FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS 

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE = Public Health Service I Number 35 = Satxe*ar 61978 

An	 Overview of Nursing Home Characteristics: Provisional 

Data from the 1977 National Nursing Home Survey’ “ 

This report presents provisional statistics on 

an estimated 18,300 nursing homes in the coterminous United States. The data are from the 

1977 National Nursing Home Survey (NNHS). 

This nationwide sample survey of nursing 

homes–their residents, their discharges, and 

their staff–was conducted by the NationaI 

Center for Health Statistics from May through 

December 1977. The survey is the second in an 

ongoing NNHS system. The first survey was conducted between August 1973 and April 1974. 

The estimates presented here are provisional, 

since they are based on a subsample of about 

340 of the 1,700 facilities in the national survey. 

Nursing homes included in the survey were 

those classified by the 1973 Master Facility Inventory (MFI) as nursing care homes, personal 

cm-e homes (with and without nursing), and 

domiciliary care homes as well as all nursing 

homes opened for business between the time the 

1973 MFI was conducted and December 1976.2 

This represents a broadening of the scope of 

coverage over that of the 1973-74 NNHS. The 

eadier survey excluded facilities providing only 

personal care or domiciliary care. Since the impact of including these facilities in the 1977 

NNHS is expected to be small (they comprised 

1This report was prepared by Mark R. Meiners, formerly with the Division of Health Resources Utilization 

Statistics. 

*]National Center for Health Statistics: Inpatient 

health facilities as reported from the 1973 MFI Survey, 

by A. Sirrocco. Vital and Health Statistics, Series 14N0. 

16. DHEW Pub. No. (HRA) 76-1811. Health Resources 

Administration. Washington. U.S. Government Printing 

Office, May 1976. 

only about 2 Dercent of all nursing homes in the 

1973 MFI anti housed only abou. 1 percent of 

the beds and residents), no speckd adjustments 

are made in this report when comparing data 

from the 1977 NNHS with the 1973-74 NNHS. 

Provisional estimates of the characteristics of 

residents and discharges are presented in Advance Data Number 29.3 

The focus of this report is facility characteristics with the estimates presented by type of 

ownership, certification status, facility bed size, 

and geographic region. Estimates of the number 

of facilities; beds, residents, full-time equivalent 

employees, and the average monthly charge are 

based on 1977 data and reflect the situation on 

any day during the survey period. Estimates of 

the annual occupancy rate, median duration of 

stay, admissims, discharges, resident days, and 

cost per resident day are for 1976. In most cases 

they reflect the calendar year, although for the 

latter two types of estimates fiscal year data 

were acceptable. 

The sampIe design for the 1977 NNHS was a 

stratified two-stage probability sample. The first 

stage was a selection of facilities and the second 

stage was a selection of residents, discharges, and 

staff from the sample facilities. Data on the 

characteristics of the facility were colIected by 

interviewing the administrator. Data on costs 

were obtained from the facility’s accountant, 

3 National Center for Health Statistics: A comparison 

of nursing home residents and discharges from the 1977 

National Home Survey: United States, by E. Hing and 

A. Zappolo, Advance Data from Vital and Health Statzktics, Number 29, DHEW Pub. No. (PHS) 78-1250. Public 

Health Service. Hyattsville, Md., May 17, 1978. 
.

.

� 

. “. . . 

,. . .: ,! ..- 2 dvancedata , 

who completed the questionnaire and returned 

it by mail. Data for a sample of residents on the 

factity’s roster at the time of the survey were 

colIected by interviewing the nurse most familiar 

with the care provided to the resident. When 

necessary, the nurse referred to the resident’s 

medical record. Data for a sample of discharges 

in 1976 were also collected by interviewing the 

nurse most familiar with the medical record of 

the discharged resident. Data on a sample of employees were collected by leaving a questionnaire for the sampled person to complete and to 

return by mail. 

Since all the estimates are based on a sample 

of nursing homes rather than on a complete 

enumeration, they are subject to sampling variability. Information on sampling variability is 

presented in the Technical Notes. 

FACILITY 

CHARACTERISTICS 

For the period May to December 1977, the 

provisional national estimates indicated some 

18,300 nursing homes had a total of 1,383,600 

beds and served 1,287,400 residents (table 1). 

Proprietary ownership continued to be 

dominant in the nursing home segment of the 

health care delivery system with an estimated 74 

percent of the facilities operated for profit. Although the nonprofit and Government nursing 

homes comprised only about 26 percent of the 

facilities, their greater capacity (average size 97 

beds compared to 68 beds for proprietary facilities) enabled them to serve as a partiaI offset to 

the difference .in the number of residents served. 

