Data from the Series 12 

NATIONAL HEALTH SURVEY Number 24 

Measuresof 

ChronicIllness 

AmongResidentsof 

Nursingand PersonalCareHomes 

UnitedStates,June-August1969 

Statistics on number of chronic conditions and impairments, mobility 

status, primary type of service, level of patient care, and number and types 

of special aids used. Comparisons made with data collected in May-June 

1964. Based on data collected from a national survey of institutions during 

the period June-August 1969. 

DHEW Publication No. (HRA) 75-1709 

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE 

Public Health Service 

Health Resources Administration 

National Center for Health Statistics 

Rockville, Maryland 
Library of Congress Cataloging in Publication Data 

Measures of chronic illness among residents of nursing and personal care homes: United 

States: June-August 1969. 

(National Center for Health Statistics. Vital and health statistics. Series 12: Data from the 

National Health Survey, no. 24) (DHEW publication no. (HRA) 74-l 709) 

Supt. of Dots. no.: HE 20.2210: 12/24. 

Includes bibliographical references. 

1. Chronic diseases-United States-Statistics. 2. Nursing homes-United States-Statistics. 

I. Title. II. Series: United States. National Center for Health Statistics. Vital and health statistics. Series: 12: Data form the National Health Survey. Data from the institutional population surveys, no. 24. III. Series: United States. Dept. of Health, Education, and Welfare. 

DHEW publication no. (HRA) 74-1709. [DNLM: 1. Chronic disease-Occurrence-U.S. 

2.. Nursing homes--U.S.-Statistics. 3. Personal health services-U.S.-Statistics. 4. Residential 

facilities--U.S.-Statistics. W2A N148vL no. 24 19741 

RA407.3.,4348 no. 24 [RA408.A3] 362.1’1’0973s 

ISBN O-8406-0012-7 [362.1’6’0973] 74-4190 

Vital and Health Statistics-Series l2-No. 24 

First issued as DHEW Publication No. (HRA) 74-1709 

March 1974 
NATIONAL CENTER FOR HEALTH STATISTICS 

EDWARD B. PERRlN, Ph.D., l)irector 

PHILIP S. LAWRENCE, Sc.D., Deputy Director 

JACOB J. FELDMAN, Ph.D., Acting Associate Directorfor Analysis 

GAIL F. FISHER, Associate Director for the Cooperative Health Statistics System 

ELIJAH L. WHITE, Associate Directorfor Data Systems 

IWAO M. MORIYAMA, Ph.D., Associate Directorfor Internationd Statistics 

EDWARD E. MINTY, Associate Director for Management 

ROBERT A. ISRAEL, Associate Director for Operations 

QUENTIN R. REMEIN, Associate Director for Program Development 

PHILIP S. LAWRENCE, Sc.D., Acting Associate Directorfor Research 

ALICE HAYWOOD, Information Ofjker 

COOPERATION OF THE BUREAU OF THE CENSUS 

Under the legislation establishing the National Health Survey, 

the Public Health Service is authorized to use, insofar as possible, 

the services or facilities of other Federal, State, or private agencies. 

In accordance with specifications established by the National 

Center for Health Statistics, the Bureau of the Census, under a 

contractual arrangement, participated in planning the survey and 

collecting the data. 

Library of Congress Catalog Card Number 74-41 PO 
CONTENTS 

The Survey ................................... 

An Overview ................................. 

Scope .................................... 

Sources and Qualifications of Data ..................... 

The PopuIation ................................. 

Age ..................................... 

Sex ..................................... 

Color .................................... 

Marital Status ................................ 

Health Status .................................. 

Number of Chronic Conditions and Impairments .............. 

Mobility Status ............................... 

Mobility Status and Number of Conditions ................. 

Health Status and Health Services ....................... 

Primary Type of Service ........................... 

Level of Patient Care ............................ 

Special Aids Used .............................. 

Health Status: A Comparison Between the Resident PopuIations of 

1964 and 1969 ................................ 

Comparison of Demographic Profiles .................... 

Comparison of Health Profiles ........................ 

References ................................... 

List of Detailed Tables ............................. 

Appendix I. TechnicaI Notes on Methods .................. 

Survey Design ................................ 

General Qualifications ............................ 

Appendix II. Definitions of Certain Terms Used in This Report ....... 

Demographic Terms ............................. 

Terms Relating to Health Status ....................... 

Levels of Nursing or Personal Care ..................... 

Special Aid ................................. 

Classification of Homes by Type of Service ................. 

Page 

1 

1 

2 

4 

8 

8 

10 

14 

15 

16 

18 

22 

27 

28 

29 

33 

34 

48 

48 

50 

52 

52 

52 

52 

53 

53 

iii 
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CONTENTS-Con. 

Page 

Appendix III. Resident Places Survey-3 Forms and Questionnaires 

Introductory Letter ............................. 

...... 55 

55 

Facility Questionnaire ............................. 56 

Administrator Questionnaire ........................ 58 

Staff Questionnaire ............................. zg 

Staff and Information Control Record ................... 

List of Selected Job Categories ....................... 

Current Patient Questionnaire ........................ 

63 

64 

SYMBOLS 

Data not available ________________________________________ 

Category not applicable _______c_______________________ . . . 

Quantity zero ________________________________________------

Quantity more than 0 but less than 0.05----- 0.0 

Figure does not meet standards of 

reliability or precision ________-_____________________ * 

iv 
MEASURES OF CHRONIC ILLNESS 

AMONG RESIDENTS OF NURSING AND PERSONAL CARE HOMES 

Donald K. Ingram, Diuision of Health Resources Statistics 

THE SURVEY 

An Overview 

“Companions of the aged” exemplifies the 

significant role that chronic health problems 

play in the lives of older Americans. Old age and 

chronic illness have become almost synonymous. 

It is the lack of ability to cope with the wide 

range of chronic illnesses at home which has created the great demand for the services provided 

in nursing and personal care homes; the residents 

of these institutions have thus been traditionally 

characterized as a population among which these 

problems are highly prevalent. 

About 4 percent of the total civilian population aged 6.5 years and over resided in the Nation’s 18,390 nursing and personal care homes 

during June-August 1969. The total number of 

residents was estimated at 815,130, of which 89 

percent were 65 and over. This institutionalized 

population is being studied here to update the 

extent and some of the effects and implications 

of chronic health problems among its members. 

The data to be analyzed represent the product 

of a survey that sampled those establishments 

providing care to the aged and chronically ill in 

the United States. In cooperation with the U.S. 

Bureau of the Census, the Division of Health 

Resources Statistics undertook the study, referred to as the Resident Places Survey-3 

(RPS-3), during J une-August 1969. The RPS-3 

represented one in a series of multiple-purpose 

surveys of these particular instituti0ns.l It was 

preceded by RPS-1, conducted April-June 1963, 

and RPS-2, conducted May-June 1964. Each of 

these surveys has attempted to provide basic, 

statistical information about the nature and evolution of this segment of the Nation’s health 

care system. The RPS-3 approach to the study 

of health and chronic illness in nursing and personal care homes was highlighted against two significant backdrops. 

First, the prevalence of chronic illness among 

older Americans in general provided a striking 

statistical backdrop. It appeared that chronic 

health problems among older, noninstitutionalized persons had reached pandemic proportions, as seen through the Health Interview 

Survey.z Six of every seven persons aged 65 and 

over in the country were estimated to have at 

least one chronic condition. The number of individual cases of chronic illness in 1967 exceeded 

50 million for 15 million individuals, an average 

of 2.8 conditions per person aged 65 years and 

over, or 3.3 per person when counting only 

those with chronic conditions. 

Also striking were the statistics reflecting the 

impact of chronic illness on persons living outside institutions. Nearly half of those with 

chronic health problems suffered some limitations of activity at these ages, e.g., one of every 

1 
six persons was unable to work or keep house. 

Correspondingly, the ability to get about freely 

was also affected when a chronic condition existed. About one of every five persons 65 years 

and over has been reported to endure some type 

of chronic mobility limitation. 

From the more positive perspective, it should 

be noted that, although most older Americans 

have chronic conditions, a substantial proportion of those living outside institutions are not 

limited in activity or mobility and are able to 

conduct their daily lives unhampered to any 

great extent by their chronic ailments. Less fortunate, however, are those who, as their age 

progresses and the severity of their conditions 

possibly intensifies, are confronted with the 

many problems involved in determining if they 

should leave a domestic environment and enter 

an institution. 

Providing the second backdrop to this report, 

the question then is one of the policy affecting 

the institutionalization of chronically ill persons. 

The RPS-3 was concerned with what is apparently one of the fastest growing segments of the 

country’s health care. system. Since RPS-2, the 

advent of Medicare has apparently provided a 

considerable impetus to the development of new 

nursing care facilities. The number of nursing 

and personal care homes increased over 5 percent during the period between the two surveys; 

the number of residents increased much more 

sharply at near 50 percent. 

Even with this tremendous growth, however, 

the number of older persons in these institutions 

was still apparently less than the number of persons receiving health-related care at home. As 

reported by the Health Interview Survey, about 

1.7 million persons (about 5 percent of the civilian, noninstitutionalized population aged 55 and 

over) were receiving personal assistance or personal services at home as a result of illness, injury, impairment, or advanced age. Although 

personal care represented the bulk of services 

received, medically related care accounted for 

over one-fourth of all the services rendered, and 

the services of a registered nurse accounted for 

about one-fourteenth.3 The availability of care 

at home is, of course, one of the main contributory factors in determining whether the older, 

chronically ill person enters a nursing home. 

Other factors would include the severity of the 

condition (hence the need of the services), the 

availability of the services, and the ability to pay 

for them. 

These factors and others have interacted in 

spotlighting the role of these institutions within 

the health care system. Increasingly, attention is 

being focused on the role of the nursing home as 

the primary provider of care to the chronically 

ill and infirm. From the traditional concept of 

an “old folks’ home” for the aged, indigent, and 

unwanted to the newly intended concept of a 

medical facility equipped to handle a multiplicity of chronic health problems and to provide a variety of medical, personal, and rehabilitative services, the transition and changing 

character of these institutions have been vital to 

the process of revamping their status in the delivery system. Intended is an interfacing of their 

role into the gap between the time the person 

requires hospitalization and the time the person 

is completely ambulatory. Although this report 

focuses primarily on the older residents and 

their chronic ailments, it also shows that nursing 

homes do not provide care for the aged exclusively. Approximately 11 percent of all residents 

were under 65 years of age. In addition, the intended transition may be represented in the designation for all homes certified for Medicare 

sponsorship. The inclusive term “extended care 

facility” illustrates the new medical scope of 

many of these institutions-comprehensive medical care; management; and rehabilitation for the 

chronically ill, impaired, and convalescent. It 

should be noted, however, that the term does 

not apply to all facilities studied in this report. 

As shown in table A, many are personal care 

homes offering limited or no nursing care 

services. 

Scope 

This report attempts to summarize the general 

health @tus of residents in nursing and personal 

care homes based on the survey data. Chronic 

health problems provide the principal focus for 

an analysis involving residents of these institutions; consequently, health has been examined 

through several indexes as a synthesis of the 

problems resulting from chronic illness. First, 

the prevalence of chronic conditions and impairments is used to reflect the extent of chronic 

2 
Table A. Selected data on nursing and personal care homes and their residents, by primary type of service: United States, 

June-August 1969 

~ Ratio of Ratio of 

Ratio of all other married 

males residents residents Primary type of service Institutions Residents Males Females 

per 100 per100 per 100 

females white other 

residents residents 

-INumber 

Median age in 

years 

Alltypes........................ 18,390 1 815,100 79.71 I 81.9 15 

Percent distribution 

Nursing care . . . . . . . . . . . . . . . . . . . . . . . . . . 63 78 79.1 82.0 17 

Personal care with nursing . . . . . . . . . . . . . . . . . 20 17 77.8 82.3 12 

Personal care . _ . . . . . . . . . . . . . . . _ . . . . . . . 17 5 75.0 78.1 6 

illness in the population. (A subsequent report 

will examine in detail the specific chronic diseases and impairments reported on in the 

RPS-3.) Second, the effect of chronic health 

problems is examined through the mobility status of the residents, or their ability to move 

about freely. Third, the implications of chronic 

illness are studied through an analysis of the 

health services available and received. Factors 

such as the type of service available in the facility, the level of patient care received, the number and types of special aids employed are used 

as indexes of health services relative to the care 

of chronic health problems. 

For further purposes of this report, the number of chronic conditions and impairments is to 

serve as a major indicator of the general health 

status of the nursing home population. The 

mean number of conditions per resident has 

been used as an index to measure the departure 

from health; consequently, this one variable has 

been analyzed in great detail to determine its 

relationship to patient and other health 

variables. 

The analysis to be presented closely parallels 

that of an RPM report on chronic illness.4 The 

feasibility of applying a crude index of chronic 

illness to the nursing home population gained 

significant credibility from several findings in 

that study. It was demonstrated that the residents’ mobility, or the freedom to move about, 

was affected to a great degree by the number of 

chronic conditions present. This relationship was 

again markedly expressed in the RPS-3 population. Of the residents with two conditions or 

less, only about 12 percent were bedridden as 

compared with the estimated 33 percent with 

more than two conditions. In addition, the number of conditions reported in RPS-2 was related 

to the interval since the resident last saw a doctor while in the home. These data were not collected in the survey reported here, but the relationship between the increased number of 

physician visits and the increased number of 

conditions in the 1964 study also gives added 

support to the reliability of using the chronic 

illness index as a measure of the level of health. 

In at least one other study, the number of diagnosed illnesses among older persons has also 

been found as the most significant factor affecting the rate of use of medical services.5 

Other findings in the RPS-2 showed that residents of homes providing nursing care and residents who actually received intense levels of 

nursing care had a greater prevalence of chronic 

illness than persons in other types of homes and 

persons who received only personal care.6 These 

relationships were also confirmed in the RPS-3 

results. Another finding that was related to the 

increased number of chronic conditions and confirmed in this study was the increased likelihood 

that special aids, including eyeglasses, hearing 

aids, and more particularly orthopedic aids were 

used.7 

3 
In the noninstitutionalized population, many 

of the same general relationships are seen when 

the average number of conditions is applied as a 

measure of health. According to data from the 

Health Interview Survey, as the number of 

conditions per person increases, so does the 

degree of severity of activity limitations and the 

extent of mobility limitation among persons 

affected by chronic illness.* 

It was therefore assumed that the number of 

chronic conditions and impairments could yield 

an easily applicable and reliable index of health 

status in the nursing home population. Chronic 

illness is reported as a quantifiable entity related 

to the negative component of health. The crude 

index applied here is certainly not to be compared with a complex, statistical model; but 

rather, in coordination with other measures of 

the effects of chronic illness, it is intended as a 

general summary of the state of health in the 

1969 nursing home population. In addition to 

the chronic illness index, the mobility status of 

the residents and the health services available 

and received are analyzed as they relate to such 

demographic characteristics of the residents as 

age, sex, color, and marital status. Comparisons 

between the health status of the RPS-2 and 

RPS-3 populations’ are also made since they can 

yield trend data revealing any significant changes 

following the advent of Medicare and Medicaid. 

SOURCES AND QUALIFICATIONS 

OF DATA 

Since information in this report is derived 

from a sample survey, the reader should be cognizant of certain qualifications involved. The 

three appendixes are intended to properly interpret the statistics presented. 

Appendix I contains a general description of 

the survey, the sample design used, and the survey procedures utilized. Imputation procedures, 

estimation techniques, and estimates of sampling 

variation are also described before directing the 

reader to the tables of standard errors. 

Definitions of the terms used in the report are 

presented in appendix II and are also essential 

for the interpretation of data. It should be particularly noted that the classification of establishments in the survey was based on the type of 

service provided in the home and on the availability of nursing care, rather than relying on 

what the home was called or how it was licensed 

in the State. Accordingly, since frequent reference is made to the term nursing home, it is 

important to note again that not all residents 

were in homes that supplied nursing care as defined in this study (table A). 

Facsimiles of the questionnaires and of the 

forms used to obtain the data presented in this 

report are shown in appendix III. In collecting 

information on chronic illness, the study fa. 

cused on conditions and impairments thought to 

have special significance for the aged population, 

rather than on determinations of the prevalence 

of all types of conditions and impairments. The 

conditions counted were obtained from the list 

in item 6 of the Current Patient Questionnaire 

and from items 12 and 13, pertaining to impairments in hearing and vision, respectively. 

All information concerning the resident’s 

state of health was obtained from proxy respondents available in the home, such as nurses 

or other personnel, who were thought to be the 

persons best acquainted with the resident’s general, medical condition. From personal knowledge of the residents and from the residents’ 

medical records, the respondents only reported 

the conditions listed in appendix III that the 

sample person had; therefore, every chronic condition or impairment that a resident had may 

not have been reported. Furthermore, although 

each category was counted as an exclusive event, 

there were multiple conditions listed in several 

of them. For the purposes at hand, this combination of several conditions was assumed to contribute to a resident’s ill health in a uniformly 

unique fashion. To reemphasize the line of reasoning employed, the conditions listed were 

those thought to be most relevant to the population under study and those the respondents 

could easily recognize. 

Acknowledged, too, are the limitations inherent to reporting the extremely elusive concepts 

basic to the present analysis. The concepts of 

health and indexes of health have been dealt 

with at length, too much to be encapsulated in 

this report; and yet uniform agreement has still 

not been achieved.8 

The negative component of health may be 

measured to an extent through mobility and disability statistics, as reported for the nursing 

home population; this method, however, fails to 

4 
assessthe positive element implicit in the definition of health offered by the World Health 

Organization.8 

Health is a state of complete physical, mental, and 

social well being and not merely the absence of disease and 

illness. 

The value of such a study among home residents is certaimy recognized. The extremely 

poor health condition of some residents, 

however, would make them unreliable respondents. Proxy respondents who actually care daily 

for the residents would be more reliable. An expert opinion based on clinical observation, examination, and/or testing of the individual is 

perhaps the most valid; but this approach could 

not be used here because of the obvious cost and 

logistics involved. Medical diagnoses from physical examinations were reported in RPS-3 and 

will be analyzed in a subsequent report; but 

they, too, have their qualifications. 

Another important limitation that must be 

acknowledged is implicit in the definition of 

chronic illness. This report refers to all chronic 

illnesses, diseases, problems, ailments, afflictions, and impairments as chronic condition, or, 

simply, condition. Consequently, a resident’s 

count of conditions may involve a number of 

varying or related diagnoses and may range in 

severity from a terminal breast cancer to simple 

loss of hearing. Whenever an attempt is made to 

measure these conditions and to quantify the 

problems they present, many difficulties are 

encountered. By their nature, chronic conditions are slow in onset, progress gradually, and 

may exist for months or years before death occurs. Many chronic illnesses can be medically 

controlled. Nearly all residents in nursing homes 

were found to have chronic health problems; yet 

apparently many of them, at the time of the 

survey, were not disabled to any great extent. 

Many, and at very advanced ages, moved about 

even without the aid of a wheelchair. In addition, diagnostic criteria are far from uniform. 

They vary greatly, depending on the needs of a 

particular study, so that comparisons between 

household and institutional surveys, for example, must be done in regard to these differing 

diagnostic criteria. No attempt was made to assess the degree of difference. Even if chronic 

diseases could have been measured at comparable levels of severity, in this report there 

would still exist the questions of which clinical 

measure of severity to employ, since they, too, 

vary with the disease in question8 The data 

analysis must be interpreted in the light of all 

the limitations presented by the definitions and 

by the statistical measures employed. 

As previously mentioned, the RPS-3 was a 

multiple-purpose survey to collect statistics on 

basic personal and health characteristics of residents, and on the services provided, the charges 

for the services, and the administrators and employees in the establishments which house them. 

Though this report is primarily concerned with 

the health of residents as indicated by the number of conditions, mobility status, and health 

services, additional reports from RPS-3 have 

been published which deal with other aspects of 

this sector of the health care system.g-11 

THE POPULATION 

A detailed analysis of the population’s demographic profiIe has been reported previous1y.l r 

Before examining the health status of the institutionalized population under study here, however, an overview of the population characteristics will provide some perspectives into factors 

affecting the utilization of these facilities. Projecting what has become the classic, demographic profile of nursing home residents, the 

profile of the 1969 population was again characterized as very aged, predominantly female 

and unmarried, and almost exclusively white 

(tables A and B). 

Age 

The skewness in the age distribution has traditionally been the identifying mark of the population. The median age of the residents in the 

1969 population was 81 years. There were more 

very aged residents than younger residents-12 

percent were 90 years and over as compared 

with 11 percent under age 65 and only about 2 

percent under age 45. The highest concentration 

of residents, however, was in the age group between 75 and 84 years, which accounted for approximately 40 percent of the population (table 

W 

5 
Table B. Number and percent distribution of residents in nursing and personal care homes by age, according to sex, color, and marital 

status: United States, June-August 1969 

Sex, color, and marital status 

Percent distribution 

All residents . . . . . . . . . . . . . . . . . . . . . . . . . . . 815,100 100 11 A 17.0 39.5 32.1 81 

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251,900 loo 17.8 20.8 36.0 25.5 79 

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5ssgoo 100 8.5 15.3 41 .o 35.1 82 

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 778,500 100 10.7 16.6 39.9 32.7 81 

All other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36,600 100 25.5 24.4 29.9 20.2 75 

Marital status 

Married .................................. 95800 100 13.2 22.9 45.0 18.9 79 

Widowed ................................. 518,200 100 3.3 13.7 43.1 39.9 83 

Divorcedseparated .......................... 34JOO 100 39.7 31.2 21.7 7.4 69 

Never married .............................. 167,000 100 29.7 21.2 28.6 20.6 75 

Some interesting comparisons may be drawn 

if the age distribution of the nursing home profile is related to the total civilian population. 

Approximately 7 of every 1,000 persons 20 

years and over were residents of nursing and personal care homes in 1969 (table C). At ages 65 

and over, this rate of residency, or the rate of 

institutionalization, increased to 36 per 1,000; 

that is, 1 of every 25 persons in this age group 

was a resident of a nursing or of a personal care 

home. The residency rate increased more than 

five times at age 85 and over to 203 per 1,000 

persons. At this advanced age, about one of 

every five persons was a resident of such an 

institution. 

Sex 

Women outnumbered men in the nursing 

home population by more than 2 to 1. Only 31 

percent of the nursing home members were 

male, compared with about 69 percent female. 

