A series of recommendations, based on the findings of the study, are presented.

15. Peeples, William J., M. D.; Ong, Beale H.; and Maxwell, Virginia B. An Evaluation of Nursing Homes in a Suburban Community. Southern Medical Journal 52:1454-1460, November 1959.

Each of the 33 institutions licensed in Montgomery County, Maryland, as nursing or care homes was visited to obtain data on the personal characteristics of the patients and characteristics of the nursing

homes.

It was found that 74 percent of the patients were over 75 years of age,
and that 80 percent were women. Only 39 percent of all the patients
were from Montgomery County. The average monthly charge for
care was $200, with a range of $110 to $400. Of the 540 patients in-
cluded in the survey, 474 financed their care by means of private
funds.

Only 5 percent of the nursing home personnel were registered nurses; an average of one for each 38. 5 patients. Fourteen homes had no registered nurse or licensed practical nurse on their staff. Most of the supervision and care was given by unlicensed nursing personnel, who in most cases had little or no formal training. Also, little or nothing was being done in the nursing homes to meet the social needs of the patients, and there had been only scattered attempts at providing any rehabilitation.

MICHIGAN

16. Mahaffey, Thomas E. Proprietary Nursing Homes. Research Series No. 18. New York, Health Information Foundation, 1961. 44 pp.

The purpose of this study was "to analyze the feelings of the proprietary nursing home operator about his role in the health field, the function of the proprietary nursing home in the community, and the problems involved in caring for the aged patient. "A random sample of 35 owners of licensed nursing homes in Detroit (domiciliary care homes were not included) was made. Generally, the owners were interviewed, but when the ownership of a home was primarily of an investment nature, the administrator or business manager was interviewed.

In size, the 35 nursing homes ranged from 10 to 89 beds. All but
one of the homes were in buildings originally constructed for other
purposes.

Among the subjects about which the owners or administrators were interviewed were: staffing problems, the licensing program, the opinions they believed the public had of proprietary nursing homes, how the prestige of this type of home could be increased, and the current problems facing proprietary nursing homes.

Data were obtained regarding the professional background of the sample population, their race, sex, and the level of education of those other than registered professional nurses or doctors. The sample group was questioned as to their reasons for working in a proprietary home, and the qualities they believed essential for one in charge of the administration of a nursing home.

The sample owner/administrator group was also asked to indicate the most difficult problems in caring for the aged patients and to list special problems in setting up rehabilitation programs. The most frequent response to the former question was "mental deterioration," and to the latter a recurring reply was that the patients lacked interest in rehabilitation.

17. Winter, Kenton E. A Survey of Facilities for the Care of the Chronically Ill and Aged in Oakland County, Michigan. Ann Arbor, Michigan, Bureau of Public Health Economics, School of Public Health, University of Michigan, 1955. 64 pp. Processed.

A six-week survey was made in the spring of 1955 of the 41 nonactive treatment facilities in Oakland County, Michigan, licensed by the Michigan State Department of Social Welfare, to gain information on the type of care provided and the characteristics and nature of disabilities of the patients.

The report (which includes sections on facilities, patients, and conclusions) presents information on size of homes, beds provided, rates charged, the type and quality of care, including the training and experience of operators and staff, and the utilization of facilities. The patient information is classified according to demographic characteristics, sources of patient funds, length of stay, patient relationship with other patients and staff, their types of interests, activities, and hobbies.

The facilities surveyed appeared to be well-equipped and staffed and seemed to be providing adequate custodial and personal care services

to the aged and chronically disabled people who are unable to care
for themselves, although they are not "skilled nursing" facilities
and are not designed or equipped to handle cases with any significant
rehabilitation potential.

18. Winter, Kenton E. Michigan Nursing Facilities and Their Fatients: A Source-Book of State and County Data. Ann Arbor, Michigan, School of Public Health, University of Michigan, 1960. 172 pp.

This reports a 1957 Statewide survey of all approved or licensed nursing facilities in Michigan. These facilities comprised 61 county operated establishments and 486 privately operated nursing homes. Field interviewers obtained information for 15, 807 patients out of an estimated total of 15, 856.

A questionnaire was used in each facility to obtain information about
the building, bed capacity, qualifications and experience of the staff,
and nature of the arrangements for physician services. In addition,
a patient census schedule was completed for every patient housed in
the facility at the time of the survey. Data on age, sex, marital
status, length of stay in the facility, the services received, physical
and mental status, and the primary diagnoses were obtained from the
nursing supervisor and from patient records.

