ASSESSMENT FOR REST HOME SUBSIDY - ARE THE ELDERLY GETTING A FAIR DEAL

Aim. To describe the role of a geriatric service in assessing the need s of elderly people at home or in rest homes referred for a subsidy fo r rest home care, and to compare this assessment with the composite de pendency scale (CDS), a Department of Social Welfare assessment instru ment. Methods. A 47 item questionnaire was completed by the geriatric service at the time of assessment of elderly people in the community o r in rest homes. Results. Of 280 assessments, 100 were from private ho mes, 180 from rest homes. Sixty-three per cent in rest homes were refe rred only because private funds were exhausted, 33% for a change in de pendency category. These two groups plus those at home were used as a basis for comparison in subsequent analysis. Of those at home: 30% alr eady had a rest home bed arranged; 77% remembered being consulted abou t rest home care, but only 38% were sure they wanted to go into such c are. The proportion of those too independent or too sick for rest home care was: private homes 14%, rest home resident requiring subsidy 6%, rest home requiring change in category status 11%. Twenty three perce nt of those at home could continue there with or without additional su pport. No significant difference was found in dependency between those in rest homes only seeking funding, and those at home, but both of th ese groups were significantly less dependent than those seeking an inc rease in subsidy. There was only a moderate correlation (r(s) = 0.778) between the geriatric service assessment of dependency and the compos ite dependency score. Conclusions. Many elderly people do not feel pro perly consulted about rest home placement, and some could be supported at home for longer. It is likely that many who can afford rest home f ees are entering too early and then asking for a subsidy when their fu nds are exhausted. By then it is almost impossible to insist on altern atives in the community. A policy of geriatric service assessment for all seeking entry into rest home care should ensure independent consul tation and consideration of alternative strategies. More research is r equired to examine cost implications of unrestricted movement into res t homes.