Summary
Linkage between hospital and residential aged care data
The movement of people between acute hospital care and residential aged care has long been recognised as an important issue, but existing national data sets provide only limited information on such movement. For some years the Australian Institute of Health and Welfare has been developing an event-based data linkage method (termed E linkage) to link national hospital morbidity data and residential aged care data.
A previous collaborative study compared the event-based linkage method with linkage using name data for Western Australia. This showed that the linked data resulting from the event-based method can be successfully used to look at the characteristics of people who move from hospital to residential aged care and compare them with those who move back to the community. However, E linkage underestimates the true number of transitions and so should not be used without adjustment to measure the volume of flow from hospital to residential aged care.
Having successfully demonstrated the utility of this method for examining the movement of people between the two sectors, data have now been linked for six states and territories for 2001–02 and preliminary results are now available.
Before data linkage for this project began, ethics approvals were obtained from required ethics committees, and permission to use the hospital morbidity and residential aged care data was obtained from all data custodians (national and state and territory).
Approximate estimates of flow
Using results from the Western Australian comparative study, the linked data for six jurisdictions were weighted to get estimates of the volume of flow. During 2001–02, across the six jurisdictions included in the study, there were 620,000 hospital separations for stays lasting at least 1 night for people aged 65 years and over. Of these, an estimated 10% were separations into residential aged care, with around two-thirds of this group being for people already living in permanent residential care and one-third being for people who were new admissions. Conversely, it is estimated that one-third of the 67,300 admissions into residential aged care in 2001–02 were from hospital, with about 70% of these admissions being for permanent care. Nearly one-quarter of all the admissions were for people transferring between different residential aged care facilities.
People moving from hospital to residential aged care
Of people moving to residential aged care, about two-thirds were women, and nearly three-quarters of them were aged 80 or older. Men and women each comprised about one-half of the older people returning to the community from hospital, and the majority were aged under 80 years.
Older people who moved into permanent residential care from hospital averaged longer hospital stays than people returning to residential aged care after an episode in hospital. About 10% of those moving into permanent residential care had hospital stays of at least 64 days.
People moving into permanent residential aged care from hospital generally had higher care needs than people moving from the community.
Transitions from hospital to the community via residential aged care
Of particular interest from a policy perspective is what happens to people who enter residential aged care from hospital: do they remain in aged care or do they return to the community?
Just over one-half of people who moved from hospital to respite care and about 8% who moved to permanent care returned to live in the community within 12 weeks and did not return to residential aged care within 4 weeks. One-fifth of people who moved into permanent residential care died within 12 weeks, compared with 6% of people who moved into respite care.
For those transferring into respite care the level of care needed by a person was associated with the likelihood of returning to the community within 12 weeks. Nearly two-thirds of people admitted into low-level respite care from hospital returned to the community within 12 weeks and did not return within 4 weeks compared with about just over 40% of people admitted to high-level respite care.
Conclusion
This project demonstrates the value of analysing linked data in providing new information to help understand the movement of people across service sectors. Such information can assist in planning and improving both hospital and residential aged care services for older Australians.