A 21st Century Census 

Curated Data Enterprise:

Demonstration Use 

Case on Skilled Nursing

Facilities

Presentation to FCSM

October 24, 2023

Team: Vicki Lancaster, Stephanie

Shipp, Aaron Schroeder, Dawen 

Xie, Henning Mortveit, Samarth

Swarup, Sallie Keller
21st Century Census Curated Data Enterprise

The 21st Century Census Curated Data Enterprise (CDE) is a proposed shift of 

focus away from relying solely on individual surveys and towards creating 

statistical products defined by stakeholders’ purposes and uses –

Statistical Products First.

The statistical product first process starts with research questions and ends with 

products that provide data-driven insights into these questions.

Demonstration Use Cases are being used to test this idea out

and shed light on what capabilities will be needed 

to develop and deploy the CDE. 

Each Use Case follows the CDE Framework.
Curated Data Environment Framework

The outer rectangle 

identifies the guiding 

principles for ethical 

transparent and 

reproducible product 

development and 

dissemination.

The inner rectangle 

identifies the 

statistical product 

development steps. 
Curated Data Environment Framework

One can think of this 

as the scientific 

method for research 

using multiple data 

sources and types 

that are discovered 

and wrangled rather 

than collected based 

on a statistical model 

like an experimental 

design. 
?

Purpose & Use

1. Are Skilled Nursing Facilities (SNF) prepared for 

extreme climate events?

2. Will the nursing staff be able to get to the facility 

in the event of an extreme climate event?

3. Will communities be able to provide support to 

SNFs?

PURPOSE: Conduct a realistic appraisal of the 

skilled nursing facility that includes the physical 

facility, community in which the SNF resides, and 

the ability of the nursing staff to get to work and 

function.

USE: Provide a baseline assessment of the 

emergency preparedness of SNFs and the 

communities in which they reside that can be used 

by SNFs, emergency responders, and policy 

makers.
Subject Matter Input

PURPOSE: Conduct a realistic appraisal of the skilled nursing 

facility that includes the physical facility, community in which the SNF 

resides, the ability of the nursing staff to get to work and function.

USE: Provide a baseline assessment of the emergency 

preparedness of SNFs and the communities in which they reside that 

can be used by SNFs, emergency responders, and policy makers.

We met with SNF administrators, resident 

advocates, & researchers through discussions & 

listening sessions and conducted a library search. 
Data Discovery

Based on subject 

matter input & literature we 

made a wish list of variables 

for SNFs, climate threat, & 

community preparedness. 
Data Ingest & Governance

Set up a GitHub repository to 

store public data, metadata, 

code, statistical products, 

data processes, & relevant 

literature on SNF resilience 

& regulations.
Data Wrangling

288 SNFs in

Virginia, 283 had sufficient 

staffing data to be 

included in 

this Use Case. 

Data wrangling issues:

• Nonstandard names for hospitals and 

classification system

• Absence of data dictionaries that would 

allow users to compare variables across 

data sets

• Inconsistent geographic information

Data Wrangling Process

Profiling Preparation Linkage Exploration

Quantity,

Structure,

Metadata,

Provenance

Cleaning,

Transforming,

Restructuring,

Ontology,

Selection & 

Alignment,

Harmonization

Visualization,

Exploratory

Data Analyses,

Characterization
Fitness-for-Purpose

Exploratory data analyses 

were done to ensure the 

SNF Deficiency Indices had 

sufficient variability to 

discriminate between high 

and low-performing SNFs. 
Statistical Development

• Integrated Use Case Database

• Composite Indices

o SNF Deficiency Indices

o Community Resiliencies 

Indices

• Choropleth & Isochrone Maps

• Modeling Results

• Simulation Estimates

• R code use to 

o Download, clean & integrate 

multiple data sources 

o Produce the various 

statistical products
Are SNF prepared for emergencies?

Emergency Preparedness (EP)

• Emergency plans

• Communication plan

• Training and testing

• Policies and procedures

Life Safety Code (LSC) Deficiencies 

Fire protection requirements

• Designed to provide a reasonable degree 

of safety from fire, smoke, and panic

• Construction

• Protection

• Operational features

CMS Skilled Nursing Home Deficiencies as a proxy for preparedness
Will nursing staff reach the facility?

blue [0 – 5)

yellow [5 – 10) 

orange [10 – 20) 

red [20 – 30)

dark red [30 – 55]

Transportation Routes to 

King George SNF 495300

Very Low

Very High

Transportation Route Risks

0

15

30

45

60

75

90

105

120

135

150

165

180

195

210

225

240

255

270

283 Skilled Nursing Facilities

Average Daily Nursing Staff

Orange Line = Observed Average Daily Nursing Staff

Black Line = Estimated Average Daily Nursing Staff

Grey Band = 95% Nonparametric Confidence Interval

Observed and Estimated Average Daily Nursing Staff* Under an Extreme Climate Event

by Skilled Nursing Facility

FEMA National Risk Index (Nov 2021)

LTCFocus Public Use Data sponsored by the National Institute on Aging (P01 AG027296)

*Nursing staff includes: Med aide/Technician, Nurse's aide, CNA, LPN, LPN with administrative duties, RN, RN with administrative duties, RN Director of Nursing
Can communities provide support?

Most Deficient

Least Deficient

No Deficiencies

 Fire Safety & Emergency

Preparedness Deficiency Index

495260

495327

495423

495393

49A022

49E084

Population Resiliency Composite Index

(0=Least Resilient, 1=Most Resilient)

0.61132 0.72164 0.78462 0.82152 0.5312 0.87426 0.89712 0.95796

Fraction Employed, No Disability, High School Diploma or Greater,

Households with at Least One Vehicle, and Reverse Gini Index

2020 Richmond Resiliance Composite Index by Census Tract

 ACS 2020 5...Year Estimates Detailed Tables (B18101, B19083, B23025, S0101, S1501)

 Fire Safety Deficiencies and Inspection Dates (01/2018−03/2022): The Centers for Medicare & Medicaid Services
What CDE capabilities identified in this Use Case?

CDE Capabilities developed: 

• Identify the home location of SNF workers.

• SNF workers’ transportation routes + risk of flooding by route 

• Monte Carlo simulation to estimate the average probability of getting to 

work and the percentage loss in nursing staff based on the average daily 

skilled nursing staff numbers from CMS.

• SNF combined deficiency index 

• SNF Emergency Preparedness deficiencies metric

• SNF Life Safety Code (fire) deficiencies metric

• Community resilience indicators

• Number of shelter facilities and emergency service providers per 10,000 

people. 

• Mapping health professional shortage areas. 
What are the gaps to be filled in future use cases?

• Provide crosswalks that link location variables such as lats & long, FIPS 

codes, ZIP codes, addresses, etc. 

• Resolve inconsistencies and omissions observed across data sources on the 

same topic. In this Use Case, three data sets on hospitals had different 

names and federal IDs such as Medical Provider Number. 

• Provide private-equity ownership data, there is no definitive source that is 

publicly available (GAO 2023).

Technical Report: Lancaster V, Shipp S, Keller S, Schroeder A, Mortveit H, Swarup S, Xie D, (2023), Census Curated 

Data Enterprise Use Case Demonstration: Climate Resiliency of Skilled Nursing Facilities. Proceedings of the 

Biocomplexity Institute, Technical Report. TR# 2023-53. University of Virginia. https://doi.org/10.18130/ce97-sp05