nursing home data compendium 2000 - centers for medicare ......introduction to the data compendium...

Nursing Home Data Compendium2000

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Acknowledgements

The following were contributors to the Data Compendium:

David Champney, West Virginia Medical InstituteMark Champney, Champney AssociatesC. McKeen Cowles, Cowles Research GroupJames Forsythe, Ph.D., West Virginia Medical InstituteYifei Hu, West Virginia Medical InstituteJill Kelly, CMSBryan Mission, Champney AssociatesEdward Mortimore, CMSJean C. Scott, Dr. P.H., CMSDaniel Zeller, CMS

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Introduction to the Data Compendium

More than 2.9 million Americans, largely vulnerable and elderly, resided in ournation's nursing homes for at least some part of 2000. The majority of these werelong-term nursing home residents and some had shorter stays for rehabilitation careafter an acute hospitalization. The care of this population is of high priority forCongress and for the Centers for Medicare & Medicaid Services (CMS) (formerlythe Health Care Financing Administration), regardless of the reasons for theiradmissions to the nursing homes or the lengths of their stays.

Both legislative and regulatory reforms in recent years have been important inassuring that these residents receive a high quality of care. The Omnibus BudgetReconciliation Act of 1987 (OBRA) specified a number of reforms, and in 1995CMS began enforcing a new set of nursing home regulations. An assessment of theeffect of these regulations in 1997 and 1998 (presented in a July 1998 report toCongress) resulted in the conceptualization of the Nursing Home OversightImprovement Program (NHOIP, formerly the Nursing Home Initiative). TheNHOIP includes many ongoing provisions that were designed to address weaknessesin the Federal and State oversight of nursing homes. These include: makinginspections less predictable and helping states improve inspection quality; quicklyinvestigating complaints that allege actual harm to residents; making facilities withrepeated violations the subject of greater scrutiny and immediate sanctions;preventing facilities terminated from Medicare and Medicaid from immediately re-entering the programs; preventing dehydration, malnutrition, and abuse of nursinghome residents; and providing better consumer information about nursing homes.

As part of the oversight of the care given to our nation's nursing home residents,CMS monitors on a regular basis both Minimum Data Set (MDS) data, which arereported by Medicare- and Medicaid-certified nursing homes, and administrativedata from the Online Survey, Certification, and Reporting System (OSCAR). Someof these data have been organized into tables in this data compendium. We believethe compendium will serve as a valuable resource for policy makers concerned withissues of aging and long term care.

The compendium contains figures and tables presenting data on all residents inMedicare- and Medicaid-certified nursing homes in the United States. To ourknowledge, this is the first comprehensive aggregation of data at the level of theindividual. Previous reports from CMS have relied on aggregate data calculated atthe nursing home level. National survey data rely on samples of nursing homes ornursing home residents, not the total universe of nursing home residents, thereforethe numbers presented may differ somewhat from estimates based on probabilitysampling strategies. The use of these comprehensive individual data allows a more

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complex understanding of the demographic profile of nursing home residents and ofhow their care contributes to their health outcomes.

A series of graphs, charts, and maps highlights some of the most interesting data,while detailed data are available in accompanying tables. In some cases, we havealso used measures, such as Activity of Daily Living Impairment (ADL), that maydiffer methodologically from other ADL measures commonly published. These areexplained in more detail in the Methods Section. Data in the compendium arepresented at both the national and the state level. A brief synopsis of some of thematerial from the compendium is presented below.

In 2000, just over 16,800 nursing homes were certified to participate in the Medicareand/or Medicaid programs, down from about 17,200 in 1997. Most of these facilitiesare of a medium size, having between 50 and 200 beds. There are about 2,600 smallfacilities (fewer than 50 beds) and fewer than 1,500 very large facilities (200 or morebeds). Most certified nursing homes participate in both Medicare and Medicaid;seven percent are certified to participate in Medicare only and about 12 percentparticipate in Medicaid only. For-profit facilities account for about 65 percent of thecertified homes and care for almost two-thirds of nursing home residents. About 28percent of nursing homes are non-profit. The others are government-operated.

More than 20 percent of the population of large nursing homes (with 200 or morebeds) consist of non-white residents. Minority groups account for less than 15percent of the population of smaller nursing homes.

Occupancy rates for nursing homes have been decreasing slowly since 1996. In1996, nursing homes, on average had about 85 percent of their beds occupied. Thishas decreased to about 82 percent occupancy in 2000.

Almost 3 million individuals had at least one completed MDS assessment in 2000.About 70 percent of these residents were female. The female to male ratio varied bystate, from 1.4 to 1 in Alaska to 2.7 to 1 in Alabama. Seventy-five percent of allnursing home residents were 75 years of age or older. Alaska, Puerto Rico, andLouisiana had the highest proportions of young nursing home residents (under theage of 65 years) while South Dakota, Iowa, and North Dakota had the highestproportions of residents aged 95 years and older.

Both cognitive and functional impairments are common in nursing homes. Onlyabout one-quarter of residents had no cognitive impairment, while more than 15percent had severe or very severe cognitive impairment. Facilities with fewer than50 beds reported that just over 50 percent of their residents have some degree ofcognitive impairment, while about 75 percent of residents in larger homes arecognitively impaired. More than a third of nursing home residents require extensiveassistance with at least four of the five Activities of Daily Living (ADL) that wereexamined (bed mobility, transferring, dressing, eating, or toileting). Facilities with

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fewer than 50 beds report lower levels of ADL impairment in residents than dolarger facilities.

Clinical problems are also common in nursing homes. Incontinence remains a severeproblem. More than one-third of nursing home residents are incontinent of bowel orbladder all or most of the time. Pressure ulcer prevalence has increased slightly overthe observation period from 7.1 to 7.9 percent. The incidence has remained relativelystable at about 2 percent. While the estimates of the prevalence of reported weightloss vary somewhat over time. They show a downward trend from the beginning of1999 to 2000.

The use of restraints appears to be decreasing, from 7.5 percent in 1998 to 6.3percent in 2000, while the incidence of new use of restraints has remained steady atabout 1 percent. Data on reported involuntary weight loss also appears to support adownward trend from the beginning of 1999 through 2000. Since the beginning of1999 the prevalence of tube feeding has been fairly steady, at 4.2 to 4.4 percent.

Results from the on-site surveys of nursing homes have also changed somewhat overtime. The compendium presents data from 1996 through 2000. The average numberof health deficiencies cited during the survey has increased from 5.1 per facility in1996 to 6.1 per facility in 2000. The percentage of nursing homes that did not receiveany citations for health deficiencies during the survey has decreased substantially;while 22 percent of nursing homes were not cited for health deficiencies in 1996,fewer than 13 percent were not cited in 2000. Fewer facilities are being cited for theimproper use of physical and chemical restraints. In 1996, 14.4 percent of nursinghomes were cited. Fewer than 10 percent were cited in 2000. Citations for failure totreat or prevent pressure ulcers increased from 15.3 percent in 1996 to 18.6 percent in1999, then decreased to 17.8 percent in 2000.

The percentage of nursing homes cited for substandard quality of care has fluctuatedsomewhat from year to year, but has never been above 5.8 percent during the four-year period. The lowest citation rate for this type of deficiency was 4.4 percent (in2000). In 2000, only 3 states: Alaska, South Dakota, and Vermont had no instances ofcitations for substandard quality of care. During the four-year observation period,fewer than 2.5 percent of facilities per year were cited for abuse. In 2000, 13 statescited no instances of abuse in nursing homes, while four states cited 5 percent or moreof their facilities for abuse. The percentage of nursing homes cited for deficiencies atthe highest level of severity, immediate jeopardy, has increased every year since1996. However, only a small proportion of facilities are cited for this type ofdeficiency. In 2000, the citation rate was 1.9 percent. In fact, more facilities werecited for isolated problems that caused minimal harm to residents than for any otherlevel of deficiency.

Additional information about the material highlighted above is available at the statelevel in the figures, maps, and tables that follow.

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Methods Used in the Data Compendium

Notes on Data QualityIn self-reported databases such as the Minimum Data Set (MDS), there are likely to besignificant variations in the quality of record keeping and reporting at the facility level(for example, errors in coding date of birth, race, sex and facility). Additionally, we havefound some instances where states may have assigned the same resident identifier tomultiple nursing home residents. Based on an examination of data from about 5 states, weestimate that between 1 percent and 7 percent of the assessment records have a miscodedresident identifier code, meaning that the same code was assigned to two differentindividuals, or that the same individual may have more than one code. We are currentlyexploring this variation and believe that much of the inaccuracy appeared in the earliestweeks of MDS data collection. An important change in the algorithm that assigns residentidentifiers was made in November 1999. As the data are refined in the future weanticipate an improvement in accuracy.

Notes on Measures of Resident Clinical CharacteristicsIt is important to note that the measures used throughout this report were derived usingstandard epidemiological and demographic methods. Although many of the measures usedescriptions similar to those used in quality indicators (for example, the prevalence ofpressure ulcers) they were often calculated in different ways. We describe thecalculations in more detail below.

Calculation of Resident-Specific Measures

Annual MeasuresGender, age, race, Cognitive Performance Scale (CPS) Score, and number of ADLimpairments were calculated for each resident from the MDS assessment closest to July 1of the year of interest. All of these measures are reported by the nursing home.

CPSThe Cognitive Performance Scale (Morris, 1994) is one method for estimating thecognitive ability of nursing home residents based on items reported in the MDSassessment. Based on the scoring algorithm a resident is classified as having very severe,severe, moderately severe, moderate, mild, very mild, or no impairment.

Activities of Daily LivingThere are many ways of estimating the amount of impairment in ADLs. For this analysisthe ADLs evaluated were: bed mobility, dressing, eating, transferring, and toileting. Inaddition, dependency was considered to exist only when a resident required extensiveassistance with one or more of these activities. The data presented are summary counts ofthe number of ADLs with which a resident requires extensive assistance.

