NATIONAL CENTER Series 12 

For HEALTH STATISTICS I Number 7 

VITAL and HEALTH STATISTICS 

DATA FROM THE NATIONAL HEALTH SURVEY 

Chronic Illness Among 

Residentsof Nursing and 

Personal Care Homes 

United States - May- June 1964 

Statistics on number of chronic conditions and impairments, 

mobility status, time interval since resident last saw doctor, 

length of stay, primary type of service, nurse or nurse’s aide 

on duty, supervisory nurse, and level of patient care in nursing 

and personal care homes Based on data collected from institutions during the period May-June 1964. 

Washington, D. C. March 1961 

U.S. DEPARTMENT OF 

HEALTH, EDUCATION, AND WELFARE Public Health Service 

John W. Gardner William H. Stewart 

Secretary Surgeon General 
Public Health Service Publication No. lOOO-Series 12-No. 7 

For sale by the Superintendent of Documents, U.S. Government Printing oilice 

Washington, D.C., 20402 - Price 35 cents 
NATIONALCENTERFOR HEALTHSTATISTICS 

FORREST E. LINDER, PH.D., Director 

THEODORE D. WOOLSEY, Deputy Director 

OSWALD K. SAGEN, PH.D., Assistant Director for State Relations 

WALT R. SIMMONS, M.A., Statistical Advisor 

PHILIP S. LAWRENCE, Sc.D., Planning Officer 

ALICE M. WATERHOUSE, M.D., Medical Consultant 

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

LOUIS R. STOLCIS, M.A., Executive Officer 

DONALD GREEN, lnfomdtion Officer 

DIVISION OF HEALTH RECORDS STATISTICS 

MONROE G. SIRKEN, PH.D., Director 

JOHN MONROE, M.S., , Assistant Director 

ARNE B. NELSON, Chief, Vital Records Survey Bm~ch 

PETER L. HURLEY, Chief, Institutional Population Survey Branch 

COOPERATlONOFTHEBUREAUOFTHECENSUS 

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. 

Public Health Service Publication No. 1000~Series 12-No. 7 

Library of Congress Catalog Card Number 6642095 
--- 

CONTENTS 

Page 

Selected Findings-----------------------------------------------------

Source and Qualifications of Data ____ _ ____ _ ___ ___-_ _ _--_____-__-_ ____ 

Health of Residents---------------------------------------------------

Number of Chronic Conditions and Impairments------------------------

Mobility Status-----------------------------------------------------

Age and Sex of Resident---------------------------------------------

Relationships Between Health and Health Services------------------------

Time Interval Since Last Saw actor _________________________________ 

primary Type ofService--------------------------------------------

Nurse or Nurse’s Aide on Duty and Supervisory Nurse------------------

Levels of Patient Care----------------------------------------------

Detailed Tables-------------------------------------------------------

Appendix I. 

A. T&&Cal Notes on Survey Design _________________________________ 

B. General Qualifications-------------------------------------------

Appendix II. 

A. Definitions of Certain Terms Used in This Report------------------

B. Classification of Homes by Type of Service------------------------

C. Rules for Coding Chronic Conditions and Impairments---------------

D. Basic List of Diagnostic Categories Reported for Residents in Nursing 

and Personal Care Homes ------_---__-__--_-_------------------

Appendix III. Resident Questionnaire and Other Survey Forms-------------

1 

2 

3 

3 

4 

5 

7 

7 

9 

11 

13 

15 

17 

29 

31 

35 

36 

36 

37 

39 
- - 

IN THIS REPORT residents of n-ursing and personal caYe homes aye described in 

terms of their health and the health services provided to tkem. The principal health 

characteristics aYe number of chronic conditions and impairments and mobility status; meaSuYes of health services inchde time interval since resident last saw doctor, primary type of service provided by the home, nuY.se OY nuYse’s aide on duty, 

SupeYvisoYy nurse, and Level of patient caYe. 

At the time of the suYvey, an estimated 554,000 residents weYe being caYed for in 

17,400 nursing OYpersonal caYe homes. Their median age was 80 years; more than 

96 percent of the residents had one OY move chronic conditions OY impairments. 

Multiple chronic conditions occuYYed frequently; the average number for all residents was 3.1 conditions. This varied fYo/om2.6 for residents UndeY 65 years to 3.4 

for those 85 and ovey. 

,Almost two-fifths of the residents weye Limited in mobility to their bed OY Yoom. AS 

number of conditions increased, the resident’s mobility decreased. The proportion 

of bed OY room limited residents increased with age. The increase was greater for 

Yoom limited residents than for bed limited ones. A higher proportion of females 

than males weYe Yoom limited and, to a lesser extent, bed Limited. 

Number of conditions was related to the interval since the resident last saw a doctor while in the home. Bed limited residents had seen a doctor moYe recently than 

others. In this respect, bed limitation was a moYe significant factor than number Of 

conditions in determining interval since doctor was last seen. 

Type of service provided was rehted to number of conditions and mobility status. 

Nursing caYe homes provided service to a Larger proportion of residents with multiple conditions than did other homes. Residents with five or more conditions constituted one-fourth of all residents in nursing caye homes compared with one-eighth 

of those in personal-care-with-nursing homes arzd one-sixteenth in personal caYe 

homes. 

Among homes having a nurse oY nurse’s aide on duty 24 ho-urs, those with a registered 

nurse supervising nursing caye had residents with more conditions than those without. Sixty percent of all residents received some hovel of nursing care dUYing the 

week prior to the survey. Level of care was associated with number of conditions 

and impairments, but many residents with multiple conditions ‘either received Only 

minor nursing service oy none at all. 

SYMBOLS 

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

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

Quantity zero---------------------------- _ 

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

Figure does not meet standards of * reliability or precision------------------
CHRONIC ILLNESSAMONG RESIDENTSOF 

NURSING AND PERSONAL CARE HOMES 

Arne B. Nelson, Division of Health Records Statistics 

SELECTED FINDINGS 

During the period May-June 1964, an estimated 554,000 persons were residents or patients 

in the Nation’s 17,400 nursing and personal care 

homes. About 94 percent of the residents were in 

homes providing some nursing care (table A). 

Residents being cared for in nursing and personal care homes were for the most part aged 

or chronically ill. Their median age was 80 years, 

and about 96 percent of them were reported to 

have one or more chronic conditions or impairments. 

More than two-thirds 

homes providing nursing 

and predominant service. 

were in homes providing 

less care than that provided 

of the residents were in 

care as their primary 

Another one-fourth 

some nursing care but 

in nursing care homes. 

These are referred to as personal-care-withnursing homes. ‘The balance of the residents (6 

percent) were domiciled in places classified as 

personal care homes. A detailed description of 

the classification procedure is given in Appendix 

II. 

A distinct characteristic of this population 

was the predominance of females. The ratio of 

Table A. Selected data on nursing and personal care homes and their residents, by primary type of service: United States, May-June 1964 

Ratio of 

Primary type of service Institutions Residents Males Females females per

100 males 

Number 

All types----------------- 17,400 ) 554,000 

Percent distribution 

Nursing care-------------------- 68 

Personal care with nursing------ 5: 26 Personal care------------------- 16 6 

Median age in years 

78 81 186 

193 

587 2 182 

75 79 142 
females to males was almost 2 to 1, although it 

varied by the type of service provided. However, 

even in personal care homes, where the ratio 

was lowest, there were 142 females for every 

100 males. 

Most residents, regardless of age, had 

several chronic conditions or impairments. The 

*average for all residents was 3.1 conditions per 

person, ranging from 2.6 for persons under 65 

years of age to 3.4 for those 85 and over. The 

relationship of number of conditions to advancing 

age is illustrated in the group of residents with 

five conditions or more, where the proportions 

range from about one-tenth for residents under 

65 years to one-fourth for those 85 andover. This 

pattern holds true for both men and women. 

Number of conditions per resident is used in 

this report as an index of the residents’ health. 

Such an index is supported by at least two findings 

in the survey. As the number of conditions increased, there was a decrease in the resident’s 

mobility and an increase in the number of physician visits. For example, only 1 percent of the 

residents with no reported conditions were bedridden compared with 29 percent of those with 

five conditions or more. About one-fifth of the 

residents with no conditions had seen a doctor 

while in the home within a month prior to the 

survey compared with one-third of the residents 

with one or two conditions; more than two-fifths 

of those with three conditions or more had seen 

a doctor within a month. 

Although a few residents with multiple conditions were in personal care homes, most of 

the very ill residents were in homes providing 

skilled nursing care. About three-fourths of the 

residents with three or four conditions and fourfifths of those with five conditions or more were 

in nursing care homes. In contrast, only onethird of the residents with no reported conditions 

were in nursing care homes. 

Almost all of the homes providing nursing 

care reported that round-the-clock nursing service was provided and that nursing care was 

supervised b>Teither a registered nurse (RN) or 

a licensed practical nurse (LPN). As number of 

conditions increased, a higher proportion of 

residents were cared for in homes employing 

RN supervisors. This is illustrated by the fact 

that 70 percent of the residents with five conditions or more were in such homes in comparison 

with one-half of the residents with no reported 

conditions. 

The data on nursing and personal services 

provided during the week prior to the survey 

indicated that the majority of residents were receiving some level of nursing care, but for the 

most part, nursing services were limited to giving 

bed baths and routine care such as taking temperature and pulse and giving enemas. Of the 60 

percent receiving nursing care, about 6 percent 

received intensive care, 46 percent were given 

full bed baths but not intensive care, 12 percent 

received less intensive care, and 36 percent were 

given routine care. (These nursing care classes 

are defined in Appendix 11.) However, many of 

the residents with multiple conditions either received only minor nursing service or received 

none at all. The level of nursing care provided 

increased as the number of conditions or impairments increased. 

SOURCE AND QUALIFICATIONS 

OF DATA 

The data in this report are based on the 

findings of a sample survey of institutions in the 

United States which provide nursing or personal 

care to the aged and chronically ill. The survey, 

commonly referred to as Resident Places Survey2 (RPS-2), was conducted during May and June 

1964 by the Division of Health Records Statistics 

in cooperation with the U.S. Bureau of the 

Census. 

The scope of RPS-2 included such institutional 

establishments as nursing homes, homes for the 

aged, and similar types of places, as well as 

geriatric hospitals. Two 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 or 

more beds for residents or patients, Thus homes 

providing only room and board to aged people 

were not within scope of the survey. 

RPS-2 was a multiple purpose survey, collecting statistics about establishments, the residents or patients domiciled in the establishments, 

and the employees in the establishments. Reports 

have been published on the number and types of 

employees and on their work experience, special 

training, and wages. lq2 This report accounts for 

2 
the health of residents as reflected by the number 

of chronic conditions and impairments reported 

for them and by the health services provided by 

the establishments. 

In order to interpret properly the statistics 

presented in this report, the reader should become familiar with the material in the appendixes. Appendix I gives a general description of 

the survey, the sampling frame used, the sample 

design, and the survey procedures. Also discussed are imputation procedures, estimation 

technique, and sampling variation. Tables and 

charts of standard errors are provided with 

illustrations of their use. Definitions of terms, 

the procedure for classifying establishments, 

and rules for diagnostic coding are shown in 

Appendix II. 

It is important to note that classification 

of the establishments in the study is based on 

the type of service provided in the home and on 

the availability of nursing staff, rather than on 

what the home is called or how it is licensed by 

the State. 

Facsimiles of questionnaires and forms used 

in the survey are shown in Appendix III. The study 

did not include an attempt to determine the prevalence of all types of chronic conditions and 

impairments; rather, it was directed toward 

those thought to have special significance for 

the aged population. These conditions are listed 

on Cards D and E in Appendix III, By the use of 

these flash cards, health data were obtained 

from nurses or other respondents who were said 

to be best acquainted with the health ofresidents. 

Also, available medical records were examined 

to determine if the patients had any other conditions not known or remembered by the respondent. 

Since much of this report is based on the 

number of chronic conditions and impairments 

which residents had, the procedures followed 

in coding conditions are especially important. 

In general, the International Classification of 

Diseases3 was used in coding conditions, supplemented by a special procedure for classifying 

impairments. The list of conditions and impairments and the rules used in the coding process 

appear in Appendix II. 

As a part of the medical coding of each 

questionnaire, the number of conditions and impairments was counted and tabulated as the 

figure for chronic illness for each resident in 

this report. The number of conditions could vary 

from one to whatever number of coded conditions 

the resident might have had. No attempt is made 

in this report to compare residents on the basis 

of the specific combination of chronic conditions 

and impairments they might have had, although 

the value of such a study is recognized. 

HEALTH OF RESIDENTS 

The objective of this portion of the analysis 

is to describe the degree of ill health of residents 

of nursing and personal care homes in terms of 

number of chronic conditions and impairments 

and mobility status. The analysis also describes 

the extent of medical and nursing care received 

by the residents while in the home on the basis 

of the time elapsed since they last saw a doctor 

and the types of nursing care they received. 

Finally, the analysis will correlate the different 

degrees of ill health of the residents with the 

levels of nursing care received. 

