Factors influencing entry to residential care among older people

Abstract

With the population increasing, and the occupancy and dependency levels of older people in residential care rising, it is essential to examine the factors surrounding admission. The reasons for an older person choosing to move to residential care in New Zealand are not well documented, and little evidence surrounds the process. Clearly there is interplay of many factors, such as risk mitigation by health professionals, co-morbid disease, and concerns of the family. Objective: To seek out the significant factors and influences which persuade an older person to enter residential care, and the subsequent satisfaction. Design: Longitudinal mixed methods design (N = 31), using interviews with older people who were referred by the Needs Assessment Services Co-ordination (NASC). Also interviewed were caregivers, NASC managers, and the Multidisciplinary team. This research, called Older People Entering Residential Accommodation (OPERA) was a sub-study of the Assessment of Services Promoting Independence and Recovery in Elders (ASPIRE) trial (N=569). The data from ASPIRE was also available for use in the analysis. Face-to-face or telephone interviews were held with older people in three cities who needed substantial levels of support. Findings: The most significant factors for increasing the likelihood of residential care entry were: to have the potential care-giving child living far away, and needing a lot of support with the higher level daily living tasks. Also significant was the older person being home alone for long periods. It was clearly shown that while the doctor had the most influence over the person’s entry into residential care, the older person had the most influence with the decision to stay at home. The vast majority of the older people staying at home were happy with their decision to stay there, but unfortunately the vast majority of older people who entered residential care were unhappy with their decision to move there. Conclusions: This study demonstrated who was at risk of residential care entry, who had the controlling influence, and the subsequent older person satisfaction. Also highlighted was the need for improved communication to the older person, with improved community support and more customer-focused residential care.