From Vital and Health Stat[stlcs of the Nattonal Center for Health Stat[stlcs Number 91 � August 11, 1983 

* 

PROPE~ OF flF “ 

PUBL!CATION5WMKh 

EDITORIAL LIBRARY 

An Overview of the 1980 National Master Facility 

Inventory Survey of Nursing and Related Care Homes 

e 

% 

by Al Sirrocco, Division of 

Introduction 

In this report the 1980 National Master Facility Inventory 

Survey of nursing and related care homes is described. Statistics 

are presented on the numbers of homes, beds, residents, and 

employees, along with occupancy and turnover rates. These 

.:,ariables are categorized @Suchcharacteristics as ownership a 

+UPS, bed size groups, and geographic regions. Additional 

pies covered in this report include survey procedures, problems encountered, editing procedures, and qualifications of 

the data. 

The National Center for Health Statistics (NCHS) first 

conducted the National Master Facility Inventory (NMFI) 

Survey in 1963 and continued in 1967, 1969, 1971, 1973, 

1976, and 1978. Prior to 1978, the inventow included hospitals, nursing and related care homes, and other types of inpatient health facilities including, for example, homes for the 

blind, deaf, mentally retarded, and emotionally disturbed,l The 

1978 and 1980 NMFI surveys have data on only nursing and 

related care homes. Data for hospitals are now obtained directly from the American Hospital Association (AHA). For 

convenience, this report will use the terms “nursing and related 

care homes” and “nursing homes” interchangeably. 

The NCHS definition of “nursing homes” has remained 

the same over the years of the NMFI surveys. The definition 

states basically that a home must maintain three or more inpatient beds, and, at a minimum, it must provide one or more 

personal care services (such as help with eating, walking, correspondence, shopping, dressing, bathing, or massage). 

While this definition has remained constant, the coverage 

of the NMFI has not. Due to changes in collection coverage 

tional Center for Health Statistics, G. Straharr: Inpatient health facilities 

rth 

,.sties, United States, 1978. Viral and Health Statistics. Series 14-No. 24. 

HHS Pub. No. (PHS) 81-1819. Office of Health Research, Statistics, and 

Technology. Washington. U.S. Government Printing Otlice, Mar. 1981. 

Health Care Statistics 

starting in 1976 (see Technical notes), certain types of facilities have been added and others deleted. The most notable 

change in coverage for 1980 involved the addition of more 

than 2,500 adult foster care homes in Michigan and 1,000 

new] y added residential community care facilities in California. 

These homes may or may not have been in existence in prior 

years, but were only recently identified as meeting the minimum 

definitional requirements of NCHS for inclusion in the NMFI. 

One other notable change occurred in the 1980 coverage. 

All identifiable hospital-based nursing homes and extended 

care facilities were excluded from the survey. Previous NMFI 

surveys included many of these; however, the inability to obtain data on all such facilities from all States resulted in the 

decision to drop them from the survey and use the AHA figures for these facilities. 

Therefore, any comparisons made between the 1980 

NMFI and prior NMFI’s must be done with extreme caution. 

It is recommended that if comparisons are attempted they 

should be performed using only the larger homes (25 beds or 

more) because most of the additions, deletions, and definitional 

changes that occurred between NMFI surveys were in the 

smaller homes. In addition, the hospital-based nursing homes 

should be removed from the earlier counts when comparing 

those surveys with the 1980 Survey. 

Discussion 

Facility characteristics 

In 1980 the NMFI identified 23,065 nursing homes in 

the United States. At the time of the survey there were 

1,537,338 beds and 1,396,132 residents in these facilities. 

