nursinghome utilizationin california,illinois,mqsachusetts ...as a whole (19 percent). texas had...

Data from theNATIONAL HEALTH SURVEY

NursingHome UtilizationinCalifornia,Illinois,Mqsachusetts,New York,and Texas:1977 NationalNursing Home Sunrey

Estimates are for the coterminous United States and for California,Illinois, Massachusetts, New York, and Texas. Data include type ofownership, certification status, bed size, occupancy rate, cost per.resident day, discharge status (alive or dead), and demographic char-acteristics and health status of residents. Estimates are based ondata collected in the 1977 NationaI Nursing Home Survey.

DHHS Publication No. (PHS) 81-1799

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESPublic Health Service

Office of Health Research, Statistics, and TechnologyNational Center for Health Statisti~Hyattsville, Md. October 1980

Series 13Number 48

For snle by the Superintendent of Documents, U.S. Government Printi& 05ce, Washington, ‘D.C. 20402

.—

v

/

Library of Congress Cataloging in Publication Data

Foley, Daniel Joseph.Nursing home utilization in California, Illinois, Massachusetts, New York, and Texas:

1977 national nursing home survey.

(Vital and health statistics: Series 13, Data from the National Health Survey, Data onhealth resources utilization; no. 48) (DHHS publication; no. (PHS) 81-1 799)

Supt. of Dots. no.: HE 20.6209:13/481. Nursing homes –California-Statistics. 2. Nursing homes–Illinois-Statistics. 3. Nurs-

ing homes—Massachusetts—Statistics. 4. Nursing homes–New York (State) –Statistics.5. Nursing homes–Texas–Statistics. 6. Nursing homes–United States–Statistics. I. Title.II. Series: United States. National Center for Health Statistics. Vital and health statistics:Series 13, Data from the National Health Survey, Data on health resources utilization; no.48. 111. Series: United States. Dept. of Health and Human Services. DHHS publication; no.(PHS) 81-1799. [DNLM: 1. Nursing homes-United States-Statistics. 2. Health facilityplanning–United States. W2 A N148vm no. 48]RA407.3.A349 no. 48 [RA997] 362.1’1’0973s 80-14677

[362.1’6’09794]

NATIONAL CENTER FOR HEALTH

DOROTHY P. RICE, Director

ROBERT A. ISRAEL, Depu@ Director

STATISTICS

JACOB J. FELDMAN, Ph.D., Associate Directorfor AnalysisGAIL F. FISHER, PhiD., Associate Director for the Cooperative Health Statistics System

ROBERT A. ISRAEL, Acting AssoczizteDirector for Data SystemsALVAN O. ZARATE, Ph.D., Acting Assoctite Director for International Statistics

ROBERT C. HUBER, Associate Director for ManagementMONROE G. SIRKEN, Ph.D., Associate Director for Mathematical Statistics

PETER L. HURLEY, Associate Director for OperationsJAMES M. ROBEY, Ph.D., Associate Director forprogmm Development

GEORGE A. SCHNACK,Acting Asscwhte Director for ResearchALICE HAYWOOD,Information djj?cer

DIVISION OF HEALTH RESOURCESUTILIZATION “STATISTICS

W. EDWARD BACON, Ph.D., Acting DirectorJOAN l?. VAN NOSTRAND, ChiefiLong-Te?m CareStatistics Branch

JAMES E. DELOZIER, ChiefiAmbulatory CareStatistics BranchW. EDWARD BACON,Ph.D., Acting chie~ Hospital ChreStatistics Branch

MANOOCHEHR K. NOZARY, Chiej Technica2Services BranchSTEWART C. RICE, chie~ Family PlanningStatistics Branch

Vital and Health Statistics-Series 13-No. 48

DHI-IS Publication No. (PHS) 81-1799Libwy of CongressCatahg CardNumber 80-14677

CONTENTS

Introduction ........................................................................................................................................... I

Facility Cbaracteristies........................................................................................................................... 2

Utilization .............................................................................................................................................. 2

ResidentCharacteristicsand HealthStatus............................................................................................. 4

List of DetailedTables ........................................................................................................................... 5

Appendixes............................................................................................................................................. III. Tecludcal Notes ........................................................................................................................ 12II. Definition of CertainTermsUsedin Thii Report ...................................................................... 20

SYMBOLS

Data not available— —.— .-.

Category notapplicable-—-———— . . .

Quantity zero—— ———

Quantity morethan Obutlessthan0.05—— 0.0

l?igwe does not meet standards ofreliability or precision— —-—-——- *

NURSING HOME UTILIZATION INCALIFORNIA, ILLINOIS,

MASSACHUSEllS, NEW YORK, AND TEXAS

Daniel J. Foley, Division of Health Resources Utilization Statistics

INTRODUCTION

This report presents selected characteristicsof nursing homes for the coterrninous UnitedStates and for the five States on the NationalMaster Facility Inventory with the largest pro-portion of nursing home residents–Califomia,Illinois, Massachusetts, New York, and Texas.Data are from the 1977 National Nursing HomeSurvey, conducted by the National Center forHealth Statistics from May through December1977. This is the second in a continuing seriesof surveys, but it is the first from which statisti-cally reliable State estimates have been obtained.The first survey in the series was conductedfrom August 1973 through April 1974.

The 1977 National Nursing Home Surveywas a nationwide sample survey of nursinghomes in which descriptive data about the facil-ities, their costs, and the characteristics of theirresidents, discharges, and staff were collected.In order to produce State estimates, the nationalsample was supplemented with the additionalnursing homes needed to produce reliable Stateestimates. State supplement samples were drawnfor Massachusetts, Illinois, New York, andTexas. This was not done for California since thesample for that State was already sufficient toproduce State estimates. Nursing homes in-cluded in the survey were those classified by the1973 National Master Facility Inventory (NMFI)as nursing care homes, personal care homes (withor without nursing), and domiciliary care homes,as well as all nursing homes that opened for

business from the time the 1973 NMFI was con-ducted through December 1976. The NMFI is acensus of zdl inpatient health facilities conductedevery 2 or 3 years by mail by the National Cen-ter for Health Statistics.l

This report focuses on comparisons of Statewith national data and addresses only thoseStates with substantial differences from thenational norms rather than making comparisonsfor each of the five States. Data in this reportcenter on facifity characteristics and selectedmeasures of utilization. Facility characteristicsinclude bed size, ownership, certification, andstaff. The measures of utilization selected fordiscussion are financing of resident days of care,primary source of payment, occupancy rate, dis-charge status (alive or dead), costs of providingcare, “and charges for care. Demographic data onnursing home residents and a profile of theirhealth status and the services they received arealso presented. Estimates of the number of facil-ities, beds, residents, full-time equivalent em-ployees (further information about this andother terms can be found in appendix 11 of thisreport), and the average monthly charge arebased on 1977 data; and estimates of the annual

] National Center for Health Statistics: Inpatienthealth facilities as reported from the 1973 MFI Survey,by A. Sirrocco. Vital and Health Statistics. Series 14-No.16. DHEW Pub. No. (HRA) 76-1811. Health ResourcesAdministration. Washington. U.S. Government PrintingOffice, May 1976.