Comparing median ages, table B shows that 

women as a group were also older than men. The 

table also shows that there were proportionately 

twice as many males than females under 65 

years of age, but 10 percent more females than 

males were 85 years and over. 

Since the sex differential in life expectancy 

takes its toll in the older age group, there are, 

accordingly, more women than men aged 65 and 

over in the general population outside institutions. This comparison, however, is about 75 

men per 100 women; whereas, in the 1969 nursing home population, there were only 40 men 

per 100 women aged 65 and over. As table C 

indicates, a sex differential is definitely evident 

in the utilization of these facilities. The rate of 

institutionalization in nursing homes was higher 

among women, and it increased with age. 

Color 

Residents of the “all other” category (see appendix III) were much in the minority in the 

nursing home population. Only about 37,000 

persons in this category, 92 percent of whom 

were black, were estimated to.be residents’at the 

6 
Table C. Number of residents in nursing and personai care homes per 1,000 population 20 years and over, by age, sex, and color: 

United States, June-August 1969 

Sex Color 

Age Total 

Male Female White All other 

Number per 1,000 population 

All ages, 20 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.5 4.2 8.5 6.9 2.7 

2064years.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.9 0.9 0.9 0.9 0.8 

65-74 years . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . II.6 9.9 12.9 Il.7 9.6 

75-84years................................................. 51.7 36.0 62.3 54.1 259 

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203.2 130.8 247.6 221.9 52.4 

NOTE.-Source of population base estimates was U.S. Bureau of the Census, Current Population Reports, Esrimares of rhe 

Population of the United Stares by Age, Race, and Sex: July I, 1967, to July 1, 1969, Series P-25, No. 441, March 19, 1970. 

time of the survey. Over 95 percent of all 

residents were white. As a group, white residents 

were also older than all other residents. The 

median age of all other residents was 75 years 

compared with a median age of 81 for white 

residents (table B). 

There was also a disparity in the residency 

rates for white residents and all other residents 

(table C). The older (65 years and over) white 

population utilized these facilities twice as often 

as did the all other population. This color differential in residency rates is better than four times 

greater for ages’85 and over. 

Part of the explanation for the low utilization 

rates among persons other than white in the 

nursing home population may possibly be derived by comparing the proportions of white and 

all other persons in the general population who 

receive health-related personal care outside the 

institutions, or in the home. According to data 

from the Health Interview Survey, proportionately more persons other than white are receiving home care than are white persons. For 

the period July 1966~June 1968, about 4.7 percent of the white population 55 years and over 

and not in institutions reported receiving home 

care as compared with 7.2 percent of all other 

persons in the same age grou~.~ The availability 

of care at home and the ability to pay for institutional care have probably been interacting 

factors that have produced this disparity in the 

utilization of nursing homes. 

Marital Status 

Only about one of every eight residents in 

nursing and personal care homes was married at 

the time of the survey (table A). The great majority did not have spouses, most persons (twothirds) being widowed. Based on a previous 

RPS-3 report that presented data on marital 

status at the resident’s time of admission, it is 

apparent that at least 1 of every 10 persons married had become widowed since entering the 

nursing home. 1 r At the time of the survey, a 

small proportion (about 1 in 25) had dissolved 

their marriage through divorce or separation. 

And one of every five residents had never 

married. 

There were definite variations among the marital status groups when the ages of the residents 

were compared (table B). The median age of 

never-married residents was 74.6 years. More 

than half the population under 65 years comprised residents who had never married. Part of 

this group may have been younger, single persons in need of intensive, extended care; however, here, too, is indicated the tendency of 

older, single persons to seek care in these institutions at younger ages than do other persons because the care is less likely to be afforded 

through some kind of a familial environment in 

the home-l 2 Only about 13 percent of the persons who receive home care have been reported 

as living alone or with nonrelatives, while the 

7 
great majority (89 percent) of those receiving 

care at home were living with relatives.3 

The same factor is possibly involved in the 

small group of divorced or separated residents 

who had the lowest median age at 68.8 years, 

but the reasoning is not entirely clear. The marital status group most inconspicuous at the 

younger ages under 65 years were married residents, another factor indicating the role that the 

availability of home care plays in determining 

the decision to enter a nursing home. Additionally, there was only a small proportion of the 

widowed residents at the younger ages, while 

around four-fifths of the population 85 years 

and over had outlived their spouses and their 

potential source of care. In general, married residents were older than never-married residents, 

but younger than the widowed group. The median age for those with living spouses was 78.7 

years compared with 83.1 years for those whose 

spouses were deceased. 

HEALTH STATUS 

In this section, the analysis of the degree of ill 

health among residents in nursing and personal 

care homes is based on two primary measures 

available from the survey data. First, the prevalence of chronic conditions and impairments in 

the population is used as an index to measure 

the primary extent of chronic morbidity. 

Second, the impact of chronic illness, or the resultant disability, is analyzed as it pertains to 

mobility status, i.e., the resident’s ability to 

move about freely. Both indexes are examined 

in relation to personal variables-e.g., age, sex, 

color, and marital status-to conjecture various 

sociologic and epidemiologic factors interacting 

in demographic groupings of the nursing home 

population. Finally, an analysis describing how 

the number of conditions affects the residents’ 

mobility status is used to indicate the correlation between the number of conditions and 

the general health status of the population. 

(Refer to tables l-3.) 

Number of Conditions and Impairments 

Chronic health problems were not only highly 

prevalent in the nursing home population, affecting 98 percent of the residents, but they also 

occurred in combination. The estimated total 

number of chronic conditions and impairments 

was 2.8 million, with an average of 3.4 conditions for every resident. A combination of five 

conditions or more was reported for over 25 percent of the residents. 

For residents of all ages, a multiplicity of various conditions was the rule. Younger residents 

under 65 years had a mean of 2.5 conditions 

each, and residents over 85 years of age had on 

the average at least one more chronic condition 

or impairment than did the other age groups, the 

mean being 3.8 per person. Figure 1 shows the 

correlation between increased age and increased 

number of conditions. It is particularly evident 

when residents with five conditions or more are 

compared by age. Nearly a third of persons 85 

years and over had this strikingly high number 

of conditions, three times that of people under 

65. When nearly identical population groups 

with no evidence of chronic illness were compared by age, another fact remained clear; i.e., a 

resident of a nursing or personal care home was 

likely to have at least one chronic condition, no 

matter the age. 

The prevalence of chronic conditions also varied somewhat between male and female residents. Women had a slightly higher number of 

conditions than did men: 3.5 per female resident 

compared with 3.3 per male resident. Twotenths’ difference between the means indicates, 

however, that for comparable groups, women in 

nursing homes averaged an excess 7 percent in 

the number of conditions; i.e., for every five residents of each sex, women averaged at least one 

more condition than did men. Even this disparity had not been projected in the 1964 study 

when the mean for each sex was identical, computed at 3.1 conditions per resident. 

Although not analyzed thoroughly here, most 

of the variation between the sex means in the 

RPS-3 was probably largely caused by the differences in age between the 1964 and the 1969 

populations. Since RPS-2, the median age for 

females has increased by nearly 1% years and 

that for males has increased by less than half a 

year only. Even though the increased age of the 

female population must be acknowledged since 

it relates to increased exposure to chronic illness, there appears to persist a modest variation 

by sex even when age is considered. Men under 

65 years appear to average more conditions than 

8 
PERCENT DlSTRlBUTlON 

0 20 40 60 80 100 

AGE GROUP I I I I I I 

All ages 

Under 65 years 

Number of conditions 

Figure 1. Percent distribution of residents in nursing and personal care homes by number of chronic conditions and impairments, 

according to age. 

women of the same age. This disparity seems to 

reverse, however, at older ages, appearing most 

significant at the ages of 8.5 and over. These differences were statistically insignificant in the last 

survey, and they do not hold to significance testing in this one. It only suggests that, with the 

exception of residents under 65 years, women 

may tend to have more conditions on the average at every older age than men. 

Age Males Females 

Average number of conditions per resident 

All ages . . . 3.29 3.49 

Under 65 years . . 2.64 2.41 

65-74 years . . . . 3.24 3.27 

75-84 years . . . . 3.43 3.77 

85 years and over. 3.65 3.88 

Considering older persons in the general population, the sex differential in the prevalence of 

chronic conditions has been demonstrated repeatedly in several classic and several current 

surveys of chronic illness.’ 3-1 8 The most current Health Interview Survey statistics on 

chronic morbidity again show that women averaged higher numbers of chronic conditions than 

did men. Females aged 65 years and over had a 

mean of 3.0 conditions which compared with 

2.7 for ma les in the same age group. Here, again, 

the consistent variation is probably explainable 

largely through the excess of women in the older 

segments of the populations who are consequently exposed to further excessive deterioration from general old age and accompanying 

chronic illness; however, other factors possibly 

involved, both epidemiologic and sociologic, rema in largely unexplainable. 

When the level of chronic illness between 

white and all other residents was compared, 

there was no discernible difference between the. 

mean number of chronic conditions for the two 

subpopulations. Some disparity did appear to 

exist, though, when the mean was compared for 

9 
each age level. For each age group, white residents consistently averaged fewer conditions 

than did all other residents. The disparity was 

greatest at the younger ages, and it gradually 

converged at the older ages. Since there were 

about 13 percent more white than all other residents at ages 85 years and over, the lack of disparity in the overall average was probably attributed to the excess of older, white residents. 

Because the comparisons at each age were not 

statistically significant, however, any definite 

conclusion remains difficult to reach. 

White All other Age residents residents 

Average number of conditions 

per resident 

All ages , . . . . . . . . , . 3.43 3.46 

Under 65 years . . . . . , . . . . 2.43 2.84 

65-74 years . . . . . , . . . . . . 3.24 3.56 

3.50 3.66 

i~~:‘~d diei ’ : : : : : : : : 3.77 3.82 

There was a discernible contrast in the number of conditions among residents grouped by 

their marital status. This variation had been uncovered in an RPS-2 report to reveal that residents who were divorced, separated, or never 

married tended to have fewer conditions on the 

average than did married or widowed residents1 2 Again, the percent distributions by 

number of conditions were closely aligned for 

married and widowed persons with means at 3.5 

and 3.6 conditions, respectively. An identical 

mean of 3.0 conditions was computed for the 

other two groups, never-married and divorced or 

separated persons. Especially evident was the 

disparity for those with multiple combinations 

of conditions. Around two-thirds of the residents married or widowed had three conditions 

or more as compared with just over half the residents who were divorced, separated, or widowed. When the degree of chronic illness is 

measured at each age level, married and widowed residents, as a combined group, maintained consistently higher numbers of conditions 

per person than did the other group, the differences here proving statistically significant 

throughout. 

Age 

All ages . . . . . . . , . . . 

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

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

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

85 years and over ......... 

Widowed Divorced, 

or married separated, 

or never married 

Average number of conditions 

per resident 

3.58 2.97 

2.79 2.32 

3.39 3.00 

3.55 3.27 

3.80 3.61 

Few studies on chronic illness have yielded 

data on its prevalence among marital status 

groups in the general population. A pattern of 

higher prevalence of disabling illnesses among 

unmarried women (including widowed, never 

married, divorced, and separated) was shown in 

one study, which would seem to confuse the 

patterns exhibited in the RPS-3 resu1ts.l g However, the differences in chronic morbidity levels 

among marital status groups in the nursing home 

population suggest more probably the influence 

of factors affecting the decision to enter an institution rather than factors epidemiologic in nature. If care is unavailable at home, then a person is more likely to seek care in a nursing 

home. Though the pattern for the small group of 

divorced or separated residents is not clear, it is 

clear that the group of never-married persons 

were less likely to be receiving care at home and 

were forced to look elsewhere. Again referring 

to data from the Health Interview Survey, nearly 

9 out of every 10 persons receiving home care 

were living with relatives.3 The RPS-2 report on 

marital status also indicated that a resident entered a nursing home with fewer conditions if he 

had been living alone.’ * 

Mobility Status 

The data have shown the nearly universal extent of chronic health problems in the nursing 

home population. Nearly all residents reported 

at least one chronic condition or impairment; 

most had multiple conditions. However, the implications of chronic illness are more adequately 

reflected in their effect on a resident, particularly on his or her ability to get out of bed, to 

move around with minimal help, and to leave 

10 
the premises. To an accurate extent, a resident’s 

mobility status is a measure of the degree of 

severity of the chronic conditions through its 

accompanying disability. 

The proxy respondent was asked the following question about the resident: “Which of 

these categories best describes his ability to 

move about?” Ranging in the degree of mobility 

limitation involved, the responses were categorized as follows: (1) capable of going off the 

premises with or without assistance; (2) confined to premises but does not use a wheelchair; 

(3) needs a wheelchair but requires minimal help 

in getting around; (4) generally confined to bed 

but up in a wheelchair for at least a few hours a 

day; and (5) restricted to total bed rest. 

For the purpose of this report, these categories are rated according to the degree of mobility limitation involved. Residents fitting the 

last two categories, or those who were either 

totally or generally confined to bed, were defined as being bedfast. Residents in the first 

three categories were referred to as ambulatory. 

Ambulatory in this instance does not concern 

the act of walking but refers to the residents’ 

ability to move about relatively freely, or 

specifically to their freedom from bed confinement. Other limitations in mobility must also be 

recognized. Although considered ambulatory, residents included in the third category are referred to as chairfast; they are limited to 

mobility in a wheelchair and cannot leave the 

premises. Those in the second category who are 

not chairfast yet remain restricted to the premises are referred to as ambulatory, confined. 

Only the residents in the first category-called 

ambulatory, unconfined-are to be considered 

free from limitations in their mobility. An important qualification to this classification remains. It involves, as will be seen in the section 

concerning the use of special aids, the many residents who were using wheelchairs and other aids 

and who were reported as capable of leaving the 

premises. In this case, therefore, they must be 

included in the group of ambulatory, unconfined, residents, since they are apparently unlimited in mobility. 

It was determined from these classifications 

that although most nursing home residents reported an ambulatory status, the majority appeared to experience some form of limitation in 

their mobility. Of the estimated 56 percent of 

residents who were not capable of going off the 

premises, nearly half were bedfast. Only about 6 

percent of all residents were restricted to total 

bed rest, and over 20 percent could get up in a 

wheelchair for at least a few hours a day. These 

residents constituted the 26 percent considered 

nonambulatory. 

Ahhough maintaining an ambulatory status, 

the other half of those restricted in mobility included the 11 percent of all residents who were 

reported as chairfast and the 19 percent who 

were confined to the premises but did not require a wheelchair to move about. The remaining 44 percent, a minority of the population, 

were considered ambulatory, unconfined, since 

they were capable of leaving the premises with 

or without assistance. 

This relatively high proportion of persons 

with no mobility limitations in the nursing home 

population appears striking. Since the extent of 

help these persons received when leaving the 

premises is not entirely clear, however, comparisons with the general population, as seen 

through the Health Interview Survey, are awkward. Chronic mobility limitations, reported to 

affect nearly 20 percent of the noninstitutionalized population 65 and over, included the 

categories of “having trouble getting around 

alone” or “needing help in getting around.” One 

of the few mutually compatible categories referred to the person being “confined to house.” 

About 4.8 percent of the general population in 

the age group 65 years and over was confined to 

house. Another compatible category was the 

proportion of older persons who were confined 

to bed. Only an estimated 1 percent in the general population 65 years and over was bedfast.*O 

When comparing this estimate to that of over a 

fourth of all nursing home residents who were 

bedfast at these ages, it is evident that the level 

of chronic ilIness in nursing homes, as measured 

by its effect, was clearly much more severe than 

in the population outside institutions. 

Age again appeared to be a consistent primary 

factor contributing to a deterioration in health 

as measured by the resident’s mobility status. As 

shown in figure 2, mobility limitations generally 

increased with age. The proportion of residents 

bedfast at ages 85 years and over was over 10 

percent more than that for residents under 65 

11 
PERCENT DISTRIBUTION 

0 20 40 60 80 100 

AGE GROUP 

All ages 

Under 65 years 

65.74 years 

75.84 years 

Ambulatory, confined 

q Chairfast Ambulatory, unconfined 

Figure 2. Percent distribution of residents in nursing and personal care homes by mobility status, according to age, 

years. Likewise, the proportion of those unrestricted in mobility at ages 85 years and over 

was 14 percent less than the proportion for the 

younger residents under age 65. For chairfast or 

ambulatory, confined residents, however, there 

was little or inconsistent change in mobility status with increasing age. It should be noted, too, 

that many of the older residents appeared unlimited in their mobility. About 38 percent of those 

85 years and over were reported to be capable of 

leaving the premises. This was more than the 

number who were confined to bed at this advanced age. 

As with the prevalence of chronic conditions, 

a tenuous variation between male and female residents seemed to materialize with respect to 

mobility status. Women were slightly more restricted in mobility than men. Around 7 percent 

more females than males were bedfast; and accordingly about 7 percent more were confined 

to the premises (table D). There is little difference between the proportions of males and females grouped as chairfast or as ambulatory, 

confined. When considering only those residents 

confined to bed, the sequence of increased mobility limitation with increased age is nearly consistent for both sexes. Male residents showed a 

general increase, but female residents showed 

higher levels of mobility restrictions at each age 

level. The sex differential for bedfast residents 

also increased proportionately, ranging from 2 

percent at ages under 65 to nearly 10 percent at 

85 and over. 

Age Males Females 

Percent bedfast 

All ages . . . . . . . , . . . . . . . . . . . , 20.9 28.4 

Under 65 years . . , . . . . , . . . . . . . . . . . 17.0 19.3 

65-74 years . . . . . . . . . . , . . . , . . , . . . . 21.2 24.3 

75-84 years . . . . . . . . . . . . . . , . . . . . . . 20.6 26.7 

85 years and over . . . . . . , . . . . . . . , . , . 24.0 33.6 

In the RPS-2, women had been slightly more 

restricted !.n mobility than men; but the sex differential for the residents who were bed limited 

had not been significant. Although women in 

12 
Table D. Number and percent distribution of residents in nursing and personal care homes by mobility status, according to sex, color, 

and marital status: United States, June-August 1969 

Mobility status 

Sex, color, and marital status [\‘umber of 

residents Total Ambulatory, Ambulatory, Chairfast Bedfast unconfined confined 

Percent distribution 

All residents . . . . . . . . . . . . . . . . . . . . . . . . . 815,100 100 44.3 18.8 10.9 26.1 

Male .................................. 251,900 100 48.7 19.9 10.6 20.9 

Female ................................ 563,300 100 42.3 18.3 11.1 28.4 

Color 

White ................................. 778,500 100 44.6 18.6 10.7 26.1 

All other ............................... 36,600 100 36.3 22.6 14.3 26.8 

Marital status 

Married ................................ 95,600 100 35.8 15.3 13.0 35.9 

Widowed ............................... 518,200 100 43.0 18.7 11.1 27.3 

Divorced-separated ........................ 34300 100 55.3 17.0 11.1 16.5 

Never married ............................ 167,000 loo 50.8 21.4 9.2 18.7 

that survey tended to be slightly more limited group confined to bed. There was some variation 

than men at the younger ages, any potential with age, but it was inconsistent and statistically 

overall difference was canceled since men were insignificant. 

equally bed limited, suprisingly enough, at the 

older ages.4 In the RPS-1, however, more White I

All other

females than males, but only about 4 percent, Age I residents residents 

were reported to be bedridden most of the 

time.*l In the same report, about 8 percent 

more females than males were classified as Percent bedfast 

“never walking.” In the population outside in- All ages . . . . . . . . . . . . . . . . . 26.1 26.8

stitutions, differences in mobility limitations 

between older males and females were not quite Under 65 years ................ 19.8 18.3 

discernible. For men and women 65 years and 65-74 years ................... 22.9 24.4 

over, there was little significant variation in the 75-84 years ................... 24.7 32.4 

reported degrees of mobility limitations. More 85 years and over ............... 31.2 31.9 

study is needed to determine whether a sex differential exists in the level of health at older There appeared to be slight proportionate 

ages, as measured by the prevalence of chronic differences among residents in each group who 

illness and by the residents’ mobility status, or were chairfast or ambulatory, confined; howwhether the differential results from factors ever, it is not until the proportions of residents 

inherent in the study design and procedures. in each group considered unlimited in mobility 

White and all other residents, ranging around are examined that any significant variation 

26 percent, were divided nearly equally for each emerges. About 8 percent more white residents 

13 
than all other residents were capable of leaving 

the institution (table D). This disparity held 

constant at each age level. 

White All other Age residents residents 

Percent ambulatory, 

unconfined 

All ages . . . . . . . . . . . . . . . . . 44.6 36.3 

Under 65 years . . . . . . . . . . . . . . . . 52.9 46.5 

65-74 years . . . . . . . . . . . . . . . . . . . 47.3 35.2 

75434 years . . . . . . . . . . . . . . . . . . . 46.4 31.2 

85 years and over . . . . . . . . . . . . . . . 38.2 32.0 

In the noninstitutionalized population, there 

has been a tangible pattern toward higher levels 

of mobility limitations among older persons 

other than white.2 The disparity has not been 

great in magnitude but rather has been spread 

over each type of limitation in mobility. 

Mobility status did vary greatly among residents grouped by marital status. As shown in 

table D, more than a third of the married residents were bedfast, which was proportionally 

around twice as many as the divorced or separated or never married residents. Over a fourth 

of all the widowed residents were bedfast, and 

both married and widowed residents apparently 

had proportionally higher levels of limitations 

that prevented them from leaving the premises. 

This pattern is congruent to the one shown for 

the number of conditions. By age, the pattern in 

mobility status holds higher for married and for 

widowed residents, but it is not consistent (table 

2). 

Using these indexes of health, it does seem 

apparent that married and widowed residents 

were probably more seriously ill than were residents who were divorced or separated or never 

married. On the average, married or widowed 

residents had more chronic conditions seriously 

affecting their health; and, as a result, it is apparent that they were more likely to be confined 

to bed. An RPS-2 report has given further support to this claim by showing that when admitted, married and widowed residents were 

given more intensive care than were divorced or 

separated or never married residents. l2 

Mobility Status and Number of 

Conditions 

The distinct pattern of interrelationship between mobility status and the number of conditions was seen as the most direct’expression of 

the implication between disability and chronic 

illness. As shown in figure 3, limitations in mobility tended to increase substantially with the 

number of chronic conditions and impairments. 