Number of Chronic Conditions 

and Impairments 

The data on chronic conditions and impairments presented in this report were obtained 

from proxy respondents such as nurses or other 

personnel who were considered to be the persons 

available in the homes best acquainted with the 

health of residents, Respondents reported conditions for each sample person on the basis of their 

personal knowledge supplemented by medical 

‘records. All conditions reported for a person 

were recorded on the questionnaire, and all 

such conditions were coded and tabulated for this 

analysis. It should be pointed out, however, that 

every chronic condition or impairment a person 

had may not have been reported, since only certain ones were specifically asked for. Those asked 

about, listed in Appendix III, were the ones 

thought to be most relevant to this population. 

An estimated 96 percent of the residents had 

one or more chronic conditions or impairments 

as shown in table 1; the average (mean) was 3.1 

conditions per person. Four-fifths of the residents had two conditions or more, while onefifth of them had five conditions or more. 

3 
PERCENT DISTRJBUTION 

II 20 40 60 80 100 

I 1 . I I I I 

Age grcmp 

All ages-... 

Under 65 

years...... 

65-74 

years...... 

85 years 

and over.. 

Number of conditions 

Figure I. Percent distribution of‘ residents in 

nursing and personal care homes, by number of 

chronic conditions and impairments according to 

age. 

This large number of conditions per person 

prevailed regardless of age; the average ranged 

from 2.6 conditions per person for residents 

under 65 years to 3.4 conditions for those 85 

and over. For those in the intermediate age 

groups, 65-74 and 75-84, the means were about 

the same, 3.0 and 3.1 conditions per person, 

respectively. This relationship of increasing 

number of conditions with advancing age is also 

evident from figure 1, especially when residents 

with five conditions or more are compared by age. 

Only 12 percent of the residents under 65 years 

of age had five conditions or more, compared 

with 26 percent of those 85 and over. 

The data also indicate that the average number of chronic conditions and impairments was 

similar for both men and women (a mean of 3.1 

conditions per person for each) and that there 

was little variation by sex when age was considered. 

Mobility Status 

The number of chronic conditions furnishes 

a general indication of the health of residents. 

Some of the implications of the health levels are 

to be found in the resident’s ability to get out of 

bed, to walk, and to leave the premises. 

The respondent was asked the following questions about the resident: “Does he stay in bed all 

or most of the day?‘I “Does he stay in his own 

room all or most of the day?” and “Does he go off 

the premises just to walk, shop, or visit with 

friends or relatives and so forth?” The residents 

for whom “yes” was checked for the question 

“Does he stay in bed all or most of the day” 

are defined in this report as being bed limited. 

Those for whom “yes” was checked for ‘Does 

he stay in his room all or most of the day” are 

defined as room limited. The remaining residents, 

for whom “yes” or “no” was checked for “Does 

he go off the premises just to walk, shop, or visit 

with friends or relatives and so forth,” are defined as neither bed nor room limited. Residents 

who were routinely taken out of the room in a 

wheel chair for most of the day were considered 

neither bed nor room limited and thus were included as a part of this last group. 

In this discussion it is recognized that bed 

limitation also entails room limitation and that 

comparison between the two is based on the degree of limitation. Characteristics of the resident such as age, sex, and number of chronic 

conditions are discussed in relation to the factor 

of mobility (table 1). Data collected in the first 

Resident Places Survey (RPS-1) have shown 

mobility to be closely associated $ith age of resident.* Differences were also observed in the 

mobility status of ma les and females. Another 

variable related to mobility is the health of the 

individual as indicated by the number of chronic 

conditions and impairments. 

Almost two-fifths of the residents were 

limited either to bed or to room. As the number 

of conditions increased, bed and ream limitation 

also increased. About one-fifth of the residents 

with three to four conditions were bed limited 

as opposed to almost three-tenths of the residents with five conditions or more. Of the 

residents with one or two conditions, 18 percent 

were room limited compared with 25 percent of 

those with three conditions or more. 

4 
Age and Sex of Resident 

Residents of nursing and personal care homes 

were, for the most part, aged; the median age of 

all residents was about 80 years (table 2). Females were, on the average, older than males. 

Approximately three-fourths of the females were 

aged 75 years and over compared with threefifths of the males. 

Patient mobility decreased with age (fig. 2). 

However, only at age 85 or over was there a 

significantly higher proportion of bed limited 

persons than at lower ages, while the proportion 

of those who were room limited was significantly 

greater at each succeeding age group. There 

tended to be about the same proportion of bed 

and room limited residents at the lower age 

groups. For the oldest age groups a larger percent of residents were room limited than bed 

limited. Of residents under 65 years, 13 percent 

were bed limited; for those in age groups 65-74 

and 75-84 this figure was 16 percent, and at 85 

and over, one-fifth were limited to bed. The 

proportion of room limited residents was signif30 

ROOM YMITATION 

Under 65 years 65-74 years 

PERCENT DISTRIBUTION 

0 20 40 60 80 100 

I 1 I I I I 

Age sroup 

h&r 65 

years . . . ..-

85 years 

and over-. 

Neither bed 

nor rwm 

limitation 

Figure 2. Percent distribution of residents in 

nursing and personal care homes, by mobility 

status according to age. 

BED LJMITATION 

MALE FEMALE 

Figure 3. Percent of residents in nursing and personal care homes with mobility status, by sex and age. 

5 
------------------------------------ 

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

Table B. Percent distribution of residents, by mobility status according to number of 

chronic conditions and impairments and sex: United States, May-June 1964 

Mobility status 

Number of Number of chronic conditions and sex residents Bed Room Neither 

limitaAll conditions 

Both sexes------------------------

Male ------__------_---------------------

Female ------_-_---___-------------------

No conditions 

Both sexes------------------------

Male------------------------------------

Female----------------------------------

1-2 conditions 

Both sexes------------------------

Male------------------------------------

Female----------------------------------

3-4 conditions 

Both sexes------------------------

Male

Female----------------------------------

5 conditions or more 

Both sexes------------------------

Male------------------------------------

Total limita- limitation tion tion 

Percent distribution 

554,000 I 100 17 21 

132E 100 18 23 

20,400 100 5 

6,800 

13,600 

100 

100 

4 

5 

221,700 100 18 

78,200

143,500 

100 

100 

12 

21 

201,100 100 24 

69,400 

131) 700 

100 

100 2 

110,700 100 26 

100 15 17

> 

Female ---w-wicantly higher than the proportion of bed limited 

residents at ages 75-84 and 85 or over. 

Mobility limitation was more closely associated with number of conditions than with age. The 

percent of bed limited residents within each condition level was with few exceptions about the same 

for each age group atthat level. There were, however, significant differences in the proportion of 

bedridden residents among residents in different 

condition levels within the same age interval. For 

example, at age 8.5 or over, 3 percent of the residents with no conditions were bedridden, as were 

6 

100 

100 

one-eighth of those with one or two conditions, 

over one-fifth with three to four conditions, and 

one-third with five conditions or more. 

For all condition levels a higher proportion 

of females than males were limited to room 

(table B). However, there were no significant 

differences in bed limitation for males and females, regardless of the number of conditions. 

Sex differences by age held more consistently for room limitation than for bed limitation, 

as shown in figure 3. The proportion of females 

with bed limitation was significantly higher than 

62 
-- 

Table C. Percent distribution of residents, by time interval since last saw doctor 

while in home according to number of chronic conditions and impairments : United 

States, May-June 1964 

Number of chronic conditions 

Time interval since 

last saw doctor All No l-2 3-4 5 

conditions conditions conditions conditions conditions 

or more 

Number of residents-- 554,000 20,400 221,700 201,100 llO,?OO 

All intervals--------

Under 1 month------------

1-2 months---------------

3-5 months---------------

6-11 ~nths--------------

1 year or more-----------

Not seen while in home--­

the proportion of males at ages under 6.5years. 

At 85 and over, the proportion of bed limited 

males and females was about equal. For room 

limitation there were differences by sex at each 

age level; however, the proportion of females who 

were room restricted most greatly exceeded 

that of males at ages under 65 and over 85. 

RELATIONSHIPS BETWEEN HEALTH 

AND HEALTH SERVICES 

Number of conditions as a measure of degrees of ill health and limitation of mobility 

are studied in this section against some of the 

variables of health services. Since both bed and 

room limitation were found to be associated with 

number of chronic conditions, it is useful to see 

how they are distributed against health services. 

Because the general burden of nursing care is 

closely related to patient mobility, the specific 

levels of mobility give helpful information as to 

where the principal burden of patient care existed. 

The variables reflecting health services 

which will be studied in this portion of the report 

are as follows: time interval since the resident 

last saw a doctor while in the home, primary type 

Percent distribution 

of service, whether a nurse or nurse’s aide was 

on duty 24 hours a day, supervisory nurse, and 

level of patient care provided in the home during 

the week prior to the date of the survey. Tables 

3-8 contain data relating to these distributions. 

Time Interval Since Last Saw Doctor 

Tables C and 3 show a pronounceddifference 

between residents with chronic conditions and 

those with no conditions in regard to whether they 

had seen a doctor since entering the home. For 

persons free of chronic conditions, about four out 

of five had seen a doctor since entering the home; 

this is in comparison with 94 percent, 97 percent, 

and 99 percent for persons with one or two conditions, three or four conditions, and five conditions or more, respectively. Also, it is apparent 

that the greater the number of conditions that a 

person had, the shorter the interval since he had 

last seen a doctor. This is shown in table C by 

the higher proportions at each condition level 

for residents who had seen a doctor either during 

the last month or within 1 or 2 months. A small 

proportion of residents with chronic conditions 

had not seen a doctor in over a year. 

7 
-------- 

Table D. Percent distribution of residents, by time interval since last saw doctor 

while in home according to length of stay in home: United States, May-June 1964 

Time interval since 

last saw doctor 

Number of residents-­

All intervals--------

Under 1 month------------

1-2 months---------------

3-5 months---------------

6-11 months--------------

1 year or more-----------

Not seen while in home---

A larger proportion of residents with long 

lengths of stay could be expected to have seen 

a doctor than residents with short lengthsofstay. 

This is borne out in tables D and 4 by the fact 

that about one-tenth of the residents with a stay 

of less than 6 months had not seen a doctor comLength of stay in home 

Percent distribution 

pared with smaller proportions of residents with 

longer lengths of stay. The extent to which the 

condition of a resident is related to his length 

of stay would have some influence on the time 

interval since he last saw a doctor. However, 

table 3 indicates that there are no important 

Table E. Percent distribution of residents, by time interval since last saw doctor 

while in home according to mobility status: United States, May-June 1964 

Mobility status 

Time interval since last saw doctor Bed Room Neither 

Total limi- limi- limitation tation tation 

Number of residents------------------------ 554,000 92,200 116,900 344,900 

Percent distribution 

6-11 

All intervals -----_--_----_--_------------- 100 100 1 -100 1 100 

I I 

Under 1 month --_-----------_----_---------------- 39 49 

l-2 months ---_--------_--_-----------------------

3-5 months ---_-_--------___--_------------- --.m-w- 2: 9;

4 

2

months ------------------------------- -c-----

1 year or more ----------_---------____c__ :: 

Not seen while in home--------------------_______ L4 2 

8 
Table F. Median time interval in months since resident last saw doctor while in home,

by mobility status and number of chronic conditions and impairments: United States,

May-June 1964 

Mobility status 

Number of chronic conditions 

All conditions-----------------------------

No conditions------------------------------------

1 condition--------------------------------------

2 conditions-------------------------------------

3 conditions-------------------------------------

4 conditions-------------------------------------

5 conditions or more----------------------------­

differences in lengths of stay of residents with 

different numbers of chronic conditions. 

In table E it is shown that bed limited residents saw a doctor more recently than either 

room limited persons or those not limited; almost 

one-half of the bed limited residents had seen a 

doctor within the past month as opposed to 38 

percent of room limited residents and 36 percent 

of those not limited. The proportion of roomlimited residents who had seen a doctor 1 or 2 

months previously was significantly higher than 

the proportion of those who were bed limited and 

was about the same for those who were not limited. 

A small percent in each group (2-5percent) had 

not seen a doctor for more than a year. 

The median time periods since the residents 

iast saw a doctor, shown in table F, indicate a 

relationship with number of conditions and limitation of mobility. It is apparent either that 

being bedridden is the principal factor influencing recency of doctor visits, or, possibly, that 

having seen a doctor leads to a change in mobility 

status. The median time interval since last seeing a doctor for bed limited persons was constant 

at 1 month for all condition levels; the median 

was higher at each condition level for room limited persons and for those not limited. However, 

the differences were not statistically significant 

All 

residents Bed Room Neither 

lid- limi- limitation tation tation 

Median time interval in months 

1.5 1.0 1.6 1.6 

1:0 X 

throughout. Number of conditions apparently was 

not a factor in determining the time interval 

since the resident last saw a doctor forresidents 

who were neither bed nor room limited. A comparatively long interval since the resident last 

saw a doctor (2.4 months) was evident for residents with no conditions who were neither bed nor 

room limited. 

Primary Type of Service 

The primary function of nursing and personal 

care homes is to provide the type of care which 

is commensurate with the needs of the residents. 

