Residential or nursing home care? The appropriateness of placement decisions

Abstract

Routinely-collected statistics show considerable variation between local authorities in Great Britain, in the proportions of supported residents placed in nursing and residential care. This raises the question of whether this is due to variations in demand (the type of resident approaching authorities), supply (the level and type of provision available for local authorities to purchase), or policy (in terms of eligibility criteria or interpretations of need at field level). Data were used from a national longitudinal survey of individuals admitted to publicly-funded residential and nursing home care. Information was collected from  local authorities on a cohort of , local authority supported residents who had been admitted to residential and nursing home care. The paper examines the pattern of admissions, the characteristics of people admitted and the relationship between these characteristics and admissions to residential or nursing home care. Characteristics of the individual explained the placement of over  per cent of admissions. Supply factors were statistically significant but did not improve the explanatory power of the model. Survival among those admitted to a type of care that was not predicted by the model, suggested that some unmeasured aspects of prognosis may account for some of the residual variation in placements. Overall, the results indicate a reasonably high level of consistency between authorities in nursing home placement decisions. This suggests that either there is considerable variation in the types of individual approaching local authorities or, more likely, that some authorities are more successful in maintaining people for longer at home than others. In addition to maintaining people at home to a higher level of dependency, prevention of admission to residential care is likely to be associated with : interventions that address carer support, safety issues among people who are deaf, and motivation.KEY WORDS -old age, residential care, nursing home care, predictors of placement..

Inducting older adults into volunteer work to sustain their psychological well-being

“…The resident under residential care is likely to be dependent on and receptive to social worker support (Clark & Bowling, 1989;Netter et al, 2001). Social worker induction is therefore compatible with the resident's need for support.…”

Physicians' expectations regarding registered nurses caring for older people living in sheltered housing, retirement homes and group dwellings

“…Today and in the future, older people living in residential home care have a wide range of needs with regards to nursing care (Netten et al, 2001;Kemp et al, 2003;Mcilfatrick et al, 2001). Sometimes the structure of nursing care is like caring in a hospital and sometimes like caring in home health care.…”

“…In this paper, sheltered housing, retirement homes and group dwellings are described as residential home care (cf. Netten et al, 2001). Residential home care provides a protective environment for older people, with need defined by an assessment made by the municipality.…”

The cost implications of the changing population and characteristics of care homes

“…There are wide variations in the proportion of publicly-funded residents placed in nursing home care (Department of Health, 2000). However, a companion longitudinal survey of admissions of publicly-funded residents, begun in 1995, found that over 80 per cent of placements could be predicted by variations in characteristics of the individual or local supply factors (Netten et al, 2001). It appeared unlikely that variations between local authorities in the types of people approaching them for support could account for the differences between authorities.…”