Data from the

NATIONAL HEALTH SURVEY

Series 12

Number 23

Selected Characteristics of

NursingHomesfor the

AgedandChronically Ill

United States -June-August 1969

Statistics on the number of nursing homes, services provided,

admissions, discharges, days of care, employees, and rate of occupancy

in homes for the aged and chronically ill. Based on data collected

from homes during the period June-August 1969.

DHEW Publication No. (HRA) 74-1708

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

Public Health Service

Health Resources Administration

National Center for Health Statistics

Rockville, Md. “January 1974
Vital and Health Statistics-Series 12-No. 23

—

For sale by the Superintendent of Documents, U.S. Government I’rinting Ofiice, Wmhhrgton, D.C. 20402- Price 80 CCIIIS
NATIONAL CENTER FOR HEALTH STATISTICSEDWARD B. PERRIN, Ph. D., 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. MOUN’T,Chief, Health Manpower Statistics Branch

PETER L. HURLEY, Acting Chiej Family Pkmning Statistics Branch

WILLIAM’ F. STEWART, Acting Chie~ H~spital Discharge Sutvey Branch

COOPERATION OF THE BUREAU OF THE CENSUS

Under the legislation establishing the National Health Survey,

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

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

In accordance with specifications established by the National

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

contractual arrangement, participated in planning the survey and

collecting the data.

Vital and Health Statistics-Series 12~No. 23

DHEW Publication No. (HRA), 74-1708

Library of Congress Catakg Card Number 73~600255
CONTENTS

Page

Introduction ----------------------------------------------------------

Highlights ----------------------------------------------------------

Background and Description of Survey --------------------------------

Sources and Qualifications of Data ------------------------------------

Institutions -----------------------------------------------------------

Routine Personal Services -------------------------------------------

Percent Occupancy and Days ofCare ----------------------------------

Admissions and Discharges ------------------------------------------

Services Provided by Sources Outside theHome ------------------------

Employees ---------------------------------------------------------

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

List of DetailedTables -------------------------------------------------

Appendix 1: Technical Notes on Methods -------------------------------

Survey Design ------------------------------------------------------

General Qualifications ----------------------------------------------

Appendix II: Definitions of Certain Terms Used in This Report -----------

Demographic Terms ------------------------------------------------

Classificationof Homes by Type of Service ----------------------------

Appendix 111: Forms and Questionnaires --------------------------------

Introductory Letter toEstablishment ----------------------------------

Facility Questionnaire ----------------------------------------------

Staff Information and ControlRecord ----------------------------------

List of Selected JobCategories ---------------------------------------

Staff Questionnaire -------------------------------------------------

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

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

1

1

1

1

2

2

3

4

9

9

11

12

22

22

24

26

26

26

28

28

29

31

32

33

35

37

...

Ill
SYMBOLS

Data not available ------------------------ ---

Category not applicable ------------------- . . .

Quantity zero ---------------------------- -

Quantity morethan O but less than O.05---- 0.0

Figure doesnot meet standards of

reliabilityor precision ------------------

*

iv
SELECTED

HOMES FOR

CHARACTERISTICSOF NURSING

THE AGED AND CHRONICALLY ILL

Raymond O. Gagnon, Diviswn of Health Resowces Statistics

INTRODUCTION

Highlights

The data collected in the Resident Places

Survey- 3 reveal that approximately 968,000 persons were admitted to the 18,391 nursing homes

for the aged and 900,000 persons were discharged during 1968. On the average, 91 percent

of the beds in these homes were, occupied at the

time of the survey. The highest rates of turnover

in residents were observed for proprietary homes

(1.3 admissions per year per bed) and for

nursing care homes (1.2). About a third of all

discharges were because of death. The discharge

rate for persons discharged dead seems to be

more a function of type of service than type of

ownership. Over 80 percent of the homes in RPS3 were either nursing care homes or personal

care with nursing homes and these types of homes

experienced a discharge rate because of deaths

of almost five times that of personal care homes.

About 40 percent of those discharged alive were

discharged to their own or their families’ homes,

and 25 percent were discharged to general hospitals,

Since the Resident Places Survey- 1 was conducted in 1963, the number of long-term care

institutions has increased from 16,370 to 18,391

in 1969. Accompanying this increase is a sizable

increase in the percent of homes providing nursing care, from 48 to 63 percent. The proportion

of smaller homes, less than 30 beds, decreased

by a third and the proportion of larger homes,

50 beds or more, increased from 17 to 37 percent. For all homes in the Resident Places Survey- 1 39 percent of the discharges were because

of deaths, and in RPS-3 33 percent were because

of deaths. The percent of beds occupied increased

from 88 percent in 1963 to 91 percent in 1969.

Background and Description of Survey

The data presented in this report are based

on the third Resident Places Survey conducted

by the Division of Health Resources Statistics

(DHRS). The survey was conducted in cooperation

with the U.S. Bureau of the Census during JuneAugust of 1969. The first two Resident Places

Surveys were conducted. in 1963 and 1964 and

designated Resident Places Survey- 1 and -2,

respectively; likewise the survey upon which this

report is based was designated Resident Places

Survey-3. Hereafter these surveys will be referred to as RPS-1, RPS-2, and RPS-3. Another

survey of the institutional population not in the

Resident Places Survey series was conducted by

DHRS in 1968. Data from that survey are available

in several reports in Series 14 of Vital and

Health Statistics.

In this report statistics are presented on

services provided by the home, average daily

occupancy rates, the number of admissions and

discharges, the place patient discharged to, the

days of care rendered, and the occupation and

sex of employees, by the type of service, type

o? ‘ownership, and bed size of the home. Subsequent reports in this publication series will

present other data collected in RPS-3.

Sources and Qualifications of Data

Institutional establishments such as nursing

homes, homes for the aged, and similar types of

1
places were included in RPS- 30Two basic criteria

for including an establishment in the survey were

(1) it must routinely provide some level of

nursing or personal care and (2) it must maintain

three beds or more for residents or patients.

Thus, homes providing only room and board or

domiciliary care to aged people were not within

the scope of the survey.

RPS- 3 was a multiple-purpose survey collecting statistical information about establishments, patients domiciled in the establishments,

and the employees of the establishments.

A description of the survey, the sampling

frame used, the sample design, and the survey

procedures are presented in appendix I. Also in

appendix I are imputation procedures, estimation

techniques, and estimates of sampling variation.

Since the data in this report are national estimates based on a sample and are therefore

subject to sampling errors, tables of standard

errors are provided in appendix I. Definitions of

the terms and the procedure for classifying establishments can be found in appendix II. Facsimiles of questionnaires and forms used in the

survey are shown in appendix 111.

Reference to the definitions in appendix II

is essential to the interpretation of data in this

report. Special attention is called to the procedure

for classifying homes. The classification of

establishments, i.e., nursing homes, personal

care with nursing homes, and personal care

homes, is based on the type of service provided

in the home rather than on what the home may be

called or how it may be licensed by the State.

INSTITUTIONS

On the basis of data collected in RPS- 3 in

the summer of 1969, there were an estimated

18,391 institutions in the United States which

provided nursing and personal care to the aged

and chronically ill. Other surveys (see appendix

I for an explanation of these other surveys)

conducted at or about this time also collected

information about long-term care institutions.

As a result, this report will not present detailed

information on institutions which maybe available

from these other surveys, but rather it will

present information on services provided by

institutions which

other surveys.

Routine Personal

is not available from the

Services

The routine services listed on page 2 of

the Facility Questionnaire (see appendix 111)are

provided by most homes. However, some services

are provided by fewer homes than others (table

1 and figure 1).

“Medications and treatments administered in

accordance with physicians’ orders” is a service

that is almost always provided, yet “supervision

over medications which may be self-administered” is not always provided. Reportedly, 99

percent of the long-term care homes do administer

medications and treatments in accordance with

physicians’ orders, which is what one would

expect. Yet only 67 percent of the homes provide’

“supervision over medications which may be

self-administered. ”

“Rub and massage” and “help with eating”

are routine services which are provided in

slightly more than 80 percent of the homes.

“Help with dressing, “ “help with correspondence

or shopping, ” and “help with walking or getting

about” are services which are provided in about

90 percent of the homes. Comparing the primary

types of service of homes, nursing care homes

and personal care with nursing homes differ

little, proportionately, in providing these routine

services. However, personal care homes have

substantially lower proportions of homes providing these services than do the other types of

homes. Specifically, only 35 percent of the personal care homes provide a “rub and massage,lt

30 percent provide “help with eating,” and less

than 50 percent provide “help with walking or

getting about.”

This latter difference is also reflected in

the comparison of nursing homes by bed size

and ownership as the smaller homes, those

having less than 30 beds, and government-owned

homes are generally personal care homes. The

proportion of homes providing routine personal

services is considerably lower for homes with

less than 30 beds than for all other homes, and

government-owned homes have slightly lower

proportions of homes providing routine services

than do nonprofit or proprietary homes.

2
supervisor Medications Rub Help Help with Help with Help

over administered and with correspondence walking with

medications In accordance massage dressing or shopping or g+%ting eating

with physician’s about

order

ROUTINE SERVICES

Figure1.Perctyt of homes for the aged providing routine services by seiected routine services: United States, June-August 1969.

Percent Occupancy and “Days of Care

One measure of the utilization of nursing

homes for the aged is the occupancy rate. This

ratio or proportion can be expressed as an

annual occupancy rate or as an average daily

occupancy rate. The components of each are as

fOUOWS:

Annual occupancy rate:

aggregate number of days of care in a year

number of beds X number of days in year

Average daily occupancy rate:

number of inpatients on day of survey

number of beds on day of survey

The annual occupancy rate is the ratio of

the number of days of care to the number of

days which would have been provided if every

bed in every nursing home had been occupied

every day. However, it should be noted that the

number of beds in a home may change many

times in a year and an annual occupancy rate

cannot accurately refkct these changes. On the

other hand, the average daily occupancy rate for

a characteristic refers to the number of persons

occupying beds on an average day in the year.

It is a daily rather than an annual rate and as

‘such is not affected by any fluctuable changes in

the number of beds. Also, it is quite useful in

depicting minor changes in institutional utilization

from one year to the next. As a result, the average

daily occupancy rate rather than the annual rate

will be discussed in the text of this report and

will be included in the detailed tables.

As calculated in this report, the number of

residents on the register of the nursing home

was used as the numerator of the occupancy rate.

This included about 1 percent of the residents

who were in a hospital or some other place at the

time of the survey. Including these persons in

the numerator of the occupancy rate gives a more

valid picture of the proportion of beds actually

available for new admissions.

Table 2 presents average daily occupancy

rates by type of service, ownership, and bed size

of the home. It should be noted at this point that,

although the occupancy rates have increased

considerably from RPS- 1 to RPS- 3, the differences among the rates by types of service and

ownership which existed at the time RPS- 1 was

3
Table A. Percent of beds occupied in homes for the aged and chronically ill, by pri,-

mary type of service and type of ownership of home: United States, ApriS-June 1963

and June-August 1969

Nursing care---

Personal care

with nursing--

Personal care--

All

types

of

owner -

ship

88.2

90.6

88.0

82.6

April-June 1963

Propri- Nonetary profit

89.0 90.3

m90.6 90.8

88.3 91.8

82.9 86.4

Govern -

ment

84.2

90.1

79.9

72.2

All

tygefs

inner.

ship

90.9

91.0

91.6

87.4

June-August 1969

Propri -

e tary

91.2

91.5

90.7

87.0

Non -

profit

91.2

90.3

93.3

85.3

Govern -

ment

88.6

88..5

88.2

92.3

conducted did not change even 6years later when resentative of the years in which the surveys

RPS-3 was conducted (table A). The exception,

however, is the occupancy rate for government- .

owned personal care homes which increasedfrom

72t092 percent. This exception accounted forthe

only real difference in the rates’for RPS-3. The

occupancy rate was 92 percent in governmentowned personal care homes whereas proprietary

and nonprofit personal care homes experienced

rates of87and 85 percent, respectively.