Since these homes are classified according to the 

primary and predominant type of service provided 

for residents, their classification is a general 

indication of the type of service available in the 

home. Number of conditions is a rough measure 

of the residents’ needs for health services. The 

resident is described in this section in terms of 

number of conditions and mobility status by primary type of service provided in the home. The 

data on which the discussions are based are 

contained in table 5. 

Residents with multiple chronic conditions 

were found in varying proportions in homes, 

depending on how they were classified by type of 

9 
-------------------------- 

Table G. Percent distribution of residents by primary type of service according to 

number of chronic conditions and impaknents: United States, May-June 1964 

Primary type of service 

Number of chronic conditions 

Number of residents---------------------

All conditions--------------------------

No conditions ------------------_-___________c_ 

l-2 conditions -------------------_------------ 3-4 conditions--------------------------------

5 conditions or more 

service. As indicated in table G, the proportion 

of residents with multiple conditions was higher 

in homes providing different degrees of nursing 

care services than in homes not providing nursing 

care. 

In nursing care homes almost one-fourth of 

the residents had five conditions or more; in 

personal-care-with-nursing homes about oneeighth had five conditions or more, and in personal care homes the proportion was 1 in 16 

(table 5). A somewhat similar relationship existed 

for residents with three or four conditions; two 

out of five residents in nursing care homes had 

three or four conditions, as did slightly over 

three-tenths of the residents in personal-carewith-nursing homes and just over one-fifth of 

the residents in personal care homes. Conversely, 

the proportion of residents with no conditions 

was larger in homes providing personal care 

services only than in other types of homes. In 

personal care homes, almost one-tenth of the 

residents had no conditions compared with 7 

percent in personal-care-with-nursing homes and 

2 percent in nursing care homes. 

The mobility status of residents corresponded 

generally with the primary type of service provided in the home. Figure 4 and table 5 show 

that one-fifth of the residents in nursing care 

homes were bed limited compared with onePersonal All Nursing care with Personal 

x=s care nursing care 

554,000 373,300 145,400 35,300 

Percent distribution 

100 100 100 100 

2 

4: 4; 2; ‘% 21 

24 6 

tenth of the residents in personal-cal-e-withnursing homes and less than 2 percent of those 

in personal care homes. The distribution of 

room limited residents was somewhat similar: 

about one-fourth of the residents in nursing care 

homes were room limited compared with onesixth and one-tenth of the residents in personalcare-with-nursing atid personal care homes, 

respectively. 

-l 

PERCENT DISTFUBUTION 

0 20 40 60 80 10( 

pi%’ I I I I I 

service 

Nursing 

care . . . . . . . . . 

Personal 

care with 

nursing . ..-1 

Pt?l-60X%1 

care .._...... 

Figure 4. Percent distribution of residents of 

nursing and personal care homes, by mobilrty 

status according to primary type of service. 

10 
Nurse or Nurse’s Aide on Duty 

and Supervisory Nurse 

More specific information on the available 

nursing care services is provided by whether a 

home hada nurse or nurse’s aide on duty 24 hours 

a day and by the type of supervisory nurse. This 

grouping is in addition to categorization by primary type of service. Personal care homes by 

definition do not provide nursing care. All three 

types of homes are included in the analysis which 

follows. 

Almost nine-tenths of the residents were in 

homes which had a nurse or nurse’s aide on duty 

24 hours a day (table 6). Only 5 percent were in 

homes which had a nurse or nurse’s aide on duty 

less than 24 hours per day. The balance of the 

residents, 6 percent, were in homes which did 

not provide nursing service. 

In relation to all homes, in those where a 

nurse or nurse’s aide was on duty 24 hours an 

RN provided supervision for 64 percent of all 

residents. As shown in figure 5 and table6, residents with a greater number of chronic conditions 

were more commonly found in these homes. For 

example, approximately one-half of the residents 

with no conditions were in these homes, and this 

figure was greater at each condition level, reaching seven-tenths for residents with five conditions 

PERCENT DI?.TMBUTfON 

0 20 40 00 80 100 

I I I I I Number of 

ccmdltione 

All 

conditions--..--

3-4 

cmditions..----

Nurse or 

IvJnm’S aide 

on duty 

24 hours 

RN nor LPN 

Figure 5. Percent distribution of residents of 

nursing and personal care homes, by nurse or 

nurse's aide on duty and supervisory nurse according to number of chronic conditions and impairments. 

Table H. Mean number of chronic conditions and impairments,by supervisory nurse and 

nurse or nurse’s aide on duty: United States, May-June 1964 

Nurse or nurse's 

aide on duty Nursing All Supervisory nurse residents care not 

Less than provided 

24 hours 24 hours 

Mean number of chronic conditions 

and impairments 

Total ---------_-_------_-____________ 3.1 3.2 2.6 2.0 

RN supervisor -----_-_--_------_____________ 

LPN supervisor -_____-_-____-_---_---------- Neither m nor LPN-------------------------

2.8 . . . . . . . . . 

11 
or more. As number of conditions increased, 

there were minor increases in the proportion of 

LPN’s providing supervision, varying from 15 

to 20 percent; the proportion having “other” 

nurse in charge gradually declined. 

In homes having a nurse or nurse’s aide on 

duty less than 24 hours there were no statistically 

significant differences within each category of 

type of nurse in charge by various condition 

levels. 

Table H shows the mean number of conditions 

by type of supervisory nurse and by whether a 

nurse or nurse’s aide was on duty 24 hours a 

day. The principal differences disclosed by this 

table were related to whether the home had a 

nurse on duty 24 hours a day. The mean number 

of conditions varied from an average of 3.2 

conditions for homes with a nurse on duty 24 

hours to 2.6 for those with a nurse on duty less 

than 24 hours and to 2.0 for those with no nurse 

or nurse’s aide on duty. The differences in the 

table were statistically significant only between 

the categories for nurse on duty 24 hours and 

for nursing care not provided. This difference 

held consistently by type of supervisory nurse. 

The mean number of conditions was the same in 

PERCENT DISTRIBUTION 

0 20 40 60 60 100 Mobility 

e ’ I I I I I 

Bed 

limitation-~ 

Neither bed 

Ilox room 

IimitatIon.-, 

Nurse or nurse’s aide 

on duty less than 24 hours 

Nursing care 

not provided 

Figure 6. Percent distribution of residents in 

nursing and personal care homes, by nurse or 

nurse's aide on duty and supervisory nurse according to mobility status. 

Table J. Percent distribution of residents, by time interval since last saw a doctor 

while in home according to nurse or nurse’s aide on duty and supervisory nurse: 

United States, May-June 1964 

Time interval since 

last saw doctor 

All intervals--------

Under 1 month------------

1-2 months---------------

3-5 months---------------

6-11 months--------------

1 year or more-----------

Not seen while in home---

12 
homes having an RN or LPN supervisor, but the 

average number of conditions was less in those 

having “other” nurse in charge. 

As shown in figure 6, in homes with a nurse 

or nurse’s aide on duty 24 hours (RNsupervisor), 

the proportion of residents who were bed limited 

was significantly higher than the proportion not 

limited to room or bed and moderately higher 

than those who were room limited. A significantly 

larger proportion of bed or room limited residents than residents who were not limited were 

in homes with an LPN supervisor. In homes 

where nursing care was not provided, a small 

proportion of persons were limited to bed (under 

1 percent), an increasing proportion were limited 

to room (3 percent), and a considerably larger 

proportion were not limited to room or bed 

(9 percent). 

Whether a person had seen a doctor recently 

had important implications from the viewpoint of 

the nurse or nurse’s aide on duty and the supervisory nurse. In homes having a nurse or nurse’s 

aide on duty 24 hours, a doctor was seen more 

recently in the homes where an RN was supervisor than in other homes (tables J and 7). Likewise, the proportion of residents who had not 

seen a doctor was lower in homes having an RN 

supervisor than in those with an LPN or “other” 

nurse as supervisor. The differences were statistically significant only between RN supervisor 

and LPN supervisor. 

The proportion of residents who had not seen 

a doctor since entering the home was generally 

higher in homes where nursing care was not 

provided than in the other homes. 

The median number of months since the resident last saw a doctor, by type of supervisory 

nurse and by whether a nurse or nurse’s aide 

was on duty 24 hours, is shown in table K. This 

table reveals an increasing time period since 

last saw a doctor as the availability of a nurse 

in the home declined. The relationship maintained 

for homes with an RN supervisor and “other” 

nurse in charge, but not for LPN supervisor. 

For homes having a nurse on duty 24 hours, the 

median number of months increased as level 

of nursing supervision declined. For RN or LPN 

supervisor as compared with “other” nurse in 

charge, the same pattern was apparent in homes 

with a nurse on duty less than 24 hours. 

Table K. Median time period since resident last saw a doctor while in home,

by nurse or nurse’s aide on duty and 

supervisory nurse: United States, MayJune 1964 

Nurse or 

nurse’s 

aide on 

Supervisory 

nurse 

Nursing 

care not

provided 

Median time period

in months 

Total------ 1.4 1.9 2.1 

RN supervisor---- LPN supervisor---

Neither RN 

1.3 

1.7 

1.9 

1.6 . . . . . . 

nor LpN--------- 1.8 2.2 . . . I I 1 

Levels of Patient Care 

The respondent was asked, “During the past 

7 days which of these services did this resident 

(patient) receive?” A list of nursing and personal 

care services as contained in Card F, Appendix 

III, was then shown to the respondent. Each 

service mentioned by the respondent was checked 

on the questionnaire. The services varied from 

intensive nursing care services to personal care 

services. Based on an appraisal of the intensiveness of care and possible condition of the resident, these services have been grouped according to the procedure described in Appendix II. 

The levels of services have been related to the 

number of conditions to see if the services rendered were somewhat commensurate with the 

resident’s health condition. 

Figure 7 shows that of the total residents, 

three-fifths received one or more nursing care 

services during the week preceding the survey. 

Over one-fourth received personal care services 

only, and 13 percent received none of the services 

listed. The nursing care services were for the ,. 

13 
PERCENT DISTRIBUTION 

Number of 

conditions 

All 

c0nditions 

No 

conditions 

1 

condition 

2 

conditions 

3 

conditions 

5 

conditions 

or more 

0 20 40 60 80 100 

1 

Intensive . . . . . . . . . . . . . . 

Bed bath, 

excluding intensive 

Routine . . . . . . . . . . . . . . -. 

Neither nursing 

care nor 

personal care .. ..-. 

Figure 7. Percent distribution of residents of nursing and personal care homes, by level of patient 

care according to number of chronic conditions and impairments. 

most part limited to giving bed baths and routine care including taking pulse and giving enemas. 

Only 4 percent of all residents received 

intensive care; 27 percent, full bed baths but 

not intensive care; 7 percent, less intensive 

care; and 22 percent, routine nursing care. 

The level of patient care provided was 

associated with the number of conditions or 

impairments (table 8). The proportion of residents receiving intensive care services increased 

with each increase in number of conditions. 

However, the differences were not statistically 

significant throughout. In contrast, the proportion 

of residents receiving full bed bath, excluding 

intensive nursing services, increased considerably with each increase in number of conditions. 

The differences were statistically significant 

between each condition level. Likewise, there 

were general increases in the proportion of 

residents who received less intensive services, 

but the differences were irregular. For residents 

who received routine services, only minor differences were noted for persons who had two 

conditions or more, but the differences were 

statistically significant between no conditions 

and one or two conditions. 

Looking. at the data from the opposite viewpoint, almost one-fourth of the residents with 

two or more conditions were receiving only 

routine nursing services. A large proportion of 

residents with multiple conditions were receiving 

personal care services only, and some were 

receiving neither nursing nor personal care 

service. This proportion varied from 15 percent 

of those with two conditions to 3 percent of those 

with five conditions or more. The proportion of 

those receiving personal care varied from onethird of the residents with one or two conditions 

down to 14 percent of those with five conditions 

or more. 

The distribution of services among residents 

with no conditions lends consistency to the value 

14 
of using number of conditions as a measure of 

health. More than two-thirds of these residents 

received no type of service, and more than onefifth received personal care only. As to thenursing services, 7 percent received routine service 

only, and the remaining 4 percent receivedeither 

full bed bath excluding intensive care or less intensive services. 

REFERENCES 

lNationa1 Center for Health Statistics: Employees in nursrng and personal care homes, United States, May-June 1964. 

VitaZandHeaZth Statistics. PHSPub.No. 1000Series 12-No. 5. 

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

Office, Sept. 1966. 

2National Center for Health Statistics: Employees in nursing and personal care homes: number, work experience, special training, and wages, United States, May-June 1964. Vital 

and Health Slatistics. PHS Pub. h’o. 1000.Series 12-No. 6. 

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

Office, Jan. 1967. 

000 

3World Health Organization: Manual of the International 

Statistical Classification of Diseases, Injuries, and Causes 

of Death, Based on the Recommendations of the Seventh Revision Conference, 1955. Geneva, Switzerland, 1957. 

4National Center for Health Statistics: Characteristics of 

residents in institutions for theaged and chronically ill, United 

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

Pub. No. lOOO-Series 12-No. 2. Public Health Service. Washington. U.S. Government Printing Office, Sept. 1965. 

5National Center for Health Statistics: Development and 

maintenance of a national inventory of hospitals and institutions. Vital and HeaZth Statistics. PBS Pub. No. lOOO-series 

l-No. 3. Public Health Service. Washington. U.S. Goternment Printing Office, Feb. 1965. 

6National Center for Health Statistics: Origin, program, 

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

Health Statistics. PHS Pub. No. IOOO-Series l-No. 1. Public 

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

Aug. 1963. 

7National Center for Health Statistics: Iledical Coding Manual and the Short Index. IiHS-HISli’.OO. PublicHealthService. 

Washington, D.C., July 1964. 

15 
Table 1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

9. 

DETAILED TABLES 

Number and percent distribution of residents of nursing and personal care homes, by sex and mobility status according to number of chronic conditions and impair­ ments and age: United States, May-June 1964 -------------------------------------

Number and percent distribution of residents of nursing and personal care homes, by sex and age according to primary typeof service: United States,May-June 1964-

Number and percent distribution of residents of nursing and personal care homes, by time interval since last saw doctor according to number of chronic conditions and impairments and length of stay: United States, May-June 1964----------

Number and percent distribution of residents of nursing and personal care homes, by time interval since last saw doctor in home according to number of chronic 

conditions and impairments and mobility status: United States, May-June 1964----

Number and percent distribution of residents of nursing and personal care homes, by primary type of service and mobility status according to number of chronic 

conditions and impairments and age: United States, May-June 1964----------------

Number and percent distribution of residents of nursing and personal care homes, b nurse or nurse's aide on duty and supervisory nurse according to number of 

cii ronic conditions and impairments and mobility 1964----------_----------------------------------------------------------------- status: United States, May-June 

Number and percent distribution of residents of nursing and personal care homes, by nurse or nurse's aide on duty and supervisory nurse according to number of 

chronic conditions and impairments and time interval since last saw doctor while 

-Jn hoa: United States, My-June 1964-------------------------------------------

Number and percent distribution of residents of nursing and personal care homes, by level of patient care according to number of chronic conditions and impairments: United States, May-June 1964---------------------------------------------

Civilian resident population aged 21 years and over usedinobtaining rates shown 

in this publication, by sex and age: United States, July 1, 1964----------------

Page 

18 

20 

21 

22 

24 

26 

27 

28 

28 

17 
Table 1. Number and percent distribution of residents of nursing and personal care homes, by sex 

and mobility status according to number of chronic conditions and impairments and age: United 

States, May-June 1964 

-

T Both sexes 1 

Number of chronic conditions, impairments, Mobility status 

and age Number 

of 

residents Total w 

All conditions Percent distribution 

All ages--------------------------------- 554,000 100.0 16.6 21.1 62.3 

Under 65 years--------------------------------- 66,200 100.0 12.7 12.9 74.4 

65-74 years------------------------------------ 104,500 100.0 15.6 17.3 67.1 

75-84 years------------------------------------ 230,900 100.0 15.8 21.3 62.9 

85 years and over------------------------------ 152,400 100.0 20.3 27.1 52.6 

No conditions 

Al1 ages--------------------------------- 20,400 100.0 1.3 4.5 94.2 

Under 65 years--------------------------------- 1,800 100.0 3.0 97.0 

65-74 years------------------------------------ 3,700 100.0 1.4 4.3 94.3 

75-84 years------------------------------------ 10,100 100.0 0.5 4.0 95.6 

85 years and over------------------------------ 4,900 100.0 3.2 6.4 90.4 

1-2 conditions 

All ages--------------------------------- 221,700 100.0 9.5 17.9 72.6 

Under 65 years-------------------------------,, 34,700 100.0 9.4 9.9 80.7 

65-74 years------------------------------------ 46,100 100.0 a.2 14.3 77.5 

75-84 years------------------------------------ 86,600 100.0. a.5 19.0 72.5 

85 years and over------------------------------ 54,300 100.0 12; 1 24.6 63.2 

3-4 conditions 

All ages--------------------------------- 201,100 100.0 19.2 23.4 57.3 

Under 65 years.--------------------------------- 22,100 100.0 15.9 14.9 69.2 

65-74 years------------------------------------ 37,200 100.0 19.0 20.2 60.8 

75-84 years------------------------------------ 87,500 100.0 19.1 23.8 57.2 

85 years and over------------------------------ 54,300 100.0 21.0 28.7 50.3 

5 conditions or more 

All ages--------------------------------- 110,700 100.0 29.1 26.2 44.7 

Under 65 years--------------------------------- 7,600 100.0 21.2 23.1 55.7 

65-74 years------------------------------------ 17,500 100.0 30.9 21. a 47.2 

75-84 years------------------------------------ 46,700 100.0 26.6 24.6 48.8 

85 years and over------------------------------ 39,000 100.0 32.9 30.7 36.4 

18 
Table 1. Number and percent distribution of residents of nursing and personal care homes, by sex 

and mobility status according to number of chronic conditions and impairments and age: United 

States, May-June 1964-Con. -

Male T Female 

Mobility status Mobility status 

Number Number 

of 

residents 

of 

residents Total 

Bed 

limiRoom 

limiNeither limi- Itation tation tation 

Percent distribution Percent distribution 

193,800 100.0 

36,200 100.0 

40,400 100.0 

74,100 100.0 

43,100 100.0 

6,800 100.0 

1,200 100.0 

900 100.0 

2,900 100.0 

1,700 100.0 

78,200 100.0 

19,500 100.0 

18,200 100.0 

25,400 100.0 

15,100 100.0 

69.400 100.0 

11,400 100.0 

14,200 100.0 

28,600 100.0 

15,100 100.0 

39,400 100.0 

4,000 100.0 

7;100 100.0 

17,100 100.0 

11,200 100.0 

15.1 17.1 67.8 360,200 100.0 - 17.5 23.3 59.3 

10.1 8.9 81.0 30,000 100.0 15.8 17.7 66.5 

14.1 16.3 69.6 64,000 100.0 16.5 18.0 65.5 

15.0 19.4 65.6 156,800 100.0 16.2 22.1 61.7 

20.4 20.8 58.8 109,300 100.0 20.3 29.5 50.2 

3.9 96.1 13,600 100.0 1.9 4.8 93.3 

4.3 95.7 600 100.0 100.0 

5.6 94.4 2,700 100.0 1.9 3.9 94.2 

3.5 96.5 7,100 100.0 0.7 4.1 95.2 

3.3 96.7 3,200 100.0 4.9 8.1 87.1 

9.2 12.1 78.8 143,500 100.0 9.6 21.2 69.2 

8.2 5.1 86.6 15,100 100.0 11.0 16.0 73.0 

6.2 10.2 83.6 28,000 100.0 9.5 16.9 73.6 

8.5 16.3 75.2 61,200 100.0 8.5 20.1 71.4 

14.9 16.2 68.8 39,200 100.0 11.0 27.9 61.1 

16.6 21.0 62.4 131,700 100.0 20.6 24.7 54.6 

11.4 12.0 76.6 10,700 100.0 20.7 17.9 61.4 

18.2 22.3 59.6 22,900 100.0 19.5 18.9 61.6 

16.7 22.6 60.7 58,800 100.0 20.2 24.3 55.5 

18.8 23.6 57.6 39,200 100.0 21.9 30.6 47.5 

26.9 22.3 50.7 71,400 100.0 30.3 28.3 41.3 

18.6 19.4 61.9 3,600 100.0 24.2 27.2 48.7 

28.2 21.0 50.7 10,400 100.0 32.8 22.4 44.9 

24.4 21.3 54.3 29,600 100.0 27.9 26.5 45.6 

33.1 25.8 41.1 27,800 100.0 32.8 32.7 34.5 

19 
Table 2. Number and percent distribution of residents of nursing and personal care homes, by sex 

and age according to primary type of service: United States, May-June 1964 

Primary type of service 

Sex and age Number of 

residents 

j 

Both sexes Percent distribution 

All ages---------------------------------- 554,000 100.0 100.0 100.0 100.0 

Under 65 years---------------------------------- 66,200 11.9 10.9 12.7 20.4 

65-74 years------------------------------------- 104,500 18.9 19.2 18.0 18.8 

75-84 years------------------------------------- 230,900 41.7 41.5 42.6 39.8 

85 years and over------------------------------- 152,400 27.5 28.4 26.8 21.1 

Male 

All ages---------------------------------- 193,800 100.0 100.0 100.0 100.0 

Under 65 years---------------------------------- 36,200 18.7 15.8 22.1 32.1 

65-74 years------------------------------------- 40,400 20.9 20.8 21.7 18.3 

75-84 years------------------------------------- 74,100 38.2 40.2 34.9 32.9 

85 years and over------------------------------- 43,100 22.2 23.3 21.3 16.7 

Female 

All ages---------------------------------- 360,200 100.0 100.0 100 .o 100.0 

Under 65 years---------------------------------- 30,000 8.3 8.3 7.5 12.2 

65-74 years------------------------------------- 64,000 17.8 18'.4 15.9 19.1 

75-84 years------------------------------------- 156,800 43.5 42.2 46.8 44.6 

85 years and over------------------------------- 109,300 30.4 31.1 29.8 24.1 

20 
Table 3. Number and percent distribution of residents of nursing and personal care homes, by time 

interval since last saw doctor according to number of chronic conditions and impairments and 

length of stay: United States, May-June 1964 

-

Number of chronic Number T Time interval since last saw doctor 

of conditions and length of resi- All Under lm2 stay dents 1 interva .S month months 

All conditions Percent distribution 

Total---------------- 554,ooc 100 .( 38.7 35.s 11.1 6.: 3.5 4.3 

Under 6 months------------- 106,5OC 1oo.c 49.4 6.: 6-11 months---------------- 77,7OC 100 .c 40.0 1-2 years------------------ 113,ooc 100 .c 35.3 :"L-; 4.; 2-3 years------------------ 76,lOC 100 .c 11:7 

5 years or more------------ 98,200 1oo.c 3614 13.7 7:E 

No conditions 

Total ----___________- 20,400 100 .c 20.2 12.4 8.1 18.7 

Under 6 months-------------

6-11 months----------------

1-2 years------------------

2-3 years------------------

3-5 years------------------

5 years or more------------

3,800 

1,900 

3,600 

2,900 

3,600 

4,600 

1oo.a 

100.0 

100 .a 

100 .a 

100.0 

100 .o 

19.8 

16.1 

16.8 

26.8 

22.4 

18.8 

29.: 

30.1 

30.E 

23.2 

32.5 

27.4 

9.6 

8.3 

11.7 

17.5 

12.1 

14.1 

29.5 

:32*: 

5:i 

16.: 

1::: 

1;:: 

41.3 

15.7 

18.4 

8.7 

20.1 

6.6 

1-2 conditions 

Total---------------- 221,700 100 .o 34.6 34.6 12.4 7.i 5.2 6.0 

3-5 years------------------ 82,4OC 100 .c E-Z 13.9 E 

Under 6 months------------- 45,400 100 .o 45.3 33.5 13.3 6-11 months---------------- 30,600 100.0 38.0 34.0 11'92 10.: 6.3 1-2 years------------------ 45,400 100.0 31.1 36.6 13:9

2-3 years------------------ 28,400 100.0 37.8 11.7 ;:5 5:; 2; 3-5 years------------------ 30,500 100 .o % 37.5 15.1 9:i 

5 years or more------------ 41,400 100.0 31:9 29.6 15.0 9.6 1;:: 32:: 

3-4 conditions 

Total- ----___________ ~01,100 100.0 41.8 36.4 10.5 5.4 3.0 

Under 6 months------------- 38,600 100 .o 53.8 33.4 5.6 6-11 months---------------- 30,200 100 .o 41.2 40.4 10.2 1-2 years------------------ 100 .o 38.3 40.1 2:: 4.; 2-3 years------------------ 4:%z 100 .o 40.4 35.8 193.2 3.6 3-5 years------------------ 301400 100.0 36.5 35.0 13:2 E 

5 years or more------------ 32,700 100.0 38.7 33.5 13.4 8:l ::: 

5 conditions or more 

Total--------------- .10,700 100 .o 44.6 38.8 9.1 4.2 2.2 1.1 

Under 6 months------------- 18,700 100 .o 56.2 36.8 3.6 6-11 months---------------- 15,000 100 .o 44.8 38.3 9’2 22 3.; :*95 

1-2 years------------------ 22,200 100.0 41.0 42.9 

1.7 

2-3 years------------------ 17,500 100.0 44.7 38.7 i-i! 2-z 4:5 0:3 3-5 years------------------ 17,800 100.0 34.8 42.5 13:3 

5 years or more------------ 19,500 100 .o 46.3 33.1 11.5 517 3.5 

21 
Table 4. Number and percent distribution of residents of nursing and personal care homes, by time 

interval since last saw doctor in home accordingtonumber of chronic conditions and impairments and mobility status: United States, May-June 1964 

Time interval since last saw doctor 

Number of chronic Number 

of conditions and mobility resi- All Under 1-2 3-5 6-11 1 year Not seen status dents 1 or intervals month months months months more 

while in 

home 

All conditions Percent distribution 

Total---------------- 554,000 100.0 38.7 35.9 11.1 6.1 3.9 4.3 

Neither bed nor room

limitation---------------- 344,900 100.0 

;E 

36.1 

38.1 

35.9 

11.9 

11.1 

5.7 

6.8 

Z 

4.7 

3:: 

5.3 

No conditions 

Total---------------- 20.400 100.0 20.2 28.9 12.4 11.7 8.i 18.7 

Bed limitation------------- Jr x -k -2 9< 

Room limitation------------

Neither bed nor room

limitation----------------

900 

19,200 

100.; 

100.0 

11.9 

20.8 

28.1 

28.6 

5.2 

12.6 

11.7 

11.6 

16.4 

7.8 

26.; 

18.6 

1-2 conditions 

Total---------------- 221,700 100.0 34.6 34.6 12.4 7.2 5.2 6.0 

Bed limitation-------------

Room limitation------------

Neither bed nor room 

21,000

39,800 

100.0 

100.0 

47.0 

33.8 

28.8 

37.5 

11.3 

12.9 

4.9 

7.6 2:: 35:: 

limitation---------------- 160,900 100.0 33.2 34.6 12.4 7.4 5.7 6.6 . 

