, who

refer to billing and payment records. NH financing is

sufficiently complex that interviewers are trained to

collect the expenditure data from a respondent and to

abstract data only when the facility refuses to provide a

respondent. 

Health Services Use. The CAPI Health Services

Use section collects information for the periods of time

during 1996 that the sampled person was an NH

resident. Like the Expenditures section, it is

administered in Rounds 2 and 3 and covers the entire

1996 reference period. Typical respondents are nursing

staff, who refer to medical records during the interview.

These data may also be abstracted from medical records

by the interviewer. Data items include frequency of

physician use, physical therapy use, hospital emergency

room visits, and hospital outpatient visits (Table 11).

Data on inpatient hospital use (stays of one or more

nights) are collected in the Residence History section of

the application rather than here.

Like the Round 2 FQ, the Health Services Use

section contains facility-level questions on physicians

who practice in the nursing home. These questions are

asked only once per facility, in either the Health

Services Use section or in the Round 2 FQ. They are

asked as part of the Health Services Use section if it is

administered before the Round 2 FQ. These questions

are used to create a Physician Roster, a list of physicians

whose services are billed for through the facility as part

of the facility’s basic room and board rate. This

information makes it possible to distinguish physician

services that are billed separately from those that are

billed for as part of the basic (or ancillary) NH charges. 

Community Respondent Roster. The last sampled

facility instrument is a paper-and- pencil instrument.

The Community Respondent Roster (CRR) is used to

collect information from NH sources on potential

community respondents. It is administered to each NH

respondent who provides data about the sampled person.

For each potential community respondent identified, the

CRR collects locating information, attributes of the

potential respondent, and the potential respondent’s

relationship to the sampled person. Once all CRRs are

completed for a sampled person, the interviewer enters

the data into the laptop for transmission to the home

office, where an algorithm (based on the work of

Tourangeau and Johnson, 1993) is used to determine the

best community respondent for the sampled person. 

Person-Level Data, Community

Community data collection generally takes place

once for each sampled person for whom a community

respondent was identified. For persons sampled as

January 1st residents or Round 2 admissions, it occurs

during Round 2 after facility data collection is

completed for the person. Similarly, for persons

sampled as admissions in Round 3, community data are

collected in Round 3. Field interviewers, typically those

who collected the sampled person’s NH data, collect

community data by telephone from the interviewer’s

home. Computer-assisted interviewing technology is

used. Community respondents usually are next-of-kin

living in the community but could also be friends,

guardians, and others who are knowledgeable about the

sampled person’s condition prior to admission to the

NH. When no other respondent is available, community

data could be collected from facility staff or, in the case

of a sampled person who was discharged from the NH,

the sampled person.

In addition to collecting information about the

sampled person’s situation prior to admission to the NH,

the Community Questionnaire collects information that

the facility is known to have a difficult time providing,

such as living kin (Tourangeau and Blair, 1993),

income, assets, and caregiving information. The

caregiving data are collected only for persons sampled

as an admission and entering the NH from the

community or from the hospital with a community stay

immediately before.

The Community Questionnaire is also used to

update residence history data for all persons sampled as

an admission (i.e., it collects residence history data for

the period prior to NH admission). These data are used

to make a final determination of a person’s survey

eligibility. Sampled admissions who had a prior 1996

admission to an NH or who were resident in an NH on 

20
21

January 1, 1996, are ineligible for the survey. Once a

sampled person is identified as ineligible, all future data

collection for the person is suspended.

For all sampled persons discharged from the NH,

residence history data are collected from a community

respondent for the period after discharge from the NH.

For some persons, this results in a second Community

Questionnaire being conducted to update missing

residence history information. See Tables 8 and 12 for

an overview of the community data items.

Data Collection in New Facilities

The MEPS NHC follows persons throughout 1996

as they move from nursing home to nursing home; thus,

estimates for all of 1996 are possible. Each sampled

person’s residence history data are reviewed by the

Westat home office staff on an ongoing basis to identify

persons who transfer into new facilities. Whenever a

sampled person moves into a potentially eligible new

facility, new facility data collection procedures are

initiated. They consist of: 

• Determination of facility eligibility as a nursing

home.

• Collection of facility-level data on the new facility.

• Collection of person-level data on the transfer person

while the person is a resident in the new facility.

Data collection instruments and procedures in the

new facilities are similar to those used in the sampled

facilities except that no information is collected on

background, insurance, baseline health status, or

potential community respondents. In most cases,

potential new facilities identified during Round 1 are

fielded in Round 2; those identified during Round 2 are

fielded at the beginning of Round 3; and those identified

during Round 3 are fielded later in Round 3. Potential

new facilities are defined as: 

• Nursing homes.

• Any place listed on the NHC sampling frame of

facilities.

• Board and care homes, personal care homes, assisted

living facilities, or similar places.

• SNF and LTC units of hospitals.

Final determination of the new facility’s eligibility as an

NH is made with the New Facility Questionnaire. This

instrument mirrors the Round 1 Sampled Facility

Questionnaire in determining eligibility and in collecting

facility-level information on the new facility (Table 5),

but also includes Round 2 sampled facility questions on

physicians. Person-level sampling does not occur in new

facilities.

In facilities found to be an eligible NH, person-level

data are collected on use of health care services,

prescribed medicines, expenditures, and incident health

conditions. Each of these data items is collected by

round for the time period the sampled person was in the

transfer NH during 1996. Some cross-sectional health

status data for Time 2 (for the January 1st sample, as of

December 31; for the admissions sample, as of KAD

plus 90 days) are also collected if the person resided in

the transfer NH on the reference date for the item. (See

the health status section under Person-Level Data,

Sampled NH, for details). Residence history data,

measured from the time of discharge from the previous

nursing home to the end of the reference period, are also

collected in new facilities.

If the new facility is not an eligible nursing home,

the only person-level data collected are residence history

data. 

Medicare Claims Data

In addition to primary data collection activities,

MEPS NHC plans to acquire claims data (including

billing and payment information) from HCFA for the

Medicare beneficiary population in the NHC sample.

Both Part A and Part B claims data are targeted for

collection. 
22

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Hallman S. MDS mapping. Rockville (MD): Westat, Inc.;

1995. Internal memorandum 2-95-595.

Harrington C, Preston S, Grant L, et al. Trends in nursing

home bed capacity in the states. Presented at the 1990 annual

meeting of the American Public Health Association, New

York (NY), Fall 1990.

Medical Economics Company, Inc. 1995 drug topics Red

Book: pharmacy’s fundamental reference. Motvale (NJ):

Medical Economics Company, Inc.; 1995.

Northrup D, Anderson S. IPC expenditure data: an evaluation

of data collection procedures, National Medical Expenditure

Survey (NMES-3) IPC Feasibility Study. Rockville (MD):

Agency for Health Care Policy and Research; 1993. Report

No. PB 93-198505. 

Northrup D, Ward P. Alternative strategies for collecting the

IPC use and expenditure data: National Medical Expenditure

Survey (NMES-3) IPC Feasibility Study. Rockville (MD):

Agency for Health Care Policy and Research; 1993. Report

No. PB 93-198612. 

Potter DEB. Nonresponse in a survey of nursing home

residents and facilities for persons with mental retardation:

findings from the National Medical Expenditure Survey,

Institutional Population Component. Proceedings of the

Section on Survey Research Methods, annual meeting of the

American Statistical Association, New Orleans, LA, August

22-25, 1988. Alexandria (VA): American Statistical

Association.

Potter DEB, Braden J. Item nonresponse of medical provider

utilization data in the NMES institutional survey. Proceedings

of the Section on Survey Research Methods, annual meeting

of the American Statistical Association, San Francisco, CA,

August 8-12, 1993. Alexandria (VA): American Statistical

Association.

