SHRUGs national report Information & Statistics Division The National Health Service in Scotland Edinburgh June 2000

Transcription

1 Scottish Health Resource Utilisation Groups SHRUGs national report 1999 Information & Statistics Division The National Health Service in Scotland Edinburgh June 2000 Contents -- click on the section of your choice to access it Copyright page Acknowledgements 1 Introduction 2 The SHRUGs Method 3 SHRUGs data collection in Trusts 3.1 Coverage of SHRUGs data collection 3.2 Age and sex of SHRUGs residents 3.3 Proportions of residents in each SHRUGs group 3.4Trends in casemix complexity 3.5 Distribution of residents within SHRUGs dependency variables 3.6 Distribution of residents within SHRUGs care need variables 3.7 Distribution of residents within SHRUGs supplementary variables Incontinence Emotional and Psychological Support and Behaviour 4 Current and future developments 4.1 SCRUGs algorithm 4.2 Development of SCRUGs Appendix 1 Trust tables Appendix 2 Trusts and units participating in SHRUGs data collection Appendix 3 SHRUGs interview questions Appendix 4Validity and reliability of SHRUGs data Appendix 5 Method of deriving relative weights for SHRUGs

2 Common Services Agency/ Crown Copyright 2000 First published 2000 Brief extracts from this publication may be reproduced provided the source is fully acknowledged. Proposals for reproduction of large extracts should be addressed to: ISD Scotland Publications, Trinity Park House, Edinburgh EH5 3SQ. Price 5.00 Information & Statistics Division The National Health Service in Scotland Trinity Park House South Trinity Road Edinburgh EH5 3SQ Phone GTN 7167 Fax (UK) (International) Publication enquiries and orders ISD Customer Liaison Trinity Park House Edinburgh EH5 3SQ Phone SHRUGs enquiries Barbara Graham ISD New Information Development Unit Trinity Park House Edinburgh EH5 3SQ Phone ISD Online ii Designed and typeset by ISD Scotland Publications

3 Acknowledgements The publication is based upon information collected directly from care of the elderly establishments throughout Scotland. The Information and Statistics Division would like to thank the nursing staff and care staff who continue to provide the information upon which this report is based. iv

4 Introduction 1 Introduction Welcome to the third edition of the SHRUGs annual national report Information for this report has been collected from geriatric long stay hospital wards throughout Scotland In the six months ending March 1999 SHRUGs data were collected on 3209 geriatric long stay residents from within 26 trusts These results are detailed in Section 3 and Appendix 1 Data are also presented over nine data collection periods, corresponding approximately to each six month period ending March 1995 to March 1999 (although in each data collection period, the information for some trusts was collected subsequent to these dates) SCRUGs (Scottish Care Resource Utilisation Groups) data have now been collected on residents in private nursing homes and residential homes within 18 Scottish Local Authority areas, covering 2754 residents of private nursing home care (as at 6 months ending March 1999) and 1992 residents of residential care (as at 6 months ending November 1999) Details of the SCRUGs algorithm and developments are given in Section 4 For the purposes of comparison across NHS continuing care, private nursing home care and residential home care, both the SHRUGs and SCRUGs algorithms are interchangeable However, as staff in residential homes do not provide nursing care as such, questions relating to the patient s care needs are omitted from the interview and are subsequently given a zero score when the SCRUGs algorithm is applied In addition to the standard SCRUGS variables, a variety of supplementary information is also collected to meet the needs of individual local authorities and local joint planning needs Details of both SHRUGs and SCRUGs interview questions are shown in Appendix 3 As SCRUGs continues to evolve, pilot developments are being undertaken in an augmented home care facility and a sheltered housing development Throughout this report the participating trusts are each identified in tables and graphs by a unique number This number is made available only to the individual trust it identifies The Information and Statistics Division (ISD) maintain a central file of SHRUGs information and provide an analytical service* to participating trusts and to the NHSiS in general * For further information on SHRUGs please contact: Barbara Graham, Operational Development Manager / Health Economist, New Information Systems Development Unit, Information and Statistics Division, Trinity Park House, Edinburgh EH5 3SQ. Tel: For requests for analysis please contact: Matthew Armstrong, Statistician, Primary Care Information Unit, Information and Statistics division, Trinity Park House, Edinburgh EH5 3SQ. Tel:

5 The SHRUGS Method 2 The SHRUGs Method SHRUGs is based upon a measurement of dependency and need for special care For the SHRUGs method currently applied in hospitals, care needs are described in terms of needs for special care, clinically complex treatments and behavioural difficulties Dependency is described in terms of feeding, use of the lavatory and transferring position For details of all the SHRUGs variables see Appendix 3 A variety of supplementary information is also collected for the individual resident, including data on clinically complex conditions, incontinence, visual and hearing impairment and problems of communication Data are obtained by interviewing care staff who know the residents well and are entered directly onto a database held on a laptop computer Interviewing requires an average of approximately 90 minutes for 20 residents Using trained interviewers to collect data has advantages in terms of both cost and data quality In particular, consistency of SHRUGs information across different data providers is achieved, allowing meaningful comparisons between the different establishments as well as robust data at a national level Inter-rater reliability of SHRUGs data was evaluated by separately asking two independent members of care staff the same questions about the same residents This is described in detail in Appendix 4 In general the reliability of the SHRUGs method has been shown to be good The SHRUGs measure makes use of hierarchical methods of grouping data to generate the five resource utilisation group categories Each category can be described in terms which can be readily understood by the care professional Each resident is placed in a resource utilisation group according to their dependency and needs characteristics, as shown in Table 1 Table 1 SHRUGs resource grouping SHRUGs Description Weight* Group A Low dependency; no behavioural difficulties 0.62 B Low dependency; with behavioural difficulty 0.77 C Moderate dependency; no need for special care or clinically complex treatment 0.88 D Moderate dependency; with need for special care and/or clinically complex treatment or High dependency; no need for special care or clinically complex treatment 1.10 E High dependency; with need for special care and/or clinically complex treatment 1.47 * These weights are derived from a sample of 939 residents for the period June 1994 to June

6 The SHRUGS Method The weights shown against each group correspond to the relative amount of staffing resource used during a defined time period (June 1994 to June 1995) where the average for all residents is 1 00 Thus residents of low dependency with no behavioural difficulties (Group A) would utilise, on average, 0 62 of the average staff resource, while residents of high dependency and needs for special care or clinically complex treatments (Group E) would utilise, on average, 1 47 of the average staff resource The method of arriving at these weightings is set out in Appendix 5 It should be emphasised that the weights utilised in SHRUGs are relative weights which are then applied to the cost base of the trust concerned The method cannot and has not been used to derive a definitive Scottish cost 3

7 SHRUGs data collection in Trusts 3 SHRUGs data collection in Trusts This section of the report represents SHRUGs data collected in the six months ending March 1999 on residents in geriatric long stay wards throughout Scotland Many of these results are compared with data collected in the six months ending March 1998, the equivalent time period for the previous year 3.1 Coverage of SHRUGs data collection Twenty-six trusts throughout Scotland now participate in the collection of SHRUGs data In the six months ending March 1999 SHRUGs data were collected on 3209 residents from within these trusts, equivalent to 90% of all residents in geriatric long stay care wards (Appendix 2) Table 2 Coverage of SHRUGs data collection ; by data collection period Data Collection Period (six months ending) First Second Third Fourth Fifth Sixth Seventh Eighth Ninth Mar. 95 Sept. 95 Mar. 96 Sept. 96 Mar. 97 Sept. 97 Mar. 98 Sept. 98 Mar. 99 Number of residents in Scotland Number for whom SHRUGs data are available SHRUGs coverage 18% 58% 63% 68% 77% 87% 87% 90% 90% 1 Average daily occupied beds during period. Includes residents receiving respite care. Figures for periods up to and including March 1996 are derived from old specialty geriatric long stay ; figures for six months ending September 1997 onwards are derived from new specialty geriatric medicine and significant facility Long Stay Unit for the Care of the Elderly ; figures for six months ending September 1996 and March 1997 are based on a composite of these recording methods. Source: ISD(S)1 2 Excludes residents receiving respite care. 4

