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 ( , 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 National Nursing Home Survey (NNHS) Medicare Current Beneficiary Survey (MCBS) -CMS’ Minimum Data Set (MDS) -CMS’ Online Survey Certification and Reporting Survey (OSCAR) Medical Expenditures Survey Nursing Home Component (MEPS NHC) National Long-term Care Survey -National Longitudinal Study of Aging

Conceptual Model Structure Process Outcomes -Key Personnel -Immunization practices -ED/hospitalizations -Advance practice RNs -Mechanical Lifts -Pressure sores -Turnover -Permanent assignments -Falls -Benefits -Palliative care -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 symptoms  ADLs  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 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 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

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: (NCHS)  Fax:  To learn more---  One way Listserv   LTCSB