1

occupancy rate, resident days, discharges, andcost per resident day of care are based on 1976data. Information on sampling variability is pre-sented in appendix I of this report. For a sum-mary of the national data collected in the 1977National Nursing Home Sumey, see footnote 2.

FACILITY CHARACTERISTICS

From May through December 1977, therewere about 6,700 nursing homes in the fiveStates of California, Illinois, Massachusetts, NewYork, and Texas, representing about 35 percentof the 18,900 nursing homes nationwide. Thesefive States also accounted for about one-third ofthe Nation’s 1.3 million nursing home residentsand about one-third of the Nation’s 1.4 millionnursing ho’me beds (table 1).

California aIone had 16 percent of the nurs-ing homes nationally and 9 percent of the beds,while New York, with only 5 percent of thehomes, had nearly as many beds (8 percent) asCalifornia, reflecting a dramatic difference inaverage bed size. In California nursing homesaveraged 42 beds each, and those in New Yorkaveraged 123 beds. However, 20 percent of thehomes in New York (200) had a bed size of 200beds or more and provided care for about halfthe nursing home residents in the State.

The national distribution of nursing homesby type of ownership indicates that about three-fourths (77 percent) of the homes operatedunder proprietary auspices. By State, however,a significantly larger proportion of facilities inCaIifomia (88 percent), Massachusetts (87 per-cent), and Texas (89 percent) were proprietary,while a significantly smaller proportion of thosein New York (64 percent) were proprietary.

Certification refers to a facility’s certifica-tion by the Medicare or Medicaid program or byboth. A skilled nursing facility (SNF) providesthe most intensive nursing care available outside

‘National Center for Health Statistics: The NationalNursing Home Survey: 1977 supmaty for the UnitedStates, by J. F. Van Nostrand et al. V{tal and HealthStatistics. Series 13-No. 43. DHEW Pub. No. (PHS) 79-1794. Public Health Service. Washington. U.S. Gover-nmentPrinting Office, July 1979.

a hospital. Skilled nursing facilities certified byMedicare provide posthospital care to eligibleMedicare enrollees. Facilities certified by Medi-caid as skilled nursing facilities provide intensivenursing care on a daily basis to individual eligi-ble for Medicaid benefits. An intermediate carefacility (ICF) is certified by the Medicaid pro-gram only and provides health-related serviceson a regular basis to persons eligible for Medi-caid who do not require hospital or skilled nurs-ing facility care but do require institutional careabove the level of room and board. A health re-lated faciIity (HRF) in the State of New York isequivalent to an ICF facility.

Table 1 shows that in 1977 there were sig-nificantly higher proportions of facilities certi-fied as SNF only in New York (49 percent) andCalifornia (37 percent) than in the United Statesas a whole (19 percent). Texas had over twiceas many homes certified as ICF only than thenational average—nearly three-fourths (72 per-cent) for Texas compared with only 32 percentnationwide. Massachusetts, with about half (50percent) of its nursing homes certified as ICFonly, also had a significantly Iarger proportionthan the national average.

To provide direct health-related sewices toresidents, the Nation’s nursing homes employedthe equivzdent of 46 full-time staff members per100 beds. Two-thirds of the health services staffwere nurse’s aides (table 2). In Illinois, Massachu-setts, and Texas, where many nursing homes arecertified as ICF only and very few as SNF only,the full-time equivalent staffing rat;os were signif-icantly lower than nationality. However, in eachof the five States there was no significant differ-ence between the proportions of staff employedas nurse’s aides, licensed practical nurses, regis-tered nurses, or administrative, therapeutic, andprofessional staff and the national

UTILIZATION

proportions.

In this section, the utilization of nursinghomes in the five States is compared with na-tional estimates. The nursing home utilizationmeasures discussed are resident days of care,source of payment, occupancy rate, dischargestatus, costs, and charges for care.

2

Table 3 indicates that in 1976 about 60 per-cent of the Nation’s resident days of care innursing homes were financed either totally orpartially by the Medicaid program. The propor-tions of Medicaid resident days of care in Illinoisand Massachusetts were roughly the same as thenational level, while New York (67 percent) andTexas (72 percent) had significantly higher pro-portions. Although the proportion of Medicaidresident days of care in California (51 percent)was significantly lower than nationally, it stillconstituted a maj,ority of the State’s total num-ber of resident days of care. Thus Medicaid wasthe principal purchaser of long-term care servicesboth at the national level and, as was evidencedin these five States, at the State level.

Data on the primary source of payment re-ported for residents in 1977 further highlightMedicaid’s role in providing nursing home care.The primary source of payment refers to thesource that paid the greatest amount of the resi-dent’s charge in the last completed calendarmonth prior to the survey. The records of about48 percent of the Nation’s nursing home resi-dents reported Medicaid as their primary sourceof payment (table 4). California had significantlylower Medicaid participation than nationally,with about 42 percent of its resident records in-dicating Medicaid as the primary source of pay-ment. Massachusetts, New York, and Texas hadsignificantly higher proportions of Medicaidresidents (57 percent, 61 percent, and 54 per-cent, respectively).

These State differences in Medicaid partici-pation and utilization were influenced by themarked differences between States in benefitpackages and outlay of Medicaid expenditures.Although Medicaid is jointly funded by the Fed-eral and State governments, it is operated andadministered by each State. Each State deter-mines the benefits, rates of payment, and eligi-bility criteria for Medicaid services, subject toFederal guidelines.

Another measure of the utilization of nurs-ing homes is the occupancy rate of the beds inthe home. An occupancy rate based on days ofcare provided for a calendar year gives a morestable estimate of utilization than a rate basedon number of beds occupied the night beforethe survey was administered. This rate was com-

puted for this report by using the followingforrnulx

Aggregate number of days~ of care provided to resi-

dents in 1976X 100Occupancy rate =

zEstimated number of beds

in 1976 X 366

The number of beds in 1976 was estimated byadjusting the number of beds in 1977 for anychange in beds during the preceding yew of1976.