About 34 percent of all residents were served by 

Table 1. Provisional number and percent distribution of nursing homes, beds, and residents, by selectad nursing homa characteristics: 

United States, 1977 

Nursing homes Beds Residents 

Nursing home characteristics Percent Percent Percent 

Number Distribution Number ~istribution Number ~istribution 

e


1, 

All nursing homes ............... ............... .............. 

Ownership 

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

Nonprofit and Govern merit ....................................... 

Certification 

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

Skilled nursing and intermediate care facility ............. 

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

Not cemified .............................................................. 

Bed size 

Less than 50 bds ...................................................... 

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

100.199beds ............. .. ............... ............................... 

200 beds or mre ....................................................... 

Geographic region 

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

North Central ................................ ....... .......... ........... 

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

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

NOTE: Fgures may not add to totals due to rounding. 

18,300 100.0 1,383,600 100.0 1,287,400 100.0 

13,600 74.3 926,100 66.9 851,700 66.2 

4,700 25.7 457,600 33.1 435,700 33.8 

3,600 19.9 271,700 19.6 252,100 19.6 

3,900 21.1 484,300 35.0 462,200 35.9 

6,200 33.7 455,700 32.9 414,300 32.2 

4,600 25.3 171,900 12.4 158,800 12.3 

7,800 42.5 205,700 14.9 193,500 15.0 

5,200 28.5 376,600 27.2 353,000 27.4 

4,600 24.9 590,600 42.7 547,400 42.5 

* * 210,800 15.2 193,500 15.0 

4,300 23.4 302,100 21.8 274,600 21.3 

5,800 31.8 472,300 34.1 446,700 34.7 

4,200 22.9 404,000 29.2 377,800 29.3 

4,000 21.9 205,300 14.8 188,300 14.6 

* 

i 
acklcda3 

nursing homes operated under nonprofit or 

Government auspices. 

Nursing homes can also be classified according to their certification status. Facilities in the 

1977 NNHS were comprised of 

. Those certified as skilled nursing facilities (SNF’S) by Medicare (Title XVIII 

of the Social Security Act). 

. Those certified as SNF’S by Medicaid 

(Title XIX of the Social Security Act). 

� Those certified as intermediate care facilities (ICF’S) by Medicaid (Title XIX of 

the Social Security Act), and 

. Those not certified by either program. 

The SNF regulations were identical under 

Medicare and Medicaid and nursing homes could 

be certified under both these programs. Furthermore, nursing homes that were certified could 

be certified under both the SNF and ICF regulations. 

About 75 percent of the nursing homes in 

the 1977 NNHS were certi~ed either as SNF’S, 

ICF’S or both. The largest share of the certified 

facilities (45 percent) were certified only as 

ICF’S. Facilities certified as both an SNF and an 

ICF were larger (124 beds per facility) than the 

other facilities. They comprised about 21 percent of all the nursing homes but housed about 

35 percent of the beds and 36 percent of the 

residents. Nursing homes which were not certified by Medicare or Medicaid were generally 

small, averaging about 37 beds per facility. 

These facilities comprised about 25 percent of all 

nursing homes but housed only about 12 percent of the beds and residents. 

The distribution of facilities, beds, and residents by bed size and geographic region is also 

presented in table 1. 

Employees 

The employee data in this. report are presented in terms of fulhtime equivalent (FTE) employees. Thirty-five hours of part-time employees’ work are conventionally taken as 

equivalent to one full-time employee. Part-time 

employees were converted to FTE employees by 

dividing the number of hours worked by 35. By 

using the number of FTE employees rather than 

total employees, the variation between facilities 

in the proportion of part-time staff is held constant. The procedures used to estimate the number of FTE employees differed slightly from 

those used in the previous NNHS in that the 

1977 estimates are based on a sample of employees from each sample facility while the 

1973-74 estimates are based on all staff in each 

sample facility. Although the effect on the estimate is not expected to be great, this caveat of 

the data should be recognized. 

The employee survey covered individuals 

employed full-time, part-time, or under contract who provided direct or health-related services to nursing home residents. This group 

consists of nursing, administrative, medical, and 

therapeutic personnel. Clerical, food service, 

housekeeping, and maintenance personnel as 

well as any other empIoyee not performing nursing, ad m inktrative, medical or therapeutic 

functions were not surveyed. 

In 1977 there were an estimated 624,600 

FT E employees providing direct or health 

related services to nursing home residents (table 

2). This was about 45 employees per 100 beds. 

The majority of this group (66 percent) were 

empIoyed as nurses’ aides. An additional 13 percent were licensed practicaI nurses; 11 percent 

were administrative, medical, or therapeutic personnel; and 10 percent were registered nurses. 

Differences in staffing patterns are most 

noticeable on the basis of certification status. 