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Incidence and Prevalence Measures: A General NoteIt is important to examine both incidence and prevalence rates in assessing many aspectsof quality of care provided to nursing home residents. The two measures give differentinformation. Prevalence quantifies the proportion of individuals in a population whohave a given condition at a specific point in time. Incidence quantifies the number ofnew events or occurrences of a condition that develop in a population of individuals atrisk during a time interval (Hennekens, 1987). For example, prevalence of pressureulcers in a nursing home would give the proportion of the residents who had a pressureulcer during a time interval. These could be newly occurring ulcers or ulcers that hadbeen present for some period of time. Incidence of pressure ulcers in a nursing homewould be the proportion of residents who have newly occurring ulcers during a timeinterval. If we exclude pressure ulcers noted on admission or readmission MDSassessments, we can infer that incident ulcers occurred while the residents were under thecare of the nursing home.

Since MDS assessments are collected on a schedule that differs for every resident, thereare methodological challenges in the calculation of incidence and prevalence measures.For these figures and tables, prevalence was assessed using the midpoint of each calendarquarter as a starting point (baseline). Cases of interest occurred 60 days before or after themidpoint and were unique. That is, if a resident had two assessments collected during theobservation period, only the one closest in time to the starting point was retained.Prevalence was calculated as the number of identified cases divided by the number ofeligible residents at baseline (the midpoint estimate of the nursing home population).Prevalence calculations include admission and readmission assessments.

Incidence calculations were slightly more complicated. To illustrate, incidence ofpressure ulcers was calculated by identifying all pressure ulcer cases that are not noted onadmission or readmission assessments during a quarter of interest (for example, January 1to March 31). Each assessment indicating presence of a pressure ulcer (index assessment)is then compared with the resident’s immediately preceding assessment. If the precedingcomparison assessment indicates that no pressure ulcer is present, then the indexassessment is considered an incident pressure ulcer. Incident pressure ulcers constitutethe numerator of the quarter. The denominator consists of all eligible assessments closestto the midpoint of the quarter (but not more than 60 days from the midpoint) that indicatepresence of no pressure ulcers.

Use of Descriptive Statistics: A General Note

A number of the conditions and characteristics assessed for this report are not normallydistributed in the nursing home population; sometimes the distribution is quite skewed.For example, in 2000 the prevalence of dehydration is zero percent for more than half thenursing homes in the nation. For conditions like dehydration, the use of a mean (oraverage) value will not characterize how the data are distributed (or spread out).Therefore, in the tables for those conditions and characteristics we have presented themedian (or middle value) as well as the 90th and 10th percentile values. The 90th percentileis the value below which 90 percent of the values in the distribution fall, and the 10th

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percentile is the value below which 10 percent of the values fall. These two pieces ofinformation help one understand how values are clustered at the ends of the distribution.

Prevalence of DehydrationTo estimate the prevalence of dehydration, we identified all individuals for whom thenursing home indicated that fluid output exceeded fluid input. It is important to note thatwe excluded individuals who were reported by the nursing home to be in end-stagedisease or who were receiving hospice care.

Pressure Ulcer Incidence and PrevalenceTo estimate the incidence and prevalence of pressure ulcers, we identified individualswith a pressure ulcer of stage 2 or greater. We then calculated incidence and prevalencerates as detailed in "Incidence and Prevalence Measures: A General Note" above.

Restraints Incidence and PrevalenceTo estimate the incidence and prevalence of physical restraint use, we adopted aconservative approach, considering only individuals whom the nursing home reportedwere in a trunk restraint, limb restraint, or some sort of restraining chair at least onceduring the 7 days prior to the assessment. It is important to note that we did not report theuse of bed rails for this measure, because of our concern about biases in the measurementof this item.

Prevalence of Weight LossTo estimate the prevalence of weight loss, we identified all individuals whom the nursinghome indicated had experienced weight loss of more than 5 percent in the 30 days priorto the assessment or more than 10 percent in the last 180 days. It is important to note thatwe excluded individuals who were reported by the nursing home to be in end-stagedisease or who were receiving hospice care.

Prevalence of Tube FeedingTo estimate the prevalence of feeding tube use in nursing homes we identified allindividuals whom the nursing home reported had a feeding tube, defined as “any tubethat can deliver food/nutritional substances/fluids/medications directly into thegastrointestinal system.” We excluded individuals admitted to the nursing home withfeeding tubes because we wanted to separate the use of feeding tubes by nursing homesfrom the use of feeding tubes by hospitals.

Prevalence of IncontinenceFor this measure, we identified persons who were incontinent of bladder or of bowel onalmost all occasions. This is a measure of severe incontinence. It is important to note thatthis differs from the Quality Indicator on incontinence that is used in the survey process.

OSCAR Measures

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Number of Nursing HomesWe have derived counts of the number of nursing homes from an Online SurveyCertification and Report (OSCAR) file created in March of each year. The counts maydiffer slightly from other estimates of the number of providers. This may occur becauseother counts were made at different points in the year, or because different assumptionswere made about eliminating potential duplicate records, or because the number ofproviders was derived from the master provider table in OSCAR, rather than fromrecords of surveys.

Average Number of DeficienciesThe figures and tables report the mean number of health deficiencies cited during an on-site survey by state and for the nation by calendar year. Health deficiency citations arebased on the Interpretive Guidelines from the "State Operations Manual for ProviderCertification." Note that for all of the calendar year tables the weighting scheme isunique. Any facility that was not surveyed during the particular calendar year is notcounted and any facility that was surveyed twice during the year is doubly counted,giving it a weight of 2. Facilities are surveyed once a year on average.

Percentage of Surveys Resulting in No DeficienciesThis measure is defined as the number of surveys that resulted in zero citations fordeficiencies during a calendar year, divided by the number of surveys conducted.

Percentage of Surveys Resulting in Citation for Substandard Quality of CareThe table reports the percentage of surveys resulting in citations for substandard qualityof care (SSQC) nationally and by state by calendar year. SSQC is defined as anydeficiency in the Code of Federal Regulations (42 CFR 483.13 Resident Behavior andFacility Practices, 42 CFR 483.15 Quality of Life, or 42CFR 483.25 Quality of Care), at ascope and severity level of 'F', 'H', 'I', 'J', 'K', or 'L'. A grid that details the scope andseverity levels is included as the last page of this Methods Section.

Percentage of Surveys Resulting in Citation for AbuseThe table reports the percentage of on-site nursing home surveys resulting in citations forabuse of residents. Abuse citations are those deficiencies cited under tag F223 of theInterpretive Guidelines from the "State Operations Manual for Provider Certification".

Percentage of Surveys Resulting in Citation for Improper Restraint UseThe table reports the percentage of nursing home surveys resulting in a citation forimproper restraint use (tags F221-F222 of the Interpretive Guidelines from the "StateOperations Manual for Provider Certification").

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Percentage of Surveys Resulting in Citation for Pressure UlcersThis table reports the percentage of nursing home surveys resulting in a citation forpressure ulcers (tag F314 of the Interpretive Guidelines from the "State OperationsManual for Provider Certification").

Percentage of Surveys Resulting in Citation for Actual Harm or WorseThis table reports the percentage of surveys resulting in a citation for actual harm,defined as a deficiency citation that is rated at scope and severity ‘G’ or more severe.(See grid at the end of the Methods Section.)

Percentage of Surveys Resulting in Citation for Immediate JeopardyThis table reports the percentage of surveys resulting in a citation for immediatejeopardy. Immediate jeopardy is a deficiency that constitutes an immediate threat to thehealth or life of one or more nursing home residents. It is recorded by the state surveyagency at scope and severity of 'J' or higher. (See grid at the end of the Methods Section.)

Scope and Severity Distribution by YearIt should be noted that for this table the denominator is the number of deficiencycitations, not nursing homes or surveys. (See grid at the end of the Methods Section.)

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References

Hennekens CH, Buring JE. Epidemiology in Medicine. Boston: Little, Brown andCompany, 1987.

Morris JN, Fries BE, Mehr DR, Hawes C, Phillips C, Mor V, Lipsitz LA. MDS CognitivePerformance Scale. J Gerontol. 1994 Jul;49(4):M174-82.

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Scope and Severity Grid

Immediate Jeopardy to resident health or safety J K L

Actual Harm that is not Immediate Jeopardy G H I

No Actual Harm with Potential for More than Minimal Harm that is not Immediate Jeopardy

D E F

No Actual Harm with Potential for Minimal Harm

A B C

Isolated Pattern Widespread

Sev

erit

y

Scope

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List of Highlights

Characteristics of Nursing Homes _______________________________________________1

Characteristics of Nursing Home Residents ________________________________________10

Nursing Home Resident Clinical Characteristics

Pressure Ulcers ___________________________________________________________19

Restraint Use_____________________________________________________________24

Tube Feeding, Weight Loss, and Dehydration ___________________________________27

Incontinence _____________________________________________________________33

Nursing Home Survey Results

Mean Number of Health Deficiencies _________________________________________37

Health Deficiencies – Scope and Severity ______________________________________44

Health Deficiencies – Substandard Quality of Care _______________________________53

Health Deficiencies – Abuse, Restraint Use and Pressure Ulcer Citations _____________57

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List of Figures

Figure 1 Number of Nursing Homes by Year: United States, 1996-2000 _______________2

Figure 2 Number of Nursing Homes by State: United States, 2000 ____________________3

Figure 3 Number of Nursing Homes by Bed Size by Year: United States,1996-2000 ______________________________________________________4

Figure 4 Number of Nursing Homes by Ownership by Year: United States,1996-2000 ______________________________________________________5

Figure 5 Percent of Nursing Homes that are For Profit by State: United States, 2000______6

Figure 6 Number of Nursing Homes by Certification by Year: United States, 1996-2000___________________________________________________________7

