Assessment for rest home subsidy: are the elderly getting a fair deal?
OBJECTIVE
To describe the role of a geriatric service in assessing the needs of elderly people at home or in rest homes referred for a subsidy for rest home care, and to compare this assessment with the composite dependency scale (CDS), a Department of Social Welfare assessment instrument.


METHODS
A 47 item questionnaire was completed by the geriatric service at the time of assessment of elderly people in the community or in rest homes.


RESULTS
Of 280 assessments, 100 were from private homes, 180 from rest homes. Sixty-three per cent in rest homes were referred only because private funds were exhausted, 33% for a change in dependency category. These two groups plus those at home were used as a basis for comparison in subsequent analysis. Of those at home: 30% already had a rest home bed arranged; 77% remembered being consulted about rest home care, but only 38% were sure they wanted to go into such care. The proportion of those too independent or too sick for rest home care was: private homes 14%, rest home resident requiring subsidy 6%, rest home requiring change in category status 11%. Twenty three percent of those at home could continue there with or without additional support. No significant difference was found in dependency between those in rest homes only seeking funding, and those at home, but both of these groups were significantly less dependent than those seeking an increase in subsidy. There was only a moderate correlation (rs = 0.778) between the geriatric service assessment of dependency and the composite dependency score.


CONCLUSIONS
Many elderly people do not feel properly consulted about rest home placement, and some could be supported at home for longer. It is likely that many who can afford rest home fees are entering too early and then asking for a subsidy when their funds are exhausted. By then it is almost impossible to insist on alternatives in the community. A policy of geriatric service assessment for all seeking entry into rest home care should ensure independent consultation and consideration of alternative strategies. More research is required to examine cost implications of unrestricted movement into rest homes.
Baskett
J J
JJ
Department of Medicine, North Shore Hospital Takapuna, Auckland.
Broad
J B
JB
Richmond
D E
DE
Okpala
J
J
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment; D006301:Health Services Needs and Demand; D006707:Homes for the Aged / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D009735:Nursing Homes / Q000191:economics / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires