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Improving the Quality of Care in Nursing Homes (1986)

Chapter: Appendix D: Selected Data on Nursing Homes and Residents

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Suggested Citation:"Appendix D: Selected Data on Nursing Homes and Residents." Institute of Medicine. 1986. Improving the Quality of Care in Nursing Homes. Washington, DC: The National Academies Press. doi: 10.17226/646.
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APPENDIX D Selectecl Data on Nursing Homes and Residents The following tables show national and state statistics on characteristics of the nursing home industry, of the nursing home population, and of state regulatory agencies. These tables show information the committee considered important for understanding the nursing home industry, its residents, and its regulators. They do not represent all of the information gathered and used by the committee for its study. The following tables are attached: TABLE A National Totals of Certified Facilities by Certification Status, 1981. (SOURCE: Health Care Financing Administration, Medicare Medicaid Automated Certification System. 1 98 1.) TABLE B Number of Facilities by Certification Status and State, 1981. (SOURCE: Health Care Financing Administration, Medicare Medicaid Automated Certification System. 1981.) TABLE C Number and Percentage of Facilities by Level of Care and State, 1981. (SOURCE: Health Care Financing Administration, Medicare 351

352 / APPENDIX D Medicaid Automated Certification System. 1981.) TABLE D Number of Certified Facilities by Ownership Status and State, 1981. (SOURCE: Health Care Financing Administration, Medicare Medicaid Automated Certification System. 1981.) TABLE E Number of Facilities and Percentage by Bed Size and State, 1981. (SOURCE: Health Care Financing Administration, Medicare Medicaid Automated Certification System. 1981.) TABLE F Total Nursing Home Beds During 1978, 1980, and 1983, and Percentage Change in Number of Beds, by State, 1978-1983. (SOURCE: Aging Health Policy Center, University of California. 1983.) TABLE G Comparison of Nursing Home Beds per 1,000 Population Aged 65 and Over in 1978, 1980, and 1983 and Percentage Change During 1978-1983, by State. (SOURCE: Aging Health Policy Center, University of California. 1983.) TABLE H Total Nursing Home Beds per Licensed Nurse, Total Licensed Nurses, and Ratio of RNs to LPNs, by State, 1981. (SOURCE: Health Care Financing Administration, Medicare Medicaid Automated Certification System. 1981.) TABLE I Number of Facilities, by State and by Level of Care, with Fewer Than Five Licensed Nurses, 1983. (SOURCE: Health Care Financing Administration, Office of Research and Demonstrations, Research in Progress. 1984.) TABLE J Number of Licensed Nurses Needed in Facilities with Fewer Than Five Licensed Nurses, by State and Type of Facility, 1983. (SOURCE: Health Care Financing Administration, Office of Research and Demonstrations, Research in Progress. 1984.)

APPENDIX D / 353 TABLE K State Minimum Requirements for Nursing Hours per Resident-Day, 1985. (SOURCE: American Health Care Association. 1985.) TABLE L State Minimum Requirements for Nurse's Aide Training, 1985. (SOURCE: American Health Care Association. 1985.) TABLE M Average SNF and ICE Medicaid Reimbursement Rates per Resident-Day, by State, 1982. (SOURCE: Analysis of State Medicaid Program Characteristics. La Jolla, California. 1983.) TABLE N Total SNF and ICE Resident-Days of Care (in thousands) Reimbursed by Medicaid, by State, 1982. (SOURCE: Analysis of State Medicaid Program Characteristics. La Jolla, California. 1983.) TABLE O Elderly Population by State, 1981. (SOURCE: Health Care Financing Administration, Medicare Medicaid Automated Certification System. 1981.) TABLE P U.S. Life Expectancy (by sex) at Birth, Age 65, and Age 85,1960-2040. (SOURCES: Social Security Administration, Office of the Actuary, 1983, and U.S. Bureau of the Census, 1 984.) TABLE Q Projected Number (in thousands) of U.S. Nursing Home Residents by Age and Sex, 1980-2040. (SOURCE: National Center for Health Statistics, Office of Analysis and Epidemiology. 1977.) TABLE R Percentage Distribution of Nursing Home Residents Who Were Dependent in Activities of Daily Living, 1973-1974 and 1977. (SOURCE: National Center for Health Statistics, National Nursing Home Survey. 1977.)

354 / APPENDIX D TABLE S Health Care Financing Administration Expenditures (in millions of dollars) for State Survey Activities, 1977- 1984. (SOURCE: Health Care Financing Administration, Health Standards Quality Bureau. 1984.) TABLE T Total 1980 Expenditures (in millions of dollars) for State Survey Agency Activities, and Percentage Change in 1983-1984. (SOURCE: Institute of Medicine Survey. 1985.) TABLE U Total State Survey Agency Staffing in 1980 and Percentage Change in 1983- 1984. (SOURCE: Institute of Medicine Survey. 1985.) TABLE ~ Total Survey Visits Made by State Survey Agencies in 1980 and Percentage Change in 1983-1984. (SOURCE: Institute of Medicine Survey. 1985.) TABLE W Percentage of Facilities Cited with A-Key Def iciencies, by State, 1983. (SOURCE: Health Care Financing Administration, Medicare Medicaid Automated Certification System. 1981.)