Figure 7 Nursing Home Occupancy Rates by Year: United States, 1996-2000 ___________8

Figure 8 Nursing Home Occupancy Rates by State: United States, 2000 _______________9

Figure 9 Nursing Home Residents by Gender by Year: United States, 1998-2000 ________12

Figure 10 Nursing Home Residents by Age Group by Year: United States, 1998-2000 _____13

Figure 11 Percent of Nursing Home Residents Aged 65 Years and Older by State:United States, 2000_______________________________________________14

Figure 12 Percent of Nursing Home Residents Aged 85 Years and Older by State:United States, 2000_______________________________________________15

Figure 13 Nursing Home Residents by Race by Year: United States, 1998-2000 __________16

Figure 14 Distribution of Number of ADL Impairments in Nursing Home Residents byYear: United States, 1998-2000 _____________________________________17

Figure 15 Distribution of Cognitive Impairments in Nursing Home Residents by Year:United States, 1998-2000 __________________________________________18

Figure 16 Median Pressure Ulcer Prevalence in Nursing Home Residents by Year:United States, Third Quarter 1998-2000_______________________________20

Figure 17 Median Pressure Ulcer Prevalence in Nursing Home Residents by State:United States, Third Quarter 2000 ___________________________________21

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Figure 18 Prevalence of Pressure Ulcers in Nursing Home Residents by State: UnitedStates, Third Quarter 2000 _________________________________________22

Figure 19 Incidence of Pressure Ulcers in Nursing Home Residents by Quarter: UnitedStates, 1998-2000 ________________________________________________23

Figure 20 Median Prevalence of Use of Restraints in Nursing Home Residents by State:United States, Third Quarter 2000 ___________________________________25

Figure 21 Prevalence of Physical Restraints in Nursing Home Residents by State: UnitedStates, Third Quarter 2000 _________________________________________26

Figure 22 Median Prevalence of Tube Feeding in Nursing Home Residents by State:United States, Third Quarter 2000 ___________________________________28

Figure 23 Prevalence of Tube Feeding in Nursing Home Residents by State: UnitedStates, Third Quarter 2000 _________________________________________29

Figure 24 Median Prevalence of Weight Loss in Nursing Home Residents by State:United States, Third Quarter 2000 ___________________________________30

Figure 25 90th Percentile Level of Prevalence of Dehydration in Nursing HomeResidents by Year: United States, Third Quarter 1998-2000 _______________31

Figure 26 90th Percentile Level of Prevalence of Dehydration in Nursing HomeResidents by State: United States, Third Quarter 2000 ___________________32

Figure 27 Prevalence of Severe Bowel or Bladder Incontinence in Nursing HomeResidents by Quarter: United States, Quarterly 1998-2000 ________________34

Figure 28 Median Prevalence of Severe Bowel or Bladder Incontinence in NursingHome Residents by State: United States, Third Quarter 2000 ______________35

Figure 29 Prevalence of Severe Bowel or Bladder Incontinence in Nursing HomeResidents by State: United States, 2000 _______________________________36

Figure 30 Mean Number of Health Deficiencies Cited in Nursing Home Surveys byYear: United States, 1996-2000 _____________________________________38

Figure 31 Mean Number of Health Deficiencies Cited in Nursing Home Surveys byState: United States, 2000__________________________________________39

Figure 32 Mean Number of Health Deficiencies Cited in Nursing Home Surveys byState: United States, 2000__________________________________________40

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Figure 33 Percent of Nursing Home Surveys Resulting in Zero Health DeficiencyCitations by Year: United States, 1996-2000 ___________________________41

Figure 34 Percent of Nursing Home Surveys Resulting in Zero Health DeficiencyCitations by State: United States, 2000 _______________________________42

Figure 35 Percent of Nursing Home Surveys Resulting in Zero Health DeficiencyCitations by State: United States, 2000 _______________________________43

Figure 36 Percent Distribution of Scope & Severity of Health Deficiency Citations byYear: United States, 1996-2000 (Grid)________________________________45

Figure 37 Percent Distribution of Scope and Severity of Health Deficiency Citations byYear: United States, 1996-2000 _____________________________________47

Figure 38 Percent of Nursing Home Surveys Resulting in a Health Deficiency of ActualHarm or Immediate Jeopardy to Nursing Home Residents by Year: UnitedStates, 1996-2000 ________________________________________________48

Figure 39 Percent of Nursing Home Surveys Resulting in a Health Deficiency of ActualHarm or Immediate Jeopardy to Nursing Home Residents by State: UnitedStates, 2000_____________________________________________________49

Figure 40 Percent of Nursing Home Surveys Resulting in a Health Deficiency of ActualHarm or Immediate Jeopardy to Nursing Home Residents by State: UnitedStates, 2000_____________________________________________________50

Figure 41 Percent of Nursing Home Surveys Resulting in a Health Deficiency ofImmediate Jeopardy to Nursing Home Residents by Year: United States,1996-2000 ______________________________________________________51

Figure 42 Percent of Nursing Home Surveys Resulting in a Health Deficiency ofImmediate Jeopardy to Nursing Home Residents by State: United States,2000___________________________________________________________52

Figure 43 Percent of Nursing Home Surveys Resulting in Citation for SubstandardQuality of Care by Year: United States, 1996-2000______________________54

Figure 44 Percent of Nursing Homes Surveys Resulting in Citation for SubstandardQuality of Care by State: United States, 2000 __________________________55

Figure 45 Percent of Nursing Home Surveys Resulting in a Citation for SubstandardQuality of Care by State: United States, 2000 __________________________56

Figure 46 Percent of Nursing Home Surveys Resulting in a Citation for Abuse ofResidents by Year: United States, 1996-2000 __________________________58

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Figure 47 Percent of Nursing Home Surveys Resulting in a Citation for Abuse ofResidents by State: United States, 2000 _______________________________59

Figure 48 Percent of Nursing Home Surveys Resulting in a Citation for Abuse ofResidents by State: United States, 2000 _______________________________60

Figure 49 Percent of Nursing Home Surveys Resulting in a Citation for Use ofRestraints by Year: United States, 1996-2000 __________________________61

Figure 50 Percent of Nursing Home Surveys Resulting in a Citation for Use ofRestraints by State: United States, 2000_______________________________62

Figure 51 Percent of Nursing Home Surveys Resulting in a Citation for Failure to Treator Prevent Pressure Ulcers by Year: United States, 1996-2000 _____________63

Figure 52 Percent of Nursing Home Surveys Resulting in a Citation for Failure to Treator Prevent Pressure Ulcers by State: United States, 2000 _________________64

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List of TablesNursing Homes

Table 1 Number of Nursing Homes by Bed Size Category and State: United States,1996-2000 ______________________________________________________65

Table 2 Number of Nursing Homes by Ownership and State: United States, 1996-2000___________________________________________________________70

Table 3 Number of Nursing Homes by Type of Certification and State: UnitedStates, 1996-2000 ________________________________________________75

Table 4 Nursing Home Occupancy Rates by State: United States, 1996-2000________80

Nursing Home Residents

Table 5 Summary of Characteristics of Nursing Home Residents: United States,2000___________________________________________________________81

Table 6 Summary of Incidence and Prevalence of Clinical Measures in NursingHome Residents: United States, Quarterly 1998-2000 ____________________82

Table 7 Nursing Home Residents by Gender and Type of Nursing Home: UnitedStates, 1998-2000 ________________________________________________83

Table 8 Nursing Home Residents by Gender and State: United States, 1998-2000 ____84

Table 9 Nursing Home Residents by Age Group and Type of Nursing Home:United States, 1998-2000 __________________________________________85

Table 10 Nursing Home Residents by Age Group and State: United States, 1998-2000___________________________________________________________86

Table 11 Nursing Home Residents by Race and Type of Nursing Home: UnitedStates, 1998-2000 ________________________________________________89

Table12 Nursing Home Residents by Race and State: United States, 1998-2000 ______90

Table 13 Distribution of Activity of Daily Living (ADL) Impairments in NursingHome Residents by Type of Nursing Home: United States, 1998-2000 ______93

Table 14 Distribution of Activity of Daily Living (ADL) Impairments in NursingHome Residents by State: United States, 1998-2000 _____________________94

Table 15 Distribution of Cognitive Impairments in Nursing Home Residents byType of Nursing Home: United States, 1998-2000 ______________________97

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Table 16 Distribution of Cognitive Impairments in Nursing Home Residents byState: United States, 1998-2000 _____________________________________98

Table 17 90th Percentile, Median, and 10th Percentile of Prevalence of PressureUlcers in Nursing Home Residents by Type of Nursing Home: UnitedStates, Quarterly 1998-2000 ________________________________________101

Table 18 90th Percentile, Median, and 10th Percentile of Prevalence of PressureUlcers in Nursing Home Residents by State: United States, Third Quarter1998-2000 ______________________________________________________102

Table 19 90th Percentile, Median, and 10th Percentile of Incidence of PressureUlcers in Nursing Home Residents by Type of Nursing Home: UnitedStates, Quarterly 1999-2000 ________________________________________103

Table 20 90th Percentile, Median, and 10th Percentile of Incidence of PressureUlcers in Nursing Home Residents by State: United States, Third Quarter1999-2000 ______________________________________________________104

Table 21 90th Percentile, Median, and 10th Percentile of Prevalence of PhysicalRestraint Use in Nursing Homes by Type of Nursing Home: United States,Quarterly 1998-2000______________________________________________105

Table 22 90th Percentile, Median, and 10th Percentile of Prevalence of PhysicalRestraint Use in Nursing Homes by State: United States, Third Quarter1998-2000 ______________________________________________________106

Table 23 90th Percentile, Median, and 10th Percentile of Incidence of PhysicalRestraint Use in Nursing Homes by Type of Nursing Home: United States,Quarterly 1999-2000______________________________________________107