For example, the proportion of bedfast residents 

with more than one condition was over three 

times greater than the proportion of bedfast residents reporting only one condition or no conditions. Likewise, there were twice as many chairfast residents with morethan one condition than 

chairfast residents with one condition or no conditions reported. In the ambulatory, confined, 

category, the number of residents with up to 

three conditions increased only moderately and 

then decreased as it was affected by the greater 

proportions of more severely limited residents 

who had more than three conditions. The trend 

in the proportions of residents who were 

classified as ambulatory, unconfined, is markedly consistent throughout its inverse relation with 

the number of conditions; i.e., as the number of 

conditions increase, there is a substantial decrease in the proportion of residents unrestricted 

in mobility. 

Thus seen as a reliable indicator of mobility 

status, the number of conditions appeared to 

provide a reliable measure of the general level of 

health among nursing home residents. It should 

be noted, however, that many persons with multiple conditions were .apparently unaffected in 

their mobility. For instance, only around oneeighth of those residents reporting no conditions 

were incapable of leaving the premises. This 

comparison strongly indicates that the number 

of conditions was the primary determinant of 

the resident’s mobility limitation; but possibly 

overlooked are over one-fourth of the residents 

who had as many as five conditions and yet were 

classified as ambulatory, unconfined; i.e., they 

were unlimited in mobility even with several 

conditions with which to contend. Not reported 

here, though, are the possible types of other disability affecting the persons who were capable 

of leaving the premises. Mobility status as measured in this study did not give adequate representation to these problems. Some insight may 

14 
PERCENT DISTRIBUTION 

0 20 40 60 80 

NUMBER OF CONDITIONS 

All residents 

No conditions 

1 condition 

2 conditions 

3 conditions 

4 conditions 

Bedfast Ambulatory, confined 

r-l Ambulatory, unconfined 

Figure 3. Percent distribution of residents in nursing and personal care homes by mobility status, according to the number of chronic 

conditions and impairments. 

be gained, however, when the use of special aids 

is examined later in this report for the residents 

in the different mobility classes. 

As discussed previously, the age of the resident also emerged as a primary determinant of 

increased mobility limitations. But again it is the 

number of chronic conditions that appeared to 

have overriding influence on the degree of mobility limitation affecting a resident. Considering 

residents in similar age groups and mobility status categories, it is seen from table E that with 

each decrease in a resident’s mobility status 

there is a corresponding increase in the average 

number of chronic conditions and impairments. 

That is, residents with limitations ‘in mobility 

average more conditions than residents with 

fewer or no limitations, at every age level. 

HEALTH STATUS AND 

HEALTH SERVICES 

In attempting to measure the general level of 

health in the nursing home population, the two 

variabIes-number of chronic conditions and impairments and mobility status-provided what 

might be called absolute measures. To the extent 

the reporting procedures were assumed reliable, 

the number of chronic conditions reported for 

each resident should not have varied greatly over 

time; it was considered an absolute measure of 

heahh status. To the extent that policies on patient mobility did not vary greatly among the 

institutions, the ability of a resident to move 

about freely should not vary greatly over time; 

15 
Table E. Average number of chronic conditions and impairments per resident of nursing and personal care homes, by mobility status 

and age: United States, June-August 1969 

Mobility status 

Age Ambulatory, Ambulatory, Chairfast Bedfast unconfined confined 

Number of conditions per resident 

Alltypes .......................................... 2.8 3.3 3.8 4.4 

Under 65 years .......................................... 2.1 2.4 2.9 3.2 

6574years.. ............................................ 2.7 3.2 3.7 4.2 

7584years ............................................. 2.9 3.4 3.8 4.5 

85 years and over ......................................... 3.0 3.6 4.1 4.7 

then this ability, too, may be assumed an abso- of the residents and significant insight into 

lute measure of health status. where the general burden of patient care may 

By examining the health services given to the ’ have existed (refer to tables 4-9). 

residents, an expanded picture encompassing the 

relative health status may be developed. The Primary Type of Service 

type of service available in the home, the level of 

care actually given to the resident, and the num- The decision to enter a home is based partly 

ber and types of special aids used are the vari- on the type of care the person is to require as 

ables studied against the absolute measures of measured against the type of service the facility 

health status in this section. Under examination has available. Through a classification scheme rewas the question of increased requirements for lying on schedules of nursing care and patterns 

health services from those residents with chronic of staffing, homes were categorized into three 

health problems, particularly sicker residents groups by type of service provided: nursing care 

who had many conditions or who were severely homes, personal care homes with nursing, and 

limited in their mobility. The measures of health personal care homes (appendix II). The type of 

services are considered relative since it was possi- service provided served as a general measure of 

ble that they could be given independently of the type of service available in the home. 

the health condition of the resident; that is, the Of the estimated 18,390 facilities in the counpatient not requiring them could have been try, the greatest proportion, about 63 percent, 

given them just as routine, or patients requiring were classified as providing primarily nursing 

them might not have been given the services at care. These facilities housed 78 percent of this 

all. It .is difficult to assume. Furthermore, the institutionalized population. Homes classified as 

health services may have been given in response personal care with nursing represented 20 perto acute illnesses, events that could confound cent of all facilities and provided care to 17 perthe measures employed thus far that attempt to cent of the population. Those classified as prifocus on chronic illness. For example, a resident marily personal care homes comprised about 17 

with few chronic conditions or none could have percent of the facility inventory, but only 5 perbeen given intensive care or could have been cent of all members-of the population resided in 

using a wheelchair for some acute condition this type of home. 

only temporarily. Or persons in need of special As measured by the number of chronic condiaids might not have been using any. Thus, health tions, the level of health varied greatly among 

services, as analyzed through this study, must be the homes classified by the type of service proassumed to be relative measures; but, together vided. Those residents free from chronic conwith the absolute measures, they can provide ditions or impairments remained very much in 

further, useful information on the health status minority in all homes; however, the proportion 

16 
of those reporting no conditions did increase 

from around 1 percent of the residents in nursing cure homes to 5 percent in homes providing 

personal care with nursing to around 10 percent 

in homes offering personal care as their primary 

service. In effect, figure 4 shows that multiple 

conditions remained evident in all homes, but 

were markedly more prevalent among the residents of nursing cure facilities. Around 70 percent of these residents reported three conditions 

or more in combination, the average being 3.6. 

This estimate represents over one and a half 

more conditions or impairments per resident 

than was evident in personal care homes, or 

where nursing care was not routinely provided. 

About 70 percent of these residents reported 

two conditions or less in combination, the average being 1.9. The average number of conditions 

in homes that provided personal care with nursing lay almost midpoint in this range at 2.9 per 

resident, with about 65 percent of the residents 

reporting three conditions or more. 

If the number of conditions is assumed to reflect the need for services, then it is quite evident from these comparisons that homes which 

were providing greater levels of care were providing the care to persons in need of the services. 

Persons who had entered personal cure homes 

apparently had less of a medical factor involved 

in their decision. They were probably seeking 

primarily custodial care since what chronic conditions they had did not require routine nursing 

care. On the other hand, persons entering nursing care homes apparently required greater availability of this type of care, since most had a 

variety of chronic conditions and impairments, 

any of which could have demanded nursing 

attention. 

The age of the residents varied among the 

homes typed by primary service. Residents of 

nursing care homes tended to be slightly older 

than were residents of other homes. The median 

age was 81.3 years ;ompared with 81.2 for residents of personal care homes with nursing and 

77.1 for residents of personal care homes. However, the difference in median age of patients 

among the types of homes did not confound the 

difference in the level of health between them 

when the number of conditions was used to 

measure the need for services among age groups. 

For each type of service home, this difference in 

the number of conditions per resident increased 

at each age level, the range between nursing care 

and personal care homes being nearly two 

conditions at ages of 85 years and over. 

Age 

Number of conditions per resident 

All ages ....... 3.63 1 2.90 1.94 

-

Under 65 years ....... 1.77 

65-74 years ......... 1.98 

75-84 years ......... 1.94 

85 years and over ..... 2.08 

Mobility status 7 LSused to provide atnother 

crude measure of the need of services among the 

residents of this population and to indicate 

where the principal burden of patient care existed. Persons restricted in mobility, it was assumed, presented a potentially greater demand 

for nursing services. As shown in figure 5, this 

demand, considered commensurate with the 

needs of the residents, varied significantly 

among the three types of homes classified according to primary service provided. As expected, the pattern was identical to the one 

measured by the number of chronic conditions. 

With nearly a third reporting a nonambulatory 

status, residents of nursing care homes were 

portrayed through these measures at levels of 

health requiring more nursing attention; i.e., 

they tended to have more limitations in their 

mobility as they had had more chronic conditions and impairments potentially affecting 

them when compared with residents in other 

types of homes. The proportion of bedfast and 

chairfast residents in nursing care homes was approximately double that of homes classified as 

personal care with nursing. On the other hand, 

only about 5 percent of the residents of personaE 

care homes suffered these severe limitations in 

mobility; in fact, about 80 percent of the population of these facilities were reported capable of 

leaving the premises. Age differences did not 

appear to have a great effect on these patterns in 

mobility among the residents of these facilities 

classified by type of service (table 5). 

17 
PERCENT DISTRIBUTION 

0 20 40 60 a0 100 

TYPE OF SERVICE 

Nursing care 

Persclnal care -Y---­ wth nvrsmg 

Personal care 

L 

Number of conditi 

Figure 4. Percent distribution of residents in nursing and personal care homes by number of chronic conditions and impairments, 

according to type of service. 

Level of Patient Care there was a range from intensive nursing care 

services to basic, personal care services. Some More direct data on the particular types of patients received neither personal nor nursing services a resident was receiving were also ob- care services, but about 94 percent received at

tained. The proxy respondent was asked about least one. Most received more than one service, the services that were actually given to each sam- the average being more than five per resident.

ple resident during the week before the survey. Representing the vojume of each service renOf the 20 services for which data were collected, 

PERCEFjT DISTRIBUTION 

0 20 40 60 a0 100 

TYPE OF SERVICE 

Personal care 

with nursing 

Personal care 

Mobility status 

Bedfast Ambulatory. confined 

Chairfast Ambulatory, unconfined 

El 

Figure 5. Percent distribution of residents in nursing and personal care homes by mobility status, according to type of service. 

18 
dered, the detailed percent distribution is 

presented in table F. As shown, the list of services has been grouped into levels of care based 

on an appraisal of the intensiveness of care. This 

grouping was fashioned to aid in further analyzing the relationship between the potential need 

of care, as measured by the number of conditions and the mobility status, and the delivery of 

care, as measured by the level of care provided 

by the staff of the home. Each succeeding level 

is considered exclusive of the previous levels. 

As shown in figure 6, about three-fourths of 

all residents in these facilities were receiving 

some type of nursing care during the week preceding the survey. Most services provided were 

routine nursing care-temperature-pulserespiration, enema, or blood pressure. Nearly a 

fifth of all residents, though, had received the 

intensive levels of care. On the other end of the 

spectrum, about a fifth of all residents were receiving care related only to personal needs, such 

as help with dressing or eating. Some residentsTable F. Number and percent of residents in nursing and personal care homes, by patient care services received: United States, 

June-August 1969 

Patient care services received Number of ‘ercent of 

residents residents 

Intensive care 

Catheterization ............................................................. =3m 6.9 

Bowel and bladder retraining ............................... . ..................... 99,700 12.2 

Oxygen therapy ............................................................ 

Intravenous injection ......................................................... 

Nasal feeding .............................................................. 

Full bed bath 

Fullbedbath .............................................................. 

Less intensive nursing care 

Application of sterile bandages or dressings .......................................... 

Irrigation ................................................................. 

Intramuscular injection ........................................................ 

Subcutaneous injection ........... .............................................. 

lntradermal injection ......................................................... 

Routine nursing care 

Temperature-pulse-respiration ................................................... 

Enema ................................................................... 

Blood pressure ............................................................. 

Personal care 

Help with dressing, shaving, care of hair ............................................. 

Help with tub bath or shower ................................................... 

Help with eating ............................................................ 

Rub and massage ............................................................ 

Administration of medications or treatment .......................................... 

Special diet ............................................................... 

None of the above services received ................................................ 

10,600 1.3 

4900 0.6 

3900 0.4 

182,500 22.4 

59,600 7.3 

43,100 5.3 

85.700 10.5 

23,100 2.8 

2m 0.4 

447,100 54.9 

155900 19.1 

429,700 52.7 

564JOO 69.2 

6oogoo 73.7 

232,600 28.5 

435&lo 53.5 

697,700 85.6 

265,700 32.6 

%W 6.2 

19 
PERCENT DlSTRlWJTlON 

0 20 40 60 80 100 

AGE GROUP 

All ages 

Under 65 years 

75.84 years 

a5 years and OYH 

Level of patient care 

Intensive nursing care Routine nursing care 

Full bed bath q Personal care 

Less intensive %iiii: Neither nursing 

:::::::: nursing care q . . . . . . . . nor personal care

Figure 6. Percent distribution of residents in nursing and personal care homes by level of patient care, according to age. 

more than 1 in 16-received no services related 

either to nursing or personal requirements. 

Figure 6 also shows the direct relationship between the level of patient care and the resident’s 

age. The older the resident, the more intense the 

level of nursing care tended to be. About 14 

percent of those under 65 years had received 

intensive care. The proportion increased to 21 

percent for those residents at ages 85 years and 

over. 

A direct relationship between the level of care 

and the number of chronic conditions was also 

very evident, as seen in table G. Residents who 

had not received personal or nursing care services averaged 1.6 conditions. Compared to these 

residents, those under intensive nursing care averaged nearly three additional chronic conditions or impairments, the mean computing to 

4.4. Those receiving full bed baths as their 

highest level of care averaged 4.0 conditions per 

resident; those receiving less intensive care, 3.6. 

Residents receiving routine nursing services averaged 3.3 conditions; those receiving personal 

care only, 2.7 conditions. 

This relationship emphasizes the potential 

role that the number of conditions plays as a 

primary determinant of the services the resident 

required and received. Of course, no true distinction can be made from this survey which could 

determine if the services provided truly were 

commensurate with the resident’s needs. In addition, it may be said that persons with chronic 

conditions do not necessarily require continuous 

nursing care; it may only be needed on a 

periodic or a routine basis, but at intervals of 

longer than a week. Furthermore, it is somewhat 

difficult to assume that it is the multiplicity of 

chronic conditions which requires the additional 

nursing care and not an individual condition 

with the other conditions remaining neutral in 

effect or only demanding nursing attention in a 

slightly vicarious fashion. Multiple conditions, 

20 
Table G. Number of residents and average number of chronic conditions and impairments per resident of nursing and personal care 

homes, by level of patient care and age: United States, June-August 1969 

Level of patient care 

Number of 

residents Total 

II IIntensive 

Inursing 

Less 

Full intensive 

bed bath nursing 

Routine 

nursing 

I 

Personal 

care None 

care care care I I I 

Number of chronic conditions and impairments per resident 

Ail ages ................... 815,100 I 3.4 

-

Under 65 years .................. 92300 2.5 

65-74 years ..................... 138,500 3.3 

75-84 years ..................... 321,800 3.5 

85 years and over ................. 261,900 3.8 

then, do not necessarily preclude that services, 

particularly nursing care, should have been or 

were given during that week before the survey. 

Although nearly a third of the residents with as 

many as five conditions or more had received 

intensive nursing care, it should be noted that 

about a tenth of these residents had received 

only personal care or no services at all. As a 

further example, about a third of all residents 

with three conditions or more had received no 

services related to nursing care. 

The validity of using the number of conditions as a crude measure of the relationship between the general level of health and the receipt 

of services in the nursing home is reinforced, 

though, when the level of care for different age 

groups is examined. Within any age group, table 

G shows that the average number of conditions 

tended to increase with each successive level of 

care. A multiplicity of chronic conditions again 

appears to demand a more intensive level of 

care, regardless of the age of the resident. 

Previous reports from nursing home surveys 

have shown the level of patient care to be very 

sensitive to the mobility status of the residents, 

and this pattern was again repeated in the 

RPS-3.4~6 The effect of bedfastness was particularly evident since over three-fourths of the 

bedfast residents received other than routine 

nursing care. About 1 in 20 had received 

personal care only; and a few bedfast residents 

had received no services during the week 

1.6 

1.4 

1.6 

1.5 

1.8 

before the survey, but the numbers involved 

are of questionable reliability. 

Figure 7 shows the general pattern of increasing restrictions in mobility with each successively more intensive level of care. Well over half 

those residents receiving intensive nursing care 

or a full bed bath during the week before the 

survey were bedfast. Yet it is particularly interesting to note that about 15 percent of both 

these groups requiring care that reflects a higher 

degree of illness were reported to be completely 

ambulatory and capable of leaving the premises 

freely. The proportions of chairfast residents reported at each level of patient care varied somewhat and showed only a slightly increasing pattern with more intensive levels of care. When 

compared with residents receiving personal care, 

there were proportionately about 4 percent 

more chairfast residents among those who had 

received some form of nursing care. Those residents who had apparently not required any services that week had very few restrictions on their 

mobility. About 87 percent were ambulatory, 

unconfined. 

Overlooking the few exceptions, there was 

general consistency between the services received and the level of health as measured by the 

degree of disability. This consistency also remained generally intact when the age of the resident was considered (table 7). In summary, restrictions in mobility tended to produce more 

intensive levels of care at every age level. 

21 
PERCENT DISTRIBUTION 

0 20 40 60 80 100 

LEVEL OF CARE I I I I I 

All residents 

Neither nursing 

nor personal care 

Routine nursing care 

Full bed bath 

Intensive nursing care 

Mobility status 

Ambulatory. confinM 

Chairfast Ambulatory, unconfined 

cl 

Figure 7. Percent distribution of residents in nursing and personal care homes by mobility status, according to level of patient care. 

Special Aids Used 

At the time of the survey, there were nearly a 

million special aids in use in nursing homes. As 

shown in table H, about half these aids were 

eyeglasses; the other half included hearing aids 

and orthopedic aids such as walkers, crutches, 

braces, and wheelchairs. 

Over three-fourths of all residents were using 

at least one special aid, and nearly half were 

using two or more. Representing about 61 percent of this population, residents who wore eyeglasses were naturally the most commonly reported. About 5 percent of this institutionalized 

population used a hearing aid. Of the orthopedic 

aids, the wheelchair was the most prevalent. An 

estimated 31 percent of all residents were reported to be using a wheelchair, while about 12 

percent moved about with the use of a walker. 

Only around 1 percent of the population used 

either crutches or braces, but about 11 percent 

22 

reported the use of other types 

which comprised artificial limbs, 

not otherwise specified. 

The use of special aids can 

extent of disability associated 

health problems. Since eyeglasses 

of special aids, 

canes, and any 

also reflect the 

with chronic 

are commonly 

used among older persons and since they relate 

mainly to a single impairment, their use among 

residents of nursing homes does not reflect this 

particular relationship in any dramatic fashion. 

The proportion of users may be expected to be 

high. The same is probably true of hearing aids. 

In fact, the proportion of users over 65 years of 

age both in and out of institutions was an identical 5 percent. 22 In contrast, it was interesting 

to note that the high proportion of residents 

who used eyeglasses was considerably less than 

the proportion representing comparable age 

groups in the noninstitutionalized population. 

The use of eyeglasses among persons 65 years 

and over who are not in institutions has been 
- Table H. Number and percent distribution of residents and number and percent of residents in nursing and personal care homes by the 

number of aids used in combination and type of aid in use, according to age: United States, June-August 1969 

I Number of aids used in combination and type of aid in use 

All residents .................................. 

Number of aids used 

No aids used ...................................... 

One aid used ...................................... 

Two aids used ..................................... 

Three or more aids used .............................. 

Type of aid 

Eyegla~es ........................................ 

Hearing aids ...................................... 

Wheelchairs ....................................... 

Walkers ......................................... 

Crutches ......................................... 

Braces .......................................... 

Others .......................................... 

Total number of aids used ......................... 

reported to be nearly universal, at 92 percent of 

the population. 22 This compares with an estimated 64 percent of nursing home residents of 

the same age who were users of eyeglasses. 

Noting also this disparity in the use of eyeglasses, a previous report on special aids in nursing homes has postulated that the disparity may 

be attributed to the high proportion of bedridden residents who are possibly in such poor 

health that they could not use eyeglasses even if 

they had them.’ 

The use of orthopedic aids shows the relationship between disability and chronic illness most 

clearly. Only about 5 percent of the general population aged 65 years and over have been reported to use braces, crutches, wheelchairs, or 

walkers.23 This measure compares with 45 percent of the nursing home population 65 years 

and over who used any of these special aids. The 

disparity in the level of health as indicated by 

the degree of disability is profoundly apparent. 

Since it has been shown repeatedly that the 

age of a resident increases the likelihood ‘of 

chronic conditions and the problems that accompany them, it was not surprising to find that 

the probability of using a special aid followed a 

Total Under 65-74 7584 85 years 

number 

All ages 65 years years years and over 

Percent distribution 

815,100 100 100 I 100 100 100 

181,900 22.3 43.9 25.9 18.7 17.2 

342.200 42.0 38.5 42.3 44.1 40.4 

228,900 28.1 13.7 24.5 29.3 33.5 

62,100 7.6 3.9 7.3 7.9 t8.8 

Percent 

496,900 61 .O 34.4 57.8 66.6 65.2 

38,200 4.7 2.5 4.8 7.0 

253,900 31 .l 27.4 30.8 30.5 33.5 

96,600 11.8 5.3 10.6 12.3 14.3 

10,000 1.2 2.0 1.5 1.1 1 .o 

8,900 1 .l 2.4 2.2 0.8 0.4 

89,900 11 .o 5.9 8.9 11.3 13.7 

994,300 . . . . . . f.. . . . 1 . . .

similar pattern. Considering the residents under 

65 years of age, about 55 percent were using 

some type of special aid. About 84 percent of 

the residents 65 years and over reported the use 

of an aid. The increased use of eyeglasses probably contributes significantly to this disparity; 

however, older residents were also more likely to 

be using a combination of aids (table H). 

Although it is clear that age increased the 

chances that a resident was using a special aid, 

the relationship was not entirely consistent 

when it was examined for each particular type. 

For some aids, a direct relationship remained between increased age and increased utilization of 

the aid; for others, there appeared to be an inverse relationship. For instance, when the use 

rate of eyeglasses, walkers, and the category including other special aids for residents 85 years 

and over was compared with that of residents 

under 65 years, it was more than double. The 

use of hearing aids was apparently much greater 

among older residents. Use rates for wheelchairs 

increased slightly with age. In contrast, the use 

rates appeared to decrease with age among the 

few residents who used crutches and braces. Although these trends were not statistically signifi23 

i 
cant in their proportions, it seems reasonable to 

speculate that crutches and braces tend to be 

discarded as the resident gets older because of 

the strength required to use them. 