Admissions and Discharges

In thissectionsome comparisonswill bemade

between data from RPS-1 and data from RPS-3.

Although RPS-1 was conducted in the spring of

1963, data on admissions and discharges were

collected for the year 1962 to obtain totals for

the last full calend& year. Also, RPS-3 was

conducted in the summer of 1969 and data on

admissions and discharges were collected forthe

year 1968. As a result, the data on admissions

and discharges are representative of the years

1962 and 1968 whereas all other data in this

report concerning RPS-1 and RPS-3 are repwere actually conducted—1963 and 1969.

During 1968 an estimated 968,000 persons

were admitted to nursing homes for the aged and

900,000 were discharged. Ofthedischarges, abopt

one-third were because of death. Table 3 shows

how these data are distributed according to the

primary type of service provided in the homes,

type of ownership, and bed size of the home. The

table also shows the number of admissions per

bed, a relative measure of turnover which allows

a comparison of admissions to the various types “

of homes. Tables B through D show the distributions of admissions, discharges, and homes for

RPS- 3 and those for RPS- 1.

The ratio of admissions to beds varied by

type of service, bed size of home, and type of

ownership (table 3). The highest rate of turnover

in residents was observed for proprietary homes

which had a ratio of 1.3 admissions per year

per bed, almost twice that for nonprofit homes

and almost three times that for government

homes. There was also considerable variation by

type of service. The data indicate a more rapid

rate of turnover in residents for nursing care

homes than for other types of homes; nursing

4
Table B. Number of admissions to homes for the aged and chronically ill and number of

admissions per bed, by primary type of service and type of owners{ 1P of home: United

States, 1962 and 1968

Type of service and type of ownership

All homes--------------------------

T!7De Of St?IWf,Ce

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

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

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

Type of ownership

Proprietary ------------------------------

Nonprofit--------------------------------

Government-------------------------------

. .

Number of admissions

19621

402,896

264,955

93,529

44,412

281,545

57,761

63,590

1968

968,750

876,645

69,373

22,732

788,142

1:;,;;:

2

Number of admissions

per bed

19621

0.8

0.8

:::

0.8

0.4

0.7

1968

1.1

1

These figures were selected from a published report on Resident places survey-l,

conducted in April, May, and Juneof 1963, Vital and Health Statistics,Series 12-No. 4.

The 1962 figures were adjusted to exclude hospitals tn order that the figures would be

compatible with 1968.figures. Bed sizes were not compared because data by bed size for

1962 were not available.

care homes had about 1.2 admissions per year

per bed compared with 0.5 admissions per bed

for personal care with nursing homes and personal care homes. There was little variation in

the ratio by bed size of home. Generally the rate

was slightly higher for homes having less than

200 beds (about 1.2) than for homes having 200

beds ormore (about 0.8).

Comparing the rates of turnover for 1962

with those for 1968 (table B), it was found that

the ratio increased considerably for nursingcare

homes, from 0.8 to 1.2 admissions per year

per bed. The rate ofturnoverremained unchanged

at 0,5 for personal care with nursing homes and

decreased somewhat, from 0,8to0.5,for personal

care homes.

About athirdof all discharges from nursing

homes for the aged were becauseof death. These

deaths represent approximately 15percent ofall

deaths in the United States in 1968. This same

proportion, the percent of deaths occurring in

homes for the aged, was about 10 percent in1962

(table D).

The death rate in 1968 of 366 per 1,000

residents was about six times that of the U.S.

population 65 years and over (62 per 1,000).

In 1962, the death rate of308perl,000 residents

was only five times that of the U.S. population

65 years and over.

The proportion of death discharges varied

somewhat by type of service. In homes providing

nursing care and personal care with nursing the

proportion was about five times aslarge as that

in personal care homes. This difference is

probably due more to the characteristics of

residents (age, sex, and health) being treated in

the homes than to any other factor.

An in-depth study of residents by type of

service of homes can be found in a previous

reportl from RPS-1. Detailed information about

5
Table C. Number and percent distribution of homes for the aged and chronically ill by

primary type of service, type of ownership, and bed size of home: United States,

April-June 1963 and June-August 1969

Type of service, type of ownership,

and bed size

All homes ---------------- -------- --------

Type of service

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

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

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

Type of ownership

Proprietary -------- -------- -------- -------- ----

Nonprofit -------- -------- -------- -------- ------

Government -------------------------------------

Bed size

Less than 30 beds ------------------------------

30-49 beds -------------------------------------

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

100 beds or more -------------------------------

residents surveyed in RPS-3 has been published

recently.15

By type of ownership, the proportionof death

discharges was slightly higher for government

institutions. In 1962 just the opposite was true,

that is, the proportion of death discharges was

lower for government institutions (table D). It

seems that during the 6 years between RPS-1

and RPS-3, the proportion of death discharges

decreased for every type of service and typeof

ownership class except government institutions,

which actually increased. It should be noted that

in 1962 the higher rate of death discharges for

proprietary and nonprofit institutions was thought

to bemoreafunction oftypeofservice than typeof

ownership. The reason was that about 90 percent

of the homes were either nursing care homes or

personal care with nursing homes and thesetypes

of homes experienced rate of death discharges

twice that ofpersonal care homes.

pri.1-June 1963

mber

6,370

7,834

4,968

3,568

3,428

2,012

930

.:, !55;

1;921

888

Percent

100.0

47.9

::.;

.

82.0

12.3

5.7

64.2

18.7

1:.;

.

Tune-August 1969

Wnber

18,391

11,576

3,768

3,047

1;,::;

1;383

8,100

3,574

4,573

2,144

Percent

100,0

62.9

::.:

.

77.0

15.5

7.5

44.0

19.4

24.9

11.7

Interestingly enough the situation seems

unchanged. For RPS-3 about 83 percent of the

homes wereeither nursingcarehomes orpersonal

care with nursing homes,andthese typesofhomes

experienced a rate of death discharges almost

five times that of personal care homes. In

addition,. from RPS-1 to RPS-3 the number of

government homes increased by more than 450

(table C) and most of these homes were nursing

care homes. This may be one explanation why

the proportion of deathdischarges forgovernment

homes increased by 45 percentduring thisperiod.

Data on place patient discharged to are

available from RPS-3; data on admissions by

former place’ of residence are available from

the 1968 Nursing Home Survey (see appendix I),

conducted a year earlier than RPS-3. These

dataare presented in tables 4 and 5 andin

figure 2. Because these two types of data were

collected in consecutive years, they may be
Table D. Number of discharges, percent discharged alive, and percent discharged dead

from homes for the aged and chronically ill, by.primary type of service and type of

ownership of home: United States, 1962 and 1968

Type of service and type of

ownership

All homes ----------------

Type of service

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

Personal care with nursing -----

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

Type of ownership

Proprietary--------------------

Nonprofit----------------------

Government---------------------

Number of

discharges

19621

378,326

253,156

86,106

39,064

263,602

53,515

61,209

1968

900,521

803,365

68,887

28,269

716,589

145,362

38,568

Percent

discharged

alive

19621

60.9

59.6

56.9

77.9

59.0

58.0

71.2

1968

66.9

66.1

64.7

92.7

66.7

69.0

58.3

Percent

discharged

dead

19621

39.1

40.4

43.1

22.1

41.0

42.0

28.8

1968

33.1

33.9

35.3

7.3

33.3

30.1

41.7

‘These figures were selected from a published report on Resident Places Survey-1,

conducted in April, May, and June of 1963,Vital and Health Statistics,Series12-No. 4.

The 1962 figures were’ adjusted to exclude hospitals in order that the figures would be

compatible with 1968 figures. Bed sizes were not compared because data by bed size for

1962 were not available.

useful in depicting the movement ofolder people

before and after their stay in long-term care

institutions.

Several reports from the 1968 NursingHome

Survey have been published. Data onlengthofstay

of residents collectedinRP S-3willbeforthcoming

in future reports in this series.

According to the 1968 Nursing Home Survey

there were reportedly 801,000admissions inlongterm care institutions in 1967 (table 4). More

than half of these patients (54 percent) were

admitted from general hospitals and 26 percent

formerly resided in their own homes. As many

as 10 percent were admittedfromanothernursing

home whereas the remaining 11 percent were

admitted from specialty hospitals, mental hospitals, or other places.

According to RPS-3, approximately 602,000

residents were discharged alive from long-term

care institutions in1968, andthisrepresents about

two-thirds of all discharges (table 5). Of those

discharged alive 25 percent were dischargedto

general or short-stay hospitals and almost 40

percent were discharged to the home of the

patient or family. About 14 percent were discharged to other long-term care institutions,

3.5 percent to mental and long-term specialty

hospitals, andl 7percent to other places.

Examining the place patient discharged to

versus the former place of residence, about

half of theadmissions werefromgeneral hospitals

and 25 percent of the residents discharged alive

a year later were discharged to generalhospitals

(figure 2). Also, 26 percent of the admissions

came from their own homes and 40percentof the

discharges were discharged to their own or their

families’ homes.

These proportions reflect to an extent the

influence of the Medicare program on admission

and discharge policies. of long-term care in7

.
1

D

General

hospital

Other

hospital

Patient’s

home

Another

Nursinghcmw

Admissions

All homes

Issions

1-24 beds

i Admissions

G

25-49 b+ds

❑

:

Adml$dom

50-99 beds

lCKIt.?dsor

Adtmssmm

more

J I I I I I I I I I I

o 10 20 30 40 50 60 70 80 90 100

PERCENT

Figure2. Proportionsof admissionsand dischargesby bad size of home and selected former places of residence and place patientl

discharged to: United States, 1967 for admissions and 1968 for discharges

stitutions. According totheprovisions of Medicare

(Title XVIII--Health Insurance Act), after the

patient has received 3 consecutive days of care

in a hospital, Medicare will pay for up to 100

days of skilled nursing care in a nursing home

or other Medicare-approved extended care facility. This payment is made only if the patient

is admitted within 14 days of his discharge from

the hospital. As a result many general hospitals

have arrangements with long-term care institutions which qualify as extended care facilities

under the Medicare guidelines concerning patients

eligible for or receiving Medicare benefits. It is

felt that this type of arrangement is somewhat

responsible for long-term care institutions’

having such a large proportion of admissions

from general hospitals.

In comparing admissions of patients from

former places of residence by the bed size of

the home, it was found that for small homes

(1 to 24 beds) only 25 percent of the patients

admitted had resided in general hospitals (table

4 and figure 2). However, this proportion increased steadily with size as evidenced by

homes with 100 beds or more where almost

60 percent of the admissions were from general

hospitals. The converse was true for persons

admitted from their own homes or another nursing

home—where the proportion decreased as the

bed size of the home increased. In homes having

less than 25 beds, 38 percent of the admissions

formerly resided in their homes and 16 percent

formerly lived in another nursing home. In

larger homes (100 beds or more) only 22 per-
cent had previously lived at home and 8 percent

formerly resided in another nursing home.