Table 24 90th Percentile, Median, and 10th Percentile of Incidence of PhysicalRestraint Use in Nursing Homes by State: United States, Third Quarter1999-2000 ______________________________________________________108

Table 25 90th Percentile, Median, and 10th Percentile of Prevalence of Tube Feedingin Nursing Homes by Type of Nursing Home: United States, Quarterly1998-2000 ______________________________________________________109

Table 26 90th Percentile, Median, and 10th Percentile of Prevalence of Tube Feedingin Nursing Homes by State: United States, Third Quarter 1998-2000 ________110

Table 27 90th Percentile, Median, and 10th Percentile of Prevalence of Weight Lossin Nursing Homes by Type of Nursing Home: United States, Quarterly1998-2000 ______________________________________________________111

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Table 28 90th Percentile, Median, and 10th Percentile of Prevalence of Weight Lossin Nursing Homes by State: United States, Third Quarter 1998-2000 ________112

Table 29 90th Percentile, Median, and 10th Percentile of Prevalence of Dehydrationin Nursing Homes by Type of Nursing Home: United States, Quarterly1998-2000 ______________________________________________________113

Table 30 90th Percentile, Median, and 10th Percentile Prevalence of Dehydration inNursing Homes by State: United States, Third Quarter 1998-2000 __________114

Table 31 90th Percentile, Median, and 10th Percentile of Prevalence of Severe Bowelor Bladder Incontinence by Type of Nursing Home: United States,Quarterly 1998-2000______________________________________________115

Table 32 90th Percentile, Median, and 10th Percentile of Prevalence of Severe Bowelor Bladder Incontinence by State: United States, Third Quarter 1998-2000 ___116


Table 33 Mean Number of Health Deficiencies Cited in Nursing Home Surveys byBed Size Category and State: United States, 1996-2000 __________________117

Table 34 Mean Number of Health Deficiencies Cited in Nursing Home Surveys byType of Ownership and State: United States, 1996-2000 _________________122

Table 35 Percent of Nursing Home Surveys Resulting in Zero Health DeficiencyCitations, by Bed Size Category and State: United States, 1996-2000 _______127

Table 36 Percent of Nursing Home Surveys Resulting in Zero Health DeficiencyCitations, by Type of Ownership and State: United States, 1996-2000 ______132

Table 37 Percent Distribution of Scope and Severity of Health Deficiency Citationsby State: United States, 1996-2000___________________________________137

Table 38 Percent of Nursing Home Surveys Resulting in a Health Deficiency ofActual Harm or Immediate Jeopardy to Nursing Home Residents by BedSize Category and State: United States, 1996-2000 ______________________142

Table 39 Percent of Nursing Home Surveys Resulting in a Health Deficiency ofActual Harm or Immediate Jeopardy to Nursing Home Residents by Typeof Ownership and State: United States, 1996-2000 ______________________147

Table 40 Percent of Nursing Home Surveys Resulting in a Health Deficiency ofImmediate Jeopardy to Nursing Home Residents by Bed Size Categoryand State: United States, 1996-2000__________________________________152

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Table 41 Percent of Nursing Home Surveys Resulting in a Health Deficiency ofImmediate Jeopardy to Nursing Home Residents by Type of Ownershipand State: United States, 1996-2000__________________________________157

Table 42 Percent of Nursing Home Surveys Resulting in a Citation for SubstandardQuality of Care by Bed Size Category and State: United States, 1996-2000___162

Table 43 Percent of Nursing Home Surveys Resulting in a Citation for SubstandardQuality of Care by Type of Ownership and State: United States, 1996-2000___________________________________________________________167

Table 44 Percent of Nursing Home Surveys Resulting in a Citation for Abuse ofResidents by Bed Size Category and State: United States, 1996-2000 _______172

Table 45 Percent of Nursing Home Surveys Resulting in a Citation for Abuse ofResidents by Type of Ownership and State: United States, 1996-2000 ______177

Table 46 Percent of Nursing Home Surveys Resulting in a Citation for Use ofPhysical Restraints by Bed Size Category and State: United States, 1996-2000___________________________________________________________182

Table 47 Percent of Nursing Home Surveys Resulting in a Citation for Use ofPhysical Restraints by Type of Ownership and State: United States, 1996-2000___________________________________________________________187

Table 48 Percent of Nursing Home Surveys Resulting in a Citation for Failure toTreat or Prevent Pressure Ulcers by Bed Size Category and State: UnitedStates, 1996-2000 ________________________________________________192

Table 49 Percent of Nursing Home Surveys Resulting in a Citation for Failure toTreat or Prevent Pressure Ulcers by Type of Ownership and State: UnitedStates, 1996-2000 ________________________________________________197

Figures and supporting tables are Italicized.Puerto Rico and the Virgin Islands have been excluded from the discussion due to the small number (fewer than 10) of nursing homes in thoseentities.

Characteristics of Nursing Homes

n About 17,000 nursing homes are certifiedto participate in the Medicare and/orMedicaid programs. The number ofparticipating nursing homes has decreasedfrom 17,253 (in 1997) to 16,847 (in 2000).

Figure 1; Tables 1, 2, 3 and 4

n California, Ohio and Texas each have morethan 1,000 nursing homes in their states(2000 data). There are fewer than 50nursing homes in Alaska, Delaware, theDistrict of Columbia, Hawaii, Vermont, andWyoming.

Figure 2; Tables 1, 2, 3 and 4

n In 2000, most facilities had 50 to 199 beds.Fewer than 1,500 nursing homes had 200beds or more. About 2,600 facilities hadfewer than 50 beds.

Figure 3, Table 1

n In 2000, approximately 65 percent (10,999)of nursing homes were for-profit, and about28 percent (4,764) were non-profit. Thegovernment controlled the remainder(1,084).

Figures 4 and 5, Table 2

n Most certified nursing homes participate inboth Medicare and Medicaid. In 2000,1,159 (7 percent) of nursing homes werecertified to participate in Medicare only and2,054 (12 percent) participated in Medicaidonly.

Figure 6, Table 3

n Nursing home occupancy rates have beendecreasing since 1996. In 1996, theoccupancy rate was about 85 percent. Theoccupancy rate in 2000 was about 82percent.

Figure 7 and 8, Table 4

n Technical Note:

These data are from CMS’s Online SurveyCertification and Reporting (OSCAR)System, an administrative database thatcaptures data about the survey andcertification process. Data from OSCARare a combination of self-reported datafrom nursing facilities and compliance datagathered by survey teams.

prichardson

1

Sour

ce: O

SCAR

Figu

re 1

. Num

ber o

f Nur

sing

Hom

es b

y Ye

ar: U

nite

d St

ates

, 199

6-20

00

17,1

83

17,2

53

17,2

03

17,0

18

16,8

47

16,6

00

16,7

00

16,8

00

16,9

00

17,0

00

17,1

00

17,2

00

17,3

00

1996

1997

1998

1999

2000

Year

Number of Nursing Homes

prichardson

2

Sour

ce: O

SCAR

Figu

re 2

. Num

ber o

f Nur

sing

Hom

es b

y St

ate:

Uni

ted

Stat

es, 2

000

-200

400

600

800

1,00

0

1,20

0

1,40

0

1,60

0

AlabamaAlaska Arizona Arkansas California Colorado Connecticut Delaware

District of ColumbiaFlorida GeorgiaHawaiiIdaho

Illinois Indiana

Iowa Kansas Kentucky LouisianaMaine Maryland

Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska NevadaNew Hampshire New Jersey New Mexico New YorkNorth CarolinaNorth Dakota

Ohio Oklahoma OregonPennsylvania Rhode Island

South CarolinaSouth Dakota Tennessee

TexasUtah Vermont Virginia Washington

West Virginia Wisconsin Wyoming


prichardson

3

Sour

ce: O

SCAR

Figu

re 3

. Num

ber o

f Nur

sing

Hom

es b

y B

ed S

ize

by Y

ear:

Uni

ted

Stat

es, 1

996-

2000

2,937

5,988

6,985

1,273

2,991

5,942

7,038

1,282

2,945

5,877

7,097

1,284

2,773

5,869

7,116

1,260

2,634

5,844

7,128

1,241

0

1,00

0

2,00

0

3,00

0

4,00

0

5,00

0

6,00

0

7,00

0

8,00

0

<50

50-9

910

0-19

9>1

99

Bed

Siz

e


1996

1997

1998

1999

2000

prichardson

4

Sour

ce: O

SCAR

Figu

re 4

. Num

ber o

f Nur

sing

Hom

es b

y O

wne

rshi

p by

Yea

r: U

nite

d St

ates

, 199

6-20

00

11,332

4,715

1,136

11,300

4,816

1,137

11,198

4,884

1,121

11,086

4,824

1,108

10,999

4,764

1,084

0

2,00

0

4,00

0

6,00

0

8,00

0

10,0

00

12,0

00

For-P

rofit

Non

-Pro

fitG

over

nmen

t

Ow

ners

hip


1996

1997

1998

1999

2000

prichardson

5

Figu

re 5

. Pe

rcen

t of N

ursi

ng H

omes

that

are

For

-Pro

fit b

y St

ate:

Uni

ted

Stat

es, 2

000

70.1

– 8

3.0

60.1

– 7

0.0

45.1

– 6

0.0

12.6

– 4

5.0

0.0

– 1

2.5

Perc

ent o

f Nur

sing

Hom

es

Sour

ce: O

SCA

R

prichardson

6

Sour

ce: O

SCAR

Figu

re 6

. Num

ber o

f Nur

sing

Hom

es b

y C

ertif

icat

ion

by Y

ear:

Uni

ted

Stat

es, 1

996-

2000

12,797

1,392

2,994

13,339

1,478

2,436

13,536

1,428

2,239

13,533

1,305

2,180

13,634

1,159

2,054

0

2,00

0

4,00

0

6,00

0

8,00

0

10,0

00

12,0

00

14,0

00

16,0

00

Dua

lly-C

ertif

ied

Med

icar

e O

nly

Med

icai

d O

nly

Cer

tific

atio

n


1996

1997

1998

1999

2000

prichardson

7

Sour

ce: O

SCAR

Figu

re 7

. Nur

sing

Hom

e O

ccup

ancy

Rat

es b

y Ye

ar:

Uni

ted

Stat

es, 1

996-

2000

84.8

83.9

83.4

82.7

82.4

81

81.582

82.583

83.584

84.585

1996

1997

1998

1999

2000

Year

Percent of Beds

prichardson

8

Sour

ce: O

SCARFigu

re 8

. Nur

sing

Hom

e O

ccup

ancy

Rat

es b

y St

ate:

Uni

ted

Stat

es, 2

000

65.0

70.0

75.0

80.0

85.0

90.0

95.0

100.