Again used as a measure of health, the number of chronic conditions appeared to have a 

marked influence on the use of special aids. Residents using aids almost always reported more 

conditions in combination than those who did 

not (table J). Residents who were not using aids 

still reported a multiplicity of conditions, which 

averaged 3.1 per person. Residents who were 

using at least one aid averaged 3.5 conditions, 

however. Those using as many as two averaged 

3.7 conditions, and those using three or more 

aids averaged 4.1 chronic conditions. The trend 

of increasing numbers of conditions with increased use of aids is consistent. In fact, more 

than four out of every five residents with three 

or more conditions had required the use of at 

least one special aid (table 8). 

Even when considering each aid in particular, 

the average number of conditions for persons 

using any one aid was significantly higher than 

the average for those who were using no aids at 

all. Residents using wheelchairs had the highest 

average number of conditions as a group at 4.1. 

Those using hearing aids were next highest at 3.9 

conditions, followed by 3.7 for those residents 

using walkers and 3.6 for those using braces and 

other special aids. It was 3.5 for users of 

crutches and 3.4, the lowest, for users of 

eyeglasses. 

The number of conditions per resident using a 

particular aid also was affected by age. The general rule of an increasing average number of conditions with increasing age prevailed, but the effect was not entirely consistent for certain 

special aids (table J). U sers of eyeglasses,braces, 

and aids listed as other averaged the same or 

lower numbers of conditions per resident at ages 

85 years and over than did residents who used 

no aids. For a11other aids, however, the average 

number of conditions per user was higher than 

that of non-users at every age level. In addition, 

the more aids used, the higher the number of 

conditions averaged at nearly every age level. 

Since the usage of special aids was shown to 

indicate an increased number of conditions, or 

an increased potential for poorer health, an analysis relating usage to mobility status was employed to determine if mobility was possibly 

enhanced through the use of these special aids. 

As depicted in figure 8, the expected pattern 

revealing reduced limitations in mobility was not 

entirely clear or consistent when overall use of 

special aids was examined. 

The proportions of bedfast residents using 

any number of aids were not very revealing. 

There was a range of only about 7 percent between the smallest proportion of around 23 percent for residents using three aids or more to the 

largest proportion of 30 percent for residents , 

using exactly two aids. Only when the category 

defining bedfast residents was broken down to 

distinguish separate categories for those generTable J. Average number of chronic conditions and impairments per resident of nursing and personal care homes by age, according to 

number of aids used in combination and type of aid in use: United States, June-August 1969 

-

Under 65-74 Number of aids used in combination and type of aid in use All ages 65 years years 

Allresidents.. ........................................ 

Noaidsused.. ............................................ 

Oneaidused .............................................. 

Twoaidsused ............................................. 

Threeormoreaidsused ...................................... 

Eyeglasses ............................................... 

Hearing aids .............................................. 

Wheelchairs .............................................. 

Walkers ................................................. 

Crutches ................................................ 

Braces .................................................. 

Others .................................................. 

3.4 2.5 3.3 - -

3.1 2.1 2.9 

3.3 2.6 3.1 

3.7 3.1 3.7 

4.1 3.4 4.0 

3.4 2.6 3.3 

3.9 3.2 4.0 

4.1 3.1 4.0 

3.8 3.3 3.6 

3.5 2.8 3.6 

3.6 3.4 3.6 

3.6 3.1 3.8 

-

75-84 35 years 

years md over 

3.5 3.8 -

3.3 3.7 

3.3 3.6 

3.7 3.9 

4.2 4.1 

3.4 3.7 

3.9 3.9 

4.2 4.4 

3.8 3.8 

3.6 3.8 

3.9 3.5 

3.7 3.6 

24 
PERCENT DISTRIBUTION 

0 20 40 60 80 loo 

NUMBER OF AIDS USED I I I I I 

All residents 

No aids used 

One aid used 

Two aids used 

Mobility status 

Totally bedfast Ambulatory, confined 

:::::::::::::::::: 

@:;z; Generally bedfast q Ambulatory, unconfined q ::::::::::::::::::

Figure 8. Percent distribution of residents in nursing and personal care homes by mobility status, according to number of aids used. 

ally and those totally bedfast was any enhancement in mobility seen (see appendix II). With 

nearly 6 percent of all residents considered totally bedfast, proportions were seen to be consistently affected by the number of aids in use. 

For instance, about 14 percent of those who did 

not use an aid were totally bedfast. This proportion was reduced to 5 percent of those residents 

using only one aid, but only 1 percent of those 

using two aids or more suffered this ma jor limitation in mobility. The use of special aids thus 

appeared to be a partial alleviation of any severe 

mobility limitation that could be present were it 

not for the use of one aid or more. From a 

different perspective, it may be said that persons 

who were totally bedfast really had very little 

need for any of the special aids for which specific data were collected. The aid used most 

often among residents totally confined to bed 

was eyeglasses. From an examination of the 

users of other types of aids, it was clear that 

only the smallest proportions, around 1 percent, 

of those residents using any of the specified orthopedic aids were restricted to total bed rest. 

So even while apparently avoiding a severe 

limitation in mobility, those residents using aids 

nonetheless appeared generally more restricted 

in their mobility than those who did not use 

aids. This pattern was seen as quite distinct 

among residents classed as chairfast. The more 

aids used in combination, the greater was the 

proportion of chairfast residents. The effect of 

mu ltiple aids in use was clear, too, when the 

proportions of residents classed as ambulatory, 

unconfined, were examined. For example, about 

38 percent of those using two aids or more were 

capable of leaving the premises, although this 

proportion increased to around 45 percent for 

residents reported as not using aids and not limited in mobility. 

A pattern of mobility restrictions was not entirely consistent because it obviously varied according to the type of aid used. The use of particular orthopedic aids assisted the residents in 

25 
only varying degrees in maintaining ambulatory 

status as seen in figure 9. For instance, over 90 

percent of the residents using crutches, over 85 

percent of those who used walkers, and over 80 

percent of those using braces maintained an ambulatory status. Even though these particular 

aids accounted for about 12 percent of the aids 

used by the population, they represented only 

half this proportion among bedfast residents. In 

contrast, nearly half. the residents using wheelchairs were bedfast. Representing about 47 percent, the wheelchair was the most prevalent aid 

in use among bedfast residents, greater even than 

eyeglasses, which were reported at 39 percent. 

The bedfast category, however, included those 

residents who could be up in a wheelchair for at 

least a few hours a day but were considered generally bedfast. Naturally, use of the wheelchair 

was also prominent among residents classed as 

chair-fast; -it is, important to note, however, that 

only about 30 percent of all users of wheelchairs 

were placed in the chairfast category. It is apparent that residents classed as chairfast possibly 

relied upon several other aids in addition to their 

wheelchairs (figure 9). Nearly half, or about 47 

percent, the aids used by chairfast residents were 

wheelchairs. Eyeglasses represented the next 

highest proportion at 33 percent of all aids in 

use; but, representing 14 percent of a11 aids in 

use by chair-fast residents, the other orthopedic 

devices such as walkers, crutches, and braces 

apparently also figured prominently in patterns 

of use of special aids among those residents who 

were considered to require minimal help in getting around. These particular aids were more 

prevalent, however, among residents classed as 

PERCENT DISTRIBUTION 

0 20 40 60 80 100 

AIDS USED 

All residents 

Hearing aid 

Wheelchair 

Walker 

Crutches 

Other aids 

Bedfast Ambulatory, confined 

Chairfast q Ambulatory, unconfined 

Ezl 

1 ’ 

Figure 9. Percent distribution of residents in nursing and personal care homes by mobility status, according to special aids used. 

26 
ambulatory, unconfined, where nearly 20 percent of the aids in use were reported to be either 

a walker, crutches, or braces. Eyeglasses completely dominated this category at 58 percent of 

the aids in use. Accounting for about 15 percent, other aids-the category of those not 

specified-were also apparently more prevalent 

among those aids used by ambulatory, confined 

residents than among more restricted residents. 

Though remaining at equally minor IeveIs in 

most mobility categories, the proportions representing the use of hearing aids were sIightly 

higher in the category defined as ambulatory, 

confined. There was a smaII proportion of 

wheelchairs in use, about 4 percent, in a category that should have excluded users of this particular aid; but, for reasons involved in judging 

discriminations in the severity of the mobility 

restrictions, the respondents apparently felt that 

the resident belonged in this particular category. 

For studying the problems invoived in determining the degree of disability, the category that 

is of most importance represents those residents 

considered unrestricted in mobility. Most ambulatory, unconfined residents apparently relied on 

special aids to maintain their ability to leave the 

premises. In fact, the proportion of users was an 

identicaI 78 percent when the comparison was 

made between those confined to the premises 

and those unconfined. Residents who were restricted to the premises of the nursing home, 

however, apparently were more likely to be 

using a combination of aids (table 9). 

A look at table K reveals any differences in 

the patterns of use for aids on and off the premises. Eyeglasses were significantly more prevalent 

among residents capable of leaving the nursing 

home; hearing aids were only slightly more prevalent. Although wheelchairs were in extensive 

use among residents confined to the premises, an 

estimated 10 percent of al1 aids in use among 

unconfined residents were wheelchairs. Additionally, walkers, crutches, and braces accounted 

for. close to this proportio-? of aids in use by 

persons unrestricted in mob&y. The proportion 

of these particular orthopedic aids matches in 

use on and off the premises. The category of 

other aids in use by unrestricted residents involved a proportion double that of the proportion of aids in use by restricted residents. These 

figures vividly show the level of disability that 

must have existed among persons whom this survey defined as unlimited in mobility. Approximately one-fourth of the residents classified as 

ambulatory, unconfined, or about one-tenth of 

the nursing home population, apparently relied 

on a wheelchair, a walker, crutches, or braces to 

maintain their ability to leave the premises. 

HEALTH STATUS: A COMPARISON 

BETWEEN THE RESIDENT 

POPULATIONS OF 1964 AND 1969 

As discussed in the first section of this report, 

the RPS-3 was conducted against two significant 

backdrops. One depicted an apparent “epidemic” 

Table K. Number and percent distribution of special aids used in nursing and personal care homes, by type of aid used and utilization 

on and off the premises: United States, June-August 1969 

Type of aid 

Utilization on and off All 7 

the premises aids Total Eyeglasses Hearing Wheelchairs Walkers Crutches Braces Other aids 

Used by residents not confined 

Percent distribution 

Both mobility statuses . , 100 50.0 3.8 1.0 0.9 9.0 

Used by residents confined to 

_ the premises . . . . . . . . . . . 580,200 100 42.3 0.8 0.9 6.7 

to the premises . . . . . . . . . 414206 L 

109 L60.7 1.3 0.9 1. 12.3

27 
of chronic health problems among the Nation’s 

older population. Of those not institutionalized, 

six of every seven persons aged 65 years and 

over have been estimated to have at least one 

chronic condition. The second backdrop highlighted what can be considered the response of 

the health care system to an ever-increasing demand for services, partly prompted by the epidemic of chronic illness. This response has been 

a reemphasis on the role of the nursing home in 

the health care delivery system and the resulting 

increase in the number of such institutions and 

in the size of the resident populations they 

serve. The number of nursing and personal care 

homes had increased over 5 percent since the 

RPS-2 in 1964, the number of residents increasing much more sharply at near 50 percent. 

Besides the response to the demands of 

chronic illness, there are severa other factors 

which probably contributed to the increased demand and the resultant increased supply of these 

facilities and their residents. Most notably would 

be a proportionate increase in the older population of the country. The proportion of persons 

aged 65 years and over in the U.S. population 

did increase from 9.3 percent in 1964 to 9.6 

percent in 1969. Other factors might include increased means of financing a person’s stay in an 

institution and less means for keeping a chronically ill person at home-this through social 

changes in family responsibilities to older persons. Since there were only 5 years between the 

RPS-2 and the RPS-3, the influence of these factors had probably much less impact than did the 

initiation of both the Medicare and Medicaid 

programs during that time. These two federally 

sponsored programs have apparently provided 

the main impetus for the reemphasis, reshaping, 

and redefining of the role and scope of nursing 

homes in the health care delivery system. In 

Iight of these acknowledgments, following is an 

examination of several significant changes that 

have occurred in the demographic and in the 

health profiles of the resident population, as 

studied by RPS-2 and RPS-3. 

Comparison of Demographic Profiles 

As seen in table L, there were several significant changes in the demographic profile. A look 

at these is necessary for providing insights into 

factors that may have affected changes in the 

population’s health character. Most significant is 

the increase in the median age for all residents. 

It was up 1.3 years from 1964. This change is 

Table L. Selected comparisons in the demographic profiles of the PIPS-2 and RPS-3 populations: United States, 

May-June 1964 and June-August 1969 

- -

Population I:‘ercent of Comparison 

IRPS-2 RPS-3 i increase 

Total number of residents ................................. 554,000 815,100 47.1 , 

Number of residents 85 years and over ............................. 

Number of residents under 65 years ............................... 

Median age of all residents ..................................... 

Number of female residents .................................... 

Number of male residents ..................................... 

Median age of female residents .................................. 

Median age of male residents ................................... 

Number of married residents ................................... 

Number of widowed residents ................................... 

Number of divorced-separated residents ............................ 

Number of never married residents ............................... 

152,400 261,900 71.8 

66,200 92,900 40.7 

79.8 81.1 1.6 

360,200 563,300 56.4 

193,800 360,200 30.0 

80.5 81.9 1.7 

78.3 78.7 0.5 

54,900 95,600 74.1 

348,100 518,200 48.9 

27,200 34,300 26.1 

122,700 167,000 36.1 

28 
indicated from the increase in the proportion of 

the population 85 years and over. This proportion increased by 4 percent since RPS-2. At 

these older ages, residents had increased in 

number over 70 percent between the two 

surveys, while the population proportion under 

65 years of age remained stable, perhaps even 

decreasing somewhat. 

The influx of more females into the population was also significant. Female residents far 

outnumbered male residents, and the gap has 

grown. The sex ratio in 1964 was 186 female 

residents for every 100 male residents. In 1969 

the ratio was 224 females for 100 males. The 

number of women increased 56 percent between 

the surveys, while the number of men was up 

only 30 percent. As previously discussed, female 

residents as a group are older than male residents. The indications are, too, that the age of 

female residents had increased more than that 

for male residents since the RPS-2. The median 

age for women was up nearly a year and a half, 

while that of men increased less than half a year. 

There had also been some changes in the composition of the population by color. Since the 

RPS-2 did not collect any data pertaining to the 

color of the residents, the change in the racial 

composition of the nursing home population 

during that time is examined through data collected by the RPS-1, a mail survey conducted a 

year earlier. In 1963, RPS-1 estimated that there 

were 19,840 residents other than white-about 

3.9 percent of the total population. In 1969, the 

proportion of the population represented by all 

other residents had increased to only 4.5 percent, but the number of all other residents was 

estimated at 36,600. While the total population 

of nursing homes had grown by 61 percent since 

the RPS-1 in 1963, the number of all other residents had grown by 84 percent. 

The population’s composition by marital status had also changed somewhat. While most unmarried groups-widowed, divorced-separated, 

and never married-remained either stable or decreased somewhat in the proportion of the total 

population they represented, a significant gain 

was made among married residents. Married residents comprised about 1.8 percent more of the 

population during 1969 than during 1964. The 

increase of 74 percent in the total number of 

married residents was much greater than the increase of unmarried residents at 45 percent. The 

small increase in the number of residents who 

had never married contributed considerably to 

this disparity. Proportionately, there was a decrease of 1.6 percent between 1964 and 1969 in 

the total population who had never married. 

Comparison of Health Profiles 

The changes in the demographic profile between RPS-2 and RPS-3 would, of course, have 

direct bearing on changes in the health profile. 

The aging of the population since 1964 probably 

carries most of the influential weight; but the 

influx of more females, more married residents, 

and perhaps even more persons in the “all 

other” category could have had some effect. In 

varying degrees, all these factors have been 

shown in this report to carry with them a potentially more severe degree of chronic illness. Most 

probably, however, the sheer impact of the Medicare and Medicaid programs has contributed to 

many major changes in the health profile of this 

institutionalized population between RPS-2 and 

RPS-3. Medicare and Medicaid have changed the 

emphasis on the role of the nursing home in the 

health care system and, in effect, have made 

these facilities more available to the older populace. What have been the changes? Are they 

significant? 

Table M shows that there have been changes, 

several of them quite significant. The first and 

probably the most significant change, however, 

does not concern the health characteristics of 

the residents directly. The type of care available 

in the home indicates the type of care required 

and, thus, indirectly the health of the residents. 

There was a dramatic increase in the number of 

facilities classified as nursing care homes. In 

1964 only 54 percent of al1 facilities were classified as providing nursing cure. In 1969 this proportion had increased to represent 63 percent of 

all facilities. On the other hand, the proportion 

of all facilities classified as providing personal 

care with some nursing had decreased from 30 

to 20 percent. It is apparent that many of the 

facilities in this latter classification in 1964 were 

probably upgraded and made more nursing services available to their residents to conform to 

the more stringent regulations for Medicare and 

Medicaid certification. In terms of the number 

29 
Table M. Selected comparisons in the health profile of the RPS-2 and 

1964 and June-August 1969 

Comparison 

Total number of residents ................................. 

Average number of conditions per resident .......................... 

RPS3 populations: United States, May-June 

- - r Population TPercent i of 

increase RPS-2 R PS3 

554,000 815,100 47.1 

3.1 3.4 9.7 

533,600 796,700 49.3 

311,900 53 1,900 70.5 

110,700 211,300 99.9 

92,200 212,700 130.7 

344,900 360,700 4.6 

2,110 153,800 7.190.9 

150,700 113,500 - 24.7 

38,600 72,500 87.8 

120,200 264,300 119.9 

148,800 160,600 7.9 

74,600 50,500 -32.4 

537,560 994,300 85.0 

395,002 633,300 60.3 

330,900 496,900 50.2 

22,200 38,200 71.9 

117,400 253,900 116.3 

48,000 96,600 101.2 

11,600 10,000 -13.7 

5,400 8,900 64.3 

17,400 18,390 5.7 

9,396 11,580 23.2 

376,700 638,800 70.0 

5,220 3,770 -29.1 

144,000 139,500 -3.1 

2,784 3,040 9.2 

33,000 36,900 11.8 

Number of residents 

Number of residents 

Number of residents 

Number of residents 

Number of residents 

Number of residents 

Number of residents 

Number of residents 

Number of residents 

Number of residents 

Number of residents 

Total number 

Number of residents 

Number of residents 

Number of residents 

Number of residents 

Number of residents 

Number of residents 

Number of residents 

Total number 

Number of nursing 

Number of residents 

Number of personal 

Number of residents 

Number of personal 

Number of residents 

of residents for 

with at least one condition ........................ 

with three or more conditions ..................... 

with five or more conditions ...................... 

bedfast .................................... 

without mobility restrictions ..................... 

at intensive care level .......................... 

at full bed bath level ........................... 

at less intensive nursing care level .................. 

at routine nursing care level ...................... 

at personal care level ........................... 

receiving no services ........................... 

of special aids in use ........................... 

using at least one aid ........................... 

using eyeglasses .............................. 

using hearing aids ............................. 

using wheelchairs ............................. 

using walkers ................................ 

using crutches ............................... 

using braces ................................. 

of institutions ............................... 

care homes .................................. 

in nursing care homes .......................... 

care with nursing homes ......................... 

in personal care with nursing homes ................. 

care homes ................................. 

in personal care homes ......................... 

which the facilities provided 

care, homes classified as exclusively personal 

care homes were housing only about 5 percent 

more residents in 1969. Homes classified as personal care with nursing actually decreased in the 

resident population they served, the number of 

residents being down about 4 percent since 

1964. However, the number of residents in nursing care homes was up over a quarter million, or 

a Ill-percent increase. It is clear that Medicare 

and Medicaid made these particular facilities 

more available to the older populace. 

In view of this significant change and of the 

fact that many more persons were seeking facilities offering nursing care, one would expect a 

compensatory change in the health status of the 

30 
institutionalized population. This apparently did 

occur as measured along the several parameters 

that have been employed throughout this report. 

First, the number of chronic conditions and 

impairments per resident had changed; it was up 

from 3.1 in 1964 to 3.4 in 1969. This was the 

primary indication that health status had 

changed in that the prevalence of chronic illness 

appeared to be greater in the RPS-3 population. 

The proportion of all residents with at least one 

chronic condition increased only slightly between the surveys, though, from 96 percent to 

98 percent. However, about 9 percent more of 

the 1969 population had three conditions or 

more than did the 1964 population; about 6 percent more had five conditions or more. 

Although the questions and survey items pertaining to mobility status slightly differed for 

the two surveys, a good comparison can be 

drawn on two classifications: those residents 

considered bedfast and those considered without 

restrictions in mobility. In the RPS-2 the question was asked, “Does he stay in bed all or most 

of the day?” For about 20 percent of all residents in 1964, the answer to this question was 

affirmative. As discussed previously, in the 

RPS-3 two questions were asked, is he “generally confined to bed, but up in a wheelchair for 

at least a few hours a day” or is he “restricted to 

total bed rest?” An estimated 26 percent of all 

residents felI into either of these categories, or 

were defined as bedfast. The total number of 

bedfast residents had increased 131 percent between the surveys. Accordingly, the percent of 

the population considered without any restrictions in mobility, i.e., capable of leaving the 

premises, had decreased considerably from 62 

percent in 1964 to 44 percent in 1969. The 

number of unrestricted residents had increased 

only around 5 percent since the RPS-2. The 

1969 population was obviously more restricted 

overall in mobility, although it does seem apparent from other data in this report that a great 

many residents of these institutions in 1969 

were not so ill as to prevent them from leaving 

the premises even though they may have had 

several chronic conditions or impairments. 

Certainly the most significant parameter in 

studying any changes in health status between 

1964 and 1969 is the level of patient care. The 

criteria for determining these levels were identical for each survey. The number of residents receiving intensive care had increased over 7,000 

percent to affect nearly 20 percent of the 1969 

population. Only about 4 percent of the residents in 1964 were receiving this level of care. 

