Dependency, quality and staffing of institutions for elderly people.

Abstract

There have been dramatic changes in residential and nursing care of elderly people in the community over the last decade. Despite this, little is known about how these institutions compare in terms of: the quality of care they provide to residents; the dependency of the residents; or the manpower levels and qualifications of the staff employed. This study was undertaken with the aim of comparing the public and private sectors providing care to elderly people. A random selection of institutions was invited to participate, including private residential and nursing homes, Social Services homes and National Health Services long-term care wards. The findings show that the dependency of residents in the public sector was greater than in the private sector, with more mentally confused, incontinent and socially disengaged residents in the public sector. The staff to resident ratio in public institutions did not differ significantly from the private sector. Overall scores of quality of care were similar. Nevertheless, these scores masked important differences between the sectors, eg poorer buildings and facilities characterised the National Health Service units. Fewer activities and therapies, but a better ambience, was noted in the private nursing homes. These results suggest that the outcome of a policy to transfer the most heavily dependent patients from the care of the public sector could increasingly burden the private sector. This would result increase the proportion of highly dependent residents, with no clear provision for improved staff ratios, quality of care or training of staff.