8 SHRUGs data collection in Trusts Figure 1 Coverage of SHRUGs data collection ; by data collection period Average daily occupied beds No. residents in SHRUGs data collection First Second Third Fourth Fifth Sixth Seventh Eighth Ninth Average daily occupied beds No. residents in SHRUGs data collecion Source : ISD(S)1 (for average number of occupied beds during data collection period) There has been a steady fall over the nine data collection periods in the number of geriatric long stay beds throughout Scotland Over the same time periods there has been a notable rise in the coverage of SHRUGs data collection, relative to the number of geriatric long stay beds (Table 2, Figure 1) 3.2 Age and Sex of SHRUGs residents Figure 2 Residents aged 75 years and over percentages; in individual trusts and all trusts; at time of interview in six months ending March All Trusts (83%) Trust number In the six months ending 31 March 1999, the percentage of residents aged 75 years and over ranged from 74% in trust 13 to 90% in trust 5, giving an average of 83% for all trusts When compared with data collected in the six months ending 31 March 1998 the average has remained the same However 6 more trusts now lie above the average than in the previous year (Figure 2, Appendix 1:Table 1) 5

9 SHRUGs data collection in Trusts Figure 3 Residents aged under 60 years percentages; in individual trusts and all trusts; at time of interview in six months ending March All Trusts (2%) Trust number Twelve of the 26 participating trusts had residents under the age of 60 years in the six months ending March 1999 This accounted for 2% of all residents within the participating trusts The proportions within these trusts ranged from 1% in trust 14 to 6% in trust 10 (Figure 3, Appendix 1:Table 1) It should be noted however that some percentages were based upon small numbers of residents 3.3 Proportions of residents in each SHRUGs group Table 3 Residents in each SHRUGs group percentages; by data collection period Data Collection Period (six months ending) First Second Third Fourth Fifth Sixth Seventh Eighth Ninth Mar. 95 Sept. 95 Mar. 96 Sept. 96 Mar. 97 Sept. 97 Mar. 98 Sept. 98 Mar. 99 Number of residents % of residents in resource use group A B C D E Note : Percentages are rounded to the nearest integer. When considering all nine data collection periods, the latest period (six months ending March 1999) has the highest proportion of residents allocated to group E - those residents of high dependency with a need for special care and/or clinically complex treatment (Table 3) 6

10 SHRUGs data collection in Trusts Figure 4 Residents in each SHRUGs group percentages; by data collection period % of residents Mar. 95 Sept. 95 Mar. 96 Sept. 96 Mar. 97 Sept. 97 Mar. 98 Sept. 98 Mar A B C D E Resource Utilisation Group Over time, the distribution in the proportion of residents to SHRUGs groups has remained relatively stable with the majority falling into SHRUGs group D - residents of moderate dependency with a need for special care and/or clinically complex treatment or residents of high dependency without a need for special care or clinically complex treatment ( Figure 4, Appendix 1:Table 8) Figure 5 Residents in each SHRUGs group percentages; in the six months ending March 1999 Resources utilised in each SHRUGs group percentages; in the six months ending March 1999 A 9% B 1% A 5% B 1% E 16% C 35% E 22% C 30% D 39% D 42% number of residents = 3209 The relative amount of staffing resources can be estimated by applying the SHRUGs weights to each of the SHRUGs groups (see section 2 - The SHRUGs Method for a more detailed explanation) For example, 1 47 is the weight applied to SHRUGs group E Therefore, the 16% of all residents who fell within this group for the period six months ending March 1999 utilised 22% of the total amount of staffing resource In contrast, 0 62 is the weight applied to SHRUGs Group A When this was applied to the 9% of all residents in group A, it was estimated that they utilised only 5% of the total staffing resources (Figure 5, Appendix 1:Table 2) 7

11 SHRUGs data collection in Trusts 3.4 Trends in casemix complexity A summary measure of the overall resource utilisation across all five SHRUGs groups is the casemix complexity factor (CCF) The CCF is a statistical index of resource utilisation for a defined population of residents in geriatric long stay wards It is an approximate indicator of the average amount of nursing staff resource utilised per resident for such a population The CCF is calculated by multiplying the number of residents in each SHRUGs group by the weight for that group (for example, multiplying 45 by 0 62 if there were 45 residents in Group A), adding together the result for each of the five groups and then dividing that total by the total number of residents in the population Figure 6 Casemix complexity factor 1 for SHRUGs residents percentages; in individual trusts and all trusts; at time of interview in six months ending March 1999 All Trusts (1.04) Trust number 1 The CCF can only range between 0.62 and The distribution of the CCF among individual trusts ranged from 1 00 in trust 4 to 1 13 in trust 25 for the six months ending March 1999 (Figure 6, Appendix 1:Table 2) In comparison with data collected in the six months ending March 1998, 3 trusts have moved above the average whilst 5 have moved below Table 4 Casemix complexity factor for all SHRUGs residents ; by data collection period Data Collection Period (six months ending) First Second Third Fourth Fifth Sixth Seventh Eighth Ninth Mar. 95 Sept. 95 Mar. 96 Sept. 96 Mar. 97 Sept. 97 Mar. 98 Sept. 98 Mar. 99 Casemix complexity factor (CCF) The CCF has remained relatively stable over time However, the latest period (the ninth) has been the highest since SHRUGs data collection began (Table 4, Appendix 1:Table 9), at