APPENDIX D / 3 55 TABLE A National Totals of Certified Facilities by Certification Status, 1981 MEDICARE MEDICARE/ MEDICAID FACILITY ONLY MEDICAID ONLY TOTAL SNF ONLY Not 1,999 533 2,532 available (15%) (4%) (19%) SNF/ICF Not 1,333 666 1,999 DISTINCT applicable (10%) (5%) (15%) PART SNF/ICF Not 1,866 1,199 3,065 DUAL applicable (14%) (9%) (23%) ICE ONLY Not Not Not 5,730 applicable applicable applicable (43%) Not 5,197 8,129 13,326 available (39%) (61%) SOURCE: Health Care Financing Administration, Medicare Medicaid Automated Certification System, 1981.

356 / APPENDIX D TABLE B Number of Facilities by Certification Status and State, 1981 Total Certified Total State Facilities SNF Only Total SNF/ICF Total SNF/ Total Distinct Part ICE Dual ICE Only AK1300103 AL20651493319 AR2078111124 AZ2525000 CA1,1849142720736 CO17352211729 CT23116441026 DC60123 DE2639410 FL30629252466 GA301282617671 HI34133108 IA4276118402 ID6220546 IL6872745314301 IN4241610314291 KS36881829313 KY20424701109 LA2251021212 MA513452173248 MDE14548115719128 MI421419242129 MN4546519750142 MO237102156150 MS1432029724 MT942552611 NC20243101256 ND83065126 NE2175718187 NH74619049 NJ23314819120 NM4322039 NV2621203 NY570330192345 OH8562328317488 OK363720354 OR17828222126 PA556362151736 RI106356146 SC123708531 SD1141213656 TN2295547172 TX976801242770 UT80063440 VT44617021 VA16310411111 WA262112518838 WI438349273113 WV74023240 WY2600179 TOTAL13,3262,5041,9553,1085,759 SOURCE: Health Care Financing Administration, Medicare Medicaid Automated Certification System. 1981.

APPENDIX D / 357 TABLE C Number and Percentage of Facilities by Level of Care and State, 1981 State Number SNF and SNF/ICF ICE Only Total Percentage Number Percentage Facilities AK10 773 2313 AL187 9119 9206 AR83 40124 60207 AZ25 1000 025 CA1,148 9736 31,184 CO144 8329 17173 CT205 8926 11231 DC3 503 506 DE16 6210 3826 FL300 986 2306 GA230 7671 24301 HI26 768 2434 IA25 6402 94427 ID56 906 1062 IL386 56301 44687 IN133 31291 69424 KS55 15313 85368 KY95 47109 53204 LA13 6212 94225 MA265 52248 48513 MD92 5382 47174 ME17 12128 88145 MI292 69129 31421 MN312 69142 31454 MS119 8324 17143 MO89 37150 63239 MT83 8811 1294 NC146 7256 28202 ND57 6926 3183 NE30 14187 86217 NH25 3449 6674 NJ213 9120 9233 NM4 939 9143 NV23 883 1226 NY525 9245 8570 OH368 43488 57856 OK9 2354 98363 OR52 29126 71178 PA520 9436 6556 RI60 5746 43106 SC92 7531 25123 SD58 5156 49114 TN57 25172 75229 TX206 21770 79976 UT40 5040 5080 VA52 32111 68163 VT23 5221 4844 WA224 8538 15262 WI325 74113 26438 WV34 4640 5474 WY17 659 3526 SOURCE: Health Care Financing Administration, Medicare Medicaid Automated Certification System. 1981.

