Functioning and service needs of older people – RAI benchmarking data 2022
This quality description of the statistics assesses the reliability and suitability of the statistics for different purposes. The quality description follows the recommendations of Official Statistics of Finland (in Finnish: Suomen virallinen tilasto, SVT).
Relevance of statistical data
The Resident Assessment Instrument (RAI) is a standardized data collection and observation toolkit that can be used to assess a client's functional capacity and service needs regularly and consistently. The assessment data are used to compile rehabilitation and care plans or to update previous plans. The benchmarking data compiled from the RAI assessment data can be utilised in decision-making and knowledge-based management.
Service needs and functional capacity assessments carried out using RAI tools have been collected to THL's RAI data pool since 2000. According to the Act on Supporting the Functional Capacity of the Older Population and on Social and Health Services for Older Persons(980/2012), the wellbeing service counties are obligated to use the RAI assessment tools for assessing the service needs and functional capacity of older people as of 1.4.2023 in regular services and client guidance for older people. The collection of data for the Finnish Institute for Health and Welfare (THL) is based on the Act on the National Institute for Health and Welfare (668/2008).
The RAI assessment comprehensively describes the clients, their condition, and life situation. Assessments are carried out every six months and, if necessary, when the client's condition changes. Follow-up data on the client's functioning and service needs help in planning appropriate and timely care, rehabilitation, and other services, as well as their effectiveness.
In addition to the answers to the assessment questions, the RAI assessment also consists of RAI indicators that describe, e.g., the clients' health status, functioning, and individual resources, as well as their need for care, services and rehabilitation. The indicators also help monitor the results of care, services or rehabilitation.
The body of the statistical report presents the concepts used in the data pool.
A detailed description of the data stored in the RAI data pool can be found in the Aineistokatalogi.fi service: Aineistokatalogi.fi
Description of methods
RAI assessment data are generated as part of social or health care operations. A RAI assessment is carried out on a client receiving regular services at the beginning and every six months thereafter and whenever the client's condition changes substantially. RAI assessments are also made when assessing the need for regular services (customer and service guidance), but the assessment data in question are excluded from these published statistics. The assessments are stored in the service provider's customer/patient information system ("RAI software").
Copies of the RAI assessment data are submitted to THL twice a year, in February and August. The data are transferred to THL with personal identifiers as individual-level data. The data collection covers all assessments completed and locked by the time of transfer. The assessments that have been locked after the data collection period will be transferred to THL at the next data collection time. The data are sent to THL as a customer and patient information system extract. At present, missing data transmissions are not requested to be resubmitted at the operational unit level; only more considerable deficiencies are requested, e.g., the absence of the entire register at transmissions.
The assessment data transferred to THL are checked on the basis of the data content specifications of the RAI tools and added to the RAI data pool.
The data in the statistical report include RAI assessment data for clients aged 65 or over in home care and long-term care facilities. Long-term care facilities for older people include round-the-clock care and nursing home care. RAI assessments carried out in inpatient care at health centres are excluded from the data used in this statistical report.
The data include the client's latest RAI assessment from 2022 by wellbeing service county and service type. The wellbeing service county has been defined on the basis of the municipality of residence responsible for organising services for the RAI-assessed client. The same clients may appear in the data on different services and in the figures for the whole country if the service received by the customer has changed during the year.
The information content of RAI assessments is extensive. The number of questions in the RAI instruments ranges from 100 to 500. In addition, dozens of RAI indicators are calculated based on the answers to individual questions. Based on questions and indicator values, statistical variables (shares, averages) can be calculated from individual data by wellbeing service county. It should be noted that the information content shown in the statistical report is only a small extract from the large data pool.
The indicators and variables included in the statistical report have been selected based on the data's relevance from the knowledge management perspective.
The coverage information presented in the report has been calculated for home care by comparing the number of RAI-assessed clients to the number of service users obtained from primary care outpatient care registers (AvoHilmo). Correspondingly, coverage data for long-term care facilities have been calculated as a proportion of the number of RAI-assessed clients from the number of service users obtained from social welfare care registers (SosiaaliHilmo).