Potter DEB, Cunningham PJ. An evaluation of a method used

to impute missing residence history data. Journal of

Economic and Social Measurement 1994; 20:263-83.

Prospective Payment Assessment Commission (US).

Medicare and the American health care system report to the

Congress. Washington: The Commission; 1996 June. pp. 92-

93.

Sirrocco A. Nursing homes and board and care homes: data

from the 1991 National Health Provider Inventory.

Hyattsville (MD): National Center for Health Statistics; Feb.

23, 1994. Advance Data From Vital and Health Statistics,

No. 244. DHHS Pub. No. (PHS) 94-1250.
23

Sommers J. Survey design of the National Nursing Home

Expenditure Survey. Presented at the 1995 annual meeting of

the American Public Health Association, San Diego, CA,

October 29-November 2, 1995.

Sommers J. The 1991 Health Provider Inventory as a

sampling frame. Proceedings of the International Conference

on Establishment Surveys: Survey Methods for Business,

Farm and Institutions, Invited and Contributed Papers,

Buffalo, NY, June 27-30, 1993. Alexandria (VA): American

Statistical Association, pp. 563-8.

Sommers J, Bethel J, Broene P. Construction of sampling

weights for the Medical Expenditure Panel Survey Nursing

Home Component. Rockville (MD): Agency for Health Care

Policy and Research; forthcoming. MEPS Methodology

Report.

Sperry S, Edwards B, Dulaney R, et al. Evaluating

interviewer use of CAPI navigation features. In: Couper MC,

Baker RP, Bethlehem JG, et al. (editors), Computer-assisted

survey information collection. New York: John Wiley and

Sons; forthcoming.

Tourangeau K, Vincent C, Anderson S, et al. Comparison of

alternative data collection strategies for chronological

profiles: National Medical Expenditure Survey (NMES-3)

IPC Feasibility Study. Rockville (MD): Agency for Health

Care Policy and Research; 1993. Report No. PB 93-231124. 

Tourangeau R, Blair J. Respondents for the background data:

National Medical Expenditure Survey (NMES-3) IPC

Feasibility Study. Final report. Rockville (MD): Agency for

Health Care Policy and Research; 1993. Report No. PB 93-

198570.

Tourangeau R, Johnson RA. Nonresponse on the Personal

History Questionnaire: National Medical Expenditure Survey

(NMES-3) IPC Feasibility Study. Final report. Rockville

(MD): Agency for Health Care Policy and Research; 1993.

Report No. PB 93-198588. 

Tourangeau R, Kuby A. Strategies for collecting data on

prescribed medicines: National Medical Expenditure Survey

(NMES-3) IPC Feasibility Study. Final report. Rockville

(MD): Agency for Health Care Policy and Research; 1993.

Report No. PB 93-198638. 

Note: Reports with PB numbers are available from

the National Technical Information Service (NTIS),

Springfield,VA 22161, 800-553-6847.
24

Table 1. Number of nursing facilities and beds in sampling frame, by source

from which facilities were added to frame: 1996 Medical Expenditure Panel

Survey Nursing Home Component (MEPS NHC)

Source of facilities 

New facilities added

from State licensing

lists and lists of Hospital-based

Unduplicated HCFA-certified LTC units added Total on

Item 1991 NHPI1 facilities from AHA list updated frame

Facilities 15,811 2,391 275 17,572

Beds 1,615,686 146,231 29,979 1,789,772

1Eventually 205 of these facilities (representing 2,124 beds) were dropped from the MEPS NHC sampling frame because they

did not meet the MEPS NHC eligibility criteria.

Note: AHA is American Hospital Association. HCFA is Health Care Financing Administration. LTC is long-term care. NHPI

is National Health Provider Inventory.

Source: Sommers J. Survey design of the National Nursing Home Expenditure Survey. Presented at the annual meeting of

the American Public Health Association, San Diego, CA, October 29-November 2, 1995.
25

Table 2. Number of nursing facilities selected during first- and second-phase

sample of facilities, by cost stratum: 1996 Medical Expenditure Panel Survey

Nursing Home Component

Facilities selected Facilities selected 

during first-phase during second-phase 

sample of facilities sample of facilities 

Percent of

first-phase 

Cost Interviewer Percent sample

stratum workload and travel Number distribution Number selected

Total 1,651 100.0 1,150 69.7

1 Full interviewer 855 51.8 616 72.0

workload, located 

in a single 

contiguous 

geographic area

2 Partial workload, 439 26.6 292 66.5

considerable 

distance

3 Single facility 

in area,

considerable 

distance 255 15.4 178 70.1

4 Single facility,

air travel 102 6.2 64 62.4

Source: Agency for Health Care Policy and Research, Medical Expenditure Panel Survey Nursing Home Component, 1996.
26

Table 3. Projected sample yield of nursing homes and sampled persons:

numbers sampled and responding, by round: 1996 Medical Expenditure

Panel Survey Nursing Home Component

Sampled unit Round 1 Round 2 Round 3 Total

Facilities

Selected at first phase 1,651 — — —

Selected at second phase 1,150 — — —

Eligible 1,127 — — —

Completed Facility Questionnaire in round 862 — — —

Cooperated with sampling in round 836 811 787 —

Cooperated in all rounds — — — 787

January 1st residents

Selected and eligible 3,344 — — —

Baseline health status data provided 3,210 — — —

Expenditure data provided1 — 3,243 3,144 3,144

Admissions

Selected — 1,622 1,574 3,196

Not first admissions — 357 346 703

Eligible first admissions — 1,265 1,228 2,493

Baseline health status data provided — 1,163 1,130 2,293

Expenditure data provided1 — 1,622 1,155 2,344

1 Defined as at least one-third of expenditure data completed.

Note: For final sample yield, see Sommers J, Bethel J, Broene P. Construction of sampling weights for the Medical

Expenditure Panel Survey Nursing Home Component. Rockville (MD): Agency for Health Care Policy and Research;

forthcoming. MEPS Methodology Report.

Source: Bethel J, Broene P, Sommers JP. Sample design report of the 1996 Medical Expenditure Panel Survey Nursing

Home Component. Rockville (MD): Agency for Health Care Policy and Research; 1998. MEPS Methodology Report No.

4. AHCPR Pub. No. 98-0042.
27

Table 4. Overview of data collection activities for the 1996 Medical Exp

Panel Survey Nursing Home Component

Screener/

Data Subject Recruitment Round1 Round 12 Round 23 Round 34Nursing home • Verify address • Structure/eligibility • Services • Revenue 

• Administrator’s name • Staffing • Update facility rate schedule • Update 

• Recruit facility • Rate schedule • Sample first admissions • Sample f

• Sample current residents • Characteristics of transfer NH • Charact

January 1st No data collection • Residence history • Update residence history • Update 

residents5 • Health status at baseline • NH expenditures • NH exp

• Incident health conditions • P-Meds use • Incident • Demographic background • Use of health services • Health s

• Insurance • Incident health conditions • P-Meds • P-Meds use • Identify community respondents • Use of h

• Community data collection6

Residents No data collection No data collection • Residence history • Update 

admitted • Health status at baseline • Health s1/1/96 - 6/30/96 • Health status 90 days after baseline

baseline • Incident 

• Incident health conditions • NH exp

• Demographic background • P-Meds 

• Insurance • Use of h

• NH expenditures• P-Meds use• Use of health services• Identify community respondents

• Community data collection6

Residents No data collection No data collection No data collection • Residencadmitted • Health s7/1/96 - 12/31/96 • Health s

baseline

• Incident • Demogr

• Insuranc• NH exp• P-Meds • Use of h• Identify c

• Commu

Notes:1 Conducted 1/96-2/96 by telephone. 4 Conducted 4/97-8/97 in person.2 Conducted 3/96-6/96 in person. 5 Current residents as of 1/1/96.3 Conducted 8/96-1/97 in person. 6 Conducted by telephone.

