Hospital care of people living in residential care facilities: Profile, utilization patterns and factors impacting on quality and safety of care

Background: Residents in residential care facilities (RCF) are frequent users of acute hospital services. However, the interface between the two sectors remains relatively unexplored. Our objective was to determine the patterns of utilization, characteristics and experiences of RCF residents accessing a tertiary referral center (TRC). Methods: An observational study of RCF residents presenting to the TRC emergency department (ED). The experiences of acute care services were explored for more than one-quarter of this group 2-3 days postdischarge. The carer within the RCF acted as the proxy respondent. Results: During the study period, RCF residents accounted for 2.3% of all ED presentations. These presentations involved 526 residents. The dimension continuity of care for the Picker Patient Experience questionnaire had the highest proportion (53.1%) reporting a problem. The likelihood of reporting a problem for continuity of care (odds ratio [OR], 3.58; confidence interval [CI], 1.72-7.45) and information and education (OR, 2.62; CI, 1.14-3.01) were higher if the resident was admitted to a ward compared to ED only. If the resident had a low level care status the likelihood of reporting a problem for continuity of care (OR, 2.8; CI, 1.02-7.72) also increased. The odds of RCF staff reporting a problem for ambulance service were significantly higher if the resident's presentation was related to a fall. (OR, 3.35; CI, 1.28-8.8). Conclusion: The utilization rates for acute hospital care in our study were similar to the two previous Australian studies. Factors at the patient and organizational level impacted significantly on problems relating to the quality and safety of care being reported.