22.

23.

24.

Sudduth, James N. and Whitten, Lawrence. These Long-Term Care Units Meet a Growing Community Need in Alabama. Hospitals 32:32, July 1, 1958.

Reports on a 30-bed nursing home in Alabama, built in conjunction with a county general hospital and operated especially for long-term elderly patients. Although constructed as a separate unit, the home is connected with the hospital by a long corridor, so that the facilities of the hospital are immediately available to the residents. The home is staffed by nursing aides and orderlies. However, a registered nurse from the hospital makes routine rounds.

The per diem cost of a patient in the nursing home is now less than $5.00. It is stated that they hope to provide more care for the patients in the future and the per diem costs will probably rise.

U. S. Congress. House. Committee on Interstate and Foreign Commerce.
Public Health Service Act (Hospital Survey and Construction Amend-
ments of 1954). Hearings Before the Committee
83d Congress,
2d Sess., on H.R. 7341. Washington, U. S. Govt. Print. Off., 1954,
PP. 11-17.

...

Dr. Leonard A. Scheele, at that time (1954) Surgeon General of the Public Health Service, in testifying with respect to the provisions of H.R. 7341 provided background information as to the impact of the aging population and the need for long-term care facilities.

In discussing more economical means of providing services to patients
needing some type of institutional care, Dr. Scheele cited operating
costs in the three principal types of facilities available for the
chronically ill. The average operating cost in short-term general
hospitals was $18.35 per patient day and in chronic disease hospitals
it was approximately $6.63 per patient day. Although the cost varies
widely among individual nursing homes, it was estimated that the per
patient day operating cost ranged from $2 to $8 in these homes.
Dr. Scheele noted that the cost of care in long-term chronic hospitals
is just a little more than one-third of the cost of care in a general
hospital; costs in nursing homes are substantially below the cost of
care in a general hospital.

U. S. Congress. House. Committee on Ways and Means. Hospitalization
Insurance for OASDI Beneficiaries. (Committee Print, 1959). 85th
Congress, 2d Sess., H. Rept. 2288. Washington, U. S. Govt. Print.
Off., April 3, 1959, pp. 83-84.

Report submitted by the Honorable Arthur S. Flemming, Secretary of
Health, Education, and Welfare includes a discussion of nursing home
benefit costs under the proposed hospitalization insurance for Old-
Age, Survivors, and Disability Insurance Beneficiaries.

The report states that it was possible to mke only very rough estimates of the potential costs of such benefits because of the great need for additional nursing homes and the possible expansion that might occur if a method of paying for care were to become available.

An estimate of the potential costs of a "very limited" skilled
nursing home benefit is based upon a per diem cost of about $10.
This type of nursing home benefit would substitute nursing home care
for much more expensive days of hospital care. The 1960 cost of this
benefit would be about $14 million.

Also included is an estimate for a nursing home benefit covering care
in all types of long-term care facilities, based upon an average per
diem cost of $10 and another based on a $15 daily cost. The annual
cost of such a nursing home benefit for the 1960 eligible aged group
would be $590 million, assuming an average daily cost of $10, and
$885 million if the daily cost were $15.

25. University of Pittsburgh. Graduate School of Public Health. Department of Biostatistics. Principles and Recommendations for the Planning of Medical Facilities in Pennsylvania. Harrisburg, Pennsylvania, Department of Welfare, January 1958. 102 pp.

In developing "a set of principles and guidelines" for planning medical facilities in Pennsylvania, the Graduate School of Public Health, University of Pittsburgh, in cooperation with the Department of Welfare conducted a survey in 1956 of all medical facilities in the State. Data were collected not only on the physical plant but on such pertinent factors as financing and personnel.

Relative to costs in nursing homes, the report states that "such data
as could be collected on nursing homes showed per diem expenditures
to be low." In the 18 nonprofit homes reporting cost data, the per
diem cost averaged $6; nine of these homes had costs less than $5
per day.

In the 53 proprietary nursing homes reporting, 32 showed an average daily cost of less than $5; the per diem cost ranged from $5-$10 in 20 homes and only one home reported a cost of more than $10.

26. Utica Community Chest and Planning Council. Health and Welfare Committee of the Committee on Aging. Report of the Survey Committee on Community Resources for the Care and Housing of the Chronically Ill in the Utica, New York Area. Utica, New York, June 1957. 5 pp. Processed,

This survey, conducted by a subcommittee of the Health and Welfare
Committee of the Committee on Aging affiliated with the Greater Utica
Community Chest and Planning Council, covered 23 nursing homes in
the Utica, New York area, as of June 11, 1957.

These 23 homes had a total bed capacity of 538 beds, ranging in size from 5 beds to 44 beds; the average size was 23 beds. At the time of the survey, over one-half of the total 439 patients were bed patients and 403 were considered to be chronic cases.

Operating costs for 11 of the 23 nursing homes reporting complete data varied from $3.00 per patient day to $8.00 per patient day. The average cost was $5.36 per patient day.

27. Wheeler, Charles and Livingston, H. Farrand. Nursing and Rest Homes in Ohio. Columbus, Ohio, Legislative Service Commission, January 1959. 42 pp. (Staff Research Report No. 31.)

In 1958, the research staff of the Legislative Service Commission requested each nursing home in the State to report information on total operating costs, total patient days, and rates charged for care. Replies to this mail questionnaire were received from 119 proprietary homes and 49 philanthropic homes. Not all replies were complete.

Costs per patient day varied from $1.41 - $10.00; the average for
80 homes reporting these data was $4.59. An analysis of the
limited number of homes indicated that: (1) there was no relation-
ship between the size of the home and the operating cost and (2)
within the State there was no regional variation in per patient
day costs. Though the homes having the lowest and the highest
cost per patient day both had a ratio of 5 patients per "person
capable of giving nursing care," there appeared to be some evidence
that the cost per patient day decreased as the nursing staff in-
creased.

Data on per patient day operating costs, by major item of expenditure, for each of the 22 proprietary nursing homes that submitted detailed financial statements are included in the report.

The following summary shows average, minimum and maximum per patient day costs for each item in these homes:

The report includes a discussion of determining costs of providing adequate care to patients in nursing homes. It is stated that "studies indicate that average overhead costs are relatively uniform regardless of the nursing care needs of the patients. necessary nursing care is the chief cost variable."

The

Reports the lowest and highest costs for each item in the 22 As studied. Therefore, individual items will not add to the totals shwe.

NONPROFIT HOMES FOR THE AGED

28. Association of Southern California Homes for the Aged. Cost of Care Study, 1958, 22 pp. Processed. (William A. Heidman, Chairman, Cost of Care Study Committee.)

This study on cost of care in nonprofit homes for aged was undertaken primarily to assist the Bureau of Old Age Security of the California State Department of Social Welfare in clarifying regulations regarding Old Age Security grants to residents in these institutions. In January 1958, schedules were sent to about 60 institutions that were members of the Association of Southern California Homes for the Aged; usable responses were received from 20 homes.

For the fiscal year 1956-57, the average (mean and median) monthly costs per capita are given for the various categories of expenditures such as housing, food, personal services and medical expenses; per capita costs for each of the 20 institutions are also reported. On the basis of the data cited, the following daily per capita costs have been derived:

It is stated that "costs of care have risen approximately 5 percent" during the year since these data were collected,

The report lists the units of costs which were included in the
various expenditure category and cites the general methodology
followed.