Identification of registered nursing care of residents in English nursing homes using the minimum data set resident assessment instrument (MDS/RAI) and resource utilization groups version 111 (RUG-111)

Aim: to determine if a combination of Minimum Data Set/Resident Assessment Instrument (MDS/RAI) assessment

variables and the Resource Utilisation Groups version III (RUG-III) case-mix system could be used as a method of

identifying and reimbursing registered nursing care needs in long-term care.

Method: the sample included 193 nursing home residents from four nursing homes from three different locations

and care providers in England. The study included assessments of residents’ care needs using either the MDS/RAI

assessments or RUG stand-alone questionnaires and a time study that recorded the amount of nursing time received

by residents over a 24-h period. Validity of RUG-III for explaining the distribution of care time between residents in

different RUG-III groups was tested. The difference in direct and indirect care provided by registered general nurses

(RGN) and care assistants (CA) to residents in RUG-III clinical groups was compared.

Results: the RUG-III system explained 56% of the variance in care time (Eta2, P=0.0001). Residents in RUG-III

groups associated with particular medical and nursing needs (enhanced RGN care) received more than twice as much

indirect RGN care time (t-test, P-0.001) and 1.4 times as much direct RGN and direct CA time (t-test, P-0.01) than

residents with primarily cognitive impairment or physical problems only (standard RGN care). Residents with

enhanced RGN care received an average of 48.1 min of RGN care in 24 h (95% CI 4.1–55.2) compared with an

average of 31.1 min (95% CI 26.8–35.5) for residents in the standard RGN care group. A third low RGN care group

was created following publication of the Department of Health guidance on NHS Funded Nursing Care. With three

levels, the enhanced care group receives about 38% more than the standard group, and the low group receives about

50% of the standard group.

Conclusions: the RUG-III system effectively differentiated between nursing home residents who are receiving ‘low’,

‘standard’ and ‘enhanced’ RGN care time. The findings could provide the basis of a reimbursement system for

registered nursing time in long-term care facilities in the UK.