Introduction

This concept will discuss various definitions that may be used for analyses of admissions into Long Term Care (LTC) facilities. The information will include examples of usage of the admissions file (2009) of the Long Term Care (LTC) Utilization History Database for these purposes, and insights into when each of the definition could be favored over the others.

Background Information and Definitions

• Long term care (LTC) includes any chronic and rehabilitative services provided by a long term care hospital or Personal Care Home (PCH).
  
  
• Personal Care Homes (PCHs) are residential facilities for predominantly older persons with chronic illness or disability.
  
  
• PCHs are also known as Nursing Homes (NHs) .

In order to be admitted to a PCH or Chronic Care facility, an application form must be completed and reviewed by a panel which determines whether the person requires admission.

Many persons who apply to enter a PCH have been home care clients for a considerable period of time, but their care needs have become too great to manage in the community. They generally continue to receive home care until admitted to a PCH.

In other cases, persons can suffer acute episodes of illness, such as a stroke, after which if they do not sufficiently recover to go back in the community, they could be placed into CC/PCH immediately following discharge from acute care hospital.

Level of Care

When an individual is receiving long term care, he/she is assigned a level of care ranging from 1 to 9, distinguishing the type of care he/she is receiving.

• PCH residents are classified by "level of care" based on their dependence and the approximate amount of daily nursing care they may require. All nursing home (PCH) residents are assessed at one of four levels of care based on the residents' abilities to complete ADL (activities of daily living) tasks, their need for professional interventions, and their degree of behavioral problems. This determines the number of nursing hours they require per day. Level 1 is the lightest at 0.5 hours, level 2 at 2 hours, with levels 3 and 4 at least 3.5 hours, with level 4 being the most dependent and/or requiring the most nursing care.
  
  
• Other long term care patients, such as those in respite placement, chronic care (CC) programs, personal care (PC) beds in hospital or CC beds in hospital, are assigned a level of care ranging from level 5 to 9. See the Methods section below for more detailed information on Level of Care.

Data Sources

The Long Term Care (LTC) Utilization History Data contains an admissions file, where all historical admissions into LTC facilities in the province are recorded. Each record has among other variables a facility number, from which type of facility can be determined, and the level of care at admission. The use of these 2 variables determines types of admission being selected for analytical purposes.

The most recent file should always be used (admission2009 - as of June 2010) as this will contain all data from June 1973 (data from dates prior to this are combined into the 1973 year) to 2009, inclusive.

Methods

It is important to define the type of care being examined based on what information the researcher wants to gain from analysis of the admission data from the Long Term Care (LTC) Utilization History Database. Admission into Personal Care may be defined as:


1. admission into licensed NH only;
   
   
2. admission to a PCH bed within any facility with such beds;
   
   
3. admission into any type of LTC facility (such as NH, PCH bed in hospital, or CC facility).

These 3 definitions vary by what facility types and levels of care at admission they incorporate. Within the Long Term Care Database, the LevelOfCare variable is described as follows:


• Var=LevelOfCare
  
  
  • Level 1-4 - Nursing Home (Personal Care)
  • Level 5 - Respite placement
  • Level 6 - Chronic care (CC)
  • Level 7 - PC bed - waiting in hosp for respite (5)
  • Level 8 - PC bed - waiting in hosp for NH (1-4)
  • Level 9 - CC bed - waiting in hosp for CC (6)

The range of the level of care variable in the database has changed over time; therefore not all nine levels were used every year. Levels 7 to 9 were only used between 1997 and 2002. After this period, levels of care specified by levels 7, 8 and 9 were captured within levels 1 through 6 (with Facility=Hospital).

1. Admission into a Licensed Nursing Home:

This definition would be used to analyze care provided only in NHs or to observe or compare differences between NHs. This information is captured by restricting the analysis of the level of care variable to levels 1 through 4 and by identifying facility numbers between 500 and 825 [ (LevelOfCare=1, 2, 3, or 4) + (Facility=500-825) ].

2. Admission into any Facility with designated PC beds:

This definition may be used to predict the level of need and use of PC beds, transfer of individuals, and costs. This information is captured by restricting analysis of the level of care variable to levels 1-4, 8.

As mentioned earlier, the level of care variable has changed over time. This is important when defining a PCH as a PC bed within a hospital; level 8 (PC bed - waiting in hospital for NH) was only used between 1997 and 2002. Since then, level 8 is captured by levels 1 through 4 AND a hospital facility number [ (LevelOfCare=1,2,3, or 4) + (Facility=Hospital) ] OR [ LevelOfCare =8 ].

Level 8 should be taken into account when using admission data that includes 1997-2002.

3. Admission into any Long Term Care Facility:

This definition would be used to analyze all types of LTC (NHs, Chronic Care facilities, designated beds in Hospitals and Respite care). All levels of care would be included in this analysis; however, often respite care (level 5) is excluded [ LevelofCare=1, 2, 3, 4, 5, 6, 7, 8, or 9 ] OR [ LevelofCare=1, 2, 3, 4, 6, 7, 8, or 9 ].

Limitations & Cautions

• Any analysis using the admission file is not 100% reproducible. When a new file becomes available, the most recent year(s) has been added and errors in past years are edited. Therefore, the dataset from a period of time may have been altered during this edit and may be different in the new file. For example, the admission2008 file contains admission data from 1973 to 2008, inclusive, whereas the admission2009 file contains data from 1973 to 2009. Even though both files contain data from 1973 to 2008, the data in this time period may not be the same in both files due to edits made for the admission2009 file when the 2009 data was added. If duplication of an analysis is desired, the same file used the first time must be used in subsequent analysis, not the most recent file.
  
  
• Facility 507 represents the companion care program and does not indicate a specific location or address. When defining a PCH as a licensed nursing home, this facility number should be excluded if a physical location is required, such as a regional health authority or district.
  
  
• Level 8 of the LevelOfCare variable limits the information available to the researcher in that it does not disclose the level of dependency or level of care an individual is admitted to.

SAS code examples

Please see SAS code examples for analysis of the above PCH definitions in the New Admission into PCH PowerPoint presentation (internal access only) by Natalia Dik.

This concept was developed from the above presentations and personal communication with Natalia Dik in May 2011.