The data in the outpatient and social care registers and the RAI data pool are combined at THL according to personal identity code, service type, year, and municipality of residence. Of the RAI assessments, only those care units that mainly provide regular services are included.
Correctness and accuracy of data
RAI assessment data are generated as part of the assessment of clients' service needs. An organisation using RAI tools is responsible for ensuring the RAI assessment competence of its personnel. The RAI Assessment Handbook guides the assessment. A client receiving regular services undergoes a comprehensive assessment at the start of care and thereafter every six months and whenever the client's condition changes substantially.
The data submitted to THL are checked according to the RAI data content specifications. Information system providers are informed of incorrect data. However, they are mainly not corrected or requested to be corrected because the data are submitted to THL with a delay every six months. In reporting, any incorrect values are interpreted as missing values.
When examining the RAI assessment data and the values expressed by the RAI indicators, it must be considered that no single data or figure gives a clear picture of the situation of an individual, organisation, or wellbeing service county. The readings of individual assessment data and the RAI indicators based on them should be critically examined, considering the overall situation, such as the client structure, available resources, as well as practices of care and record-keeping.
Timeliness and promptness of published data
The data in the statistical report are based on RAI assessments carried out during the previous calendar year. The statistical report is published annually.
The data for the 2022 statistical report were retrieved from the RAI data pool in November 2023. At that time, the RAI data pool included pre-registered, i.e., locked, assessments submitted to THL by February 2023. Evaluations that have been locked later and that take place in 2022 are therefore not included in the data.
Availability and transparency/clarity of data
The statistical report is published on THL's website.
RAI benchmarking data are also published in THL's RAI benchmarking databases. The RAI benchmarking database for regular services of older people is intended for public use, the use of which does not require login. Other RAI benchmarking databases are intended for use by health and social services organisations and require logging in with a username and password.
RAI reference databases (thl.fi) (in Finnish)
Findata can create datasets and tables by combining different register data and granting researchers permission to use the data in the RAI data pool in scientific research.
Comparability of statistical data
The statistical report is published for the first time in February 2024. The comparability of the first statistical report with future statistical reports is hampered by the insufficient coverage of the RAI assessments at the national level in 2022 data. In 2022, the coverage of the RAI assessments was approximately half of regular home care clients aged 75 or over and about two-thirds of clients in long-term care facilities. From 2023 onwards, coverage should be close to 100 percent for regular services after the end of the transition period of the Act.
The transition from MDS to interRAI versions of RAI instruments may cause some changes over time in the longitudinal follow-up data. The instrument transition is expected to be over after 2024. Data from RAI assessment tools that will be decommissioned were not selected for the statistical report, so the same variables and measures can be used in future statistical reports.
Practical example: MDS LTC and interRAI LTCF instruments have different monitoring periods for some specific issues: MDS LTC generally has seven days to assess, compared to three days for interRAI vLTCF. For MDS HC and interRAI HC, the period is three days. Some of the questions follow a longer period of time.
THL's RAI benchmarking databases are tailored for different purposes, such as service providers, organisers, subscribers and customer guidance. The data contained in the RAI benchmarking databases are somewhat different from the data presented in the statistical report, as the data generation method and data sources (RAI tools) are slightly different due to different usage purposes.
The figures for the indicator "No rehabilitation, although a possibility of rehabilitation, %" have been calculated only for those clients for whom the rehabilitation opportunity stimulus (CAP1) of daily activities indicates the possibilities of rehabilitation of functional capacity. Approximately 50 % of home care assessments are excluded from the calculation when the CAP1 limit is used. In addition, it should be noted that the interRAI HC tool lacks information on exercise therapy, the prevalence of which in home care assessments performed with MDS HC was approximately 16 % in the City of Helsinki's data, and in other wellbeing services counties less than 2 % in total.
Coherence and consistency
The statistical report contains RAI data for Mainland Finland and the Åland Islands. The data are reported by wellbeing service county, including Helsinki and Åland. Data on home care in Åland could not be presented for 2022 because the number of assessments was so small that the data protection of individual clients would be compromised.
