The national network for long-term care in Portugal: assessing the characteristics and the outcomes of the nursing homes and home and community based-services' beneficiaries

Background: The Portuguese National Network for Long-term Care (RNCCI) was formally created in 2006. The main goals of this work are to assess the reform of the RNCCI and to compare the long-term care (LTC) delivered through Home and Community-Based Services (HCBS) with care provided in the three Nursing Homes (NH) units, by identifying their main characteristics, the outcomes after treatment and the main predictors of length of care (LOC). Data Source: Extracted from the LTC monitoring system, the dataset contained the records of 20,984 people aged ≥60 years, admitted and discharged in 2015 in mainland Portugal. Methods: Firstly, we assessed the evolution of the main features of LTC reform in Portugal, identified its strengths, weaknesses and the main challenges ahead. Then, in order to identify the main risk factors on the likelihood of a person receiving care in each care setting, we used odds ratios and marginal effect. Thirdly, we used the Cox Proportional Hazards Model and ordinal logistic regressions to assess, respectively, mortality and patients’ outcomes after treatment. Finally, the General Linear Model was performed to assess the influence of patients’ dependence levels on their LOC. Results: Despite regional asymmetries in the provision of care, the creation of the RNCCI filled a gap in the National Health Service. Secondly, after adjusting for several variables, there are differences in the numbers of people correctly referred to each care setting. Then, most people present no changes in their cognitive and physical status after treatment. Finally, LOC is mostly influenced by the to which setting patients are admitted. Conclusions: Although the full implementation of the RNCCI was planned to be concluded over a 10-year period, public spending financial constraints have slowed its development since 2011. Thus, given the scarcity of resources, it is vital to adopt a robust, comprehensive assessment tool to ensure that the provision of care is tailored to each person’s needs. ; RESUMO - ...