Government Inventories Nursing Homes

John E. Andrus Memorial Home, Hastings-on-Hudson, NY, 1955
Built as a nursing home in 1953. Library of Congress: Architecture and Interior Design for 20th Century America Photographs by Samuel Gottscho and William Schleisner, 1935-1955

Now that the government was so involved in the provision of nursing home care, it was determined that a national survey of the facilities was needed to identify how many there were and other basic characteristics of the facilities. The names given to these surveys varied, but most of the early ones were called "Master Facility Inventory Surveys". One of the problems designers of the surveys had was in defining what constituted a "nursing home". They settled on four classifications: nursing care homes, personal care with nursing homes, personal care homes, and domiciliary homes, and decided to count all facilities with 3 or more beds.

The "personal care home" classification more nearly resembles what we today call "assisted living" and the "domiciliary care home" is more of a board and care home, neither of which are included in modern statistics about nursing homes. To make things even more confusing, in later reports, the term "nursing home" sometimes refers to the first two categories combined, and in other reports only homes in the first category are counted as "nursing homes" and all three of the lower categories are grouped together as "personal care and other homes". 

Another problem in early surveys was making sure that all facilities had been identified and counted. The federal government provided no certification or oversight to the industry, so there was no "master list" to refer to. The surveyors relied partly on information provided by the state licensing bureaus, but the states all had different standards for licensing homes, and some of them had little or no information in their own files. For several years after the surveys were initiated, reports analyzing the data emphasized that there was no way to be sure whether facilities that appeared for the first time on a new survey were actually new nursing homes, or whether they had just been omitted from earlier reports.

The first ever national inventory of nursing homes was done in 1954. When the first survey was tabulated, it was estimated that there were about 270,000 people living in 9,000 homes classified as "nursing care home" or "personal care home with nursing". Virtually all the homes were for-profit facilities -- 86% of all nursing homes were proprietary, 10% were voluntary, and only 4% were public. 

Hotel St. Regis, Cleveland, OH
Built 1905, Remodeled into efficiency units in 1929. Converted to a retirement home in 1959, later became Abbey Nursing Home. Scheduled for demolition in 1989. Library of Congress: Historic American Buildings Survey (HABS)