NATIONAL CENTER Series 12 

For HEALTH STATISTICS I Number 13 

VITAL arpd HEALTH STATISTICS 

DATA FROM THE NATIONAL HEALTH SURVEY 

Arrangementsfor 

PhysicianServices 

to Residentsin Nursing 

andPersonaCare l Homes 

UnitedStates - May-June1964 

Statistics on types of arrangements made by nursing and 

personal care homes with physicians for care of residents. 

Types of arrangements are related to characteristics of 

establishments and to characteristics and care of residents. Based on data collected from institutions during 

the period May-June 1964. 

KS. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE 

Public Health Service 

Health Services and Mental Health Administration 

Washington, D.C. February 1970 
rut~lic Jealtir Sen ice Publication So. 1000-Series 12-No. 13 

For sale by the Superintendent of Documents, U.S. Oovemment Printing Office, Washington, D.C., 20402- Price 60 cents 
NATIONAL CENTER FOR HEALTH STATISTICS 

THEODORE D. WOOLSEY, Director 

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

OSWALD K. SAGEN, PH.D.,, Assistant Director for Health Statistics Development 

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

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

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

EDWARD E. MINTY, Executive Officer 

MARGERY R. CUNNINGHAM, Infomatian O/ficer 

DIVISION OF HEALTH RESOURCES STATISTICS 

SIEGFRIED A. HOERMANN, Director 

PETER L. HURLEY, Chief, Health Facilities Statistics Branch 

JACQUELINE GLEASON, M.A., Chief, Health Manpower Statistics Branch 

EDYTHE GRAY, M.A., Chief, Hospital Discharge Survey Branch 

NOAH WERMAN, Chief, Family Planning Statistics Branch 

Public Health Service Publication No. 1000~Eeries 12-No. 13 

Library of Congress Catalog Card Number 76-607418 
CONTENTS 

Page 

Introduction ____-___________________________________------------------ 1 

Problem----------------------------------------------------------- 1 

Objective---------------------------------------------------------- 2 

Overall plan of the Survey--------------------------------------------- 2 

General Data------------------------------------------------------- 2 

Questions Regarding Physician Services------------------------------ 3 

Characteristics of Establishments ______________________________________ 4 

Size of Home------------------------------------------------------- 4 

primary Type of Service-------------------------------------------- 4 

Type of Ownership-------------------------------------------------- 6 

Geographic Region-------------------------------------------------- 7 

Nursing Coverage-------------------------------------------------- 7 

Characteristics of Residents ________________________________________- -_ 9 

Sex andAge-,----------.--------------------------------------------- 9 

Mobility Status----------------------------------------------------- 10 

Number of Chronic Conditions and Impairments------------------------ 10 

Care of Residents----------------------------------------------------- 10 

Levels of Care----------------------------------------------------- 10 

The Last Saw physician _______ - ___________________________ - ________ 11 

Future Research------------------------------------------------------ 11 

13 

Detailed Tables------------------------------------------------------- 14 

Append& 1. Technical Notes ________________________________________ - 25 

A, Survey Design-------------------------------------------------- 25 

B. General Qualifications and Reliability of Estimates------------------ 27 

C. Terms and Definitions _________________________________ - ________ - 30 

.Demographic Terms-------------------------------------------- 30 

physician Arrangements---------------------------------------- 30 

Type of Ownership--------------------------------------------- 30 

Level of Nursing Supervision and Nursing Coverage--------------- 30 

Levels of Ca~e------------------------------------------------- 31 

Terms Relating to Residents ____________________________________ 31 

D. Classification of Homes By Type of Service----------------------- 32 

Appendix II. Survey .Forms and Questionnaires------------------------- 33 

A. Introductory Letters-------------------------------------------- 33 * 

B. Establishment Questionnaire _____________________________________ 35 

C. Staff Questi0Mair.e ____C,__________ ___________ - _____________ - _____ 38 

D. Resident (patient) QuestioMaire __________________________________ 40 

E. Lists of Chronic Conditions and Services------------o-------------- 42 

. . . III 
IN THIS REPORT statistics ave presented on arrangements made with 

physicians by the Nation’s estimated 17,400 nursing and personal cave 

homes for the cave of their 554,000 Yesidents OY patients. 

These statistics aye based on a 1964 survey in which personal interviews weye conducted with the homes’ administvatovs OYother responsible staff. 

The nursing and personal cave homes aye classified in this Yepovt by 

type of service, size, ownexship,geographic region, and extent of nwsing coverage. Data for Yesidentsof the homes include sex, age, mobility status, number of chronic conditions, level of cave, and time last 

saw physician. 

Four-fifths of the homes had made arrangements fov visiting physicians, 

either to be called when needed (45 percent) ok on a regular visiting 

schedule (36 percent). Few homes (4 percent) employed full-time physicians, About one-tenth of the homes had made no arrangements for 

physician covwage. 

Pyopovtionally more of the large homes than smaller homes had fulltimeand regular-visiting physicians. Awangements made for physician 

covevage weye found to be associated with the pyimavy type of service 

chavactevizing a home-a sequence from more to less intensive types 

of physician coverage was exhibited in the followiw order: ge&atvic 

hospitals, nursing care homes, peysonul care homes with nursing, and 

personal care homes. Similarly, the sequencefrom more to less intensive physician coverage with yega-ardto type of ownership was .govevllmental, nonprofit, and pyopyietary. 

Homes with a full- time Yegisteved nurse in chavge wwe most likely to 

have arrangements fov &El- time OY regular-visiting physicians. Such 

physician covevage in homes withouta full- time RN in charge was found 

in lessev but substantial pyopovtions only where nursing service (by 

nurse OYnurse% aide) was provided at all times. 

Three-fifths of all residents were in homes that had fill-time OY regulay-visiting physicians. Seven percent of all residents were in homes 

that had no avvangement for physician caye. 

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 ~_~___~__~~~~_~~~~ 8 

iv 
ARRA’NGEMENTS’FOR PHYSICIAN SERVICES 

TO RESIDENTS IN NURSING AND PERSONAL CARE HOMES 

Jerry A. Solon, P~.D., University of Pittsburgh Graduate School of Public Health,a 

Ame B. Nelson, M.P.H., National Center for Health Statistics 

INTRODUCTION 

The character of nursing and personal care 

homes has been substantially documented within 

the past decade. From the midfifties, when the 

first extensive, multi-State survey of patients ir 

such facilities was conducted jointly by the Commission on Chronic Illness and the Public Health 

Service, t until the midsixties, when national 

coverage for such data was first achieved by the 

Institutional Population Survey, 2-13 a rather 

thorough profile has been drawn. The kinds of 

staff, residents, and services characterizing 

nursing and personal care homes have become 

increasingly clear from these wide-angle surveys 

and from a series of local and State studies. 

Problem 

The extensive delineation of what nursing and 

personal care homes are and of what they do has 

nevertheless left bare a central area. Not filled 

in, except with only beginning suggestive information, is that part of the picture which tells of 

physicians and their services. 

Some of the earliest data regarding the care 

of patients began to identify this problem: “Iso­

‘Dr. Solonis’presently with the Community Health Service, 

Health Services and Mental Health Administration, PHS, U.S. 

Department of Health, Education, and Welfare. 

lation . . . of the nursing home from the medical 

resources of a community is perhaps the most 

prominent issue. . . .Tll Cataloguing patients’ receipt of physician services highlighted a relative 

sparsity of such services, raising the question of 

what provisions were made for physician coverage 

in nursing homes. This lack of information was 

emphasized in 1963 with the acknowledgment that 

“The arrangements by which patients receive 

physicians’ services in nursing homes have not 

been generally documented.‘* I* 

A tenuous beginning was made during 195% 

59 in a survey conducted by the American Medical 

Association and the American Nursing Home AssociationJ5 The information obtained was grossly 

indicative of some of the types of arrangements 

made with physicians; but perhaps most telling 

were the implications of the inadequacy of theinformation, which patently solicited further search 

for more instructive information. 

Considerably more detail about physician 

arrangements was subsequently obtained in a 

series of surveys in Illinois beginning in 196l,.ts-1s 

More than producing specific data for Illinois, 

the investigators provided steppingstones for 

further research in their formulations of physician 

roles and functions in nursing homes. Such formulations provide the foundation for what will undoubtedly be more comprehensive research in the 

future on physician participation in nursing home 

practice. 
The limited research to date regarding physicians in nursing homes points up a necessary 

methodological aspect of such research. Two kinds 

of tasks confront those who would seek toproduce 

data on nursing home arrangements with physicians. One is the data gathering itself; the other, 

and more fundamental task, is the conceptualization of the variety of roles through which 

physicians serve (or could serve) nursing homes 

and their patients. This task still lies largely 

ahead. 

Objectiv’e 

The present survey undertook to obtain national data on nursing and personal care homes, 

including geriatric hospitals, on a variety of 

subjects such as information about the establishments, their staffs, and their residents or patients. 

Additionally, the survey addressed itself to the 

establishments’ arrangements for physician services. 

OVERALL PLAN OF THE SURVEY 

Various materials explaining the survey asa 

whole are given in appendixes I and II. Brief 

descriptions of the survey and its general findings 

will be given at this point to furnish the necessary 

context for the specific analysis to follow on 

arrangements for physician services. 

A national sample survey of institutions which 

furnish nursing and personal care to the agedand 

chronically ill was conducted in the spring of 

1964. The survey was sponsored by the National 

Center for Health Statistics and was carried out 

with the cooperation of the Bureau of the Census. 

The survey is known as Resident Places Survey-2 

(RPS-2), and it succeeds a related one of a year 

earlier in which less detailed information was 

obtained. 

Included in the scope of the survey were 

resident institutions with three beds or more 

which regularly provide some level of nursing or 

personal care beyond that of mere room and board. 

These included establishments such as nursing 

homes, convalescent homes, rest homes, homes 

for. the aged, and geriatric hospitals. 

Data were gathered by well-trained, experienced interviewers through personal visits to the 

establishments drawn for the survey sample. The 

desired information about the home and its residents was obtained by interview with knowledgeable staff respondents and was supplemented by 

reference to records as needed. 

The information sought concerned not only 

the nature and provisions of the facility (appendix 

II-B) but also the personal, socioeconomic, and 

health characteristics of the residents and the 

services they receive (appendixII-D). Information 

about the staff obtained from the Establishment 

Questionnaire was supplemented by a questionnaire completed by me sampled staff members 

(appendix II-C). 

General Data 

Several reports have been published on certain findings of the survey. Detailed data have been 

reported on the number, types, characteristics, 

training and experience, hours worked, and wages 

of employees in nursing and personal care homes; 

on residents, with reference to the extent of 

chronic illness exhibited; on charges for care; on 

levels of care received; on the useof special aids 

for ambulation and sensory functions; and on 

marital status and living arrangements prior to 

admission. 6-13 

The present analysis of physician services 

deals with the 17,400 nursing and personal care 

homes throughout the United States and their estimated 554,000 residents or patients, These homes 

had about 281,000 employees who were working 

15 hours or more per week. 

Table A shows the composition of the universe 

of these homes by primary type of service. (See 

appendix I-D for explanation of the classification.) 

Somewhat over half of the total number of establishments, with two-thirds of the residents, were 

homes whose primary function was nursing care. 

