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Age and Ageing 2003; 32: 279-285
© 2003, British Geriatrics Society

Research paper

Identification of registered nursing care of residents in English nursing homes using the Minimum Data Set Resident Assessment Instrument (MDS/RAI) and Resource Utilisation Groups version III (RUG-III)

Iain Carpenter1,, Michelle Perry2, David Challis3 and Kevin Hope4

1 Centre for Health Service Studies, University of Kent, Canterbury, GKT School of Medicine and Dentistry, London, and East Kent Hospitals NHS Trust, UK
2 CHSS, George Allen Wing, University of Kent, Canterbury CT2 7NF, UK
3 PSSRU, Faculty of Medicine, Dentistry, Nursing and Pharmacy, University of Manchester, Dover Street Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK
4 School of Nursing, Midwifery and Health Visiting, Coupland III Building, University of Manchester, Oxford Road, Manchester, UK
The Study was conducted from the Centre for Health Services Studies

Abstract

Aim: to determine if a combination of Minimum Data Set/Resident Assessment Instrument (MDS/RAI) assessment variables and the Resource Utilisation Groups version III (RUG-III) case-mix system could be used as a method of identifying and reimbursing registered nursing care needs in long-term care.

Method: the sample included 193 nursing home residents from four nursing homes from three different locations and care providers in England. The study included assessments of residents' care needs using either the MDS/RAI assessments or RUG stand-alone questionnaires and a time study that recorded the amount of nursing time received by residents over a 24-h period. Validity of RUG-III for explaining the distribution of care time between residents in different RUG-III groups was tested. The difference in direct and indirect care provided by registered general nurses (RGN) and care assistants (CA) to residents in RUG-III clinical groups was compared.

Results: the RUG-III system explained 56% of the variance in care time (Eta2, P=0.0001). Residents in RUG-III groups associated with particular medical and nursing needs (enhanced RGN care) received more than twice as much indirect RGN care time (t-test, P<0.001) and 1.4 times as much direct RGN and direct CA time (t-test, P<0.01) than residents with primarily cognitive impairment or physical problems only (standard RGN care). Residents with enhanced RGN care received an average of 48.1 min of RGN care in 24 h (95% CI 4.1–55.2) compared with an average of 31.1 min (95% CI 26.8–35.5) for residents in the standard RGN care group. A third low RGN care group was created following publication of the Department of Health guidance on NHS Funded Nursing Care. With three levels, the enhanced care group receives about 38% more than the standard group, and the low group receives about 50% of the standard group.

Conclusions: the RUG-III system effectively differentiated between nursing home residents who are receiving ‘low’, ‘standard’ and ‘enhanced’ RGN care time. The findings could provide the basis of a reimbursement system for registered nursing time in long-term care facilities in the UK.

Keywords: elderly, assessment, long-term care, reimbursement, case-mix


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Home page
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G. I. Carpenter
Accuracy, validity and reliability in assessment and in evaluation of services for older people: the role of the interRAI MDS assessment system.
Age Ageing, July 1, 2006; 35(4): 327 - 329.
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