For discharges, comparing the proportions by

place of discharge and bed size of home, only

slight variations are noted.

Services Provided by Sources Outside

the Home

In contrast to routine personal services,

other services are provided to residents on a

regular basis by outside sources through contract

or other fee arrangements with a home.

Of the 11 such services listed on the Facility Questionnaire, physician services (M.D.

or D. O.) are provided by more homes (45 percent) than any other service (figure 3). Pharmaceutical services, die~ary services, food services, and housekeeping are contractual services provided to residents in more than 30

percent of all long-term care homes, whereas

each of the remaining services is provided in

less than 25 percent of the homes.

There is a great deal of variation in the

provision of contract services among the primary

types of service of homes as shown in table 6. This

variation seems to be a direct function of the

level of care rendered by each type of service.

The proportions of nursing care homes providing

contract services, except for food service and

housekeeping, are much greater than the proportions of personal care with nursing homes providing contract services. In addition, the proportions

of personal care with nursing homes providing

contract services are considerably greater than

the proportions of personal care homes providing

these services.

The variation between the different types of

ownership is minimal; however, there is considerable variation when comparing the bed size

of homes. The proportions of homes providing

contract services increase sharply with bed size.

Few of the homes with les~ than 30 beds provide

contract services, whereas homes having 50 beds

or more are much more likely to provide contract

services than are other homes.

Employees

Although there were 24 occupational categories within the scope of RPS-3, several were

combined in the detailed tables because of low

frequencies. Data on administrators and assistant

administrators are not presented separately but,

rather, are included in the totals for all employees and professional employees. Detailed

45.0

,.

,:,,,

.,

...

.,, ,,, :

Physician’s Dental Pharmaceutical Physical Occupational Recreational Speech Social O,etav Food Housekeeping Other

service serdce service

[M.D. or D.O.)

therapy therapy therapy therapy work service serwce contractual

serwces

CONTRACTUAL SERVICES

igure 3. Percent of homes for the aged providing contractual services by selected contract services: United States, June-August 1969.

9
Table E. Percent distribution of employees in homes for the aged and chronically ill

by status of employees, according to geographic region and bed size of home: United

States, 1969

[Excludes Alaska and Hawaii]

Employee status

All statusesProfessional -------

Nonprofessional ----

.00.0

24,0

76,0

Geographic regi,on

North- North

east Central South West

100.0

29.1

70.9

Bed size

Less ‘ 200

than 30-99 ;;;- beds

30 beds

beds beds ‘r

more

Percent distribution

100.O

20.7

79.3

100.0 100.0 100.0 100.0 100 ● o 100.0

22.8 24.5 31.6 23.8 22.0 20.6

77.2 75.5 68.4 76.2 78.0 79.4

separate RPS-3 reports: .Vitlzl and Health Statistics, Series 12,No. 182and No.20~s

Professional employees of l4differentoccupations (see footnote on table 7 and Card Ainappendix III) accounted foronly24percent ofthe employees in long-term care institutions in 1969,

whereas nonprofessional employees ofonlyseven

Mferentoc !cupations accounted for76 percent.In

other words”, about one of everyfour employeesin

homes for the aged in 1969 was a professional.

As shown in table E, this proportion didnot vary

much by type of ownership of home, but it did

vary slightly by size and geographic region”

(table E). As the bed size ofthehomes increased,

the proportionof employeeswho wereprofessional

decreased. In homes with less than 30 beds,32

percent of the employees were professionals,

whereas in homes having 200 beds or more only

21 percent of the employees were professionals.

Regionally, the proportion was highest in the

Northeast with 29 percent of the staff being

professionals and the lowest was in the North

Central with 21 percent of the staff being professionals.

Of the 135,000 professional employees, 70

percent were nurses and 30 percent were other

professionals (table 7). This difference accounts

information on administrators can be found in two for the high proportion of female professional

employees. Females accounted for 88 percent of

the entire professional staff of long-term care

nursing homes, and 78 percent of these women

were nurses. Although the major proportion of

male professionals were employed in fields other

than nursing, only 12 percent of the professional

staff was male. According to size of home, that

proportion of the professional staff who were

nurses was lower for homes having less than 30

beds than for all other homes. Only 52 percent

of the professional staff of homes with less than

30 beds were nurses compared with 70 percent

or better for all other homes. Comparing regions

and types of ownership (table 8) there is relatively

little difference in the proportion of the professional staff who were nurses.

Of the 429,000 employees that were nonprofessionals, more than 56 percent were nurse’s

aides, orderlies, or student nurses. Of the

remaining nonprofessionals about 37 percent were

either food service personnel or housekeeping

personnel. These proportions did not vary greatly

by region or size of the home; they did vary,

however, by sex and type of ownership. For

female nonprofessionals, 61 percent were nurse’s

aides, orderlies, or student nurses and 33 percent

were food service personnel or housekeeping

10
personnel. In contrast, only 25 percent of the male orderlies, or student nurses in proprietary homes

nonprofessionals were nurse’s aides, orderlies, (61.6 percent) was slightly higher than the proporor student nurses and 66 percent were food tion for government homes (51.4 percent) ‘and

service personnel or housekeeping personnel. considerably higher than that of nonprofit homes

By type of ownership of home, the proportion of (45.7 percent).

nonprofessionals employed as nurse’s aides,

REFERENCES

1Nation~ 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.

2Nation~ Center for Health Statistics: Administrators of

nursing and personal 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 and Mental Health Administration. Washington. U.S.

Government Printing Office, Feb. 1973.

3Nation~ 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, Mar. 1973.

4Nation~ Center for Health Statistics: Institutions for the

aged and chronically ill, United States, Apt-d-June 1963. Vital

md Heakh Statistics. PHS Pub. No. 1000-Series 12-No. 1.

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

Office, July 1965.

5 Nation~ Center for Health Statistics: Characteristics of

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

Vital and Health Statistics. PHSPub. No. 1000-Series 12-No. 3.

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

Office, Dec. 1965.

6Nation~ Center for He&h Statistics: utilization of

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 Health Service. Washington. U.S.

Government Printing Office, Feb. 1966.

7Nationd Center for Health Statistics: Employees in nursing and personal care homes, United States, May-June 1964.

Vital and Heakh Statistics. PHS Pub. No. 1000-Series 12-No. 5.

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

Office, Sept. 1966.

8 Nation~ 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

HealthStUtMcS.PHSPub, No. 1000-Series12-No,6. Public

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

Jan. 1967,

9Nation~ Center for Health Statistics: Chronic ihess

among residents of nursing and personal care homes, United

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

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

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

10Nationd Center for Health Statistics: Prevalence of

chronic conditions and impairments among residents of nursing

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

and Health Statistics. PHS Pub. No. 1000-Series 12-No. 8.

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

Office, July 1967.

11Nation~ 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.

12Nation~ Center for Health Statistics: Nu~sing and personal care services received by re;idents of nursing and personal

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

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

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.

14Nation~ Center for Health Statistics: Markd 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-Senes 12-No. 12. Public Health

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

1969.

15Nation~ Center for Health Statistics: Characteristics of

residents in nursing and personal care homes, United States,

June-August 1969. Vital and Health Statistics. PHS pub. No.

1000-Series 12-No. 19. Public Health Service. Washington. U.S.

Government Printing Office,Feb. 1973.

16Nation~ center for Health Statistics Design and

methodology of the 1967 Master Facihty Inventory Survey.

Vrtal and Health Statistics. PHSpub. No. 1000-Seriesl-No. 9.

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

Office, Jan. 1971.

11
.

LIST OF DETAILED TABLES

Table 1.

2.

3.

4.

5.

6.

7.

8.

Number of homes for the aged and chronically ill and percent providingroutine

personal services, by type of home, bed size, and type of ownership: United

States, June-August1969----------- ------------------------.----,------------------ -

Percent of beds occupied in homes for the aged and chronicallyill, by type of

service and ownershipand bed size of home: United States, June-August1969-----

Number of admissions to and dischargesfrom homes for the aged and chronically

ill, number of admissionsper bed, percent discharged alive, and percent discharged dead, by type of service,bed size, and typeofownershipof home: United

States, l968----------:-------------------7-------------------------------------

Number and percent distributionof admissions”to homes for the aged and chronically ill by patient’s former placeofresidence,according to type of service,

bed size, and type of ownership of home: United States, 1967--------------------

Number and percent distributionof live discharges from homes for the aged and

chronicallyill by place patient dischargedto, according to type of service,

bed size, and type of ownership of home: United States, 1968--------------------

Number of homes for the aged and chronicallyill and percent providing contractual services on a regular basis through contract or other fee arrangements,by

type of home, bed size, and type of ownership:United States, June-August1969--

Number and percent distributionof employeesinhomes for the aged and chronically

ill by status of employees,according to sex of employeesand bed size of home:

United States, 1969------------------ --------------------------- ----------------

Number and percent distribution ofempXoyees inhomes for the aged and chronically

ill by status of employees, according to geographic region and type of ownership

of home: United States, l969----------------------------------------------------

Page

13

14

19

16

17

18

20

21

12
Table 1. Number of homes for the aged and chronicallyill and percent providing routine personal

services,by type of home, bed size, and type of ownership:United States, June-August1969

[Excludes Alaska and Hawaii]

Type of home, bed size,

and type of ownership

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

Type of home

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

P~ern; care with

------------------

Personal care.............

Bed size

Less than 30 beds---------

30-49 beds----------------

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

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

200 beds or more----------

Tide of Ownership

Proprietary---------------

Nonprofit-----------------

Government----------------

All

homes

18,391

11,576

3,768

3,047

8,100

3,574

4,573

1,835

309

14,161

2,847

1,383

Supervision

over

medications

66.9

60.0

72.2

86.8

71.9

63.4

62.0

64.9

63.4

64.0

77.4

74.8

Medication

administered

in accordance

with

physician’s

orders

Routine personal services

Rub and

massage

98.3

99.5

98.8

94.3

97.1

99.6

99.8

99.3

99.7

98.1

99.8

99.7

80.8

93.1

79.3

35.6

68.8

86.1

93.0

91.1

91.3

79.9

87.6

75*3

Help

with

dressing

.

90.0

96.6

90.1

65.0

82.8

93.5

97.3

96.8

94.2

90.2

94.6

79.0

Help

with

correspondence

or

shopping

90.4

91.5

87.1

90.4

88.6

90.7

93.2

90.6

93.5

90.5

90.5

9002

Help

with

walking

g:::$g

86.0

95.6

86.4

49.2

72.9

95.4

97.3

96.4

94.5

85.6

93.6

74.6

Help

with

eating

81.9

95.4

82.0

30.5

66.0

91.9

95.9

95.9

93.2

8J..4

88.7

73.6

13
“Table2. Percent of beds occupied in homes for the aged and chronically ill, by typef

of service and ownership and bed size of home: United States, June-August 1969

[Excludes Alaska and Hawaiil

Type of service and type of

o“kmership

All types of services------------

Proprietary----------------........----

Nonprofit------------------------------

Government-----------------------------

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

Proprietary----------------------------

Nonprofit---------------------------.--

Govement -----------------------------

Personal care with nursing-------

Proprietary..................----------

Nonprofit------------------------------

Government.............................