Nursing care homes averaged about 40 beds 

or residents, compared with about 30 in the 

personal care homes with nursing and about 15 

in personal care homes (table A). In sharp contrast were the geriatric hospitals, with an average 

of 275 beds and 254 patients. All categories of 

2 
Table A. Number and percent distribution of nursing and personal care homes, beds, and 

residents, and mean size of homes, by primary type of service: United States, MayJune 1964 

Primary type of service Homes Beds Residents Homes Beds Residents 

Beds Residents 

Number Percent 

distribution Mean size 

All types---------- 17,400 618,900 554,000 100 100 100 36 32 

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

Personal care with 

9,280 392,800 355,800 53 63 64 42 38 

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

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

Geriatric hospital-------

5,240

2,810

70 

163,800

43,400

18,900 

145,400

35,300

17,500 

26 

2 i 

0.0 

26 

Fi E IT 

275 254 

homes had an average percentage occupancy of home for physician coverage. As shown below, 

roughly 90 percent. the Establishment Questionnaire included several 

Median age of residents was 80 years; only questions (appendix II-B, items 7a-d) regarding 

12 percent were under 65 years. Women pre- the existence of four types of arrangementsmade 

dominated by a 2:l ratio. About one-sixth of the for the care of residents, arrived at by written 

residents were confined to their beds, andanother or oral agreement with a physician: 

one-fifth to their rooms. Ninety-six perdent of 1. Employment of a jXZ- time staff physician all the residents had one or more chronic conditions or impairments; four-fifths of the resi- for the care of the residents, 

dents had multiple conditions. 2. Arrangement for a physician to come to 

Additional information about the homes, the home at regular interwzls for the care 

staffing, and patients and care will be discussed of the residents. 

in the analysis of the provisions made for phy- 3. Arrangement for a physician to come to sician services. the home when needed, but not at regular 

intervals. Questions Regarding Physician Services 

4. Arrangement with a physician to give 

Information sought about each resident in- medical care to the residents in his ofice 

cluded the length of time that had elapsed since 

the resident had been attended by *a physician. The existence of an “arrangement” as deQuestion 10 of the Resident (Patient) Question- scribed above is not negated byprovisionfor paynaire asked “During his stay here when did he ment by the residents for the physician services 

last see a doctor for treatment, medication, or received. The essential feature is that the estabfor an examination by the doctor?” (See appendix lishment is the responsible party to the agreeII-D.) This information will be dealt with below ment to secure assurance of physician care to 

in relation to the type of physician arrangement any or all of its residents. 

in the home. The findings reported below are based on 

Central to the present analysis is the matter responses to the specific questions. about these 

of what specific a?-vangements were made by the four types of provisions. Information on other 

3 
types of physician relationships to nursing and 

personal care homes is not within the scope of the 

present survey. 

CHARACTERISTICS OF 

ESTABLISHMENTS 

The most common arrangement for physician 

services among nursing and personal care homes 

was that of calling a doctor whenneeded. As figure 

1 shows, 45 percent of the homes relied on this 

type of arrangement, while over one-third had 

provisions for regular visits by a physician. Although the frequency of regular visits varied 

among the homes, they were made at prearranged 

times. Thus four-fifths of the establishments had 

arrangements for coverage byavisitingphysician, 

either regularly scheduled or on an “on-call” 

basis, 

Few facilities employed a full-time physicfan 

(4 percent). Very few took the residents to a 

doctor’s office as a regular arrangement (3 percent). One-tenth of the homes had made no arrangements for physician coverage. 

0 

Full time Fxegvtor Visits OffICe None 

visits when needed visits 

ARRANGEMENTFOR PHYSICIAN SERVICES 

Figure I. Percent distribution of nursing and personal care homes and beds, by arrangement for physician services. 

Size of Home 

Figure 1 shows that the more intensivekinds 

of arrangements with physicians tended to be 

found in the larger establishments. Facilities with 

physicians visiting regularly-slightly more than 

one-third of the homes-accounted for almost 

one-half of the total number of beds. While only 

4 percent of the establishments had full-time 

physicians, they accounted for 11 percent of all 

the beds in nursing and personal care facilities. 

Conversely, the homes with less intensive arrangements for physician services were generally 

the smaller facilities. Thus figure 1 shows proportionately smaller percentages of beds than of 

homes in the categories with less intensive 

arrangements. 

The apparent effect of size of establishment 

(number of beds) on physician arrangements can 

be seen in table 1. As size of home increased, there 

was a corresponding increase in the proportion 

of homes which had arranged the more intensive 

types of coverage. To illustrate withnursingcare 

homes, the percentages of all homes in each given 

bed-size group with the more intensive arrangements showed a definite trend: 

Number 

Under 25 beds------------

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

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

100-299 beds-------------

300 beds or over---------

Primary Type of Service 

Percent 

1 32 

5 2: 

12 70 

30 ‘70 

Another factor greatly influencing arrangements for physician services was the basic service 

character of the home. Table B shows the relationship of physician arrangements to the level of 

service that the home offered. 

4 
Perhaps nothing could more prominently 

display the distinctive character of geriatric 

hospitals than a comparative distribution of physician coverage. The percent distribution qf 

geriatric hospitals can be seen to depart radically 

from those of the other types of homes. While 

only 4 percent of all institutions had full-time 

physicians, 41 percent of the geriatric hospitals 

had such coverage. An additional 55 percent of 

the geriatric hospitals had physicians on a 

regular-visiting schedule, again distinctly higher 

than the corresponding percentages of the other 

types of facilities surveyed. Very few of the 

geriatric hospitals depended on a physician’s 

agreement to visit when needed. This distinctiveness of the geriatric hospitals among nursing and 

personal care facilities is especially noteworthy 

in view of the fact that these institutions classified themselves as “geriatric hospitals” through 

the completion of a mail questionnaire in the 

national inventory of hospitals and institutions,.lg 

Size of institution was confirmed as an important factor in the arrangements for physician 

services. The larger homes in each of the primary-type-of-service categories were more 

likely to employ full-time physicians (table 1). 

Of all the bed-size categFries in all the types of 

homes, geriatric hospitals ,with 300 beds or more 

had the largest proportion of full-timephysicians 

(92 percent). Table B shows that the *two-fifths of 

the geriatric hospitals employing physicians on a 

full-time basis accounted for four-fifths ofallthe 

beds in this type-of-service category. 

The kinds of arrangements for physician 

services were unmistakably associated with the 

level of care offered by the respective types of 

Table B. Percent distribution of nursing and personal care homes and beds, by home's 

arrangement for physician services according to primary type of service: United 

States, May-June 1964 

Primary type of service 

All types-----------------

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

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

Geriatric hospital--------------

All typos-----------------

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

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

Geriatric hospital--------------

Arrangement for physician services 

Total . . 

Total Full Regular v~~~~ Office None

time visits needed visits 

Percent distribution of homes 

17,400 11 

9,280

5,240 : 

2,810 25 

70 

Percent distribution of beds 

618,900 7 

392,800

163,800 ; 43,400 27

18,900 

5 
-- 

homes (observe, vertically in table B, the sequences of percents of honies with the respective 

arrangements). 

Type of Ownership 

The association of type of ownership with 

arrangements for physician services reflects in 

part the already noted influences of size of home 

and primary type of service, since the respective 

ownership categories were differentlyconstituted 

with regard to these two characteristics of homes. 

It is apparent from table C that the several auspices undertake different levels of care in different proportions. It is also clear that the average 

size of establishment varies consistently among 

the ownership categories, with proprietary homes 

having the smallest average number of beds, governmental auspices the largest, and nonprofit 

auspices the intermediate. 

Physician arrangements according to type of 

ownership (with the other influences naturallyincorporated) are shown in detail in tables 2 and 3. 

Figure 2 brings out a key aspect of these distributions, showing that a higher proportion of government institutions had arrangements for physicians on a full-time or regular-visiting basis 

(about 10 percent and 48 percent, respectively) 

than of nonprofit institutions (7 and 38 percent) or 

proprietary institutions (4 and 35 percent). 

Table C. Number and percent distribution of nursing and personal care homes and beds, 

and mean size of homes, by primary type of service and ownership: United States,

May-June 1964 

-

1 Per cent Number distribution Mean 

Primary type of service and ownership I size 

(beds)

Homes Beds Homes 

All types------------------------- 17,400 618;900 100 

Proprietary----------------------------- 14,200 372,900 Nonprofit-------------------------------

Government------------------------------ 2,220 147,500 !E 

990 98,600 6

N-sing care---------------------- 9,280 392,800 1 100 

Proprietary----------------------------- 8,160 283,200 88 Nonprofit------------------------------- 620 51,900 Government------------------------------ 510 57,700 57 

Personal care with nursing-------- 5,240 163,800 100 100 31 

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

Nonprofit------------------------------- ..-.-- 3,710 

z; z Government------------------------------ 1,270 

260 13 85 

personal care--------------------- I

2,810 100 15 .-

Proprietary----------------------------- 2,310 Nonprofit------------------------------- 300 60 :: Government------------------------------ 200 1; 41 

Geriatric hospital---------------- 70 . . . 275 

6 
ERRATA 

Please substitute this page for page 7 in your copy of PHS 1,O 0 0, Series 12, No. 13, entitled “Arrangemeiits 

for Physician Services to Residents in Nursing and Personal Care Homes, United States, May-June 19 6 4 .” 

PERCENT OlSTRlBUTlON 

0 20 40 60 60 100 

T& I I II III III1 

ownership 

Proprietary 

Governman! 

ARRANGEMENT FOR PHYSICIAN SERVICES 

Figure 2. Percent distribution of nursing and personal care homes, by arrangement for physician services according to type of ownership. 

Table 2 shows the relationship of type of 

ownership to physician arrangements according 

to primary type of service. The govemmentnonprofit-proprietary ranking noted above holds 

for nursing care homes, but with the nonprofit 

institutions closely approximating the government 

institutions. The character of personal care homes 

(with or without nursing) seems to inject variations 

vhich depart in unexplained particulars from the 

foregoing pattern. 

Geographic Region 

A comprehensive interpretation of physician 

data for all types of establishments by geographic 

regions shows that the North Central Region had 

the most balanced, graduated pattern of institutional arrangements for physician coverage 

relative to the levels of care provided (table 4 

and fig. 3). 

In each of the other three regions,, the comparative distributions of physician coverage reveal certain irregularities with regard to the 

relation of levels of care and availability of 

physician services. Particularly outstanding 

among these irregularities are the substantially 

large proportions of nursing care homes with no 

arrangements for physician coverage. 

Nursing Coverage 

When more intensive nursing coverage has 

been provided, arrangements for a corresponding 

intensity of physician coverage might be expected. 

This is largely borne out by the study findings. 

Percentages in table D show to what extent 

the more intensive forms of physician coverage 

paralleled those of nursing coverage. Nursing 

coverage is considered in terms of the skill 

level of the supervisory nurse of the home and 

the availability of 24-hour nursing service on any 

level (nurse or nurse’s aide). The combined proportion of homes having physician arrangements 

on either a full-time or regular-visiting basis 

shows the close relationship between nursing 

coverage and physician service. 

Homes with both RN (registerednurse) supervision and round-the-clock nursing were most 

likely to have had intensive physician coverage. 

PERCENT OISTRIBUTION 

Primary tvpe b 20 40 60 so 100 

of service I I I I I I I I I I I 

Nursing core 

Personal core with nursing 

ARRANGEMENT FOR PHYSICIAN SERVICES 

Figure 3. Percent distribution of nursing and personal care homes in the North Central Region, by 

arrangement for physician services according to 

primary type of service. 

4 
W,$&&ly three-fifths of these homes had the more 

intensive types of physician arrangements, whereas substantially less than half of the homes in 

the other categories evidenced such physician 

coverage (table D). 

A surprising pattern is shown for homes with 

minimal nursing care. Among the homes with 

neither an RN ?WY an LPN (licensed practical 

nurse) in chavge and with less than round-theTable D. Number and percent of nursing and 

full-time or regular-visiting physicians, nursing coverage: United States, May-June 

Level of supervisory nurse 

All types---------------------------------­

clock nursing, 45 percent had arrangements for 

regular-visiting physicians (none had full-time 

physicians, per table 5). This group of homes was 

largely composed of small proprietary homes 

providing personal care or personal care with 

some nursing. 

Except for these homes, it appeared that both 

the level of nursing supervision and the extent of 

nursing coverage throughout the day were posipersonal care homes with arrangements for 

by level of supervisory nurse and extent of ” 1964 

Extent of nursing coverage (nurse or nurse’s aide 

All on duty) 

homes I I 

Total number of homes 

17,400 12,370 2,220 2,810 

6,780 6,570 ’ 200 . . . 4,390 3,820 570 .,. 3,420 1,970 1,450 .,. 2,810 .e. .e. 2,810 

Number of homes with full-time or 

regular -visiting physician 

7,070 1 5,960 760 350 

3,810 90 0.. 

1,530

620 66; ::: 

..* ..D 350 

Percent of all homes in given 

category with full-time or regularvisiting physician 

==i 41 48 34 12 

58 208 46

9<’ :;: 

z’7 32 45 . . . 12 . . . . . . 12 
tively associated with the more intensive types of 

physician coverage (table D). Figure 4 shows that 

when comparing homes with full-time and parttime RN or LPN supervision, those with a fulltime RN in charge and with round-the-clock 

nursing were more likely than others to have intensive physician coverage. In the absence of a 

full-time RN supervisor, nursing coverage for 

less than 24 hours went hand-in-hand with little 

likelihood of any full-time or regular-visiting 

physicians. (Apparently there were no homes with 

a part-time LPN in charge and also less than 24 

hours of nursing coverage; see table 5.) 

