Assessing the care requirements and perceptions of elderly applying to long-term care: the need for alternatives to institutionalization along the continuum

Walsh, Meghan Christine (2007) Assessing the care requirements and perceptions of elderly applying to long-term care: the need for alternatives to institutionalization along the continuum. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

Despite changes in the 1990's to the long-term care system in the Eastern Health region of Newfoundland and Labrador problems persisted. The system continued to be plagued by inappropriate use of nursing home beds, unnecessary acute care use, a discrepancy between the supply and demand of nursing home beds and a deficit of housing and alternatives to institutional care. Research suggested that a portion of applicants to the single-entry system with modest care needs might be better suited to an alternative housing arrangement rather than the two existing options: personal care homes and nursing homes. With the high cost of nursing home beds, lengthy wait times for placement, and a lack of interest in personal care homes, these issues demanded further investigation. The purpose of the study was therefore to gain an in-depth understanding of the system from a segment of applicants with modest care needs that could be extrapolated to a larger population of applicants with similar needs. Consequently, a chart review of an incident cohort of elderly applicants for long-term care placement was conducted to determine disability levels and support requirements. Data collected included care requirements and functional status, acute and chronic care usage, stated preferences for facilities and reasons for application, presence and use of formal and informal support, wait times, and outcomes of applications. In the second phase of the study, twenty individuals from the incident cohort were interviewed using grounded theory to explore experiences of the elderly with long-term care and the meanings of their decisions in relation to their personal experiences of aging and more specifically, the application process. Additionally, the objectives were to determine participants' perceptions of their needs; reasons for and causes of the decision to apply for long-term care placement; the role of applicants' support networks; attitudes regarding existing options; and, finally, opinions regarding a theoretical alternative housing option. -- The quantitative findings confirmed: that, firstly, many applicants with modest care needs would be better suited to an alternative housing arrangement (such as a supportive housing) rather than present options; that there are significant problems regarding both informal and formal supports of many applicants; and, lastly, emphasized the important role of critical episodes in many applications. The qualitative research found study participants made continual adjustments and readjustments to all facets of their lives including their environment, support and social networks, expectations and self-identities to avoid moving to a home as their needs increased. It was found that a weighing of support occurred between participants' existing circumstances and the expectation of support they viewed they would receive in a home. The inconsistencies in their support network and growing difficulties maintaining independence were measured against the perceived consistent care a nursing home or personal care home could provide. A gradual reconciliation to the move occurred, making the decision increasingly easier, while one or more critical episodes - such as a loss of a spouse or sudden decline in health - commonly acted as a trigger in the decision to apply for long-term care. It was found, however, that the decision-making process occurred in stages and that it extended beyond the application to the time of placement, which signified the actual final decision to applicants. The findings suggest that a comprehensive integrated system of long-term care services combined with a range of accessible, alternative housing options designed to avoid or delay placement would reduce demand on the system from the elderly without professional care requirements.

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