There was a decrease in proportion of the pc pulation receiving a bed bath as their highest level 

of care; as seen in table M, however, there were 

increases in the population proportions receiving 

other forms of nursing care. That proportion of 

residents receiving exclusively personal care services was down considerably from 1964, from 

over one-fourth to about one-fifth of the popuIation. It is evident that a larger proportion of 

the population had received some type of service 

during the week before the 1969 survey than did 

the popuIation before the 1964 survey. Only 6 

percent of the RPS-3 population did not receive 

any service. This compared with 13 percent of 

the RPS-2 population. The level of care provided 

the resident population had increased considerably-most probabIy as a result of the influx of 

residents into nursing care facilities. 

Pursuant to a 50-percent increase in the 

population from 1964, there was an estimated 

85-percent increase in the number of special aids 

being used by residents of nursing homes. Approximately 78 percent of the RPS-3 residents 

used at least one aid, an increase of about 7 

percent over the utilization rate in the 1964 

population in which 71 percent of all residents 

used a special aid. As seen in table M, the use of 

the wheelchair primarily contributed to this substantial increase in the utilization of aids. The 

number of people using the two generally more 

common aids, eyeglasses and hearing aids, remained relatively stable; but the proportion of 

all residents using a wheeIchair was up by 10 

percent and represented a third of the 1969 

nursing home population. In 1964 wheelchairs 

were used by only about a fifth of all residents. 

The number of wheelchairs in use had more than 

doubled since the RPS-2. There had been slight 

changes in the utilization of other types of orthopedic aids as well. The number of residents 

using walkers had also doubled, the use up about 

3 percent among all residents. Although there 

was a 64-percent increase in the number of residents using braces, the proportion of the population using this aid remained essentially the 

same: Conversely, the number of residents using . 

31 
crutches actually decreased slightly. The proportion of users in the population was down about 

1 percent. The RPS-2 also counted the number 

of residents using artificial limbs at 2,100 persons. This specific datum was not collected in 

the later study, but was included in the catch-ah 

category, which in this report encompassed 

“other” special aids. No such category was included in the RPS-2. Since in 1969 nearly 

90,000 aids other than those specified were in 

use, it is clear that the number of aids in this 

catch-all category contributed substantially to 

the total count of aids, and, therefore biased the 

comparison between the two surveys. Nonetheless, if this bias is taken into account, it remains 

apparent that the overall utilization of special 

aids was more prevalent in 1969. 

Health status changes have been considerable 

in the nursing home populations as measured by 

the parameters available to the RPS series. In the 

span of 5 years separating the two studies, 

chronic illness itself had become perhaps only 

slightly more prevalent, but considerably more 

residents had apparently been feeling its effects, 

or were receiving more services to cope with 

their chronic health problems. The average number of chronic conditions and impairments per 

resident was up from 3.1 in 1964 to 3.4 in 1969. 

Mobility restrictions applied to much broader 

proportions of the population, with over onefourth of all residents generally bedfast in 1969 

compared with only one-fifth in 1964. The spectrum of patient care moved toward more intensive levels, with nearly one-fifth of the residents 

receiving intensive care compared with less than 

one-twentieth in the RPS-2. And applying to 

well over three-fourths of all residents in 1969, 

the utilization of special aids was more prevalent. The increase in the extent of disability was 

demonstrated in particular by the increase in the 

utilization of the wheelchair, which was used by 

only a fifth of all residents in 1964 but had to 

be used by nearly a third of all residents in 

1969. These changes in the health profile of the 

resident population were accompanied by a shift 

in the services that were available. In 1969 an 

estimated 63 percent of all facilities were providing nursing care as opposed to only 54 percent in 1964. There had been an increase of 71 

percent in the number of residents in nursing 

care facilities compared with very little or no 

increases in the number of residents in the other 

types of facilities. Many more chronically ill patients, or other persons in need of institutionalized care, were seeking the more intensive type 

provided in a nursing care home, rather than primarily custodial care. The influx of more persons into nursing care facilities has contributed 

greatly to the changes in health profile since the 

RPS-2. This report has suggested that the implementation of Medicare and Medicaid in the interval between the surveys has increased the 

availability of all facilities through a reemphasis 

on the role of the nursing home in the health 

care system. Through certification criteria, the 

nursing care home, however, has obviously been 

most affected. Thus, when discussing reasons for 

any changes in health status between 1964 and 

1969, considerable weight must be given to the 

impact of these programs. Other factorsdemographic, social, and epidemiologic-also significantly influenced changes in health status, 

but will probably require more sophisticated research and analysis before any exact relationships are made clear. 

32 
REFERENCES 

1National Center for Health Statistics: Design and methodology for a national survey of nursing homes. Vital and Health 

Statistics. PHS Pub. No. 1000~Series l-No. 7. Public Health Service. Washington. U.S. Government Printing Office, Sept. 1968. 

*National Center for Health Statistics: Chronic conditions 

and limitations of activity and mobility: United States, July 

1965June 1967. Vital and Health Statistics. PHS Pub. No. 

IOOO-Series IO-No. 61. Public Health Service. Washington. U.S. 

Government Printing Office, Jan. 1971. 

3National Center for Health Statistics: Home care for persons 

55 years and over: United States, July 1966-June 1968. Vital 

and Health Statistics. Series 10, No. 73. DHEW Pub. No. (HSM) 

72-1062. Health Services and Mental Health Administration. 

Washington. U.S. Government Printing Office, July 1972. 

4National Center for Health Statistics: Chronic illness among 

residents of nursing and personal care homes: United States, 

May-June, 1964. Vital and Health Statistics. PHS Pub. No. 

IOOO-Series 12-No. 7. Public Health Service. Washington. U.S. 

Government Printing Office, Mar. 1967. 

5Gaspard, N. J., and Hopkins, C. E.: Determinants of use of 

ambulatory medical services by an aged population. Inquiry 

14( 1):28-36, Mar. 1967. 

6National Center for Health Statistics: Nursing and personal 

care services received by residents of nursing and personal care 

homes: United States, May-June 1964. Vital and Health Statistics. PHS Pub. No. 1000~Series 12-No. 10. Public Health Setice. 

Washington. U.S. Government Printing Office, Sept. 1968. 

7National Center for Health Statistics: Use of special aids in 

homes for the aged and chronically ill: United States, May-June 

1964. Vital and Health Statistics. PHS Pub. No. 1000~Series 

12-No. 11. Public Health Service. Washington. U.S. Government 

Printing Office, Dec. 1968. 

8National Center for Health Statistics: Disability components 

for an index of health. Vital and Health Stat&tics. PHS Pub. NO. 

1000~Series ~-NO. 42. Public Health Service. Washington. U.S. 

Government Printing Office, July 197 1. 

gNational Center for Health Statistics: Administrators of 

nursing and personal care homes: Education and training, United 

States, June-Aug. 1969. Vital and Health Statistics. Series 12, 

NO. 18. DHEW Pub. NO. (HSM) 73-01703. Health Services and 

Mental Health Administration. Washington. U.S. Government 

Printing Office, Feb. 1973. 

lONational Center for Health Statistics: Administrators of 

nursing and personal care homes: Work experience; United 

States, June-Aug. 1969. Vital and Health Statistics. Series 12, 

No. 20. DHEW Pub. No. (HSM) 73-01705. Health Services and 

Mental Health Administration. Washington. U.S. Government 

Printing Office, Mar. 1973. 

1 lNational Center for Health Statistics: Characteristics of residents in nursing and personal care homes: United States, JuneAug. 1969. Vital and Health Statistics. Series 12, No. 19. DHEW 

Pub. No. (HSM) 73-01704. Health Services and Mental Health 

Administration. Washington. U.S. Government Printing Office, 

Feb. 1973. 

‘*National Center for Health Statistics: Marital status and 

living arrangements before admission to nursing and personal 

care homes: United States, May-June 1964. Vital and Health 

Statistics. PHS Pub. No. 1000~Series 12-No. 12. Public Health 

Service. Washington. U.S. Government Printing Office, May 

1969. 

13State of California, Department of Public Health: Health 

in CalifonGu. Sacramento, Calif. State Printing Office, 1957. 

14Committee for a Special Research Project in the Health 

Insurance Plan of Greater New York: Health and Medicnl Care in 

New York City. Cambridge, Mass. Harvard University Press, 

1957. 

15Collins, S. D., Trantham, K. S., and Lehmann, J. L.: Sickness experience in selected areas of the United States. PHS Pub. 

No. 390. Public Health Service. Washington. U.S. Government 

Printing Office, 1955. 

l%J.S. Public Health Service: Limitation of activity and mobility due to chronic conditions, July 1957-June 1958. Washington. U.S. Government Printing Office, 1958 and 1959. 

17Carter, H. W., and Webber, I. L.: The aged and chronic 

disease: Research in a local health department. Monograph Series 

No. 9. Florida State Board of Health. Jacksonville, Fla., 1966. 

18National Center for Health Statistics: Unpublished data 

from the Health Interview Survey, 1967. 

lgWoolsey, T. D.: 1952 estimates of disabling illness prevalance in the United States. PHS Pub. No. 181. Public Health 

Service. Washington. U.S. Government Printing Office, 1952. 

20National Center for Health Statistics: Unpublished data 

from the Health Interview Survey, 1967. 

*lNational Center for Health Statistics: Characteristics of residents in institutions for the aged and chronically ill: United 

States, April-June 1963. Vital and Health Statistics. PHS Pub. 

No. 1000Series 12-No. 2. Public Health Service. Washington. 

U.S. Government Printing Office, Sept. 1965. 

**National Center for Health Statistics: Current estimates 

from the Health Interview Survey: United States, 1971. Vital 

and Health Statistics. PHS Pub. No. 1000Series lo-No. 53. Public Health Service. Washington. U.S. Government Printing Office, 

June 1969. 

23National Center for Health Statistics: Use of Special Aids, 

United States, 1969. Vital and Health Statistics. Series 10, No. 

78. DHEW Pub. NO. (HSM) 73-1504. Health Services and Mental 

Health Administration. Washington. U.S. Government Printing 

Office, Dec. 1972. 

24National Center for Health Statistics: Design and methodology of the 1967 Master Facility Inventory Survey. VitaZ and 

Health Statistics. PHS Pub. No. lOOO-Series l-No. 9. Public 

Health Service. Washington. U.S. Government Printing Office, 

Jan. 1971. 

33 
LIST OF DETAILED TABL& 

Page 

Table 1. Number and percent distribution of residents in nursing and personal care homes by number of chronic conditions 

and impairments, according to sex, color, marital status, and age: United States, June-August 1969 . . . . . . . . . 35 

2. Number and percent distribution of residents in nursing and personal care homes by mobility status, according to sex, 

color, marital status, and age: United States, June-August 1969 . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 

3. Number and percent distribution of residents in nursing and personal care homes by mobility status, according to 

number of chronicconditionsand impairments and age: United States, June-August 1969 . . . . . . . . . . . . . . 39 

4. Number and percent distribution of residents in nursing and personal care homes by number of chronic conditions 

and impairments, according to type of service and age: United States, June-August 1969 . . . . . . . . . . . . . . . 49 

5. Number and percent distribution of residents in nursing and personal care homes by mobility status, according to 

type of service and age: United States, June-August 1969 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 

6. Number and percent distribution of residents in nursing and personal care homes by number of chronic conditions 

and impairments, according to level of patient care and age: United States, June-August 1969 . . . . . . . . . . . . 42 

7. Number and percent distribution of residents in nursing and personal care homes by mobility status, according to 

level of patient care and age: United States, June-August 1969 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 

8. Number and percent distribution of residents in nursing and personal care homes by number of chronic conditions 

and impairments, according to number and types of special aids and age: United States, June-August 1969 . . . . . 44 

9. Number and percent distribution of residents in nursing and personal care homes by mobility status, according to 

number and types of special aids and age: United States, June-August 1969 . . . . . . . . . . . . . . . . : . . . . 46 

NOTE: Numbers and percents in tables may not add to totals due to rounding. 

34 
Table 1. Number and percent distribution of residents in nursing and personal care homes by number of chronic conditions and impairments, according 

to sex, color, marital status, and age: United States, June-August 1969 

Number of chronic conditions and impairments Average 

Sex, color, marital status, Number of number 

and age residents Total No 1 2 3 4 5 conditions of 

conditions condition conditions conditions conditions or more conditions 

ALL RESIDENTS Percent distribution 

All ages ............ 815,100 100 2.3 13.1 19.4 21.6 17.7 25.9 3.4 

Under 65 years ........... 92,900 loo 2.6 302 26.0 19.7 11.2 10.4 2.5 

65-74 years .............. 138,500 loo 2.6 14.8 22.6 21.0 15.7 23.3 3.3 

75-84 years .............. 321,800 loo 2.3 10.9 19.0 22.4 18.5 26.7 3.5 

85 years and over .......... 261,900 loo 1.9 8.7 15.9 21.6 20.1 31.8 3.8 

SEX 

All ages ............ 251,900 100 29 14.6 20.5 21.0 17.3 23.7 3.3 

Under 65 years ........... 44,800 loo 3.0 28.3 25.8 20.3 11.1 11.4 2.5 

65-74 years .............. 52,300 1w 2.8 14.7 23.7 19.7 16.0 23.1 3.2 

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

85yearsandover .......... 

90,700 

64,100 

100 

100 

2.6 

3.3 

11.5 

9.3 

19.6 

15.7 

21.3 

22.2 

19.4 

19.6 

25.6 

299 

3.4 

3.7 

Female 

All ages ............ 563300 100 2.0 12.4 189 21.9 17.9 26.9 3.5 

Under 65 years ........... 48,100 100 2.2 319 26.1 19.1 11.3 9.4 2.4 

65-74 years .............. 86,200 loo 2.4 149 22.0 21.8 15.5 23.5 3.3 

75-84 years .............. 231,100 loo 2.2 10.7 18.6 22.8 18.2 272 3.5 

85 years and over .......... 197,800 loo 1.5 8.5 16.0 21.4 20.3 32.4 3.8 

COLOR 

White 

All ages ............ 778,500 loo 2.3 13.0 19.4 21.6 17.9 25.9 3.4 

Under 65 years ........... 83500 100 2.6 30.9 263 19.4 109 9.9 2.4 

65-74 years .............. 129~00 106 2.7 15.1 22.7 20.6 15.9 229 32 

75-84 years .............. 310900 100 2.3 109 19.1 22.4 18.6 26.6 3.5 

85 years and over .......... 264,500 100 1.9 8.6 15.8 21.8 20.2 31.7 3.8 

All other 

All ages ............ 36,000 loo l 14.0 20.2 22.3 149 26.8 3.5 

Under 65 years ........... 9300 100 c 23.4 22.9 22.0 14.1 15.0 2.8 

65-74 years .............. 9,000 100 t l 21.6 26.0 12.3 29.2 3.6 

7544 years .............. 

85 years and over .......... 

10,900 

7,400 

loo 

loo 

l 

* 

10.8 l 

17.4 

19.5 

23.5 

16.5 

15.8 

17.6 

30.3 

33.9 

3.7 

3.9 

MARITAL STATUS 

Married 

All ages ............ 95,600 loo 2.1 11.0 20.1 21.3 18.4 27.1 3.5 

Under 66 years ........... 12,600 100 l 16.7 25.7 28.8 13.2 12.1 2.8 * 65-74 years .............. 21#900 100 11.5 22.6 18.5 18.5 27.3 3.5 

75-84 years .............. 43,000 loo l 9.7 18.8 20.7 19.2 29.5 3.6 

85 years and over .......... 18,100 100 l 9.6 15.9 209 20.0 31.8 3.8 

’ I 

35 
Table 1. Number and percent distribution of residents in nursing and personal care homes by number of chronic conditions and impairments, according 

to sex, color, marital status, and age: United States, June-August 1969-Con. 

Sex, color, marital status, Number of 

and age residents 

MAR ITAL STATUS-Con. 

Widowed 

All ages ............ 518,200 

Under 65 years ........... 17,000 

65-74 years .............. 70,800 

7544 years .............. 223,600 

85 years and over .......... 206,900 

Divorced-Separated 

All ages ............ 34,300 

Under 65 years ........... 13,600 

6574 years .............. 10,700 

75-84 years .............. 7,400 

85 years and over .......... 2,500 

Never married 

All ages ............ 167,000 

Under 65 years ........... 49,700 

65-74 years .............. 35,200 

75-84 years .............. 47,800 

85 years and over .......... 34,400 

Number of chronic conditions and impairments Average 

number 

Total No 1 2 3 4 5 conditions of 

conditions condition conditions conditions conditions or more :onditions 

100 

100 

100 

100 

100 

100 

100 

100 

100 

100 

100 

100 

100 

100 

100 

Percent distribution 

2.0 10.5 18.1 22.0 18.9 28.5 3.6 

* 25.4 24.5 16.0 14.8 16.8 2.8 

2.7 13.2 21.0 22.0 16.6 24.6 3.4 

2.0 10.5 18.9 22.8 18.8 27.0 3.5 

‘1.7 8.4 15.7 21.5 20.2 32.3 3.8 

* 22.2 22.8 20.0 14.0 19.5 3.0 

30.2 25.0 20.1 13.3 9.5 2.5 

20.6 26.4 19.7 11.5 20.7 3.0 

14.8 18.1 20.1 14.8 30.2 3.6 

t c * 1 I 4.2 

3.4 20.1 22.5 21.0 14.4 18.6 3.0 

2.6 35.2 26.8 18.5 8.9 8.0 2.3 

3.5 18.4 24.7 20.9 13.4 19.2 3.0 

4.2 13.2 20.1 22.6 17.5 22.4 3.2 

3.1 9.8 17.6 22.7 19.0 27.9 3.6 

36 
Table 2. Number and percent distribution of residents in nursing and personal care homes by mobility status, according to sex, color, 

marital status, and age: United States, June-August 1969 

Mobility status 

Number of Sex, color, marital status, and age residents 

ALL RESIDENTS Percent distribution 

All ages ............................ 815,100 100 44.3 18.8 10.9 26.1 

Under 65 years ........................... 92,900 100 52.3 17.7 10.3 19.8 

65-74 years ............................. 138,500 100 46.6 19.1 11.2 23.2 

75-84 years ............................. 321,800 100 46.0 18.3 10.7 25.0 

85 years and over ......................... 261,900 100 38.1 19.5 11.2 31.2 

Male 

All ages ............................ 251,900 100 48.7 19.9 10.6 20.9 

Under 65 years ........................... 44,800 100 54.3 17.8 11.0 16.9 

65-74 years ............................. 52,300 100 46.2 21.0 11.5 21.2 

75-84 years ............................. 90,700 100 49.6 18.9 11.0 20.6 

85 years and over ......................... 64,100 100 45.4 21.8 8.9 24.0 

Female 

All ages ............................ 563,300 100 42.3 18.3 11.1 28.4 

Under 65 years ........................... 48,100 100 50.3 17.6, 9.7 22.4 

65-74 years ............................. 86200 100 46.8 17.9 11.0 24.3 

75-84 years ............................. 231,100 100 44.6 18.1 10.6 26.8 

85 years and over ......................... 197,800 100 35.7 18.8 12.0 33.6 

COLOR 

White 

All ages ............................ 778,500 100 44.6 18.6 10.7 26.1 

Under 65 years ........................... 83,500 100 52.9 17.8 9.4 19.9 

65-74 years ............................. 129,500 100 47.4 18.6 10.9 23.1 

75-84 years ............................. 31opoo 100 46.5 18.1 10.6 24.8 

85 years and over ......................... 254,500 100 38.2 19.4 11.2 31.2 

All other 

All ages ............................ 36,000 100 36.3 22.6 14.3 26.8 

Under 65 years ........................... 9300 106 46.5 16.5 18.7 18.3 

65-74 years ...... , ...................... 9,000 100 35.2 25.8 14.6 24.4 

75-84 years ............................. IOPOO 100 31.4 24.0 12.2 32.4 * 85 years and over ......................... 7,400 100 32.0 24.5 31.9 

37 
Table 2. Number and percent distribution of residents in nursing and personal care homes by mobility status, according to sex, color, 

marital status, and age: United States, June-August 1969-Con. 