Generally, 89 percent of the Nation’s nurs-ing home beds were occupied in 1976. At theState level, only Texas had a significantly loweroccupancy rate (80 percent) than nationally.While the other States did vary from the na-tional occupancy rate, no significant differenceswere found.

In 1976 an estimated 1,117,500 personswere discharged from the Nation’s 18,900 nurs-ing homes, and most (74 percent) were dis-charged dive. Live discharges were more likelyto be discharged to another health facility thanto a private or semiprivate residence (seetable 5). Illinois, Massachusetts, and New Yorkhad about the same percent of live discharges asnationally, and California (82 percent) andTexas (83 percent) had significantly higher pro-portions. As in the Nation, within each of thefive States more live discharges were transfemedto other health facilities than to private or semi-private residences.

Nationally, the average cost to a nursinghome to provide a single resident day of care in1976 was $23.84, of which 60 percent was spenton labor (table 3). The costs per resident day inCalifornia ($21 .56), Illinois ($21.1 1), Massa-chusetts ($24.23), and Texas ($19 .33) were notsignificantly different from the national figure,but New York’s cost per resident day of care($40.12) was about 68 percent higher than thenational average. In all five States, labor ac-counted for most of this cost.

i%other measure related to the fiiancialcondition of nursing homes is the monthlycharge. The monthly charge is the total amountcharged to a resident by the facility in the lastcompleted calendar month prior to the 1977

3

NNHS. It includes all basic charges and allcharges for private duty nursing, drugs, and spe-cial medical supplies. The average monthlycharge to residents in nursing homes nationallywas $689 (table 4). The average monthly chargesfor California, I1linois, Massachusetts, and Texaswere not significantly different from the na-tional average; however, the monthly charge inNew York ($1,1 24) was about 63 percenthigher.

RESIDENT CHARACTERISTICSAND HEALTH STATUS

Table 6 shows that in 1977 the elderly popu-lation (defined as 65 years of age and over)represented about 11 percent of the total U.S.population and roughly 11 percent of the popu-lation in each of the five States. About 5 percentof the Nation’s elderly cohort resided in nursinghomes, with about six nursing home beds avail-able per 100 population 65 years of age andover. Table 6 also presents State estimates thatindicate that as the availability of nursing homebeds increased, the proportion of elderly resid-ing in nursing homes also increased. Thus NewYork and California, with about 5 and 6 bedsavailable per 100 elderly, respectively, had about5 percent of their elderly in nursing homes,while Massachusetts, with about 9 beds per 100elderly, had about 7 percent of its elderly peopleresiding in nursing homes.

The “typical” nursing home resident in eachof the five States as well as nationally was white,female, widowed, and about 80 years old. Themedian length of stay for a nursing home resi-dent varied from 1.2 years for California to 1.7years for Massachusetts; the national medianlength of stay was 1.6 years (table 7).

As is shown in table 4, the largest proportionof nursing home residents nationwide (40 per-cent) were admitted from private or semiprivateresidences, followed by those admitted fromgeneral or short-stay hospitals (32 percent),other nursing homes (13 percent ), mental hospi-tals (6 percent), and other types of arrangementsor unknown (9 percent). In California, Massa-chusetts, and New York, the largest proportionsof residents were admitted from general or

short-stay hospitals (42, 45, and 41 percent,respectively) rather than from private or semi-private residences.

I1linois and Massachusetts had significa.dyhigher proportions of residents admitted frommental hospitals (9 and 12 percent, respectively)than nationally (6 percent). This finding suggestsgreater than average utilization of nursing homeservices for the care of the mentally impaired inthese two States. Data on resident health statusfurther support this finding (table 7). In Illinoisand Massachusetts about one-fourth of the resi-dents were diagnosed in the category of “mentaldisorders ~d senility without psychosis.” Thisproportion was significantly higher than thosefor California (18 percent), New York (17 per-cent), Texas (13 percent), and the Nation (2 Opercent). Illinois and Massachusetts also had sig-nificantly higher proportions of residents suffer-ing from mental illness or mental retardation asa chronic condition (28 percent in Illinois and25 percent in Massachusetts) than the propor-tions in California (15 percent), New York (13percent), Texas (12 percent), and the Nation (18percent).

The nursing home residents were a function-ally dependent population (table 8). About 86percent of the Nation’s nursing home residentsrequired assistance in bathing; 69 percent re-quired assistance in dressing; 53 percent requiredassistance in using the toilet room; 33 percentrequired assistance in eating; 66 percent werechairfast, bedfast, or walked only with assist-ance; and 45 percent had difficulty with boweland/or bladder control. About 23 percent of theNation’s nursing home residents were dependentin all six of these activities. In California, Illi- “nois, New York, and Texas these proportionswere roughly similar to those found nationally.Massachusetts alone showed marked differencesfrom the national proportions; these differenceswere in specific activities as well as in the pro-portion dependent in all six activities. Exceptfor incontinence, Massachusetts residents wereless dependent in bathing, dressing, using thetoilet room, eating, and mobility. Only 16 per-cent of Massachusetts residents were dependentin all activities as compared with 23 percent na-tionally. No attempt to explain this differencewill be made until further analysis is conducted.

LIST OF DETAILED TABLES

1.

2.

3.

4.

5.

6.

7.

8.

Percent distribution of nursing homes, beds, and residents by selected facility characteristics: United States, California, I ili-nois, Massachusetts, New York, and Texas, 1977 .. ... .. .. ... .. .. .... ... ... . ... .... . . .... . .. ... .. .. ... .. . .... . .. .... . . .... .. .. .... .. . ... .. .. ... .. . .... .. .. ... . .. .... . ...

Selected staffing characteristics for nursing homes: United States, California, I Ilinois, Massachusetts, Naw York, and Texas,1977 ..... . ... ... ... .. .... .. . .... .. .. ... .. . .... . . ..... . ... ... .. . .... .. . .... . ... .. .. .. .... . .. .... . .. ... .. . .... .. . .... ... ... ... . ... .............. ............................ ...................

Selected nursing home utilization characteristics: United States, California, Illinois, Massachusetts, New York, and Texas,1976 ... .. . ..... . ... ... ... . ..... . ... .. .. .. ... .. . .... .. .. ... .. .. ... .. . .... .. .... .. .. ... ... .. .... .. .... . .. ... .... . .... . ... ... . .. ....... ................................ .........................

