Self-funding and community care admissions to nursing homes in Aberdeen

Admissions to nursing homes are an essential component of community care following the Community Care Act reforms. The present study sought to evaluate recent admissions from the community or hospital to private nursing homes in Aberdeen, in order to assess care management in operation and to determine whether admission criteria or access are influenced by funding.

A census of admissions to 11 private nursing homes within Aberdeen City boundary was performed over a nine-month period (April 1994 to January 1995), one year after the NHS and Community Care Act reforms had been implemented. One hundred and nineteen residents (102 females), means (SEM) age, 83(1) years range 64-98 years, admitted from the community or hospital since 1 April 1994, were included. For each resident an evaluation of Barthel Index, Abbreviated Mental Test Score (AMTS), source of funding (Local Authority Funding (LAF) or private) and appropriateness of placement was made.

Twenty-seven residents were admitted from home, 77 from hospital and 15 from residential or nursing homes. 58% (69 residents) were funded by LAF and 42% (50 residents) were funded privately. Barthel scores as mean (SEM): 10.7 (0.72) vs 14.1 (0.55), p < 0.001, were significantly higher in the privately funded group. 68.1% (81 residents) were considered to be appropriately placed. However, a significantly higher proportion of those with LAF funding were appropriately placed: (number of residents); 53 vs 28, p = 0.016.

It would appear that there is a selection in favour of privately funded residents with a lower level of dependency. If resources are limited this could disadvantage more dependent patients in hospital who merit institutional care but require Local Authority funding support.