3-4 conditions 

Total---------------- 201,100 100.0 41.8 36.4 10.5 5.4 3.0 2.8 

Bed limitation-------------

Room limitation------------

Neither bed nor room

limitation----------------

38,700

47,200 

115,300 

100.0 

100.0 

100.0 

51.2 

39.9 

39.4 

31.6 

37.4 

37.7 

10.4 

11.8 

10.1 

Z i 

6.3 

2.0 

2.6 

3.6 

1.7 

3.4 

3.0 

Bed limitation------------- 92,200 100.0 32.8 10.0 4.0 

Room limitation------------ 116,900 100.0 “. 

5 conditions or more 

Total---------------- 110,700 100.0 44.6 38.8 9.1 4.2 2.2 1.1 

Bed limitation------------- 32,300 100.0 48.2 36.7 4.1

Room limitation------------ 29,000 100.0 41.6 40.5 1% 4.1 2: 2: 

Neither bed nor room

limitation---------------- 49,500 100.0 44.0 39.1 8.4 '4.2 2.9 1.3 

L 

22 
Table 5. Number and percent distribution of residents of nursing and personal care homes, by primary type of service and mobility status according to number of chronic conditions and impairments and age: United States, May-June 1964 

-

T Nursing care 1 

Number of chronic conditions All Mobility status 

and age residents Number 

of 

residents ) 

All conditions Percent distribution 

All ages--------------------- 554,000 373,300 100.0 20.4 23.7 55.9 

Under 65 years--------------------- 66,200 40,600 100.0 16.6 15.2 68.2 

65-74 years------------------------ 104,500 71,700 100.0 19.5 19.2 61.3 

75-84 years------------------------ 230,900 154,900 100.0 19.7 24.0 56.2 

85 years and over------------------ 152,400 106,100 100.0 23.4 29.7 46.9 

No conditions 

All ages--------------------- 20,400 6,700 100.0 1.5 5.9 92.6 

Under 65 years--------------------- 1,800 800 100.0 100.0 

65-74 years------------------------ 3,700 1,100 100.0 - 4.7 95.3 

75-84 years------------------------ 10,100 3,200 100.0 1.5 9.2 89.3 

85 years and over------------------ 4,900 1,500 100.0 3.3 3.1 93.6 

1-2 conditions 

All ages--------------------- 221,700 128,000 100 .o 12.8 21.0 66.2 

Under 65 years--------------------- 34,700 17,800 100.0 13.7 12.6 73.7 

65-74 years------------------------ 46,100 27,800 100.0 12.1 16.7 71.1 

75-84 years------------------------ 86,600 49,700 100.0 11.1 21.1 67.8 

85 years and over------------------ 54,300 32,700 100.0 15.5 28.9 55.6 

3-4 conditions 

All ages--------------------- 201,100 147,400 100.0 21.3 25.4 53.4 

Under 65 years--------------------- 22,100 15,300 100.0 18.8 14.9 66.4 

65-74 years------------------------ 37,200 28,200 100.0 21.1 20.9 58.0 

75-84 years------------------------ 87,500 63,900 100.0 22.0 26.4 51.6 

85 years and over------------------ 54,300 40,000 100.0 21.2 30.8 48.0 

5 conditions or more 

All ages--------------------- 110,700 91,200 100.0 31.0 26.3 42.7 

Under 65 years--------------------- 7,600 6,600 100.0 21.3 25.0 53.8 

65-74 years------------------------ 17,500 14,600 100.0 32.1 21.5 46.4 

75-84 years------------------------ 46,700 38,100 100.0 28.8 25.0 46.1 

85 years and over------------------ 39,000 31,900 100.0 35.2 30.2 34.6 

24 
Table 5. Number and percent distribution of residents of nursing and personal care homes, by primary type of service and mobility status according to number of chronic conditions and impairments and age: United States, May-June 1964-Con. 

sidents 

Personal care with nursing Personal care 

Mobility status Mobility status 

umber Number 

of Bed of Bed Room Neither 

Total limi- limi- limiRoom Neither residents Total limi- limi- limitation tation tation tation tation tation 

Percent distribution Percent distribution 

145,400 72.6 

18,400 100.o 8.8 9.5 81.7 7,200 0.8 8.3 90.9 

26,100 100.o 8.5 13.8 77.7 6,600 0.8 11.1 88.1 

61,900 100.o 9.3 16.8 73.9 14,000 1.2 10.3 88.5 

38,900 100.o 15.2 22.1 62.7 7,400 3.0 16.0 81.0 

10,400 100.o 1.5 3.5 95 .o 3,300 5.0 95 .o 

700 100.0 8.3 91.7 * * * 

1,900 100 .o 2.7 2.7 94.7 600 9.2 90.8 

5,400 100.0 2.0 98.0 1,500 100 .o 

2,400 100.0 4.3 6.3 89.4 900 12.4 87.6 

71,500 100 .o 5.9 15.4 78.7 22.200 9.0 89.5 

11,100 100.0 6.9 7.2 85.9 5,700 100.0 1.0 6.7 92.3 

13,800 100 .o 2.5 11.0 86.4 4,500 100.0 1.2 9.1 89.6 

29,500 100 .o 6.0 17.8 76.2 7,400 100 .o 0.7 9.0 90.3 

17,100 100.0 7.9 19.9 72.2 4,600 100 .o 3.6 11.8 84.6 

46,200 100 .o 15.7 18.1 66.2 7,500 100.0 1.5 18.7 79.8 

5,800 100 .o 11.2 13.7 75.1 1,000 100.0 21.1 78.9 

7,700 100.0 14.5 18.3 67.3 1,300 100.0 16.3 83.7 

19,600 100.0 13.2 16.4 70.4 3,900 100 .o 1.5 17.1 81.5 

13,000 100 .o 22.2 22.5 55.4 1,300 100 .o 4.5 24.1 71.5 

17,300 100 .o 22.6 27.0 50.5 2,200 100.0 2.6 17.6 79.8 

800 24.8 11.9 63.3 * * * * 

2,600 26.8 23.3 49.9 * * * * 

7,400 19.1 24.7 56.2 1,200 4.8 9.3 85.9 

6,400 24.6 33.0 42.4 700 34.3 65.7 

25 
Table 6. Number and percent distribution of residents of nursing and personal care homes,by nurse 

or nurse's aide on duty and supervisory nurse according to number of chronic conditions and impairments and mobility status: United States, May-June 1964 

-

Nurse or nurse's aide on duty 

Number of chronic Number 

of conditions and mobility resi­ status dents 

All conditions Percent distribution 

Total------------- 554,000 100.0 64.3 18.0 6.3 2.1 2.9 6.4 

Bed limitation----------

Room limitation---------

Neither bed nor room

limitation-------------

92,200

116,900 

344,900 

100.0 

100.0 

100.0 

67.7 

65.2 

63.1 

23.3 

21.4 

15.4 

2’1 

6.3 

1.0 

1.8 

2.5 

0.9 

2.1 

3.8 

0.5 

3.4 

8.9 

No conditions 

Total------------- 20,400 100.0 51.9 15.3 8.9 4.2 3.4 16.3 

Bed limitation---------- 9; 9: ?k t 9< 7t 9: 

Room limitation--------- 900 100.0 44.4 26.8 10.8 18.0 

Neither bed nor room limitation------------- 19,200 100.0 52.7 14.1 8.7 6.9 3.6 16.5 

1-2 conditions 

Tot-l------------- 221,700 100.0 59.7 17.0 6.8 2.4 4.1 10.o 

Bed limitation---------- 21,000 100.0 67.4 21.3 

Room limitation--------- 39,800 100.0 63.3 20.2 2: 2: ::“5 51:: 

Neither bed nor room

limitation------------- 160,900 100.0 57.8 15.6 6.7 2.6 4.9 12.3 

3-4 conditions 

Total------------- 201,100 100 .o 67.4 18.1 6.1 1.9 2.7 3.7 

Bed limitation---------- 38,700 100.0 70.3 21.2 0.9 0.3 

Room limitation--------- 47,200 100.0 63.0 22.7 2:: 2.4 ::: 3.0 

Neither bed nor room

limitation------------- 115,300 100.0 68.3 15.2 5.9 2.1 3.3 5.2 

5 conditions or more 

Total------------- 110,700 100.0 70.2 20.2 5.2 1.4 1.0 2.0 

Bed limitation---------- 32,300 100.0 65.2 26.9 0.4 0.2 

Room limitation--------- 29,00_ 100.0 72.1 20:8 ::: 205 1.0 1.4 

Neither bed nor room

limitation------------- 49,500 100.0 72.4 15.2 5.1 2.2 1.3 3.6 

26 
Table 7. Number and percent distribution of residents of nursing and personal care homes,by nurse 

or nurse's aide on duty and supervisory nurse according to number of chronic conditions and impairments and time interval since last saw doctor while in home: United States, May-June 1964 -

Nurse or nurse's aide on duty 

Number of chronic Number 24 hours Less than 24 hours Nursing conditions of 

interval since 

and 

last 

time 

saw resi- Total care not 

doctor dents RN LPN Neither RN or Neither provided 

super- super- RN nor LPN super- RN nor 

visor visor LPN visor LPN 

i 

All conditions Percent distribution 

All intervals----- 554,000 100.0 64.3 18.0 6.3 2.1 2.9 6.4 

1-2 months--------------

3-5 months--------------

6-11 months-------------

1 year or more----------

Not seen while in home--

100.0 

100.0 

100.0 

100.0 

100.0 

63.6 

59.4 

:z 

40:7 

19.0 

21.7 

18.9 

14.0 

19.9 

21

z-: 

6:6 

7.8 

:*i 

1:2 

1.0

9.‘; 

. 

No conditions 

All intervals----- 100.0 51.9 15.3 8.9 4.2 16.3 

Under 1 month-----------

1-2 months-------------- 100.0 

100.0 

72.6 8.5 

25.5 ;*: 22 10.2 

16.1 

Under 1 month----------- 214,300 100.0 71.0 16.0 

3-5 months-------------- 100.0 t:*i 16.1 11:9 214 6-11 months------------- 100.0 53:3 12.5 12; 1 year or more---------- 100.0 45.9 2: 3310 

Not seen while in home-- 100.0 39.8 15:4 E 24.2 

1-2 conditions 

All intervals----- 221,700 100.0 2.4 

Under 1 month----------- 76,700 100.0 67.4 1-2 months-------------- 76,700 100.0 60.3 :6’*; E 3-5 months-------------- 27,500 100.0 53.6 21:6 6-11 months------------- 16,000 100.0 51.7 19.6 1:*2

1 year or more---------- 11,600 100.0 13.6 1512 

Not seen while in home-- 13,200 100.0 z;*z. 15.7 2Il 29.1 

3-4 conditions 

All intervals----- 100.0 67.4 18.1 6.1 2.7 

Under 1 month----------- 84,100 100.0 73.3 1-2 months-------------- 73,300 100.0 65.6 3: 29

3-5 months-------------- 100.0 62.5 019 2:o 6-11 months------------- :x:: 100.0 63.0 1.0

1 year or more---------- 6;lOO 100.0 58.9 57:; Not seen while in home-- 5,600 100.0 40.1 k.; 7.5 

5 conditions or more 

All intervals----- 110,700 100.0 70.2 5.2 

Under 1 month----------- 100.0 72.5 18.7 1-2 months-------------- txzi 100.0 68.9 22.0

3-5 months-------------- 10:100 100.0 67.9 20.5 6-11 months------------- 4,600 100.0 66.2 22.6 

1 year or more---------- 2,500 100.0 

Not seen'while in home-- 1,200 100.0 % . :x . 

