Characteristics of Elderly Nursing Home Current

Residents and Discharges: Data from the 1997

National Nursing Home Survey

by Celia S. Gabrel, M.S., Division of Health Care Statistics

Abstract

Objective—This report presents data on the diversity of current nursing home

residents and discharges in terms of gender, age, race, ethnicity, functional status,

type of services used, and source of payment. It focuses on utilization of nursing

home care among elderly persons 65 years and over.

Methods—Estimates in this report are from data collected between July and

December 1997 for the 1997 National Nursing Home Survey. This survey is

conducted periodically by the National Center for Health Statistics and collects

information on a sample of providers and recipients of care from nursing home

facilities. The major emphasis of the survey is to collect descriptive and utilization

data on current residents and discharges. Current residents are persons in the

nursing home on the day of the survey, and discharges represent completed episodes

of care that ended during a one-year period prior to the survey.

Results—In 1997, approximately 1.5 million elderly residents lived in nursing

homes on an average day in the United States. The majority of these residents were

white, widowed, and functionally dependent females. There were 2.1 million elderly

nursing home discharges from October 1996–September 1997 with the primary

reasons for discharge being hospitalization or death. The most common primary

diagnostic category for current residents and discharges was diseases of the

circulatory system. The primary source of payment at admission for current elderly

residents was Medicaid. Medicare was the primary source of payment at the time of

discharge for elderly discharges.

Keywords: National Nursing Home Survey c long-term care c current residents

discharges

Introduction

Although long-term care services

can be delivered in an institution, in a

home or residence, or in a community

setting, and people of any age might

experience some degree of functional

limitations that requires long-term care,

this report focuses on elderly nursing

home residents, which is defined as

those age 65 years and over. With the

substantial growth of the elderly

population in the last decade, issues

surrounding long-term care are

becoming increasingly important. The

needs of the elderly and the institutions

and agencies through which services are

delivered create problems for the

elderly, their families, their health care

providers, and policy makers who make

decisions about the provision, use, and

financing of long-term care.

This report provides data on facility

characteristics, demographic

characteristics, functional dependencies

in activities of daily living (ADL’s) and

instrumental activities of daily living

(IADL’s), primary admission diagnosis,

service utilization, and source of

payment for elderly nursing home

current residents and discharges.

Information on all current nursing home

residents and discharges has been

published in a separate report (1).

Long-term care can be viewed as a

program of health, personal care, and

social services delivered over time to

persons who have lost or never acquired

some degree of functional capacity (2).

These services may be provided in a

variety of settings. While nursing home

care comprises the most easily

Advance

Data

Number 312 + April 25, 2000

From Vital and Health Statistics of the CENTERS FOR DISEASE CONTROL AND PREVENTION/National Center for Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics CENTERS FOR DISEASE CONTROL

AND PREVENTION
recognized form of long-term care,

home care and community services

accommodate a much larger percent of

the population using long-term care. In

the family setting, the long-term care

needs of the frail person are met by one

(often the spouse) or more family

members with or without support of

medical and nonmedical home-care

services (3). In the institutional setting,

more than 90 percent of the elderly

people live in nursing homes, while the

remainder live in mental institutions or

chronic disease hospitals (4). Nursing

homes are defined as facilities with

three or more beds that routinely

provide nursing care services. Facilities

may be certified by Medicare or

Medicaid, or not certified but licensed

by the state as a nursing home. These

facilities may be free standing or a

distinct unit of a larger facility. In

nursing homes, basic medical care for

the long-term care needs of frail

residents are provided by an organized

staff.

Data presented in this report

summarize nursing home utilization

from two perspectives: utilization on

any particular day in the data collection

period July–December 1997 (current

residents) and utilization during an

entire year from October 1996 through

September 1997 (discharges).

Method

The 1997 National Nursing Home

Survey (NNHS) is the fifth in a series of

nationwide sample surveys of nursing

home facilities, their current residents,

and their discharges. It has been

conducted periodically since 1973 by

the National Center for Health Statistics

(NCHS). Data collection for NNHS was

conducted from July through December

1997. The sampling frame for this

survey was derived from a frame

consisting of all nursing home facilities

identified in the 1991 National Health

Provider Inventory (NHPI) and updated

through 1997 (5). These updated files

were obtained from the Health Care

Financing Administration (HCFA) and

other private and national organizations.

A sample consisting of 1,488 nursing

homes was selected from the universe.

Additional information on the data set,

with information on the sample frame,

sample design, data collection

procedures, and sampling errors has

been published in a previous NCHS

report (1).

NNHS collects information from

each participating facility on a number

of facility characteristics including

ownership, certification status, bed size,

location, affiliation, and services

provided. In addition, the survey also

collects information on a sample of

current residents and discharges in each

facility. Data collection for current

residents and discharges includes

demographic characteristics (age, sex,

race, marital status), date of admission,

living arrangement prior to admission,

primary and other diagnoses at

admission and at time of survey or at

discharge, source of payment, functional

status (ADL’s and IADL’s), and reason

for discharge.

Estimates in this report are based on

the current resident and discharged

resident samples. The sample of current

residents was obtained by randomly

selecting up to six residents who were

on the rolls of the facility as of

midnight the day prior to the day of the

survey. Data were collected by

interviewing the facility staff most

familiar with the care provided to the

resident. Discharges were obtained by

randomly selecting up to six residents

who had been removed from the rolls of

the nursing home (including those

whose care ended because of death)

during a designated month (from

October 1996 through September 1997).

Discharges represent discharged events,

not persons. Thus, the same resident

could be included more than once if that

person had multiple completed episodes

Table 1. Number and percent distribution of elderly nursing home residents 65 years and

over by selected facility characteristics, according to sex: United States, 1997

Facility characteristic

Both

sexes Male Female

Both

sexes Male Female

Number Percent distribution

Total........................ 1,465,000 372,100 1,092,900 100.0 100.0 100.0

Ownership

Proprietary.................... 948,400 242,400 706,100 64.7 65.1 64.6

Voluntary nonprofit ............... 399,700 87,600 312,000 27.3 23.6 28.6

Government and other ............ 116,900 42,100 74,800 8.0 11.3 6.8

Certification

Certified by Medicare and Medicaid .... 1,246,800 311,900 934,800 85.1 83.8 85.5

Certified by Medicare only .......... 46,200 *11,400 34,800 3.2 *3.1 3.2

Certified by Medicaid only .......... 135,700 37,000 98,700 9.3 9.9 9.0

Not certified ................... 36,400 11,800 24,600 2.5 3.2 2.3

Bed size

Less than 50 beds ............... 57,000 15,100 41,900 3.9 4.1 3.8

50 - 99 beds .................. 364,600 95,000 269,600 24.9 25.5 24.7

100 - 199 beds ................. 766,700 185,400 581,300 52.3 49.8 53.2

200 beds or more ............... 276,700 76,600 200,100 18.9 20.6 18.3

Census region

Northeast .................... 346,500 84,600 261,900 23.7 22.7 24.0

Midwest ..................... 452,100 114,000 338,100 30.9 30.6 30.9

South ....................... 477,400 122,200 355,200 32.6 32.8 32.5

West . . . . . . . . . . . . . . . . . . . . . . . 189,000 51,400 137,600 12.9 13.8 12.6

Metropolitan Statistical Area (MSA)

MSA . . . . . . . . . . . . . . . . . . . . . . . 1,006,500 245,100 761,500 68.7 65.9 69.7

Not MSA . . . . . . . . . . . . . . . . . . . . . 458,500 127,000 331,400 31.3 34.1 30.3

Affiliation1

Chain ....................... 821,500 210,000 611,400 56.1 56.4 56.0

Independent ................... 635,000 160,200 474,800 43.4 43.1 43.5

* Data should not be assumed reliable because the sample size is between 30–59 or the sample size is greater than 59 but has

a relative standard error over 30 percent.