0

Nation Alabama Alaska Arizona Arkansas California ColoradoConnecticut Delaware

District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana

Iowa Kansas Kentucky Louisiana Maine MarylandMassachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada

New Hampshire New JerseyNew Mexico New York

North CarolinaNorth Dakota

Ohio Oklahoma OregonPennsylvaniaRhode Island

South CarolinaSouth Dakota Tennessee Texas

Utah Vermont Virginia WashingtonWest Virginia Wisconsin Wyoming

Percent of Beds

prichardson

9


Characteristics of Nursing HomeResidents

n More than 2.9 million individuals resided inour nation’s nursing homes in 2000.

Table 5

n In 2000, nursing homes reported that 70percent of their residents were female.

Figure 9, Tables 5 and 7

n A higher proportion of residents ofgovernment nursing homes are male andunder age 65.

Table 5

n Homes that participate only in Medicarehave a higher male to female ratio than dodually-certified or Medicaid-only nursinghomes.

Table 7

n In 2000, the proportion of female nursinghome residents varied from 58.5% of allresidents in Alaska to 72.9% in Alabama.

Table 8

n In 2000, 75 percent all nursing homeresidents were 75 years of age or older.


n Residents under the age of 65 account fora large proportion of the population ofnursing homes with more than 200 beds.

Tables 5 and 11

n In 2000, west-coast and southwesternstates had lower percentages of residentsaged 65 years and older on average, whilenorth central states had higher percentagesof residents in this category.

Figure 11, Table 10

n Hawaii, Iowa, Kansas, Minnesota,Nebraska, North Dakota, South Dakota,and Wisconsin have the highestproportions of residents aged 95 years andolder. Alaska, California, Illinois, andLouisiana have the highest proportion ofnursing home residents under the age of65.

Table 10

n West coast and southwestern states hadlower percentages of residents aged 85years and older on average, while thepercentage of residents in central, northcentral, and northeastern states had higherpercentages of residents in this category in2000.

Figure 12, Table 10

n Race distribution rates remained stablefrom 1998, to and 2000. White residentsmade up about 85 percent of the nursinghome population in 2000. The same year,Black and Hispanic residents comprisedapproximately 10 and 3 percent,respectively, of the population. In 2000,fewer than 2 percent of nursing homeresidents were Asian/Pacific Islanders andNative Americans.


n Over 20 percent of the population ofnursing homes with 200 or more bedsconsist of non-white residents, whileminority groups account for less than 15percent of the population of smaller nursinghomes.

Tables 5 and 11

prichardson

10


n In 2000, more than a third of nursing homeresidents required extensive assistancewith 4 or more Activities in Daily Living (bedmobility, transferring, dressing, eating, ortoileting).


n Small facilities with fewer than 50 bedsreport smaller populations of residents withhigh levels of ADL impairments.

Table 13

n As measured by the CognitivePerformance Scale, more than one-quarterof nursing home residents had no cognitiveimpairment in 2000, while more than 15percent had severe or very severecognitive impairment.


n Government facilities have a higherproportion of residents with severecognitive impairment relative to otherownership types.

Table 15

n Facilities with fewer than 50 beds reportthat more than 50 percent of their residentshave no cognitive impairment.

Table 15

n Technical Notes:

The source of these data is the MinimumData Set (MDS). These data are collectedand reported by nursing homes.

The Cognitive Performance Scale (Morris,1994) is one method for estimating thecognitive ability of nursing home residentsbased on items reported in the MDSassessment. Based on the scoringalgorithm a resident is classified as havingvery severe, severe, moderately severe,moderate, mild, very mild, or noimpairment.

The activities of daily living (ADLs)evaluated were: bed mobility, dressing,eating, transferring, and toileting. There aremany ways of estimating the amount ofimpairment in ADLs. For these charts andtables, dependency was considered toexist only when a resident requiredextensive assistance with one or more ofthese activities. The data presented aresummary counts of the number of ADLswith which a resident requires extensiveassistance.

References:

Morris JN, Fries BE, Mehr DR, Hawes C, Phillips C, MorV, Lipsitz LA. MDS Cognitive Performance Scale. JGerontol. 1994 Jul;49(4):M174-82.

prichardson

11

Sour

ce: M

DS

Figu

re 9

. Nur

sing

Hom

e R

esid

ents

by

Gen

der b

y Ye

ar: U

nite

d St

ates

, 199

8-20

00

29.8

70.2

31.7

68.3

31.8

68.2

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Mal

eFe

mal

e

Percent of Residents

1998

1999

2000

prichardson

12

Figu

re 1

0. N

ursi

ng H

ome

Res

iden

ts b

y A

ge G

roup

by

Year

: U

nite

d St

ates

, 199

8-20

00

0.8

9.2

14.1

33.8

35.3

6.8

0.7

9.3

14.9

34.5

34.1

6.5

0.7

9.7

14.7

34.6

34

6.5

-5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

0-30

31-64

65-74

75-84

85-94

95+

Age

Gro

up


1998

1999

2000

prichardson

Source: MDS

prichardson

13

Fig

ure

11.

Per

cen

t o

f N

urs

ing

Ho

me

Res

iden

ts A

ged

65

Yea

rs a

nd

Old

er b

y S

tate

: U

nit

ed S

tate

s, 2

000

So

urc

e: O

SC

AR

prichardson

14

Fig

ure

12.

Per

cen

t o

f N

urs

ing

Ho

me

Res

iden

ts A

ged

85

Yea

rs a

nd

Old

er b

y S

tate

: U

nit

ed S

tate

s, 2

000

So

urc

e: O

SC

AR

prichardson

15

Sour

ce: M

DS

Figu

re 1

3. N

ursi

ng H

ome

Res

iden

ts b

y R

ace

by Y

ear:

Uni

ted

Stat

es, 1

998-

2000

0.6

1.0

10.3

2.7

85.4

0.5

1.0

10.0

2.9

85.6

0.4

1.1

10.2

3.1

85.2

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

Amer

ican

Indi

an/A

lask

anN

ativ

eAs

ian/

Paci

fic Is

land

erBl

ack,

not

His

pani

c or

igin

His

pani

cW

hite

, not

His

pani

cor

igin


1998

1999

2000

prichardson

16

Sour

ce: M

DS

Figu

re 1

4. D

istr

ibut

ion

of N

umbe

r of A

DL

Impa

irmen

ts in

Nur

sing

Hom

e R

esid

ents

by

Year

: U

nite

d St

ates

, 199

8-20

00

35.6

9.1

9.6

10.8

16.3

18.6

36.1

9.5

8.9

10.0

16.4

19.0

35.6

9.5

8.8

10.0

17.2

19.0

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

01

23

45

Num

ber o

f AD

L Im

pairm

ents


1998

1999

2000

prichardson

17

Sour

ce: M

DS

Figu

re 1

5. D

istr

ibut

ion

of C

ogni

tive

Impa

irmen

ts in

Nur

sing

Hom

e R

esid

ents

by

Year

: U

nite

d St

ates

, 199

8-20

00

23.9

12.7

12.8

24.5

7.4

8.3

10.4

28.4

12.6

12.8

22.5

6.9

7.0

9.8

28.5

12.6

13.0

22.8

6.9

6.8

9.5

0.0

5.0

10.0

15.0

20.0

25.0

30.0

No

Impa

irmen

tVe

ry M

ildIm

pairm

ent

Mild

Impa

irmen

tM

oder

ate

Impa

irmen

tM

oder

atel

ySe

vere

Impa

irmen

t

Seve

reIm

pairm

ent

Very

Sev

ere

Impa

irmen

t


1998

1999

2000

prichardson

18


Nursing Home Resident ClinicalCharacteristics

Pressure Ulcers

n The median pressure ulcer prevalence was7.1, 7.4, and 7.7 in the third quarters of1998, 1998, and 2000, respectively.Although the prevalence appears to beincreasing, the quarterly data presented inTable 17 shows that the medianprevalence fluctuates and that there is noobvious trend over time.

Figure 16, Table 17

n In the third quarter of 2000, the medianlevel of pressure ulcer prevalence wasgreater than 10 percent in 4 States.


n From the fourth quarter of 1998 to thefourth quarter 2000, the median incidenceof pressure ulcers remained relativelystable at about 2 percent.

Figure 19, Tables 19, 20

n Technical notes:


We defined pressure ulcer as anypressure ulcer of stage 2 or greater.

Prevalence was assessed using themidpoint of each calendar quarter as astarting point. Cases of interest occurred60 days before or after the midpoint andwere unique. That is, if a resident had twoassessments collected during theobservation period, only the one closest intime to the starting point was retained.Prevalence was calculated as the numberof identified cases divided by the numberof eligible residents at baseline (the

midpoint estimate of the nursing homepopulation).

