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Challenges and Issues in Enumerating and Surveying Health Related Group Quarters (HRGQ): Skilled Nursing and Hospice Facilities

*Sonia Salari, University of Utah 

Keywords: group quarters, ethnographic methods, skilled nursing, hospice

Census enumeration in health related group quarters has historically presented a challenge. Residents typically have serious disabilities from poor health status, dementia, mental illness, injuries or a history of developmental delay. Population transitions are rapid in these facilities due to a high rate of death, discharge, admission, rehabilitation and the provision of short term respite care services. Hence, HRGQ populations are often counted with the use of administrative lists. This option requires the use of staff time, with very little resident participation. Allowing resident self report would require a selection process that identifies those capable and willing to participate. This research is part of a larger U.S. Census Bureau 2010 Ethnographic Study designed to develop the most feasible method to evaluate the accuracy of the census count in the type of living arrangements known as “group quarters,” including health related group quarters such as skilled nursing and hospice facilities. The findings of this study are based on ethnographic observational data and focus group interviews collected from two skilled nursing homes and an in-patient hospice. Population transitions associated with admissions, discharges and deaths complicated the count of facility residents. Medicare rehabilitation short stays and respite care services increased the transitory nature of residence in skilled nursing facilities on the census date. Recommendations included the collection of admission date and last known residence as well as in-person resident visits to prevent duplicate counts. In addition, measurement would benefit from paid institutional assistance from administrative staff who often felt “census fatigue” as they dedicated time and financial resources to the creation of administrative lists.