12 SHRUGs data collection in Trusts 3.5 Distribution of residents within SHRUGs dependency variables An activity of daily living score (ADL) is derived from SHRUGs data collected on residents in relation to feeding, use of the lavatory and transferring position This ADL score gives an indication of the level of dependency of each resident and is used as part of the SHRUGs grouping algorithm Table 5 Percentage of all residents within SHRUGs dependency variables ; at time of interview in six months ending March 1998 and March 1999 March March March March Feeding % % Use of the lavatory % % eats unaided copes independently 7 8 eats with help needs help/direction/prompting requires feeding/fed by tube or infusion completely dependent /does not use the toilet Transferring Position Activities of Daily Living copes independently 9 9 low dependency (ADL = 3,4) 9 10 needs supervision /assistance of one person moderate dependency (ADL = 5,6,7) needs supervision /assistance of high dependency (ADL = 8,9) two/more persons Number of residents in 6 months ending March 1998 = 3448 Number of residents in 6 months ending March 1999 = 3209 Note: Percentages are rounded to nearest integer. Ninety percent of all SHRUGs residents were of moderate or high dependency in the six months ending March 1999 Only 8% of residents could cope independently with the use of the lavatory and 9% when transferring position A larger proportion (38%) were able to eat unaided (Appendix 1: Table 3) Compared with data collected in the six months ending March 1998, there has been a decrease in the proportion of residents of moderate dependency and an increase in those of high However, these were not significant differences and overall there has been little change (Table 5) 9

13 SHRUGs data collection in Trusts Figure 7 SHRUGs residents with ADL scores of 3 or 4 (low dependency) percentages; in individual trusts and all trusts; at time of interview in six months ending March All Trusts (10%) Trust number The proportion of SHRUGs residents in individual trusts who, at the time of interview, were classed as being of low dependency ranged from zero in trust 17 to 25% in trust 24 (Figure 7, Appendix 1:Table 3) This compared with a range from zero to 17% in the six months ending March 1998 There have also been changes over these time periods in the relative position of individual trusts Three trusts have moved above the average and 2 below Figure 8 SHRUGs residents with ADL scores of 5, 6 or 7 (moderate dependency) percentages; in individual trusts and all trusts; at time of interview in six months ending March All Trusts (40%) Trust number With the exception of trust 25, which had a relatively small number of residents, the distribution in the percentage of residents classed as being of moderate dependency ranged from 29% in trust 9 to 53% in trust 13 (Figure 8, Appendix 1:Table 3) Forty percent of all residents were classed as being of moderate dependency, 3% lower than that for the equivalent time period in the previous year Since the six months ending March 1998, the distribution in the relative position of individual trusts has changed Five trusts have moved above the average and 3 below 10

14 SHRUGs data collection in Trusts Figure 9 SHRUGs residents with ADL scores of 8 or 9 (high dependency) percentages; in individual trusts and all trusts; at time of interview in six months ending March All Trusts (50%) Trust number Fifty percent of all SHRUGs residents were of high dependency Again, excluding trust 25, the distribution among individual trusts ranged from 35% in trust 13 to 69% in trust 9 (Figure 9, Appendix 1:Table 3) This compared with a range of 38% to 71% in the six months ending March 1998 The relative position of individual trusts to the average for all trusts has changed from the six months ending March 1998 Two trusts have moved above the average and 7 below 11