Percent distribution of nursing home residents according to selected demographics, living arrangements prior to admission,primary source of payment, and averaga monthly charges: United States, California, Illinois, Massachusetts, New York, and

Texas, 1977 ...... .. .. .... . .. .... . .. ... .. .. .... .. . .... . .. .... .. .. .. ... . ... .. .. ... . ... ... . .. .... . . ..... .... ... . .. ..... . ..... . .. ... . ... ... ................ .......................... ........

Percent distribution of nursing home discharges by discharge status and percent distribution of live discharges by livingarrangement after discharge: Unitad States, California, Illinois, Massachusetts, New York, and Texas, 1976 ... . .. ... .. .. .... .. . .... .. ...

Selected population characteristics: United States, California, Illinois, Massachusetts, New York, and Texas, 1977 .. ... .. .. ..... . ...

Median length of stay and selected services received by nursing home residents: United States, California, I Ilinois, Massa-

chusetts, New York, and Texas, 1977 .. .. ... ... . .... . . .... ... .. ... . .. .... ... ... . ... .. ... .. ... .. . .... .. ... . ... . ... ... . ... .. .. .... . ... .. .. . .... . .. ... . .. .... .. . ........ ........

Percent of nursing home residents by salacted health status characteristics: United States, California, i Ilinois, Massachusetts,New York, and Texas, 1977 .. . ..... ... ... .. ... .. .. .. .... . . ..... . ... .... .. .... .. . .... . ... ... .. .. .... . .. ... .. . . .... . . .... .. . .... .. ... ... .. . .... . . ... .. .. ..................... .......

6

7

7

8

9

9

9

10

5

Table 1. Percent distribution of nursing homes, beds, and residents by selected facility characteristics: United States, California, Illinois,Massachusetts, New York, and Texas, 1977

Facility characteristic

All nursing homes.......................................................................

Ownership

Proprietary .................................................................................................Voluntary nonprofit and government .........................................................

Certification

Skilled nursing facility only ........................................................................Skilled nursing and intermediate care facility .............................................Intermediate cere facility only ...................................................................Not certif ied...............................................................................................

Bed size

Lessthan 50 beds.................................................. .....................................50-99 beds..................................................................................................100-199 beds..............................................................................................200 beds or more .......................................................................................

All beds......................................................................................

Ownership


Certification

Skilled nursing facility only ........................................................................Skilled nursing and intermediate care facility .............................................Intermediate care facility only ...................................................................Noncertif ied............... ..............................................................................

Bed size

Lessthan 50 beds.......................................................................................50-99 beds..................................................................................................100-199 beds..............................................................................................200 beds or more .......................................................................................

All residents ...............................................................................

Ownarship


Certification

Skilled nursing facility only ........................................................................Skilled nursing and intermediate care facility .............................................Intermediate care facility only ............... ...................................................Not cartif ied...............................................................................................

Bed size

Lessthan 50 beds.................. ....................................................................50-99 beds..................................................................................................100-199 beds..............................................................................................200 beds or more .......................................................................................

I I I I IUnitad I California Illinois I Massachusetts New York TaxasStates

I I I I I

Number of nursing homes

18,900 I 3,000 j 900 ] 900 I 900 / 1,000

Percent distribution

76.723.3

19.224.231.625.0

42.330.822.3

4.6

88.0“1 2.0

36.916.9●7.838.4

67.621.5●9.5●1.5

76.523.5

10.733.132.024.1

28.232.627.911.2

87.013.0

●7.923.449.519.1

54.821.522.1●1.6

63.8 B9.236,2 10.8

49.1 ●8.223.1 12.8●4.B 72.423.0 ●6.5

37.6 10.919.:3 40.823.3 44.019.$) ●4,3

Number of beds

1,402,400 I 127,300 j 92,400 j 61,200 I 110,600 j 100,300


69.330.8

21.039.227.911.9

13.029.839.016.2

83.716.3

54.627.7+1.316.4

20.740.129.6

9.7

77.322.7

14.143.730.911.2

8.925.535.430.2

86.913.1

6.636.348.2

9.0

21.322.050.6

6.1

53.546.5

41.140.4

7.810.7

6.912.026.954.2

64.415.6

8.418.768.4

4.6

4.629.255.210.9

Number of residents

1,303,100 j 115,400 I 83,100 I 58,000 I 102,800 I 88,700


68.231.8

20.740.528.310.6

12.930.538.817.9

84.515.5

54.628.2●1.315.8

20.240.030.1

9.7

74.525.5

10.446.536.2

6.9

6.326.834.832.1

86.113.9

6.636.249.8

7.3

21.924,650.0

3.5

51.6 62.548.4 17.5

42.4 7.142.1 24.7

7.7 63.87.8 4.5

6.7 4.812.7 28.327.2 55.653.3 11.3

Table 2, Selected staffing characteristics for nursing homes United States, California, I Ilinois, Massachusetts, New York. and Texas,

Type of employee

Full-time equivalent amployeesl

All health-related amployaes2 ... . .... . . .... . ... .... .. . ... . .. .

Administrativa, therapeutic, and professional . . .... .. .. ... .. . .. .. . .. .Ragisterad nurse .. .. ... .. . ..... .. .. .... . . .... .. .. .... . .. ... .. . .... .. .. ... . ... ... .. ...Licensed practical nurse .. .. ... ... . .. ..... . .. ... . ... ... .. . .... . . ..... ... ... . ... ..Nurse’s aide .. .... .. .. .... ... . .... . .. ... .. ... ... .. . .... . .. ... .. . . .... . . .... .. .. ... . .. ...

Nursing homes with a registered nurse on dutyaround the clock . .. .. .... .. .. ... .. .. ... .. .. ... .. .. ... .. ... .. .. .. .... .. .... .. .. ... .

1977

UnitedStatas

California Illinois Massachusetts New York Texas

Number per 100 beds

46.2

5.04.86.1

30.3

46.9 I 40.4 I 43.5 48.8 I 35.0

I I I6.1

II4.9 4.8

4.8 4.6 6.2.5.6 4.8 4.9

30.5 26.2 27.6

6.6 3.36.6 1.67.4 6.9

28.2 23.2

Percent of total

22.2 I 13.5 I 23.3 I 16.7 I 49.5 I *5.1

135 hours of pti.time employees’ work is considered equivalent to 1 full-time employee. part-time employees were converted tofull-time equivalent employees by divMing the number of hours worked per week by 3S.

2~cludes only employees providiig duect health-related services to residents.

Table 3. Selected nursing home utilization characteristics Unitad States, California, Illinois. Massechusette, Naw York, and Texas, 1976

Type of certification

Program certif icetion

All days of care .............................. .............

