Part I--Proposed New Industry Structure for Ambulatory Health Care Services, Hospitals, Nursing and Residential Care Facilities, and Social Assistance Section A--NAICS Structure North American Industry Classification System (NAICS) Agreement Number 11 This Document represents the proposed agreement on the structure of the North American Industry Classification System (NAICS) for the following industries: Ambulatory Health Care Services Hospitals Nursing and Residential Care Facilities Social Assistance The detailed NAICS structure along with a brief description of the structure is attached (Attachments 1 and 2). Each country agrees to release a copy of the proposed NAICS structure to interested data users. Comments received will be shared among the countries and additional discussions will be held before a final decision on the structure is made. Each country may add additional detailed industries, below the 4-digit level of NAICS, as necessary to meet national needs, so long as this additional detail aggregates to a 4-digit NAICS level in order to ensure full comparability among the three countries. This NAICS structure was presented and provisionally accepted at the NAICS Committee meeting held on September 27, 1995 - September 29, 1995 in Mexico City, Mexico. Accepted Signature Date Canada /S/ Jacob Ryten 9/29/95 Mexico /S/ Enrique Ordaz 9/29/95 United States /S/ Jack E. Triplett 9/29/95 ATTACHMENT 1--NAICS STRUCTURE XX Ambulatory Health Care Services XXX Offices of Physicians XXXX Offices of Physicians XXX Offices of Dentists XXXX Offices of Dentists XXX Offices of Other Health Practitioners XXXX Offices of Chiropractors XXXX Offices of Optometrists XXXX Offices of Mental Health Practitioners, except Physicians XXXX Offices of Physical, Occupational, and Speech Therapists and Audiologists XXXX Offices of All Other Health Practitioners XXX Outpatient Care Facilities XXXX Family Planning Centers XXXX Outpatient Mental Health Facilities XXXX Other Outpatient Care Facilities XXX Medical and Diagnostic Laboratories XXXX Medical and Diagnostic Laboratories XXX Home Health Care Services XXXX Home Health Care Services XXX Miscellaneous Ambulatory Health Care Services XXXX Ambulance Services XXXX Other Miscellaneous Ambulatory Health Care Services XX Hospitals XXX General Medical and Surgical Hospitals XXXX General Medical and Surgical Hospitals XXX Psychiatric and Substance Abuse Hospitals XXXX Psychiatric and Substance Abuse Hospitals XXX Specialty Hospitals, Except Psychiatric and Substance Abuse Hospitals XXXX Specialty Hospitals, Except Psychiatric and Substance Abuse Hospitals XX Nursing and Residential Care Facilities XXX Nursing Care Facilities XXXX Nursing Care Facilities XXX Mental Health, Mental Retardation, and Substance Abuse Facilities XXXX Mental Retardation Facilities XXXX Mental Health and Substance Abuse Facilities XXX Community Care Facilities for the Elderly XXXX Community Care Facilities for the Elderly XXX Other Residential Care Facilities XXXX Other Residential Care Facilities XX Social Assistance XXX Individual and Family Services XXXX Child and Youth Services XXXX Services for the Elderly and Persons with Disabilities XXXX Other Individual and Family Services XXX Community Food, Shelter, and Emergency and Relief Services XXXX Community Food Services XXXX Community Housing Services XXXX Emergency and Other Relief Services XXX Job Training and Vocational Rehabilitation Services XXXX Job Training and Vocational Rehabilitation Services XXX Child Day-care Services XXXX Child Day-care Services Attachment 2--North American Industry Classification System Draft Classification for: Ambulatory Health Care Services Hospitals Nursing and Residential Care Facilities Social Assistance Representatives of the statistical agencies of Canada, Mexico and the United States agree to a draft classification for these industries. The draft classification constitutes the sector Health and Social Assistance. The sector is subdivided into 4 subsectors, 18 industry groups, and 30 industries. A General Outline The health and social services industries provide health care and social assistance for individuals. Because it is sometimes difficult to distinguish between the boundaries of health care and social assistance, these industries are grouped together in a new Health and Social Assistance sector. The industries are arranged in order from those providing the most intensive type of health care to those providing minimal health care with social assistance to those providing only