There are a number of challenging issues to be decided relative to the sample design for studies of the nature and prevalence of abuse and neglect in long-term care settings. For example, most studies seeking to establish prevalence will involve a multistage sample design. For example, a study that proposed in-person interviews with residents or staff would probably select geographic areas at the first stage, facilities at the second stage, and residents or staff at the third stage.17
For nursing homes, a sampling list exists at the national level from the OSCAR database listing all facilities that participate in Medicare or Medicaid. This covers nearly all licensed nursing homes (i.e., more than 95 percent) (Strahan, 1997).
For residential care facilities, there is no national list of facilities. Indeed, securing a list will be a challenging task. First, the list must be constructed at the state level. Second, there are multiple licensing agencies in many states. Thus, a decision must be made about what types of facilities to include and what types to exclude. In general, there are two types of residential care facilities. One group includes facilities specifically licensed for special populations, such as for persons with substance abuse, mental illness, or developmental disabilities. They represent a small proportion of all residential care facilities (e.g., about 7,000 of more than 40,000 facilities) and an even smaller proportion of beds (Clark et al., 1994; Hawes et al., 1995a). Moreover, they tend to receive special funding for programmatic services and to have higher staffing levels than traditional residential care facilities. A second group of facilities, the most common, is licensed for general populations and includes frail elderly and persons with psychiatric conditions. These facilities are generally licensed by state health departments, departments of aging, and departments of community services. In some states, there is a separate licensure category for very small homes (e.g., two to six beds). Moreover, as noted, in a few states, even for the general, mixed population facilities, there are multiple licensing agencies, or some that license while others offer registration (e.g., for Medicaid waiver programs) or certification. Thus, securing a comprehensive, unduplicated list is a challenge.
Another critical sampling issue is whether to oversample among larger facilities. An estimated two-thirds of all residential care facilities have 2 to