Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-05T13:46:40.745Z Has data issue: false hasContentIssue false

Predictors of the Level of Care assigned to New Nursing Home Residents

Published online by Cambridge University Press:  29 November 2010

Peter R. Grant
Affiliation:
University of Saskatchewan

Abstract

Admission data from 159 residents of four Saskatchewan nursing homes were analysed in order to identify predictors of level of care. Multiple regression analyses showed that a high level of care was assigned to those who were unable to perform various activities of daily living, those who had behavioral problems, and those who had recently experienced a stressful life event; with these variables and a nursing home variable explaining 47.2% of the variance. Appropriately, the most important predictor is activities of daily living. The other major predictor is behavioral problems which, the results suggest, are caused by either an organic psychotic disorder or a high level of stress. It is recommended that, following admission, new residents with behavioral problems caused by stress should be the recipients of programs designed to help them cope with this stress and mitigate their behavioral problems. Then, they should be reassessed and, where appropriate, reassigned to a lower level of care.

Résumé

Les données provenant des fiches d'admission de 159 personnes vivant dans quatre maisons de retraite de la Saskatchewan ont été analysées en vue d'identifier les indices permettant de prévoir le degré de soins qui leur seraient nécessaires. Les analyses de régression multiple ont montré que les soins les plus intensifs sont attribués aux sujets qui sont incapables de s'acquitter des activités de la vie quotidienne, à ceux qui présentent des problèmes du comportement, et à ceux qui ont traversé une crise récente; ces variables ainsi que la variable de la maison de retraite expliquent 47,2% de la variance. Le principal indice est celui des activités quotidiennes. Le second indice par ordre d'importance est celui des problèmes du comportement engendrés, selon le rapport, par un désordre psychotique d'origine organique ou par un stress élevé. Il est recommendé que suite à l'admission en maison de retraite les personnes présentant des problèmes du comportement engenderés par le stress soient dirigées vers des programmes conçus en vue de les aider à surmonter ce stress et à atténuer les problèmes du comportement. Une fois ces objectifs atteints, les intéressés pourront être soumis à un nouvel examen et assignés à un degré de soins moins intensifs.