PERCENT 

rypa 

iupervisory tide on duly 

\und 

port 

time Under 

24 hours +K 

time Under 

24 hours % 

Figure 4. Percent of nursing and personal care homes 

with arrangement for full-time or regular-visiting 

physicians, by type of supervisory nurse and extent 

of nursing coverage. 

Figure 5. Percent distribution of residents in nursing and personal care homes, by home's arrangement 

for physician services. 

CHARACTERISTICS OF RESIDENTS 

Of all the residents in nursing and personal 

care homes, about one-half were in homes that 

had arrangements for regular-visiting physicians, 

and about one-tenth were in establishments that 

had full-time physicians (fig. 5). Thus three-fifths 

of all the residents resided in homes that had the 

more intensive types of physician coverage. Almost one-third were in homes that had physicians 

on an on-call basis only. 

Sex and Age 

There is little difference between the distributions of male and female residents by their 

home’s arrangements for physician services 

(table 6). 

The expectation might be that a larger proportion of older than of younger residents would 

9 
be in homes with the more intensive types of 

physician coverage. The difference was slight, in 

fact, and in the opposite direction. By age groups 

the proportions of residents in homes having 

arrangements for full-time or regular-visiting 

physicians were as follows: 

Aae Percent 

Under 65 years------------------

65-74 vears---------------------

75-84 ;ears--------------------- 60 

85 years and over--------------- 58 

This sequence of decreasing proportions with 

advancing ag.e holds for both the men and the 

women. As table 6 shows, however, the decreasing 

sequence for the men is attributable entirely 

to their decreasing coverage by full-time physicians, while for the women it is attributable 

entirely to their decreasing coverage by regularvisiting physicians. While not much confidence 

can be placed in the small differences, their di­

: rectional regularity and their reflection separately among the men and women residents may 

speak for the possibility that some real phenomena 

exist here. The factors producing the differences 

are undoubtedly quite complex. The types of homes 

where men are more likely than women to be 

housed (governmental establishments, for example), differences in financial capability as between the younger aged and the older aged, and 

various other influences such as previous living 

arrangements and cultural sensitivities may be 

at work in intricate ways that do not allow for 

analysis here with the limited data available, 

Mobility Status 

Using restriction of mobility as a general 

measure of actual disability, a relationship of 

mobility status to type of physician arrangement 

might be expected. Again, no such association 

appears (table 7). The progression of mobility 

restriction from those free to move from bedand 

room, to those restricted to their room, and 

finally to those confined to bed finds no parallel 

progression in the arrangements made for more 

intense physician coverage. 

ir(umber of Chronic Conditions 

and Impairments 

An earlier report makes an impressive case 

for using as a measure of health status the number 

of chronic conditions a resident has.8 The distri-. 

bution of residents by arrangements for physician 

services reflects this measure of health (table 8). 

As the number of chronic conditions increased, 

the proportions of residents in homes with fulltime or regular-visiting physicians increased. 

Number 

I 

Percent 

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

1-2 conditions------------------’ 

3-4 conditions------------------

5 conditions or.more----;-------

Of all residents with a given number of conditions, the proportion Jn homes with no arrangements for physician services showed a marked 

downward trend wirh increasing numbers of con,­

ditions. Over 14 percent of the residents with 

no chronic conditions reported were in homes 

with no arrangements for physician services, 

compared with 5 percent of those with 5 conditions or more (table 8). 

CARE OF RESIDENTS 

levels of Care 

On the basis of specified services receir .r: 

by the resident’ during the week preceding the 

time of survey the level of care was designated 

for the resident within a rough classification 

(appendix I-C). Two of the categories in this 

classification--“’ mtensive nursing care” and 

“personal care”- lend themselves well to acomparative view of physician arrangements made by 

the respective homes. Percent distribution of 

r&dents who Geceived’ “intensive nursing care” 

and those who received only “personal care” are 

10 
Table E. Percent distributionofresidents in nursing and personal care homes receiveing two contrasting levels of care, by home’s arrangement for physician services: 

United States, May-June 1964 

Arrangement for physician services 

Level of care Number of 

residents Regular v$$is Office Total Full time visits None

needed visits 

Percent distribution 

Intensive nursing care--- 21,100 100 15 4 

Personal care------------ 148,800 100 9 13 33: 2 7 

shown in tables E and 9. Differences in corresponding physician arrangements are evident in 

the expected direction. Thus 56 percent of the 

residents who received only “personal care” 

were in homes with arrangements for physicians 

on a full-time or regular-visiting basis, while 67 

percent of .the residents who received “intensive 

nursing care” were in homes with such arrangements . 

Time Last Saw Physician 

Maintenance of physician contact with residents in nursing and personal care homes is 

effectively reflected in the proportion of residents 

who had not had any physician attendance in 6 

months or more or who had not been seen by a 

physician since coming to the home (table 10). 

These percentages vary by primary type of 

care offered by the home. 

Percent not seen: 

Primary type of 

service 

Nursing care (including geriatric hos­ pitals)-------------- 7 3 

Personal care with nursing-------------- 15 6 

Personal care--------- 18 15 

Figure 6 shows the relationship between the 

extent of nonattendance by physicians and the type 

of arrangement made by the homes with physicians. The fundamental import of the data profiled in figure 6 is that in each type of homewhether primarily for nursing care or not-provision for consistent coverage through full-time 

or regular-visiting physicians was matched by the 

lowest proportions of residents unattended for 

long periods of time. 

FUTURE RESEARCH 

This survey (RPS-2) has explored relatively 

untouched territory in securing information on 

nursing homes’ arrangements for physician services. In terms of the variety and complexity of 

such arrangements, however, the present survey 

has merely opened the door to still more revealing 

information yet to be sought about nursing homes’ 

use of physicians. 

The purpose of this survey was to establish 

the prevalence of four specified types of physician 

coverage utilized by nursing homes for the care 

of their residents. It should be appreciated, however, that arrangements for such coverage take 

more numerous and complex forms than have been 

identified by the present survey. To inquire 

whether the nursing home has provided for physician coverage on a full-time, regularly scheduled, on-call, or office-call basis is to take but 

one dimension of physician service, even though 

an important one. 

11 
Other dimensions worthy of exploration include: 

1. The&l1 variety of roles that physicians 

may ficlfill in nursing homes. These include direct patient care, admission of 

patients, consultation with administrative 

PERCENT 

Primary type 

of service 

Full time 

Nursing care Regular visits 

(including Visits when geriatric “Mdd 

hospitals) Office visits I 

ND”e 

Full time 

None 

Fi gure 6. Percent of residents in nursing and personal care homes who have not been seen by a physician in 6 months or more, or not seen at all during their stay in thehome, byhome's arrangement for 

physician services and home's primary type of service. 

staff on medical policies, and taking full 

responsibility for directing the me’dical 

affairs of the home. Other functions around 

which different roles may be structured 

are, for example, inservice training of 

the nursing home’s staff and participation 

in review of service utilization under 

Medicare and Medicaid provisions. Until 

research deals more fully with tbis matter 

of roles, the extent to which physicians 

do function and can function within nursing homes will not be known. 

2. The organizational strmctwes through 

which physicians provide the& services. 

The solo practitioner, an organizedmedical staff of the nursing home, a group 

practice combine, a hospital’s medical 

staff, a medical school faculty groupthese and other media for bringing medical services to the home’s residents exist 

in unknown variety and distribution. 

3. The numbers of physicians attending 

patients OY otherwise serving in nursing 

homes and the amount of time they spend 

in such activities. 

4. The methods of compensation of physicians for given types of service in nwsing homes. 

5. The characteristics of physicians who 

participate in nursing homes. 

These and other lines of development offer 

opportunities for extensive and productive research on physicians and medical care innursing 

homes. 

12 
REFERENCES 

‘Solon, J., Roberts, D. W., Krueger, D. L., and Daney, 

A. I&: Nursing homes, their patients and their care: A study 

of nursing homes and similar long-term care facilities in 13 

States. Public Health Z!onograph No. 46. Public Health Secvice. Washington. U.S. Government Printing Office, 1957. 

2National Center for Health Statistics: Institutions for the 

aged and chronically ill, United States, April-June 1963. 

Vita2 and Health Statistics. PHS Pub. No. 1000~Series 12-

No. 1. Public Health Service. Washington. U.S. Government 

Printing Office, July 1965. 

3National Center for Health Statistics: Characteristics of 

residents in institutions for the aged and chronically ill, 

United States, April-June 1963. Vita2 and HeaZth Statistics. 

PHS Pub. No. 1000~Series &?-No. 2. Public Health Service. 

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

‘1National Center for Health Statistics: Characteristics of 

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

Vital and Health Statistics. PHS Pub. No. lOOO-Series 12-

No. 3. Public Health Service. Washington. U.S. Government 

Printing Office, Dec. 1965. 

5YI ational Center for Health Statistics: Utilization of institutions for the aged and chronically ill, United States, 

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

1000~Series 12-No. 4. Public Health Service. Washington. 

U.S. Covernment Printing Office, Feb. 1966. n 

‘National Center for Health Statistics: Employees in 

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

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

12-No. 5. Public Health Service. Washington. U.S. Govemment Printing Office, Sept. 1966. 

‘National Center for Health Statistics: Employees in 

nursing and personal care homes: number, work experience 

special training, and wages, United States, May-June 19 64. 

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

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

Office, Jan. 1967. 

3National Center for Health Statistics: Chronic illness 

among residents of nursing and personal care homes, United 

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

Ho. lOOO-Series B-No. 7. Public Health Service. Washington. 

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

gNational Center, for Health Statistics: Prevalence of 

chronic conditions and impairments among residents of nursing and personal care homes, United States, May-June 1964. 

Vita2 and HeaZth Statistics. PHS Pub. No. lOOO-Series 12-

No. 8. Public Health Service. Washington. U.S. Government 

Printing Office, July 1967. 

10 National Center for Health Statistics: Charges for care 

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

hlay-June 1964. Vita2 and Health Statistics. PHS Pub. NO. 

1000-Series x2-No. 9. Public Health Service. Washington. 

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

11National Center for Health Statistics: Nursing and pecsonal care services received by residents of nursing and pecsonal care homes, United States, May-June 1964. Vital and 

Health Statistics. PHS Pub. No. lOOO-Series 12-NO. 10. 

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

Office, Sept. 1968. 

12National Center for Health Statistics: Use of special 

aids in homes for the aged and chronically ill, United States, 

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

IOOO-Series 12-No. 11. Public Health Service. Washington. 

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

“National Center for Health Statistics: Marital status 

and living arrangements before admission to nursing and 

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

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

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

Office, hlay 1969. 

14Solon, J. A.: Nursing homes and medical care. New 

England J.Wed. 269:1067-1074, Nov. 1963. (Also appears, 

with minor revisions, as chapter 15, Nursing homes and medical care, in L. J. DeGroot (ed.), iliedical Care: Social and 

Organizational Aspects. Springfield, 111. Charles C. Thomas, 

1966. pp. 194-212. 

15.4merican Medical Association. Summary of a survey of 

nursing homes, 1958-59. Nursing Homes 9(7):2-5, July 1960. . 

“Kramer, C. Ii., and Lessing, J. C.: Medical care in 

Illinois nursing homes. J.Am.Getiattics Sot. 10:963-994, 

Nov. 1962. 

17Kramer, C. H. and Sondag, P,. F.: Xedical care of nursing home patients. Gerontoologist 4:89-91, June 1964. 

18Kramer, C. H. and Kramer, D. I?.: Is medical care improving? ProfessionaZ Nursing Home 10(1):6-$0, Jan. 1968. 

19*National Center for Health Statistics: Development and 

maintenance of a national inventory of hospitals and institutions. Vital and BeaZth Statistics. PHS Pub. No. 100OSecies 

l-No. 3. Public Health Service. Washington. U.S. Government 

Printing Office, Feb. 1965. 

20 National Center for Health Statistics: Origin, program, 

and operation of the U.S. National Health Survey. Vi&Z and 

Health Statistics. PYS Pub. No. 100OSeries l-No. 1. Public 

‘3ealLh Service. Washington. U.S. Government Printing OlDice, 

Aug. 1963. 

