Case-mix analyses in long-term care institutions in Stockholm

In order to describe the patient case-mix in long-term care, several methods have been developed. One resource-based method, Resource Utilization Groups, RUGs, developed in New York and validated in several U.S. states, has also been validated in Stockholm and used there for studying various types of geriatric institutions. The variables used in this analysis, the distribution of the RUG categories, an ADL-index, and a case-mix index, show differences between geriatric departments, local nursing homes, mixed institutions, and private nursing homes. The geriatric departments show a high percentage of patients undergoing rehabilitation, a high case-mix index, and a relatively low ADL-index. In the local nursing homes, there is a majority of patients with behaviour problems and reduced physical functions. They show a low case-mix index but also a low ADL-index. Mixed institutions show results lying between these two types of institutions. The costs of the institutions, however, do not correlate well to the case-mix. This raises issues on efficiency and the need for new reimbursement models in geriatric care.