Why are Clients Inappropriately Placed in High Levels of Care?


Madhuri Reddy, MD, FRCPC
Associate Editor,
Geriatrics & Aging,
Toronto, ON.


It is well documented that, throughout North America, a large percentage of elderly clients (10-52%) do not have the medical need or are not sufficiently disabled to justify placement in high level of care settings such as a nursing home (NH).1,2,3,4

The placement of low-care clients in NH is often assumed to indicate inappropriate and inefficient use of NH resources.5 In addition, it is well established that disabled clients prefer home or community-based care rather than receiving care in NHs.6 So why do clients continue to be placed in high levels of care that they do not need?

Subjective Placement Criteria
The process of client placement does not always explore the possibility that the client may best be cared for outside of a long-term care (LTC) institution. In addition, even when clients truly do need NH care, the definitions of the various levels of care are often vague; thus, adherence by placement committees is often inconsistent. This lack of objective criteria regarding the level of care required by a particular patient leads to subjective decision-making by a placement panel; this can result in patients who require the same level of care being placed in different levels depending on who makes the decision.