social assistance to individuals. Industries in the Ambulatory Health Care Services subsector provide health care services directly or indirectly to ambulatory patients and do not usually provide inpatient overnight services. Health practitioners in this subsector provide outpatient services, with the facilities and equipment not usually being the most significant part of the production process. The Hospitals subsector includes establishments that provide medical, diagnostic, and treatment services that include physician, nursing and other health services to inpatients and the specialized accommodation services required by inpatients. Hospitals also may provide outpatient services as a secondary activity. Establishments in the Hospitals subsector provide inpatient health services, many of which can only be provided using the specialized facilities and equipment that form a significant and integral part of the production process. The Nursing and Residential Care Facilities subsector includes establishments that provide residential care combined with either nursing, supervisory or other types of care as required by the residents. In this subsector, the facilities are a significant part of the production process and the care provided is a mix of health and social services with the health services being largely some level of nursing services. The Social Assistance subsector includes establishments that provide a wide variety of assistance services directly to their clients. These services do not include residential or accommodation services except on a short stay basis. Limitations and Constraints of the Classification The draft classification avoids the problem of the delineation of the boundary between health and social services by incorporating both into a continuum. General Medical and Surgical Hospitals is a very large industry group. NAICS developers considered subdividing this NAICS industry; however, research indicated a wide range of services are typically provided at general medical and surgical hospitals. Some hospitals provide specific advanced medical procedures such as organ transplants that require skilled specialists and special equipment for the operating and recovery phases of the procedures. Other hospitals may offer the same or different advanced medical procedures with their corresponding technologies, along with the less specialized services and less sophisticated technologies that are offered by virtually all hospitals. The mix of services and technologies among hospitals varies significantly along this continuum, but no clear basis for differentiating among general and surgical hospitals based on their mix of services or technological threshold was found. Relationship to ISIC All of the 30 industries included in these subsectors are contained within Division 85, Health and Social Work, in the current International Standard Industrial Classification of All Economic Activities (ISIC, Revision 3) of the United Nations. ISIC Division 85, however, includes veterinary services; in NAICS, veterinary services are in the Professional, Scientific, and Technical Services subsector. Some Changes to the National Classifications Changes to the Canadian SIC include splitting CSIC 8621, Homes for Personal and Nursing Care, into Nursing Care Facilities and Community Care Facilities for the Elderly, and expanding CSIC 8646, Meal Services (Non-Commercial), to include a broader range of food services in the new industry Community Food Services. Community Housing Services and Emergency and Other Relief Services are essentially new industries for Canada. Air ambulance services move out of CSIC 4513, Non-Scheduled Air Transport, Specialty Industry, to Ambulance Services. CSIC 8689, Other Health Laboratories, moves out of this sector. CSIC 8693, Health Care Research Agencies, moves out of this sector. For Mexico, the new Health and Social services sector represents the grouping of medical and social assistance classified in CMAP groups 9231, Medical, Dental, and Veterinary Services (Private Sector); 9232, Medical, Dental, and Veterinary Services (Public Sector); 9241, Social Security Services (Private Sector); and 9242, Social Security Services (Public Sector). Veterinary services are no longer included in this sector. A distinction is made between the public and private sector in CMAP for both health and social services. Because this distinction is not maintained in NAICS, it will be made by Mexico at the national industry level. For the United States, there is a major