Identification of registered nursing care of residents in English nursing homes using the Minimum Data Set Resident Assessment Instrument (MDS/RAI) and Resource Utilisation Groups version III (RUG-III).
OBJECTIVE
to determine if a combination of Minimum Data Set/Resident Assessment Instrument (MDS/RAI) assessment variables and the Resource Utilisation Groups version III (RUG-III) case-mix system could be used as a method of identifying and reimbursing registered nursing care needs in long-term care.


METHODS
the sample included 193 nursing home residents from four nursing homes from three different locations and care providers in England. The study included assessments of residents' care needs using either the MDS/RAI assessments or RUG stand-alone questionnaires and a time study that recorded the amount of nursing time received by residents over a 24-h period. Validity of RUG-III for explaining the distribution of care time between residents in different RUG-III groups was tested. The difference in direct and indirect care provided by registered general nurses (RGN) and care assistants (CA) to residents in RUG-III clinical groups was compared.


RESULTS
the RUG-III system explained 56% of the variance in care time (Eta2, P=0.0001). Residents in RUG-III groups associated with particular medical and nursing needs (enhanced RGN care) received more than twice as much indirect RGN care time (t-test, P<0.001) and 1.4 times as much direct RGN and direct CA time (t-test, P<0.01) than residents with primarily cognitive impairment or physical problems only (standard RGN care). Residents with enhanced RGN care received an average of 48.1 min of RGN care in 24 h (95% CI 4.1-55.2) compared with an average of 31.1 min (95% CI 26.8-35.5) for residents in the standard RGN care group. A third low RGN care group was created following publication of the Department of Health guidance on NHS Funded Nursing Care. With three levels, the enhanced care group receives about 38% more than the standard group, and the low group receives about 50% of the standard group.


CONCLUSIONS
the RUG-III system effectively differentiated between nursing home residents who are receiving 'low', 'standard' and 'enhanced' RGN care time. The findings could provide the basis of a reimbursement system for registered nursing time in long-term care facilities in the UK.
Carpenter
Iain
I
Centre for Health Service Studies, University of Kent, Canterbury, GKT School of Medicine and Dentistry, London, UK. g.i.carpenter@ukc.ac.uk
Perry
Michelle
M
Challis
David
D
Hope
Kevin
K
D000368:Aged; D004739:England; D005851:Geriatric Nursing / Q000706:statistics & numerical data; D006295:Health Resources; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006707:Homes for the Aged; D006801:Humans; D008134:Long-Term Care; D009726:Nurses / Q000600:supply & distribution*; D009728:Nursing Assistants; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010561:Personnel Staffing and Scheduling; D011795:Surveys and Questionnaires