Comparing the case-mix of frail olderpeople at home and of those beingadmitted into residential care: alongitudinal study

Background:In order to optimize interventions and services in the community, it is important to identify theprofile of persons who are able to stay at home and of those who are being admitted into residential care.Understanding their needs and their use of resources is essential. The main objective of the study is to identifypersons who are likely to enter residential care based upon their needs and resource utilization, so that careproviders can plan interventions effectively and optimize services and resources to meet the persons’needs.Methods:This is a longitudinal quasi-experimental study. The data consists of primary data from the communitysetting collected every six months during the period of 2010–2016. Interventions had the goal of keeping olderpeople longer at home. Participants were at least 65 years old and were living in the community. The interRAIResource Utilization Group system (RUG-III) was used to calculate the case-mix indexes (CMI) of all participants.Comparisons were made between the case-mix of those who were still living at home and those who wereadmitted into residential care at follow-up.Results:A total of 10,289 older persons participated in the study (81.2 ± 7.1 yrs., 69.1% female). From thispopulation, 853 participants (8.3%) were admitted into residential care. The CMI of the persons receiving night careat home were the highest (1.6 at baseline and 1.7 at the entry point of residential care), followed by persons receiving occupational therapy (1.5 at baseline and 1.6 at the entry point of residential care) and persons enrolled in case management interventions with rehabilitation (1.4 at baseline and 1.6 at the entry point of residential care).The CMIs at follow-up were significantly higher than at baseline and the linear regression model showed that admission to residential care was a significant factor in the model. Conclusions:The study showed that the RUG-III system offers possibilities for identifying persons at risk ofinstitutionalization. Interventions designed to avoid early nursing home admission can make use of the RUG-IIIsystem to optimize care planning and the allocation of services and resources. Based on the RUG-III case-mix,resources can be allocated to keep older persons at home longer, bearing in mind the complexity of care and theavailability of services in the community