358 / APPENDIX D TABLE D Number of Certified Facilities by Ownership Status and State, 1981 State/Local Voluntary/Other Nonprof it For Prof it Govt-Owned Total Church-Related Voluntary StateTotal No. %No. % No. %No. % No. % AK13 3 233 23 7 541 86 46 AL 206169 82 25 12 12 6 10 5 2 1 AR 207159 77 19 9 29 14 5 2 24 12 AZ 2514 56 2 8 9 36 1 4 8 32 CA 1,184949 80 32 3 203 17 83 7 120 10 CO 173114 66 17 10 42 24 11 6 31 18 CT 231192 83 3 1 36 16 13 6 23 10 DC 61 17 1 17 4 66 2 33 2 33 DE 2611 42 3 12 12 46 4 15 8 31 FL 306227 74 15 5 64 21 29 10 35 11 GA 301239 79 36 12 26 9 11 4 15 5 HI 3412 35 11 32 11 33 3 9 8 24 IA 427278 65 18 4 131 31 49 12 82 19 ID 6238 61 14 23 10 16 2 3 8 13 IL 687479 70 50 7 158 23 71 10 87 13 IN 424366 86 5 1 53 13 36 9 17 4 KS 368216 59 44 12 108 29 53 14 55 15 KY 204140 69 12 6 52 25 15 7 37 18 LA 225197 88 7 3 21 9 14 6 7 3 MA 513440 86 15 3 58 11 21 4 37 7 MD 174117 67 11 6 46 27 15 9 31 18 ME 145118 81 4 3 23 16 4 3 19 13 MI 421292 69 53 13 76 18 38 9 38 9 MN 454175 38 86 19 193 43 98 22 95 21 MO 237140 59 19 8 78 33 18 8 60 25 MS 143112 78 22 15 9 6 2 1 7 5 MT 9434 36 29 31 31 33 6 6 25 27 NC 202154 76 10 5 38 19 17 9 21 10 ND 8318 22 1 1 64 77 28 34 36 43 NE 21785 39 48 22 84 39 23 11 61 28 NH 7438 52 12 16 24 32 7 9 17 23 NJ 233157 67 24 10 52 23 27 12 25 11 NM 4317 39 5 12 21 49 8 19 13 30 NV 2620 77 6 23 0 0 0 0 0 0 NY 570293 51 54 10 223 39 72 13 151 26 OH 856704 82 32 4 120 14 74 9 46 5 OK 363318 88 8 2 37 10 21 6 16 4 OR 178133 75 16 9 29 16 14 8 15 8 PA 556269 48 58 11 229 41 145 26 84 15 RI 10687 82 0 0 19 18 7 7 12 11 SC 12388 72 26 21 9 7 4 3 5 4 SD 11442 37 4 3 68 60 20 18 48 42 TN 229150 66 49 21 30 13 17 7 13 6 TX 976875 90 15 1 86 9 50 5 36 4 UT 8065 81 9 11 6 8 1 1 5 7 VA 163108 66 16 10 39 24 11 7 28 17 VT 4429 66 0 0 15 34 2 5 13 29 WA 262206 79 10 4 46 17 22 8 24 9 WI 438212 48 82 19 144 33 66 15 78 18 WV 7447 64 6 8 21 28 6 8 15 20 WY 2610 39 5 10 11 42 1 4 10 18 U.S. 13,3269,357 70 1,052 8 2,917 22 1,258 9 1,659 13 SOURCE: Health Care Financing Administration, Medicare Medicaid Automated Certification System. 1981.

APPENDIX D / 359 TABLE E Number of Facilities and Percentage by Bed Size and State, 1981 State Total Facilities 1-60 Beds Percentage of Facilities by Size 61-120 Beds 121+ Beds AK13 69 23 8 AL206 27 46 28 AR207 22 59 19 AZ25 16 44 40 CA1,184 34 47 19 CO173 36 39 25 CT231 36 34 29 DC6 50 0 50 DE26 31 46 23 FL306 25 48 26 GA301 23 54 23 HI34 56 24 21 IA427 39 48 13 ID62 45 40 15 IL687 15 44 41 IN424 38 35 27 KS368 56 38 6 KY204 26 48 26 LA225 13 56 31 MA513 38 38 24 MD174 25 33 43 ME145 58 35 7 MI421 25 43 32 MN454 24 48 28 MO239 27 49 24 MS143 47 41 12 MT94 57 31 12 NC202 24 55 21 ND83 41 47 12 NE217 38 49 13 NH74 43 39 18 NJ233 17 40 43 NM43 28 65 7 NV26 31 46 23 NY570 15 35 50 OH856 46 37 17 OK363 41 50 9 OR178 34 51 15 PA556 29 36 35 RI106 48 32 19 SC123 31 46 23 SD114 47 46 6 TN229 27 45 28 TX976 25 51 24 UT80 53 43 5 VA163 26 34 40 VT44 59 32 9 WA262 31 44 26 WI438 25 40 35 WV74 47 47 5 WY26 46 50 4 SOURCE: Health Care Financing Administration, Medicare Medicaid Automated Certification System. 1981.

360 / APPENDIX D TABLE F Total Nursing Home Beds During 197S, 1980, and 1983, and Percentage Change in Number of Beds, by State, 1978-1983 Total Beds Percentage Change State 1978 1980 1983 1978-1983 AK 823823 814-1.1 AL19,954 20,522 21,476 7.6 AR18,548 19,111 20,405 10.0 AZ5,354 6,197 7,834 46.3 CA110,826 111,556 113,612 2.5 CO20,066 18,305 18,030 -10.1 CT24 169 26,127 26,395 9.2 DC1 881 1,748 2,573 36.8 DE2,997 3,646 4,269 42.4 FL34,003 37,420 44,745 31.6 GA31,496 32,881 36,689 16.5 HI2,171 2,620 2,605 20.0 IA32,125 32,277 34,021 5.9 ID4,454 4,637 4,645 4.3 IL85 888 87,284 87,918 2.4 IN41 010 42,445 50,078 22.1 KS26,227 25,793 26,356 0.5 KY16,167 18,154 18,884 16.8 LA22,541 25,600 26,980 19.7 MA45,300 46,830 46,050 1.7 MD19,322 20,582 23,056 19.3 ME8 693 8,872 9,191 5.7 MI46 026 46,477 48,275 4.9 MN44,492 45,681 44,940 1.0 MO34,706 38,142 45,134 30.0 MS12 399 12,245 14,051 13.3 MT6 270 6,267 6,317 0.7 NC17,424 19,652 21,880 25.6 ND5,956 6,277 6,757 13.4 NE18,284 18,108 18,536 1.4 NH6 253 6,696 6,981 11.6 NJ26 790 29,659 31,229 16.6 NM2,910 3,276 4,531 55.7 NV2,009 2,170 2,470 22.9 NY90,178 92,162 95,727 6.2 1965,126 70,714 74,334 14.1 OK28 122 28,944 29,797 6.0 OR14 653 14,922 15,254 4.1 PA66,673 72,205 78,632 17.9 RI8,228 8,685 9,252 12.4 SC9,875 11,362 12,899 30.6 SD7 386 7,589 7,731 4.7 TN18 505 23,003 26,596 43.7 TX99,000 101,101 100,986 2.0 UT5,758 5,548 5,600 -2.7 VA16,283 19,177 22,625 38.9 VT2,852 2,826 3,111 9.1 WA28,225 26,876 27,379 -3.0 WI50 542 51,689 53,627 6.1 WV4 789 5,086 7,038 47.0 WY1,962 2,050 2,098 6.9 U.S"1,315,691 1,372,019 1,450,413 10.2 SOURCE: Aging Health Policy Center, University of California.