Note: NH is nursing home. P-Meds are prescribed medicines. Source: Agency for Health Care Policy and Research, Medical Expenditure 

Panel Survey Nursing Home Component, 1996.
28

Table 5. Major sampled facility-level data items, by round of data collection:

1996 Medical Expenditure Panel Survey Nursing Home Component

Round 1 

Facility Questionnaire (FQ)

Whether the sampled facility/unit(s) is freestanding or part of a larger facility or campus (e.g., part of a 

retirement center, hospital). All parts of the larger facility (e.g., nursing unit, assisted living, independent living) 

are enumerated as to:

Place type (e.g., nursing, assisted living)

Name of place 

Number of beds/units

Characteristics of eligible facility/unit:

Whether it has any unlicensed beds (e.g., personal care unit)

All unlicensed (non-nursing) units are enumerated as to:

Place type Name of place

Number of beds/units Year unit began operation 

Whether it has any special care units (e.g.,Alzheimer’s unit)

All special care units are enumerated as to:

Unit type Unit name

Number of beds/units Number of residents

Year unit began operation

Whether unit has any Medicare residents

Whether unit has any Medicaid residents

Whether unit has direct care staff dedicated to it

Certification status by Medicare and Medicaid

Number of Medicare beds

Number of Medicaid beds

Number of dually certified beds

Number of noncertified beds in sampled facility/unit

Number of residents:

In eligible facility/unit

With Medicare as primary source of payment

With Medicaid as a source of payment

With private pay as only source of payment

Size, ownership type, and chain membership

Sampling Section of FQ directs interviewer in sampling 4 January 1st residents from eligible facility/unit and 

sets up person-level data collection (name of sampled person, etc.)
29

Table 5. Major sampled facility-level data items, by round of data collection:

1996 Medical Expenditure Panel Survey Nursing Home Component

(continued)

Self-Administered Questionnaire (SAQ)

Medicare and Medicaid provider numbers

Number of admissions to eligible LTC place in 1995

Number of nursing staff employees, by type (RN, LPN, aide), for 1st full week in January

Number of nursing staff hired by facility from agencies as registry or pool staff, by type

Wage rate for entry-level nursing aide at facility

Nursing wage rates for RNs and LPNs for both employee and agency staff 

Hard Copy of Sampled Facility’s Rate Schedule

Round 2

Facility Questionnaire

Updated Medicare/Medicaid certification status 

For newly certified facilities, information on:

Number of beds certified by Medicare, Medicaid, and dually certified

Number of residents with Medicare, Medicaid, and private pay as a source of payment

Characteristics of sampled facility/unit

Accreditation by JCAHO

Population group primarily served

Availability of specially trained providers at the facility routinely providing services to residents:

Physical therapist Speech therapist

Occupational therapist Respiratory therapist

Audiologist Podiatrist

Dentist Dental hygienist

Nutritionist/dietitian Psychiatrist

Psychologist Psychiatric social worker

Psychiatric nurse Optometrist

Pharmacist Other mental health professional

Special education provider/teacher
30

Table 5. Major sampled facility-level data items, by round of data collection:

1996 Medical Expenditure Panel Survey Nursing Home Component

(continued)

Services provided routinely onsite to residents:

Ventilator care Intravenous therapy

Dialysis Tube feeding

Isolation (for highly contagious conditions or 

compromised immune system)

Other services provided to residents:

Hearing tests 

Transportation services for health care

Whether facility vaccinated residents and proportion of residents vaccinated for:

Influenza Pneumonia

Services routinely provided onsite to nonresidents:

Adult day care Rehabilitation therapy (physical, occupational,

Dialysis or speech therapy)

Family support service Case-management services

Services routinely provided to nonresidents off-site:

Home-delivered meals Homemaker/chore services

Infusion therapy Rehabilitation therapy

Hospice services Case-management services

Wound care or other post-acute skilled nursing care

Admission and discharge policies

Whether facility provided respite care and number of respite beds

Characteristics of larger facility (if sampled facility/unit is part of larger facility)

Population groups served

Availability of services routinely provided by larger facility to residents:

Physical therapy Speech therapy

Occupational therapy Respiratory therapy

Hearing therapy Podiatry

Dental services Nutritional services 

Mental health services Ventilator care

Intravenous therapy Dialysis

Tube feeding
31

Table 5. Major sampled facility-level data items, by round of data collection:

1996 Medical Expenditure Panel Survey Nursing Home Component

(continued)

Services routinely provided by larger facility to nonresidents:

Adult day care Home-delivered meals

Homemaker services Home health care

Hospice care Case-management services

Characteristics of physicians who provide services in sampled facility/unit:

Whether facility had contract with a group of physicians

Whether facility billed for physician care through the facility basic or ancillary rate

Names of all physicians who bill through facility

Whether group billed through facility entirely or sometimes

Whether there are other physicians for whom the facility bills for care through the basic 

or ancillary rate

Names of all physicians who bill through facility

Whether physician bills through facility entirely or sometimes

Round 2 Sampling Questionnaire

Directs interviewer on sampling 2-3 persons who were admitted to the facility 1/1-6/30/96 and sets up 

person-level data collection 

Missing Round 1 Self-Administered Questionnaire

Facility Rate Schedule Form

Retrieves missing rate schedule information

Obtains billing rate for each special care unit facility is known to have

Whether the facility has special private-pay billing rates with health maintenance organizations

Billing rate amounts
32

Table 5. Major sampled facility-level data items, by round of data collection:

1996 Medical Expenditure Panel Survey Nursing Home Component

(continued)

Round 3

Round 3 Facility Questionnaire (Cost-of-Patient-Care Questionnaire)

Number of residents in sampled facility/unit last night (late spring 1997)

Whether the facility filed a Medicaid cost report annual financial report; date of report

Revenue and expense data for the facility:

Total patient revenues Total patient days

Total patient expenses Total nonpatient revenues

Total revenues and patient days from following sources:

Medicaid Medicare

Private pay Veterans Affairs

Other sources

Round 3 Sampling Questionnaire 

Directs interviewer on sampling 2-3 persons who were admitted to the facility 

7/1-12/31/96 and sets up person-level data collection

Round 3 Self-Administered Questionnaire 

Number of nursing staff employees, by type (RN, LPN, aide), for last full week in December

Number of nursing staff hired by facility from agencies as registry or pool staff, by type

Wage rate for entry-level nursing aide at facility

Nursing wage rates for RNs and LPNs for both employee and agency staff 

Number of nursing staff hired, by type, during 1996

Number of physicians caring for eligible LTC place/unit residents

Criteria used for a physician to obtain practice privileges at facility

Number of physicians who are salaried employees of the facility

Note: JCAHO is Joint Commission on Accreditation of Healthcare Organizations. LPN is licensed practical nurse. LTC is

long-term care. RN is registered nurse.

