An evaluation of institutional long-term care in the St. John’s Region and implications for policy

Wilson, Robert Craig (2015) An evaluation of institutional long-term care in the St. John’s Region and implications for policy. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

Introduction: Restructuring of the institutional long-term care (LTC) sector in the St. John’s health region has occurred during the past two decades. A single entry system has improved the efficiency of placement and the appropriateness of nursing home (NH) bed utilization, and provision of more supervised care (SC) beds and downsizing of NH has been undertaken. 1) To assess the impact of restructuring of institutional LTC in the St. John’s region, the annual incidence of clients, defined by disability, was determined. 2) Also, the efficiency and appropriateness of placement over a 10 year period was examined using three incident cohorts of clients seeking placement through the single entry system. Results: Incidence rates of clients seeking institutional placement increased from 21.7 to 30.8 per 1000 ≥ 65 years of age. Appropriateness of placement was better in 2005/6 in that 8.7% of clients recommended for NH had no indicators for NH compared to 20.3% in 1995/6, and all SC clients had low Alberta Resident Classification scores compared to 91.7% in 1995/6. Time to placement from 1995-2006 improved over time for both SC (from 26 to 7 days) and NH (from 76 to 42 days). Median survival following assessment was significantly longer in 2005/6 (27.6 vs. 37.7 months; p=0.003) with the major increase occurring in those referred to SC. This difference in survival was independent of age, gender and degree of disability. The optimal configuration of the LTC sector for the region in 2014 was assessed using predictions derived from the 1999/00 incident cohort and the 2005/6 incident cohort. Beds required for appropriate housing increased by 65%, supervised care bed need increased by 21%, specialized care for the cognitively impaired increased by 107% and NH bed need increased by 41 %. The major policy issues in LTC in the region were discussed with 3 decision makers. The major policy issues in Newfoundland and Labrador and 3 provinces of similar population size were explored. Policy options for the St. John’s region and for the government of NL include an integrated approach to LTC, more resources in home care, support of the private sector to provide more SC, building of facilities specifically for those with cognitive impairment and restructuring of NH. However, supply induced demand may create further need for each component of the LTC system. Conclusions: Consequently, monitoring the match between need based on disability and client placement, together with the annual incidence rates by degree of disability will be necessary to facilitate planning and evaluation.

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