Objective: to investigate dependency and health status of a cohort of older people admitted for long term nursing or residential care and to compare these findings with assessments conducted by social services departments prior to placement. Design: retrospective cohort study. Setting: residential, nursing and dual registered homes within Nottingham Health Authority boundaries. Subjects: 205 residents placed over 3 months. Main outcome measures: levels of disability, cognitive impairment and

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... avioural disturbance identified by assessment before and after admission. Results: cognitive impairment and physical disability were significantly higher in nursing homes, although a third of residents in residential care had substantial physical disability. In nursing homes, a quarter of residents had low dependency needs but these had greater cognitive impairment than those in residential homes with the same level of dependency. Most residents had some degree of behavioural disturbance (particularly in nursing homes) and more severe disturbance was associated with greater cognitive impairment and more depressed mood, but not physical disability. A moderate level of agreement was found between preadmission and follow-up assessments of health status. Conclusions: a case-mix which includes higher dependency residents in residential homes and lower dependency residents in nursing homes is likely to reflect changes in the health status of residents following placement but also suggests that a range of placement criteria were used together, rather than individual indicators of need. Although preplacement measures of disability and dependency were supported by follow-up assessments, it is essential that the needs of residents in long-term care are adequately monitored and managed, in particular those in residential care with higher dependency needs.