1Excludes unknown.

NOTES: Numbers may not add to totals because of rounding. Percents are based on unrounded figures.

2 Advance Data No. 312 + April 25, 2000
of care in one or more facilities that

ended during the designated month

assigned to the facility. When referring

to the health status of and services

received by discharges, the term ‘‘at the

time of discharge’’ was used for live

discharges, and ‘‘immediately prior to

discharge’’ was used for persons

discharged dead.

Although the survey included

residents and discharges of all ages, data

presented in this report are limited to

those 65 years of age and over. This age

group represents 91 percent of the

nursing home residents and 89 percent

of the discharges. The estimates in this

report are based on responses for 7,363

current residents and 5,980 discharges

age 65 years and over. The sample of

both current residents and discharges is

weighted to produce national estimates.

Results

Current residents

On an average day in 1997, there

were an estimated 1,465,000 nursing

home residents aged 65 years and over

residing in the United States.

Information on elderly nursing home

residents by selected facility

characteristics are shown in table 1. The

majority of elderly residents were in

privately owned facilities (65 percent),

and 27 percent lived in voluntary

nonprofit facilities. Most elderly

residents received care from facilities

that were dually certified by Medicare

and Medicaid. Only 3 percent of the

residents received care from facilities

that were not certified. Some regional

differences existed in nursing home

utilization, with the Midwest and the

South having a greater proportion of

current residents than the Northeast and

West. Fifty-six percent of elderly

residents were in facilities affiliated with

other nursing homes in a chain.

Of the 1.5 million elderly nursing

home residents, about three-fourths were

women and nearly 90 percent were

white. Only 17 percent were married,

and about 63 percent were widowed

(table 2). The mean age at interview was

84 years (85 years for women and 81

years for men). Fourteen percent of the

elderly residents were 65–74 years old,

36 percent were 75–84 years of age, and

50 percent were 85 years and over.

While males were more likely to be in

the 75–84 years age group, females

were more likely to be in the oldest age

group. The living arrangements of

elderly nursing home residents prior to

admission to a nursing home varied

widely. Thirty-two percent of the

admissions entered from a private

residence, 45 percent were admitted

from a hospital, and about 12 percent

were admitted from another nursing

home.

Table 3 presents information on the

type of aids used, continence status, and

impairment of vision and hearing at the

time of interview. The most frequently

used aids were eye glasses (62 percent

males and 68 percent females),

wheelchairs (61 percent males and

63 percent females), and walkers

(22 percent males and 26 percent

females). Forty-four percent of the

residents had difficulty controlling both

the bowel and bladder, only 1 percent

had difficulty controlling bowel only,

and 13 percent had trouble controlling

the bladder only. About one-fourth of

the residents were visually or hearing

impaired.

Most nursing home residents need

assistance in performing the activities of

daily living (ADL): the ability of the

resident to bathe, dress, eat, transfer

from bed to chair, and use the toilet

(table 4). Seventy-five percent of the

residents over the age of 65 needed

assistance in three or more ADL’s at the

time of interview and only 3 percent did

not need assistance with any ADL’s at

the time of interview. Bathing or

showering (96 percent) was the ADL

Table 2. Number and percent distribution of elderly nursing home residents 65 years and

over by selected demographic characteristics, according to sex: United States, 1997

Resident characteristic

Both

sexes Male Female

Both

sexes Male Female

Number Percent distribution

Total........................ 1,465,000 372,100 1,092,900 100.0 100.0 100.0

Age

65–74 years ................... 198,400 80,800 117,700 13.5 21.7 10.8

75–84 years ................... 528,300 159,300 368,900 36.1 42.8 33.8

85 years and over ............... 738,300 132,000 606,300 50.4 35.5 55.5

Race

White ....................... 1,294,900 315,800 979,100 88.4 84.9 89.6

Black ....................... 137,400 44,800 92,500 9.4 12.0 8.5

Other ....................... 18,000 *7,400 *10,600 1.2 *2.0 *1.0

Unknown..................... 14,700 * *10,600 1.0 * *1.0

Hispanic origin

Hispanic ..................... 32,100 *11,100 20,900 2.2 *3.0 1.9

Non-Hispanic .................. 1,339,900 338,900 1,001,000 91.5 91.1 91.6

Unknown..................... 93,000 22,100 71,000 6.4 5.9 6.5

Marital status

Married ...................... 248,800 140,200 108,600 17.0 37.7 9.9

Widowed ..................... 924,400 131,000 793,400 63.1 35.2 72.6

Divorced/separated .............. 98,200 34,600 63,600 6.7 9.3 5.8

Never married/single.............. 173,800 61,300 112,500 11.9 16.5 10.3

Unknown..................... 19,800 * 14,800 1.4 * 1.4

Living arrangement prior to admission

Private residence................ 472,100 114,600 357,500 32.2 30.8 32.7

Retirement home................ 33,900 * 28,600 2.3 * 2.6

Board and care/residential facility...... 67,300 15,300 51,900 4.6 4.1 4.8

Nursing home .................. 179,000 47,600 131,400 12.2 12.8 12.0

Hospital ..................... 651,300 172,400 478,900 44.5 46.3 43.8

Mental health facility.............. 19,000 *5,900 13,100 1.3 *1.6 1.2

Other or unknown ............... 42,400 *11,000 31,500 2.9 *2.9 2.9

* Data do not meet standard reliability or precision (sample size less than 30) and are therefore not reported. If asterisk precedes

a number, data should not be assumed reliable because the sample size is between 30–59 or the sample size is greater than 59

but has a relative standard error over 30 percent.

NOTES: Numbers may not add to totals because of rounding. Percents are based on the unrounded figures.

Advance Data No. 312 + April 25, 2000 3
that residents most frequently required

assistance, followed by dressing

(87 percent). Another group of common

activities that nursing home residents

need assistance with are IADL’s, which

included using the telephone, caring for

personal possessions, securing personal

items, and money management. At the

time of interview, elderly residents

required the most assistance in taking

care of personal possessions (77 percent)

and securing personal items

(76 percent). More than half of the

elderly residents needed assistance in all

the IADL’s (54 percent) at the time of

interview. On the other hand, 11 percent

of the current residents were functional

enough in the IADL’s not to need

assistance at the time of interview.

The leading admission diagnoses for

both elderly male and female nursing

home residents were diseases of the

circulatory system, followed by mental

disorders (table 5). The services received

by elderly nursing home residents are

shown in table 6. The services most

frequently received by the elderly while

staying in a nursing home were nursing

services (97 percent), prescribed or

nonprescribed medicine (94 percent),

medical and personal care services (91

percent each), and nutritional services

(74 percent). Other services included

social services (70 percent), equipment

or devices (51 percent), and physical

therapy (27 percent).

Table 7 shows, by various

demographic characteristics, the length

of time since admission for elderly

nursing home residents. The average

length of time since admission for

current elderly nursing home residents

since admission was 870 days. Women

(907 days), unmarried persons (1,318

days), and those aged 85 years and over

(932 days) had longer average stays

than men (761 days), married persons

(596 days), and those slightly younger at

age 75–84 years (789 days).