15 SHRUGs data collection in Trusts 3.6 Distribution of residents within SHRUGs care need variables The majority of residents in participating trusts did not have a need for special care, clinically complex treatment or exhibit behavioural difficulties as defined in SHRUGs (Table 6, Appendix 1: Table 4) Table 6 Percentage of all residents within SHRUGs care need variables ; at time of interview in six months ending March 1998 and March 1999 Mar. 98 Mar. 99 % % Need for special care Clinically complex treatment 4 5 Need for special care and / or clinically complex treatment Behavioural difficulties requiring immediate intervention on at least one occasion each week Number of residents in 6 months ending Mar 98 = 3448 Number of residents in 6 months ending Mar 99 = 3209 Note : percentages are rounded to the nearest integer. While there has been an increase in the percentage of residents with a need for special care and clinically complex treatments from the six months ending March 1998, there has been a decrease in those with behavioural difficulties requiring immediate intervention on at least one occasion each week Figure 10 SHRUGs residents with a need for special care and/or clinically complex treatment percentages; in individual trusts and all trusts; at time of interview in six months ending March All Trusts (22%) Trust number For all residents in all trusts, 22% had a need for special care and/or clinically complex treatment The distribution among individual trusts varied considerably from 4% in trust 17 to 47% in trust 19 (Figure 10, Appendix 1:Table 4) In the six months ending March 1997, March 1998 and March 1999, trust 19 had the highest proportions of residents with these special needs; 32%, 40% and 47% respectively Changes in the relative position of trusts from the previous year showed 2 trusts had moved above the average and 3 below 12

16 SHRUGs data collection in Trusts Figure 11 SHRUGs residents exhibiting behavioural difficulties which required immediate intervention at least once a week percentages; in individual trusts and all trusts; at time of interview in six months ending March All Trusts (15%) Trust number None of the residents in trust 25 had a behavioural difficulty which required immediate intervention by a member of staff on at least one occasion each week in the six months ending March 1999 The percentages of those in the remaining trusts varied between 7% in trust 26 and 22% in trust 21 (Figure 11, Appendix 1:Table 4) 3.7 Distribution of residents within SHRUGs supplementary variables Incontinence Overall in the six months ending March 1999, the great majority of SHRUGs residents experienced some form of urinary and faecal incontinence, both during the day and night Table 7 Percentage of all residents within SHRUGs continence variables at time of interview in six months ending March 1998 and March 1999 March March Urinary incontinence - at night % % never no more than once a week more than once a week but not nightly nightly Urinary incontinence - daytime never no more than once a week more than once a week but not daily daily March March Faecal incontinence - at night % % never no more than once a week more than once a week but not nightly nightly 8 10 Faecal incontinence - daytime never no more than once a week more than once a week but not daily daily 7 10 Number of residents in 6 months ending Mar 98 = 3448 Number of residents in 6 months ending Mar 99 = 3209 Note : percentages are rounded to the nearest integer. Proportions among each of the four levels of urinary and faecal incontinence remained relatively unchanged from the six months ending March 1998 (Table 7) 13

17 SHRUGs data collection in Trusts Among individual trusts, the distribution in the proportions of residents who were incontinent of urine both during the day and night followed a similar pattern (Figure 12, Figure 13, Appendix 1: Table 5) Figure 12 SHRUGs residents who experienced urinary incontinence during the night percentages; in individual trusts and all trusts; at time of interview in six months ending March 1999 All Trusts (84%) Trust number Eighty-four per cent of all residents in all trusts in the six months ending March 1999 were incontinent of urine during the night (Figure 12, Appendix 1:Table 5) In comparison with the six months ending March 1998, 5 trusts have moved above the average and 6 below Figure 13 SHRUGs residents who experienced urinary incontinence during the day percentages; in individual trusts and all trusts; at time of interview in six months ending March All Trusts (82%) Trust number Among individual trusts the proportions experiencing urinary incontinence during the day mainly fell within a fairly narrow band around the mean (Figure 13, Appendix 1:Table 5) This was also true for the six months ending March

18 SHRUGs data collection in Trusts Figure 14 SHRUGs residents who experienced faecal incontinence during the night percentages; in individual trusts and all trusts; at time of interview in six months ending March All Trusts (68%) Trust number There was a wide distribution among individual trusts in the proportions experiencing faecal incontinence during the night This ranged from 25% in trust 25 to 86% in trust 26 (Figure 14, Appendix 1:Table 5) In the equivalent time period for 1998, this ranged from 50% to 77% Changes in the relative position of trusts within the overall distribution have changed since 1998 with 4 trusts having moved above the average and 5 below Figure 15 SHRUGs residents who experienced faecal incontinence during the day percentages; in individual trusts and all trusts; at time of interview in six months ending March All Trusts (70%) Trust number Faecal incontinence during the day occurred among 70% of all SHRUGs residents The proportions ranged from 47% in trust 24 to 83% in trust 26, again showing considerable variation among individual trusts (Figure 15, Appendix 1:Table 5) 15

