The use of hospitals by people living in residential care and the admission of people into residential care following a period in hospital is of interest to both policy analysts and service providers in the hospital and residential care sectors. This report updates a 2001-02 study on movement from hospital into residential care by people aged 65 and over. The use of hospitals by people already living in residential care is examined for the first time.
The analysis is based on multi-day hospital episodes ending in 2008-09 for people aged 65 and over on 1 July 2008. Movements between the two sectors were identified by linking national 2008-09 hospital and residential aged care service use data. To allow for the different age-sex profiles of the various movement groups, estimates have been age-sex standardised where appropriate.
Hospital use by people in residential aged care
Most (nearly 91%) of the nearly 1.1 million hospitalisations for people aged 65 and over were for people who had come from their home in the community. However, almost 9% were for people living in residential aged care. Respiratory conditions (17%) were the most common reason for hospital admission of permanent aged care residents while circulatory conditions (19%) were most common for people admitted from the community. Falls were a much more common cause of admission for aged care residents than for others (10% versus 5%).
Movement from hospital into residential aged care
On leaving hospital, 83% of patients aged 65 and over returned to their home in the community; a further 8% were discharged back to their home in residential care. Just over 4% of patients were admitted into residential aged care or transition care when they left hospital. The remaining 5% of hospitalisations ended with the patient's death.
Including transfers between residential aged care facilities, it is estimated that in 2008-09 almost one-third of all admissions into residential care were via hospital, with two-thirds of these latter being for permanent care.
Propensity to enter residential aged care
The most significant predictors of admission into residential care as opposed to a return to the community were: longer length of stay; having a diagnosis of dementia or stroke; older age; having an unplanned admission; being in palliative care before discharge; and the state or territory of the hospital. Having at least one of a group of comorbid conditions also tended to increase the likelihood of entering care. Observed geographic effects indicate that variation in regional aged care service provision and practices may be influencing outcomes.
Analysis suggests that admission into residential respite care from hospital may be either for post-hospital care before returning home or as a stepping-stone into permanent care.
Time in hospital
People transitioning from the community into permanent residential care via hospital had the longest stays in hospital, with single-episode stays (that is, no hospital transfers involved) averaging 28.0 days compared with an overall average of 6.1 days. People who returned to their usual residence on discharge tended to have the shortest stays. Death in hospital was generally preceded by a moderately short stay (mean of 12 days for a single- episode stay).
Preliminary material: Acknowledgments; Abbreviations; Symbols
1.1 Event data
1.2 Linkage methods
1.3 Estimates of flow
1.4 Age–sex standardisation
2 Movement into and out of hospital
2.3 Age and sex
2.4 Care type
2.5 Principal diagnosis
2.6 Selected diagnoses
2.7 First reported procedure
3 Patient days by selected characteristics
3.1 By pre-hospital origin
3.2 By discharge destination
3.3 By principal diagnosis causing admission
4. Moving into residential aged care
4.1 Age and sex differences
4.2 Location of ACAT assessment
4.3 Regional patterns
4.4 Care needs
5 Person outcomes: entry into RAC from hospital
5.1 Propensity to be discharged to RAC
5.2 Discharge to permanent rather than respite RAC
6 Person outcomes: short-term use of residential aged care after hospital
6.1 People admitted for respite care
6.2 People admitted for permanent care
Appendix A: Unstandardised tables
Appendix B: Data linkage and weighting
Appendix C: Disease classification and groupings
Appendix D: Logistic regression models
End matter: Glossary; References; List of tables; List of boxes; List of figures; Related publications