Medicare .......................... ...........................................Medicaid-skilled ................. ... .......... ............................Mdimid.intermdia~ ................................................ .Ail other .................... .................................... .. ...........

Facility certification

All nursing horn+ss.......................................

Willed nursing fecilitias only ........... ...........................Skilled nursing and intermediate care fecilitias ............intermediate care facilities .............. ............................Not certified ........... ............. .......................................

Ail nursing homes ......................... ..............

Skilled nursing facilities only .......... ............................Skilled nursing and intermediate care facilities ............Intermediate care fecilitias ..........................................Not certified ..................... ..........................................

Percent of cost per rasident day spent on labor ...........

UnitedStates I

California I Illinois I Massachusetts I New York I TexasNumber of resident days of care

452,878,700 I 42,017,300 I 28,131,500 I 20,479,900 I 36,738,000 I 29,345,700

2.9 5.325.5 44.234.4 6.937.2 43.6

89.0

92,088.687.368.1

ParCant

●2.6 +0.9 5.219.0 16.5 46.039.2 46.3 21.239.2 36.2 27.7

Occupancy rate per 100 beds

80.1I 84.7 I 91.9 I 90.3,

87.988.0

●85.989.8

66.8 ●95.9 98.086.4 92.2 82.285.8 92.5 ●88.872.6 84.9 92.9

●1.67.3

64.926.2

80.1

● 74.688.578.4

●81 .6

Total cost in dollars per resident day

23.64 I 21.56 ] 21.11 I 24.23 I 40.12 \ 19.33

29.7126.53‘18.37

24.88 22.08 %34.03 46.9523.97 23.58 27.88 41.97

●1O.13 17.62 21.04 ●25.14

22.3623.1116.95

16.88 [ 8.94 I 19.34 I 18.90 I 16.63 I “32.02

Percent of total cost

59.7 I 56.2 i 57.7 I 564 [ 62.0 I 57.9

7

Tabla 4. Percent distribution of nursing home residents according to selected demographics, living errangemen~ prior to admission,primary sourca of payment, and average monthly charges: United Statas, California, 1Ilinois, Massachusetts, New York, and Texas. 1977

Resident characteristic

All residents ..... ... .. .... . . .. ... . .. .. ... .. .. .. .. . .. ... ... .. ... ...

DEMOGRAPHIC CHARACTERISTIC

Sex—

Male ... .. .... .. .. ..... .... . .... .. . ..... .. .. .... . .. ..... .. . ..... . .. ... ... .. ... ... . .... .Female .. .... .. ... ... .. .. .. ... .. ... ... .. .. ..... . .. .... .. . ..... .. .. ... .. ... ... . .. .. ...

Race or athnicitv

White (not Hispanic) 1 .. .. .... ... . .... .. .. .... ... . .... .. .. ... .. .. ..... . .. ....All others2 ... ... .... .. . ..... . . .. ... ... .. .... .. .. .... . ... .... . ... ... .. .. .... . .. ....

Marital status

Married .. .. .... . .. ..... . .. .... ... . ..... .. . ..... . ... ..... .. .... ... . ..... .. . .... .. . ...Widowadl ... ... ... .. .. . . .... ... .. .... .. ... .... .. ..... .. ... .. ... .. .... . .. .... .. .. ..Divorced or $aparawd .. ... . ..... .. .. .... ... . .... .. . .... ... . .... ... .. ... .. .. .Never married ... .... .. . ..... .. ... ... ... . ..... . .. .... . ... ... ... . ..... .. .. .... . .. .

Living arrangement Drier to admission

private or semiprivate residence .. .... . .. ... 00. .. ....

Table 5. Percent distribution of nursing home diwharges by discharge status and percent distribution of live discharges by livingarrangement after discharge: United States, California, I Ilinois, Massachusetts, New York, and Texas, 1976

Discharge status

All diachargesl ... .... ... . .... .. . ... .. . .... ... . ... .. . ... .. . .... . .

Discharged alive ..... .. .. .... . .. ... .. ... ... . . .... .. .. ... .. .. ... .. . .... .. . .... .. .Discharged dead ..... . .. ..... . . ..... . .. ... ... . ... .. .. .... . .. ... . .. ... ... . .... .. .

Livina arrarroement after discharge

Ail live diwharges . .. .... . .. .... . .. ... .. .. ... .. . .... . .. ... ... . ..

Private or semiprivate residence . ..... .. . ... .. .. ... .. .. ... .. . .... .. .. ...Another health faciliW .... .. ... ... .. . ..... .. .... .. .. ... .. . .... .. . .... . .. ... .

Anothar nursing home .. .... .. .. ... .. . .... .. . ... ... .. ... .. . .... . .. .... .General or short-stay hospital .. .. .. ... .. . ... ... . .... .. . ... .. .. ... . .Mental hoWital ... .. .... . ... ... . ... ... .. .. ... .. .. ... .. .. ... .. .. .. ... . .... . .Other health facility or unknown ... .. . ... .. .. ... .. .. .... . .. ... .. .

Unknown or other arrangemnt .. .. .. ... .. . ..... . . .... .. .. ... .. .. ... . ..

1 Includes unknowns.

UnitedStates

California Illinois Massachusetts New York Texas

Number of alI discharges

1,117,500 I 175,600 I 69,300 I 37,100 I 81,700 I 80,300


73.9 I Ml %1 I El w77.525.9 22.4Number of live discharges

825,500 I 143,500 I 52,800 I 28,800 I 61,300 I 66,400


37.258.713.241.1

1.52.94.2

44.446.110.928.7●1.1*5.4

9.5

31.467.912.250.1●1.O●4.6●0.7

23.775.6●7.965.9+1.4

“0.5“0.6 L

19.1 30.279.0 66.418.0 9.752.4 55.5●4.6 “0.4+4.0 “0.8●1.9 ●3.4

Table 6. Selected population characteriati~ United States, California, Illinois, Massachusetts, New York, and Texas, 1977

Population characteristicUnited

California Illinois Massachusetts New York TexasStates

Total population 1 . ... . .... .. . .. ... . ... .. .. .. .... .. . .... . 216,332,000 21,896,000 11,245,000 5,782,000 17,924,000 12,830,000Total population 65 years and over . .... . .. ... 23.484,000 2,185,000 1,194,000 667,000 2,082,000 1,228,000Percent of total population 65 years

and over in nursing homes .. .. .... .. .. .... . . ..... . 4.8 4.5 5.8 7.1 4.5 6.5

lu.S. Bureau of the Census: Estimates of the population of States, by age, July 1, 1971 to 1977. -mrrt pOPUkStiOrr~ePo~ seriesP-2s, No. 734. Washington. U.S. Government Printing Office, 1978.