000 

13 
DETAILED TABLES 

Page 

Table 1. Number and percent distribution of nursing and personal care homes, by home's 

arrangement for physician services according to primary type of service and size 

of institution: United States, May-June 1964 -_---_------_-------________________ 15 

2. Number and percent distribution of nursing and personal care homes, by home's 

arrangement for physician services according to primary type ofservice and ownership: United States, May-June 1964 ----__-__--_-----_---------------------------- 16 

3. Number and percent distribution of beds in nursing and personal care homes, by home's arrangement for physician services according to primary type of service 

and ownership: United States, May-June 1964 --_"_--_----------------------"------ 17 

4. Number and percent distribution of nursing and personal care homes, by home's 

arrangement for physician services according to geographic region and primary type of service: United States, May-June 1964----------------------------------- 18 

5. Number and percent distribution of nursing and personal care homes, by home's 

arrangement for physician services according to level of supervisory nurse and 

nursing coverage: United States, May-June 1964 ""l-l-----"-"------_I_____________ 19 

6. Number and percent distribution of residents in nursing and personal care homes,

by home's arrangement for physician services according to sex and 

States, May-June 1964----------------_--------------------------------~~~~-~~~~~ 20 

7. Number and percent distribution of residents in nursing and personal care homes,

by home's arrangement for physician services according toage and mobility status: 

United States, May-June 1964 _---------------------------------"----------------- 21 

8. Number and percent distribution of residents in nursing and personal care homes,

by home's arrangement for physician services according to age and number of 

chronic conditions and impairments: United States, May-June 1964---------------- 22 

9. Number and percent distribution of residents in nursing and personal care homes,

by home's arrangement for physician services according to age and level of care: 

United States, May-June 1964---------------------------------------------------- 23 

10. Number and percent distribution of residents in nursing and personal care homes,

by time interval since .last sawadoctor according to primary type of service and 

arrangement for physician services: United States, May-June 1964---------------- 24 
Table 1. Number and percent distribution of nursing and personal care homes, by home's arran sme;i for physician servrces accordine to primary type of service and size of institution: 8 

States; May-June 1964 

Number 

Primary type of service and of 

size of institution establishments 

All types of service 

All sizes--------------------- 17,400 

Under 25 beds----------------------- 9,820 25-49 beds-------------------------- 4,440 50-99 beds-------------------------- 2,070 100-299 beds------------------------ 970 300 beds and over------------------- 100 

Nursing care 

All sizes--------------------- 9,280 

lJ&er 25 beds----------------------- 3,710 25-49 beds-------------------------- 3,350 50-99 beds-------------------------- 1,560 100-299 beds------------------------

300 be& and over------------------- "2: 

Personal care with nursing 

All sizes--------------------- 5,240 

Under 25 beds----------------------- 3,650 25-49 beds-------------------------- 820

50-99 beds-------------------------- 420

100-299 beds------------------------ 310

300 be& and over------------------- 30 

Personal care 

All sizes--------------------- 2,810 

Under 25 beds-----------------------

25-49 beds ----------------_-_-_____^ 2>fg; 

50-99 beds ------_-_------_--_-______ 90 loo-299 beds------------------------

300 beds and over-------------------

20.'-

Geriatric hospitals 

All sixes------------.-------- 70 

pdt; ~~d~eds---.------------------- * 

:- ----1.--------.----------- * 

50-99 beds ------__--_-__-__---______ * 

loo-299 beds------------------------

300 be& and over-------.----------- 2: 

Arrangement for physician services 

All Full Regular Visits Gffice 

arrange- when time visits needed visits None 

ments 

Percent distribution 

100.0 4.3 36.3 44.5 3.1 11.4 

100.0 27.4 51.: 4.8 14.2 

100.0 37.8 46.5 10.2 

100.0 58.5 27.C F-2 6.2 

100.0 70.3 15.C 1:5 1.2 

100.0 48.0 4.c 1.0 1.0 

100.0 4.9 43.5 42.2 0.1 9.2 

100.0 1.4 31.5 54.6 12.6 

100.0 42.5 42.2 

100.0 2: 62.6 25.2 E:Y-2 12:o 70.2 14.6 2.0 

EE . 30.2 69.8 

100.0 4.7 36.6 47.1 3.5 8.1 

100.0 

100.0 

33.5 

26.4 z 4.1 

100.0 

100.0 

53.6 

74.9 

3314 

14.9 

5:: -'-

100.0 46.7 13.3 3.3 

100.0 11.7 50.5 12.0 25.2 

100.0 12.2C: 50.8 13.2 23.8 

100.0 55.6 39.0 

100.0 ?: CC 28.0 -'- 29.0 

100.0-'- 14.3-'c 19.0

-': 57.15: .'- 9.5* 

100.0 41.4 54.3 * 

* * * * * 

* * * * * 

* * s- * * 

* -A100.: 91.; 8.; m 
Table 2. Number and percent distribution of nursing and personal care homes,by home's arrangement for physician services according to primary type of service and ownership: United States, May; June 1964 

Number Arrangement for physician services 

'Primary type of service and 

ownership 

of 

establishments 

All 

arrange- Full Regular Visits 

when tfff:E 

ments time visits needed 

None ' 

All types of service Percent distribution 

All ownerships---------------- 17,400 100.0 4.3 36.3 44.9 3.1 11.4 

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

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

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

14,190 

2,220 

100.0 3.5 35.3 45.9 

100.0 7.0 37.9 42.6 2: 

11.9 

'X . 

Nursing care 

All ownerships---------------- 9,280 100.0 4.9 43.5 42.2 0.1 9.2 

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

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

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

8,150 

620 

510 

100.0 40.9 44.9 

100.0 1K 22.3 * 

100.0 11:o z:-::. 23.6 

10.1 

3.2 

2.4 

990 100.0 9.5 47.7 36.1 

Personal care with nursing 

All o~erships---------------- 5,240 100.0 4.7 36.6 47.1 3.5 8.1 

Proprietary------------------------- 100.0 E 37.3 Nonprofit---------------------------

Government-------------------------- xi 

'260 

100.0 

8:9 

32.9 2; 100.0 43.8 4713 

Personal care 

All ownerships---------------- 2,810 100.0 0.6 11.7 50.4 12.0 25.2 

Proprietary------------------------- 2,310 100.0 0.6

* 

11.8 51.6 14.6 21.4 Nonprofit--------------------------- 300 52.8 Government---------------------------- 200 %i . * 1::; 3567 . ’; 27.5

Geriatric hosoitals 

All ownerships---------------- 70 100.0 40.6 55.1 * 

Proprietary------------------------- * * 

Nonprofit--------------------------- * ik * 

Government-------------------------- * * 

16 
Table 3. Number and percent distribution of beds in nursing and personal care homes, by home's 

arrangement for physician services according to primary type of service and ownership: United 

States, May-June 1964 

Arrangement for physician services 

Primary type of service and Number 

of ownership beds All Full Regular Visits Office

arrange- when time visits needed visits Nwe ments 

All types of service Percent distribution 

All ownership-------------------- 618,900 100.0 11.1 48.9 31.6 1.4 6.9 

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

Nonprofit------------------------------ 372,900 100.0 

27.1 Government----------------------------- 1;;, 2;; 100.0 ;;I; 45.1 38.9 $2 , 100.0 . x . 10.9 

Nursing care 

All ownerships------------------- 392,800 100.0 9.3 54.1 30.5 0.3 

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

Nonprofit ---_---_--_------------------- Government----------------------------- E*i

1oo:o 

5.8 

2%. 

49.8

61.9

68.2 

37.2

18.5 

8.5 

2.; 

Personal care with nursing 

All ownerships------------------- 163,800 100.0 9.5 48.1 35.0 2.1 5.2 

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

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

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

61,700

80,100

22,000 

100.0

100.0 

100.0 

3.8 

3% 

37.4

53.8 

57.3 

45.9

32.9 

12.5 

10.7 f :Z 2.4 

Personal care 

All ownerships------------------- 43,400 100.0 4.5 17.9 41.8 9.3 26.5 

Proprietary -_-------_-_-----___-------- Nonprofit -----------_-----_--__________ Gove-~t-----------------------------

5,;;; 

8:300 

100.0

100.0

100.0 

3.2 

2:: 

14.4 

42:: 

43.6

41.0 

36.8 

15.6 23.1 

50.3 

10.6 

Geriatric hospitals 

All ownerships------------------- 18,900 100.0 78.7 19.5 1.8 

Proprietary---------------------------- 2,000 100.0 80.6 19.4

Nonprofit ----_-__--_-_-----_----------- 6,300 100.0 60.0 34.5 5.; Government----------------------------- 10,600 100.0 89.4 10.6 

17 
Table 4. Number and percent distribution of nursing and personal care homes, by home's arrangement for physician services according to geographic region and primary type of service: United 

States, May-June 1964 

Arrangement for physician services 

Number 

of Region and primary type of service establish- Visits 

when Office ments i None

needed visits 

All regions Percent distribution 

All types of service---------- 17,400 t 100.0 4.3 36.3 44.9 3.1 11.4 

Nursing care------------------------ 9,280 100.0 43.5 42.2 

Personal care with nursing---------- 5,240 100.0 36.6 47.1 2: 2:

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

Geriatric hospitaLs----------------- 2,810 100.0 11.7 50.4Jr 12:o 25:2 

70 100.0 55.1 

Northeast 

All types of service---------- 4,400 100.0 43.2 34.3 0.7 18.3 

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

Personal care with nursing---------- Pej-sonal care-----------------------

Geriatric hospitals-----------------

2,880

:z* 

100.0 

100.0;'r 

100.0 

32.5 15.7 

x.

Jx 3.:>k 33.2* 

13.8 

North Central 

All types of service---------- 5,980 100.0 52.7 4.3 5.3 

Nursing care------------------------ 3,010 100.0 6.1 47.5 43.9 0.4 

Personal care with nursing---------- 2,000 100.0 0.5 29.1 62.9 L”G Personal care----------------------­

Geriatric hospitals----------------- * -k

960 100.0* +< 2.9 

x 

59.9* 11:: 

* 22:6 

Jr 

South 

All types of service---------- 3,490 100.0 5.9 31.3 50.3 1.6 11.0 

Nursing care------------------------ 2,090 100.0 4.5 34.8 51.9 

Personal care with nursing---------- 1,060 100.0 10.6 33.2 39.9 5.2 1;*; Personal care----------------------- 2318 Geriatric hospitals----------------- * 340 100.0* 9< 3.5* 72.7* Jr ?c 

West 

All types of service---------- 3,520 100.0 503 36.3 39.5 5.3 13.6 

Nursing care------------------------ 1,300 100.0 12.0 

Personal care with nursing---------- 1,420 100.0 2: “;“;*z 11.5

personal care----------------------- 760 100.0* * 4113* 2% * 21.' Geriatric hospitals----------------- 4 a<

18 
------------------------ 

-

Table 5. Number and percent distribution of nursing and personal care homes, by home's arrange­ ment for physician services according to level of supervisory nurseand nursing coverage: United 

States, May-June 1964 

Arrangement for physician services 

Level of supervisor and nursing. Number of 

estab­ coverage lishments I

All 

xrange- Full Regular v$C$~ Office 

ments time visits needed visits .None 

All types-supervisory nurse Percent distribution 

Nurse or nurse's aide on duty--- 17,400 100.0 4.3 36.3 44.9 3.1 

24 hours a day------------------------ Less than 24 hours--------------------

No nursing care-----------------------

12,370 

2,220 

2,810 

100.0

100.0 

100.0 

5.9 42.6 2 f 50.7 

0.7 11:s 50.4 

0.9 

15:: 

Full-time RN supervisor 

Nurse or nurse's aide of duty--- 6,160 100.0 7.2 51.3 34,s 0,3 6.6 

24 hours a day------------------------

Less than 24 hours--------------------

5,970 190 100.0 

100.0 

7.5 51.4 34.0 

48.9 51.1 

0.3 6.8 

Part-time RN supervisor 

Nurse or nurse's aide on duty--- 620 100.0 3; 45.0 38.3 * 12.5 

24 hours a day- ____----__-__-_____ -_--

Less than 24 hours--------------------

600* 100,o* 

* 45.9 39.1 * * * * 

12.8* 

Full-time LPN supervisor 

Nurse or nurse's aide on duty--- 4,150 100.0 4.7 29.8 54.1 1.4 9.9 

24 hour- a day------------------------

Less than 24 hours--------------------

3,580 

570 

100.0

100.0 

5.5 34.: 50.1 

79.6 

1.6 

Part-time LPN supervisor 

Nurse or nurse's aide on duty--- 240 100.0 10.9 33.9 55.2 

24 hours Less than 24 a da

BOUTS--------------------

240 100.0 10.9 33.9 55.2 

Neither RN nor LPN 

Nurse or nurse's aide on duty::-- 3,420 100.0 1.6 35.9 48.2 3.1 

24 hours a,day------------------------

Less than 24 hours--------------------

1,970

1,450 

100.0

100.0 

2.7 29.0 

45.3. 