Source: Agency for Health Care Policy and Research, Medical Expenditure Panel Survey Nursing Home Component, 1996.
33

Table 6. Major data items collected in facility Residence History (RH) section

of person-level questionnaire: 1996 Medical Expenditure Panel Survey Nursing

Home Component

Reference period for RH data for sampled persons:

January 1st sample:

Start—date of most recent community stay prior to 1/1/96

End—12/31/96

Sample of admissions:

Start—1/1/96 or date of most recent community stay prior to 1/1, whichever occurs first

End—12/31/961

Place types for which RH data are collected:

Eligible LTC2 —such places as freestanding nursing homes and LTC nursing units of retirement centers,

CCRCs, hospitals, and VA centers

Ineligible long-term care3—such places as residential care facilities, board and care homes, assisted living 

facilities, and group homes

Hospitals—all hospital types

Community—includes independent living units in retirement centers as well as private homes and 

apartments

Information collected about all stays:

Beginning and end dates of stay

Place type

Place type typology

Information collected about stays in a nursing home/unit (eligible LTC):2

Name and address of place/unit where stay occurred

Whether a formal discharge occurred

If facility has multiple units:4

Which unit the stay occurred in

Whether stay was in an LTC nursing unit

Whether facility was on the sampling frame
34

Table 6. Major data items collected in facility Residence History (RH) section

of person-level questionnaire: 1996 Medical Expenditure Panel Survey Nursing

Home Component (continued)

Information collected about hospital stays:5

Name and address of place/unit where stay occurred

Whether stay was in an LTC nursing unit (e.g.,skilled nursing facility unit)

Type of hospital (if not already available)

Main diagnosis that caused the hospitalization6,7

Information collected about ineligible LTC stays:3

Name and address of place/unit where stay occurred

Whether stay was in an LTC nursing unit

Whether place provided help with bathing or dressing8

Information collected about stays in the community:

Who lived with person

Whether person received formal home health services

City, State, and ZIP Code of the community stay immediately prior to start of 

institutionalization episode

1 For persons admitted during last quarter of 1996, the Health Status questionnaire collects some residence history information for the period 1/1/97 to 90 days after admission.

2 An eligible LTC place is defined as a place/unit certified by Medicare or Medicaid, or licensed as a nursing home 

with 3 or more beds and providing 24-hour onsite supervision by an RN or LPN 7 days a week, 24 hours a day.

3 An ineligible LTC place is defined as a place/unit not licensed or certified (i.e., not a nursing home), with services 

provided for personal care such as assistance with bathing or dressing.

4 For example, nursing facilities that are part of a retirement center or hospital, or nursing facilities that contain special care 

units such as Alzheimer’s or rehabilitation units; this information is initially collected in the Facility Questionnaire (see Table 5).

5 To reduce the burden on facility respondents, for most hospital stays, details about the hospital were obtained from 

American Hospital Association data.

6 Collected only for hospital stays that occurred during 1996.

7 The main diagnosis of a hospital stay could be collected with the RH or Health Status section of the questionnaire, 

depending on where the interviewer finds the information.

8 Information is not collected if the ineligible LTC unit/place is part of the sampled facility. (Sampled facility structure 

is collected with the Round 1 Facility Questionnaire.)

Note: CCRC is continuing care retirement center. LTC is long-term care. VA is Department of Veterans Affairs.

Source: Agency for Health Care Policy and Research, Medical Expenditure Panel Survey Nursing Home Component, 1996.
35

Table 7. Overview of health status data items collected in nursing home, by

sample type, time points of measurement, and whether question wording

based on minimum data set (MDS): 1996 Medical Expenditure Panel Survey

Nursing Home Component 

Question

wording

based on

Time 2, key Version 2

Baseline, key admission of MDS

Baseline, Time 2, admission date plus 

Health status data item 1/1/96 12/31/961 date 2 90 days1,3 All of 19961

History of mental retardation,

mental illness, or 

developmental disability 4X 4X X

Advance directives:

Living will X X X

Do not resuscitate X X X

Do not hospitalize X X X

Feeding/medication restriction X X X

Person comatose X X X X

Memory/cognitive skills:

Short-term memory X X X X X

Long-term memory X X X X X

Recall ability (4 items) X X X X X

Independence in daily decisions X X X X X

Hearing/communication:

Condition of hearing X X X

Hearing aid use X X

Ability to communicate X X X

Ability to see X X X

Behavioral symptoms:

Wandering X X X X X

Verbally abusive X X X X X

Physically abusive X X X X X

Disruptive behavior X X X X X

Resistance to care X X X X X

Collected for

both samples,

measured for:

Collected for the 

January 1st sample,

measured at:

Collected for sample 

of admissions,

measured at:
36

Table 7. Overview of health status data items collected in nursing home, by

sample type, time points of measurement, and whether question wording

based on minimum data set (MDS): 1996 Medical Expenditure Panel Survey

Nursing Home Component (continued)

Question

wording

based on

Time 2, key Version 2

Baseline, key admission of MDS

Baseline, Time 2, admission date plus 

Health status data item 1/1/96 12/31/961 date 2 90 days1,3 All of 19961

Self-performance in:

Transferring X X X X X

Locomotion on unit X X X X X

Dressing X X X X X

Eating X X X X X

Toilet use X X X X X

Modes of locomotion:

Cane/walker X X X X X

Wheeled,self X X X X X

Wheeled, other person X X X X X

Continence

Bowel control X X X

Bladder control X X X

Psychosocial well-being:

Interacts with others X X X

Plans or structures activities X X X

Establishes own goals X X X

Pursues involvement X X X

Accepts invitations X X X

Has absence of contact X X X

Active diagnoses and 

conditions on MDS assessment X X X

Collected for

both samples,

measured for:

Collected for the 

January 1st sample,

measured at:

Collected for sample 

of admissions,

measured at:
37

Table 7. Overview of health status data items collected in nursing home, by

sample type, time points of measurement, and whether question wording

based on minimum data set (MDS): 1996 Medical Expenditure Panel Survey

Nursing Home Component (continued)

Question

wording

based on

Time 2, key Version 2

Baseline, key admission of MDS

Baseline, Time 2, admission date plus 

Health status data item 1/1/96 12/31/961 date 2 90 days1,3 All of 19961

Active infections at date:

Clostridium difficulty X X X

HIV X X X

Conjunctivitis X X X

Methicillin resistant staph X X X

Pneumonia X X X X

Respiratory infection X X X

Septicemia X X X X

Sexually transmitted diseases X X

Tuberculosis X X X

Urinary tract infection X X X X

Viral hepatitis X X X

Wound infection X X X

Any other active diagnoses 

or conditions in medical record X X

Fractures, by site X X X X

Did person experience:

Dehydration X X X

Delusions X X X

Hallucinations X X X

Oral/nutritional status

Chewing problem X X X

Swallowing problem X X X

Mouth pain X X X

Collected for

both samples,

measured for:

Collected for the 

January 1st sample,

measured at:

Collected for sample 

of admissions,

measured at:
38

Table 7. Overview of health status data items collected in nursing home, by

sample type, time points of measurement, and whether question wording

based on minimum data set (MDS): 1996 Medical Expenditure Panel Survey

Nursing Home Component (continued)

Question

wording

based on

Time 2, key Version 2

Baseline, key admission of MDS

Baseline, Time 2, admission date plus 

Health status data item 1/1/96 12/31/961 date 2 90 days1,3 All of 19961

Height X X X

Weight X X X X X

Dental health:

Debris in mouth X X X

Dentures X X X

Tooth loss X X X

Broken/carious teeth X X X

Inflamed gums X X X

Pressure sores X X X X

Active X X X

Stage X X X

Restraint devices:

Bed rails X X X X X

Trunk restraint X X X X X

Limb restraint X X X X X

Chair prevents rising X X X X X

Main reason/diagnosis

for hospitalization(s) 5,6X

Items specific to MDS 

record identification:

Date of form X X X X X

Type of MDS form X X X X X

Version of MDS X X X X X

Collected for

both samples,

measured for:

Collected for the 

January 1st sample,

measured at:

Collected for sample 

of admissions,

measured at:
39

Table 7. Overview of health status data items collected in nursing home, by

sample type, time points of measurement, and whether question wording

based on minimum data set (MDS): 1996 Medical Expenditure Panel Survey

Nursing Home Component (continued)

Question

wording

based on

Time 2, key Version 2

Baseline, key admission of MDS

Baseline, Time 2, admission date plus 

Health status data item 1/1/96 12/31/961 date 2 90 days1,3 All of 19961

Miscellaneous items on 

MDS form:

Medicaid ID number X X X

Medicare ID number X X X

Social Security number X X X

Level of education X X X

1 Collected only if person is still in an eligible facility/unit on reference date.

2 Collected at time of first admission to the facility excluding any readmissions from a hospital.

3 Collected if key admission date plus 90 days occurs during 1996 or 1997 and person is still in an eligible facility/unit 

on the reference date.

