Clinical characteristics and outcomes in a cohort of patients who were assessed as in need of nursing-home care

Information use in discharge accommodation recommendations for stroke patients

The discharge of stroke patients to appropriate accommodation presents rehabilitation teams with a difficult task, as clinical recommendations concerning accommodation may have a considerable impact on patients' future lifestyle and independence. A Social Judgment Theory task was employed to identify the informational cues considered by 82 rehabilitation professionals when making accommodation decisions for stroke patients at discharge from rehabilitation. Several factors, including patient mobility, social supports and activity of daily living (ADL) status, were found to be highly weighted in this decision. However, there were substantial individual differences in the weighting by the study partici pants of informational cues. These differences were not consistently attributable to profession or experience.

The costs and experiences of caring for sick and disabled geriatric patients--Australian observations

The costs and experiences of caring for geriatric patients and the effectiveness of a geriatric assessment team have been reviewed in this study from the New South Wales Central Coast. The findings were: that some clients who are referred for placement in nursing homes and who meet standard criteria for admission can be maintained in the community; the cost to the taxpayer of persons admitted to nursing homes was at least $449 to $776 per week (1991 prices), compared to an average cost of $89 per week to maintain at home those whose original assessment met all the criteria for nursing home placement; assessments of needs of some clients were being conducted by five or more separate agencies which led to increased costs and created distrust and confusion for the client; a key factor in the decision to maintain a client in the community was found to be the availability and motivation of carers. A geriatric assessment team has an essential role in mobilising expert assessment and facilitates access to community-based support services to obviate or delay admissions to nursing homes.

A population-based study of assessed applicants to long-term nursing home care

OBJECTIVE

To examine the characteristics of all individuals assessed as requiring nursing home care arising from a population living within a defined geographical region and to study the manner in which they presented for assessment.

DESIGN

Clinical assessment by a physician in geriatric medicine with the assistance of other disciplines.

SETTING

Regional Geriatric Assessment Service.

SUBJECTS

All persons recommended for nursing home care within the study period.

RESULTS

The major diseases contributing to the need for nursing home care were organic brain disorders (60%) and stroke (32%). Dementia was present in 64% of cases; significant behavioral disturbance in 18%; severe communication disorders were frequent. The majority (86%) had been ill for greater than 1 year. The mode of presentation was acute in 9%, acute-on-chronic in 46%, and chronic in 45%. It was associated with significant differences in case characteristics including the location at the time of assessment, diagnoses, duration of illness, physical dependency, communication disorders, behavioral disturbance, and skilled nursing care requirements.

CONCLUSIONS

These observations suggest that progression to nursing home care varies considerably. Strategies directed toward the prevention of institutionalization should be organized in recognition of these variations.