A proposal to restructure the long-term care sector in the St. John's region of Newfoundland and Labrador

Reddy, Madhuri (2002) A proposal to restructure the long-term care sector in the St. John's region of Newfoundland and Labrador. Masters thesis, Memorial University of Newfoundland.

[English] PDF (Migrated (PDF/A Conversion) from original format: (application/pdf)) - Accepted Version Available under License - The author retains copyright ownership and moral rights in this thesis. Neither the thesis nor substantial extracts from it may be printed or otherwise reproduced without the author's permission. Download (15MB) [English] PDF - Accepted Version Available under License - The author retains copyright ownership and moral rights in this thesis. Neither the thesis nor substantial extracts from it may be printed or otherwise reproduced without the author's permission. (Original Version)

Abstract

There is a concern that there is a mismatch between the needs of the elderly and the level of care provided in long-term care (LTC) facilities. In 1991, the number of LTC beds per 1000 people over the age of 75 years in NF was the highest in Canada. Alternatives to institutional placement would be preferable for a multitude of reasons, including social, medical, and financial. The absence of data concerning the mismatch makes it premature to recommend plans for restructuring. A descriptive profile of residents of LTC facilities can help provide a foundation for current and future program planning. Describing the characteristics of the current and potential residents of LTC facilities provides a basis for confirming needs, identifying developmental priorities, establishing program objectives, and evaluating program outcomes. -- The primary objective of this study is to assess the care requirements of institutional LTC residents in the St. John's Region and to determine actual and optimal population rates for institutional care. The LTC needs in the St. John's region were studied. All clients seeking placement in the institutional LTC sector for the year February 20/1995 through February 20/1996 were prospectively followed. Data on degree of disability for these clients was obtained prior to placement in LTC and at intervals following placement. -- Mortality data on this incident cohort was collected following acceptance for placement in LTC as well as at yearly intervals after initial placement. Using this information as well as a search of the medical literature, the natural history of LTC residents was determined. A more accurate estimate for demand for LTC beds assuming an efficient system using an appropriate number of appropriate beds) was ascertained. A Decision Algorithm was developed, incorporating two objective, validated tools for assessing the need for professional nursing care (RUG-III) and client disability (ARCS). The current needs and level of care of the inception cohort were assessed and compared with objective placement criteria as defined by the Decision Algorithm. By determining the natural history of LTC clients and incorporating predicted demographic trends, predictions for the number of LTC beds required in 2007 was determined. -- 36% of clients accepted for institutional LTC had no objective measurable disability as determined by RUG-III and probably do not require the resources of a NH. 43% of residents were found to have a moderate level of impairment, but 63% of these clients have cognitive impairment as their major reason for seeking LTC. If present methods of placement are continued, there will be a large deficit in SC beds by 2007. If objective criteria (Decision Algorithm) are used to determine appropriate placement and no alternative facilities to NH or SC are available, the deficit in NH will be decreased by 50%. If special facilities for the cognitively impaired are available, there will indeed be a surplus of NH beds. -- Suggestions for change to the LTC sector in the St. John's Region are presented. A true single-entry system should exist and there should be consistency of assessors in determining placement into institutional LTC. Objective criteria should be used to determine appropriateness of placement, clients should be re-evaluated after placement and facilities should be case-mix funded. Alternatives to NH and SC should be available, especially for the cognitively impaired. This information can help provide a foundation for current and future program planning of LTC facilities.

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