The pattern of transfers of clients between different levels of care in an area-based system of long-term care for elderly and disabled people is described and analysed using data collected through a monitoring system, called ASIM, from 1985–1991 in the Municipality of Solna, Sweden. Transfers between levels of care occurred in both directions but the frequency of downward transfers was small compared to the number of upward transfers – especially for sheltered housing and residential homes. For all levels of care there were great variations in disability among the entering clients, suggesting non-systematic assessment procedures in connection with admission. An analysis of changes over time in the pattern of transfers illustrated the interdependence of the different levels of care. Reduced resources in long-term hospital care resulted in a near blocking of transfers from the residential homes and increased average disability for the admitted patients in general.