change to 1987 SIC's 8011, Offices and Clinics of Doctors of Medicine, and 8031, Offices and Clinics of Doctors of Osteopathy. NAICS industry Offices of Physicians now includes both doctors of medicine and doctors of osteopathy. The 1987 distinction between the two types of doctors has been eliminated to recognize the convergence of the two types of medical service. The training and the specialities in which the doctors of medicine and doctors of osteopathy are engaged in many cases are the same and it is more and more common for the two types of doctors to practice together. The U.S. will define a separate national industry for physicians who practice mental health specialties. In addition to this change to 1987 SIC's 8011 and 8031, HMO medical centers and ambulatory surgical and free-standing emergency centers have been moved to NAICS industry Other Outpatient Care Facilities. The U.S. will recognize separate industries for these activities in its national detail. Another major change is the transfer of ambulance services from 1987 SIC's 4119, Local Passenger Transportation, Not Elsewhere Classified, and 4522, Air Transportation, Nonscheduled, into Ambulatory Health Care Services. The medical services included in the Ambulance Services industry are judged to be of greater significance than the vehicle used and the significance of the medical service dwarfs the transportation service also provided. Dental Laboratories, 1987 SIC 8072, are moved from the medical subsector to the Miscellaneous Manufacturing subsector, because making dentures, crowns, bridgework and artificial teeth is similar to other manufacturing processes classified there. Achievements of Objectives The classification meets the objectives for the North American Industry Classification System (NAICS). It is comprised of industries that group establishments with similar production processes, that is, it applies the production-oriented economic concept. In the main, the hierarchical structure of the classification also follows the production concept. The classification achieves comparability for the three participating countries. All countries agree on the definitions of the industries. Other objectives of the NAICS project have also been met. New industries that recognize current health and social service establishments have been established. New and emerging service industries have been created, especially in the area of social assistance. The industries are economically significant. Some NAICS industries are much larger than others, but this was necessary to ensure comparability among the countries or because it was not possible to further subdivide large industries. Finally, disruptions to time series, while they exist, have been minimized to the extent possible. Most of the changes to time series reflect the changing structure of health care across the three countries. For the U.S., additional changes have been made to the national detail to reflect these changes. Section B-Annex: United States National Industry Detail As explained in the Structure presentation of this notice, for a number of reasons 4-digit industries in the four NAICS industry subsectors presented in Part 1, Section A--Attachment 1, contain less detail than is currently in the U.S. SIC system, and less detail than is required to meet important analytical requirements in the U.S. The three country agreement on NAICS envisions that each country may develop national detailed industries below the NAICS industry level, so long as the national detail can be aggregated to the NAICS classification, thus assuring full North American comparability. The ECPC is proposing U.S. 5-digit industry detail for the four NAICS industry subsectors covered in Part I of this notice. For cases where no 5-digit detail is shown, the ECPC is proposing that the NAICS 4-digit industries will also represent the most detailed U.S. industries. TABLE 1 The definitions of status codes are as follows: E-existing industry; N-new industry; R-revised industry; and * means "part of". The abbreviation NEC is used for Not Elsewhere Classified. 