At the time of admission, Medicaid

was the primary public funding source

(38 percent) for elderly nursing home

residents (table 8). Medicare was the

source of payment for 30 percent of the

current residents. Private insurance, own

income, or family support paid for

28 percent of the residents. Because

Medicare benefits for nursing home care

are for a limited time period, table 9

shows the change that occurred by the

time of the interview in the source of

payment for elderly residents. The

proportion of current elderly residents

with a primary source of payment of

Medicare decreased from 30 percent (at

admission) to 15 percent (in the month

prior to interview). Medicaid, on the

other hand, increased from 38 percent at

admission to 56 percent in month prior

to interview.

Discharges

The size of nursing homes increased

from 75 beds per home in 1985 to 107

beds per home in 1997. This growth

coincides with increased use of these

facilities; the number of nursing home

discharges rose from 1.2 million in

1984–85 (6) to 2.1 million in 1996–97.

This increase can be attributed to the

increasing number of nursing homes

providing subacute care as well as

rehabilitative care (7). Among all

discharges in the survey, 73 percent

were discharged alive. This proportion

was about the same for men and for

women. The most common reasons for

discharge (figure 1) was admission to a

hospital or death (27 percent each).

Figure 2 shows the average length of

stay by reason for discharge. As

expected, the shortest length of stay was

for discharges listed as stabilized or

recovered (54.9 and 60.4, respectively)

compared with those deceased (729

days) or admitted to the hospital (329.1

days). Older discharges (85 years and

older) were more likely to be discharged

dead, while discharges resulting in

admission to the hospital were equally

distributed across age groups (table 10).

The number and percent distribution

of elderly nursing home discharges by

Table 3. Number and percent of elderly nursing home residents 65 years and over by use

of selected aids, continence, vision and hearing status, and sex: United States, 1997

Functional status

Both

sexes Male Female

Both

sexes Male Female

Number Percent

Total............................ 1,465,000 372,100 1,092,900 . . . . . . . . .

Aids used

Glasses ......................... 973,400 230,100 743,200 66.5 61.9 68.0

Hearing aid ....................... 155,600 39,400 116,200 10.6 10.6 10.6

Transfer equipment .................. 185,000 52,000 133,000 12.6 14.0 12.2

Wheelchair........................ 913,300 227,500 685,800 62.3 61.2 62.7

Cane ........................... 95,400 34,000 61,300 6.5 9.2 5.6

Walker .......................... 369,100 82,600 286,500 25.2 22.2 26.2

Oxygen.......................... 84,500 28,100 56,500 5.8 7.5 5.2

Brace (any type) .................... 46,200 12,200 34,100 3.2 3.3 3.1

Commode ........................ 121,600 25,400 96,200 8.3 6.8 8.8

Other aids or devices ................. 250,100 69,800 180,300 17.1 18.6 16.5

Continence status

Difficulty controlling both bowels and bladder . . 647,200 156,400 490,900 44.2 42.0 44.9

Difficulty controlling bowels.............. 18,900 *6,600 12,200 1.3 *1.8 1.1

Difficulty controlling bladder ............. 189,700 44,600 145,100 13.0 12.0 13.3

Vision

Not impaired ...................... 959,200 254,200 705,000 65.5 68.3 64.5

Impaired ......................... 396,700 93,000 303,700 27.1 25.0 27.8

Unknown1 ........................ 109,100 24,900 84,100 7.5 6.7 7.7

Hearing

Not impaired ...................... 1,005,800 256,500 749,300 68.7 68.9 68.6

Impaired ......................... 347,600 90,800 256,800 23.7 24.4 23.5

Unknown1 . . . . . . . . . . . . . . . . . . . . . . . . 111,600 24,800 86,800 7.6 6.7 7.9

. . . Category not applicable.

* Data should not be assumed reliable because the sample size is between 30–59 or the sample size is greater than 59 but has

a relative standard error over 30 percent.

1Includes those for whom status could not be determined (e.g., comatose patients)

NOTES: Numbers may not add to totals because of rounding. Percents are based on the unrounded figures.

4 Advance Data No. 312 + April 25, 2000
facility characteristics is shown in

table 11. Sixty-six percent of all elderly

discharges were from privately owned

nursing homes. Voluntary nonprofit

homes accounted for 29 percent of all

discharges, and government and other

types of nursing homes made up about

5 percent. Ninety-nine percent of these

nursing homes were certified by either

Medicaid and/or Medicare and the

remaining 1 percent was not certified.

The largest proportion of discharges

were from facilities located in the

Midwest (29 percent) and South

(30 percent) and from nursing homes

located in a metropolitan statistical area

(76 percent). Facilities affiliated with

other nursing homes in a chain

accounted for more than half of all

discharges (61 percent).

Table 12 presents demographic

characteristics of the 2.1 million

discharges from nursing home care

during a one year period. The mean age

for all elderly discharges at the time of

discharge was 82 years. The average age

of male discharges was 81 years and for

females it was 83 years. The majority of

the female discharges were 85 years and

older (45 percent) and males were

between the ages of 75–84 years

(44 percent). Eighty-nine percent of all

discharges were white, 7 percent were

black, and about 3 percent were

Hispanic. Overall, the majority of all

elderly patients at the time of discharge

were widowed (57 percent), and females

accounted for 82 percent of them. By

contrast, 26 percent of the discharges

were married, and 62 percent were

males. Prior to entering a nursing home,

the majority of discharges (68 percent)

were admitted from another health

facility. Sixty-one percent of them were

admitted from a hospital, and 7 percent

had transferred from another nursing

home.

Table 13 displays information on

types of aids used, continence status,

and vision and hearing status of elderly

patients at the time of discharge. The

most frequently used aids were eye

glasses (61 percent of males and

67 percent of females) and walker

(55 percent of males and 54 percent of

females). Thirty-three percent of

discharges aged 65 years and over had

difficulty controlling both bowels and

bladder at the time of discharge. About

one-fifth of all elderly discharges had

some vision (23 percent) or hearing

impairment (20 percent). At the time of

discharge, 32 percent of elderly patients

were dependent in four of the five listed

ADL’s. Only 5 percent did not need

assistance in performing any ADL

(table 14). The most common ADL’s for

which assistance was received by

elderly discharges was bathing or

showering (93 percent) and dressing

(86 percent). For elderly discharges

requiring assistance with IADL’s,

66 percent received help with caring for

personal possessions and securing

personal items. Most elderly discharges

were dependent in all four IADL’s

(46 percent), and 23 percent required no

assistance in IADL’s at the time of

discharge. The proportion of discharges

requiring assistance with ADL’s and

IADL’s was similar for both males and

females.

Data on primary diagnoses of

nursing home discharges were collected

in the 1997 NNHS at the time of

admission (table 15) and time of

discharge. The most frequent primary

admission diagnosis for elderly

discharges was diseases of the

circulatory system (26 percent), followed

by diseases of the respiratory system

(11 percent) and mental disorders

(7.0 percent).

Information on the services received

(during the billing period that included

the date of discharge) by elderly

discharges is shown in table 16. Most

discharges received nursing services

(98 percent), medical services

(94 percent), prescribed or nonprescribed

medicines (92 percent), personal services

(89 percent), nutritional services

(77 percent), and social services

(74 percent). Other frequently used

services were equipment and devices,

Table 4. Number and percent of elderly nursing home residents 65 years and over by

dependency in activities of daily living and instrumental activities of daily living and sex:

United States, 1997

Functional status

Both

sexes Male Female

Both

sexes Male Female

Number Percent

Total............................ 1,465,000 372,100 1,092,900 . . . . . . . . .