Table 7. Median length of stay and selected services received by nursing home residents: United States. California, Illinois,Massachusetts, New York; and Te~as, 1977

Median length of stay since admission in days ... . ... . .. ... ... . .... . . .Median time since last physician visit in days .. ... ... . .. .... .. .... .. ..Percent of residents receiving intensive nursing care during

the last 7 days .. . .. .... . .. .... .. .. ... .. .. .... . ... .. .. .. ... .. . .... .. . .... .. .. ... .. . ..Percent of residents receiving therapy during the last

I UnitedStates ICalifornia597

18

43.8

35.0

46214

42.0

40.4

Illinois I Massachusetts

1566 623

20 20

39.6 37.7

44.8 50.7

1New York I Texas

552 I 50514 2146.0 I 43.9

9

Table 8. Percent of nursing home residents by selected health status characteristics: United States, California, I Ilinois, Massachusetts,New York, and Texas, 1977

Resident characteristic

All residenw ... . .. .... .. .. .... .. . ..... . .. .... ... . .... . .. ... .... . ..

Primary diagnosis at last examination

Mental disorders and senility without psychosis . .. .... .. .. .. . ..Diseases of the circulatory system ... .... .. .. .... . .. .... ... . .... . ... ...Other diagnosis . .... .. .. ... ... . ..... . .. .... .. ... .... .. .. .... . . .... ... . .... .. .. ..Diagnosis unknown 1 .. .... . ... ... ... .. ... ... ..... .. ... ... . .. .... .. .. .... ... ..

Chronic conditions or impairments

Marital disorders and senility without psychosis:Senility . .. ... ... ... . .... .... . .... .. .. .... . .. ... ... . ..... .. . .... .. .. .... . ... ....Mental Retardation .. .. ...ti . .. . ... ... . ..... . .. .... .. .. .... ... ..... . ... ..Mental illness ... ... .. ... .. ... ... .. .. ... .. . .... ... .. ... ... . ..... . .. .... .. .. ..Chronic brain syndrome .... .. .. .... . .. .... . .... ... .. .. ..... . . ..... . ...insomnia ...... ... ... ... .. .... . ... ... . ... ... .. .. .... .. .. .... .. .. .... . ... .... .. .

Diseases of the circulatory system:Arteriosclerosis ..... .. .. .... . . ..... .. .. ... .. ... .... . .. .... .. . .... .. .. .... ..Hypertension . .. .. .. . ... . .... .. .. ... . .. .... ... .. .... . ... ... .. ... .... ... ... .Stroke ..... ... . ..... .. ... ... . .. .... .. .. ... ... . .... .. ... ... .. .. ... .. .. .... .. .. ...Heart trouble .... ... . .... .. .. ... .. .. .... .. .. .... .. .. ... ... .. ... ... . .... .. .. .

Other chronic conditions or impairments:Arthritis and rheumatism .... .. .. .... .. .. .... .. . .... ... .. .... . . .... . ..Constipation .. . .. .. ... .. . ..... . . ..... .. .. .... .. . .... .. . .. ... .. .. .... . .. .....Diabetes .. . .. .... .. .. .... . ... .... .. .. ... .. ... ... ... .. ... .. .. ... .. .. .... .. ... ...Edema .. .. .. .. . ..... ... .... . .. . .... .. .. .... ... . .... .. . .... .. .. .... .. .. ... .. .. ...Cancer ... ... ... . ..... . ... .... .. . .... .. . ...... . .. .... . .. .... .. ... ... .. .. .... .. . ..

Chronic reviratory disease .... ... .. . .. ... .. ... ... .. . .... .. .. .... .. ..Anemia .. .... .. ... ... .. .. .... . ... .... .. .. .... .. .. ... ... .. ... .. ... ... . .. ..... . ..Camracts ..... .. .. ..... .. .. ... ... . .... .. .. .... . ... .... .. . .... ... .. .... .. ..... . .Hip or other bone fracture ... .. .. ... ... .. .... . ... ... ... . .... .. .. ... ..Blindness or deafness ... ... .. .... .. .. ... ... . ..... .. . .... ... . .... .. . .... .Kidney trouble .. ..... ... . .... .. . .... . ... .... ... . .... .. .. .... ... . .... .. ... ..

Dependency in activities of dailing living:Requires assistance in bathing ... . .... .. .. .... ... .. ... .. .. ... .. ... ..Requires assistance in dressing ... . ..... .. .. .. .. .. . .... .. ... .. .. .. ..Requires assistance in using toilet room ... .. . ..... ... ..... . .. .Requires assistance in eating ..... .. .. .... . ... .... .. .. .... .. . .... .. ..Walks only with assistance or is chairfast or bedfast .. . ..Difficulty with bowel and/or bladder control ..... . .. .... . .Dependent ina116 activities .. . .... ... .. .... . ... ... .. ... ... .. . ..... .

UnitedStates

Cal if orn ia IIIllinois Massachusetts New York ITexasNumber of resid?nts

1,303,100 I 115,400 I 83,100 I 58,000 j 102,800 I 88,700


20.439.733.0

6.9

32.06.1

11.424.9

9.6

47.620.916.434.5

24.624.014.517.9

4.96.65.46.1

11.311.110.1

86.369.452.532.666.1

45.323.3

1~cl~des residents who received no physician viaits while in factiity.

17.941.7

34.75.7

32.54.1

10.527.013.9

49.118.419.734.2

23.820.712.612.0

5.26.73.54.7

10.210.3

8.2

84.168.244.8

32.166.447.821.0

25.343.024.4

7.4

Percent

33.710.617.022.410.5

47.418.712.131.4

22.921.115.015.7

3.96.03.44.0

10.412.0

9.2

82.965.746.4

35.562.246.124.3

27.233.4

32.1

7.3

28.03.9

21.514.3

9.8

46.613.913.027.7

19.118.523.110.5

4,76.55.34.98.4

10.211.8

78.955.329.522.951.3

39.815.7

16.941.1

36.45.6

22.54.48.9

27.19.8

51.924.314.243.1

24.218.918.815.8

5.58.48.19.1

11.611.2

7.7

88.071.948.837.966.548.025.2

I

13.345.7

32.28.8

33.83.38.2

32.17.1

54.526.218.736.5

26.220.612.813.9

4.87.86.74.9

11.115.011.8

88.272.851.138.769.145.626.9

z~,gures may not add go total because resident may have had more than 1 reported condition or impairment.

