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