Received assistance with ADL’s1

Bathing or showering ................. 1,409,300 351,400 1,057,900 96.2 94.4 96.8

Dressing ......................... 1,277,600 318,900 958,700 87.2 85.7 87.7

Eating........................... 658,800 159,300 499,500 45.0 42.8 45.7

Transferring in or out of bed or chair........ 372,100 87,300 284,800 25.4 23.5 26.1

Using toilet room .................... 822,600 196,300 626,300 56.2 52.8 57.3

Number of dependencies in ADL’s1

None ........................... 44,000 17,600 26,800 3.0 4.6 2.5

1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115,000 28,900 86,100 7.9 7.8 7.9

2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210,400 59,400 151,000 14.4 16.0 13.8

3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513,500 129,200 384,300 35.1 34.7 35.2

4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 446,300 108,600 337,700 30.5 29.2 30.9

5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135,800 28,700 107,100 9.3 7.7 9.8

Received assistance with IADL’s1

Care of personal possessions ............ 1,130,100 287,200 842,900 77.1 77.2 77.1

Managing money .................... 1,057,900 266,500 791,400 72.2 71.6 72.4

Securing personal items . . . . . . . . . . . . . . . 1,115,800 278,100 837,700 76.2 74.7 76.7

Using telephone .................... 910,500 233,500 677,000 62.2 62.8 61.9

Number of dependencies in IADL’s1

None ........................... 161,700 42,500 119,200 11.3 11.7 11.2

1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110,400 29,000 81,500 7.7 8.0 7.6

2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138,300 32,700 105,600 9.7 9.0 9.9

3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253,600 65,200 188,400 17.7 18.0 17.7

4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 766,700 193,800 572,800 53.6 53.4 53.7

. . . Category not applicable.

1ADL is activities of daily living, and IADL is instrumental activities of daily living.

NOTES: Numbers may not add to totals because of rounding. Percents are based on the unrounded figures.

Advance Data No. 312 + April 25, 2000 5
physical therapy, and occupational

therapy.

The average length of stay for all

discharges was 290 days (table 17).

Females had a longer average length of

stay than males (329 days vs. 215 days).

Married (168 days) elderly discharges

had shorter average stays than never

married/single (424 days). Whites (297

days) had a longer length of stay than

blacks and other races (265 days).

The number and percent distribution

of elderly nursing home discharges by

primary source of payment in the month

of discharge is detailed in table 18.

Medicare (50 percent) was the primary

source of payment for all discharges 65

years and older, followed by Medicaid

(25 percent). Private sources, which

includes private insurance, own income,

and family support, was the primary

source of payment for 21 percent of

elderly discharges. Government and

other sources was the primary source of

Table 5. Number and percent distribution of elderly nursing home residents 65 years and over by primary diagnosis at admission,

according to sex: United States, 1997

Primary diagnosis at admission and ICD–9–CM Code1

Both

sexes Male Female

Both

sexes Male Female

Number Percent distribution

Total................................................ 1,465,000 372,100 1,092,900 100.0 100.0 100.0

Infectious and parasitic diseases . . . . . . . . . . . . . . . . . . . . . . . . . .1–139 12,600 * *8,500 0.9 * *0.8

Neoplasms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140–239 30,100 14,000 16,100 2.1 3.8 1.5

Malignant neoplasms . . . . . . . . . . . . . . . . . . . . . . . . 140–208,230–234 28,200 13,000 15,200 1.9 3.5 1.4

Endocrine, nutritional and metabolic diseases and immunity disorder. . 240–279 92,900 25,000 67,900 6.3 6.7 6.2

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 56,400 15,600 40,800 3.9 4.2 3.7

Diseases of the blood and blood-forming organs . . . . . . . . . . . . . . 280–289 14,300 * *11,200 1.0 * *1.0

Mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290–319 228,700 60,800 167,900 15.6 16.3 15.4

Diseases of the nervous system and sense organs. . . . . . . . . . . . . 320–389 191,400 49,700 141,700 13.1 13.4 13.0

Diseases of the circulatory system . . . . . . . . . . . . . . . . . . . . . . . 390–459 377,500 96,000 281,500 25.8 25.8 25.8

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401 53,300 *8,400 44,900 3.6 *2.3 4.1

Heart disease . . . . . . . . . 391–392.0,393–398, 402,404,410–416,420–429 151,300 35,000 116,300 10.3 9.4 10.6

Cerebrovascular diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . 430–438 34,600 *10,100 24,400 2.4 *2.7 2.3

Diseases of the respiratory system . . . . . . . . . . . . . . . . . . . . . . . 460–519 92,400 32,400 60,000 6.3 8.7 5.5

Chronic obstructive pulmonary disease . . . . . . . . . . . . . . . . . . . 494–496 27,000 *10,600 16,300 1.8 *2.9 1.5

Diseases of the digestive system . . . . . . . . . . . . . . . . . . . . . . . . 520–597 46,300 12,300 34,000 3.2 3.3 3.1

Diseases of the genitourinary system . . . . . . . . . . . . . . . . . . . . . 580–629 33,600 *10,100 23,500 2.3 *2.7 2.2

Diseases of the skin and subcutaneous tissue. . . . . . . . . . . . . . . . 680–709 15,800 * 11,800 1.1 * 1.1

Diseases of the musculoskeletal system and connective tissue . . . . . 710–739 69,100 *7,800 61,300 4.7 *2.1 5.6

Congenital anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 740–759 * * * * * *

Symptoms, signs, and ill-defined conditions . . . . . . . . . . . . . . . . . 780–799 67,300 17,700 49,600 4.6 4.8 4.5

Injury and poisonings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800–999 116,500 16,500 100,000 8.0 4.4 9.2

Supplementary classification and unknown . . . . . . . . . . . . . . . V01–V82, 00 74,700 18,100 56,600 5.1 4.9 5.2

* Data do not meet standard of reliability or precision (sample size less than 30) and are therefore not reported. If shown with a number, data should not be assumed reliable because the sample

size is between 30–59 or the sample size is greater than 59 but has a relative standard error over 30 percent. 1Based on the International Classification of Diseases, 9th Revision, Clinical Modification (8).

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

Table 6. Number and percent of elderly nursing home residents 65 years and over by services received and sex: United States, 1997

Service received

Both

sexes Male Female

Both

sexes Male Female

Number Percent

Total............................ 1,465,000 372,100 1,092,900 . . . . . . . . .

Dental care ....................... 267,200 73,300 193,900 18.2 19.7 17.7

Equipment or devices ................. 743,100 188,700 554,400 50.7 50.7 50.7

Medical services .................... 1,334,400 340,700 993,800 91.1 91.6 90.6

Mental health services ................ 242,200 69,200 173,000 16.5 18.6 15.8

Nursing services .................... 1,425,600 362,700 1,062,900 97.3 97.5 97.3

Nutritional services................... 1,084,700 278,900 805,800 74.0 75.0 73.7

Occupational therapy ................. 277,500 75,800 201,600 18.9 20.4 18.5

Personal care ...................... 1,333,600 339,000 994,500 91.0 91.1 91.0

Physical therapy .................... 399,100 110,400 288,700 27.2 29.7 26.4

Prescribed or nonprescribed medicines ...... 1,371,800 348,400 1,023,400 93.6 93.6 93.6

Social services ..................... 1,029,200 258,900 770,400 70.3 69.6 70.5

Speech or hearing therapy .............. 118,700 37,000 81,700 8.1 9.9 7.5

Transportation...................... 282,400 79,900 202,600 19.3 21.5 18.5

Other services ..................... 202,700 50,500 152,100 13.8 13.6 13.9

. . . Category not applicable.

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

6 Advance Data No. 312 + April 25, 2000
payment for the remaining 4 percent of

elderly discharges.