APPENDIX D / 361 TABLE G Comparison of Nursing Home Beds to 1,000 Population Aged 65 and Over in 1978, 1980, and 1983 and Percentage Change During 1978-1983, by State Total Beds per 1000 Population 65 and Over State 1978 1980 1983 Percentage Change 1978-1983 AK 82.3 71.4 58.1-29.4 AL 48.8 46.6 45.8-6.1 AR 63.5 61.2 62.0-2.4 AZ 19.8 20.2 22.011.4 CA 49.3 46.2 43.4-11.9 CO 86.5 74.0 66.8-22.8 CT 69.5 71.6 66.3-4.5 DC 26.1 23.6 34.833.1 DE 54.5 61.5 65.720.5 FL 22.3 22.2 24.07.4 GA 66.6 63.6 65.2-2.1 HI 32.4 34.4 29.3-9.7 IA 85.2 83.3 84.2-1.2 ID 51.2 49.5 44.2-13.6 IL 71.3 69.2 66.1-7.4 IN 73.1 72.5 80.39.8 KS 88.3 84.2 82.6-6.4 KY 41.8 44.3 43.84.9 LA 60.9 63.4 63.34.0 MA 64.7 64.5 60.4-6.7 MD 52.2 52.0 53.11.7 ME 65.4 63.0 61.7-5.6 MI 53.0 50.9 49.1-7.4 MN 96.3 95.2 88.5-8.1 MO 55.4 58.8 67.021.0 MS 45.9 42.3 46.41.0 MT 77.4 74.1 67.9-12.3 NC 31.6 32.6 32.83.7 ND 76.4 78.0 79.54.1 NE 90.5 88.1 87.0-3.9 NH 65.1 65.0 62.9-3.4 NJ 32.5 34.5 33.94.2 NM 28.0 28.3 34.924.6 NV 35.9 33.0 30.5-15.0 NY 43.0 42.7 43.10.0 OH 57.9 60.5 59.52.6 OK 79.0 77.0 75.8-4.0 OR 51.4 49.2 45.8-10.9 PA 45.6 47.2 48.05.1 RI 68.0 68.4 68.50.8 SC 38.3 39.5 40.25.0 SD 83.0 83.4 81.4-1.9 TN 38.7 44.4 48.024.0 TX 78.3 73.7 68.7-12.2 UT 56.5 50.8 45.5-19.3 VA 34.8 38.0 40.817.4 VT 51.9 48.6 50.2-3.2 WA 70.4 62.3 57.6-18.1 WI 92.7 91.6 89.4-3.6 WV 21.6 21.4 28.030.0 WY 54.5 55.1 52.5-3.8 State Avg 57.4 57.5 55.8-2.8 SOURCE: Aging Health Policy Center, University of California.

362 t APPENDIX D TABLE H Total Nursing Home Beds per Licensed Nurse Total Licensed Nurses, and Ratio of RNs to LPNs, by State, 1981 SNF and ICE BedsTotal Licensed RN/LPN State per Licensed NurseNurses Ratio AK 4.5143 1.3 AL 8.42,469 0.3 AR 11.01,799 0.3 AZ 16.2199 1.6 CA 9.312,308 0.7 CO 10.81,753 1.3 CT 6.83,645 1.6 DC 6.5179 1.3 DE 7.1393 1.5 FL 11.03,155 0.8 GA 9.03,405 0.4 HI 4.8524 1.1 IA 11.82,891 0.8 ID 8.3575 0.9 IL 12.77,095 1.2 IN 16.92,462 0.9 KS 16.91,520 0.8 KY 12.61,611 0.5 LA 11.32,181 0.3 MA 7.56,000 1.1 MD 9.22,273 1.1 ME 8.51,075 1.1 MI 10.14,582 0.9 MN 10.14,588 0.9 MS 5.62,195 0.3 MO 12.22,151 0.6 MT 8.2772 1.1 NC 8.22,649 0.8 ND 9.7677 1.1 NE 13.81,263 0.8 NH 7.1949 1.9 NJ 8.13,979 1.7 NM 9.0396 0.5 NV 6.6344 1.5 NY 5.816,228 0.9 OH 9.07,867 0.8 OK 18.81,507 0.4 OR 11.61,282 1.3 PA 7.69,075 1.1 RI 7.31,171 1.3 SC 6.91,577 0.7 SD 11.5685 1.2 TN 9.62,556 0.3 TX 12.97,757 0.2 UT 8.9586 0.6 VA 7.12,877 0.7 VT 7.0426 1.1 WA 8.52,926 1.5 WI 10.45,155 1.0 WV 7.8733 0.8 WY 9.7196 1.2 SOURCE: Health Care Financing Administration, Medicare Medicaid Automated Certification System. 1981.