Included in these figures were 2,524 adult foster care homes 

(AFCH’S) in Michigan that had never been included as part 

of the NMFI. These facilities had 18,824 beds and 15,709 

residents. Excluded from the 1980 NMFI were hospital-based 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service 
2 

Table A, Number and percent distribution of nursing and related 

care homes and beds by bed size, type of ownership, end 

geographic region: Unitad Statas, 1980 

Homes Beds 

Characteristic Percent Percent 

Plumber distri- Number distribution butlon 

All homes . . . . . . . . . . . 23,065 100.0 1,537,338 100.0 

Bed size 

3–9 beds, . . . . . . . . . . 5,492 23.8 29,238 1.9 

10-24 beds . . . . . . . . . 3,006 13,0 47,965 3.1 

25-49 beds ...,..... 3,030 13.1 112,093 7.3 

50-74 beds . . . . . . . . . 3,332 14,4 199,673 13,0 

75-99 beds. .,....., 2,375 10.3 208,995 13.6 

100-199 beds, . . . . . . 4,737 20.5 617,165 40,1 

200-299 beds, 766 3.3 177,581 11,6 

300-499 beds. . . . . 250 1.1 90,584 5.9 

500 beds or more ., 77 0.3 54,044 3.5 

Type of ownership 

Government . . . . ., 936 4,1 126,907 8.3 

Proprietary ., ...,,... 18,669 80,9 1,072,243 69.7 

Nonprofit, . . . . . . . . . . 3,460 15.0 338,188 22.0 

Geographic region 

Northeast ., . . . . . . . . . 3,762 16.3 322,530 21.0 

North Central . . . 8,252 35.8 521,661 33.9 

South . . . . . . . . . . . . . . 5,306 23.0 420,762 27.4 

West . . . . . . . . . . . . . . . 5,745 24.9 272,385 17.7 

nursing homes and extended care facilities, which, according 

to AHA, numbered 1,056 facilities and 76,024 beds in 1980.2 

Half of all nursing homes had less than 50 beds (table 

A). Although the largest group (5,492) had less than 10 beds, 

the next largest group (4,737) had between 100 and 199 beds. 

By contrast, only 1,093 nursing homes had more than 199 

beds. Over 40 percent of all nursing home beds are in homes 

having 100 to 199 beds. 

As expected, the vast majority of nursing homes were operated for profit. Approximately 81 percent of the homes and 

70 percent of the beds were proprietary. The average govemment-operated home, however, was nearly 2H times bigger 

than the average for-profit home (table B). Even when Michigan AFCH’S were excluded, the government-operated homes 

were still more than twice the size of the propriety homes. 

The nonprofit homes, with about a 98-bed average, were halfway between the two other ownership groups. 

The North Central Region had by far more nursing homes 

and beds than any other region. Excluding the Michigan 

AFCH’S the North Central Region would have had the highest 

average bed size, but when these were included it was a distant 

third behind the Northeast and South Regions (table B). 

The number of nursing home beds per 1,000 population 

65 years of age and over are shown by region in figure 1. The 

North Central Region had the highest such rate at 78.0 with 

the West a distant second at 63.4. The exclusion of Michigan 

z,4~~ri~~ HOS@tiAssociation:Hospita/ Statistics. 1981 edition. Data from 

the AHA 1980 ,%usua] Survey. 

Table 8. Average bed size of nursing and related care homes by 

type of ownership and geographic region, including and 

excluding Michigan’s adult foster care homes (AFCH’S): 

United States, 1980 

Average bed s{ze 

Average bed s!ze excludlng Characteristic of all homes M\ch\gan’s 

A FCH ‘S 

All homes,,,.........,,., 66.7 73.9 

Type of ownership 

Government . . . . . . . . . . . . . . 135,6 135.6 

Proprietary, ,, . . . . . . . . . . 57.4 65.2 

Nonprofit, ,,, . . . . . . . . . . . . . 977 97.7 

Geographic region 

Northeast, . . . . . . . . . . . . . . . 85.7 85.7 

North Central......,...,,. 63.2 87.8 

South . . . . . . . . . . . . . . . . . . . . 79.3 79,3 

West . . . . . . . . . . . . . . . . . . . . 47.4 47.4 

AFCH’S would have little impact on this figure, reducing the 

rate of the North Central Region to 75.1. 

There was moderate fluctuation in nursing home occupancy rates among bed size groups, ownership categories, and 

geographic regions (table C). A much wider fluctuation in the 

U.S. average 63.4 

= 60.3 

53.1 

Northeast North South West ~ 

Central 

Regions 

I 

Figure 1. Beds in nursing and related care homes per 1,000 population 

65 years of age and over by region: United States, 1980 
adwncedata 3 

Table C, Occupancy rete and number of edmiasions per 10 beds turnover rate (admissions per bed) was found among these 

‘urnover rata) for nursing and related cere homes, by bed size, three categories. The highest turnover rates among the bed size 

pe of ownership, end geographic region: United States, 1980 

groups were 8.5 and 8.4 admissions per 10 beds in homes with


Number of 100 to 199 beds and 75 to 99 beds, respectively (table C).