Incidence of pressure ulcers wascalculated by identifying all pressure ulcercases that are not noted on admission orreadmission assessments during a quarterof interest (e.g., January 1 to March 31).Each assessment indicating presence of apressure ulcer is then compared with theresident’s immediately precedingassessment. If the preceding comparisonassessment indicates that no pressureulcer is present, then the indexassessment is considered an incidentpressure ulcer. Incident pressure ulcersconstitute the numerator of the quarter.The denominator consists of all eligibleassessments closest to the midpoint of thequarter (but not more than 60 days fromthe midpoint) that indicate presence of nopressure ulcers.

prichardson

19

Sour

ce: M

DS

Figu

re 1

6. M

edia

n Pr

essu

re U

lcer

Pre

vale

nce

in N

ursi

ng H

ome

Res

iden

ts b

y Ye

ar:

Uni

ted

Stat

es, T

hird

Qua

rter

199

8-20

00

7.1

7.4

7.7

6.8

6.9

7.0

7.1

7.2

7.3

7.4

7.5

7.6

7.7

7.8

1998

Qua

rter 3

1999

Qua

rter 3

2000

Qua

rter 3


prichardson

20

Figu

re 1

7. M

edia

n Pr

essu

re U

lcer

Pre

vale

nce

in N

ursi

ng H

ome

Res

iden

ts b

y St

ate:

Uni

ted

Stat

es, T

hird

Qua

rter

200

0

0.0

2.0

4.0

6.0

8.0

10.0

12.0

Nation Alab

ama Alaska Arizon

a Arkans

as Califor

nia Colorad

oCon

necti

cut

Delaware

Distric

t of C

olumbia

Florida Georgi

a Hawaii

Idaho

Illinois Indian

aIow

a Kansa

s Kentuc

ky Louis

iana Maine Mary

land

Massa

chus

etts Mich

igan

Minnes

ota Mississ

ippi Miss

ouri Mon

tana Neb

raska Nevad

a

New H

amps

hire

New Je

rsey

New M

exico New

York

North C

arolin

a

North D

akotaOhio Oklaho

ma Oregon

Penns

ylvan

ia

Rhode

Islan

d

South

Carolin

a

South

Dakota Ten

ness

eeTex

asUtah Verm

ont Virg

inia

Washin

gton

West V

irgini

aWisc

onsin Wyo

mingPercent of Residents

prichardson

Source: MDS

prichardson

21

Figu

re 1

8. P

reva

lenc

e of

Pre

ssur

e U

lcer

s in

Nur

sing

Hom

e R

esid

ents

by

Stat

e: U

nite

d St

ates

, Thi

rd Q

uart

er 2

000

9.0

– 11

.17.

8 –

8.9

7.2

– 7.

75.

7 –

7.1

3.6

– 5.

6

Perc

ent o

f Res

iden

ts

Sour

ce: O

SCA

R

prichardson

22

Sour

ce: M

DS

Figu

re 1

9. In

cide

nce

of P

ress

ure

Ulc

ers

in N

ursi

ng H

ome

Res

iden

ts b

y Q

uart

er: U

nite

d St

ates

, 19

98-2

000

1.7

2.0

2.0

1.9

2.0

2.1

2.0

2.1

2.2

0.0

0.5

1.0

1.5

2.0

2.5

4Q98

1Q99

2Q99

3Q99

4Q99

1Q00

2Q00

3Q00

4Q00

Qua

rter


prichardson

23



Restraint Use

n In 5 States, the median prevalence of useof restraints was15 percent or greater inthe third quarter of 2000.


n The median prevalence of restraints hasdecreased from 7.5 percent to 6.3 percentover the years examined, while the medianincidence of new restraint use hasremained steady at about 1 percent.

Tables 21, 22, 23, and 24

n Technical Notes:


To estimate the incidence and prevalenceof physical restraint use, we adopted aconservative approach, considering onlyindividuals whom the nursing homereported were in a trunk restraint, limbrestraint, or some sort of restraining chairat least once during the 7 days prior to theassessment. It is important to note that wedid not report the use of bed rails for thismeasure, because of our concern aboutbiases in the measurement of this item.

prichardson

24

Figu

re 2

0. M

edia

n Pr

eval

ence

of U

se o

f Res

trai

nts

in N

ursi

ng H

ome

Res

iden

ts b

y St

ate:

U

nite

d St

ates

, Thi

rd Q

uart

er 2

000

0.0

5.0

10.0

15.0

20.0

25.0

Nation AlabamaAlaska Arizona Arkansas California Colorado Connecticut Delaware

District of ColumbiaFlorida GeorgiaHawaiiIdahoIllin

ois IndianaIowa Kansas Kentucky Louisiana

Maine MarylandMassachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada

New Hampshire New Jersey New Mexico New YorkNorth CarolinaNorth Dakota

Ohio Oklahoma OregonPennsylvania Rhode Island


TexasUtah Vermont Virginia Washington



prichardson

Source: MDS

prichardson

25

Figu

re 2

1. P

reva

lenc

e of

Phy

sica

l Res

trai

nts

in N

ursi

ng H

ome

Res

iden

ts b

y St

ate:

Uni

ted

Stat

es, T

hird

Qua

rter

200

0

7.7

– 21

.46.

0 –

7.6

4.9

– 5.

93.

5 –

4.8

0.0

– 3.

4

Perc

ent o

f Res

iden

ts

Sour

ce: O

SCA

R

prichardson

26



Tube Feeding, Weight Loss, andDehydration

n The prevalence of tube feeding has beenfairly steady, at 4.2 – 4.4 percent, since thebeginning of 1999. State level tube feedingprevalence rates are displayed in Figures22 and 23.


n In the third quarter of 2000, the medianprevalence of weight loss in nursing homeresidents was 9.5 percent. This is lowerthan the third quarter 1999 prevalence of10.2 percent, and the third quarter 1998prevalence of 10.1 percent.


n There has been a decrease in the 90th

percentile level of prevalence ofdehydration in nursing home residents from2.7 percent during the third quarter of 1998to 1.7 percent during the third quarter of2000.


n In the third quarter of 2000, the national90th percentile level of prevalence ofdehydration was 1.7 percent. Acrossstates, the prevalence of dehydration at the90th percentile did not vary much from thenational value.


n Technical Notes:


To estimate the prevalence of feeding tubeuse in nursing homes we identified allindividuals whom the nursing home

reported had a feeding tube, defined as“any tube that can deliver food/nutritionalsubstances/fluids/medications directly intothe gastrointestinal system.” We excludedindividuals admitted to the nursing homewith feeding tubes because we wanted toseparate the use of feeding tubes bynursing homes from the use of feedingtubes by hospitals.

To estimate the prevalence of weight loss,we identified all individuals whom thenursing home indicated had experiencedweight loss of more than 5 percent in the30 days prior the assessment or more than10 percent in the last 180 days. It isimportant to note that we excludedindividuals who were reported by thenursing home to be in end-stage disease orwho were receiving hospice care.

To estimate the prevalence of dehydration,we identified all individuals for whom thenursing home indicated that fluid outputexceeds fluid input. It is important to notethat we excluded individuals who werereported by the nursing home to be in end-stage disease or who were receivinghospice care.

prichardson

27

Figu

re 2

2. M

edia

n Pr

eval

ence

of T

ube

Feed

ing

in N

ursi

ng H

ome

Res

iden

ts b

y St

ate:

U

nite

d St

ates

, Thi

rd Q

uart

er 2

000

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0








Utah Vermont VirginiaWashington



prichardson

Source: MDS

prichardson

28

Figu

re 2

3. P

reva

lenc

e of

Tub

e Fe

edin

g in

Nur

sing

Hom

e R

esid

ents

by

Stat

e: U

nite

d St

ates

, Thi

rd Q

uart

er 2

000

6.7

– 12

.65.

5 –

6.5

3.0

– 5.

41.

9 –

2.9

0.7

– 1.

8

Perc

ent o

f Res

iden

ts

Sour

ce: O

SCA

R

prichardson

29

Figu

re 2

4. M

edia

n Pr

eval

ence

of W

eigh

t Los

s in

Nur

sing

Hom

e R

esid

ents

by

Stat

e:U

nite

d St

ates

, Thi

rd Q

uart

er 2

000

2.0

4.0

6.0

8.0

10.0

12.0

14.0

Nation AlabamaAlaska Arizona Arkansas California Colorado Connecticut Delaware

District of ColumbiaFlorida GeorgiaHawaiiIdahoIllin

ois IndianaIowa Kansas Kentucky Louisiana

Maine MarylandMassachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada

New Hampshire New Jersey New Mexico New YorkNorth CarolinaNorth Dakota

Ohio Oklahoma OregonPennsylvania Puerto RicoRhode Island


TexasUtah Vermont

Virgin Islands Virginia WashingtonWest Virginia Wisconsin Wyoming


prichardson

Source: MDS

prichardson

30

Sour

ce: M

DS

Figu

re 2

5. 9

0th

Perc

entil

e Le

vel o

f Pre

vale

nce

of D

ehyd

ratio

n in

Nur

sing

Hom

e R

esid

ents

by

Year

: Uni

ted

Stat

es, T

hird

Qua

rter

199

8-20

00

2.7

2.4

1.7

0

0.51

1.52

2.53

1998

Qua

rter 3

1999

Qua

rter 3

2000

Qua

rter 3


prichardson

31

Figu

re 2

6. 9

0th

Perc

entil

e Le

vel o

f Pre

vale

nce

of D

ehyd

ratio

n in

Nur

sing

Hom

e R

esid

ents

by

Stat

e: U

nite

d St

ates

, Thi

rd Q

uart

er 2

000

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0 Nati

on Alabam

a Alaska Arizon

a Arkans

as Califor

nia Colorad

oCon

necti

cut

Delaware

Distric

t of C

olumbia

Florida Georgi

a Hawaii

Idaho

Illinois Indian

aIow

a Kansa

s Kentuc

ky Louis

iana Maine Mary

land

Massa

chus

etts Mich

igan

Minnes

ota Mississ

ippi Miss

ouri Mon

tana Neb

raska Nevad

a

New H

amps

hire

New Je

rsey

New M

exico New

York

North C

arolin

a

North D

akotaOhio Oklaho

ma Oregon

Penns

ylvan

ia

Rhode

Islan

d

South

Carolin

a

South

Dakota Ten

ness

eeTex

asUtah Verm

ont Virg

inia

Washin

gton

West V

irgini

aWisc

onsin Wyo

mingPercent of Residents

prichardson

Source: MDS

prichardson

32



Incontinence

n Nursing homes report that more than, in2000, one third of their residentsexperienced bowel or bladder incontinenceall or most of the time.