APPENDIX D / 363 TABLE I Numloer of Facilities, by State and by Level of Care, with Fewer Than Five Licensed Nurses, 1983 State SNF Only SNF/ICFICE OnlyTotal Percentage AK 0 000 0 AL 0 31114 7 AR 0 04141 20 AZ 6 006 24 CA 71 91595 8 CO 0 4913 8 CT 5 0914 6 DC 0 000 0 DE 0 022 8 FL 4 37142 14 GA 0 033 1 HI 1 034 1 IA 1 0107108 25 ID 1 528 13 IL 4 494699 14 IN 0 0156156 37 KS 3 6246255 69 KY 1 16971 35 LA 0 066 3 MA 0 09696 19 MD 0 01414 8 ME 1 04445 31 MI 2 283666 16 MN 7 146788 19 MS 1 089 6 MO 2 25862 26 MT 0 4610 11 NC 2 1912 6 AD 0 41014 17 HE 1 0133134 62 NH 0 055 7 NJ 0 8614 6 NM 0 011 2 NV 1 001 4 NY 4 1510 2 OH 2 15185202 24 OK 1 0244245 67 OR 12 04860 34 PA 23 11135 6 RI 0 33235 33 SC 0 066 5 SD 0 24648 42 TN 0 11617 7 TX 2 1206209 21 UT 0 32225 31 VA 0 066 4 VT 0 123 7 WA 5 152444 17 WI 0 97584 19 WV 0 099 12 WY 0 246 23 SOURCE: Health Care Financing Administration, Office of Research and Demonstrations, Research in Progress. 1984.

364 / APPENDIX D TABLE J Number of Licensed Nurses Needed in Facilities with Fewer Than Five Licensed Nurses, by State and Type of Facility, 1983 State SNF Only SNF/ICF ICE Only Total AK0 000 AL0 22123 AR0 06363 AZ12 0012 CA110 1031151 CO0 61420 CT10 01222 DC0 000 DE0 022 FL8 61170 GA0 033 HI1 078 IA2 0160162 ID1 7311 IL7 9787191 IN0 0255255 KS6 10555571 KY2 1166169 LA0 01010 MA0 0144144 MD0 02222 ME1 09596 MI5 6274141 MN12 22134168 MS3 01316 MO4 4106114 MT0 41216 NC2 01315 ND0 61521 NE1 0267268 NH0 01010 NJ0 102131 NM0 011 NV0 000 NY8 11120 OH2 25299326 OK1 0498499 OR8 0412 PA30 11243 RI0 38487 SC0 01010 SD0 49094 TN0 12324 TX5 1345351 UT0 34649 VA0 088 VT0 033 WA10 235588 WI0 12182194 WV0 01818 WY0 2911 SOURCE: Health Care Financing Administration, Office of Research and Demonstrations, Research in Progress. 1984.

APPENDIX D / 365 TABLE K State Minimum Requirements for Nursing Hours per Resident-Day, 1985 State SNF ICE Notes AK AL AR AZ CA CO CT DC DE FL GA HI IA only ID IL IN KS KY LA MA MD ME MI MN MS MO MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY 0.32-0.8 0.17 2.5 2.8 2.0 1.9 2.4 2.5 0.53-1.0 2.0 3.2-4.0 1.68-2.24 1.7 1.5 2.5 2.5 2.0 0.9 0.87 1.0-1.7 1.5 1.75 2.0 2.6 2.0 0.5-1.12 2.25 2.0 2.33 0.4-0.53 0.8-1.6 0.4-0.9 1.1-1.2 1.0 2.0 0.32 2.75 1.25-2.5 2.25-3.0 1.0-4.0 1.4 2.0 2.5 2.5 0.58-1.5 0.53-1.73 1.16 0.16 0.53 2.5 0.32 1.9 2.0 0.25-2.0 0.16-0.53 0.8 1.61 2.0 0.9 1.28 0.26 2.0 1.6 _ _ 2.25 1.5 Follows federal requirements Varies by shift; refers to RN, LPN only Refers to RN, LPN only Varies by shift Varies by number of residents Varies by number of residents; RN, LPN Follows federal requirements; RN for SNF Varies by number of residents Varies by shift and number of Varies by shift and number of Varies by shift and number of Varies by shift and number of Varies by shift and number of Varies by shift and number of Follows federal requirements Follows federal requirements; Refers to RN only Follows federal requirements residents residents residents residents residents residents requires RN Varies by functional status of residents Varies by shift Varies by number of residents Varies by shift and number of residents Varies by number of residents; RN, LPN only Refers to RN, LPN only Refers to RN, LPN only Refers to RN, LPN only 1.25-2.0 No minimum Follows federal requirements; requires RN SOURCE: American Health Care Association. 1985.

