Data from the

NATIONAL HEALTH SURVEY

Series 12

Number 22

ChronicConditionsand

Impairments of Nursing

HomeResidents:

United States -1969

Statistics on six major chronic conditions (heart conditions, cerebrovascular

diseases, arteriosclerosis, diabetes, senility, and arthritis or rheumatism) and

two major types of impairments (vision and hearing), how they affect nursing home residents and how this compares to the general noninstitutional

population. Based on data collected from June through August 1969.

DHEW Publication No. (HRA) 74-1707

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

Public Health Service

Health Resources Administration

National Center for Health Statistics

Rockville, Md. December 1973
Vital and Health Statistics-Series 12-No. 22

For sale by the Superintendent of Documents, U.S. Cioyernment Printing Office, Washington, D.C. 20402- Price S5 cents
NATIONAL CENTER FOR HEALTH STATISTICS

EDWARD B. PERRIN, Ph. D., Acting Director

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

GAIL F. FISHER, Assistant Director for Health Statistics Development

WALT R. SIMMONS, M.A., Assistant Director for Research and Scientific Development

JOHN J. HANLON, M.D., Medical Advisor

JAMES E. KELLY, D.D.S,, Dental Advisor

EDWARD E. MINTY, Executive Officer

ALICE HAYWOOD, Information Officer

DIVISION OF HEALTH RESOURCES STATISTICS

SIEGFRIED A. HOERMANN, Director

PETER L. HURLEY, Deputy Director

G. GLORIA HOLLIS, Chiej Health Facilities Statistics Branch

HENRY S, MOUNT, Chief, Health Manpower Statistics Braizch

PETER L. HURLEY, Acting Chiej Family I%znning Statistics Branch

WILLIAM P. STEWART, Acting Chiej Hospital Discharge Survey Branch

COOPERATION OF THE BUREAU OF THE CENSUS

Under the legislation establishing the Natiomd 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.

Vital and Health Statistics-Series 12-No. 22

DHEW Publication No. (HRA) 74-1707

Library of Co7z~ess Catalog Card Number 73-600044
CONTENTS

Page

Introduction ------ ------ -----------.- ------ ------ .-------- .-----------

Background-----------------------------------------------------------

Sources and Qualifications ofData ---------------------------------------

Prevalence of Conditions -------- --.----- .------ -------- -------- --------

Male - Female Comparison --------. --------- --------- --------- --------

TheSixMajorConditions ------- -------- ------- ------- -------- -------- --

HeartTrouble ------- ------- -------- ----.--- ------- -------- -------- -

Stroke -------------- ------- ------- ------- -------- -------- -------- --

-Arteriosclerosis ------- ------- -------- -------- -------- --------- ----

Diabetes ------- ------- ------- ------- --------- ------- -------- -------

Senility -------- -------- ------- ------- ---------- ---------- -------- --

Arthritis and~eumatism -------------------------------------------

Impairments ------- ------- ------- ------- -------- -------- -------- ------

Vision Impairments ------- -------- -------- --------- -------- ------- --

Hearing Impairments ------- ------- -------- -------- -------- -------- -

Other Factors ---------------------------------------------------------

Summary -------------------------------------------------------------

References -----------------------------------------------------------

List of Detailed Tables ------------------------------------------------

Appendix 1. Technical Notes on Methtis -------------------------------

Survey Desi~------------------------------------------------------

General`Qualifications -----------------------------------------------

Appendix 11. Definitions of Certain Terms Used in This Report -----------

TermsRelating to Residents------------------------"-----------------

Classificationof Homes byT~eof Service ----------------------------

Coding Ranges for ChronicConditions ---------------------------------

Appendix III. Resident Places Survey-3: Forms and Questionnaires --------

Introductory btter -------------------------------------------------

Staff Information and CoritrolRecord ----------------------------------

Facility Questiomaire ----------------------------------------------

Administrator Questionnaire -----------------------------------------

Current PatientQuestionnaire ----------------------------------------

Staff Questiomaire --------------------------------------------------

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Datanot available---------------------------------------- ---

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Quantity morethan Obutless than0.05----- 0.0

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CHRONIC CONDITIONS AND IMPAIRMENTS

OF NURSING HOME RESIDENTS

AlvinSirrocco,Division of Health Resources Statistics

INTRODUCTION

A chronic condition, by definition, is one

that is prolonged, lingering, and recurrent. Consequently, chronic conditions often cause people

to miss work, restrict their everyday activities

and, with the elderly in particular, cause confinement to a wheelchair or a bed, Therefore,

in discussing the health of any individual or

any group of individuals, of primary importance would be the answers to the following

questions:

Does he or she have any chronic conditions or

impairments?

If so, what are they?

How severe are they?

Some chronic conditions are acquired early in

life while others are acquired at a much later

stage, Because of the recurrent nature of chronic

conditions, many of those that are acquired early

in life are carried into middle and old age. As a

result, the older population (45 years and over)

is much more affected by chronic conditions and

impairments than the younger population (under

45). Table 1 shows this 9uite clearly.

These three questions become even more

relevant when discussing the health of nursing

home residents, since most nursing home residents are of this older population and more prone

to chronic ailments. For example, there were an

estimated 815,130 residents in nursing homes ‘in

1969. Almost 90 percent (88.6 to be exact) were

65 years of age or older and only 2 percent were

under age 45.

Accordingly, these questions were asked

(using different wording) of the nursing home

residents in the 1969 Resident Places Survey-3.

When it. was discovered that 98 percent of the

residents had chronic conditions or impairments,

the responses to the second and third questions—

what are they and how severe are they-took on

added importance. This report deals with those

responses.

BACKGROUND

The ‘data presented in this report are based

on the third Resident Places Survey (RPS-3)

conducted by the Division of Health Resources

Statistics. The survey was conducted in cooperation with the U.S. Bureau of the Census during

June-August of 1969.

RPS-3 is the fourth in a series of ad hoc

surveys of institutional health facilities which

are part of the National Health Survey program to
provide current health statistics on the Nation.1

The first of these surveys was conducted in

April- June 1963 and collected sample data on

nursing homes, chronic disease and geriatric

hospitals, and nursing home units and chronic

disease wards of general and mental hospitals.

Further information on the Resident Places

Survey- 1, including a description of its design

and methodology, may be found in several previously published reports. 2-6 The Resident Places

Survey-2, which was conducted in May-June 1964,

is the second of these ad hoc surveys; it concentrated mainly on a sample of nursing homes

and geriatric hospitals. This second survey

collected more detailed information about each

institution, its residents, and its employees?-15

The 1968 Nursing Home Survey, conducted during

April-September :968, was the third survey. It

was a census of all nursing homes in the United

States, It collected detailed information on the

characteristics of the facilities .lG-zlThe fourth

survey —RPS- 3—was multipurpose, collecting information about the nursing home, its residents,

and its employees. This report is one of several

on the data collected in RPS-3. z~-~G

This report deals with the chronic conditions and impairments that afflicted nursing home

residents in 1969, The conditions and impairments

of each resident were reported by a member of

the nursing honie ktaff who was familiar with the

resident.

One of the chronic conditions listed on the

questionnaire is “other mental disorders,” which

includes mental illness or retardation and excludes senility. Because of the wide range of

symptoms covered under this heading, comparisons between the nursing home population and

the general population are virtually impossible.

Therefore “other mental disorders” will not be

discussed in the text of this report but will be

included in the detailed tables,

Although RPS-3 obtained diagnostic information, the results indicated an apparent underreporting of chronic conditions and impairments.

One explanation for this underreporting can be

found in a publication which compares reported

conditions to diagnosed conditions and concludes

that a physician will list on a patient~s record

conditions that are active but may not list other

conditions that are present but inactive at the

time of the v~sit. 27Thus reported rather than

diagnosed conditions are used in the present

report. The conditions and impairments are classified according to the Eighth Revision International Classification of Dkases, Adapted for

Use in the United States (ICDA),~~with certain

modifications. The chronic conditions and impairments and their codes are listed in appendix

H.

SOURCES AND QUALIFICATIONS

OF DATA

Nursing homes, homes for the aged, and

similar facilities of this kind were included in

RPS-3. Two basic criteria for including a facility

in the survey were (1) it must rout jnely provide

some level of nursing or personal care and (2) it

must maintain three beds or more. Thus homes

providing only room and board or domiciliary

care to aged people were not within the scope

of the survey.

A description of RPS-3, the sampling frame

used, the sample design, and the” survey procedures are presented in appendix I. Appendix I

also includes imputation procedures, estimation

techniques, and estimates of sampling variation.

Since the data in this report are national estimates

based on a sample, they are subject to sampling

errors.

Appendix 11presents definitions of terms and

the procedure for classifying establishments.

Reference to the definitions is essential to the

interpretation of data in this report. Special

attention is called to the procedure for classifying institutions by level of nursing service. The

classification of establishments as nursing homes,

personal care homes with nursing, and personal

care homes is based on the services provided

in the home rather than on what the home may be

called or how it may be licensed by the State.

Facsimiles of questionnaires and forms used

in the survey are shown in appendix 111.

PREVALENCE OF CONDITIONS

Table A lists. the 10 most common types of

conditions suffered by nursing home residents in

1969. (Table 2 gives the prevalence figUreS for

these conditions by age and sex of the residents.)

2

.
Table A. Percent of residents in nursing

homes with reported chronic conditions:

United States, 1969

Chronic condition

Arteriosclerosis -------------

Senility (including

advanced)-------------------

Heart trouble ----------------

Arthritis or rheumatism ------

Cerebrovascular disease

p~~;~;te~~:~:~-~-:~ -------

deformity (limbs or’back)---

Di.abetes ---------------------

Diabetes--------------------Chronic trouble with back

or spine --------------------

Paralysis or palsy not due

to a stroke -----------------

Chronic conditions of

digestive system ------------

Percent

57.5

56.4

36.3

33.2

25.1

23.8

11.9

10.O

9.8

8.6

%.CDAcodes can be found in appendix

11.

From table Ait is apparent that arteriosclerosis and senility were the two most prevalent

conditions, occurring in more than half of the

residents. Heart conditions and arthritis or

rheumatism Were the next most commonly occurring conditions, with each being prevalentin

approximately one-third of the residents,

It should be pointed out that if senility and

advanced senility were separated the percents

would bq 34.2 for advanced senility and22.2 for

senility. They have been combined because of the

difficulty in many cases of determining the resident’s degreeof senility.

The bulk of this report will deal with only

six of the 10 conditions listed in tableA. These

six are arteriosclerosis, senility, heart trouble,

arthritis or rheumatism, cerebrovascular diseases, and diabetes. The remaining four conditionswill be shown in some detailed tables, but

because of their complexity and the difficultyin

comparing them with other surveys, they will not

be discussed,

These six conditions probably are the most

studied and publicized of all chronic conditions.

The reason for this can betraced tothe thousands

and in some instances millions of people in the

United States affected by these conditions. For

instance:

●Unestimated 27,130,000 peoplein1969were

afflicted by cardiovascular diseases.~~ This

included heart conditions, arteriosclerosis,

and strokes.

●An estimated 4.4 million people had diabetes.30

●Unestimated 50millionpeople sufferedfrom

arthritis or rheumatism; 17millionsuffered

severely enough to require medical care.31

●In 1969, 739,265 people died from heart

diseases, the number 1 cause ofdeath.3g

●In 1969, 33~063 people died from arteriosclerosis.

●In 1969, 207,179 people died from cerebrovascular diseases (the number 3causeof

death) .39

.In 1969, 38,541 people died from diabetes

mellitus.3g

The sheer magnitude of these numbers illustrates the problem these conditions represent

for the people in the United States. Add to it

old age and institutionalization and you have

the even bigger problem faced by residents of

nursing homes. As evidence, table 1 shows

that older people were more likely to have

these conditions ”than younger people, and table

B shows that nursing home residents were more

likely to have the conditions than noninstitutionalized people. In fact, 65 percent of the

residents had three or more conditions. 32

The table shows marked differences in rates

for the noninstitutional population (which were

based on household interview responses) and

the rates for the nursing home population. The

ratio of rates ranged from about 2.1 for arthritis

and rheumatism to 35.1 for senility.

3
Table B. Number and rate of selected chronic conditions in limited persons aged 65

vears and over in the noninstitutionalizedpopulation and in the nursing home POPU-

~ation: United States, 1969

Selected chronic

conditions

Heart trouble------

Cerebrovascular

diseases (stroke

effects)-----------

Arthritis or

rheumatism--------

Diabetes-----------

Senility (including advanced)-

Arteriosclerosis---

Civilian noninstitutionalized population 65 years and

over limited in any

activityl

Number in

thousands

1,628

,376

1,691

354

2241

3338

late per

1,000

population

87.3

20.2

90.6

19.0

~12.9

%8.1

Wrsing home population 65 years and over

Lesidentswith conditions

Wuuber in

:housands

285

183

259

88

445

453

394.7

253.5

358.7

121.9

616.3

627.4

tesidentswith conilitionslimited in

mobility

Number in

thousands ‘a;:08F

residents

168 232.9

146 j 202.1

152 210.6

50 69.2

;;$ 406.6

381.7

lsee refer-ence 51 at end of text.

‘Includes other types of mental and nervous conditions.

‘Includes other conditions of the circulatory system.

MALE - FEMALE COMPARISON

A comparisonof the prevalencerates ofmale

and female residents in nursing homeS for each

of the sixconditions isshowninfigure 1.

The figure shows thatwomenhadsignificantly

higher prevalence rates than men for arteriosclerosis, arthritis or rheumatism, and senility.

Although thewomen alsoshowedhigher prevalence

rates for heart conditions and diabetes, the rates

were not significantly higher. Men, on the other

hand, had significantly higher prevalence rates

than women for effects of a stroke.

Perhaps the most striking characteristic in

figure 1 is thedifferenceinthenumberof men and

women witharthritis orrheumatism. Thewomen’s

rate is 105per l,OOOfemale residents higherthan

the men’s rate, In terms of numbers, 205,401

women had arthritis or rheumatism while just

65,586 men had it--a ratio of more than 3tol.

Is this characteristic unique to nursing homesor

is it acharacteristic of the population ingeneral?

Looking again at table 1 we find that there

is infacta rather substantial difference between

the number of women and the number of men

affected by arthritis and rheumatism. Of the

3,265,000 noninstitutionalized people who hadto

limit their activities because of arthritis and

rheumatism, 2,170,000 of them were women--

almost twice as many as men. The prevalence

rate for men 65 years and over was 144per

1,000 men, and for women 65 and over itwas

271 per 1,000. Although these rates were notas

high as the corresponding rates innursinghomes,

they reflect the same picture-that many more

women than men suffer from arthritis. Arthritis

and rheumatism are discussed in greater detail

in the next section of this report.

4
700

r T -r

All ws

Under 66 65 years

years and over

HEART TROUBLE

All aW Un&r 65 65 years

yeala and over

ARTHRITIS OR RHEUMATISM

All a$es Undw 65

years

SENILITY

65 years

and over

7s0

600

Em

:

g 41313

E-.

fjml

E

: 200

ml

o

All aws Under 65 65 years AH aW Under 65 65 years Un&r 65 65 VWB yOars and over yews and wer All ‘aWS

years and over

ARTER105cLEF10sIs EFFECTS OF A SI’ROKE DIA6ETES

Figure 1. Prevalence ratesper 1,000residentsof nursinghomes for six chronicconditions,by”ageand sex: 1969 “

THE SIX MAJOR CONDITIONS

In this section each of the six major conditions

will be defined and discussed. Statistics are

presented showing the impact these conditions had

on nursing hom”eresidents in 1969 and whenever

possible their impact on the population of the

United States in general. Because of the inter-.

relationship that exists between heart conditions,

stroke, and arteriosclerosis, a brief discussion

will be presented for each; followed by a more

detailed analysis of the three together.