1997 NAICS and U.S. description Status code 1987 SIC code 1987 SIC description XX Ambulatory Health Care Services XXX Offices of Physicians XXXX Offices of Physicians XXXXX Offices of Physicians except Mental Health Specialists N *8011 Offices and Clinics of Doctors of Medicine (except mental health specialists) *8031 Offices and Clinics of Doctors of Osteopathy (except mental health specialists) XXXXX Offices of Physicians, Mental Health Specialists N *8011 Offices and Clinics of Doctors of Medicine (mental health specialists) *8031 Offices and Clinics of Doctors of Osteopathy (mental health specialists) XXX Offices of Dentists XXXX Offices of Dentists E 8021 Offices and Clinics of Dentists XXX Offices of Other Health Practitioners XXXX Offices of Chiropractors E 8041 Offices and Clinics of Chiropractors XXXX Offices of Optometrists E 8042 Offices and Clinics of Optometrists XXXX Offices of Mental Health Practitioners, except Physicians N *8049 Offices and Clinics of Health Practitioners, NEC (mental health practitioners except physicians) XXXX Offices of Physical, Occupational, and Speech Therapists and Audiologists N *8049 Offices and Clinics of Health Practitioners, NEC (physical, occupational, speech therapists, and audiologists) XXXX Offices of All Other Health Practitioners XXXXX Offices of Podiatrists E 8043 Offices and Clinics of Podiatrists XXXXX Miscellaneous Health Practitioners N *8049 Offices and Clinics of Health Practitioners, NEC (except mental health practitioners, physical, occupational, speech therapists, and audiologists) XXX Outpatient Care Facilities XXXX Family Planning Centers N *8093 Speciality Outpatient Facilities, NEC (family planning centers) *8099 Health and Allied Services, NEC (childbirth preparation) XXXX Outpatient Mental Health Facilities N *8093 Specialty Outpatient Facilities, NEC (mental health facilities) XXXX Other Outpatient Care Facilities XXXXX HMO Medical Centers N *8011 Offices and Clinics of Doctors of Medicine (HMO Medical Centers) XXXXX Kidney Dialysis Centers E 8092 Kidney Dialysis Centers XXXXX Ambulatory Surgical and Freestanding Emergency Centers N *8011 Offices and Clinics of Doctors of Medicine (surgical and emergency centers) XXXXX All Other Outpatient Care Facilities N *8093 Specialty Outpatient Facilities, NEC (except family planning and mental health centers) XXX Medical and Diagnostic Laboratories XXXX Medical and Diagnostic Laboratories XXXXX Medical Laboratories R *8071 Medical Laboratories (except diagnostic imaging centers) XXXXX Diagnostic Imaging Centers N *8071 Medical Laboratories (diagnostic imaging centers) XXX Home Health Care Services XXXX Home Health Care Services XXXXX Home Health Agencies N *8082 Home Health Care Services (home health agencies) XXXXX Other Home Health Care Services N *8082 Home Health Care Services (except home health agencies) XXX Miscellaneous Ambulatory Health Care Services XXXX Ambulance Services N *4119 Local Passenger Transportation, NEC (land ambulance) *4522 Air Transportation, Nonscheduled (air ambulance) XXXX Other Miscellaneous Health Care Services XXXXX Blood and Organ Banks N *8099 Health and Allied Services, NEC (blood and organ banks) XXXXX All Other Miscellaneous Health Care Services N *8099 Health and Allied Services, NEC (except blood and organ banks) XX Hospitals XXX General Medical and Surgical Hospitals XXXX General Medical and Surgical Hospitals R 8062 General Medical and Surgical Hospitals *8069 Specialty Hospitals, Except Psychiatric (childrens' hospitals) XXX Psychiatric and Substance Abuse Hospitals XXXX Psychiatric and Substance Abuse Hospitals R 8063 Psychiatric Hospitals *8069 Specialty Hospitals, Except Psychiatric (substance abuse hospitals) XXX Specialty Hospitals, except Psychiatric and Substance Abuse Hospitals XXXX Specialty Hospitals, except Psychiatric and Substance Abuse Hospitals R *8069 Specialty Hospitals, Except Psychiatric (except childrens' and substance abuse hospitals) XX Nursing and Residential Care Facilities XXX Nursing Care Facilities XXXX Nursing Care Facilities N *8051 Skilled Nursing Care Facilities (except continuing care retirement communities) *8052 Intermediate Care Facilities (except continuing care retirement communities and mental retardation facilities) *8059 Nursing and Personal Care Facilities, NEC (except continuing care retirement communities) XXX Mental Health, Mental Retardation, and Substance Abuse Facilities XXXX Mental Retardation Facilities N *8052 Intermediate Care Facilities (mental retardation facilities) XXXX Mental Health and Substance Abuse Facilities N *8361 Residential Care (mental health and substance abuse facilities) XXX Community Care Facilities for the Elderly XXXX Community Care Facilities for the Elderly XXXXX Continuing Care Retirement Communities N *8051 Skilled Nursing Care Facilities (continuing care retirement communities) *8052 Intermediate Care Facilities (continuing care retirement communities) *8059 Nursing and