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This chapter examines data collected on the demography, dependency characteristics and ability levels of older people living in the two Care Homes of the Helping Hand in 2006. Furthermore, it investigates whether any changes occurred from 1990 to 2006, particularly with the introduction of ‘the Standardised Care Need Assessment Mechanism’ (SCNAM) from November 2000. All the older people in residence in the two Care Homes had been there less than three years as at 1990. This was due to the commencement of service operation at Chak On and Lai Yiu in 1989 and 1988 respectively. At the time of writing, very few residents in the two Care Homes had been admitted prior to 1998. In order to minimise the effects arising from the length of stay, this study has selected to focus principally on those with three or fewer years of residence. The use of a 3-year cut-off coincidently divides the total number of respondents in the 2006 survey into two halves, and provides a way of comparing long and lesser-stay residents. Though somewhat arbitrary, the choice of three years as a cut-off point is practical.

Two forms of analysis are presented. Firstly, the two cohorts - residents of more than 3 years and those of 3 years or less - are set side by side to reveal the changing characteristics of the older residents (if any) at the two Care Homes in the 2006 survey. Those with more than 3 years of residence will have received institutional care before the new policy (SCNAM), whereas those with 3 years or less were admitted after this ‘gatekeeping’ policy in late 2000. It is hypothesised that those admitted after the start of the new policy will have higher degrees of frailty. It is also likely that residents become more functionally impaired and older, the longer

their stay. However, it is to be expected that the introduction of gatekeeping will have reduced the differences in age and dependency between the longer and shorter-stay groups.

Secondly, comparisons are made between the findings in 1990 and 2006 to examine whether there were any significant changes between the two cohorts of residents with 3 years or less periods of stay at the two specific points of time. As hypothesised, the shorter-stayers in 2006 should be more disabled and older than their comparator group from 1990. Based on foundations of the 1990 data, this analysis explores changes in the resident case mix between 1990 and 2006.

Along with the inception of the formal ‘gatekeeping’ policy in late 2000, the present study places its focal interest upon whether admission policies have become more targetted. Those with higher levels of frailty and functional disabilities should have been given greater priority in admission to institutional care. Consequently new home residents are likely to be more frail, old and functionally impaired in 2006 than in 1990. Put in the other way, if these two Care Homes admit only those who are in most need of long-term care greater vertical target efficiency (the proportion receiving a service who actually satisfy the target criteria) in access and care are a more likely consequence.

Two cohorts of home residents in 2006

Comparisons are made between two cohorts, namely, those resident for more than 3 years versus those with 3 years or less of stay in the 2006 survey. In the first place, a T-test is used to compare the difference between the mean scores of the

two cohorts of residents in the two Care Homes at Chak On and Lai Yiu as at 2006.

Referring to Table 7.1, no significant differences (p > 0.05) are identified among many items across these two cohorts of home residents in 2006. Those resident for 3 years or less do not differ significantly from those with over 3 years of stay. However, there is some evidence of declining ability levels. This is well reflected from the higher mean scores in: ‘walking aid’ (3.11 versus 2.60), ‘urine incontinence’ (1.31 versus 1.08), ‘faeces incontinence’ (1.00 versus .74), ‘vision’ (.88 versus .74), and ‘bed making’ (1.69 versus 1.59).

On the other hand, the statistical significance is particularly prominent in the two variables of ‘age’ and ‘hearing’. Concerning ‘age’, respondents with 3 years or longer period of stay appear to be distinctly older. The mean is 87.78, compared with that of 84.39 in the shorter-stay cohort (Table 7.1). As revealed by the T-test, the two cohorts differ significantly as at 2006 (p = 0.007; t-value = -2.742). In both residential facilities, more than 51 per cent of the respondents (3 years or less period of stay) belong to the age range of 80-89 (Table 7.2). Interestingly, over a quarter (26%) are of aged 90 and above. Hence in this shorter-stay cohort, about 77 per cent are classified as very old (aged 80 and above). Meanwhile, for those longer-stay respondents (having over 3 years of residence), the vast majority (approximately 87%) fall within the age range of 80 and above.

As far as the ‘hearing’ is concerned, residents experiencing ‘no hearing difficulties’ score ‘0’, ‘1’ for having ‘some hearing problems’ and ‘2’ for ‘totally deaf’ respectively in the questionnaire (Q.13). Again a higher mean of .75 is identified among the longer-stay cohort in 2006, compared with that of .42 in 1990

(Table 7.1). T-test indicates a high significance level (p = 0.003; t-value = -2.992). Over half of the senior respondents with longer period of residence appear to experience severe hearing difficulties, comprising 18 per cent being classified as ‘deaf’ (Table 7.3). On top of that, around 39 per cent suffer from ‘some difficulties’. While for those with 3 years or less of stay, the proportions are smaller, 5 per cent and 33 per cent respectively.

However, broadly speaking, those newly admitted (with 3 years or less of stay) appear to be almost as frail as those who have lived in the residential homes for over 3 years. This is some evidence that the use of ‘the Standardised Care Need Assessment Mechanism’ meant people with greater functional need were admitted to residential facilities.

Residents’ conditions across the two Care Homes as at 2006

As there are no major differences between the two cohorts in 2006, the analysis explores if there exists any disparity across the two Care Homes of the Helping Hand. Again a T-test is used to measure the differences between the mean scores for those with 3 years or less residence period in the two local homes under study.

Among items such as ‘mobility’, ‘incontinence’, ‘age’, ‘toileting’, ‘bathing’, no significant differences (p > 0.05) are detected between the two care and attention homes (Table 7.4). Only in the two items of ‘expressiveness’ and ‘bed making’ do the older residents differ significantly at both institutional facilities. In the Chak On Care Home, the mean of ‘expressiveness’ equates to .76, higher than that of .28 in