Heart Trouble

The term “heart trouble” is so broad it must

be defined by ICDA codes. “Heart trouble” and

“heart conditions” are used synonymously in

this report. The codes for this and other conditions

used in this report can be found in appendix I.

In general, in this report “heart conditions”

5
refers to rheumatic heart disease, hypertensive

heart disease, and ischemic heart disease. These

are all cardiovascular diseases (diseases of the

blood vessels of the heart) and are defined as

follows:

Rheumatic heart disease occurs when rheumatic fever causes heart damage by scarring and

deforming the valves of the heart.

Hypertensive heart disease occurs when high

blood pressure (hypertension) persists at such a

high level that the heart, which must now pump

harder to push blood through the circulatory

system, grows larger and weaker from the

demands put on it and loses its efficiency.

Ischemic heart disease occurs when there is

inadequate blood supply to certain areas of the

heart due to blockage in the coronary arteries.

If the blockage is slight, the result could be

angina pectoris or “angina” (pains in the chest).

If the blockage becomes more severe the result

could be coronary insufficiency. However, if the

“blockage becomes complete and the blood supply

cut off, the result is a myocardial infarction, more

commonly referred to as a heart attack.

The mortality and prevalence figures in table

C show the magnitude of these three diseases in

1969.29The 669,829 deaths for ischemic heart

disease+he largest number of deaths for any

single cause in 1969—were primarily the result of

heart attacks.

Table C. Mortality and prevalence figures

for rheumatic, hypertensive, and ischemic

heart disease: United States, 1969

Heart

diseases

Rheumatic

“heart dis -

ease -------

Hyperten -

sive heart

disease----

Ischemic

heart dis -

Deaths 1

15,432

;4, 712

Prevalence

1,670,000

21,790,000

ease ------ 669,829

Isee reference 39 at end of text.

4,040,000

Although data are not available on the prevalence of heart conditions in older people for 1969,

evidence has shown that older people (65 and over,

for example) have higher rates of heart conditions

than younger people. According to information reported in household interviews, for instance, in

1967 approximately 1percent of the noninstitution.

alized population under 45 years of age had heart

conditions, while 7 percent of those 45 to 64 and 19

percent of3;hose 65 years and over had heart

conditions.

Having established the magnitude of the problem of heart conditions in the general population,

the next step is to compare these statistics with the

statistics on heart conditions for the nursing home

population.

Detailed table 2 shows that in 1969 over

296,000 nursing home residents were reported to

have heart conditions. That was more than a third

of all nursing home residents. Of those residents

65 years “and over, approximately 39 percent had

heart conditions, a higher rate than the 19percent

that was experienced by the general noninstitutionalized population in 1967. Some of the difference

between these two figures may be explained by the

differing procedures that were used in collecting

the data for these surveys. Therefore, in order

to substantiate that heart conditions were more

common to nursing home residents than they were

to the noninstitutionalized population, it is necessary to consider those persons who were’ limited

by heart conditions.

Table 1 indicates there were approximately

3,148,000 noninstitutionalized persons 45 years

and over who were limited in activity in 1969-70

partly or solely because of heart conditions.

Roughly speaking, that was about 5 percent of the

noninstitutionalized population 45 years and over.

Of the residents in nursing homes (98 percent of

which were 45,years and over), 173,653, or about

24 percent, were limited partially or solely because of their heart conditions (table 3). Although

the figures for nursing home residents’ limitations

were based on mobility and those for the noninstitutionalized population’s limitations were based on

activity, it must be remembered that for older people activity and mobility are often synonymous.

Before leaving this discussion on heart conditions, there is one other area that bears

mentioning, In discussions of the various heart

6
conditions in medical literature, a basic concept

that” is repeatedly brought out is that heart attacks

are primarily the result of heart diseases becoming severely worse (i.e., heart attacks are fairly

slow in developing). But what about the deaths from

heart attacks that frequently happen to people who

had no known history of heart conditions—the

sudden cardiac deaths. The following discussion

sums up what has generally been learned about

this medical phenomenon:

By sudden cardiac death is meant death occurring within one hour from the onset of a

sudden and unexpected acute cardiac event.

Because of the time element involved in the

definition, such an event obviously requires a

witness ....

Subsequent anatomic studies have amply demonstrated the prominent place of coronary

artery disease inpatients dying suddenly. The

recent data, chiefly derived from the experiences of medical examiners, show that

coronary atherosclerosis is present in the

overwhelming majority and that it is diffusely

distributed .... In the patients in whom death

was actually witnessed and could be judged to

be instantaneous, the infrequency of fresh or

recent thrombosis has been confirmed. %34

Hence most “sudden cardiac deaths” are not as

abrupt as they appear but instead are often caused

by atherosclerosis (the most common form of arteriosclerosis). The next two topics deal with

cerebrovascular diseases and arteriosclerosis

and how they affect nursing home residents.

Stroke

Cerebrovascular diseases and vascular lesions affecting the central nervous system are the

technical terms for what most people refer to as

“stroke.” Cerebrovascular diseases are diseases

affecting the blood vessels in the brain (cerebro

meaning brain and vascular referring to blood

vessels).

A stroke occurs when the blood supply to a

part of the brain is cut off depriving the nerve cells

in that area of the blood they need to function. Since

those nerve cells control body movements, the part

of the body they control may become paralyzed or

otherwise unresponsive. A stroke can also occur

as a result of hemorrhage.

‘By permission of Grune and Stratton, Inc. Medical and ScientificPublishers.

In 1969, over 207,000 people in the United

States died from strokes and another 1,620,000

people were afflicted by them.~g Although it is

not known how many nursing home residents died

from strokes, it is known that one-fourth (204,655)

of the residents were afflicted by them (table

2). These afflictions took the form of paralysis,

speech defects, and other ill effects of a stroke.

These figures show that almost 13 percent

of those persons afflicted by strokes resided in

nursing homes. (By comparison, less than onehalf of 1 percent of all the people in the United

States resided in nursing homes.) Further

analysis shows that the 1,620,000 afflicted persons

in the United States represented less than 1

percent of the total population. In fact, even if

every one of these afflicted persons were over 65

(it is not known how many actually were), they

would only make up 8 percent of the population 65

years and over. In nursing homes, by comparison,

25 percent of all the residents and 25 percent of

those 65 years and over were afflicted by strokes.

It seems quite apparent from these figures

that nursing homes play an important role to the

stroke patient. A look at table 3 helps to explain

why. This table shows that of the nearly 205,000

residents suffering from the effects of a stroke,

less than 22 percent were able to move about

freely; In fact, more than half of these 205,000

residents were confined or restricted to bed. The

remaining 27 percent were either confined to the

premises or needed a wheelchair to get about.

Thus of all the conditions listed in table 3, stroke

appears to be the most limiting.

As with heart conditions, multiple disease

factors must be considered when discussing the

patient who has had a stroke, for risk of stroke

has been found to be higher in persons with a

history of hypertension (2.1 times as high),

coronary heart disease (2.4 times), diabetes

(1.9 times), or angina pectoris (2.3 times). ~~

Nursing home residents with multiple diseases is one of the subjects covered in the

following section on arteriosclerosis.

Arteriosclerosis

Heart attacks and strokes have much in

common. In addition to the crippling and deadly

aspects of each, they can both be caused when a

7
blockage occurs in the arteries and the blood supply is ‘cut off. If the blockage occurs in the arteries

leading to the heart (coronary arteries), a heart

attack results; if the blockage occurs in the arteries leading to the brain, a stroke results.

The blockage ~~ferred to is usually caused by

arteriosclerosis. Actually the term arteriosclerosis is very general and refe~s to all types

of degenerative changes in the arterial wall. The

most common type of arteriosclerosis is atherosclerosis-generally known as “hardening of

the arteries. ” Atherosclerosis is the process by

which the inner linings of the arteries become

thickened and roughened by deposits of fat,

fibrin, cellular debris; and calcium, thus interfering with both the smooth flow of blood and the

amount of blood carried through the artery. The

inner walls become thick and heavy, lose their

ability to expand and contract, and may eventually block the channel completely. (To avoid

confusion, arteviosclgods will be used throughout this section.)

As mentioned before, when the arteries are

completely blocked, heart” attacks and strokes

occur; whe’nthey are partially blocked, the lesser

(but still painful and dangerous) heart and cerebrovascular diseases occur.

As an indication of its prevalence, it is

estimated that arteriosclerosis, as an underlying

cause, contributes directly to more than 850,000

deaths a year from heart attacks and strokes. ~~

It is not known how many millions of people are

afflicted with arteriosclerosis, but because of the

nature of the arteriosclerotic process elderly

people usually experience it the most.

This relationship that exists between arteriosclerosis and aging is -one of the most written . .

and talked about aspects of the disease. It is

generally agreed that arteriosclerosis is not

necessarily a process of aging.36 Nevertheless,

all experience tends to show that the numk:r of

arteriosclerotic pat ients, the severity of the disease, and its fatal complication all increase with

age. On the other hand, these relationships are

not linear (though these relationships show a general increase with age, they do not increase at

each age level) as would be expected in a normal

natural occurrence.’7

Though prevalence figures are not available

for the general population, they are available for

the nursing home population. As mentioned earlier

in this report, in 1969 arteriosclerosis was the

most prevalent condition in nursing homes, affecting more than 469,000 residents (over 57 percent

of all the residents). Of those residents 65

years and over, almost 63 percent had arteriosclerosis.

In 1969, 293,330 residents of nursing homes

died.~s Unfortunately neither the cause of death nor

the conditions these residents suffered from before death are known, but many of these residents

were surely among the aforementioned 850,000

deaths a year from heart attacks and strokes due

to arteriosclerosis.

Equally apparent is the fact that the 469,000

residents with arteriosclerosis were in a high

risk situation because of the disease and their

age. In addition, to make matters worse, many of

them were also suffering from heart conditions

and the effects of a stroke (table 4).

“From table 4 it can be found that 261,917

(56 percent) of the residents with arteriosclerosis

also suffered from either heart conditions, the

effects of a stroke, or both. Table 4, in conjunction with table 2, can also be used to determine

how many residents had eithw heart conditions,

stroke, arteriosclerosis, or any combination of

these. Appropriate manipulations will reveal that

more than three-fourths (76.7 percent) of the

residents had one, two, or all three of these

conditions.

One can see from table 4 the extent to which

nursing home residents had multiple disorders.

Considering the fact that this table includes only

the six major conditions, it is not surprising

that 65 percent of the residents had three or

more of any type of chronic condition.s~ However,

because of the effect multiple disorders had on

residents, it is difficult to determine which of

the disorders was most responsible for the

residents’ mobility limitations.

Table D, which is derived from table 4,

shows combinations of the six major conditions

crossed with the two severest mobility limitations—restricted or confined to bed. This table

indicates that whenever the condition effects of a

stroke are present, the percentage of those residents severely limited is between 55 and 60 and

that whenever this condition is not present,

the percentage drops to about 30. This informa8
Table D, Number of residents In nursing homes having specified multiple chronic conditions, and number and percent with mobility status D or E: United States, 1969

Multiple chronic conditions

Stroke, heart trouble, arteriosclerosis----------

Stroke, heart trouble--------------------------

Stroke, arteriosclerosis-----------------------

Heart trouble, arteriosclerosis----------------

Stroke, heart trouble, arthritis-rheumatism------

Stroke, heart trouble--------------------------

Stroke, arthritis-rheumatism -------------------

Heart trouble, arthritis-rheumatism------------

Stroke, arteriosclerosis,arthritis-rheumatism---

Stroke, arteriosclerosis-----------------------

Stroke, arthritis-rheumatism-------------------

Arteriosclerosis,arthritis-rheumatism--------

Stroke, heart’trouble, diabetes------------------

Stroke, heait trouble--------------------------

Stroke, diabetes-------------------------------

Heart trouble, diabetes------------------------

Stroke, arteriosclerosis,diabetes---------------

Stroke, arteriosclerosis-----------------------

Stroke, diabetes-------------------------------

Arteriosclerosis,diabetes---------------------

Stroke, senility (including advanced),

arteriosclerosis--------------------------------

Stroke, senility (including advanced)~---------

Stroke, arteriosclerosis-----------------------

Senility (including advanced),

arteriosclerosis------------------------------

Heart trouble, arteriosclerosis,diabetes--------

Heart trouble arteriosclerosis, senility

(including a&anced) -------- .------- -------- ----

Heart trouble, arteriosclerosis,

arthritis-rheumatism---------------------------

Residents

37,390

45,634

74,848

224,459

17,504

j:,;;;

121:022

;:,;:;

36;502

195,816

6,809

~:,:;:

42;108

9,203

74,848

14,411

56,404

57,079

73,239

74,848

334,064

30,854

159,245

100,234

Residents with mobility

status D or El

Number

21,996

26,101

42,777

69,923

10,100

26,101

20,556

35,583

17,377

::,;;:

58;741

3,650

26,101

8,084

12,220

5,260

4:,$;:

16;810

34,540

43,399

42,777

115,022

9,444

58,733

30,653

Percent

58.8

57.2

57.2

31.2

57.7

57.2

56.3

29.4

58.9

57.2

57.2

30.0

53.6

57.2

56.1

29.0

57.2

57’.2

56.1

29.8

60.5

59.3

57.2

34.4

30.6

36.9

30.6

lMobility status categories D and E are as follows:

D = Generally confined to bed but is in wheelchair for at least a few hours a day.

E = Restricted to total bed rest.

tion combined with that in table 3 demonstrates more conditions which can be caused or agfairly conclusively that the condition most prom- gravated by arteriosclerosis.

inent in causing mobility restrictions is the effect

ofa stroke. Diabetes

The prominent role played by arterioscle- Diabetes mellitus is the technical term for

rosis in heart disease and stroke has been what is generally referred to as diabetes. Itis

discussed. The next two sections reveal two defined usually as a chronic disorder of car-
bohydrate metabolism characterized by hyperglycemia and glycosuria.ss It is also defined in

terms of a deficiency of insulin.

Although the exact cause of diabetes has not

been found, contributing factors such as heredity and obesity have been recognized.

It has been estimated that approximately 4.4

million people are diabetics, with females having

a higher prevalence than males. 30 In nursing

homes in 1969, approximately 12 percent of the

residents of each sex were diabetics (table 2).

Of major concern in the study of diabetes is

its association with arteriosclerosis. Findings

indicate that together with hypertension, diabetes

mellitus is the principal precursor to arteriosclerosis. It has been said that there is no other

disease with which arteriosclerosis is so frequently associated and that there can no longer be

any doubt that arteriosclerosis, with its resulting

diseases, is the main cause of death to diabetics. 37

Indeed, studies have shown that the incidence

of death from cardiovascular complications has

risen from 32 to 65 percent among diabetics.’~

However, in addition to diabetics dying from heart

conditions, many die from diabetes itself, as

evidenced by the fact that in 1969 over 38,000

deaths were attributed to diabetes mellitus, 39

Although no cause-of-death data are available for nursing home residents, figures are

available on the numbers of diabetic residents with

arteriosclerosis and/or heart conditions, Tabulations show that 67,658 (70 percent) of the residents

with diabetes also had either arteriosclerosis,

heart conditions, or both (table 4). Similar

tabulations for residents 65 years and over

revealed a percentage (73) of diabetics having

one or both of these disorders. Based on the

above incidence of death figures, if an actuarial

table of diseases were drawn up, these residents

would undoubtedly fall into the highest risk

category.

Senility

Because of the difficulty encountered in

classifying residents as senile or advanced senile,

the two have been combined for the purposes of

this report, However, for the benefit of the

reader, they are defined separately here.

Advanced senility is the Iayman~s term for

senile psychosis and chronic brain syndrome-two

terms which themselves fall under the overall

heading of senile dementia. Advanced senility

(using the definition for chronic brain syndrome)

is a syndrome characterized by essentially irreversible impairment of cerebral functions, i.e.,

memory deficit (primarily for recent event s),

loss of orientation, affective disturbance, and

decline of intellect and judgment,

Cerebral arteriosclerosis is the most frequent cause of chronic brain syndrome. It usually

begins between the ages of 50 and 60 and is

characterized by acute episodes of confusion and

excitement followed by partial remissions, so

deterioration progresses in a step-wise pattern.

