Nursing Home Update, 1996
Characteristics of Nursing Home
Facilities and Residents
Nancy A. Krauss, Marc
P. Freiman, Jeffrey A. Rhoades, Barbara M. Altman, Erwin Brown,
Jr., and D. E. B. Potter
The dramatic growth in the number of
Americans over age 75, the desire to minimize the duration of
expensive inpatient hospital care, and the trend toward community-based
all lend importance to data on the nursing home industry.
The Medical Expenditure Panel Survey (MEPS)
collects nationally representative data on health care use, expenditures,
sources of payment, and insurance coverage. The MEPS Nursing
Home Component is now releasing Round 1 data for nursing homes
and person-level data collected for persons in residence on January
1, 1996. This Round 1 information was gathered from a nationally
representative sample of nursing homes during the first half
- Of the approximately 16,800
U.S. nursing homes in 1996, most (66 percent) operated for profit.
About 68 percent of for-profit homes were part of a chain.
- For-profit nursing homes
were much more likely than either nonprofit or government-owned
homes to consist of only nursing home beds.
- Formally defined special
care units accounted for 6.9 percent of all nursing home beds.
Most were dedicated to Alzheimer's disease and related dementias.
Twelve percent of all nursing homes had a special Alzheimer's unit.
- Nursing home residents
had a high degree of functional difficulty. Over 80 percent needed
help with three or more activities of daily living. Nearly half
had some form of dementia.
- Fifty-eight percent of
nursing home residents had some kind of advance directive, such
as a do-not-resuscitate order.
- Most residents were enrolled
in Medicare (91.3 percent), with 62.2 percent dually eligible for
both Medicare and Medicaid. Only about 4.5 percent were eligible
for Medicaid only.
Size and Ownership
About 1.6 million persons were receiving care
in approximately 16,800 nursing homes on January 1, 1996. Nearly
1.8 million certified or licensed beds were available for use,
with an occupancy rate of 88.8 percent. Almost 66 percent of
nursing homes were operated for profit, while another 26.2 percent
were nonprofit. The remaining 7.9 percent were owned by Federal,
State, or local governments. Forty-five percent of all nursing
homes were both for-profit and part of a chain, whereas only
7.4 percent were nonprofit and part of a chain. For details,
select Figure 1.
Continuum of Care
Compared with nonprofit and government-owned
nursing homes, those that operated for profit were more likely
to consist solely of nursing home beds. Nonprofit and government-owned
nursing facilities were comparatively more likely to be part
of a more complex organizational structure--for example, hospital-based
nursing homes or those providing or affiliated with non-nursing
units such as personal care or independent living. For details,
select Figure 2 .
Over 3,200 facilities (19.3 percent) had formally
defined nursing units with a specific number of beds identified
and dedicated for residents with specific needs or diagnoses,
such as an Alzheimer's, rehabilitation, ventilator/pulmonary,
subacute care, or hospice unit. These special care units accounted
for 6.9 percent of all nursing home beds. The majority of special
care units were dedicated to Alzheimer's disease and related
dementias. Approximately 2,100 nursing homes (12.6 percent) had
a special Alzheimer's care unit. Alzheimer's units accounted
for 73,400 beds and had an average unit size of 34.5 beds.
Functional Status and
Measured by their ability to perform activities
of daily living (ADLs)--bathing, eating, using a toilet, mobility,
dressing, and transferring to a bed or chair--nursing home residents
had high levels of functional difficulty. Just over 83 percent
of residents required assistance with three or more ADLs. For
details, select Table 1 .
Slightly over 2 percent of residents did not
require assistance with ADLs, nor did they have dementia. However,
they may have had other functional limitations, such as behavioral
problems or incontinence, that resulted in nursing home placement.
Full-year data may add more insight into the reasons for nursing
Data for most residents indicate limitations
that require nursing care. Some residents have also directed
that constraints be placed on specific types of care that they
may receive. Fifty-eight percent of nursing home residents had
some kind of advance directive, in the form of a living will,
do-not-resuscitate order, do-not-hospitalize order, or other
directive with regard to feeding, medication, or treatment.