54.4 

39.7 

11.9 2:; 10.2 

No nursing care----------------- 2,810 100.0 0.7 11.8 50.4 12.0 !5.2 

19 
-- 

Table 6. Number and percent distribution of residents in nursing and personal care homes, by home's arrangement for physician services according 

-

to sex and age: United States,May-June 1964 

Arrangement for physician services 

Number 

Sex and age Of All 

when residents i Office None Irrange- Full Regular visits IFtime visits needed visits ments 

Both sexes Percent distribution 

All ages----------------------- 554,000 100.0 11.2 48.9 31.5 1.3 700 

n 

Under 65 years----------------------- 66,200 100.0 14.0 50.0 28.1 1.2 6.8 

65-74 years-------------------------- 104,500 100.0 12.1 50.1 30.4 1.0 6.4 

75-84 years-------------------------- 230,900 100.0 11.0 48.7 31.7 1.3 7.3 

85 years and over-------------------- 152,400 100.0 9.7 48.1 33.5 1.6 7.1 

Male 

All ages----------------------- 193,800 100 .o 13.4 48.4 30.0 1.5 6.7 

-’ 

Under 65 years----------------------- 36,200 100.0 18.1 47.1 26.3 1.7 608 

65-74 years-------------------------- 40,400 100.0 15.5 49.2 2808 1.3 5.2 

75-84 years-------------------------- 74,100 100.0 11.9 48.4 31.2 1.4 7.1 

85 year- and over-------------------- 43,100 100.0 10.0 48.7 32.1 1.9 7,3 

Female 

All ages----------------------- 360,200 100 .o 10.0 49.2 32.3 102 7.2 

Under 65 years----------------------- 30,000 100,o 9.0 53.4 30.3 0.5 6.7 

65-74 years-------------------------- 64,000 100.0 9.9 50.7 31.4 0.8 7.2 

75-84 years-------------------------- 156,800 100.0 10.5 48.9 31.9 1.3 704 

85 years and over-------------------- 109,300 100.0 9.6 47.8 34.0 1.5 7.1 

20 
Table 7. Number and percent distribution of residents in nursing and personal care homes, by home's arrangement for physician services according to age and mobility status: United States, May-June 1964 

Arrangement for physician services 

Age and mobility status of I, I 1 I I 

:sidents 

All ages Percent distribution 

Total-------------------------- 100.0 48.9 

Bed limitation----------------------- 92,200 100.0 10.3 46.8 36.2 0.8 5.8 

Room limitation---------------------- 116,900 100.0 9.8 47.6 34.5 0.6 7.5 

Neither bed nor room limitatlon------ 344,900 100.0 11.9 50.0 29.3 1.7 7.1 

Under 65 years 

Total-------------------------- 100.0 28.1 

Bed limitation----------------------- 8,400 100.0 9.1 57.2 26.5 6.0 

Room limitation---------------------- 8,500 100.0 10.6 48.7 29.7 10.4 

Neither bed nor room limitation------ 49,300 100.0 15.4 49.0 28.1 6.3 

65-74 years 

Total-------------------------- 100.0 6.4 

Bed limitation----------------------- 16,300 100.0 11.0 47.4 34.4 0.6 6.6 

Room li~tati~---------------------- 18,100 100.0 10.2 46.1 36.7 0.3 6.j 

Neither bed nor room limitation------ 70,100 100,o 12.8 51.8 27.8 1.3 6.3 

75-84 years 

Total-------------------------- 230,900 100.0 48.7 

Bed limitation----------------------- 36,500 100.0 44.6 0.3 

Room limitation---------------------- 49,100 100.0 50.2 0.6 

Neither bed nor room limitation------ 145,300 100.0 49.3. 1.8 

85 years and over 

Total-------------------------- 152,400 100.0 48.1 1.6 7.1_ -* 

Bed limitation----------------------- 31,000 100.0 10.2 46.4 35.6 6.3 

Room limitation---------------------- 41,200 100.0 8.7 45.0 38.5 7.0 

Neither bed nor room limitation-----; 80,200 100.0 10.0 50.2 30.1 7.5 

.2i 
Table 8. Number and percent distribution of residents in nursing and personal care homes by home's arrangement for physician services according to age and number of chronic conditions'and 

impairments: United States, May-June 1964 

Arrangement for physician services 

Age and number of conditions 

Number II , I I I of 

residents 

II I I ! I 

All ages Percent distribution 

All conditions----------------- 554,000 100.0 11.2 4809 31.5 1.3 

No conditions------------------------ 20,400 100.0 9.6 45.1 29.1 1.7 

1-2 conditions----------------------- 221,700 100.0 9.6 49.0 3201 1.5 

3-4 conditions----------------------- 201,100 100.0 11.8 49.5 30.6 1.3 

5 conditions or more----------------- 110,700 100.0 13.5 48.5 32.5 0.9 

Under 65 years t 

All conditions----------------- 66,200 100.0 14.0 50.0 28.1 1.2 

No conditions------------------------ 1,800 100.0 11.6 59.5 16.8 

l-2 conditions----------------------- 34,700 100.0 12.7 48.7 28.7 1.5 

3-4 conditions----------------------- 22,100 100.0 13.4 50.8 29.1 1.1 

5 conditions or more----------------- 7,600 100.0 22.1 51.4 25.1 

65-74 years 

All conditions----------------- 104,500 100.0 12.1 50,l 30.4 1.0 

No conditions------------------------ 3,700 100.0 9.7 4804 29.2 

1-2 conditions----------------------- 46,200 100.0 9.3 51.7 30,6 1.0 

3-4 conditions----------------------- 37,200 100.0 14.3 48.3 31.2 1.3 

5 conditions or more----------------- 17,500 100.0 15.2 50.1 28.4 0.6 

75-84 years 

All conditions----------------- 230,900 100.0 11.0 4807 31.7 1.3 

No c~ditions------------------------ 10,100 100.0 805 43.1 31.2 2.5 

l-2 conditions----------------------- 86,600 100.0 908 49.5 31.0 1.8 

3-4 conditions----------------------- 87,500 100.0 11.0 49.6 30.8 1.1 

5 conditic& or more----------------- 46,700 100.0 13,6 46.8 35.0 0.7 

85 years and over 

All conditions----------------- 152,400 100.0 9.7 4801 33,5 1.6 

No conditions------------------------ 4,900 100.0 11.2 41.5 29.0 2.1 

1-2 conditions----------------------- 54,300 100.0 706 46.1 37.2 1.6 

3-4 conditions----------------------- 54,300 100.0 lo,7 4908 30.6 1.9 

5 conditions or more----------------- 39,000 100,o 11.1 49.2 32,8 1.3 

7.0 

14.4 

7.8 

607 

4.6 

6.8 

12.1 

8.4 

5.6 

1.4 

6.4 

12,7 

7.3 

4.9 

507 

7,3 

1406 

8.0 

7.5 

3.9 

7.1 

L6,2 

7.4 

7.1 

5.6 

22 
Table 9. Number and percent distribution of residents in nursing and personal care home% by home's 

arrangement for physician services according to age and level of care: United States, May-June 1964 

Arrangement for physician services 

Number

Age and level of care of . residents All Full v$!$s . Office arrange- time Rvei~:~ needed visits None ments 

All ages Percent distribution 

All levels--------------------- 100.0 48.9 

Intensive---------------------------- 21, loa 100.0 51.7 29.7

Bed bath, excluding intensive-------- 150,700 100.0 4808 35.3 

Routine------------------------------

personal care only-------------------

Neither nursing nor personal care----

120,200

148,800

74,600 

100.0 

100.0 

100.0 

52.8 

47.3 

43.1 

28.5 

;f;*z0 

Under 65 years 

All levels--------------------- 66,200 100.0 28.1 

Intensive---------------------- ----mBed bath, excluding intensive-------- Less intensive-----------------------

Routine------------------------------

Personal care only-------------------

Neither nursing nor personal care----

2,500

14,200

3,900

12,200

20,800

12,600 

100,o

100.0

100.0 

100.0 

100.0 

100.0 

58.5

54.9 

so,4

57.8 

fE . 

23.2 

30.7

22.1 

23.0 

33.1 

24.6 

65-74 years 

All levels--------------------- 100.0 

Intensive----------------------------

Bed bath, excluding intensive-------- Less intensive-----------------------

3,800 100.0 

100.0 

100.0 

15.9 

6.3 

19.9 

51.1

51.5 

48.5 

30.4 

33.7 

27.3 

Less intensive----------------------- 38,600 100.0 53.7 24.3 

Neither 

Routine------------------------------

Personal care only-------------------

Neither nursing nor personal care----

100.0 

100.0

100.0 

14.9 

1% 

52.0 

22 . 

29,l 

22 . 

75-84 years 

All levels--------------------- 230,900 100.0 48.7 

Intensive----------------------------

Bed bath, excluding intensive-------- Less intensive-----------------------

Routine------------------------------

Personal care only-------------------

Neither nursing nor personal care----

9,200 

!x: 

50:ooo 

62,700

30,500 

100.0 

100.0

100.0 

100.0 

100.0 

100.0 

13.6 

6.8

15.9 

1;.; 

1312 

27.0 

36.5 

24.5

28.5 

34.4 

27.7 

85 years and over 

All levels-------------------- 152,400 100.0 

Intensive---------------------------

Bed-bath, excluding intensive------- Less intensive----r------~----------

Routine-----------------------------

personal care only------------------

100.0 

100.0 

100.0 

100.0 

100.0 

16.2 

1::: 

.1;.; 

41.8 

47.3

60.1 

52.6 

45.6 

36.6 

36.1 

22.1 

30.0 

36.2 

nursing nor personal care--- 100.0 11:2 41.5 31.2 
Table 10. Number and percent distribution of residents in nursing and personal care homes, by time interval since last saw a doctor according to primary type of servke and arrangement for physician services:United States, May-June 1964 

- -

Time Znterval since last saw doctor Median 

Primary type of Number time 

service and arrangement of All Under l-2 3-5. 6-11 1 year N;;i;$en interval 

for physician services residents I

1 month months months months in- 1 more 

or 

in home 1(in :ervals nonths) 

All types of service Percent distribution 

All arrangements- 554,000 100.0 38.7 35.,9 11.1 6.1 3.9 4.3 I 1.5 

Full time-------------- 62,000 100.0 55.8 27.7 7.6 4.6 2.7 P.6 0.9 

Regular visits--------- 271',200 iOO.a 43.6 3710 9.3 4.6 3.1 "2.5 1.3 

Visits when needed----- 174,600 100.0 27.5 37.5 14.9 8.9 4.9 6.3 2.0 

Office 'visits---------- 74,000 100.0 21.6 36.2 14.3 9.6 10.1 8.2 2,? 

None------------------- 388,000 100.0 30.7 34.1 11.4 5.8 .6.3 11.7 1.8 

Nursine care 

All arrangements- 373,300 100.0 43.5 36;5 10.1 4.7 2.7 2.6 -’ 1.3 

pull time-------------- 46;500 100.0 61.2 26.0 6.7 3.1 2.3 0.8 0.8 

Regular visits--------- 193,700 100.0 47.1 37.6 7.7 3.8 2.2. 115 1.4 

Visits when needed----- 110,600 100.0 '31.3 39.2 14.8 6.9 3.4 '. 4.5, 1.8 

Office visits---------- 1,100 100.0 34.8 21.7 21.7 17.4 4.3 m 2.4 

None------------------- 21,400 100.0 36.0 35.6 13.2 5.0 4.5 5.7 1.6 

Personal care with 

nursing 

All arrangements- 145,400 100.0 30.0 35.0 13.9 9.0 6.0 6.1 2.a 

fill time-------------- 14,100 100.0 40.8 33.0 9.1 8.9 3.7 4.4 1.4 

Regular visits--------- 71,200 100.0 35.4 34.3 13.4 7.0 5.5 4.4 1.7 

Visits when needed----- 49,400 100.0 21.5 34.7 16-L 12.4 7.3 8.0 2.4 

Office visits---------- 3,000 1oo.p 12.0 42.5 11.9 11.7 13.9 8.1 2.d 

None------------------- 7,700 100.0 21.8 43.0 13t7 5.4 3.2 12;9 2.Q 

Personal care 

All arrangements- 35,300 100.0 23.5 

- 33.4 lQ.2 8.8 8..7 15.4 2.1: 

Full time-------------- 1,500 100.0 28.6 31.1 22.6 11.3 3.2 34 2.3 

Regular visits--------- 6,200 100.0 27.8 46.2 8.7 3.5 3.4 10.3 I.? 