Senile dementia rarely occurs before age 60 and

follows a steady progressive course. ‘u

Senility is a shortened version of senility

without mention of psychosis or presenile brain

disease. Senility is a mental disorder associated

with cerebral atrophy or degeneration which

causes debility (feebleness) and aphasia (loss of

the power to articulate speech). Both senility and

advanced senility are known as diseases of old

age. From here on, senility and advanced senility

will be combined and referred to as senility.

Though prevalence figures on senility for the

general population are not available, institutionalized population rates are moderately high for

people over 60. In nursing homes, for instance,

459,672 residents were reported as senile, That

represented 56 percent of all the nursing home

Table E. Number and percent of nurshg

home residents with senility, by age:

United States, 1969

I

Number Percent

I I

Under 45 years ------

Under 6.5 years ------

65-74 years ---------

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

85 years and over- --

1,020

14,333

62,518

197,435

185,386

J::

45,1

61.3

70.8

10
residents. Table E shows a steady increase with

age in the percent of senility of nursing home

residents.

Referring back to table 4, it can be seen that

of the residents with senility, 73 percent also had

arteriosclerosis. It should also be noted that of the

residents with arteriosclerosis, 71 percent were

reported as senile. Thus for nursing home residents, these two diseases seem highly associated

with each other.

At the beginning of this section mention was

made of the difficulty encountered between classifying residents as senile or advanced senile. It

must also be mentioned that the classifying of a

resident as senile or not senile is often just as

hard, as noted in the following excerpt:

It is difficult to determine which aspects of

the older personts behavior are the result of

his aging and which are the result of his

diminished social contacts, his relative lack

of education, his loss of employment, or the

poor state of his health. ~0

Another factor to be considered is how

physical changes that occur with age relate to

behavioral changes occurring during the same

period, For example, an older resident whose

vision and hearing are beginning to fail may

show marked behavioral changes which might be

interpreted as signs of senility. This same incorrect interpretation might result’ from many

kinds of physical changes that occur.

That old age and senility are very closely

related can be witnessed by the following observation:

Psychologists and scholars in various fields

have observed pronounced changes in the

behavior of the aging organism. Among

these are deficits in sensation and perception, in muscular strength, in the ability to

react quickly to stimuli. . ●nd among

persons over 60, deficits in the ability to

remember, learn, and respond with intelligence. J1

Many of the defici~s mentioned are found in

the definition of senility, in particular those

involving perception and the ability to remember.

In the area of perception, however, old age and

senility may not be the only factors present:

Various experiments indicate a tendency for

older persons to perceive time as moving

more rapidly than it actually does. But this

tendency appears to be at least partially a

function of the environment and attitudes

rather than simply a result of increasing

age per se. 11

The nursing home environment along with the

resident’s attitude towards it might very well

contribute to this loss of perception. One of the

experiments conducted, for instance, indicated

that older institutionalized subjects underestimated time intervals of 30 to 300 seconds to a

greater extent than the older noninstitutionalized

subjects did. At the same time, the study demonstrated there were no differences between

young, middle-aged, and older noninstitutionalized groups.~1

Arthritis and Rheumatism

Arthritis is the inflammation of one or more

joints due to infectious, metabolic, or constitutional causes. Rheumatism is a condition

which causes inflammation or pain in muscles,

joints, or fibrous tissue. The most common forms

of these two related conditions are rheumatoid

arthritis, osteoarthritis, and gout.

In terms of age distribution, rheumatoid

arthritis (the most devastating and crippling form

of arthritis) can affect both young and old alike,

but usually occurs in later years. About five

million Americans have it. Osteoarthritis is

associated with aging and degeneration of joint

tissue, thus affect ing the older population. About

10 million people suffer from it. Gout affects

about one million people and apparently can be

acquired at any age. s1

For simplicit y’s sake, the term arthritis will

be used from here on to describe arthritic and

rheumatoid conditions.

It is estimated that at least 50 million people

in the United States have arthritis to some extent,

of which 17 million have it severely enough to

require medical care.~1 Arthritis ranks second

only to heart diseases as the major cause of

11
activity limitation, affecting over 3.2 million

people (table 1).

In 1969 almost 271,000 nursing home residents had arthritis-one-third of the nursing home

population. Depending on whether one uses the 50

million or the 17 million estimate, &ween onefourth and one-twelfth of the general population

had arthritis.

In terms of mobility, approximately 58 percent of the residents with arthritis had some form

of mobility restriction, with” 28 percent confined

to bed most or all of the time (table 3). However,

it is difficult to determine how much of this restriction was due to other conditions being

present.

IMPAIRMENTS

Vision Impairments

Before discussing vision impairments of

older people, it should be mentioned that the

aging process has a detrimental” effect on vision.

According to Mayts Manual of the Diseases of

the Eye, the power of accommodation needed to

bring near objects into clear focus gradually diminishes with age, due chiefly to. loss of elasticity of the lens. The physiological change becomes most pronounced’ when nearing the age of

45. Distance vision is not similarly affected?

From 1960 through 1962, as part of the nationwide Health Examination Survey of noninstitutionalized people aged 18 through 79 years, visual

acuity tests were administered#2 These eye examinat ions r:vealed, as May’s Manual suggested,

that visual acuity does decline with age from about

45 years on and that near vision tends to be more

deficient than distance vision.

Eye examinations are the most accurate

means of detecting vision deficiencies. However>

the personnel and equipment that are necessary

in administering these tests are usually not available. As a result, most surveys are forced to

rely on other means of measuring vision deficiencies. This can be done through a series of

questions.

For example, can this person read ordinary

newspaper print, can he see across the street,

can he identify moving objects, can he see light,

and so on. These are typical questions that might

be asked of a person concerning-his vision. But

even if these questions could..be arranged in some

logical order whereby “no” answers indicate an

ever-lessening degree of sight, additional information would be needed in order to determine

the extent of the impairment.

For instance, does this person wear glasses

and, if so, were his answers based on hi& sight

while wearing his glasses or while not wearing

them? In other words, if a person has a vision

impairment but his glasses correct the problem,

is he still considered visually impaired?

If a person has impaired vision in one eye

but has perfect vision in the other eye, is his

vision impaired? What about the extreme case

when a person is blind in one eye but can see

perfectly with the other one?

These are just a few of the problems encountered when trying to measure vision impairment by means other than eye examinations.

Although interviews may not be as accurate as

actual eye examinations, they nevertheless produce valuable information of their own.

In a survey of the civilian noninstitutionalized

population conducted from ,July 1963 to June 1964

the questions concerning vision dealt with the

person’s ability to read newsprint, see features

and/or objects, see a friend across the street, and

see light. 43 The survey also determined whether

one or both eyes were involved.

The results of the survey indicated that an

estimated 5,029,000 persons aged 6 and over were

visually impaired in one or both eyes. Of these,

2,415,000 were 65 years and over. For visually impaired persons aged 6 through 64 the rate per

1,000 population (noninstitutionalized) was 18.2,

while for the people 65 years and over the rate

was 141.9. Table 5 gives the numbers and rates

of visually impaired persons by various age

groups.

The 1969 RPS-3, on which this report is

based, used the following set of questions to determine the vision impairment of nursing home

residents. The questions were directed to a

member of the nursing home staff who was

familiar with the resident in question.

Does he USE eyeglasses? yes no

How well can he see?

12
Table F. Numberofnursing home residents with ability to see with and without_glasses,

by age and sex: United States, 1969

Under

65

years

Male Female

65

years

and

over

All

residents

Ability to see 65

years

and

over

207,102

77,498

20,399

15,191

43,330

23,065

18,654

8,965

65

years

and

over

Under

65

years

44,766

10,608

1,922

636

21,411

5,907

2,143

2,139

Under

65

years

Total ------------- 815,i30 92,866 48,1OC

25,546

4,027

2,082

40,594

11,988

5,184

3,445

no

no

722,261

310, 80S

78,218

66,739

112,670

55,485

65,702

32,641

515,162

233,311

57,819

51,548

69,340

32,420

47,048

23,676

Uses

a.

b.

c.

Does

eyeglasses and:

Can read ordinary

newspaper print----

Can watch television across the

room (8 to 12

feet)--------------

Can recognize the

features of people

he knows if they

are within 2 to 3

feet ---------------

not use eyeglasses

336,355

82,245

68,821

153,264

67,473

14,938

2,105

1,446

19,183

6,081

3,041

1,306

and:

a.

b.

c.

Can read ordinary

newspaper print----

Can watch television across the

room (8 to 12

feet)--------------

Can recognize the

features-of people

he knows if they

are within 2 to 3

feet ---------------

Blind -------------------

] 70,886

36,086

(a) Can read ordinary

(b)

(c)

was obtained. A person’s vision was considered

newspaper print with

or without glasses yes

Can watch television

to be seriously impaired if a “yes’’answerwas

given to either (c) or (d).

Approximately 22 percent of the residents

had seriously impaired vision. The 487,421 residents who wore glasses represented 60 percent

of all residents. (It was also discovered in the

1963-64 survey that 60 percent of all nursing

home residents wore glasses.)13

Table F shows the results of combining the

answers to the questions, some ofwhich are as

follows :

●l%at 487,421 residents wore glasses.

across the room (8

to 12 feet)

Can recognize the

yes

featuresofpeople

he knows iftheyare

within 2 to 3 feet

(d) Is blind

For the second question,

proceeded from (a) to (d) until

yes no

yes no

the interviewer

a “yes” answer

13
●That 489,619 residents could read ordinary

newspaper print with or without glasses.

● That 149,718 residents could watch television

across the room (8 to 12 feet).

● That 139,707 residents could recognize the

features of people they know if they were within 2 to 3 feet.

● That 36,086 residents were blind.

When discussing blindness it should be remembered that there are two definitions of blindness—the medical definition and the legal definition. According to the medical definition blindness

is the lack or loss of ability to see, lack of perception of visual stimuli due to disorders of the

organs of sight or to lesions in certain areas of

the brain.

The legal definition of blindness represents

an economic definition derived from Title X of

the Social Security Act which is based on an arbitrary point below which individuals are presumed to be unable to perform econornically.31

Using this legal definition, an estimated

435,000 Americans were legally blind in 1969,

34,200 of these were new cases of blindness which

occurred in 1969. On the average this meant that

94 times every day of the year an American man,

woman, or child lost his or her sight~l

The most common causes of blindness are

senile cataracts (15.6 percent of all blindness),

glaucoma (13.5 percent), diabetes (11.2 percent),

and the vascular diseases hypertension, arteriosclerosis, and nephritis (combine for 7.6 percent) .31

The 36,086 blind nursing’ home residents

shown in table F were classified as such based

on the nursing home staff’s definition of blindness,

which more than likely corresponded to the

medical rather than the legal definition. For this

reason, it is possible that some residents who

might have been legally blind were placed in answer

category (c) rather than (d) because (c) best described how well they could see.

Hearing Impairments

Aging has a detrimental effect on hearing as

well as vision.

The increasing age of our population is probably the greatest single factor for the increased incidence of hearing loss. People developing the sclerotic changes of old age have

a far higher incidence of sensorineural deafness than people in the younger groups. The

degree of hearing loss seems proportional to

the degree of the aging process.31

Deafness is defined as a lack or loss, complete or partial, of the sense of hearing. Similarly,

a deaf person is someone lacking the sense of

hearing or not having the full power of hearing.

For this reason, to state that a person is deaf is

not enough, instead it must be stated whether he

is @rt&My or tofdy deaf. As might be expected,

the d~fference in prevalence between the two is

tremendous. Approximately 236,000 Americans

are totally deaf, and an estimated 20,000,000

Americans are partially deaf.31

The two major types of hearing loss are 1)

middle ear or conductive hearing loss and 2)

sensorineural hearing 10SSS. The first one usually

occurs early in life (at birth or early school

age), when children are subjected to upper respiratory infections. The second one i’sassociated

with the dangers of being brought into the world

or the degenerative changes of old age and as

such, occurs at the beginning and near the end

of life.31

In the survey of the civilian noninstitutionalized population from 1963 to 1965 in which hearing impairments were defined as “deafness or

serious trouble hearing with one or both ears, ”

it was found that over 8.5 million persons were

so afflicted. 44 Table 6 indicates the numbers

and rates of these people by age groups. The

table shows the marked increase in the rates

in the older age group.

The RPS- 3 used the following set of questions

to determine hearing deficiencies of the residents in nursing homes. Again these questions

were directed to a member of the staff who was

familiar with the resident.

Does he USE a hearing aid? yes no

How well can he hear?

(a) Can hear a telephone

conversation on an ordinary telephone (no

amplifier) yes no

14
.Table G. Number of nursing home residents with ability to hear with and.without &earing aid, by age and sex: United States, 1969

*

Ability to hear

Total-.:----------

Uses

a.

b.

c.

d.

Does

aid

a.

b.

c.

d.

a hearing ‘aid and:

Can hear a telephone conversation

on an ordinary

phone (no amplifier)--------------

Can hear most of

the things a

person says-..=----

Can hear a few

words a person

says ---------------

Can hear only

loud noises --------

/’

not use a hearing

and:

Can hear a telephone conversation

on an ordinary

phone (no amplifier)--------------

Can hear most of

the things a person says -----------

Can hear a few

words a person

says ------------- --

Can hear onlv

loud noises --------

Can’t hear anything -----

(b)

(c)

(d)

(e)

Canhear mostof the

All

residents

815,130

10,243

11,594

6,721

6,378

457,615

230,519

47,622

I

29,892

14,546

Under

65

years

92.866

543

94

81

176

70,087

17,145

1,449

1,185

2,106

65

years

and

over

722,264

9,700

11,500

6,640

6,202

387,528

213,374

46,173

28,707

12,440

Male

Jnder

65

Tears

14,766

310

48

42

42

34,423

7,563

783

298

1,257

65

ye&s

over

207,102

2,288

2,914

1,730

1,900

L05,124

66,876

14>078

8,686

3,506

Female

-

Under

65

years

48,100

233

46

39

134

35,664

9,582

666

887

849

65

y:~s

over

515,162

7,412

8,586

4,910

4,302

282,404

146,498

32,095

20,021

8,934

(e) were considered to be seriously impaired.

things a person says yes no

Canhear afew words

a person says yes no

Can hear only loud

noises yes no

Can’t hear anything yes no

Once again the interviewer proceeded in the

second question from (a) to (e) until a “yes”

answer was obtained. Persons whose hearing

ability fell within answer categories (c), (d), or

Table G indicates the extent to which the nursing

home residents had hearing problems.

Table G indicates that approximately 35,000

residents used hearing aids, which was4.3 percent of all the residents. (In 1964 virtually the

same percent (4.4) of nursing home residents

used hearing aids,13) Most of the residents had

little or no trouble hearing. Over 688,000 (84.4

percent) heard sufficiently with no hearing aid

to be grouped in answer categories (a) or (b).

Only 14,546 (1.8 percent) of the residents tiould

not hear anything, i.e., were totally deaf.

15
OTHER FACTORS

This report has demonstrated the high occurrence in nursing home residents of arteriosclerosis and its associated cardiovascular and cerebrovascular diseases. Certain outside factors are

known to aggravate these diseases; among them

are stress, lack of exercise, smoking, and obesity.

Smoking and obesity are individual rather than

group oriented and as such cannot be related to

the nursing home population. Stress and lack of

exercise on the other hand are factors which can

be related to the nursing home population.

Lack of exercise is a common problem for

nursing home residents. Although exercise is a

difficult factor to measure, it has been found

that :

h-tgeneral it appears that moderate activities

exert a favorable influence upon heart disease and that inactivity may have some deleterious effects.b’ 45

Stress is generally accepted as an important

factor in the arteriosclerotic process. It has

been the subject of considerable discussion in

the medical literature:

There seems to be evidence that individuals

living under constant stress and tension are

subject to more frequent heart attacks than

those with well-regulated lives .*5

In many instances institutionalization creates

stress.