366 / APPENDIX D TABLE L State Minimum Requirements for Nurse's Aide Training, 1 985 Hours State Applicability Classroom Clinical Timing CA Nursing homes only CT Nursing homes only FL Nursing homes only IL Nursing homes IA KS MD ME MN MO Hospitals and nursing homes Nursing homes only Nursing homes Hospitals and nursing homes Nursing homes only Nursing homes NE Nursing homes NH RI Nursing homes, hospitals, and home health agencies OR Hospitals and 32 nursing homes Nursing homes 15 TX Nursing homes 19 VA Nursing homes 30 WA Nursing homes 25 50 Varies; aide must pass exam 80 30 100 50 40 30 Total 90 hours 40 hours of direct patient care skills must be com- pleted prior to giving hands-on care 30 60 Total 30 hours 35 28 60 100 Total of at least 20 hours plus reporting sus- pected abuse or neglect 30 70 28 30 Open until skills inventory satisfied 50 50 Complete training within 9 months of date of employment Complete training within 90 days of employment Enrolls in next course Begun within 45 days of employment and completed within 120 days Begun at time of employment Begun by 91st day of employment, completed within 6 months Completed within 180 days Preemployment and begun within first month Begun within 2 months Begun within 60 days, completed within 12 months Completed within 120 days of employment Preemployment, but facilities having certified program and instructor are given 90 days to begin program Begun/completed within 12 months Begun following a 30- or 60-day pro- bationary period determined by facility policy 3 hours' orientation within 10 days; completed within 4 months Within 90-120 days of employment Completed within 6 months SOURCE: Health Care Financing Administration, Office of Research and Demonstrations, Research in Progress. 1984.

APPENDIX D / 367 TABLE M Average SNF and ICE Medicaid Reimbursement Rates per Resident-Day, by State, 1982 State SNF Rate ICE Rate AK 97.39* 104.26 AL 37.61 25.81 AR 26.35 25.35 CA 36.10'; 28.90* CO 30.90 30.92 CT 41.49* 26.57* DC 65.90* 50.87* DE 44.28* 44.28''; FL 36.26 33.21 GA 28.20 25.94 HI 71.56* 58.18* IA 59.69 25.89 ID 32.39 31.33 IL 28.35 34.04 IN 41.98 32.68 KS 27.88': 22.16'' KY 49.92 31.95 LA 31.85; 26.62* MA 44.40 33.24 MD 36.14'; 36.14'; ME 64.47 40.30 MI 36.72 36.72 MN 44.81* 35.88* MS 31.32 29.12 MO 42.10 32.53 MT 36.75* 36.75'; NC 46.73 33.49 ND 40.85 30.00 NE 44.64 26.07 NH 53.62 44.54 NJ 51.91 43.81 NM 51.14 32.08 NV 48.26 43.61 NY 78.70 49.21 OH 42.26 36.80 OK 30.00 26.53 OR 42.34 32.85 PA 42.26 37.62 RI 43.48 38.95 SC 42.99 32.05 SD 30.08 26.88 TN 46.50'; 27.40* TX 35.51 26.79 UT 39.32* 34.06* VA 61.90 42.66 VT 44.07 44.07 WA 35.08 34.37* WI 42.00* 32.00* WV 44.39 37.46 WY 33.71* 33.71* U.S. 42.88 35.98 SOURCE: Analysis of State Medicaid Characteristics, La Jolla, California. 1983. ';1981 data.

368 / APPENDIX D TABLE N Total SNF and ICE Resident-Days of Care (in thousands) Reimbursed by Medicaid, by State, 1982 State SNF Days ICE Days Total Days AK4159*163 AL--5,7185,718 AR2,5683,1685,736 AZ----- CA23,8542,21526,064 CO1,1792,7883,767 CT5,1259496,074 DE17434451 FL2,0755,5467,621 GA3,3105,5218,831 HI313420733 IA305,8005,830 ID338626964 IL4,87213,33218,204 IN1,400*7,406*8,806* KS1244,2974,421 KY7233,8064,529 LA1246,6016,725 MA5,2486,01911,267 MD4,5274,5274,527 ME522,4382,490 MI2,6998,97411,673 MN8,0715,21013,281 MS2,0121,8213,833 MO1325,3785,510 MT791,3551,434 NC2,0113,2815,292 ND6625831,245 NE1872,5662,753 NH271,4901,517 NJ4526,6707,122 NM25797822 NV30595625 NY18,5507,33525,885 OH7,5797,56115,140 OK--6,2066,206 OR1312,8402,971 PA10,7524,59115,343 RI572,1052,162 SC3,1193,1196,238 SD1501J3811,531 TN3066,7227,028 TX1,42321,66723,090 UT2251,0761,301 VA2764,4404,716 VT20743763 WA8816 WI6,9007,00013,900 WV520*523523 WY426426852 SOURCE: Analysis of State Medicaid Characteristics, La Jolla, California. 1983. *1981 data.