Nursing homes certified by Medicare or hfedicaid to provide skiIIed nursing care had significantly more employees per 100 beds than the 

other types of facilities. The SNF-only group 

had about 59 FTE employees per 100 beds to 

provide health-related services and the SNF and 

ICF group had about 48 FTE employees per 100 

beds. In contrast, nursing homes certified only 

as ICF’S had about 38 employees per 100 beds 

and the nursing homes not certified had about 

35 employees per 100 beds. 

Utilization 

The most important single measure of nursing home utilization from the standpoint of nursing home administrators is probably the occupancy rate. In 1976 the Nation’s nursing homes 

used about 90 percent of their available bed 
-----

4 ackncedata 

capacity to provide an estimated 440,195,000 vance Data Number 29 for more detailed estidays of care (table 3). Although this does not mates of the characteristics of discharges.) o 

represent a statistically significant change from Caution is recommended when comparing ~ 

the 87 percent occupancy rate of 1972, the estimates of admission with estimates of disnumber of days of care provided during 1976 charges from the 1977 NNHS, since the proceincreased by about 19 percent. Also during 1976 dures for collecting these statistics differed. The 

an estimated 1,112,000 residents (81 per 100 numb er of admissions in 1976 was determined 

beds) were admitted for care and 973,000 (71 by directly asking the administrator for this inper 100 beds) were discharged. Most of these formation. Estimates of the number of dispeople (74 percent) were discharged alive to charges and their characteristics were made from 

either a private or semiprivate residence or, more a sampIe of the patients formaIly discharged 

commonly, to another health facility. (See Ad- from the nursing home during 1976. The survey 

Table 2. Provisional number and rate per 100 beds of nursing home full-time equivalent (FTE) employees, by occupational categories and 

selected nursing home characteristics: United States, 1977 

Occupational category of employee 

. 1 

Nursing home employeesl Administrative, 

characteristics medical, and 

therapeutic Tota I Nurses’ aide 

v 

Alll-lt Nursing 

Number Rate dumber Rate Number Rate Number Rate 

. -----Hl--t-- All employees ................ 624,600 I 45.1 ] I 68,400 I 4.9 556,200 40.2 60,700 4.4 82,700 6.0 412,800 

— 

. 

Ownership 

Proprietary ....................... ..... 395,700 42.7 39,100 4.2 356,600 38.5 34,300 3.7 54,600 5.9 267,700 28.9 

Nonprofit and Government ... 228,900 50.0 29,300 6.4 199,600 43.6 26,400 5.8 28,200 6.2 145,100 31.7 

Certification 

Skilled nursing facility .... . .. .. .. 158,900 58.5 17,000 6.3 141$00 52.2 21,000 7.7 19,600 7.2 101,300 37.3 

Skilled nursing and intermediate care facility .. . ... .. .. .. 233,900 48.3 21,500 4.4 212,300 43.8 25,200 5.2 28,800 5.9 158,400 32.7 

Intermediate care facility .. .... . 172,600 37.9 20,600 4.5 152,000 33.4 9,700 2.1 26,700 5.9 115,600 25.4 

Not certified . ... .. .... . ... .. .... .. .... 59,300 34.5 ~ 9,300 5.4 50,000 29.1 4,800 2.8 7,600 4.4 37,600 21.9 

Bed size 

Less than 50 beds .... .... .. .. ... ... 103,100 50.1 18,200 8.9 64,800 41.3 9,400 4.6 14,200 6.9 61,200 29.7 

50-99 beds .. .... .. .... .. .. ..... .. .. .... 173,000 45.9 17,200 4.6 155,800 41.2 15,300 4.1 21,400 5.7 119,000 31.6 

100-199 beds .. .. .. .. .. .. .. ..... ... .. . 262,800 44.5 24,200 4.1 238,600 40.4 25,400 4.3 36,500 6.2 176,700 29.9 

200 or more beds ... .. .. .. .. .... .. .. 85,700 40.7 8,800 * 77,000 36.5 10,500 5.0 10,500 5.0 55,900 26.5 

Geographic region 

Northeast ............................... 153,300 50.7 17,800 5.9 I 35,500 44.8 21,800 7.2 20,800 6.9 92,900 30.7 

North Central ........ ...... .......... 220,300 46.6 24,300 5.1 196,000 41.5 19,100 4.0 24,200 5.1 152,700 32.3 

South ... .... ...... .. ........ .......... .... 159,600 39.5 15,100 3.7 144,600 35.8 9,200 2.3 27,100 6.7 108,200 26.8 

West ........................................ 91,400 44.5 11,300 5.5 80,200 39.1 10,500 5.1 10,500 5.1 59,100 28.8 

135 hours of pafi.time employees$ work is considered equivalent to one full-time emuloyde. part-time eMIIbYWs W?Je converted to 

full-time equivalent employeesb y dividing the number of hours worked per week by 35. 

p~ncludes only emPloYees pro~dtig direct health-related services to residents. 