Life in an institution—any institution-–has a

profound effect upon the resident. Human experiences take place within its walls which

are helpful or harmful to recovery. For

most it was neitfier choice nor wish to establish residency in the institution. Yet

thousands, young and old, face the prospect

of spending years, perhaps even a lifetime

in an institution. . . .

The person who newly enters into situations

where others have been before him, tends to

bOriginally published by the University of California Press;

reprinted by permission of The Regents of the University of

C:difomia.

●

feel lonely, isolated, often unwanted and

generally endangered$6

While some new residents may react calmly

in these situations, others may show signs of

stress, anxiety, tension, and perhaps even fear.

A number of investigators have studied the

effects of radical environmental changes on

the psychological well-being and physical

survival of the aged. Many of these studies

have involved changes from community living

to life in an institution; others have studied

relocation from one institutional setting to

another. . . . The majority of these studies

. . . showed that changing the environment of

elderly persons sharply increased the death

rate. Although more precision is required in

understanding which conditions and what types

of aged will experience such environmental

changes as severe crises, overall the evidence suggests that radical environmental

change for the aged leads to destructive

physical processes and has noxious psychological effects.47

The foregoing discussion is not meant to

downgrade nursing homes. Indeed, nursing homes

are extremely valuable and have much to offer

the elderly. The purpose of the discussion was

to point out that certain factors which might

exist in nursing homes could have potentially

dangerous side effects on the nursing home residen~. An awareness of this could

eficial.

in time be benSUMMARY

This report dealt with the chronic conditions

and impairments which affected nursing home

residents in 1969 and related the prevalence figures for the nursing home population to the figures for the noninstitutionalized population. The

six basic chronic conditions discussed were heart

trouble, stroke, arteriosclerosis, diabetes, senility, and arthritis or rheumatism. The impairments discussed were those of vision and of hearing. The conditions and impairments of each

resident were reported by a member of the nursing

home staff who was familiar with the resident.

16
Since it would be impossible to present all

of the findings within the contents of this summary,

only one or two important findings for each condition and impairment are presented here.

. Of the nursing home residents in 1969 who

were 65 years and over, 39 percent had

heart trouble. Of the noninstitutionalized

population 65 years and over in 1967 (the

closest prevalence data available) about 19

percent had heart trouble.

● About a fourth of all nursing home residents

in 1969 were afflicted by strokes. These

afflictions took the form of paralysis, speech

defects, and other ill effects of a stroke. In

1969, less than 8 percent of the total United

States population 65 years and over were

afflicted by strokes, whereas 25 percent of

the nursing home residents 65 years and

over were so afflicted.

. It is estimated that arteriosclerosis, as an

underlying cause, contributes directly to

more than 850,000 deaths a year from heart

attacks and strokes.

● Arteriosclerosis and its cardiovascular

complications are highly prevalent among

persons with diabetes. Approximately 70

percent of the nursing home resid:nts with

diabetes also had either arteriosclerosis or

heart trouble or both.

● In 1969, 56 percent of all nursing home residents were reported as senile. Age seemed

to be a definite factor among nursing home

residents reported as senile. Only 15 percent

of the residents under 65 years of age were

senile, whereas 71 percent of the residents

85 years and over were senile.

.Almost 271,000 nursing home residents

(a third of all the residents) had arthritis

or rheumatism in 1969. More women than

men suffered from arthritis or rheumatism

in both nursing homes and the general population.

.Approximately 22 percent of the nursing

home residents had seriously impaired

vision in 1969.

● Approximately 16 percent of the nursing

home residents had seriously impaired

hearing in 1969.

17
1Nation~ Center for Health Statistics: origh,

and operation of the U.S. National Health Survey.

Health Statistics. PHS Pub. No. 1000-Series l-No.

program,

Vital and

1. Public

Health Service. Washington. U.S. Government Printing Of~ce,

Aug. 1963.

2National 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.

3NationaI Center for Heakh Statistics: Institutions for the

agedand chronically ill, United States, Apd-June 1963. ~ital

and Health Statistics. PHS Pub. No. 1000-Series 12-No. 1,

Public Health Service. Washington. U.S. Government Printing

Office, July 1965.

4National 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. 1000-Series 12-No. 2. Public Health Service. Washington.

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

5 Natiomd Center for Health Statistics: Characteristics of

patients in mental hospitals, United States, April-June 1963.

Vital and Health Statistics. PHS Pub. No. 1000-Series 12-No. 3.

Public Health Service. Washington. U.S. Government Printing

Office, Dec. 1965.

6Nation~ Center for Health Statistics: Utilization d

institutions for the aged and chronically ill,. United States,

April-June 1963. Vital and Health Statistics, PHS Pub. No.

1000-Series 12-No. 4. Public Heakh Service. Washington, U.S.

Government Printing Office, Feb. 1966.

7National Center for Health Statistics: Employees in

nursing and personal care homes, United States, May-June

1964. Vital and Health Statistics, PHS Pub. No, 1000-Series

12-No. 5. Public Health Service. Washington. U.S. Government

Printing Office, Sept. 1966.

8 National center for Health Statistics: Employees in

nursing and personal care homes: number, work experience,

special training, and wages, United States, May-June 1964.

Vital and Health Statistics. PHS Pub. No. 1000-Series 12-No. 6.

Public Health Service. Washington. U.S. Government Printing

Office, Jan. 1967.

9Nation~ Center for He&h Statistics: Chronic illness

among residents of nursing and personal care homes, United

States, May-June 1964. Vital and Hearth Statistics. PHS Pub.

No. 1000-Series 12-No. 7. Public Health Service. Washington.

U.S. Government Printing Office, Mar. 1967.

1oNational center for Health statistics: prevalence of’

chronic conditions and impairments among residents of nursing

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

and Health .Statistics, PH”S Pub. No. 1000-Series 12-No. 8.

Public Health Service. Washington. U.S. Government Printing

Office, july 1967.

1lNational Center for Health Statistics: Charges for care

in institutions for the aged and chronically ill, United States,

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

1000-Series 12-No. 9. Public Health Service. Washington. U.S.

Government Printing Office, Aug. 1967.

12National 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

Heakh Statistics. PHS Pub. No. 1000-Series 12-No. 10. Public

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

Sept. 1968.

13National 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.

14National Center for He&h 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.

15National Center for Health Statistics: Arrangement fot’

physician services to residents in nursing and personal care

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

Statistics. PHS Pub. No. 1000-Seriek 12-No. 13. public Health

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

1970.

16Nation~ Center for Health Statistics: Charges for $are

in nursing homes, United States, April-September 1968. Vital

and Health StAtics. Series 12-No. 14. DHEW pub. No. (HSM)

72-1037. Health Services and Mental Health Administration,

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

17National Center for Health Statistics: Employees in

nursing homes, United States, April-September 1968. Vital and

Health Statistics. Series 12-No. 15. DHEW Pub. No. (HSM)

73-1700. Health Services and Mental Health Administration.

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

18National Center, for Health Statistics: Nursing homes:

their admission policies, admissions and discharges, United

States, Ap@-September 1968. Vital and Health Statistics.

Series 12-No. 16. DHEW pub. No. (HSM) 73-1701. Health

Services and Mental Health Administration. Washington. U.S.

Government Printing Office, Dec. 1972.

19Nation~ Center for He&h Statistics: Services and

activities offered to nursing home residents, united States,

1968. Vital and Health Statistics. Series 12-No. 17. DHEW Pub.

No. (HSM) 73-1702. Health Services and Mental Health

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

DeC, 1972.

18
2~National Center for Health Statistics: Comparison of

selcctcd characteristics of institutions for the aged, United

States, 1963 and 1968. Monthly Vital Statistics Report. Vol.

20, No. 1, Supplement. Rockville, Md. Public Health Service,

Apr. 15, 1971.

21Nati0nal Center for Health Statistics: Nursing homes,

their yews in business and changes of ownership, United States,

Septumber 1968. Afoddy, Vital Statistics Report. vol. 21, No.

4, Supplement, (HSM) 72-1134. Rockville, Md. Health Services

and Mental Health Administration, July 7, 1972.

22National Center for Health Statistics: Administrators of

nursing and persomd care homes: education and training,

United States, June-August 1969. Vital and Health Statistics.

Series 12-No, 18. DHEW Pub. No. (HSM) 73-1703. Health

Services tnd Mental Health Administration. Washington. U.S.

Government Printing Office, Feb. 1973.

23National Center for Health Statistics: Characteristics of

residents in nursing and personal care homes, age, sex, color,

and marital status of residents, United Stat,es, June-August

1969. t’itd and Health Statistics, Series 12-No. 19. DHEW Pub.

No. (HSM) 73-1704. Health Services and Mental Health

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

Feb. 1973,

24National Center for Health Statistics: Administrators of

nursing and personal care homes, work experience, United

States, June- August 1969. Vital and Health Statistics. Series

12-No. 20. DHEW Pub, No. (HSM) 73-1705. Health Services

and Mental Health Administration. Washington. U.S.

Government Printing Office, Feb. 1973.

25National for He~th Statistics: Selected ~hwactefistics

of institutions for the aged and chronically ill, United States,

June-August. 1969. Vital and Health Statistics. Series 12.

Health Resources Administration, DHEW, Rockville, Md. To be

published,

26National Center for Health Statistics: Selected measures

of health among residents of nursing and personal care homes,

United States, June-August 1969. Vital and Health Statistics.

Series 12. Health Resources Administration, DHEW, Rockville,

Md. To bc published.

27National Center for He~th Statistics yIntemiew data on

chronic conditions compared with information derived from

medical records. Vital and Health Statistics. PHS Pub, No,

1000-Series 2-No. 23. Public Health Service. Washington. U.S.

Government Printing Office, May 1967.

~ National Center for Health Statistics: Eighth Revision

International Classification of Diseases, Adapted for Use in the

Clnitcd states, F’HS pub. No. 1693. Public Health Service.

Washington. U.S. Government Prihting Office, 1967.

29AMerican Heat Association: 1973 Heart Facts. pub.

No. PHE 8-72 -125M, New York.

30 Division of Chronic Diseases: Diabetes Source Book.

PHS pub. No. 1168. Public Health Service. Washington. U.S.

Government Printing Office, 1969 (Revised 1968).

31The Na~ion~ He~th Education committee,Inc.: Facts

on the Major Killing and Crippling Diseases in the United

States. New York, 1971.

32National Center for Health Statistics, Division of Health

Resources Statistics: Unpublished data from the 1969 Resident

Places Survey-3.

33 National Center for Health Statistics, Division of Health

Interview Statistics: Unpublished data based on information

reported in the Health Interview Survey.

34 Surawicz, B., and pellegfio,EOD.:suddenCardjac

Death. New -York. Grune and Stratton, 1964.

35 Fields, W. S., and Spencer, W.A.: Stroke Rehabilitation.

St: Louis. Warren H. Green, Inc., 1967.

36

Griffith, G.C.: Coronary amery disease. Phibbs, Brendan:

The Human Heart, ed. 2. St. Louis. C.V. Mosby Co., 1971.

37s Chettler, F.G., and DoYd, G.S.: Atherosclerosis.

Amsterdam, London, New York. Elsevier Publishing Co., 1969.

38 Malins, J.; Clinical Diabetes Mellitus. London. Eyre and

Spottiswoode, 1968. p. 1.

39National Center for Health Statistics: Vital Statistics of

the United Stutes, 1969, Vol. IL DHEW Pub. No, (HSM)

72-1101. Health Services and Mental Health Administration.

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

40 Riley, M.W., and Foner, A.: Aging and Socr”ety, vol. 1.

New York. C 1968 Russe~ Sage Foundation. p. 241.

41 Perera, C.A., edito~ May’s Manual of the Diseases of

the Eye, 22d edition. Baltimore. Williams and Wilkins Co.,

1957,

42National Center for Health Statistics: Binocukr visual

acuity of adults. Vital and Health Statistics. PH.$ Pub. No.

1000-Series 1l-No. 3. Public Health Service. Washington. U.S.

Government Printing Office, June 1964.

43 Nation~ Center for He~th Statistics: Chwactenstics of

visually impaired persons, United States, July 1963-June 1964.

Vital and Healtti Statistics. PHS Pub. No. 1000-Senes 1O-NO.

46. Public Health Service. Washington. U.S. Government

Printing Office, Aug. 1968.

44 Nati&al Center for Health Statistics: Prewdence of

selected impairments, United States, July 1963-June 1965.

Vital and He&h Statistics. PHS pub. No. 1000 -Series 1O-NO.

48. Public Health Service. Washington. U.S. Government

Printing Office, Nov. 1968.

45 Seizer, A.: The Heart, Its Function in Health and

Disease. Berkeley. University of California Press, 1966. pp.

149-159.

46National Institute of Mental Health: It Can ‘t Be Home.

DHEW pub. No. (HSM) 71-9050. Health Service and Mental

Health Administration. Washington. U.S. Government Printing

Office, 1971.

47Lieberman, M.A., Prock, V.N., and Tobin, S,S.:

“Psychological Effects of Institutionalization.” ]. Gerorztal.

23(3):343-353, July 1968.

19
48National Center for Health Statistics: Development and

maintenance of a national inventory of hospitals and

institutions. Vital and Health Statistics. PHS Pub. No. 1000-

Series 1-No. 3. Public Health Service. Washington. U.S. Government Printing Office, Feb. 1965.

49 Nation~ Center for Health Statistics: Design and

methodology of the 1967 Master Facility Inventory Survey.

Vital and Health Statistics. pf-IS Pub. No. 1000-Series l-No. 9.

public Health Service. Washington. U.S. Government Printing

Office, Jan. 1971.

5 ONa~onaI Center for He&h Statistics: The Agency

Reporting System for maintaining the national inventory of

hospitals and institutions. Vital and Health Statistics. PHS pub.

No. 1000-Series l-No. 6. public Health Service. Washington.

U.S. Government Printing Office, Apr. 1968.

5lNational Center for Health Statistics: Limitation of

activity due to chronic conditions, United States, 1969 and

1970. Vital and Health Statistics. Series 1O-NO. 80. DHEW Pub.

No. (HSM) 73-1506. Health Services and Mental Health

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

Apr. 1973.

52Merck, Sharp, and Dohme Research Laboratory: T&e

Merck Manual, llth Revision. West Point, Pa., Nov. 1966.

000

20
LIST OF DETAILED TABLES

Page

Table 1. Average number of civilian noninstitutionalized population with limitation of

activity due to selected chronic conditions, by sex and age: United States,

1969-70-------------------- ..........-------------------- ..........------------- 22

2. Number of nursing home residents with selected chronic conditions, by sex and

age: United States, 1969........-----------..................................---- 23

3. Number and percent distribution of nursing home residents with selected chronic

conditions by mobility status: United States, 1969---------.----------------- ... 24

4. Number of nursing home residents with specified multiple chronic conditions by

sex, age, and mobility status: United States, 1969---------.........------------ 25

5. Number and rate per 1,000 persons in total population, and number and percent

distribution of visually impaired persons aged 6 years and over by degree of impairment, according to sex and age: United States, July 1963-June 1964---------- 26

6. Average number of persons with hearing impairments, percent distribution, and

rate per 1,000 persons in total noninstitutionalized population, by age and sex:

United States, July 1963-June 1965---------------------------------------------- 28

21
Table 1. Average number of civilian noninstitutionalizedpopulation with limitation of activity due to selected chronic conditions,

by sex and age: United States, 1969-70

~.1,m< h..wi on ini.m,ntbn wpml.dinhou..hold intro im$. d lh. ci, ili.n ncmtn.liluiim.liz.d Iwp.latmn during the Hrnlth1.1.?, i.. Sun:>. d lNIO .A 107d

Persons limited in activity

Total civilian noninstitutionalized

population-----------

Mental and nervous

conditions-----------------

Cerebrovasculardisease-----

Heart trouble---.......-..-.