APPENDIX D / 369 TABLE O Elderly Population by State, 1981 State Population Percentage of State Population State65 Years85 Years 65 Years 85 Years State Populationand Overand Over and Over and Over AK412,000 11,798 780 2.9 6.6 AL3,917,000 436,338 37,963 11.1 8.7 AR2,296,000 306,952 28,019 13.4 9~1 AZ2,794,000 308,222 21,846 11.0 7.1 CA24,196,000 2,400,017 234,995 9.9 9.8 CO2,965,000 250,151 26,074 8.4 10.4 CT3,134,000 370,905 38,811 16.8 10.5 DC631,000 70,074 8,055 11.1 11.5 DE598,000 60,739 5,680 10.2 9.4 FL10,183,000 1,626,466 128,205 16.0 7.9 GA5,574,000 511,582 42,865 9.1 8.4 HI981,000 77,613 6,071 7.9 7.8 IA2,899,000 391,503 47,288 13.5 12.1 ID959,000 97,707 8,957 10.2 9.2 IL11,462,000 1,256,995 124,195 11.0 9.9 IN5,468,000 590,198 56,868 10.8 9.6 KS2,383,000 307,320 35,377 12.9 11.5 KY3,662,000 407,365 37,548 11.1 9.2 LA4,308,000 385,639 37,380 9.0 9.7 MA5,773,000 723,376 81,324 12.5 11.2 MD4,263,000 390,757 35,826 9.2 9.2 ME1,133,000 144,618 15,416 12.8 10.7 MI9,204,000 935,958 88,287 10.2 9.4 MN4,094,000 487,635 57,077 12.0 11.7 MS2,531,000 283,613 27,459 11.2 9.7 MO4,941,000 644,610 65,941 13.1 10.2 MT793,000 87,670 9,301 11.1 10.6 NC5,953,000 606,456 49,280 10.2 8.1 ND658,000 82,844 8,807 12.6 10.6 NE1,577,000 207,141 25,083 13.1 12.1 NH936,000 105,766 10,490 11.3 9.9 NJ7,404,000 866,691 79,645 11.7 9.2 NM1,328,000 118,353 10,115 8.9 8.5 NV845,000 69,547 4,246 8.3 6.1 NY17,602,000 2,137,685 221,811 12.1 10.4 OH10,781,000 1,182,861 115,930 11.0 9.8 OK3,100,000 366,271 35,671 11.8 9.7 OR2,651,000 308,877 30,425 11.7 9.9 PA11,871,000 1,543,787 141,335 13.0 9.1 RI953,000 126,589 12,908 13.3 10.2 SC3,167,000 287,630 22,251 9.1 7.7 SD686,000 92,788 11,168 13.6 12.0 TN4,612,000 511,766 44,460 11.1 8.7 TX14,766,000 1,345,669 118,969 9.1 8.8 UT1,518,000 112,166 9,691 7.4 8.6 VA5,430,000 502,867 45,489 9.3 9.0 VT516,000 59,314 6,389 11.5 10.8 WA4,217,000 438,947 44,337 10.4 10.1 WI4,742,000 578,070 59,906 12.2 10.4 WV1,952,000 235,914 20,799 12.1 8.8 WY492,000 38,711 3,758 7.9 9.7 U.S.229,311,000 25,492,531 2,440,571 11.1 9.5 SOURCE: Health Care Financing Administration, Medicare Medicaid Automated Certification System. 1981.

370 / APPENDIX D TABLE P U.S. Life Expectancy (by sex) at Birth, Age 65, and Age 85, 1960-2040 Date and Age Male Female 1960 Birth 65 85 1980 Birth 65 85 1982* Birth 65 85 2000 66.66 12.91 4.61 69.94 14.04 5.09 70.63 14.50 5.24 73.24 15.89 5.11 77.52 18.36 6.32 78.10 18.79 6.60 Birth 73.65 81.11 65 15.65 20.66 85 5.98 7.75 2040 Birth 75.70 83.36 65 17.10 22.46 85 6.89 9.00 SOURCE: Social Security Administration, Office of the Actuary. Life Tables for the United States: 1900-2050, Actuarial Study No. 89, 1983. *From U.S. Bureau of the Census, Estimates and Projections, Series P-25, No. 952, Projections of the Population of the United States, by Age, Sex, and Race, 1983 to 2080. pp. 147 Table B-4A, 1984.

APPENDIX D / 371 TABLE Q Projected Number (in thousands) of U.S. Nursing Home Residents by Age and Sex, 1980-2040 Sex and Age1980200020202040 TOTAL All ages1,511.32,541.33,370.85,227.1 Under 65196.4225.8241.5248.1 65 & over1,314.92,316.13,129.34,979.0 65-74226.6265.1434.4424.5 75-84525.4849.81,005.61,651.4 85 & over562.81,201.21,639.42,903.1 MALE All ages421.5640.9864.81,303.6 Under 6593.3107.4115.0118.3 65 & over328.2533.5749.51,185.3 65-7486.6104.8175.0172.2 75-84134.5224.7280.0469.0 85 & over107.1204.0294.8544.0 FEMALE All ages1,089.81,900.92,506.13,923.5 Under 65103.1118.3126.5129.8 65 & over986.71,782.62,379.53,793.7 65-74140.0160.3259.4252.3 75-84390.9625.1725.61,182.4 85 & over455.7997.21,394.62,339.1 SOURCE: National Center for Health Statistics, Office of Analysis and Epidemiology. 1977.

