Planning the restructuring of long-term care : the demand, need and provision of institutional long-term care beds in Newfoundland and Labrador

The demand for long-term care (LTC) services in Canada is increasing because the population is aging. In Newfoundland and Labrador (NL) nursing homes (NHs) and supervised care (SC) facilities provide long-term care. There may be a mismatch between the provision of LTC beds and the needs of clients. To compare the type and annual rate of clients seeking placement to LTC, incident annual cohorts (N=1496) in five provincial health regions within Newfoundland and Labrador were compared using objective measures of disability, the Alberta Resident Classification Scores (ARCS) and the Resource Utilization Groups (RUGs 111). Client's need was assessed using a decision tree and optimal distribution of LTC beds determined. Regional incidence rates by disability of clients were compared, and whether these differences were associated with differences in the rate of supervised care (SC) or nursing home (NH) beds provided. -- Within the four regions of Newfoundland little difference was observed in degree of disability, but Labrador clients differed from the island regions in age, degree and type of disability. Annual rate of presentation for LTC differed by region, with the highest incidence rate of LTC clients in regions with highest rates of supervised care (SC) beds and lowest rates of nursing home (NH) beds. -- Thirty four % of applicants for LTC were referred for supervised care placement and sixty six % for nursing home. However, seven % had no functional disability being independent for activities of daily living, were continent and without cognitive impairment (CI). Fifteen % of clients recommended for nursing home had no indicators for nursing home. A decision tree suggested that optimal placement was seven % to supportive housing, thirty four % to supervised care, 17% to supervised care for cognitive impairment, and 42% to nursing home. -- In NL, a large component of institutional LTC is 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 differences in rates of presentation for LTC and availability of nursing home and appropriate supervised care beds