Hypertension without heart

involvement ----------------

Other conditions of

circulatory system---------

Arthritis and rheumatism----

Diabetes--------------------

Paralysis, complete or

partial--------------------

Impairments (except

paralysis) of back or

spine----------------------

Impairments (except

paralysis and absence) of

upper extremities and

should ers ------------------

Impaimnents (except

paralysis and absence) of

lower extremities and

hips-----------------------

Visual impairments----------

Hearing impairments---------

Malignant neOplasms---------

Emphysema-------------------

Asthma., with or without hay

fever---------: ------------

Both sexes II Male I

Female

Average number in thousands

.97,422

1,033

604

3,609

1,059

694

3,265

865

817

1,613

431

1,551

1,115

431

358

566

1,010

138,022

389

*

461

132

114

321

115

279

771

196

648

259

211

54

31

595

10,742

403

206

1,520

416

242

1,254

396

254

622

156

480

302

101

178

252

260

L8,658

241

376

1,628

510

338

1,691

354

284

220

80

423

554

119

125

282

154

5,002

477

335

1,937

351

324

L,096

356

470

859

285

887

623

267

161

455

574

67,610

188

*

216

51

47

122

59

168

410

145

449

188

140

*

*

343

.9,402

192

127

917

152

126

442

157

146

363

105

281

178

64

80

201

133

‘,990

I

97

197

804

147

151

532

140

156

86

35

157

257

63

63

238

98

102,420

556

270

1,672

708

370

2,170

509

347

754

146

664

492

165

197

111

435

70,414

200

*

245

81

67

199

56

111

361

50

199

70

71

36

*

252

11,399

212

79

603

264

115

812

238

108

258

50

199

125

38

98

51

127

10,667

144

179

824

363

188

1,159

215

128

134

45

266

297

56

62

44

56

22
Table 2. Number of nursing home residents with selected chronic conditions,

Selected chronic conditions

Total ----------------------

Senility (including advanced)----

Other mental disorders-----------

Effect@ of a stroke--------------

Heart trouble--------------------

Arteriosclerosis-----------------

Paral sis or palsy not due to a

stro1e--------------------------

Arthritis or rheumatism----------

Diabetes-------------------------

Chronic trouble with back or

Spine---------------------------

Permanent stiffness or an

deformity (limbs or backJ-------

Chronic conditions of digestive

system (excluding stomach

ulcer, hernia of abdominal

cavity, liver or gallbladder

trouble-------------------------

All

residents

815,130

459,672

147,705

204,655

296,129

469,011

79,604

270,9S7

96,759

S1,720

194,404

70,351

All

ages

251,868

130,586

54,064

70,820

86,249

133,578

28,220

65,586

27,572

20,795

57,5s3

20,904

Male

Jnder

65

fears

44,766

7,093

23,431

12,283

6,009

8,708

8,517

5,334

3,964

4,041

12,542

3,562

5-74

ears

52,262

23,977

14,852

20,215

15,855

25,583

6,110

11,890

6,580

4,149

12,537

3,495

‘5-84

,ears

90,734

=

55,102

11,83E

24,94’:

36,047

56,289

8,996

25,692

11,494

7,020

19,77!

7,640

85

yea&

over

64,10!

44,4U

3,94:

13,375

28,33~

42,99E

4,597

22,670

5,534

5,58S

12,729

6,207

? sex and age: United States, 1969

Female

Al1

ages

563,26;

329,08(

93,641

133,83!

209,88C

335,43:

51,384

205,7+01

69,187

60,925

136,821

49,447

Under

65

years

48,10(

7,24(

27,8-Y

9,23(

5,34!

7,70(

8,81;

6,43:

4,91:

4,298

12,269

2,565

;5-74

rears

86,229

38,541

23,038

2K,390

26,059

41,503

10,297

25,220

14,880

8,465

22,889

6,920

75-84

years

231,101

142,333

27,869

58,108

90>486

147,043

19,067

87,891

31,113

24,683

53,022

22,319

85

Y:c!s

over

197,832

140,972

14,875

38,101

87,990

139,187

13,203

85,857

18,281

23,479

48,641

17,643

23
Table 3. Number and percent distributionof nursing home residentswith selectedchronic conditionsby mobility status:United States, 1969

Selectedchronic conditions

Se,nility{includingadvanced)--------------

Other mental disorders---------------------

Effects of a stroke------------------------

Heart trouble------------------------------

Arteriosclerosis---------------------------

Paralysisor palsy not due to a stroke-----

Arthritisor rheumatism--------------------

Diabetes-----------------------------------

Chronic troublewith back or spine---------

Permanent stiffnessor any deformity

(limbs or back)---------------------------

Chronic conditionsof digestive system

(excludingstomachulcer, hernia of abdominal cavity, liver or gallbladder

trouble)----------------------------------

Senility (includingadvanced)--------------

Other mental disorders---------------------

Effects of a stroke------------------------

Heart trouble------------------------------

Arterioscleroaia---------------------------

Paralysisor palsy not due to a stroke-----

Arthritis or rheumatism--------------------

Diabetes-----------------------------------

Chronic troublewith back or spine ---------

Permanent stiffness or any deformity

(limbs or back) ---------------------------

Chronic conditions of digestive system

(excluding stomach ulcer, hernia of abdominal cavity, liver or gallbladder

trouble)----------------------------------

lMobility status categories are as fOllOwS:

Mobility statusl

All _.

residents

A B c D E

Number

459,672

147,705

204,655

296,129

469,011

79,604

270,987

96,759

81,720

194,404

70,351

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

158,430

70,593

44,863

122,476

184,511

23,219

113,085

42,620

28,925

56,545

29,142

100,422

36,689

23,345

53,051

92,402

10,442

47,759

15,656

14,385

25,514

12,308

50,237

10,123

31,516

34,103

53,399

11,757

33,481

12,448

11,864

34,190

8,289

Percent distribution

34.5

47.8

21.9

41.4

39.3

29.2

41.7

44.0

35.4

29.1

41.4

21.8

24.8

11.4

17,9

19.7

13.1

17.6

16,2

17.6

13.1

17.5

10.9

6.9

15.4

11.5

11.4

14.8

12.4

12.9

14.5

17,6

11.8

121,325

22,808

80,689

68,591

110,920

25,943

61,543

21,166

21,322

60,946

15,502

26.4

15.4

39.4

23.2

23.6

32.6

22,7

21.9

26.1

31.4

22.0

29,258

7,492

24,242

17,908

27,779

8,243

15,119

4,869

5,224

17,209

5,110

6.4

5,1

11.8

6,0

5,9

10,4

5.6

5.0

6,4

8.9

7,3

A = Capable of going off the premiseswith or without assistance.

B = Confined to the premisesbut does not use a wheelchair.

C = Needa a wheelchair but requiresminimal help in getting around.

.D= Generallyconfined to bed but is iq wheelchair for at least a few houra a day.

E = Restricted to total bed rest.

24
Table 4. Number of nursing home residents with specified multiple chronic conditions by sax, age, and mobility

Multiple chronic conditions

Heart trouble, stroke -----------

Heart trouble, arteriosclerosis----------------------

Heart trouble, diabetes ---------

Heart trouble, senility

(including advanced) -----------

Heart trouble, arthritisrheumatism ---------------------

Stroke, arteriosclerosis --------

Stroke, diabetes ----------------

Stroke, senility (including

advanced )----------------------

Stroke, arthritis -rheumatism----

Arteriosclerosis, diabetes ------

Arteriosclerosis, senility

(including advanced) -----------

Arteriosclerosis, arthritisrheumatism ---------------------

Diabetes, senility (including

advanced )----------------------

Diabetes, arthritis -rheumatism--

Senility (including advanced),

arthritic -rheumatism -----------

Arteriosclerosis? heart trouble,

stroke-------------------------

Arteriosclerosis, heart trouble,

diabetes -----------------------

Arteriosclerosis, heart trouble,

arthritis -rheumatism-----------

Arteriosclerosis, heart trouble,

senility (including advanced) --

Arteriosclerosis, stroke,

diabetes -----------------------

Arteriosclerosis, arthritisrheumatism, stroke -------------

Arteriosclerosis, senility (including advanced), stroke ------

Heart trouble, stroke, diabetesHeart trouble, stroke,

arthritis -rheumatism -----------

Arteriosclerosis, heart trouble,

stroke, senility (including

advanced )----------------------

Arteriosclerosis, heart trouble,

stroke, arthritis -rheumatism---

All

residents

45,634

224,459

42,108

190,558

121,022

74,848

14,411

73,239

36,502

56,404

334,064

195,S16

52,360

30,933

175,146

37,390

30,854

100,234

159,245

9,203

29,481

57,079

6,809

17,504

28,907

15,759

status: United States, 1969

Under

65

years

1,927

3,470

1,151

1,790

1,236

3,071

963

1,853

1,169

1,216

3,672

2,414

868

490

1,389

1,418

740

895

1,285

528

868

1,550

376

523

630

481

lMobility status categories are aa follows:

65

y:’es

over

13,579

60,824

10,105

31,002

27,548

21,880

3,633

21,118

9,4s7

14,504

89,325

45,358

13,544

6,024

41,163

11,278

7,710

23,259

43,737

2,026

7,723

16,374

1,646

5,118

8,804

4,717

Female

Under

65

years

1,065

2,502

1,014

1,474

1,774

1,698

871

1,147

1,015

1,418

3,451

2,359

1,113

857

1,650

489

582

1,125

970

386

459

615

203

291

121

85

65

y:~s

over

29,063

.57,663

29,838

.34,518

90,464

48,199

8,944

49,121

24,831

39,266

!37,616

.45,685

36,835

23,562

.30,944

24,205

21,822

74,955

.13,253

6,263

20,431

38,540

4,584

11,572

19,352

10,476

A

8,497

86,733

17,630

62,915

49,422

12,726

3,214

11,765

6,044

22,723

10,652

76,954

18,105

13,726

58,664

6,170

12,105

39,370

51,147

1,916

4,298

8,217

1,649

2,940

4,010

2,497

Mobility statusl

B

4,621

40,763

6,943

37,865

20,716

8,904

1,100

9,055

4,549

9,621

71,305

35,903

9,310

4,772

34,744

3,861

5,412

17,230

31,229

808

3,845

7,308

700

2,107

3,252

1,978

c

6,415

27,040

5,315

21,355

15,301

10,441

2,013

9,020

5,353

7,250

37,085

24,218

6,545

3,893

21,321

5,363

3,893

12,981

18,136

1,219

3,961

7,014

810

2,357

3,240

1,871

D

20,16C

55,634

10,107

55,108

28,357

32 ,47E

6,462

33,29&

15,555

13,674

92,954

47,413

14,839

6,718

49,01C

16,886

7,888

24,499

47,119

4,099

13,199

26,336

3,056

7,609

14,137

7,105

E

5,941

14,289

2,113

13,315

7,226

10,299

1,622

10,101

5,001

3,136

22,068

11,328

3,561

1,824

11,407

5,110

1,556

6,154

11,614

1,161

4,178

8,204

594

2,491

4,268

2,308

A - Capable of going off the premises with or without assistance.

B = Confined to the premises but does not use a wheelchair.

C - Needs a wheelchair but requires minimal help in getting around.

D = Generally confined to bed but ia in wheelchair for at least a few hours a day.

E - Restricted to total bed rest.

25
Table ~. Number and rate per 1,000 persons in total population,and number and percent distribution of visually impairedpersons aged 6 years and over by degree of impairment, accordingto

sex and age: United States, July 1963-June1964

@Ja,awbasedoninformation reported in household interview of the civilian nminstityticmlized populatikm during the Health Intcwiw Stmvoy

of July 1963 to June 1964

●

Sex and age

Both sexes

6 years and over------------------

6-64 years--------------------------

6,-16years------------------------------

17-44 year5-----------------------------

45-64 years-----------------------------

65 years and over-------------------

65-74 years-----------------------------

75 years and over-----------------------

Male

6 years and over------------------

6-64 years--------------------------

6-16 years------------------------------

17-44 years-----------------------------

45-64 years-----------------------------

65 years and over-------------------

65-74 years-----------------------------

75 years and over-----------------------

Female

6 years and over------------------

6-64 years--------------------------

6-16 years------------------------------

17-44 years-----------------------------

45-64 years-----------------------------

65 years and over-------------------

65-74 years-----------------------------

75 years and over-----------------------

Total

population

160,824

143,802

40,956

65,244

37,602

17,022

11,120

5,903

77,398

69,855

20,830

30,872

.18,153

7,544

5,031

2,512

83,426

73,948

20,126

34,373

19,449

9,479

6,088

3,390

Total

visually

impaired

personsl

Degree of visual impairment

Both eyes involved I

Tota12

Cannot

read

newsprint

5,029

2,614

314

910

1,391

2,415

1,087

1,328

2,270

1,325

171

$;:

945

442

502

2.759

1,289

142

435

712

1,:;;

826

Can

read

newsprint

One eye

involved

Number in thousands

2,666

1,159

131

310

719

1,507

590

916

1,005

490

l%

301

514

194

320

1.661

669

1:!!

418

992

396

596

969

290

24

1;:

679

188

491

348

118

*

*25

2;:

1X

621

171

*

*48

116

449

123

326

1,687

865

107

236

522

822

401

421

651

369

*47

101

221

282

128

154

1..O36

496

1%!

301

540

273

267

2,281

1,411

174

588

649

1,229

816

105

346

364

413

244

170

1,052

lIncludesunknown whether both eyes involved or one eye.

21ncludesunknown whether or not can read newsprint.

26
Table 5. Number and rate per 1,000 persons in total population,and number and percent distribution of visually impaired persons aged 6 years and over by degree of impairment, according to

sex and age: United States, July 1963-June 1964-Con.

~ata m tmwl on infcmtnnt.im rqmtt’ed in household interviews of the civilian nmkstitutimmlixd pormlatim during k Healthhten’hwSww

of July 1963 to June 1964

Degree of visual impairment

Total

visually

impaired

personsl

Both eyes involved Total I

Sex and age p(#&aCannot IICan One eye

involved

Total= read read

news- newsprint print

Rate per

1,000

persons

Both sexes Percent distribution

6 years and over------------------ 31.3 100.0 53.0

44.3

;;.;

51:7

62.4

54.3

69.0

44.3

19.3

11.1

7.6

1;:;

28.1

17.3

37.0

15.3

33.5

33.1

34.1

25.9

37.5

34.0

36.9

31.7

28.7

45.4

6-64 years--------------------------

6-16 years------------------------------

17-44 years-----------------------------

45-64 years-----------------------------

65 years and over-------------------

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

75 years and over-----------------------

18.2

1;:;

37.0

141.9

97.8

225.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

54.0

55.4

64.6

46.7

36.0

44.5

29.1

Male

6 years and over------------------ 29.3 54.1

6-64 years---------.................

6-16 years---------------------------- -..

17-44 years-----------------------.-----

45-64 years-----------------------------

65 years and over-------------------

65-74 years-----------------------------

75 years and over-----------------------

19.0

$!

1;;:;

199:8

33.1

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

:;.:

26:7

44.3

54.4

43.9

63.7

$

60.2

61.6

:;.:

53:6

43.7

55.2

33.9

8.9

*5.;

11.3

24.2

;;.;

.

22.5

27.8

*27.5

21.3

32.5

29.8

29.0

30.7

37.5

Female

6 years and over------------------ 38.1

6.64 years........-.................

6-16 years------------------------------

17-44 years-----------------------------

45-64 years-----------------------------

65 years and over-------------------

65-74 years-----------------------------

75 years and over-----------------------

1;.:

;::~

155:2

105.9

243.7

100.0

100.0

100.0

100.0

100.0

100.0

100.0

51.9

47.9

42.1

58.7

67.4

61.4

72.2

13.3

*

*11.0

16.3

30.5

19.1

39.5

38.5

:;.;

;::;

42:3

32.3

46.2

47.9

::.$

31:1

37.4

26.2

lIncludesunknown whether both eyes involved or one eye.