Some of the findings are quoted below:

Nursing facility care typically was being given in buildings not
originally designed for the purpose... Buildings were typically
aged and did not generally incorporate modern fire detection
or sprinkler equipment.

Professional training in nursing at the supervisory level was
found in a minority of facilities, though these contained
slightly over one-half of all beds. This varied greatly by
type of facility, being almost universal in county-operated
medical care units and the typical pattern in incorporated
profit homes.

Charges for patient care averaged $165 per month. However,
they tended to vary widely, and only a small proportion of
facilities levied a uniform charge over all their patients.

One-half of the entire patient population was being maintained
entirely out of public funds. Only 32 percent of the patients
were being supported entirely out of private funds...

... The requirements of a large majority of the
patients were such that they could not have been cared
for in private dwellings, in the opinion of the person
in charge of nursing care, even if this alternative had
actually been available.

Seven out of ten residents of the homes were shown by the survey to need facility care, because of the necessity for nursing, custodial, or personal services not available in a private household.

19.

MINNESOTA

Nelson, Edmund K. Pilot Study to Correlate Nursing Time Requirements with Degrees of Illness of Nursing Home Patients. Minneapolis, Minnesota, University of Minnesota, April 1958. 41 pp. w/appendices, bibliography. Processed.

In this pilot study, six nursing homes representing "good
present-day care, " located in the Twin City area, were selected
to determine how nursing staff needs vary with the degree of ill-
ness of patients. A Patient Evaluation Chart was devised to pro-
vide for numerically rating the degree of illness of each of the
668 patients in the six homes. Then all patients were distributed
among the five classes based on the point-ratings obtained. The
following eight factors relating to the patient's physical and
mental condition were evaluated: (1) locomotion, (2) continence
status, (3) eating ability, (4) number and relative frequency of
medications and treatments, (5) mental status, (6) personality or
reaction toward illness, (7) instructional needs, and (8) hygienic
needs.

Ninety-six percent of the patients were distributed almost
equally among Classes I-IV, and 4 percent were in Class V,
those most disabled and requiring the most nursing care. Class I
had only a minimum degree of illness. The study showed that the
patients in any nursing home exhibit a wide range of variation in
degrees of illness and that the amount of nursing time required
for various degrees of illness can be determined. Time studies
on a selected number of patients revealed that Class I patients
required 34 minutes of nursing care daily; Class II, 1 hour,
29 minutes; Class III, 2 hours, 12 minutes; Class IV, 2 hours,
46 minutes; Class V, 4 hours, 6 minutes. The author suggests
that the patient evaluation chart could serve as a basic tool to

classify patients on admission for assignment to various nursing care areas, and also periodically to reevaluate the degree of each patient's illness.

MISSOURI

20. Washington University, The George Warren Brown School of Social Work. The 1955 Study of St. Louis County Nursing Home Residents. (An unpublished study presented as a joint master's degree thesis by 38 graduates of the school in partial fulfillment of the degree of Master of Social Work.) St. Louis, Missouri, June 1956. 311 pp. Processed.

This study, presented as a joint thesis, was undertaken in coopera-
tion with the St. Louis County Health Department at the request of
the U.S. Public Health Service. Its purpose was "to ascertain the
circumstances which lead to the use of nursing homes by the residents,
the response of each resident to this solution of his problem, and
whether any changes might be made in him or his living arrangement
that would restore or maintain him at his maximum level of
functioning and happiness.

The sample was drawn at random from a study population of patients aged 70 to 85 years who were clear of mind, who had been in a nursing home for one to three years, and who had at least one relative in the St. Louis metropolitan area. This study population was part of a group of 1, 625 persons 65 years of age or over who were residing in nursing homes in St. Louis County in 1954.

Ninety percent of the residents had adjusted to living in a nursing
home. Factors influencing the resident's adjustment to the nursing
home were analyzed. The analysis disclosed a definite relationship
between a resident's preparation for entry to a nursing home and his
later reaction to it. Almost two-thirds of the residents had not
deteriorated in either physical or psychological health since their
entry into the home. The study also attempted to assess the nursing
home administrator's attitude toward the residents, as well as the
resident's attitude toward the administrator. It found that the
administrator plays an important role in the resident's adjustment
to the nursing home. The study notes the training of administrators
as one of the most serious program needs.