Long-Term Care in the St. John's Region: Impact of Single Entry and Prediction of Bed Need

Abstract

In 1996, the St. John's region had a population of 8,435 > or = 75 years, with 996 nursing home (NH) beds and 550 supervised care (SC) beds. A single entry system to these institutions was implemented in 1995. To determine the impact of the single entry system, the demographic and clinical characteristics of NH residents were assessed in 1997 (N = 1,044) and in 2003 (N = 963). To determine the efficiency of placement and the need for long-term care beds, two incident cohorts requesting placement were studied in 1995/96 (N = 467) and in 1999/2000 (N = 464). Degree of disability was determined using the Residents Utilization Groups III classification (RUG-III) and the Alberta Resident Classification Score (ARCS), and time to placement and to death was measured. In prevalent NH residents, the percentage without RUGS-III disability decreased from 18.5% in 1997 and to 9.9% in 2003. The proportion recommended for NH was 75% in 1995/96 and 72% in 1999/2000, despite the fact that the proportion with RUGS-III disability was 64% in both periods. Using a decision tree, optimal placement for the 1999/2000 cohort was 36% to SC, 20% to SC for the cognitively impaired, and 44% to NH. Predicted need for long-term care beds in 2004 matched poorly with current provision of NH and SC beds, and the mismatch will be worse in 2014. It was concluded that the single entry system was associated with improved appropriateness of NH bed utilization. However, there was a mismatch in need for and provision of institutional long-term care. Investment in the reconfiguration of long-term care beds by case mix and by geography is necessary.

Planning the Restructuring of Long-Term Care: The Demand, Need and Provision of Institutional Long-Term Care Beds in Newfoundland and Labrador

“…(Figure 1) A previous study compared the demographic and clinical characteristics of two St. John's incident cohorts for 1995/96 and 1999/00 and found no differences between the two. [60] Comparison by region revealed no significant difference in the age or degree of disability in the four Newfoundland regions. (Table 5.1) However, compared to Newfoundland, the mean age of clients in Labrador was significantly younger, 76 versus 81 years (P < .001), significantly less were female (41 % vs. 62%, P = .003), significantly more had cognitive impairment or behaviour disorders as the major reason for placement (53% vs. 23%, P < .001), and only 16% compared to 36% in Newfoundland had no clinical indicators for nursing home placement (P = .003).…”