Nursing Home and Home Health Care
Nursing home and home health care include the provision of personal, social, and medical services to people who have functional or cognitive limitations in their ability to perform self-care and other activities necessary to live independently. On an average day in 1999, 1.6 million people resided in one of America's 18,000 nursing homes38. Almost three-quarters of persons discharged from nursing homes required help with three or more activities of daily living (ADLs) prior to discharge. Of persons discharged from nursing homes, 24% leave by dying, 29% are admitted to a hospital, and only 33% are recovered and stabilized. Average length of stay for people discharged from nursing homes is 272 days. In 1998, nursing home expenditures totaled almost $80 billion, about half of which was paid by Medicaid and Medicare. About 70% of nursing home residents are supported in part by Medicaid39. Racial, ethnic, and socioeconomic differences in nursing home care have been observed40, particularly in the management of pain41,42 and rates of rehabilitative services43. Moreover, black nursing home residents are more likely to live in nursing homes that have limited resources (e.g., fewer nurses)44. Long-stay nursing home residents require chronic care for extended periods while short-stay nursing home residents require temporary skilled nursing care or rehabilitation services after a hospital stay and are expected to return home. Both types of residents should be checked by nursing home staff for pain so that pain can be treated. However, some residents may refuse pain medications or choose to take less because of side effects or personal or cultural preferences.
Figure 2.7. Nursing home residents with moderate to severe pain among long-stay nursing home residents (top) and short-stay nursing home residents (bottom), 2002.
Long-stay residents
![Figure 2.7. Nursing home residents with moderate to severe pain among long-stay nursing home residents, 2002.. Select Full Text Description [D] for details.](Figure-2-7a.gif)
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Short-stay residents
![Figure 2.7. Nursing home residents with moderate to severe pain among short-stay nursing home residents, 2002.. Select Full Text Description [D] for details.](Figure-2-7b.gif)
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Source: CMS Minimum Data Set, 2002.
Reference population: Long-stay (top) and short-stay (bottom) nursing home residents.
Note: White, Black, API, and AI/AN are non-Hispanic groups. Moderate to severe pain is defined as very bad pain at any time or moderate pain every day in the last week. For findings related to all nursing home measures, see Table 2.9a. Available data do not support analyses stratified by SES.
- In 2002, the proportion of long-stay nursing home residents who reported moderate to severe pain was higher among AI/ANs and lower among non-Hispanic blacks, APIs, and Hispanics compared with non-Hispanic whites (Figure 2.7, top).
- In 2002, the proportion of short-stay nursing home residents who reported moderate to severe pain was lower among non-Hispanic blacks, APIs, and Hispanics compared with non-Hispanic whites (Figure 2.7, bottom).
On an average day in 2000, 1.5 million people were under the care of one of America's 11,400 home health care agencies45. Half of persons served by home health care agencies received help with at least one ADL. Average length of stay for people served by home health care agencies is 312 days, and Medicare is the primary payment source for half of home health care patients. Home health care includes skilled nursing care, physical and occupational therapy, speech-language therapy, and medical social services provided by skilled health care professionals in a patient's home. Most home health care is temporary and part time; home health staff teach patients and their informal caregivers to provide needed care, such as medications, wound care, therapy, and stress management, and to become as self-sufficient as possible. Home health care quality measures relate to activities that are important to live independently and provide information about patients' physical and mental health, and whether their ability to perform basic daily activities is maintained or improved. How well a patient improves in ability level while getting home health care reflects both the agency's quality of service and the patient's level of cooperation. Being able to get to and from the toilet is important for patients to stay clean, feel comfortable, and remain healthy and typically improves with home health care. Independent toileting is critical for patients who do not have informal caregivers to help when home health caregivers are not present
Figure 2.8. Home health care patients who get better at getting to and from the toilet, by race (top) and ethnicity (bottom), 2002
![Figure 2.8. Home health care patients who get better at getting to and from the toilet, by race, 2002. Select Full Text Description [D] for details.](Figure-2-8a.gif)
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![Figure 2.8. Home health care patients who get better at getting to and from the toilet, by ethnicity, 2002. Select Full Text Description [D] for details.](Figure-2-8b.gif)
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Source: CMS Outcome and Assessment Information Set, 2002.
Reference population: Home health care patients.
Note: For findings related to all home health care measures, see Table 2.9a. Available data do not support analyses stratified by SES.
- In 2002, the proportion of home health care patients who got better at getting to and from the toilet was lower among blacks and people of more than one race compared with whites (Figure 2.8, top).
- In 2002, the proportion of home health care patients who got better at getting to and from the toilet was lower among Hispanics compared with non-Hispanic whites (Figure 2.8, bottom).