Summary and Discussion

As more people live to the oldest

ages, the number of elderly nursing

home residents will continue to increase.

Since many chronic debilitating

illnesses, such as diabetes, dementia,

and osteoporosis, increase with age,

there will be greater demand from the

health care system for services to assist

people in performing the activities of

daily living. In 1997, the majority of

current nursing home residents and

discharges were 85 years and over. Most

of these residents and discharges were

female and widowed. Because of the

preponderance of the very old in nursing

homes, many residents required

assistance or did not perform the basic

ADL’s and IADL’s needed for

independent living. Three-fourths of the

current residents and discharges required

Table 7. Number and standard error of elderly nursing home residents 65 years and over

by average length of time since admission, age, marital status, race, and sex:

United States, 1997

Demographic characteristic

Both

sexes

Standard

error Male

Standard

error Female

Standard

error

Total........................ 1,465,000 . . . 372,100 . . . 1,092,900 . . .

Number in days

Average length of stay in days . . . . . . . 870 15.1 761 28.7 907 16.8

Age

65–74 years . . . . . . . . . . . . . . . . . . . 857 41.8 823 61.1 881 54.6

75–84 years . . . . . . . . . . . . . . . . . . . 789 24.2 759 51.6 801 25.5

85 years and over . . . . . . . . . . . . . . . 932 19.2 725 34.3 977 21.5

Marital status

Married . . . . . . . . . . . . . . . . . . . . . . 596 22.1 531 27.0 681 36.2

Widowed . . . . . . . . . . . . . . . . . . . . . 852 15.6 677 30.1 881 17.0

Divorced/separated . . . . . . . . . . . . . . 911 58.3 867 91.2 936 75.0

Never married/single.............. 1,318 60.8 1,325 103.7 1,314 74.5

Race

White . . . . . . . . . . . . . . . . . . . . . . . 874 16.1 770 32.9 907 17.5

Black and other. . . . . . . . . . . . . . . . . 844 43.7 723 63.0 906 53.4

Black . . . . . . . . . . . . . . . . . . . . . . . 827 45.2 695 62.9 891 55.9

. . . Category not applicable.

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

Table 8. Number and percent distribution of elderly nursing home residents 65 years and over by their primary source of payment at the

time of admission, according to sex: United States, 1997

Source of payment

Both

sexes Male Female

Both

sexes Male Female

Number Percent distribution

Total............................... 1,465,000 372,100 1,092,900 100.0 100.0 100.0

Private insurance, own income, family support1 .... 413,600 97,000 316,600 28.2 26.1 29.0

Medicare ............................ 435,600 107,000 328,600 29.7 28.8 30.1

Medicaid ............................ 560,000 144,100 415,900 38.2 38.7 38.1

Government assistance, charity, and other2 ...... 25,200 14,500 10,800 1.7 3.9 1.0

Unknown............................ 30,500 9,500 21,000 2.1 2.6 1.9

1

Includes social security benefits, retirement funds. 2

Includes supplemental security income, welfare, religious organizations, foundations, agencies, VA contract, pensions, or other compensation, payment source not yet determined, and other.

NOTES: Numbers may not add to totals because of rounding. Percents are based on unrounded figures.

Table 9. Number and percent distribution of elderly nursing home residents 65 years and over by their primary source of payment in

month before interview, according to sex: United States, 1997

Source of payment

Both

sexes Male Female

Both

sexes Male Female

Number Percent distribution

Total............................... 1,465,000 372,100 1,092,900 100.0 100.0 100.0

Private insurance, own income, family support1 .... 380,200 90,200 289,900 26.0 24.3 26.5

Medicare ............................ 220,500 57,900 162,600 15.1 15.6 14.9

Medicaid ............................ 822,400 204,600 617,800 56.1 55.0 56.5

Government assistance, charity, and other2 ...... 28,600 13,800 14,800 2.0 3.7 1.4

Unknown............................ 13,400 * *7,700 *0.9 * *0.7

* Data do not meet standard reliability or precision (sample size less than 30) and are therefore not reported. If asterisk precedes a number, data should not be assumed reliable because the

sample size is between 30–59 or the sample size is greater than 59 but has a relative standard error over 30 percent. 1

Includes Social Security benefits, retirement funds. 2

Includes supplemental security income, welfare, religious organizations, foundations, agencies, VA contract, pensions, or other compensation, payment source not yet determined and other.

NOTES: Numbers may not add to totals because of rounding. Percents are based on unrounded figures.

Advance Data No. 312 + April 25, 2000 7
assistance in three or more ADLs.

Discharges had better functional status

than their current resident counterparts

in that only 3 percent of current

residents and 5 percent of discharges

were independent in all five activities.

They required less help with bathing,

dressing and eating than current

residents; however, discharges needed

more assistance with transferring.

The most common reasons for

discharge from a nursing home were

admission to a hospital or death. Only a

small percentage (10 percent) of the

discharges were discharged because they

recovered. Younger discharges were

more likely to be discharged alive than

older discharges. Current residents were

more likely to have a primary diagnosis

of diseases of the respiratory system

than were discharges. As with all

discharges, elderly discharges with a

diagnosis of diseases of the respiratory

system were discharged because of

death or hospitalization.

With Medicare’s shift in payment

strategies to the prospective payment

system, hospital stays are now shorter

and thus cause an increase in the need

for rehabilitative and recuperative

services such as nursing home and home

heath care. This increase is evident in

shorter lengths of stays for nursing

home discharges. The average length of

stay in a nursing home for elderly

discharges decreased from 416 days in

1985 to 290 days in 1997 with a median

length of stay of 84 days and 63 days,

respectively. At the time of discharge,

Medicare was the primary

source of payment for twice as many

discharges as any other source of

payment. Other factors may also account

for the decline in length of stay, such as

increased use of alternative services,

improved medical management of

chronic diseases, the increase in number

of discharges to hospitals as well as the

change in population from old to very

old.

References

1. Gabrel C. An overview of nursing

home facilities: Data from the 1997

National Nursing Home Survey.

Advance data for vital and health

statistics; no. 311, Hyattsville,

Maryland: National Center for Health

Statistics. 1997.

Table 10. Number and percent distribution of elderly nursing home discharges by age and primary admission diagnosis, according to

reason for discharge: United States, October 1996–September 1997

Age and primary admission diagnosis

All

reasons Recovered Stabilized Deceased

Admitted

to hospital

Admitted to

nursing home All other2

Number Percent distribution

All discharges ........................... 2,100,800 100.0 10.2 19.0 27.0 28.3 7.5 7.9

Age

65–74 years ............................ 406,000 100.0 13.0 24.2 17.0 28.7 6.7 10.4

75–84 years ............................ 836,100 100.0 11.1 19.9 23.1 29.2 8.8 8.0

85 years and over ........................ 858,600 100.0 8.0 15.8 35.6 27.3 6.7 6.5

Diagnosis and ICD–9–CM code1

Infectious and parasitic diseases . . . . . . . . . .001–139 *15,100 *100.0 * * * * * *

Neoplasms. . . . . . . . . . . . . . . . . . . . . . . .140–239 124,600 100.0 * * 51.3 19.7 * *

Malignant neoplasms . . . . . . . . . . 140–208,230–234 114,600 100.0 * * 55.0 21.4 * *

Endocrine, nutritional, and metabolic diseases

and immunity disorders . . . . . . . . . . . . . . .240–279 109,000 100.0 9.5 13.2 21.8 39.2 5.7 10.3

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . 250 69,700 100.0 * *13.7 21.0 38.5 * *

Diseases of the blood and blood-forming

organs . . . . . . . . . . . . . . . . . . . . . . . . .280–289 *17,800 *100.0 – ** * * *