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

Proprietary----------------------------

Nonprofit------------------------------

Govement -----------------------------

H

bed

sizes Less

than

30 beds

Bed size

30-99

beds

100-299

beds

II I I

Percent

90.9

91.2

91.2

88.6

91.0

91.5

90.3

88.5

91.6

90.7

93.3

88.2

87.4

87.0

85.3

92.3

90.2

90.3

89.0

91.0

92.9

93.6

89.6

88.2

88.7

87.9

93.8

91.3

86.8

86.7

80.3

94.2

91.7

92.0

90.6

92.1

91.7

92.0

90.1

93.2

92.3

93.0

91.6

91,1

87.7

86.2

97.1

86.9

90.3

90.0

92.4

86.8

89.8

89.9

91.2

86.7

93.4

93.6

94.3

86.6

89.3

92.0

82.3

99.0

300

beds

or more I

I

88.3

90.4

89.4

86.8

87.6

89.2

86.5

87.6

89.4

97.9

93.0

84.6

96.6

99.1

93.1

14
Table 3. Number of admissions to and discharges from homes for the aged and chroni.

tally ill, number of-admissions per bed,

charged dead, by type of service,

percent discharged alive, and percent dished size, and type of ownership of home: United

States, 1968

[Excludes AlaskaandHawaii]

Type of service, bed size, and

type of ownership

Total---------.........--------

Type of service

NursLng care---......................

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

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

Bed s%ze

Less than 30 beds--------------------

30-49 beds--......-------------------

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

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

200 beds or more----.................

Type of ownership

Proprietary--------------------------

Nonprofit----------------------------

Government ---------------------------

Number

of

admis.

I

sions

968,750

876,645

69,373

22,732

81,648

143,993

387,070

280,844

75,195

788,142

L40,374

40,234

Number

of

admissions

per bed

1.1

1.2

0.5

0.5

1.2

1.0

1.2

1.2

0.8

1.3

0.7

0.5

Number

of discharges

900,522

803,365

68,887

28,269

90,073

125,705

354,848

265,462

64,434

716,589

145,362

38,568

Percent

discharged

alive

66.9

66.1

64.7

92.7

64.3

67.0

67.7

65.5

71.3

66.7

69.9

58.3

Percent

discharged

dead

33.1

33.9

35.3

7.3

35.7

33.0

32.3

34.5

28.7

33.3

30.1

41.7

15
Table 4. Number and percent distributionof admissions to homes for the aged and chronicallyill

by patient’s former place of residence,accordingto type of service,bed size, ad type of Om.

ership of home: United States, 1967

[Excludes AlaskaandHawaii]

II

All admissions II Patient’s former place of residence

Type of service, bed

size, and type of

ownership

Total----------

Type of service

Nursin,g care---------

Personal care with

nursing-------------

Personal care--------

Bed size

1-24 beds------------

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

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

100 beds or more-----

Type of ownership

.,

Government-----------

Nonprofit------------

Proprietary----------

Number

301,013

581,797

85,090

34,126

59,659

127,714

257,693

355,947

47,915

109,415

643,683

Percent

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100,0

100.0

100.0

100.0

I I

Mental General I

Other

hospital hospital hospital

I I

3.5

2.3

7.7

15.9

10.0

4.3

2.4

2.8

10.3

2.2

3.1

Patient’s

home

Percent distribution

53.9

59.2

26.6

16.1

25.2

44.3

56.9

59.8

39.0

41.1

57.1

5.0

5.2

4.0

4.6

5.0

5.7

5.6

4.3

4.0

3.4

5.3

25.9

22.4

46.7

41.9

38.2

31.0

24.7

22.8

31.1

40.8

22.9

9.4

9.1

10.1

13.8

16.2

12.3

8.8

7.7

8.8

7.7

9.7

2.4

1.8

I

4.9

767

5.4

2.3

1.4

2.5

6.8

4.5

167

16
Table 5. Number and percent distribution of live discharges from homes for the aged and chronically ill by

place patient discharged to, according to type of service, bed size, and type of ownership of home: United

States; 1968

Type of service, bec

size, and type of

ownership

Total---------

Type of service

Nursing care--------

Personalcare with

nursing------------

Personal care-------

Bed size

Less than 25 beds---

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

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

100 beds or more----

Less than 30 beds---

30-49 beds----------

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

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

200 beds or more----

Type of ownership

Proprietary---------

Nmprofit -----------

Government----------

All live discha

502.192

531,385

44,601

26,204

42,466

99,737

240,210

219,783

57,950

84,249

240,210

173,857

45,925

478,123

101,582

22,484

?s

?ercent

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

[ExcludesAl,skaand Hawii]

Place patient discharged to

;enera 1

or

short -

stay

?ospital

25.1

25.5

27.2

13.9

21.4

27.5

23.7

26.2

23.8

26.9

23.7

26.5

25.1

25.5

22.3

28.C

Long-term

specialty

hospital

1.8

1.3

2.7

10.4

7.2

1.9

1.2

1.2

5.8

1.9

1.2

1.1

1.6

1.8

1.6

2.0

Mental

Iospital

1.7

1.3

4.4

7.0

6.6

2.2

1.3

1.1

5.6

2.0

1.3

1.0

1.8

1.7

1.3

5.4

inother

mrs ing

home

11.0

10.5

15.0

14.7

16.5

14.6

10.1

9.3

16.7

14.2

10.1

9.9

6.9

11.3

9.7

10.7

Personal

care or

domiciliary

home

—.

3.8

3.9

3.2

1.7

2.0

5.5

3.6

3.4

3.7

5.0

3.6

2.8

5.6

3.4

4.4

8.9

Paient’s

home

Ea%y

39.6

40.5

28.2

40.7

32.0

36.6

37.7

44.6

30.9

38.3

37.7

44.8

43.6

38.9

45.7

28.1

)ther

)laces

17.0

17.1

19.4

11.6

14.2

11.7

22.4

14.1

13.4

11.7

22.4

13.8

15.4

17.5

15.0

16.9

17
Table 6. Number of homes for the aged and chronically ill and percent providing contractual services on a regular basis through contract or other fee arrangements, by,

type of home, bed size, and type of ownership: United States, June-August 1969

[Excludes AlaskaandHawaii]

Type of home, bed size, and

type of ownership

Tonal------------------

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

Personal care with nursing---

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

Bed size

Less than 30 beds------------

30-49 beds-------------------

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

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

200 beds or more-------------

Type of ownership

Proprietary------------------

Nonprofit--------------------

Government-------------------

Number

of

homes

18,391

11,576

3,768

3,047

8,100

3,574

4,573

1,835

309

14,161

2,847

1,383

Contractual service

Physician’s

service

(M5D6 ;r

. .

Dental

service

Pharmaceutical

service

Physical

therapy

Wl$

therapy

45.0

51.6

40.8

25.0

22.6

50.5

51.8

57.8

67.6

42.5

57.2

45.2

18.9

23.1

16.4

6.0

7.6

21.5

27.8

35.9

50.1

16.6

28.1

22.8

Percent

31.1

38.4

22.2

14.4

16.3

32.6

46.0

51.8

58.3

30.8

34.6

27.2

22.4

32.0

8.9

2.4

4.6

20.4

40.7

53.3

55.7

22.3

28.0

11.5

14.4

19.3

7.6

3.9

5.1

13.2

23.0

30.7

45.6

13.6

21.1

7.7

18
Table 6. Number of homes for the aged and chronically ill and percent providing con=

Eractual services on a regular basis through contract or other fee arrangements, by

type of home, bed size, and type of ownership: United States, June-August 1969-Con.

[Excludes Ahskaand Hawaii]

.

Contractual service-Con.

Recrea- Dietary

tional Speech Social service

therapy therapy work (:::;;-

23,8

30.0

16.9

6.9

9.8

25.9

36.5

43.8

40.1

23.2

28.5

15.8

5;6

8.5

0.9

0.1

*

5.9

8.0

18.7

*

5.8

5.0

*

24.9

29.5

21.1

12.3

14.3

24.6

35.3

44.0

42.1

25.0

24.3

25.7

Percent

33.9

48.3

15.3

2.0

11.4

35.9

57.9

64.6

60.2

34.0

42.4

14.5

Food

service

(meal preparation)

31.8

33.8

34.2

21.3

24.3

36.4

37.6

39.2

45.3

29.9

39.8

34.6

Housekeeping

34.6

36.5”

35.0

26.5

27.9

39.6

39.3

40.8

43.0

33.2

39.4

38.7

Other

contractual

services

27.0

18.7

32.8

51.6

40.5

21.7

15.9

8.4

12.0

28.1

19.1

32.2

19
Table 7. Number and percent distributionofemployees in homes for the aged and chronically ill by status of employees,according to sex of employees and bed size of home:

United States, 1969

[ExcludesAlaskaandHawaii]

Employee status

All statuses------

Professional------

Nurses2-----------------

Other professiona13-----

Nonprofessional---

Nurse’s aides, etc.4----

Clerical----------------

Food service------------

Housekeeping------------

Other nonprofessional---

All statuses------

Professional

Nurses2-----------------

Other professional3-----

Nonprofessional

Sexl Bed size

All

Less 200

pl~;es Male Female than 20-99 1::::99 beds

30 beds or

beds more

564,Z83 JI68,134 ]494,570 ]71,487 ]292,721/ 147,905 52,669

Number

135.658

94,507

41,151

429,124

243,927

16,786

85,919

71,747

10,745

100.0

69.7

30.3

Nurse’s aides, etc.4---- 56.8

Clerical----------------

Food service-...-------- 2%:

Housekeeping------------ 16.7

Other nonprofessional--- 2.5

16,149

1,088

15,060

51,986

12,744

1,578

9,818

24,398

3,447

100.0

9$;

24.5

1;::

46.9

6.6

119,105

93,186

25,919

375,465

230,372

15,173

75,774

47,018

7,128

T

22,557 69 764

11,700 50,311

10,857 19,453

48,930 1222.957

26,517 130,099

782 8,005

10,771 45,378

9,340 34,943

1,520 4,532

Percent distribution

100.0

78.2

21.8

61.4

2;:;

12.5

1.9

100.0

51.9

48.1

54.2

2;::

19.1

3.1

100.0

72.1

27.9

58.3

2:::

15.7

2.0

*

24,635

7,854

115,417

6~,;;;

21:780

18,598

2,624

100.0

75.8

24.2

5:.;

18:9

16.1

2.3

10,849

7,862

2,987

41,821

20,261

2,633

7,991

8,867

2,070

100.0

72.5

27.5

48.4

18:?

21.2

4.9

lFigures for “all employees“ include 2,046 employees (0.38 percent) forwhom sex was

unknown; these employees not included in the subtotals for males or females.

%ncludes registered nurses, licensed practical nurses or vocational nurses, and

practical nurseii.

sIncludesadministrators, physicians (M.D. or D.O.), dentists, registered occupational therapists or other occupational therapist assistants,qualified physical therapists or physical therapist assistants, recreation therapists,dietitians or nutritionists, registered medical record Librariansorother medical record librarians and technicians, social workers, speech therapists, and other professional persons.

