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© 1997 Oxford University Press

Articles

Low-Care Cases in Long-Term Care Settings: Variation among Nations

Naoki Ikegami, John N. Morris1 and Brant E. Fries2

Department of Health Policy and Management, Keio University School of Medicine 35 Shinanomachi, Shinjukuku, Tokyo 160, Japan
1 Division of Social Gerontology, Hebrew Rehabilitation Center for Aged Boston, MA 02313, USA
2 Institute of Gerontology and School of Public Health, University of Michigan and Ann Arbor Veterans Affairs Medical Center Ann Arbor, MI 48109-2007, USA

Address correspondence to N. Ikegami. Fax: (+81) 3 3225 4828. E-mail: ikegami{at}mc.med.keio.ac.jp

Method: Residents of long-term care settings without major activity of daily living (ADL) deficits are often referred to as ‘low-care cases’ and are deemed inappropriately placed in an institution. We compare the prevalence and characteristics of this population in Denmark, Iceland, Italy, Japan, Sweden and the USA, using the Resident Assessment Instrument Minimum Data Set.

Results: Among the six nations, the percentage of low-care cases ranged from 27 to 52% using a broad definition of no physical assistance required in late-loss ADLs (bed mobility, toileting, transfer and eating). With a more narrow definition which additionally excludes those falling into the Resource Utilization Groups, version III categories of rehabilitation, clinically complex, impaired cognition and behaviour problems, the percentages seen range from 9 to 35%. Finally, 2–14% meet the most restrictive definition, which further excluded residents requiring any supervision in late-loss ADLs, with any deficits in early-loss ADLs (dressing or grooming) or needing medical and psychiatric supervision.

Conclusion: Although long-term care settings differ, making comparison by country difficult, the use of the same standard assessment form makes it possible to compare the many reasons for institutionalization.

Keywords: cross-national comparisons, nursing homes, placement decisions, resident classification


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