4 Collected at time of first admisssion as part of the pre-admission screening.

5 If reason for hospitalization(s) was not collected in the Residence History section, it is collected here. If the person is 

admitted to an emergency room (ER) during the course of the 1996 nursing home stay, the main reason/diagnosis 

for the ER visit is collected in the Health Services Use section rather than the Health Status section. 

6 Health Status section also collects dates of hospitalization in 1997 and reason for hospitalization if key admission 

date plus 90 days occurs during 1997. 

Source: Agency for Health Care Policy and Research, Medical Expenditure Panel Survey Nursing Home Component, 1996.

Collected for

both samples,

measured for:

Collected for the 

January 1st sample,

measured at:

Collected for sample 

of admissions,

measured at:
40

Table 8. Overview of demographic data items collected in nursing home and

community questionnaires, by primary and secondary data source for item:

1996 Medical Expenditure Panel Survey Nursing Home Component

Collected No primary

in facility; source; Collected 

missing data collected in in both Collected in

Collected in collected in both facility community community

Demographic data items facility only community and community and facility only

Background

Age 1,2 X

Sex 1,2 X

Race X

Hispanic descent X

Prior lifetime use of LTC X

Type of facility X

When X

Education3 X

Veterans’ status X

Marital status2,4 X

Spouse’s residence X

Ownership of spouse’s X

home 

Spouse’s health status X

Numbers of living 

daughters,sons,sisters,

and brothers (4 items) X

Vital status of parents 

(2 items)5 X

Reason for entry to facility 

(8 items) X

Insurance coverage

Ever Medicaid covered X

Medicaid coverage at X

baseline2,6

Date of first coverage X

Place of first coverage6 X

Medicaid coverage at admission X

Medicare Part A coverage2,6 X

Medicare Part B coverage2,6 X

Private health insurance 

(e.g., Medigap) coverage6 X

Facility is primary source Community is primary source 
41

Table 8. Overview of demographic data items collected in nursing home and

community questionnaires,by primary and secondary data source for item: 1996

Medical Expenditure Panel Survey Nursing Home Component (continued)

Collected No primary

in facility; source; Collected 

missing data collected in in both Collected in

Collected in collected in both facility community community

Demographic data items facility only community and community and facility only

Private LTC coverage6 X

Did policy pay for 

nursing home costs? X

Did policy pay family

directly? X

Amount paid to family X

Did family members other 

than sampled person/spouse 

pay any NH costs? X

CHAMPUS/CHAMPVA 

coverage6 X

Other VA contract coverage6 X

Other public assistance health 

insurance coverage6 X

Income and assets

Any Social Security income 7X

Amount last month 7X

Any pension income 7X

Amount last month X

Any income from other sources X

Total 1995 income X

Home ownership by person 7X

Worth of home X

Any financial assets at admission X

Worth of assets X

1 Actually asked in the Residence History rather than Background section of questionnaire in order to set up question word 

fills for all subsequent questionnaire sections.

2 If the first facility respondent fails to provide this information, it is retrieved from other facility respondents during the 

current round.

3 In the facility, this information can be collected as part of the Background or Health Status section, depending on where 

the interviewer finds the information first. 

4 For January 1st residents, measured at January 1 and the key admission date; for admissions, measured at the key admission date.

5 Only asked of persons under 65 years of age.

6 For January 1st residents, measured at January 1; for admissions, measured at the key admission date.

7 Facility-reported data were collected in the Expenditure section of the questionnaire for all persons in an NH any time 

during Round 3.

Note: CHAMPUS and CHAMPVA are the Civilian Health and Medical Programs of the Uniformed Services and Department of

Veterans Affairs, respectively. LTC is long-term care. NH is nursing home.

Source: Agency for Health Care Policy and Research, Medical Expenditure Panel Survey Nursing Home Component, 1996.

Facility is primary source Community is primary source 
42

Table 9. Major data items collected in facility Prescribed Medicines section

of the person-level questionnaire: 1996 Medical Expenditure Panel Survey

Nursing Home Component

Prescribed medicine data are collected for each person for each month during 1996 that the person was

a resident of an eligible facility/unit:

Whether any prescribed medicines were administered that month

Name of each prescribed medicine, including any given PRN (when needed)

Form,strength, and dosage of the prescribed medicine1

Frequency of administration during the month

Whether the prescribed medicine was discontinued during the month

1 These data are not collected for over-the-counter medicines prescribed by a physician.

Source: Agency for Health Care Policy and Research, Medical Expenditure Panel Survey Nursing Home Component, 1996
43

Table 10. Major data items collected in the facility Expenditures section of

the person-level questionnaire: 1996 Medical Expenditure Panel Survey

Nursing Home Component

This information is collected for persons admitted to the sampled facility/unit prior to January 1, 1996 

(January 1st residents):

Primary source of payment at the time of admission (key admission date)

Collected for each person for the time during 1996 that the person used an eligible facility/unit:

Whether there was a charge for basic care

Reason for no charge

Whether the person was billed separately for health-related ancillary charges

Length of facility billing period (BP)

Collected for each person, for each BP, for the time during 1996 that the person used an eligible facility/unit:

Number of days billed for care

Why number of days in the BP is different from number of days care was billed for

Rates billed for basic care

Number of days at each rate

Sources of payments for BP and amount of payments from each source; possible sources:

Medicaid Private pay

Sampled person’s/family’s income Social Security

Private health insurance Pension

VA contract HMO contract

Medicare Part A Other

Whether ancillary charges were billed:

Total ancillary charges

Sources of payments and amount of payments from each source

Items used to reconcile inconsistent billing amounts with payment amounts,collected when necessary:

Why Medicare paid for care but stay in the eligible facility was not preceded by a hospital stay

Why total amount billed is not equal to the sum of the sources of payments

Why Medicare/Medicaid is a source of payment in a facility that is not certified by Medicare/Medicaid

Why Medicare/Medicaid is a source of payment when person’s insurance coverage data indicates 

person was not covered by Medicare/Medicaid

Why Medicaid is not a source of payment in the BP when it was a source of payment in previous 

billing periods

When Medicare is a source of payment and Medicare payments in the BP are < 10 percent of the 

total BP payment, verify that Medicare is not Medicare Part B rather than Medicare Part A

For persons with LTC insurance, determine why the LTC insurance is not a source of payment

Note: HMO is health maintenance organization. LTC is long-term care. VA is Department of Veterans Affairs.

