Is home care a realistic alternative to residential care among institutionalized elderly people in Finland?

The high rate of institutionalization among elderly people in Finland is widely discussed among policy-makers. We studied how realistic the wishes for deinstitutionalization are among the least sick elderly people in residential care, and what patient characteristics predict whether residential care is appropriate. This issue was assessed by the residential home personnel. Personnel assessment of institutional care as appropriate was mainly explained by patients' needing help with medication, limitations in activities of daily living, absence of own home to return to, no living children, incontinence, and poor vision. Discharging elderly people from long-term residential care back to society is limited by factors such as inadequate housing and shortage of domiciliary and rehabilitative services, as well as by attitudes among the institutionalized elderly people themselves. It seems more realistic to prevent the inappropriate institutionalization of elderly people than to discharge the small numbers of fairly independent individuals already in residential homes.