FAQ

Long-Term Care (LTC) is a blanket term that "brings together a range of services for persons who are dependent on help with basic activities of daily living (ADLs) over an extended period of time" (OECD, 2005). This range includes ‘medical and/or social services designed to help people who have disabilities or chronic care needs. Services may be short- or long-term and may be provided in a person's home, in the community, or in residential facilities’ (US Dept of Health). At present Member States of the European Union use a variety of definitions of LTC that do not always concur (EC, 2008).

OECD. The OECD Health Project: Long Term Care for Older People. Paris: OECD Publishing; 2005.
Office of Disability, Aging, and Long-Term Care Policy. Glossary of Terms. United States. Department of Health and Human Services online 12 November 2003 cited 2009, January 18th.

Available at: http://aspe.hhs.gov/daltcp/diction.shtml

The ‘Description and Evaluation of Services and Directories in Europe for Long Term Care’ (DESDE-LTC) is an instrument for the standardised description and classification of services for Long-Term Care (LTC) in Europe.

It follows the approach to service evaluation developed by the EPCAT Group (European Psychiatric Care Assessment Team) and PSICOST Scientific Association since 1997, starting with the development of ESMS (European Service Mapping Schedule) for the evaluation of services in mental health (Johnson et al, 2000), and related adaptations to the evaluation of services for older people in Spain (DESDAE) (Salvador-Carulla et al, 2005) and services for disabilities (Salvador-Carulla et al, 2006).

This instrument is intended to compile service information on input and process at the meso (-level (health/social areas) and micro-level (individual services) as defined at a modified version of the Thornicroft & Tansella Matrix that was developed for the assessment of mental health care services (Tansella & Thornicroft, 1998).

DESDE-LTC allows the following tasks to be carried out in a standardized way:

Johnson S, Kuhlmann R and the EPCAT Group. The European Service Mapping Schedule (ESMS): Development of an instrument for the description and classification of mental health services. Acta Psychiat Scand 2000; 102 (Suppl. 405): 14-23

Salvador-Carulla L. Descripción estandarizada de los servicios de discapacidad para ancianos en España. IMSERSO online 12/07/2005 Access date: 18 January 2009:

IMSERSO View PDF

Salvador-Carulla L, Poole M, González-Caballero JL, Romero C, Salinas JA, Lagares-Franco CM, for RIRAG/PSICOST Group and DESDE Consensus Panel. Development and usefulness of an instrument for the standard description and comparison of services for disabilities (DESDE). Acta Psychiatr Scand. 2006; 114 (Supp.432): 19–28.

Tansella M, Thornicroft G. A conceptual framework for mental health services: the matrix model. Psychol Med 1998; 28: 503-508.

The training material (PDF documents and video tutorials), is available in English and it can be downloaded from the DESDE-LTC website. It is intended to support trainees in their training process

Trainees include health service researchers, providers, planners and any stakeholder in the LTC field interested in standarised assessment and comparison of services. Although face-to-face training is required and it can be requested from the eDESDE-LTC consortium, the training package is open access.

DESDE-LTC describes services according to a number of descriptors classified on levels of care:

• First Level – Status of user. This level relates to the clinical status of the users who are attended in the care setting (i.e. whether there is a crisis situation or not).
• Second Level – Type general of care. This level describes the general typology of care (home & mobile/non-mobile, hospital/non- hospital...).
• Third Level – Intensity of care. This level refers to the intensity of care that the service can offer.
• Fourth Level – Subtype of care. This level provides a more specific description of the type of care in a setting.
• Fifth Level – Additional qualifiers. This level incorporates additional qualifiers that may be needed to differentiate between similar care settings.

This specific version of DESDE-LTC is focused on services for the following groups: Adult (18+) and frail older people (65+) with:

• i) severe physical disabilities (registered in official national, regional or local registers for this population group, or an equivalent system where registers are not available);
• ii) intellectual disabilities (ICD-10);
• iii) mental disorders (ICD-10); and
• iv) Older people with severe disability (registered in official national, regional or local registers for this population group, or an equivalent system where registers are not available).

DESDE-LTC uses a ‘Tree System’ to describe the availability and utilisation of services (Long Term Care Mapping Tree). Its overall structure is illustrated on page 9 of the instrument. It has four major sections:

• A. Introductory Questions: These relate to the catchment area and target population that complete the questionnaire.
• B. Care Type Mapping (Main Types of Care -MTC- Coding): These provide a standardised method for classifying and coding basic care/service categories for the population of a particular catchment area, based on the main activities provided by every service.
• C. Care Use Mapping (MTC Counting): This provides a standardised method of measuring levels of the main types of care use by the population of a catchment area.
• D. Service Inventory: This provides a detailed description of individual services for LTC, obtaining two types of lists: a categorised service list according to the codes established in section B and secondly a list with the characteristics of every service following a traditional approach (service listing, directory or catalogue).