Figures 27; Tables 31 and 32

n The median prevalence of severe bowel orbladder incontinence has varied little sincethe third quarter of 1998; between 35.2 and35.6 percent of residents were severelyincontinent between third quarter 1998 andthe fourth quarter 2000.


n Nursing homes reported that the medianprevalence of severe bladder and bowelincontinence was above 50 percent in 2States in 2000. The prevalence of this typeof incontinence was less than 20 percent in4 States in 2000.


n Technical Note:


For this measure, incontinence, weidentified persons who were incontinent ofbladder or of bowel on almost alloccasions. This is a measure of severeincontinence. It is important to note thatthis differs from the Quality Indicator onincontinence that is used in the surveyprocess.

prichardson

33

Sour

ce: M

DS

Figu

re 2

7. P

reva

lenc

e of

Sev

ere

Bow

el o

r Bla

dder

Inco

ntin

ence

in N

ursi

ng H

ome

Res

iden

ts

by Q

uart

er: U

nite

d St

ates

, Qua

rter

ly 1

998-

2000

35.7

35.9

35.7

35.6

36.0

35.9

35.3

35.2

35.7

35.6

34.5

35.0

35.5

36.0

36.5

3Q98

4Q98

1Q99

2Q99

3Q99

4Q99

1Q00

2Q00

3Q00

4Q00

Qua

rter


prichardson

34

Figu

re 2

8. M

edia

n Pr

eval

ence

of S

ever

e B

owel

or B

ladd

er In

cont

inen

ce in

Nur

sing

Hom

e R

esid

ents

by

Stat

e: U

nite

d St

ates

, Thi

rd Q

uart

er 2

000

0.0

10.0

20.0

30.0

40.0

50.0

60.0 Nati

on Alabam

a Alaska Ariz

ona Arka

nsas Cali

fornia Colo

rado

Conne

cticu

t

Delaware

Distric

t of C

olumbia

Florida Geo

rgia Haw

aiiIda

hoIllin

ois Indian

aIow

a Kansa

s Kentuc

ky Louis

iana Main

e Marylan

d

Massa

chus

etts Mich

igan

Minnes

ota Mississ

ippi Miss

ouri Mon

tana

Nebras

ka Nevad

a

New H

amps

hire

New Je

rsey

New M

exico New

York

North C

arolin

a

North D

akota

Ohio Oklaho

ma Oregon

Penns

ylvan

ia

Rhode

Islan

d

South

Carolin

a

South

Dakota Ten

ness

eeTex

asUtah Verm

ont Virg

inia

Was

hingto

n

Wes

t Virg

inia

Wisc

onsin W

yoming


prichardson

Source: MDS

prichardson

35

Figu

re 2

9. P

reva

lenc

e of

Sev

ere

Bow

el o

r Bla

dder

Inco

ntin

ence

in N

ursi

ng H

ome

Res

iden

ts b

y St

ate:

Uni

ted

Stat

es, 2

000

44.0

– 5

2.3

38.2

– 4

3.9

30.7

– 3

8.1

24.1

– 3

0.6

17.3

– 2

4.0

Perc

ent o

f Res

iden

ts

Sour

ce: O

SCA

R

prichardson

36



Mean Number of HealthDeficiencies

n Nationally, the average number of healthdeficiencies per nursing home survey hasincreased from 5.1 in 1996 to 6.1 in 2000.


n There is great state variation in the meannumber of health deficiencies cited innursing home surveys in 2000.

Figures 31 and 32, Tables 33 and 34

n Since 1997, the percentage of nursinghome surveys that do not result in healthdeficiencies has decreased substantially;while 22 percent of nursing home surveysdid not result in health deficiencies in 1997,fewer than 13 percent were withoutdeficiencies 2000.


n There is great state variation in the percentof nursing home surveys resulting in zerohealth deficiency citations in 2000. Onaverage, northeastern states had higherrates of nursing home surveys with zerohealth deficiencies.


n Technical Notes:

These data are from the CMS’s OnlineSurvey Certification and Reporting(OSCAR) System, an administrativedatabase that captures data about thesurvey and certification process. Data fromOSCAR are a combination of self-reporteddata from nursing facilities and compliancedata gathered by survey teams.

Note that for all of the calendar yearcalculations of health deficiencies, theweighting scheme is unique. The facilitythat was not surveyed during the particularcalendar year is not counted and the facilitythat was surveyed twice during the year isdoubly counted, giving it a weight of 2.

The percentage of surveys resulting in zerodeficiencies is defined as the number ofnursing home surveys that received zerodeficiencies divided by the number ofsurveys conducted that year.

prichardson

37

Sour

ce: O

SCAR

Figu

re 3

0. M

ean

Num

ber o

f Hea

lth D

efic

ienc

ies

Cite

d in

Nur

sing

Hom

e Su

rvey

s by

Yea

r:

Uni

ted

Stat

es, 1

996-

2000

5.1

4.9

5.3

5.8

6.1

01234567

1996

1997

1998

1999

2000

Year

Mean Number of Deficiencies

prichardson

38

Sour

ce: O

SCAR

Figu

re 3

1. M

ean

Num

ber o

f Hea

lth D

efic

ienc

ies

Cite

d in

Nur

sing

Hom

e Su

rvey

s by

Sta

te:

Uni

ted

Stat

es, 2

000

02468101214










Mean Number of Deficiencies

prichardson

39

Figu

re 3

2. M

ean

Num

ber o

f Hea

lth D

efic

ienc

ies

Cite

d in

Nur

sing

Hom

e Su

rvey

s by

Sta

te: U

nite

d St

ates

, 200

0

7.6

– 11

.56.

3 –

7.5

4.7

– 6.

14.

1 –

4.6

2.5

– 4.

0

Mea

n N

umbe

r of D

efic

ienc

ies

Sour

ce: O

SCA

R

prichardson

40

Sour

ce: O

SCARFi

gure

33.

Per

cent

of N

ursi

ng H

ome

Surv

eys

Res

ultin

g in

Zer

o H

ealth

Def

icie

ncy

Cita

tions

by

Year

: Uni

ted

Stat

es, 1

996-

2000

20.9

22.0

19.1

16.1

12.9

0510152025

1996

1997

1998

1999

2000

Year

Percent of Surveys

prichardson

41

Sour

ce: O

SCAR

Figu

re 3

4. P

erce

nt o

f Nur

sing

Hom

e Su

rvey

s R

esul

ting

in Z

ero

Hea

lth D

efic

ienc

y C

itatio

ns b

y St

ate:

Uni

ted

Stat

es, 2

000

0510152025303540










Percent of Surveys

prichardson

42

Fig

ure

35:

Per

cen

t o

f N

urs

ing

Ho

me

Su

rvey

s R

esu

ltin

g in

Zer

o H

ealt

h D

efic

ien

cy C

itat

ion

s b

y S

tate

: U

nit

edS

tate

s, 2

000

17.1

– 3

7.8

14.3

– 1

7.0

10.9

– 1

4.2

5.4

– 10

.82.

3 –

5.3

Per

cen

t o

f S

urv

eys

So

urc

e: O

SC

AR

prichardson

43

prichardson

43



Health Deficiencies -- Scope andSeverity

n More citations are for isolated problemsthat caused minimal harm to residents thanfor any other level of deficiency.


n The percent of nursing home surveysresulting in a health deficiency of actualharm or immediate jeopardy increasedeach year from 1996 to 1999. In 1999,more than 31 percent of facilities were citedat these levels. In 2000, at 25.1 percent,the rate decreased, falling below the1996rate of 26.3 percent.


n In 4 States, over 40 percent of nursinghome surveys resulted in a healthdeficiency of actual harm or immediatejeopardy in 2000; in 4 States the citationrate was10 percent or less.


n There is great state variation in the percentof nursing home surveys resulting in ahealth deficiency of actual harm orimmediate jeopardy to residents.


n The percentage of deficiencies with thehighest level of severity, immediatejeopardy, has increased every year since1996. However, only a small proportion ofsurveys results in citations at this level: in2000, the citation rate was 1.9 percent.


n Technical Notes:

These data are from the CMS’s OnlineSurvey Certification and Reporting

(OSCAR) System, an administrativedatabase that captures data about thesurvey and certification process. Data fromOSCAR are a combination of self-reporteddata from nursing facilities and compliancedata gathered by survey teams.

In distributions of the scope and severity byyear, the denominator is the number ofcitations, not nursing homes or surveys.


An “actual harm” deficiency is defined as adeficiency citation that is rated at scopeand severity ‘G’ or more severe.

