Predicting admission to nursing home rather than to residential home care

Purpose

Local authorities in Great Britain vary considerably in the proportions of residents placed in nursing or residential care. This may be due to variations in demand (the type of resident approaching authorities), supply (the level and type of provision available), or policy (in terms of eligibility criteria or interpretations of need at field level). The paper will examine the pattern of admissions, the characteristics of people admitted and the relationship between these characteristics and admissions to residential or nursing home care.

Method

A national longitudinal survey of 2,544 people aged 65 or over, admitted to publicly-funded residential and nursing home care, was conducted in a stratified sample of 18 local authorities between 1995 and 1999.

Results

Using logistic regression analysis, characteristics of the individual explained the placement of over 80 per cent of admissions. Supply factors were statistically significant but did not improve the explanatory power. Survival among those admitted to a type of care that was not predicted by the model suggested that some unmeasured aspects of prognosis might account for some of the residual variation in placements.

Conclusions

Local authorities were reasonably consistent in nursing home placement decisions, suggesting that some 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.