Crossing the threshold: A study of older people moving into residential care.

Introduction: The present thesis examined the reasons for and outcomes of admission to local authority residential homes for older people. Method: A randomised controlled trial of applicants to Leicestershire homes was conducted. Applicants were assessed for health and morale, the intervention group was medically examined and all applicants were re-assessed at 6, 12 and 52 weeks using a repeat of baseline measures. A retrospective analysis was also undertaken of admissions, comparing one year mortality with a community population. Finally, walking distances of short-stay users at home and in residential care were compared. Results: High levels of disability (54%), urinary incontmence (38%) and cognitive impairment (47%) indicated that 41% of admissions were inappropriate. Intervention group applicants experienced similar health outcomes to controls at 6 and 12 weeks but significantly more transferred to nursing/hospital care and experienced improvements in morale at the latter follow-up. One quarter had died within a year (twice the expected rate) and 11% were discharged. Baseline disability was predictive of both outcomes. Of those remaining in the homes after one year, deterioration in function necessitated greater assistance from staff. Additionally it was apparent that walking distances in residential homes were much greater than at home and that this may have had implications for the health status of some older residents. Discussion: Leicestershire homes admit older people who are unsuited to residential care and many deteriorate during their first year of residence. Despite the death or discharge of the most frail, more help is needed by the remainder, justifying a review of staffing and admission criteria. The medical intervention redirected inappropriate admissions but no improvements in physical function were detected, despite improvements in morale. This suggested that selective medical screening may be advisable.