Contrasting acute care and long-term care information systems needs.

Information systems in nursing facilities have their own set of requirements. While these may appear to be less complex than those required of acute care systems, they offer their own series of traps and pitfalls and the information systems manager should be wary of vendors who suggest that acute care systems can be readily modified for long-term care usage. Well-designed and implemented long-term care applications demand the same challenges to integration as do acute care products. Information provided by these systems must be designed to support not only the routine transactions of the facility, but also the strategic planning necessary for intelligent management decision making. It is not sufficient in this era to record and replay data. Data must be synthesized into meaningful summaries in order to be effectively used by executives. [7] This is also true for clinicians. Assessment data are increasingly used to position a patient in a case-mix or reimbursement group. Whereas acute care revolves around DRGs and ICD-9 codes (soon to be ICD-10), long-term care uses a patient review instrument (PRI), resident assessment protocols (RAPs), and resource utilization groups (RUGS). The successful information systems manager will have all of these measures at his or her disposal by financial class, insurance class, and days receivable if eyes are kept on the goal of planning all of the systems with equal care and an eye to the future.

Expenditures for long-term care services by community elders.

Costs of care are presented for elderly persons in five community-based settings. These settings include elderly persons living in their own homes or in group housing and who do or do not receive case-managed home care. Expenditures for care ranged from a low of about $1,100 per year to a high of $4,025. The level of expenditure was directly related to risk of institutionalization and was higher for those receiving case-managed home care. As a majority of the elderly use a substantial amount of care even without case management, the potential for community care demonstration programs to yield significant cost savings appears quite limited.

Inst-Risk II: an approach to forecasting relative risk of future institutional placement.

This article describes a model development process that represents a useful step in classifying populations in terms of risk of institutionalization (Inst-Risk II). A four-category risk classification system--"High risk, Some risk, Low risk, and Very Low Risk"--was developed, based on combinations of measures of functional status, age, health status, demographics, and social supports. Our review of variables found by other researchers to be related to high risk of institutional placement, as well as our own research with Massachusetts elderly, confirmed functional impairment, diagnostic conditions, and advanced age to be major predictors of institutional placement. At the other extreme, Very Low risk status was indicated by combinations of functional independence, absence of health problems, and relatively younger age. Using baseline data of the kind that can be easily gathered and are often obtained in social agency screening interviews, our research indicates that this instrument differentiates among these risk status groups for two- to four-year periods.

The cost of residential care homes serving elderly adults.

Given increasing expenditures for long-term nursing home care costs, the residential care home (RCH) provides a viable alternative for elderly Americans requiring daily supervision but not extensive care. Purposive and random sampling procedures were used to select 181 RCHs serving the elderly in five states in order to analyze their expenditures. Home operator interviews yielded facility and patient descriptors as well as expenditure data. Analyses of these data revealed total expenditures per resident month to be $330 in 1980 dollars. Based on multivariate analyses, measures of resident case mix were significantly related to food costs but not to staffing costs. Findings suggest that small homes commit more resources to resident care since operator labor is not an expenditure.

Psychiatric history as a barrier to residential care.

Bias against individuals with a history of psychiatric hospitalization can block their access to residential care homes and thus impede deinstitutionalization efforts. After surveying home operators in nine residential care programs in five states, the authors found that providers tend to accept a physically impaired client over one with behavioral problems or a history of psychiatric hospitalization. The authors also point out that actual admission practices may not reflect facility policies. For example, more than 30 percent of the operators said they admitted persons with behavioral problems or psychiatric histories, yet no such persons resided in their homes. The authors suggest strategies such as provider education and financial incentives to combat the operator's bias against former mental patients.