Study: Most Nursing Home Residents’ Care Needs Can’t Be Managed Cost Effectively Elsewhere

June 27, 2017
Perry Gwen Meyers,

Most individuals admitted to nursing homes have high levels of care needs—because of conditions such as dementia and stroke—that cannot be met cost-effectively elsewhere, such as in the community. According to a Canadian study in the July issue of JAMDA, “Level of Need, Divertibility, and Outcomes of Newly Admitted Nursing Home Residents,” close to half of the nearly 65,000 Canadian nursing home residents studied were considered to be “indivertible,” that is, they could not receive appropriate, cost-effective care elsewhere.

The vast majority of the residents in the study had difficulties with activities of daily living (such as dressing or bathing) and two-thirds had some level of cognitive impairment. Many did not have a caregiver at home. Such individuals, with high levels of physical and mental disability, are very unlikely to return to the community. The researchers in this study concluded that only about 1 in 20 residents could potentially be safely and cost-effectively maintained in the community.

With the older adult population expected to skyrocket in the next 20 years—in Canada and elsewhere, the researchers suggested an urgency for efforts to address a long-term care (LTC) system currently at capacity. The authors recommended looking at “promising practices in care for those with dementia in the community” such as dementia villages, dementia-focused models of care, and short-stay dementia units. They also noted, “To address the growing population care demand for those with LTC needs, it may be useful to think less about LTC beds, and more about what it would take to create LTC ‘spaces.’ Such LTC spaces can occur across multiple settings in the community, including private homes, supportive housing…and in specialized units.”

The study was conducted by researchers at the Bruyere Research Institute (Bruyere Center of Learning, Research and Innovative in Long-Term Care in Ottawa), Ottawa Hospital Research Institute (Clinical Epidemiology Program, Ottawa), Institute for Clinical Evaluative Sciences (Population Health and Primary Care, Ottawa), and Institute for Health Policy, Management and Evaluation (University of Toronto, Toronto) in Ontario, Canada.

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