Acute medical bed usage by nursing home residents

An increasing number of elderly patients in nursing home care appears to be presenting to hospital for acute medical admission. A survey of acute hosp ital care was undertaken to establish accurately the number and character o f such admissions. A total of 1300 acute medical beds was surveyed in North ern Ireland in June 1996 and January 1997 on a single day using a standardi sed proforma. Demographic details, diagnosis and length of admission were r ecorded. A total of 84 patients over the age of 65 (mean 79.5 years) admitted from n ursing home care was identified in June 1996 and a total of 125 (mean 83.3 years) in January 1997. A total of 88 (70%) of admissions in 1997 were acco mpanied by a general practitioner's letter. The assessing doctor judged tha t 12 (9.6%) of admissions in 1997 could have had investigations and or trea tment reasonably instituted in a nursing home. The proportion of acute medi cal beds occupied by nursing home residents was 6% in June 1996 rising to 1 0% in January 1997. The study accurately identifies the significant contribution of nursing hom e patients to acute medical admissions and the low proportion in whom admis sion was unnecessary. Closure of long stay hospital facilities should be ac companied by investment in community medical services and also reinvestment in acute hospital care for elderly people.