NOTE: Figures may not add to totals due to rounding. 
� 

ackwecw5 

@ of discharges represents an addition to the earIier 

NNHS design and provides the information 

necessary to determine the duration of a completed nursing home stay. For those dkcharged 

in 1976, the medkn duration of stay was 84 

days or 12 weeks. 

Nursing home utilization patterns are particularly influenced by certification status. The 

regulations distinguishing SNF care and ICF care 

followed different models. SNF care is oriented 

to rehabilitation (the medical model adapted to 

a less intensive need for services than is present 

in hospitals). ICF care is oriented to maintenance (the health care related service model 

with emphasis on personal rather than medicaI 

care). 

The effect of this difference on duration of 

stay and patient turnover rates is significant. 

Nursing homes certified only as SNF’S had a substantially shorter median duration of stay (39 

days) than did nursing homes certified onIy as 

ICF’S (181 days). In addition, nursing homes 

certified only as SNF’S had 133 admissions and 

about 116 discharges per 100 beds, while nursing homes certified only as ICF’S had about 59 

admissions and 54 discharges per 100 beds. 

Table 3. Selected provisional measures of nursing home utilization, by selected nursing home characteristics: United States, 1976 

Discharges 

Admissions 

Median Total Live 

Resident Annual Iuration 

Nursing home characteristics days in :cupancy f stay ir Rate Rate Rate 

thousands ratel days Number 

per Number per Wrmber ercent 

in 100 in 100 in l% of 

housands beds thousands bed: Iousands ~ds total 

I 

Total .... ........ .............................. 440,195 89.6 84 1,112 81.4 973 71.2 722 52.9 74.2 

@ 

Ownership 

+ 

Proprietary .............. .... ...... ............... 293,071 90.2 89 778 85.2 666 75.1 508 55.7 74.1 

Nonprofit and Government .............. 147,124 88.6 65 334 73.7 287 63.4 214 47.3 74.6 

Certification 

Skilled nursing facility .. .. .. .. .. . .... . .. .. . 87,419 91.3 39 357 133.0 310 115.7 247 92.2 79.8 

Skilled nursing and intermediate care facility . .. .. .... . . .... .. .. ... . 158,452 90.1 83 400 83.2 335 69.7 237 49.3 70.7 

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

Not certified ... .... .. .. .... . . .... ... ... ... .. .. .. 

138,541 

55,783 

88.1 

89.7 

181 

94 

260* 58.5* 240 

� 

53.8 

51.5 

173 

* 38.7 

* 

72.1 * 

Bed size 

Less than 50 beds ......... .................... 65,194 90.5 65 140 68.1 134 65.2 

50-99 beds ...................................... . 127,146 93.6 73 263 76.1 252 67.7 17; 48.; 71.; 

100-199 beds ... .. .. ... ... .. .. .. .. .. .. . ... .. .. .. 181,411 86.8 72 532 92.2 449 77.9 333 57.8 74.2 

200 beds or more .. .. .. .. .. .. .. ... .. . ... . . ... . 66,443 89.6 188 157 74.4 137 65.0 * * * 

Geographic region 

Northeast .. .. . ... .. .. .... . .... . . ... .. . .. .... ... .. . 99272 88.6 86 237 78.5 204 67.7 145 47.9 70.7 

North Central ......... ........ .................. 152,361 91.9 116 313 66.9 271 68.0 193 41.2 71.1 

South .. .................. ...... ............ ......... 121,956 87.8 96 280 74.2 252 64.4 172 44.1 68.5 

Wew ... .. .. .. .. .... .. .... .. .... .. .... .. .. .. .. .... .. .. 65,906 89.5 43 272 132.6 246 119.7 213 103.6 86.5 

1~ ~gregate number of days of care provided to residents in 1976 x 100 

Z Estimated number of beds in 1976 x 366 

NOTE F~ures may not add to totals due to rounding. 
6 acimncedata 

Cost of Providing Care 

In 1976 the Nation’s nursing homes spent an 

estimated $10.6 billion providing services to 

their residents. This amounted to a cost per resident day of $24.04, the majority (59 percent) of 

which went for labor costs (figure 1). Operating, 

fixed, and miscekmeous costs accounted for an 

additional 22 percent, 15 percent, and 5 percent 

of the total, respectively. A1though the total 

cost per resident day for all nursing homes was 

$24.04, only about 30 percent of the facilities 

had an average cost of $25.00 or more (figure 2). 

Another 32 percent of the facilities had an average cost of less than $15.00 per resident day. 

