long term outcomes of restorative home care

Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J

Gill Lewin, Janine Alan, Helman Alfonso

Long Term Outcomes of Restorative Home Care

IFA May 2012


Restorative Home Care Long Term Outcomes

Restorative Home Care Programs

Aim to maximise independence, self esteem and quality of life and reduce care required

Key elements:• Comprehensive assessment

• Goal setting

• Individualised care plans

• Targeted evidence-based interventions

• Often time limited

• May be directed to specific target groups

IFA May 2012


Restorative Home Care Long Term Outcomes

Silver Chain

West Australian

Community Health and Aged Care Provider

40,000 + clients annually

Many health and home support services

~ 45% of Govt. funded home care in WA

In 1999 had waitlists for home care services

Developed Restorative Home Care programs, HIP + PEP

HIP + PEP available across Perth since 2002

IFA May 2012

WA


Restorative Home Care Outcomes

Silver Chain’s Restorative Programs

Home Independence Program (HIP)

• Older individuals needing homecare

• Community based referral

• 12 weeks maximum

Personal Enablement Program (PEP)

• Leaving hospital, potential to improve

• Hospital referral (may include post acute nursing)

• 8 weeks maximum

IFA May 2012



Study Objectives

Primary objective:

Compare aged care service use over 5 yrs of individuals who

participated in HIP / PEP with that of individuals who received HACC.

Secondary objectives:

Examine the impact of participating in an independence program, as

compared to receiving usual home care services, on delaying the need for

recommendation into residential care, improving survival and reducing care

costs over time.

IFA May 2012



Study Design and Method

Retrospective Cohort Study

65+ yr old HIP, PEP and HACC clients

Referred for service 1 Jan 2004 – 31 Dec 2008

No diagnosis of dementia

2004-2009 client data from Silver Chain Comcare, HACC MDS, ACAP database and mortality register linked

Service use examined at 12, 24,36, 48 and 60 months

Poisson regression to identify predictors of service use

Cox regression to compare ACAT assessment or death

Quantile regression to compare costs between groups

IFA May 2012



Results - Demographics

IFA May 2012

35.4

34.9

25.5

58.1

39.6

26.8

63.4

71.6%

N=2,332

6.1

44.1

22.2

44.6

60.3

64.6

74.3

49.3%

5,450

9.6

42.7

19.3

48.0

58.5

57.7

78.3

59.8%

2,586

Control PEP HIP

Dependence high

Dependence mod

Dependence low

Previous HAAC

Living with others

Need carer

Females

Older than 78y

0 1 2 3 4 5 6 7 8 9 10 11 12TITLE

0.00 0.50 1.00 1.50 2.00Prevalence Ratio


Results – HACC All Service Use

IFA May 2012Restorative Home Care Outcomes

20

40

60

80

100

% r

equirin

g s

erv

ices

0 12 24 36 48 60Months of follow up

Control PEP

HIP

2002 (90.9) 1068 (65.8) 518 (50.2) 244 (39.2) 111 (33.0) 26 (34.2)Control, n(%)

3813 (71.8) 2031 (44.3) 1323 (40.8) 782 (38.5) 382 (37.8) 127 (41.5)PEP, n(%)

1878 (75.2) 1068 (48.2) 694 (42.8) 428 (40.8) 224 (41.0) 70 (46.7)HIP, n(%)

*Adjusted for age, sex, living arrangement, having carer, dependence level and requiring PC service previous start study



Results – HACC Personal Care Use

26.10.2011

020

40

60

80

100

% r

equirin

g s

erv

ices

0 12 24 36 48 60Months of follow up

Control PEP

HIP

1886 (85.6) 877 (54.0) 403 (39.1) 183 (29.4) 81 (24.1) 19 (25.0)Control, n(%)

1300 (24.5) 336 (7.3) 189 (5.8) 129 (6.4) 58 (5.7) 10 (3.3)PEP, n(%)

825 (33.0) 224 (10.1) 131 (8.1) 68 (6.5) 34 (6.2) 3 (2.0)HIP, n(%)




Results – ACAT assessment over time

IFA May 2012

Year acap ControlN=2,332

PEPN=5,450

HIPN=2,586

200414 (0.60) 10 (0.18) 7 (0.27)

2005

24 (1.03) 27 (0.50) 12 (0.46)2006

30 (1.29) 54 (0.99) 22 (0.85)2007

35 (1.50) 78 (1.43) 42 (1.62)2008

31 (1.33) 68 (1.25) 24 (0.93)2009

13 (0.56) 19 (0.35) 18 (0.70)Total

147 (6.30) 256 (4.70) 125 (4.83)

outcome level ControlN=2,332

PEPN=5,450

HIPN=2,586

appcomm 191 (3.90) 176 (3.23) 87 (3.36)

appeach 127 (1.16) 22 (0.40) 13 (0.50)

appother 199 (4.25) 204 (3.74) 94 (3.63)

appresi 186 (3.69) 160 (2.94) 75 (2.90)

appresi 2

29 (1.24) 20 (0.37) 13 (0.50)

group Crude OR(95% CI)

Adjusted* OR (95% CI)

PEP0.64 (0.52-0.79) 0.96 (0.75-1.22)

HIP0.65 (0.51-0.82) 0.91 (0.69-1.19)

*Adjusted for age, sex, living arrangement, having carer, dependence level and requiring PC service previous start study , using Cox regression



Results – Risk of death

IFA May 2012

0.5

11.

5C

umul

ativ

e M

orta

lity

Rat

e

0 2 4 6Years of follow up

Control PEPHIP

group Crude OR(95% CI)

Adjusted* OR (95% CI)

PEP

0.39 (0.36-0.42) 0.52 (0.47-0.57)HIP

0.45 (0.41-0.50) 0.58 (0.52-0.65)

*Adjusted for age, sex, living arrangement, having carer, dependence level and requiring PC service previous start study , using Cox regression



Results – Adjusted Median Cumulative Costs

IFA May 2012




Returns on Investment

IFA May 2012




Conclusions

Individuals who receive a restorative home care service rather than usual HACC home care:

have a reduced likelihood of subsequently using: - any home care service for three years - a personal care service for five years

are somewhat less likely to be ACAT assessed within the next 5 years and much less likely to be approved for nursing home high level care

are less likely to die over the next 5 years

represent a much better return on investment

IFA May 2012



Contact for more information:

[email protected]

IFA May 2012

long term outcomes of restorative home care

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