Elderly People in Residential Care. Survey design for SSA and other purposes. A paper for information and discussion with local government representative bodies.

Abstract

1. This report proposes a survey of residential care (used here to encompass both residential and nursing home care) which has the purpose of improving SSA formulae for elderly people, and for which the Department of Health has identified related interests, including: the need for new analyses of the relationship between costs and dependency;information about non-publicly funded residents; appropriateness of placement decisions.2. For SSA purposes (section 2 of the report), the study will: lead to new estimates of the relative need for supported residential care under the new Community Care arrangements, based principally on an analysis of the circumstances of people currently being admitted, compared with elderly people generally; investigate whether the inclusion of the socio-demographic factors about elderly people living in an area would improve the estimate of the likely average cost of residential care under a standard level of services. Readers interested primarily in SSA aspects of the study need read only sections 1 and 2, together with the methodologydescribed in section 6 (admissions study, subsections 6.1-6.8). 3. Information about the relationship between dependency and costs would provide a basic building block of information which could be used for a number of analyses, including estimating national costs of provision, making cost projections and the estimation of lifetime costs of people admitted at different levels of dependency (sections 3 of the report). This last is of particular importance: the Audit Commission have identified the problems associated with local authorities taking on caring commitments with no clear idea how long these will last. 4. The type of information collections required to explore these issues would have a wide variety of applications, including the appropriateness of placements in residential care (sections 4 and 5 of the report). These will be greatly enhanced by links with other ongoing and proposed research studies. 5. A three part survey is proposed (section 6 of the report): An Admissions study would identify elderly people who will have a significant financial impact on local authority resources committed to residential care. This includes those people: for whom the decision has been made that they are to be admitted to residential care;who have been admitted on an emergency basis and need to be at least financially assessed by the local authority; who are already in residential care who are being assessed because they no longer have the resources to pay for residential care; who are moving from one home to another with important cost implications. Data would be collected about the characteristics of the person being admitted and the home they are being admitted to (see Box 1). 6. A Longitudinal follow-up study would provide information about: how long people stay in residential care and mortality; destinational outcomes; changes in dependency and financial arrangements over time. (see Box 4) 7. A Cross-sectional study would identify: the characteristics of the resident population currently in residential care; the characteristics of homes, including some assessment of quality of care; the characteristics of short stay emergency, NHS and private funded admissions to homes. (see Box 3) 8. Other studies that would provide valuable links include: an ongoing study of quality of life in residential care (led by Anthony Mann); a proposed longitudinal study of quality of life in residential care (led by Peter Huxley); an evaluation of community care of elderly people (ECCEP, led by Bleddyn Davies): the current programme of mixed economy of care (MEOC, led by Martin Knapp); validation and development of Resource Utilisation Groups (RUGS, led by Iain Carpenter). 9. At the time of writing a survey of admissions and the first wave of the longitudinal follow-up have been commissioned,though design details remain to be finalised in consultation with all interested parties. Outline approval has been given for the cross-sectional survey of homes. The earliest completion dates for the main field work and analysis of these studies is as follows: Admissions survey: May 1996. Longitudinal survey (first wave): December 1996. Cross-sectional survey (subject to contract): December 1996. 10. The value of a three part linked survey is that it will allow a wide variety of analyses and provide a benchmark from which future changes in the role and characteristics of residential care can be measured. The proposed methodology should allow a wide variety of comparisons to be made, over time, cross-sectorally and cross-nationally