The procedures for collecting the cost data 

in the 1977 NNHS differed somewhat from 

those used in the 1973-74 NNHS. In the earlier 

survey the Expense Questionnaire was only 

given to those facilities in business for 2 years 

or more; in the current survey all facilities 

received the Expense Questionnaire. The effect 

of this change on the cost per resident day estimates is minimal, however, since the 1976 total 

Figure2. PROVISIONAL PERCENT DISTRIBUTION OF NURSING 

HOMES BY TOTAL COST PER RESIDENT DAY: UNITED 

STATES, 1976. 

I 

~E ~-T--~llllll~ I -. ~ ~ Xy .$$.>~~ . . . . . . 

Lessthan ~$15.se S20.oo - S30.00 or 

$15.00 $19.e9 S24.S9 $2%99 .0. 

TOTAL COST PER RESIDENT DAY 

cost per resident day for nursing homes in busi- ing this period the average cost to nursing homes 

ness 2 years or more was $23.86. Therefore of providing care increased 45-46 percent, a rate 

there is little problem with direct comparisons ex~eeding he general inflation rite of 36 perbetween the estimates for 1972 and 1976. Dur- cent indicated by the U.S. Bureau of Labor 

Figure 1. PROVISIONAL AMOUNT AND PERCENT DISTRIBUTION 

OF TOTAL COSTS PER RESIDENT DAY TO NURSING 

HOMES BY MAJOR COMPONENTS: UNITED STATES, 1976. 

MISCELLANEOUS COSTS 

Total costsper residentday to nursinghomez $24.04 

Statistics’ Consumer Price Index. However, it is 

in line with the 46-percent increase in the hospital service charges component of that index. 

The basic patterns of variability in average total 

cost by ownership, certification, size, and region 

found in the previous NNHS are substantiated 

by the 1976 data. Total cost per resident day 

tends to be highest in nonprofit and Government 

facilities, in facilities certified only as SNF’S, in 

facilities with 200 beds or more, and in facilities 

located in the Northeast (table 4). 

Presented along with the cost data in table 4 

is some information, not collected in the previous NNHS, concerning the distribution of resident days of care among the alternative certificat ion programs. These data highlight the 

substantial involvement of the Medicaid program 

in the financing of nursing home care. About 60 

percent of all the days of care provided in 1976 

were financed either totally or partially by the 

Medicaid program (22.5 per~ent under the SNF 

regulations and 37.2 percent under the ICF regulations). These data, along with the national 
� 

� 

dmncdcw7 

o Table 4. Provisional total cost per resident day to nursing homes, number, and percent distribution of resident days by type of 

certification, according to selected nursing home characteristics: United States, 1976 

Resident days by type of certification 

Total Resident Medicaid 

Nursing home characteristics cost per 

esident day 

days in 

:housends Total 

Skilled nursing facility intermediate 

Not 

certified 

care Medicare Medicaid facility 

All nursing homes .................. ................... $24.04 440,195 100.0 2.4 22.5 37.2 38.0 

Ownership 

* Proprie@ry ... .......................... ......................... 22.32 293,071 100.0 23.5 37.8 37.0 

* Nonprofit and Government ................ ............. 27.52 147,124 100.0 20.5 36.0 39.8 

Certification 

Skilled ,nursing facility .... . .. .. .. . . ... . .. .... . .. ... .. . .... 33.80 87,419 100.0 * 56.7 . . . 38.9 

Skilled nursing and intermediate care facility.. 25.75 158,452 100.0 * 32.7 36.7 26.5 

Intermediate care facility ... .. .. .. ... . .. .. .. .. .. .. .. .... . 19.44 138,541 100.0 . . . . . . 72.1 27.9 

Not certified ... .. .. .. .. .. . .... . .. ... . .. ... . .. .... .. .. .. .. .. .. .. 15.59 55,783 100.0 . . . . . . . . . 100.0 

Bed size 

Less than 50 beds .... .. .............. .... ............ ........ 21.58 65,194 100.0 * * 34.0 52.4 

50-99 beds ........ .................................. ............ 22.18 127,146 100.0 * 16.0 40.5 42.1 * 100-199 beds .......... .............. ...... .................... 23.64 181,411 100.0 26.0 36.3 35.5 

200 beds or more ............................................ 31.08 66,443 100.0 * 35.0 36.3 * 

GeoaraDhic reoion 

Northeast .... .. . .. .. .. .. .. .. .. .... .. .... .. .. .. .. .. . ... .. .. .. .... . 36.17 99,972 100.0 * 31.4 30.4 33.1 

North Central .. .. .. .. .... .. .... .. . ... .. . ... . ... .. . . .. .. .. .. .... 19.30 152,361 100.0 16.4 41.2 40.8 

South ... .. . ..... .. .... .. .. ... .. . .... .. ... . ..... . .. .... ... . .. .. ..... 19.37 121,956 100.0 * * 49.3 35.0 

West .... .. .. .... . . .. .. .. .. .. .. . . .... .. . ... . .. .. . .... .. .. .. .. .. .. .... 25.68 65,906 100.0 * 37.3 * 44.2 

NOTE: Fgures may not add to totals due to rounding. 

health expenditure estimates from the Social 

Security Administration, indicate that in 1976 

the Medicaid program spent approximately 

$20.41 per resident day on nursing home care 

while the Medicare program spent approximately $28.87.4 Although the resident days of 

care not financed by either Medicaid or Medicare are in the minority, they do represent a 

substantial proportion (38 percent) of all days. 

