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

Abstract

Many governments have introduced or encouraged home‐care reablement schemes for older people at home with the aim of improving outcomes and reducing costs. We examined if such schemes have the potential to reduce costs from the perspective of the National Health Service (NHS) and Personal Social Services (PSS) in England. Our study was carried out to inform recommendations of a national guideline. Cost‐minimisation analysis was carried out using decision‐analytic Markov modelling. Home‐care reablement was compared with standard home care. Costs included those of the intervention, home care and hospital admission. Uncertainty was explored using univariate and probabilistic sensitivity analysis. Mean costs per person were £56,499 (95% confidence interval 55,690 to 57,307) in the reablement group, and £58,560 (95% confidence interval 57,800 to 59,319) in the standard care group. The mean difference was ‐£2,061 (95% confidence interval 1,933 to 2,129). The probability that home‐care reablement costs less than standard home care was 94.5% (95% confidence interval 93.1 to 95.9). In sensitivity analyses, this probability remained above 85% in all scenarios. Home‐care reablement can be a successful cost‐minimisation strategy for supporting some older people. More research is needed about the impact of home‐care reablement on health outcomes for different groups of older people; and the effects of different durations of reablement on outcomes and costs for different subpopulations.

Reablement through time and space: a scoping review of how the concept of ‘reablement’ for older people has been defined and operationalised

“…This philosophy emphasises a collaborative approach in service delivery, (…and) translates into specific individualised interventions aimed at optimising functioning [49]. • In a cost analysis of home care reablement for older people, reablement "actively engages the person in activities of daily living, thus improving their ability to perform those activities, which they might have lost after an episode of illness or other adverse life event" [94].…”

Reablement through time and space: A scoping review of how the concept of ‘reablement’ for older people has been defined and operationalised

“…This philosophy emphasises a collaborative approach in service delivery, (…and) translates into specific individualised interventions aimed at optimising functioning" (Clare et al, 2019b). Most recently, in a cost-minimisation analysis of home care reablement (HCR) for older people, the authors defined reablement as a programme that "actively engages the person in activities of daily living, thus improving their ability to perform those activities, which they might have lost after an episode of illness or other adverse life event" (Bauer et al, 2019).…”

Valuable aspects of home rehabilitation in Sweden: Experiences from older adults

“…In several countries, home rehabilitation is often implemented as a national or local strategy to deal with the aging population 10‐13 . Home rehabilitation programs sometimes only involve one professional category, such as physiotherapist, 14 but because the focus in this study is programs implemented by multidisciplinary teams, findings from such studies are less relevant for the purpose of the present study and not considered in the following text.…”

“…In several countries, home rehabilitation is often implemented as a national or local strategy to deal with the aging population. [10][11][12][13] Home rehabilitation programs sometimes only involve one professional category, such as physiotherapist, 14 but because the focus in this study is programs implemented by multidisciplinary teams, findings from such studies are less relevant for the purpose of the present study and not considered in the following text. Multidisciplinary home rehabilitation is not a uniform concept and programs have been independently developed in different parts of the world, for example, reablement, active service model, home independent program, restorative home support, or restorative care.…”