Characteristic Occupancy admissions rate J These rates were quite a bit higher than those for the two


smallest bed size groups, and considerably higher than those 

All homes...,,,,,.......,,,, ,,, ,.. 90.8 7.6 for the two largest bed size groups. 

The turnover rate for proprietary homes was nearly twice 

Bed size the rate for government-operated homes. The West Region 

3–9 beds................,.,,. 84.6 

10-24 beds,,,,,,.........,,,,. 89.1 

25–49 beds . . . . . . . . . . . . . . . . . . . 91.8 

6.0 

5.8 

6.2 

had the highest turnover rate with every bed being turned over 

once during the year (10 admissions per 10 beds). 

50-74 beds, . . . . . . . . . . . . . . . . . ,, 92.3 7.1 

75–99 beds,,.............,,, 92,4 8,4 Employee data 

100–199 beds . . . . . . . . . . . . . . . . . 91.1 8.5 

200–299 beds.........,.,,,. 89.8 7.9 In 1980, an estimated 952,600 full-time equivalent (FTE) 

300–499 beds.............,.. 87.9 

500 beds or more . . . . . . . . . . . . . 87.1 

5.3 

3.5 

employees worked in nursing homes. Of these, approximately 

62,200 were registered nurses (RN’s) and about 76,700 were 

Type of ownership licensed practical nurses (LPN’s) (table D). Data on the 

Government . . . . . . . . . . . . . . . . . . 91,3 4.4 numbers of these employees and their numbers per home and 

Proprleta~ . . . . . . . . . . . . . . . . . . . 91.4 8.6 per 100 beds are provided and categorized by bed size, owner- Nonprofit . . . . . . . . . . . . . . . . . . . . .,, ., 88.8 6.0 ship type, and geographic region (table D). The NMFI surveys 

Geographic region included in their counts only those nursing home employees 

Northeast, ,, . . . . . . . . . . . . . . . . ,,, ,.. 93.1 6,8 who are on the staff payroll; they excluded those employed 

North Central............,,,. 89,7 6.6 under contract. Because RN’s and LPN’s are sometimes em- South . . . . . . . . . . . . . . . . . . . . . . . . 90,2 

West . . . . . . . . . . . . . . . . . . . . . . . . 91.1 

8.1 

10.0 ployed under contract, they are somewhat undercounted, 

lNumber of rssidsnts diwded by number of bads set up snd staffed (exprassed employees per home also increases. This is not surprising, be- ,* a percent). 

‘>mes that did not repoti admissions were excluded—there were 6,648 cause the more beds there are in a home, the more employees 

I homes. are needed to staff them. 

per 10 beds2 

As the bed-size groups get larger, the number of FTE 

Tabla D. Number of full-time equivalent (FTE) employees in nursing and related care homes that reportad full-time employees, number of 

FTE employees per home, and number of FTE employaes per 100 rasidents, by bed size, type of ownership, and geographic ragion: United States, 

1980 

Estimated number of all FTE RN’s13 FTE LPN’s1 3 

Characteristic FTE employeesl 2 

Total Per home Per 100 beds Total Per home Per 100 beds Total Per home Per 100 beds 

