In 1996, the St. John's region had a population of 8,435 > or = 75 years, with 996 nursing home (NH) beds and 550 supervised care (SC) beds. A single entry system to these institutions was implemented in 1995. To determine the impact of the single entry system, the demographic and clinical characteristics of NH residents were assessed in 1997 (N = 1,044) and in 2003 (N = 963). To determine the efficiency of placement and the need for long-term care beds, two incident cohorts requesting placement were studied in 1995/96 (N = 467) and in 1999/2000 (N = 464). Degree of disability was determined using the Residents Utilization Groups III classification (RUG-III) and the Alberta Resident Classification Score (ARCS), and time to placement and to death was measured. In prevalent NH residents, the percentage without RUGS-III disability decreased from 18.5% in 1997 and to 9.9% in 2003. The proportion recommended for NH was 75% in 1995/96 and 72% in 1999/2000, despite the fact that the proportion with RUGS-III disability was 64% in both periods. Using a decision tree, optimal placement for the 1999/2000 cohort was 36% to SC, 20% to SC for the cognitively impaired, and 44% to NH. Predicted need for long-term care beds in 2004 matched poorly with current provision of NH and SC beds, and the mismatch will be worse in 2014. It was concluded that the single entry system was associated with improved appropriateness of NH bed utilization. However, there was a mismatch in need for and provision of institutional long-term care. Investment in the reconfiguration of long-term care beds by case mix and by geography is necessary.
The Canadian population is aging. In Newfoundland and Labrador, nursing homes and supervised care facilities provide Long-Term Care (LTC). There may be a mismatch between the provision of LTC beds and clients' needs. To compare the type and annual rate of clients seeking placement to LTC, incident annual cohorts (N = 1,496) in five provincial health regions within Newfoundland and Labrador were compared using objective measures of disability. Client need was assessed using a decision tree and the optimal distribution of LTC beds was determined. Within the four island regions, little difference was observed in degree of disability, but Labrador clients differed from the island regions in age, degree and type of disability. A decision tree suggested that optimal placement was 7% to housing, 34% to supervised care, 17% to supervised care for cognitive impairment and 42% to nursing home care. In Newfoundland and Labrador, institutional LTC is dependent on nursing homes, whereas the major need is for appropriate supervised care for those with modest disability, with or without cognitive impairment. Different approaches to restructuring of long-term care in each region are necessary because of the differences in rates of presentation for LTC and differences in availability of nursing home and appropriate supervised care beds.
Restructuring of institutional long-term care was undertaken using predictions of future bed need with assumptions made on incidence rates of clients defined by type of disability, survival, and demographic changes. Recent substantial increase in the population rate of clients seeking placement across all degrees of disability, coincident with new facilities for those with modest disability, occurred. Consequently, more appropriate housing and supervised care beds, and more limited downsizing of nursing homes will be required.