Care Homes for Older People: Volume 2. Admissions, Needs and Outcomes. The 1995/96 National ...

114 Pages·2002·1.26 MB·English

Care Homes
for Older People
VOLUME 2 ADMISSIONS, NEEDS AND OUTCOMES
Andrew Bebbington
Robin Darton
Ann Netten
PSSRU
at the University of Kent at Canterbury,
the London School of Economics
and the University of Manchester
TITLE
Care Homes
for Older People
Volume 2
Admissions, Needs and
Outcomes
The 1995/96 National Longitudinal Survey of
Publicly-Funded Admissions
Andrew Bebbington
Robin Darton
and Ann Netten
PSSRU
attheUniversityofKentatCanterbury,
theLondonSchoolofEconomics
andtheUniversityofManchester
©2001PersonalSocialServicesResearchUnit
ISBN1-902671-25-2
Firstpublishedin2001bythePersonalSocialServicesResearchUnit,Universityof KentatCanterbury.
ThisworkreceivedsupportfromtheDepartmentof Health.Theviewsexpressedinthispublication
arethoseof theauthorsandnotnecessarilythoseof theDepartmentof Healthorotherfunders.
TypesetbyNickBrawnatthePSSRU,CanterburyandprintedbytheUniversityof KentatCanterbury
PrintUnit.
rev.001
C O N T E N T S
Contents
Preface .....................................................vii
Acknowledgements ..........................................viii
Summary....................................................1
Chapter1:Introduction............................................1
Chapter2:TheRiskofAdmission....................................1
Chapter3:TheCircumstancesofAdmission ...........................1
Chapter4:TheInitialPlacementDecision..............................2
Chapter5:LengthofStayandMortality ...............................2
Chapter6:HealthOutcomes........................................3
Chapter7:MovesBetweenTypesofHomeandBed .....................3
Chapter8:PeopleWhoLeaveResidentialandNursingHomeCare.........4
Chapter9:PeoplefromEthnicMinorities..............................4
Chapter10:LifetimeCostofanAdmission.............................5
Chapter11:Toolkit................................................5
1 Introduction...............................................7
Objectivesofthestudy ............................................7
Methodology.....................................................8
Glossaryanddefinitions...........................................11
2 TheRiskofAdmission .....................................15
Introduction ....................................................15
Numbersofresidents.............................................15
Theriskofadmission.............................................16
Conclusions ....................................................18
3 TheCircumstancesofAdmission ............................19
Introduction ....................................................19
Reasonsforadmission ............................................20
Personalcircumstances ...........................................20
Aneedindicatorforcare..........................................24
Conclusions ....................................................24
iii
C O N T E N T S
4 TheInitialPlacementDecision..............................25
Introduction ....................................................25
Patternsofadmission.............................................25
Individualcharacteristicsassociatedwithadmission.....................26
Appropriatenessofplacements.....................................30
Outcomesat30months ..........................................31
Discussion......................................................31
Conclusions ....................................................32
5 LengthofStayandMortality................................33
Introduction ....................................................33
Survivalrates ...................................................33
Factorsaffectingsurvivalrates......................................34
Seasonality .....................................................36
Averagelengthofsurvival .........................................36
Trends.........................................................37
Predictingsurvival................................................37
Conclusions ....................................................37
6 HealthOutcomes.........................................39
Introduction ....................................................39
Changesindependencyfollowingadmission...........................39
Changesincognitivefunctionfollowingadmission......................41
Healthylifeexpectancyfollowingadmission ...........................41
Peoplewithlowneedsincarehomes................................42
Conclusions ....................................................43
7 MovesBetweenTypesofHomeandBed ......................45
Introduction ....................................................45
Moves.........................................................45
Characteristicsofpeoplewhomove.................................46
Changesindependencyamongpeoplewhomove......................46
Survivalaccordingtomovesbetweentypesofhomeandbed.............47
Conclusions ....................................................47
Dischargerates..................................................49
8 PeoplewhoLeaveResidentialandNursingHomeCare..........49
Introduction ....................................................49
Whydopeoplereturntoprivatehouseholds?.........................50
Appropriatenessofplacement......................................51
Whathappensfollowingreturntoaprivatehousehold? .................53