Personal Care Facilities, NEC (continuing care retirement communities) XXXXX Homes for the Elderly N *8361 Residential Care (homes for the elderly) XXX Other Residential Care Facilities XXXX Other Residential Care Facilities N *8361 Residential Care (except mental health and substance abuse facilities, homes for the elderly) XX Social Assistance XXX Individual and Family Services XXXX Child and Youth Services N *8322 Individual and Family Social Services (child and youth services) XXXX Services for the Elderly and Persons with Disabilities N *8322 Individual and Family Social Services (services for the elderly and disabled) XXXX Other Individual and Family Services N *8322 Individual and Family Social Services (except services for children, youth, elderly, disabled; food, housing, emergency and relief) XXX Community Food, Shelter, and Emergency Relief Services XXXX Community Food Services N *8322 Individual and Family Social Services (food services) XXXX Community Housing Services XXXXX Temporary Shelter N *8322 Individual and Family Social Services (temporary shelter) XXXXX Other Community Housing Services N *8322 Individual and Family Social Services (housing services except temporary shelter) XXXX Emergency and Other Relief Services N *8322 Individual and Family Social Services (emergency and relief services) XXX Job Training and Vocational Rehabilitation Services XXXX Job Training and Vocational Rehabilitation Services E 8331 Job Training and Vocational Rehabilitation Services XXX Child Day Care Services XXXX Child Day-care Services E 8351 Child Day Care Services TABLE 2 The abbreviation "pt" mean "part of". @ means a time series break has been created that is greater than 3% of the 1992 revenues for the 1987 SIC industry. 1987 SIC code 1987 SIC description 1997 U.S. description 4119@ Local Passenger Transportation, NEC Ambulance Services (pt.) 4522@ Air Transportation, Nonschedulaed Ambulance Services (pt.) 8011@ Offices and Clinics of Doctors of Medicine Clinics of Physicians, Surgical and Emergency Centers Ambulatory Surgical and Freestanding Emergency Centers HMO Medical Centers HMO Medical Centers Offices of Physicians, Mental Health Specialists Offices of Physicians, Mental Health Specialists (pt.) Other Offices of Physicians Offices of Physicians, Except Mental Health Specialists (pt.) 8021 Offices and Clinics of Dentists Offices of Dentists 8031@ Offices and Clinics of Doctors of Osteopathy Offices of Doctors of Osteopathy, Except Mental Health Offices of Physicians, Except Mental Health Specialists (pt.) Offices of Doctors of Osteopathy, Mental Health Specialists Offices of Physicians, Mental Health Specialists (pt.) 8041 Offices and Clinics of Chiropractors Offices of Chiropractors 8042 Offices and Clinics of Optometrists Offices of Optometrists 8043 Offices and Clinics of Podiatrists Offices of Podiatrists 8049 Offices and Clinics of Health Practitioners, Not Elsewhere Classified Mental Health Practitioners, Except Physicians Offices of Mental Health Practitioners, Except Physicians Offices of Physical, Occupational, and Speech Therapists and Audiologists Offices of Physical, Occupational, and Speech Therapists and Audiologists Other Offices of Heath Practitioners Miscellaneous Health Practitioners 8051@ Skilled Nursing Care Facilities Continuing Care Retirement Communities Continuing Care Retirement Communities (pt.) All Other Skilled Nursing Care Facilities Nursing Care Facilities (pt.) 8052@ Intermediate Care Facilities Continuing Care Retirement Communities Continuing Care Retirement Communities (pt.) Mental Retardation Facilities Mental Retardation Facilities Other Intermediate Care Facilities Nursing Care Facilities (pt.) 8059@ Nursing and Personal Care Facilities, Not Elsewhere Classified Continuing Care Retirement Communities Continuing Care Retirement Communities (pt.) Other Nursing and Personal Care Facilities Nursing Care Facilities (pt.) 8062@ General Medical and Surgical Hospitals General Medical and Surgical Hospitals (pt.) 8063@ Psychiatric Hospitals Psychiatric and Substance Abuse Hospitals (pt.) 8069@ Specialty Hospitals, Except Psychiatric Children's Hospitals General Medical and Surgical Hospitals (pt.) Psychiatric and Substance Abuse Hospitals Psychiatric and Substance Abuse Hospitals (pt.) Other Specialty Hospitals Specialty Hospitals, Except Psychiatric and Substance Abuse Hospitals 8071 Medical Laboratories Diagnostic Imaging Centers Diagnostic Imaging Centers Medical Laboratories, Except Diagnostic Imaging Centers Medical Laboratories 