1 in five seniors in residential care don’t need to be there, study says

Report says it might be better to give patients more time before assessment

It’s not about the aging population, it’s how do they use the system and how do we be sure to provide the best care.

A fifth of seniors admitted to residential care in Canada don’t need to be there and could have continued living longer in their own homes if they had proper support, according to a study released Tuesday by the Canadian Institute for Health Information.

The study also showed that a senior already in hospital is more than six times more likely to go directly into long-term care than a senior who’s assessed for longterm care while living at home.

The study, Seniors in Transition, highlights the need for health organizations to plan and co-ordinate their services as Canada’s population ages, said Georgina MacDonald, CIHI’s vice-president.

“We’ve had a lot of population growth and we’re all feeling the impact of aging. But we haven’t come close to what we’re going to be experiencing in the next 20 years,” MacDonald said in a phone interview from Vancouver Island. “As a health system, we really need to focus on how we provide the best care for this population. It’s not about the aging population, it’s how do they use the system and how do we be sure to provide the best care.”

In 2017, Canada has 6.2 million people over the age of 65, including 2.6 million over age 75. In 20 years, those numbers are expected to nearly double to 10.4 million, including 5.7 million over age 75.

The need of the elderly to move into long-term care is based on an objective survey known as MAPLe, Method of Assigning Priority Levels. The CIHI study found that the single biggest factor determining whether a patient was placed in long-term care was whether their MAPLe assessment was done in hospital.

“Hospitals were designed for short-term stays, but with seniors, they often have multiple conditions,” MacDonald said. “They present with one condition, but there can be a number of things going on.”

The CIHI results show that it might be better to give patients more time to recuperate before doing the assessment, or perhaps even waiting until after the patient has returned home.

“What this study shows is we need to be giving a little bit longer to recover before doing an assessment that could determine the rest of their lives,” she said.

Other key factors determining whether a person moves into longterm care include requiring extensive physical assistance, a cognitive impairment such as dementia, living alone, caregiver burnout and whether the person is at risk of wandering. The study shows the average age of a person in residential care is 86, 70 per cent are female, 67 per cent have dementia and 98 per cent have some sort of cognitive or physical impairment.

Nationally, the study showed 22 per cent of those in residential care had a low to moderate MAPLe score, meaning they could potentially be living in their own home. That figure was highest in Manitoba — 33 per cent — and lowest in B.C., at 15 per cent. Ontario’s rate was 23 per cent.

“There’s not a health organization in the country that doesn’t have this on their (radar),” MacDonald said. “What organizations are really looking at it is how they can provide support in the community to keep people in the community longer. If you look at the projections, it’s very clear we’re going to have to do things a little bit differently tomorrow than we do now. We’re simply not going to be able to build enough beds, nor would we want to.”