Peopledischargedtohospital ......................................54
Conclusions ....................................................55
iv
C O N T E N T S
9 PeoplefromEthnicMinorities...............................57
Introduction ....................................................57
Representativeness...............................................58
Admissionratesfromethnicminorities ..............................58
Characteristicsofpeopleadmitted..................................58
Consequencesofadmission........................................59
Conclusions ....................................................60
10 LifetimeCostofanAdmission ..............................61
Introduction ....................................................61
Grossunitcostestimates..........................................62
Changesincharges...............................................62
Netunitcostestimates ...........................................64
Totalcosts......................................................65
Discussion......................................................66
Conclusions ....................................................67
11 PlanningToolkit ..........................................69
Introduction ....................................................69
Tool1:Theprobabilityofadmission .................................70
Tool2:Apopulationneedindicator..................................72
Tool3:Predictingplacementforanewadmission.......................75
Tool4:Predictingsurvival..........................................77
Tool5:Predictingdependencychanges ...............................82
Tool6:Predictinglifetimecost......................................84
Appendix1..................................................87
PSSRUSurveyofAdmissionstoResidentialandNursingHomes
forElderlyPeople,October1995–January1996........................87
Appendix2..................................................95
PSSRUSurveyofAdmissionstoResidentialandNursingHomes
forElderlyPeople:18MonthFollow-UpQuestionnaire..................95
References .................................................101
v
Contents
Preface .....................................................vii
Acknowledgements ..........................................viii
Summary....................................................1
Chapter1:Introduction............................................1
Chapter2:TheRiskofAdmission....................................1
Chapter3:TheCircumstancesofAdmission ...........................1
Chapter4:TheInitialPlacementDecision..............................2
Chapter5:LengthofStayandMortality ...............................2
Chapter6:HealthOutcomes........................................3
Chapter7:MovesBetweenTypesofHomeandBed .....................3
Chapter8:PeopleWhoLeaveResidentialandNursingHomeCare.........4
Chapter9:PeoplefromEthnicMinorities..............................4
Chapter10:LifetimeCostofanAdmission.............................5
Chapter11:Toolkit................................................5
1 Introduction...............................................7
Objectivesofthestudy ............................................7
Methodology.....................................................8
2 TheRiskofAdmission .....................................15
Introduction ....................................................15
Numbersofresidents.............................................15
Theriskofadmission.............................................16
Conclusions ....................................................18
3 TheCircumstancesofAdmission ............................19
Introduction ....................................................19
Reasonsforadmission ............................................20
Personalcircumstances ...........................................20
Aneedindicatorforcare..........................................24
Conclusions ....................................................24
vi
P R E F A C E
Preface
Carehomeshavealwayshadakeyroleintheprovisionofcareforolderpeople.
Themostappropriateuseandfundingofcareincarehomeshasbeenthesubject
ofmanyimportantpolicyinitiativesovertheyears.Thisisdemonstratedmost
recentlybytheNHSPlan(Cm4818-I,2000)andtheGovernment’sresponseto
theRoyalCommissiononLongTermCare.Inpartthisisbecauseofthe
vulnerabilityoftheresidents,theeffectsofdemographicchangeonthenumbers
ofolderpeoplewhomayneedresidentialcareandthevisibilityofthehighcosts
associatedwiththisformofcare.Itisessentialthatwehaveagoodunderstanding
ofthiskeyaspectofcareprovision.
Ithasbeenarguedthatthelackofrelevantresearchanddatameansthatmany
policyproposalsarebasedonwhatmaynotbewell-foundedassumptionsacrossa
rangeofissues(King’sFund,1999).Itisdifficulttoconstructanoverallpicture
whentherearedifferencesbetweentheinformationavailableonresidentialand
nursinghomes,whenthetypeofinformationcollectedvariesovertime,and
wheretherearevariationsinpracticebetweenthedifferentpartsoftheUnited
Kingdom.Inthiscontext,theestablishmentin2002ofaNationalCareStandards
Commission(undertheCareStandardsAct2000),whoseregulatory
responsibilitieswillincludecollectingdataaboutservices,shouldprovidethe
opportunitytoprovidemorecoherentstatisticsnationwideinthefuture.Butin
ordertoavoidoverburdeningthroughdatacollectionrequirementsthoseinthe
businessofprovidingcare,abalanceneedstobestruckbetweenroutinedata
collectionandothersourcesofstatistics,suchasspeciallycommissionedsurveys.