Mental disorders . . . . . . . . . . . . . . . . . . . .290–319 147,800 100.0 * *6.3 34.1 38.1 10.4 *8.2

Diseases of the nervous system and sense

organs . . . . . . . . . . . . . . . . . . . . . . . . 320–389 155,200 100.0 * *13.5 37.5 27.8 *7.0 *11.1

Diseases of the circulatory system . . . . . . . . .390–459 536,200 100.0 6.5 20.0 30.7 29.2 7.9 5.7

Essential hypertension . . . . . . . . . . . . . . . . . . 401 41,200 100.0 * * *33.3 *29.4 * *

Heart disease . . . . . . . . . .391–392.0,393–398,402,

404,410–416,420–429 229,200 100.0 *7.6 17.5 30.5 32.0 *6.8 *5.6

Cerebrovascular diseases . . . . . . . . . . . . .430–438 42,500 100.0 * * *26.9 *18.9 * *

Diseases of the respiratory system . . . . . . . . .460–519 229,400 100.0 *9.6 *17.0 26.8 32.4 *6.3 *6.9

Diseases of the digestive system . . . . . . . . . .520–579 65,900 100.0 * * *24.0 33.7 * *

Diseases of the genitourinary system . . . . . . .580–629 67,900 100.0 * * 28.9 43.9 * *

Diseases of the skin and subcutaneous tissue. .680–709 34,000 100.0 * * * 31.1 * *

Diseases of the musculoskeletal system and

connective tissue . . . . . . . . . . . . . . . . . . 710–739 104,500 100.0 *20.1 *23.7 21.3 20.9 * *

Congenital anomalies . . . . . . . . . . . . . . . . .740–759 * * – - – * – *

Symptoms, signs, and ill-defined conditions . . .780–799 115,800 100.0 *10.8 *24.3 19.5 27.9 * *10.7

Injury and poisoning . . . . . . . . . . . . . . . . . .800–999 215,500 100.0 24.2 29.0 14.3 18.9 *7.0 *6.6

Supplementary classification. . . . . . . . . . . . V01–V82 161,200 100.0 21.5 27.5 10.4 17.9 10.8 11.7

* Data do not meet standard of reliability or precision (sample size is less than 30) and are therefore not reported. If shown with a number, it should not be assumed reliable because the sample

size is between 30–59 or the sample size is greater than 59 but has a relative standard error over 30 percent.

– Quantity zero.

1Based on the International Classification of Diseases, 9th Revision, Clinical Modification (8). 2Excludes unknown.

NOTES: Numbers may not add to total because of rounding. Percents are based on unrounded figures.

8 Advance Data No. 312 + April 25, 2000
2. McCullough LB, Wilson NL, eds.

Long-term care decisions ethical and

conceptual dimensions. In: Wilson

NL eds. Long-term care in the

United States: An overview of the

current system. Baltimore: The Johns

Hopkins University Press, 35–59.

1995.

3. Wallace RB, Woolson RF. The

epidemiologic study of the elderly.

In: Foley DJ, eds. Epidemiologic

research on nursing home

populations. New York: Oxford

University Press, 234–241. 1992.

4. Williams ME. The American

Geriatrics Society’s complete guide

to aging and health. New York, New

York: Harmony Books. 1995.

5. National Center for Health Statistics:

Development and maintenance of a

national inventory of hospitals and

institutions. Vital and Health

Statistics 1(3):6–13. 1965.

6. Hing E, Sekscenski E, Strahn G. The

National Nursing Home Survey:

1985 Summary for the United States.

National Center for Health Statistics.

Vital Health Stat 13 (97). 1989.

7. Hazzard WR, Blass JP, Ettinger WH

Jr, Halter JB, Ouslander JG, eds.

Principles of geriatric medicine and

gerontology. In: Ouslander JG,

Schnelle JF. Nursing home care. 4th

edition. New York: McGraw-Hill,

509–528. 1999.

8. Public Health Service and Health

Care Financing Administration.

International Classification of

Diseases, 9th Revision, Clinical

Modification, 4th ed. Washington:

Public Health Service. 1991.

10.2

19

27.1

28.3

7.5

7.6

8.4

16.9

28.3

29.8

8.7

7.7

11.1

20.2

26.4

27.6

6.9

7.6

Recovered

Reason for discharge

Stabilized

Deceased

Admitted to

hospital

Admitted to

nursing home

Other

Percent of nursing home discharges

0 5 10 15 20 25 30 35

Both sexes Male Female

Figure 1. Percent distribution of elderly nursing home discharges by reason for discharge

and sex: United States, October 1996–September 1997

60.4

54.9

729

392.1

126.4

78.2

Recovered

Stabilized

Deceased

Admitted to

hospital

Admitted to

nursing home

Other

Reason for discharge

0 200 400 600 800 1000

Average length of stay in days

Figure 2. Average length of stay of elderly nursing home discharges by reason for

discharge: United States, October 1996–September 1997

Advance Data No. 312 + April 25, 2000 9
Table 11. Number and percent distribution of elderly nursing home discharges 65 years and over by selected facility characteristics,

according to sex: United States, October 1996–September 1997

Facility characteristic

Both

sexes Male Female

Both

sexes Male Female

Number Percent distribution

Total............................ 2,100,800 723,800 1,377,000 100.0 100.0 100.0

Ownership

Proprietary........................ 1,390,900 501,800 889,000 66.2 69.3 64.6

Voluntary nonprofit. . . . . . . . . . . . . . . . . . . 607,900 187,600 420,300 28.9 25.9 30.5

Government and other ................ 102,000 34,300 67,700 4.9 4.7 4.9

Certification

Certified by Medicare and Medicaid ........ 1,803,100 643,400 1,159,800 85.8 88.9 84.2

Certified by Medicare only .............. 181,900 45,700 136,200 8.7 6.3 9.9

Certified by Medicaid only .............. 89,000 26,100 62,900 4.2 3.6 4.6

Not certified . . . . . . . . . . . . . . . . . . . . . . . 26,800 *8,600 18,200 1.3 *1.2 1.3

Bed size

Less than 50 beds ................... 230,500 *58,100 172,300 11.0 *8.0 12.5

50–99 beds ....................... 464,600 179,400 285,300 22.1 24.8 20.7

100–199 beds...................... 1,094,500 375,000 719,500 52.1 51.8 52.3

200 beds or more . . . . . . . . . . . . . . . . . . . 311,200 111,300 199,900 14.8 15.4 14.5

Census region

Northeast ........................ 386,700 125,700 261,000 18.4 17.4 19.0

Midwest ......................... 599,200 180,900 418,300 28.5 25.0 30.4

South ........................... 634,300 232,100 402,300 30.2 32.1 29.2

West . . . . . . . . . . . . . . . . . . . . . . . . . . . 480,500 185,100 295,500 22.9 25.6 21.5

Metropolitan Statistical Area (MSA)

MSA . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,600,100 554,200 1,045,900 76.2 76.6 76.0

Not MSA . . . . . . . . . . . . . . . . . . . . . . . . . 500,700 169,600 331,100 23.8 23.4 24.1

Affiliation1

Chain ........................... 1,287,000 460,800 826,200 61.3 63.7 60.0

Independent ....................... 805,100 259,900 545,200 38.3 35.9 39.6

* Data should not be assumed reliable because the sample size is between 30–59 or the sample size is greater than 59 but has a relative standard error over 30 percent. 1Excludes unknown.