27 
Table 8. Number and percent distribution of residents of nursing and personal care homes,by level 

of patient care according to number of chronic conditions and impairments: United States, MayJune 1964 

Number of -L----'. 

conditions 

care 

Percent distribution 

All conditions-- I 554,000 1 100.0 JI 3.8 27.2 7.0 21.7 I 26.9 I 13.4 

No conditions------- 20,400 100.0 2.7 21.6 67.3 

1 condition--------- 94,400 100.0 0.9 14.1 ::; ;:,:; 36.9 27.3

2 conditions-------- 127,400 100 .o z.03 20.5 33.3 14.7

3 conditions-------- 118,800 100.0 30.2 E 2417 27.9 

4 conditions-------- 82,300 100 .o 5:o 33.6 9:3 24.5 22.3 ::2 

5 conditions or 

more--------------- 110,700 100.0 7.7 42.7 10.0 22.4 14.2 3.1 

I I U 

Table 9. Civilian resident population aged 21 years and over usedinobtaininp rates shown in this 

publication, by sex and age: United States, July 1, 1964 

Both Age sexes Male Female 

Population in thousands 

54,824 1 58,849 

21-64 years---------------------------------------------------------- 46,976 48,837 65-74 years---------------------------------------------------------- 5,149 6,259 75-84 years---------------------------------------------------------- 2,304 3,111 85 years and over---------------------------------------------------- 395 642 

k.S. Bureau of Census: Estimates of the population of the United States, by age and sex: 

July 1, 1964. Current Population Reports, Series P-25, No. 293, Washington, D.C., Oct. 1964. 
APPENDIX I 

A. TECHNICAL NOTES ON SURVEY DESIGN 

General.-The Resident Places Survey-2 (RPS-2) 

was conducted during May and June 1964 by the Division 

of Health Records Statistics in cooperationwith the U.S. 

Bureau of the Census. It was a survey of resident 

institutions in the United States which provide nursing 

or personal care to the aged and chronically ill, of 

their patients or residents, and of their employees. 

The institutions within the scope of the survey included 

such places as nursing homes, convalescent homes, 

rest homes, homes for the aged, other related facilities, 

and geriatric hospitals. To be eligible for the survey 

an establishment must have maintained three or more 

beds and must have provided some level of nursing or 

personal care. The procedure for classifying establishments for the RPS-2 universe is described in 

Appendix II-B. 

This appendix presents a brief description of the 

survey design, general qualifications of the data, and 

the reliability of estimates presented in this report. 

Succeeding appendixes are concerned with classification 

procedures, definitions, and questionnaires used in the 

survey for collecting information about employees. 

Sampling fYame.- A “multiframe” technique was 

used in establishing the sampling universe for RPS-2. 

The principal frame was the Master Facility Inventory 

(MW 1 which contained the names, addresses, and 

descriptive information for about 90-95 percent of the 

nursing and personal care homes in the United States. 

Establishments not listed intheMF1 were, theoretically, 

on another list referred to as the Complement Survey 

list. A description of the MFI and the Complement 

Survey has been published. s 

The Complement Survey is based on an area 

probability design, using the sample design of the Health 

Interview Survey.6 In the Health Interview Survey, 

interviewers make visits each week to households 

located in probability samples of small segments of the 

United States. In addition to collecting information about 

the health of the household members, the interviewers 

are instructed to record the names and addresses of 

hospitals and institutions located wholly or partially 

within the specified areas. The Complement Survey 

list is composed of the establishments identified inthese 

sample areas between January 1959 and July 1963 which 

were not listed in the MFI and which were in business 

as of July 1, 1962. The Complement Survey sample for 

RPS-2 included four establishments representing an 

estimated total of about 800 such facilitiesinthe United 

States, 

Sample design.-The sample design was a stratified, two-stage probability design. The first stage was a 

selection of establishments from the MFI and the 

Complement Survey; the second stage, a selection of 

employees and residents from registers of the sample 

establishments. In preparation for the first-stage 

sample selection, the MFI was divided into two groups 

on the basis of whether current information was available about the establishment. Group I was composed 

of establishments which had returned a questionnaire 

in a previous MFI survey. Group II contained places 

which were possibly within the scope of RPS-2 but were 

not confirmed in the MFI survey, e.g., nonresponses and 

questionnaires not delivered by the post office because 

of insufficient addresses. Group I was then sorted into 

three type-of-service strata: nursing care homes, including geriatric hospitals; personal-care-with-nursing 

homes; and personal care homes. Group II was treated 

as a fourth type-of-service stratum. Each of these four 

strata was further sorted into four bed-size groups, 

producing 16 primary strata, as shown in table I. 

Within each primary stratum the listing of establishments was ordered by type of ownership, State, and 

county. The sample of establishments was then selected systematically after a random start within each 

of the primary strata. 

Table I shows the distribution by primary strata of 

establishments in ‘the MFI and in the sample and shows 

the final disposition of the sample places with regard 

to their response and in-scope status. Of the 1,201 

homes originally selected, 1,085 were found to be in 

business and within the scope of the survey. 

The second-stage sample selection of residents was 

carried out by Bureau of the Census interviewers in 

accordance with specific instructions given for each 

sample establishment as contained in the Resident 

Questionnaire (HRS-3c, Appendix III). All the residents 

on the register of the establishment on the day of the 

survey were listed on the Establishment Questionnaire 

(HRS-3a). The interviewers were furnished with the 

numbers of predetermined sample lines for each home 

29 
Table I. Distribution of institutions for the aged in the Master Facility Inventory and in the

RPS-2 sample,by response status to the RPS-2 and by primary strata (type of service and size of 

institution): United States 

-

T Number of homes in the sample 

In-scope and

Type of service and size Number of 

out of in business 

of institution homes in 

the MFI1 Total scope or 

home& out of Nonre­ business sponding Re.sggiing 

homes 

All types------------------------------ 19,520 1,201 116 12 1,073 -

Nursing carea-------------------------- 8,155 634 37 8 589 

Under 30 beds-------------------------------- 4,400 179 21 153 

30-99 beds----------------------------------- 3,247 260 11 246 

100-299 beds--------------------------------- 448 135 3 132 

300 beds or more----------------------------- 60 60 2 58 

Personal care with nursing------------- 4,972 381 12 367 

Under 30 beds-------------------------------- 3,168 128 10 117 

30-99 beds----------------------------------- 1,423 114 1 112 

100-299 beds--------------------------------- 345 103 1 102 

300 beds or more----------------------------- 36 36 36 

personal care-------------------------- 3,621 L13 13 98 

Under 30 beds-------------------------------- 3,187 64 11 53 

30-99 beds----------------------------------- 402 32 31 

loo-2'9 beds--------------------------------- 29 14 2 11 

300 beds or more----------------------------- 3 3 - 3 

Group 113------------------------------ 2,772 73 54 19 

Under 25 beds-------------------------------- 2,578 52 37 15 

25-99 beds----------------------------------- 185 15 12 3 

100-299 beds--------------------------------- 6 3 3 

300 beds or more----------------------------- 3 3 2 1 

'The universe for the RPS-2 sample consisted of the MPI and the Complement Survey. Included

in the RPS-2 sample were 4 homes from the Complement Survey. 

'Included geriatric hospitals. 

'Group II consists of those institutions assumed to be in scope of the RPS-2 survey but for wh.ich current data were not available. 

30 
(e.g., every seventh line). The first three sample 

designations were entered on the questionnaire worksheet, and the interviewer entered the remaining 

predetermined numbers until the last selected number 

exceeded the total number now on the register. The name 

of the sample resident (patient) was entered opposite 

the sample designation number. For each sample 

resident a questionnaire was completed by the interviewer from information furnished by the respondent. 

The total sample selected from establishments cooperating in the survey consisted of 10,560 residents. 

Survey procedure.-The Bureau of the Census 

employed about 140 of their regular interviewers for the 

survey. All were experienced in the continuing surveys 

conducted by the Bureau of the Census; about half were 

employed in the Health Interview Survey, one of the 

major programs of the National Center for Health 

Statistics, and about half in other surveys. Since the 

interviewers were well trained in general survey 

methodology, it was relatively easy to train them in the 

specific methods used in RPS-2. Briefly, their training 

consisted of home study materials and observation by the 

Census Regional Supervisor on the first interview 

assignment. 

The initial contact with an establishment was a letter 

signed by the Director of the Bureauofthe Census. The 

letter (HRS-3f, Appendix III) notified each administrator 

about the survey, requested his cooperation, and stated 

that a representative would contact him for an appointment. The interviewer’s telephone call usually followed 

within 3 or 4 days. 

During the course of the interview, the interviewer 

collected data on the establishment, the resident, and the 

employees. The establishment and resident information 

was obtained by personal interview, and the staff information was collected by personal interview and by 

mean5 of a self-enumeration questionnaire. The respondent for the Resident (Patient) Questionnaire (HRS3c) was a member of the staff who had close contact with 

the resident, thus having firsthand knowledge of the 

resident’s health condition. This was usually a nurse 

who was responsible ‘for the individual sample resident. One nurse might have completed questionnaires 

for all resident5 in a small home, or shared the 

responsibility in a large home. The interviewer was 

instructed to encourage maximum use of records by the 

respondent. For data on chronic conditions and impairments, medical records, if available, were routinely 

used to supplement the information provided by the 

respondent. 

The Census regional offices also performed certain 

checks during the course of the survey to insure that 

the interviewers were conducting the survey according 

to specified procedures. They reviewed all questionnaires for completeness prior to transmittal to the 

Washington office and made inquiries as necessary to 

obtain the missing information. 

The completed questionnaires were edited andcoded 

by the National Center for Health Statistics, and the data 

were processed on an electronic computer. This processing included assignment of weights, ratio adjustments, and other related procedures necessary to 

produce national estimates from the sample data. It also 

included matching with basic identifying information 

contained in the Master Facility Inventory, as well as 

carrying out internal edits and consistency checks to 

eliminate “impossible” response and errors in editing, 

coding, or processing. 

B. GENERAL QUALIFICATIONS 

Nonresponse anta imputation of missing data.-The 

survey was conducted in 1,073 homes, or about 89 

percent of the original sample. About 7 percent of the 

sample places were found to be out of business, and an 

additional 3 percent were found to be out of scope of the 

survey, that is, they either did not provide nursing or 

personal care to their residents or maintained fewer 

than three beds. Only 12 homes, or about 1 percent of 

the sample, refused to cooperate inthesurvey(table 1). 

The response rate for the in-scope sample was 98.9 

percent. 

Statistics in this report were adjusted for the failure 

of a home to respond by use of a separate nonresponse 

adjustment factor for each service-size stratum further 

stratified by three major ownership groups. This factor 

was the ratio of all in-scope sample homes in a stratum 

to the responding in-scope sample homes in the stratum. 

Data were also adjusted for nonresponse of sample 

residents within an establishment by a procedure which 

imputed to residents for whom data were not obtained 

the characteristic5 of residents of the same age and in 

the same type of home. For item nonresponse on age, 

the adjustment was restricted to characteristics of 

residents in the same type of home. Adjustment for 

nonresponse in resident data for responding homes 

ranged from 0.7 percent for age to 3.5 percent for date 

last saw doctor. 

Rounding of n?rmbers.- Estimates relatingto residents have been rounded to the nearest hundred, and 

homes to the nearest ten. For this reason detailed 

figures within the tables do not always add to totals. 

Percents were calculated using the original unrounded 

figures and will not necessarily agree with percents 

which might be calculated from rounded data. 

31 
.Qtimation procedure. -Statistics reported in this 

publication are the result of two stages of ratio 

adjustments, one at each stage of selection. ‘The 

purpose of ratio estimation is to take into account all 

relevant information in the estimation process, thereby 

reducing the variability of the estimate. The first-stage 

ratio adjustment was included in the estimation of 

establishment and resident data for all primary servicesize strata from which a sample of homes was,drawn. 

‘Ibis factor was a ratio, calculated for each stratum. The 

numerator was the total beds according to the Master 

Facility Inventory for all homes in the stratum. The 

denominator was the estimate of the total beds obtained 

through a simple inflation of the Master Facility 

Inventory data for the sample homes in the stratum. The 

effect of the first-stage ratio adjustment was to bring 

the sample in cIoser agreement withtheknownuniverse 

of beds. The second-stage ratio adjustment was included 

in the estimation of resident data for all primary strata. 

For resident data, the second-stage ratio adjustmentis 

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

total number of residents in the establishment to the 

number of residents for whom questionnaires were 

completed within the home; the second is the sampling 

fraction for residents upon which the selectionis based. 

Reliability of estimates.- Since statistics presented in this report are based on a sample, they will 

differ somewhat from figures that would have been 

obtained if a complete census had been taken using the 

same schedules, instructions, and procedures. 

As in any survey, the results are also subject to 

reporting and processing errors and errors due to 

nonresponse. To the extent possible, these types of 

errors were kept to a minimum by methods built into 

survey procedures. 

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

number of observations in the sample. Thus, as the 

sample size increases, the standard error decreases. 

The standard error is primarily a measure of the 

variability that occurs by chance because only a sample, 

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

part of the measurement error, but it does not measure 

Figure I. Approximate relative standard errors of estimated numbers of residents, conditions, or 

establisbments shown in this report. 

Size of Estimate 

Example of use of figure I: An estimate of 100,000 total residents has a relative standard error 

of 3.3 percent (read from scale at. left side of figure). The estimate has a standard error of 

3,300 (3.3 percent of 100,000). 