372 / APPENDIX D TABLE R Percentage Distribution of Nursing Home Residents Who Were Dependent in Activities of Daily Living, 1973-1974 and 1977 Activity 1973/74 1977 I. Total Percentage Dependent in: Bathing 70.7 86.3 Dressing 58.9 69.4 Toileting 52.7 52.5 Transferring 51.6 66.1 Continence 33.8 45.3 Eating 17.6 32.6 II. Cumulative Percentage Dependent in Activities of Daily Living, Katz Index Not dependent Dependent in one activity Dependent in bathing and one other activity Dependent in bathing, dressing, and one other activity Dependent in bathing, dressing, toileting, and one other activity Dependent in bathing, dressing, toileting, transferring, and one other activity Dependent in all six activities 14.4 Other combinations of dependencies 6.2 23.5 12.7 8.4 4.5 14.3 16.0 100.0 9.6 12.4 12.2 8.5 9.6 15.6 8.9 100.0 SOURCES: U.S. Department of Health and Human Services, National Center for Health Statistics, Nursing Home Costs--1972, United States, National Nursing Home Survey, August 1973 - April 1974, Vital and Health Statistics, Series 13, No. 38; November Home Survey, 1977 Summary for the United States, Vital and Health Statistics, Series 13, No. 43, June 1980.

APPENDIX D / 373 TABLE S Health Care Financing Administration Expenditures (in millions of dollars) for State Survey Activities, 1977-1984 Fiscal Year Medicare Medicaid Total 1977 23.6 33.2 56.8 1978 24.9 36.2 61.1 1979 25.3 34.4 59.7 1980 27.4 (+ 8.37) 38.4 (+11.6%) 65.8 (+10.2%) 1981 24.6 (-10.2%) 34.2 (-10.9%) 58.8 (-10.6%)* 1982 13.6 (-44.7%) 31.8 (- 7.0%) 45.4 (-22.8%) 1984 35.6 32.2 67.8 SOURCE: Health Care Financing Administration, Health Standards Quality Bureau. 1984. *Federal matching for surveyor salaries, travel, and training was cut from 100 to 75 percent in 1981.

374 / APPENDIX D TABLE T Total 1980 Expenditures (in millions of dollars) for State Survey Agency Activities, and Percentage Change in 1983- 1984 1980 Statewide Expenditures Median 1983/1984 Statewide National Median Total (% Change) National Total (% Change) Title 18 0.4 18.5 0.7 32.0 (+75%) (+73%) Title 19 1.0 39.3 1.1 49.3 (+10%) (+25%) State 0.2 21.3 0.3 29.0 Licensing (+50%) (+36%) Total 79.1 110.3 SOURCE: Institute of Medicine, Survey.

APPENDIX D / 375 TABLE U Total State Survey Agency Staffing in 1980 and Percentage Change in 1983-1984 1980 1983-1984 State National StateNational Median Total MedianTotal (% Change) (% Change) RNs 231,463 26 1,742 (+13%) (+19%) Other 13902 14 962 (+7%) (+7%) Total 2,365 2,704 (+19%) (+8%) SOURCE: Institute of Medicine,Survey. 1985.

376 / APPENDIX D TABLE V Total Survey Visits Made by State Survey Agencies in 1980 and Percentage Change in 1983-1984 1980 1983/1984 Statewide National Statewide National Median Total Median Total (% Change) (% Change) Full Licensing/ 280 21,458 Certification 285.5 (+2%) 24,619 (+15%) Post 275.5 14,619 193.5 15,880 Certification (-30%) (+8%) Complaint 154 15,556 143 24,438 Investigation (-7%) (+57) Inspection 248 5,929 110 of Care (-56%) 8,408 (+42%) Total Visits 36,104 48,726 (+46%) SOURCE: Institute of Medicine, Survey. 1985.

APPENDIX D / 377 TABLE W Percentage of Facilities Cited with A-Key Deficiencies, by State, 1983 Percentage Facilities with Percentage Facilities with l State No A-Key Deficiencies or More A-Key Deficiencies AK AL .AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MS MO MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY 78 75 30 65 55 48 67 00 60 66 62 82 68 78 72 52 51 59 54 51 81 65 80 83 54 74 68 72 68 30 69 44 33 62 54 68 67 89 89 78 70 31 71 75 44 74 54 77 95 67 41 22 25 70 35 45 52 33 100 40 34 38 18 32 22 28 48 49 41 46 49 19 35 20 17 46 26 32 28 32 70 31 56 67 38 46 32 33 11 11 22 30 69 29 25 56 26 46 23 05 33 59 SOURCE: Health Care Financing Administration, Medicare Medicaid Automated Certification System. 1981.

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Improving the Quality of Care in Nursing Homes Get This Book
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As more people live longer, the need for quality long-term care for the elderly will increase dramatically. This volume examines the current system of nursing home regulations, and proposes an overhaul to better provide for those confined to such facilities. It determines the need for regulations, and concludes that the present regulatory system is inadequate, stating that what is needed is not more regulation, but better regulation. This long-anticipated study provides a wealth of useful background information, in-depth study, and discussion for nursing home administrators, students, and teachers in the health care field; professionals involved in caring for the elderly; and geriatric specialists.

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