NH Residents with Low Care Needs

Where there are large numbers of people living in nursing homes who have low care needs, this can indicate a lack of HCBS access and/or service capacity in that area. People who require fairly low levels of support can almost always be served more appropriately in the community. While this indicator uses nursing home data, we consider it primarily an indicator of how much choice people have with regard to setting and provider. At the national level, nine percent of nursing home residents have low care needs. At the state level, this rate ranges from under five percent in six states (District of Columbia, Hawaii, Indiana, Maine, Maryland, North Carolina, Utah) to more than 20 percent in five states (Montana, Kansas, South Dakota, Oklahoma and Missouri).

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†† Due to small sample size of one or more racial/ethnic groups, this indicator could not be calculated.  An imputed value was used for scoring, but is not displayed or ranked.


The percentage of nursing home residents who met the criteria of having low care needs. MDS assessments were used to establish the population of residents in all nursing facilities on the 1st Thursday in April. This measure was calculated from the most recent MDS assessment as of April 2021. Low care status is met if a resident does not require physical assistance in any of the four late-loss ADLs (bed mobility, transferring, using the toilet, and eating) and is not classified in either the “Special Rehab” or “Clinically Complex” Resource Utilization Group (RUG-IV). *Low care status may apply to a resident who is also classified in either of the lowest 2 of the 44 RUG-IV groups.

*On October 1, 2019, CMS replaced RUG-IV with a new case mix methodology, the Patient Driven Payment Model (PDPM), and stopped supporting precalculated RUG-IV values via the MDS. To continue utilizing the low care algorithm, RUG-IV values for a given MDS assessment were instead calculated using the last version of the public SAS classification code available from CMS.

These data were averaged at the state level following the LTSS State Scorecard approach to measuring equity.

Equity adjustment: Race/ethnicity is indicated in MDS by a 6 category multiple response variable with choices:

  • American Indian or Alaska Native
  • Asian
  • Black or African American
  • Hispanic or Latino
  • Native Hawaiian or Other Pacific Islander
  • White 

Residents were classified by race/ethnicity as follows:

  • Hispanic/Latino: “Hispanic or Latino” is selected
  • All Other Races/Ethnicities: exactly one race/ethnicity is selected (a resident is classified as “Asian” if and only if “Asian” is selected and no other races/ethnicity is selected)
  • Multiracial: “Hispanic or Latino” is not selected and two or more other races/ethnicities are selected

Data are presented for all residents and for each race/ethnicity group with sufficient sample size to report.  Residents without any race/ethnicity category selected are included in all residents but not in any subgroup.

For the equity adjusted metric score, residents are divided into 2 groups: White, and an aggregate grouping of {American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, Native Hawaiian or Other Pacific Islander, and Multiracial}.  The lower performing group (higher percentage of residents with low care needs) is scored and ranked as a performance metric.

In District of Columbia, Maine, New Hampshire, Vermont, and Wyoming the sample size was not sufficient to score both groups.  The metric value is therefore shown as N/A and the state is not ranked.  The metric value for all nursing home residents is used for calculating dimension-level performance.

Analysis of 2021 MDS 3.0 state-level care data provided by the Changing Long-Term Care in America Project at Brown University in February-April 2023.

Brown University (2023). Changing Long Term Care in America Project at Brown University funded in part by the National Institute on Aging (1P01AG027296). Providence, RI: Brown University School of Public Health,


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