10

APPENDIXES

CONTENTS

I. Technical Notes .. ... .. .. ... .. .. ... .. .. .. .. . . ..... . . .... . .. ... .. .. ... .. . .... . . .... . .. .... .. . ... .. .. ... .. . .... .. .... .. .. ... . . .... .. . .... . ...

II. Definition of Certain Terms Used in This Report .. .. .. ... . .. .... . . .... . ... .. .. .. ... .. . .... . .. ... . ... .. ... . .... . .. .... . .. .

LIST OF APPENDIX FIGURES

I. Relative standard errors for estimated number of faciMies .. . ... .. . .. .. .. . .... . .. .... . . ... .. .. .... . .. ... .. .. ... . ... ..

II. Relative standard errors for estimated number of residents .. ... .. . .... . .. .. ... . .... .. . ... .. . .... .. .. ... .. .... . ... ...

III. Relative standard errors for estimated number of tisd=ges ... . . .... . .. ... ... .. .. .. .. ... . .. .... .. . ... .. .. ... .. . ....

IV. Relative standard errors for estimated number of beds . .. .. .. ... .. .. ... .. . .... . .. ... . .. ... .. . . .... . .. ... .. .. .. .. .. .... .

V. Relative standard errors for estimated number of resident days ... .. .. ... . ... ... ... .. ... . .... .. . .... .. . .... . .. ... ..

W. Relative standsrd errors for estimated costs ... ... .. .. ... .. .... . ... .. ... .. ... .. . .... . . .... .. .. ... . .. .... . .. ... .. . .... . ... ... ..

VII. Relative standard errors for estimated nmnber of staff .. . . .... .. .. ... .. .. ... .. . .... . .. ... .. . ..... . .. ... . .. ... .. .. .... ..

12

20

13

14

15

16

17

18

19

11

APPENDIX 1

TECHNICAL NOTES

The sample design for the 1977 NationalNursing Home Survey, conducted by the Na-tional Center for Health Statistics, was a strati-fied two-stage probability sample. The first stagewas a selection of facilities; and the second stagewas a selection of residents, discharges, and stafffrom the sample facilities. Data on facility char-acteristics were collected by interviewing the ad-ministrator, while cost data were obtained fromthe facility’s accountant via a mailback question-naire. Data for a sample of residents on the facil-ity’s roster at the time of the survey were col-lected by interviewing the nurse most familiarwith the care provided to the resident. Whennecessary, the nurse referred to the resident’smedical record. Data for a sample of dischargesin 1976 were also collected by interviewing thenurse most familiar with the medical record ofthe discharged resident. Data on a sample of em-ployees were collected by leaving a question-naire for the sampled person to complete andreturn by mail.

Since the statistics presented in this reportare based on a sample, they will differ somewhatfrom figures that would have been obtained if acomplete census had been taken using the sameschedules, instructions, and procedures. Thestandard error is primarily a measure of thevariability that occurs by chance because only asample, rather than the entire universe, is sur-veyed. The standard error also reflects part ofthe measurement error, but it does not measureany systematic biases in the data. The chancesare about 95 out of 100 that an estimate fromthe sample differs from the value that would beobtained from a complete census by less thantwice the standard error.

Rather than presenting specific errors for aparticular statistic, the approximate relativestandard errors of estimates have been provided.The relative standard error of an estimate is thestandard error of the estimate divided by the

estimate itself and is expressed as a percent ofthe total estimate. In this report an asterisk isshown next to an estimate with more than a 30-percent relative standard error.

Estimates of relative standard errors for thenational estimates are presented in appendix Iof Series 13-No. 43 in the Vital and Health Sta-tistics series.3 Estimates of relative standarderrors for the estimated number of facilities ineach of the five States are presented in figure 1.Relative standard errors for each State’s esti-mated number of residents are presented in fig-ure II, discharges in figure III, beds in figure IV,resident days in figure V, total cost in figure VI,and total staff in figure VII.

Because of the relationship between the rela-tive standard error ‘and the estimate, the stand-ard error of an estimate can be found by multi-plying the estimate by its relative standard error.For example, curve A of figure IV shows therelative standard error for beds in California.Table 1 shows that the total number of beds inall California facilities with less than 50 beds is20.7 percent of the total 127,300 Californiafacilities, or 26,350. The relative standard errorcorresponding to this estimate on curve A of fig-ure IV is approximately 17.0 percent. The stand-mxl-enmr is 26,350 (0.17) = 4,480.

The approximate standard error of a ratiosuch as that for full-time equivalent (FTE) em-ployees per 100 beds can be calculated as in thefollowing example: Suppose the standard error(arl) for the ratio of total FTE employees per100 beds is desired for New York nursinghomes. In table 2 the total FTE employees per100 beds for nursing homes in New York isshown as 48.8, which is equal to a total of54,000 FTE employees divided by 110,600 beds

3See footnote 2.

12

Figure 1. Relative standard errors for estimatad number of facilities

-..A 2 34 56789A 210 100

SIZE OF

times 100. The relative standard error of 54,000total FTE employees is (from figure VII, curveD) approximately 3.2 percent, and the relativestandard error of 110,600 beds (from figure IV,curve D) is approximately 4.5 percent. Thesquare root of the sum of the squares of thesetwo relative standard errors minus their covari-ance provides an approximation of the relative

34 56789A 2 34 56789A

1,000

ESTIMATE

standard error ofV. # is the relative

the ratio. In other words, ifstandard error of the number

of total FTE empIoyees, VYJ is the relativestandard error of the number of beds, r is thesample correlation coefficient between totalFTE employees and beds (conservatively esti-mated to be O.5), and VqJ is the relative standarderror of the ratio R’ =X /Y}:

13

Figure 11. Relative standard errors for estimated number of residents

1-Cj

Lua

““A 2 34 56789A 2 34 56789A 2 341,000

56789A

10,000 100,000

SIZE OF EST~MATE

~r,2 = ~x,2 + ~y,2 - zr~x,~y, total FTE employees per 100 beds may now beobtained by multiplying the relative standard

= (.032)2 + (.045)2 -1.00 (.032 X .045) error by the ratio as is done below:

= .0010+ .0020 - .0014= .0016 UrI ‘R’ X V??=48.8 X .04 = 1.95

v,! = .0150 = .04 The sample correlation coefficient (r) forcalculating the standard error estimates of the

The approximate standard error of the ratio of ratios presented in this report is assumed, to be

14

i-Uj

IJ.1a

1009080

70

60

w

40

30

20

109

8

7

6

5

4

3

2

1.!,8.7

,6

5

,4

3

2

0.1

Figure II L Relative standard errors for estimated number of discharges

1,660 10,000 100,000SIZE OF ESTIMATE

zero exce~t in the case of full-time equivalent was used to test all commu-isons mentioned in. .employees per 100 beds, occupancy rate, and this report. Since not ~ observed differencescost per resident day ratio estimates, where the were tested, lack of comment in the text doescorrelation coefficient used was O.5. not mean that the difference was not statisti-

The z test with a 0.05 level of significance tally significant.