32 
Table II. Approximate standard errors of percentages for residents 

Base of percent (number of residents) 

any systematic biases in the data. The chances are 

about two out of three that an estimate from the sample 

differs from the value which would be obtained from a 

complete census by less than the standard error. The 

chances are about 95 out of 100 that the difference is 

less than twice the standard error and about 99 out of 

100 that it is less than 2% times as large. 

Relative standard errors of aggregates shown in 

this report can be determined from figure I. The relative 

standard error of an estimate is obtained by dividing 

the standard error of the estimate by the estimate itself 

and is expressed as a percent of the estimate. An 

example of how to convert the relative error into a 

standard error is given with figure I. Standard errors 

of estimated percentages are shown in table II. 

To determine the standard error of a mean value, 

of a median value, or of the difference between two 

statistics, the following rules may be used. 

Standard ewor of mean member Of Conditions fieY 

person.- From figure I, obtain the relative standard 

error of the estimated number of conditions and of the 

estimated number of persons. The square root of the sum 

of the squares of these two relative standard errors 

provides an approximation for the relative standard 

error of the desired mean. The stanaard error of the 

mean may be obtained by multiplying the relative 

standard error by the mean value. 

Estimated percent 

! or 98 5 or 95 10 or 90 25 or 75 50 

Standard error expressed in percentage points 

4.4 6.9 9.5 13.6 15.8 

2.8 4.4 6.0 8.6 10.0 

2.0 3.1 4.2 6.1 7.1 

1.4 2.2 3.0 4.3 5.0 

1.0 1.5 2.1 3.0 3.5 

0.8 1.3 1.7 2.5 2.9 

0.7 1.1 1.5 2.1 2.5 

0.6 1.0 1.3 1.6 2.2 

0.5 0.8 1.1 1.5 1.8 

0.4 0.7 0.9 1.0 1.6 

0.3 0.5 0.7 0.8 1.1 

0.2 0.3 0.4 0.5 0.7 

Example: For a mean of three conditions per person 

based on a denominator of 50,000 residents, the standard 

error may be obtained as follows: 

1. The relative standard error of 150,OqO conditions is about 2.7 percent, or .027 (curve A). 

2. The relative standard error of 50,OOOresidents 

is about 4.6 percent, or .046 (curve A). 

3. The relative standard error of the mean 3 

conditions per personis$(.027)’ + (.046)’ = .169 

4. The standard error is .169 x 3 = -507 conditions per person. 

&mdard ewo’oy of a median.- The medians shown 

in this report were calculated from grouped data. Approximate confidence intervals for these estimated 

medians can be computed as follows: 

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

characteristic whose denominator is equal to 

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

based. For example, the median age of males 

is 77.7 years. The estimated number of males 

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

a 50-percent characteristic whose base is 

193,784 is shown in table II, by interpolation, 

to be 1.13 percentage points. 

33 
(b) Apply this standard error to the cumulative 

frequency distribution to obtain a confidence 

interval around the median. The steps are as 

follows: For the above example, using the 

95-percent level of confidence, determine the 

points on the cumulative frequency distribution 

corresponding to the 47.74 percent (50 percent 

minus two standard errors) and 52.26 percent 

(50 percent plus two standard errors). The 

points are 92,512 (47.74 x 193,784) and101,272 

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

ages that correspond to these points. They are 

77.1 and 78.3 years, respectively. Therefore, 

the confidence limit for the estimated median 

age of 77.7 years is 77.1-78.3 years at the 

95-percent level of confidence. 

It is possible to investigate whether the observed 

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

68-percent confidence limit, .?I;, of the smaller median, 

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

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

using the method outlined above, but using one standard 

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

squared differences between M; and Vi and M: and 

Lb is the standard error of the difference between M; 

and M; ; that is, 

s (Ml,- MlZ) =+M; - U,)* -t CM; -L;)’ 

For the purpose of this report, any difference between 

M; and M; greater than 2 .zS~,,~_ “,*) has been considered a significant difference. 

Standard eu-oY of a aiffeerence between two estimates.- The standard error of a difference is approximately the square root of the sum of the squares 

of each standard error considered separately. This 

formula will represent the actual standard error quite 

accurately for the difference between separate and 

uncorrelated characteristics, although it is only a 

rough approximation in most other cases. 

34 
APPENDIX II 

A. DEFINITIONS OF CERTAIN TERMS USED IN THIS REPORT 

Resident: 

A resident is defined as a person who has been 

formally admitted to an establishment but not 

discharged. All such persons were included in 

the survey even though they were not physically 

present. 

Chronic conditions and inapdrments: 

These are defined as the conditions and impairments contained in Cards D and E of Appendix III. 

This list was expanded, baaed on the further query 

“Does he have any other chronic conditions listed 

in his record you have not told me about?” and 

additional questions about specified conditions. 

The expanded list is contained in Appendix II-C as 

a basic list of diagnostic categories used for coding purposes. 

Con&ion: 

lhia term is used synonomoualy with the term 

“chronic conditions and impairments” since no 

distinction has been made between the two groups 

in this report. 

Limitation of mobility: 

Restriction in mobility is defined in this report as 

being limited to bed or room. All other residents, 

including those who were routinely taken out of the 

room in a wheel chair for moat of the day, were considered neither bed nor room limited. 

Length of stay: 

Length of stay refers to the current period of stay 

in the institution. The period of stay starts with the 

date of last admission to the institution and ends with 

the date of the survey. 

Time interval since last saw doctor: 

This refers to the period of time from the date 

the resident last saw a doctor in the institution 

during his current stay to the date of the survey. 

Supervisory nut-se: 

This is defined as the person in charge of the 

daily nursing activities provided in the home, 

such as the head nurse. 

Nurse OY nuysets aid on duty 24 hours a day: 

Nursing service is routinely provided at all hours 

of the day or night by either a nurse or a nurse’s 

aide. A person is not “on duty” if she is available to provide care only upon call or in emergencies. 

Levels of nursing oy personal care: 

These levels are defined in terms of the implied 

intensiveness of care or the condition of the resident. Baaed on these criteria, nursingandpersonal 

care services are grouped as follows, each aucceeding level being exclusive of the previous levels: 

Intensive care 

Catheterization 

Bowel and bladder retraining 

Oxygen therapy 

Intravenous injection 

Nasal feeding 

Full bed bath 

Less intensive care 

Application of sterile dressings or bandages 

Irrigation 

Hypodermic injection 

Intramuscular injection 

Routine nursing care 

Temperature-pulse 

Enema 

Blood pressure 

Personal care 

Help with dressing, shaving, or care of hair 

Help with tub bath or shower 

Help with eating (feeding of resident) 

Rub and massage 

Administrations of medications or treatment 

Special diet 

Nursing or personal care not provided 

35 
B. CLASSIFICATION OF HOMES BY TYPE OF SERVICE 

For purposes of stratification of the universe 

prior to the selection of the sample, the homes in the 

MFI were classified as either nursing care, personalcare-with-nursing, personal care, or domiciliary care 

homes. The latter two classes were combined and designated as personal care homes. Details of the classification procedure in the MFI have been published. 

Due to the interval between the MFI survey and the 

RPS-2 survey it was felt that for producing statistics 

by type of service for the RPS-2 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 by RPS-2 are defined as follows: 

1. A nursing care home is defined as one in which 

50 percent or more of the residents received 

nursing care during the week prior to the survey 

C. RULES FOR CODING CHRONIC 

The list of diagnostic categories which was used 

far coding chronic conditions and impairments is shown 

below. This list represents an expansion of the two 

lists (Cards D and E) furnished to the interviewers. 

The classification scheme was basedon the International 

Classification of Diseases with some modifications. 

Certain medical coding principles developed by the 

Health Interview Survey (HIS), from which statistics 

on the institutional population of the United States are 

derived,7 were used in coding the data for RPS-2. The 

medical coding consisted of assigning a code to each 

codable chronic condition and impairment reported for a 

resident. All codable conditions which were not specified 

as chronic but which could be acute or chronic (i.e., 

sinusitis, bronchitis, gastritis, or a hearing or visual 

disturbance) were assumed to be chronic. 

The medical coding principles developed by the 

HIS were adapted to the coding of chronic diseases and 

impairments as follows: Impairments were coded in the 

same general manner as for the HIS, but in less detail. 

in the home, with an RN or LPN employed 15 

hours or more per week. In this report, geriatric hospitals are included with nursing care 

homes. 

2. A personal-care-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. 

3. A personal care home is defined as one in 

which residents routinely received personal. 

care, but no residents received nursing care 

during the week prior to the survey. 

CONDITIONS AND IMPAIRMENTS 

Symptoms, and conditions said to be due to other conditions, were coded for themostpart as for HIS. Heart, 

hypertensive, andarterioscleroticconditions werecombined as for HIS. 

The coding rules allow for the assignment of one 

or more chronic conditions and impairments for each 

resident, with some loss of detail due tothe restricted 

number of diagnostic categories. Some restriction exists 

for the assignment of impairments which are a result 

of the chronic condition. Some chronic conditions are 

not reported separately, but are combined with other 

categories under coding rules. 

Special coding procedures were followed in coding 

categories related to senility and mental conditions. 

Injuries and traumatic origin of chronic conditions 

were not identified as such except in cases of fracture 

of the hip. Also, specific coding procedures for other 

individual chronic conditions and impairments were 

followed. 

36 
D. BASIC LIST OF DIAGNOSTtC CATEGORIES REPORTED FOR RESIDENTS 

IN NURSING AND PERSONAL CARE HOMES 

Malignant neoplasms, without mention of surgery-----

Malignant neoplasms, with mention of surgery--------

Benign and unspecified neoplasms-------------------

Asthma ________________________________________--

Diseases of thyroid gla&------- _________-__________ 

Diabetes mellims ----__- -~-~~~~~~~~______________ 

Avitaminoses and other nutritional weight problems---

Mental retardation without mention of senility1 

Mental retardation with mention of senile psychosis1 

Mental retardation with senility not specified as psychotic 1 

Senile psychosis with or without other mental conditionSenility without mention of psychosis----------------

Specified mental disorders-------------------------

Vascular lesions affecting central nervous system----

Multiple sclerosis---------------------------------

Parkinson’s disease (paralysis agitans)--------------

Epilepsy ________________________________________-

Other nervous systemdisorders--------------------

Cataract ________________________________________-

Glaucoma ________________________________________ 

O&r &seases oftheeye---------------------------

Diseases of he ear--------------------------------

Diseases of he heart------------------------------

Hypertension without mention of heart---------------

General ~teriosclerosis ___________________________ 

V&cose veins------------------------------------

Hemorrhoids _____________________________________ 

Other conditions of circulatory system--------------

Chronic sjnusitis __________________________________ 

&onchitis,wie emphysema------------------------

Bronchitis, without emphysema---------------------

Emphysema without mention of bronchitis------------

Other chronic respiratory conditions----------------

Ulcer of stomach and duodenum---------------------

Hernia of af,dombd cavity _________________________ 

Diseases of gallbladder and bile ducts---------------

Other chronic conditions of the digestive system------

Incontinence @j--e or feces) ________________________ 

Diseases ofurinarysystem-------------------------

Diseases of male genitalorgans---------------------

Diseases of breast and female genital organs---------

Diseases of skin and other subcutaneous tissue-------

Arthritis _________________________________________ 

Rheumatism ___________________-___ ____-_-__ ______ 

Intemutionul Classification of Diseases 

Code Numbers, 1955 Revision 

140-205 

140-205 

210-239 

241 

250-254 

260 

280-283,285,286l 

304 

794 

300-303,305-324 

330-334 

345 

350 

353 

340-343, 354-357,361-369 

385 

387 

370-379, 380-384,386,388 

390-396 

410-443, 782.1, 782.2, 782.4 

444-447 

450 

460,462 

461 

400-403, 451-456, 463-468, 782.0, 782.3, 782.5-7829 

513 

502.O 

502.1 

527.1 

510.0, 512, 514-526, 527.0, 527.2,783 

540-542 

560, 561 

584-586 

530-539, 543-545, 552, 553, 570, 572-574, 577, 578, 

580-583, 587, 784 

785.7, 786.2 

591-594, 600409, 786.0, 786.1, 786.3-786.5, 789 

610-617, 786.6 

620,621,623,625, 626, 630-637, 786.7 

700-716 

720-725 

726.0, 726.1, 726.3, 727 

37 
-- 

Other specified diseases of bones and organs of movement __-_L__--__-__--____________r______r____-~-

Fracture, femur (old)-------------------- __________ 

All other chronic conditions ( excluding impairmentsVisual impairment: inability to read newspaper with 

glasses ’ 

Other visual impairments 1 

Hearing impairments1 

Speech impairments due to stroke’ 

Speech impairments due to other or unspecified 

causes 1 

Paralysis, palsy due to stroke ’ 

Paralysis, palsy due to other unspecified causes1 

Absence, fingers and/or toes’ 

Absence, major extremities1 

Impairment, limbs, back, trunk’ 

All other impairments t 

730.1,730.3,731-733,735,738,740-744 

N820,9,N821.9 

Residual 

kelected conditions and all impairments are classified by means of a special supplementary code developed for the Household Interview SUP 

vey. The details of this classification ace contained in the Medical Coding Manual and Short Index, NHS-HIS-1000, 1965. 

