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Sidney Katz, MD (born 1924) was a pioneering American physician, scientist, educator, author, and public servant. Although he is best known for developing the developing the Index of Independence of Activities for Daily Living (ADLs), his career spanned more than sixty years. He is credited with advancing several other achievements in geriatric care including the US Nursing Home Reform Act of 1987, which established basic rights for nursing home residents. During Dr. Katz’s career, he was honored with numerous public and private awards for his service including the Maxwell A. Pollak Award (1993) and the American Geriatrics Society’s (AGS) Foundation for Health in Aging (2001). He shares the AGS award with notable public servants such as former US President Jimmy Carter and poet Maya Angelou.

Dr. Katz held several prestigious academic positions during his long career including Professor Emeritus of Geriatric Medicine at Columbia University, and distinguished scholar at the Benjamin Rose Institute on Aging. In addition, he was a lifetime member of the National Academy of Sciences’ Institute of Medicine (IoM), serving as the head of IoM’s Committee on Nursing Home Regulation from 1983-1985. During his time leading the committee, Dr. Katz spearheaded a review of current nursing home conditions and the committee developed a report that recommended an extensive redesign of nursing home policies, regulations, and standards. These recommendations were adopted into Omnibus Budget Reconciliation Act of 1987 (OBRA-87), commonly known as the Nursing Home Reform Act of 1987, which mandated standardized nursing home patient rights and enforced new regulatory requirements to ensure equal treatment of nursing home residents.

Dr. Katz was a dedicated public servant who worked until the age of 87, retiring in 2011 from public life. He passed away in his home on May 4, 2012 (4).

Biography and Medical Career
Sidney Katz was born in Cleveland, Ohio in 1924. His father owned a dry goods shop, and his mother ran the household and kept the books for the business. Sidney Katz credits his mother for encouraging his education and his medical career (5).

After high school, Sidney was interested in pursing a medical degree; however, World War II interrupted his studies. In 1942 Sidney, at the age of 18, volunteered for the US Navy, and was assigned to various medical details including running the health services department at Purdue University for enlisted men. During his service, Sidney moved up the ranks and became a functioning specialist in nursing surgery. While at Purdue University, Sidney developed a deep interest in virology and was accepted into medical school at Western Reserve Medical School (now known as Case Western Reserve University School of Medicine) (5).

After his service, Sidney attended Western Reserve and continued his research in virology. Upon graduation in 1948, he was received a fellowship from the American Cancer Society.

Not long after his fellowship started, Dr. Katz’s career was interrupted again by war. Dr. Katz volunteered to serve in the Army during the Korean War. During this service, he was responsible for a Mobile Army Surgical Hospital (MASH) unit with two other physicians. One of the main goals of this unit was to fight the growing hemorrhagic fever epidemic that had inflicted 1000, and killed 10% of those that were infected (5). Sidney and his colleagues were the first physicians to truly describe both the disease and the effectiveness of known cures. The cures that seemed to be most effective to treat the disease were compiled into a protocol that was used to standardize treatment of the disease. Through this work, Sidney lowered the mortality rate of the disease from 10% to 1%.

After his military career ended, Dr. Katz decided to pursue a medical career that involved more interaction with patients, and accepted a position at the Benjamin Rose Rehabilitation Hospital back in Cleveland. His original position was to study the affect of vitamins on elderly patients.

Index of Independence of Activities for Daily Living
As Dr. Katz began to understand more about the medicine sub-specialty of long-term care for elderly adults, his team at Benjamin Rose began to gather data on how different treatments affected patient outcomes. Dr. Katz’s first attempt at formally capturing this data was to study 64 hip fracture patients during an 18-month period. Comprehensive data on treatments, patient progression, and outcomes were collected during this study. After analyzing the study data, the researchers discovered that patients that were most independent could all perform a set of basic activities- ranging from the most complex bathing activity to the least complex feeding activity. From this data, Dr. Katz developed a scale to score a patients ability to live independently. This scale was called the index of activities for daily living, and was first published in the 1963 in the Journal of the American Medical Association (JAMA). Since publication, Dr. Katz’s initial paper has been cited more than 46,000 times. Dr. Katz and his team at Benjamin Rose Rehabilitation Hospital than spent the next ten years revising the scale including a more, diverse patient population.