15

Figure IV. Relative standard errors for estimated number of beds

a0zaLu

na~z2CnLu>

i=a-1

UJK

1,000 10,000 100,000

SIZE OF ESTIMATE

16

Figure V. Relative standard errors for estimated number of resident days

~KaLI.1

10090

so70

w

so

40

30

20

1:

8

7

85

4

3

2

1.:

,8.$

,6

5

4

3

,2

0.1

106 1,000 1,000,000 10,000,000 100,000,000

SIZE OF ESTIMATE

17

Figure V1. Relative standard errors for estimated costs

1009084

70

e3

el

40

30

20

109B

7

6

5

3

2

1.0,98

.7

0

,5

,4

,3

.2

0.1

1 10 100 1,00(

SIZE OF ESTIMATE (IN MILLIONS)

18

claac1z~Lu>

i=ajI.lJK

10090so70

60

m

40

30

1:

B

7

6

5

4

3

2

1.0.9

.8.-l

,6

,5

.4

3

2

0.1

Figure VI 1. Relative standard errors for estimated number of staff

A 2 34 56789A 2 34 56789A 2 34 56789A700 1,000 10,000 100,000

SIZE OF ESTIMATE

000

19

APPENDIX II

DEFINITION OF CERTAIN TERMS USED IN THIS REPORT

Ownership. –Type of ownership refers to thetype of organization that controls and operatesthe nursing home.

Proprietary facila’ty.-A proprietary facility isoperated under private commercial owner-ship .

Nonprofit facWy.-A nonprofit facifity isoperated under voluntary on nonprofitauspices, including both church-related facil-ities and those not church-related.

Government facility. –A government facilityis operated under Federal, State, or localgovernment auspices.

Discharge. –A discharge is a person who wasforrnaIly discharged from a nursing home during1976. Both live and dead discharges are in-cluded. Theoretically, the same person can becounted more than once if he was ,dischargedmore than once from a nursing home during1976.

Discharge status. –The discharge status iswhether the person was discharged from thenursing home alive or dead.

Full-time equivalent (FTE). –Thirty-fivehours of part-time employees’ work per week isconsidered equivalent to that of one full-timeemployee.

ooo —

20w.5. GOVERNMENT PRINTING OFFICE: 1980 341-161/25 1-3

VITAL AND HEALTH STATISTICS Series

Scri”es1. Programs and Collection Procedures. –Reports which decicnbe the general programs of the NationalCenter for Health Statistic and its offices and diviziom and data collection methods used and includedefinitions and other material neces.saty for understanding the data.

Series 2. Data Evaluation and Methods Research. –Studies of new statistical methodology including experi-mental tests of new survey methods, studies of vital statistics collection methods, new amdyticaltechniques, objective evaluations of reliability of collected data, .ond contributions to statistical theory.

Series 3. Analytical Studies. –Reports presenting analytical or interpretive studies based cm vit~l and healthstatistics, carrying the snalysis further than the expository types of reports in the other series.

Series 4 Documents and Committer Reports. – Final reports of major committees concerned w,ith vital andhwfth statistics and documents such as recommended model vital r~gistration laws and revised birthand death certificates.

Series 10. Data From the Health Interview Surrnq. –Statistics on illness, accidental injuries, disability, use ofhospital, medical, dental, and other servicm, and other health-related topics, all b~sed on data collectedin a continuing national household interview survey.

.kic~ 11. Data From th~, Health Examination Survey and the Health and Nutrition Examination Survey. –Datafrom direct examination, testing, and measurement of national samples of the civilian noninstitu-tionalized population provide the basis for two types of reports: (1) estimates of the medicafly definedprevalence of specific diseases in the United States and the distributions of the population with respectto physicaf, physiological, and psychological characteristics and (2) analysis of relationships among thevarious measurements without reference to an explicit finite universe of persons.

Seri.s 12. I)aia From tile Institutionalized Population Survey s.-Discontinued effective 1975. Future reports fromthese surveys will be in Series 13.

SCries 13. Data on Health Resources Utilization. –Statistics on the utilization of health manpower and facilitiesproviding long-term care, ambulatory care, hospital care, and family pkmning services.

Series 14 Data on Health Resources: Manpower and Facilities. –Statistics on the numbers, geographic distri-bution, and characteristics of health resources including physicians, dentists, nurses, other healthoccupations, hospitafs, nursing homes, and outpatient facilities.

Series 20. Data on Mortality. –Various statistics on mortality other than as incIuded in regular annuaf or monthlyreports. Speciaf analyses by cause of death, age, and other demographic variables; geographic and timeseries analyses; and statistics on characteristics of deaths not available from the vital records based onsample surveys of those records.

Series 21, Data on Natalzly, Marriage, and Divorce. —Various statistics on natality, marriage, and divorce otherthan as included in regular annual or monthly reports. Special analyses by demographic variables;geographic and time series analyses; studies of fertility; and statistics on characteristics of births notavailable from the vitaf records based on sample surveys of those records.

Series 22, Data From the National Mortality and Aratality Surveys. –Discontinued effective 1975. Future reportsfrom these sample surveys based on vital records will be included in Series 20 and 21, respectively.

Sm.es 23. Data From the National Survey of Family Growth. –Statistics on fertility, family formation and dis-solution, family planning, and related matemaf and infant health topics deri~,ed from a biennial surveyof a nationwide probability sample of ever-msxried women 1544 years of age.

For a list of titles of reports published in these series, write to: Scientific and Technical Information BranchNational Center for Health StatisticsPublic Heafth ServiceHyattsvilIe, hfd. 20782

.

u S DEPARTMENT OF H H S

HHS 396

FIRST CLASS MA, L

CONTENTSINTRODUCTIONFACILITY CHARACTERISTICSUTILIZATIONRESIDENT CHARACTERISTICS AND HEALTH STATUSLIST OF DETAILED TABLESAPPENDIX I. TECHNICAL NOTESAPPENDIX II. DEFINITION OF CERTAIN TERMS USED IN THIS REPORT