Source: Agency for Health Care Policy and Research, Medical Expenditure Panel Survey Nursing Home Component, 1996.
44

Table 11. Major data items collected in the facility Health Services Use

section of the person-level questionnaire: 1996 Medical Expenditure Panel

Survey Nursing Home Component

Health services use information is collected for each sampled person for the time during 1996 that the person was 

resident in an eligible facility/unit:

While a resident of the facility, did person see a:

Physician outside of the facility

Number of visits

Physician within the facility

Name of doctor who provided care 

Number of visits

Dental provider

Number of visits

Psychiatrist or other mental health provider

Type of provider

Number of visits

Whether therapy was individual, group, or both

Podiatrist

While a resident of the facility, did person receive any:

Physical therapy

Frequency of therapy

Time period over which therapy was provided

Occupational therapy

Frequency of therapy

Time period over which therapy was provided
45

Table 11. Major data items collected in the facility Health Services Use

section of the person-level questionnaire: 1996 Medical Expenditure Panel

Survey Nursing Home Component (continued)

Speech and hearing therapy

Frequency of therapy

Respiratory therapy

Intravenous therapy

Educational or habilitation services

Frequency of therapy, by type

Time period over which service was provided

While a resident, did person have any:

Hospital emergency room visits

Date of each emergency room visit

Main reason or diagnosis

Visits to the hospital without an overnight stay1

Number of visits

Characteristics of physicians who provide services in the eligible facility/unit (if not previously collected 

with Round 2 Facility Questionnaire):

Whether facility had contract with a group of physicians

Whether facility billed for physician care through the facility basic or ancillary rate

Names of all physicians who bill through facility

Whether group billed through facility entirely or sometimes

Whether there are other physicians for whom the facility bills for care through 

the basic or ancillary rate

Names of all physicians who bill through facility

Whether physician bills through facility entirely or sometimes

1 Visits to the hospital with an overnight stay are collected in the Residence History section. See Table 6.

Source: Agency for Health Care Policy and Research, Medical Expenditure Panel Survey Nursing Home Component, 1996.
46

Table 12. Overview of data items collected in the Community

Questionnaire: 1996 Medical Expenditure Panel Survey Nursing Home

Component

This information is collected for each sampled person for whom a cooperating community respondent 

was identified:

Residence history information 1

Whereabouts of the person prior to admission 2

Whereabouts of the person after discharge from sampled facility or a transfer facility 3

Background and insurance information 4

Reason for admission to the eligible facility/unit (8 items)

Health status of person immediately prior to admission:

Physical health status Mental health status

ADL supervision required IADL supervision required

Use of walker/grab bars Difficulty in locomotion

Memory loss

Income and assets of sampled person4

This information is collected for persons sampled as an admission if they were admitted to the sampled 

facility/unit either directly from the community or from a hospital stay that was immediately preceded 

by a stay in the community (and if a cooperating community respondent could be identified for the 

sampled person):

Potential caregiver network (limited to the person’s children and all members of the sampled 

person’s household prior to admission), including information on:

Age of potential caregiver 

Sex of potential caregiver 

Potential caregiver’s relationship to person

Characteristics of persons who provided caregiving assistance5 to the sampled person or who

arranged for the sampled person to receive paid care:

Data items collected for those who provided caregiving assistance5 and were immediate

family members of the sampled person (limited to the person’s spouse, children,

parents, siblings, and the wives of married sons) who provided caregiving assistance:

Age Caregiver’s relationship to person

Sex Marital status

Place of residence6 Whether minor children lived in home of caregiver8

Health status7 Whether caregiver had a job and whether the job was 

Level of education7 full time

Whether the caregiver Whether caregiver also arranged for paid care

lived with the person
47

Table 12. Overview of data items collected in the Community

Questionnaire: 1996 Medical Expenditure Panel Survey Nursing Home

Component (continued)

Items collected for all persons who provided caregiving assistance5 but were not immediate

family members (i.e., not a spouse, child, parent, sibling, or the wife of a married son who

provided care), including paid and unpaid caregivers:

Age of caregiver Caregiver’s relationship to person

Sex of caregiver Whether caregiver also arranged for paid care

Whether caregiver lived 

with the person

Items collected for persons who did not provide caregiving assistance5 but who arranged

for the sampled person to receive paid care:

Age of arranger Arranger’s relationship to person

Sex of arranger Whether the arranger lived with the person

Information, by caregiver, on the type of care provided (enumerated for all unpaid and paid 

caregivers), including:

Whether the caregiver provided skilled care

Whether the caregiver provided ADL assistance

Whether the caregiver provided IADL assistance

Frequency of care provided

Who arranged for the care to be provided

Whether the care provided was paid or unpaid care

Which caregiver helped the most 

Characteristics of the sampled person’s children who did not provide caregiving assistance5

(limited to a maximum of 4 children and the wives of those children),9 including:

Age Marital status

Sex Whether minor children lived in the home 

Place of residence6 of the non-caregiver8

Health status7 Whether the non-caregiver had a job and whether 

Level of education7 the job was full time

Non-caregiver’s relationship Whether the non-caregiver lived with the sampled 

to person person

1 Data items collected from community respondents on the preadmission and post-discharge nursing home stays are 

comparable to items in the facility Residence History section (see Table 6 for details), although not collected for all 

sampled persons.

2 Collected for all persons sampled as an admission. For January 1st residents admitted to the eligible facility in 1995 

or 1996, preadmission data from the community respondent are obtained only when the sampled facility cannot provide 

the information, and are limited to retrieving the key admission date and the place type of the stay immediately prior to 

admission. Otherwise, community Residence History data were not collected for persons sampled as January 1st residents. 

Table notes continued on next page.
Table 12. Overview of data items collected in the Community

Questionnaire: 1996 Medical Expenditure Panel Survey Nursing Home

Component (continued)

3 Collected for all sampled persons discharged from the eligible facility. For persons sampled during Round 1 (January 1st

residents) or Round 2 (half of the admissions sample) who did not reside in an eligible facility at the end of Round 2, 

a Round 3 Community Questionnaire is conducted to update residence history data.

4 See Table 8 for details on these data items. 

5 Care was defined as assistance with any one of the following activities: bathing, dressing, getting around the house, 

taking medications, paying bills, preparing light meals, doing laundry, going shopping, getting to places outside of 

walking distance, shots or injections, catheter or ostomy care, intravenous or oxygen therapy, or wound care. 

6 Limited to city, State, and ZIP Code.

7 These items were not collected on daughters in law. 

8 This item was not asked for the wives of the married sons but was asked for the married sons. 

9 In situations where the sampled person had more than 4 children who did not provide care, these data were collected 

on a random sample of 4 children; this process was built into the computer-assisted personal interview (CAPI) program. 

If a married son was selected as one of the 4, similar data were collected for the son’s wife. If the sampled person had 4 

or fewer children who did not provide care, these data were collected on all children and associated daughters in law. 

Note: ADLs are activities of daily living. IADLs are instrumental activities of daily living.

Source: Agency for Health Care Policy and Research, Medical Expenditure Panel Survey Nursing Home Component, 1996.

48
49

Appendix. List of Acronyms and Terms Used in This Report

and in the MEPS Nursing Home Component Questionnaires

ADLs Activities of daily living.

AHA American Hospital Association. The NHC CAPI application contained a preloaded Hospital 

Provider Directory that interviewers used during data collection to obtain address information on 

hospitals. The AHA file of hospitals was used as the source data for the directory.

AHCPR Agency for Health Care Policy and Research.

APHA American Public Health Association.

B Baseline, initial assessment date for the health status and insurance coverage questions. B was 

measured at January 1, 1996, for the January 1st sample and at the key admission date for persons 

sampled as an admission. 

BCAVD Closest valid assessment date for baseline health status data.

BP Billing period.

BQ 1. Background Questionnaire, also known as the Facility Background Questionnaire. 

2. Used to denote the background history and demographic questions.

BRK Break-off, a partially completed interview.

C A questionnaire disposition code indicating a completed questionnaire.

CADE Computer-assisted data entry.

CAI Computer-assisted interview.

CAPI Computer-assisted personal interview.

CCRC Continuing care retirement center.

CED Community end date, the end date of the most recent time the sampled person lived in 

the community.

CHAMPUS Civilian Health and Medical Program of the Uniformed Services, a health insurance program 

that covers both active-duty and retired military personnel, their dependents, and survivors.

CHAMPVA Civilian Health and Medical Program of the Department of Veterans Affairs, a health insurance 

program that covers disabled veterans, their dependents, and survivors.

