Dependency in older people recently admitted to care homes

Objective: to investigate dependency and general hearth status of a cohort of older people admitted to residential or nursing homes for long-term care . Method: we assessed 308 people aged over 65 years within 2 weeks of admissi on for long-term care to one of 30 nursing or residential homes in north-we st England. Dependency was assessed using the Barthel activities of daily L iving index and the Crichton Royal Behaviour Rating Scale. We collected inf ormation from the homes' records on diagnosed conditions and current medica tion. Results: 50% of the cohort were in a 'low dependency' band (Barthel score 1 3 - 20): 31% of those in nursing homes and 71% of those in residential home s. In nursing homes, low-dependency residents were more likely to be self-f unding than those with higher dependency. Of a number of broad diagnostic g roupings, only a diagnosis of dementia was associated with nursing- rather than residential-home admission. Of 47 residents who scored 9 or less on th e Mini-Mental State Examination (indicating severe cognitive impairment), 8 5% had no diagnosis of dementia, neurological disorder or other psychiatric disorder. Discussion: the high proportion of new admissions of subjects with low depe ndency needs raises questions about the effective targeting of resources an d about management of the boundary between home-based and institutional car e. The existence of an important group of self-funded, low-dependency new a dmissions to nursing homes suggests a need to provide better assessment and placement services for those who are financially independent of local auth orities. Many new admissions had conditions which might benefit from rehabi litation but there were almost no therapy staff in the studied homes. In so me cases where severe cognitive impairment was evident, there was no eviden ce that the result of any formal pre-admission psychiatric evaluation had b een communicated to nursing or care staff.