38 
APPENDIX III 

RESIDENT QUESTIONNAIRE AND OTHER SURVEY FORMS 

0r-m.x DC 

THE DmEcroR 

ymi4RS3f U.S. DEPARTMENT OF COMMERCE BUREAU OFTHE CENSUS 

WASHINGTON, D.C. 20231 

r 1 

-I 

Dear Administrator: 

The Bureau of the Census, acting as the collecting agent for the 

United States Public Health Service, is conducting a nationwide survey of nursing homes, homes for the aged, and other establishments providing nursing, personal, and domiciliary care to the aged and infirm. The 

purpose of this survey is to collect much needed statistical information 

on the health of residents and on the types of employees in these homes. 

This survey is part of the National Health Survey program authorized by Congress because of the urgent need for up-to-date statistics on the 

health of our people. 

The purpose of this 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 conduct the survey. Prior 

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

convenient appointment time. 

All the information given to the Census representative will be.kept

strictly confidential by the Public Health Service and the Bureau of 

the Census, and will be used for statistical purposes only. 

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

Sincerely yours, 

a& 

Richard M. Scammon 

Director 

Bureau of the Census 

39 

L 
Budset Bureau No. G&RG20.R2: Appmval Expires December 31. 1964 

CONFIDENTIAL - This information is collected for the U.S. Public Health Service under aurhority of Public Law 652 of the 84th Gnsress (70 Stat. 489; 42 U.S.C. 305). All information which would permit identification of the individual will be held strictly confidential, will be 

used WIY by ~wons ewwed in and for rhc purports of the survey. and till nor be disclosed or released w others for any other putposcs 

(22 FR 1687). 

FORM HRS-30 Werlfynamo and sddmea and make any nscsassry corrsctione) ,1-1-e,, 

U.S. DEPARTMENT OF C0MMERCE 

BUREAU OF THE CENSUS 

ACTING AS COLLECTING AGENT FOR THE 

U.S. NATIONAL HEALTH SURVEY 

ESTABLISHMENT QUESTIONNAIRE 

Licensed 4. Is the person who supervises NURSING CARE * IJ practical s 0 boy= D r.giswr&d professional nurse, a licawed nurse “WSI? practical nurse, 0, somsons slss? 

I

5. Door she work full-time or port-time?’ I 0 Full-time 2 0 Part-time 

.BY full-time we mean 40 or more hours a week. 

I[7 Yes 20 No 

6. Is there a nurse or nurs!.‘s aida ON DUTY 24 hours (I day? 

40 

I 
I Budset Bureau No. 6&R620.R2; Approval Expires December 31. 1964 

Establishment number Resident’s (patienr’s) line No. 

Month ; Year 

1. What is the month and year of this resident’s (patient’s) birth? I 

2 Sex 1 0 Male (Ash question 3) z 0 Female (Go to queatim 4) 

.-_ 30. Hos he served in 3c. ?VOTE zu INTERVIEWER: 

the Armed Forces of swrce of “emran status the United States? 1 0 Yes (AS& Q. 3b) 2 i--J No (Go Lo Q 4) 3 0 unknown informslion 

10 Record b. Did he serve in tnYCS 20NO 3 0 Unknown 3 0 Respondent 

2 0 Sample persol 

World War I? 

4. Is this resident (patient) married, I c] Married B 0 Divorced 5 0 Never married widowed, divorced, separated, or 

“ever married? 2 0 Widowed 4 0 Sepnrared 

Month ’ Year 

5. I” what month and year was he (last) admitted to this home? I 

6. With whom did he live ot 1 0 Spouse only 7 0 In another nursing home or 

the time of his admission? 2 cl Children only related facility 

(Chock lhs FIRST J 0 Spouse and children B 0 In mental hospital

box that applies) 4 0 Relatives ocher than spouse ox 9 (7 In P long-term specialty hospital 

children (except mental) 

5 0 Lived in apartment or own home- 10 n In a general or short-stay hospital 

810”~ oc with unrelated persons I I l---J Other place (Specify) 

6 0 In boarding home 

7. How often do friw-ads or I 0 At least ““ce a week 3 0 Less than once a month relatives visit kim? 

(Check the FIRST z 0 Less often than once a week but at 4 0 Never

box that applies) ieasr once a month 

8a. Does he stay in bed all or most of the day? I 0 Yes (Go to question 9) 2 0 No’(Aek question 8b) 

b. Doss he st”y in his own room all or most of the day? I n Yes z n No (Ask qusstion 84 

C. Doas he go off the premises just to walk, shop, or 

visit with friends or rslotivss and so forth? 10 Yes 2 0 No 

9. Which of these special aids (Check all that apply) does this resident (patient) 

use? (show card C) 10 Hearing aid 4 i--J Braces 7 0 Eye glasses 

z n Walker s 0 Wheel chair OR 

J 0 Crutches 6 0 Artificial limb(s) 8 0 None of these aids used 

0. During his stay hero when did he 

doctor for treatment, medication, or for M I-J Never saw doctor 

cxaminofion by the doctor? while here 

la. During his stay here, 

has he see” o dentist? I 0 Yes (Ask qusation 116) 2 0 No (Go to question 12) 

Monrh ;YCaI 

b. When was the lost time he row (I dentist? I 

20. tilts he lost ALL of his teeth? I 0 Yes Wsk wsaticn 12b) z [3 No (Go to quedion 13) 

b. Doer he ,vear full upper ond lower dentures? 3i-JYes 4I7No 

3. Does this resident (patient) have ony of these conditions? 

(Show card D. Recordin Table 1 each condition which the pstimt has) 1 ll Yes 2l7NO 

4. Doss he have any of these conditions? 

(Show card E. Recom’in Table 1 each condition which the pationf has) 1 u Yes 20 No 

50. Does he hove any other CHRONIC conditions listed in his record that you have not told me about? 1 j-J Yes ZI-JNO 

If “Yes 1I’ ask. . 

b. What ore they?

(Record in Table 1 each chronic cmch’tion mentioned) 
-- 

I 

Enter conditions from questions 13, 14 or 15 1 For the following conditions ask these questions I .

I ILL EFFECTS OF STROKE.. . . . What ore the present ill affects? I

I SPEECH DEFECT . . . ..I..... What caused the ipeach defect? I Do 

PARALYSIS, PERMANENT not 

Enter the words used by the respondent to STIFFNESS . . . . . . . . . . . . . . . What part of the body is affected? write 

describe the condition. TUMOR, CYST, OR GROWTH. . . . ffhot pwt of the body is affected? in 

Is it malignant or banign? I this 

DEAFNESS, HEARING TROUBLE, column 

OR ANY EYE CONDITION. . . . . . I. one or both ears (eyes) 

I (Include glaucoma and cataracts) affected? I 

(a) I (b) (c) 

1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. I 16. If any eye condirions have been recorded in Table 1, ask: 0 No eye condition reported (Go to question 17) 

You told me about this resident’s ( atient’s) eye condition. 

Can he see well enough to rood or c/f#nary newspaper print with glosses? 10 Yes 2 I-J No 

7 dayi whichpastof 1 n- F(rln ar;tl? Ar.=ccinn cl.a.,:s.n‘*, 17. During the 0 r--J T p.....ap^ * ...- .-- .__._____.~. .-.--2 grw;rare.. . ..I -.-l”...~, I ..-... 0 - ““‘~“.yL”‘-pU.z,.z- . . ..I^_ 1 I u lnrra”c”O”S qcc”o” 

these services 

,,f hair resplrarlon 18 0 Intramuscular injection 

did this resident 2 0 Help with rub bath 9 0 Full-bed bath 19 0 Nasal feeding 

(patient) receive? or snower I o 0 Enema 

3 0 Help with eating ) 11 0 Catheterization OR (Show card F and (feeding the r&d I.? 0 Bowel and bladder check each one 4 0 Rub and I retraining mentioned) 5 0 Administr 13 0 Blood pressure 20 0 None of the above 

mr~lca~,onsdiet or treacme”c 14 0 Irrigation services received 

1 Special 

7 A_-,!--_!_- -I -.--.,- I 5 0 Oxygen therapy 

16 0 Hypodermic injection 

18. At the time this resident (patient) was admitted to 1 0 Primarily 2 a Primarily a 0 Room and this home, what kind of care did he receive-primarily nursing pCKXXil board only nursing core, primarily personal care, or room and cate care board only? [Check one box onlv, 

Amount 

19. What was the TOTAL charge for this resident’s (patient’s) ewe last month? J 

200. What is the PRIMARY SOUICC of payment for his care? i 20b. Are there any additional, sources of payment?

(Check ONE box only) I (Check ALL boxes that apply) 

6 

1 0 Own income or family support (Include retirement funds, social secudty, etc.) private plans, ; 

I 

1 0 Own income or family supporr (IncZude 

retirement funds, social security, etc.) 

private plans, 

2 0 Church support I 2 0 Church support 

3 0 Veterans benefits I 3 0 Veterans benefits 

4 0 Public assistance or welfare I 4 0 Public assistance or welfare 

6 0 Initial payment - life care I 5 0 Initial payment - life care 

0 Other (Please describe) I 

I 6 0 Other (Please describe) 

I 

I OR 

I 7 0 No additional sources I 

42 
Card D 

IXSTOF CHRONICCONDITIONS 

Does this resident have any of these conditions? 

1, Asthma 

2. CHRONICbronchitis 

3. REPEATEDattacks of sinus trouble 

4. Hardening of the arteries 

5. High blood pressure 

6. Heart trouble 

7. 111 effects of a stroke 

8. TROUBLEwith varicose veins 

9. Hemorrhoids or piles 

10, Tumor, cyst or growth 

11. CHRONICgall bladder or liver trouble 

12, Stomach ulcer 

13. Any other CHRONICstomach trouble 

14. Bowel or lower intestinal disorders 

15. Kidney stones or CHRONICkidney trouble 

16. Mental illness 

17. CHRONICnervous trouble 

18. Mental retardation 

19. Arthritis or rheumatism 

20. Diabetes 

21. Thyroid trouble or goiter 

22. Epilepsy 

23. Hernia or rupture 

24. Prostate trouble 

25. ADVANCEDsenility 

Card E 

LXSTOFSELECTEDCONDITIONS 

Does this reside&have any of these conditions? 

1. Deafness or SERIOUS trouble hearing with one or both ears 

2. SERIOUS trouble seeing with one or

both eyes even when wearing glasses 3. Any speech defect 

4. Missing fingers, hand, or arm--toes, foot, or leg 5. Palsy 6. Paralysis of any kind 

7. Any CHRONICtrouble with back or spine 8. PERMANENTstiffness or any deformity of the foot,leg, fingers, arm, or back 

Card F 

LXSTOFSERVICES 

1. z;lE,$th dressing, shaving, or care 

2. Help with tub bath or shower 

3. Help with eating (feeding the patient) 4. Rub and massage 5. Administration of medications or treatment

6. Special diet 

7. Application of sterile dressings or 

bandages 8. Temperature - pulse - respiration 9. Full bed bath 

10. Enema 

11. Catheterization

12. Bowel and bladder retraining 13. Blood pressure 14. Irrigation 15, Oxygen therapy 16. Hypodermic injection 17. Intravenous injection 18. Intramuscular injection 19. Nasal feeding 
OUTLINE OF REPORT SERIES FOR VITAL AND HEALTH STATISTICS 

Public Health Service Publication No. 1000 

Series 1. Programs and collection procedures .-Reports which describe the general programs of the National 

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

and other material necessary for understanding the data. 

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 

statistics, carrying the andlysib: 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 recommendedmodelvital registration laws and revised birth 

and death certificates. 

Series 10. Data from the Health Interview Survey.- Statistics on illness, accidental injuries, disability, use of 

hospital, medical, dental, and other services, andother health-related topics, based on data collected 

in a continuing national household interview survey. 

Series 11. Data from the Health Examination Survey. -Data from direct examination, testing, and measurement of national samples of the population provide the basis for two types of reports: (1) estimates 

of the medically defined prevalence of specific diseases in the United States and the distributions of 

the population with respect to physical, physiological, and psychological characteristics; and (2) 

analysis of relationships among the various measurements without reference to an explicit finite 

universe of persons. 

Series 12. Data from the Institutional Population Surveys.- Statistics relating to the health characteristics of 

persons in institutions, and on medical, nursing, and personal care received, based on national 

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

Serzes 13. Data from the Hospital Discharge Survey .-Statistics relating to discharged patients in short-stay 

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

Series 20. Data on mortality.- Various statistics on mortality other than as included in annual or monthly 

reports- special analyses by cause of death, age, andother demographic variables, also geographic 

and time series analyses. 

Series 21. Data on natality, marriage, anddivorce. -Various statistics on natality, marriage, and divorce other 

than as included in annual or monthly reports- special analyses by demographic variables, also 

geographic and time series analyses, studies of fertility. 

Series 22. Data from the National Natality and Mortality Surveys. - Statistics on characteristics of births and 

deaths not available from the vital records, basedon sample surveys stemming from these records, 

including such topics as mortality by socioeconomic class, medical experience in the last year of 

life, characteristics of pregnancy, etc. 

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

National Center for Health Statistics 

U.S. Public Health Service 

Washington, D.C. 20201