At least a fourth of all the days of care 

provided in the certified nursing homes were not 

financed by Medicaid or Medicare. For facilities 

4Gibson, R. M. and Mueller, M. S.: National Health 

Expenditures, Fiscal Year 1976. Social Securr-tyBulletin, 

HEW Pub. No. (SSA) 77-11700. APril 1977. ., 

. 

certified only as SNF’S the proportion was about 

39 percent. 

Charges for care 

Facility-related information concerning the 

charges made to residents for their care is presented in table 5. In 1977 the average total 

monthly charge was estimated to be $669. 

About 11 percent of the residents had monthly 

charges of less than $400 and about 25 percent 

were cl-uwged $800 or more per month. One of 

the most noticeable differences in these data is 

that the average charge to residents in nonprofit 

and Government nursing homes ($7 22) appears 

to be higher than the average charge to residents 
� 

8


in proprietary nursing homes ($641). Although nment group has widened and the decreasing im0 

the provisional standard errors of these estimates pact of donations and subsidies has necessitated 

are such that the difference is not statistically more reliance on user charges by nonprofit and 

significant, the data do imply a different rela- Government nursing homes. The data on charges 

tionship than was found in the 1973-74 NNHS. also show that it continues to be substantiality 

In the earlier survey, residents in proprietary more costly for residents using nursing homes in 

facilities had higher monthly charges, on the the Northeast than in any other area of the 

average, than those in the nonprofit and Gover- country. The average monthly charge for resinment facilities. The change is likely to be related dents in Northeastern nursing homes was $864 

to the fact that the disparity in costs between compared to an average of $614 to $643 in the 

the profit group and the nonprofit and Gover- other regions. 

Table 5. Provisional average total monthly charges for care in nursing homes, number of residents, and percent distribution of 

residents bv monthlv.-chame intervals, according to selected nursing homa characteristics: United States, 1977 

Monthly charges Average Nu#fber Nursing home characteristics total Total ~~~~;g~or $().$399 

chargel residents 

Percent distribution of resdients 

All residents ................ .............. $668 1,287,400 100.0 3.1 11.2 31.4 29.5 24.7 

Ownership 

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

+!= *

+ 

641 851,700 100.0 11.5 34.4 31.2 20.4

Nonprofit * and Government ............. . 722 435,700 100.0 10.5 25.7 26.2 33.3 

Certification 

Skilled nursing facility ... ...... .. .... .. . . .. 852 252,100 100.0 * * 14.0 31.0 46.6 

Skilled nursing and intermediate care facility .. .. .. ..... . .. ... .. . 752 462~00 100.0 � * 21.7 39.0 32.9 

Intermediate care facility ... .... . ... .... .. 565 414300 100.0 � 8.6 55.2 24.5 9.2 

Not certified .. .. .... .... .. .. .... .. .. .. ... .. .... . 409 168J300 100.0 � 44.3 25.5 12.8 * 

Bed size 

Less than 50 beds .. .. .... .. .. .... .. .. .. .. .. .. . 593 193,500 100.0 � 30.5 23.7 22.4 21.5 

,50-89 beds ... .. .. . ..... . ... .. .. .. .. ... . .. ... . .... 628 353Jxrfl 100.0 � 9.9 39.8 31.4 15.9 

100-199 beds .......... ......................... 689 547,400 100.0 � 6.8 31.5 31.2 27.7 

200 beds or more ................. .. ......... 764 193,500 100.0 � * 23.8 28.7 35.5 

Geographic region 

NortheaH ... .. .. .. .... .. .. ... . .. .... .. .. .. .. .. .. .. 

North Central ... .. .. .. .. .. .. .. .. .... .. .. ... . .. .. 

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

Weti ... .. .. .. .... .. .. .. .... .. .. .... .. .. .... .. .. .... .. m � 

� 

� 

� 

* 

13.6 

* 

19.1 

14.1 

35.8 

47.3 

14.5 

20.3 

31.0 

25.4 

47.8 

56.3 

18.6 

14.1 

++ 

lInclude~ ~ie.care ~esident5 and no-charge residents but excludes the residentsfor whomthe chargewas‘Ot ‘nom. 

