Survey of Admissions to Residential and Nursing Home Care. 30 Month Follow-Up

<p>This report presents results from the third follow-up of individuals included in the 1995 PSSRU Survey of Admissions to<p><p>Residential and Nursing Homes. This survey included 2544 people over 65 who were admitted from 18 local authorities during the autumn of 1995, as long-stay, local authority supported residents of residential or nursing homes. The follow-ups concern the survival, location, health (dependency) and funding of the original sample. Information is for the most part being provided by home managers, though people leaving homes to live elsewhere have also been followed up.

<p><p><p>The first and second follow-ups were at six and 18 months, and the third, to which this report relates, was at 30 months. One further follow-up will be made at 42 months. This is a preliminary report of the 30 month stage: a further report developing more fully some of the issues considered in this report will be prepared.

<p><p><p>Chapter 2 outlines the methodology and describes the location at 30 months, length of stay in residential and nursing homes, and changes in the dependency of survivors. Chapter 3 describes people who had been discharged and were known to be living outside homes, from six months after admission onwards. Chapter 4 analyses the pattern of mortality up to 30 months, and develops a model which enables survival to be predicted from circumstances at admission.

<p><p><p>Chapter 2 reports that:

<p><p><p><li>27 per cent of the cases for whom information on location was known at 30 months were still in the same type of bed as on admission (19 per cent of those originally admitted to a nursing bed and 33 per cent of those originally admitted to a residential bed).</li><p><p><p><li>67 per cent of the cases for whom information on location was known at 30 months had died. This included 77 per cent of those originally admitted to a nursing bed and 59 per cent of those originally admitted to a residential bed.</li><p><p><p><li>Of those who left within 30 months, 95 per cent of those admitted to nursing beds and 84 per cent of those admitted to residential beds had died. The average length of stay had been 234 days and 333 days respectively.</li><p><p><p><li>Levels of dependency on admission among those who were in a nursing bed at the 30 month follow-up were substantially greater than the corresponding levels of dependency among those who were in a residential bed.</li><p><p><p><li>Individuals who returned to a private household were more likely to have been living with others prior to admission, but those who survived to 30 months were no more likely to have been living with others prior to admission. (Chapter 3 also reports that those who returned to a private household were likely to have originally had accommodation problems.) Those who survived to 30 months had below average levels of dependency on admission, particularly with regard to confusion.</li><p><p><p><li>At 30 months, levels of dependency among those remaining in residential or nursing home care tended to be greater than on admission. Physical dependency had increased more among those admitted to a residential bed than among those admitted to a nursing bed, but confusion had increased more among those admitted to a nursing bed.</li><p><p><pChapter 3 reports that:

<p><p><p><li>The level of discharges in the 30 months following admission to residential and nursing home care was low, 8 per cent of all admissions, half of whom were to the community.</li><p><p><p><li>Two thirds of all moves out of care occurred within 6 months of admission, the discharge rate becoming negligible by 30 months</li><p><p><p><li>Discharges to the community occurred more frequently in the counties and much less frequently in the London boroughs, where there were proportionately more discharges to hospital.</li><p><p><p><li>Survival of those returning to the community is better than those remaining in residential care.</li><p><p><p><li>Social services departments provided support on discharge to one third of people who returned to the community; for these, the level of input was moderately high.</li><p><p><p>Chapter 4 reports that:

<p><p><p><li>The median survival for the whole sample is 18.3 months (± 0.8 months). For those originally admitted to nursing homes it is 10.5 months (± 0.9 months), and for residential care is 25.3 months (± 0.9 months).</li><p><p><p><li>Mortality rates are high initially, especially in nursing homes, but after about 6 months settle to around 2½% per month (for the combined sample), rising slowly to about 3½% by 30 months.</li><p><p><p><li>The factors at admission that significantly raise subsequent mortality are, in order of their significance: having a malignancy (cancer), having a low Barthel score (high disability), old age, being a man, being admitted to a nursing home, being admitted from a hospital, having a respiratory illness.</li><p><p><p><li>There are no significant differences between local authorities in survival outcomes, after taking into account other factors.</li> <p><p><p><li>As a few residents will live for a long while, the average length of survival is much greater than the median. At this stage it seems likely to be about 27-29 months. </li><p><p><p<Chapter 4 also develops a model for predicting likely survival from the circumstances at the time of admission.