In his latest information bulletin, disability lawyer Steve Gold reviews the CMS Nursing Home Data Compendium, 2008. Below is the information bulletin. 



2008 Nursing Residents' Data, Information Bulletin # 270 (12/08)

The 2008 Nursing Home Data Compendium is now available (with 2007
data), and it provides useful information for disability advocates. CMS
collects this data primarily from two sources - the Minimum Data Set (MDS)
(data provided quarterly for each nursing home resident from nursing
homes) and from OSCAR (data collected from CMS's own surveys and
certifications). Also, all of this data is available in this Compendium by
state.

1. Why are people in facilities?

A. ADL Impairments:

Nearly 29% of persons in nursing facilities had NO Activity of Daily
Living impairment; that's more than 930,840 people institutionalized at
sometime during 2007 who had no ADL impairments. Another 8.1% (260,893)
had only one ADL Impairment. (Table 3.3.(e))

The following states had the largest percentage of persons in nursing
facilities who had NO ADL Impairments: IL, OK, MO, KA, LA, AR.

The following states had the largest percentage of persons in nursing
facilities who had only one ADL Impairment: RI, NH, IO, ND, WI, CT and MN.


B. Cognitive Impairments:

Nearly 31.4% of residents had NO Cognitive Impairment; that's more than
886,749 persons without any cognitive impairments. Another 12.2%
(390,025) had only a very mild cognitive impairment. 58.2% had a mild or
less cognitive impairment. (Table 3.5(3))

The following states had the largest percentage of persons with NO
Cognitive Impairments: AZ, NJ, FL, DC, NV, and MD

2. How are People Doing in Nursing Facilities?

Many of the following are life threatening conditions.

A. Pressure Ulcers (only if the pressure sore was at stage 2 or greater,
and does not include stage 1 pressure sores)(Table 3.7 and 3.9). They are
associated with increased mortality and often require aggressive (and
expensive) medical and surgical therapy. Prevention requires regular
turning, eliminating focal pressure, and keeping the skin dry.

i. Nationally, half of all nursing facilities (the median) had more than
7.8% of its residents with these pressure ulcers.

ii. The following States had the highest percentages of nursing
facilities (90th percentile) with residents who had stage 2 or greater
pressure ulcers: DC, CA, MD, NJ, NV, VA, and PA. (Table 3.7).

iii. The following States had the highest incidence of pressure ulcers
which occurred while the residents were entirely under the care of the
nursing facility, i.e., they did not have these ulcers on admission: IN,
KY, DC, PA, and WY. (Table 3.9)

B. Use of Physical Restraints (whether trunk restraint, limb restrain or
some sort of restraining chair):

i. Nationally, half of all nursing facilities (the median) had more than
2.3 % of its resident who were put in physical restraints.

ii. The following States had the highest percentages of facilities (90th
percentile)with residents in such physical restraints: LA, CA, AR, OK, MS,
NV, TN, and NM. (Table 3.11).

C. Tube Feeding (The following data excludes persons admitted who had
feeding tubes at time of admission.) (Table 3.15):

i. Nationally, more than half the nursing facilities (the median) had 3.2
% of their residents who had feeding tubes.

ii. The following States had the highest percentages of facilities (90th
percentile) with residents who were put on feeding tubes: HI, DC, CA, NV,
MS, AK, and KY.

D. Weight Loss (i.e., more than 5% weight loss in the last 30 days or
more than 10% in last 180 days, and data excludes residents with end-stage
disease or receiving hospice care):

i. Nationally, half of all nursing facilities (the median) had more than
7.7% of its residents had such weight loss.

ii. The following States had the highest percentages of facilities (90th
percentile) with residents who had such weight loss: OR, NV, WY, HI, WA,
VA. (Table 3.17).

E. Severe Bladder or Bowel Incontinence (Nor episodic but on almost all
occasions, and therefore an indication of severe incontinence):

i. Nationally, half of all nursing facilities (the median) had more than
32.7% of its residents had severe bladder or bowel incontinence.

ii. The following States had the highest percentages of facilities (90th
percentile) with residents who had severe bladder or bowel incontinence on
almost all occasions: HI, CA, SC, DC, SC, NV, VA, GA. (Table 3.19).

3. Nursing Facility Deficiencies

A. Only 8% of the states' nursing home surveys had ZERO health
deficiencies' citations. (Table 4.5.(e)). The following states had the
most health deficiencies cited: RI, MA, PA,.OR, NH, NV.

B. 17.1% of all states' nursing facilities had surveys which recorded a
health deficiency of "actual harm or immediate jeopardy to residents."
(Table 4.8.(e)) The following states had the most health deficiencies of
"actual harm or immediate jeopardy to residents": CO, CT, DC, DE, ID, MI,,
WI ,WY, NE, NM..

4. Specific Nursing Facility Deficiencies:

A. Nearly 18.3% of all states' nursing facilities had surveys resulting
in a citation for failure to treat or prevent pressure ulcers, but there
was a wide spread among the states. (Table 4.18.(e)).

What follows is the percent of all nursing facilities by state that were
cited for "Failure to Treat or Prevent Pressure Ulcers."

Alabama	17.0%
Alaska	5.3%
Arizona	17.1%
Arkansas	46.9%
California	19.8%
Colorado	20.3%
Connecticut	34.5%
Delaware	29.8%
D. C.	28.6%
Florida	10.3%
Georgia	17.6%
Hawaii	10.3%
Idaho	28.8%
Illinois	21.5%
Indiana	26.4%
Iowa	17.5%
Kansas	38.1%
Kentucky	11.5%
Louisiana	16.8%
Maine	16.2%
Maryland	9.0%
Massachusetts	8.5%
Michigan	19.4%
Minnesota	62.4%
Mississippi	5.9%
Missouri	26.6%
Montana	14.5%
Nebraska	21.9%
Nevada	10.9%
New Hampshire	7.4%
New Jersey	14.8%
New Mexico	13.9%
New York	17.7%
North Carolina	6.6%
North Dakota	7.7%
Ohio	20.5%
Oklahoma	12.1%
Oregon	12.8%
Pennsylvania	8.8%
Rhode Island	9.3%
South Carolina	22.2%
South Dakota	4.6%
Tennessee	8.0%
Texas	10.6%
Utah	3.7%
Vermont	16.2%
Virginia	20.0%
Washington	23.7%
West Virginia	5.4%
Wisconsin	18.8%
Wyoming	15.4%
National	14.7%