Acuity vs complexity vs dementia
Care funding formulae are intended to ensure more hours of care are allocated to higher acuity residents. However, recent CHAA research shows the model isn’t perfect: it doesn’t truly account for the reality that residents with dementia don’t just need a few more minutes of care per day — they will usually benefit from more time for all aspects of care and daily living.
This means more staff time associated with getting dressed and ready for breakfast. More time for cueing during meals. More time to get to recreational activities, and more supervision during those activities. More staff time to receive a bath or a shower. And time for redirecting or refocusing during times of anxiety or confusion.
Length of stay is tied to resident acuity
Length of stay (LOS) is a system metric that tracks how long residents live in a care facility. Three factors in Alberta have led to a two-decade trend toward shorter resident LOS in long-term care:
Alberta created and funded a new level of continuing care (designated supportive living, or DSL) as a middle ground between living at home (with supports) and entering a long-term care or nursing home facility. Alberta residents can do well for many years in DSL levels of care, meaning only the most frail and ill resident ever progress to a LTC facility.
Life expectancy among seniors has increased in recent decades, with many seniors living into their late-80s and 90s. The residents who do enter LTC homes tend to be the residents with the highest acuity or complex health conditions.
Many long-living seniors have progressive dementia, and a large proportion (80-90%) of residents in LTC settings have dementia as either a contributing factor or the primary reason for admission.
Consequently, most of today’s LTC info residents are in the last 12-18 months of life. This is a reflection of a population today that has more frailty and complexity than in previous decades.
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