‘ZIncludesunknown whether or not can read newsprint.

NOTE: For official populationestimates for more general use, see U.S. Bureau of the Census

re orta on the civilian populationof the United States”in Current PopulationReports,

P-$O, P-25, and P-60.

Series

27
Table 6. Averag& number of persons with hearing impairments, percent distribution, and

rate per 1,000 persons in total noninstitutionalized population,by. age and sex:United

States, July 1963-June 1965

[Dataarebasedoninformationreportedinhouseholdinkrviewsofthetivilian noinstitutionalized population dutingtheHealth

InterviewSurvey of July 1963 to June 19651

Sex and age

Both sexes

All ages----------------------------------

Under 25 years----------------------------------

25-44years-------------------------------------

45-64 years------------------------........-----

65-74years-------------------------------------

75 years and over-------------------------------

Male

All ages............................--..--

Under 25 years----------------------------------

25-44years-------------------------------------

45-64 years-------------------------------------

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

75 years and over-------------------------------

Female

All ages----------------------------------

Under 25 years----------------.-----------------

25-44years-------------------------------------

45-64 years-------------------------------------

65-74years-------------------------------------

75 years and over-------------------------------

Average

mmber in

thousands

8,549

823

1,341

2,673

1,808

1,904

4,785

:;:

1,591

1,046

916

3,764

379

554

1,081

763

987

Percent

Distribution

100.0

21:1

22.3

100.0

1::;

33.2

21.9

19.1

100.0

10.1

14.7

28.7

20.3

26.2

‘;:808er

population

45.7

70*5

162.1

317.2

52.8

10.3

36.4

87.1

207.9

359,9

39.0

55.1

124.6

285.4

28
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. Data

about the sample establishment itself, about the health

of a sample of the patients or residerits, about the

administrator of the establishment, and about a sample

of the employees were collected in the survey.

Sampling fname. —The uhiverse for RPS-3 consisted of all institutions classified as nursing homes in

the 1967 survey of the Master Facility Inventory (MFI).

A detailed description of how the MFI was developed,

its content, maintenance plans, and a procedure for

assessing the completeness of its coverage has been

published. 4S~49 The MFI includes the names, addresses,

and certain. descriptive information about “all” hospitals

and resident institutions in the United States. It was

originally developed by collating a Ia,rge number of

published and unpublished lists of establishments and

surveying these establishments by mail to obtain information on their nature and status of business.

Since the MFI serves as a sampling frame for

institutions within the scope of the various health

facilities surveys, it is imperative that it be kept as

current as possible. To aid in accomplishing this

purpose, a mechanism known as the Agency Reporting

System (ARS) has been developed to provide information

on new institutions. This information is incorporated

into the MFI at regular intervals. A report on the

origin and development of the ARS has been publisked. 50

Although it was conducted in 1969, it should be

noted that estimates from RPS - 3 will’ not correspond

precisely with figures from the 1969 MFI survey. This

is because the two surveys used different data collection mechanisms; RPS-3 data are subject to sampling

variability y, and the RPS-3 universe did not include

all MFI facilities. In general, however, the data from

the two sources are compatible.

Sample design. —The sample was a stratified twostage probability desi~ 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 firststage sample selection, establishments listed in the

MFI were sorted into three types of service strata:

nursing care homes, personal care homes with nursing, and personal care homes. (The classification

scheme for homes is described in appendix II.) “Births”

(newly opened homes identified by the Agency Reporting System as not in the MFI) were treated as a

fourth type of service stratum. Each of these four

strata was sorted into seven bed-size groups, producing the 28 primary strata 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 stratum.

Table I shows the distribution of establishments in

the sampling frame and the final disposition of the

sample with regard to response and inscope status.

The second-stage 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 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; he sampled only professional and semiprofessional employees, using predesignated sampling instructions that appeared at the

head of each column of this form.

Swvey 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

and 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 questionnaire was usually the administrator or another member

of the staff designated by the operator of the establishment. The administrator questionnaire was self-enu29
Table I. Distributionof homes in the Resident Places Survey-3universe and dispositionof sample

homes according to primary strata (type of service and bed size of home): United States, JuneAugust 1969

[ExcludesMask. and Hawaifl

●

Type of service and bed size of home

All types of service--------------------

Nursing care------------------------------

Less than 15 beds-----------------------------

15-24 beds------------------------------------

25-49 beds------------------------------------

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

100-199 beds----------------------------------

200-299 beds----------------------------------

300 beds or more------------------------------

Personal care with nursing----------------

Less than 15 beds-----------------------------

15-24 beds------------------------------------

25-49 beds--------------------,----------------

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

100-199 beds----------------------------------

200-299 beds----------------------------------

300 beds or more ------------------------------

Personal care-----------------------------

Less than 15 beds-----------------------------

15-24 beds------------------------------------

25-49 beds------------------------------------

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

100-199 beds----------------------------------

200-299 beds----------------------------------

300 beds or more------------------------------

“Births’’2---------------------------------

Unknown beds~---------------------------------

Less than 15 beds-----------------------------

15-24 beds------------------------------------

25-49 beds------------------------------------

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

100-199 beds----------------------------------

200-299 beds----------------------------------

300 beds or more------------------------------

Komes in

sniversel

(:&mn;ng

21,301

10,480

858

1,756

3,448

3,166

1,;;:

64

3,608

;3;

828

612

332

%

4,725

2,937

988

561

183

48

6

2

2,488

473

304

255

492

;5;

30

12

Total

2,088

1,289

;:

260

477

316

64

63

402

:?

;;

100

41

46

183

::

35

:;

5

2

214

1:

&

58

13

12

Homes in sample

out of

scope

or out

of

business

153

48

4

35

42

16

11

28

In scope and in

business

Nonresponding

81

66

2

3

;:

2;

1

7

i

3

2

i

3

-

i

2

.

.

5

i

?

Responding

1.854

1,175

15

2;:

449

2:;

61

360

18

28

;:

%

42

138

44

29

30

?:

3

2

181

j

27

;:

10

6

lThe universe for the RPS-3 sample consisted of the nursing and personal care homes included

in the Master Facility Inventoryand the Agency Reporting System.

2“Births”consist of homes which were assumed to

data were not available.

be in scope of RPS-3 but for which current

81tBirthsl!of unknown bed size were inadvertentlyexcluded from fr~e.

30
merative, and it was completed by the person who was

designated as “administrator” by the owner or operator

of the sample facility. These two forms were later

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 at 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 residents health condition.

Staff information was obtained by means of a selfcnumerative questionnaire (HRS-4C, appendix III), which

the interviewer left at the facility with instructions for

return by mail.

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 data were processed on

an electronic computer. This processing included assignment of weights, ratio adjustments, and other related procedures necessary to produce national estimates from the sample data.

General Qualifications

Nowesponse and adjustment for 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 from failure to complete

an item on a questionnaire.

Estimating pvoceduve. --Statistics reported in this

publication are the result of two stages of ratio adjustments, one at each stage of selection. The purpose of

ratio estimation is to take into account all relevant information in the estimation process, thereby reducing

the variability of the estimate. The first-stage ratio

adjustment is included in the estimation of establishment and resident data for all primary service-size

strato from which a sample of homes was drawn. This

factor is a ratio calculated for each stratum. The numerator is the total number of beds according to the

hiaster Facility Inventory for all homes in the stratum.

Ilm denominator is the estimate of the total beds obtained through a simple inflation of the Master Facility

Inventory data for the sample homes in the stratum.

The uffect of the first-stage ratio adjustment is to bring

thu sample in closer agreement with the known universe

of beds. The second-stage ratio adjustment is included

in the estimation of resident data for all primary strata.

For resident data, the second- stage ratio adjustment is

the product of two fractions: the first is the ratio of the

total number of residents in the establishment to the

number of residents. for whom questionnaires were

completed within the home; the second is the sampling

fraction for residents on which the selection is based.

Reliability of estimates. —As in any survey, the

results are 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. 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.

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. It 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.

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 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 2~2times as large.

Relative standard errors of aggregates shown in

this report can be determined from figure I. The relative

standard error of an estimate is obtained by dividing

the standard error of the estimate by the estimate itself and is expressed as a percent of the estimate. An

example of how to convert the relative error into a

standard error is given with figure 1. Standard errors

of estimated percentages are shown in table Hand those

of estimated numbers in table 111.

To determine the standard error of a median

value or of the difference between two statistics the

following rules may be used.

Stundavd W?’OYof a median. – The medians shown

in this report were calculated from grouped data.

Approximate confidence intervals for these estimated medians can be computed as follows:

(a) Determine the standard error of a 50-percent

characteristic whose denominator is equal to

the estimated number of persons in the frequency distribution on which the median is

based. For example, the median age of males

is 77.7 years. The estimated number of males

is 193,784 (table 2). The standard error of a

50-percent characteristic whose base is 193,784

is shown in table HI, by interpolation, to be

1.13 percentage points.

31
100.. .

I 1-1’1 I +1 I 1 I I I I I I 1 I I

I I I Ilil I I I I

I

I I I Ill

I I I I I I I I I II I I I I I I t I I II

...- ... ----. . ---- --- .—-

... , }. t..,.-:I ,.. .

. .

, ,.-.1. , ..4 .-. . 1-; 1.; I 1 ! I : 1 I I-7-U 1 I I I t i I t 1 I-i-t--hi

I I I I

I

I I I

I

1- (

I I —-. = .—4 —. .—. J- .j. -1

,1

i -1 — —- —... - -- - i J- ,-,,—, -1-1-1

160 1,-MO lojiloo 100;000 aoiooo

SIZE OF ESTIMATE OF NUMBER OF RESIDENTS

Figure I. Approximate relative standard errors of estimated numbers of residents shown in this report.

Example of the use of figure 1: An estimate of 100,000 total residents has a relative standard error of 2.8 percent (read from scale at left side

of figure). Theestimatehasa standarderrorof2,800(2.8percentof100,000).

Table II. Approximate standard errors of percentages of residents:RPS-3, June-August 1969

Table III. Approximate relative standard errors

of estimated numbers of residents: RPS-3,June- Estimated percent

Base of

estimated

percent

(number of

residents)

August 1969

iMEw&kStandard error expressed in

Size of

estimate

80,000-----

90,000-----

1oo,ooo----

2oo,ooo----

3oo,ooo----

4oo,ooo----

5oo,ooo----

&#)();----

800:000=

9oo,ooo----

Relative

standard

error in

percent

71.4

32.0

22.6

14.4

10.2

u

;.:

.

::$

3.1

Relative

standard

error in

percent

Size of

estimate

percentage pbints

l,ooo ------

2,000------

5,000------

lo,ooo-----

20,000-----

30,000-----

40,000-----

50,000-----

80,000-----

1oo,ooo----

2oo,ooo----

5oo,ooo----

600,000----

800,000----

3.2

2:2

1.4

1.0

M

0.5

0.4

0.4

0.3

0.2

0.1

0.1

0.1

11.3

8.0

5.0

3.6

2.5

2.1

1.8

1.6

1.3

1.1

0.8

0.5

0.5

0.4

4.9

3.5

2.2

1.6

1.1

0.9

0.8

0.7

0.6

0.5

0.3

0.2

0.2

0.2

:::

3.0

2.1

1.5

:::

1.0

0.8

0.7

0.5

0.3

0.3

0.2

9.0

6.4

;.;

2:0

:::

1.3

1.0

0.9

0.6

0.4

0.4

0.3

.0.311.1

7.3 7.8

4.6 4.9

3.3 3.5

2.3 2.5

1.9 2.0

1.6 1.7

1.5 1.6

1.2 1.2

1.0 1.1

0.7 0.8

0.5 0.5

0.4 0.5

0.4 0.4

1oo---------

5oo---------

l,ooo-------

2,500-------

5,000-------

lo,ooo------

20,000------

30,000------

40,000------

50,000------

60,000------

70,000------

3.0

2.9

2.8

2.3

2.1

2.0

1.9

1.8

1.8

1.8

1.8

32
(b) Apply this standard error to the cumulative

frequency distribution to obtain a confidence

interval around the median. The steps are as

follows: For the above example, using the 95-

percent level of confidence, determine the

points on the cumulative frequency distribution

corresponding to the 47.74 percent (50 percent

minus two standard errors) and 52.26 percent

(50 percent plus two standard errors). The

points are 92,512 (47.74 x 193,784) and 101,272

(52.26 x 193,784). From table 2, determine the

ages that correspond to these points. They are

77.1 and 78.3 years, respectively. Therefore

the confidence limit for the estimated median

age of 77.7 years is 77.1 -78.3 years at the 95-

percent level of confidence.

It is possible to investigate whether the observed

differences between two estimated medians can be attributed to sampling error alone by obtaining the upper

68-percent confidence limit, U{ of the smaller median,

M;, and the lower 68-percent confidence limit, L;, of

the larger median, M: . These limits may be found by

using the method outlined above, but using one standard

error instead of two, The square root of the sum of the

squared differences between Ml’ and U: and M; and L;

is the standard error of the difference between M{

and MA that is,

‘(M; - M;)

= /(M; - U;)’ + (M; -L;)2

For the purpose of this report, any difference between

M; and M; greater than 2S(M/ - M;) has been considered a significant difference.

Standard ww of a difference between two estimtes.—l%e standard error of a difference is approximately the square root of the sum of the

squares of each standard error considered separately. This formula will represent the actual

standard error quite accurately for the difference

between separate and uncorrelated characteristics,

although it is only a rough approximation in most

other cases.

—o o o—

33
APPENDIX II

DEFINITIONS OF CERTAIN TERMS USED IN THIS

Terms Relating to Residents

Age.—Age is defined as age at last birthday.

Resident, —A resident is a person who has been

formally admitted to an establiahment but not discharged. AU such persons were incIuded in the survey

whether or not they were physically present at the time.

Classification of Homes by Type of Service

For purposes of stratification of the universe prior

to selection of a sample, the homes on the MFI have

been classified as nursing care homes, personal care

homes with nursing, and personal care homes. The

classification scheme for type of service was based on

the following four criteria:

1,

2.

3.

4.

The number of persona receiving nursing care

during the “paat 7 days.” Nursing care is defined as the provision of one or more of the

following services:

Taking of temperature-pulse-respiration or

blood pressure

Full bed bath

Application of dressing or bandages

Catheterization

Intravenous injection

Intramuscular injection

Nasal feeding

Irrigation

Bowel and bladder retraining

Hypodermic injection

Oxygen therapy

Enema

The presence or absence of nurces on the

staff,

Whether or not the institution provides administration of medications or supervision

over aelf-adminiatered medications.

The number of activities for daily living for

which the institution offers assistance, These

include provisions of rub and maaaage, help

with tub bath or shower, help with dressing,

correspondence,

REPORT

or ahopping; help with

walking or getting about; and help with feeding.

The type of service provided by a home might have

changed during the 2-year interval between the 1967

MFI survey (used as the basic sampling universe) and

the RPS-3. To produce reliable statistics by type of

service from the RPS-3; the homes were reclassified

by type of service on the basis of the data collected in

RPS-3, This classification procedure is essentially

the same as the MFI scheme. The three types of service

classes delineated for RPS- 3 are defined as follows:

Nu?%ing cave home. -Home in which 50 percent or

more of the residents received nursing care during

the week before the survey and in which a registered dttrse (RN) or licensed practical nurse

(LPN) was employed at least 35 hours or more per

week.

Personal care home with nursinq-Home in which

either (a) some but less than 50 percent of the residents received nursing care during the week before

the survey and at least one full-time RN or LPN

waa employed or (b) some of the residents received

nursing care during the week before the survey,

no RN or LPN was employed, and at least one of

the following conditions was met:

The institution provided administration of medicine or supervision over self-administered

medicines.