Medicaid is the largest single payer for nursing
home care. Although Medicare pays for nursing home care for only
a limited duration following a hospitalization, it nevertheless
pays for a substantial amount of nursing home care and is the
primary source of coverage for most other types of care for the
elderly. Most nursing home residents (91.3 percent) were enrolled
in Medicare. About 455,300 residents (29.1 percent) were enrolled
only in Medicare, and nearly 972,000 (62.2 percent) were dually
eligible for both Medicare and Medicaid. About 70,300 residents
(4.5 percent) were covered only by Medicaid. About 37,500 residents
(2.4 percent) had neither Medicare nor Medicaid coverage. Type
of coverage could not be determined for about 28,700 residents
(1.8 percent) during this round of data collection. These data
reflect insurance coverage only. The actual source of payment
for nursing home stays will not be available until the release
of full-year nursing home data. For details, select Figure
Sample Design and
Accuracy of Estimates
All of the data presented here are being explored
in more detail in MEPS Research Findings reports that will be
published soon. The data were obtained from a representative
sample of nursing homes that compose the Nursing Home Component
(NHC) of the 1996 MEPS. The NHC provides unbiased national and
regional estimates of a range of characteristics of nursing homes
and their residents.
The NHC sample was selected using a two-stage
stratified probability design. The first stage was used to select
facilities; the second stage sampled current facility residents
and new admissions. Tests of statistical significance were used
to determine whether the differences between populations existed
at specified levels of confidence or whether they occurred by
chance. Any comparison made in this Highlights is based on tests
using Z-scores having asymptotic normal properties, at the .05
level of significance.
DATA SOURCE: 1996 Medical Expenditure Panel
Survey Nursing Home Component, Round 1.
1. Nursing home distribution by ownership
and chain affiliation: 1996
About two-thirds of nursing homes are
operated for profit. Over half are part of a chain, either
for-profit or nonprofit.
DATA SOURCE: 1996 Medical
Expenditure Panel Survey Nursing home Component, Round 1.
Figure 2. Nursing
homes by type and ownership: 1996
For-profit nursing homes
are more likely than nonprofit or government facilities to
consist of only nursing beds.
a small number of nursing homes (<1% of this category) with
units such as an ICF-MR (intermediate care facility for the
continuing care retirement communities and retirement centers,
and nursing homes that contain or are affiliated with personal
DATA SOURCE: 1996 Medical
Expenditure Panel Survey Nursing home Component, Round 1.
3. Medicare and Medicaid enrollment of persons residing
in nursing homes on January 1, 1996
Most nursing home residents
are enrolled in both Medicaid and Medicare.
SOURCE: 1996 Medical Expenditure Panel Survey Nursing home
Component, Round 1.
1Percents may not add to 100 due
DATA SOURCE: 1996 Medical Expenditure
Panel Survey Nursing Home Component, Round 1.
For more information about the 1996 MEPS Nursing
Home Component, including the availability of public use data
files, contact the MEPS Information Coordinator by calling 301/594-1406;
writing to the Agency for Health Care Policy and Research, 2101
East Jefferson Street, Suite 500, Rockville, MD 20852; or contacting
the MEPS Project Director by E-mail at firstname.lastname@example.org.
For a detailed description of the MEPS NHC
Potter DEB. Design and methods of the 1996
Medical Expenditure Panel Survey Nursing Home Component. Rockville
(MD): Agency for Health Care Policy and Research; 1997.
MEPS Methodology Report No. 3. AHRQ Pub. No. 97-0028.
Bethel J, Broene P, Sommers JP. Sample design
of the 1996 Medical Expenditure Panel Survey Nursing Home Component.
Rockville (MD): Agency for Health Care Policy and Research; 1997.
MEPS Methodology Report No. 4. AHRQ Pub. No. 97-0029.
MEPS Highlights No. 2, AHRQ Pub. No. 97-0036, July 1997.
Krauss, N. A., Freiman, M. P., Rhoades, J. A., Altman, B. M., Brown Jr., E., and Potter, D. E. B. Highlights #2: Nursing Home Update, 1996. July 1997. Agency for Healthcare Research and Quality, Rockville, MD.