Mobility status 

Number of Sex, color, marital status, and age residents Total ( Amb&!ammy’ Chairfast 1 Bedfast 

MARITAL STATUS Percent distribution 

Married 

Allages ............................ 95,600 100 15.3 13.0 35.9 

Under 65 years ........................... 12,600 loo 26.7 13.7 16.4 43.3 ’ 

65-74 years ........ .' .................... 21 go0 100 35.7 13.8 13.3 37.2 

75-84years ............................. 43,000 100 37.4 14.8 93.4 34.4 

85 years and over ......................... 18,100 100 38.4 19.3 9.4 32.9 

Widowed 

Alages ............................ 518,200 loo 18.7 11.1 27.3 

Under 65 years ........................... 17,000 100 14.6 10.5 21.1 

65-74 years ............................. 70900 100 18.4 11.8 22.8 

7584years ............................. 223,600 100 18.8 10.5 25.0 

85 years and over ......................... 206900 100 19.0 11.5 31.8 

Divorcedseparated 

Allages.. .......................... 34,300 100 17.0 11.1 16.5 

Under 65 years ........................... 13,600 loo 61.1 12.3 10.1 16.5 

65-74vears ............................. 10,700 100 52.4 19.1 12.0 16.5 

75-84years ............................. 7.400 100 52.1 20.0 l 17.9 

85yearsandover ......................... 2,500 100 46.5 l * 

Never married 

Alages ............................ 167,000 100 21.4 9.2 18.7 

Under 65 years ........................... 49,700 100 55.8 21.2 6.8 14.2 

65-74 years ............................. 35200 100 50.8 23.8 6.4 17.1 

75-84years ............................. 47600 109 53.8 19.0 9.5 17.7 

85yearsandover ......................... 34,400 100 39.4 22.3 10.1 28.2 

38 

l 
Table 3. Number and percent distribution of residents in nursing and personal care homes by mobility status, according to number of chronic conditions and 

impairments and age: United States, June-August 1969 

Mobility status 

Number of Number of chronic conditions and impairments and age residents Total Ambulatory, Ambulatory, Chair-fast Bedfast unconfined I confined 

-

All residents Percent distribution 

Allages ........................................... 815,109 100 44.3 18.8 10.6 26.1 

- E - -

Under 65 years .......................................... 92,900 100 52.3 17.7 10.3 19.8 

6574years ............................................ 138,500 100 46.6 19.1 11.; 23.2 

75-84 years ............................................ 32 1,800 100 46.0 18.3 10.7 25.0 

85 years and over ........................................ 261,900 100 38.1 19.5 11 .i 31.2 

No conditions 

Allages ........................................... 18,400 100 86.8 5.8 I l 

Under 65 years .......................................... 2,400 100 81.7 

65-74years ............................................ 3,500 100 82.7 

75-84 years ............................................ 7,500 100 88.5 

85 years and over ........................................ 5,000 100 89.8 

7 condition 

Allages ........................................... 106,400 100 66.3 17.5 6.5 9.6 

Under65years .......................................... 28,000 100 66.3 18.9 5.4 9.4 

65-74 years ............................................ 20,600 100 63.1 19.6 7.6 9.7 

75-84years ............................................ 35,200 100 66.8 16.2 7.5 9.5 

85 years and over ........................................ 22,700 100 68.7 16.0 5.2 10.1 

2 conditions 

Adages ........................................... 158,400 loo 53.6 21.6 9.7 15.1 

Under 65 years .......................................... 24,100 100 50.8 20.0 12.2 17.0 

65-74 years ............................................ 31,300 100 54.5 22.0 8.5 15.0 

75-84 years ............................................ 61,300 100 57.1 21.1 9.1 12.7 

85 years and over ........................................ 41,700 100 49.5 22.9 9.9 17.7 

3 conditions 

Allages ........................................... 176,100 100 44.9 21.5 11.6 22.1 

Under 65 years .......................................... 18,300 100 44.4 18.9 13.8 22.9 

65-74years ............................................ 29,100 100 46.6 18.9 12.1 22.4 

75-84years ............................................ 72,100 100 47.0 21.9 11.1 19.9 

85 years and over ........................................ 56,600 100 41.4 23.1 11.1 24.4 

4 conditions 

Allages ........................................... 144,500 100 37.5 19.2 12.0 31.2 

Under 65 years .......................................... 10,400 100 42.3 10.1 12.2 35.4 

6674years ............................................ 21,700 100 39.3 20.8 14.0 25.8 

75-84years ............................................ 59,700 100 40.2 18.1 11 .I 30.6 

85 years and over ........................................ 52,700 100 32.9 21.6 12.3 33.3 

5 conditions or more 

Allages ........................................... 211,300 100 26.5 15.8 13.3 44.5 

Under 65 years .......................................... 9,600 100 33.7 16.8 13.3 36.2 

65-74years ............................................ 32,300 100 29.4 16.2 13.7 40.8 

7594years ............................................ 86,100 100 29.0 15.3 13.1 42.6 

85 years and over ........................................ 83,200 100 21.9 15.9 13.3 48.6 

-

39 
Table 4. Number and percent distribution of residents in nursing and personal care homes by number of chronic conditions and impairments, according -

to type of service and age: United States, June-August 1969 

Number of chronic conditions and impairments 

Number of Type of service and age residents Total No 1 2 3 4 6 conditions Iconditions condition conditions conditions I conditions I or more 

All types Percent distribution 

All ages ............ 815,100 100 2.3 13.1 19.4 21.6 17.7 25.9 3.4 

Z 

Under 65 years ........... 92,900 100 2.6 30.2 26.0 19.7 11.2 10.4 2.5 

65-74years.. ............ 138,500 100 2.6 14.8 22.6 21.0 15.7 23.3 3.3 

75-84yean .............. 321,800 100 2.3 10.9 19.0 22.4 18.5 26.7 3.5 

85 years and over .......... 261,900 100 1.9 8.7 15.9 21.6 20.1 31.8 3.8 

Nursing care 

All ages ............ 638,800 100 1.3 10.0 18.7 22.1 19.3 28.6 3.6 

Under 65 years ........... 66,500 100 2.3 24.2 26.5 21.0 13.4 12.7 2.7 

65-74 years .............. 108,800 100 1.4 11.8 22.1 21.7 17.3 25.8 3.5 

75.84 years .............. 255,400 100 1.1 8.3 18.0 23.0 20.2 29.4 3.7 

85 years and over .......... 208,100 100 1.1 6.8 15.2 21.5 21.2 34.3 3.9 

Personal care with nursing 

All ages ............ 139,500 100 4.8 20.7 21.5 20.7 13.5 18.8 2.9 

Under 65 years ........... 17,900 100 t 44.1 25.1 15.7 6.2 6.0 2.0 

8574 years .............. 22,100 100 6.2 23.6 22.9 19.8 9.9 17.6 2.8 

75-84 years .............. 53,700 100 5.8 18.0 23.0 20.3 14.1 18.8 2.9 

85 years and over .......... 45,900 100 3.8 13.4 17.7 23.6 17.3 24.2 3.3 

Personal care 

All ages ............ 36,900 100 9.6 36.2 25.1 17.2 6.1 5.8 1 .Q . 

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

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

8,500 

7,700 

100 

100 

. 

* 

47.8 

32.7 

23.2 

29.5 

18.3 

14.6 

4.4 

9.3 

1.7 

4.7 

'I.8 

2.0 

7584 years .............. 12,800 ICI6 11.8 33.6 23.6 20.0 4.8 6.1 1.9 

85 years and over .......... 7900 100 l 31.4 24.4 14.1 7.1 10.5 2.1 

40 
. 

-

Table 5. Number and percent distribution of residents in nursing and personal care homes by mobility status, according to type of 

service and age: United States, June-August 1969 

Mobility status 

Number of I I 1 I 

Type of service and age residents Total Ambulatory, Ambulatory, Chair-fast Bedfast 

II unconfined I confined I I 

All types Percent distribution 

All ages ............................ 815,100 100 44.3 18.8 10.9 26.1 

Under 65 years ........................... 92,900 100 52.3 17.7 10.3 19.8 

65-74 years ............................. 138,500 100 46.6 19.1 11.2 23.2 

76-84years ............................. 321,800 100 46.0 18.3 10.7 25.0 

85 years and over ......................... 261,900 100 38.1 19.5 11.2 31.2 

Nursing care 

All ages ............................ 638,800 100 38.2 19.3 12.3 30.2 

Under 65 years ........................... 66,500 100 44.4 17.8 12.7 25.1 

65-74 years ............................. 108,800 100 40.6 19.2 12.9 27.3 

75-84 years ............................. 255,400 100 39.5 19.2 12.1 29.2 

85 years and over ......................... 208,100 100 33.2 19.9 12.2 34.7 

Personal care with nursing 

All ages ............................ 139,500 100 62.9 17.1 6.5 13.6 

Under 65 years ........................... 17900 100 64.0 21.7 5.9 8.4 

65-74 years ............................. 22,100 100 66.1 17.4 5.7 70.9 

75-84 years .............................. 53,700 100 68.3 15.5 5.5 10.8 

85 years and over ......................... 45,900 100 54.6 17.1 8.2 20.2 

Personal care 

All ages ............................ 36,900 100 79.6 15.9 

Under 65 years ........................... 8,500 100 89.0 * 

65-74 years ............................. 7,700 100 75.8 21.8 

75-84 years ............................. 12,800 100 81.9 13.0 

85 years and over ......................... 7943 100 69.6 22.5 

41 
Table 6. Number and percent distribution of residents in nursing and personal care homes by number of chronic conditions and impairments, according to 

level of patient care end age: United States, June-August 1969 

- -

Number of chronic conditions and impairments Average 

Number of number Level of patient care and age residents No 1 2 3 4 5 conditions of Total conditions condition conditions conditions conditions or more :onditions 

All levels Percent distribution 

All ages .............. 815,100 1oc 2.3 13.1 19.4 21.E 17.1 25.9 3.4 

- G - - - - -

Under 65 years ............. 92,900 1OC 2.6 30.: 26.C 19.1 11.2 10.4 2.5 

6574years ................ 138,500 1oc 2.6 14.E 22.E 21.0 15.7 23.3 3.3 

7544 years ................ 321,800 1oc 2.3 102 19.c 22.4 18.5 26.7 3.5 

85 years and over ............ 261,900 IOC 1.9 8.; 15.E 21.8 20.1 31.8 3.8 

Intensive 

All ages .............. 153,800 1oc 4.c 1 I 9 19.1 21.1 ‘43.6 4.4 

Under 65 years ............. 13,200 1oc 1 1.5 17.: 27.3 21.6 21.2 3.4 

65-74 years ................ 23,900 100 5.1 15.4 20.7 18.6 40.0 4.2 

7544 years ................ 61,300 100 2.i 12.4 19.1 21.1 44.5 4.5 

85 years and over ............ 55,400 100 3.1 8.5 16.6 22.0 49.5 4.7 

Bed bath 

All ages .............. 113,500 100 * 6A 16.2 20.4 20.6 36.0 4.0 

Under 65 years ............. 9,800 IW 14.1 28.E 21.1 17.a 16.4 3.0 

65-74 years ................ 18,500 100 9.; I8.C 20.1 16.4 35.6 3.9 

7544 years ................ 43,300 100 5.c 15.5 22.3 20.8 36.3 4.1 

85 years and over ............ 42,000 100 4.E 13.1 18.3 23.2 40.5 4.3 

Less intensive 

All ages .............. 72,500 100 1 8.5 17.8 24.6 19.6 28.2 3.6 

Under 65 years ............. 6,700 100 21.2 22.3 27.3 * * 2.8 

65-74 years ................ 13,800 100 9s 19.4 29.0 15.6 24.7 3.5 

7544 years ................ 30,600 100 7.s 17.7 24.5 21.6 27.5 3.7 

85 years and over ............ 21,500 100 5.6 15.a 21.2 21 .I 35.8 4.0 

All ages .............. 264,300 100 0.9 12.2 21.7 23.2 18.9 23.1 3.3 

Under 65 years ............. 28,700 100 28.E 29.3 18.1 11.3 11.0 2.5 

65-74 years ................ 45,000 100 13.6 25.4 21.5 16.5 21.9 3.3 

7544 years ................ 106,800 100 10.6 2p.a 23.4 20.4 23.9 3.4 

85 years and over ............ 83,700 100 7.8 18.1 25.5 20.9 26.9 3.6 

Personal 

All ages .............. 160,500 100 2.2 22.3 25.6 23.5 14.0 12.3 2.7 

Under 65 years ............. 24,800 100 c 40.0 28.0 18.5 6.3 4.6 2.1 

* 65-74 years ................ 28,000 100 25.4 27.6 19.9 15.1 9.6 2.6 

7544 years ................ 60,900 lop 1.9 18.5 26.0 26.8 13.9 13.9 2.8 

85 years and over ............ 46,900 100 2.4 16.1 22.6 25.4 17.7 15.9 3.0 

All ages .............. 50,500 100 21.4 36.6 21.2 13.1 3.8 3.9 1.6 

Under 65 years ............. 9,700 100 l 55.9 22.1 10.4 1.3 1.4 

65-74 years ................ 9,300 100 21.0 32.3 27.1 12.4 5.1 2.1 1.6 

7544 years ................ 19,000 100 26.7 33.6 18.3 13.5 4.7 3.3 I.5 

85 years and over ............ 12,400 100 22.3 29.4 20.5 15.2 3.4 9.1 1.8 

-

42 
Table 7. Number and percent distribution of residents in nursing and personal care homes by mobility status, according to level of patient care and age: 

United States, June-August 1969 

-

Mobility status 

Number of Level of patient care and age residents 

All levels 

Allages ........................................... 815,100 -

Under65years.. ........................................ 92300 

65-74 years ............................................ 138,500 

76.84 yea15 ............................................ 321,8W 

85 years and over ........................................ 261,900 

Intensive 

Allages ........................................... 153,800 

Under 65 years .......................................... 13,2W 

6574 years ............................................ 23900 

7564yean ............................................ 61.300 

85 years and over ........................................ 55,400 

Bed bath 

Aflages ........................................... 113,500 

Under65yaars.. ........................................ 

6574 years ............................................ 

93w 

IS= 

7564 years ............................................ 43300 

1 85yeanandover ........................................ 42,000 

I Lass intensive 

t Allages ........................................... 72,5W 

Under 65 years .......................................... 6,7W . 6574 years ............................................ 13,800 

7564 years ............................................ 30,600 

85 years and over ........................................ 21,500 

Routine 

All ages ........................................... 264,300 

Under65yean .......................................... 28,700 

6574 years ............................................ 45,000 

76-84 years ............................................ 106,800 

85yaarsandover ........................................ 83,700 

Personal 

Anages ........................................... 160,600 

Under 65 years .......................................... 24,800 

65.74 years ............................................ 28,~ 

75-84 years ............................................ 60.900 

85 years and over ........................................ 46900 

Ah ages ........................................... 50,500 

Under65yean .......................................... 9,7oa 

65-74 years ........................................... 99w 

7584 years ............................................ 19,wa 

85 years and over ........................................ 12,590 

100 44.3 18.8 103 -

loo 52.3 17.7 10.3 

loo 46.6 19.1 112 

loo 46.0 183 10.7 

loo 38.1 19.5 112 

loo 14.5 15.7 132 

loo 16.2 12.4 15.6 

loo 17.4 168 12.5 

loo 15.7 16.6 122 

loo 11.7 14.9 14.0 

loo 15.5 14.3 119 

100 16.6 l 11.5 

loo 17.6 112 119 

loo 16.8 15.2 129 

loo 13.0 15.9 11.0 

loo 46.4 20.6 142 

loo 53.2 20.6 15.3 

loo 462 18.4 18.4 

loo 51.7 183 13.3 

loo 43.7 24.6 12.4 

loo 51.7 23.5 11.7 

loo 56.5 24.1 10.5 

loo 52.1 25.5 12.1 

loo 54.0 21.7 11.3 

loo 46.8 24.5 12.4 

loo 65.4 20.4 8.0 

loo 66.3 20.0 9.7 

loo 68.8 20.4 7.4 

loo 66.1 20.2 8.1 

loo 62.1 20.7 7.8 

loo 87.4 5.8 2.0 

loo 88.1 I l 

100 86.1 I l 

100 91.8 4 t 

loci 809 4 l 

26.1 -

19.8 

23.2 

25.0 

31.2 

66.7 

55.8 

53.3 

55.6 

59.5 

58.3 

623 

59.3 

55.2 

60.0 

16.8 

l 

17.0 

16.1 

19.4 

13.2 

83 

10.3 

13.0 

16.3 

6.3 

5.0 l 

5.6 

9.5 
Table 8. Number and percent distribution of residents in nursing and personal care homes by number of chronic conditions and impairments, according 

to number and types of special aids and age: United States, June-August 1969 

Number of chronic conditions and impairments 

Number and type of special aids Number of 

and age residents No 1 2 3 4 5 conditions of Total conditions condition conditions conditions conditions or more :onditions 

ALL RESIDENTS Percent distribution 

All ages ............ 815,100 100 2.3 13.1 19.4 21.6 17.7 25.9 3.4 

Under 65 years ........... 92,900 100 2.6 30.2 26.0 19.7 11.2 10.4 2.5 

65-74 years .............. 138,500 100 2.6 14.8 22.6 21.0 15.7 23.3 3.3 

75-84 years .............. 321,800 100 2.3 10.9 19.0 22.4 18.5 26.7 3.5 

85 years and over .......... 261,900 100 1.9 8.7 15.9 21.6 20.1 31.8 3.8 

NUMBER OF AIDS USED 

No aids used 

All ages ............ 181,900 100 3.6 20.2 20.4 21.0 14.9 19.9 3.1 

Under 65 years ........... 40,700 100 3.4 40.4 25.9 16.7 7.4 6.3 2.1 

65-74 years .............. 35,900 100 3.6 21.2 25.1 20.4 13.3 16.4 2.9 

75-84 years .............. 60,100 100 3.3 13.6 19.0 24.2 16.5 23.4 3.3 

85 years and over .......... 45,200 100 4.4 10.1 13.7 21.0 20.7 30.3 3.7 

1 aid -

All ages ............ 342,245 100 2.7 13.6 21.2 21.9 16.9 23.6 3.3 

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

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

35,800 

58,500 

100 

100 

* 

3.4 

26.1 

15.0 

27.2 

24.5 

19.9 

20.6 

13.3 

14.5 

11.3 

22.0 

2.6 

3.1 f 

75-84 years .............. 142,000 100 3.1 12.6 21.3 22.4 17.7 23.0 3.3 1 

85 years and over .......... 105,900 100 2.1 99 17.4 22.6 18.5 29.6 3.6 

2 aids 1

I 

All ages ............ 228,900 100 1 .o 8.3 17.3 22.2 20.4 30.8 3.7 

Under 65 years ........... 12,700 100 I 15.0 23.6 26.3 14.9 18.4 3.1 

65-74 years .............. 34,000 100 l 10.5 18.1 21.8 19.8 29.3 3.7 

75-84 years .............. 94,400 100 1.1 7.9 17.5 22.3 20.7 30.5 3.7 

85 years and over .......... 87,800 100 x 6.9 16.0 21.7 21.2 33.6 3.9 

3 or more aids 

All ages ............ 62,100 100 6.7 14.4 19.7 20.6 38.2 4.1 

Under 65 years ........... 3,600 100 * l 29.0 c * 3.4 

65-74 years .............. 10,100 100 l 18.2 22.5 17.2 35.6 4.0 

75-84 years .............. 25,300 100 6.2 12.6 18.4 20.5 41.9 4.2 

85 years and over .......... 23,100 100 7.2 13.4 18.4 .22.3 38.1 4.1 

TYPE OF AIDS USED 

* 

Eyeglasses 

All ages ............ 496,900 100 2.2 12.1 20.0 22.1 18.0 25.5 3.4 

Under 65 years ........... 32,000 100 t 27 A 25.9 20.3 11.5 12.3 2.6 

65-74 years .............. 80,000 100 2.7 14.3 22.8 21.2 16.0 22.9 3.3 

75-84 years .............. 214,200 100 2.5 11.3 20.0 22.4 18.6 25.2 3.4 

85 years and over .......... 170,700 100 1.6 9.3 17.7 22.5 19.4 29.5 3.7 

44 
Table 8. Number and percent distribution of residents in nursing and personal care homes by number of chronic conditions and impairments, according 

to number and types of special aids and age: United States, June-August 1969-Con. 

Number of chronic conditions and impairments Average 

Number and type of special aid! Number of number 

and age residents No 1 2 3 4 5 conditions of Total conditions condition conditions conditions conditions or more onditions 

TYPES OF AIDS USED-Con. Percent distribution 

Hearing aid 

All ages ............ 38,200 100 I 9.9 13.3 21.6 18.4 34.7 3.9 

Under 65 years ........... l 100 I l I l l l 

65-74 years .............. 3.500 100 l z l l 33.4 4.0 

75-84 years .............. 15,500 loo l 8.5 14.0 21.5 16.3 36.4 3.9 

85 years and over .......... 18,200 100 l 10.2 13.5 20.3 20.4 34.3 3.9 

Wheelchair 

All ages ............ 253,900 100 0.4 5.7 14.6 20.7 20.7 38.0 4.1 

Under 65 years ........... 25,400 100 I 13.2 24.7 26.8 18.2 16.1 3.1 

65-74 years .............. 42,700 loo l 6.6 17.8 21.7 18.3 35.3 4.0 

75434 years .............. 98,100 100 I 5.4 13.4 19.7 21.6 39.6 4.2 

85 years and over .......... 87,800 loo l 3.3 11 A 19.6 21.5 43.8 4.4 

Walker 

All ages ............ 96,600 100 l 8.4 17.8 21.4 20.2 31.3 3.8 

Under 65 years ........... 4,900 100 t l 21.2 25.8 l 22.3 3.3 

65-74 years .............. 14,600 loo l 13.0 18.9 21.3 16.4 30.1 3.6 

I 75.84 years .............. 39,600 100 l 6.4 18.6 22.0 20.5 31.7 3.8 . 85 years and over .......... 37,406 100 8.5 16.2 20.2 21.7 32.6 3.8 

Crutches 

1 All ages ............ 10,ow 100 l l 23.0 19.6 23.7 24.4 3.5 

Under 65 years ........... 1 go0 109 I + l 2.8 

65-74 years .............. 2,000 100 l l l 3.6 

75-84 years .............. 3,400 100 l c 3.6 

85 years and over .......... 2,700 100 l l 3.8 

Braces 

All ages ............ 8,900 100 I l 24.2 22.6 23.2 24.4 3.6 

Under 65 years ........... 2,200 100 l 3.4 

6574 years .............. 3,100 loo l c 3.6 

75-84 years .............. 2,500 100 l 3.9 

85 years and over .......... 1,100 100 l 3.5 

Other aids 

All ages ............ 89,!300 loo I 10.2 18.5 21.7 21.2 27.7 3.6 

Under 65 years ........... 5,500 loo t 27.2 21.8 l 19.3 3.1 

6574years .............. 12,400 loo l l 17.9 21.9 22.8 30.0 3.8 

75-84 years .............. 36,200 loo l 10.6 17.0 22.5 20.4 28.8 3.7 

85 years and over .......... 35900 loo I 9.9 18.8 20.8 22.4 26.9 3.6 

L 

45 
Table 9. Number and percent distribution of residents in nursing and personal care homes by mobility status, according to number and types of special aids 

and age: United States, June-August 1969 

-

Mobility status 

Uumber of Number and type of special aids and age 

1 

ALL RESIDENTS Percent distribution 

Allages ........................................... 815,100 t 100 44.3 18.8 10.9 26.1 

Under 65 years .......................................... 92,900 100 52.3 17.7 10.3 19.8 

6574years ............................................ 136,500 100 46.6 19.1 11.2 23.2 

75-84years ............................................ 321,800 100 46.0 18.3 10.7 25.0 

85 years and over ........................................ 261,900 100 38.1 19.5 11.2 31.2 

NUMBER OF AIDS USED 

No aids used 

Allages ........................................... 181,900 100 44.5 28.4 1.1 26.0 * 

Under 65 years .......................................... 40,700 100 58.2 27.7 l 13.6 

65-74years ............................................ 35300 100 48.1 32.0 I 18.7 

7564 years ............................................ 60,106 100 42.8 28.9 l 27.2 

* 85 years and over ........................................ 45,206 100 31.6 25.6 41.5 

1 aid -

Ailages ........................................... 342,200 100 49.9 18.3 7.4 24.4 

Under 65 years ........................ _.-................ 35,800 100 52.1 11.4 12.7 23.8 

6574years ............................................ 58,500 100 54.4 16.6 6.7 22.3 

76-84 years ............................................ 142,000 100 53.6 18.5 6.7 21.2 ’ 

85yearsandowr ........................................ 105900 100 41.7 21.2 7.0 30.2 I 

2 aids 

Allages ........................................... 228300 100 37.8 14.5 18.1 29.5 

I 

Under 65 years .......................................... 12,706 100 40.5 l 25.C 27.2 

6574vears ............................................ 34,000 100 35.6 13.3 20.5 30.7 

7584years ............................................ 94,400 100 38.6 13.9 17.7 29.7 

85 years and over ........................................ 87,800 100 37.4 16.7 16.7 29.2 

3 or more aids 

Allages ........................................... 62,100 100 36.3 8.6 32.1 22.9 

Under 65 years .......................................... 3,600 100 29.4 l 44.1 l 

6574years ............................................ 10,100 100 33.1 l 41.2 18.8 

75-84years ............................................ 25,300 100 38.4 8.4 29.7 23.6 

85yeanandover ........................................ 23,100 100 36.6 10.4 29.0 24.0 

TYPE OF AIDS USED 

Eyeglasses 

Allages ........................................... 496,900 100 50.6 17.1 11.5 20.8 

Under65yean.. ........................................ 32,000 100 61 .I 11.3 12.0 15.7 

6574yean ............................................ 80,000 100 52.7 15.1 12.9 19.3 

76-84years ............................................ 214,200 100 52.3 17.0 10.8 20.0 

86yearsandover ........................................ 170,700 100 45.5 19.3 11.8 23.5 

46 
Table 9. Number and percent distribution of residents in nursing and personal care homes by mobility status, according to number and types of special aids 

and age: United States, June-August 1969-Con. 

