Persons With Mental Retardation and Related Conditions in Mental Retardation Facilities: Selected Findings from the 1987 National Medical Expenditure Survey. Resident Movement

12/01/1989

Table 7 and Table 8 present basic resident movement statistics for calendar year 1986 for ICF-MR and noncertified facilities by type of operation and size. Movement is expressed as a percentage of the "current residents." Movement data were based on Facility Questionnaire responses, but included only facilities open for all of 1986. This had the effect of underestimating admissions to small facilities which generally have very high occupancy and which as a class tend to increase their total resident population by the creation of new facilities rather than increasing number of people in existing facilities. Again, underrepresentation of small facilities may have affected the reported rates.

Admission/Discharge Rates

In general, the facilities that were most active in admissions and discharges during 1986 were the smallest facilities (3-6 residents) and the private for profit facilities. The 3-6 person facilities had admissions in 1986 equal to 18.9% of their residential population. They had discharges equal to 14.2% of their residential population. Private for profit facilities reported admissions equal to 19.1% of total residents and discharges equal to 14.6% of their residents. Movement was considerably higher in facilities without ICF-MR certification than in the ICFs-MR (16.2% vs. 9.0% for admissions and 14.0% vs. 9.9% for discharges).

Deaths

The estimated national death rate in residential facilities serving persons with mental retardation was 1.4% of the resident population. This compares with a rate of 1.2% obtained in the 1982 NCRF (Lakin, Hill, & Bruininks, 1985). One factor in the difference between the two estimates was the underrepresentation of small facilities in which the death rate was on average approximately half that of the larger institutions (.9% vs. 1.6%). But there may also have been a small actual increase. Compared with the 1982 NCRF, the estimated death rates for both small and large facilities was larger on small facilities, .7% in the 1982 NCRF and .9% in the 1987 NMES; in large facilities, 1.5% in the 1982 NCRF and 1.6% in the 1987 NMES although either difference could have been due to sampling error). But increases in death rates might be expected in both types of facilities as both types house increasingly aging populations and populations which are more severely impaired.

Net Population Change

Public institutions continued to experience depopulation as a result of considerably higher discharges and deaths (9.7% and 1.4%, respectively) than admissions (6.7%). The net reduction of 4.4% during 1986 was part of the general depopulation of public institutions from 1982 to 1987 (from 117,160 average daily residents to 94,696, or an annual average decrease of 4.2%) (Lakin et al., 1989). Not population losses were greatest among institutions with 300 or more residents (5.4%).

Waiting Lists

Facilities were asked to report the number of people they had wait listed for placement in their facilities. Considerable caution must be exercised in considering these statistics. Individuals may have been on more than one facility list, overestimating the unduplicated count of people waiting. Second, use of waking lists (even among facilities with no people currently listed) were reported by only 60.5% of the small facilities. This reflects a tendency for decisions about access to some facilities (and the lists of people waiting) to be maintained outside the facility. Such tendencies underestimate the total number of people waiting. It cannot be determined how these factors affected the estimate of 22,500 people being on wafting lists. Facility maintained waiting lists were relatively long in facilities of 7-15 residents and 16-75 residents, particularly among those with ICF-MR certification (on the average 33.4% and 24.3% of their current residents, respectively). Facilities of 16 or more residents reported waking lists of about 15,150 people. Perhaps most striking in the waiting list statistics was the size of the waiting lists for the "intermediate" size institutions of 16 to 75 residents (almost 10,100 persons).

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