Nursing Facility Data - Information Bulletin #106A, (4/06)

The CMS Nursing Home Data Compendium, 2005, is now available, and it
provides useful information for disability advocates. CMS collects this
data primarily from two sources - the Minimum Data Set (MDS) (data
provided quarterly for each nursing home resident from nursing homes) and
from OSCAR (data collected from CMS's own surveys and certifications).
Also, all of this data is available for your state.

This Information Bulletin focuses on the institutional characteristics of
the nursing facilities. The next one will focus on how the residents are
actually treated.

1. Large Institutions:

In 2005, there were 16,489 nursing facilities (down from 17,183 in
1996). 84% had more than beds. Nursing facilities with 100+ beds made up
48% of the total facilities. (Table 1.1.(e)). To refer to these
institutions as "homes" is grossly inaccurate.

The 100+ bed nursing facilities have more than 2.8 million beds, where
the less than 50 bed facilities have only 300,000 beds. Therefore, the
largest institutions (50+ beds) control 89% of the total nursing facility
beds. (Table 2.1).

As far as size, these are clearly institutions.

2. Age of residents:

The national breakdown by residents' ages is interesting. (Table
2.5.(e)).

A. Nationally, persons ages 0-30 comprised 0.6 % (nearly 19,000
persons) of the total number of residents in nursing facilities, and CA,
NV, UT, IL, AR, AZ, HI, NB, NJ, NY, OR had the highest percentages
throughout the country. Why do states have any persons under 30
institutionalized, let alone nearly 19,000?

B. Persons ages 31-64 years comprised 12% (370,000) of the total
residents, and Alaska, IL, LA, Arizona, CA, DC, NV, and UT had the highest
percentages. Why have not states successfully diverted younger persons
back to the community?

C. Persons 65-74 years made up 15.4% of the total number of
residents, and DC, Alaska, UT, NV, SC, WV, TN, AL, KY had the highest
percentages. Isn't it time disability advocates recognized that all
persons, including those under 74, should be offered community-based
services?

3. Beds and State Populations:

One way to compare your state's nursing facility industry with other
states is by the number of beds per 1000 state residents.(Table 1.5).
Nationally, there were 5.8 nursing facility beds per 1000 residents. The
states with the most nursing facility beds per 1000 were Iowa(11.3), ND,
and SD, and those with the fewest beds were Alaska (1.1), NV and WA.
However, the range among states was stark. Do the differences reflect the
strength of the nursing facility industry in your state? Again, does your
nursing facility trade association contribute money to your elected
officials and receive beds as pay backs?

4. Occupancy rates:

Occupancy rates also varied a lot. (Table 1.4). In 2004, 84.2% of the
beds were occupied, as compared to 85.9% in 1996. The states with the
least occupied beds were OR (66%) and OK (66%); the states with the most
occupied were VR (95%) and RI (92%). The following states had fewer
occupied beds for EACH of the past four years than the national average:
Ariz, Ark, CO, ID, IL, IN, LA, Missouri, Montana, OK, OR, TX, UT, WA, WY.
Why have not these states decertified beds, closed them down, and have the
Money Follow the Persons. They do NOT need so many nursing facility beds.
Why is there such an enormous spread among the states? Does your nursing
facility trade association contribute money to your elected officials and
in return your state permits more beds than are needed? What's the deal?

Here is the 2004 occupancy breakdown by State:

National Average 84.2%
Alabama 88.1%
Alaska 79.4%
Arizona 78.2%
Arkansas 73.3%
California 85.0%
Colorado 81.8%
Connecticut 91.7%
Delaware 84.1%
D. C. 90.7%
Florida 88.5%
Georgia 88.7%
Hawaii 87.9%
Idaho 77.6%
Illinois 78.9%
Indiana 82.3%
Iowa 82.7%
Kansas 83.7%
Kentucky 87.3%
Louisiana 75.3%
Maine 91.2%
Maryland 84.2%
Massachus 89.1%
Michigan 87.7%
Minnesota 91.6%
Mississippi 87.9%
Missouri 74.6%
Montana 75.1%
Nebraska 82.6%
Nevada 84.6%
New Hampshire 90.0%
New Jersey 87.7%
New Mexico 83.9%
New York 93.2%
North Carolina 87.3%
North Dakota 91.9%
Ohio 86.5%
Oklahoma 65.6%
Oregon 66.3%
Pennsylvania 89.4%
Rhode Island 92.4%
South Carolina 90.1%
South Dakota 92.3%
Tennessee 87.4%
Texas 75.1%
Utah 70.1%
Vermont 94.9%
Virginia 89.3%
Washington 84.9%
West Virginia 88.4%
Wisconsin 88.2%
Wyoming 80.6%

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Nursing Residents' Data, Information Bulletin #106B (4/06)

Early we provided Nursing Home Data from the CMS Nursing Home Data
Compendium 2005. Using the same source, we will now provide CMS data about the
people who are in those facilities.

1. Why are people in facilities?

ADL Impairments:

Nearly 33% of persons in nursing facilities had NO Activity of Daily
Living Impairment; that's more than one million persons institutionalized
at sometime during the year who had no ADL Impairment. Another 8.8% have
only one ADL Impairment. More than 50% of the persons had two or fewer ADL
Impairments (Table 3.3.(e)), as compared to nearly 55% in 1999.

The following states have the largest percentage of persons with NO
ADL Impairments: Illinois, Missouri, OK, Arkansas, Montana, KA, NM, and
Iowa.