NOTE: Fgures may not add to totals due to rounding. 
dmcedaa9 

TECHNICAL NOTES 

Since the statistics presented in this report 

are based on a sample, they will differ somewhat 

from figures that would have been obtained if a 

complete census had been taken using the same 

schedules, instructions, and procedures. me 

standard error is primarily a measure of the variability that occurs by chance because only a 

sample, rather than the entire universe, .is surveyed. The standard error ‘iilso reflects part of 

the measurement error, but it does not measure 

any systematic biases in the data. The chances 

are about 95 out of 100 that an estimate from 

the sample differs from the value which would 

be obtained from a complete census by Iess than 

twice the standard error. 

Rather than present specific errors for a 

particular statistic, the provisional approximate 

relative standard errors and standard errors for a 

wide variety of estimates have been provided. 

Provisional estimates of relative standard errors 

for the estimated numbers of admissions, beds, 

residents, discharges, total FTE employees, administrative, medical, and therapeutic FTE employees, RN FTE employees, LPN FTE employees, nurses’ aide FTE employees, and facilities are presented in figure I. Provisional relative 

standard errors for resident days axe presented in 

figure II, provisional standard errors for average 

cost per resident day are presented in table I, and 

provisionaI standard errors for average monthly 

charges are presented in table II. 

The relative standard error of an estimate is 

the standard error of the estimate divided by the 

estimate itself and is expressed as a percentage 

of the estimate. III this report, an asterisk is 

shown for any estimate with more than a 25-

percent relative standard error. Because of the 

relationship between the relative standard error 

and the estimate, the standard error of an estimate can be found by multiplying the estimate 

by its relative standard error. For exampIe, curve 

B of figure I shows the relative standard error 

for beds. Table 1 gives the total number of beds 

in all facilities with less than 50 beds as 205,700. 

Figure 1.PROVISIONAL RELATIVE STANDARD ERRORS FOR ESTIMATEDNUMBERS OF ADMISSIONS, 

BEDS, RESIDENTS, DISCHARGES, FULL-JIME EQUIVALENT (17E) EMPLOYEES, AND FACILITIES 

I I I I I I I I w I I I 11111 40 

30 

20 

z I I I I I I I I 1 T d:’ I I I I I I I I 6 56 . s z= 

<4 I I I I 11111 Y I I I I 1111 4 

3 

2 

,5 

Curve A Admission-. A 

Curvm B: Bwk 

.3 Curve C Residents:and disdwiws 

la cu we D Total FTE: employ= ard nurses’ aide FTE employees 

Curve E: Administrative, mdical and therapeutic FTE .2 cmplowes; registered nurse FTE empby~ ad r- 2 H practical nurse FTE employ=

I 

Curve F: Facilities 

.1 J 1111 I I I I I I Ill

456789 

A“’’s’”’A” A 2 3 4= ’’*’A ‘ 34’’7” A
 1,000 10,COO loo,eoe l,wo,mm 10,COI,OW


SIZE OF ESTIMATE 
10 achancedata 

Table 1. Provisional standard errors of percentages for average cost per resident day 

o I 

Average cost per resident day 

Resident days (base of ratio) 

$8.00 I $12.00 I $16.00 I $20.00 I $30.00 I $40.00 

Standard error in dollars ~ 

50.000.000 .. .. .. .. .. . . ...... . ... .. .. .. .... .. .. .... .. .. ‘0.59 *1.11 1.35 1.79 2.20 2.62 2.84 3.38 

60.000.000 ... .. .. .... .. .. .... .. .. .... .. . ... .. .. .... ... ‘0.54 *1.01 1.23 1,62 1.99 2.36 2.55 3.04 

70.000.000 .... .. .. .. .. .. .. .... .. . ..... .. .. .. .. .. .... .. *0.50 0.93 1.14 1.49 1.82 2.16 2.33 2.77 

80.000.000 ... .... .. .. .. .. .... ... . .. ... . .. . ... .. .. .. .. . ‘0.46 0.87 1.06 1.38 1.68 1.99 2.15 2.55 

90.000.000 .. .. . ... .. .. .... .. . ..... .. .. .. .. .. .. ... . .... *0.44 0.82 0.99 1.29 1.57 1.85 1,99 2.37 

100,000,000 .. .. .. .. .. . ..... .... .. .. .. .... .. . ... .. .. .. *0.42 0.78 0!94 1.21 1.47 1.73 1.86 2.20 

2oo.ooo.ooo .. .. .. .. .. . . .. .... .. .. .. .. .. .... .. .. ... .. . *0.30 0.54 0.64 0.78 0.91 1.02 1.09 1.25 

3oo.ooo8000 ..... . .. .... .. .. .... .. .. .. .. .. .. .. .. ...... 0.25 0.44 0.51 0.58 0.62 0.64 0.64 0.69 

