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Turrell et al1 describe the consequences of the lack of information
in the United Kingdom about the health needs of older people in long stay
homes. In Scotland a measure has been devised by a group comprising
geriatricians, nurses and the Information & Statistics Division (ISD)
to provide a method of describing the characteristics of elderly people in
all forms of continuing care. This method, the Scottish Health Resource
Utilisation Groups or SHRUGs measure, comprises three categories of care
need and three categories of dependency. Care needs are described in
terms of needs for special care, clinically complex treatments and
behaviour; dependency is described in terms of feeding, toileting and
transferring position. Supplementary information includes clinically
complex conditions, continence, visual and hearing impairment and problems
of communication for the individual resident. Subsequently the method has
been developed in association with social work interests to incorporate
social care parameters (SCRUGs).
Trained interviewers obtain data from care staff who know the
residents well. Staff are asked to provide a profile of each resident
based on observations over the past seven days. Responses are scored for
each resident, taking approximately 90 minutes for 20 residents.
Individuals are grouped to small numbers of care categories, which are
each described in terms which would be readily understood by care
professionals, eg the patient ‘has behavioural difficulties and low
dependency'. Reliability testing demonstrates satisfactory test/retest
characteristics. Development studies show that the resource costs of
each of the categories has a range of nearly three from the highest to the
lowest.
The SHRUGs/SCRUGs categories provide a relatively cheap method of
estimating resource use. They also provide a basis for dialogue about the
nature and quantity of services provided, including unmet need and changes
over time. The measure is evolving, being modified with experience,
although it is important to maintain a constant core data set in order to
analyse changes over time. At present it is used in 86% of NHS continuing
care beds and in rapidly increasing numbers of nursing and residential
homes in Scotland.
In addition ISD is piloting an admission and discharge record for
nursing home residents which is similar to hospital-based information.
This is completed by nursing home staff and provides demographic data,
funding source, whether admitted from home or hospital, outcome and length
of stay. The two data sets could ultimately be linked.
Gordon Brown, Information and Statistics Division, Common Services
Agency, Trinity Park House, South Trinity Road, Edinburgh, EH5 3SQ.
David Burke and Helen Watson, Social Work Department, West
Dunbartonshire Council, Rosebury Place, Clydebank, G81 1TG.
Linda de Caestecker and John Womersley, Consultants in Public Health
Medicine, Greater Glasgow Health Board, Dalian House, 350 St Vincent
Street, Glasgow, G3 8YU.
. Turrell AR, Castleden CM, Freestone B. Long stay care and the NHS:
discontinuities between policy and practice. BMJ 1998; 317: 942-944. (3
October).
390 Words
Scotland describes characteristics of elderly in continuing care
Editor -
Turrell et al1 describe the consequences of the lack of information
in the United Kingdom about the health needs of older people in long stay
homes. In Scotland a measure has been devised by a group comprising
geriatricians, nurses and the Information & Statistics Division (ISD)
to provide a method of describing the characteristics of elderly people in
all forms of continuing care. This method, the Scottish Health Resource
Utilisation Groups or SHRUGs measure, comprises three categories of care
need and three categories of dependency. Care needs are described in
terms of needs for special care, clinically complex treatments and
behaviour; dependency is described in terms of feeding, toileting and
transferring position. Supplementary information includes clinically
complex conditions, continence, visual and hearing impairment and problems
of communication for the individual resident. Subsequently the method has
been developed in association with social work interests to incorporate
social care parameters (SCRUGs).
Trained interviewers obtain data from care staff who know the
residents well. Staff are asked to provide a profile of each resident
based on observations over the past seven days. Responses are scored for
each resident, taking approximately 90 minutes for 20 residents.
Individuals are grouped to small numbers of care categories, which are
each described in terms which would be readily understood by care
professionals, eg the patient ‘has behavioural difficulties and low
dependency'. Reliability testing demonstrates satisfactory test/retest
characteristics. Development studies show that the resource costs of
each of the categories has a range of nearly three from the highest to the
lowest.
The SHRUGs/SCRUGs categories provide a relatively cheap method of
estimating resource use. They also provide a basis for dialogue about the
nature and quantity of services provided, including unmet need and changes
over time. The measure is evolving, being modified with experience,
although it is important to maintain a constant core data set in order to
analyse changes over time. At present it is used in 86% of NHS continuing
care beds and in rapidly increasing numbers of nursing and residential
homes in Scotland.
In addition ISD is piloting an admission and discharge record for
nursing home residents which is similar to hospital-based information.
This is completed by nursing home staff and provides demographic data,
funding source, whether admitted from home or hospital, outcome and length
of stay. The two data sets could ultimately be linked.
Gordon Brown, Information and Statistics Division, Common Services
Agency, Trinity Park House, South Trinity Road, Edinburgh, EH5 3SQ.
David Burke and Helen Watson, Social Work Department, West
Dunbartonshire Council, Rosebury Place, Clydebank, G81 1TG.
Linda de Caestecker and John Womersley, Consultants in Public Health
Medicine, Greater Glasgow Health Board, Dalian House, 350 St Vincent
Street, Glasgow, G3 8YU.
Corresponding author: John Womersley, Telephone 0141 201 4815; fax
0141 201 4733; e-mail: publichealth.gghb@dial.pipex.com
. Turrell AR, Castleden CM, Freestone B. Long stay care and the NHS:
discontinuities between policy and practice. BMJ 1998; 317: 942-944. (3
October).
390 Words
Competing interests: No competing interests