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

10 Advance Data No. 312 + April 25, 2000
Table 12. Number and percent distribution of elderly nursing home discharges 65 years and over by selected demographic

characteristics, according to sex: United States, October 1996–September 1997

Both

sexes Male Female

Both

sexes Male Female

Number Percent distribution

Total............................ 2,100,800 723,800 1,377,000 100.0 100.0 100.0

Age

65–74 years ....................... 406,000 164,900 241,200 19.3 22.8 17.5

75–84 years ....................... 836,100 318,600 517,600 39.8 44.0 37.6

85 years and over ................... 858,600 240,300 618,300 40.9 33.2 44.9

Race

White ........................... 1,864,300 631,200 1,233,100 88.7 87.2 89.6

Black ........................... 147,400 61,700 85,600 7.0 8.5 6.2

Other ........................... 48,100 *15,300 *32,800 2.3 *2.1 *2.4

Unknown......................... 41,100 * 25,500 2.0 * 1.9

Hispanic origin

Hispanic ......................... 66,500 32,900 33,700 3.2 4.5 2.4

Non-Hispanic ...................... 1,810,600 617,400 1,193,200 86.2 85.3 86.7

Unknown......................... 223,600 73,500 150,100 10.6 10.2 10.9

Marital status

Married .......................... 550,300 343,100 207,200 26.2 47.4 15.1

Widowed ......................... 1,191,300 219,900 971,500 56.7 30.4 70.6

Divorced/separated .................. 122,400 49,800 72,700 5.8 6.9 5.3

Never married/single.................. 194,900 94,900 100,000 9.3 13.1 7.3

Unknown......................... 41,900 *16,200 25,700 2.0 *2.2 1.9

Living arrangement prior to admission

Private residence.................... 512,700 176,000 336,700 24.4 24.3 24.5

Retirement home.................... 40,300 * 28,500 1.9 * 2.1

Board and care/residential facility.......... 55,800 19,200 36,600 2.7 2.7 2.7

Nursing home ...................... 143,500 40,600 102,800 6.8 5.6 7.5

Hospital ......................... 1,280,900 448,200 832,800 61.0 61.9 60.5

Mental health facility.................. *7,600 * * *0.4 * *

Other or unknown ................... 60,000 25,300 34,600 2.9 3.5 2.5

* Data do not meet standard reliability or precision (sample size less than 30) and are therefore not reported. If asterisk precedes a number, data should not be assumed reliable because the

sample size is between 30–59 or the sample size is greater than 59 but has a relative standard error over 30 percent.

NOTES: Numbers may not add to totals because of rounding. Percents are based on the unrounded figures.

Advance Data No. 312 + April 25, 2000 11
Table 13. Number and percent of elderly nursing home discharges 65 years and over by use of selected aids, continence, vision and

hearing status, and sex: United States, October 1996–September 1997

Functional status

Both

sexes Male Female

Both

sexes Male Female

Number Percent

Total............................ 2,100,800 723,800 1,377,000 100.0 100.0 100.0

Aids used

Glasses ......................... 1,365,600 445,200 920,400 65.0 61.5 66.8

Hearing aid ....................... 235,200 79,200 156,000 11.2 11.0 11.3

Transfer equipment .................. 830,400 266,800 563,700 39.5 36.9 40.9

Wheelchair........................ 213,100 82,800 130,300 10.1 11.4 9.5

Cane ........................... 1,137,000 400,300 736,700 54.1 55.3 53.5

Walker .......................... 144,100 50,000 94,100 6.9 6.9 6.8

Brace (any type) .................... * * * * * *

Oxygen.......................... 64,100 *18,300 45,800 3.1 *2.5 3.3

Commode ........................ 373,400 145,900 227,500 17.8 20.2 16.5

Other aids or devices ................. 807,900 237,200 570,600 38.5 32.8 41.4

Continence status

Difficulty controlling both bowels and bladder . . 683,200 237,900 445,400 32.5 32.9 32.3

Difficulty controlling bowels.............. *17,400 * *9,900 *0.8 * *0.7

Difficulty controlling bladder ............. 177,000 69,200 107,800 8.4 9.6 7.8

Vision

Not impaired ...................... 1,398,800 496,300 902,500 66.6 68.6 65.5

Impaired ......................... 479,200 149,500 329,600 22.8 20.7 23.9

Unknown1 ........................ 222,900 78,000 144,900 10.6 10.8 10.5

Hearing

Not impaired ...................... 1,436,600 479,100 957,500 68.4 66.2 69.5

Impaired ......................... 415,400 158,000 257,300 19.8 21.8 18.7

Unknown1 ........................ 248,900 86,700 162,200 11.9 12.0 11.8

* Data should not be assumed reliable because the sample size is between 30–59 or the sample size is greater than 59 but has a relative standard error over 30 percent. 1Includes those for who status could not be determined (e.g., comatose patients)

NOTES: Numbers may not add to totals because of rounding. Percents are based on the unrounded figures.

12 Advance Data No. 312 + April 25, 2000
Table 14. Number and percent of elderly nursing home discharges 65 years and over by dependency in activities of daily living and

instrumental activities of daily living and sex: United States, October 1996–September 1997

Functional status

Both

sexes Male Female

Both

sexes Male Female

Number Percent

Total............................ 2,100,800 723,800 1,377,000 100.0 100.0 100.0

Received assistance with ADL’s1

Bathing or showering ................. 1,944,000 673,600 1,270,500 92.5 93.1 92.3

Dressing ......................... 1,797,600 629,500 1,168,100 85.6 87.0 84.8

Eating........................... 975,100 349,900 625,200 46.4 48.4 45.4

Transferring in or out of bed or chair........ 674,000 227,900 446,100 32.1 31.5 32.4

Using toilet room .................... 1,104,400 379,500 724,900 52.6 52.4 52.6

Number of dependencies in ADL’s1

None ........................... 98,500 29,900 68,600 4.7 4.2 5.0

1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107,100 32,700 74,400 5.1 4.5 5.4

2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284,100 96,600 187,600 13.6 13.4 13.7

3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 764,600 268,000 496,600 36.5 37.2 36.2

4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 667,100 236,500 430,600 31.9 32.8 31.4

5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171,500 56,900 114,600 8.2 7.9 8.4

Received assistance with IADL’s1

Care of personal possessions ............ 1,387,300 471,400 915,900 66.0 65.1 66.5

Managing money .................... 1,242,800 409,900 832,900 59.2 56.6 60.5

Securing personal items ............... 1,376,600 475,000 901,600 65.5 65.6 65.5

Using telephone .................... 1,040,700 362,700 678,000 49.5 50.1 49.2

Number of dependencies in IADL’s1

None ........................... 459,900 158,900 301,000 23.1 23.3 23.0

1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142,500 54,500 88,000 7.2 8.0 6.7

2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174,600 63,200 111,400 8.8 9.3 8.5

3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298,500 85,500 212,900 15.0 12.5 16.3

4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 915,100 320,400 594,600 46.0 47.0 45.5

1ADL is activities of daily living, and IADL is instrumental activities of daily living.

NOTES: Numbers may not add to totals because of rounding. Percents are based on the unrounded figures.

