LTC Bullet--Nursing Home Yearbook for LTC Data Mavens

Thursday, October 3, 2002

Dallas, TX--

LTC Comment: Cowles Research Group's "2001 Nursing Home Statistical Yearbook" could have been subtitled "Everything You Ever Wanted to Know About Nursing Homes but Didn't Know Whom to Ask." You'll find a lot of fascinating facts in the yearbook's "Executive Summary," which follows the news below. But if you really want to slice and dice this data every which way (including by state), you'll need to buy the whole book. You can do that for $95 by visiting . Most of the past years' editions are also available. The Center for Long-Term Care Financing received no compensation for making this information available. We just think it's interesting and we thought you might think so too.

*** Today's Bullet is sponsored by LTC, "a third-party, unbiased online resource for the LTC insurance industry which provides an efficient and cost effective delivery method committed to enhancing the information exchange in the long-term care insurance industry." For more information, contact James Dove ( or toll free 888-LTC-3750 x205) or visit LTC at . Thanks so much to LTC for its generous support of the Center and commitment to our common mission of ensuring quality long-term care for all Americans. Won't you help too? Go to to sponsor an LTC Bullet. Find out how you can sponsor other Center activities (e.g., our forthcoming book, articles, speeches, and LTC Graduate Seminars) by contacting Amy Marohn at 425-377-9500 or***

*** News about the LTC Graduate Seminars: Ever since last March, the Center for Long-Term Care Financing has been conducting full-day LTC Graduate seminars for senior financial advisers. The feedback on these programs has been excellent. (Read the testimonials and the detailed program description at .) We would like the LTC Graduate Seminar to reach many more people. So, we're going to request your assistance.

If you can pull together a group of a dozen or more paying attendees (at $225 each), we'll provide one free enrollment and deliver the LTC Graduate Seminar wherever you are. If you can provide a conference room, TV, VCR and an audio player, we'll throw in another free enrollment. You could sponsor this extraordinary training experience for 15 attendees for only $2925 or $195 each. Add ten more attendees, make it a "classroom event" for 25 people, and we'll provide two more free enrollments: total cost $4725 or $189 each. Plan at least three months in advance and we'll apply for seven continuing education credits, for which we've never yet been declined. (CEU credits for this program have already been approved in several states.)

Contact Amy Marohn-McDougall at 425-377-9500 or to start planning an LTC Graduate Seminar. Urge your favorite LTCI carrier or broker to sponsor an LTC Graduate Seminar. We also encourage think tanks, government agencies, law firms, financial planners and long-term care providers, including nursing home, assisted living and home health companies, to sponsor LTC Graduate Seminars. This is a wonderful way to build bridges of understanding and cooperation between the provider and insurance sectors of the long-term care profession. Thanks for your interest. ***

*** New content added today to the donor-only zone includes "The LTC Week in Review for September 30-October 4, 2002: LTC E-Alerts #231-#235." Every LTC E-Alert contains some news or information that will help people understand the need to prepare early for the risk and cost of long-term care. If you already qualify for The Zone, you can click the following link, enter your user name and password, and go directly to the latest

E-Alerts: .

LTC E-Alert #231--Retiree Health Benefits Falling, Need for LTCI Rising
LTC E-Alert #232--Indentured Servitude in Nursing Homes
LTC E-Alert #233--LTC Hits the Gospel Charts
LTC E-Alert #234--Medicaid "Train Wreck" Coming
LTC E-Alert #235--Nursing Home Sex

To Zone In, mail your tax-deductible contribution of $100 or more to the Center for Long-Term Care Financing, 2212 Queen Anne Avenue North, #110, Seattle, WA 98109. Then email your preferred password and user name (up to 10 characters each). You can also contribute online at . ***


C. Mckeen Cowles, "2001 Nursing Home Statistical Yearbook," Cowles Research Group, Montgomery Village, MD, 2002.


With each year, our series of Nursing Home Statistical Yearbooks are able to further document changes in long term care provided in nursing homes. The 2001 Nursing Home Statistical Yearbook (NHSY2001) marks our seventh consecutive edition.

By computing the same tables from consecutive annual data files, our intention is to create an historical record of the nursing home profession. The database from which the Yearbooks are constructed is uniquely suited to this task. The Online Survey Certification and Reporting (OSCAR) file is the only place where standardized data are routinely collected from every certified nursing home in the country. The serialized annual presentation of these data documents important trends in the nursing home profession, some of which are detailed below.



