Exhibit 4:
Nursing home characteristics by nursing homes deciles based on Alzheimer’s disease and related dementias (ADRD) or cognitive impairment (CI) distribution, US national nursing home residents, 2017–19
| Characteristics | ADRD-CI residents as percentage of total nursing home census (deciles) | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 0%–10% (mean) | 11%–20% (mean) | 21%–30% (mean) | 31%–40% (mean) | 41%–50% (mean) | 51%–60% (mean) | 61%–70% (mean) | 71%–80% (mean) | 81%–90% (mean) | 91%–100% (mean) | |
| Number of nursing homes in the decile | 22 | 89 | 221 | 765 | 2,203 | 4,035 | 4,029 | 1,967 | 448 | 130 |
| Ownership (%) | ||||||||||
| For profit | 63.6 | 66.3 | 79.2 | 82.4 | 78.8 | 75.2 | 68.3 | 64.5 | 74.1 | 78.5 |
| Part of a chain | 59.1 | 58.4 | 60.2 | 68.5 | 68.0 | 60.9 | 56.7 | 52.4 | 51.8 | 65.4 |
| Nursing homes with dementia special care units | 0.00 | 0.00 | 0.45 | 1.44 | 6.04 | 11.6 | 20.7 | 24.1 | 20.5 | 34.6 |
| Staffing hours per resident-day | ||||||||||
| RNs | 1.43 | 1.23 | 0.80 | 0.53 | 0.45 | 0.40 | 0.38 | 0.35 | 0.31 | 0.35 |
| LPNs | 0.91 | 0.90 | 0.87 | 0.82 | 0.80 | 0.79 | 0.78 | 0.78 | 0.77 | 0.71 |
| CNAs | 2.44 | 2.49 | 2.26 | 2.13 | 2.12 | 2.14 | 2.18 | 2.18 | 2.19 | 2.37 |
| Staffing instability a | ||||||||||
| RNs | 28.8 | 25.4 | 30.2 | 30.2 | 30.5 | 31.6 | 31.8 | 33.1 | 35.8 | 35.5 |
| LPNs | 31.7 | 26.8 | 24.8 | 20.3 | 18.4 | 17.2 | 16.4 | 16.2 | 15.9 | 17.8 |
| CNAs | 13.7 | 10.3 | 9.2 | 7.2 | 6.2 | 6.0 | 5.6 | 5.9 | 6.1 | 5.9 |
| Beds and occupancy | ||||||||||
| Average number of beds | 37.4 | 64.4 | 84.3 | 98.1 | 104.7 | 109.7 | 116.5 | 115.3 | 103.6 | 81.8 |
| Occupancy (%) | 74.2 | 76.6 | 72.3 | 76.3 | 78.5 | 80.3 | 81.2 | 81.5 | 81.8 | 86.6 |
| Quality a | ||||||||||
| Average 5-star overall | 4.28 | 4.29 | 3.63 | 3.30 | 3.24 | 3.19 | 3.29 | 3.33 | 3.23 | 3.57 |
| Average 5-star quality measures | 3.95 | 3.94 | 4.01 | 3.99 | 3.89 | 3.78 | 3.77 | 3.80 | 3.71 | 3.96 |
| Average 5-star survey | 3.96 | 3.70 | 3.05 | 2.67 | 2.68 | 2.72 | 2.87 | 2.93 | 2.93 | 3.10 |
| Average 5-star staffing | 4.21 | 4.06 | 3.48 | 3.24 | 3.17 | 3.06 | 3.03 | 2.98 | 2.81 | 3.03 |
SOURCE Authors’ analysis of 2017–19 National Nursing Homes Payroll Based Journal Data, Long-Term Care Focus data, and the Centers for Medicare and Medicaid Services data catalog. NOTES All numbers are means by decile except in the rows indicated as “number.” RN is registered nurse. LPN is licensed practical or vocational nurse. CNA is certified nurse aide.
a
Number of nursing homes with data for these categories were somewhat smaller from the other categories and are available from the lead author on request.