Visits when needed----- 14,600 100.0 19.0 34.0 11.9 aF.4 8.7 14.'1 ,,,2 . 4 

Office visits---------- 3,300 100.0 25.9 35.5 13.9 5.0 8.6 11.1 2;6‘ 

None----------;- -----, -_ 9,700 100.0 26.U 23.8 5.5 7.8 d2.9 24.0 2.01 

- -_ . I _,_.-.*I ,. . -

24 
APPENDIX I. TECHNICAL NOTES 

A. SURVEY DESIGN 

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

was conducted during May and June 1964 by the then 

Division of Health Records Statistics in cooperation 

with 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 beds or more 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 I-D. 

This appendix presents a brief description of the 

survey design, general qualifications of the data, the 

reliability of estimates presented in this report, terms 

and definitions, and classification procedures. Appendix 

II contains questionnaires and related materials used 

in the survey for collecting information about the 

facilities, their staff, and their residents. 

Sampling frame. -A “multiframe” technique was 

used in establishing the sampling universe for RPS-2. 

The principal frame was the Master Facility Inventory 

(MFI), 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 in the MFI were, theoretically, on another list referred to as the Complement 

Survey list. A description of the MFI and the Complement Survey has been published. 19 

The Complement Survey is based on an area 

probability design, using the sample design of the 

Health Interview Survey. 201n 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 in these 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 facilities in the United States that had 

not been included in the Master Facility Inventory. 

SampZe cZe.sim.-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 

was then sorted into 

nursing care homes, 

personal care homes 

homes. Group II was 

service stratum. Each 

insufficient addresses. Group 

three type-of-service strata: 

including geriatric hospitals; 

with nursing; and personal care 

treated as a fourth type-ofof these four strata was further 

sorted into four bed-size groups, producing 16primary 

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 the Bureau of the Census interviewers in accordance with specific instructions given 

for each sample establishment as contained in the 

Resident Questionnaire (HRS-3c, appendix II-D). All 

25 

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

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

to the RPS-2: United States 

-

Number of homes in sample 

Number In skope and 

Type of service and size of institution of homes F out of in business 

in the :otal scope or MFII- lames 1 out of Nonre- Re­ business sponding sponding homes homes 

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

Nursing bares---------------_---------------- 8,155 634 37 8 589 

Under 30 beds----------------------------------- 4,400 179 21 5 153 

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

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

300 beds and over------------------------------- 60 60 2 58 

Personal care with nursing---------------- 4,972 381 12 2 367 

Under 30 beds----------------------------------- 3,168 128 10 1 117 

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

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

300 beds and over------------------------------- 36 36 36 

Personal care"------"-------------------- 3,621 113 13 2 98 

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

30-99 beds-------------------------------------- 402 32 1 31 

100-299 beds------------------------------------ 29 14 2 1 11 

300 beds and over------------------------------- 3 3 3 

Group II~--------------------------------- 2,772 73 54 s 19 

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

25-99 beds __-__----c-_-___---___________________ 185 15 12 s 3 

loo-299 beds------------------------------------ 6 3 3 - -

;300 beds and over------------------------------- 3 3 2 1 

, 

lThe universe for the RPS-2 sample consisted of the MF'I and the Complement Survey. Included in" 

the RPS-2 sample were 4 homeb'from the Complement Survey. 

21ncludes geriatric hospitals. 

3Group II consists of those institutions assumed to be in scope of the RPS-2 survey but for 

which current data were not available. 
the residents on the register of the establishment on 

the day of the survey were listed on the Establishment 

Questionnaire (HRS-3a, appendix II-B). The interviewers were furnished with the numbers of predetermined sample lines for each home (e.g., every 

seventh line). The first three sample designations 

were entered on the questionnaire worksheet, and the 

interviewer entered the remaining predeterminednumbers until the last selected number exceeded the total 

number on the establishments register at the time. 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, a staff member. 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 its 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 methodONY, 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 mterview_‘assignment. 

The initial contact with an establishment was a 

letter signed by the Director of the Bureau of the Census. The letter (HRS-3f, appendix II-A) 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 4days. 

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 means of a self-enumeration questionnaire. The 

respondent for the Resident (Patient) Questionnaire 

(HRS-3c, appendix II-D) 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 usualIy a nurse who was responsible for the 

individual sample resident. One nurse might have 

completed questionnaires for all residents 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 tberespondent. 

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 and 

coded by the National Center for Health Statistics, 

and the data were processed on an electronic computer. 

This processing included assignment of weights, ratio 

adjustments, and other related procedures necessary 

to produce national estimates from the sample data. 

It also included matching with basic identifying information contained in the MFI, as well as carrying 

out internal edits and consistency checks to eliminate 

“impossible” response and errors in editing, coding, or 

processing. 

r‘ B. GENERAL QUALIFICATIONS AND RELIABILITY OF ESTIMATES 

Nonresponse and impututi& 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 beout 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 in the survey (table I). 

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 allin-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 procedurewhich 

imputed to residents for whom data werenot obtained the 

characteristics of residents of the same age and in the 

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

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 num bws .-Estimates relating to 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. 

27 
Percents were calculated using the original unrounded 

figures and will not necessarily agree with percents 

which might be calculated from rounded data. 

Estimation procedure: -Statistics reported in this 

publication are the result of two stages of ratio adjustment, 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 establisliment and resident data for all primary service-size 

strata from which a sample of homes was drawn. 

This 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 closer agreement 

with the known universe 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 

adjustment ‘is the product of two fractions: the first 

is the ratio of the total number of residents in the 

establishment to the number of residents for whom 

questionnaires were completed within the home; the 

second is the sampling fraction for residents upon 

which the selection is based. 

Reliability of estimate&-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 

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

'Y A A A A 

IOb I.000 lO,OOO 100,000 600,000 

SIZE OF ESTIMATE 

Example of use of figure I. An estimated 10,000 total residents or beds has a relative standard error of 10.0 

percent. The estimate has a standard error of 1,000 (10.0 percent of 10,000). 

28 
of the number of observations in the sample. Thus, ‘I’able III. Approximate standard errors of peras the sample size increases, the standard error centages for establishments 

decreases. The standard error is primarily a measure 

of the variability that occurs by chance because only Base of Estimated percent 

a sample, rather than the entire universe, is surveyed. estimated 

As calculated for this report, the standard error percent 

also reflects part of the measurement error, but it %izsiz iqqqqqz 

does not measure any systematic biases in the data. merits)

The chances are about two out of three that an estimate from the sample differs from the value which Standard error expressed in 

would be obtained from a complete census by less percentage points 

than the standard error. The chances are about 95 1(J)---- L4.3 16.4 17.5 17.9 

out of 100 that the difference is less than twice the 2(-J)--- E LO.1 L1.6 12.4 12.6 

standard error and about 99 out of 100 that it is less 500----m- 3:5 6.4 7.3 7.8 8.0 

than 

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 

2,000------

3,000------

4,000------

:*; 

1:4 

1.2 

2.4 

2.0 

1.7 

2: 

2=.3 

5.: 

3:o 

2.6 

5-z 

3:2 

2.8 

E 

3:3 

2.8 

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. 

5,000------

7,500------

10,000------

15,000------

1.1 

2: 

0:6 

1.5 

?:: 

0:9 

2.3 

1.9 

2: 

2.5 

2.1 

Z 

Standard errors of estimated percentages are shown 

in tables II and III. 

To determine the standard error of a mean value 

or of the difference between two statistics, the follow2% times as large. l,OOO------ 3.4 4.5 

ing rules may be used. standard error of the estimated number of beds and 

Stundard MOY of mean number of beds per the estimated number of establishments. The square 

establishment.-From figure I, obtain the relative 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 

standard error of the mean may be obtained by mulTable II. Approximate standard errors of per- tiplying the relative standard error by the mean value. 

centages for residents (patients) or beds 

Example: For a mean of 30 beds per establishment 

Estimated percent based on a denominator of 1,000 establishments, the 

Base of estimated standard error may be obtained as follows: 

residents or beds) 1. The relative standard error of 30,000 beds is 

about 4.7 percent, or .047 (curve A). 

I I I I 2. The relative standard error of 1,000 establishStandard error expressed

in percentage points 

ments is about IO.4 percent, or .104 (curve B). 

3. The relative standard error of the mean30 beds 

per establishment is \/(.047f + (.104)*= ,114. 

percent (number of 

4. The standard error is .114 x 30 = 3.4 beds 

per establishment. 

Sta7ldayd ernw of the diffe-rence 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. 

29 
------- 

----------- 

C. TERMS AND DEFINITIONS 

Demographic Terms 

Age: 

Age is defined as age at last birthday. 

Geographic region: 

Classification of establishments by geographic 

area is provided by grouping the States into 

regions. These regions correspond to those used 

by the Bureau of the Census and are as follows: 

Region St&es Included 

Northeast Maine, New Hampshire, Vermont, 

Massachusetts, Rhode Island, 

Connecticut, New York, 

New Jersey, and Pennsylvania 

North Central--- Michigan, Ohio, Illinois, Indiana, 

Wisconsin, Minnesota, Iowa, 

Missouri, North Dakota, 

South Dakota, NebrasE. 2, andKansas 

South Delaware, Maryland, District of 

Columbia, Virginia, West Virginia, 

North Carolina, South Carolina, 

Georgia, Florida, Kentucky, 

Tennessee, Alabama, Mississippi, 

Arkansas, Louisiana, Oklahoma, 

and Texas 

West __ __ ______ _ Montana, Idaho, Wyoming, 

Colorado, New Mexico, Arizona, 

Utah, Nevada, Washington, Oregon, 

California, Hawaii, and Alaska 

Physician Arrangements 

Full-time Staff Physician: 

A full-time staff physician is a physician, doctor 

of medicine (M.D.), or doctor of osteopathy (D.O.) 

who is empIo::cc! by the home for the care of the 

residents and who works in the establishment at 

least 40 hours a week. 

Avangement with a physician to come to the home at 

Yefilar intervals: 

An agreement, written or oral, between the home 

and a doctor, specifying that the doctor will come 

to the pEace at regular intervals and providemedical care to any or all of the residents who need 

care on that day. This does not necessarily mean 

that the doctor will be paid by the home. It is 

Possible that the doctor will send a bill to the 

individual patients. This does not include the 

patient’s own doctor who might come to the home 

when needed by the patient at the patient’s request. 

The term “regular intervals” is defined as “once 

a week,” “once a month,” “once every week for 

half a day,” or any other specified interval of time. 

30 

Amangement with the physician to come td the time 

when needed: 

An agreement, written or oral, between the home 

and the doctor, specifying that the doctor will come 

b the place only when medical care is needed by 

the patients, and not at regular intervals. 

Anangement with a physician to give medical caye in 

his office: 

An agreement, written or oral, between the home 

and a doctor, specifying that the residents in the 

home will be taken to the doctor’s office to receive medical care. This includes taking the 

patient to his own doctor, either by a relative, a 

friend, or by the home. 

Type of Ownership 

PropYietaavy: 

A home operated under private commercial ownership. 

Nonpyofi t: 

A home operated under voluntary or nonprofit 

auspices, including both church-related and nonchurch-related homes. 

Government: 

Homes operated under Federal, State, or local 

government auspices. 

Level of Nursing Supervision and Nursing 

Coverage 

Supervisor: 

Is defined as the person who is actually in charge 

of the daily nursing activities provided in the home. 

It does not mean the person who employs the 

nursing staff, such as the owner or administrator, 

unless this person also supervises the daily 

nursing activities. 