AIncludes nurse’s aides, orderlies, and student nurses.

.20
Table 8. Number and percent distributionof employeesin homes for the aged and chronicallyill

by status of employees, according to geographicregion and type of ownership of home: United

States, 1969

[Excludes AlaskaandHawaii]

Employee status

All statuses-----

Professional-----

Nursesl -----..-..-z----

Other professional----

Nonprofessional--

Nurse’s aides, etc.3---

Clerical---------------

Food service-----------

Housekeeping-----------

Other nonprofessional--

All statuses-----

Professional

Nursesl-----------;----

Other professional-----

Nonprofessional

t!urae’s aides, etc.a---

lerical---------------

Food service-----------

Housekeeping-----------

Other nonprofessional--

All

pl~;es

564,783

135,658

94,507

41,151

429,124

243,927

16,786

85,919

71,747

10,745

100.0

69.7

30.3

56.8

2:::

16.7

2.5

Geographicregion

43,262

32,447

10,815

105,183

56,051

4,592

21,752

1;,::;

>

100,0

75.0

25.0

53.3

2::!

18.4

3,3

Number

38,6861 33,368120,342

25,523 23,526 13,011

13,163 9,842 7,332

‘fypeof ownership

I I

48,409 135,137 381,237

10,881

7,424

3,457

37,528

8$;;; 6;,;l; 35,549 1;,3;;

30:948 20;990 J;;% 7;078

25,103 16,988 10,329 7,758

3,303 2,072 1,908 1,766

Percent distribution

100.0

66.0

34.0

56.7

2;:;

16.9

2.2

100 ● o

70,5

29.5

60.4

1::;

1;.;

●

100.0

64.0

36.0

56.6

1;:2

16.5

3.0

100.0

68.2

31.8

51.4

1:::

20.7

4.7

30,064

20,927

9,137

105,074

47,990

5,410

24,981

22,920

3,774

100.0

69.6

30.4

45.7

2%:

21.8

3.6

94,714

66,157

28,558

286,522

176,636

9,752

53,860

41,069

5,206

100.0

69.8

30.2

l~ncludes registerednursess licensedpracticalnurses or vocationalnurses, and practical

nur$es.

‘Includesadministrators,physicians (M.D. or D.O.), dentists, registeredoccupationaltherapists or other occupationaltherapistassistants,qualifiedphysical therapistsor physical therepist assistants,recreationtherapists,dietitiansor nutritionists,registeredmedical record librarians or other medical record librariansand technicians, socialworkers, .speeclitherapists,

and other professionalpersons.

$Includesnurse’s aides, orderlies,and studentnurses.

21
APPENDIX 1

TECHNICAL NOTES ON METHODS

Survey Design

Gsrzeml.-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

patients. Collected in the survey were data about the

sample establishment itself, about the health of a sample of the patients or residents, about the administrator of the establishment, and about a sample of the

employees.

Resident Places Survey-3 (RPS-3) is the third such

survey of the institutional population, the previous surveys being designated as RPS-1 and RPS-2. Several

reports on the results of RPS-1, RPS-2, and RPS-3

have been published. 1-151naddition to these, other sur -

veys of the institutional population have been conducted

by the Division of Health Resources Statistics-in particular, the 1968 Nursing Home Survey and the Master

Facility Inventory Surveys for 1967 and 1969. Reports

on these surveys can be found in Series 14.

fknnpling~me. -The list of nursing and personal

care homes included in the 1967 Master Facility Inventory (MFI) was the primary sampling frame (universe) for Resident Places Survey-3. The MFI was

supplemented by a list of new homes, ‘‘Births,1’ which

were possibly within scope of RPS-3 but were not confirmed in the 1967 MFI survey. The Births had been

reported in the Agency Reporting System (ARS) as

being in operation at the time of the survey. (A description of the MFI and ARS has been published)!6

To be eligible for the survey, establishments must

have maintained at least three beds and routinely provided some level of nursing or personal care. Thus, a

home provid+~g only room and board or domiciliary

care to its residents was not eligible for RPS-3 even

if it was a home for the aged. The classification scheme

for homes is described in appendix II.

ample design. -The sample was a stratified twostage probability design; the first stage was a selection

of establishments and their administrators, and the

second stage was a selection of residents and employees

NOTE: The list of references follows the text.

22

of the sample establishments. In preparation for the

first-stage sample selection, establishments listed in

the MFI were sorted into three types of service strata:

nursing care homes, personal care with nursing homes,

and personal care homes. The Births from the ARS were

treated as a fourth type of service stratum. Each of these

four strata was sorted into seven bed-size groups,

producing 28 primary strata as shown in table I. MFI

establishments were ordered by type of ownership,

State, and cormsy. The sample of MFI establishments

and the Births were then selected systematically after

a random start within each primary strata. Table I

shows the distribution of establishments in the sampling tkame and the final disposition of the sample

with regard to response and in-scope status.

The second-stage sample selection of residents

and employees was carried out by Bureau of the 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 111)

on which the interviewer listed the names of all employees of the establishment and sampled only professional and semiprofessional employees by using

predesignated sampling instructions that appeared at

the head of each column of this form.

Survey procedures. -The U.S. Bureau of the Cen.

sus collected the data according to specifications of

the Division of Health Resources Statistics. The initial contact with an establishment was a letter (HRS4g- 1, appendix III) signed by the Director of the Bu.

reau of the Census mailed prior to a personal visit to

each sample facility. This letter was accompanied by

the facility and administrator questionnaires (HRS-4a

and HRS-4b, appendix III). The respondent for the

facility questionnaire was usually the administrator or

another member of the staff designated by the operator

of the establishment. Information on the administrator

questionnaire was self-enumerative and was completed

by the person who was designated as administrator by

the owner or operator of the sample facility. These two

forms were collected by an interviewer during the

personal visit to the facility arsd were edited for completeness and consistency at that time. The resident
Table I. Distributionof homes in the Resident Places Survey-3 universe and dispositionof sample

homes accordingto primary strata (type of service and bed size of home): United States

[ExcludesAlaskaand Hawaii]

Type of service and bed size

All types of services----------------

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

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

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

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

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

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

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

300beds 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 bedsm--------------------------- ------

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

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

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

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

“Births”2------------------------------

Unknown bed size3-------------------------.

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

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

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

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

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

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

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

Jniversel

(:unnng

21,301

10,480

858

1,756

3,448

3,166

1,062

126

64

3,608

941

767

828

612

332

:;

4,725

2,937

988

561

183

48

6

2

2,488

473

304

255

492

681

241

30

12

Number of homes in sample

All

homes

2,088

1,289

21

88

260

477

316

64

63

402

24

37

62

1::

&

183

out of

scope or

out of

business

153

48

&

13

16

4

9

1

1

42

28

In scope and in

business

Nonresponding

homes

81

66

24

24

2

1

7

1

3

5

1

3

1

ReSp:lg

1,854

1,175

15

2;:

449

283

61

61

360

18

28

138

181

lThe universe for the RPs-3 sample consistedof the nursing and personal care homes included

in the Master Facility Inventoryand the Agency Reporting System.

‘Birthsconsist of those homes which were assumed to be in scope of RPS-3 but for which current data were not available.

~Birthsof unknown bed size were inadvertentlyexcluded from frame.

23
information was obtained during the personal interview to the sample establishment. The sample of residents within an establishment was selected systematically according to predetermined sampling schemes.

The interviewer was asked to list on the back of the

Current Patient Questionnaire (HRS-4f, appendix III)

all the residents or patients in the sample and to complete the health information for each of the sample patients from personal knowledge of a staff member of

the establishment who had close contact with the resident and first-hand knowledge of the resident’s health

condition.

The staff information was obtained by means of a

self-enumeration questionnaire (HRS-4C, appendix III).

The usual checks and followups were performed

during the course of the survey. The completed questionnaires were edited and coded by theNational 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 sample data.

General Qualifications

Norwesponse and im@&ition of missing GW&-

Statiatics presented in this report were adjusted for

failure of a home to respond. Data were also adjusted

for nonresponse which resulted from failure to complete one of the questionnaires or the failure to complete an item on a questionnaire.

Rounding of numbe-nv.—Estimates relating to residents and employees have been rounded to the nearest

hundred and homes or administrators to the nearest

ten. For this reason detailed figures within tables do

not always add to totals. Percents were calculated on

the basis of original, unrounded figures and will not

necessarily agree with percents which might be calculated from rounded data.

Estimation procedwe, -The statistics presented

in this report are essentially the result of ratio estimation techniques. These techniques have been de.

scribed in the appendixes of earlier pubIicatidns}3’ 5-15

Reliability of estimates. -Since statistics pre.

sented in this report are based on a sample, they will

differ somewhat from figures that would have been obtained if a complete census had been taken using the

same schedules, instructions, and procedures. As in

any survey, theresults are also subject .to reporting

and processing errors and errors due to nonresponse.

To the extent possible, these types of errors were kept

to a minimum by methods built into survey procedures.

The sampling error (or standard error) of a statistic is inversely proportional to the square root of the

number of observations in the sample. Thus, as the

sample size increases, the standard error decreases.

NOTE: The list of references follows the text.

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

rather than the entire universe, is surveyed. As calculated for this report, the standard error also reflects

part of the measurement error, but it does not measure

any systematic biases in the data. The chances are

about two out of three that an estimate from the sample

differs from the value whfch would be obtained from a

complete census by less than the standard error. The

chances are abut 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%Umes as large.

Table II. Approximate standard errors of estimated numbers of homes shown in this reporti

Number of

homes

1oo--------

2oo--------

3oo--------

4oo--------

5oo--------

;ll;--------

--------

800--------

9oo--------

l,ooo ------

Standard

error

89

1%

105

Number of

homes

Standard

error

2,000 -

3,000 -

$:;:-

6;000:

7,000 -

8,000 -

9,000 -

lo, ooo15,000 -

20,000 -

146

174

196

210

228

238

2’40

252

250

240

160

Table III. Approximate standard errors of estf.mated numbers o f bed a, admissions, discharge

days of care, and employees ahown in this report

Size of

estimate

l,ooo ------

2,000 ------

3,000 ------

4,000 ------

5,000 ------

6,000 ------

7,000 ------

8,000 ------

9,000 ------

lo, ooo-----

20,000 -----

30,000 -----

40,000 -----

50,000 -----

I

Standard

error

4%

579

668

750

822

882

944

1,008

1,060

1,500

1,830

2,120

2,350

Size of

eetimate

60,000 --

70,000 --

80,000 --

90.000 --

iob, ooo2oo, ooo -

3oo, ooo -

@:,:W&-

600;000:

7oo, ooo -

800,000 -

9oo, ooo -

;tandard

error

2,580

2,800

2,960

3,150

3,300

4,800

5,700

;,;::

8;400

9,100

;,;::

9

Standard errors of aggregates shown in this report can be obtained from tables IIand IIIofthisap.

peridix. The relative standard error of anestfmate ia

obtained by dividing the standard error of the estimate

by the estimate itself andisexpressed asapercentof

the estimate. Standard errors of estimated percentagee

shown in this report can be obtained from tables IV

and V.
Table IV. Approximate standard errors, expressed in percentage points, of percentages of homes

Base of estimated percent

(number of homes)

200------------------------------

500------------------------------

1,000----------------------------

2,000----------------------------

3,000----------------------------

4,000----------------------------

5,000----------------------------

6,000----------------------------

7,000----------------------------

8,000----------------------------

9,000----------------------------

10,000 --------- ------------------

20,000---------------------------

shown in this report

Estimated percent

10 or 1 or 99 5“or 95 $)0 20 or 30 or 40 or so

80 70 60

Standard error

2.4

1.5

1.1

0.8

0.6

0.5

0.5

0.4

0.4

0.4

0.4

R

5.3

;:;

1.7

1.4

1.2

1.1

:::

0.8

0.8

u

:::

3.2

2.3

1.9

1.6

1.4

1.3

1.2

1.1

1.1

i ;

9,6

::;

3.0

2.5

2.2

$::

1.6

1.5

1.4

1.4

1.0

11.0

::;

3.5

2.9

2.5

2.2

2.0

1.9

1.7

1.6

;:?