Type
Articles
Copyright
Copyright © Canadian Association on Gerontology 1985

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Allison-Cooke, S. & Thomberry, H. (1977). Factors affecting nursing home medical review: Implications for program and facility planning. Medical Care, 15, 494504.CrossRefGoogle ScholarPubMed
Barney, J.L. (1977). The prerogative of choice in long-term care. Gerontologist, 17, 309314.CrossRefGoogle ScholarPubMed
Bayne, J.R.D. (1981). Placement of the elderly. Canadian Family Physician, 27, 15891591.Google ScholarPubMed
Bayne, J.R.D. & Caygill, J. (1977). Identifying needs and services for the aged. Journal of the American Geriatrics Society, 25, 264268.CrossRefGoogle ScholarPubMed
Becker, B. (1982). The nursing home scoring system. A policy analysis. Gerontologist, 22, 3944.CrossRefGoogle ScholarPubMed
Brody, E.M. & Gumner, B. (1967). Aged applicants and non-applicants to a voluntary home: An exploratory comparison. Gerontologist, 7, 234243.CrossRefGoogle ScholarPubMed
Cape, R.D.T., Shorrock, C., Tree, R., Pablo, R., Campbell, A.J., & Seymour, D.G. (1977). Square pegs in round holes: A study of residents in long-term institutions in London, Ontario. Canadian Medical Association Journal 117, 12841287.Google Scholar
Fillenbaum, G.G. (1977–78). An examination of the vulnerability hypothesis. Journal of Aging and Human Development, 8, 155160.CrossRefGoogle ScholarPubMed
Fillenbaum, G.G. & Smyer, M.A. (1981). The development, validity, and reliability of the OARS multidimensional functional assessment questionnaire. Journal of Gerontology, 36, 428434.CrossRefGoogle ScholarPubMed
Grant, P.R. (in press). Who experiences the move into a nursing home as stressful? Examination of the relocation stress hypothesis using archival, time-series data. Canadian Journal on Aging.Google Scholar
Greenburg, J.N. & Ginn, A. (1979). A multivariate analysis of the predictors of long-term care placement Home Health Care Services Quarterly, 1, 7599.CrossRefGoogle Scholar
Gutman, G.M., Stark, A.J., & Kliewer, E. (1980, November). Placement decisions: Attempts at reducing variables to a manageable set.A paper presented at the annual meeting of the Gerontology Society of America,San Diego.Google Scholar
Haddad, L.B. (1981). Utilizing rating instruments for evaluating behavioral characteristics differentiating elderly patients selected for skilled nursing, intermediate, and psychiatric care. Journal of Gerontology, 36, 583585.CrossRefGoogle ScholarPubMed
Kate, S. (1983). Assessing self-maintenance: Activities of daily living, mobility, and instrumental activities of daily living. Journal of American Geriatrics Society, 31, 721727.Google Scholar
Kraus, A.S., Spasoff, R.A., Beattie, E.J., Holden, E.W., Lawson, J.S., Rodenburg, M. & Woodcock, G.M. (1976a). Elderly applicants to long-term care institutions. I. Their characteristics, health problems, and state of mind. Journal of the American Geriatrics Society, 24, 117125.CrossRefGoogle ScholarPubMed
Kraus, A.S., Spasoff, R.A., Beattie, E.J., Holden, E.W., Lawson, J.S., Rodenburg, M. & Woodcock, G.M. (1976b). Elderly applicants to long-term care institutions. II. The application process; placement and care needs. Journal of the American Geriatrics Society, 24, 165172.CrossRefGoogle ScholarPubMed
Lawton, M.P., Moss, M., Fulcomer, M., & Kleban, M.H. (1982). A research and service multilevel assessment instrument. Journal of Gerontology, 37, 9199.CrossRefGoogle ScholarPubMed
Loeser, W.D. & Dickstein, E.S. (1979). Avoiding diagnostic error in admitting patients to a nursing home. Journal of the American Geriatrics Society, 27, 558559.CrossRefGoogle ScholarPubMed
McAuley, W.J. & Prohaska, T.R. (1981). Professional recommendations for long-term care placement: A comparison of two groups of institutionally vulnerable elderly. Home Health Care Services Quarterly, 2, 4157.CrossRefGoogle ScholarPubMed
Miller, M.B. & Elliott, D.F. (1976). Errors and omissions in diagnostic records on admission of patients to a nursing home. Journal of the American Geriatrics Society, 24, 108116.CrossRefGoogle ScholarPubMed
Pfeiffer, E., Johnson, T.M., & Chiofolo, R.C. (1981). Functional assessment of elderly subjects in four service settings. Journal of the American Geriatrics Society, 29, 433437.CrossRefGoogle ScholarPubMed
Rubenstein, L. (1983). The clinical effectiveness of multidimensional geriatric assessment. Journal of the American Geriatrics Society, 31, 758762.CrossRefGoogle ScholarPubMed
Rubenstein, L.Z., Abrass, I.B., & Kane, R.L. (1981). Improved care for patients on a new geriatric evaluation unit. Journal of the American Geriatrics Society, 29, 531536.CrossRefGoogle ScholarPubMed
Senior Citizens' Provincial Council (1983). The first institutional year: The results of relocation in special care homes. Regina, Saskatchewan.Google Scholar
Sherwood, S., Morris, J.N. & Bamhart, E. (1975). Developing a system for assigning individuals into an appropriate residential setting. Journal of Gerontology. 30, 331342.CrossRefGoogle ScholarPubMed
Sloane, P.D. (1980). Nursing home candidates: Hospital inpatient trial to identify those appropriately assignable to less intensive care. Journal of the American Geriatrics Society., 27, 511514.CrossRefGoogle Scholar
Smallegan, M. (1981). Decision making for nursing home admission: A preliminary study. Journal of Gerontological Nursing, 7, 280285.CrossRefGoogle ScholarPubMed
Smyer, M.A. (1980). The differential usage services by impaired elderly. Journal of Gerontology, 35, 249255.CrossRefGoogle ScholarPubMed
Spasoff, R.A., Kraus, A.S., Beattie, E.J., Holden, D.E.W., Lawson, J.S., Rodenburg, M., Woodcock, G.M. (1978). A longitudinal study of elderly residents of long-stay institutions. Gerontologist, 18, 281292.CrossRefGoogle ScholarPubMed
Stolee, P., Rockwood, K., & Robertson, D. (1982). The elderly in the community: Report of the Saskatchewan Health Status Survey of the Elderly Part II (Preliminary Report). Saskatchewan: Division of Geriatric Medicine, Univeristy of Saskatchewan.Google Scholar
Williams, T.F., Hill, J.G., Fairbank, M.E. & Knox, K.E. (1973). Appropriate placement of the chronically ill and aged. Journal of the Americon Medical Association, 226, 13321335.CrossRefGoogle ScholarPubMed
World Health Organization (1977). Manual of the international classification of diseases, injuries, and causes of death.Based on the recommendations of the ninth revision conference,Geneva,1975.Google Scholar