Use of in-patient hospital beds by people living in residential care

Background: There is concern that people living in residential care in Aust ralia make significant and often inappropriate use of acute in-patient hosp ital services. To date, no factual information has been collected in Austra lia and its absence may allow myths and negative stereotypes to proliferate . Objective: To determine how and why people living in residential care in Australia use inpatient hospital beds. To determine the outcome of hospital isation and functional status at 3 months following discharge. Methods: Pro spective study of 184 consecutive admissions to hospital following Emergenc y Department (ED) attendance involving people aged over 65 years and living in residential care in southern Adelaide, South Australia. Information was obtained from the facilities' transfer letters, and where these were inade quate or absent, telephone interviews were held with residential care staff . Results: 153 people accounted for the 184 admissions. They had a mean age of 84 years and 69% were female. 61% dame from hostels and 35% from nursin g homes. They had a wide range of clinical problems and twice as many were admitted to medical than to surgical units. Their mean length of hospital s tay was 7.9 days, 2.3 days higher than for non-same-day patients and was hi gher for hostel than for nursing home residents. All but two admissions wer e considered unavoidable though the provision of specialised care within re sidential care could have prevented a further 19 (10%) admissions. 96% of a dmissions resulted in survival to leave hospital and in 74%, people returne d directly to their place of origin. At 3 months follow-up, a further 20% o f the group had died while 5% were in hospital. In all, 14% of the original group were in a different longterm care facility while 56% were living at their former residence. Conclusions: People living in residential care are often hospitalised because of acute illness. In the vast majority of cases hospitalisation is both appropriate and unavoidable. Most did not require p rolonged hospitalisation and were discharged alive, usually to their origin al residence. However, within 3 months many had died or had functionally de clined. Strategies that prevent health breakdown in the residential care se tting need to be developed and trialed. Copyright (C) 2000 S. Karger AG. Ba sel.