The right person? the right place? the right time? a pilot study of the appropriateness of nursing home placements

The appropriate use of health services is a key challenge for the NHS. Olde r people have been consistently identified as being disproportionately repr esented amongst those defined as 'inappropriately' located within the acute health sector. Prior to the introduction of community care it was hypothes ised that older people were entering nursing home care inappropriately. Wit h the requirement for assessment prior to entry into nursing homes now a fe ature of the system such 'inappropriate' admissions should not occur. This pilot study investigates the feasibility of determining inappropriate admis sions and the extent of this phenomenon in nursing homes used by three inne r London Boroughs. To determine the number of 'inappropriate' placements in nursing homes in three London Boroughs (Lambeth, Southwark & Lewisham). Re trospective audit of nursing home case notes using standardised data collec tion method. New local authority funded admissions to nursing homes from LS L during the period 1 April 1993-31 March 1995. One hundred and fifty seven people entered the 25 nursing homes identified. For 65% nursing home place ment was appropriate, 14% were apparently more suited to residential care a nd 17% for community care. Documentation concerning clients held by the nur sing homes was generally poor. Despite the introduction of the Community Ca re Act and the clear requirement for assessment before entry into nursing h ome care, approximately one-third of the placements reviewed were inappropr iate and did not meet the individual's care needs. Further research is unde rway to determine if these findings apply nationally. (C) 2000 Elsevier Sci ence Ireland Ltd. All rights reserved.