Immediate jeopardy is a deficiency thatconstitutes an immediate threat to thehealth or life of one or more nursing homeresidents. It is recorded by the state surveyagency at scope and severity of “J” orhigher.

prichardson

44

ISOLATED PATTERN WIDESPREAD


1996

1997

1998

16.67

B

10.04

C

31.02

D

2.55

H

0.07

L

0.13

K

0.07

J

0.44

I

23.60

E

5.58

F

9.83

G

N/A

A

13.69

B

7.86

C

38.20

D

1.67

H

0.06

L

0.17

K

0.16

J

0.15

I

21.99

E

4.97

F

11.08

G

N/A

AMINIMAL

HARM

> MINIMAL

HARM

ACTUAL

HARM

IMMEDIATE

JEOPARDY

MINIMAL

HARM

> MINIMAL

HARM

ACTUAL

HARM

IMMEDIATE

JEOPARDY


1998

10.81

B

6.78

C

40.71

D

1.70

H

0.08

L

0.25

K

0.31

J

0.13

I

22.81

E

5.13

F

11.27

G

N/A

AMINIMAL

HARM

> MINIMAL

HARM

ACTUAL

HARM

IMMEDIATE

JEOPARDY

Figure 36 (page 1 of 2). Percent Distribution of Scope and Severity of HealthDeficiency Citations by Year: United States, 1996-2000

prichardson

45


MINIMAL

HARM

> MINIMAL

HARM

ACTUAL

HARM

IMMEDIATE

JEOPARDY

1999

2000

8.65

B

6.41

C

43.70

D

1.30

H

0.10

L

0.24

K

0.26

J

0.09

I

23.11

E

5.54

F

10.60

G

N/A

A

9.00

B

6.20

C

46.74

D

0.82

H

0.10

L

0.28

K

0.25

J

0.05

I

23.58

E

5.50

F

7.48

G

N/A

A

MINIMAL

HARM

> MINIMAL

HARM

ACTUAL

HARM

IMMEDIATE

JEOPARDY

Figure 36 (page 2 of 2). Percent Distribution of Scope and Severity of HealthDeficiency Citations by Year: United States, 1996-2000


Source: OSCAR

prichardson

46

Fig

ure

37.

Per

cen

t D

istr

ibu

tio

n o

f S

cop

e an

d S

ever

ity

of

Hea

lth

Def

icie

ncy

Cit

atio

ns

by

Yea

r:

Un

ited

Sta

tes,

199

6-20

00

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

B

C

D

E

F

G

H

I J

K

L

Sco

pe

& S

ever

ity

Percent of Citations

1996

1997

1998

1999

2000

Sou

rce:

OS

CA

R

prichardson

47

prichardson

47

Sour

ce: O

SCARFigu

re 3

8. P

erce

nt o

f Nur

sing

Hom

e Su

rvey

s R

esul

ting

in a

Hea

lth D

efic

ienc

y of

Act

ual H

arm

or

Imm

edia

te J

eopa

rdy

to N

ursi

ng H

ome

Res

iden

ts b

y Ye

ar: U

nite

d St

ates

, 199

6-20

00

26.3

27.9

30.1

31.4

25.1

05101520253035

1996

1997

1998

1999

2000

Year

s

Percent of Surveys

prichardson

48

Sour

ce: O

SCAR

Figu

re 3

9. P

erce

nt o

f Nur

sing

Hom

e Su

rvey

s R

esul

ting

in a

Hea

lth D

efic

ienc

y of

Act

ual H

arm

or

Imm

edia

te J

eopa

rdy

to N

ursi

ng H

ome

Res

iden

ts b

y St

ate:

Uni

ted

Stat

es, 2

000

0102030405060










Percent of Surveys

prichardson

49

Figu

re 4

0. P

erce

nt o

f Nur

sing

Hom

e Su

rvey

s R

esul

ting

in a

Hea

lth D

efic

ienc

y of

Act

ual H

arm

or I

mm

edia

te J

eopa

rdy

to N

ursi

ng H

ome

Res

iden

ts b

y St

ate:

Uni

ted

Stat

es, 2

000

35.5

– 5

0.0

24.9

– 3

5.4

20.6

– 2

4.8

16.8

– 2

0.5

0.0

– 1

6.7

Perc

ent o

f Sur

veys

Sour

ce: O

SCA

R

prichardson

50

Sour

ce: O

SCAR

Figu

re 4

1. P

erce

nt o

f Nur

sing

Hom

e Su

rvey

s R

esul

ting

in a

Hea

lth D

efic

ienc

y of

Imm

edia

te

Jeop

ardy

to N

ursi

ng H

ome

Res

iden

ts b

y Ye

ar: U

nite

d St

ates

, 199

6-20

00

0.6

1.1

1.7

1.7

1.9

0

0.2

0.4

0.6

0.81

1.2

1.4

1.6

1.82

1996

1997

1998

1999

2000

Year

Percent of Surveys

prichardson

51

Sour

ce: O

SCARFi

gure

42.

Per

cent

of N

ursi

ng H

ome

Surv

eys

Res

ultin

g in

a H

ealth

Def

icie

ncy

of Im

med

iate

Je

opar

dy to

Nur

sing

Hom

e R

esid

ents

by

Stat

e: U

nite

d St

ates

, 200

0

012345678 Nation Alabama Alaska Arizona Arkansas California ColoradoConnecticut Delaware









Percent of Surveys

prichardson

52



Health Deficiencies -- SubstandardQuality of Care

n The percentage of nursing home surveysresulting in citations for substandard qualityof care fluctuated from year to year, butwas never above 5.8 percent during thefour-year period (1996-2000). The lowestcitation rate for this type of deficiency was4.4 percent (in 2000).


n In 2000, only 3 states found zero instancesof substandard quality of care.


n Technical Notes:



Substandard quality of care is defined asany deficiency in the Code of FederalRegulations (42 CFR 483.13 ResidentBehavior and Facility Practices, 42 CFR483.15 Quality of Life, or 42CFR 483.25Quality of Care), at a scope and severitylevel of F, H, I, J, K, or L.

prichardson

53

Sour

ce: O

SCARFigu

re 4

3. P

erce

nt o

f Nur

sing

Hom

e Su

rvey

s R

esul

ting

in C

itatio

n fo

r Sub

stan

dard

Qua

lity

of

Car

e by

Yea

r: U

nite

d St

ates

, 199

6-20

00

5.8

4.8

5.5

5.2

4.4

01234567

1996

1997

1998

1999

2000

Year

Percent of Surveys

prichardson

54

Sour

ce: O

SCARFigu

re 4

4. P

erce

nt o

f Nur

sing

Hom

e Su

rvey

s R

esul

ting

in C

itatio

n fo

r Sub

stan

dard

Qua

lity

of

Car

e by

Sta

te: U

nite

d St

ates

, 200

0

02468101214










Percent of Surveys

prichardson

55

Figu

re 4

5. P

erce

nt o

f Nur

sing

Hom

e Su

rvey

s R

esul

ting

in a

Cita

tion

for S

ubst

anda

rd Q

ualit

y of

Car

e by

Sta

te:

Uni

ted

Stat

es, 2

000

5.6

– 12

.54.

1 –

5.5

2.8

– 3.

81.

7 –

2.7

0.0

– 1.

6

Perc

ent o

f Nur

sing

Hom

es

Sour

ce: O

SCA

R

prichardson

56



Health Deficiencies – Abuse,Restraint Use, and Pressure UlcerCitations

n During the four-year period (1996 to 2000),fewer than 2.5 percent of surveys per yearresulted in citations for abuse. In 2000, 13states cited no instances of abuse innursing homes, while 4 states cited thisdeficiency in 5 percent or more of itssurveys.

Figures 46, 47, and 48; Tables 44 and 45

n Fewer nursing home surveys are resultingin citations for the improper use of physicaland chemical restraints. In 1996, 14.4percent of surveys resulted in citations.These deficiencies were cited in fewer than10 percent of surveys performed in 2000.


n The pressure ulcer citation rate increasedfrom 15.3 percent in 1996 to 18.6 percentin 1999. The rate decreased to 17.8percent in 2000.


n Technical Notes:



Abuse citations are those deficiencies citedunder tag F223 of the InterpretiveGuidelines from the "State OperationsManual for Provider Certification"

Restraint use citations are thosedeficiencies cited under tags F221-F222 ofthe Interpretive Guidelines from the "StateOperations Manual for ProviderCertification"

Pressure ulcer citations are thosedeficiencies cited under tag F314 of theInterpretive Guidelines from the "StateOperations Manual for ProviderCertification"

prichardson

57

Sour

ce: O

SCARFi

gure

46.

Per

cent

of N

ursi

ng H

ome

Surv

eys

Res

ultin

g in

a C

itatio

n fo

r Abu

se o

f Res

iden

ts b

y Ye

ar: U

nite

d St

ates

, 199

6-20

00

1.6

1.6

1.8

2.1

1.7

0

0.51

1.52

2.5

1996

1997

1998

1999

2000

Year

Percent of Nursing Home Surveys

prichardson

58

Sour

ce: O

SCARFi

gure

47.

Per

cent

of N

ursi

ng H

ome

Surv

eys

Res

ultin

g in

a C

itatio

n fo

r Abu

se o

f Res

iden

ts b

y St

ate:

Uni

ted

Stat

es, 2

000

01234567 Nation Alabama Alaska Arizona Arkansas California ColoradoConnecticut Delaware










prichardson

59

Figu

re 4

8. P

erce

nt o

f Nur

sing

Hom

e Su

rvey

s R

esul

ting

in a

Cita

tion

for A

buse

of R

esid

ents

by

Stat

e: U

nite

dSt

ates

, 200

0

2.3

– 6.

31.

7 –

2.3

0.8

– 1.

60.

1 –

0.7

0

Perc

ent o

f Nur

sing

Hom

es

Sour

ce: O

SCA

R

prichardson

60

Sour

ce: O

SCARFi

gure

49.

Per

cent

of N

ursi

ng H

ome

Surv

eys

Res

ultin

g in

a C

itatio

n fo

r Use

of R

estr

aint

s by

Ye

ar: U

nite

d St

ates

, 199

6-20

00

14.4

13.9

13.2

11.8

10.9

0246810121416

1996

1997

1998

1999

2000

Year


prichardson

61

Sour

ce: O

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prichardson

62

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prichardson

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05101520253035











prichardson

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nursing home data compendium 2000 - centers for medicare ......introduction to the data compendium...

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