8072 Dental Laboratories Dental Laboratories (Included in Miscellaneous Manufacturing subsector) 8082 Home Health Care Services Home Health Agencies Home Health Agencies Home Health Care Services, Except Home Health Agencies Other Home Health Care Services 8092 Kidney Dialysis Centers Kidney Dialysis Centers 8093 Specialty Outpatient Facilities, Not Elsewhere Classified Family Planning Centers Family Planning Centers Outpatient Mental Health Facilities Outpatient Mental Health Facilities Other Specialty Outpatient Facilities All Other Outpatient Care Facilities 8099 Health and Allied Services, Not Elsewhere Classified Blood and Organ Banks Blood and Organ Banks Medical artists Graphic Design Services (pt.) (Included in Professional, Scientific, and Technical Services subsector) Medical Photography Commercial Photography (pt.) (Included in Professional, Scientific, and Technical Services subsector) Other Health and Allied Services All Other Miscellaneous Health Care Services 8322 Individual and Family Social Services Child and Youth Services Child and Youth Services Community Food Services Community Food Services Community Housing Services, Except Temporary Shelters Other Community Housing Services Emergency and Other Relief Services Emergency and Other Relief Services Services for the Elderly and Persons with Disabilities Services for the Elderly and Persons with Disabilities Temporary Shelter Temporary Shelter Other Individual and Family Services Other Individual and Family Services 8331 Job Training and Vocational Rehabilitation Services Job Training and Vocational Rehabilitation Services 8351 Child Day-care Services Child Day Care Services 8361 Residential Care Homes for the Elderly Homes for the Elderly Mental Health and Substance Abuse Facilities Mental Health and Substance Abuse Facilities Other Residential Care Other Residential Care Facilities Description of Changes to the U.S. System 1. Ambulatory Health Care Services Sixteen new NAICS or national industries were added to the 1997 industry structure for this subsector to better describe the growing and changing U.S. Ambulatory Health Care Services industries. A number of these new industries were created from 1987 Not Elsewhere Classified (NEC) industries. The new industries are: Offices of Physicians, except Mental Health Specialists from part of 1987 SIC code 8011, Offices and Clinics of Doctors of Medicine, and part of 1987 SIC code 8031, Offices and Clinics of Doctors of Osteopathy. In most cases, these two types of physicians provide the same services. Offices of Physicians, Mental Health Specialists from Part of 1987 SIC code 8011, Offices and Clinics of Doctors of Medicine, and part of 1987 SIC code 8031, Offices and Clinics of Doctors of Osteopathy. Mental health is separated from other physicians because the production process they use most differs from that used by other physicians. Offices of Mental Health Practitioners, Except Physicians from part of 1987 SIC 8049, Offices of Health Practitioners, NEC. This new industry was created because it had a unique production process. Offices of Physical, Occupational, and Speech Therapists and Audiologists from part of 1987 SIC 8049, Offices of Health Practitioners, NEC. This new industry was created because it had a unique production process. Miscellaneous Health Practitioners from part of 1987 SIC 8049, Offices and Clinics of Health Practitioners, NEC. This is one of two new residual categories from the current NEC category. It includes only offices of practitioners. Family Planning Centers from part of 1987 SIC 8093, Specialty Outpatient Clinics, NEC, and part of 1987 SIC 8099, Health and Allied Services, NEC. This new industry was created because it had a unique production process. Outpatient Mental Health Facilities from part of 1987 SIC 8093, Specialty Outpatient Clinics, NEC. This new industry was created because it had a unique production process. HMO Medical Centers from part of 1987 SIC 8011, Offices and Clinics of Doctors of Medicine. The range of services provided in these centers are generally greater than in physician offices. Ambulatory Surgical and Freestanding Emergency Centers from part of 1987 SIC 8011, Offices and Clinics of Doctors of Medicine. This new industry was created because it had a unique production process . All Other Outpatient Care Facilities from part of 1987 SIC 8049, Offices and Clinics of Health Practitioners, NEC. This is the second residual category from the current NEC. It contains only outpatient care facilities. Diagnostic