National Invitational Conference on Long-Term Care Data Bases: Conference Proceedings. B. Inventory of Long Term Care Places


Curt D. Mueller, National Center for Health Services Research

The Inventory of Long Term Care Places (ILTCP), is a comprehensive listing of nursing and personal care homes and facilities for the mentally retarded or developmentally disabled.

It was created primarily to serve as a sampling frame for the institutionalized population component portion of the 1987 National Medical Expenditure Survey (NMES).

The institutionalized population component is currently in the field and data is being collected which describes medical care use and expenditures by persons in nursing homes and facilities for the mentally retarded.

The sample of facilities of the NMES were selected from the universe of places as depicted by the inventory.

The inventory data that was collected were used to stratify the sampling frame prior to the sample drawn.

The inventory is of interest from a research standpoint because it is an up-to-date census of these kinds of facilities.

Inventory development and fieldwork were cosponsored by NCHS, the Health Care Financing Administration (HCFA), and the National Center for Health Services Research (NCHSR).

Inventory data were collected by the Bureau of the Census using a mail questionnaire. Three rounds of mail questionnaires were distributed, the first in February 1986.

After the first mail out, up to two additional questionnaires were sent to non-responding facilities. Those facilities which did not respond or which responded in a way which did not give us certain key data items were subject to certain kinds of follow-ups, primarily telephone, but some personal follow-ups were attempted as well.

Census attempted to contact some 56,700 places identified by NCHS. Those 56,700 places were on mailing lists that personnel at NCHS compiled.

The nursing home list was obtained by updating the list of places appearing in the 1982 National Master Facility Inventory (NMFI).

That process involved contacting states and relevant associations for their most current listings and these were then compared to the NMFI listings. What appeared to be new places were added to the list.

The list of places appearing in the 1982 National Census of Residential Facilities (NCRF) was updated to serve as the mailing list for facilities for the mentally retarded and developmentally disabled.

This list was compiled by the Center for Residential and Community Services at the University of Minnesota in 1982.

The updating procedures used to compile this list were similar to those used to update the list of nursing homes. States and relevant associations were contacted for their listings and facilities not appearing on the earlier list were added to the mailing list.

This updating process, of course, is not exact and consequently was a source of some error. One problem is that the mailing lists did contain some facilities which were represented more than once.

This often happens because of minor differences in facility names and addresses and it is difficult to say, "Well, yes, this is the same facility," or, "No, it is a completely different facility."

Some of these duplicates were identified in the field by Census. On the public use tape, which is soon to be released, these places are identified as such.

Another problem with the updating process is that it is only as good as the sources of lists that you have. At the time the lists were compiled, a complete unduplicated listing of skilled nursing facilities (SNF), that are hospital-based was not available. It is probably true that the ILTCP undercounts these places.

The inventory data of some 56,000 places will be released in two parts. The first part contains some 45,000 facility level records representing these homes or facilities, which had complete or partial responses to the mail questionnaire and follow-ups.

The remaining 11,500 or so are on a separate file. This file, again, is facility level records, but they are records of facilities for which data was not available for a variety of reasons, the facility may have gone out of business, some just could not be located, a small number of refusals and so on. There is a list of the different kinds of field status codes which comes as part of the public use tape.

I would like to briefly concentrate on the data items which are available for either the complete or the partial respondents, that is the 45,000 some places.

Each facility was asked to characterize itself from a list of different facility types. There were approximately seven different kinds of places you might regard as a nursing home or a personal care home in the list.

The list includes such types of facilities as the SNF's, approximately 20 percent of the 45,000 indicated that they were skilled nursing facilities SNF's.

Intermediate care facilities (ICF's), and as I said earlier, long term care units of hospitals, licensed personal care homes, but homes which were not certified and so on.

There were also five or six different kinds of facilities for the mentally retarded identified on the questionnaire. These include ICF's for the mentally retarded, foster homes for the mentally retarded or developmentally disabled, state institutions, semi-independent living quarters and so on.

This characterization can be used, and in the public use data, is a crucial part of identifying which places should be defined as nursing homes and which places would be facilities for the mentally retarded.

I might add at this point that the definition that the institutionalized population component of NMES us

Most of the remainder appear to be facilities for the mentally retarded on the public use tape. Although, there are some other facilities which managed to slip on the mailing lists, such as homes for unwed mothers.

The ILTCP provides various measures of facility size. I guess the most important one is the total number of beds set up and staffed for use.

In addition to the total number of beds, you can identify the number of beds certified under the various public programs, Medicare SNF beds, Medicaid SNF beds, Medicaid ICF beds and ICF/MR beds as well.

Other measures of size available include the number of residents in the facility the previous night and the number of admissions occurring during the calendar year of 1985.

As part of the inventory there are questions which refer to the type of ownership of the facility, whether it is for profit, nonprofit, or some sort of government owned facility, federal, state, or local.

For a large number of the facilities, the county can be identified and for most facilities, you certainly know the state of the facility.

Finally, there is a set of variables which I like to call administrative variables. These mainly describe the facilities response to the various mail questionnaires. When, for example, the first mail questionnaire was received, if the first mail questionnaire was returned and so on. There are variables which can be used for certain kinds of methodological studies.

A couple of final notes. The public use file is soon to be released. For the most part, the data appear as reported. There has been very little editing done in attempts to get the data in public use form as quickly as possible.

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