11.8

R

3.7

3.0

2.6

2.4

2.2

2.0

1.9

1.8

1.7

1.2

12.1

;::

;::

2.7

;:;

2.0

1.9

1.8

;:;

Table V. Approximate standard errors , expressed in percentage points, of percentages of beds, admissions, discharges, days of care, and employees shown in this report

Estimated percent

Base of estimated percent

1,000----------------------------

2,000-----------------------------

5,000----------------------------

10,000---------------------------

20,000-------+------------------

30,000 --------- --------- ---------

40,000 ------------------ ---------

50,000---------------------------

80,000---------------------------

100,000--------------------------

200,000--------------------------

500,000--------------------------

900,000--------------------------

1 or 99

3.3

2.4

1.5

& ;

0.6

0.5

%2

0.3

0.2

0.1

0.1

5 or 95 10 or

90

20 or I

30 or I40 or so

80 70 60

Standard error

2:

3.3

;::

1.3

1.2

:::

::;

0.3

0.2

10.0

:::

H

1.8

1.6

1.4

1.1

i ;

0.4

0.3

13.4

9.5

6.0

:.;

2:4

2.1

1.9

1.5

::;

0.6

0.4

15.3

10.8

R

3.4

2.8

2.4

2.2

1.7

1.5

1.1

0.7

0.5

16.4

11.6

;:;

3.7

3.0

2.6

2.3

1.8

1.6

::;

0.5

16.7

11.8

;::

3.7

3.1

2.6

2.4

i?

1.2

0.7

0.6

-000

25
DEFINITIONS

Demographic Terms

APPENDIX II

OF CERTAIN TERMS USED IN THIS REPORT

Bed.-A bed is defined as one set up and regularly

maintained for patients or residents. Beds maintained

for staff and beds used exclusively for emergency services are excluded.

Resident.-A person who has been formally admitted but not discharged from an establishment. All

such persons were included in the survey whether or

not they were physically present at the time.

Nursi~ cave. -Nursing care is defined as the

provision of one or more of the following items:

Hypodermic injection

Intravenous injection

‘Intramuscular injection

Taking of temperature, pulse, respiration, or blood

pressure

Application of dressings or bandages

Bowel and bladder retraining

Nasal feeding

Catheterization

Irrigation

Oxygen therapy

Full bed bath

F70prietiry home,-A home operated under private commercial ownership.

Nonprofit home. -A home operated under voluntary or nonprofit auapices, including both churchrelated institutions and institutions that are not church

related.

“Government home, -A home operated under Federal, State, or local government auspices.

Geographic region. -The regions of the United

States (excluding Alaska and Hawaii) that correspond to

U.S. Bureau of the Census regiona are:

Region

Northeast -------

North Central---

States Included

Maine, New Hampshire, Vermont,

Massachusetts, Rhode Island,

Connecticut, New York, New Jersey,

and Pennsylvania

Michigan, Ohio, Illinois, Indiana,

Wisconsin, Minnesota, Iowa,

Missouri, North Dakota, South

Dakota, Nebraska, and Kansas

South -----------

West -----------

Classification of

Delaware, Maryland, District of

Columbia, Virginia, West Virginia,

North Carolina, South Carolina,

Georgia, Florida, Kentucky,

Tennessee, Alabama, Mississippi,

Arkansas, Louisiana, Oklahoma,

and Texas

Montana, Idaho, Wyoming, Colorado,

New Mexico, Arizona, Utah, Nevada,

Washington, Oregon, California,

Hawaii, and Alaska

Homes by Type of Service

For purposes of stratification of the universe prior

to selection of the sample, the homes on the MFI were

classified as nursing care, personal care with nursing,

or personal care. Details of the classification procedure in the MFI have been published.

Due to the 2-year interval between the MFI sur.

vey and RPS-3 survey, it was felt that, for producing

statistics by ~pe of service from the RPS-3 survey,

the homes should be reclassified on the basis of the

current data collected in the survey. This classification

procedure is essentially the same as the MFI scheme.

The three types of service classes delineated for RPS3 are defined as follows:

1.

2.

A nursing care home is defined as one & which

50 percent or more of the residents received

nursing care during the week prior to the survey in the home, with an RN or LPN employed.

A personal cave with nursing home is defined

as one in which either (a) over 50 percent of the

residents received nursing care during the week

prior to the survey, but.there were no RN’s or

LPN’s on the staff, or (b) some, but less than 50

percent, of the residents received nursing care

during the week prior to the survey regardless

of the presence of RN’s or LPN’s on the staff,

but one or more of the following conditions were

met:

26
(1) Medications and treatments were administered in accordance with physicians’

orders.

(2) Supervision over self-administered medications was provided.

(3) Three or more personal services were

routinely provided.

3. A personal cave home is defined as one in

which residents routinely received pers~nal

care, but no residents received nursing care

during the week prior to the survey, and medications and treatments were administered in

accordance with physician’s orders or supervision over medications which may be self-

.administered was provided.

000

27
—

OFFICE OF THE DIRECTOR

r

APPENDIX Ill

FORMS AND QUESTIONNAIRES

U.S. DEPARTMENT OF COMMERCE

BURSAU OF THE CENSUS

WASHINGTON, D.c. 20233

1

HRS-49-1 (4-69)

L -1

Dear Sir:

The Bureau of the Ceneus, acting for the United Stitee Public Health

Service, is conducting a survey of nureing homes, homee for the aged,

and other eetabliebments which provide nursing care, pereonal care, or

domiciliary care for the aged or infirm. The purpose of this survey is

to collect much needed information about both the facilities and the

employees and patients. This activity is part of the National Health

Swey program authorized by Congrees because of the urgent need for

more comprehensive and up-to-date health statistics.

Thie letter is to request your cooperation and to inform you that a

representative of the Bureau of the Census will visit your establishment

within the next week or so to obtain the needed information. Prior to

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

convenient appointment the. Meanwhile, to save the, I ehould appreciate your completing the two enclosed questionnaires which reques,tsome

information about you and your establishment. our Census representative

will pick up these questionnaires when ehe visite you to obtain the

additional desired information.

‘All the information provided on the questionnaires and given to the

Census representative will be kept strictly confidential by the Public

Health Service and the Bureau of the Ceneue, and will be ueed for statistical purpoees only.

Your cooperation in this important eurvey will be very much appreciated.

Sincerely,

&.6&4J.-6~

A. Rose Eckl.er

Director

2 Enclosure

INTRODUCTORY LETTER TO ESTABLISHMENT

28
Budget Bureau No. 66-S69022; Approval Expires August 31, 1969

NOTICE - All information whl.h would permit Identification of the facility will be hold in strict confidence, will be used only

by persons engaged In and for the purposes of the survey, and will not be disclosed or released to others for any purposes.

oRM ltRS.40

1.8.60) (Please correct any .rmr in name and address in.ludng ZIP code)

U.S. DEPARTMENT OF COMMERCE

BuREAU OF THE cENsUS

ACTING AS COLLECTING AGENT FOR THE

U.S. PUBLIC HEALTH SERVICE

FACILITY QUESTIONNAIRE I,

1. What was the number of inpatients in this facility on December 31, 1968?

Numbar

2. During tho swen 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 fol lowing services:

Nasal feeding Catheterization Irrigation No. of

Oxygen therapy Full bed-bath Enema persons

H podermlc injection

Y

Intravenous Injection Temperature. pulse-respiration

B ood pressure Application of dressing Bowel and bladder retraining

or bandage

3. In 1968, what was tho total inpatient days of core provided? (The sum of the number of Days

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

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

5. In 1968, how many of the admissions were Medicare patients? Number

6a. In 1968, how many discharges, excluding deaths, did this facility have? Number

r

B

Total How many were

b. How many patients were discharged to the following places -

No. edicare patlants

(l)gener.l orshort-stay hospital? . . . . . . . . . . . . . . . . . . . . . . . —uNo”=

(2) long-term specialty hospital (except mental)?’. . . . . . . . . . . . . .

m None

(3) mental hospitol? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . — m None

(4) anothernursinghome? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . — None

(5)personttl career domiciliary home? . . . . . . . . . . . . . . . . . . . . mNo”e

(6) patient’s honreorfcrrnily? . . . . . . . . . . . . . . . . . . . . . . . . . . . —UNOne

(7) other places? (Speclt iplace) — n None

7. In 1968, howmany persons died while patients ofthis facility? il None

8. What is thetotal number ofpatient beds regularly maintained Beds

(set u. –, and staffed foruse) inthisfacilitv?

9. What isthetotaI NUMBER OFINPATIENTS (patients or residents)

Number

who stayed in your faci[ity Iast night? (DO NOT IN CLUOE EMPLOYEES OR OWNERS)

10. During kepostseven days, howmany of thelNPATl ENTSinquestion 9 received

“Nursingc are”? 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 sherapy Full bed-bath Enema persons

Hypodermic injec; on Intravenous injection Temperature-pu Ise-res pi ration

Blood pressure Application of dressing Bowel and bladder retraining

or bandage

, 1

Please conti”.e .“ reverse side

FACILITY QUESTIONNAIRE

29
1. Which of the following services are ROUTINELY provided?

a. Supervision over medications which may be self -administered. . . . . . . . , . . . . . . .

la Yes 20N0

b. Medication. and treatments administered in accordance with physicians’ orders . . . . .

lm Yes 20N0

c. Ruh and massage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

-

l(__J Yes 2UN0

d. Help with dressing lmYes 2CINo

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e. Help with correspondence or shopping . .

In Yes 20N0

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f. Helpwitb walkingor.gettingabout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Y=S20N”

g. fl;lpwith eating ..:..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

lmYes 2~N0

h. Noneofthe above services Routinely provided, room and board provided only.... a

1

!Oy=s zl_JNo

2. ls this FACILITY Darticirmtinctin the Medicare prowam? (:flp

3, Howmany beds orecertified for Medicare? Number

40. Forhow many patients isthlsfacility nowreceiving Medicare payments?

Number

b. Howmany of these Medicare patients lived (had their home)

Number

in this State when admitted to this facility?

5, lnoddition totwophysicians, does the Utilization Review Committee includea. the nursing director? . . . . . . . . . . . . . . . . . .

H

In Yes z~No

b. o socialworker? . . . . . . . . . . . . . . . . . . . . .

laYes 20N0

c. the nursing home administrator? . . . . . . . . . . .

li_JYes 2QN0

b--i d. aphysica[ therapist? . . . . . . . . . . . . . . . . . . lClyeS ZUNO

e. any other members? (specify occupation)

I

6. Howmany persons araemployed in this facility? Total employees

(Include members ofrellolous or.a.nizatfons ond orders

whoprcwlde thekservf c&J -

7. Last month, were the following services providedon areguiar

basis ihrough contracts orother fee arrangements?

