Profile of residents in unlicensed homes for the aged in the Eastern Townships of Quebec

Abstract

BACKGROUND: The number of unlicensed homes for the aged in Quebec has increased rapidly over the last decade. Because these homes are not linked in any formal way to the Quebec Ministry of Health and Social Services, little is known about their residents. The objective of this study was to describe the sociodemographic characteristics and disability profile of elderly residents in unlicensed homes for the aged. Comparisons were made to a sample of residents drawn from licensed long-term facilities. METHODS: The target population was restricted to residents aged 65 years and over in facilities in the Eastern Townships of Quebec who had some difficulties with at least 2 activities of daily living. This population included 94% of elderly people in licensed facilities and 64% of those in unlicensed homes. The study population comprised 301 impaired people in 88 residential care facilities (36 licensed, 52 unlicensed). They were selected using a 2-stage sampling scheme: stratified sampling of the primary units (homes) and simple random sampling of the secondary units (residents). Facility managers were interviewed to collect descriptive information about themselves and their facilities. Residents were assessed with regard to their cognitive abilities (using the Modified Mini-Mental State [3MS] Examination) and their functional autonomy (using the Functional Autonomy Measurement System [Systeme de mesure de lautonomie fonctionnelle (SMAF)]. RESULTS: Although residents without impairment were excluded from the study, the unlicensed facilities were found to house people who were, on average, less cognitively and physically impaired than their counterparts in the licensed facilities (p < 0.001). Nonetheless, a substantial proportion of the residents in the unlicensed homes had severe cognitive disabilities (38.5% had 3MS score of less than 60) and functional disabilities (17.0% had an SMAF score of more than 40). The corresponding figures for residents in the licensed facilities with these scores were 65.3% and 66.7%. Of the managers of the unlicensed facilities 31.9% had no training and 58.8% had no previous experience in caring for the elderly people. The staff-resident ratio was lower among the unlicensed homes than among the licensed facilities (mean 0.05 [standard error of the mean (SEM) 0.01] v. 0.39 [SEM 0.03], p < 0.001). In addition, only 26.0% of the unlicensed homes employed qualified staff, as compared with 63.0% of the licensed facilities (p < 0.001). INTERPRETATION: This study provides evidence that many residents of unlicensed homes have considerable care needs. These homes appear ill-equipped to address their needs, which raises doubts about their ability to deliver high-quality care.