DEATHS WITHIN THE FIRST YEAR OF ADMISSION TO LONG TERM CARE GloriaM. Gutman, Simon Fraser University Annette J. Stark GailWitney Brian McCashin The University of British Columbia ABSTRACT On January 1, 1978, a new Long Term Care Program was introduced in British Columbia. Five levels of care are offered, any one of which may be provided at home or in a facility. This paper presents data from a longitudinal study of program clients (N = 3518) in two health districts, one urban, one semi-rural. The period of interest is the first twelve months after ad- mission. Approximately one-quarter of these clients were discharged within one year of admis- sion—one-half of them due to death. One-third of the deaths occurred in the first two months after admission and a further one-third in the following four months. Fewer than one-third of clients changed level or placement before death. Where transfers did occur they tended to be to higher levels of care and from home to an institution. The characteristics of clients who died are examined. These data may assist care providers to identify high risk clients. As well, they have implications for future resource allocation and planning. Introduction On January 1, 1978, a Long Term Care (LTC) Program was introduced by the Ministry of Health in British Columbia. The primary aim of the program is to enable those who qualify for services to remain in their own homes for as long as it is possible and practical for them to do so. Placement in an approved facility or admission to a hospital-based extended care unit (ECU) is provided when this is no longer possible. Decisions regarding admission to the pro- gram, level of care and location at which ser- The research described in this paper as well as the larger study of which it is a part is supported by a grant from the B.C. Health Care Research Founda- tion. In addition, the cooperation and support of the Ministry of Health, Province of British Columbia, is gratefully acknowledged. This paper was pre- sented at the joint annual meeting of the Canadian Association on Gerontology and the Gerontological Society of America, Toronto, November 8-12, 1981. Requests for reprints should be sent to: Division of Health Services Research and Develop- ment, The John F. McCreary Health Sciences Centre, University of British Columbia, Vancouver, B.C., V6T 1W5 vices will be provided are based on a standard pre-admission assessment conducted by trained program staff. Five levels of care have been defined and each can be provided either in the client's own home or in a facility. These levels are: Personal Care, Intermediate I, II and III and Extended Care. Current program policy dictates that clients be reviewed no later than 90 days after placement in a facility or com- mencement of home support services and every twelve months thereafter or earlier if the client's condition or circumstances change [ 1 ]. A study of selected clients in the LTC Pro- gram is in progress. The study encompasses two health districts, one urban (Unit A) and one semi-rural (Unit B). All clients (N = 3518) ad- mitted to the LTC Program in these areas in 1978 are subjects of the study. The data source is client files maintained by Program staff and made available, with names removed, to the re- searchers. Each file contains a copy of all writ- ten documentation pertaining to the client be- ginning with the initial assessment. As re- views, reassessments, transfers, level changes and discharges occur, they are added to the file. The study is designed to extend knowledge concerning the disability level and the length of stay in various care placements. It is antici- pated that this will aid future resource alloca- Canadian Journal on Aging, Vol. 1, Nos. 3 and 4