Reliability of level of care decisions in a Long-Term Care program

Abstract

This paper addresses the question of the degree of agreement between experienced assessors making level-of-care placement decisions for the same client, given a comparable opportunity to obtain and record client information in a community-based Long-Term Care program.

A systematic sample of 246 cases was selected, consisting of 47 preadmission assessments and 199 reviews. The resulting data were subjected to analysis using the statistic Kappa

and the degree of agreement categories suggested by Fleiss.¹ It was found that at the level-of-care extremes— Extended Care and Personal Care—the agreement between two nurse assessors for reviews could be considered “excellent.” In the Intermediate Care range, however, the reliability of the level-of-care decision can only be considered “fair.” Agreement for initial assessments was less, withK=0.469 indicating, overall, only “fair” agreement. While there was most often only a one-care-level difference between assessors, the program assessor tended to recommend a higher level than the study or “check” assessor. This has implications for funding agencies and/or facility planners who must assess the likely care requirements of an increasing number of disabled elderly. From a program management perspective, the preceding analyses allow an objective judgement of the extent of the placement decision problem, if any, and further provide a definition of areas most in need of revision. The value of collaboration between practitioner and researcher is evident in these analyses.