The institution provided assistance with three

or more activities for daily living,

Personal cave home. -Home in which one or more

of the following criteria were met: (a) some of the

residents received nursing care during the week

before the survey, no full-time RN or LPN wae

employed, the institution did not provide administration of medicine or supervision over self-administered medicines, and the institution provided

assistance with one or two activities for daily

living or (b) none of the residents received nursing

care during the week before the survey, at least

one full-time RN or LPN was employed, and at

least one of the following conditions was met:

34
Table IV. Claaa’ification of instf.tuti.ona by type of service

Classification variables Classification criteria

1 1

Porcsnt- of total reaidenta who received nursing 50 percent or ❑ ore I

Some but less than

care during the week prior to day of survey 50 percent

Numbar of registered or licensed practica 1

nuraea

1+

Does the inatitution rovide:

(a) Adminiatrati.on o! medicine or treatments

according to doctor’s ordera

(b) su~c~~:;on over s~lf-administered

.0,

Does the institution offer assistance with

threa ●ctivities or more for daily living?

DWS the institution offer ●asiatance with

one or two ●ctivities for daily living?

Doaa the institution offer room and/or board

● s ita only service?

. . .

. . .

—

● ✌✎

Inatitut ion’ M

‘Nc-Nursing care hems

Pcn-Paraonal care with nursing home

Pc=Peraona 1 care home

D.Domiciliary care home (out of scope)

B-Boarding or rooming house (out of scope)

I

None 1+ None

Yea No . . . Yes No

. . . Yes No . . . . . . Yes No

. . . . . . Yes No . . . . . . . . . Yes No

.,0 .$. ..0 Yes . . . . . . ,... ,.. Yea

Pcn Pcn Pc D Pcn Pcn Pcn Pc D

None

o+

Yes I No

. . . Yes No

. . . . . . Yes No

. . . . . . ● .* Yes

Pc Pc D B

The institution provided administration of med- Institutions which provided assistance with one or

icine or supervision over self-administered two activities for daily living or offered room and

medicines. board as the only service were classified as out of

The institution provided assistance with three scope of the RPS- 3. Table IV shows in detail the scheme

or more activities for daily living. for classifying institutions according 10 type of service.

35
Advanced senility . . . . . . . . . . . . . . . . .

Senility, notpsychotic . . . . . . . . . . . . . . .

Other mental conditions (such as mental ilIness and

retardation) . . . . . . . . . . . . . . . . . . .

Cerebrovascular diseases

Speech defect orparalysis (palsy )dueto a stroke . . .

Other illeffects of stroke . . . . , . . . . . . .

Hea~trouble . . . . . . . .. . . . . . . . . . . .

Hardening of thearteries. . . . . . . . . . . . . . .

Paralysis or palsy not due to a stroke . . . . . . . . . .

Arthritis or rheumatism . . . . . . . . . . . . . . .

Diabetes . . . .. . . . . . . . . . . . . . . . . .

Any chronic trouble with back or spine . . . . . . . . .

Permanent stiffness or any deformity of the foot, leg, fingers,

arm, or back . . . . . . . . . . . . . . . . . .

Chronic conditions of digastive system (excluding stomach

ulcer, hernia of abdominal cavity, liver or gallbladder

trouble) ..,,...,.,., . . . . . . . .

Auditory impairments . . . . . . . . . . . . . . . .

Vision impairments . . . . . . . . . . . . . . . . .

ICDA Code Numbers

290.0

309.6,794

290.1-309.5,309.7-31 5,790

436,781.5

430-436

390-398,400.1,402,404,41 0-429,782.1,782 .2,782.4

440

342,343,344,348,349.1 -349.5, 350,787 .0,780.3

710-718

250

353,722.0,725,726,728, 729.0,729.1,731.0,735,

756.1,756.2

722.1,727,729.4,736, 737,738.2-738.9, 7%, 755

530,535-537,540-543, 560-569,577.1:577.9, 750.1-751.9,

754.1 -754.5

388,389

370.9,378.9,379

Figure Il.

Coding Ranges for Chronic Conditions numbers 2s are listed in figure H. (An explanation of

this

the categories used in table 1 may be found in appendix

The chronic conditions and impairments used in H of Vital and H&alth Statistics, Series 10, Number

report and their International Classification code 80.51)

—oo~

36
APPENDIX Ill

RESIDENT PLACES SURVEY-3: FORMS AND QUESTIONNAIRES

Introductory Letter

Q

~.+’y%..

.

59:.

$?.,, *.*

,s d

OFFICE OF THE DIRECTOR

r

U.S. DEPARTMENT OF COMMERCE

BUREAU OF THE CENSUS

WASHINGTON, D.C. 20233

1

HRS-4g-l (4-69)

1- -l

Dear Sir:

The Hureauof the Census,actingfor the UnitedStatesPublicHealth

Service,is conductinga surveyof nursinghomes,homes for the aged,

and otherestablishmentswhich providenursingcare,personalcare,or

domiciliarycare for the aged or infirm. The purposeof this surveyis

to collectmuch neededinformationabout both the facilitiesand the

employeesand patients. This activityis part of the NationalHealth

Surveyprogramauthorizedby Congressbecauseof the urgentneed for

more comprehensiveand up-to-datehealthstatistics.

This letteris to requestyour cooperationanclto informyou thata

representativeof the Bureauof the Ceneuswill visit your establishment

withinthe next week or so to obtainthe neededinformation.Priorto

this visit,the Census representative will call you to arrange for a

convenient appointment time. Meanwhile, to cave time, I should appreciate your completing the two enclosed questionnaireswhich request come

information about you and your establishment. Our Census representative

will pick up thesequestionnaireswhen she visitsyou to obtainthe

additionaldesiredinformation.

All the informationprovidedon the questionnairesand givento the

Ceneusrepresentativewill be kept strictlyconfidentialby the Public

HealthServiceand the Bureauof the Census,and will be used for statisticalpurposesonly.

YOLU cooperationin this importantsurveywill be very much appreciated.

Sincerely,

=L.&&3.-O~

A. Ross Eckler

Director

2 Enclosures

37
Staff Information and Control Record

,ORM HRS-4e US. DEPARTMENT OF COMMERCE

S-27+9}

Bud*et Bureau No.

@uReAu OF T~e ‘=ENSUS NOTICE -A(I reformation whlchwOuld permltldentlflcati~ of~e .$~.~q~~ Establtshm.nt N@.

individual will be held in strict confidence, will t-s used only by

STAFF INFORMATION ANO CONTROL RECORO

persons engaged In and for the p.rpases of the survey, and will, Approval Expires

not be disclosed or released to others for any purposes. August 31, 1969

1

OCCUPJ

STAFF SEX RACE Enter number

H

1-11 12

List below the names of all persons who work

in thlsfacllity. - Male W-Wh Ite Professional Professional

P - Female

.ine Include members ofrell; lous organizations a“d

%.

N-Negro

orders who provide thelrservlcas, O-Other

sw_,

I No,.: Be sure to list adml”lstrator a“d assistant I I

I

administrator. (b) I

(4

1 21 2 3

, ., ,., N o

II 1’”1 I I

I

lTE—_

.

4

5

6

7

8

9

.-

13

1A.,

15

[6

I I I I I I I I

18

19

10 I I I

1

TIONS

fr.m Card A

13-20 21-24

senll - Nonprofessional pro fess l.a”af

$W

TE _

Clrc 1. Do “Ot fill

-%

~

sample stoff q.espersons t form c1lre

~

(f) (g)

I

DISPOSITION OF

STAFF

QUESTIONNAIRE

(h) ~~e

Oate

received

1“ R.o.

*

j

I

2

3

4

5

6

7

8

9

10

II

12

13

14

15

16

17

Ill

19

20

38
Facility Question ncsire

Budget Bureau No. 68-SS9022; Approval Expires August S1, 1969

a

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 rhe purposes of the survey, and wi I I not be disclosed or released to others for any Purposes.

FORM HRS.40

(44.69) I

(Pleeee correct any error in name and address ti.luding ZIP code)

US. Department OF COMMERCE

6UREAU OF THE CENSUS

ACTINQ AS COLLrECTINa AGENT FOR THE

U.S. PUBLIC HEALTH SERVICE

FACILITY QUESTIONNAIRE

I

1. What was tho number of inpatients in this facilitv on December 31, 1968? Number

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:

I

Nasal feeding Catheterization Irrigation No. of

Oxygen tiwrapy Full bed-bath Enema persons

Hypodermic injection Intravenous injection Temperature-pu Ise-respiration

Blood pressure Application of dressing Bowel and bladder retraining

or bandage

3. In 1968; what wos the tatal inpatient cloys af care provided? (The sum of the number of Days

days of care given to each patient from I/1/68 through 12/3 1/68)

4. In 1968, how many admissions did this facility have? Number

5. in 1968, haw many af the admissions were Medicare patients? Number

6a, In 1968, haw mony discharges, excluding daaths, did this facility have? Number

1

b. Haw many patiants ware discharged ta the faliowing places -

I

Total

K

ow mony were

No. edieare patients A

(l)genemi orshart.stay hospital? . . . . . . . . . . . . . . . . . . . . . . . l— u None

(2) tang-term speciaity haspital (except mentai)?. . . . . . . . . . . . . .

I_ o None

(3)mentai hospital? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . l— m None

(4)anothernursing hame? . . . . . . . . . . . . . . . . . . . . . . . . . . ...] ]_ m None

(5) persanal cara or domiciliary home? . . . . . . . . . . . . . . . . . . . . I_ m None

(6)patient’s home or family ? . . . . . . . . . . . . . . . . . . . . . . . . . . . l— n None

(7) ather places? (SPec/fy pface) / m None

7. In 1968, how many persons died while patients of this facility? m None

8. What is the total numberof patient beds regularly maintained Beds

(set up and staffed for use) in this faciiity?

9. Whet is the tatai NUMBER OF inpatients (patients ar residehis) Number

wha stayed in yaur hrciiity last night? (DO NOT INCLUDE EMPLOYEES OR OWNERS)

10. During the past seven days, how rn’onyof the lNPATi ENTS in question 9 receivsd

“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 Fuli bed-bath Enema persons

Hypodermic injedian Intravenous injection Temperature-pui se-respiration

Blood pressure Application of dressing Bowei and biadder retraining

or bandage

I

i i

Please continue cmreverse side

39
1. Which of tfrc following sorvi..s am ROUTINELY provldd?

1

0. Supervision over medications which may be self -orktinistwed. . . . . . . . . . . . . . . .

b. Modicotions ond traotnmnt. arkninistorod in accer&nco with physicians’ orders . . . . .

c. Rubandmassa~. . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d. Help with dressing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

●.Holpwitfr corrospandanco orshapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f. Holpwith walking ar,gotting about . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g. Holpwiifr aating . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .

OR

h. Non. of the above sorviccs ROUTINELY providod, room ,arrd board provided only . . .“.

2. Is this FACILITY participating in the Mcdicara progmm?

3. How many beds are ccrtifiod br Modicar.?

40. For how many patiwrts is this facility naw rocoiving Mcdicaro payments?

b. How many of thcso Modicam patiants Iivcd (had their horn.) ‘

in tfsis Stota whmr admittad to this faciiity?.

5. “in addition to two physicians, daos the Utilization Roviow Committoo include -

a.thenursing diroctar? . . . . . . . . . . . . . . . . . .

b.asociai warkor? . . . . . . . . . . . . . . . . . . . . .

c. tho nursing horn. odmhtistrotor? . . . . . . . . . . .

d.aphysical therapist? . . . . . . . .. . . .. . . . . . .

. . any oth.r munirers? (Specify occupa?lon)

6. Haw many persons’are arnployed in this facility?

(Include members of relfglous organlzatfans and orders

who provide their sewlces J

7. Last manth, war. #r. following sorvicos pmvidad on a regular

basis drrau$r contmcts or otfror f.. arrongarnants?

a. Physician (M.D. ar D. O.)

b. Dental

c. Pharmaceutical

d. Physical therapy

e, Occupational therapy

f. Recreational therapy

g. Speech therapy

h. Sociai warker

i. Dietary (Dietitian)

j. Food service (meal preparation@

k. Housekeeping

1. None of above

2DN0

20N0

2DN0

20N0

2(_JNa

2DN0

l-l

Hsw marry p.rmns

providsd this

scrvica?

Na. of parsons

10YC8 snNo

c1

fnYis 2QN0

(Skip U

NumMr

Number

Tatal emplayaas

Last manttr hti marry

hours did ti-y qrsnd

pravldlrrg this SSWIC.?

Hnurs I

==1
Administrator Questionnaire

Budget Bureau No. 68-S69022; Approval Expires August 31, 1%9

NOTICE - All Information vdrich would permit identification of tie individual will be held In strict confidence, will be used only

by parsons encaged In end for the purposes of the survey, and will not be disclosed or released to others for any purposes.

FORM HRS.4b

t4.4.6M U.S. DEPARTMENT OF’ COMMERCE A. Name of admkri strator

BUREAU OF THlt CIiNSUS

AcTIN13 As c0LLccrlN9 AGENT FOR mc

U..% PUBLIC HltALTH SERVICE

B. Establishment No.

ADMINISTRATOR QUESTIONNAIRE

The U.S. National Heelth Survey of the Public Heelth

Service Is conducting a nationwide survey in nursing

homes, homas for the aged, and other related types of

astebliahmants. The purpose of the survey is to

obtain carteln information about the staff employed in

thasa aetablishments as well aa about the heelth of

petlents or residants in the establishments.

your answers wil I be given confidential treatment by

the U.S. Nationai Health Survey and the Bureau of

the Census. The information wili be used for statistical purposes only, and will be presanted in such a

manner that no individual person or establishment

can be identified.

Thank you for your cooperation.

1. whenwore you “born? lMonth I Year

I I

. In what Stat. (or foreign country) woro you barn? State or foreign country

I

3. How long hava you baen tire adntipistmtar - INC.. of years I No. of months

a. in this facility? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

l==+===

I

b. in athar nursing homes, hamos for tho agad,

ar similar facilities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. of years j No. of months I

c. in haspiteis? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4a. Are yw the administmtor far mora than cm NURSING HOME? 1 Q Yes (4b) I

I

2 n No (Skfp to Q.5)

b. Far haw many ath.r NURSiNG HOMES? Number

c. What is tho number of patient bads in EACff of the athar NURSiNG HOMES?

5a. Haw many hours did yau wark LAST WEEK iN THIS FACILITY ONLY? Hours

I

,

b. How man of these hours did you spand LAST WEEK pdomring EACH

of tlm fa i’iowing scrvicas IN THiS FACILiTY ONLY -

I

I

(l)akinistratian afthaticiii~? . .. . . . . . . . . . . . . . . . . . . . . D None I

I

(2)nrsrsing car.? .o . . . . . ..o . . . . . . . . . . . . . . . . . . . . . . . n None

(3) mcdicai ond dantal car.? . . . . .. . . . . . . . . . . . . . . . . . . . . D None

I

I (4) physical ttmmpy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

a None

I

(5)occupatianal thempy? . . . . . . . . . . . . . . . . . . . . . . . . . . .

a Nane

(6) racreotiortai therapy? . . . . . . . . . . . . . . . . . . . . . . . . . . . a None

(7)sp*och aadh-tring thampy? . . . . . . . . . . . . . . . . . . . . . . .

a Nan,

( (8) social work? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ None

(9) ci~rical wark? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D None

(10) kitchan/dietary work, gmcary shopping? . . . . . . . . . . . . . . D None

(Il)housekaoping swvices?. . . . . . . . . . . . . .. . .. . . . . . . . . . a None

6. Bosldas tho hours worked iN THiS FACiLiTY, how many additional

hours did you work in yaur prafessian LAST WEEK? D None

7. AS an adminietmtor, are you sel$amployad or o salariad amployaa? 1 m Self-em piayed

I

—20 Employee s n B.J~h

~

P1.as. continua on reverse Ad=

41
a

*

Circle highest grade comP/eted

8. What i. the highest grade you completed

in school?

a. Elementary school . . . . . . . . I 2345678

}

;kl,gOto

b. High school . . . . . . . . . . ..[2 34

c. Junior college . . . . . . . ...12

d. Nursing school (diploma). . . . I 2 3

e. College . . . . . . . . . . . . . ..123450r more

Mark ail that apply

Major field of study

9. Which of the following degrees do you have?

D Associa:e degree

orcertlftcate . . . . . . . . . . . . . . .

a Bachelor’s degree. . . . . . . . . . . .

aMasterls degree . . . . . . . . . . . . .

n Doctorate (M. D., D. O.,

or Ph. D., etc.) . . . . . . . . . . . . . . L

a None of these

10. Which of the following professional degrees,

licenses, or association registmtions do

Mark all that app/y

you hove? m Ph~sician (M. D.)

m Physician (D.O.)

m Registered Nurse (R. N.)

n Licensed Practical or Vocational Nurse (L.P.N. or L.V.N.)

