Is there a shift of burden from geriatric medicine services to old age psychiatry services?

The introduction of the Community Care (Delayed Discharge) Act 2003 in England led to a reduction in the mean and median length of stay of patients admitted to geriatric medicine (GM) units despite an increase in the number of admissions (Shah, 2007) because it imposed financial penalties on local authorities for delays in the discharge of patients. However, mean and median length of stay of patients admitted to old age psychiatry (OAP) units increased, along with the number of bed days utilized, despite a reduction in the number of admissions (Shah, 2007). This raised concerns that community care budgets may have been moved from OAP services to GM services because there were no financial penalties for delays in discharging patients from OAP units. However, closer examination of the data suggested that some of the observed changes began to occur before the Community Care Act 2003 was implemented, particularly in OAP services. This raised the possibility that other governmental initiatives may have also shifted the burden from GM services to OAP services prior to the implementation of this Act. This shift in burden from GM services to OAP services has been formally examined and is reported here. Data on the number of finished inpatient episodes, mean and median length of stay, and the number of bed days for patients admitted to GM and OAP services in England were ascertained from nationally collected data (Hospital Episode Statistics – www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID= 1937&CategoryID=192) for the eight financial years between 1998/1999 and 2005/2006. Each of these eight years was numerically coded from 1 to 8. Trends over time for all the measured variables were examined by correlating these numerical codes and the measured variables in GM and OAP using Spearman’s correlation coefficient (ρ). Also, the relationship between GM and OAP services for all the measured variables was examined using Spearman’s correlation coefficient. Furthermore, a trend over time for the combined total of bed days for both GM and OAP services was examined to find evidence supporting the hypothesis that the number of bed days in the combined GM and OAP services remained constant over the eight-year period. In GM services, there was a decline in the median length of stay (ρ=−0.76, p= 0.027) and an increase in the number of finished inpatient episodes (ρ=+0.79, p= 0.021) over the eight-year period; there was no change over time in the mean length of stay and bed days. In OAP services, there was an increase in the mean (ρ=+0.91, p= 0.002) and median (ρ=+0.99, p< 0.0001) length of stay, and in bed days (ρ=+0.93, p< 0.0001), and a decline in the number of finished inpatient episodes (ρ=−0.95, p< 0.0001)