DESDE-LTC has been designed to allow national and international comparisons. Therefore, the most important types of care within each catchment area must be assigned to one of a number of specific codes: Information, Accessibility, Self-help, Out-Patient, Day Car and Residential. DESDE-LTC is intended to provide a description of the social care and health services within a catchment area. The instrument allows for the separate analysis of social and health care services in any geographical area if requested and agreed within all the study areas.

This schedule can be used in two ways:

• i) a simple description to catalogue services and the main types of care in the target area (a maximum of two digits in its codification); or
• ii) a complex or quantitative assessment to compare types of care and services in several catchment areas or in the same target area throughout a defined period of time. Basic training on the use of DESDE-LTC is needed before the instrument can be used.

Services located out of the catchment area but that are used by at least five inhabitants per annum, per 100,000 inhabitants (for residential and day facilities) will be included.

Where information is limited, and it does not allow one to fill a specific or end branch, it is possible to count data just for a branch on higher level of the mapping tree (i.e. when it is not possible to differentiate contacts according to intensity in outpatient non-acute care, the counting could be made just for home & mobile [05 to 07] and non-mobile contacts [08 to 010].

It is possible to obtain different grades of detail in the final information depending on the access and availability of the data required:

• Grade I: general information at the level of Main Branches - e.g. 90 users for Outpatient services but no specifications for home & mobile/ non mobile or on the level of intensity. These are classified as “O”.
• Grade II: extended general information at the level of sub-branches -i.e. 20 places for home & mobile and medium intensity (classified as O6) and 70 non mobile and low intensity places for (classified as O10) continued outpatient care.
• Grade III: Extensive data gathering by external raters: -retrospective use of databases and prospective assessment limited to one day (i.e. emergency care) -retrospective use of databases and prospective assessment limited to one week (i.e. day care). For retrospective data gathering the monthly average rate of use registered in the database for a specific month of the previous year excluding holiday periods (December, January, February, April, June, July and August) may be used. Prospective data collection limited to a one month period. It is important that the level of specificity reached, as well as the period of reference for the data gathering, are the same for all the evaluated geographical areas and recorded in Section A, general information.

Hospitals are meso-organisations. They don’t fulfill the criteria of a BISC because they constitute a higher unit of analysis. A hospital is constituted for a set o BSICs in the same location.

These services should be rated as BSIC if they fulfil the following criteria:

• Criterium “A”: The service is registered as an independent legal organisation (with its own company tax code or an official register). This register is separate and not as a part of a meso-organisation (for example a service of rehabilitation within a general hospital) IF NOT:
• Criterium “B”: The service has its own administrative unit and/or secretary’s office and fulfils two additional descriptors (see below) IF NOT:
• Criterium “C”: The service fulfils 4 additional descriptors: C1. To have its own professional staff. C2. All activities are used by the same users. C3. To have its own premises and not as part of other facility (e.g. a hospital) C4. Separate financing and specific accountancy C5. Separated documentation when in a meso-organization

Mobile services or BSIC are facilities where contact with users occurs in a range of settings outside the service premises including users’ homes, as judged most appropriate by professionals and users. In order to provide more clarity to this group it has been re-named ‘Home and mobile’. For a service to be classified as ‘home & mobile’ at the eDESDE-LTC, at least 50% of contacts should take place away from the premises at which the service is based. There are several services which are difficult to code and where additional information is needed:

• Services that provide care to other services (i.e. a liaison unit providing care on a weekly basis to a nursing home) In this case the service will be classified as ‘home & mobile’ if at least 50% of contacts take place away from the premises at which the service is based. If mobile care is provided at least for 20% of contacts a secondary mobile code should be added to the MTC Non-mobile code. In other cases of mobile outpatient care an additional qualifier “d” could be provided to describe its mobile activity.
• Services which provide care in a different setting every day of the week (for example rural services that provide care on a different municipality from Monday to Friday). Although in this case the main site of provision for service delivery vary from day to day this does not mean they should be classified as ‘home & mobile’ unless staff go and do work at locations away from that day’s main site. A fix scheduled day is assigned for service delivery which is actually ‘non-mobile’.