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M .4-1 Nursing Home Data Compendium ~*A> 2001 dtM CMSLibrary C2-07-13 i':\:J\ 7500Security re,W * 1 I 1 I m m m m m 4 Introduction to the CMS Nursing Home Data Compendium, 2001 This is the second edition of the Center for Medicare & Medicaid Services (CMS) annual Nursing Home Data Compendium. CMS, which has the responsibility for overseeing quality of care in the nation's 16,800 Medicare- and Medicaid-certified nursing homes, publishes this volume to provide a more detailed picture about the residents of these nursing homes. We hope that this data compendium will serve as a useful resource for policy makers, researchers, and consumers. The compendium contains figures and tables presenting data on aH residents in Medicare- and Medicaid-certified nursing homes in the United States A series of graphs, charts, and maps highlights some of the most interesting data, while detailed data are available in accompanying tables. The Methods Section, found in Appendix A, lists the sources of the data used in this report and explains the methods used in calculating many of the data elements presented in the Data Compendium tables. OverviewofContents NursingHomeCertificationandOwnership In 2001, just over 16,600 nursing homes were certified to participate in the Medicare and/or Medicaid programs. Nationally, the number of nursing homes participating in Medicare and Medicaid has decreased steadily since 1997. This decrease has occurred in most, but not all, states. The bulk of the decrease has occurred among for-profit nursing homes and among nursing homes with fewer than 50 beds. Government-owned nursing homes, which represent the smallest category of ownership at about 6.496 of nursing homes, experienced the greatest proportional decline in ownership. Most nursing homes are of a medium size: mor—e than three-fourths have been 50 and 200 beds. In 2001, only about 15% of nursing homes have fewer than 50 beds down from 1796 of nursing homes in 1997. More than 8096 of certified nursing homes participate in both Medicare and Medicaid; Slightly more than 696 are certified to participate only in Medicare; 1296 participate only in Medicaid. For-profit facilities account for about 6596 of the certified homes and care for almost two-thirds of nursing home residents. About 2896 of nursing homes are non-profit. The others are government-operated. NursingHomeResidents More than 3 million individuals had at least one completed MDS assessment in 2001. About 7096 of these residents were female. The female to male ratio varied by state, from 1.4 to 1 in Alaska to 2.7 to 1 in Alabama. Seventy-five percent of all nursing home residents were 75 years of age or older. Alaska, Puerto Rico, and Louisiana had the highest proportions of young nursing home residents (under the age of 65 years) while South Dakota, Iowa, and North Dakota had the highest proportions of residents aged 95 years and older. m m m These data show that about 1596 of the U.S. nursing population consists of Asian, African-American, or other ethnic and racial minorities. Minorities make up a larger proportion of the population of large nursing homes (with 200 or more beds). According to these data, more than 6896 of nursing home residents are over the age of 75, while a steadily increasing proportion of residents are under the age of 30. The proportion of residents under the age of 30 increased from 10.096to 10.796from 1999 to 2001. Occupancy rates for nursing home have been decreasing slowly since 1996. In 1996, nursing homes, on average had about 8596 oftheir beds occupied. This has decreased to about 8296 occupancy in 2000. Both cognitive and functional impairments are common in nursing homes. About 28.596 of residents had no cognitive impairment as measured by the Cognitive Performance Scale (CPS). This proportion remained constant from 1999 to 2001. The proportion of residents with severe or very severe cognitive impairment scores on the CPS decreased slightly, from 16.8 96to 16.296 from 1999 to 2001.. Residents of nursing homes with fewer than 50 beds or about half as likely as residents of larger nursing homes to have severe cognitive impairment. More than one third of nursing home residents require extensive assistance with at least four of the five Activities of Daily Living (ADL) that were examined (bed mobility, transferring, dressing, eating, or toileting). Facilities with fewer than 50 beds report lower levels of ADL impairment in residents than do largerfacilities. Clinical problems are also common in nursing homes. As noted in the Nursing Home Data Compendium for 2000, incontinence remains a severe problem. More than one-third of nursing home residents are incontinent of bowel or bladder all or most ofthe time. The median prevalence of pressure ulcers across all nursing homes increased slightly over the observation period from 7.496 to 7.996. The incidence remained relatively stable at about 296. The median prevalence of physical restraint use decreased from 1999 to 2000, but remained approximately constant from 2000 to 2001 while the incidence of new use of restraints has remained steady at about 196. Data on reported involuntary weight loss also appears to support a downward trend from the beginning of 1999 through 2001, decreasing from 11.496 to 9.396 during that period. Since the beginning of 1999 the prevalence of tube feeding has been fairly steady, at 4.296 to 4.496. Fewer nursing homes are reporting high proportions of residents who are dehydrated, as represented by the 90th percentile of facility-reported prevalence measures. Results from the on-site surveys of nursing homes have also changed somewhat over time. The compendium presents data from 1996 through 2001. The average number of health deficiencies cited during the survey has increased from 5.1 per facility in 1996 to 6.3 per facility in 2001. The percentage of nursing homes that did not receive any citations for health deficiencies during the survey has decreased substantially; while 2296 of nursing homes were not cited for health deficiencies in 1996, about 1196 were not cited in 2000. However, the proportion of facilities cited for deficiencies at the level of actual harm or greater decreased by about 3296 from 1999 to 2001 (the proportion of deficiencies cited at this level decreased by 4596). Fewer facilities are being cited for the improper use of physical and chemical restraints. In 1996, 14.496 of nursing homes were cited. About 1196 were cited in 2000 and 2001. Citations for instances of abuse have declined, after a period of increase from 1998-2000. Citations for pressure ulcers increased from 15.396 in 1996 to 18.696 in 1999, and then declined to 17.296 in 2001. The percentage of nursing homes cited for substandard quality of care has fluctuated somewhat from year to year, but has never been above 5.896 during the four-year period. The proportion of nursing homes being cited for ft ft ft ft ft ft II — substandard quality of care declined to 4.3% the lowest level since the implementation of the nursing home enforcement regulations in 1995. Additional information about the material highlighted above is available at the state level in the figures, maps, and tables thatfollow. 1 I I I I 1 I ft I ft ft ft ft ft m