350.000.000 .... .. .. .. .... .. .. .. ... . .... .. . . ... . .. .... 0.23 0.41 0.47 0.52 0.52 0.46 0.45 *0.46 

1 1 

The relative standard error corresponding to this Table II. Provisional standard errors of average monthly charges 

estimate on curve B of figure I is approximately 

14.0 percent. The standard error is 205,700 Number of Average monthly charge 

(.14) = 28,798. residents or 

discharges 

full-time equivalent employees per 100 beds can 

be calculated as in the following example: Standard error in dollars 

Suppose the standard error (OR,) for the ratio of 90,000 .. .. .. .. .... . 84 100 116 131 147 162 178 

Approximate standard error of ratios such as (base of ratio) $400 $500 $600 $700 

total FTE employees per 100 beds is desired for 100,000 ........... 80 95 110 124 139 154 168 

nursing homes with less than 50 beds. In table 2 400,000 

200,000 .

..

..

..

..

..

.

.

.

.

.

.

.

.

.. 

. 

56 67 77 88 98 109 119 �

40 47 55 62 69 76 84 the total FTE employees per 100 beds for 600,000 ........... 32 38 44 50 56 62 68 

800,000 ........... 28 33 38 43 49 54 59 

1,000,000 ........ 25 30 34 39 43 48 52 

1,200,000 ... ..... 23 27 35 39 43 48 

Fi9UraIl. PROVISIONAL RELATIVE STANOARD ERRORS FOR — — 3 — — 

ESTIMATEO NUMBER OF RESIOENT DAYS 

103%5I q 

homes with Iess than 50 beds is 50.1 which is 

equal to a total of 103,100 FTE employees divided by 205,700 beds times 100. The relative 

standard error of 103,100 total FTE employees 

is (from figure I, curve D) approximately 8.7 

percent, and the reIative standard error of 

205,700 beds (from figure I, curve B) i? approximately 14.0 percent. The square root 6f the sum 

of the squares of these two relative standard 

errors minus their covariance provides an 

approximation for the relative standard error of 

4 +H+HtH+ the ratio. In other words, if V’xr is the relative .3


2 standard error of number of total FTE em­


ployees, VYt is the relative standard error of .1- number of beds, r is the sample correlation coefficient between totaI FTE employees and beds SIZE OF ESTIMATE IN MILLIONS (conservatively estimated to be 0.5) and ~R J is 
---

--

aklceda 11 

9 the relative standard error of the ratio R’=X’/ Y’: 

vR#2=v~#2’+vy r2-2rv~J Vyr 

=(.087)2 + (.140)2 -1.00 (.087X .140) 

=.0076 + .0196 - .0122= .0150 

VR8 =-=.1225 

The approximate standard error of the ratio 

of total FTE employees per 100 beds may now 

be obtained by multiplying the relative standard 

error by the ratio as done below: 

(J~.=R’ X V~r = 50.1 X .1225= 6.14 

The sample correlation coefficient (7) for 

calculating the standard error estimates of the 

ratios presented in this report is assumed to be 

zero except in the case of full-time equivalent 

employees per 100 beds, occupancy rate, and 

cost per resident day ratio estimates where the 

correlation coefficient used was .5. 

The Z-test with a 0.05 IeveI of significance 

was used to test alI comparisons mentioned in 

this report. Since all observed differences were 

not tested, lack of comment in the text does not 

mean that the difference was not statistically 

significant. 

SYMBOLS 

Data not available-––--—-––——–——----

Category not applicable–--—-–-–--–-—---—-- . . . 

Quantity zero-—--— ———_— —-

Quantity more than O but less than 0.05--— 0.0 

Figure does not meet standards of 

* reliability or precision-—- _-- —-

Recent Issues of Advance Data From Vital and Health Statistics 

No. 34.	 Office Vkits to C)tolaryngologists, National 

Ambulatory Medicd Care Survey: United 

States, 1975-76 (Issued August 18, 1978) 

No. 33.	 Office Vkits to Orthopedic Surgeons, National 

Ambulatory Me&lcsd Care Survey: United 

States, 1975-76 (Issued: July 18, 1978) 

No. 32.	 SociodemograpM]c and Health Characteristics 

of Persons by Private Health Insurance CoverA complete list of Advance Data From Vital and Health 

Information Branch. 

age and Type of Plan, United States, 1975 

(Issued August 22, 1978) 

No. 31.	 Office Vkits to Ophthalmologists: National 

Ambulatory Medical Care Survey, United 

States, 1976 (Issued: July 14, 1978) 

No. 30.1976 Summary: Nationaf Ambulatory Medical 

Care Survey, United States (Issued: July 13, 

1978) 

Statistics is available from the Scientific and Technical 

.