COMM Community places of residence, one of the four place type designators used in the MEPS NHC. 

It includes all independent living units of retirement centers as well as private homes or apartments.
50

CPCQ Cost-of-Patient-Care Questionnaire, the Round 3 Sampled Facility Questionnaire.

CQ 1. Community Questionnaire. 2. Used to denote questions that are asked only of community 

respondents (e.g., caregiving data). 

CR Current residents, sampled persons who were resident in a sampled NH on January 1, 1996. 

These persons were all sampled during Round 1. 

CRQ Consent required, a questionnaire disposition code indicating that consent of the sampled 

person’s next of kin was required prior to data collection.

CRR Community Respondent Roster, a paper questionnaire used to obtain names and locating 

information on persons nominated as potential community respondents for the sampled person. 

CTRL/A A preprogrammed CAPI function key that the interviewer used to add a new text line to a list 

of items (e.g., a roster) displayed by CAPI.

CTRL/B A preprogrammed CAPI function key that the interviewer used to navigate the CAPI

application backward one screen at a time.

CTRL/D A preprogrammed CAPI function key that the interviewer used to delete a text item from a list 

of items displayed by CAPI; typically used to correct an entry.

CTRL/E A preprogrammed CAPI function key that the interviewer used to break off an interview for 

resumption later.

CTRL/F A preprogrammed CAPI function key that the interviewer used to navigate the CAPI 

application forward one screen at a time within an episode of backward movement.

CTRL/G A preprogrammed CAPI function key that the interviewer used to “fast forward” the CAPI 

application to the next field with no data entry.

CTRL/J A preprogrammed CAPI function key that the interviewer used to open a “jumpback” menu 

window; used to navigate the application backward across multiple screens simultaneously.

CTRL/K A preprogrammed CAPI function key that the interviewer used to open a comment window.

CVAD Closest valid assessment date for health status items. For January 1st residents, measured at 

January 1 and December 31, 1996. For persons sampled as admissions, measured at the key 

admission date and 90 days after the key admission date. Some health status items are also 

measured across all of 1996.

DE Data entry.

DHHS Department of Health and Human Services.

DK Don’t know, indicated in the public use database as a “ − 8”.
51

DOA Dead on arrival.

DOB Date of birth.

DOD Date of death.

DOI Date of interview.

DON Director of Nursing.

Dx Diagnosis.

EF Eligibility code used to identify an eligible first admission.

ELIG LTC Eligible long-term care place, one of the four place type designators used in the MEPS NHC. 

It is defined as a facility or distinct part of a facility certified by Medicare as a skilled nursing 

facility or by Medicaid as a nursing facility, or licensed as a nursing home with three or more 

beds that provides onsite supervision by an RN or LPN 7 days a week, 24 hours a day.

ER Emergency room.

EX 1. Expenditure Questionnaire. 2. Used to denote questions on NH expenditures and sources 

of payment.

F2 A sampled person whose first admission to the sampled nursing home in 1996 was on or 

between 1/1/96 and 6/30/96; a person sampled as a first admission during Round 2.

F3 A sampled person whose first admission to the sampled nursing home in 1996 was on or 

between 7/1/96 and 12/31/96; a person sampled as a first admission during Round 3.

FA 1. First admission, sampled person admitted to the sampled nursing home during 1996 on January 1 

or later who had no earlier admission to any eligible nursing home (F2 and F3). 2. Denotes 

questions in the Round 1 Facility Questionnaire on the structure and basic characteristics of the NH.

Face sheet Document used by the interviewing staff to manage their interviewing assignments.

FACILITY A nursing home, used to denote the NH where data collection is occurring or to indicate data 

collected from NH sources. 

FB Identifies facility-level questions on the services provided by the nursing home. 

FC 1. Identifies questions in the Round 3 Sampled Facility Questionnaires on cost of patient care and 

NH revenues. 2. Facility complete, a questionnaire disposition code.

FCD Final consent denied, a questionnaire disposition code.

FG Facility Records Organizational Grid, a form used by the interviewers to determine the best NH 

respondents, by type of information to be collected. Also know as the FROG.
52

FLU Year of first (lifetime) long-term care use.

FQ Facility Questionnaire. An FQ is administered within sampled and transfer nursing homes each 

round and is used to collect facility-level information about the nursing home.

FR 1. Facility Rate Schedule, information obtained from the NH (usually as a printed document) on 

the rates charged NH residents. Also known as FRS. 2. Used to denote items associated with the 

retrieval of the NH’s rate schedule. 3. Final refusal, a questionnaire disposition code.

FROG Facility Records Organizational Grid; see FG.

FRS Facility Rate Schedule; see FR.

FTE Full-time equivalent (employee).

HA Used to denote the Health Status questions that measure health status at a point in time 

(e.g., Baseline and Time 2).

HB Used to denote the Health Status questions that measure health status across time 

(e.g., all of 1996 while an NH resident). 

HC Used to denote questions concerning the data collection method used to collect health status 

data in the NH.

HCFA Health Care Financing Administration.

HMO Health maintenance organization.

HOSP Hospital, one of the four place type designators used in the MEPS NHC, included acute or 

long-term care hospitals. In the case of a hospital with a skilled nursing unit or an eligible 

long-term care unit, the SNF/LTC unit was classified as an eligible LTC place and the remaining 

hospital units were classified as appropriate (e.g., hospital).

HS Health Status Questionnaire administered in the NH.

IA 1. Income and Assets Questionnaire. 2. Used to denote questions on income and assets.

IAD Inscope admission date, the beginning of the episode of eligible nursing home care; the date of 

the first admission to the sampled facility, excluding re-admissions following an acute hospital stay.

IADLs Instrumental activities of daily living.

ICD Initial consent denied, a questionnaire disposition code.

ICF Intermediate care facility.

IF First-admission eligibility code used to denote an ineligible first admission.
53

IN 1. Insurance Questionnaire, also known as the Facility Health Insurance Questionnaire. 

2. Used to denote the health insurance coverage questions.

INEL LTC Ineligible long-term care place, one of the four place type designators used in the MEPS NHC. 

It is defined as a facility or distinct part of a facility that is not certified or licensed as an eligible 

nursing home but provides services for personal care assistance with dressing or bathing.

INMD Insurance Questionnaire Missing Data Module. If the initial NH respondent was unable to provide 

the interviewer with data on a sampled person’s Medicare and Medicaid coverage, these questions 

were re-asked of alternative NH respondents in an attempt to acquire complete information on 

Medicare and Medicaid coverage. 

IPC Institutional Population Component of the 1987 National Medical Expenditure Survey.

January 1st The cross-sectional sample of persons who were resident in the NH on January 1, 1996; 

residents also known as “current residents.”

JCAHO Joint Commission on Accreditation of Healthcare Organizations.

KAD Key admission date, the beginning of the episode of sampled nursing home care; the date of 

the first admission to the sampled facility, excluding readmission following an acute hospital stay.

KAD unit The unit within the sampled NH where the sampled person resided at the key admission date. 

Keyfitz A statistical method for improving the efficiency of sample selection.

procedure

Larger Some nursing homes are part of a larger organizational or physical structure, such as a continuing 

facility care retirement center or a hospital. In these cases, the larger structure (provided it is on the same 

campus as the NH) is referred to as the “larger facility.”

LPN Licensed practical nurse.

LTC Long-term care. An LTC place is defined as a place or distinct unit that provides a residence and 

some surveillance and has assistance available for persons no longer willing or able to live on their

own. This includes the following types of places: nursing home, SNF unit of a hospital or 

retirement center, residential care facility, assisted living facility, board and care home, domiciliary 

care home, personal care home, rest home, shelter care facility, community living facility, 

community residential alternative group home for the mentally disabled, group senior assisted 

housing for the elderly, group care home, adult group home, foster care home, VA home for adults, 

hospital for the mentally ill or mentally retarded. Long-term care places/units in the MEPS NHC 

are further classified as either “eligible LTC” (e.g., a nursing home) or “ineligible LTC” 

(e.g., a personal care unit). 

