The 4% Fallacy: A Methodological and Empirical Critique of Extended Care Facility Population Statistics

Much use has been made of population statistics which indicate that only 4% of those over 65 are in nursing homes and other extended care facilities (ECF). These data are misleading, however, for they are cross-sectional and seriously underestimate the probability of a person coming to an ECF sooner or later. Two small empirical studies are reported using, respectively, published obituary notices and death certificates for the metropolitan Detroit area during 1971. It was found that a minimum of 20% of all men and women over 65 who died in the study year were residents of a nursing home, and 24% were residents of one or another kind of ECF. Clearly, more people died in ECFs than are usually thought to be there in the first place. Discussion focuses upon the magnitude of the terminal care problem and the need to recognize the full scope of ECF difficulties which have often been underestimated because of careless use of the population data.