19 SHRUGs data collection in Trusts Emotional and Psychological Support, and Behaviour Table 8 Emotional and psychological support, and behaviour (supplementary variables) percentage distribution of residents ; at time of interview in six months ending March 1998 and March 1999 Emotional and Psychological Support Mar 98 Mar 99 Mar 98 Mar 99 Spending time with the resident % % Engaging in activities % % No No Yes - but not daily Yes - this is part of the daily routine of Yes - daily or more often the resident Yes - resident requires staff time over and above daily routine care Behaviour Mar 98 Mar 99 Mar 98 Mar 99 Co-operation % % Preventing problem behaviour % % Actively co-operative No Passively co-operative Yes - requires little or no extra staff time Actively unco-operative / resists help Yes - requires extra staff time Mar 98 Mar 99 Has one or more specified % % behaviours Yes No Number of residents in six months ending March 1998 = 3448 Number of residents in six months ending March 1999 = 3209 Note : percentages are rounded to the nearest integer. In comparison with the six months ending March 1998, there has been an increase of 3% in the proportion of residents with whom staff spent time on at least a daily basis In contrast, 4% fewer residents required extra staff time in the prevention of problem behaviour (Table 8, Appendix 1:Table 7) However, over this time period the figures in the above table show that there have not been significant changes in the distribution of residents to these emotional and behavioural supplementary variables 16

20 SHRUGs data collection in Trusts Figure 16 Emotional and psychological support spending time with the resident percentage of SHRUGs residents for whom response was Yes daily or more often in individual trusts and all trusts; at time of interview in six months ending March All Trusts (47%) Trust number The proportions in individual trusts of residents for whom staff spent time on a daily or more often basis (over and above time spent carrying out the essential physical tasks of care) varied greatly from 18% in trust 17 to 83% in trust 19 Twelve of the participating 26 trusts were above the average of 47% for all trusts (Figure 16, Appendix 1:Table 7) When compared with the six months ending March 1998, 4 trusts have moved above the average and 7 below Figure 17 Emotional and psychological support engaging in activities percentage of SHRUGs residents for whom response was Yes residents require staff time over and above the daily routine care ; in individual trusts and all trusts; at time of interview in six months ending March All Trusts (16%) Trust number 17

21 SHRUGs data collection in Trusts Overall, staff spent time with 16% of all residents helping and encouraging them to engage in activities, over and above their daily routine care Among individual trusts this ranged from zero in trust 3 to 50% in trust 25, showing considerable variation (Figure 17, Appendix 1:Table 7) This compared with a range from zero to 38% in the six months ending March 1998 Figure 18 Residents with one or more specified behavioural difficulties percentages; in individual trusts and all trusts; at time of interview in six months ending March All Trusts (59%) Trust number In the six months ending March 1999, the proportions of residents among individual trusts who displayed at least one of a specified number of behavioural difficulties at the time of the interview varied from 46% in trust 5 to 83% in trust 21 and 100% (all residents) in trust 25 This gave an average of 59% for all residents in all trusts (Figure 18, Appendix 1: Table 7) Figure 19 Behavioural difficulties co-operation percentage of SHRUGs residents for whom the response was Actively unco-operative/resists help in individual trusts and all trusts; at time of interview in six months ending March All Trusts (18%) Trust number 18

22 SHRUGs data collection in Trusts None of the residents in trust 25 and only 3% in trust 3 were considered actively uncooperative or resistant to help For the remaining trusts the proportion of residents ranged from 13% in trust 7 to 39% in trust 17 (Figure 19, Appendix 1:Table 7) This range was similar to that in the six months ending March 1998 which varied from 4% to 39% Figure 20 Behavioural difficulties preventing problem behaviour percentage of SHRUGs residents for whom the response was Yes - requires extra staff time in individual trusts and all trusts; at time of interview in six months ending March All Trusts (16%) Trust number Compared with the six months ending March 1998, there has been a 4% decrease (20% to 16%) in the proportion of all residents in all trusts who required extra staff time in preventing the occurrence of problem behaviour The proportions of residents in 15 of the 26 trusts fell below the average for all trusts (16%) in the six months ending March

