A randomised controlled trial of a care home rehabilitation service to reduce long-term institutionalisation for elderly people.

OBJECTIVES to evaluate the effect of a care home rehabilitation service on institutionalisation, health outcomes and service use. DESIGN randomised controlled trial, stratified by Barthel ADL index, social service sector and whether living alone. The intervention was a rehabilitation service based in Social Services old people's homes in Nottingham, UK. The control group received usual health and social care. PARTICIPANTS 165 elderly and disabled hospitalised patients who wished to go home but were at high risk of institutionalisation (81 intervention, 84 control). MAIN OUTCOME MEASURES institutionalisation rates, Barthel ADL index, Nottingham Extended ADL score, General Health Questionnaire (12 item version) at 3 and 12 months, Health and Social Service resource use. RESULTS the number of participants institutionalised was similar at 3 months (relative risk 1.04, 95% confidence intervals 0.65-1.65) and 12 months (relative risk 1.23, 95% confidence intervals 0.75-2.02). Barthel ADL Index, Nottingham Extended ADL score and General Health Questionnaire scores were similar at 3 and 12 months. The intervention group spent significantly fewer days in hospital over 3 and 12 months (mean reduction 12.1 and 27.6 days respectively, P < 0.01), but spent a mean of 36 days in a care home rehabilitation service facility. CONCLUSIONS this service did not reduce institutionalisation, but diverted patients from the hospital to social services sector without major effects on activity levels or well-being.