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Investigating community-based care service factors delaying residential care home admission of community dwelling older adults and cost consequence
OBJECTIVES: To examine factors contributing to delaying care home admission; and compare the rates of care home admission and cost consequence between two government subsidised programmes, Veterans’ Affairs Community Nursing (VCN) and Home Care Package (HCP). METHODS: Our national, population-based...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10611449/ https://www.ncbi.nlm.nih.gov/pubmed/37890521 http://dx.doi.org/10.1093/ageing/afad195 |
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author | Jeon, Yun-Hee Simpson, Judy M Comans, Tracy Shin, Mirim Fethney, Judith McKenzie, Heather Crawford, Tonia Lang, Catherine Inacio, Maria |
author_facet | Jeon, Yun-Hee Simpson, Judy M Comans, Tracy Shin, Mirim Fethney, Judith McKenzie, Heather Crawford, Tonia Lang, Catherine Inacio, Maria |
author_sort | Jeon, Yun-Hee |
collection | PubMed |
description | OBJECTIVES: To examine factors contributing to delaying care home admission; and compare the rates of care home admission and cost consequence between two government subsidised programmes, Veterans’ Affairs Community Nursing (VCN) and Home Care Package (HCP). METHODS: Our national, population-based retrospective cohort study and cost analysis used existing, de-identified veterans’ claims databases (2010–19) and the Registry of Senior Australians Historical Cohort (2010–17), plus aggregate programme expenditure data. This involved 21,636 VCN clients (20,980 aged 65–100 years), and an age- and sex-matched HCP cohort (N = 20,980). RESULTS: Service factors associated with lower risk of care home admission in the VCN cohort were periodic (versus continuous) service delivery (HR 0.27 [95%CI, 0.24–0.31] for ≤18 months; HR 0.89 [95%CI, 0.84–0.95] for >18 months), and majority care delivered by registered nurses (versus personal care workers) (HR 0.86 [95%CI, 0.75–0.99] for ≤18 months; HR 0.91 [95%CI, 0.85–0.98] for >18 months). In the matched cohorts, the time to care home admission for VCN clients (median 28 months, IQR 14–42) was higher than for HCP clients (14, IQR 6–27). Within 5 years of service access, 57.6% (95%CI, 56.9–58.4) of HCP clients and 26.6% (95%CI, 26.0–27.2) of VCN clients had care home admission. The estimated cost saving for VCN recipients compared to HCP recipients over 5 years for relevant government providers was over A$1 billion. CONCLUSIONS: Compared to an HCP model, individuals receiving VCN services remained at home longer, with potentially significant cost savings. This new understanding suggests timely opportunity for many countries’ efforts to enhance community-based care services. |
format | Online Article Text |
id | pubmed-10611449 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-106114492023-10-28 Investigating community-based care service factors delaying residential care home admission of community dwelling older adults and cost consequence Jeon, Yun-Hee Simpson, Judy M Comans, Tracy Shin, Mirim Fethney, Judith McKenzie, Heather Crawford, Tonia Lang, Catherine Inacio, Maria Age Ageing Research Paper OBJECTIVES: To examine factors contributing to delaying care home admission; and compare the rates of care home admission and cost consequence between two government subsidised programmes, Veterans’ Affairs Community Nursing (VCN) and Home Care Package (HCP). METHODS: Our national, population-based retrospective cohort study and cost analysis used existing, de-identified veterans’ claims databases (2010–19) and the Registry of Senior Australians Historical Cohort (2010–17), plus aggregate programme expenditure data. This involved 21,636 VCN clients (20,980 aged 65–100 years), and an age- and sex-matched HCP cohort (N = 20,980). RESULTS: Service factors associated with lower risk of care home admission in the VCN cohort were periodic (versus continuous) service delivery (HR 0.27 [95%CI, 0.24–0.31] for ≤18 months; HR 0.89 [95%CI, 0.84–0.95] for >18 months), and majority care delivered by registered nurses (versus personal care workers) (HR 0.86 [95%CI, 0.75–0.99] for ≤18 months; HR 0.91 [95%CI, 0.85–0.98] for >18 months). In the matched cohorts, the time to care home admission for VCN clients (median 28 months, IQR 14–42) was higher than for HCP clients (14, IQR 6–27). Within 5 years of service access, 57.6% (95%CI, 56.9–58.4) of HCP clients and 26.6% (95%CI, 26.0–27.2) of VCN clients had care home admission. The estimated cost saving for VCN recipients compared to HCP recipients over 5 years for relevant government providers was over A$1 billion. CONCLUSIONS: Compared to an HCP model, individuals receiving VCN services remained at home longer, with potentially significant cost savings. This new understanding suggests timely opportunity for many countries’ efforts to enhance community-based care services. Oxford University Press 2023-10-26 /pmc/articles/PMC10611449/ /pubmed/37890521 http://dx.doi.org/10.1093/ageing/afad195 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Research Paper Jeon, Yun-Hee Simpson, Judy M Comans, Tracy Shin, Mirim Fethney, Judith McKenzie, Heather Crawford, Tonia Lang, Catherine Inacio, Maria Investigating community-based care service factors delaying residential care home admission of community dwelling older adults and cost consequence |
title | Investigating community-based care service factors delaying residential care home admission of community dwelling older adults and cost consequence |
title_full | Investigating community-based care service factors delaying residential care home admission of community dwelling older adults and cost consequence |
title_fullStr | Investigating community-based care service factors delaying residential care home admission of community dwelling older adults and cost consequence |
title_full_unstemmed | Investigating community-based care service factors delaying residential care home admission of community dwelling older adults and cost consequence |
title_short | Investigating community-based care service factors delaying residential care home admission of community dwelling older adults and cost consequence |
title_sort | investigating community-based care service factors delaying residential care home admission of community dwelling older adults and cost consequence |
topic | Research Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10611449/ https://www.ncbi.nlm.nih.gov/pubmed/37890521 http://dx.doi.org/10.1093/ageing/afad195 |
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