23 Current and future developments 4 Current and future developments 4.1 The SCRUGs algorithm Through consultation with members of social work departments and care staff from residential homes, the existing SHRUGs system was reviewed during 1998 with a view to better describe the dependency and care needs of residents in private nursing home and residential home care The result was SCRUGs (Scottish Care Resource Utilisation Groups) The SCRUGs algorithm consists of eight groups (Table 9), showing greater discrimination in the relative use of staff resources than the existing five group SHRUGs algorithm currently used in hospitals The dependency category is measured in terms of feeding, toileting, transferring position and moving location The scores for these four variables are combined to produce an Activities of Daily Living (ADL) score which are grouped into four dependency categories; low, low to moderate, moderate and high In addition the behaviour module is applied to all ADL categories In private nursing home facilities care needs are described in terms of needs for special care, other needs for special care, clinically complex treatments, clinically complex conditions, behavioural difficulties requiring immediate intervention and the prevention of problem behaviour However, as staff in residential homes do not provide nursing care as such, questions relating to the patient s care needs are omitted from the interview and replaced by an inventory of the range and frequency of community health care inputs A variety of supplementary information is collected for the individual resident, but this information now varies between hospital, nursing home and residential home settings At present data collection in respect of encouraging independence is limited to private nursing home and residential care It is anticipated that a discrete supplementary weight will be able to be ascribed to this element of care and the SCRUGs categories amended accordingly Table 9 New developments; SCRUGs resource grouping SCRUGs Description Weight* Group A Low dependency; neither Behaviour nor Special Care Needs 0.50 B Low dependency; either Behaviour or Special Care Needs 0.69 C Low to moderate dependency; neither Behaviour nor Special Care Needs 0.59 D Low to moderate dependency; either Behaviour or Special Care Needs 0.77 E Moderate dependency; neither Behaviour nor Special Care Needs 0.87 F G or or Moderate dependency; either Behaviour or Special Care Needs High dependency; neither Behaviour nor Special Care Needs 1.07 Moderate dependency; both Behaviour and Special Care Needs High dependency; either Behaviour or Special Care Needs 1.27 H High dependency; both Behaviour and Special Care Needs 1.43 * These weights are derived from a sample of 592 residents for the period May 1996 to February

24 Current and future developments The weights shown against each of these groups correspond to the relative amount of staffing resource used during a defined period in time (May 1996 to February 1997) where the average for all residents is 1 00 The weights range from 0 50 in group A for those residents of low dependency with neither behavioural difficulties nor special care needs to 1 43 in group H for those residents of high dependency with both behavioural difficulties and special care needs The validity and reliability of the SCRUGs algorithm is discussed in Appendix Development of SCRUGs The past two years has seen the development of what was originally a health service based dependency and resource use measure (SHRUGS), for application in private nursing home and residential care facilities for elderly people (SCRUGS) Data is now collected in 18 Scottish Local Authority areas, covering 2754 residents of private nursing home care (as at 6 months ending March 1999) and 1992 residents of residential care (as at 6 months ending November 1999) Pilot developments are also being undertaken in augmented home care and sheltered housing facilities Particular emphasis has been given, as part of the development process, to identifying and analysing: a) the resource use implications of staff time spent on encouraging the independence of patients/residents; b) the range and frequency of service inputs to residential care by health care agencies In addition to the variables that impact on resource use, a variety of supplementary information is collected to meet the needs of individual local authorities, health authorities and local joint planning needs In many respects the development work undertaken by ISD in this area anticipated the current emphasis on the need to develop and demonstrate effective joint working arrangements between health and social work agencies Consequently, SCRUGS provides a tangible example of a joined-up information process The developing uses of SHRUGS/SCRUGS include : a standardised needs/resource use measure to describe the characteristics of residents and to provide a valid and reliable comparator across a range of residential settings/service providers (NHS, local authority and independent sector) a baseline for the application of best value criteria a baseline to assess quality parameters a baseline to assess the application of eligibility for admission criteria a baseline to assess outcomes: this in association with SCR 55* * Scottish Care Record (SCR) 55 has been developed in association with social work interests for application in private nursing home facilities. SCR 55 provides an admission/discharge equivalent of the SMR 50 return used in the geriatric long stay hospital setting. It has been piloted by Greater Glasgow Health Board and the data used in conjunction with SCRUGS assessment information to undertake a detailed analysis of low dependency placements in private nursing home facilities. 21