The distribution of ADL Impairment by size of the nursing facility
shows that in those with 50 or less beds have nearly 48% with NO ADL
Impairment, as compared to the 33% national average. Conversely, these
smallest institutions also have the fewest persons who have significant
ADL Impairments.

Our questions: Why are any persons in nursing facilities with so few ADL
Impairments? Why are States, for those residents on Medical Assistance,
permitting these people to be admitted into nursing facilities and then
paying for them to be unnecessarily institutionalized? Why aren't
advocates making the States "Close the Front Door" and not admit or pay
for these persons, or AT LEAST offer them services in the community? If
they have psychiatric disabilities, have they received PASSAR evaluations
before they were admitted and are they receiving appropriate services?

Cognitive Impairments:

Nearly 30% of residents had NO Cognitive Impairment; that's more than
900,000 persons without any cognitive impairments. Another 12.2% had only
a very mild cognitive impairment. Nearly 56% had a mild or less cognitive
impairment.

The following states had the largest percentage of persons with NO
Cognitive Impairments: Arizona, DC, NJ, Flo, DE, Maryland, NV and OR.

Our questions: Again, why are these persons in nursing facilities,
especially since most persons with cognitive impairments also have ADL
impairments? When one looks at both ADL and Cognitive Impairments, a
frightening picture emerges. Have nursing facilities become the last
refuge for many persons who are mentally ill, homeless, developmentally
disabled? Why is your State wasting Medical Assistance dollars on those
persons who could easily and readily be treated and provided for in the
community?

2. How are People Doing in Nursing Facilities?

Many of the following are life endangering, are caused by the nursing
facilities, should be treated by a "nursing" facility, and demonstrate
that people are at significant risk when they enter a nursing facility.

A. Pressure Ulcers (only if the pressure sore was at stage 2 or
greater, and does not include stage 1):

a. Nationally, half of all nursing facilities had more than 8.2%
of its residents with these pressure ulcers.

b. The following States had the highest percentages of residents
who had these pressure ulcers: DC, CA, NV, PA, Maryland, NJ, DE, KY, LA,
NY and NC. (Table 3.7).

B. Use of Physical Restraints:

a. Nationally, half of all nursing facilities had more than 4.1%
of its resident who were put in physical restraints.

b. The following States had the highest percentages of residents
in physical restraint: Arkansas, CA, LA, OK, Mississippi, UT, and NV.
(Table 3.11).

C. Dehydration (i.e., fluid output exceeded fluid input and excludes
residents with end-stage disease or receiving hospice care):

a. Nationally, more than half the nursing facilities had zero
percentage of their residents who had dehydration.

b. The following States had the highest percentages of residents
who were dehydrated: Alaska, WY, WA, OR, WV, ID, and VE. (Table 3.19).

D. Weight Loss (i.e., more than 5% in last 30 days or more than 10%
in last 180 days and excludes residents with end-stage disease or
receiving hospice care):

a. Nationally, half of all nursing facilities had more than 8.2%
of its residents who had such weight loss.

b. The following States had the highest percentages of residents
who had such weight loss: WY, HI, WA, OR, Virginia, NJ, and WV. (Table
3.17).

E. Severe Bladder or Bowel Incontinence (on almost all occasions):

a. Nationally, half of all nursing facilities had more than 34%
of its residents who had severe bladder or bowel incontinence.

b. The following States had the highest percentages of residents
who had severe bladder or bowel incontinence on almost all occasions: HI,
CA, SC, DC, NV, NC, GA, VG, TX (Table 3.21).

3. Nursing Facility Deficiencies:

A. Only 10% of the states' nursing home surveys had ZERO health
deficiencies' citations. (Table 4.5.(e)). The following states had the
most health deficiencies cited: NH, OR, Virginia, WI, MA, RI, and IN.

B. 16% of all states' nursing facilities had surveys resulting in a
health deficiency of "actual harm or immediate jeopardy to residents."
(Table 4.8.(e)) The following states had the most health deficiencies of
"actual harm or immediate jeopardy to residents": CT, ID, DC, SC, KA, WA,
and CO.

C. Nearly 15% of all states' nursing facilities had surveys resulting
in a citation for Failure to treat or prevent pressure ulcers, but there
was a wide spread among the states. (Table 4.18.(e)).

What follows is the percent of all nursing facilities by state that
were cited for "Failure to Treat or Prevent Pressure Ulcers."

Alabama 15.2%
Alaska 5.9%
Arizona 11.2%
Arkansas 19.2%
California 18.9%
Colorado 24.2%
Connecticut 34.0%
Delaware 26.2%
D. C. 9.1%
Florida 6.1%
Georgia 19.1%
Hawaii 14.3%
Idaho 27.3%
Illinois 18.7%
Indiana 14.5%
Iowa 9.9%
Kansas 24.8%
Kentucky 7.6%
Louisiana 12.5%
Maine 4.9%
Maryland 11.6%
Massachus 7.7%
Michigan 20.5%
Minnesota 17.1%
Mississippi 1.6%
Missouri 16.7%
Montana 7.4%
Nebraska 10.3%
Nevada 27.3%
New Hamp 14.8%
New Jersey 10.9%
New Mexico 13.0%
New York 17.5%
North Carolina 9.3%
North Dakota 4.8%
Ohio 13.6%
Oklahoma 11.8%
Oregon 17.1%
Pennsylvania 15.2%
Rhode Island 20.0%
South Carolina 22.6%
South Dakota 11.9%
Tennessee 21.3%
Texas 9.0%
Utah 3.5%
Vermont 33.3%
Virginia 12.9%
Washington 23.8%
West Virginia 6.3%
Wisconsin 10.7%
Wyoming 13.9%
National 14.7%