How many per..”. Last month, hmum.any

Pr.vid.d ~hi. how. dldth.ysp..d

service? providing thl. -rvfi..?

lNOOfpersOns ! ~

a, Physician (M. D,or O.O.) 20N0 1 m’””~

b. Dental 2DN0

‘ny’-~

c. Pharmaceutical 213N0

d. Physical therapy 213N0

e. Occupational therapy 20N0

f. Recreational therapy 2DN0

g. Speech therapy 2DN0

h, Social worker 20N0

i. Dietary (Dietitian) 213N0

j. Food service (meal preparation) 213N0

k. Housekeeping 20N0 %=~

1. None of above D J

ORM 14Rs.4, {4.S.691 u,ccn.4M.Dc
FORM ffRS.4m U.S. DEPARTMENT OF COMMERCt

184748) BUREAU OF TNE CENSU!

STAFFINFORMATIONANOCONTROLRECORO

Bud~et Bureau No.

‘40TICE - Al I lnfwmatlOn Ml ch would Parml t Identlfk.tlm of tie ~&3@~* Establishment No.

,ndlvidual will be held In strict confidence, will !M used only by

lemons engaged In and for the purposes of the surv=y, and will Approval Expires

Iot be disclosed or released to others for any purposes. August 31, 1969

.Int

No.

—

I

-

-

—8

—9

&

II —

—12

—13

14

-

—Is

—

STAFF

List below the namas of all persons who work

In this facility.

Include members of religious or;anlzatlons and

orders who provlda their services.

Notre Be sure to list administrator and assistant

adm[”lstrator.

(a)

SEX

- Male

- Femal

(b)

2

1 F

RACE

W-White

N–N egro

O-O ther

(c)

2 3

v N o

OCCUPATIONS

Enter number from Cord A

1-11 12

I

13-20 I

21-24

Pmfession.1 Professional semi. I

NcJnpro fessimal pro fesslona

sw_ Sw

DISPOSITION OF

STAFF

QUESTIONNAIRE

(h)

Date

; received

g i“ R.O.

g 3

Line

No.

T

—

2 —

3 —

4

.

—5

6

T- —

—8

9 —

—10

II

—12

—13

~

IS—

16 —

—17

—18

—19

-

STAFF INFORMATION AND CONTROL RECORD

31
Which of the following job categories best fits the iob

which this employee does in this faci Iity?

1. Administrator

2. Physician (M.D. or D.O.)

3. Dentist

4. Registered Occupational Therapist

5. Qualified Physical Therapist

6. Recreation Therapist

7. Dietitian or Nutritionist

8. Registered Medical Record Librarian

9. Social Worker

10. Speech Therapist

II. Other professional occupations

12. Registered Nurse

13. Occupational Therapist Assistant

14. Physical Therapist Assistant

15. Other Medical Record Librarians and Technicians

16. Licensed Practical Nurse or Vocational Nurse

I 7. Practical nurse

18. Nurse’s aide

19. Orderly

20. Student nurse

21. Clerical, bookkeeping, or other staff

22. Food service personnel (cook, kitchen help, etc.)

23. Housekeeping personnel (maid, Iaundryman,

maintenance man, etc.)

24. Job other than those listed above (Please describe

employee’s duties)

.

:o!=w HRS-4k U.S. DEPARTMENT OF COMMERCE

3.27.69)

,sCOMM-DC

8UREAIJ OF ‘WE CENSUS

LIST OF SELECTED JOB CATEGORIES

LIST OF SELECTED JOB CATEGORIES
Budget Buren. No. 68-.%9022; Approval Expires August 31, 196

ITICE - All information which would permit identification of the individual will b. held i. str,ct cO.fid.,nce, will be .s.d ..V

persons engaged In and for the purposes of the survey, and will not be disclosed or released t. others for any purposes.

~yJRS-4c 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

Seryid,e is conducting a nationwide survey in nursing the U.S. National Health Survey and the Bureau of the

homes, hbmes 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.

lnthepostage-paid envelop; provide~.

Please complete the form and return it within 5 days Thank you for your cooperation.

tothe Bureau of the Census. Washington. D.C 20233.

Mon ti Year

When were you born?.

How many years have you worked os a

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

b. in other nursing homes, homes for the aged,

. . . . .

orslmdar facllrtles? . . . . . . . . . . . . . . . . . . . . . . . . . . .

c. in hospitals? (NOTE TO NURSES: Do not hclud.

SP. CI.1 duty or prlv. te duty nursing. ) . . . . . . . . . . . . . . . .

. How many hour5 did you work LAST WEEK IN THIS FACILITY ONLY?

How many of these hours did you spend LAST WEEK performing

“ EACH of the following services IN THIS FACILITY ONLY-

(1) administration of the facility? . . . . . . . . . . . . . . . . . . . . .

(2)nwsi”g care? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(3)medical anddental care? . . . . . . . . . . . . . . . . . . . . . . . .

(4) physical therapy? . . . . . . . . . . . . . . . . . . . . . . . .

(5)occupational therapy? . . . . . . . . . . . . . . . . . . . . . .

(6) recreational theropy? . . . . . . . . . . . . . . . . . . . . . .

(7) spee.handhearingther.py? . . . . . . . . . . . . . . ...”

(8) social work? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . .

. . .

.,.

. . .

. . .

(9) clerical work? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(10) kitcheti/dietary work, grocery shopping? . . . . . . . . . . . . .

(ll)housekeeping services? . . . . . . . . . . . . . . . . . . . . . . . .

(12) otherservices? (Spectfy service) . . . . . . . . . . . . . . . . . .

No. of years No. of months

I

Hour.

m None

m None

= None

m None

= None

= None

a None

= None

I_J None

a None

m None

= None

Besides the hours worked IN THIS FACILITY, how many additional

hours did you work in your profession LAST WEEK? . . . . . . . . . . . . . . . . . . . D None

Ple.asecontlnueo. r.verse side

STAFF QUESTIONNAIRE

33
Circle hlghestgrode completed

L What Isthohighwtgmdo you wmplatod a. Elementary school

}

. . . . . ...12345678 Sk, to

in scheol? b. High school . . . . . . . . . . ..lz34 Q.i’

1

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

d~Nursing school (diploma) . .. I z 3

e.co!lege . . . . . . . . . . . . ...12345 or more

Mark 0/f t/)Ot ..Dp/y Major field of study

L Which ofthc following d~gmas de yw have?

n Associate degree

orcertlficste .,..,. . . . . . . .

a Bachelor’s degree .,.......

nMaster”s degree . . . . . . . . . . .

D l)~~:~~D., D. O.,

. . . . . . . . . . . . . . . . .

m None of these

M.rk all that apply

‘. Which ofthofollowing professional dagm.s, n Physician (M. D.)

Iiwrmw, or association mgistmtions do you hsvo? U Physician (D. O.)

n Registered Nurse (R.N.)

a Licensed Practical or Vocational Nurse (L.P.N. or L.V.NJ

m Registered Physical Therspist (R. P.T.)

a Registered Occupational Therspist (0.T,R.)

a Other professional degree, license, or

association registration (Speef&)

7

n Noneof the shove

Ftll ColS. (2)-(4) fore.ch “Yes’’o nswerinCol.( l)’

How mmy

Whet w.,. th. TOTAL

1. Have ouworiakam any of HOURS of class

** fzllewirrg COUM*S:

COURSES werm

TOTAL NUMBER taken n+llo instruction?

7

of courses taken working for a Number of hours per week

degree or rimes number ofwaeks

diploma? arrmdedper course

O. Nursing cam of the agtd In Yes+ v

w chronically ill? 2 ❑ No (8b)

b. Medical or dental cam of 1 DYESthe aged or chronical [y ill? 2 ❑ No (8c)

c. Mantel or social pmblcms of !nY.asthe aged or chronically ill?. 2 n No (8dJ

ll-JYa2-

d. Physical thompyor rahabflltation? 2DN. (8.)

tDYes-

●. Occupational tfmmpy? 20 NO[89

10y=s~

f. Nutrition or ked sc~ices? 2DNo(&7gJ

1❑ Ya2+

g. Nursing horn- admini strzitien? “213N0
Budget Burean No.68-S69022; Approval Expires A.gust3l, 1969

NOTICE- AllinformatIon which would permit identification oftielndivIdual will behe[dln strlctconfidence, wlllbeusedo”ly

bypersons=nzazed in and fOrthepurpo.e. of*. survey. .ndwill n.tbedlsclosed orreleased toothers for any purposes.

~ORM HRS-4b

4.4.80) U.S. DEPARTMENT OF COMMERCE A. Name .afadmlnistrator

BUREAU OF THE CENSIJS

ACTING A. C0LLECTt14G AGEt4T FOR THE

U.S. PUBLIC HEALTN SERVICE

B. Establish”e”t No.

ADMINISTRATOR QUESTIONNAIRE

The U.S. National Health Survey of the Public Health Your answers will be given confidential treatment by

Service [s conducting nationwide survey in nursing the U.S. National Health Survey and the Bureau of

homes, homes for the aged, and other related types of the Census. The information will be used for statis.

establishments. The purpose of the survey is to tical purposes only, and will be presented in such a

obtain certain information about the staff employed in manner that no individual person or establishment

these establishments as well as about the health of can be identified.

patients or residents in theestsblishments. Thank you for your cooperation.

Wh~n were you born? Month Year

‘. In what $tate(or foreign country) were you born? State or forefgn country

. How long have you been the administrator- No. of years No. ofmonfhs

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

No. of years No. ofm.mths

b. in other n.rsi”g homes, homes for the aged,

or similar facilities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. of years No. ofmontis

c.inhospita[s? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

a. Are yorrthe administrator formare thmsone NURSING HOME? 1 mYes (4b)

2= No(Sklpto 0.5)

b. Farhowma.y other NURSING HOMES? Number

c. What is the number of patient beds in EACHofthe other NURSING HOMES?

a. Howmany hours did you work LAST WEEK IN THIS FACILITY ONLY? Hours

b. Howmany of these ho.rsdid yo. spe.d LAST WE EKperf.ming EACH

of the following services IN THIS FACILITY ONLY -

(l)administration of the facility? . . . . . . . . . . . . . . . . . . . . . . m None

(2) mwsi”gc.are?.., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . = None

(3)rnedical cmdde”tol core? . . . . . . . . . . . . . . . . . . . . . . . . . U None

(4) physical therapy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . m None

(5) occupational thwtpy?. . . . . . . . . . . . . . . . . . . . . . . . . . .

a None

(6) re.reationol theropy? . . . . . . . . . . . . . . . . . . . . . . . . . . . a None

(7) speech andhearingtherapy?. . . . . . . . . . . . . . . . . . . . . . . D None

(8) sc.cicrlwork? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . = None

(9) clerical work? ., ...!.. . . . . . . . . . . . . . . . . . . . . . . . . m None

(lO)kitchen/dietary work, gracery shopping? . . . . . . . . . . . . . . a None

(ll)ho.sekeepingservices?.......... . . . . . . . . . . . . . . . . m No”.