MD Missing data or Missing Data Module. If the initial NH respondent was unable to provide the 

interviewer with a key data item (e.g., sex, age, Medicaid insurance coverage, sources of payment), 

the question (i.e., the missing data item) was re-asked of alternative NH respondents in an attempt to
54

acquire complete information. The key items for which missing data activities were conducted are 

specified as part of the various CAPI questionnaires in the Missing Data Module section of each 

questionnaire. Not all questionnaires have a Missing Data Module. 

MDS Minimum data set.

MEPS Medical Expenditure Panel Survey.

NA Item not applicable due to a skip pattern, indicated in the public use database as a “ − 1”. 

NCHS National Center for Health Statistics.

NF 1. Medicaid certified nursing facility. 2. A new facility, an eligible nursing home (sampled or 

otherwise) into which a sampled person transferred during 1996; also known as a transfer facility. 

NH Nursing home, an eligible long-term care place, defined as a facility or distinct part of a facility 

certified by Medicare or Medicaid or licensed as a nursing home with three or more beds that 

provides onsite supervision by an RN or LPN 7 days a week, 24 hours a day.

NHC Nursing Home Component of the 1996 Medical Expenditure Panel Survey.

NHPI National Health Provider Inventory; an updated NHPI served as the sampling frame for the 

MEPS NHC. To assist in data collection, the sampling frame was preloaded onto each 

interviewer’s laptop computer and used to identify eligible LTC facilities.

NMCES 1977 National Medical Care Expenditure Survey.

NMES 1987 National Medical Expenditure Survey. 

NMES-2 Alternative name for the 1987 National Medical Expenditure Survey.

NMES-3 Name previously given to the 1996 Medical Expenditure Panel Survey.

NNHES National Nursing Home Expenditure Survey, name previously given to the 1996 Medical 

Expenditure Panel Survey Nursing Home Component.

NNHS National Nursing Home Survey, a periodic survey conducted by the National Center for 

Health Statistics.

NOK Next of kin of the sampled person, the typical respondent for the Community Questionnaire.

Non-nursing Beds that are not certified or licensed to provide residents the level of skilled 

beds nursing care, rehabilitation services, or other health-related services that is provided in 

nursing beds (i.e., beds in an INEL LTC unit).
55

Nursing Beds that are certified or licensed to provide residents the same level of skilled nursing care, 

beds rehabilitation services, or other health-related services that is provided in nursing beds 

(i.e., beds in an ELIG LTC unit).

Offsite Outside the premises of the nursing home or facility. 

Onsite On the premises of the nursing home or facility.

OTC Over-the-counter, medications available without a prescription.

PF First admission eligibility code used to identify a provisionally eligible first admission. All persons 

initially classified as PF were eventually classified as eligible or ineligible as additional data 

became available.

Place roster A listing of all places enumerated during data collection. The place roster is unique for each 

participating NH and lists all units within the NH and parts of the larger facility (if the NH is part 

of a larger facility), as well as hospitals, other LTC places, and community residences ascertained 

during facility-level and person-level data collection in a nursing home.

PM 1. Prescribed Medicines Questionnaire. 2. Used to denote the questions on prescribed medicines 

administered in the NH. 

PRN Standing order, administer as necessary.

QR Questionnaire respondent.

QxQ Question-by-question specifications; QxQ’s provide item-specific information to interviewers 

on the intent of question wording. In the MEPS NHC these were provided online as part of the 

CAPI questionnaires. 

R1 ( R2 and The first round (second round and third round) of data collection. 

R3)

RDY Ready for interviewing, a questionnaire disposition code.

Red Book A standard reference of the pharmacy industry that contains detailed information on all 

File medications sold in the United States.

REF 1. Final refusal, a questionnaire disposition code. 2. An item refused by a respondent, 

indicated in the public use database as a “ − 7”.

REF DATE Reference date. The reference date for the MEPS NHC is calendar year 1996. The reference 

date for a particular person, particular nursing home, or specific questionnaire or question item 

can vary depending on, among other things, the round of data collection, kind of information 

to be collected, when the sampled person was sampled, when data collection was initiated 

in the nursing home, and the current and past location(s) of a sampled person. Questionnaire 

reference dates can be a point in time or for periods of time. (See this report for details and the 

MEPS NHC questionnaires for complete reference date specifications.) 
56

Respondent A facility-level online directory that contains the names, title, and locating information of all

roster potential respondents and all actual respondents within an NH. Questions denoted “RR” indicate 

items about the questionnaire respondents. 

RF Refused; see REF. 

RH 1. Residence History Questionnaire. 2. Used to denote person-level questions on residence history. 

RN Registered nurse.

ROC Record of calls, used by the interviewers to document all contacts with the nursing homes and 

community respondents.

RR Respondent roster; see Respondent roster. 

RRB Railroad Retirement Board.

SAD Sampled admission date. For January 1st residents, the date of the most recent admission to the 

sampled facility prior to January 1, 1996. For persons sampled as first admissions, the date of the 

first admission to the sampled facility during the reference year (January 1 to December 31, 1996).

SAD unit The unit within the sampled NH where the sampled person resided at the sampled admission date. 

SAQ 1. Self-Administered Questionnaire; a SAQ, distributed to nursing home respondents during 

Rounds 1 and 3, collected facility-level staffing information. 2. Used to denote questions from 

the Self-Administered Questionnaires. 

SE First admission eligibility code assigned by the CAPI program to indicate that the sampled 

person was sampled by the interviewer in error.

SF Sampled facility, one of the sampled nursing homes. 

SHIFT/5 A CAPI function key used to indicate that the respondent “will never know” the information 

asked for. Denoted in the public use database as a “ − 5”.

SNF Medicare skilled nursing facility.

SOP Source of payment.

SP Sampled person.

SS Sampling section, used to denote the question items in the Facility Questionnaire on the 

sampling of persons within a sampled NH. 

SSA Social Security Administration.

SSDI Social Security Disability Income.
57

SSI Supplemental Security Income.

SSN Social Security Number.

T2 Time 2, the second assessment point for cross-sectional health status data. It is collected only 

when the sampled person was a resident of a nursing home at Time 2 point. For January 1st 

residents, Time 2 is measured at December 31, 1996; for admissions, it is measured at the key 

admission date plus 90 days.

TAD Transfer admission date, the date of admission to the eligible facility, either sampled or new, 

by a sampled person who transfers out of the originally sampled NH to another NH during the 

reference year (as reported by the transfer facility).

TAD unit The unit within the transfer facility where the sampled person resided at the time of 

admission to the transfer facility. 

TCVAD Closest valid assessment date for Time 2 health status data; see T2.

Tentative An interim disposition regarding the eligibility of a unit within the nursing home 

additions or within the larger facility (if the NH is part of a larger facility). All units are eventually 

classified into one of the four place type designators (e.g., eligible LTC, ineligible LTC). 

TIME 2 See T2. 

TR Transferred person, used to designate a sampled person within a new facility. These persons were 

discharged from their sampled nursing home during 1996 and were subsequently admitted to 

another NH (either a sampled NH or some other NH).

URI Upper respiratory infection.

US Used to denote questions from the Use of Health Care Services Questionnaire.

USE Use of Health Care Services Questionnaire.

VA Veterans Affairs (Department of).
U.S. Department of Health and Human Services

Public Health Service

Agency for Health Care Policy and Research

2101 East Jefferson Street, Suite 501

Rockville, MD 20852

AHCPR Pub. No. 98-0041

September 1998