U.S. Nursing Homes Profiled in A New Report

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An Overview of Nursing Home Facilities: Data from the 1997 National Nursing Home Survey. Advance Data No. 311. 12 pp. (PHS) 2000-1250 [PDF – 217 KB]

There were 17,000 nursing homes in the United States, providing service to 1.6 million current residents and 2.4 million residents were discharged in the year prior to the survey, according to the 1997 survey of nursing home facilities. The 1997 survey of providers and recipients of nursing home care is the latest in a series of surveys monitoring long-term care in America. Findings are presented in a new report from the National Center for Health Statistics.

The study found that nursing homes were predominantly proprietary and certified by both Medicare and Medicaid. There was an average of 107 beds per nursing home with an occupancy rate of 88 percent.

To meet the needs of a growing elderly population, nursing home care is an increasingly important component of health care. More than 90 percent of current residents are 65 years of age and over and almost half are 85 years or over. With the 85-and-older population expected to double in the next several decades, data on nursing home availability, utilization, services, and cost will be essential to plan for and monitor this facet of health care.

Facilities Profile – Of the 17,000 nursing homes in the United States, 67 percent are proprietary, just over a quarter are voluntary nonprofit, and the government operates about 7 percent of the homes. Almost 80 percent of nursing homes are certified by both Medicare and Medicaid, only 4 percent are not certified, and the remainder are certified by either Medicare or Medicaid. There are nearly twice as many nursing homes and nursing home beds in the midwest and south as in the northeast and west. Over 60 percent of nursing homes are located in metropolitan areas and over half are affiliated with a nursing home chain.

Nursing home costs – The average basic daily charge of private-pay nursing home residents varies by the level of care of the facility as well as certification status. The highest per diem cost is the $217 reported in Medicare-certified homes compared to $98 in Medicaid-certified facilities. Costs also vary by ownership with voluntary nonprofit homes averaging the highest per diem rate of $147, compared to the $132 charged in the propriety homes and $129 homes operated by the government.

Nursing home services and staff – Certified nurse aides provide the majority of care to residents of nursing homes. Nurses’ aides and orderlies account for nearly two-thirds of the nursing staff, while registered nurses make up only 15 percent of the staff involved in direct patient care. On average, nursing homes employ about one staff member to provide nursing care for every two residents. Counting administrative, medical, and therapeutic staff the ratio jumps to about 90 full-time equivalent employees per 100 residents.

The employees deliver a variety of services to residents, ranging from nursing and medical services provided in virtually all homes to only about a quarter that offer home health services. Other services including speech and hearing therapy, medication, and podiatry services are provided in the vast majority of homes. Just over 70 percent of homes provide hospice services.

Nursing home residents – The overall occupancy rate in nursing homes in 1997 was 88 percent, with little or no variation in occupancy rate across facility characteristics. Women accounted for 72 percent of nursing home residents, continuing a long-standing pattern where about three-fourths of nursing home residents are women. On average, women residents are older than their male counterparts. The majority (87 percent) of nursing home residents are white.