All homes.,,.......,,. 952,600 41.4 62.1 62,200 2.7 4.0 76,700 3.3 5.0 

Bed size 

3-9 beds..........,.. 9,900 1.8 33.9 48 0.0 0.2 35 0,0 0.1 

10–24 beds. . . . . . . . . . . 24,500 8.2 51.1 900 0,3 1.8 1,300 0.4 2.7 

25-49 beds . . . . . . . . . . . 65,000 21.5 58.0 3,800 1.2 3.4 5,200 1.7 4,6 

50-74 beds . . . . . . . . . . . 123,200 37.0 61.7 7,100 2,1 3.5 9,900 3.0 5.0 

75–99 beds . . . . . . . . . . . 133,900 56.4 64.1 8,500 3.6 4.1 11,500 4.9 5,5 

100-199 beds 384,300 81.2 62.3 26,800 5.7 4.4 32,500 6.9 5.3 

200-299 beds 111,900 146,1 63.0 7,900 10,3 4.4 9,300 12.2 5.2 

300–499 beds 55,900 223.6 61.7 4,100 16.5 4.5 3,800 15,1 4.2 

500 beds or more ., 44<000 571,4 81.4 3,100 40,4 5.7 3,200 41.6 5.9 

Type of ownership 

Government, . . . . . . . . . . 104,200 111.3 82.1 6,500 7.0 5.1 8,600 9.2 6.8 

Proprietary, . . . . . . . . . . . 623,200 33.4 58.1 39,400 2,1 3.7 52,400 2.8 4.9 

Nonprofit . . . . . . . . . . . . . 225,200 65.1 66.6 16,200 4.7 4.8 15,700 4.5 4.6 

Geographic region 

,~rtheast . . . . . . . . . . . . . 230,100 61.2 71,3 22,600 6.0 7.0 18,500 4.9 5.7 

th Central, ..,...... 306,300 37.1 58.7 18,500 2.2 3.5 21,600 2.6 4.1 

uth . . . . . . . . . . . . . . . . 252,700 47.6 60.1 11,100 2,1 2.6 25,700 4.8 6.1 

@Jest, . . . . . . . . . . . . . . . . 163,500 28.5 60.0 10,000 1.7 3.7 10,900 1.9 4.0 

1FTE = full-time equivalents = full-time employees + ‘% part-time employees. 

2See Techntcal notes for explanation of estimstm” procedwes. 

3FTE RN’s and LPN’s were actual counts but have been mu”ded to nearest hundred except when total was less than 100 
4 ackncedata 

When the rates per 100 beds for all employees are compared by bed-size groups, a somewhat different picture appears. 

Whereas the largest group (500 beds or more) has a rate almost 2% times as large as the smallest group (3 to 9 beds), 

the six bed-size groups starting with 25 beds and ending with 

499 beds have relatively small variations in rates. 

The rates per 100 beds for both RN’s and LPN’s had 

similar patterns. Their most substantial increases occurred from 

the first (smallest) bed-size group to the second, from the 

second to the third, and from the next-to-the-largest bed-size 

group to the largest. 

In terms of ownership, the government-operated homes 

had the highest rates for both FTE employees per home and 

FTE employees per 100 beds. This was true for RN’s and 

LPN’s as well as for total employees. 

These high rates can be understood by reviewing data 

presented earlier. Specifically, the government-operated homes 

averaged nearly 136 beds per home—far more than the other 

two ownership types. Because large nursing homes have more 

total employees, RN’s, and LPN’s than do small homes, the 

government-operated homes would be expected to have the 

highest employee-per-home rates. Conversely, because proprietary homes tend to be small and because smaller homes 

have fewer employees, the proprietary homes had very low 

rates of FTE employees per home. The government homes 

also had the highest rates of FTE employees per 100 beds for 

all three employee groups. Proprietary homes had the lowest 

rates for all employees and for RN’s, but for LPN’s the rate 

was slightly higher than the rate for nonprofit homes. 

At the regional level, the Northeast had substantially 

higher FTE employee-per-bed rates than the other regions for 

all employees and for RN’s. The Northeast was second to the 

South, however, in FTE LPN’s per bed. 

Although the Northeast had fewer nursing homes than any 

other region, it had the highest number of FTE RN’s-mo 

* 

than the South and West Regions combined. This is drama== 

ically shown where the number of FTE RN’s per home is 6.0 

in the Northeast but only 2.2 or less in the other three regions 

(table D). 

A possible explanation for this could be in the types and 

sizes of the nursing homes within regions. The certification 

data collected in the survey were incomplete (see Technical 

notes), but according to the information that was available the 

Northeast had many more large skilled nursing facilities 

(SNF’S) than the South and West Regions did. In SNF homes 

with 200 or more beds, the Northeast had 295, compared with 

the Souths’ 113 and the Wests’ 64. Of the SNF homes with 

500 beds or more, the Northeast had 37, the South 4, and the 

West none. 