Imaging Centers from part of 1987 SIC 8071, Medical Laboratories. This new industry was created because it had a unique production process . Home Health Agencies from part of 1987 SIC 8082, Home Health Care Services. This industry provides skilled nursing, physical and other therapy, and other services provided in the home. Other Home Health Care Services from part of 1987 SIC 8082, Home Health Care Services. This residual of the current industry includes, for example, home inhalation, infusion, and perfusion therapy. Ambulance Services from parts of 1987 SIC 4119, Local Passenger Transportation, Not Elsewhere Classified, and 1987 SIC 4522, Air Transportation, Nonscheduled. The medical service provided by ambulance personnel is more important than the transportation. Blood and Organ Banks from part of 1987 SIC 8099, Health and Allied Services, NEC. The new industry was created because it had a unique production process. All Other Miscellaneous Health Care Services from part of 1987 SIC 8099, Health and Allied Services, NEC. This is the new residual category for the current 8099. 2. Hospitals There are no new industries, but some content changes were made to achieve comparability among the three countries. These are: Children's hospitals were moved from 1987 SIC 8069, Specialty Hospitals, except Psychiatric, to General Medical and Surgical Hospitals. These hospitals provide the wide variety of services found in general hospitals. Alcohol and drug abuse hospitals were moved from 1987 SIC 8069, Speciality Hospitals, except Psychiatric, to form part of Psychiatric and Substance Abuse Hospitals to recognize the growing number of these hospitals. 3. Nursing and Residential Care Facilities The three industries in 1987 SIC Industry Group 805, Nursing and Personal Care Facilities, and 1987 SIC 8361, Residential Care, have been redistributed into five NAICS industries and two additional National industries to better describe this growing activity and to eliminate the distinction made in 1987 based on the Medicare/Medicaid programs. The new industries are: Nursing Care Facilities from parts of 1987 SIC 8051, Skilled Nursing Care Facilities; 1987 SIC 8052, Intermediate Care Facilities; and 1987 SIC 8059, Nursing and Personal Care Facilities, NEC. These industries were combined because many establishments provide care for persons needing varying levels of health care. Mental Retardation Facilities from part of 1987 SIC 8052, Intermediate Care Facilities. This new industry was created because it had a production process not found in nursing homes. Mental Health and Substance Abuse Facilities from part of 1987 SIC 8361, Residential Care. This new industry was created because it had a unique production process. Continuing Care Retirement Communities from parts of 1987 SIC 8051, Skilled Nursing Care Facilities; 1987 SIC 8052, Intermediate Care Facilities; and 1987 SIC 8059, Nursing and Personal Care Facilities, NEC. This new industry was created to handle the growing number of establishments having facilities for various levels of care at one facility, including nursing care, housekeeping, meal service, and other services to assist elderly persons in daily living. Homes for the Elderly from part of SIC 1987 8361, Residential Care. This new industry was created to provide data on establishments known as retirement homes or assisted living facilities, where medical care is incidental. Other Residential Care Facilities from part of 1987 SIC 8361, Residential Care. This is a new residual category from the current 8361, Residential Care. 4. Social Assistance 1989 SIC 8322, Individual and Family Social Services, has been split into seven new industries in two industry groups. These new industries reflect the growing and changing character of social assistance industries. Additional industries for social assistance were requested by several organizations interested in activities of not for profit organizations. These new industries were created to fill that need and because the new industries had different production processes. The industries included in the industry group Individual and Family Services are: Child and Youth Services, Services for the Elderly and Persons with Disabilities, Other Individual and Family Services The industries under the new industry group Community Food, Shelter, and Emergency Relief Services are: Community Food Services Temporary Shelter (U.S. national industry) Other Community Housing Services (U.S. national industry) Emergency and Other Relief Services