Registered nurses: 

Includes registered professional nurses and graduate nurses. 

Licensed practical nwses: 

Includes licensed practical nurses and licensed 

voc&ional nurses. 

Nwse’s aides: 

Includes practical nurses, nurse’s aides, student 

nurses, and other supporting nursing sta’ff. 

Nwsing coverage: 

Is defined in terms of whether or not a nurse or 

nurse’s aide was on duty 24 hours a day. Full 

coverage would require that nursing service be 

provided at al1 hours of the day or night by either 

a nurse or a nurse’s aide. 

Full- time work: 

Is defined as usually working 35 hours or more 

a week. 
Part- time work: 

Is defined as usually working less than 35 hours 

a week. 

levels ot Care 

These levels are defined in terms of the implied 

intensiveness of care or the condition of the resident. 

The care is defined by the services performed, not by 

who performed the service. Based on these criteria, 

nursing and personal care services are grouped as follows, each succeeding level being exclusive of the previous level(s) . 

Intensive nursing caye 

Catheterization 

Bowel and bladder retraining 

Oxygen therapy 

Intravenous injection 

Nasal feeding 

Full bed bath 

Other nursir+g care 

Application of sterile dressing or bandages 

Irrigation 

Hypodermic injection 

Intramuscular injection 

Taking of temperature-pulse-respiration or blood 

pressure 

Enema 

Personal cave 

Help with dressing, shaving, or care of hair 

Help with tub bath or shower 

Help with eating (feeding of resident) 

Rub and massage 

Administration of medications or treatment 

Special diet 

Neither nursing TWY personal care 

None of the above 

Terms Relating to Residents 

Resident: 

Is defined as a person who has been formally 

admitted but not discharged from an establishment. 

All such persons were included in the survey 

whether or not they were physically present at the 

time. 

Mobility sWu.% 

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 wheelchair for most of the day, 

were considered neither bed nor room limited. 

Chronic conditions and impairments: 

These are defined as the conditions and impairments contained in Cards D and E of appendix II-E. 

This list was expanded, based 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. 

Time interval since saw doctor last: 

This refers to the period of time from the date the 

resident last saw a doctor during his current stay 

to the date of the survey. 

31 
D. CLASSIFICATION OF HOMES BY TYPE OF SERVICE 

For purposes of stratification of the universe 

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

were classified as either nursing care,’ personal care 

with nursing, personal care, or domiciliary care 

homes. The latter two classes were combined, leaving 

the three types of service classes shown in table I. 

Geriatric hospitals were included in the sampling 

frame with nursing care homes. Details of the classification procedure in the MFI have been published.lg 

Due to the 2-year 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 for 

RPS-2 are defined as follows: 

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

50 percent or more of the residents received 

nursing care (see definitions above for levels 

of care) during the week prior to the survey, 

with an RN or LPN employed 15 hours or more 

per week. 

2. A pe~so?uzl care home with nursing is defined

3. 

4. 

as one in which either (a) over 50 percent 

the residents received nursing care during 

week prior to the survey, but there were 

RN’s or LPN’s on the staff; or (b) some, 

less than 50 percent, of the residents’received 

nursing care during the week prior to 

survey, regardless of the presence of RN’s 

LPN’s on the staff. 

A person& care home is defined as one 

of 

the 

no 

but 

the 

or 

in 

which residents routinely received personal 

care, but no residents received nursing care 

during the week prior to the survey. 

Geriatric hospitals were self-classifieddirectly 

by the responding facility. This contrasted with 

the classification procedure followed for nursing and personal care homes, which proceeded 

on the basis of detailed information on the types 

of services provided. 

oo32 
APPENDIX II 

SURVEY FORMS AND QUESTIONNAIRES 

A. INTRODUCTORY LETTERS 

U.S. DEPARTMENT OF COMMERCE 

BUREAU OF-rHEcENSOS 

WASHINGTON. D.C. 20233 

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 ori 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 purpose- only. 

Your cooperation in this important survey will be very mt, appreciated. 

Sincerely yours, 

6s-f-J 

Pilchard M. Scammon 

Director 

Bureau of the Census 

33 

L 
U.S. DEPARTMENT OF COMMERCE 

BUREAU OFTHECENS”S 

Dear 

About a week ago the Bureau of the Census conducted a survey in the 

establishment in which you are employed to obtain information on the work 

experience and education of certain professional and semi-urofessional 

employees of the home. At that time we left a questionnaire for you to 

complete and return to us. According to our records, the questionnaire 

has not been received. 

Another copy of the questionnaire is enclosed for your use if the other 

copy has been lost or misplaced. Please complete the questionnaire and 

mail it to the Bureau of the Census within 5 days. For your convenience, 

a self-addressed envelope which requires no postage is enclosed. 

If you have already returned the original questionnaire, please disregard 

this reminder. 

Thank you for your cooperation. 

GGSincerely yours, 

Richard M. Scammon 

Director 

Bureau of the Census 

Enclosures 

Please send completed

form to: 

34 
B. ESTABLISHMENT QUESTIONNAIRE 

Budser Burcan No. 6%RGX.RZ: Ap~mvzl Expires December 31, 1964 

CONFIDENTIAL - This i”f”mmtion is collccwd for the U.S. Public Health Service nnder nurkority of Public Law 652 of rke 84th b”gress (70 Star. 489; 42 ".SC. 309. All m f omuxfon which would permir idendficarion of the indfvidvol will be held srdctly confidendal,will kc 

(22 

used FR only 16871. by persons engaged in nnd for the purposes of ~hr suvey, and ail1 not he disclosed or relensed to orher; for any ocher purposes 1 U.S. DEPAFITMENT OF COMMERCE SURE*” OF THE CENSUS 

*Cl-IN0 *s COLLECTING *GENT FOR THE 

U.S. NATIONAL HEALTH SURVEY 

ESTABLISHMENT QUESTIONNAIRE 

N”“IbtC I. How many ksds are regularly maintained for residents (patients)? (Include nny beds set up for we wkcckcr or not rkey are in use x rke present rime. Exclude beds used by staff or nny beds used rzclusivcly for emergency services) 

Number 

!. How mn” residents (patients) we cwrontly on you, register “5 formal a dmissions who knvo not keen disehwged?

(Do nor’include employees or proprierors) 

1 Number 

I. During the part 7 days how mo” of there - - rsridcnts OR 0 None (patients) received nursing co,- TB y nursing cam we *em i my fGo0 to q. 7, of +hs services listed on this card. (Show cmd A) 

Re isrczed Licensed I. Is the person who supervises NURSING CARE Someone I 0 pro ? essional 2 0 practical o registercad profsssional nurse, D liz..tred ’ 0 else nurse nurse p,ac+ic.al nurra, 0, saneo”o else? 

8. Doss she w,k full-time o, pa,+-time? I 0 Full-time P 0 Pan-rime 

By full-tima we me”” 40 o, me,e hews vzweek. 

IO Yes 20 No . Is there D nurse o, WI%.‘. .ald. ON DUTY 24 how. a d”y? 

a. Doer this horns employ 0 full-time staff physician for tha CD,O of the residents (patients)? 

b. Doss this home have on drrengement with a physicion to come to rhe home o+ ,e ula, intervals fo, the ewe of the residents (patients P? 

c. Doss this horns have a” wrongcment with D physician to cc.mo to the home v&on needed, but not a+ regulo, i”+e,v.lr? 

d. Door this home have on o,,,m emen+ with a 

d hyrician to give medical EWO to the residents 9-pot~mtr) IN IS OFFICE? 

P. Doer this homa employ ” dentis+ M the premises full time to give dental c”,e +D the residents (patients)? 

b. Doss this home hava an a,,a”gcme”+ with a dmtirt I 0 Yes 20 No IO eom~ +o the horns a, rsgul., i”+c,v.l. to give (Go to question 9) dental ca,e to the residents (patients)? 

G Does +his homa hove cm a,,e”geme”+ with D datist to came 10 Yes 20 No 

M the home when “oeded but not a+ regular intawals? (Go to question 9) 

d. Doss this hom.‘hava a” srrongomant with a dentist to /ye 10 Yes 20 No 

dental c”,e to the rssida”ts4ppstietats) IN HIS OFFICE! 

Page 1 ~JCOMM~DC P4,P,.POd 

35 
9. We wont to know the torn1 number of residents (potlents) who were dischmgcd during 1963--both +hors who were discharged 

to their homa o, Rome other ~laso and those who died. First. I want to ark about those who died. 

Number a. How many persons died durin 1963 whi.le residents (patisnts) in you, ertoblirhment? include 

thou who died while ON YO 3 R REGISTER even rhough they wwc tampwarily way in B hospital 

o, LW+ID other pl.ce. 

b. Excluding deaths. how many other discharger did you have in 19631 . . . . . . . . . . . . . . . . . . . . . . . . 

I 

Of tbs.+, - c4. 9b) _ di&ha,gas, other than deaths, how many wt~e disshorgsd to the following 

(1) Resident’s (w+ion+‘=) horn= 0, family? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

(2) Another nursing home, home for ths aged, o, slmilo, srtablirhmant? . , . . . . . . . . . . . . . . . . . . . . 

(3) Mental hospital? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

I 

(4) Nonmental hospital? . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

(5) Other ploea.? . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

(6) Place unknown? . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Number 

10.. How many parrcar work in this ss+oblishmen+? (Includs owners who work in the establishment as wzll as all paid employees and members of religions orders) 

h. How many of there - (9. 10a) - persons usually work LESS than 15 hours a weak in 

this srtablishmsnt? 

C. Now I need +o list thanames of the employsss who uruelly work 15 hours o, mo,e per week in this 

srtoblishmsnt. 

Name of ,espondcnrW Telephone number and ext. 

Title or position Dare completed 

Census Interviewer’s name , Code 

I 

Gmmenrs 

36 
------ 

------ 

STAFF INFORMATION AND CONTROL RECORD - Continued 

In addition to What Is his ioh hsrs? (Enter How ohan is What are his cash wager number from Card B) INTERVIEWER

“hi- “NW- sex 

Employees who work 15 ‘TbJfes- prafes-’ profev or more hours n week sional” sianal” sional” (Enter Fill buff Staff Quesdomaire in this esrablishmcnr (Nukrs (Number (Numbers 

for 

M 1 -, 10) form (F&x, HRS3d) for each 11) 12-15) sample cmpfo ee in columns 

(Enrcr hfr., hfrs., Miss, SW- SW- SW- g; (b) and (c) .& 

1

E or Dr., first inirinl =E- TE- TE F (Check one box for each - 2 nnd lnsr name) (Circle (Circle (Cimlc for sample employee eligible SXllplC SImplc s%C?ple female) man*? for staff form) . 

“.c Pf=ons) persons) persons) cl 

(a) (b) Cc) (d) (4 (0 (n) (h) (9 (i) (k) 

Month 0 Ccmplcted ac rime of visit 

0 Form left to be mailed in ------.-------

Year Date reccive~~~~6----

8 

Month 0 Completed at time of visit 

0 Form left to be mailed in -----_ Year -lJZFEZGlinR 0. 

9 

Month 0 Completed at time of visit 

0 Farm left to be moilcd in __---- Year -753r;TeZEl~n~B.~-~~ 

10 

Month 0 Campleted at time of visit 

------------r-3------- 0 Form left to be mailed in 

YeaI Dare rccclred tr, R. 0. 

11 

hlonth 0 Complcred at rime of visir 

0 Form left to be mailed in 

Year --~~i;~~~=i~~d-i~~.-o~---. 

12 

hIon& 0 Complcred at time of visit 

53 Form left co be mailed in _------

Yea* Dee reccivcd in R. 0. 

