A comparison of the home‐care and healthcare service use and costs of older A ustralians randomised to receive a restorative or a conventional home‐care service

Abstract

Restorative home-care services, or re-ablement home-care services as they are now known in the UK, aim to assist older individuals who are experiencing difficulties in everyday living to optimise their functioning and reduce their need for ongoing home care. Until recently, the effectiveness of restorative home-care services had only been investigated in terms of singular outcomes such as length of home-care episode, admission to hospital and quality of life. This paper reports on a more complex and perhaps more significant measure – the use and cost of the home-care and healthcare services received over the 2-year period following service commencement. Seven hundred and fifty older individuals referred for government-funded home care were randomly assigned to a restorative or standard service between June 2005 and August 2007. Health and aged care service data were sourced and linked via the Western Australian Data Linkage System. Restorative clients used fewer home-care hours (mean [SD], 117.3 [129.4] vs. 191.2 [230.4]), had lower total home-care costs (AU$5570 vs. AU$8541) and were less likely to be approved for a higher level of aged care (N [%], 171 [55.2] vs. 249 [63.0]) during follow-up. They were also less likely to have presented at an emergency department (OR = 0.69, 95% CI = 0.50–0.94) or have had an unplanned hospital admission [OR (95% CI), 0.69 (0.50–0.95)]. Additionally, the aggregated health and home-care costs of the restorative clients were lower by a factor of 0.83 (95% CI 0.72–0.96) over the 2-year follow-up (AU$19,090 vs. AU$23,428). These results indicate that at a time when Australia is facing the challenges of population ageing and an expected increase in demand for health and aged care services, the provision of a restorative service when an older person is referred for home care is potentially a more cost-effective option than providing conventional home care.

Experiences of home‐care workers with the ‘Stay Active at Home’ programme targeting reablement of community‐living older adults: An exploratory study

“…As a potential result of the diverse conceptualisations and applications of reablement, previous studies have shown contradicting research findings. While several studies underline that the effectiveness of reablement is uncertain and there is a need for more thorough research (Aspinal et al, ; Cochrane et al, ; Legg et al, ; Whitehead, Worthington, Parry, Walker, & Drummond, ), other studies have shown beneficial effects of reablement related to, for instance, daily functioning or activity performance (Langeland et al, ; Lewin & Vandermeulen, ; Tuntland, Aaslund, Espehaug, Førland, & Kjeken, ; Winkel, Langberg, & Wæhrens, ) and healthcare use or costs (King, Parsons, Robinson, & Jorgensen, ; Lewin, Alfonso, & Alan, ; Lewin, De San Miguel, et al, , Lewin et al, ; Parsons et al, ; Tessier, Beaulieu, McGinn, & Latulippe, ). However, only a few studies were conducted to get insight into the experiences of home‐care workers.…”

Cost‐minimisation analysis of home care reablement for older people in England: A modelling study

“…Studies carried out in England, Australia, and Norway confirm that HCR is able to achieve positive independence outcomes (Glendinning et al, ; Lewin et al, ; Lewin & Vandermeulen, ; Tuntland, Aaslund, Espehaug, Førland, & Kjeken, ; Whitehead, Worthington, Parry, Walker, & Drummond, ). In particular it has been found to decrease dependency, as measured in terms of activities of daily living scores (Whitehead et al, ) and to increase self‐perceived activity performance and satisfaction with performance (Tuntland et al, ).…”

“…In the absence of clear evidence on health outcomes, the question whether HCR can lead to cost savings is an important question given the expectation of policy makers in England in this regard. Lewin et al (, ) found in their evaluation of HCR in Australia that over a 2‐year period aggregated hospital and home care costs in the intervention group (reablement) were between AU$2,869 and AU$4,338 lower than in the control group. This finding referred specifically to people who required personal care (rather than other types of home care).…”

“…Our aim was to examine the overall impact of HCR on costs and savings arising from potential reductions in hospital and home care use in the current English context. In particular, since the population targeted in Lewin et al (, ) was especially relevant to the current context of health and social care in England, we wanted to understand how their findings translate into the English context to help explore whether HCR was likely to lead to overall cost savings when compared to standard home care (involving personal care).…”

Translating Strong for Life Into the Community Care Program: Lessons Learned

“…Physical activity (PA) interventions are not included in these services despite the known functional and physical benefits of these interventions (American College of Sports Medicine [ACSM] et al, 2009). Specific to the population of older adults receiving reablement, or restorative home care services from a personal care attendant, exercise can have measurable cost savings, as well as physical health benefits for older adults (Lewin et al, 2014). Reablement services in the United Kingdom and Australia have integrated wellness approaches into the line of services; however, this model has not been commonly adopted in the United States at this point.…”