Sources of Funds and Charges for Care

Perhaps the outstanding fact which emerges from the study regarding the financing of care of patients in nursing homes is the role of public assistance funds. Fully half of all proprietary nursing home residents are recipients of public assistance, with these funds paying the full bill in 4 out of 5 of these cases. Table 13 details the various sources of funds and their combinations in paying for care of patients.

The extent of coverage by public assistance varies considerably among the States, as figure 10 shows, but is substantial in every State in the study. In none of these States is the proportion covered by welfare funds less than 25 percent of all proprietary nursing home patients. In several of the States the proportion is as high as 70 percent. Among the factors which may explain

Proprietary Nursing Homes

differences among States are the varying provisions made for care of needy patients in public institutions which provide nursing

care.

About as many patients pay their own way as are financed from public assistance funds. Other sources of funds may include community chest and other voluntary organizations and public programs such as workmen's compensation and rehabilitation. To some extent the home itself may furnish free care. These sources, however, play a minimal role.

Amount of Charges. In proprietary nursing homes, the average (median) monthly charge for care is about $150. Average monthly charges range from about $90 in New Mexico and Oklahoma to $200 in California. The range among individual homes is of course much greater.

the States to highlight a difficult situation. The difference is at a minimum in Minnesota, where the private-pay average is $153 and the public assistance average is $140, or 92 percent of the private-pay average. The largest proportionate difference appears in Georgia, where the respective median payments are $122 and $55, the average public assistance payment being only 45 percent of the private-pay average.

In composite, the data produce national estimates for average private-pay and public assistance monthly payments of $175 and $128, respectively.

Charges tend to go up with the size of the nursing home:

charges for care in 12 of the study States as they vary with the physical and mental capacities of the patients. A difference of about $20 a month is noted in charges for patients who walk independently and for those severely restricted in walking ability. Nearly the same difference is found between charges for the care of continent and incontinent patients, and approximately a $10 variation between charges for the care of mentally clear patients and confused patients. Interestingly, a smaller variation appears between charges for patients who are out of bed and for those who are bedfast. Higher rates are generally understood to be charged for the bedfast patient. Welfare agencies, in fact, not uncommonly authorize larger payments for patients who are confined to bed. The failure of the study to reveal a more distinct difference in charges with extent of confinement to bed may reflect recognition in practice of the sometimes greater needs for services by the ambulatory or semiambulatory patient.

305-310

184

$154

162

Walking status:

132

112

110

98

6.0 and over

The average payment increases distinctly with the level of care the patients are judged to require. Those reported as needing mainly boarding care are charged an average of $115 a month. Those whose needs are of the type that could conceivably have been met at home with someone to care for the patient pay about $150 on the average. The median charge is about $160 for patients who need nursing care of a type which could not be expected to be provided at home.

Table 14 presents the average (median)

ample evidence that the growth of nursing homes during the past 25 years is continuing. Although there is some discontinuance of nursing homes with time, the influx of new homes seems to more than offset the losses. Information gathered in the survey for 12 of the 13 study States (Maryland not included) brings out the phenomenon of new accessions in almost startling relief: Half of the presently operating proprietary nursing homes have opened within the past 4 years; one-fourth have been in operation for less than 2 years.

The 2,590 homes in the 12 States for which this information was obtained were distributed as follows, according to their age, based on present ownership in present location:

Rate of occupancy in proprietary nursing homes, by size of home

8

15

of homes occupancy

26

36

Under 10.

59

10-14..

83

15-24

25-34..

The picture is not the same for all States, as table 9 of appendix B brings out. Nursing homes have probably had a longer history in some States than in others and are more stabilized in some States than in others. Thus, in New York and Vermont, fully one-fourth of the establishments have been in existence for more than 10 years; the average home is 5 or 6 years old in these States. On the other hand, the average home is barely 2 years old in New Mexico, Oklahoma, and Wyoming; in these States as many as one-third of the homes have been operating for less than a year.

Rate of Occupancy. Eighty-three percent of the beds in the surveyed homes were occupied at the time of the survey. As in hospitals, the occupancy rate for nursing homes tends to increase with the size of the institution. Table 15 traces the average percentage of occupancy through the groups of nursing homes of different sizes.

Occupancy experience is not the same in all study States. Roughly two-thirds of the nursing home beds in Wyoming were occupied when the survey was taken while the

35-49 50-74.. 75-99 100 and over..

Nursing Homes and Near-Nursing Homes

Early in this report we recognized that the facilities included as proprietary nursing homes did not always conform to the more confining definition which had been intended as the criterion for inclusion in the study. From the standpoint of that definition-involving the provision of a skilled form of nursing care as the primary purpose of the home other facilities which were included might be regarded as “near-nursing" homes. A closer look at this distinction can be taken very briefly in the case of New York (upstate) and Wyoming. In upstate New York, the licensure program officially distinguishes between "nursing homes" and "convalescent homes," with the convalescent home giving a less skilled type of service. In Wyoming, the distinctions made in the national inventory (9) between "skilled nursing homes" and "personal care homes with

skilled nursing" were carried back through the patient study in a complete retabulation of the original data.

With the distinctions so clearly deliberate in these two instances, we shall see how the survey data emerge for the separate categories in the two States. From this, we may hope to gain some appreciation of the effect of delineating types of homes in a more exacting fashion than is generally done in most States.

Table 16 presents selected information on the characteristics and care of the patients in nursing and near-nursing homes in New York and Wyoming. A brief review of these items will give the general sense of the differences between the two types of homes.

Personal Characteristics of Patients The two levels of nursing homes in both States show the same basic characteristic so

immediately apparent for nursing homes as a whole: their aged clientele. There are some differences, due to the small numbers of homes in Wyoming, but the fundamental sameness in respect to age of the patients is clear. Their median age in both types of homes is about 80 years, with about onefourth past 85 years of age. The predominance of widowed patients noted earlier appears in both nursing and near-nursing homes. About two-thirds of the patients in each category are widowed.

Medical Condition of Patients

The close similarity between nursing homes and near-nursing homes ceases with the physical and mental condition of the residents. Clearly and consistently, the "true" nursing homes have a more heavily disabled group of patients. About half of their patients are unable to walk independ