Identifying the long-term care beneficiaries: differences between risk factors of nursing homes and community-based serv
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ORIGINAL ARTICLE
Identifying the long‑term care beneficiaries: differences between risk factors of nursing homes and community‑based services admissions Hugo Lopes1 · Céu Mateus2 · Nicoletta Rosati3 Received: 3 July 2019 / Accepted: 12 November 2019 © Springer Nature Switzerland AG 2019
Abstract Background The Portuguese long-term care sector is classified into home and community-based services (HCBS) and three nursing home (NH) units: convalescence, medium term and rehabilitation, and long term and maintenance. Aims To identify the main factors of admission into each care setting and explore to what extent these populations are different. 14,140 patients from NH and 6844 from HCBS were included from all over the country. Methods A logistic regression was estimated to identify determinants of admission into NH care, using sociodemographic characteristics, medical conditions and dependence levels at admission as independent variables, and region of care, referral entity and placement process as control variables. Then, ordered logistic regression was used to identify the contribution of the above factors in each specific NH unit. Results Being female, not being married, not having family/neighbour support, being literate, having mental illness, being cognitively or physically impaired are the main predictors of being admitted into a NH. Within the NH units, placements of the large majority of patients were accurately predicted, based on the available variables. However, for around half of the patients referred to long-term care units, the model expected placements into medium-term units, while for those admitted into short-stay units, the model returned that 29% could have benefited from being admitted into a medium-term care unit. Discussion and conclusions Patients’ accurate placement is a highly complex and challenging process, demanding more variables than the ones available for the model here presented. Our work confirms the need to collect other type of variables to improve the placement decision process. Keywords Portuguese long-term care · Nursing homes · Home and community-based services · Dependence levels · Types of care units
Background The widespread increase in life expectancy is perhaps one of the greatest achievements of humankind. Consequently, changes in demographic features—characterized by an elderly population, an increase in chronic diseases and new
* Hugo Lopes [email protected] 1
Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
2
Health Economics Group, Division of Health Research, Furness College, Lancaster University, Lancaster LA1 4YG, UK
3
ISEG, University of Lisbon, and CEMAPRE, Rua do Quelhas 6, 1200‑781 Lisbon, Portugal
patterns of growing morbidity and functional restrictions [1, 2]—are already a reality in most of the developed countries. Thus, the evolution and (re)configuration of the health system should be influenced by the adoption of adequate health policies to encourage the coordination of the healthcar
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