13 

Month 0 Completed at time of visit 

0 Form left to be mailed in --------D~te-~~--- Ye23 

14 , 

37 
-- 

C. STAFF QUESTIONNAIRE 

FORM HRS-Sd CONFIDENTIAL - This information is collected for the U.S. Public Health Sewice under CPJ1.14, authority of Public Law 652 of the 84th Congress (70 Star. 489; 42 U.S.C. 305). Nl info= U.S. DEPARTMENT OF COMMERCE madon which would permit identification of rhe individual will be held strictly confidcn- BUREAU OF THE CENSUS rid, will be used only by persons engaged ih atld for zbc pu~poscs of rhc survey, and will *CnNG A5 COLLECT,NC *CENT FOR THE nor be disclosed 01 released to others far any orber puqposes (22 FR 1687). 

n”mber b. Line number U.S. NATIONAL HEALTH SURVEY ‘- Estab’ishmcnr I 

I STAFF QUESTIONNAIRE C. Name of person who should fill this form 

The U.S.. National Health Survey of the Public Health Since it takes only a few minutes to complete the quesService is conducting a nationwide survey in nursing tionnaire, we would very much ap reciare it if you will 

homes, homes for the aged, and other related types of complete and mail the form within t f: e next 5 days. 

establishments. The purpose of the survey is to obtain 

certain information about the staff employed in these Your answers will be given confidential treatment by the 

establishments as well as about the health of parients OI U.S. National Health Survey and the Bureau of the Census 

residenrs in the establishments. The information will be used for statistical purposes only, 

and will be presented in such a manner thatno individual 

Please answer the questions on this questionnaire. When person OI establishment can be identified. 

you have completed it, mail it to the Bureau of the Census 

in the postage-free, self-addressed envelope provided. Thank you for your cooperation. 

I A&= 1. How old were you on your last birthday?. . . . . . _ . . . , . . . . , _. . . . . _ . . . . 

Number of - 2. How many years have you worked as a 

I 

u - - in this establishment?. . . . . . . . . . . . . . . . . . . . 1 Y.ara and inonrha 1 

b - - in other nursing homes, homes for the aged, or related facilities? YOQI. and lTl.D”,hW 

c--inhospitals? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ysar. and l-z-G 

(If your present job is in a hospital, do not include the experience

shown in question 28.) 

NOTE TO NURSES: Do not include special duty mpriuate duty nursing. 

3. What is the highest grads you 

COMPLETED in school? I Elementary school. . . 1 2345678 (Grade school) 

(Circle the hi@est &ade cmpleted) 2 High school. , . . . . . . 1 2 3 4 

3 College.. . . . . . . . . 1 2 3 4 5t 

. 4. Which, if any, of the following 

degrees, diplomas, or licenses I 0 Regisrered professiooal I 0 Doctor of Dental Surgery 

do you have? nnrse (R.N.) or Dental Medicine (D.D.S. or D.M.D.) 

2 0 Licensed practical B 0 Physician (M.D. or D.O.) 1 nurse (L.P.N.) 

J 0 Degree in home I 0 Master of Social Welfare 

economics (M.S.W.) 

rl 0 Member-American IO 0 Ocher f~foa.s opscffy, 

Dietetic As’sociarion 

I 0 Registered occupational therapist 

6 0 Registered physical OR 

therapisr I I I-J None of rhe above 

38 
e by checking the appmpriate golumn, r tqjversity sponsorship” or 

39 
D. RESIDENT (PATIENT) QUESTIONNAIRE 

Budget Bureau No. G&R620.R2; Approval Expires December 31. 1964 

Establishment number 1 Resident’s (patient’s) line No. 1 

Month ; Year 

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

I 

2. Sex I 0 Male (Ask question 3) 2 0 Female (Go Lo question 4) 

30. Has he served in ~S.NO~ TOI~+TTERVIEWER: 

the Armed Forces of Source of ve*e*an st*tus 

the United States? t 0 Yes (Ask Q. 3b> 2 0 No (Go to Q. 4) B 0 Unknown information 

b. Did he serve in 

World War I? to Yes 

4. Is this resident (patient) married, I c] Married 3 0 Divorced 5 0 Never married widowed, divorced, separated, or 2 0 Widowed 4 0 Separarecr never married? 

Month ;<Yea 

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

6. With whom did he live a+ 1 17 Spouse only T 0 In anorher nursing home or 

the’time afhis admission? z 0 Children only r&red facility 

(Check

that 

the FIRST 3 n Spouse and children B 0 In mental hospital 

box applies) 4 0 Relatives other than spouse or 9 0 In a long-term specialty hospital 

children (except mental) 

5 c1] Lived in aparrment or own home - I o 0 In a general or short-stay hospital 

alone or with unrelated persons I I 0 Other place (Specify) 

6 0 In boarding home 

I

7. How often do friends or I 0 Ar least once a week 3 0 Less than once a month relatives visit him? 

(Check the FIRST 2 n Less often rhan once a week but at 4 II Never I 

80. Does he stay in bed all or most of the !oy? t 0 Yes (Go lo quesfion 9) 2 0 No (Ask question Sb) 

b. Does he stay in his own room all or mast of the day? t 0 Yes ?. 0 No (Ask question SC) 

c. Does he go off the premises just to walk, shop, or 

visit with friends or relatives and so forth? 1 [? Yes z 0 No 

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

use? (Show card C) I n Hearing aid 4 0 Braces -J 0 Eye glasses 

2 u Walker 5 0 Wheel chair OR 

3 0 Crutches 6 0 Artificial limb(s) 8 0 None of these aids used 

10. During his stay here when did he last see a Month 1 Year 

doctor for treatment, medication, or for an 0 Never saw doctor 

examination by the doctor? I while here 

_-

110. During his stay here, 

has he seen a dentist? + 0 Yes (Ask question llb) 2 0 No (Go to question 12) 

1 Month 1Year 

b. When was the last time he saw (I dentist? I 

120. Has he IDS? ALL of his teem? + n Yes (Ask question -_12b) 2 0 No (Go to question 13) 

b. Does he wear full upper and lower dentures? 3UYes 4l--JNo 

13. Does this resident (patient) have any of these conditions? 

(Show card D. Record in Table I each condition which the patient has) 10 Yes 20NO 

4. Does he hove cony of these conditions? 

(Show card E. Record in Table 1 each condition which the patient has) I aYe* ZI-JNO 

51. Does he have any other CHRONIC conditions listed in his record that you have not +old me about? 1l-JYes 2UNO 

If ‘<Yes,: ask: 

b. What are they? 

(Record in Table 1 each chronic condition mentioned) 

‘ORM H RS-JC m-23-84) 
Table 1 

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

ILL EFFECTS OF STROKE.. . . . Who+ are the present ill effects? 

SPEECH DEFECT. . . . . . . . . . . What caused the speech defect? Do 

PARALYSIS, PERMANENT “0, 

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

describe the condition. TUMOR, CYST, OR GROWTH. . . . What part of the body is affected? in 

Is it malignant or benign? this 

‘DEAFNESS, HEARING TROUBLL, column 

OR ANY EYE CONDITION. . . . . . Is one or both ears (eyes) (Include & ‘Zaucoma and cataracts) affected? 

(a) (b) (cl 

If any eye conditions have been recorded in Table 1, ask 0 No eye condition reported (Co to question 17) 

You told m. about this resident’s ( aiimt’s) ey. condition. 

Can he s.. wall enough to wad or B tnary newspap.r print with pl.a.se.? 10 Yes 2l-JN-2 

Durlnp tlw past 

of t 0 Help with dressing, shaving, 8 i-J Temperature-pulse- 17 0 Iatravenous injection 7 days which a care of hair respiration 18 u Intramuscular injection thmsm servicms 

did this resident z 0 Help with tub bath 9 I-J Full-bed bath 19 0 Nnsai feeding 

(patiant) res*iv*? or shower IO 0 Enema 

J 0 Help with eating I+ 0 Catheterization OR (Show cud F and (feeding the res:dent(patienr)) 12 0 Bowel and bladder check each one , I-J Rub and massage retraining mentioned) 20 0 None of the above s ~.Admiaisuarion of 1-d 0 Blood pressure services rcccived medications or rre~rment 14 0 Irrigation 

7 0 Application of sterile 

dressings or bandages 

I 5 0 Oxygen therapy 

16 0 Hypodermic injection 

At the time this resldmt (patient was admitted to 

this home, what kind of CCIN did I . receive-primarily 

nursing core, primarily pwsonal car., or room and 

bawd only? (Check one box onfy) 

1 0 Primarily 2 0 nursing 

care 

Primarily 

pC%Mbd 

care 

3 0 Room 

board 

and 

only 

Amount 

What WM the TOTAL charge for this raidant’s (patient’s) care lost month? s 

What is the PRIMARY source of payment for his care? i 2Ob. Are there any addition-4 sources of payment? 

6 0 Special diet 

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

I 0 Own income or family support (Include private 

rstfmnmt funds, eociaI secudfy, etc.> 

plans, I 

I 

I 0 Own income or family support (Include private 

retirement funds, social securfty, etc-) 

plans, 

z 0 

~0 

Church support 

Veterans benefits I z 0 

3 0 

Church support 

Veterans benefits 

a 0 Public assistance or welfare I 4 17 Public assistance or welfare 

8 0 

6 0 

Initial payment - life care 

Other (Pleam deacrfbe) 

I 

I 

I 

5 0 

6 I-J 

Initial payment - lift care 

Other (Please descrfbe) 

I 

I 

I OR 

7 0 No additional sources 

41 
E. LISTS OF CHRONIC CONDlTlON$ AND SERVICES 

Card D Card E 

LIST OF CHRONIC CONDITIONS LIST OF SELEC.TED CONDITIONS 

Does this resident have any of these conditions? Does this resident have any of these conditions? 

1. Asthma 1. Deafness or SERIOUS trouble hearing with one or both ears 2. CHRONIC bronchitis 2. SERIOUS trouble seeing with ohe or 

3. REPEATED attacks of sinus trouble both eyes even when wearing glasses

3. Any speech defect 4. Hardening of tne arteries 4. Missing fingers, hand, or arm--toes, 

5. High blond pressure foot, or leg 

5. Palsy

6. Heart trouble 6. Paralysis of any kind 

7. Any CHRONIC trouble.with back or spine 7. Ill effects of a stroke 8. PERMANENT stiffness or any deformity

8. TROUBLE with varicose veins of the foot,leg, fingers, arm, or back ~ 9. Hemorrhoids or piles 

10. Tumor, cyst or growth 

11. CHRONIC gall bladder or liver trouble Card F 

12. Stomach ulcer :LIST OF SERVICES 

13. Any other CHRONIC stomaGh trouble 

14. Bowel or lower intestinal disorders 1. Hei; with dressing, shaving, or care of 

15. Kidney stones or CHRONIC kidney trouble 

2. Help with tub bath or shower 

16. Mental illness 

17. CHRONIC nervous trouble 3. Help with eating (feeding the patient) 

18. Mental retardation 4. Rub and massage 

19. Arthritis or rheumatism 5. Adminisrration of medications or treatmenl 

20. Diabetes 

6. Special diet 

21. Thyroid trouble or goiter 

22. Epilepsy 7. Application of sterile dressings or 

bandages 23. Hernia or rupture 

24. Prostate trouble 8. Temperature-pulse-respiration 

25. ADVANCED senility 9. Full bed bath 

LO. Enema 

11. Catheterization 

L2. Bowel and bladder retrairiing 

L3. Blood pressure 

L4. Irrigation 

15. Oxygen therapy 

16. Hypodermic injection 

17. Intravenous injection 

L8. Intramuscular injection 

19. Nasal feeding 

ooo42 
Series 1. 

Series 2. 

Series 3. 

Series 4. 

Series 10. 

Series 11. 

Series 12. 

Series 13. 

Series 14. 

Series 20. 

Series 21. 

Series 22. 

OUTLINE OF REPORT SERIES FOR VITAL AND HEALTH STATISTICS 

Public Health Service Publication No. 1000 

Programs and collection proceduves.- Reports which describe the general programs of the National 

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

and other material necessary for understanding the data. 

Data evaluation and methods I-esearch. - 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. 

Al&ytical studies.-Reports presenting analytical or interpretive studies based on vital and health 

statistics, carrying the analysis further than the expository types of reports in the other series. 

Documents and committee reports.-Final reports of major committees concerned with vital and 

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

and death certificates. 

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

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

in a continuing national household interview survey. 

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

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

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

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

universe of persons. 

Data from the Institutional Population Suuveys.- 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. 

Data jrom 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. 

Data on health resources: manpoloev a&facilities.-Statistics on the numbers, geographic dlstribution, and characteristics of health resources including physicians, dentists, nurses, orher health 

manpower occupations, hospitals, nursing homes, and outpatient and other inpatient facilities. 

Data on movtality.- 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. 

Data on natality, malkage, anddivorce. --Various statistics onnatality, 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. 

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 hy socioeconomic class, medical experience in the last year of 

life, characteristics of pregnancy, Ptc. 

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

National Center for Health Statistics 

U.S. Public Health Service 

Washington, D.C. 20201