In addition to recreating every table that was in NHSY2000, we've added one new table in NHSY2001, Table VI-9, Staffing Hours Per Patient Day by Class of Ownership. This new table shows that, on a national level, government-owned and not-for-profit nursing homes averaged more direct patient care staff time than did for-profit facilities. Total registered nurse (RN) time averaged .90 hours per patient day (ppd) in not-for-profit homes, compared to .82 in government-owned facilities, and .56 hours ppd in for-profit homes. (NHSY2001, page 226)


By all measures, the nursing home profession is shrinking. The number of nursing homes, the number of nursing home beds, and the number of nursing home residents in 2001 reflect this overall contraction.

The number of residents and the number of facilities have been falling steadily since 1998 when they peaked at 1.51 million residents in 17,259 facilities. The total number of beds in certified facilities has been falling since hitting a peak of 1.83 million in 1997. There were 1,779,924 nursing home beds, in America's 16,675 certified nursing homes in 2001. On an average day in 2001 these homes cared for 1,469,001 residents.


Statistics showing the national contraction in nursing homes mask some rather dramatic individual state data. For example, while the number of nursing home residents in the U.S. fell 2.9 percent nationally between 1998 and 2001, the number of nursing home residents in Oregon fell more than 15 percent over the same three-year period. Maine was down 10 percent over the period, Oklahoma 9, and Arkansas, Wisconsin, Washington and Minnesota each fell 8 percent. A few states had increasing numbers of residents over the same period, e.g., nursing home residents in Nevada, South Carolina, and Hawaii increased 9, 4, and 3 percent respectively between 1998 and 2001.


The proportion of residents for whom Medicare was the primary payor reached an all time high of 9.55 percent in 2001. The previous high was 9.41 percent in 1998. There remains considerable interstate variation in payor mix. Medicare and Medicaid combined accounted for fewer than 60 percent of all nursing home residents in Nebraska in 2001, while in other states, like Georgia, Mississippi, and North Carolina, the two programs accounted for more than 85 percent of residents, and in Alaska Medicare and Medicaid were the primary payors for more than 91 percent of residents in 2001.


Changes in the distribution of the size of certified nursing homes between 1998 and 2001 have been particularly interesting. The number of smaller facilities (fewer than 61 beds) fell by 11 percent, while the number of larger facilities (more than 120 beds) fell by only 2 percent. At the same time, the number of mid-sized facilities (61-120 beds) has actually grown, albeit only modestly. These trends suggest that market forces may be determining an optimal size for nursing homes, or perhaps economies of scale are squeezing out the smaller providers.


Nursing home resident acuity increased in 2001, continuing a long running trend. This is reflected in increases in ADLINDEX, ACUINDEX, PROPAC, and ADLSCORE and decreases in the percentage of residents who were independent at various activities of daily living. Nationally, the percentage of residents requiring assistance with bathing increased from 92% to 95% between 1996 and 2001. Dressing dependence increased from 84% to 87% over the same period. Toileting, transferring, and eating dependence has similarly increased between 3 and 5 percentage points over the period.


Nationally, occupancy rates have remained stable over the last 7 years at between 82 and 83 percent, although in some cases there have been strong counter-trends at the individual state level. Oregon, for example, has seen occupancy rates drop from 89 to 73 percent between 1995 and 2001.


Survey deficiencies continue to vary dramatically by state and class of ownership. In some states, such as Maryland, Rhode Island, Vermont, and Virginia, the standard annual health survey results in an average of three survey deficiencies while in others, such as Arizona, California and Nevada, the average survey results in 10 or 11 deficiencies. The not for profit facilities continue to average fewer deficiencies than government and for-profit facilities. This finding holds both nationally and at the individual state level.

As this Executive Summary was being written, the phrase "dramatic state-to-state variations" occurred repeatedly. It may be that this is one of the reasons that the data in this yearbook are so valuable. Most of our data are presented at a state level, and this presentation makes it very clear that conclusions that can be drawn at the national level about the nursing home profession are rarely true for every state. Long term care is provided state by state, and it is important that anyone seeking to understand the profession look at it that way. See the section "How the Tables were Constructed" for descriptive methodology.