Advance Data No. 312 + April 25, 2000 13
Table 15. Number and percent distribution of elderly nursing home discharges 65 years and over by primary diagnosis at admission,

according to sex: United States, October 1996–September 1997

Primary diagnosis at admission and ICD–9–CM Code1

Both

sexes Male Female

Both

sexes Male Female

Number Percent distribution

Total............................................. 2,100,800 723,800 1,377,000 100.0 100.0 100.0

Infectious and parasitic diseases .......................1–139 *15,100 * * *0.7 * *

Neoplasms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140–239 124,600 61,400 63,300 5.9 8.5 4.6

Malignant neoplasms . . . . . . . . . . . . . . . . . . . . . . 140–208,230–234 114,600 53,500 61,000 5.5 7.4 4.4

Endocrine, nutritional, and metabolic diseases and

immunity disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .240–279 109,000 40,700 68,300 5.2 5.6 5.0

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 69,700 23,000 46,700 3.3 3.2 3.4

Diseases of the blood and blood-forming organs . . . . . . . . . . . .280–289 *17,800 * *11,200 *0.9 * *0.8

Mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .290–319 147,800 50,600 97,200 7.0 7.0 7.1

Diseases of the nervous system and sense organs. . . . . . . . . . .320–389 155,200 59,900 95,300 7.4 8.3 6.9

Diseases of the circulatory system . . . . . . . . . . . . . . . . . . . . .390–459 536,200 188,500 347,700 25.5 26.0 25.3

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401 41,200 *9,600 31,700 2.0 *1.3 2.3

Heart disease . . . . . . . .391–392.0,393–398,402,404,410–416,420–429 229,200 69,500 159,700 10.9 9.6 11.6

Cerebrovascular diseases . . . . . . . . . . . . . . . . . . . . . . . . .430–438 42,500 *14,100 28,400 2.0 *2.0 2.1

Diseases of the respiratory system . . . . . . . . . . . . . . . . . . . . .460–519 229,400 90,500 138,900 10.9 12.5 10.1

Chronic obstructive pulmonary disease . . . . . . . . . . . . . . . . .494–496 54,700 19,800 34,900 2.6 2.7 2.5

Diseases of the digestive system . . . . . . . . . . . . . . . . . . . . . .520–597 65,900 *18,900 47,000 3.1 *2.6 3.4

Diseases of the genitourinary system . . . . . . . . . . . . . . . . . . .580–629 67,900 25,600 42,300 3.2 3.5 3.1

Diseases of the skin and subcutaneous tissue. . . . . . . . . . . . . .680–709 34,000 *19,800 *14,200 1.6 *2.7 *1.0

Diseases of the musculoskeletal system and connective tissue . . .710–739 104,500 18,900 85,700 5.0 2.6 6.2

Congenital anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . .740–759 * * * * * *

Symptoms, signs, and ill-defined conditions . . . . . . . . . . . . . . .780–799 115,800 45,800 70,000 5.5 6.3 5.1

Injury and poisonings . . . . . . . . . . . . . . . . . . . . . . . . . . . . .800–999 215,500 37,800 177,700 10.3 5.2 12.9

Supplementary classification and unknown . . . . . . . . . . . . . V01–V82, 00 161,200 51,500 109,700 7.7 7.1 8.0

* Data do not meet standard of reliability or precision (sample size less than 30) and are therefore not reported. If shown with a number, data should not be assumed reliable because the sample

size is between 30–59 or the sample size is greater than 59 but has a relative standard error over 30 percent. 1Based on the International Classification of Diseases, 9th Revision, Clinical Modification (8).

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

Table 16. Number and percent of elderly nursing home discharges 65 years and over by services received during the billing period that

included date of discharge, and sex: United States, October 1996–September 1997

Service received

Both

sexes Male Female

Both

sexes Male Female

Number Percent

Total............................ 2,100,800 723,800 1,377,000 100.0 100.0 100.0

Dental care ....................... 190,200 63,300 126,900 9.1 8.8 9.2

Equipment or devices ................. 1,210,300 415,400 794,900 57.6 57.4 57.7

Medical services .................... 1,973,300 684,000 1,289,400 93.9 94.5 93.6

Mental health services ................ 241,500 82,900 158,600 11.5 11.5 11.5

Nursing services .................... 2,052,800 711,000 1,341,800 97.7 98.2 97.5

Nutritional services................... 1,618,200 553,100 1,065,100 77.0 76.4 77.4

Occupational therapy ................. 832,000 297,200 534,800 39.6 41.1 38.8

Personal care ...................... 1,876,700 647,400 1,229,300 89.3 89.4 89.3

Physical therapy .................... 1,067,200 371,600 695,600 50.8 51.3 50.5

Prescribed or nonprescribed medicines ...... 1,940,700 667,600 1,273,100 92.4 92.2 92.5

Social services ..................... 1,558,900 527,200 1,031,700 74.2 72.8 74.9

Speech or hearing therapy .............. 240,000 113,100 126,900 11.4 15.6 9.2

Transportation...................... 358,800 136,100 222,700 17.1 18.8 16.2

Other services ..................... 360,700 131,600 229,200 17.2 18.2 16.6

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

14 Advance Data No. 312 + April 25, 2000
Table 17. Number and standard error of elderly nursing home discharges 65 years and over by average and median length of stay, age,

marital status, race, and sex: United States, October 1996–September 1997

Demographic characteristics

Both

sexes

Standard

error Male

Standard

error Female

Standard

error

Total............................ 2,100,800 . . . 723,800 . . . 1,377,000 . . .

Number in days

Average length of stay in days . . . . . . . . . . . 290 15.3 215 15.0 329 19.5

Median length of stay in days . . . . . . . . . . . . 63 51 69

Age

65–74 years . . . . . . . . . . . . . . . . . . . . . . . 146 14.4 153 18.8 142 19.3

75–84 years . . . . . . . . . . . . . . . . . . . . . . . 233 17.2 219 26.4 242 20.6

85 years and over . . . . . . . . . . . . . . . . . . . 413 24.7 254 23.0 475 30.9

Marital status

Married . . . . . . . . . . . . . . . . . . . . . . . . . . 168 12.6 152 14.1 195 22.5

Widowed . . . . . . . . . . . . . . . . . . . . . . . . . 323 19.6 243 21.6 341 22.7

Divorced/separated . . . . . . . . . . . . . . . . . . 347 47.5 367 73.7 333 61.8

Never married/single. . . . . . . . . . . . . . . . . . 424 53.7 312 57.9 530 83.3

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . 297 16.0 214 15.0 340 20.6

Black and other. . . . . . . . . . . . . . . . . . . . . 265 34.2 263 43.1 266 41.9

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . 304 33.1 268 41.8 331 45.8

. . . Category not applicable.

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

Table 18. Number and percent distribution of elderly nursing home discharges 65 years and over by their primary source of payment at

the time of discharge, according to sex: United States, October 1996–September 1997

Source of payment

Both

sexes Male Female

Both

sexes Male Female

Number Percent distribution

Total............................... 2,100,800 723,800 1,377,000 100.0 100.0 100.0

Private insurance, own income, family support1 .... 441,600 142,900 298,700 21.0 19.8 21.7

Medicare ............................ 1,053,700 378,100 675,600 50.2 52.2 49.1

Medicaid ............................ 526,000 161,100 364,800 25.0 22.3 26.5

Government assistance, charity, and other2 ...... 55,500 32,800 *22,700 2.6 4.5 *1.7

Unknown............................ 24,000 * *15,200 1.1 * *1.1

* Figure does not meet standard of reliability or precision.

1Includes social security benefits, retirement funds. 2Includes supplemental security income, welfare, religious organizations, foundations, agencies, VA contract, pensions, or other compensation, payment source not yet determined, and other.

Advance Data No. 312 + April 25, 2000 15
Suggested citation

Gabrel CS. Characteristics of elderly nursing

home current residents and discharges: Data

from the 1997 National Nursing Home Survey.

Advance data from vital and health statistics;

no. 312. Hyattsville, Maryland: National Center

for Health Statistics. 2000.

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source, however, is appreciated.

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16 Advance Data No. 312 + April 25, 2000

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