25 22

26 Appendix 1 Appendix 1 Trust tables 23

27 24 1 Number of residents Cumulative age and sex distribution of residents in geriatric long stay wards in six months ending March ,2 % distribution under 60 years under 75 years under 85 years All Number of males % distribution under 60 years under 75 years under 85 years All Number of females % distribution under 60 years under 75 years under 85 years All Trusts / DMU s All Appendix 1 1 Age as at date of SHRUGs interview. 2 Excludes one resident with an unknown date of birth. Note Percentages are rounded to nearest integer.

28 2 Percentage allocation of residents in geriatric long stay wards and percentage of resources utilised within each SHRUGs Resource Use Group, and Casemix Complexity Factor in six months ending March 1999 Number of residents % of residents Resource use group : % of resources utilised Resource use group : Casemix Complexity Factor 1 A B C D E A B C D E Trusts / DMU s All Appendix 1 1 Calculated using weights derived from a sample of 939 residents during the period June 1994 to June 1995 Note Percentages are rounded to nearest integer. 25

29 26 3 Number of residents Percentage of residents in geriatric long stay wards by dependency variable and dependency category in six months ending March 1999 Feeding (%) eats unaided eats with help requires feeding/fed by tube or infusion Toileting (%) copes independently needs help/direction prompting completely dependent /does not use the toilet Transferring Position (%) copes independently needs supervision /assistance of one person needs supervision /assistance of two/more persons Trusts / DMU s All Appendix 1 Activities of Daily Living (%) 1 low dependency (ADL = 3,4) moderate dependency (ADL = 5,6,7) high dependency (ADL = 8,9) The activities of daily living (ADL) score is calculated by adding together scores from answers to questions about feeding, toileting and transferring position. Note Percentages are rounded to nearest integer.

30 Appendix 1 4 Percentage of residents in geriatric long stay wards by Need for Special Care, Clinically Complex Treatment and Behavioural Difficulty in six months ending March 1999 Trusts / DMU s All Number of residents Need for special care (%) Yes No Clinically complex treatment (%) Yes No Need for special care and / or clinically complex treatment (%) Yes No Behaviour - Immediate intervention (%) No Less than once a week More than once a week but not daily Once a day (on average) More than once a day Note Percentages are rounded to nearest integer. 27

31 28 5 Percentage of residents in geriatric long stay wards by continence variables in six months ending March 1999 Trusts / DMU s All Number of residents Urinary incontinence - at night (%) never no more than once a week more than once a week but not nightly nightly Urinary incontinence - daytime (%) never no more than once a week more than once a week but not daily daily Faecal incontinence - at night (%) never no more than once a week more than once a week but not nightly nightly Appendix 1 Faecal incontinence - daytime (%) never no more than once a week more than once a week but not daily daily Note Percentages are rounded to nearest integer

32 6 Percentage of residents in geriatric long stay wards by supplementary variables in six months ending March 1999 Trusts / DMU s All Number of residents Communicates needs (%) verbally/understood by most people verbally/understood only by those who know him/her well non verbally no Profoundly deaf? (%) yes no cannot be determined Useful vision? (%) no yes cannot be determined Mobility around ward (%) copes independently needs supervision/assistance of one person needs supervision/assistance of two/more persons Appendix 1 Clinically complex condition (%) yes no Other needs for special care (%) yes no Note Percentages are rounded to nearest integer.

33 30 7 Percentage of residents in geriatric long stay wards by emotional support and behaviour variables - in six months ending March 1999 Trusts / DMU s All Number of residents Emotional & Psychological Support - Spending time with the resident (%) No Yes - but not daily Yes - daily or more often Emotional & Psychological Support - Engaging in activities (%) No Yes - this is part of the daily routine of the resident Yes - resident requires staff time over and above daily routine care Has one or more of specified behaviours (%) yes no Behaviour - Co-operation (%) Actively co-operative Passively co-operative Actively unco-operative/resists help Behaviour - Preventing problem behaviour (%) No Yes - requires little or no extra staff time Yes - requires extra staff time Appendix 1 Note Percentages are rounded to nearest integer.