Thelatterfulfilavitalroleinprovidinguswithadetailedpictureofcarehomes
andtheirresidentsneededforpolicydevelopmentandplanning.
Thisreportpresentsthefindingsofonepartofatwo-partstudyfundedbythe
DepartmentofHealth:anational,cross-sectionalsurveyofcarehomesforolder
peopleandalongitudinalfollow-upofpublicly-fundedadmissions.Atthetime
theworkwascommissionedtherewerefourkeyobjectives:
a) toprovideabaselinedescriptionoftheuseofresidentialandnursinghome
carebybothpubliclyandprivately-fundedresidents;
b)toprovidedatatofeedintothedevelopmentoftherelevantStandard
SpendingAssessmentformulae;
c) toincreaseunderstandingofoutcomesofresidentialcare,includingmortality,
changesinlocationandchangesindependency;
d)toincreaseunderstandingoftherelationshipbetweendependencyandcostsof
careunderthenewarrangementsforcommunitycareintroducedin1993.
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A C K N O W L E D G E M E N T S
Thereportofthestudyisintwoparts.Thisvolumereportsonthelongitudinal
studythatwasstartedinautumn1995,andcontinueduntil1999,sometimeafter
implementationofthereformsintroducedin1993bytheNHSandCommunity
CareAct1990,whichhadextendedlocalauthorities’responsibilitiesforassessing
andfundingresidents.Thispartofthestudyfocusedonthecharacteristicsof
newlyadmittedlong-staypublicly-fundedresidents,andtheiroutcomesandcosts
overthefollowing3½years.Thesurveycoveredapproximately2500residentsin
18localauthorities.Informationwascollectedon:
(cid:1)theirpersonalcharacteristics,health,dependencyandchargesatthetimeof
admission
(cid:1)theircircumstancespriortoadmission
(cid:1)theirsubsequentmovesandsurvival,healthanddependencyat6,18,30and
42monthsafteradmission.
Togetherwithitscompanionreport,whichdescribesthecross-sectionalsurveyof
homesandresidents(Nettenetal.,2001a,CareHomesforOlderPeople:Volume1.
Facilities,ResidentsandCosts),thisisavaluablesourceofinformationforthefuture
andwillprovidemuchinformationforthepolicydebate.Thedataonwhichthis
reportisbasedwillbemadepubliclyavailableinduecourse.
GregPhillpotts
DeputyDirectorofStatistics
DepartmentofHealth
Acknowledgements
ThisreportisbasedonasurveyfundedbytheDepartmentofHealthaspartofa
widerstudyofresidentialandnursinghomecareforolderpeoplecommissioned
fromthePersonalSocialServicesResearchUnit(PSSRU).Wewouldliketo
thankthelocalauthoritieswhichagreedtoparticipateinthisstudy,andin
particularourliaisonofficers;thestaffbothintheauthoritiesandinthe
residentialandnursinghomesforprovidingtheinformation;ResearchServices
Limited(nowIPSOS-RSL),whomanagedthemaindatacollections;colleagues
PamelaBrown,KathrynMummeryandRoystonBartholomew,whoworkedon
theprojectandcontributedtovariouschapters;JudyHartley,foreditorialservices
indraftingthereport;LesleyCox,theprojectsecretary;theAdvisoryGroup
whichoversawtheresearch;andfinallytoGregPhilpottsandAntoniaRobertsof
theDepartmentofHealth,whocoordinatedtheAdvisoryGroup.Theviews
expressedinthisreportarethoseoftheauthorsandarenotnecessarilythoseof
theDepartmentofHealth.
Notes on the tables
(cid:1)Percentagesshowninthetableshavebeenroundedtowholenumbersandmay
notsumto100duetorounding.
(cid:1)Thesymbol‘<1’denotesnon-zeropercentagesofunder1percent.
viii