Planning the Restructuring of Long-Term Care: The Demand, Need and Provision of Institutional Long-Term Care Beds in Newfoundland and Labrador

Abstract

The Canadian population is aging. In Newfoundland and Labrador, nursing homes and supervised care facilities provide Long-Term Care (LTC). There may be a mismatch between the provision of LTC beds and clients' needs. To compare the type and annual rate of clients seeking placement to LTC, incident annual cohorts (N = 1,496) in five provincial health regions within Newfoundland and Labrador were compared using objective measures of disability. Client need was assessed using a decision tree and the optimal distribution of LTC beds was determined. Within the four island regions, little difference was observed in degree of disability, but Labrador clients differed from the island regions in age, degree and type of disability. A decision tree suggested that optimal placement was 7% to housing, 34% to supervised care, 17% to supervised care for cognitive impairment and 42% to nursing home care. In Newfoundland and Labrador, institutional LTC is dependent on nursing homes, whereas the major need is for appropriate supervised care for those with modest disability, with or without cognitive impairment. Different approaches to restructuring of long-term care in each region are necessary because of the differences in rates of presentation for LTC and differences in availability of nursing home and appropriate supervised care beds.