Because SNF’S are required to ( 1) provide skilled nursing 

care and (2) maintain 24-hour coverage by RN’s, they would 

be expected to have more RN’s than noncertified homes. Results from the 1977 National Nursing Home Survey tended to 

substantiate this with the finding that of the 66,900 estimated 

FTE RN’s employed in nursing homes at that time, 53,000 

(79 percent) were in homes classified as SNF’S.3 The Northeast, with many more large SNF’S, could therefore be expected 

to have many more RN’s also. 

3Natj~na] Center for Health Statistics, A. Sirrocco: Employeesin nursingl._ 

homes in the United States, 1977 National Nursing Home Survey. Viral and 

Health ,$ta!isfics. Series 14-No, 25. DHHS Pub. No. (PHS) 8 I – 1820, Office 

of Health Research, Statistics, and Technology, Washington. U.S. Government Printing Offke, Feb. 1981. 
acktncedata 5 

Technical notes � Although the 1980 National Master Facility Inventory � Because neither 1980 nor 1978 data were available for 

(NMFI) Survey was a universe rather than a sa&ple survey approximately 200 residential care homes in New York, 

and, as such, is not subject to sampling error, it is subject to these homes were excluded from the figures in this report. 

other types of errors. One type of error was questionnaire-item � Number of beds and type of ownership were the only data 

nonresponse. reported by the 3,013 residential community care facilities 

All the NMFI Surveys (of nonhospitals) through 1973 in California. The number of residents was imputed by 

were conducted directly by the National Center for Health multiplying beds by 0.90—the average occupancy rate in 

Statistics (NCHS) with the assistance of the U.S. Bureau of nursing and related care homes. Admissions, discharges, 

the Census. From 1976 through 1980 the Cooperative Health inpatient days of care, and employees were not imputed; 

Statistics System (CHSS) was active. This system decentral- therefore, these homes were not included in tables showized the responsibility for collecting data from the Federal to ing these variables. 

the State level. In 1976, 16 States within CHSS collected � The only information available for the 2,524 Michigan 

some or all the NMFI data. In 1978 there were 26 States, adult foster care homes (AFCH’S) was number of beds. 

and in 1980 there were 38 States collecting NMFI data. In The number of residents was imputed by multiplying beds 

each of these years NCHS surveyed in the non-CHSS States. by 0.90. Based on existing knowledge of the AFCH’S, 

The agency within the CHSS States that collected the these homes were assigned an ownership category of proNMFI data for NCHS was usually the licensing agency. Be- prietary. No other data were imputed, so these homes 

cause their surveys are tied into licensing laws, there were dif- were excluded from tables showing any variables other 

ferences in definitions, scope, and timing of the surveys among than beds, residents, and ownership. 

a 

the CHSS States. However, NCHS included personal care � Estimates were obtained for full-time equivalent (FTE) 

homes, homes for the aged, rest homes, and the like, some total employees in the 5,888 homes for which data on fullStates did not license these types of homes and did not survey time total employees were not provided by the home. To 

them. 

Data on nursing and related care homes mav.have biases 

get these estimates, full-time employee averages were 

computed for each bed-size and ownership group in the 

ue to the following 17,177 homes that did report full-time employees. These 

Data from nursing homes surveyed in the 1978 NMFI 

were substituted in 1980 for Alaska and South Dakota. 

averages were then applied to the 5,888 homes with corresponding bed-size and ownership groups, and the result-

�	 1978 data were substituted for 48 nursing homes in In- ing estimates were added to the known FTE data in the 

diana and 96 homes in Connecticut. 17,177 homes. 
6 adwncedata 

Recent Issues of Advance Data From Vital and Health Statistics ‘i= 

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No. 88. 1981 Summary: National Ambulatory Medical Care October 8, 1982) 

Survey (Issued: March 16, 1983) 
8 ackincedata 

Suggested Citation


National Center for Health Statistics, A. Sirrocco:


An overview of the 1980 National Master Facility


lnvento~ Survey of Nursing and Related Care


Homes. Advance Data From Vital and Health


Statistics, No. 91, DHHS Pub. No. (PHS)


83-1250. Public Health Service, Hyattsville, Md.,


Aug. 11, 1983


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