❑ Registered Physical Therapist (R, P.T.)

I_J Registered Occupational Therapist (0.T.R.)

n Other professional degree, I icense, or

association registration (Spec/fy)=

a None of the above

la. Have you ●ver taken any coursos in nursing home administmtion?

1 U Yes (1 lb) z O No (Skrp to Q. 12cI)

b. How many of thesk courses have you taken? 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 ●ver receive” any “an-the.lab” training to ba nursing home administrator? t m Yes (12b) 2 m No (Skip to Q. 13)

b. How Ioag did this training last? Months

c. Where did you receive this training? Name of place

3. Have you had any other ●ducation or training in 1 n Yes - f:~;/be zmNa

nursing hamo administration?

,ORMHRs.4b [4.4-ss) USCOMM.Ot

42
HRS4f Current Patient Questionnaire

,amoof samplepwam Line No.

Month I Year

. hllat is

IDey ,

--dstsofblrtfr? m ‘Me 1 I

,S+s I u Male 20 Female

. R~ I Dtite z~ Negro 3n Othernonwhite

a.Whstwas his rwitsl

status Stadmission?. . .

10kfarried 20 Widowad 3 n Oivorcad 4 rg Sapz4ated s u Nevermarried

b. h&s#&ararNsl

. . . . . . .

t u Married a o Nidowed s u Oivorced t u Separated s u Nevermarried

Month 106Y8 8Year

. Wl+atWSS the dsbofhis LAST AONISSIONto this PfsCS? # I

2 r HLWIrng hasha hsdthis cacditim?

No Yes :ym:a 23 to 5 36 to 11 ;2 mos.

, Whichof these cmditioas sahpshwnfadoeshe have?

mos. mos. ormora

a. AOVANCEOsanility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b.sanllify,no tpyschoti c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c. Othermentaldisorders(soch ~ mentalillness M refardatlsn) . . . . . . . . . . . . . . . .

d. ~chdef~tor p~alysis(pal~)due toastioke . . . . . . . . . . . . . . . . . . . . . . . .

e, OtherllleNacts ofaatroke, ,., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f. Hearttr~bla,,,,,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g, Hardanlngof thearteries . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h. Paralysis wpal~not duetoasboke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i. Arthritis or rheumatism.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j. Di~les.,,,.,...,.., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

k. hyCHRONIC trouble wihb&kw spine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

L RJR{AJE[T atiffneas m sny deformityof Nrsfoot, lag, fingers,

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

m. Chronicconditions of digestive system excluding stomachulcer,

herniaof abdominalcavity, fiver, or gal{bladdertrouble). . . . . . . . . . . . . . . . . . . .

n. Any otherconditions or impairments- *I&

At hla fsst ~alcsl axsmltiion, Primarydisgnosia?

‘ whatWSShis -

Zmrrdary diagnoais?

Any otherdiagnosis?

Dwfn; NWpast7 SiSYa, I u Help wiUrdressing,

‘ which 0! ths SSIViCOS

s o Temperature- pulse -

ahaving,or care of hair

16n ktraVeIIOUSinjd~

respiration

did this patient racalva? 2❑ Help wilfr tub balh

17n hfraoruscd~hjdh

9 ❑ Full bsd+ath 16❑ $hhIaous injdk)n

Check os rmiy os OF++ or shower tonhrrra

so Help Witheating

\9❑ Intradermalinjection

t 1n Catheterization 200 Nasal feeding

s o Rubor massage 12❑ Bowel or bladdar OR

s ❑ Administration of msdice- retraining

tions or traabnent 21❑ Noneof the &ove

19f_J Blood ~essrrre services received

a❑ Special diet 14❑ Irrigation

7❑ A@ication of ateriIe

dressings or bmdag.ss

15❑ Oxygenthara~

la.DoeshatfSEey@ssaea? I ❑ Yes 2uN0

b. Doeahe tfSEa hesriru aid? I n Yas zl_JNo

1. Doaahe useSOYat the toNcwinsaids- FW whstcmdltion(a)?

a, walker? ZONO I nYas _

b. crrrlchas? 2uN0 tnYes _

c. br=es? ZUNO ti_J Yes _

d. wMelchair? 2uN0 ~aYes —

a, MY other aida? ZUNO

*lfy

\nYea _

botnotas

43
11. Whichofthesecategoriesbeatdescribeshis

*iiity to WovsH

a. Cqybie of goingoff the premiseswith or without

assistwrce

b. confined to the premises,k! doesnot use a Wsfchair

c. N#: aWealchair but reqtrirasrrrinimaihelp in getting

d, Generailyconfined to badbut up in wheelchair fcr at

iaast a few hours a day

e, Restrictedto totai badrest

12. ifew waii w ha hear?

?

a. Canhear a tale wra wnveraafion on wr ordinary

teie~rne (a te epfwna wlthwt m ampiifiar)

b, Canbearmostof the things a personsejs

c. Can haiw a faw words a parson says

d. Can he~ only loud noises

a. Csm’thei%wryfbirrg

13. Howwaii can ha sea?

a. Csn raad ordinary newpaper print with or without

Ok+sses

b. Can watch television across Urarwm (8 to 12feat)

c, Canrecagnizathe featuresof wopie he knows if they

are witbin 2 to 3 feet

d. is bfind (If blfnd ask C, mark h~)

14. Howmuchcwtroi doss ha uauaiiy haveever his bawsfs’

andbiaddar-- oarmzffydoss haa. Confroi biaddar and boweis?

b. “Controi bladdar but not bowaia?

c. Control boweis hut not biadder?

d. Not controi bowais of bioddar?

a, is cafh’eterized?

1.5SOaaathis p5ti5nrsbehaviorraqulrsMwa thanUaYusuai

nwsiw time because,b is fwgatfoi,rmooparativaw

distwbing?

a, No mwe tbm usuai

b. Sli!htlv nmra

c. Moderately more

d. Much mcra

iTEM A - if patLW was not here far fuii mwdfr,check hers ❑

13s.LssI rawrffr,whatwas NWcfwge farhis icdsing,wds, ard I

I

xl Ooaatbis 1. i

I

lUY 2f_JN I

I I

taY 213N I

t . “I’* I*4

,. .+-..*-’”.4,,,

,.. -. ,

. ...+.ij..

,.. :,>,.,f,

.,

. ..

,.%J*‘ :

i

!f-J Y 213N

tn Y amN

.-” .- W

1’ ‘ I “i-

- “; “ri

.,

,.}

.. r..:

: ,.

. . .

I

II II ZI II

11-JY 2f3N

!UY ZUN

llq Y 2f3N

rd go to naxt perwn.

I

3inc CWS?Do nor inch?-a piwte dJrV rnnsoq. $

I I

b. hat WSS NW TOTAL cfrw$a far bis ewe fsat merkb? Js

17a. WhStWSIS tfw SCUCSS Of ~y~t fa hfa CSfS fSSt wdt? Chak all tkatqply

i_JOwn incomeor famiiy support

(private plans, ratirarn+ntfunds,

•:thfii~$fic aaaistanca ❑ initial paymwrt- iife care

social aacurify, etc.) l_JChurch su~orf

❑ Otiar -s=/*

❑ Medicare(Title XViii)

❑ Medicaid(Titie XiX)

❑ VA contract

b. WbStWSSffw PRik14RY SWICCS d ~ywsid fM his C#S bst d )hrk MO cmfy

I f_JOwn incoma or famiiy support

(priyate plans, retirementfunds,

4 aOthar prrbiic assistance e Uofhw - S’1*

or weifare

social security, etc.) s f_JCburch srrp$ort

z i_JMadicara (Titia XViii) s a VA contract

s f_JMadicald (Titla XiX) 7 ❑ initiai payment - iife care saNwra

patient was not hare in Decamtwr 1%9 (NWt ~tM)

18. t wws aii d his SMSCSS Ot fsSy~ti for ks~ l~?

❑ 3amaas 17a-b f_JM~icaid (Titie XiX)

❑ 0W incwnaor famiiy sqlort

❑ VA crnfract

(private pians, retirement funds,

•~tfiii~uic aaais@ca Oinifiai payment- iifa cara

sociai security, ate,) ❑ Churchauppzrt

nOfbar -.SFI*

f_Jfadicars(Titia XViii)

P*a 3
Staff Questionnaire

R..,i,,d -.”5. . %.-.,, . . . . . . N,I

..”. An.cx0n99.““ -. .,”-, ..A“..,w.I fr, -.”. -r. U....h...- ,..At.=,,=,=.-. .

11. .106C ..”

IOTICE - All information which would Permit Identification of the individual will be held in strict confidence, wi II be used only

y persons engaged hr and for the purposes of the survey, and will not be disclosed or released to others for any purposes.

ORM HRS4C

1.$491 U.S. DEPARTMENT OF COMMERCE A. Establishment No. B. Line No.

BUREAU OF THE CENSUS

AcTING AS COLLECTING AGENT FOR THE

U.S. PUBLIC 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.

Pleaae complete the form and return it within 5 days Thank you for your cooperation.

tethe Burerru of the Census, Washington, D.C 20233,

inthepostage-paid envelope provided,

Month Year

When were you born?

!. Howmony years have youworked aso

No. of years No. of months

?

o.in this facility? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No. of years

b. ino!h~r nursi~g rames, homes forthe aged,

No. of months

orslmllar facllttles? . . . . . . . . . . . . . . . . . . . . . . . . . . .

No. of years No. of manths

c. in hospitals? (NoTE TO NURSES: Do not /nc/ude

spec)al duty or private duty nursing. ) . . . . . . . . . . . . . . . .

Hours

a. How many hours did you work LAST WEEK IN THIS FACILITY ONLY?

b, How many af these haurs did yau spend LAST WEEK performing

EACH of the fellawing sewices IN THIS FACILITY ONLY-

(1) administration of the facility? . . . . . . . . . . . . . . . . . . . . . a None

(2)nursing care? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a None

(3)medic+ anddental care? . . . . . . . . . . . . . . . . . . . . . . . . a None

(4) physical therapy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . a None

(5)occrrpational therapy? . . . . . . . . . . . . . . . . . . . . . . . . . . a None

(6) recreational therapy? . . . . . . . . . . . . . . . . . . . . . . . . . . n Nane

(7) speech and hearing therapy? . . . . . . . . . . . . . . . . . . . . . a None

(8) social work? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I_J None

(9) clerical wark? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I_J None

(10) kitchen/dietary work, grocery shopping ? . . . . . . . . . . . . . m None

(ll)horrsekeeping services? . . . . . . . . . . . . . . . . . . . . . . . . m None

(12) ather services? (Specify serv/ce) . . . . . . . . . . . . . . . . . . m None

Besides the haurs worked IN THIS FACILITY, how many additional

‘. haurs did yars work in yaur prafessian LAST WEEK? . . . . . . . . . . . . . . . . . . . u None

Please continue on reverse side

45
What is the highest grade you completed

in school?

Which of the follawing degrees do you have?

Which of the following professional degrees,

licenses, ar association registrations do you have?

Have ou ever token ony of

the fo rlowing courses: 7

0. Nursing care af the aged In Yes_

ar chronically ill? 2 I_J No (8b)

b. Medical or dental care of In Yes+

the aged ar chronically ill? 2 n No (8c)

c. Mental or sacial problems of In Yes-s

the oged or chronically ill? 2 n No (8d)

In Yes+

d. Physical therapy or rehabilitation? z U NO (8e)

In Yes-e

e. Occupational therapy? 2 n NO (80

—

In Yes+

f. Nutrition or food services? 2 n No (89)

1❑ Yes+

g. Nursing home odministrtrtian? 2DN0

IRM HRS-4C (4-3-69)

Circ/e highest grade completed

z Elementary school . . . . . .

}

..12345678 SkfPto

3. High school . . . . . . . . . . .“.1234 0.7

:. Junior callege . . . . . . . ...1 2

~. Nursing school (diploma) . ..1 2 3

s. College . . . . . . . . . . . . . ..l2 3450r more

Mark all that apply Major field o,f study

~ Associ,s:e degree

orcertlf]cate . . . . . . . . . . . . .

q Bacheior’s degree . . . . . . . . .

_JMaster’s degree. . . . . . . . . .

.~

--J ;;cyat:t:y., Do.,

.. . . . . . . . . . . . . . .

~ None of these

Mark all that ‘JPP/Y

_J Physician (M. D.)

_J Physician (D.O.)

~ Registered Nurse (R. N.)

m Licensed Practical or Vocational Nurse (L.P.N. or L. V. N.)

a Registered Physical Therapist (R. P.T.)

u Registered Occupational Therapist (0.T.R.)

n Other professional degree, I icense, or

association registration (.Specify)

T

a None of the above

Fill Cols. (2)-(4) for each “Yes” answer In Col. (1)

How many

What were the TOTAL

COURSES were HOURS of CiOSS

TOTAL NUMBER taken w+ i lo instruction?

of courses taken working for a Number of hours per week

degree or times number of weeks

diploma? ottended per course

(2) (3) (4)

I

US COMM.DC

* U. S. GOVERNMENT PRINTNG 0FFIC2S :1974 543-880/40

46
Series 1.

Series 2.

Series 3.

Series 4.

Series 10.

I Series 1 i.

Series 12.

Series 13,

Series 14.

Se7ies 20.

Series 21.

Series 22.

For a list

VITAL AND HEALTH STATISTICS PUBLICATION SERIES

originally public Health service [ti[~lico ti<,tl ,\t,, t ()()0

P~ogvams and collection p~oceduyes. — Reports which describe 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.

Data euqluation and methods resea~ch. —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.

Analytical stzufies. -Reports presenting analytical or interpretive studies based on vital and health

statistics, carrying the analysis further than the expository types of reports in the other series.

Documents and committee vepo?ds. — Final reports of major committees concerned with vital and

health statistics, and documents such as recommended model vital registration laws and re~sed

birth and death certificates.

Data jkom the Health Inte~view Survev. —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.

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.

Data porn 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.

Data from the Hospital Discharge Survey. —Statistics relating to disch.mged patients in short-stay

hospitals, based on a sample of patient records in a national sample of hospitals.

Datu on health ~esou~ces: 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.

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.

Data on natality, mawiage, and divo~ce. —Various statistics on natality, marriage, and divorce

other than as included in regular annual or monthly reports +pecial analyses by demographic

variables, also geographic and time series analyses, studies of fertility.

Data porn 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.

of titles of reports published in these series, write to: Office of Information

Nat ional Center for I{ealth Stat istics

Public !Iealth Service, HRA

Rockville, Md. 20852
~ “.s. DEpAR~NT OF HEAL~ m~mON, AND WELFARE

PUBLIC HEALTH SERVICE

Health Resources Administration

5600 Fuhcrs Lane

POSTAGE AND PEES PAID

U.S. ~ARTMCNT OF HEW

o

*

Rockville, Maryland 20S52 m

OFFICIAL BUSINESS HEW 390

Pcrufty for Private Use $300

THIRD CLASS

BLK. RT.