The annual institutional long-term care needs in the St. John's Region

O'Reilly, Daria Joan (1997) The annual institutional long-term care needs in the St. John's Region. Masters thesis, Memorial University of Newfoundland.

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The St. John's region has approximately 1400 long-term care (LTC) beds in nursing homes and personal care homes. Despite this there are concerns that excessive numbers of acute care beds are occupied by clients awaiting long-term care placement that the waiting list for placement is too long, and that there is a mismatch between needs of clients and level of care provided in nursing homes. -- Actual placement within the long-term care (LTC) sector is influenced by services that are currently available, the desires/demands of clients as well as their needs. Accordingly, relating needs to utilization will assist in rational planning for LTC services to accommodate the expected growth in need as the population ages. -- The primary objective of this study was to determine the current status of the long-term care sector in the region. This analysis determined the needs of the clients entering the long-term care sector using validated scoring systems. It identified: -- the needs of the clients awaiting institutional placement; -- the proportion of acute care beds occupied while awaiting placement; -- the annual demands on the long-term care sector; -- appropriateness of client placement; -- time to placement. -- The availability of home support, the need for professional care provided in a nursing home (NH) and degree of disability was estimated for the 426 clients entering the LTC sector in 1995/96. Using validated assessment tools, the needs of these clients were compared to the actual placement. 4% of clients had no measurable disability and another 8% may have managed with home support. 20% of the clients recommended for NH care did not have a clinical indication for NH placement. Thus, the development of minimal criteria for placement in supervised care and in NH care may help maximize the utilization of the current number of beds. -- The median time to placement in a private personal care home was 8 days, whereas average wait for government-subsidized, level 1 supervised care in a NH was 302 days. There is a need for supervised care in the city aimed at clients who have disability, but who do not have need for NH level of care. The median time to placement of clients requiring nursing home placement (levels 2/3) was 96 days. A target time for placement should be developed. -- 139 LTC clients awaiting placement from an acute care hospital bed had an average wait of 97 days, and occupied less than 4% of the acute care beds. -- The annual incidence of clients requiring placement in a supervised environment was 110/426, and the incidence of those requiring the professional care available in a nursing home was 316/426, as determined by the assessment panel. Using objective criteria the former rate was 108/426 and the latter 268/426. -- The actual annual rate of placement in both supervised and nursing home care was commensurate with the demand when mortality and client wishes were taken into account. In fact there was no increase in the waiting list after 1 year of follow-up. -- We conclude that minimal criteria should be developed for admission to institutional long-term care. The current system is providing reasonable access to nursing homes, without excess blocking of acute care beds or increasing size of waiting lists. Restructuring of the long-term care system requires study of the needs and outcomes of current residents.

Item Type: Thesis (Masters)
Item ID: 11176
Additional Information: Bibliography: leaves 100-106.
Department(s): Medicine, Faculty of
Date: 1997
Date Type: Submission
Library of Congress Subject Heading: Long-term care facilities--Patients--Classification; Long-term care facilities--Utilization--Newfoundland and Labrador --St. John's.
Medical Subject Heading: Health Services Needs and Demand--Newfoundland and Labrador --microfiche; Long-Term Care--utilization--Newfoundland and Labrador--microfiche; Patients--classification--microfiche.

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