Advisory Service
While still working on developing the ADL scale, Dr. Katz became involved in the national healthcare community. In 1965, he became an active member of the working groups of the National Center for Health Services Research. In 1978, he was officially appointed to the National Academy of Sciences’ Institute of Medicine (IoM). From 1977-1978, Dr. Katz sat on the Long-Term care Technical Advisory Panel of the National Center for Health Statistics, where he first introduced the Minimum Basic Data Set for Long-Term Care. In 1981, Dr. Katz was appointed as an official Special Advisor to the White House Conference on Aging, and a Senior Advisor to the United States Preventative Services Task Force.

In 1983, Dr. Katz was asked to lead IoM’s Committee on Nursing Home Regulation on a 2-year appointment. Dr. Katz wanted his committee’s recommendations to be based off of science as much as possible, and therefore facilitated a comprehensive review of current practice and care guidelines. From this inquiry, Dr. Katz and his committee recommended sweeping changes to the standard of care, audit procedures, and better enforcement of quality assurance practices by both nursing home facilities and oversight organizations. The IoM committee recommendations were incorporated into OBRA-87 legislation, which was signed into law in 1987 by President Ronald Reagan. In addition, Dr. Katz’s recommendations also paved the way towards the 1991 mandate, as part of the Minimum Data Set legislation, that requires nursing homes to complete the national resident assessment system to ensure quality of life for residents.

Throughout Dr. Katz’s life, he remained a dedicated public servant becoming a lifetime member of the National Academy of Sciences’ Institute of Medicine. He actively advised several legislators, the Department of Human and Health Services, as well as non-profit organizations on healthcare issues. In addition, he provided international consultation for the United Nations as well as several individual countries including Sweden, France, and the United Kingdom.

Representative Papers and Technical Reports

 * Katz, S., & Stroud, M. W., 3rd. (1989). Functional assessment in geriatrics: a review of progress and directions. Journal of the American Geriatrics Society, 37, 267–271.
 * Katz, S. (1987). The science of quality life. Journal of Chronic Diseases, 40:459-463.
 * Stroud, M. W., Katz, S., & Gooding, B. A. (1985). Rehabilitation of the elderly: A tale of two hospitals. East Lansing, MI: Michigan State University Press.
 * Katz, S., Branch, L.G., Branson, M.H., Papsidero, J.A., Beck, J.C. & Green, D.S. (1983) Active life expectancy. The New England Journal of Medicine, 309, 1218-1224. doi:10.1056/NEJM198311173092005
 * U.S. National Committee on Vital and Health Statistics Technical Consultant Panel on the Long-Term Health Care Data Set. (1980). Long-term health care: Minimum data set (DHHS Publication No. [PHS] 80–1158). Hyattsville, MD: U.S. Dept. of Health and Human Services, Public Health Service, Office of Health Research, Statistics, and Technology, National Center for Health Statistics.
 * Papsidero, J. A., Katz, S., Kroger, M. H., & Akpom, C. A. (Eds.). (1979). Chance for change: Implications of a chronic disease module study. East Lansing, MI: Michigan State University Press.
 * Katz, S., Downs, T.D., Cash, H.R., & Grotz, R.C. (1970). Progress in development of the index of ADL. The Gerontologist, 10, 20-30. doi:10.1093/geront/10.1_Part_1.20
 * Katz, S., Ford, A. B., Downs, T. D., Adams, M., & Rusby, D. I. (1972). Effects of continued care: A study of chronic illness in the home DHEW Publication No. [HSM] 73–3010). Rockville, MD: National Center for Health Services Research and Development.
 * Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A., & Jaffe, M. W. (1963). Studies of illness in the aged. The index of adl: A standardized measure of biological and psychosocial function. Journal of the American Medical Association, 185, 914–919. doi:10.1001/jama.1963.03060120024016
 * Staff of the Benjamin Rose Hospital. (1959). Multidisciplinary studies of illness in aged persons: II. A new classification of functional status in activities of daily living. Journal of Chronic Diseases, 9, 55–62.
 * Katz, S., Leedham, C. L., & Kessler, W. H. (1952). Medical management of hemorrhagic fever. Journal of the American Medical Association, 150, 1363–1366. doi:10.1001/jama.1952.03680140001001