Survey of Admissions to Residential and Nursing Home Care: 18 Month Follow-Up

<h3>Introduction</h3><p><p><p>This report presents results from the second 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 provided by home managers, though people leaving homes to live elsewhere have also been followed up.

<p><p><p>The first follow-up was at 6 months, and the second, to which this report relates, was at 18 months. Further follow-ups will be made at 30 and 42 months, at which stages it will be possible to develop more fully some of the issues considered in this report.

<p><p><p>Chapter 2 outlines the methodology and describes the location at 18 months, length of stay in residential/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 between 6 and 18 months after admission. Chapter 4 analyses the pattern of mortality up to 18 months, and develops a model which enables survival to be predicted from circumstances at admission.

<p><p><h3>Findings</h3><p><p><p>Chapter 2 reports:<p><p><p><li>42 per cent of the cases for whom information on location was known at 18 months were still in the same type of bed as on admission (31 per cent of those originally admitted to a nursing bed and 50 per cent of those originally admitted to a residential bed).</li><p><p><p><li>49 per cent of the cases for whom information on location was known at 18 months had died. Excluding those who died after being discharged, 46 per cent died. This included 60 per cent of those originally admitted to a nursing bed and 35 per cent of those originally admitted to a residential bed.</li><p><p><p><li>Of those who left within 18 months, 95 per cent of those admitted to nursing beds and 80 per cent of those admitted to residential beds had died. The average length of stay had been 159 days and 203 days respectively.</li><p><p><p><li>Levels of dependency on admission among those who were in a nursing bed at the 18 month follow-up were substantially greater than the corresponding 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. (Chapter 3 reports that they were also likely to have had accommodation problems.) They had below average levels of dependency on admission, particularly with regard to confusion.</li><p><p><p><li>At 18 months, levels of dependency among those remaining in residential or nursing home care tended to be greater than on admission, particularly for physical dependency. Dependency had increased more among those admitted to a residential bed than among those admitted to a nursing bed.</li>

<p><p><p>Chapter 3 reports:

<p><p><p><li>The number of discharges (excluding discharges shortly prior to death) is small, and the discharge rate reduces through time though people are still being discharged up to 18 months.</li><p><p><p><li>Only 16 people had returned to a private household by 6 months and were still living there a year later.</li><p><p><p><li>There was a very low rate of discharge among people admitted from London boroughs.</li><p><p><p><li>Those re-admitted to residential or nursing home after being discharged tended to be the older and more solitary rather than the more dependent.</li><p><p><p><li>Social services departments were providing very considerable domiciliary support to three- quarters of those people who had returned to living in private households.</li><p><p><p><li>So far there is little evidence of misplacement. Few people are discharged (other than briefly) and of those, there is usually an obvious change of circumstances. </li>

<p><p><p>Chapter 4 reports:

<p><p><p><li>The median survival among those admitted to a nursing bed is 12.4 months (± 0.8 months), and is expected to be about 24 months for those admitted to residential care.</li><p><p><p><li>Mortality rates are high initially, specially in nursing homes, but after about four months settle to around 3.6% per month for those admitted to a nursing bed and 2.3% per month for those admitted to residential care. There is a noteworthy second effect in mortality rates.</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 dependency), old age, being a man, being admitted to a nursing home, being admitted from a hospital, having a respiratory illness, being diagnosed as clinically depressed.</li>