2004 National Nursing
Home Survey
Annual AcademyHealth Research Meeting
Robin E. Remsburg, APRN, BC
Long-term Care Statistics Branch
Division of Health Care Statistics
National Center for Health Statistics
National Nursing
Home Survey (NNHS)
 Component of the National Health Care
Survey (NHCS)
 Nationally representative sample survey
of nursing homes
 Collects information


Providers
Recipients of care
 Conducted 7 times since 1973 (1973-74,
1977, 1985, 1995, 1997, 1999 and 2004)
2004 Redesign Process
1. Reviewed documents from expert meetings



Future Directions for Residential LTC
Health Services Research (October 1999)
Future Directions for Community-based LTC Health Services
Research (June 2000)
Institute of Medicine Report from the Committee on Improving
Quality in LTC (2001).
2. Policy and Practice questions




Characteristics of nursing homes residents
Care and services provided by nursing homes
Cost/reimbursement
Quality/outcomes
Process (cont.)
3. Identify data gaps
-1999 National Nursing Home Survey (NNHS)
-1997 Medicare Current Beneficiary Survey (MCBS)
-CMS’ Minimum Data Set (MDS)
-CMS’ Online Survey Certification and Reporting
Survey (OSCAR)
-1996 Medical Expenditures Survey Nursing Home
Component (MEPS NHC)
-1999 National Long-term Care Survey
-National Longitudinal Study of Aging
Conceptual Model
Structure
-Key Personnel
-Advance practice RNs
-Turnover
-Benefits
Process
-Immunization practices
-Mechanical Lifts
-Permanent assignments
-Palliative care
Outcomes
-ED/hospitalizations
-Pressure sores
-Falls
-Medications
Features of the NNHS Redesign
 Computer Assisted Personal
Interview (CAPI)
 New sample design
 New content
 Linkage to CMS’ Minimum Data Set
Expanded clinical content
 Care episodes

 Expanded sample
 National Nursing Assistant Survey (NNAS)
Content: Facility

Administrators, Medical Directors, & Directors of Nursing





Preparation
Years of experience
Tenure at the facility
Specialty certification
Nursing Staff










FTEs
RN mix
Specialty certification
New roles----MDS nurses, case managers, QI, infection control
personnel
APNs
Entry-level wages
Recruitment/retention strategies
Benefits
Collective bargaining arrangements
Staff turnover and stability
Content: Facility
•Accreditation
•Medical services
•Electronic/computerized information systems
•Recreation activities
•Dining practices
•Mechanical lifts
•Immunization policies & practices
•End-of-life practices (POLST, Last Acts)
•Special care programs (e.g., wound, dementia)
Content: Resident-MDS
 Advance
directives
 Cognitive skills
 Mood
 Behavioral
 ADLs
symptoms
 Continence
 Accidents
 Weight
change
 Nutritional therapy
 Pressure ulcers
 Restraints
Content: Resident-New









Admission to a specialty unit (e.g., Alzheimer’s, hospice)
Receiving specialty services (e.g., Alzheimer’s, hospice)
Hospitalizations
ED visits
Pain assessment, management, relief
Medications
Recent drug adverse experiences
End-of-life care
Out of pocket charges
2004 NNHS
 National probability sample survey

Data were collected through
onsite interviews with
knowledgeable facility staff
who refer to medical and facility
records

Results are weighted to create
national estimates

1,500 facilities sampled; 1,174
participated

82% facility response rate
 2-stage stratified sample design


Nursing homes (facilities)
Residents, NAs
 Licensed or certified; 3 or more
beds
 Participation is voluntary
 Confidentiality protected by
Section 308(d) of the Public Health
Service Act
National Nurse Assistant
Survey (NNAS)
Reduces NNAS costs by utilizing a sub-sample
of an existing sample frame and data
collection methodology
 Enhances response rates and reduces burden
 Increases the analytical usefulness of NNAS
and NNHS

Plans for Dissemination
 Data products
 Public use data files
 Reports, journal articles
 Access data products
 Downloadable from the Internet
 Data files on CD-ROMS
 Research Data Center
 NCHS Office of Information Services



Telephone: 866-441-6247 (NCHS)
Fax: 301-458-4027
Email: nchsquery@cdc.gov
 To learn more-- One way Listserv
 www.cdc.gov/nchs/nnhs.htm
 LTCSB 301-458-4747