Editorial
Don’t throw out the baby with the bathwater
February 27, 2004
Every year when the Case Mix Index (CMI) findings from the province are released, there are complaints from administrators of long-term care homes, whose CMI level has dropped, that the system doesn’t work and should be replaced.

That response is very understandable since the CMI is used to determine the nursing and personal care needs of residents and consequently the level of funding provided for these services. It is difficult to administer a home with fluctuating funding.
No administrator wants to find out his or her home will receive less funding in the coming year. That means likely cuts in services to the very people the homes care for.

But it also makes very little sense to throw out the CMI, a valuable tool that effectively measures the level of care in a home. Under CMI, the level of funding is based on the level of care. The need for greater care means greater funding. It is difficult to argue with that reasoning.

Under CMI, there is a clearly defined set of criteria for assessing a resident’s care needs, including activities of daily living, behaviours and continence.

Where the CMI fails to deliver is in the timing. The CMI tally represents a once-a-year snapshot of the level of care in a home at a specific time. Registered staff at a home must carefully document levels of care which are reviewed by a nurse sent by the Ministry of Health and Long-Term Care for a two or three-day visit.

The CMI index that results represents a snapshot in time. However, eight months pass before the home receives funding for the next year, based on that faded snapshot. In long-term care, a lot happens in eight months and there are often dramatic increases or decreases in care needs.

If care needs increase during that eight-month delay in funding, a home could be left under-funded for a complete year during which additional changes occur, often acerbating the problem.

This problem could be allayed if there were quarterly adjustments in the CMI to reflect more closely the current levels of care in a home. That way, the funding would apply much more closely to the reality of the needs in a home. The quarterly adjustments could be administered in a way that does not tie up homes in lengthy, detailed documentation and review.

Minister George Smitheram, in planning his “revolution” in long-term care, should ensure that residents get the care they deserve by tying funding to a much more timely assessment of need.

In doing so however, it would be foolish to throw the baby out with the bathwater by replacing the CMI. It is a tool that has helped both homes and the province to assess and meet care needs.