[Substitution in psychogeriatrics. A comparative study in nursing homes and substitution projects in Drenthe]

Due to a strong increase of the ageing population in the Netherlands there is a growing need for care for psychogeriatric patients. The shortage of beds in psychogeriatric nursing homes has led to the development of substitute care in residential homes for the elderly and in community centers. If substitution is realized in these substitute care projects in the sense that alternative services are delivered for patients who would otherwise have been admitted to nursing homes, the level of impairment and disruptive behaviour should be of the same level in nursing homes and substitute care projects. Groups of patients of three nursing homes, three day-treatment facilities, eight day-care-projects in residential homes for the elderly and seven centers for day-care in the community were compared. Sociodemographic characteristics, behaviour and care-patterns of all 670 patients who were in care on the first of October of 1992 in these services were investigated. An assessment-scale for elderly patients, based on the Stockton Geriatric Rating Scale, was used to investigate behaviour. Substitute care appears to be possible for a limited and specific group of patients. Substitution for the severely disturbed patients (over 40% of the nursing home patients) does not seem to be possible. Due to the development of substitute care for psychogeriatric patients in residential homes for the elderly and centers for day-care in the community, services seem to develop towards more specific and specialized care. We recommend the foundation of a psychogeriatric case register, which allows the study of the transfer of patients across facilities.(ABSTRACT TRUNCATED AT 250 WORDS)