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Care home worker walking with elderly person.

Results from a new NDPH-led study show that classifying care home residents according to their mental health can help identify those most in need of community-based healthcare services.

As populations age, increasing numbers of people will live in residential and nursing homes. Many of these will have complex health needs that will require access to a range of community healthcare services, such as community nurses, hospital-at-home services, and emergency response teams. This presents a growing challenge to commissioners, who are requested to design comprehensive payment systems for these services, to reimburse community care providers from a limited NHS budget.

Ultimately, these decisions should be based on accurate information on how these services are used by different groups of people. Results from a new study from NDPH’s Health Economics Research Centre (HERC) show that clustering approaches can effectively identify classes of mental health conditions that are associated with higher and lower overall costs for community healthcare services. The results are published today in Ageing & Society.

The researchers used the Mental Health Clustering Tool (MHCT): an approach developed by the UK’s Department of Health and Social Care which groups patients together who have similar health and social care outcomes. The four categories of mental health patients used in the MHCT are psychotic conditions (for instance schizophrenia); non-psychotic conditions (such as anxiety and mild depression); cognitive impairment or dementia; and no mental health condition. Because the overall cost of community care for a person depends on both how long they live for and how often they access services, the researchers explored whether the MHCT can usefully detect variations in these for the four categories.  

The results are based on a two-year observational study on how community care services were used by all people living in care homes in Oxfordshire, conducted between April 2014 and March 2016. This involved almost 5,800 residents (with an average age of 87 years old) across 104 care homes. 

Key results:

  • Of all the care home residents in the study, 52% had cognitive impairment or dementia; 4% had a non-psychotic mental health condition; 2% had a psychotic mental health condition; and 42% had no mental health condition.
  • Overall, residents with mental health conditions accessed community care services significantly more frequently compared with residents without mental health conditions, particularly emergency out-of-hours services, hospital-at-home services and community mental health teams.
  • The average six-month cost of community care services was similar for residents with dementia or cognitive impairment and those without a mental health condition, at £431 and £407 respectively. However, this was almost twice as high for residents with non-psychotic conditions (£762) and four times higher for residents with psychotic conditions (£1,724).
  • In general, residents with mental health conditions survived for longer than those without mental health conditions. The mean survival during the follow-up period was 520 days for residents with psychotic conditions; 494 days for residents with non-psychotic conditions; 503 days for residents with dementia or cognitive impairment; and 473 for residents without a mental health condition. This result may be explained by the fact that most residents in care homes are close to end of their lives, but this might not be the case for residents with impaired mental health.

According to the research team, the variations in care costs may be partly caused by different amounts of informal care being provided alongside community services. For instance, it may be more difficult for friends and family to give supplementary care to residents with severe psychotic disorders, making them more reliant on community services. In addition, certain mental health conditions may be more associated with physical illnesses that would make care needs more complex.

Associate Professor Apostolos Tsiachristas (NDPH, HERC), who led the study, said: ‘Our findings indicate that the MHCT can usefully classify care home residents regarding both survival and their use of community care services. Such evidence can help healthcare commissioners to plan, commission and pay for the growing number of elderly people living in care homes. In particular, the finding that residents with mental health conditions generally live longer and use more community care services compared with residents without mental health conditions should be considered when allocating funding to avoid budget shortfalls.’