Institutional care for elderly people in North and West Belfast. A decade of change from 1989–1999

Background and aims: We wished to document the pattern of institutional care for dependent elderly people during a period of altered provision of care, namely a shift from National Health Service long-term hospital care provision to residential and nursing home provision in the private sector. Methods: We systematically studied all institutionalized people aged 65+ years in a single geographic area in 1989, 1992, 1995 and 1999. Subjects’ physical and mental function was assessed using the Barthel Index and the Abbreviated Mental Test. Descriptive and statistical comparisons between years and care facilities were made. Results: There were large changes in facilities providing for care between 1989 and 1999, with an 84% increase in nursing home placements and an 89% decrease in hospital admissions. Smaller reductions in residential and psychogeriatric placements were observed together with a large increase in Elderly Mentally Infirm (EMI) placements. We found significant increases in the physical dependency and mental impairment of those receiving nursing, psychogeriatric and long- term hospital care. Residential homes are now caring for people who are significantly less physically dependent, and there have been no changes in the dependency level of residents in EMI homes. Conclusions: There has been an overall mean reduction from 4.3 to 3.9% in the percentage of elderly people aged 65 and over receiving institutional care between 1989 and 1999. This trend has included a radical shift in care from hospital- based provision to nursing home care and undoubtedly an increase in support for people wishing to remain in their own homes. The increased dependency found in institutional care is believed to be due to the higher threshold now necessary for provision of care, which may be due to fiscal constraints.