Mobility status 

Number of Number and type of special aids and age residents 

TYPE OF AIDS USED-Con. Percent distribution 

Hearing aid 

AMages ........................................... 38,200 100 54.1 14.7 11.8 19.4 

Under 66 years .......................................... l 100 l I * t 

65-74 years ............................................ 3,500 100 54.6 l II l 

75.84 years ............................................ 15,500 100 59.3 12.7 10.4 17.7 

85 years and over ........................................ 18,200 100 50.0 16.0 12.9 21.2 

Wheelchair 

Allages ........................................... 253,900 100 17.1 2.5 31.4 49.0 

l Under 65 years .......................................... 25,400 100 20.8 36.1 41.6 

66-74 years ............................................ 42,700 100 20.1 2.8 32.3 44.8 

75-84years ............................................ 98,100 100 16.8 2.7 31.3 49.3 

86 years and over ........................................ 87,800 100 14.9 2.4 29.8 52.8 

Ailages ........................................... 96,600 100 40.5 24.5 20.5 14.6 

Under66years.. ........................................ 4,900 100 41.1 24.9 l * 

65-74yean ............................................ 14,600 100 39.7 23.4 25.7 11.3 

7584years ............................................ 39,600 100 43.4 22.2 19.9 14.5 

85 years and over ........................................ 37,400 100 37.6 27.2 19.3 15.9 

Crutches 

Anages ........................................... 10,000 100 51.8 21.0 18.7 8.4 

l Under 66 years .......................................... lmo 100 58.9 

65-74 years ............................................ 2,000 100 l l 

* 7584years ............................................ 3,400 100 57.5 

* 85 years and over ........................................ 2,700 100 48.5 

Braces 

Allagas ........................................... 8.900 100 40.9 13.0 27.0 19.1 

Under 65 years .......................................... 2200 100 * l l * 

6574years ............................................ 3,100 100 l * * l 

75-84 years ............................................ 2,500 100 54.2 l l l 

86 years and over ........................................ 1,100 100 * l * l 

Allagas ........................................... 89,935 100 56.6 24.3 6.6 12.6 

Under 66 years .......................................... 5,500 100 55.7 l l l 

65-74years ............................................ 12,400 100 49.2 21.9 12.3 16.6 

7584years ............................................ 36,200 100 58.9 23.2 5.7 12.2 

85 years and over ........................................ 35,900 100 56.9 27.5 4.5 11.1 

47 
APPENDIX I 

TECHNICAL NOTES ON METHODS 

Survey Design 

The Resident Places Survey-3 (RPS-3) was 

conducted during June-August 1969 by the Division of Health Resources Statistics in cooperation with the U.S. Bureau of the Census. This 

was a sample survey of nursing and personal care 

homes in the conterminous United States which 

provide care to the aged and infirm. Collected in 

the survey were data about the sample establishment itself, about the health of a sample of the 

patients or residents, about the administrator of 

the establishment, and about a sample of the 

employees. 

Resident Places Survey-3 is the third of a series of institutional population surveys conducted as part of the National Health Survey 

program. The previous surveys have been designated as Resident Places Survey-l and -2, or 

RPS-1 and RPS-2. Several reports in Vital and 

Health Statistics, Series 12 and 13, describe the 

results of RPS-1 and RPS-2. 

Sampling frame.-The list of nursing and personal care homes included in the 1967 Master 

Facility Inventory (MFI) was the primary sampling frame (universe) for Resident Places 

Survey-3. The MFI was supplemented by a list 

of new homes, “births,” which were possibly 

within scope of RPS-3 but were not confirmed 

in the 1967 MFI Survey. The “births” had been 

reported in the Agency Reporting System (ARS) 

as being in operation at the time of the survey. 

(A description of the MFI and ARS has been 

published.) * 4 

It should be noted that estimates from RPS-3 

will not correspond precisely to figures from the 

1969 MFI Survey. This is because the two surveys used different data collection mechanisms; 

the RPS-3 data are subject to sampling variability and the RPS-3 universe did not include all 

MFI facilities. In general, however, the data 

from the two sources are compatible. 

To be eligible for the survey, establishments 

must have maintained at least three beds and 

routinely provided some level of nursing or personal care. Thus a home providing only room 

and board or domiciliary care to its residents 

was not eligible for RPS-3 even if it was a home 

for the aged. The classification scheme for 

homes is described in appendix II. 

Sample &sign.-The sample was a stratified 

two-stage probability design; the first stage was a 

selection of establishments and their administrators and the second stage a selection of residents and employees of the sample establishments. In preparation for the first-stage sample 

selection, establishments listed in the MFI were 

sorted into three type of service strata: nursing 

care homes, personal care homes with nursing, 

and personal care homes. The “births” from the 

Agency Reporting System were treated as a 

fourth type of service stratum. Each of these 

four strata was sorted into seven bed-size groups, 

producing 28 primary strata as shown in table I. 

MFI establishments were ordered by type of 

ownership, State, and county. The sample of 

MFI establishments and the “births” were then 

selected systematically after a random start 

within each primary strata. In addition to showing the 28 primary strata, table I shows the distribution of establishments in the sampling 

frame and the final disposition of the sample 

with regard to response and in-scope status. 

The second-stage sample selection of residents 

, and employees was carried out by Bureau of 

Census interviewers at the time of their visit to 

the establishments in accordance with specific 

instructions given for each sample establishment. 

The sampling frame for residents was the total 

48 
Table I. Distribution of homes in the Resident Places Survey-3 universe and disposition of sample homes according to primary strata 

(type of service and bed size of home) : United States 

Number of homes in sample 

Universe’ out of T In scope and in business Type of service and bed size of home (sampling Total scope or frame) homes out of Nonresponding Responding 

business homes homes 

Alltypes................................ 21,301 2,088 153 81 1,854 

- -

Nursing care . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . 10,480 1,289 48 66 1,175 

Less than 15 beds ................................ 858 21 4 2 15 

15-24 beds ..................................... 1,756 88 I3 3 72 

2549beds ..................................... 3,448 260 16 10 234 

50-99beds ..................................... 3,166 477 4 24 449 

loo-199 beds ................................... 1,062 316 9 24 283 

200-299 beds ................................... 126 64 1 2 61 

300 beds or more ................................ 64 63 1 I 61 

Personal care with nursing . . . . . . . . . . . . . . . . . . . . . . 3.608 402 35 7 360 

Less than 15 beds ................................ 941 24 6 18 

15-24 beds ..................................... 767 37 9 28 

2549beds ..................................... 828 62 7 54 

5089 beds ..................................... 612 92 3 86 

100-199 beds ................................... 332 100 6 92 

200-299 beds ................................... 82 41 1 40 

300 beds or more ................................ 46 46 3 42 

Personal care ............................... 4,725 183 42 138 

Less than 15 beds ................................ 2,937 60 16 44 

15-24 beds ..................................... 988 40 11 29 

2549beds ..................................... 561 35 5 30 

50-99 beds ..................................... 183 24 3 20 

loo-199 beds .................................... 48 17 5 IO 

200-299 beds ................................... 6 6 2 3 

3OObedsormore ................................ 2 2 2 

“Births”” ................................. 2,488 214 28 181 

Unknown bed size3 .............................. 473 

Less than 15 beds ................................ 304 6 2 ’ 4 

15-24 beds ..................................... 255 11 3 8 

2549 beds ..................................... 492 31 3 27 

50-99 beds ..................................... 681 83 4 76 

loo-199 beds ................................... 241 58 7 50 

200-299 beds ................................... 30 I3 3 10 

300 beds or more ................................ 12 12 6 6 

‘The universe for the RPS3 sample consisted of the nursing and personal care homes included in the Master Facility Inventory and 

the Agency Reporting System, 

2 “Births” consist of homes which were assumed to be in scope of RPS3 but for which current data were not available. 

3”Births” of unknown bed size were inadvertently excluded from frame. 

49 
number of residents on the register of the establishment on the day of the survey. The sampling 

frame for employees was the Staff Information 

and Control Record (HRS-4e, appendix III) on 

which the interviewer listed the names of all employees of the establishment and sampled only 

professional and semiprofessional employees by 

using predesignated sampling instructions that 

appeared at the head of each column of this 

form. 

Survey procedures.-The Bureau of Census 

collected the data according to specifications of 

the Division of Health Resources Statistics. The 

initial contact with an establishment was a letter 

(HRS-4g-1, appendix III) signed by the Director 

of the Bureau of the Census mailed prior to a 

personal visit to each sample facility. This letter 

was accompanied by the facility and administrator questionnaires (HRS-4a and HRS-4b, appendix III). The respondent for the facility questi onnaire was usually the administrator or 

another member of the staff designated by the 

operator of the establishment. Information on 

the administrator questionnaire was selfenumerative and was completed by the person 

who was designated as “administrator” by the 

owner or operator of the sample facility. These 

two forms were collected by an interviewer during the personal visit to the facility and were 

edited for completeness and consistency at that 

time. The resident information was obtained 

during the personal interview to the sample establishment. The sample of residents within an 

establishment was selected systematically according to predetermined sampling schemes. The 

interviewer was asked to list on the back of the 

Current Patient Questionnaire (HRS-4f, appendix III) all the residents or patients in the 

sample and to complete the health information 

for each of the sample patients from the patient’s medical record and/or from the personal 

knowledge of a staff member of the establishment who had close contact with the resident 

and firsthand knowledge of the resident’s health 

condition. 

The staff information was obtained by means 

of a self-enumeration questionnaire (HRS-4e, 

appendix III). 

The usual checks and followups were performed during the course of the survey. The 

completed questionnaires were edited and coded 

by the National Center for Health Statistics, and 

the processing included assignment of weights, 

ratio adjustments, and other related procedures 

necessary to produce national estimates from 

the sample data. 

Generd Qualifications 

Nonresponse and imputation of missing 

data.-Statistics presented in this report were adjusted for failure of a home to respond. Data 

were also adjusted for nonresponse which resulted from failure to complete one of the questionnaires or the failure to complete an item on 

a questionnaire. 

Rounding of numbers.-Estimates of residents 

have been rounded to the nearest hundred. For 

this reason detailed figures within tables do not 

always add to totals. Percents and mean values 

were calculated on the basis of original, unrounded figures and will not necessarily agree 

precisely with percents or means, which might 

be calculated from rounded data. 

Estimation procedure.-The statistics presented in this report are essentially the result of 

ratio estimation techniques. These techniques 

are described in an earlier publication1 

Reliability of estimates.-Since 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. As in any survey, the 

results are also subject to reporting and processing errors and errors due to nonresponse. To 

the extent possible, these types of errors were 

kept to a minimum by methods built into survey 

procedures. 

The sampling error (or standard error) of a 

statistic is inversely proportional to the square 

root of the number of observations in the sample. Thus as the sample size increases, the standard error decreases. The standard error is primarily a measure of the variability that occurs 

by chance because only a sample, rather than 

the entire universe, is surveyed. As calculated for 

this report, the standard error also reflects part 

of the measurement error, but it does not measure any systematic biases in the data. The 

chances are about 2 out of 3 that an estimate 

from ,the sample differs from the value which 

would be obtained from a complete census by 

less than the standard error. The chances are 

50 
-- 

about 95 out of 100 that the difference is less 

than twice the standard error and about 99 out 

of 100 that it is less than 2% times as large. 

ReIative standard errors of aggregates shown 

in this report are presented in table II. The relative standard error of an estimate is obtained by 

dividing the standard error of the estimate by 

Table II. Approximate relative standard errors of estimated 

numbers shown in this report 

Relative 

standard 

Estimate error (in 

)ercentage 

points) 

2,500.. ............................ 14.4 

5,000.. ............................ 102 

20,000 ............................. 5.3 

60,006 ............................. 3.3 

90,000 ............................. 29 

200,006 ............................ 2.3 

500,000 ............................ 19 

800,000 ............................ 1.8 

the estimate itself and is expressed as a percent 

of the estimate. Standard errors of estimated 

percentages are shown in table III. 

Rules for determining the standard error of a 

mean value, of a median value, or of the difference between two statistics may be found in appendix I of Series 12, No. 7.4 

Table I I I. Approximate standard errors of percentages shown in 

this report 

f Estimated percent - - - -

Base of percentagf 2 5 10 m 30 

2,000 ........ 

5,000 ........ 

20,000 ....... 

50,000 ....... 

80,000 ....... 

200,000 ...... 

500,000 ...... 

800,000 ...... 

or or or or 

2 95 90 80 70 - - - - -

2.2 3.5 4.8 6.4 7.3 

1.4 22 3.0 4.0 4.6 

0.7 1.1 1.5 2.0 2.3 

0.4 0.7 1 .o 1.3 1.5 

0.4 0.6 0.8 1.0 12 

0.2 0.3 0.5 0.6 0.7 

0.1 02 0.3 0.4 0.5 

0.1 0.2 02 0.3 0.4 - - - - -

51 
APPENDIX II 

DEFINITIONS OF CERTAIN TERMS USED IN THIS REPORT 

Demographic Terms 

Resident (or patient).-A resident is defined 

as a person who has been formally admitted but 

not discharged from an establishment. All such 

persons were included in the survey whether or 

not they were physically present at the time of 

the survey. 

Age.-Age is defined as age at last birthday. 

Color.-The population is divided into two 

color groups, “white” and “al1 other.” The “ah 

other” group includes Negro, American Indian, 

Chinese, Japanese, and any other race. Mexican 

persons are included with “white” unless definitely known to be Indian or of another race. 

Marital status.-The marital status is that of a 

person at the time of the survey. 

Terms Relating to Health Status 

Chronic conditions and impairments.-If the 

respondent answered “yes” to a category in item 

6 of the Current Patient Questionnaire (see appendix III) then it was counted as a chronic condition or impairment and counted as only one, 

even though more than one may have been included in that category. An exception to that 

rule was category “N” which asked the respondent to specify “any other conditions or impairments.” This category was checked first to determine that it was not a repeat of the other 

conditions listed in the preceding categories; 

and, if not, each condition listed in it was 

counted individually. In addition, a hearing impairment was counted if there was an affirmative 

response to either categories “d” or “e” of item 

12 of the same questionnaire, and a vision impairment was counted if there was an affirmative 

response to either category “c” or “d” of item 

13; however, this count was made only if either 

condition had not been specified in category 

“N” of item 6. 

Condition.-This term is used synonymously , 

with the term “chronic conditions and impairments” since no distinction has been made between the two groups in this report. 

Mobility status.-Mobility was classified according to the degree of mobility limitation involved as follows: 

1. Nonambulatory-referred to those residents who were bedfast. It included two 

categories: (a) those residents who were , 

totally bedfast, or restricted to total bed 

rest and (b) those residents who were generally bedfast, or confined to bed but up 

in a wheelchair for at least a few hours a 

day. 

2. Ambulatory-referred to those residents 

who were not bedfast. It included three 

categories: (a) those residents who were 

chairfast, or needed a wheelchair but required minimal help in getting around, 

(b) those residents who were ambulatory, 

confined, or were confined to the premises 

but did not use a wheelchair, and (c) those ’ 

residents who were ambulatory, unconfined, or were capable of going off the 

premises with or without assistance. 

3. Restrictions or limitations in mobilityreferred to all residents who were not ambulatory, unconfined. 

.’ 

Levels of Nursing or Personal Care 

These levels are defined in terms of the implied intensiveness of care or the condition of 

the resident. Based on these criteria, nursing and 

personal care services are grouped as follows, 

52 
each succeeding level being exclusive of the previous levels : 

Intensive care 

Catheterization .’ 

Bowel and bladder retraining 

Oxygen therapy 

Intravenous injection 

Nasal feeding .. 

Full bed bath 

Less intensive care 

.! Application of sterile dressings or bandages 

Irrigation 

ii Hypodermic injection 

Intramuscular injection 

Subcutaneous injection 

Routine nursing care 

Temperature 

Temperature-pulse 

Enema 

Blood pressure 

Personal care 

Help with dressing, shaving, or care of hair 

Help with tub bath or shower 

Help with eating (feeding of resident) 

Rub and massage 

Administrations of medications or 

treatment 

Special diet 

Nursing or personal care not provided 

Special Aid 

A special aid is a device used to compensate 

for defects resulting from disease, injury, impairment, or congenital malformation. Aids included 

in this survey are eyeglasses, hearing aids, 

walkers, wheelchairs, crutches, braces, and other 

aids as were specified in item 10 of the Current 

Patient Questionnaire (appendix III). 

Classification of Homes by Type 

af Service 

For purposes of stratification of the universe 

before selection of the sample, the homes on the 

MFI were classified as nursing care homes, personal care homes with nursing, and personal care 

homes. Details of the classification procedure 

have been published. 

Because of the 2-year interval after the 1967 

MFI Survey (used as the basic sampling universe), it was felt that for producing statistics by 

type of service from the RPS-3 the homes 

should be reclassified on the basis of the current 

data collected in the survey. This classification 

procedure is essentially the same as the MFI 

scheme. The three types of service cIasses delineated for RPS-3 are defined as follows: 

Nursing care home.-An establishment is a 

nursing care home if nursing care is the primary 

and predominant function of the facility. Those 

meeting the following criteria are classified as 

nursing care homes in this report: one or more 

registered nurses or licensed practical nurses 

were employed, and 50 percent or more of the 

residents received nursing care during the week 

before the survey. 

Personal care home with nursing.-An estabIishment is a personal care home with nursing if 

personaI care is the primary and predominant 

function of the facility but some nursing care is 

also provided. If an establishment met either of 

the following criteria, it was classified as a personal care home with nursing: 

Some, but less than 50 percent of the residents, received nursing care during the 

week before the survey and there was one 

or more registered professional or licensed 

practical nurses on the staff. 

Some residents received nursing care during 

the week before the survey, no registered 

nurses or licensed practical nurses were on 

the staff, but one or more of the following 

conditions were met: 

1. Medications and treatments were administered in accordance with physicians’ 

orders. 

2. Supervision over self-administered medications was provided. 

3. Three or more personal services were routinely provided. 

Personal care home.-An establishment is a 

personal care home if the primary and predominant function of the facility is personal 

53 
care and no residents received nursing care dur- 1. Medications and treatments were admining the week before the survey. Places in which istered in accordance with physician’s orders, or 

one or more of the following criteria were met supervision over self-administered medications 

are classified as personal care homes in this re- was provided. 

port whether or not they employed registered 2. Three or more of the criterion personal 

nurses or licensed practical nurses. services were routinely provided. 
APPENDIX III 

RESIDENT PLACES SURVEY-3 FORMS AND QUESTIONAIRES 

INTRODUCTORY LETTER 

U.S. DEPARTMENT OF COMMERCE 

BUREAU OFTHECENSUB 

WABHINGTON. D.C. 2ow3 

HRS-4)1 (4-69) 

r- 1 

Dear Sir: 

The Bureau of the Census, acting for the United States Public Health 

Service, is conducting a survey of nursing homes, homes for the aged, and other establishments which provide nursing care, personal care, or 

domiciliary care for the aged or W&m. The purpose of this survey is 

to collect much needed information about both the facilities and the 

employees and ptients. This activity is part of the National Health 

Survey program authorized by Congress because of the urgent need for 

more comprehensive and up-to-date health statistics. 

This letter is to request your cooperation a& to inform you that a 

representativg of the Bureau of the Census will visit your establishment 

within the next week or so to obtain the needed infornmtion. Prior to 

this visit, the Census representative will call you to arrange for a 

convenient appointment time. Meanwhile, to save time, I should appre­ ciate your completing the two enclosed questionnaires which request some 

information abut you and your establishment. Our Census representative will pick up these questionnaires when she visits you tc obtain the 

additional desired information. 

All the information provided on the questionnaires and given to the 

Census representative will be kept strictly confidential by the Public 

Health Service and the Bureau of the Census, and will be used for etatistical purposes only. 

Your cooperation in this important survey will be very much appreciated. 

Slncerely, 

A. Ross Eckler 

Director 

2 Enclosures 

55 
FACILITY QUESTIONNAIRE 

Budget Bureau No. 68-569022; Approval Expires August 31, 1969 

NOTICE - All information which would permit identification of the facility will be hold in strict confidence, will be used only

by persons engaged in and for the purposes of the survey, and will nor be disclosed or released to others for any purposes. 

ORM tlRS-40 I.S.SO~ (Please correct any error in name and address hcludin~ ZIP code) 

U.S. DEPARTMENT OF COMMERCE 

BUREPIU OF THE CENSUS 

ACTING AS COLLECTING AGENT FOR THE 

U.S. PUBLIC HEALTH SERVICE 

FACILITY QUESTIONNAIRE 

Number 1. What was the number of inpatients in this facility on December 31, 1968? 

