Analysis of discontinuance of short-stay services and safety issues in a residential care institute for individuals with severe motor and intellectual disabilities

Abstract

  Objective: More than 5 years have passed since the commencement of short-stay services at SUKOYAKA-Residential Care Institute for Children with Disabilities. We investigated the status of short-stay services and the reasons for patients discontinuing to use the services due to worsening of their physical condition. We also assessed the safety of medical management, our roles, and problems in our institution. Materials and Methods: We investigated 99 individuals with severe motor and intellectual disabilities (SMIDs) who have registered for our short-stay services in March 2022 about age, main disease, presence of the mechanical ventilation, tracheotomy, tube feeding and epilepsy. We aggregated faculty utilization rate from the commencement to March 2022. In addition, we retrospectively explored the reason for early exit using patient medical records. Results: In this study, 67% of the patients were under 20 years old. Regarding their etiology, 77% of them were either congenital or caused by episodes in the perinatal period. Complication rate of tracheotomy was 44%, and eventually 41% of the patients had been on a mechanical ventilator. That of tube feeding was 73% and epilepsy was 68%, respectively. Our institute’s reservation rate was 90%, and the utilization rate was over 80% before the COVID-19 pandemic. Moreover, the percentage of medically dependent (MD) patients with SMIDs and sub-MD-SMIDs among all facility user has increased. About five patients per year left the faculty early due to illnesses (including infection and epileptic seizures). Most of these patients were younger patients or those who required advanced medical care. Conclusion: We predict that infants with unstable symptoms and SMIDs who are receiving advanced medical care will use the short-stay services more in the future. In order to safely conduct short stays with advanced medical care for patients with SMIDs, it is important to carefully collect information from parents and care for the patients in the same way as at their home. Furthermore, we must stabilize their primary disease. Hence, cooperation with other hospitals and information sharing with the attending physician will be future issues. In addition, we should consider the needs of short-stay services for walkable patients with advanced medical care requirements.