(12)0ther?, (Specify service) D None

Besides the hours worked IN THIS FACILITY, how many additional

. ho.rsdid youwork inyo.rprofession LAST WEEK?

= None

As an administrator, are you self-employ ed ora salaried employee? 1 D Self-employed

2D Employee So Both

Pt... . . - . . . . .. ... . . .-...=. .,,I.

...” . . . . . . . . . . . . . . . . . . . . . . .

ADMINISTRATOR QUESTIONNAIRE

35
Cr,c/e h,ghest gmde completed

8. Whotisthe highe.st grade you completed a. Elementary school . . . . . . . . ] 2345678

in school?

}

ship t.

b. High school . . . . . . . . . . . . 1234 0. 10

c. Junior college . . . . . . . . . . I 2

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

e.co{tege . . . . . . . . . . . . . ..] 234 5orm,xe

Mark all that apply

Major field of study

9. Which of the following degrees do you have?

I_J Associate degree

or certificate . . . . . . . . . . . . . . .

D Bachelor’s degree . . . . . . . . . . . .

mMaster’s degree . . . . . . . . . . . . .

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

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

. = None of these

10. Which of the following professional degrees,

licenses, or association registrations do

Mark Ofi that apply

YOU have? m Physician (M. D.)

n Physician (D.O.)

m Registered Nurse (R. N.)

~ Licensed Practical or Vocational Nurse (L. P.N. Or L.v.N.)

a Registered Physical Therapist (R.p.T.)

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

m Other professional degree, license, or

association registration (Specify)z

n None of the above

la. Have you ever taken ony courses in nursing home administration?

1 n Yes (l~b) Z U NO (Skip fo Q. T2aJ

b. How many of these courses have you take”? Number

c. What were the TOTAL hours of class instruction? (For each course, Hours

number of hours per week times number of weeks attended)

12a. Did you ever receive any “on-the-iob” training to be

a nursing home administrator? 1 n Yes (72bL 20 No (Ski.o to Q. 13)

b. How long did this training last? Months

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

3. Have you had any other education or training in 1 m yeS — j):,:;lbe 2UN0

nursing home administration?

,.. . ... . . ..... . .

.ORM H . . . . . ,4.4.,,, . .--.,-.-,
U.S. NATIONAL HEALTH SURVEY

RESIDENT PLACES SURVEY -3

lame of sample person Line No.

Month ! Day I Year OR Age

. What is -- date of birth? I I

!. Sex li_JMale 20 Female

, Race In White z ❑ Negro 3 I_J Other nonwhite

a. what wss his marital

status at admissim? . . .

I u Married z u Widowed 3 u Divorced 4 u Separated s m Never married

b. What is his marital

stahrs now? . . . . . . .

I Q Married z u widowed s u Divorced 4 u Separated s u Never married

. What waa Nw date of fda LAST ADMISSION to this place?

Month jDay, 8Year

1

2 1 How long has be had tfd; condificar?

J

No Yes L~m:~ 23 to 5 36 to 11;2 mos.

. Which of Nwse ccmditiacrs or impairments dces fw have?

mos. mos. or more

a, ADVANCED senilify . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b. Senllify, notpyachofic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c. Other mental disorders (such as mental i Ibress or retardation) . . . . . . . . . . . . . . . .

d. Speechdefector paralysis (palsy) due to a stroke . . . . . . . . . . . . . . . . . . . . . . . .

e. Other illeffects of a stroke, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f. Heart t!ouble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g. Hardening of the arteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h. Paralysis wpalsynot dueto a stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i. Arthritis orrheumafism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j. Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

k. Any CHRONIC trouble with backer spine.. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I. PERMANENT stiffness or any deformity of the foot, leg, fingers,

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

m. Chronic conditions of digastive system (.exclurfing stomach ulcer,

hernia of abdominal cavity, liver, or gallbladder trouble). . . . . . . . . . . . . . . . . . . .

n. Any other conditions or impairments - S=($.

At his tast physical examination, Primary diagnosis?

“ what was his -

Secondary diagnosm?

Any other diagnows?

. Drslng tfw pest 7 days, I u Halp with dressing,

wtdch of these services

a u Temperature - pulse - 16a hrtravenous NIjt?dlon

shaving, or cere of hair

did this patient receive? z= Help ~i~ tub bath

respiration 17a hrtramuscdar Injecbon

9 u Foil bed-bath

or shower

ta u Subcutaneousm]ecbon

Chekk 05 mony 0S 0,Df3iY

10 ❑ Enema 19 U Intradermal mjecfion

3 u Help with eating I I u Catheterlzahon

s o Rub or massage

20a Nasal feeding

12 fg Bowel or bladde( OR

5 u Administration of medica- retraining

tions or treatment

z o None of the above

130 Blood pressure services received

6 rg Special diet 14 U Irrigation

7 u Application of steri [e

dressings or baodages

IS o Oxygen therapy

a, DWS ha USE eyeglasw? I ❑ Yes ZDNO

b. Does he USE a beariog aid? I D Yes 213N0

O. Doas he use any of the foflowing aids - FLYWhat COIKfitiffl(S)?

a. walker? 2uN0 ,mYes _

b. crutches? ZONO ~nYes _

c. braces? 20N0 lnYes _

d, wheelchair? 20N0 laYes —

e, any other aids? 20N0 lmYes _

spdfv

‘ootnotes

cURREf’4T PATl ENT QUESTIONNAIRE 37
How long has ha bean tfds way? If /.S, rhm (

CQasthis mrh., mk

+5 require extra ;;:; 3&5 6 to 11 1’2mos. ffow w= ~

~

11. klrich of these categories best describes his nursing time? . mos. or mwe bef~ fb~l?

tiility to move about? 3 mosi ~ ~

‘j E.rw leww

.

a. Capabie of going off the premises with or without

assistance

b. r%nfinsd to the premises, but does not use a ~eelchair

c. H&: a wheelchair but requires minimal help in getting

lr-JY 213N

d. Generally confined to bed but UPin wtreefchair for at

least a few hours a day tl-JY 21_JN

e. Restricted to total bad rest 10Y 2uN

12. How well can ha hear?

a. Can hew a tele~cme conversation on so ordinary

telepime (a telephone wiibout m amplifier)

b. Cm bear most of the things a person says

c. Can hers a faw words a persemsays 1UY 213N

d. Can hear only loud noises in Y 2F_f N

e, Can’t hew srything IUY 213N

13. How well can be see?

a. Cf:s~e:d ordinary newspaper print with or without

g

b. Can watch television across the room(8 to 12 feeti

c. Can recognize the features of people he knows if they

are within 2 to 3 feet

d. IS blind (If blhd ask C, twk her.) 1mY 2rf N

14. How much control dcea he usually have over his bowels

and bladder -- nwmally does he -

.

a. Controi bladder and boweis?

b. Conhoi bladder but not bowels? lf-JY 2uN

c. Control bowels but not bladder? 11-JY ZON

d. Not control bowels or bladder? 10Y 21_JN

e. IS catheterized? IUY zi_JN

15. Dam this patient’s behavior require more than tbe usual

norsing time because he is fergetfol, uncooperative w

disturbing?

a. No more than usual

b. Slightly mora

c, Moderately more

d. Much mere

TEM A - If patiant was not bera for full month, chack here ❑ and go to next person.

6a. Last month, what was tbe charge for his lodg~ng,meals, and noraing care? D. “.t ,.CIU+ private duty nursing. $ .

b. Mrat was the TOTAL charge foi his care last month? s .

17a. Wfnt were the sowces of payment fw h!s care fsst mmfh? Ckk .lftbt .WIY

~Own income or family support mOther public assistance

(private plans, retirement funds,

Oinitial payment - life care

or welfare

social security, etc.) DOfher - S=,$

aMedicare (Title XVIII)

DChurcb su~ort

❑ Medicaid (Title XIX)

u VA contract

b. Whatwas the PRifA4RY source of payrnmt for his care fast month? ,%k - ..Iy

I❑ Own income or family support

(private plans, retirement funds,

4 u Other public assistance So Other - S=;&

or welfare

social security, etc.) s ❑ Church support

2 UMedicari (Title XVIII) 6 I_JVA COIIh.SCt

a I_J Medicaid (Title XIX) 7 I_Jlnifial payment - life care 9nNone

Patient was not here in Oecember 1968 fj+~r ~t[.~,)

era all of fdi sources of payment fcf Oecetir 1M8?

❑ Sameas 17a-b

❑ OW income or family support

❑ Medicaid (TNle XIX) ❑ VA contract

(private p]an$ retirement funds,

oOther public assistance n Initial payment - life care

or welfare

sociai security, etc.) aChrrrc&srrpport

r_JOtber - s~j~

❑ Medicare (Title XVIH)

38 * u. s. GOVernment PRINTINGOFFIcE; 1974 543-a8u4b
VITAL AND HEALTH STATISTICS PUBLICATION SERIES

Originally Public Health Service [%blic,zti(l~! ,Y(I. i ()()()

Sevies 1. Pvoqams and collection procedures. — Reports which describe the gener]l programs of the National

Center for Health Statistics and its offices and divisions, data collection methods used, definitions,

and other material necessary for understanding the data.

Series 2. Data evaluation and methods research. — Studies of new statistical methodology including: experimental tests of new survey methods, studies of vital statistics collection methods, new analytical

techniques, objective evaluations of reliability of collected data, contributions to statistical theory.

Series 3. Analytical studies —Reports presenting analytical or interpretive studies based on vital and health

statis~cs, carrying the analysis further than the expository types of reports in the other series.

Series 4. Documents and committee reports .—Final reports of major committees concerned with vital and

health statistics, and documents such as recommended model vital registration laws and revised*

birth and death certificates.

Series 10. Data from the Health Interview 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.

Series 11. Data Jrom 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 physics [, p}]ysiological, and psychological characteristics; and (2) analysis of relationships among thr various measurements without

reference to an explicit finite universe of persons.

Swies 12. Data from the Institutional Population Surveys — Statistics relating to the heaIth characteristics of

persons in institutions, and their medical, nursing, and personal car-e received, based on national

samples of establishments providing these services and samples of the residents or patients.

Series 13. Data from the Hospital Dischnrye Survey. —Statistics relating to [!izL-:1trged patients in short-stay

hospitals, based on a sample of patient records in a national sample of hospitals.

Series 14. Data on health resources: manpower and facilities. —Statistics on the numbers, geographic distribution, and characteristics of health resources including physicians, dentists, nurses, other health

occupations, hospitals, nursing homes, and outpatient facilities.

Series 20. Dakz on mortality. —Various statistics on mortality other than as included in regular annual or

monml y reports —special analyses by cause of death, age, and other demographic variables, also

geographic and time series analyses.

Series 21. Data on natality, marriage, and divorce. —Various statistics on natality, marriage, and divorce

other than as included in regular annual or monthly reports+ pecial analyses by demographic

variables, also geographic and time series analyses, studies of fertility.

Series 22. DatQ from the National Natality and Mortality Surveys. — Statistics on characteristics of births

and deaths not available from the vital records, based on sample surveys stemming from these

records, including such topics as mortality by socioeconomic class, hospital experience in the

last year of life, medical care during pregnancy, health insurance coverage, etc.

For a list of titles of reports published in these series, write to: Office of Information

National Center for Health Statistics

PubIic Health k-vice, HRA

Rockville, Md. 20852