2, During the seven days prior to December 31, 1968, how many of the PERSONS in 

question 1 received “Nursing care”? Count each person only once. Consider that 

an inpatient received nursing care if he received any of the following services: 

Nasal feeding Catheterization Irrigation No. of 

Oxygen therapy Ful I bed-bath Enema persons 

Hypodermic injection Intravenous injection Temperature-pulse-respiration 

Blood pressure Application of dressing Bowel and bladder retraining 

or bandage 

3. In 1968, what was the total inpatient days of care provided? (The sum of the number of Days 

days of care given to each patient from l/l/68 through 12131168) 

4. in 1968, bow many admissions did this facility hove? Number 

!i In 1968, h ow many of the admissions were Medicare patients? Number 

60. In 1968, how many discharges, excluding deaths, did this facility have? Number 

Total How many were 

NO. Medicarepatient!

b. How mony patients were discharged to the following places -

(1) general or short-stoy hospital? . . . . . . . . . . . . . . . . . . . . . . . 0 None 

(2) long-term specialty hospital (except mental)?. . . . . . . . . . . . . . - 0 None 

(3) mentol hospital? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - ONon 

(4) another nursing home?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . __ ONon 

(5) personol care or domiciliary home? . . . . . . . . . . . . . . . . . . . . n Non 

(6) patient’s home or family?. . . . . . . . . . . _ . . . . . . . . . . . . . . . m Non 

(7) other places? (Specify piece) r-j Non 

7. In 1968, how many persons died while patients of this facility? 0 Non 

8. What is the total number of patient beds regularly maintained Beds 

(set up and staffed for use) in this facility? 

Number 9. What is the total NUMBER OF INPATIENTS (patients or residents) 

who stayed in your facility last night ? (DO NOT INCLUDE EMPLOYEES OR OWNERS) 

10. During the past seven doys, how mony of the INPATIENTS in question 9 received 

“‘Nursing care”“? Count each person only once. Consider that an inpatient received 

nursing care if he received any of the following services: 

Nasal feeding 

Oxygen therapy 

Catheterization 

Full bed-bath 

Irrigation 

Enema 

No. of 

persons 

Hypodermic injection Intravenous injection Temperature-pulse-respiration 

Blood pressure Application of dressing Bowel and bladder retraining 

or bandage 

56 

I 
1. Which of the following services are ROUTINELY provided? 

a. Supervision over medications which may be self -administered. . . . . . . . . . . . . . . . rf--J~es 2ONo 

b. Medications and treatments administered in accordance with physicians’ orders , . . . . ’ 0 Yes ’ 0 No 

lOYes 20No c. Rub and massage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

lOYes 2nNo d. Help with dressing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

loYes 2[7No e. Help with correspondence or shopping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

1 OYes 20No f. Help with walking or.getting about . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

lOYes 2nNo g. Help with eating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

OR 

h. None of the above services ROUTINELY provided, room and board provided only . . . . 0 

‘/--JYes 20No 

2. Is this FACILITY participating in the Medicare program? t;Q;ip f( 

Number 3. How many beds are certified for Medicare? 

Number 4a. For how many patients is this facility now receiving Medicare payments? 

Number b. How many of these Medicare patients lived (had their home) 

in this State when admitted to this facility? 

5. In addition to two physicians, does the Utilization Review Committee include -

a. the nursing director? . . . . . . . . . . . . . . . . . . loYes z=No 

loYes 20No b. a social worker? . . . . . . . . . . . . . . . . . . . . . 

loYes 20No c. the nursing home administrator? . . . . . . . . . . . 

d. a physical therapist? . . . . . . . . . . . . . . . . . . loYes 2aNo 

e. any other members? (Specify occupation) lC]Yes 2C3No 

6. How many persons are employed in this facility? Total employees 

(Include members of religious organizations and orders 

who provide their services.) 

7. Last month, were the following services provided on a regular How many persons Lost month, how many 

provided this hours did they spend 

service? providing this service? 

No. of persons Hours 

basis through contracts or other fee arrangements? 

a. Physician (M.D. or D.O.) 2 0 No 10 Yes--+ 

b. Dental 20 No 10 Yes-+ 

c. Pharmaceutical 2nNo I Dyes+ 

d. Physical therapy 2 0 No 10 Yese. Occupational therapy 2 0 No I 0 Yes + 

f. Recreational therapy 2nNo lOYes+ ’ 

g. Speech therapy 2mNo I 0 Yes ---t 

h. Social worker 2nNo 1 Dyes-+ 

i. Dietary (Dietitian) 20 No 1 OYes + 

j. Food service (meal preparation) 20 No 1 OYes + 

k. Housekeeping 2C7No 1 0 Yes -+ 

I. None of above CI 

ce.o., Ymc ,.. ,* II .^. 1ICPP-m”L,_ 
ADMINISTRATOR QUESTIONNAIRE 

Budget Bureau No. 68469022; Approval Expires August 31. 1969 

NOTICE - All information which would permit identification of the individual will be held in strict confidence, will be used only

by persons engaged in and for the purposes of the survey. and will not be disclosed or released to others for any purposes. 

>o~$RWb U.S. DEPARTMENT OF COMMERCE A. Name of administrator . _ SUREI\” OF THE CSNSUS 

*CT,NG AS COLLECTlNG AGENT FOR THE U.S. PUBLIC HEALTH SERVICE 

8. Establishment No. 

ADMINISTRATOR QUESTIONNAIRE 

The U.S. National Health Survey of the Public Health Your answers will be given confidential treatment by 

Service is conducting a nationwide survey in nursing the U.S. National Health Survey and the Bureau of 

homes, homes for the aged, and other related types of the Census. The information will be used for statisestablishments. The purpose of the survey is to tical purposes only, and will be presented in such a 

obtain certain information about the staff employed in manner that no individual person or establishment 

these establishments as well as about the health of can be identified. 

patients or residents in the establishments. Thank you for your cooperation, 

I. When were you born? Month Year 

2. In what State (or foreign country) were you born? State or foreign country 

.I. How long hove you been the administrator - No. of years No. of months 

a. in this facility? ............................... 

No. of years No. of months 

b. in other nursing homes, homes for the aged, 

or similar facilities? ............................ No. of years No. of months 

c. in hospitals? ................................. 

1lo. Are you the odministmtor for more than one NURSING HOME? I 0 Yes (4b) 

2 0 No (Skip to C’S) 

b. For how many other NURSING HOMES? Number 

c. What is the number of patient beds inEACHof the other NURSING HOMES? 

!io. How many hours did you work LAST WEEK IN THIS FACILITY ONLY? Hours 

b. How many of these hours did you spend LAST WEEK performing EACH 

of the following services IN THIS FACILITY ONLY -

(1) administration of the facility?. ..................... 0 None 

(2) nursing care?. ................................ 0 None 

(3) medico1 and dental core? ......................... 0 None 

(4) physical therapy?. ............................. 0 None 

(5) occupational thempy? ........................... 0 None 

(6) recreational thempy? ........................... 0 None 

(7) speech and hearing therapy?. ...................... 0 None 

(8) social work?. ................................ 0 None 

(9) clerical work? ................................. 0 None 

(10) kitchen/dietary work, grocery shopping? .............. 0 None 

(1l)housekeeping services?. ......................... 0 None 

(12)other? (Specify service) 0 None 

5. Besides the hours worked IN THIS FACILITY, how many additional 

hours did you work in your profession LAST WEEK? 0 None 

if. As an administrotor, are you self-employed or a salaried employee? 1 0 Self-employed 

2 0 Employee 3 0 Both 

Please continue on reverse side 

58 
Circle highest grade corn ‘sted 

8. What is the highest gmde you completed a. Elementary school.. . . . . . . I 2 3 4 5 6 7 B Skip to in school? b. High school . . . . . *.... I2 3.4 Q. 10 

c. Junior college . . . . . . . . . . I 2 

d. Nu.Gi:rg school (diploma). . . . I 2 3 

e. College.. . . . . . . . . . . . . . I 2 3 4 5 or more 

Major field of study

Mark all that apply 

0 Associate degree 

9. Which of tbe following degrees do you have? or certificate . . . . . . . . . . . . . . . 

0 Bachelor’s degree. . . . . . . . . . . . 

0 Master’s degree . . . . . . . . . . . . . 

0 Doctorate (M.D., D-O., 

or Ph.D., etc.). . . . . . . . . . . . . . 

0 None of these 

10. Which of the following professional degrees, Mark o/l that apply 

licenses, or association registmtions do 

you have? 0 Physician (M.D.) 

0 Physician (D-0.) 

17 Registered Nurse (R.N.) 

0 Licensed Practical or Vocational Nurse (L.P.N. or L.V.N.) 

0 Registered Physical Therapist (R.P.T.) 

0 Registered Occupational Therapist (0-T-R.) 

0 Other professional degree, license, or 

association registration (.Sp.df+ 

E None of the above 

la. Have you cvar taken any courses in nursing home administmtion? 

1 0 Yes (1 Ib) 2 0 NO (Skip to Q. 120) 

b. How many of thes’e courses have you token? Number 

c. What were the TOTAL hours of class instruction? (For each course, Hours 

number of hours per week,times number of weeks attended) 

2a. Did you ever receive any “on-the-job” training to be 

a nursing home administrator? 1 0 Yes (72b) 2 0 No (Skip to CL 73) 

b. How long did this troining last? Months 

c. Where did you receive this training? Name of place 

3. Have you had any other education or troining in 1 c] Yes - Describe 2nNo 

nursing home administration? below 

59 
Ihlgc~~ Hurrau No. 6thS6902,, 9. Approval Flxpircs ,\ugust 31, 1969 

‘(NOTICE - All information which would permit identification of the individual will be held in strict confidence, will be used only 

my persons engaged in and for the purposes of the survey. and will not be disclosed or released to others for any purposes. 

FORM HRS-4c U.S. DEPARTMENT OF COMMERCE A. Establishment No. B. Line No.

.4-3.69) e”RE*” OF THE CENSUS 

.@,CT,NGA5 COLLECTlNG AGENT FOR THE 

U.S. PLlBLlC HEALTH SERVICE C. Name of person completing form 

STAFF QUESTIONNAIRE 

The U.S. National Health Survey of the Public Health Your answers will be given confidential treatment by 

Service is conducting a nationwide survey in nursing the U.S. National Health Survey and the Bureau of the 

homes, homes for the aged, and other related types of Census. The information will be used for statistical 

establishments. The purpose of the survey is to purposes only,and will be presented in such a manner 

obtain certain information about the staff employed in that no individual person or establishment can be 

these establishments as well as about the health of identified. 

patients or residents in the establishments. 

Please complete the form and return it within 5 days Thank you for your cooperation. 

to the Bureau of the Census, Washington, D.C 20233, 

in the postage-paid envelope provided. 

Month Year 

1. When were you born? 

No. of years No. of months 

2. How many years hove you worked as a ? 

a. in this facility?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. of years No. of months 

b. in other nursing homes, homes for the aged, 

or similar facilities? . . . . . . . . . . . . . . . . . . . . . . . . . . . 

No. of years No. of months 

c. in hospitals? (NOTE JO NURSES: Do not include 

special duty or private duty nursing.) . . . . . . . . . . . . . . . . 

Hours 

3a. How many hours did you work LAST WEEK IN THIS FACILITY ONLY? 

b. How many of these hours did you spend LAST WEEK performing 

EACH of the following services IN THIS FACILITY ONLY­

(1) administration of the facility?. . . . . . . . . . . . . . . . . . . . . 

(2) nursing core?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

(3) medical and dentol ‘core? . . . . . . . . . . . . . . . . . . . . . . . . 

(4) physical therapy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

(5) occupational therapy? . . . . . . . . . . . . . . . . . . . . . . . . . . 

(6) recreational therapy? . . . . . . . . . . . . . . . . . . . . . . . . . . 

(7) speech and hearing therapy? . . . . . . . . . . . . . . . . . . . . . 

(8) social work? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

(9) clerical work? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

(10) kitchen/dietary work, grocery shopping? . . . . . . . . . . . . . 

(11) housekeeping services? . . . . . . . . . . . . . . . . . . . . . . . . 

(12) other services? (Specify service) . . . . . . . . . . . . . . . . . . 

1. Besides the hours worked IN THIS FACILITY, how many additional 

hours did you work in your profession LAST WEEK? . . . . . . . . . . - . . . . . . * . 

0 None 

n None 

0 None 

0 None 

0 None 

0 None 

0 None 

j---J None 

0 None 

0 None 

0 None 

0 None 

0 None 

Please continue on reverse side 

60 
r Circle highest grade completed

i. What is the highest grade you completed a. Elementary school. . . . . . . .I 2 3 4 5 6 7 8 Sk10 to 

in school? b-High school.. . . . . . . . . . .I 2 3 4 > 0.7 

c. Junior college . . . . . . . . . .I 2 

d. Nursing school (diploma) . . .I 2 3 

e.College.. . . . . . . . . . . . ..I 2 3 4 5or more 

Mark all hot apply Major field of study 

I. Which of the following degrees do you hove? 

0 Associate degree 

or certificate . . . . . . . . . . . . . 

0 Bachelor’s degree . . . . . . . . . . 

0 Master’s degree. . . . . . . . . . . 

u Doctorate (M.D., D.O., 

Ph. D., etc.) . . . . . . . . . . . . . 

n None of these 

Mark all that OPP~Y 

Which of the following professional degrees, 0 Physician (M.D.) 

licenses, or association registrations do you have? 0 Physician (D-0.) 

0 Registered Nurse (R.N.) 

0 Licensed Practical or Vocational Nurse (L.P.N. or L.V.N.) 

0 Registered Physical Therapist (R.P.T.) 

0 Registered Occupational Therapist (O.T.R.) 

0 Other professional degree, license, or 

association registration (Specify] 7 

0 None of the above 

Fill Co/s. (2)-(4) far each “Yes” mswer in Co/. (I) 

How many What were the TOTAL 

COURSES were HOURS of class . Have you ever taken any of TOTAL NUMBER token while instruction? 

the following courses: of courses taken working for a Nunber of hairs per week 

-7 degree or times number of weeks 

diploma? attended per course 

(1) (2) (3) (4) 

a. Nursing care of the aged 1 q Yesor chronically ill? 2 0 No (Sb) 

b. Medical or dental care of 1 f-JYesthe aged or chronically ill? 2 0 No (8~1 

1 r-JYes­ c. Mental or social problems of 

the aged or chronically ill? 2 0 No (Sd) 

1 q Yesd. Physical therapy or rehabilitation? 2 0 No (84 

1 ayese. Occupational therapy? 20Nof80 

1 OYesf. Nutrition or food services? 2 0 No f8sJ 

(0 Yesg. Nursing home administration? 2nNo 

-.. ..-- .- ~.. CrrsuLI-nP 

61 
-

2: 

7-

I 

1 

A 

1 

JL 

7 -

8 -

9 -

IO 

T 

-

I2 -

13 -

14 

Is 

16 

n 

Is 

-

19 

20 

-

STAFF INFORMATIONAND CONTROLRECORD 

STAFF 

List below the names of all persons who work 

In this facility. 

Include members of rallgious organizations and 

orders who provide thslr services. 

Note: Be sure to list administrator and asslstant 

administrator. 

(a 

NOTICE _ All information which would permit ldcntlflcarion of rtle $&,$rsau No* Establlshmant No. 

individual will be held In strict confldanss, will be used only by 

psrsms engaged in and for the purposes of the survey, and will Approval Expires 

nor bs disclosed (lr released to others for any purposes. Augusr 31, 1969 

I I 

OCCUPATIONS 

SEX RACE Enter number from Card A DISPOSITION OF l-11 12 13-20 21-24 STAFF 

I - Male W-White Prdssslonal ProfessIonal ssmi- NOW QUESTIONNAIRE 

: - Female professional professional N-Negro SW- SW- (h) 

O-Other I I 

8 
LIST OF SELECTED JOB CATEGORIES 

CARD A 

Which of the following job categories best fits the iob 

which this employee does in this facility? 

I. Administrator 

2. Physician (M.D. or D.O.) 

3. Dentist 

4. Registered Occupational Therapist 

5. Qualified Physical Therapist 

6. Recreation Therapist 

7. Dietitian or Nutritionist 

8. Registered Medical Record Librarian 

9. Social Worker 

IO. Speech Therapist 

I I. Other professional occupations 

12. Registered Nurse 

13. Occupational Therapist Assistant 

14. Physical Therapist Assistant 

15. Other Medical Record Librarians and Techicians 

16. Licensed Practical Nurse or Vocational Nurse 

17. Practical nurse 

18. Nurse’s aide 

19. Orderly 

20. Student nurse 

21. Clerical, bookkeeping, or other staff 

22. Food service personnel (cook, kitchen help, etc.) 

23. Housekeeping personnel (maid, laundryman, 

maintenance man, etc.) 

24. Job other than those listed above (P/ease describe 

employee’s duties) 

-ORM HRS-4k U.S. DEPARTMENT OF COMMERCE 

3-27-69) BUREAU OF THE CENSUS 

JSCOMM-DC 

LIST OF SELECTED JOB CATEGORIES 

63 
CURRENT PATIENT QUESTIONNAIRE 

6. Whichof theseconditionsOTimpairmentsdoesbehave? 

a. ADVANCEDsenili~........................................... 

b. Senility,not pyschotic...,..,................................... 

c. Othermentaldisorders(suchas mentalrllnessor retardation) . . . . . . 

d. Speechdefector paralysis(palsy)dueto a stroke . . . . . . 

e. Otherill effectsof a stroke . . . . . . . 

f. Hearttrouble. . . . . . . .,.................. 

g. Hardening of thearteries. . ..,............._..............

h. Paralysisor palsynotdueto a stroke. . . . . . . . . 

i. Arthritisor rheumatism . . . . . . 

,.................................................. 

k. AnyCHRONICtroublewith backor spine. . . . . . 

I. PERMANENTstilfnessor anydeformityof thefoot, leg,fingers, 

arm,orback . . . ..,..,...........,..,.,........... 

m. Chronicconditionsof digestivesystem(excludingstomachulcer,

herniaof abdominal cavity, liver, or gallbladdertrouble).. . . . . . . . . 

n. Anyotherconditionsor impairments - SW+

did this patientreceive? Subcutaneous injection 

01apply Check rs 0 lntradermai a rncmy injection 

21(-J Noneof theabove 

servicesreceived 

,cYes ­

,cYes -

1cYes ­

tOYes ­

lOYes -

64 
11. Whichof thesecategoriesbest describeshis 

ability to moveabout? 

b. Canhearmostof the fhingsa person 

ITEMA - If patientwas not herefor full month,checkhere 0 andgolo nextperson. 

lla.Last mmth,whatwasthe chargefor his lodging,meals.andnursingcare?CZno?ixlvJe V~KI~O&l* nu~rm. S 

b. Whatwasthe TOTALchargefor his care last month? 

17a.whatweretheso~tccsof paymentfor his care Iat month?Ch=k dl that opp!y 

0 Ownincomeor familysupport mother publicassistance 

(prrvateplans,retirementfunds, or welfare 

socialsecurity,etc.) aChurch support q Medicare(TitleXVIII) f--JVA contract 

q Medicaid(TitleXIX) 

b. Whatwas tfrc PRIMARYsourceof paymentfor his care fast month?,,hrk ME only 

I mown incomeor familysupport 4nOLer publicassistance 

(privateplans,retirementfunds, or welfare 

socialsecurity.etc.) s=Chrrrch support nf-JMedicare(Title XVIII) 6 OVA contract 

sOMedicaId (Title XIX) sOInitial payment- life care 

Patientwasnot herein Oecember1968 

OSame as Ua-b aMedicaid (Title XIX)

c]Own incomeor familywpport (prrvateplans,retirementfunds, q Otfrerpublicassistance or welfare 

socialsecurity,etc.) OChurch support q Medicare(TitleXVIII) 

I 

S 

Clnitial payment- hfe care 

q Other-sFi+ 

sOOther - Spec+ 

suNone 

OVA contract 

Dlnitial payment- life care 

nOther - specify 

tr U. S. GOVERNblENT PRINTING OFFICE : 1915 594-523145 

65 
VITAL AND HEALTH STATISTICS PUBLICATION SERIES 

Formerly Public Health Service Publication No. lC)Oo 

Series 1. Propms and collection grocedures.- Reports whichdescribe the general programs of the National 

Center for Health Statistics and its offices and divisions, data collection methods used, definitions, 

and other material necessary for understanding the data. 

Series 2. Data evaluation and methods research.- Studies of new statistical methodology including: experimental tests of new survey methods, studies of vital statistics collection methods, new analytical 

techniques, objective evaluations of reliability of collected data, contributions to statistical theory. 

Series 3. Analytical studies. -Reports presenting analytical or interpretive studies basedon vital and health 

statistics, carrying the analysis further than the expository types of reports in the other series. 

Series 4. Documents and committee reports.- Final reports of major committees concerned with vital and 

health statistics, and documents such as recommended model vital registration laws and revised 

birth and death certificates. 

Series 10. Data from the Health Interview Szcrvev.- Statistics on illness, accidental injuries, disability, use 

of hospital, medical, dental, and other services, and other health-related topics, based on data 

collected in a continuing national household interview survey. 

Series 11. Data from the Health Examination Survey. -Data from direct examination, testing, and measurement of national samples of the civilian, noninstitutional population provide the basis for two types 

of reports: (1) estimates of the medically defined prevalence of specific diseases in the United 

States and the distributions of the population with respect to physical, physiological, and psychological characteristics; and (2) analysis of relationships among the various measurements without 

reference to an explicit finite universe of persons. 

Series 12. Data from the Institutional Population Surveys -Statistics relating to the health characteristics of 

persons in institutions, and their medical, nursing, and personal care received, based on national 

samples of establishments providing these services and samples of the residents or patients. 

Series 13. Data from the Hospital Discharge Survey. -Statistics relating to discharged patients in short-stay 

hospitals, based on a sample of patient records in a national sample of hospitals. 

Series 14. Data on health resources: manpower and facilities. -Statistics on the numbers, geographic distribution, and characteristics of health resources including physicians,dentists, nurses, other health 

occupations, hospitals, nursing homes, and outpatient facilities. 

Series 20. Data on mortality.- Various statistics on mortality other than as included in regular annual or 

monthly reports-special analyses by cause of death, age, and other demographic variables, also 

geographic and time series analyses. 

Series 21. Data on natality, marriage, and divorce.- Various statistics on natality, marriage, and divorce 

other than as included in regular annual or monthly reports--special analyses by demographic 

variables, also geographic and time series analyses, studies of fertility. 

Series 22. Data from the National Natality and Mortality Surveys.-Statistics on characteristics of births 

and deaths not available from the vital records, based on sample surveys stemming from these 

records, including such topics as mortality by socioeconomic class, hospital experience in the 

last year of life, medical care during pregnancy, health insurance coverage, etc. 

For a list of titles of reports published in these series, write to: Office of Information 

National Center for Health Statistics 

Public Health Service, HRA 

Rockville, Md. 20852